alternative-health
Australian scientists have found a "direct link" between what we eat and how well our immune system operates, a breakthrough that could explain rising rates of autoimmune disease across the western world.
Professor Charles Mackay, working at Sydney's Garvan Institute of Medical Research, identified how fibre in the diet plays a major role in ensuring a person's immune cells function properly.
His research, published in the prestigious journal Nature, also signals the shift of what had been a fringe concept into the scientific mainstream.
"This potentially explains all the previous data that no one had taken that seriously," Prof Mackay told AAP.
"I think it's fair to say the broader immunological research community has never really believed that diet affects immune responses.
"This does provide a direct link for the way immune cells work with the sort of things we eat."
Working along with PhD student Kendle Maslowski, Prof Mackay investigated the operation of an immune cell receptor known to bind with "short chain fatty acids" - what fibre is reduced to once processed by bacteria in the gut.
This broken-down fibre was found to "profoundly affect immune cell function", Prof Mackay said, and without it the immune cells appeared more likely to go awry.
Autoimmune disease refers to disorders in which a person's immune system mistakenly attacks part of the body, causing inflammation.
"When (immune cells) go bad they cause inflammatory diseases, so asthma, rheumatoid arthritis, inflammatory bowel disease ..." Prof Mackay said.
"We think one of the mechanisms for their normal control is short chain fatty acids binding to this receptor.
"And if we were to speculate on the real significance of this, we believe firmly that the best explanation for the increase in inflammatory diseases in western countries ... is our changes in diet."
A lack of dietary fibre could also be behind the rise in type 1 diabetes, Prof Mackay said.
The research suggests that having a healthy diet rich in fruits, vegetables, grains, nuts and seeds would reduce a person's risk of autoimmune disease.
It also helped to explain why food supplements that affect the balance of gut bacteria were known to reduce the symptoms of some inflammatory conditions.
Prof Mackay said dietary fibre, or roughage, was otherwise known to reduce the risk of cardiovascular disease and certain cancers plus it ensures you will be regular.
"The role of nutrition ... is an exciting new topic in immunology," he said.
___________________________________________________________
'Natural alternatives - A truly scientific approach - from: foodforthebrain.org
There is a curious contradiction at the heart of the drug-based approach to depression. The treatment is based on correcting a biochemical imbalance in the brain. So you might think a scientific approach would be to check whether depressed patients actually had an imbalance and if so, exactly which neurotransmitters were low so they could be given a boost. But that is not what happens. Instead, the diagnosis of depression is based solely on a checklist of psychological symptoms, which doesn’t tell you anything about what is going on with brain or indeed body chemistry.
In fact, it has taken a nutritionally minded doctor to take this obvious scientific step. Professor Tapan Audhya from New York University Medical Center in the US first showed that the level of serotonin found in platelets, which are tiny disc-like bodies in the blood, correlates with the level of these transmitters in the brain. Next he investigated whether people with depression do actually have abnormal levels of platelet serotonin by measuring platelet levels in 52 normal and 74 depressed volunteers. The difference was striking. In 73 per cent of depressed patients, serotonin levels were barely a fifth of those in the normal subjects.
Knowing that this neurotransmitter is made directly from amino acids found in food, Audhya then gave his patients 5-hydroxytryptophan (5-HTP), the amino acid that’s a direct precursor to serotonin, from which it is made. This corrected the deficiency and resulted in major and rapid relief from depression.
When it comes to treating depression or any other chronic condition, nutrition is a real alternative as it is based on finding out what is actually going on in the patient’s system and then sorting out any specific imbalances. That makes a lot more sense, and is far more scientific, than giving millions of people precisely the same chemical regardless of what is actually wrong with them.
At the Brain Bio Centre, filling in the Hamilton Rating Scale questionnaire is just the beginning. You will also be asked about your diet and other health symptoms and then given blood and urine tests to discover how well you are functioning in four key areas that can affect depression:
• Serotonin levels – do they need boosting?
• Your homocysteine level – is it too high?
• Essential fats – are your levels high enough?
• Blood sugar balance – is yours within the healthy range?
Each of these can, if necessary, be improved with one or other of the top five natural anti-depressants, which include B vitamins, omega-3 fats and amino acids.
Unlike drugs for related problems such as anxiety, depression and insomnia, which often interact with each other in damaging ways, the various elements of a nutritional approach all complement one another. As we saw in Chapter 5, to begin to cure any chronic disorder you need to be sure that the various biochemical elements involved are balanced in an optimum way. So what has to happen to lift depression?
First, you’ll need the building blocks for the relevant neurotransmitters (see Figure 11). These are tryptophan or 5-hydroxytryptophan, both amino acids found in protein foods. But they are no good without the catalysts that turn them into neurotransmitters, which are B vitamins, magnesium, zinc and something called trimethylglycine (or TMG for short). These nutrients will also keep levels of an amino acid known as homocysteine low in the blood, which is important for holding depression at bay.
Omega-3 fats, especially one called EPA, are vital. Not only do they act as catalysts, but they are also needed to build the receptors – the docking ports in brain cells that serotonin and the other neurotransmitters attach themselves to. Finally, the whole system needs a constant and stable supply of energy, which is why blood sugar levels need to be maintained within healthy limits. Other element of the new medicine package for depression could include exercise and increased exposure to natural light, both of which raise serotonin, along with psychotherapy.
But what is the evidence that each one of these elements not only works on its own but is more effective than anti-depressants? Just one of them may do the trick for you or you may benefit from several in combination. However, once you see how they all work together, it becomes clear just how limited the standard drug style clinical trials are for testing this sort of medicine.
