Poor Diet Associated with Increased Risk of Depression in Women

The Whitehall II Study is a large, longitudinal study following the health and wellness of over 10,000 British civil servants between the ages of 35 and 80. Recruitment started in 1985 and follow-up is ongoing. Whilst the study primarily releases data on the relationship between physical health and socioeconomic status the enormous amount of data collected is often shared with and analysed by international researchers interested in other aspects of health and lifestyle. A paper published in Clinical Psychological Science reviewed the Whitehall data looking at the relationship between diet and depression. They were curious as to whether the inflammatory potential of a person’s diet had any bearing on their risk of developing the illness.

Inflammation is they way that the body responds to physical illness and injury and is also associated with lifestyle factors such as chronic stress and poor diet. The Dietary Inflammatory Index (DII) is a reliable assessment of how likely certain foods are to promote inflammation in the body. Broadly, processed foods increase inflammation while whole foods, fruits, vegetables, nuts and oily fish reduce it. A higher score on the DII is linked to higher markers of inflammation in the body.

In this analysis the researchers looked at the available dietary information and depression status of 4246 people over a period of five years. They were interested in what they have called ‘recurrent depression’ - people who had depression at the start and again at the end of this five-year period. (They did not look at whether the depression was ongoing during this period or whether it had gone in to remission at any point.) Alongside diet they looked at other health-related factors such as level of exercise, smoking status, alcohol consumption, obesity, heart disease, diabetes and stroke. 

The researchers found that women with high scores on the Dietary Inflammatory Index were significantly much more likely to develop recurrent depression, and this effect was independent of other health factors. This is similar to the results of the large Spanish 'SUN Project' that showed that healthy (anti-inflammatory) diets were linked to a reduced risk of depression in men and women. The authors comment that these results support the growing body of research in to the relationship between diet, inflammation and depression. 

Reference

Akbaraly, T. N., Kerlau, C., Wyart, M., Chevallier, N., Ndiaye, L., Schivappa, N., Hébert, J. R., Kivimäki, M. (2016). Dietary Inflammatory Index and Recurrence of Depressive Symptoms: Results From the Whitehall II Study. Clinical Psychological Science, first published on August 8, 2016 doi:10.1177/2167702616645777

Chronic Fatigue in Your Gut Not Your Head

In April I reported a study demonstrating that probiotic supplementation had a beneficial effect on one of the psychological symptoms of Chronic Fatigue Syndrome (CFS). In that 2009 paper patients on the treatment for eight weeks were significantly less anxious than those taking the placebo product. Published in June this year a new study builds on that observation. The researchers at Cornell University first noted the frequent comorbidity of gastro-intestinal disorders with CFS, as well as evidence of abnormal immune response in individuals with CFS as indicated by markers of inflammation in the blood. They hypothesised that, taken together, gut microbiome diversity and levels of inflammation could predict who had a diagnosis of CFS.

This study compared the samples of 39 healthy people and 49 individuals with CFS. By looking at differences in the samples the researchers were able to identify disease cases with 83% accuracy. They found that those with CFS were significantly more likely to show signs of microbial translocation, where bacteria that reside in the gut break through the gut wall and enter the blood stream. Since they should not be present in this part of the body the immune system recognises these roving bacteria as intruders and launches an immune (inflammatory) response. This inflammation is associated with many of the symptoms of illness in CFS and other infections.

Compared to the samples of healthy individuals ME patients had reduced numbers and diversity of a type of bacteria called Firmicutes¸ typically the most abundant phyla in the human gut microbiome, as well as significantly lower amounts of types associated with an anti-inflammatory affect.

In the long-running debate about what causes Chronic Fatigue Syndrome the arguments tend to fall dichotomously: it’s either psychological OR biological in nature. Some research has shown a positive effect of psychotherapy in alleviating symptoms whilst others have found improvement with microbiome modification. The likelihood is, therefore, that a combined treatment approach will yield the best results for patients, helping them to manage both the physical and psychological symptoms of this debilitating disease. 

Giloteaux, L., Goodrich, J. K., Walters, W. A., Levine, S. M., Ley, R. E. & Hanson, M. R. (2016). Reduces diversity and altered composition of the gut microbiome in individuals with myalgic encephalomeylitis/chronic fatigue syndrome. Microbiome, 4:30.

Jason, L. A., Torres-Harding, S. Friedberg, F., Corradi, K., Njoku, M. G., Donalek., J., Reynolds, N., Brown, M., Weitner, B. B., Rademaker, A. & Papernik, M. (2007). Non-pharmalogical interventions for CFS: A randomized trial. Journal of Clinical Psychology in Medical Settings, 14, 275-296.

Borody, T. J., Nowak, A & Finlayson, S. (2012). The GI mircobiome and its role in Chronic Fatigue Syndrome: A summary of bacteriotherapy. Journal of the Australasian College of Nutritional and Environmental Medicine, 31, 3-8.

Mental Health Awareness Week – Special Focus on Depression (Probiotics)

Just last week the NHS reported a study stating that there was insufficient evidence that probiotics were beneficial for healthy people. The trials analysed so far had not been well enough designed to be sure.

“Given the limitations of the studies – including the variety of probiotics examined – it is not possible to conclude with certainty that all probiotics are ineffective.

Absence of good-quality evidence is not evidence of there being no effect. Better-designed studies may yet find some benefit from taking probiotics.”

