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.

Vegetarian, Vegan Omega 3 Sources

Vegetarian Omega 3

I’m giving a talk in a couple of weeks at the Bristol Eco Veggie Fayre on plant based sources of Essential Fatty Acids, focusing mainly on echium oil. If you want to find out more about how echium seed oil compares with other oils such as flax and hemp, check out this new website which has some really good comparisons www.vegetarian-omega3.com. It would be great to see some of you at the Veggie fayre; my talk is being held in the Veggie Nutritional Room on Sunday 30th at 2pm. It’s a fun day out for all the family, with lots of good veggie food and free samples of vegetarian friendly products to take home!

Low-carbohydrate diet – The Atkins diet

The Atkins diet has caused quite a debate with regards to its use and safety ever since Dr. Atkins launched his ‘Diet Revolution’ in 1972. So what’s wrong with it exactly? For starters, the diet totally excludes all carbohydrates, which are actually an absolutely vital component of our diet. By excluding them, the body must rely on protein and fat, not only as a source of energy, but also for vital nutrients and macronutrients. Therefore, by completely depleting the body of carbohydrate we also decrease our intake of many essential vitamins and minerals as well as fibre and another important type of carbohydrate called ‘non-starch polysaccharide’ which is absolutely essential for normal gut function.

In addition, high intake of fat, especially saturated fat derived from animal products, can increase both lipid and cholesterol levels, both of which are know to increase the risk of developing heart disease. By combining a high fat diet with one that is low in fibre results in a diet that carries an even stronger risk of developing heart disease. Furthermore, consuming too much protein is known to put strain on the kidneys, which can result in possible renal injury. Because the body cannot store protein, once the body’s needs are met, any excess must then be removed. This excess protein is converted by the liver into compounds, like urea, which are finally eliminated through the kidneys as part of urine. High protein intake also causes loss of calcium from the bones into the blood with corresponding implications on bone health.
High protein diet.gifGenerally, whilst the immediate positive benefit attributed to the Atkins diet is quick and relatively easy weight loss, the long-term consequences on cardiac, renal, bone and liver health must be all be taken into consideration. However, the ‘new’ version of the Atkins diet differs from its older counterpart in that rather than excluding carbohydrate completely, after a certain amount of weeks (depending on weight loss targets), carbohydrate is slowly reintroduced. The diet then continues, but as a ‘low-carbohydrate’ diet.

On the whole, this would appear to be a better option to restricting carbohydrate completely. However, it’s still a diet that is very low in fruit, vegetables and fibre, so in terms of digestive health, it’s not in keeping with fibre and ‘complex’ carbohydrate recommendations. Complex carbohydrates are important because they are broken down into glucose slowly, therefore providing a gradual steady stream of energy throughout the day. Eating a diet that has plenty of complex carbohydrate can help reduce the chances of developing type II diabetes for example.

The simple truth is that anyone carrying too much weight has most likely consumed more calories than they should have for some period of time. Whilst you can lose weight on anything that helps you to eat less, it does not mean it’s good for you. If you want to lose weight you need to look the amount of energy you put into your body and compare it to the amount of energy you burn. Men need approximately 2500 Kcal daily and women 2000 Kcal daily. So what do we need these calories for? Our daily calorie intake can be divided into the 3 following areas: firstly, basal metabolic rate (BMR) is the minimum amount of energy needed for our bodies to function on a daily basis and includes things like our heart beating and our breathing. Secondly is something called diet induced thermogenesis (DIT) which is the energy used when we digest our food. Finally, we need energy for physical activity, to move and to exercise and the more active a person is, the more energy they use.

Consuming more calories than we need will simply make the body store them as fat for ‘later use’. With our chaotic modern lifestyles, many of us exercise much less than we should, driving places rather than walking, with many of us having office jobs that require little, if no physical activity. The down side of all this is that sedentary individuals are much more likely to be overweight than active ones. All in all, it’s pretty easy in today’s world to pile on the pounds. Fad diets simply target vulnerable individuals who want a quick fix, and whilst the Atkins may deliver in regards to weight loss, the long-term consequences for our health may outweigh the short-term benefits. If you are really keen to shed those pounds, think about easy changes you can make to you life style and try being more active as well as adjusting what you eat to your level of activity. You simply don’t need as much energy to sit on the sofa watching television as you would playing sport for example. Being active also has numerous other benefits for our stress levels, not to mention its release of ‘happy hormones’.