So what’s the evidence?
5-HTP
We’ve now seen how serotonin is made in the body and brain from 5-HTP. In its turn, 5-HTP is made from another amino acid, tryptophan. Both can be found in food: many protein-rich foods such as meat, fish, beans and eggs contain tryptophan, while the richest source of 5-HTP is the African griffonia bean. Not getting enough tryptophan is likely to make you depressed: people fed food deficient in tryptophan became rapidly depressed within hours. Both have been shown to have an anti-depressant effect in clinical trials, although 5-HTP is more effective. There have been 27 studies, involving 990 people to date, most of which proved positive.
So how do they compare with anti-depressants? Eleven of the 5-HTP trials were double-blind placebo controlled, and six of those measured depression using the HRS. The studies differed in design, so you cannot just add up the scores to get an average, but the improvement rated 13, 30, 34, 39, 40, 56 and 61 per cent. It doesn’t take a scientist to realise these results are a lot better than the average 15 per cent improvement reported for anti-depressants.
In play-off studies between 5-HTP and SSRI anti-depressants, 5-HTP comes out slightly better. One double-blind trial headed by Dr W.P. Poldinger at the Basel University of Psychiatry gave 34 depressed volunteers either the SSRI fluvoxamine (Luvox) or 300mg of 5-HTP. At the end of the six weeks, both groups of patients had had a significant improvement in their depression. However, those taking 5-HTP had a slightly greater improvement, compared to those on the SSRI, in each of the four criteria assessed –depression, anxiety, insomnia, and physical symptoms – as well as their own self-assessment.
Since in some sensitive people, anti-depressant drugs can induce an overload of serotonin called ‘serotonin syndrome’ – characterised by feeling overheated, high blood pressure, twitching, cramping, dizziness and disorientation – some concern has been expressed about the possibility of increasing the odds of serotonin syndrome with the combination of 5-HTP and an SSRI drug. However, a recent review on the safety of 5-HTP concludes that ‘serotonin syndrome has not been reported in humans in association with 5-HTP, either as monotherapy [on its own] or in combination with other medications.’
Are there any side effects with 5-HTP? Some people experience mild gastrointestinal disturbance on 5-HTP, which usually stops within a few days. Since there are serotonin receptors in the gut, which don’t normally expect to get the real thing so easily, they can overreact if the amount is too high, resulting in transient nausea. If this happens, just lower the dose.
B vitamins and the homocysteine link
People with either low blood levels of the B vitamin folic acid, or high blood levels of the amino acid homocysteine, are both more likely to be depressed and less likely to get a positive result from anti-depressant drugs.
A study published in 2003 found that having a high level of homocysteine doubles the odds of a woman developing depression, for instance. Ensuring homocysteine stays low means that your brain will methylate well, keeping its chemistry ticking over and in balance. So one way of staving off depression is to keep your homocysteine levels in check. The ideal level is below 6, and the average level is 10-11. The risk of depression doubles with levels above 15.
Normalising homocysteine levels is mainly down to getting enough vitamins B2, B6, B12, zinc, TMG – and folic acid. In fact, the higher your blood homocysteine level, the more likely folic acid will work for you. In a study from 2000, comparing the effects of giving an SSRI with either a placebo or with folic acid, 61 per cent of patients improved on the placebo combination but 93 per cent improved with the addition of folic acid.
But how does folic acid, a cheap vitamin with no side effects, compare to anti-depressants? Three trials published in 2003 and involving 247 people addressed this question. Two, with 151 participants, assessed the use of folic acid in addition to other treatment, and found that adding folic acid reduced HRS scores on average by a further 2.65 points. That’s not as good as the results with 5-HTP but as good, if not better, than anti-depressants. These studies also show that more patients treated with folic acid experienced a 50 per cent greater reduction in their HRS after ten weeks, compared to those on anti-depressants.
As for side effects, there are none, except a lower risk for heart disease, strokes, Alzheimer’s and improved energy and concentration. However, if you are vegan – which can potentially leave you B12 deficient – taking folic acid on its own can mask the symptoms, but the underlying nerve damage caused by B12 deficiency anaemia can persist. So don’t take folic acid without also supplementing vitamin B12. (Pregnant women should also ensure they take a recommended multivitamin if they are supplementing folic acid.)
Omega-3s
The richest dietary source of omega-3 essential fats is fish, specifically carnivorous coldwater fish such as salmon, mackerel and herring. As a 1998 Lancet article reveals, surveys have shown that the more fish the population of a country eats, the lower their incidence of depression. The omega-3 fat EPA seems to be the most potent natural anti-depressant.
There have been six double-blind placebo-controlled trials to date, five of which show significant improvement in levels of depression. The first, by Dr Andrew Stoll from Harvard Medical School, published in the Archives of General Psychiatry, gave 40 depressed patients either omega-3 supplements or a placebo, and found a highly significant improvement in those given the omega-3s.
The next, published in the American Journal of Psychiatry, tested the effects of giving 20 people suffering from severe depression and who were already on anti-depressants, but still depressed, a highly concentrated form of omega-3 fat called ethyl-EPA versus a placebo. By the third week, the depressed patients were showing major improvement in their mood, while those on placebo were not. A 2006 trial by Dr Sophia Frangou from the Institute of Psychiatry in London gave a concentrated form of EPA, versus a placebo, to 26 depressed people with bipolar disorder (otherwise known as manic depression) and again found a significant improvement.
