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Why inflammation is depressing!

A recent quote in the Journal of the American Medical Association said the following: “Psychiatic and neurodevelopmental disorders are being thought of more and more as systemic illnesses in which inflammation is involved.” (1) For a long time mental health concerns were treated as though they only involved the brain, that the rest of the body was separate and irrelevant. But this is changing; balance within the rest of the body is being thought of more and more as relevant.  One aspect of balance that seems to be of interest is inflammation. 

In a previous blog post I shared some of the current understanding about the role of dietary choices in the development and progression of mental illness.  This is the main area of focus for my research work.  One topic that I did not explore in the previous post, as it deserves its own focus, is the role of inflammation in mental health, and how diet can influence these levels. 

Let’s look at what the research shows.  Patients with depression higher levels of inflammation molecules in their body and in their brain and lower levels of anti-inflammatory molecules (2).  In animals, increasing levels of inflammation leads to lack of interest, deceased activity, altered sleep and eating behaviours – all symptoms of depression.  Administering anti-inflammatory molecules to these experimental animals blocks these effects. In humans, studies have found that increasing levels of inflammation can lead to increased anxiety, irritability, hyper-arousal and mania symptoms (3). 

Why does this happen? Proposed explanations for this phenomenon cite evolutionary benefits.  If an animal is injured or infected (two major causes of inflammation), it’s advantageous for their activity to be inhibited (increased sleep, decreased interest and activity) so that resources can be used for repair and recovery.  And if the animal is more vulnerable as a result of the injury or illness, it makes sense that it would be hyper-vigilant (a state similar to anxiety) against further harm. 

Clinically, studies have shown that patients with higher levels of inflammation are less responsive to anti-depressants (4) and when patients respond to anti-depressant medications and therapy, there is an associated decrease in inflammation. 

If inflammation impacts these emotional and behavioral states, how does it happen? It turns out that high levels of inflammation decreased the production of dopamine, a brain chemical important for mood.  They also speed up the breakdown of serotonin resulting in lower levels of another important mood-supporting brain chemical.  It also affects the production of serotonin in a negative way.  Under normal conditions, the amino acid tryptophan is used as a building block to make serotonin (Remember this from the previous article? This is why including protein in your diet is so important!) But when there are high levels of inflammation or stress in the body, the tryptophan is not converted to serotonin but to kynureinine, a molecule that is toxic to nerve cells (5).   

There are many ways to influence inflammation levels in the body.  Exercise is a potent anti-inflammatory agent while obesity, insomnia, physical inactivity, chronic stress and the standard North American diet are potent inducers of inflammation (6,7).  One important diet component that influences the levels of inflammation in the body is dietary fat.  Some fats have anti-inflammatory effect – these include omega 3 and omega 9.  And some have PRO-inflammatory effects (they increase inflammation in the body!) – these include omega 6 fats and trans fats.  The historical human diet contained a ratio of omega-3 to omega-6 of about 1 to 2.  That means that for every 1 gram of omega 3 fats, people were also getting 2 grams of omega-6 fats.  The current standard north American diet? It has a ratio of 1 to 20! That means that for every 1 gram of anti-inflammatory omega-3’s, people are getting 20 grams of pro-inflammatory omega 6’s (8).  Yikes! Omega-3 fatty acids are found in fish, flax, hemp and walnuts while omega-6 fats are found in the vegetable oils (corn, cotton-seed, peanut etc).  Egg, chicken and beef from animals fed an enrichhed or grass-based diet naturally contain omega-3’s but when conventionally produced the levels of omega-3s are extremely low. 

The evidence is mounting that inflammation is an important factor in mental illness. Diet and lifestyle factors can help improve this balance - talk to your Naturopathic Doctor for a personalized recommendation. 

 

References
1. Friedrich MJ. Research on Psychiatric Disorders Targets Inflammation. JAMA. 2014; 312(5):474-6.

2. HUANG TL, LEE CT. T‐helper 1/T‐helper 2 cytokine imbalance and clinical phenotypes of acute‐phase major depression. Psychiatry and clinical neurosciences. 2007 Aug 1;61(4):415-20.

3. Müller N, Myint AM, Schwarz MJ. The impact of neuroimmune dysregulation on neuroprotection and neurotoxicity in psychiatric disorders-relation to drug treatment. Dialogues in clinical neuroscience. 2009 Sep;11(3):319.

4. Mendlewicz J, Kriwin P, Oswald P, Souery D, Alboni S, Brunello N. Shortened onset of action of antidepressants in major depression using acetylsalicylic acid augmentation: a pilot open-label study. International clinical psychopharmacology. 2006 Jul 1;21(4):227-31.

5. Oxenkrug, GF. Tryptophan–Kynurenine Metabolism as a Common Mediator of Genetic and Environmental Impacts in Major Depressive Disorder: The Serotonin Hypothesis Revisited 40 Years Later. The Israel Journal of Psychiatry and Related Sciences. 2010; 47(1), 56–63.

