Think about it. Your brain is always “on.” It takes care of your thoughts and movements, your breathing and heartbeat, your senses — it works hard 24/7, even while you’re asleep. This means your brain requires a constant supply of fuel. That “fuel” comes from the foods you eat — and what’s in that fuel makes all the difference. Put simply, what you eat directly affects the structure and function of your brain and, ultimately, your mood.
Like an expensive car, your brain functions best when it gets only premium fuel. Eating high-quality foods that contain lots of vitamins, minerals, and antioxidants nourishes the brain and protects it from oxidative stress — the “waste” (free radicals) produced when the body uses oxygen, which can damage cells.
Unfortunately, just like an expensive car, your brain can be damaged if you ingest anything other than premium fuel. If substances from “low-premium” fuel (such as what you get from processed or refined foods) get to the brain, it has little ability to get rid of them. Diets high in refined sugars, for example, are harmful to the brain. In addition to worsening your body’s regulation of insulin, they also promote inflammation and oxidative stress. Multiple studies have found a correlation between a diet high in refined sugars and impaired brain function — and even a worsening of symptoms of mood disorders, such as depression.
It makes sense. If your brain is deprived of good-quality nutrition, or if free radicals or damaging inflammatory cells are circulating within the brain’s enclosed space, further contributing to brain tissue injury, consequences are to be expected. What’s interesting is that for many years, the medical field did not fully acknowledge the connection between mood and food.
Today, fortunately, the burgeoning field of nutritional psychiatry is finding there are many consequences and correlations between not only what you eat, how you feel, and how you ultimately behave, but also the kinds of bacteria that live in your gut.
How the foods you eat affect how you feel
Serotonin is a neurotransmitter that helps regulate sleep and appetite, mediate moods, and inhibit pain. Since about 95% of your serotonin is produced in your gastrointestinal tract, and your gastrointestinal tract is lined with a hundred million nerve cells, or neurons, it makes sense that the inner workings of your digestive system don’t just help you digest food, but also guide your emotions. What’s more, the function of these neurons — and the production of neurotransmitters like serotonin — is highly influenced by the billions of “good” bacteria that make up your intestinal microbiome. These bacteria play an essential role in your health. They protect the lining of your intestines and ensure they provide a strong barrier against toxins and “bad” bacteria; they limit inflammation; they improve how well you absorb nutrients from your food; and they activate neural pathways that travel directly between the gut and the brain.
Studies have shown that when people take probiotics (supplements containing the good bacteria), their anxiety levels, perception of stress, and mental outlook improve, compared with people who did not take probiotics. Other studies have compared “traditional” diets, like the Mediterranean diet and the traditional Japanese diet, to a typical “Western” diet and have shown that the risk of depression is 25% to 35% lower in those who eat a traditional diet. Scientists account for this difference because these traditional diets tend to be high in vegetables, fruits, unprocessed grains, and fish and seafood, and to contain only modest amounts of lean meats and dairy. They are also void of processed and refined foods and sugars, which are staples of the “Western” dietary pattern. In addition, many of these unprocessed foods are fermented, and therefore act as natural probiotics. Fermentation uses bacteria and yeast to convert sugar in food to carbon dioxide, alcohol, and lactic acid. It is used to protect food from spoiling and can add a pleasant taste and texture.
This may sound implausible to you, but the notion that good bacteria not only influence what your gut digests and absorbs, but that they also affect the degree of inflammation throughout your body, as well as your mood and energy level, is gaining traction among researchers. The results so far have been quite amazing.
What does this mean for you?
Start paying attention to how eating different foods makes you feel — not just in the moment, but the next day. Try eating a “clean” diet for two to three weeks — that means cutting out all processed foods and sugar. Add fermented foods like kimchi, miso, sauerkraut, pickles, or kombucha. You also might want to try going dairy-free — and some people even feel that they feel better when their diets are grain-free. See how you feel. Then slowly introduce foods back into your diet, one by one, and see how you feel.
When my patients “go clean,” they cannot believe how much better they feel both physically and emotionally, and how much worse they then feel when they reintroduce the foods that are known to enhance inflammation. Give it a try!