In these trials, which used the HRS, the average improvement in depression in those taking omega-3s over the placebo hovered around the 50 per cent mark. Again, it doesn’t take a rocket scientist to realise that these results are a quantum leap ahead of anti-depressant drugs – and without the side effects. This is because omega-3s help to build your brain’s neuronal connections as well as the receptor sites for neurotransmitters, so the more omega-3s in your blood, the more serotonin you are likely to make and the more responsive you become to its effects.
Top fish for brain fats
Amount of EPA in 100g (3oz)
Mackerel 1,400mg
Herring/kipper 1,000mg
Sardines 1,000mg
Tuna 900mg
Anchovy 900mg
Salmon 800mg
Trout 500mg
[chart ends]
What about side effects? Participants in some earlier studies, who were consuming 14 fish oil capsules a day, experienced mild gastrointestinal discomfort – mainly loose bowels. However, nowadays you can buy more concentrated EPA-rich fish oils, so you get more omega-3 with less oil. Supplementing fish oils also reduces the risk for heart disease, alleviates arthritic pain and may improve memory and concentration.
Balancing your blood sugar
If you went to your doctor complaining of depression, you’d hardly expect them to say, ‘Eat less sugar.’ But they should, because there is a direct link between mood and blood sugar balance. As we’ve already seen, all carbohydrate foods are broken down into glucose and your brain runs on glucose. The more uneven your blood sugar supply, the more uneven your mood.
Eating lots of sugar is going to give you sudden peaks and troughs in the amount of glucose in your blood. You will experience this as fatigue, irritability, dizziness, insomnia, excessive sweating (especially at night), poor concentration and forgetfulness, severe thirst, depression, crying spells, digestive disturbances and blurred vision. (For more details on blood-sugar problems, see Chapter 8.) Since the brain depends on an even supply of glucose, it is no surprise to find that sugar has been implicated in aggressive behaviour, anxiety, depression, and fatigue,
Lots of refined sugar and refined carbohydrates (white bread, pasta, rice and most processed foods) is also linked with depression because these foods not only supply very little in the way of nutrients, but also use up the mood-enhancing B vitamins because the body needs B vitamins to turn each teaspoon of sugar into energy. Sugar also diverts the supply of another nutrient we highlighted in our discussion of diabetes in Chapter 8 – chromium. This mineral is vital for keeping your blood sugar level stable because insulin, which clears glucose from the blood, can’t work properly without it. In fact, itturns out that just supplying proper levels of chromium to certain depressed patients can make a big difference.
Chromium and ‘atypical’ depression
‘Atypical’ depression is called that because it differs markedly from so-called ‘classic’ depression, where sufferers have little appetite, don’t eat enough, lose weight and can’t sleep. Let’s look at some of the symptoms of atypical depression; if you answer yes to five or more of these questions, you might be suffering from it.
• Do you crave sweets or other carbohydrates?
• Do you tend to gain weight?
• Are you tired for no obvious reason?
• Do your arms or legs feel heavy?
• Do you tend to feel sleepy or groggy much of the time?
• Are your feelings easily hurt by the rejection of others?
• Did your depression begin before the age of 30?
Atypical depression is estimated to affect anywhere from 25 to 42 percent of the depressed population, and an even higher percentage among depressed women, so it’s actually extremely common (and misnamed).
A chance discovery by Dr Malcolm McLeod, clinical professor of psychiatrist at the University of North Carolina in the US, suggested that people who suffer from it might benefit from chromium supplementation. In a small double-blind study published in 2003, McLeod gave ten patients suffering from atypical depression chromium supplements of 600mcg a day, and five others a placebo, for eight weeks.
The results were dramatic. Seven out of the ten taking the supplements showed a big improvement, as opposed to none on the placebo. Their HRS dropped by an unheard-of 83 per cent: that is, from 29 – major depression – to 5, which is classed as not depressed. A larger trial at Cornell University in the US, involving 113 participants, confirmed the finding in 2005. After eight weeks, 65 per cent of the people taking chromium had had a major improvement, compared to 33 per cent on placebos.
Side effects None, except more energy and better weight control. Chromium has no toxicity, even at amounts 100 times those used in the trials above.
Light, exercise, air and friends
Exercise is a key part of the new medicine model’s non-drug approach. It also turns out to be as effective as taking anti-depressants. A number of studies in which people exercised for 30 to 60 minutes 3 to 5 times a week found a drop of around 5 points in their HRS – more than double what you’d expect from anti-depressants alone. In an Australian study published in 2005, involving 60 adults over the age of 60, half took up high-intensity exercise three days a week, while the other half did low-intensity exercise. Of those doing high-intensity exercise, 61 per cent halved their HRS, while only 29 per cent of those doing low-intensity exercise halved their score.
And if you exercise in bright light, you get a double dose of natural ‘anti-depressant’, as a number of studies using full-spectrum lighting (versus normal room lighting) have shown. Unlike normal ‘yellow’ lighting, sunlight is white and contains a stronger and fuller spectrum of light. Although more expensive, full-spectrum light bulbs are a worthwhile addition, especially if you are prone to the winter blues – known as SAD or seasonal-affective disorder. (See Resources for suppliers of full-spectrum lighting.)
In one study published in 2004, a third of depressed volunteers who exercised in full-spectrum lighting experienced a major improvement in their depression (a 50 per cent or more decrease in their HRS). Other studies from 2005 have also found a definitive improvement, even among those not specifically prone to SAD. The effect could be due to the direct effect of light on raising serotonin.
One other gadget, or lifestyle change, you might want to consider to beat the blues is an ionizer. These give off negative ions, which are naturally generated by turbulent water – think waterfalls and the seaside – and are thought to be good for you, while positive ions, produced especially by electronic equipment such as computers screens, air-conditioning and TV sets are not. In one controlled trial, depressed patients exposed to both full-spectrum lighting plus a high-intensity ionizer reported major improvements in their depression. By leaving an ionizer on overnight you might substantially improve mood (see Resources for the best ionizers).
