NOTE: this is an extra long post…… but it’s an important topic and there is a lot to share. So settle in and give yourself time and space to take it all in.
May is Mental Health Awareness month.
You’d think by now we wouldn’t need any more awareness and could actually move into it being Mental Health ACTION month.
But let’s just keep the conversation going, right?
It won’t be a surprise to you that mental health issues have a huge impact on society. According to the Centre for Addictions and Mental Health (CAMH) in any given year about 1 in 5 Canadians experience a mental health issue.
Some suggest that their impact is larger than any other chronic disease, including heart disease or diabetes.
CAMH says: “The annual economic cost of mental illness in Canada is estimated at over $50 billion per year. This includes health care costs, lost productivity, and reductions in health-related quality of life.”
This is the cost to society, but if you’ve ever experienced a mental health issue yourself or worked to support someone in your personal or work life who is struggling, you know that the human cost is even greater.
I am not a medical doctor or a psychotherapist or a mood or brain researcher – though I try hard to stay current on some of the newest most promising options for supporting mental health.
But let’s be clear that the suggestions I make in the article are no substitute for professional medical advice or therapy. You should continue to work with your mental health team and if you need immediate help, reach out to a local service like those provided by CAMH or the nationwide crisis intervention hotline or for young people, Kids Help Phone.
But I feel confident that the info I’m sharing will provide additional options for you to be aware of, as you navigate the journey for yourself or someone else.
There are so many factors involved in complex conditions like mental health issues. Science is just starting to unravel one of these factors – inflammation. I’ve written about this topic many times before (read Irritated by Inflammation here and read Reduce Inflammation with These Key Foods here) mostly with respect to the physical impacts of chronic inflammation.
But there are also many links between inflammation and mental health. I want to give you some of the specific connections and then I want to share some exciting research into natural approaches – things like foods, nutrients, and lifestyle upgrades – that you can consider adding to your life and your actions to further support mental health.
What is Inflammation?
Let’s start with the basics: the word inflammation comes from the Latin word “inflammo,” meaning “I set alight, I ignite.”
Because inflammation can become harmful, it has gotten a lot of bad press lately. However, inflammation isn’t always a bad thing. As in most areas of health, it’s the balance that’s important.
Inflammation is actually a natural process that our body uses to protect against infections, irritants, and damage. Inflammation helps our bodies eliminate damaged cells and tissues and helps them to repair. It also helps to reduce the cause of the damage, for example, by fighting the infection. Inflammation that happens in a big way, but for a short time can help the body to heal these injuries and infections. It’s known as “acute” inflammation.
On the other hand, lower levels of inflammation sometimes stick around longer than necessary. This long-term “chronic” inflammation can cause damage over time. Often, there are few, if any, signs or symptoms. It’s this chronic inflammation that is linked to many conditions including mental health, heart disease, and diabetes.
Inflammation mostly comes from our immune system’s response to infections and injuries. It also involves our blood vessels (arteries and veins) and other molecules. A few of these inflammatory molecules, or “markers,” include free radicals (oxidants), cytokines, and C-reactive protein (CRP).
So, what are the links between inflammation and mental health?
Inflammation and mental health
There are many factors linked to suboptimal mental health. One of these is inflammation.
In terms of depression, the link with inflammation was first discovered back in 1991. With respect to bipolar disorder, the link between it and immune dysfunction was proposed as far back as 1981. Research shows that inflammation may be a factor for about one-third of people with depression.
Something to note: While there are many links between inflammation and mental health issues, it’s not the only connection or the only catalyst/cause. Others include neurotransmitter issues (for example serotonin, dopamine imbalances etc.); reduction in growth factors (like brain-derived neurotrophic factor or BDNF); and neuroendocrine issues (and this is a biggie for those of us who live a busy modern overwhelmed life as it is rooted in chronically increased stress hormone levels).
Link 1 – Inflammation and mental health
First of all, some mental health issues are associated with increased inflammatory markers like cytokines and CRP. CRP is C-reactive protein and it can be measured through a simple blood test as part of your regular lipid panel.
People with depression tend to have higher levels of cytokines. In fact, some of the inflammatory markers found in the blood are known to reach the brain.
High levels of inflammation may also inhibit recovery in people who experience mental health symptoms. There are some researchers who believe that levels of inflammation may actually be able to predict negative mental health outcomes.
Stress plays a significant role in increasing levels of inflammatory markers. Both animal and human studies identify increased levels of inflammatory markers and lower levels of anti-inflammatory markers in those experiencing stress.