6. Lakka TA, Lakka HM. Effect of exercise training on plasma levels of C-reactive protein in healthy adults: the HERITAGE Family Study. European Heart Journal. 2005;26(19):2018–2025.

7. Vgontzas AN. Chronic insomnia is associated with a shift of interleukin-6 and tumor necrosis factor secretion from nighttime to daytime. Metabolism. 2002;51(7): 887-92.

8. Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomedicine & Pharmacotherapy. 2002; 56(8):365-379.

 

Yummy Multigrain Pancakes

These pancakes are delicious and packed with fiber! In my house, we enjoy with fresh fruit for a nutritious Sunday morning breakfast. I use a Vitamix to turn whole oats and quinoa into their flour form but the pre-made flour can also be purchased.

Ingredients
½ cup oat flour
½ cup quinoa flour
1 Tbsp honey or maple syrup
2 tsp baking powder
¼ tsp salt
1 cup milk (almond, cow, coconut or your favourite)
1 egg
2 tbsp oil

Directions: Combine all ingredients. Cook on a hot, oiled pan. Enjoy!

New Year’s Resolutions – Awesome or Terrible? Or Both?

The debate around New Year’s Resolutions has gone on for ages.  Sometimes they work and allow us to make big changes, sometimes they don’t and leave us feeling discouraged.  Unfortunately, often they don’t – studies show the success rate to be somewhere around 8% - yikes! But there may be some value to this age old tradition!

Why is it that these resolutions are often unsuccessful? There’s a FANTASTIC video that talks a bit about one challenge with New Year’s Resolutions (Click Here to watch it).  In short, humans are capable of change; however, often times it’s not in the form of one huge permanent change.  It’s more likely to be a series of small changes, a mixture of small successes and failures and a gradual progression in the right direction until substantial change is made.  I see this often in my clinical practice – people gradually increase the number of vegetables they are eating, decrease the amount of junk food, increase water intake and physical activity, practice medication more often and cope with stress in healthier ways.  There are set-backs and regressions but they are followed by getting back on track and continuing to improve.  And it’s important that these set backs are not seen as failures, just bumps on the road to success.

That being said, there are times when a dramatic change is hugely beneficial! Last year I was interviewed for a documentary on mental health and contributed to a few segments on the role of nutrition. Click Here to see the first segment.  In this clip, I speak with film maker Bryce Sage about the role of sugar in mental health, particularly the harmful effects of having too much.  Bryce decides to do a 30-day Sugar Detox to start the new year.  When he suggested this to me I had mixed feelings.  On one hand, this is a challenging thing for someone to do and not being able to complete it might be very discouraging.  But on the other hand, sometimes dramatic diet experiments can be very useful.  When we gradually decrease something, it’s much harder to notice the impact.  If you ate 10% less sugar every week, you would likely feel better gradually but week-to-week you might not notice much.  On the other hand, taking a 4 week break from sugar all together, you will clearly see how you feel in the absence of sugar in your diet and be able to clearly compare it to how you felt when you were eating the white stuff.  This can be very motivating and empowering to understand the impact and make an informed choice! Also, for some people, having a little bit less each week takes a lot of self control.  Some patients tell me that having cookies in the house and limiting themselves to one occasionally is nearly impossible – they end up eating the whole box.  In these case, cutting it out all together (and cleaning out the cupboard) can be helpful.  Lastly, and this one is somewhat unique to refined sugar which is known to have addictive-like properties, I’ve seen many times that the less sugar people are eating, the less they crave (this has to do with improved regulation of blood sugar!)  So, a significant decrease in intake results in less craving and an increase likelihood of success. 

How do we reconcile these two arguments? On one hand, making change gradually is more likely to result in long term success, but on the other, big changes have their benefits too.  In my practice, I often ask patients to experiment with removing certain foods entirely from their diet but the key is that it’s for a discrete amount of time, such as a few weeks or a month.  This is doable and gives them a lot of information about the impact of these foods on various aspects of their health.  After that time period, its up to the individual how to use this information long term.  In the case of a rheumatoid arthritis patient who got complete relief from his symptoms by cutting out gluten, I couldn’t have paid him to go back to eating it! Others might decide to avoid the food 6 days a week and feel great.  Others might work to gradually decrease intake and find a balance that works for them.  And this can apply to any lifestyle change – dive into exercise or meditation and see how you feel and then find the balance that will work for you long term.  Overall, I would say that big changes can be useful for short term experiments but probably aren’t the key to long term change.  In the long run, small steps and progressive healthy choices (mixed with the inevitable slip-up) might be the way to go.  If you’d like to work with either of these strategies to make healthy changes, I’d be happy to help.

Wishing you and yours a happy and healthy 2017!