Counselling and psychotherapy
Probably the biggest non-nutritional factor in recovering from depression is having someone to talk to about life’s inevitable problems and stresses. Much depression is linked to, or triggered by, stressful life events such as a death, the loss of a job, or the breakup of a relationship. Or you may have felt that your life was out of kilter and lacking in essential elements – a circle of supportive friends or relatives or good standing at work, for example – for some time, and feel that you’re tipping over from the blues into a real depression.
Feeling bad about yourself and lacking someone supportive to listen to you can be a major cause of depression however good your diet might be. A problem shared is a problem halved. While good nutrition might give you more mental and emotional energy to solve your problems, it doesn’t take away the underlying issues that fuel depression. For this reason, we recommend counselling and psychotherapy as well as nutritional approaches.
Food or drugs? The verdict
The evidence suggests that the nutritional approach it not only more effective. It’s also practically free of serious negative side effects. So why not do it? Well, you could argue that there’s not enough research to conclusively prove all the benefits we’ve discussed here. You might be thinking that many of the trials are small, although well designed. That’s true to an extent, and it’s also unlikely to change: there’s little profit to be made from non-patentable nutrients such as omega-3, folic acid or 5-HTP. Psychiatrist Dr Erick Turne from the Mood Disorders Center in Portland, Oregon, who uses 5-HTP in his practice, says: ‘Unfortunately, because 5-HTP is a dietary supplement and not a prescription pharmaceutical, there is comparatively little financial incentive for extensive clinical research.’ Also, since no benefits for nutrients can be put on their packaging, and there's no army of reps or marketing budget, most people simply don’t know about these highly effective, and considerably safer nutritional options.
But then there’s the other, now-familiar problem: most DOCTORs are also unfamiliar with food-based medicine. ‘A DOCTOR receives virtually no training in nutritional approaches to depression. It’s an obvious oversight, given the wealth of evidence,’ says André Tylee, professor of primary care mental health at the Institute of Psychiatry. But that is no reason why you shouldn’t try it yourself with the help of a trained clinical nutritionist.
What works
• Set up the building blocks. Most of the studies we’ve cited used 300mg of 5-HTP, but we recommend ideally testing to see whether you are low in serotonin with a platelet serotonin test (see Resources, page 406) and starting with 100mg, or 50mg, twice a day. Be aware that 5-HTP is best absorbed either on an empty stomach or with a carbohydrate snack such as a piece of fruit or an oatcake. Otherwise, make sure you eat enough protein from beans, lentils, nuts, seeds, fish, eggs and meat, which are all high in tryptophan. If your motivation is low, you could also supplement 1,000mg of tyrosine.
• Put the catalysts in place. Test your homocysteine level, which can be done using a home test kit (see Resources, page 406). Theoretically your doctor can request this, but few do. If your level is above 9mmol/l, take a combined ‘homocysteine’ supplement of B2, B6, B12, folic acid, zinc, and TMG, providing at least 400mcg of folic acid, 250mcg of B12 and 20mg of B6. If your homocysteine score is above 15mmol/l, double this amount. Also eat whole foods rich in the B vitamins – whole grains, beans, nuts, seeds, fruits and vegetables. Folic acid is particularly abundant in green vegetables, beans, lentils, nuts and seeds, while B12 is only found in animal foods – meat, fish, eggs and dairy produce.
• Take omega-3s. You need about 1,000mg of EPA a day for a mood-boosting effect. That means supplementing a concentrated omega-3 fish oil capsule providing 500mg twice a day, and eating a serving of either sardines, mackerel, herring, or wild or organic salmon, three times a week. Tuna steaks are also a good source but should be eaten only once a week because of possible mercury contamination, whereas tinned tuna has very little omega-3s because of the way it’s processed. Very little, perhaps 5%, of the omega 3 fats found in flax or pumpkin seeds convert into EPA, so while these are good to eat they don’t have the same anti-depressant effect.
• Keep your fuel supply stable. Eating a diet that will stabilise your blood sugar (see page 143), and supplementing 600mcg of chromium, will help tremendously in keeping your moods stable. Chromium supplements generally come in 200mcg pills. Take two with breakfast and one with lunch. After a month, cut down to one with breakfast and one with lunch. Don’t take chromium in the evening, as it can have a stimulating effect.
• Exercise for at least 15 minutes most days. Psychocolisthenics (see Resources, page 405) is especially good for balancing your mood.
• Consider psychotherapy (see Resources, page 403, for help with referrals).
Dig deeper by reading Optimum Nutrition for the Mind by Patrick Holford
Working with your doctor
Much of what we recommend you can either do for yourself or by seeking the guidance and support of a nutritional therapist. However, the process of weaning yourself off anti-depressants is something you must do with the support and guidance of your doctor.
We recommend that 5-HTP not be taken in significant amounts, above 50mg, if you are on an anti-depressant – 5-HTP helps the body make serotonin while SSRI anti-depressants stop it being broken down. If your doctor is willing to wean you off anti-depressants it helps, at the same time, to wean you on to 5-HTP, gradually building the daily amount up to a maximum of 300mg, but no more than 100mg before you are completely off the anti-depressant. In our experience, this minimises and shortens the withdrawal effects that many people experience when coming off anti-depressants.
All the other mood-boosting factors we’ve discussed – from omega 3s to exercise – can safely be added while you’re on medication and will probably help you reduce your need, them come off anti-depressants with less withdrawal effects.'
