Diet and Depression - Literature review Example

?Running Head: Literature Review on Nutrition Literature Review on Nutrition [Institute’s Literature Review on Nutrition Introduction Most people fail to understand the all-important link between nutrition and depression; however, a common person would be spot on in linking nutritional deficiencies with physical illness (Whitney & Rolfes, 2008). Traditionally, people view depression, anxiety and other stress related issues as an emotional and biochemical issue. However, there is a great deal of literature available, which proves that nutritional patterns play an important role in identifying the severity and duration of depression (Beck & Alford, 2009). In fact, more and more experts and people are realizing that diet and nutritional supplements not only helping in fighting depression but it also helps in curing depression and even preventing it in the first place (Wiseman, 2002). Diet and Depression Before even shedding light on the link between depression and diet, it is important to know that depression is a very critical and increasing phenomenon in the western world and especially in the United States. The figure presented above shows that in the year 2006 more than 5 percent of the population in the United States was diagnosed with depression. Diet plays an important role in influencing the mood and behavior and individuals. The same is evident from the figure presented above from Academy of American Family Physicians, which clearly shows that the cure for most of the depressive disorders lies in medication and diet (Wagemaker, 2009). This is true because neurotransmitters, which are responsible for controlling our behavior and moods are controlled by what we eat. Dopamine, serotonin, and norepinephrine appear at the top of the list of the neurotransmitters, which have their association with mood (Alaimo, Olson, & Frongillo, 2000). Important here to note is that any deficiency, excesses or imbalance in these neurotransmitters eventually result in mood swings, behavioral alternations, and impact on the perceptions of any person about pleasure and pain (Carroll & Royal Society of Canada, 1998). Serotonin plays an important role in mood, sleep, relaxation and appetite (Barker, 2002). Dopamine and norepinephrine are responsible for regulating and creating feelings and perceptions about hunger, thirst, digestion, blood pressure, aggression, sexual tendencies, breathing and respiration and others (Gropper, Smith & Groff, 2008; Licinio & Wong, 2005). A recent large cross sectional conducted by Australian researches under the umbrella of University of Melbourne reached interesting conclusions that women are more inclined towards eating a traditional diet are 30 percent less likely to face problems such as depression, dysthamia, stress and other anxiety related disorders (Escott-Stump, 2008). On the other hand, women who consume a more western diet were on a 50 percent more risk than other to face issues such as stress and depression (Markus et. al., 1998). Important here to note is that this has been one of those studies, which has looked on the link between the “whole diet” and “depression” whereas, other studies have tried to examine the impact and relationship between specific nutrients and their impact on moods and depression related illness (Whitney & Rolfes, 2008). This study was conducted with 1046 women, which were between the ages of 20-94. The diet of respondents was monitored with the help of a comprehensive questionnaire, extracted from the Cancer Council Victoria dietary questionnaire. The questionnaire has the room for noting around 74 different foods and 7 alcoholic beverages. The research took place over the time of 12 months (LaHaye & LaHaye, 1996; O'Connor, 1997; DeBruyne, Pinna, Whitney & Whitney, 2008). The principal researcher Felice Jacka, even provided concluding remarks in these words, “Simply put, if you habitually eat a healthy diet that includes fruit, vegetables, whole grains, and high-quality lean meat, then you may cut your risk of depression and anxiety” (Potokar & Potokar, 2003). Another very important issue touched by the research was regarding the impact of beef in diet. Research concluded that the quality of the meat, which is influenced by the way in which the cattle is raised, also plays an important role towards increasing or decreasing the risk of depression (Hall, 2009). Most of the beef in North America has a high chance of increasing the risk of depression since the cattle is raised in feedlots where they are fed with a corn-based diet (Carroll & Royal Society of Canada, 1998). This decreases the important fatty acids in the meat and increases saturated fat, which in turn raises the risk of depression and other problems. On the other hand, the cattle and lamb raised in Australia is fed with pasture and thus it has a good proportion of omega 3 fatty acids, which are good for health (Gotlib & Hammen, 2009; Flaws, 1998; Charney & Nestler, 2005). Another research conducted by Spanish scientists from university of Las Palmas and Navarra found out that people who follow a traditional “Mediterranean diet” were 30 percent less likely to suffer from depression. This Mediterranean diet refers to a diet, which is full of fruits, vegetables, fish, nuts, grains, and olive oil can fight with depression” (Webb, 1999). This was confirmed with a study with 10094 participants over four years. The researchers ended up summing their major findings in the following words. “It