While inflammation may be part of the cause of mental health symptoms for some people, it can go in both directions. Mental health issues may also increase some of these inflammatory markers.
Either way – chronic ongoing inflammation is not good for the body or for the mind.
Link 2 – Inflammatory illnesses and mental health
Inflammatory illnesses like allergic and autoimmune diseases, as well as metabolic conditions (like heart disease, diabetes, and obesity) are associated with higher rates of mental health symptoms.
And this link also goes both ways – people with mental health symptoms are more likely to get metabolic-related conditions.
This link between mental health symptoms and metabolic conditions has led some researchers to coin the term “mood-metabolic syndrome”. This is meant to reflect the fact that they’re linked to each other and also that these links can go both ways.
Link 3 – Inflammatory medications and mental health
People who take certain inflammatory medications may be at increased risk of developing mental health symptoms. NSAIDs which are typically used to reduce inflammation can had the opposite and adverse effect and some studies now show that they might increase mood disorder symptoms, especially depression or paranoia, in some people.
On the other hand, some medications used to treat depression (like SSRIs) reduce levels of some inflammatory markers.
It’s always prudent to discuss your overall medication regimen with your doctor or a pharmacologist on a regular basis.
Link 4 – Inflammatory diets and mental health
Here’s where things get really interesting and where I am very much engaged and excited about research findings and clinical outcomes that I see on a regular basis.
There is growing evidence that people who eat a high-quality diet tend to have a better sense of well-being and better mental health. This includes better moods and lower stress. Certain anti-inflammatory diets have lower rates of mental health issues.
This also means that studies show links between unhealthy eating patterns and mental health issues. Inflammatory diets (which we’ll go into more detail below) are associated with higher rates of mental health symptoms.
Yes – there is merit in considering what Hippocrates, who is often referred to as the father of modern medicine, had to say: “let food be thy medicine and medicine be thy food”.
Foods and moods
Evidence for a link between what we eat and how we feel is fairly new. The first studies to be published on this were as recent as 2009. This new area of study is called “nutritional psychiatry”.
I believe that this is an underused area of support that could make a difference in helping people to manage or overcome mental health challenges.
Like anything that relates to a complexity of disease – it’s not the be all and end all. It takes a village to support someone with mental health issues and so don’t misunderstand me here. I am not saying that changing your diet is the only thing that you need to do for your mental health.
But I am saying that there is enough compelling evidence now to say we can’t ignore diet and food as integral to mood.
The relationships between foods and mental health are complex, and we’re just starting to understand them. While many studies show a definite link, some of them don’t.
As an example, one study concluded:
“Our data support the hypothesis that high dietary quality is associated with good emotional well-being.” (Meegan et. al, 2017)
What foods are associated with worse moods? These not-so-healthy dietary patterns include higher intakes of:
- Saturated fat and processed meats
- Refined sugars and starches
- Fried and processed foods
People who eat this way tend to report more mental health symptoms than those who eat a more health-promoting diet. And several recent studies consider poor eating habits to be a risk factor for some mental health issues.
Not surprisingly, these not-so-healthy foods are also linked with higher inflammatory markers like CRP. Studies also show that improving the diet can reduce levels of CRP.
In fact, some studies show that the higher the “inflammatory factor” of the diet, the higher the risk for mental health issues.
What diet is best?
A question I get asked all the time is: “What diet is the best for (fill in the health concern here)?” This goes for someone who is looking to improve their mental health or lose weight or reduce digestive issues or improve their sleep.
There is no one-size fits all. For any condition or any person.
However, there are certain eating patterns that have been well-studied and have very promising results. And are relatively easy to implement and sustain – which is always a key element for consideration. After all, the best diet in the world is not going to help you if you can’t stick to it and integrate it into your life, right?
One dietary pattern that’s got some merit is the Mediterranean Diet. This diet includes a lot of vegetables, fruit, whole grains, legumes, fish, and olive oil. It also contains a wide variety of nutrients and fibre. Eating a Mediterranean-style diet is associated with lower levels of inflammatory markers and a reduced risk of mental health issues.
The complex association between food and mental health can also go both ways. Mental health symptoms can also influence appetite and food choices. And it’s likely that other factors such as obesity, exercise, food insecurity, and use of alcohol and tobacco are probably involved as well.
We don’t know exactly how these eating patterns affect mental health – inflammation is definitely one possibility. Nutrition can impact how our immune system functions, and this can affect levels of inflammation, and mental health issues. It could also be through the effects of the nutrients themselves, and even directly through the digestive system (microbiota-gut-brain axis).
