Misty Lamberton, an excellent registered nurse, was in charge of the afternoon shift of the Intensive Care Unit at Mercy Hospital. She is one of those nurses who is well liked by physicians, fellow workers, and patients alike. But then tragedy struck her home. Her husband was killed suddenly by an auto accident.
In the aftermath, Misty made a poor decision and landed a boyfriend who dumped her within a few weeks. Her associate nurses noticed that even one year after her husband’s death she was not eating much and losing weight, yet talking about how fat she was, even though she had become very thin. Her nursing friends were so concerned that they insisted on taking her to Dr. Baxter, a respected psychiatrist in town.
Not surprisingly, she was diagnosed with major depression and anorexia nervosa, which can be a lethal combination. When she did not get better with medications and counselling, he hospitalized her and even placed a tube going from her nose to her stomach (nasogastric tube) to feed her. After ten days in the hospital she improved enough to go home. But soon after discharge she relapsed and began losing weight while feeling very depressed. Dr. Baxter consulted me, simply because an internist and psychiatrist working together will often accomplish more by managing the case together then separately. It was agreed that Dr. Baxter would manage her medications, while I would manage her nutrition and lifestyle issues.
Within a few days Misty began to improve, slowly at first, and then rather dramatically. She felt happier and began to look to the future with hope and positive excitement. She actually felt hungry again and began gaining weight. What made the difference? Misty attributes her turn-around to the nutritional program outlined in this book. Within a month after feeling better, Misty went back to her “old ways” of eating, and within a week she was down in the dumps again.
She returned to the nutritional program and stayed with it since. It has now been six months since the last relapse. Misty has been back to work for the last four months and she is cheerful again. She proved to herself that her diet change was the key to her good health. She is looking good, and again she is the same excellent nurse she used to be.
Many Patients Improve Their Mood with Diet Changes
I have had many patients, all with different backgrounds and stories, respond with an improved mood simply by changing their eating habits.
I must tell you that a lifestyle approach to mental disease is not a common use for treating depressed or anxious patients. It is my hope that there will soon be large, controlled clinical trials run on the lifestyle approach, and that it will become the standard everywhere if it is confirmed in the trials, as I expect it would be. Until that happens, I am not the least bit hesitant to put patients on this program since (1) it is based on good nutritional science, (2) I have repeatedly seen it work, and (3) it has no potential adverse health effects.
Having said that, I must hasten to add that this is by no means the only treatment a depressed patient should be on. I hope I have made it abundantly clear by now that depression is almost always a multi-factorial disease, meaning that is has many potential causes. Nutritional concerns are usually only one of several causes that act together to bring about mental illness. We must search for and deal with counseling for depressed, anxious, or bipolar individuals is almost never done. I believe this leaves a gaping hole in the treatment approach to mental illness.
Serotonin is an important neurotransmitter in the brain, particularly in the frontal lobe. This is an area that needs to be vitally enhanced in depressed patients. The brain can make no serotonin unless tryptophan is first present. Most depressed patients have a loss of appetite (appetite increase occurs in only a minority of the depressed).i Thus, the foods that they do eat should have an abundance of tryptophan. Foods that are high in tryptophan are listed in Figure 1.ii
Note that whole milk has the lowest amount of tryptophan on the list, though many people believe that milk is one of the best sources of tryptophan. Fortunately, there are better sources, with tofu (soybean curd) being the best source on this list.
Some depressed individuals are very sensitive to even a small, temporary reduction in tryptophan, and missing just one day of the moderate to high tryptophan intake can send them into a relapse of depression. Misty is one of my patients who noticed that she had to get enough tryptophan to stay mentally healthy.
Getting enough tryptophan is not the only nutritional factor in serotonin production. As standard in the preceding chapter, five large amino acids complete against tryptophan in traveling to the brain. A food that contains a large total amount of these five amino acids will reduce the flow of tryptophan to the brain.iii
Thus, if our diet is moderate in tryptophan but high in those five amino acids, we may still develop a tryptophan deficiency in the frontal lobe of the brain. The amount of tryptophan compared to the amount of the five amino acids is the critical yardstick.
Foods with high ratios of tryptophan to these five competitors are shown in Figure 2.iv
Figure 2 shows that whole milk has a low amount of tryptophan compared to the five amino acids. It also contains a very little quantity of tryptophan, as shown in Figure 1. These factors work together to render milk of less value in supplying the brain with tryptophan.
Tofu, however, is in sharp contrast to whole milk. It has a high amount of tryptophan relative to the five amino acids, and high quantity of tryptophan. This makes it an excellent food for supplying a high quantity of tryptophan to the brain, which enhances the production of serotonin, which in turn combats depression.
Once sufficient tryptophan is in the brain, other lifestyle issues are crucial in the production of serotonin.
Omega-3 fats are emerging as an important nutritional element in the brain science.v There are actually two types of fat that are absolutely essential in our diets—omega-6 and omega-3 fats. The omega-6 fats are abundant in many foods, so it is extremely rare to see mental or physical problems develop due to a shortage of omega-6. Omega-3 fats are not so abundant, so it is more common to see adverse effects from a diet to low in omega-3.