Professor Charles Mackay, working at Sydney's Garvan Institute of Medical Research, identified how fibre in the diet plays a major role in ensuring a person's immune cells function properly.
His research, published in the prestigious journal Nature, also signals the shift of what had been a fringe concept into the scientific mainstream.
"This potentially explains all the previous data that no one had taken that seriously," Prof Mackay told AAP.
"I think it's fair to say the broader immunological research community has never really believed that diet affects immune responses.
"This does provide a direct link for the way immune cells work with the sort of things we eat."
Working along with PhD student Kendle Maslowski, Prof Mackay investigated the operation of an immune cell receptor known to bind with "short chain fatty acids" - what fibre is reduced to once processed by bacteria in the gut.
This broken-down fibre was found to "profoundly affect immune cell function", Prof Mackay said, and without it the immune cells appeared more likely to go awry.
Autoimmune disease refers to disorders in which a person's immune system mistakenly attacks part of the body, causing inflammation.
"When (immune cells) go bad they cause inflammatory diseases, so asthma, rheumatoid arthritis, inflammatory bowel disease ..." Prof Mackay said.
"We think one of the mechanisms for their normal control is short chain fatty acids binding to this receptor.
"And if we were to speculate on the real significance of this, we believe firmly that the best explanation for the increase in inflammatory diseases in western countries ... is our changes in diet."
A lack of dietary fibre could also be behind the rise in type 1 diabetes, Prof Mackay said.
The research suggests that having a healthy diet rich in fruits, vegetables, grains, nuts and seeds would reduce a person's risk of autoimmune disease.
It also helped to explain why food supplements that affect the balance of gut bacteria were known to reduce the symptoms of some inflammatory conditions.
Prof Mackay said dietary fibre, or roughage, was otherwise known to reduce the risk of cardiovascular disease and certain cancers plus it ensures you will be regular.
"The role of nutrition ... is an exciting new topic in immunology," he said.
___________________________________________________________
'Natural alternatives - A truly scientific approach - from: foodforthebrain.org
There is a curious contradiction at the heart of the drug-based approach to depression. The treatment is based on correcting a biochemical imbalance in the brain. So you might think a scientific approach would be to check whether depressed patients actually had an imbalance and if so, exactly which neurotransmitters were low so they could be given a boost. But that is not what happens. Instead, the diagnosis of depression is based solely on a checklist of psychological symptoms, which doesn’t tell you anything about what is going on with brain or indeed body chemistry.
In fact, it has taken a nutritionally minded doctor to take this obvious scientific step. Professor Tapan Audhya from New York University Medical Center in the US first showed that the level of serotonin found in platelets, which are tiny disc-like bodies in the blood, correlates with the level of these transmitters in the brain. Next he investigated whether people with depression do actually have abnormal levels of platelet serotonin by measuring platelet levels in 52 normal and 74 depressed volunteers. The difference was striking. In 73 per cent of depressed patients, serotonin levels were barely a fifth of those in the normal subjects.
Knowing that this neurotransmitter is made directly from amino acids found in food, Audhya then gave his patients 5-hydroxytryptophan (5-HTP), the amino acid that’s a direct precursor to serotonin, from which it is made. This corrected the deficiency and resulted in major and rapid relief from depression.
When it comes to treating depression or any other chronic condition, nutrition is a real alternative as it is based on finding out what is actually going on in the patient’s system and then sorting out any specific imbalances. That makes a lot more sense, and is far more scientific, than giving millions of people precisely the same chemical regardless of what is actually wrong with them.
At the Brain Bio Centre, filling in the Hamilton Rating Scale questionnaire is just the beginning. You will also be asked about your diet and other health symptoms and then given blood and urine tests to discover how well you are functioning in four key areas that can affect depression:
• Serotonin levels – do they need boosting?
• Your homocysteine level – is it too high?
• Essential fats – are your levels high enough?
• Blood sugar balance – is yours within the healthy range?
Each of these can, if necessary, be improved with one or other of the top five natural anti-depressants, which include B vitamins, omega-3 fats and amino acids.
Unlike drugs for related problems such as anxiety, depression and insomnia, which often interact with each other in damaging ways, the various elements of a nutritional approach all complement one another. As we saw in Chapter 5, to begin to cure any chronic disorder you need to be sure that the various biochemical elements involved are balanced in an optimum way. So what has to happen to lift depression?
First, you’ll need the building blocks for the relevant neurotransmitters (see Figure 11). These are tryptophan or 5-hydroxytryptophan, both amino acids found in protein foods. But they are no good without the catalysts that turn them into neurotransmitters, which are B vitamins, magnesium, zinc and something called trimethylglycine (or TMG for short). These nutrients will also keep levels of an amino acid known as homocysteine low in the blood, which is important for holding depression at bay.
Omega-3 fats, especially one called EPA, are vital. Not only do they act as catalysts, but they are also needed to build the receptors – the docking ports in brain cells that serotonin and the other neurotransmitters attach themselves to. Finally, the whole system needs a constant and stable supply of energy, which is why blood sugar levels need to be maintained within healthy limits. Other element of the new medicine package for depression could include exercise and increased exposure to natural light, both of which raise serotonin, along with psychotherapy.
But what is the evidence that each one of these elements not only works on its own but is more effective than anti-depressants? Just one of them may do the trick for you or you may benefit from several in combination. However, once you see how they all work together, it becomes clear just how limited the standard drug style clinical trials are for testing this sort of medicine.
So what’s the evidence?
