Are There Diets to Fight Depression In Women

Written by Dr. Steve Chaney on . Posted in Diets to Fight Depression, Health Current Events

A Story of 6 Blind Men And An Elephant

Author: Dr. Stephen Chaney

 

 

6 blind men and a elephantAre there diets to fight depression in women?  This week’s health tip reminds me of the story of 6 blind men and an elephant. You probably remember the story. One blind man grabbed a leg and declared that an elephant is like a tree trunk. Another blind man grabbed the tail and declared that an elephant was like a rope – and so it went. Each blind man had a different version of reality, but none of them really knew what an elephant was like.

Sometimes science is like that. Every scientific study is designed to test a specific hypothesis, and sometimes we scientists can become limited by the hypothesis we are testing. We only see what we are looking for. We become like the blind men trying to figure out what an elephant really is.

That thought came to mind recently when one study claimed that an anti-inflammatory diet decreased the risk of depression by 26% in women, and another claimed that increased flavonoid intake was the secret to decreasing depression in women. Of course, both of those reports came on the heels of another study a few months ago claiming that a Mediterranean diet was the secret to decreasing depression.

If all of this sounds confusing, keep that image of the blind men and the elephant in your mind for a while. I’m going to come back to the elephant later, but let me start by evaluating the merits of the two most recent studies which claim there are diets to fight depression in women.

How Were These Studies Designed?

diets to fight depressionThe first study (Shivappa et al, British Journal of Nutrition, doi:10.1017/S0007114516002853, 2016)  was designed to test the association between the anti-inflammatory potential of their diets and the risk of depression in middle-aged Australian women. The study followed 6,438 women with an average age of 52 for 12 years.

Self-administered surveys were sent to the participants every 2-3 years (most participants completed 5 surveys during the study). A Dietary Inflammation Index (DII) was calculated based on the food frequency portion of the surveys. Depression scores were calculated based on their answers to 10 questions from a well established depression rating system.

This was a well designed study and the results were fairly straight forward. Those women consuming the most anti-inflammatory diets were 26% less likely to develop depression than the women consuming the most pro-inflammatory diets.

The second study (Chang et al, American Journal of Clinical Nutrition, doi: 10.3945/ajcn.115.124545, 2016) was designed to test the association between flavonoid intake and depression in middle aged and older American women. This study followed 82,643 women ages 36-80 for an average of 10 years.

Flavonoid intake was calculated based on food frequency questionnaires administered every 4 years. Depression was assessed based on several well established ratings systems.

Again, this was a very well designed study, and the results were quite impressive:

  • Women who consumed the largest amounts of flavonoids were 7-10% less likely to develop depression than women consuming the least flavonoids.
  • When the study was broken down into flavonoid-containing foods, citrus fruits appeared to be particularly beneficial. Women consuming >2 servings per week were 18% less likely to develop depression than women consuming <1 serving per week.
  • Tea also scored high in their analysis. Women consuming >4 cups per day were 12% less likely to develop depression than women who rarely or never consumed tea.
  • While those flavonoid-rich foods stood out, the authors emphasized that there were no “magic” foods. It was a composite of all flavonoid containing foods that was related to lower depression risk.
  • The effect of a flavonoid-rich diet was particularly beneficial for older women. For women aged 65 or older at the beginning of the study, high flavonoid intake was associated with a 17% lower risk of developing depression.

 

Diets to Fight Depression:  The Secret

diets to fight depression secretsI have just described two very well designed studies on diets to fight depression in women. One concluded that an anti-inflammatory diet reduced the risk of depression while the other concluded that diets rich in flavonoids decreased the risk of depression. I have previously described studies suggesting that omega-3 fatty acids decrease depression risk in women and that consuming junk food increases depression risk . Other studies have suggested that a Mediterranean diet may significantly reduce depression.

If you are looking for a natural solution to recurring depression, these individual reports are probably confusing and overwhelming. I call it the “study du jour” syndrome. It can lead to paralysis. You just don’t know what you should try first.