For more information on this topic, please see: Nutritional medicine as mainstream in psychiatry, Sarris J, et al. Lancet Psychiatry. 2015
The field of Nutritional Psychiatry is relatively new, however there are observational data regarding the association between diet quality and mental health across countries, cultures and age groups – depression in particular. Here are links to some systematic reviews and meta-analyses:
There are also now two interventions suggesting that dietary improvement can prevent depression:
Diet during early life is also linked to mental health outcomes in children (very important from public health perspective):
Extensive animal data show that dietary manipulation affects brain plasticity and there are now data from humans to suggest the same:
Finally, while there are yet to be published RCTs testing dietary improvement as a treatment strategy for depression, the first of these is underway and results will be published within six months:
Glutathione SR from Thorne Research
For ALS, Parkinsons, neurodegenreation:
Behind the Deanna Protocol® Metabolic Plan
To understand the basis for the Deanna Protocol® Metabolic Plan, one must first consider the pathology in neurodegenerative conditions in general and ALS specifically. Death of motor neurons spreads throughout the body in individuals with ALS due to glutamate. When cells die, they burst and release intracellular glutamate into the extracellular space. This increase in extracellular glutamate causes neighboring healthy motor neurons to die, to burst, and to release more glutamate into extracellular space, which will kill even more neighboring cells. This so-called storm of glutamate in ALS causes cell death to happen at an exponential rate. (The spread of cell death via excess extracellular glutamate has already been proven in other neurodegenerative conditions, such as traumatic brain injury. It has not yet been proven in ALS research. However, we know that all cells release glutamate when they die and that excess extracellular glutamate kills neighboring cells, regardless of the disease/condition.) Dr. Tedone, Winning the Fight’s Medical Liaison, hypothesizes that somehow, the exposure to excess extracellular glutamate in ALS kills neighboring healthy neurons by interrupting the Krebs Cycle in each of them. Dr. Tedone’s hypothesis holds that this Krebs Cycle interruption is a chief cause of cell death. After all, when cells cannot produce energy efficiently, they die. How the Deanna Protocol® Metabolic Plan Stops Cell Death Caused by Extracellular Glutamate in ALS
Does the Deanna Protocol® Metabolic Plan (DP™ Plan) neutralize the excess extracellular glutamate in ALS? No. the DP™ Plan focuses on cell metabolism. the DP™ Plan delivers Alpha-ketoglutarate (AKG) to the Krebs Cycle in the neurons. The increase in AKG enables their mitochondria to produce enough energy to keep cells alive, despite their exposure to an unhealthy amount of extracellular glutamate. AKG usually does not pass through the cell membranes in normal healthy cells. Based on our experience, we found that the permeability of the cell membrane in diseased or damaged cells changes and allows AKG to permeate the cells. Due to the fact that AKG only enters diseased cells, the substance only goes where it is needed. Below is a list of the substances other than AKG that comprise the DP™ Plan, along with reasons why we included them.GABA: PALS experience excitotoxicity. This causes uncontrollable muscle twitching and makes it nearly impossible for their muscles to function properly, even before those with ALS become paralyzed. GABA, an inhibitory neurotransmitter, is used to reduce excitotoxicity. This in turn reduces twitching, and enables those with ALS to maintain control of the muscles and limbs.CoQ10, Niacin, and 5HTP: These are the precursors to NADH. NADH is one of the ingredients necessary for cells to produce the energy. Winning the Fight suggests that individuals with ALS take these three substances, which will allow their bodies to make NADH. (Taking NADH orally will not suffice because the body cannot absorb it orally, which is why we recommend taking the precursors.) Lab and Clinical Results in Individuals with ALS
The Deanna Protocol® Metabolic Plan has been proven effective in ALS research in anecdotal evidence in humans (ALSFRS scores and narrative reports from nearly 2,000 individuals following the DP™ Plan). Learn more about our results here. The DP™ Plan works differently in everyone. Those who benefit from the DP™ Plan usually live, walk, talk, breathe, speak, and function very well for years longer than expected, or even indefinitely. Based on reports, we have seen that roughly 70% of individuals see significant benefits and dramatic physical improvements. Roughly 30% see small benefits or none at all.