EPA fish oil and its role in Alzheimer’s disease risk

I have recently written an article on EPA fish oil and its role in Alzheimer’s disease, as there are currently around 700,000 people in the UK with dementia (it is believed that these figures are set to rise to one million in the next 10 years because of the ageing population) and new research adds to the weight of evidence that suggests that people who regularly include fish as part of their diet have a lower risk of developing dementia and, in particular, Alzheimer’s disease.

The human brain is a complex organ that controls our senses, our movements, receives information, analyses information, and stores this information as memories. Dementia, simply put, means ‘deprived of the mind’ and, contrary to what many of us consider an acceptable part of growing old, memory loss and dementia are not a natural part of the ageing process. Scientists are now suggesting that the omega-3 EPA, found in fish oil, can help. Like any organ, the brain needs nurturing, and if we provide our brain with the correct nutrients then we can help to ensure the function of our brain remains at its most efficient.

For those of you interested in finding out more about how EPA helps preventing memory loss, offering help for Alzheimer’s sufferers, the full article is available here: EPA fish oil and its role in Alzheimer’s disease risk

Omega 3s and Fatty Liver Disease

Whilst most people in the UK are familiar with alcohol-related liver disease as a result of heavy drinking, which is on the rise, many of us are unaware of the problems associated with another form of liver disease, non-alcoholic fatty liver disease (NAFLD) – also known as non-alcoholic steatohepatitis (NASH). A recent review of four human studies by a group based at the University of Edinburgh found that long-chain omega-3 fatty acids not only improve liver health and function, but also increase insulin sensitivity in people suffering from fatty liver disease.

I’ve recently published an article on Omega 3s and fatty liver disease and the study led by Dr Gail Masterton and I would be very interested to hear your feed back!

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.

Can bacon and eggs really help my hangover?

The answer is actually yes, but the question is how? Well there are three main steps in the processing of that large gin and tonic that is placed in your hand in the back room of the “Six Bells” on a Friday night. Firstly alcohol (AKA ethanol) isn’t actually all that bad for you. However when we drink, ethanol is processed in the liver and converted to acetaldehyde, a toxic and highly reactive compound. Acetaldehyde is then further converted into acetate, a harmless form of acetic acid (the acid which gives vinegar its sour taste and pungent smell). There are two enzymes involved in this process, alcohol dehydrogenase (converting alcohol to acetaldehyde) and acetaldehyde dehydrogenase (converting acetaldehyde to acetate). Ideally we would want to convert alcohol to acetaldehyde slowly to avoid build up, and then convert this toxic product as quickly as possible to harmless acetate. However, acetaldehyde dehydrogenase needs another substance called glutathione (a potent antioxidant), which contains high quantities of cysteine. Together, acetaldehyde dehydrogenase and the glutathione reduce acetaldehyde to acetate. Our bodies can cope efficiently as long as we don’t consume too many drinks too quickly. However, the liver’s stores of glutathione can quickly run out if large amounts of alcohol enter the system too quickly and the body struggles to keep up with the conversion of acetaldehyde to acetate, levels of acetaldehyde rise and result in that nasty hangover headache, feeling of fatigue and rather unpleasant dodgy tummy feeling! Cysteine is an amino acid found in most high-protein foods such as pork and eggs. So if you found yourself in a position of a little too much too quickly the night before the Sunday morning fry up (use olive oil, not vegetable oil) will provide the building blocks needed for the liver to replenish its depleted glutathione stores and help mop up those left-over toxins. But as I’ve said before, moderation is really the key to drinking. Make sure you line your stomach well (alcohol is an irritant), pace yourself, drink plenty of water and try to remember that a healthy liver can get rid of about one unit of alcohol an hour. So remember, that whilst that double gin and tonic may have only taken fifteen minutes to drink, your poor liver did not finish processing it for around another two hours!!

