Can diet help with mental health?

Hippocrates, father of modern medicine, said more than 2,000 years ago: “Let your food be your medicine, and your medicine be your food.” [1]Today, we're discovering more and more evidence that we should take his advice seriously, as the quality of our food can significantly influence our brain health. 

Eating a lot of processed foods, like what's often called the "western diet," is strongly connected to a higher risk of getting depression, problems with thinking, and ADHD.[2][3] Not having enough healthy food to eat, called food insecurity, can also make you more likely to have mood and anxiety issues.[4] On the bright side, eating whole foods, following traditional diets, or sticking to a Mediterranean diet can help protect you from getting depression and other mental health problems.[5][6][7]

Can diet help with mental health?

There is growing evidence shows that the food we choose is strongly connected to our mental health. However in the field of healthcare, there isn't widespread agreement among professionals that diet can be used to treat or help with mental health issues. Doctors might not feel confident talking about diets because they haven't been trained much in it, they're short on time, and they don't get paid well for it. They also get confused because there are so many different diet suggestions and groups in our society.

Nutritional psychiatry, also known as psychonutrition, is a new area of research that explores how diet influences mental health.

The exploration of diet's impact on mental health dates back to the late 1990s, when a cross-national study revealed a link between higher fish consumption in a country and lower annual rates of major depressive disorder (8).

In 2005, M. Ephimia (Ephi) Morphew-Lu introduced the first nutritional psychology course at John F. Kennedy University in Pleasant Hill, California.

Furthermore, in 2015, members of the International Society for Nutritional Psychiatry Research published a significant article titled "Nutritional Medicine as Mainstream in Psychiatry," shedding light on emerging evidence in this field (9).

Since then, researchers have conducted numerous studies revealing that the same foods beneficial for physical health also contribute to positive mental well-being.

In 2019, a groundbreaking meta-analysis [10] was conducted by researchers from various universities in the UK and Australia, marking the first comprehensive proof of diet's efficacy in mental health intervention. This analysis meticulously curated 16 high-quality studies utilizing diet as an intervention method. Among these studies, a randomized controlled clinical trial involving 45,826 participants demonstrated a significant improvement in depressive symptoms through dietary intervention. Additionally, the sole clinical study specifically addressing severe anxiety disorder revealed notable improvements in anxiety symptoms among the participants.

In a study led by psychologist Natalie Parletta, PhD, [11]and her team in South Australia, adults with self-reported depression participated in a randomized controlled trial. The study involved 95 participants who either received 3 months of biweekly cooking classes focused on the Mediterranean diet and 6 months of fish-oil supplements or 3 months of biweekly engaging social groups and an additional 3 months of fish-oil supplements. After 6 months, the moods of all participants improved, but those in the diet group showed greater improvement.

Yes, diet can have a significant impact on mental health. Research has shown that what you eat can influence your mood, cognitive function, and overall mental well-being.

How does diet affect mental health?

The relationship between diet and health is highly intricate, multifaceted, and interactive, extending beyond a single biological pathway. Diet has the potential to impact mental health through numerous diverse biological routes. Emotions were once thought to be a product of the heart, but now it has long been established that they are a problem of the brain. A recent review article, featured in the Molecular Psychiatry journal [12], which summarized 9 possible biological pathways through which diet affects mental health.

1, Inflammation

Around 25% of patients with neuropsychiatric conditions,including mood disorders and schizophrenia, exhibit increased levels of inflammation. [13][14]Stress is a common trigger for inflammation, and various stressors like psychological stress, childhood adversities, as well as physical inactivity and an unhealthy diet, can lead to increased inflammation in the body, potentially contributing to depressive symptoms.[14-a]

A healthy eating pattern also has many anti-inflammatory nutrients. For example, phytonutrients such as polyphenols have strong anti-inflammatory properties and may be beneficial for a variety of neuropsychiatric diseases; the omega-3 fatty acids EPA and DHA also have anti-inflammatory properties and can improve clinical outcomes in depression and delay cytokines Induced depressive episode.