Deanna Protocol® Metabolic Plan in Beginning Versus Advanced Stages of ALS
Typically, those who begin following the DP™ Plan soon after diagnosis notice the best results. Those who begin in the advanced stages of ALS notice improvements such as decreased discomfort in the muscles, but do not notice dramatic reverse in paralysis or dramatic increase in the body’s ability to function. Dr. Tedone’s hypothesis is the following: In advanced stages of ALS, glutamate has already killed too many neurons for AKG to cause a dramatic difference in the physical condition of the individual, even if it does keep the remaining living neurons alive.
Those who follow the DP™ Plan report zero side effects or very minor ones. All side effects reported are related to the stomach and digestive system. The most severe we have heard of include diarrhea and indigestion. Sometimes, these can decrease with time, when the body becomes used to taking the supplements.
Further ALS Research
Optimizing the DP™ Plan & Human Testing: There are still many questions left unanswered about the Deanna Protocol® Metabolic Plan and the plan is not perfect. This is why we, at Winning the Fight, continue to research ALS and the DP™ Plan. Our goals for the future include conducting a variety of studies designed to optimize the DP™ Plan. We aim to conduct more studies in animals, in human nerve cells, and in humans (clinical trials).
Combining the DP™ Plan with GOT: Winning the Fight’s scientists and Medical Liaison, Dr. Tedone, are considering the possibility of conducting a different type of ALS research, combining the DP™ Plan with a substance called GOT. GOT (made at the Weizmann Institute for Research in Israel) neutralizes extracellular glutamate. The Weizmann scientists, Dr. Tedone, and the Winning the Fight scientists believe that a combination of the DP™ Plan and the GOT would probably deliver even better results than the DP™ Plan alone. The combination would keep dying cells alive in addition to removing the excess extracellular glutamate that is killing the cells in the first place. To conduct studies on the DP™ Plan/GOT combination approach, we must not only raise money to fund the ALS research, but we must also fund the manufacturing of GOT for human consumption. The GOT used today is only known to be safe for animal consumption.
Testing the Deanna Protocol® Metabolic Plan for Other Neurodegenerative Conditions
We also plan to begin researching the DP™ Plan and its effectiveness in conditions other than ALS. Why? Other neurodegenerative conditions (such as stroke, traumatic brain injury, concussion, Alzheimer’s Disease, Parkinson’s Disease, Multiple Sclerosis, and more) may have different causes, but they all share one common denominator: Glutamate. Regardless of the disease/condition, all nerve cells release excess glutamate into the extracellular space when they die and this glutamate will kill neighboring cells. Therefore, nerve cell death probably spreads throughout the nervous system the same way in all of these conditions. Since the DP™ Plan manages the spread of neuron death, it could likely help manage all neurodegenerative conditions, regardless of their initial cause.
We have one case study showing That the DP™ Plan is extremely effective in dramatically reversing the effects of Alzheimer’s Disease, even in the advanced stages of the disease. This further encourages us to test Dr. Tedone’s hypothesis that the DP™ Plan may manage many conditions aside from ALS. We plan to conduct research testing the DP™ Plan’s effectiveness in the neurodegenerative conditions mentioned above. We also plan to test the effectiveness of the combination of the DP™ Plan and GOT in each of the aforementioned conditions above. Lastly, we aim to customize the DP™ Plan and the DP™ Plan/ GOT combination for each distinct disease.
Attention and alertness:
Compelling evidence exists to back supplementation with L-theanine, beta-alanine, and theacrine to help users
increase brain alertness, according to Hofstra University in New York.
Equally, the evidence is offset by research that concludes dietary supplementation with the omega-3 fatty acid DHA
has no impact on reading, working memory or behaviour of under-performing UK schoolchildren.
Expectations are high in anticipation of the publication entitled “Antidepressant Foods: An Evidence-based Nutrient
Profiling System for Depression,” in next month’s World Journal of Psychiatry.
The publication, written by Dr Drew Ramsey, assistant clinical professor of psychiatry at Columbia University, and Dr
Laura LaChance of the Centre for Addiction and Mental Health in Toronto, outlines a nutrient-profile scale, which lists
the most nutrient-dense foods that aid “the prevention and treatment of depressive disorders”.
