World Mental Health Day: how tea and talk may be more beneficial than you think!

A ‘nice cup of tea’ has been, for decades, associated with healing; for making things better or just as an excuse to sit down and talk. In fact, ‘tea and talk’ is the theme for this year’s awareness of World Mental Health Day, an international event which is annually held on 10th October. The event aims to bring general awareness to, and about, mental health issues, and this year’s focus surrounds the association between mental health disorders and chronic illness.

If you are participating in an organised tea and talk event this year, you might want to choose your tea wisely. Whilst ‘milk and two sugars’ may well be a common favourite way of drinking your brew, swapping to green tea this Sunday may help the way forward to feeling a little more cheery! Green tea has been, for a long time reported to have various beneficial effects (eg, anti-stress response and anti-inflammatory effects) on human health. It is these functions that are thought, in part to be associated with the development and progression of depressive symptoms. Regular consumption of green tea not only has benefits in reducing stress and therefore and depressive symptoms (Niu et al, 2009), but may even help reduce cognitive impairment by helping to protect from neuronal damage (Kuriyama, et al, 2009). Green tea is a favourite with populations such as the Japanese. Probably best known for their high intake of omega-3 from fish and other seafoods, alongside low intake of red meat, diet and lifestyle within the Japanese population plays a major role in contributing towards their low incidence of depression, as well as chronic diseases.

However, if the green type is not your cup of tea, and you prefer to stick to something more familiar like PG tips, then worry not. Green tea extract, probably more noted for its use in slimming products is widely available in supplement form. As is often the case, supplements can provide a useful alternative when the real deal just simply isn’t on the menu.

Niu K, Hozawa A, Kuriyama S, Ebihara S, Guo H, Nakaya N, Ohmori-Matsuda K, Takahashi H, Masamune Y, Asada M, Sasaki S, Arai H, Awata S, Nagatomi R, Tsuji I. (2009) Green tea consumption is associated with depressive symptoms in the elderly. Am J Clin Nutr. 90:1615-22.

Kuriyama S, Hozawa A, Ohmori K, Shimazu T, Matsui T, Ebihara S, Awata S, Nagatomi R, Arai H, Tsuji I. (2006) Green tea consumption and cognitive function: a cross-sectional study from the Tsurugaya Project 1. Am J Clin Nutr. 83:355-61.

Remembering the importance of lifestyle choices

There has been a flurry of journal publication lately focusing on methods that can help stave off cognitive impairment and dementia. According to the most recent study, published in this month’s British Medical Journal, making dietary and lifestyle changes that ultimately reduce the risk of developing diabetes and depression, could have a significant impact on an individual’s future risk of developing dementia (Ritchie et al, 2010). The study, led by French researcher Dr Karen Ritchie, of the French National Institute of Medical research, analysed the lifestyle and health of 1,433 people over the age of 65 living in the south of France over a period of seven years. Whilst there is an element of genetic risk associated with the development of dementias such as Alzheimer’s disease, the role of diet and lifestyle are long known to be of significance, and that risk can be manipulated through specific changes. Dr Ritchie was quoted as saying “health chiefs should focus on encouraging literacy, prompt treatment of depressive symptoms and early screening for glucose intolerance and insulin resistance”. The study also highlighted the importance of consuming plenty of fruit and vegetables associated with a more ‘Mediterranean’ style of eating, which would also involve the consumption of foods such as seafood which is rich in neuroprotective omega-3s. In regards to the protective role that long term education has on brain health, this recent publication supports the findings of a study published in last months journal Brain. This study involved examining the brains of 872 participants in ECLIPSE (Epidemiological Clinicopathalogical Studies in Europe), a collaboration between three large population-based studies of ageing, in which a positive association was found between education and a reduced risk of developing dementia symptoms (Brayne et al, 2010). What was particularly interesting about this study was that education had no protection on dementia itself, but only on the symptoms. When the brains of individuals were examined, those individuals who had stayed in education still, showed the pathological and molecular signs of dementia, although whilst living, those individuals showed no physical symptoms of dementia. This would suggest that education in early life appears to enable some people to cope with a lot of changes in their brain before showing dementia symptoms.

So what do we learn from this? It seems that the same messages re-emerge over and over. That exercise, education and adoption of a ‘healthy’ diet offer protection against a myriad of diseases and conditions that are often considered to be just a part of growing old. However whilst it appears that we have a lot more say in our long term fate, putting into practice the advice offered by scientist may take both time and dedication as many of us are very settled in our ways. Educating people is the first step in initiating long term lifestyle changes.

Ritchie K et al. (2010) Designing prevention programmes to reduce incidence of dementia: prospective cohort study of modifiable risk factors. BMJ August 2010

Brayne C et al. (2010) Education, the brain and dementia: neuroprotection or compensation? Brain 133:2210-2216

Why being depressed can make your brain shrink!