Better foods for better moods
What we do know though is that through the area of nutritional psychiatry and the research that looks specifically at food and its impact on mood, that there are recent clinical studies that found when people start eating a healthier diet, they can actually reduce some of their mental health symptoms!
How about that? If you nourish your body, you can nourish your mind.
This study is particularly interesting. It’s called the SMILES trial.
What makes the results from this trial strong is that it was an actual experiment. It didn’t just ask people what they ate and what their symptoms were. It was “interventional” – people agreed to actually change the way they ate! And the measurements were done from there.
The researchers say: “...this is the first RCT [randomized control trial] to explicitly seek to answer the question: If I improve my diet, will my mental health improve?” (Jacka et. al, 2017)
Here’s how it worked:
The SMILES trial recruited 67 people with depression and poor dietary quality to a trial for 12-weeks. These were people who reported a high intake of sweets, processed meats, and salty snacks and a low intake of vegetables, fruits, lean protein, and dietary fibre.
Half of them were asked to (and agreed to):
- Eat more vegetables, whole grains, fruit, legumes, low-fat unsweetened dairy, raw and unsalted nuts, fish, lean red meat, chicken, eggs and olive oil
- Eat fewer sweets, refined grains, fried food, fast food, processed meats and sugary drinks
- Drink no more than 2 glasses of wine per day (with meals, preferably red wine).
These participants were also given seven (7) nutrition counselling sessions with experienced practitioners.
This is critical as we know other studies support the concept of coaching or counselling as a critical tool to change behaviour and keep accountability resilient.
I see a massive change in the success rate for my clients who are seeking habit and behaviour change when they enrol and engage in seven to 12 coaching sessions. Humans are hard-wired not to change, so it’s critical to provide support either 1:1 or in a group setting to help people understand and embody the specific changes that will make a difference.
So half the participants in the SMILES trial got a roadmap for change PLUS other added nutrition education support. Interestingly, the other half were also given support – but it was social in nature and not educational.
They were “befriended” and discussed sports or news or played cards or board games. There was no nutrition support, nor any dietary recommendations given to people in this group.
So what happened? The researchers found that in 12 weeks, the people who improved their diet actually also improved some mental health symptoms.
They said: “we report significant reductions in depression symptoms as a result of this intervention… The results of this trial suggest that improving one’s diet according to current recommendations targeting depression may be a useful and accessible strategy for addressing depression in both the general population and in clinical settings.”(Jacka et. al, 2017)
It would be great for other, larger trials to confirm these results. In the meantime, eating a more health-promoting diet is helpful for so many conditions, not just mental health conditions!
Better nutrition for better moods
So what exactly does better nutrition look like?
Is there something special in these specific foods that may help with moods?
We know your brain needs enough of all the essential nutrients in order to function properly. And insufficient levels are linked with the stress response and the immune response.
Eating nutrient-dense foods is the best way to get nutrition. It’s not that I don’t support augmenting your diet via supplements. I do think that on rare occasions some people may need to go beyond the foods they eat to rebalance or boost certain body systems or help with healing some conditions.
But keep in mind, foods are complex combinations of nutrients. And our body wants food not powders and pills. Supplementing with individual nutrients is not the same as eating a healthy diet.
Let’s look at a few key nutrients for better moods so you can be more knowledgable as you start designing a diet that may be of help to you or someone you are supporting to improve their mental wellness.
B-vitamins such as B6, B9 (folic acid), and B12
People who tend to be low in B-vitamins are more likely to have mental health issues. Higher intakes of vitamin B6 (pyridoxine) and B12 (cobalamin) may reduce risk.
With folic acid in particular, the connection may be due to its different forms. “Folic acid” is the inactive form of vitamin B9. Our bodies naturally converted it into the active form (called L-methylfolate) by the enzyme methylenetetrahydrofolate reductase (MTHFR).
Once folic acid has been activated, it goes to the brain and is used to make neurotransmitters like serotonin, melatonin, dopamine, epinephrine, and norepinephrine.
Interestingly, many people with mental health issues are unable to convert folic acid into its active form.
One study tested supplements with the active form of folic acid (L-methylfolate) on people with mental health issues. While some people had a moderate improvement, the people who also had inflammation (higher levels of CRP) had an even greater improvement.
Where do you get these nutrients? Leafy greens, salmon, chicken, tofu, legumes, eggs, brown rice and seeds like pumpkin or sunflower, just to name a few.