The research also identifies folate (vitamin B9), iron, long-chain omega-3 fatty acids, magnesium, selenium, thiamine
(vitamin B1), vitamin A, vitamin B6, vitamin B12 and vitamin C amongst others as key nutrients in addressing
depression and anxiety.
Supplemental strategies are complimented by the use of probiotics and prebiotics as another example of a nutrientdense
Researchers are particularly encouraged by fermented foods’ ability to get at the underlying mechanism of a
“Increasing evidence for the importance of the gut-brain axis indicates that the use of probiotics and/or prebiotics to
improve some mental health conditions is a very promising area,” said Dr Richardson, who is also founder director
of Food and Behaviour (FAB) Research, based in the UK.
“But more human research studies are still needed and individual differences present both serious challenges to this
and significant opportunities for ‘personalisation.’
Omega 3 and NAFLD Nutraingredients.com
Mental illness is a top cause of global disability and the source of significant burden to social, economic, and healthcare systems. The cost of lost productivity due to psychological and related disorders is estimated to approach $8.5 trillion.1Treatment as usual with medication and psychotherapy is ineffective for a substantial portion of patients–more than 50% of those with major depressive disorder, for example2–indicating the need for alternate prevention and treatment strategies.
“Indeed, recent evidence suggests that despite a substantial increase in the use of psychotropics and wider availability of psychotherapies, the population burden of depression has not reduced, and may be increasing,” according to a review published in the Proceedings of the Nutrition Society.3 “If indeed this is the case, it suggests the presence of operative environmental risk factors for depression.”
A sizeable and increasing body of research in the growing field of nutritional psychiatry supports the role of diet in mental health, as well as its potential as a modifiable risk factor for mental illness. The new review examined evidence from systematic reviews, meta-analyses, clinical trials, and observational studies that have focused on this topic.
Overall, this research has found an inverse association between healthy dietary patterns (those with high intake of fruits, vegetables, whole grains, nuts and seeds, fish, and minimal intake of processed foods) and the risk of depression.4-6 Importantly, these associations are “independent of body weight, suggesting dietary patterns can affect mental illness via pathways that are independent of weight status,” the authors noted.
Such studies have also positively linked depression and anxiety with unhealthy dietary patterns (characterized by frequent consumption of high-fat, high-sugar, processed foods).4,7 Additional findings have observed associations between poor nutrition in utero and in early life with emotional and behavior impairment in childhood.
The most-studied pathways implicated in the connection of diet and mental illness are as follows. Each pathway likely overlaps and interacts with the others.
- Chronic low-grade inflammation, such as that caused by lifestyle factors including poor diet, smoking, lack of sleep, and psychological stress, has been observed in individuals with depression, bipolar disorder, and schizophrenia.8-10 In observational studies, dietary patterns that are higher in fruits, vegetables, and polyunsaturated fatty acids–such as the Mediterranean diet–have been linked with lower levels of inflammation, while intervention studies have demonstrated significant improvement in inflammatory markers following adherence to the Mediterranean diet.11,12
- Oxidative stress has been shown to be elevated in patients with depression, and this population has also demonstrated lower levels of antioxidants compared with healthy controls. Other research noted increased oxidative stress in patients with schizophrenia. “Given the abundance of antioxidant compounds in foods such as fruit and vegetables, this is a pathway that could be modulated through dietary means,” the authors wrote.
- Brain plasticity may be improved through healthy dietary patterns, according to some research. Evidence suggests that neurotrophins such as brain-derived neurotrophic factor (BDNF) mediate hippocampal neurogenesis, and preliminary findings reveal that a 4-week intervention to increase the intake of carotenoid-rich produce led to increased serum BDNF in patients with schizophrenia vs controls. “In addition to possessing antioxidant and anti-inﬂammatory properties, nutrients such as n-3 fatty acids, polyphenols, l-theanine and vitamin E, can also stimulate neurogenesis while energy-dense diets high in fat and sugar impair this process,” the authors stated.