For many sufferers, depression brings on many kinds of emotions and feelings including anxiety, guilt and shame, so it’s not surprising that many people fail to seek help. Often, many of the feelings that are associated with depression are, in part, caused by a general lack of understanding of the condition, not only by the sufferer, but by family members, friends, employers and colleagues. And yet the majority of people will experience some psychological problems during their lives. In fact very few people will go through life without experiencing some form of mental trauma of some description. But what is it that goes on in your head when you are feeling depressed?

There is increasing scientific focus on the mechanisms that occur within the body and brain of depressed patients. Indeed, it is becoming much clearer that inflammation significantly contributes to the cause and progress of depression, and that this triggers a myriad of processes that all contribute to the symptoms associated with the condition. It is difficult to comprehend that inflammation can trigger depression, because it is generally thought of as a response to injury or irritation that is characterised by physical processes such as pain and swelling.

However, inflammation need not be physical or obvious, and inflammatory processes and brain-immune interactions are now known to be involved in the development of major depression. Inflammation is certainly suggested to contribute to the dysfunction of biological systems involved in the production of important neurotransmitters (brain hormones) such as serotonin and noradrenalin. Indeed, increased levels of inflammatory products called cytokines (produced by immune cells, and involved in relaying messages between cells) have consistently been reported in patients with depression. Pro-inflammatory cytokines have many physiological functions but, significantly, have been reported to modulate central nervous system functions including a process called neurogenesis, which is simply the method by which nerve cells are generated. Excessive inflammation, and the production of cytokines amongst other things, causes a series of processes that ultimately damage neurones leading to their death. When cells within the brain die, this causes atrophy, or shrinking, by which there is loss of brain gray matter. Structural brain changes detected by a process called MRI scanning in depressed patients have been reported in several brain regions.

However, there appears to be hope offered through supplementing with fish oil. EPA is an omega-3 fatty acid known to help the symptoms of depression and reduce levels of inflammatory cytokines, whilst producing beneficial anti-inflammatory products. There is increasing scientific interest in the ability of EPA to prevent neuronal cell death and therefore reduce or prevent gray matter loss. Much of the pioneering work has focused on the role of EPA in Huntington’s disease with extremely promising results. Given the evidence that omega-3 fatty acids are beneficial for conditions in which there is reduced gray matter atrophy, such as Huntington’s disease, supplementing with ethyl-EPA may have further positive benefits on gray matter volume in individuals with depression, and further studies to support this hypothesis are certainly warranted.

Puri BK, Bydder GM, Manku MS, Clarke A, Waldman AD, Beckmann CF. (2008)
Reduction in cerebral atrophy associated with ethyl-eicosapentaenoic acid treatment in patients with Huntington’s disease. J Int Med Res. 36: 896-905.

Song C, Wang H. Cytokines mediated inflammation and decreased neurogenesis in animal models of depression.Prog Neuropsychopharmacol Biol Psychiatry. 2010 [Epub ahead of print]

Omega 3 and depression

IMG_0650There is growing evidence for the role of omega3 fish oil, not only in the etiology of major depression, but also as a treatment method. Given the numerous and undesirable side effects associated with conventional pharmaceutical treatments it is no wonder that many individuals actively seek natural alternatives, and the pure EPA fish oil (eicosapentaenoic acid – EPA) may just be what the doctor ordered.

Indeed, several studies have highlighted that abnormal cell membrane fatty acid composition is related to risk and incidence of major depression, and that supplementation with omega-3, and specifically with EPA, appears to normalize fatty acid levels and reduce the symptoms associated with this condition. However different studies can report different findings, and whilst several studies may appear to give varied and often conflicting results, performing a meta-analysis gives an indication of general findings by ‘pooling’ the data from several studies to give an overall picture and therefore adding clarity to a concept.

A recent meta-analysis of 14 studies comparing the levels of polyunsaturated fatty acids between depressive patients and control subjects found that omega-3 polyunsaturated fatty acid levels were significantly lower in those individuals suffering from depression (Lin et al, 2010). Because the primary sources of these long-chain omega-3 fats are fish and shellfish, it is not surprising that those individuals with the highest consumption are the least likely to suffer from depression (Suominen-Taipale et al, 2010). Treating people who suffer with depression using fish oils is therefore a viable method for alleviating symptoms whilst restoring omega-3 levels. Given that low levels of omega-3 are also associated with increased risk of cardiovascular disease, as well as several other chronic disorders and conditions, the overall health benefits of raising omega-3 levels reach out much further as a nutritional approach to improving health.

Encouragingly, improvements in depressive symptoms can be seen as quickly as 8 weeks after commencing treatment. Indeed, a group of Montreal researchers have recently confirmed that taking omega 3 fish oil supplements, at doses higher than that normally consumed in an average diet, is superior to placebo in treating symptoms and that results can be observed within a two month time period (Lespérance et al, 2010). The results of this particular study also confirm EPA to be the predominant active ingredient responsible for the benefits of omega-3.