5-HTP
We’ve now seen how serotonin is made in the body and brain from 5-HTP. In its turn, 5-HTP is made from another amino acid, tryptophan. Both can be found in food: many protein-rich foods such as meat, fish, beans and eggs contain tryptophan, while the richest source of 5-HTP is the African griffonia bean. Not getting enough tryptophan is likely to make you depressed: people fed food deficient in tryptophan became rapidly depressed within hours. Both have been shown to have an anti-depressant effect in clinical trials, although 5-HTP is more effective. There have been 27 studies, involving 990 people to date, most of which proved positive.
So how do they compare with anti-depressants? Eleven of the 5-HTP trials were double-blind placebo controlled, and six of those measured depression using the HRS. The studies differed in design, so you cannot just add up the scores to get an average, but the improvement rated 13, 30, 34, 39, 40, 56 and 61 per cent. It doesn’t take a scientist to realise these results are a lot better than the average 15 per cent improvement reported for anti-depressants.
In play-off studies between 5-HTP and SSRI anti-depressants, 5-HTP comes out slightly better. One double-blind trial headed by Dr W.P. Poldinger at the Basel University of Psychiatry gave 34 depressed volunteers either the SSRI fluvoxamine (Luvox) or 300mg of 5-HTP. At the end of the six weeks, both groups of patients had had a significant improvement in their depression. However, those taking 5-HTP had a slightly greater improvement, compared to those on the SSRI, in each of the four criteria assessed –depression, anxiety, insomnia, and physical symptoms – as well as their own self-assessment.
Since in some sensitive people, anti-depressant drugs can induce an overload of serotonin called ‘serotonin syndrome’ – characterised by feeling overheated, high blood pressure, twitching, cramping, dizziness and disorientation – some concern has been expressed about the possibility of increasing the odds of serotonin syndrome with the combination of 5-HTP and an SSRI drug. However, a recent review on the safety of 5-HTP concludes that ‘serotonin syndrome has not been reported in humans in association with 5-HTP, either as monotherapy [on its own] or in combination with other medications.’
Are there any side effects with 5-HTP? Some people experience mild gastrointestinal disturbance on 5-HTP, which usually stops within a few days. Since there are serotonin receptors in the gut, which don’t normally expect to get the real thing so easily, they can overreact if the amount is too high, resulting in transient nausea. If this happens, just lower the dose.
B vitamins and the homocysteine link
People with either low blood levels of the B vitamin folic acid, or high blood levels of the amino acid homocysteine, are both more likely to be depressed and less likely to get a positive result from anti-depressant drugs.
A study published in 2003 found that having a high level of homocysteine doubles the odds of a woman developing depression, for instance. Ensuring homocysteine stays low means that your brain will methylate well, keeping its chemistry ticking over and in balance. So one way of staving off depression is to keep your homocysteine levels in check. The ideal level is below 6, and the average level is 10-11. The risk of depression doubles with levels above 15.
Normalising homocysteine levels is mainly down to getting enough vitamins B2, B6, B12, zinc, TMG – and folic acid. In fact, the higher your blood homocysteine level, the more likely folic acid will work for you. In a study from 2000, comparing the effects of giving an SSRI with either a placebo or with folic acid, 61 per cent of patients improved on the placebo combination but 93 per cent improved with the addition of folic acid.
But how does folic acid, a cheap vitamin with no side effects, compare to anti-depressants? Three trials published in 2003 and involving 247 people addressed this question. Two, with 151 participants, assessed the use of folic acid in addition to other treatment, and found that adding folic acid reduced HRS scores on average by a further 2.65 points. That’s not as good as the results with 5-HTP but as good, if not better, than anti-depressants. These studies also show that more patients treated with folic acid experienced a 50 per cent greater reduction in their HRS after ten weeks, compared to those on anti-depressants.
As for side effects, there are none, except a lower risk for heart disease, strokes, Alzheimer’s and improved energy and concentration. However, if you are vegan – which can potentially leave you B12 deficient – taking folic acid on its own can mask the symptoms, but the underlying nerve damage caused by B12 deficiency anaemia can persist. So don’t take folic acid without also supplementing vitamin B12. (Pregnant women should also ensure they take a recommended multivitamin if they are supplementing folic acid.)
Omega-3s
The richest dietary source of omega-3 essential fats is fish, specifically carnivorous coldwater fish such as salmon, mackerel and herring. As a 1998 Lancet article reveals, surveys have shown that the more fish the population of a country eats, the lower their incidence of depression. The omega-3 fat EPA seems to be the most potent natural anti-depressant.
There have been six double-blind placebo-controlled trials to date, five of which show significant improvement in levels of depression. The first, by Dr Andrew Stoll from Harvard Medical School, published in the Archives of General Psychiatry, gave 40 depressed patients either omega-3 supplements or a placebo, and found a highly significant improvement in those given the omega-3s.
The next, published in the American Journal of Psychiatry, tested the effects of giving 20 people suffering from severe depression and who were already on anti-depressants, but still depressed, a highly concentrated form of omega-3 fat called ethyl-EPA versus a placebo. By the third week, the depressed patients were showing major improvement in their mood, while those on placebo were not. A 2006 trial by Dr Sophia Frangou from the Institute of Psychiatry in London gave a concentrated form of EPA, versus a placebo, to 26 depressed people with bipolar disorder (otherwise known as manic depression) and again found a significant improvement.
In these trials, which used the HRS, the average improvement in depression in those taking omega-3s over the placebo hovered around the 50 per cent mark. Again, it doesn’t take a rocket scientist to realise that these results are a quantum leap ahead of anti-depressant drugs – and without the side effects. This is because omega-3s help to build your brain’s neuronal connections as well as the receptor sites for neurotransmitters, so the more omega-3s in your blood, the more serotonin you are likely to make and the more responsive you become to its effects.