Tryptophan tends to be low in the diet when calorie intakes are low, but omega-3 can be too low in the diet even if calorie intakes are more than adequate.vi Even a high fat diet can be too low in omega-3, particularly when the ratio of omega-3 to omega-6 in the diet is low. Interestingly, the ratios of these two fats in the blood do have a direct relationship to rates of depression.vii
The lower the omega-3 to omega-6 ratio, the higher the rate of depression. Recent research demonstrates that bipolar disorder (manic-depression) in addition to major depression (unipolar disorder) can be helped by a diet high in omega-3.vii
Most people increase their omega-3 fat intake by eating fist. Most fish, however, are not good sources of omega-3 fats. Cold water fish are good sources, not because their bodies manufacture omega-3, but because they eat a lot of cold saltwater seaweed, which is very high in omega-3 fats. It is important to note that the original sources of omega-3 fats are plant sources, and when we obtain our omega-3 from fish we are getting the nutrients second-hand. The omega-3 content of certain fish is listed in Figure 3.ix
Note that wide variation in omega-3 content from one kind of fist to another. For example, drum fist, which has the lowest omega-3 content, has only 25 percent as much as Atlantic mackerel.
There are many benefits of a diet with adequate omega-3 fat, but there is a downside in getting it from fish: many fish have unnatural toxins in their bodies due to pollution.
Folic acid (or folate) deficiencies can be a direct cause of depression.x I have found this a much more common cause of depression in meat-eaters than in vegetarians. People with an omega-3 deficiency seem to have similar depression rates whether they are meat-eaters or vegetarians.
The RDA (recommended daily allowance) for folate is 400 micrograms. As you can see in Figure 4, which list the folate content of foods, it would require an enormous quantity of meat to obtain 400 micrograms. On the other hand, it is very easy to obtain a minimum of 400 micrograms with a diet based on plant foods, as the figure demonstrates.xi
Patients who are depressed due to a folate deficiency tend not to improve at all with standard antidepressants. The real treatment is simple—foods high in folate.
Another nutrient that is vital for optimal brain functions, including avoidance of depressed mood, is Vitamin B12.xii Plant sources that are not fortified do not contain B12 unless they are brown in I recommend the fortified plant sources of B12 as the best way to obtain B12. If a vegetarian does not have access to regular use of the fortified plant sources or B12 supplements, then I recommend the regular use of skim milk.
When Dr. Dean Ornish began to study how coronary artery disease (the disease that leads to the leading cause of death in America) can be reversed by a healthy vegetarian diet, many people though that such a diet could easily bring about depression or anxiety. Since only a minority of Americans are vegetarian, it was thought that adherence to such a diet would decrease social affiliations, increase anxiety over a “strict regimen,” and be less tasty or satisfying.
To help determine whether these assumptions were valid, Dr. Ornish’s research group surveyed both the vegetarian-treatment group as well as the non-vegetarian control group. Each participant was asked to fill out a questionnaire before and after the study regarding his or her psychological distresses. They were asked to rate their degree of anxiety, depression, insomnia, and their inability to experience pleasure (anhedonia). These four distresses were totalled to yield a distress index level for each participant.
It came as a surprise too many that after one year it was the vegetarian group that not only felt better physically, but mentally as well. They had a decrease in depression and anxiety, fewer problems with stress, and improved interpersonal relationships.xiii Many mistakenly believe that their overall enjoyment of life will deteriorate if they change to a healthy lifestyle, especially if they become vegetarians.
To the contrary, evidence continues to accumulate showing that vegetarians tend to enjoy life more and even have a better social life than before becoming vegetarians. Moreover, the incidence of both depression and anxiety has been found to be lower in vegetarians when compared to non-vegetarians.xiv
Learn how careful use of some medications and herbs can be beneficial in the quest to beat depression
i. S. Hyman, M. Rudorfer, "Depressive and bipolar mood disorders," Scientific American medicine (May 2000).
ii. ESHA Research. 2nd edition. 1990.
iii. A. Lucca, "Plasma tryptophan levels and plasma tryptophan/neutral amino acids ratio in patients with mood disorder, patients with obsessive-compulsive disorder, and normal subjects," Psychiatry Res (November 1992) :85-91.
iv. ESHA Research Second edition (1990).
v. J. Hibbelin, "Fish consumption and major depression," Lancet (April 1998): 1213.
vi. R. Edwards, M. Peet, et al., "Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients," J Affect Disord (March 1998): 149-155.
vii. P. B. Adams, S. Lawson, et al., "Arachidonic to eicosapentaenoic acid ratio in blood correlates positively with clinical symptoms of depression," Lipids (1996): S-167-176.
viii. A. Stoll, W. Severus, et al., "Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial," Arch Gen Psychiatry (May 1999): 407-412.
ix. ESHA Research Second edition (1990).
x. M. Fava, "Folate, vitamin B12, and homocysteine in major depressive disorder," Am J Psychiatry (1997): 426-428.
xi. ESHA Research Second edition (1990).
xii. B. Penninx, J. Guralnik, et al., "Vitamin B12 deficiency and depression in physically disabled older women: epidemiologic evidence from the Women’s Health and Aging Study," Am J Psychiatry (May 2000): 715-721.
xiii. D. Ornish, S. E. Brown, et al, "Can lifestyle changes reverse coronary heart disease? The lifestyle heart trial. Lancet (July 1990): 129-133.
xiv. J. Rodriguez Jiminez, J. R. Rodriguez, M. J. Gonzalez, "Indicators of anxiety and depression in subjects with different kinds of diet: vegetarian and omnivores," Bol Assoc Med PR (April-June 1998): 58-68.