is plausible that the synergistic combination of a sufficient provision of omega 3 fatty acids together with other natural unsaturated fatty acids and antioxidants from olive oil and nuts, flavonoids and other phytochemicals from fruit and other plant foods and large amounts of natural folates and other B vitamins in the overall Mediterranean dietary pattern may exert a fair degree of protection against depression” (Gropper, Smith & Groff, 2008; Wagemaker, 2009). The picture presented below is an example of the importance of differentiation between a healthy and unhealthy diet and the fact that it goes to affect the moods and behaviors of the people. Repeatedly, research has shown again that the modern western diet with fast foods, high calories, oil and others are least likely to be healthy. However, due to all the media campaigns and heavy advertising with which people are bombarded with, they fail to maintain discipline within their diets thus leading to stress, depression and other such health issues. (Herrman, Maj, & Sartorius, pp. 52, 2009) Role of Omega 3 Fats in decreasing the risk of depression Omega 3 Fats have remained in the headlines for long as essential fats because there is no evidence until this point in time, which could prove that they are also manufactured in the human body like various other acids. This explains why doctors regularly advice their patients to ensure that their diet must contain an abundant amount of oily fish since it is one of the richest sources of omega 3 fats (Wardlaw & Kessel, 2002). There are various studies, which indicate that the more fish the country eats, the less are the chances that the population would have incidence of depression. Furthermore, out of the two types of omega 3 fats, which are EPA and DHA, research has revealed that EPA has appeared to be the most efficient and effective natural anti depressant (Schwartz & Schwartz, 1993; Alaimo, Olson,& Frongillo, 2000; Wiseman, 2002; Clark, Beck & Alford, 1999). Double blind placebo experiments which are the strongest form of research in these type of situations have repeatedly show the strength of omega 3 fats in decreasing the incidence and risk of depression amongst patients from all ages, backgrounds, socioeconomic status and genders (Schwartz, 2006). The first and the most well double blind placebo experiment took place under the umbrella of Harvard Medical School conducted by Dr. Stoll who researched with 40 patients. In particular, twenty patients received omega 3 supplements whereas the rest of the patients received placebo and the first group showed significant improvement in terms of their moods and behaviors. The research also received a place in the Archives of General Psychiatry (Alaimo, Olson, & Frongillo, 2000; Roth & Townsend, 2003). Another study, published in the “American Journal of Psychiatry conducted a research with 20 people” (Herrman, Maj, & Sartorius, 2009) who were suffering from severe depression by giving them a concentrated from of omega-3 supplements, ethyl EPA and placebo. They patients were already using anti depressants. The group, which was receiving omega-3 showed improvements and signs of more control over their behavior by the start of the third week, whereas, there was absolutely no change with the people who were receiving the placebo (Papolos & Papolos, 1997; Whitney & Rolfes, 2010). Furthermore, another study looking at all other previously conducted studies about omega 3 fats put forward the result that it has the tendency to decrease depressive symptoms by more than 53 percent. Furthermore, it also concluded that the chances of any side effects with omega 3 fats were very low. The diets, which are rich in omega 3 fats, have a refreshing impact on the neurotransmitters and other brand cell connections, which in turn decrease the chances of depression (Garrow, Ralph & James, 2000; Wardlaw & Kessel, 2002; DeBruyne, Pinna, Whitney & Whitney, 2008). The figure presented below represents another study, which was conducted in the year 2006 in Edinburgh, which revealed the positive impact on HPS levels of the subjects. The study was aimed at findings the impact of omega-3 fatty acids at depression. As depicted in the figure below that within the time period of a few weeks, with regular dosage of omega-3 fatty acids, the scores on depression scales of HRS decreased significantly. (Vernick, pp. 113, 2009) Evidence regarding the role of B-Vitamin folic acid in fighting depression Another proof that there are strong links between depression and diet of an individual has its roots in the data related to B-vitamin folic acid (Panksepp, 2004). There are several studies, which have shown that either low levels of folic acid or high levels of amino acid homcystenie (sign that does not have enough folic acid and vitamin B6 or B12), are both more likely to cause depression and these people are also less likely to get any positive results from other anti-depressants (Markus et. al., 1998). A double blind placebo study found that with folic acid, patients had a 93 percent chance to improve and fight with depression. Furthermore, three different studies concerning 247 people found out that by adding folic acid to their diet their HRS scores decreased by an average of 2.65 points. Despite the fact that this may not appear to be an impressive, this is almost 50 percent better as compared to other anti depressants (Gotlib & Hammen, 2009; D'haenen, Boer & Willner, 2002). As mentioned that “having a high level homocysteine, a