Top fish for brain fats
Amount of EPA in 100g (3oz)
Mackerel 1,400mg
Herring/kipper 1,000mg
Sardines 1,000mg
Tuna 900mg
Anchovy 900mg
Salmon 800mg
Trout 500mg
[chart ends]
What about side effects? Participants in some earlier studies, who were consuming 14 fish oil capsules a day, experienced mild gastrointestinal discomfort – mainly loose bowels. However, nowadays you can buy more concentrated EPA-rich fish oils, so you get more omega-3 with less oil. Supplementing fish oils also reduces the risk for heart disease, alleviates arthritic pain and may improve memory and concentration.
Balancing your blood sugar
If you went to your doctor complaining of depression, you’d hardly expect them to say, ‘Eat less sugar.’ But they should, because there is a direct link between mood and blood sugar balance. As we’ve already seen, all carbohydrate foods are broken down into glucose and your brain runs on glucose. The more uneven your blood sugar supply, the more uneven your mood.
Eating lots of sugar is going to give you sudden peaks and troughs in the amount of glucose in your blood. You will experience this as fatigue, irritability, dizziness, insomnia, excessive sweating (especially at night), poor concentration and forgetfulness, severe thirst, depression, crying spells, digestive disturbances and blurred vision. (For more details on blood-sugar problems, see Chapter 8.) Since the brain depends on an even supply of glucose, it is no surprise to find that sugar has been implicated in aggressive behaviour, anxiety, depression, and fatigue,
Lots of refined sugar and refined carbohydrates (white bread, pasta, rice and most processed foods) is also linked with depression because these foods not only supply very little in the way of nutrients, but also use up the mood-enhancing B vitamins because the body needs B vitamins to turn each teaspoon of sugar into energy. Sugar also diverts the supply of another nutrient we highlighted in our discussion of diabetes in Chapter 8 – chromium. This mineral is vital for keeping your blood sugar level stable because insulin, which clears glucose from the blood, can’t work properly without it. In fact, itturns out that just supplying proper levels of chromium to certain depressed patients can make a big difference.
Chromium and ‘atypical’ depression
‘Atypical’ depression is called that because it differs markedly from so-called ‘classic’ depression, where sufferers have little appetite, don’t eat enough, lose weight and can’t sleep. Let’s look at some of the symptoms of atypical depression; if you answer yes to five or more of these questions, you might be suffering from it.
• Do you crave sweets or other carbohydrates?
• Do you tend to gain weight?
• Are you tired for no obvious reason?
• Do your arms or legs feel heavy?
• Do you tend to feel sleepy or groggy much of the time?
• Are your feelings easily hurt by the rejection of others?
• Did your depression begin before the age of 30?
Atypical depression is estimated to affect anywhere from 25 to 42 percent of the depressed population, and an even higher percentage among depressed women, so it’s actually extremely common (and misnamed).
A chance discovery by Dr Malcolm McLeod, clinical professor of psychiatrist at the University of North Carolina in the US, suggested that people who suffer from it might benefit from chromium supplementation. In a small double-blind study published in 2003, McLeod gave ten patients suffering from atypical depression chromium supplements of 600mcg a day, and five others a placebo, for eight weeks.
The results were dramatic. Seven out of the ten taking the supplements showed a big improvement, as opposed to none on the placebo. Their HRS dropped by an unheard-of 83 per cent: that is, from 29 – major depression – to 5, which is classed as not depressed. A larger trial at Cornell University in the US, involving 113 participants, confirmed the finding in 2005. After eight weeks, 65 per cent of the people taking chromium had had a major improvement, compared to 33 per cent on placebos.
Side effects None, except more energy and better weight control. Chromium has no toxicity, even at amounts 100 times those used in the trials above.
Light, exercise, air and friends
Exercise is a key part of the new medicine model’s non-drug approach. It also turns out to be as effective as taking anti-depressants. A number of studies in which people exercised for 30 to 60 minutes 3 to 5 times a week found a drop of around 5 points in their HRS – more than double what you’d expect from anti-depressants alone. In an Australian study published in 2005, involving 60 adults over the age of 60, half took up high-intensity exercise three days a week, while the other half did low-intensity exercise. Of those doing high-intensity exercise, 61 per cent halved their HRS, while only 29 per cent of those doing low-intensity exercise halved their score.
And if you exercise in bright light, you get a double dose of natural ‘anti-depressant’, as a number of studies using full-spectrum lighting (versus normal room lighting) have shown. Unlike normal ‘yellow’ lighting, sunlight is white and contains a stronger and fuller spectrum of light. Although more expensive, full-spectrum light bulbs are a worthwhile addition, especially if you are prone to the winter blues – known as SAD or seasonal-affective disorder. (See Resources for suppliers of full-spectrum lighting.)
In one study published in 2004, a third of depressed volunteers who exercised in full-spectrum lighting experienced a major improvement in their depression (a 50 per cent or more decrease in their HRS). Other studies from 2005 have also found a definitive improvement, even among those not specifically prone to SAD. The effect could be due to the direct effect of light on raising serotonin.
One other gadget, or lifestyle change, you might want to consider to beat the blues is an ionizer. These give off negative ions, which are naturally generated by turbulent water – think waterfalls and the seaside – and are thought to be good for you, while positive ions, produced especially by electronic equipment such as computers screens, air-conditioning and TV sets are not. In one controlled trial, depressed patients exposed to both full-spectrum lighting plus a high-intensity ionizer reported major improvements in their depression. By leaving an ionizer on overnight you might substantially improve mood (see Resources for the best ionizers).