A meta-analysis of 28 trials investigating as to whether either EPA or docosahexanoeic acid (DHA) or both are responsible for the reported benefits showed that those trials in which EPA was the predominant or only fatty acid used, gave the most significant findings. Furthermore, it was suggested that the effects of 1g daily of EPA could be enhanced and prolonged by the addition of gamma-linolenic acid (GLA), an omega-6 fatty acid found in evening primrose oil (Martins 2009). Given that 1 in 4 individuals will suffer from depression at some point in their life, it is encouraging to know that there is a safe and natural way not only to treat depression but also as a method that could reduce the possibility of developing the condition in the first place.

 

Lespérance F, Frasure-Smith N, St-André E, Turecki G, Lespérance P, Wisniewski SR. The Efficacy of Omega-3 Supplementation for Major Depression: A Randomized Controlled Trial. J Clin Psychiatry 10.4088/JCP.10m05966blu

Lin PY, Huang SY, Su KP. A Meta-Analytic Review of Polyunsaturated Fatty Acid Compositions in Patients with Depression. Biol Psychiatry. 2010 May 7. [Epub ahead of print]

Martins JG EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. 2009 28:525-42.

Suominen-Taipale AL, Partonen T, Turunen AW, Männistö S, Jula A, Verkasalo PK.Fish consumption and omega-3 polyunsaturated Fatty acids in relation to depressive episodes: a cross-sectional analysis. PLoS One. 2010 May 7;5:e10530.

The mood food connection

Each year on 10th October, the Mental Health Foundation marks the day by raising awareness about mental health and well-being. Whilst we would probably all consider ourselves as reasonably tolerant and open minded, there is still quite a significant stigma about depression. If we haven’t experienced depression directly, it’s highly probable that we know someone, perhaps a friend, relative or workmate, who suffers. Mental Health Statistics report that 1 in 4 British adults experience at least one diagnosable mental health problem in any one year and 1 in 6 of us experiences this at any given time. In 2001 the World Health Organisation (WHO) estimated that approximately 450 million people worldwide have a mental health problem, of which 154 million are affected by depression.One of the major side effects of depression is that the way we think about food changes and this can influence how we eat – both the types of food and how often. Because food can directly influence our mood, our diet is even more fundamental when we’re feeling low.

The Glycemic Index

The brain needs energy supplied at an even rate in order to function optimally. Sudden peaks in blood sugar will adversely affect behaviour, anxiety, depression, and fatigue, so it is particularly important for people with depression to keep their blood glucose levels even. Although commonly known for its diabetes and weight loss benefits, the glycemic index (most commonly referred to as GI index), which ranks carbohydrates according to their effect on blood glucose levels, is a good guide to informing us which foods to include as part of a healthy diet, and indeed which foods to limit.

While all carbohydrate foods are eventually broken down into glucose, quick-release simple carbohydrates (such as high sugar foods, glucose and fructose) are broken down more quickly into glucose than complex carbohydrates (such as wholemeal grains), releasing glucose rapidly into the bloodstream. Repeated ‘spikes’ of glucose can decrease insulin sensitivity, increasing the risk of type 2 diabetes, as well as promoting oxidative stress in the veins and arteries – a cause of coronary heart disease. After the highs come the energy-sapping blood sugar lows and, frequently, strong urges to reach for another sugary carbohydrate snack to perk us up. Indeed individuals who suffer from atypical depression (a subtype of depression) often overeat and report an almost irresistible craving for carbohydrates.

White sugar and other refined carbohydrates, such as those found in processed white bread and white pasta, white rice and most convenience foods, supply few nutrients to the body but use up important B vitamins, which are essential for our nervous and immune systems, as well as healthy digestion. Avoiding refined foods and sugar, as well as consuming foods with a low GI value, will help to keep blood sugar levels even. Perhaps a more accurate reference guide to prevent blood sugar spikes is the Glycemic Load(GL) ranking system, which is based on a food’s GI value and average portion size. For example, whilst an apple is not low GI, it has a low GL and will barely influence blood sugar levels.

Micronutrient deficiencies

It is extemely common for depression sufferers to have low levels of B vitamins and essential minerals such as zinc, selenium and magnesium. These water-soluble vitamins and minerals must be consumed daily to avoid depletion. Deficiency can, in turn, hinder the body’s ability to utilise specific omega-3 fatty acids, which are known to lift our mood by elevating serotonin and regulating levels of this important neurotransmitter.