What if these individual studies were like the blind men trying to describe an elephant?  Perhaps we need to step back and see if we can find the commonality in all of these studies. We need to look for the elephant.

For example, we might start by asking what is an anti-inflammatory diet? It turns out that diets rich in fruits, vegetables, fatty fish, olive oil and legumes are anti-inflammatory, while diets rich in saturated fats, cholesterol, and refined carbohydrates are pro-inflammatory. In short, the anti-inflammatory diet is very similar to the Mediterranean diet, and fully consistent with the reported benefits of omega-3 fatty acids. The pro-inflammatory diet, on the other hand, perfectly describes a junk food diet loaded with fat, cholesterol, and simple sugars and are not diets to fight depression.

What about diets rich in flavonoids? What are those flavonoid-rich foods? It turns out that flavonoids are found primarily in plant foods, and fruits, vegetables, and whole grains.  Beverages such as tea and coffee are particularly good sources.

So the secret is that there is no secret. Your mom was right all along. Eat your fruits, vegetables and whole grains. Take your fish oil. Take a vitamin supplement to make sure you didn’t miss anything. Avoid the junk foods. You’ll be healthier, and you’ll be happier. Include these in your diets to fight depression.

What Do These Studies Mean For You?

When considered individually these studies may seem confusing. However, when you consider them altogether the evidence is overwhelming. A good diet can significantly reduce your risk of depression, and a bad diet can make your depression even worse.

Of course, diet alone will not be enough to prevent depression in everyone. A more holistic approach would be to include exercise, socialization, and some stress reduction practices. Whether stress reduction occurs through yoga, meditation, counseling or other practices will vary from individual to individual.

Of course, if your depression is severe, professional help may be needed. I regard anti-depressant medications as a very last resort, but they can be life savers for some people.

So, with the inclusion of the right foods, the above studies seem to show there are diets to fight depression in women.

 

The Bottom Line

 

  • Two very good studies have recently been published concerning diet and depression in women:
  • One study concluded that an anti-inflammatory diet reduced the risk of depression in women.
  • Another study concluded that a diet rich in flavonoids reduced the risk of depression in women.
  • Other recent studies have concluded that diets rich in omega-3s and Mediterranean diets decrease depression risk in women. Another study concluded that consuming junk foods significantly increased depression risk.
  • When considered individually these studies may seem confusing. However, when you consider them altogether the evidence is overwhelming. A good diet can significantly reduce your risk of depression, and a bad diet can make your depression even worse.
  • Your mom was right all along. Eat your fruits, vegetables and whole grains. Take your fish oil. Take a vitamin supplement to make sure you didn’t miss anything. Avoid the junk foods. You’ll be healthier, and you’ll be happier
  • Of course, diet alone will not be enough to prevent depression in everyone. A more holistic approach would be to include exercise, socialization, and some stress reduction practices. If your depression is severe, professional help may be needed. I regard anti-depressant medications as a very last resort, but they can be life savers for some people.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Trackback from your site.

Leave a comment

Recent Videos From Dr. Steve Chaney

READ THE ARTICLE
READ THE ARTICLE

Latest Article

A Low Carb Diet and Weight Loss

Posted January 15, 2019 by Dr. Steve Chaney

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

 

low carb dietTraditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

  • How good was the study?
  • What were its limitations?
  • Are the claims justified?

 

How Was The Study Designed?

low carb diet studyThe investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

  • The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.
  • The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.
  • The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

  • The weight maintenance portion of the study lasted 5 months – much longer than any previous study.
  • All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.
  • The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.
  • Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

 

Do Low-Carb Diets Help Maintain Weight Loss?

low carb diet maintain weight lossThe results were striking:

  • The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.
  • These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.
  • These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

 

What Are The Pros And Cons Of This Study?

low carb diet pros and consThis was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

  • Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.
  • Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.
  • The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

 

low carb diet and youWhat Does This Study Mean For You?

  • This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.
  • In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.
  • The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.
  • This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

 

  • A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.
  • However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.
  • In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.
  • Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

For more details read the article above.

 

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

UA-43257393-1