toxic amino acid found in the blood, doubles the chances of any individual developing depression” (Stanfield, Hui & Hui, 2003). However, folic acid along with other vitamins has the ability to normalize the levels of homocystenie and thus in turn results in lower levels of depression (Stanfield, Hui & Hui, 2003). In the list of nutrients, which help in decreasing depression, the names of Serotonin, tryptophan and 5-HTP are also at the top of the list (Vernick, 2009). Actually, all these three compounds and mixtures are linked with each other. This is because Serotonin is produced in the body and the brain with the help of an amino acid known as tryptophan, which then gets converted into another amino acid called “6-Hydroxy Tryptophan (5-HTP), which in turn, converted into the neurotransmitter serotonin” (Shils & Shike, 2006). Food such as meat, fish, beans, eggs, and others are rich in 5-HTP and tryptophan and absence of which can make people depressed within hours. Furthermore, both these substances have proved through various researches, their ability to fight effectively with depression (Siefert, Heflin, Cororan &Williams, 2001; Herrman, Maj & Sartorius, 2009; Chern & Rickertsen, 2003; Clark, Beck & Alford, 1999). Carbohydrates, glucose and sugar levels, and their links with depression Without any doubts, there are strong and direct links between the sugar levels in the blood and the mood of an individual. It is well known that all the carbohydrate intake of the body breaks down into glucose, which eventually plays an important role in the functioning of human brain (Ingram, 2009). This explains why one can find people craving for toffees, chocolates and other products high in sugar. Furthermore, research and observation has shown that uneven sugar intake may result in uneven moods or mood swings (Clark, Beck & Alford, 1999). Moreover, a considerable number of doctors have also suggested that poor blood sugar balance, along with other reasons, is the most common factor in mood disorders of patients (Schwartz & Schwartz, 1993; Roth & Townsend, 2003). There is a great deal of evidence which suggests that consumption of high levels of refined sugar and carbohydrates such as white bread, rice, pasta and other processed foods increases the risk of depression. This is true because these foods not only supply very little of the sugar and carbohydrate but in reality they burn other mood enhancing vitamin B in the body. A study published in the British Journal of Psychiatry (Whitney & Rolfes, 2010), which was conducted with 3456 civil servants between the ages of 25-45, found out that people who had a diet rich in processed foods were at 58 percent higher risk of depression. On the other hand, people who ate less whole foods were at a 26 percent reduced chance of depression (Stanfield, Hui & Hui, 2003). Furthermore, there are various researches which have proved that uneven supply of glucose in the body results in various forms of mood and behavior disorders and stress and depression related outcomes such as fatigue, irritability, dizziness, insomnia and excessive sweating (especially at night). The list also continues to include “poor concentration and forgetfulness, excessive thirst, depression and crying spells, digestive disturbances and blurred vision” (Stanfield, Hui & Hui, 2003; Garrow, Ralph & James, 2000; Wagemaker, 2009; Chern & Rickertsen, 2003; D'haenen, Boer & Willner, 2002). Types of Depression and Chromium supplements Classical and Atypical Depression Important here to note is that there are two types of depression, one is “classical” and other is “atypical”. In the former type of depression, people fail to sleep or relax, lose their appetite and in turn lose their weight and do not eat anything (Carroll & Royal Society of Canada, 1998). On the other hand, atypical depression is completely the opposite where the subject would feel hungry for no obvious reasons, would crave chocolates and other sugar rich foods, feel dizziness, laziness and tiredness, would feel sad with the rejection of people and would gain weight (Roth & Townsend, 2003; Herrman, Maj & Sartorius, 2009). These people also feel body pain, heavy legs, and hands and this depression is more likely to start before the age of 30. Anywhere between 25 to 42 percent of the depressed population is suffering from atypical depression. Furthermore, this type of depression is very common in women (Schwartz & Schwartz, 1993; LaHaye & LaHaye, 1996l; Garrow, Ralph & James, 2000). Chromium and Depression Chromium supplements are an effective anti-depressant for atypical depression. This is true because insulin, which is responsible for absorbing and clearing sugar from your blood, depends largely on chromium. A small research conducted in the year 2005 with 10 patients found out that chromium plays an important role in fighting with depressing. This study with 20 patients, 10 of which received chromium supplements of 600mcg a-day and the other five received a placebo for over eights weeks, found out that 7 out of 10 patients which receiving the actual chromium supplement showed great improvements. Their HRS for depression dropped by, a drastic 83 percent. Cornell University also conducted similar research, except for they fact that they had a bigger sample of 110 subjects and towards the end, the study found that subjects receiving chromium supplements were 65 percent more likely to be in improved condition after right weeks (Beck & Alford, 2009; Shils & Shike, 2006; Biebel & Koenig, 