Brain Food: The Natural Cure for Depression
Some practitioners
believe that most people on antidepressants could really
just use a better diet.
From Alternative Medicine Magazine, March 2005
By Karin Evans
By the time she turned 44, Rebecca Jones (this name has been changed)
felt like she was falling apart. "Some times I was plagued
by a crushing fatigue, I was moody, and just moving through my
day was a major chore," she says. "I wasn't sleeping
well, had lots of headaches and a sluggish libido, and my memory
was often foggy." Jones chalked up some of her woes to perimenopause,
so she followed some of the standard advice for that, like cutting
out caffeine, for instance. But she still felt wobbly and low.
A clinical psychologist by profession, Jones recognized that some
of her symptoms pointed to depression. She figured she needed some
serious attention, so she made an appointment with Los Angeles
psychiatrist Hyla Cass.
Like most psychiatrists would, Cass asked Jones how she was feeling.
But that was just the beginning. Jones soon found herself detailing
what she ate for breakfast, lunch, dinner, and in between. She
was asked to describe her energy and mood swings throughout the
day, her sleep patterns, and any worrisome symptom she could think
of.
Cass sent Jones for a battery of tests — blood tests that
went far beyond the usual screenings - to look for anemia, blood
sugar levels, and thyroid function, factors widely believed to
contribute to depression. Cass also tested Jones for candida and
checked her chromium, magnesium, and estrogen levels, as well as
her adrenal function and her risk for toxic overload, among other
things.
After analyzing the results, Cass opted not to recommend antidepressants.
Instead, she told Jones to start taking supplements, including
chromium, which evens out blood sugar levels, and magnesium, vital
for brainpower. She gave her a specific supplement for candida,
plus a menopause support formula, and another remedy to help restore
adrenal function.
"Within the first week of following her program, I felt much
better," says Jones. After three weeks she went back for more
tests, and Cass prescribed additional supplements. "It's still
unbelievable to me," says Jones, "but after six weeks,
my mood swings and anxiety disappeared completely." These
days, she continues to take supplements to control her depression
and boost her energy, and has yet to take a single antidepressant.
For those accustomed to the notion that therapy means talking
through problems and getting a prescription for antidepressants,
this may seem an unusual approach. But Cass, an expert in nutritional
medicine and an assistant clinical professor at UCLA, long ago
became convinced that no form of psychotherapy can be fully effective
if the brain isn't functioning properly. And to do that the brain
needs optimal nourishment, something she says is increasingly hard
to come by in the typical American diet. "Depressed, tired,
overweight women are often told they need Prozac," Cass says, "when
in fact all they really need to get their brains and bodies on
track is a steady supply of real food." She recommends that
her patients drink lots of water and eat organic vegetables and
fruits, whole grains, and lean protein. "Diets high in refined
foods, sugars, and unhealthy fats can actually interfere with our
natural brain chemistry," says Cass.
Modern eating habits are part of what makes many people depressed,
says Michael Lesser, a psychiatrist in Berkeley, California, who
also bases his treatment on an evaluation of a patient's diet and
lifestyle. "Ironically, though we live in a wealthy society,
our diets are deficient in crucial nutrients," says Lesser,
author of The Brain Chemistry Plan.
Nutritional deficiencies can contribute to chemical imbalances,
like anemia and hypothyroidism, which in turn can lead to anxiety,
insomnia — and depression. Cass has observed that people
with depression are commonly diagnosed with low levels of zinc,
magnesium, B vitamins, essential fatty acids, and amino acids.
In fact, Lesser firmly believes that most cases of depression in
this country are either caused or exacerbated by poor nutrition.
Indeed, the last few years have seen increasing numbers of studies
finding that specific nutrients can help manage, and even reverse,
depression, along with anxiety, attention deficit hyperactivity
disorder (ADHD), schizophrenia, and even autism. One of the most
compelling, a study from Harvard, found that omega-3 fatty acids
in conjunction with medication worked so powerfully on manic depression
that the study was halted so every subject could take them.
The new research has inspired the launch of at least one scientific
journal devoted to the subject, Nutritional Neuroscience, and dozens
of books — ten of them by Cass, including Natural
Highs: Feel Good All the Time and the just-released 8
Weeks to Vibrant Health. "There have been huge advances
over the past few years finding that nutritional intervention can
treat many behavioral and mental conditions we used to think were
untreatable," says Lewis Mehl-Madrona, associate professor
of clinical psychiatry at the University of Arizona College of
Medicine.