However, there is certainly some good evidence that particular probiotics do have a beneficial effect on depression, particularly where that depression is associated with cellular inflammation. Inflammation is the body’s immune response to illness or injury; the swelling around a cut or a bruise is part of this process. But inflammation also happens within and around the cell in response to other non-injury factors such as poor diet, prolonged stress or an imbalance of bacteria in the gut. Inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease are commonly associated with psychological and behavioural changes such as lack of energy or interest, loss of appetite, loss of appetite; and depression. This consistent relationship between inflammation and depression has led to the inflammation theory of depression; that is to say that for some sufferers inflammation may be contributing to the severity of their depressive symptoms.

A well-designed study of petrochemical workers published in 2015 showed that probiotic yogurt and supplements significantly improved scores of depression and anxiety. I have reported elsewhere that probiotics have been shown to alleviate the negative thoughts associated with low mood. A more recent controlled study showed that eight weeks of probiotic supplementation was associated with a significant reduction on depression scores in patients with a diagnosis of Major Depressive Disorder. It is thought that part of the mechanism underlying this effect are the by-products of the bacteria’s metabolism. When breaking down food in the gut (particularly fibre) gut bacteria produce a number of metabolites, many of them beneficial to the human body such as vitamin K and some B vitamins. They also produce short-chain fatty acids. One of these, butyric acid, in a potent anti-inflammatory. It also forms part of a neurotransmitter called GABA, which has a calming, tranquilizing effect on the brain.

There are a lot of probiotic products on the market and it can be difficult to know which is likely to be the most effective. There is very good research data supporting the anti-inflammatory properties of a highly concentrated probiotic supplement called VSL#3 in a number of different diseases. Whilst not necessarily a recommendation, this is the product that I use as well as ensuring regular consumption of fermented and high fibre foods.

http://www.nhs.uk/news/2016/05May/Pages/No-evidence-probiotics-are-beneficial-for-healthy-adults.aspx

Mohammadi, A. A., Jazayeri, S., Khosravi-Darani, K., Mohammadpour, N., Asemi, Z., Adab, Z., Djalali, M., Tehrai-Doost, M., Hosseini, M. & Eghtesadi, S. (2015). The effects of probiotics on mental health and hypothalamic–pituitary–adrenal axis: A randomized, double-blind, placebo-controlled trial in petrochemical workers. Nutritional Neuroscience. Published online April 16th.

Laura Steenbergen, Roberta Sellaro, Saskia van Hemert, Jos A. Bosch, and Lorenza S. Colzato. 2015. A randomized controlled trial to test the effect of multispecies probiotics on cognitive reactivity to sad mood. Brain, Behavior, and Immunity, 48, 258-264.

Akkasheh, G., Kashani-Poor, Z., Tajabadi-Ebrahimi, M., Jafari, P., Akbari, H., Taghizadeh, M., Memarzadeh, M. R., Asemi, Z., & Esmaillzadeh, A. (2016). Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Nutrition, 32, 315-20.

D'Mello, C., Ronaghan, N., Zaheer, R., Dicay, M., Le, T., MacNaughton, W. K., Surrette, M. G. & Swain, M. G. (2015) Probiotics Improve Inflammation-Associated Sickness Behavior by Altering Communication between the Peripheral Immune System and the Brain. Journal of Neuroscience, 35, 10821-18030.

Mariman, R., Tielen, F., Koning, F. & Nagelkerken, L. (2014). The probiotic mixture VSL#3 dampens LPS-induced chemokine expression in human dendritic cells by inhibition of STAT-1 phosphorylation. PLoS One, 9: e11567.

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern. Speak to your GP or a trainer before making any significant changes to your exercise routine.

Short-Term Psychodynamic Psychotherapy Effective at Reducing Depressive Symptoms and Inflammatory Markers

Depression is rapidly becoming the leading cause of disease burden (negative effects on quality of life) in the world. Psychologists and biologists have been trying to understand the underlying mechanisms of depression for a long time, wondering whether it is mainly biological or psychological in nature; a disease of the body or of the mind? My clinical experience is that it can be either or both, which is why a thorough assessment is essential. For some people the roots of their depression lie in difficult early circumstances, abusive relationships or a traumatic event. For others there may be a genetic predisposition to the illness, it ‘runs in the family’, or some other physiological factor.

Several studies have demonstrated a relationship between inflammation in the body and depression. Inflammation is your body’s response to illness or infection and can be activated by a number of factors such as poor diet, underlying illness and chronic stress. Many studies have illustrated that the higher the degree of inflammation in the body the more severe the depressive symptoms and vice versa. The consistency of this finding has led to the ‘Inflammatory Hypothesis of Depression’, proposing that inflammation is the driving force in depression in many people, and that it can increase symptom severity in those already dealing with low mood.

In a trial thought to be the first of its kind researchers from Brazil and the USA looked at the levels of inflammation in patients' blood as well as the severity of their depression before and after 16 standard (50 minutes) sessions of psychotherapy (plus an extra two for data collection). The result demonstrated a relationship between the levels of markers for inflammation and the severity of symptoms such that after psychotherapy treatment patients were less depressed and their inflammation had reduced. Previous research had looked at the ways that medication and CBT could reduce inflammation but this was the first study to look at the role of psychodynamic psychotherapy and the results are interesting enough to warrant further research.

The implications are powerful because, as the upward trend of depression continues, it will become increasingly important to find effective and low-cost treatments for the illness. This study suggests that patients could potentially gain relief from their mild or moderate depression in as little as four months and without the side-effects associated with medication.

Silva, G. D. G. d., Wiener, C. D., Barbosa, L. B., Araujo, J. M. G., Molina, M. L., Martin, P. S., Oses, J. P., Jansen, K., Souza, L. D. d. M. & Silva, R. A. d. (2016). Pro-inflammatory cytokines and psychotherapy in depression: Results from a randomised clinical trial. Journal of Psychiatric Research, 75, 57-64.