2004; O'Connor, 2001). Deficiency of Vitamin D and depression Lately, there have been researches, which have revealed that the deficiency of Vitamin D may also lead to depression. People with the deficiency of Vitamin D feel depressed and stressed especially during the winters. Since more than 90 percent of the Vitamin D in the body comes from the sunlight. However, there are certain factors that decrease the ability of a person to make Vitamin D (Potokar & Potokar, 2003). Elderly people, dark skinned people, and overweight people fail to manufacture comparatively better amount of Vitamin D in their body. In fact, dark skinned people would require six times more sunlight to create the same amount of Vitamin D, which is produced with the exposure of sunlight to a white skinned person. Furthermore, as fats in the body increase, the patches, which help in the production of Vitamin D, are tucked away. Therefore, the point here is that there is ample evidence that Vitamin D deficiency may lead to depression (Licinio & Wong, 2005; Herrman, Maj & Sartorius, 2009; Escott-Stump, 2004). As mentioned earlier that there is an increased realization amongst the experts that much of the depression amongst people is actually a result of lack of nutrition. The brain, nerves, neurotransmitters, and the entire nervous system is made of nutrients, therefore, any lack in these nutrients is bound to have an impact on the mood, behavior and performance of the person(Potokar & Potokar, 2003; Henri, 2007; DeBruyne, Pinna, Whitney & Whitney, 2008). There are hundreds of studies, from the simplest to the most complex, which indicate that there is a considerable correlation between the nutrition intake or diet of the person and his or her ability to fight depression (Mahan & Escott-Stump, 2008). A study conducted in the year 1995 with 129 young adults revealed that taking vitamin supplements could have a strong impact on the mood of the people. Both the male and female targets of the research took ten times the day daily-recommended intake of 9 vitamins and after an year all these people ranked fairly high on agreeableness, were more composed, modest and were in a better mental health (Garrow, Ralph & James, 2000; Hoffer & Saul, 2009). What we eat is what we become   The point here is that “what we eat contributes greatly to what we become eventually”. Gropper, Smith & Groff (2008) quoted a research that took place in the year 1998 in one of the US federal state prisons. The research was conducted on the prisoners and especially a set of violent prisoners, which were separated from the general prison only because of the fact that they were becoming a threat to the lives of other prisoners. Without putting that into the information of the concerned guards and those prisoners, the salt used in their diet of one group of violent prisoners was replaced with Celtic Sea Salt Brand (Beck & Alford, 2009; O'Connor, 1997). However, the other group continued to use the same salt. Within a month, the paper work coming from the cellblock of the control group prisoners showed that violent behavior, fights, incidents, and others such activities decreased significantly; however, the other group continued to show, more or less, the similar trends. Therefore, that salt had a significant impact on the moods of the prisoners and shaping their overall thought process and in turn behavior (Gropper, Smith & Groff, 2008; Siefert, Heflin, Cororan &Williams, 2001). Another interesting research which links nutrition with diet, published in the Archives of General Psychiatry, where a group of researchers looked at 15 authentic studies with longitudinal approach, trying to find the link between obesity, overweight and depression. The study defined the category of overweight as BMI of 25-29.9 and the definition of obesity was of BMI with magnitude of 30 and more. The study examined the patterns provided by 55387 men and women in Europe and USA. The study ended up finding that obese subjects were at 55 percent higher risk than others of being depressed at depressed subjects were at a 58 percent risk of being obese (Stipanuk, 2006). Furthermore, the relation between depression and being overweight was weaker as compared to the relation between being depressed and obese. In short, the researchers strongly concluded that a healthy diet has higher chances of reducing the risk of depression (Mahan & Escott-Stump, 2008; Rolfes, Pinna & Whitney, 2008; Biebel & Koenig, 2004). Role of Lithium as an anti depressant Lithium is one of those elements which have received much attention is psychiatry for its role as an anti depressant. Furthermore, its role to cure and prevent the bipolar disorder has also been proven by many studies (Stipanuk, 2000). In fact, there are various experts which believe that it is best possible medication for bringing long-term mental stability, evade suicidal thoughts and control depression (Markus et. al., 1998; Rolfes, Pinna & Whitney, 2008; Chern & Rickertsen, 2003). Like lithium, zinc is also one of those elements, which in light of the recent researches has shown that it can act as an anti depressant. There are at least five different studies, which provide some evidence that depressed people have low levels of zinc in their body (Rolfes, Pinna & Whitney, 2008; D'haenen, Boer & Willner, 2002). The foods, which are rich in zinc, allow the brain to protect itself against free radicals (Potokar & Potokar, 2003; Biebel & Koenig, 2004). In case of absence of that protection, the