- The gastrointestinal microbiota has increasingly been linked with multiple pathways implicated in mental illness, including serotonin transmission, immune function, BDNF modulation, and the hypothalamic-pituitary-adrenal axis-mediated stress response. It may also be a mediating factor in each of the other potential pathways described. It is possible that diet-induced changes in gut microbiota and intestinal permeability could positively or negatively influence mental health.
- Mitochondrial dysfunction has been found to be associated with depression, bipolar disorder, and schizophrenia, and animal models indicate that mitochondrial function could be influenced by certain dietary supplements and nutraceuticals, including creatine, resveratrol, coenzyme Q10, and α-lipoic acid.
To learn more about the latest developments in this field, along with clinical implications for mental health professionals, Psychiatry Advisor spoke with one of the authors of the review: Felice Jacka, PhD, researcher and professor of nutritional and epidemiological psychiatry at Deakin University in Australia, founder and director of the Food and Mood Centre there, and founder and president of the International Society for Nutritional Psychiatry Research (ISNPR).
Psychiatry Advisor: What is the most compelling evidence supporting an influence of diet quality on mental health?
Dr Jacka: We and others have led many studies showing that the quality of people’s diets is linked to their mental health. In particular, whether people choose a diet higher in vegetables, fruits, whole grains, nuts and legumes, fish, and grass-fed meat, or a diet high in processed and junk foods–such as soda, fried and fatty foods, and foods high in refined carbohydrates and added sugars–is linked to their risk for the common mental disorders, depression and anxiety.
These relationships are largely independent of income, education, physical activity, smoking, body weight, and other important factors that might influence diet and mental health. Importantly, these long-term relationships do not appear to be explained by an impact of mental health on dietary habits, although that is also a factor to consider. We see these patterns of associations consistently across the world, in diverse countries and cultures, and–very importantly–across age groups
So, for example, the quality of adolescents’ diets is repeatedly related to their depressive symptoms, independently of family income, education, poor family functioning, family conflict, dieting behaviors, and the like. Similarly, the quality of women’s diets during pregnancy, as well as children’s diets in the first years of life, is also related to the children’s emotional health. This is very important to understand, as half of all mental disorders start before the age of 14 years; our findings point to diet as a key modifiable risk factor and a target for prevention.
At the other end of life, diet is increasingly recognized as a factor of importance in the risk for dementia, and we have shown that diet quality is clearly linked to hippocampal volumes in older adults, further supporting this association between diet and brain health. All of these very extensive observational data are supported by equally extensive animal studies, showing that diet influences key biological pathways relevant to the genesis of mental disorders, such as the immune system, brain plasticity, gene expression, the stress response system, and–very importantly–the microbiome-gut-brain axis. Finally, we have just published the first randomized controlled trial to show that dietary improvement, supported by a clinical dietitian, is efficacious in the treatment of major depression.
Psychiatry Advisor: What are the relevant treatment implications for mental health clinicians?
Dr Jacka: The quality of mental health patients’ diets, as well as their physical activity, sleep, and smoking habits are of great clinical relevance to their treatment outcomes and should not be considered as merely optional extras. If unsure about dietary recommendations, refer the patient to a dietitian. However, a detailed understanding of nutrition is not necessary to make basic and useful recommendations to consume food in line with the national dietary guidelines. We also believe that taking a “gut-focused” approach to dietary recommendations, focusing on increasing the intake of plant foods high in fiber and polyphenols, as well as healthy mono- and polyunsaturated fats from avocados, nuts, olive oil, and fish, may make it easier for people to understand and achieve a healthy diet.
Psychiatry Advisor: Can you describe your recent intervention study?
Dr Jacka: Our SMILES study recruited adults with major depressive disorder and randomly assigned them to either face-to-face social support, which is known to be helpful for those with depression and which acted as an active control condition, or to dietary support with a clinical dietitian over a 12-week period. The dietary condition comprised support from the dietitian in line with their standard clinical practices to increase the intake of healthful foods and to decrease the intake of “extras” (unhealthy foods).
The results showed a very large improvement in depressive symptoms in those in the dietary support group compared with more minimal improvements in the social support group. Indeed, roughly one-third of those in the dietary group were deemed to be in remission at the end of the study compared with 8% in the social support group.
