This week’s question is one I get a lot. This time it was asked by a reader named Lee. The lockdowns and resulting financial hardship and removal of so many of the freedoms we took for granted has triggered tremendous sadness and exacerbated depression for many.
What do we mean by depression?
First, I think it’s important to clarify what we mean by depression - because I think the term can be misleading. I have met people who mistakenly think depression just means sadness, and in some contexts it can be translated thus. But as a clinical definition there are a number of symptoms that are embodied by a depressive disorder, in addition to a sad mood. While I am not licensed to diagnose these disorders, the way they are diagnosed is published widely and can be found here.
It’s important to note that if deep sadness or mood shifts are precipitated by trauma or prolonged adversity or heartbreak, we have to ask ourselves if it’s really pathological to be sad under such circumstances. And I think this is where the DSM falls short. When life is knocking you to your knees repeatedly, is it really pathological to be unhappy about it? Melancholy in such situations is not only appropriate, but healthy as a response. Indeed, in holistic healthcare we see it as an innate signal from the psyche that something is wrong. A blinking red light if you will. Dr. Martin Luther King called this Creative Maladjustment. And it’s incredibly important in times like these to listen to these signals rather than medicating and suppressing them. But I digress.
As you can see from the DSM criteria above, clinical depression often includes symptoms other than sadness, including fatigue, a lack of drive and motivation, a lack of pleasure from previously pleasurable events or stimuli, brain fog, and an inability to tolerate the normal day to day demands of life. It can also be accompanied by a change in appetite or sleep and other disturbances of the entire system. Sometimes depression starts as situational and becomes more pathological over time. The late Dr. Hoffer once told me he hypothesized that signals in the brain are like a system of highways and the more we use one route the more ingrained and reflexive that route becomes. If we are depressed for a long time, then, it stands to reason that it might be difficult to stop reacting that way even when the situation has been ameliorated.
What does holistic healthcare have to offer?
The good news is, whether depression is situational or pathological, a holistic approach can be therapeutic - often with better outcomes.
In holistic, functional medicine / orthomolecular nutrition we look not only at the medical diagnosis to understand a dis-ease state, but the systems it embodies to help trace what the root issues may be. Fatigue can be caused by a number of areas of dysfunction - from mitochondrial dysfunction to food intolerances, from viruses to parasites, from toxicity to deficiency states. And the same can be said for most of the symptoms on the depressive symptom list. This particular symptom set can also stem from systemic inflammation, blood sugar dysregulation, and insulin intolerance, as well as poor quality sleep, environmental toxins, and extreme, prolonged stress.
Nutrition and depression
You may be surprised to learn that there is a huge correlation between clinical depression and nutrition considerations. Remember, the science of nutrition isn’t just about what you eat. It’s also about the quality of what you eat, how you digest what you eat and how you absorb and uptake nutrients from that, as well as what inhibits that process and what could be underlying those inhibitory factors. And, thanks to academic and clinical mavericks like Julia Rucklidge and Drew Ramsey, the correlation is becoming clearer. Both of these TED talks are inspirational and worth watching if you can find the time. For a few stories of people who’ve successfully treated their depression and anxiety with food, read here.
Contrary to popular belief, in nutrition science we see that different people need differing amounts of various nutrients. One person can function perfectly with a moderate (suboptimal) level of vitamin B12, for example, while another person can have seemingly ‘optimal’ levels in their diet and either be not absorbing it efficiently or in such an imbalanced state that they need more to function optimally. Symptoms tell us when a person is likely deficient but when that doesn’t line up with intake we have to go looking more closely. This is where the science of nutrition becomes an art.
The astute clinician has to know how to tease this information out of a complex case and understand the implications. If you’re getting enough of a nutrient in your diet but are showing signs of deficiency you may have low stomach acid or malabsorption, an excess of nutrients or drugs that are inhibiting absorption or skewing the levels, or a higher than normal need for said nutrient due to a number of factors. And when one nutrient is out of balance, usually there are a number of nutrients that need to be bolstered. You may even need to change your cookware or the pipes in your home, or supplement to offset damage from that. It’s a clinician's job to sleuth out these underlying issues and create a protocol to address the imbalance at the root.
The 4 nutritional roots of depression
When viewed this way, depression can be related to a number of nutritional problems. So let me clarify just a few ways depression is fundamentally impacted by nutrition considerations:
- Brain Inflammation: inflammation can affect any part of the body. In some people it’s the knees (arthritis) or the colon (colitis) or the sinuses (sinusitis). Where we are impacted has to do with our genetic fault lines. In some people this is the mind. Inflammation in the brain impedes proper function, just as it does with the joints. This can manifest as many brain related illnesses, including depression, Autism spectrum disorders, schizophrenia, and Alzheimer’s. Systemic inflammation can almost always be traced back at least in good part to malnutrition or toxicity, often related to dietary imbalances.
- Gut Biome Imbalance: a less than healthy gut biome has now been shown to lead to chronic inflammatory states and directly correlate to depression. Not only does the microbiota impact how we absorb nutrients from food, but it also plays a regulatory role in inflammatory processes in the body and neurotransmitter function. For an excellent article on this emerging data as it pertains to depression, go here. I think it’s noteworthy that the extreme increase in mental illness in our society correlates with decades of indiscriminate use of antibiotics. This is not the only factor that correlates, but given the data emerging on the gut biome connection, it’s an interesting one.
- Food Intolerances: food intolerances not only drive inflammation, they can trigger very specific mood and personality changes. Wheat, for example, contributes to brain fog, skin issues, and lethargy in intolerant individuals. Dairy intolerance contributes to mucous formation and wet, oozy skin conditions and congestive health problems, with corresponding sensitive, weepy mood conditions. Sugar intolerance tends to manifest in hyperactivity or obsessive or oscillating mood conditions, as parents have long observed in children. These are only a few common examples, but they bear out surprisingly often in clinical application. Whenever there is a bonafide mood disorder, food intolerances should be investigated by a knowledgeable professional. Watch interviews of parents and children with ADHD related to food intolerances here.
- Deficiency States: deficiency states leave the body with less than the necessary amount of one (or more often) multiple nutrients. In the absence of nutrients, the functions that most rely on those nutrients are hindered. The B vitamins are necessary in abundance to help the body cope with stress, and are often lacking when we don’t eat enough red meat or have malabsorption. B12 deficiency has been linked to depression, as has folate. High rates of deficiency have been noted in teens and the elderly with depressive symptoms. Omega fatty acids, amino acids (broken down proteins), and minerals are all equally important to mental health with data linking deficiency states to depression.
Keep in mind, science is only just starting to investigate and document the role of nutrition in mental health, but integrative practitioners have been using this common sense approach for decades to help people who are open to explore the benefits they can enjoy with improvements to their diet. To understand this science more, readers can look up orthomolecular psychiatry. If you or anyone you know would like help treating depression naturally, I invite you to contact me.
Thanks again to Lee for this query. As always, readers are encouraged to ask their nutrition questions via firstname.lastname@example.org.