ability of brain to perform its functions can be hampered and this may eventually lead to depression. Furthermore, there are studies, which have shown the potential of a child to grow and nurture effectively is affected if there is not sufficient zinc in the body. Long-term absence of zinc from the body may not directly but indirectly, lead to depression (Schwartz & Schwartz, 1993; Herrman, Maj & Sartorius, 2009). Diet and depression for childbearing women A study conducted under the umbrella of University of Pittsburgh’s Department of Epidemiology also came up with the same facts, which have been indicated with the previously mentioned. Although this study was directed at childbearing women and thus, the study ended up in making an even stronger emphasis regarding the link between nutrition and brain functioning for childbearing women (Papolos & Papolos, 1997). The researchers concluded their ideas and findings in the following words, “Poor omega-3 fatty acid status increases the risk of depression. Fish oil and folic acid supplements each have been used to treat depression successfully. Folate deficiency reduces the response to antidepressants. Deficiencies of folate, vitamin B12, iron, zinc, and selenium tend to be more common among depressed than nondepressed persons. Dietary antioxidants have not been studied rigorously in relation to depression. Poor omega-3 fatty acid status increases the risk of depression. Fish oil and folic acid supplements each have been used to treat depression successfully. Folate deficiency reduces the response to antidepressants. Deficiencies of folate, vitamin B12, iron, zinc, and selenium tend to be more common among depressed than nondepressed persons, and dietary antioxidants have not been studied rigorously in relation to depression” (LaHaye & LaHaye, 1996; Markus, Panhuysen, Tuiten, Koppeschaar, Fekkes & Peters, 1998). The above figure depicts the role of magnesium of regulating calcium ion flow in neurons. Furthermore, there are various studies, as mentioned earlier as well that calcium has an important role in mood swings and functioning of neurons. The figure shows that role that magnesium ions play in the electrical conduction activity of the nerve cell for the calcium ions. Normally, magnesium ions would block the calcium ions in the receptor channel. However, in the absence of any magnesium ions, sodium and potassium ions are free to enter into postsynaptic neurons. This ends up doing damage to the neurons, which results in depression and other mood related disorders. Another study, which looks at the links between maternal depression and lack of nutrients, provides proof for this study and reinforces the idea that there are strong links between the nutritional intake by any person and his or her mental health (DeBruyne, Pinna, Whitney, & Whitney, 2008). Maternal depression became the target of the study because more than 25 percent of the women experience some sort of depression before, during, or after their pregnancy. Important here to note is that experts believe that the original figures may be as high as 85-90 percent because most of the cases of depression do not receive formal acknowledgement (Siefert, Heflin, Cororan &Williams, 2001). Amongst many other reasons of maternal depression, the study believes that nutritional deficiency ranks at the top. In this regard, the researchers indentified “omega 3 fats, calcium, zinc, folate, iron, selenium B vitamins, and others as the major reason behind maternal depression” (Beck & Alford, 2009; Pieroni & Price, 2006; O'Connor, 1997). Foods increasing the risk of depression Most of studies presented in this literature review were focused on findings on the nutrients, elements and dietary variables, which could decrease the risk of depression; however, a research conducted in Canada focused instead of listing all the possible foods and dietary elements, which could increase the risk of depression, anxiety and stress (Herrman, Maj & Sartorius, 2009). This study conducted with 5647 participants, 53 percent men and 47 percent women looked at their diets for more than 16 months. All these participants were suspected with depression and it was found that these people share some common foods. These were wheat, carbonated beverages, alcohol, dairy products, nicotine, artificial sweeteners, processed animal products, deep fried foods, and others (Christensen & Somers, 1996; Brody, 1999; Sheffield, 1999). Conclusion Therefore, towards the end, this literature review provides sufficient evidence to prove that there is a strong link between the nutritional intake of a person and incidence of depression. Important here to note is that there is no study or experts, who claims that it is the sole determinant of depression, its severity and duration but at the same time, there are almost negligible studies, which have failed to found evidence of links between nutrition and depression (Gropper, Smith & Groff, 2008; Whitney & Rolfes, 2010; Charney & Nestler, 2005). References Alaimo, K., Olson, D. M., Frongillo, E. A. (2000). Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. The Journal of Nutrition. Volume 132, Issue 4, pp. 719-25. Barker, Helen M. (2002). Nutrition and dietetics for health care. Elsevier Health Sciences. Beck, A. T., & Alford, B. A. (2009). Depression: causes and treatments. 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R., (2010). Understanding Nutrition. Cengage Learning. Wiseman, G. (2002). Nutrition and health. Taylor & Francis. Read More