2, Oxidative stress

Oxidative stress (an imbalance of oxidative and antioxidant processes) causes damage to cellular lipids, proteins, and DNA. Sustained oxidative stress is considered a potential mechanistic pathway in depression and other mental health disorders .[15]A meta-analysis of 115 studies reported that patients with depression had elevated levels of oxidative stress markers and reduced levels of antioxidant markers.[16]Apart from causing direct cellular damage, the increased production of reactive oxygen and nitrogen compounds can result in problems with mitochondria, inflammation, and changes in tryptophan metabolism. These factors are all associated with mental health conditions.[15]

Decreased or increased intake of dietary compounds with antioxidant properties in the diet can exacerbate or ameliorate oxidative stress. Animal studies show that a high-fat Western diet increases levels of oxidative stress markers, such as protein oxidation and lipid peroxidation in the brain and periphery. [17] Improving diet quality and enhancing the body’s antioxidant defense may be a feasible intervention.

Changing your diet to include more or fewer foods with antioxidant properties can worsen or alleviate oxidative stress. Research in animals has demonstrated that a high-fat Western-style diet can raise the levels of markers indicating oxidative stress in both the brain and the body, like protein oxidation and lipid peroxidation.[17] Therefore, enhancing the quality of your diet and boosting the body's ability to counteract oxidative stress could be a practical intervention.

3, The gut microbiota

A growing body of research indicates that dietary modifications can result in alterations in gut microbiota, which, in turn, might induce behavioral changes reminiscent of symptoms seen in common mental disorders like anxiety and depression. [18][19] Studies involving animals have revealed that transplanting the gut flora from animals following a high-fat diet into the intestines of those on a different diet can also bring about changes in behavior, impacting factors such as exploration and cognition. [20] Additionally, one study demonstrated that after a year-long intervention with a Mediterranean diet, elderly individuals exhibited an increase in bacterial diversity. This dietary change was accompanied by improvements in cognitive function and reductions in the inflammatory markers C-reactive protein and interleukin-17. [21]

4, The hypothalamic–pituitary–adrenal (HPA) axis

The HPA axis, composed of the hypothalamus, pituitary gland, and adrenal glands, regulates the production of glucocorticoids and is involved in the pathophysiology of neuropsychiatric diseases. More than 60% of patients with depression exhibit cortisol hypersecretion or other HPA axis dysfunction.[22]

Clinical intervention trials employing nutrients like vitamin C have documented a decrease in cortisol reactivity during acute physiological stress in healthy adults;[23] both healthy adults and individuals with depression displayed improvements in cortisol levels after omega-3 fatty acid interventions;[24][25] and similar reductions in cortisol levels were observed in healthy individuals who underwent interventions with polyphenol-rich foods.[26]

[27] For instance, in a recent four-week trial involving healthy subjects, those who consumed dark chocolate rich in flavonoids exhibited lower total daily cortisol levels, with significant reductions in morning cortisol levels. Conversely, a brief three-day study found a slight increase in cortisol secretion associated with a high-glycemic index diet.[26]

Due to the role of the gut-brain axis in mental health, probiotics have also been explored as potential interventions targeting the HPA axis. [28]

5,Adult hippocampal neurogenesis and brain-derived neurotrophic factor (BDNF)

Increased neurogenesis in the hippocampus is associated with improved learning and memory abilities, while decreased neurogenesis is often associated with certain behaviors associated with depression. [29][30] BDNF is a neurotrophin that is highly expressed in the hippocampus Factors involved in key cellular functions such as synaptic plasticity and cell metabolism. Serum BDNF levels are reduced in patients with major depression. [31]

Diet has the capacity to influence BDNF and adult hippocampal neurogenesis. [32] Research with animals has demonstrated that a high-fat, high-sugar Western-style diet can impair neurogenesis, diminish BDNF levels in the hippocampus, and have detrimental effects on cognitive function.[33] Conversely, dietary components like omega-3 fatty acids, probiotics, and vitamins have positive effects.[34][35] Various polyphenolic compounds, such as resveratrol, blueberries, green tea, gingerin, and cocoa, can counteract adverse changes seen in conditions like psychopathology, aging, and disease, and help maintain the integrity of adult hippocampal neurogenesis. [36]

6,Neurotransmitter metabolism

Tryptophan, an essential amino acid that must be supplied in the diet, is an important building block for a number of key neuroactive molecules.[37] In psychiatry, the primary emphasis regarding tryptophan has been on its role in converting into serotonin, which is the main therapeutic target for most antidepressants and anti-anxiety medications.[38] There is an obvious tryptophan metabolism disorder in patients with depression, which can lead to depression.