Importantly, the degree of dietary improvement correlated closely with the degree of improvement in depressive symptoms. Our new economic evaluation also tells us that this was a highly cost-effective approach to treating depression, targeting overall health and resulting in lower societal and healthcare costs. The cost of our recommended diet was also cheaper than the unhealthy diets of participants at the start of the study, pointing to the fact that healthy diets do not need to be more expensive than unhealthy ones.
Psychiatry Advisor: What are some other exciting areas of emerging work in nutritional psychiatry, and what should be the focus of future research?
Dr Jacka: A rapidly developing body of evidence tells us that many of the key pathways influencing the risk for mental disorders, such as inflammation and oxidative stress, neurotrophins and brain plasticity, the stress response system, and gene expression, appear to be–to a certain extent, at least – under the control of gut microbiota. Recognizing that diet is the most important variable influencing gut microbiota, and that gut microbiota respond to dietary change within days, we are now focusing much of our research attention on this topic. In 2016 we set up the Food & Mood Centre at Deakin University, so people can head to the website and Facebook page to find out more about what we are doing there and to read about the work we have already done.
The ISNPR was founded in 2013, and we have just convened the first major international conference in Bethesda, Maryland in the middle of this year. Our next conference will be in 2019, likely in Europe, so clinicians with an interest in this topic can peruse the website and Facebook page for more information. New members are welcome.
The key point to remember is that an unhealthy diet is the leading contributor to premature death in middle- and high-income countries (second globally), while mental disorders impose the highest burden of disability worldwide. The fact that these two major causes of disability, suffering, and early death are closely linked has large implications for public health, as well as prevention and treatment. Given that so many factors that influence the risk for mental disorders, such as early life stress and trauma, social disadvantage and inequality, and genetic inheritance, are not readily modifiable, the identification of factors that are highly modifiable, such as diet, points to the importance of focusing on such factors in efforts to prevent mental disorders from developing in the first place.
- Chisholm D, Sweeny K, Sheehan P, et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry. 2016;3:415-424.
- Gaynes, BN, Warden D, Trivedi MH, et al. What did STAR*D teach us? Results from a large-scale, practical, clinical trial for patients with depression. Psychiatr Serv. 2009;60(11):1439-1445.
- Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proc Nutr Soc. 2017;76:427-436.
- Lai JS, Hiles S, Bisquera A, et al. A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. Am J Clin Nutr. 2014;99:181-197.
- Psaltopoulou T, Sergentanis TN, Panagiotakos DB, et al. Mediterranean diet, stroke, cognitive impairment, and depression: a meta-analysis. Ann Neurol. 2013;74:580-591.
- Opie RS, O’Neil A, Itsiopoulos C, Jacka FN. The impact of whole-of-diet interventions on depression and anxiety: a systematic review of randomised controlled trials. Public Health Nutr. 2015;18:2047-2093.
- O’Neil A, Quirk SE, Housden S, et al. Relationship between diet and mental health in children and adolescents: a systematic review. Am J Public Health. 2004;104:e31-e42.
- Berk M, Williams LJ, Jacka FN, et al. So depression is an inﬂammaory disease, but where does the inﬂammation come from? BMC Med. 2013;11:200.
- Fernandes BS, Steiner J, Molendijk ML, et al. C-reactive protein concentrations across the mood spectrum in bipolar disorder: a systematic review and meta-analysis. Lancet Psychiatry. 2016;3:1147-1156.
- Fernandes BS, Steiner J, Bernstein HG, et al. C-reactive protein is increased in schizophrenia but is not altered by antipsychotics: meta-analysis and implications. Mol Psychiatry. 2016;21:554-564.
- Watzl B, Kulling SE, Möseneder J, Barth SW, Bub A. A 4-wk intervention with high intake of carotenoid-rich vegetables and fruit reduces plasma C-reactive protein in healthy, nonsmoking men. Am J Clin Nutr. 2005;82:1052-1058.
- Schwingshackl L, Hoffmann G. Mediterranean dietary pattern, inﬂammation and endothelial function: a systematic review and meta-analysis of intervention trials. Nutr Metab Cardiovasc Dis. 2014;24:929-939.