Coffee debate update

So the coffee debate continues. Today’s headline in The Telegraph shouts an enthusiastic message that drinking coffee could reverse the signs of Alzhiemer’s disease. The trial led by Dr Gary Arendash, an American neuroscientist presents evidence that indicates that caffeine not only helps to stave off the disease, but can actually treat it. The defining hallmark of Alzheimer’s disease is the accumulation of β-amyloid protein plaques in the the areas of the brain responsible for memory (the cortex and hippocampus). These ‘sticky’ deposits are known to damage nerve cells, interfere with nerve signalling and therefore memory. Caffeine, it appears, actually reduces the production of β-amyloid protein and therefore would reduce the production of plaques. So that’s the good news folks. The bad news is that this groundbreaking research was conducted using mice. Not bad news as such if you’re a coffee drinking mouse who can’t remember where you’ve left your cheese. These findings do however support an earlier study published in January this year. Led by Marjo H. Eskelinen the study found that among 1,400 Finnish adults followed for 20 years, those who drank three to five cups of coffee per day in middle-age were two-thirds less likely than non-drinkers to develop dementia, including Alzheimer’s disease. So for the time being I shall continue to enjoy my morning cafetière, not only because I enjoy the ritual and the taste but because it may, just may help me retain my memory in years to come.

Statins – Should all over 50s get anti-cholesterol drugs?

Today’s Daily Mail headline announced the question “should all over 50s get anti-cholesterol drugs?” Normally statins are only prescribed to people who are considered to be at significant risk of a heart attack or stroke. In fact, it seems that these drugs can cut the risk of heart attack by 30% even in healthy people. So what are statins exactly? These are drugs that are known as HMG-CoA reductase inhibitors. HMG-CoA is an enzyme that is involved in the production of cholesterol in the liver. Ruducing or inhibiting the function of this enzyme therefore prevents cholesterol production. Statins (usually synthetic) are similar to HMG-CoA and mimic the actions of this enzyme but prevent the pathway progressing to the production of cholesterol and more than six million adults in the UK use them.

So far so good, until I open up the paper to page two where I am met with the words “although side effects are rare, they can include muscle pain and damage to the liver and kidneys.” I guess this is what infuriates me. With the majority of pharmaceuticals there will be the downside list of side effects or contraindications that steal some of the glamour from a treatment programme. Take NSAIDs, for example; these are common over-the-counter anti-inflammatory drugs, like Ibubrofen.

Whilst one of the most common over-the-counter drugs and used by millions, NSAIDs are associated with several side effects, of which many are probably not known by the common user. Whilst the frequency of side effects varies among NSAIDs, the most common side effects are nausea, vomiting, diarrhoea, constipation, rash, dizziness and headache (interesting that we often take them when we have a headache!). NSAIDs may also cause fluid retention, leading to oedema. The most serious side effects are kidney failure, liver failure, ulcers, an increased risk of heart attack and prolonged bleeding after an injury or surgery.

So why is it that if there is a natural alternative which we can take for both of these drugs and without the associated side effects, that we are not advised? Let me speak firstly about cholesterol. In the 1970s Danish researchers discovered that in spite of their high-cholesterol, high-fat, diet Greenland Eskimos had an astonishingly low incidence of cardiovascular disease (as well as arthritis and other chronic inflammatory diseases). When analysing blood samples it was discovered that they had low levels of LDL (bad cholesterol) and low levels of VLDL (triglyceride), but high levels of HDL (good cholesterol). It appeared that their high intake of omega-3 was responsible for this low risk of heart disease. Since this research emerged, much focus has been centred on the role of omega-3 fatty acids and, more recently, specifically the role of EPA in lowering cholesterol levels. EPA reduces cholesterol production by inhibiting the activity of another enzyme called acyl-CoA but without the side effects associated with statins. EPA also acts as an anti-inflammatory in a similar mechanism to that of NSAIDs, but again without the side effects. So my message today is to boost your EPA levels on a long-term basis and you may well lower the possibilities of having to resort to pharmaceuticals with all sorts of side effects.

Increase your fish intake and adopt a more Eskimo-like diet! For those who don’t like fish, you can opt for a high-EPA supplement. Purified fish oils actually are a useful alternative to oily fish consumption and, unlike most oily fish, are contamination-free.

1 2