Understanding tryptophan availability and metabolism is important when addressing the prevention and treatment of mental illness through dietary intervention. Direct tryptophan supplementation has been trialled in patients with depression as a way to improve serotonin signaling.[37]

Nutrients such as curcumin[38-a] and green tea[39], as well as dietary regimens such as the ketogenic diet[40] and fasting[41], can also modulate the activity of the Tryptophan–kynurenine pathway. Dietary regimens (such as caloric restriction) and dietary nutrients (including probiotics, resveratrol, and black tea) may also modulate kynurenine metabolism. For example, in a trial of 60 patients with depression, probiotic intervention significantly reduced kynurenine levels.[42]

7, Mitochondrial dysfunction 

Depression, as well as other mental disorders such as bipolar disorder and schizophrenia, is connected to problems in how our cells generate energy within tiny structures known as mitochondria. [43]Mitochondria - tiny factories in each of our cells that convert the food we eat and the oxygen we breathe into energy.

These energy-related problems can affect the function of both the brain and the rest of the body, result in symptoms of depression, like fatigue and cognitive difficulties . [44]

When the energy production process in mitochondria is disturbed, it can impact the growth and repair of nerve cells in the brain, which are fundamental components of the biology underlying depression.[43]

Substantial preclinical research indicates that an unhealthy diet might play a role in causing problems with mitochondria.[45]Eating a diet rich in fats is linked to irregular mitochondrial production and is also connected to higher levels of free radicals, inflammation, and insulin resistance.[46][47][48]A hyper-caloric high-carbohydrate diet drives similar path-ways [49], as well as a high salt diet.[50]

Calorie restriction shown to have beneficial effects on mitochondrial function.[45]There is also some evidence that quercetin, N-acetylcysteine, and resveratrol, among others, can increase mitochondrial biogenesis.[51][52]

8, Epigenetic Influences, Early-Life Experiences, and the Impact of Maternal and Paternal Dietary Factors

Nutrition is the most studied environmental factor affecting epigenetics. [53][54]Research suggests that increased risk of adult disease due to poor nutrition during early development is associated with epigenetic dysregulation. Certain early life nutritional exposures, such as breastfeeding and maternal obesity, can also influence epigenetic states that may modulate psychopathology in children and adolescents. [55]For example, a nutrition study in Barbados found that adults who had been hospitalized in infancy due to inadequate protein and energy intake exhibited DNA methylation changes in risk genes associated with neuropsychiatric disorders.[56]

Nutrients found in healthy diets, like vitamins such as folate, biotin, B6, and B12, as well as polyphenols like curcumin, resveratrol, and genistein, along with omega-3 fatty acids, have been proven to affect our epigenetic status through various mechanisms. [57][58]

9, Obesity and mood disorders

Meta-analysis data show that obese men and women both have a 55% increased risk of depression, and depression. People with obesity are 58% more likely to develop obesity.[59]Calorie restriction and weight loss diets may be beneficial for overweight individuals a reliable measure of body inflammatory status [60][61] and depressive symptoms. [62]

Summary:

Substantial evidence supports the use of dietary interventions as adjunctive treatments for depression. Diet may affect mental health through a variety of pathways, including inflammation, oxidative stress, gut microbiota, HPA axis, neurogenesis and BDNF, tryptophane-kynuridine metabolism, mitochondrial dysfunction, and epigenetic regulation.

The occurrence of diseases often involves multiple biological pathways, and the development of some drugs is often aimed at a specific pathway, and sometimes relief can be seen quickly, but other pathways are often ignored, so it is difficult to fundamentally solve the problem, resulting in long-term dependence on drugs, and the toxic side effects of various drugs.

The interaction between diet and health is very complex, not limited to any one biological pathway, often multiple pathways work together, diet will not be as quick as drugs to see results, but in the long run, it may be more fundamental to solve the problem.

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