EPA, a long-chain omega-3 fatty acid found in fish oil, not only influences serotonin and dopamine in the brain, but is also converted to powerful anti-inlammatories via a series of enzyme-mediated steps. It is these enzymes that rely on the presence of B vitamins and essential minerals in order to function, without which the body’s production of natural anti-inflammatories is minimal, and can even result in the production of inflammatory substances. Combining a good nutritional vitamin and mineral supplement with 1 gram EPA daily (or 4 capsules Vegepa) can help to balance serotonin levels and alleviate the symptoms of depression.

Carbohydrate cravings are also linked with low levels of chromium, which helps to regulate blood sugar levels and reduce cravings. This is because for blood sugar to provide energy, it must be escorted into each of our cells where the energy conversion takes place. Insulin then ‘unlocks’ the cell, allowing glucose to pass in. But there is a missing link. Insulin doesn’t work properly unless biologically active chromium is present as a cofactor (much like a catalyst).

With many modern food processing methods, up to 80% of chromium is lost – particularly with whole wheat and raw sugar when they are processed to white flour and refined sugar. If we regularly opt for these refined foods over their healthy wholegrain relatives, chromium levels within the body can easily become depleted.

Whilst it is likely a low priority during episodes of low mood to concentrate on our eating habits, following a few general guidelines can help to restore healthy brain chemistry and minimise sugar-induced mood swings.

– Avoid processed foods.

– Keep red meat to a minimum or eat organic (red meat is high in inflammatory omega-6 unless animals are fed on natural grass).

– Drink plenty of water, as the brain needs to be hydrated to function at its best.

– Don’t forget your ‘five a day’. Make sure you get plenty of vitamins and minerals by eating a wide variety of fresh fruit and vegetables. If you eat them raw they’ll supply even more nutrients.

– Eat two portions of oily fish weekly to top up on omega-3, containing the natural antidepressant EPA, or take 2 capsules of Vegepa morning and night.

If you found this article interesting, you might like to read more about anti depression foods.

A Natural Science-based Solution for Depression

Isn’t it strange that whilst we would probably all consider ourselves as reasonably tolerant and open minded that there is still such a huge stigma when we think about depression. If we haven’t experienced depression directly it’s highly probable that we know someone, be they a friend, relative or workmate, who suffers. I have a friend myself who was diagnosed with major depression just under a year ago. Slowly she has become quite reclusive mostly because, she tells me, she’s ashamed and embarrassed. She talks about her black days. Days with no focus, and with very little meaning or purpose. “They come less often”, she had said to me, “but nevertheless they still come. You just learn to deal with it Nina, It’s like there’s a wall between you and the world but someone’s turned the lights off too. So what’s the point of living in isolated darkness? Oh and there’s pain too. Just to top it. Immense and unbearable pain. So there we have it. Pain, darkness and isolation that is the be-all and end-all of your life.”

I didn’t really know what to say to that. Who would? She’s been taking Prozac for the last 6 months and she tells me that whilst she sees a difference she feels sick most of the time. That’s not unusual though, because that’s the trouble with most anti-depressants – the side effects. And so we got talking and I asked what was it she did with her time, did she go out, what did she eat? “I can’t be bothered” was the main theme of her answers. Not because she was lazy, there was just a lack of motivation. She’d got into a negative pattern of not going out or doing much more than watching T.V. But it was her eating patterns that really made me think. She didn’t cook at all. Everything she ate (if and when she ate) came out of a packet. Her whole diet was pretty appalling really and she seemed to have very little understanding that the food we eat really can affect our mood. So I found myself asking more and more questions. One of them was “do you ever eat fish?” The answer was a straight no, well not since it was forced on her as a child (at this point she actually laughed). So we sat and talked about changes she could make and how certain foods could help. I told her how omega-3 from fish oils can benefit people with depression. In fact the American Psychiatric Association actually recommends treatment with at least 1 gram daily of fish oil for depression, as an addition to standard treatment. We don’t get offered that here. In fact there are probably very few GPs in the UK who know about the benefits of fish oils as an alternative or as an add-on, even though more and more trials are showing that EPA (the active omega-3 in fish oil) has a distinct anti-depressant role. If you compare EPA with Prozac, just 1gram daily can equal the benefits of a standard 20 mg Prozac dose and there are no side effects!

“But be fussy” I said. “Not all fish oils are the same, don’t go for cheap like most people do. There’s meaning to the saying that ‘you get what you pay for’. Interestingly, as the link between fish and depression risk strengthens, with it comes products formulated specifically to help. Remember that it’s EPA that you need to look for on the product label, and if you combine this with a good source of gamma linolenic (GLA) then you’re laughing, literally.

Recommended reading material:

An eminent psychiatrist and researcher, Professor Basant Puri, proposes an alternative option to conventional treatments for depression, arguing that standard treatments often fail to address the underlying biochemical factors. I thoroughly recommend his book The Natural Way to Beat Depression – The Groundbreaking Discovery of EPA to Change Your Lifea well-written, concise and informative read for anyone affected by this debilitating condition.