Counselling and psychotherapy
Probably the biggest non-nutritional factor in recovering from depression is having someone to talk to about life’s inevitable problems and stresses. Much depression is linked to, or triggered by, stressful life events such as a death, the loss of a job, or the breakup of a relationship. Or you may have felt that your life was out of kilter and lacking in essential elements – a circle of supportive friends or relatives or good standing at work, for example – for some time, and feel that you’re tipping over from the blues into a real depression.
Feeling bad about yourself and lacking someone supportive to listen to you can be a major cause of depression however good your diet might be. A problem shared is a problem halved. While good nutrition might give you more mental and emotional energy to solve your problems, it doesn’t take away the underlying issues that fuel depression. For this reason, we recommend counselling and psychotherapy as well as nutritional approaches.
Food or drugs? The verdict
The evidence suggests that the nutritional approach it not only more effective. It’s also practically free of serious negative side effects. So why not do it? Well, you could argue that there’s not enough research to conclusively prove all the benefits we’ve discussed here. You might be thinking that many of the trials are small, although well designed. That’s true to an extent, and it’s also unlikely to change: there’s little profit to be made from non-patentable nutrients such as omega-3, folic acid or 5-HTP. Psychiatrist Dr Erick Turne from the Mood Disorders Center in Portland, Oregon, who uses 5-HTP in his practice, says: ‘Unfortunately, because 5-HTP is a dietary supplement and not a prescription pharmaceutical, there is comparatively little financial incentive for extensive clinical research.’ Also, since no benefits for nutrients can be put on their packaging, and there's no army of reps or marketing budget, most people simply don’t know about these highly effective, and considerably safer nutritional options.
But then there’s the other, now-familiar problem: most DOCTORs are also unfamiliar with food-based medicine. ‘A DOCTOR receives virtually no training in nutritional approaches to depression. It’s an obvious oversight, given the wealth of evidence,’ says André Tylee, professor of primary care mental health at the Institute of Psychiatry. But that is no reason why you shouldn’t try it yourself with the help of a trained clinical nutritionist.
What works
• Set up the building blocks. Most of the studies we’ve cited used 300mg of 5-HTP, but we recommend ideally testing to see whether you are low in serotonin with a platelet serotonin test (see Resources, page 406) and starting with 100mg, or 50mg, twice a day. Be aware that 5-HTP is best absorbed either on an empty stomach or with a carbohydrate snack such as a piece of fruit or an oatcake. Otherwise, make sure you eat enough protein from beans, lentils, nuts, seeds, fish, eggs and meat, which are all high in tryptophan. If your motivation is low, you could also supplement 1,000mg of tyrosine.
• Put the catalysts in place. Test your homocysteine level, which can be done using a home test kit (see Resources, page 406). Theoretically your doctor can request this, but few do. If your level is above 9mmol/l, take a combined ‘homocysteine’ supplement of B2, B6, B12, folic acid, zinc, and TMG, providing at least 400mcg of folic acid, 250mcg of B12 and 20mg of B6. If your homocysteine score is above 15mmol/l, double this amount. Also eat whole foods rich in the B vitamins – whole grains, beans, nuts, seeds, fruits and vegetables. Folic acid is particularly abundant in green vegetables, beans, lentils, nuts and seeds, while B12 is only found in animal foods – meat, fish, eggs and dairy produce.
• Take omega-3s. You need about 1,000mg of EPA a day for a mood-boosting effect. That means supplementing a concentrated omega-3 fish oil capsule providing 500mg twice a day, and eating a serving of either sardines, mackerel, herring, or wild or organic salmon, three times a week. Tuna steaks are also a good source but should be eaten only once a week because of possible mercury contamination, whereas tinned tuna has very little omega-3s because of the way it’s processed. Very little, perhaps 5%, of the omega 3 fats found in flax or pumpkin seeds convert into EPA, so while these are good to eat they don’t have the same anti-depressant effect.
• Keep your fuel supply stable. Eating a diet that will stabilise your blood sugar (see page 143), and supplementing 600mcg of chromium, will help tremendously in keeping your moods stable. Chromium supplements generally come in 200mcg pills. Take two with breakfast and one with lunch. After a month, cut down to one with breakfast and one with lunch. Don’t take chromium in the evening, as it can have a stimulating effect.
• Exercise for at least 15 minutes most days. Psychocolisthenics (see Resources, page 405) is especially good for balancing your mood.
• Consider psychotherapy (see Resources, page 403, for help with referrals).
Dig deeper by reading Optimum Nutrition for the Mind by Patrick Holford
Working with your doctor
Much of what we recommend you can either do for yourself or by seeking the guidance and support of a nutritional therapist. However, the process of weaning yourself off anti-depressants is something you must do with the support and guidance of your doctor.
We recommend that 5-HTP not be taken in significant amounts, above 50mg, if you are on an anti-depressant – 5-HTP helps the body make serotonin while SSRI anti-depressants stop it being broken down. If your doctor is willing to wean you off anti-depressants it helps, at the same time, to wean you on to 5-HTP, gradually building the daily amount up to a maximum of 300mg, but no more than 100mg before you are completely off the anti-depressant. In our experience, this minimises and shortens the withdrawal effects that many people experience when coming off anti-depressants.
All the other mood-boosting factors we’ve discussed – from omega 3s to exercise – can safely be added while you’re on medication and will probably help you reduce your need, them come off anti-depressants with less withdrawal effects.'