Why so much interest? Experts say nutritional therapy is catching
on in part due to growing discomfort with antidepressants: Physicians
are realizing they're not as effective long-term as was once hoped,
and they often have nasty side effects, such as loss of libido
and nausea. "We're becoming more realistic about the limitations
of drugs," says Susan Lord, director of nutrition programs
for the Center for Mind-Body Medicine in Washington, D.C. "They're
not the magic bullets we once thought."
Much of the interest is also coming from patients themselves,
says Cass. As more people realize they need to pay attention to
what they eat in order to feel good, more are asking their doctors
for nutritional help. Lord sees this in the growing popularity
of the "Food as Medicine" workshops her center hosts
for health care practitioners.
Within five years, she predicts, the demand among doctors for
education about nutrition will be huge. "Most physicians already
see the writing on the wall," she says, "and are in the
uncomfortable position of not knowing the answers, but feeling
they should."
While it's clear the brain can be greatly influenced by what we
eat, researchers are just beginning to figure out why. The answer
has at least something to do with the composition of neurotransmitters,
whose intricate wiring controls thinking, actions, and moods; these
chemicals are made of amino acids, and certain vitamins and minerals
play critical roles in their formation. The very makeup of brain
cells also depends on nutrients -- omega-3s are part of every cell
membrane.
When a person's diet is deficient in some of these nutrients,
neurotransmitters aren't made correctly or don't get what they
need to function properly, and various emotional and mental disorders
can result. For instance, low blood sugar can contribute to some
forms of depression, and so can low levels of zinc in some people.
For all the recent research, Lesser and Cass are still among a
maverick few who focus primarily on nutritional interventions for
mental health problems. For most psychiatrists, drugs are better
known, despite their problematic side effects -- and therefore
less risky.
Both Lesser and Cass arrived at the notion that nutrition can
influence brain chemistry early in their medical careers. Lesser,
who was conventionally trained at Cornell and Albert Einstein Medical
Center in New York City in the 1960s, started tinkering with nutrients
after becoming frustrated by his field's emphasis on drugs.
Shortly after he'd finished his residency, Lesser came across
a report that treating schizophrenics with niacin tended to improve
their symptoms. He figured that if the niacin worked, he should
also experiment with other dietary strategies that have been linked
to mood.
So he tried the approach on a patient of his own and put the young
man on a high-protein diet, gave him a slew of supplements, including
niacin, vitamin C, and zinc, and told him to cut out caffeine and
cigarettes. Soon after his patient showed dramatic improvement,
Lesser founded the Orthomolecular Medical Society, with the stated
objective of emphasizing natural substances such as vitamins, minerals,
amino acids, and essential fats in the prevention and treatment
of diseases.
As for Cass, even before she began her training she was predisposed
to the idea that drugs aren't always the answer. The daughter of
an old-fashioned family physician in Canada, she was drawn to a
personalized kind of medicine that honored both mind and body.
Shortly into her practice, she found that the standard "couch
and Prozac" combination of talk therapy and pharmacology only
goes so far.
Over time, she eventually developed the approach she uses today,
which is to start by evaluating the patient in a number of ways
-- emotionally, physically, and biochemically. Then she supplies
specific health prescriptions, which include supplements and food,
often in tandem with exercise, natural hormones, and mind-body
techniques.
The approach isn't for everyone. It requires that a patient be
a full partner in his or her care, and not everyone is motivated
enough to make what can amount to pretty daunting lifestyle changes,
including shopping for organic food, preparing meals without using
a lot of salt, sugar, and unhealthy fats, and taking all those
supplements -- especially people who are depressed to begin with.
Sometimes the best option is indeed medication, says Cass, particularly
with severe cases of depression. "The most important thing
is to help the patient," she says.
But even small changes — like cutting out processed foods,
or adding daily fish oil pills — can make a big difference,
they say. And once started, the process can develop its own momentum. "People
start eating a little better or taking a few supplements, and they
often start feeling a little better," says Lord. "That's
when they become open to trying more changes."
Many of the patients who do manage to stick to the program say
it is worth the effort. After a couple of months on Cass's regimen,
Rebecca Jones is certainly convinced. She hasn't had to make many
dietary adjustments -- she was already eating reasonably well to
begin with and exercising a few times a week. So the only change
she's made was to start taking supplements. But the results have
been dramatic.
The supplements are costly, she admits, running about $100 a month. "But
that's all it takes -- I don't need any expensive prescription
drugs." She expects to stay on some of the supplements for
the rest of her life, and to continue to consult with Cass periodically. "But
that's okay," she says. "My mood has evened out considerably
-- all of the depressive symptoms I had are gone. I'm much, much
better now."