Vitamin D
Vitamin D is well known to help absorb calcium for strong bones, but has many other functions too. In terms of immunity, vitamin D can reduce inflammatory molecules in people with certain infections and inflammatory diseases.
Additionally, Vitamin D has a number of roles within the brain. It plays a role in circadian rhythms and sleep, and influences the growth of nerve cells in the developing brain.
There is growing evidence that people who tend to be low in vitamin D also tend to have more mental health symptoms. In fact, some (but not all) studies show that vitamin D supplementation can improve mood scores and reduce mental health symptoms.
Vitamin D is the most commonly deficient nutrient in Western countries. In fact it’s estimated that shockingly between 70% and 97% of Canadians are likely deficient.
It’s known as the “sunshine vitamin” because our skin makes it when exposed to sunlight. But you need year-round exposure to bare skin for a minimum of 20 minutes daily – a tough benchmark when you live in a cold country!
It can also be found in a few foods like fatty fish (herring, mackerel, salmon for example), egg yolks and in dairy products that have been fortified.
Vitamin D is one supplement that I highly recommend everyone take.
Minerals (Calcium & Selenium)
Low intake of calcium is associated with mental health symptoms, while high intake is associated with lower rates of mental health symptoms.
Rich sources of calcium include dairy of course, but also soybeans (tofu or edamame), almonds, winter squash and dark green leafy veggies like collard greens, spinach, kale or bok choy.
Depression has been associated with low blood levels of the essential mineral, selenium. Low intake of selenium is also associated with an increased risk for depression. While selenium is a micronutrient – meaning we don’t need a lot of it – it serves a very important purpose for mental health and other conditions.
The good news is that Brazil nuts are super high in selenium. Just two a day can give you all you need. Fatty fish is another source worth considering.
Omega-3s
Omega-3 oils are healthy fats found in many foods such as seafood, nuts, legumes, and leafy greens. They have been shown to reduce inflammation.
Some (but not all) studies suggest that the omega-3 fats, specifically those found in fish and fish oil, have mental health benefits.
You can see how the vast majority of the foods suggested for supporting mental health are aligned with the Mediterranean Diet.
Better lifestyle for better moods
Food is not the only factor when it comes to helping reduce inflammation and ultimately improving mental health – lifestyle also plays a role, specifically in terms of sleep and exercise.
More on both those subjects in subsequent posts, but suffice to say – lack of sleep will raise your stress hormones and start that inflammatory cascade. There is also research that supports the link between a sedentary lifestyle and persistent systemic inflammation.
If you are looking to support your mental health, working on ways to improve sleep and moving your body in some way each day, it’s all part of the recipe for wellness.
So what does this all mean?
There’s hope and there’s help.
While food, sleep, movement may not be a substitute for other forms of mental health intervention, this is an exciting area of research that does show there are additional supports we can employ to add to our toolbox for mental wellness. Things that are within all of our reach.
That’s important to remember as we continue to raise awareness and move toward action during this month and beyond.
References:
So depression is an inflammatory disease, but where does the inflammation come from? -BMC Medicine
Diet and Common Mental Disorders: The Imperative to Translate Evidence into Action – Frontiers in Public Health
Nutritional Psychiatry: Where to Next? – EBioMedicine
A randomised controlled trial of dietary improvement for adults with major depression (the “SMILES” trial). – BMC Medicine
Depression: an inflammatory illness? – Journal of Neurology, Neurosurgery & Psychiatry
Inflammatory dietary pattern and risk of depression among women. – Brain, Behavior, and Immunity
Is there a “metabolic-mood syndrome”? A review of the relationship between obesity and mood disorders. – Neurosci Biobehavioral Reviews
A modified Mediterranean dietary intervention for adults with major depression: Dietary protocol and feasibility data from the SMILES trial. – Nutritional Neuroscience
Activation of CNS Inflammatory Pathways by Interferon-alpha: Relationship to Monoamines and Depression. – Biological Psychiatry
Prevention of depression through nutritional strategies in high-risk persons: rationale and design of the MooDFOOD prevention trial. – BMC Psychiatry
Bipolar Disorder and Immune Dysfunction: Epidemiological Findings, Proposed Pathophysiology and Clinical Implications. – Brain Sciences
The macrophage theory of depression. – Medical Hypotheses
Biomarkers for depression: recent insights, current challenges and future prospects. – Neuropsychiatric Disease and Treatment
Inflammation: opportunities for treatment stratification among individuals diagnosed with mood disorders. – Dialogues in Clinical Neuroscience
Inflammation (definition) – Wikipedia