Alternatives to Prozac
Many experts now believe that diet and supplements can make a big difference
in treating depression, though not every type. People who can tie their
sadness to a particular event, like the breakup of a relationship or
a job loss, are much more likely to find success with mood-boosting
supplements. "But if your depression is unexplained, you should
be seeing a professional and asking serious questions -- not just popping
5-HTP," says Timothy Birdsall, director of naturopathic medicine
for Cancer Treatment Centers of America. Depression might be the result
of heart trouble that doesn't allow enough oxygen to get to the brain,
for instance, or an intestinal problem that prevents efficient absorption
of vitamin B-12.
In fact, professional guidance can make any program more effective
by making it more targeted, says Mark Hyman, editor-in-chief of Alternative
Therapies in Health and Medicine. Physicians can test patients
first to diagnose chemical imbalances, and then take it from there.
Working with a doctor also helps determine what does and doesn't
work. "We're not the best judge of our own condition when
it comes to depression," says Kenneth Pelletier, clinical
professor of medicine at the University of Maryland School of Medicine. "It's
something you shouldn't tackle alone."
B vitamins Many people, particularly women over
65, have B-12 deficiencies and respond dramatically to injections
of the vitamin. But all B vitamins can boost mood; they work by
facilitating neurotransmitter function. Other pluses: B vitamins
are critical for preventing other maladies, including heart disease,
cancer, and Alzheimer's. Dosage: Take at least
800 micrograms of folate, 1,000 mcg of B-12, and 25 to 50 milligrams
of B-6. A B-complex vitamin should do the trick, says Hyman, and
if you're depressed, take more. Take them in combination because
otherwise one can mask another B vitamin deficiency. Risks:
None.
Essential Fatty Acids Their benefits are among
the best documented. The reason they're so effective? Essential
fatty acids are part of every cell membrane, and if those membranes
aren't functioning well, then neither is your brain. Dosage:
For depression, take at least 2,000 to 4,000 mg of fish oil a day.
Should be purified or distilled so it's free of heavy metals. Risks:
Very safe, albeit unstable. Since it can oxidize in your body,
take it along with other antioxidants, like vitamin E (400 IUs
a day).
Amino acids The building blocks of neurotransmitters;
5-HTP is the most popular. Taking it can elevate mood in cases
of depression, anxiety, and panic attacks, and relieve insomnia.
Increases production of the neurotransmitter serotonin. Dosage:
Start with a low dose, 50 mg two to three times a day; after two
weeks, increase the dose to 100 mg three times a day. Risks:
Mild nausea or diarrhea. Before starting, get off antidepressants
(under a doctor's supervision); the combination can produce an
overload of serotonin.
Saint-John's-wort One of the best-known remedies.
Best for mild to moderate depression. Dosage:
Start on a dose of 300 mg (standardized to 0.3 percent hypericin
extract) two to three times a day, depending on severity of depression;
it can take three weeks to show benefits. Risks:
It may interfere with up to half of all drugs, prescription and
over-the-counter.
SAM-e An amino acid combination produced by humans,
animals, and plants. Supplements come from a synthetic version
produced in a lab that has shown a lot of promise in European studies.
May affect the synthesis of neurotransmitters. Has fewer side effects
than 5-HTP and fewer drug interactions than Saint-John's-wort. Dosage:
Can range from 400 to 1,200 mg a day, though high doses can cause
jitteriness and insomnia. Risks: People with bipolar
disorder shouldn't use it without supervision because it can trigger
mania.
Rhodiola rosea Considered an adaptogen, which
means it can increase your resistance to a variety of stressors.
May be good for mild to moderately depressed patients. Dosage:
Take 100 to 200 mg three times a day, standardized to 3 percent
rosavin. Risks: More than 1,500 mg a day can cause
irritability or insomnia.
DHEA This hormone is marketed in Europe specifically
for postmenopausal depression, though it may be helpful for other
forms as well. Has been used in conjunction with estrogen to treat
hot flashes. Not clear why it helps boost mood and energy. Dosage:
25 to 200 mg a day. Risks: Any hormonal supplement
has the potential to increase cancer risk.
Finding professional help. To find an integrative doctor, visit
drweilselfhealing.com and click integrative medicine clinics; or
check holisticmedicine.org/public/public.shtml. For an orthomolecular
physician, visit orthomed.org and alternativementalhealth.com,
which is also an excellent source of information about natural
alternatives to medication.
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