Is Sugar Addictive? Mental Health Web Series Interview

Along with experts from leading Canadian hospitals, universities and mental health organizations, I was interviewed as part of a web series on mental health called 1001 Ways to Wonder. Creator Bryce Sage wonders about what causes mental illness, what we know about it and how it might be treated. My interview focused on the relationship between diet and mental health - an area of expertise in my clinical practice and research work. Some of the interview was included in the most recent installment of the video series - Bryce is giving up sugar for 1 month to see how it affects his mood! Check out the video and subscribe to the YouTube channel to be notified when more episodes are released!

And be sure to check out my blog post on New Year's Resolutions and dramatic diets! Click Here

Food and Mood

We’ve known for a long time that what we eat affects our physical health.  But research is just starting to demonstrate the connection between food and mental health as well.  Several studies show that individuals eating a poorer quality diet (more processed food, more sugar, more deep-fried foods, less vegetables) are more likely to be suffer from mental illness (1).  There are a number of ways that food is thought to affect our mental health and I am currently conducting a research project (did you know that I work in research as well as in clinic?) to try and understand the different ways that food affects mood.

One aspect of the diet that is critical is protein content.  Our brain functions through the production of chemicals called neurotransmitters and low levels of some (like serotonin) are thought to contribute to depression and anxiety.  These neurotransmitters are made of certain components of protein and if the diet doesn’t contain enough, the brain can’t make enough (2)! This doesn’t need to be a big piece of steak, vegetarian sources of protein can meet these needs if combined correctly. 

Another vital component is dietary fat.  Some people think that fats are bad for us or that they make us gain weight but the true is that some are healthy and some are unhealthy.  Some fats, like the trans fats found in deep-fried foods, are associated with poorer mental health where as omega-3 fatty acids are associated with better mental health and can be an important component of a mental health treatment plan (3). Omega-3 fats also decrease inflammation in the body – a process that is know to be associated with depression (More to come on this - The connection between inflammation and mental health deserves its own post!)

These is also a relationship between sugar and the brain.  The brain demands a steady supply of sugar – it needs a lot and unlike other organs, can’t make it. When this supply is disrupted, it impacts brain function (4).  This can happen when we eat foods that cause big changes in our blood sugar levels.  I recently published a case report sharing the results (with permission!) of a treatment plan I prescribed one of my patients.  This patient was eating a diet very high in carbohydrates and found a significant improvement in her anxiety when she ate more balanced meals.  If you want to read more about this research, click here

Other dietary factors that seem to impact mental health include the effects of food on the bacteria in our digestive system, the effects of food allergies and sensitivities and the role of different vitamins and minerals in supporting healthy brain chemistry.  To learn more about nutritional psychiatry, check out this recent article in the Huffington Post.  If you would like to use nutrition to support your own emotional wellness, let’s create a specific, individualized plan together at your next appointment.

References:  

  1. Opie RS, O’Neil A, Itsiopoulos C, Jacka FN. The impact of whole-of-diet interventions on depression and anxiety: a systematic review of randomised controlled trials. Public Health Nutrition. 2014; 18(11): 2074-2093. doi: 10.1017/S1368980014002614
  2. Sathyanarayana Rao TS, Asha MR, Ramesh BN, et al. Understanding nutrition, depression and mental illness. Indian J Psychiatry. 2008; 50(2): 77-82. doi: 10.4103/0019-5545.42391
  3. Huan M, Hamazaki K, Sun Y, et al. Suicide attempt and n-3 fatty acid levels in red blood cells: a case control study in China. Biol Psychiatry. 2004; 56(7): 490-6.
  4. Aucoin M, Bhardwaj S. Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification. Case Reports in Psychiatry. 2016 Jul 14;2016.

Thanksgiving All Year Round

Last week may have been Canadian Thanksgiving but there’s actually a tremendous amount of research suggesting that being thankful year-round is beneficial.

Expressing gratitude has been associated with increased optimism, better health choices, improved happiness and well being scores, improved relationships. Read more in these articles from New York Times and Harvard Health.

Here are some ways to practice gratitude:

1. Keep a gratitude journal: Each day, record a few things that you’re grateful for. They can be as big or small as you’d like (like a nice cup of tea and conversation or family and health).

2. Express gratitude to others: keep some thank you cards on hand and when someone helps you, gives you a gift or somehow improves your life – thank them!

3. Reflect on those things you're grateful for. For some people this might be in the form of meditation or prayer.

Midwifery and Naturopathic Medicine – Supporting the Body’s Natural Work

Seven weeks ago my husband and I welcomed our first child into the world, a little girl.  During my pregnancy, labour and deliver and post-partum period I was under the care of midwives.  It was a wonderful experience and in the process I found many parallels with naturopathic medicine. 

While I don’t claim to be an expert, midwifery care, in my understanding and experience, is based on the idea that pregnancy and child birth is a normal process that in the majority of cases occurs naturally, normally and without the need for interventions.  Pregnancy is not a disease or illness that needs treatment and those involved should be actively involved in all decisions made.  Allowing pregnancy and child birth to unfold naturally has advantages.  It is well documented that medical interventions in labour and delivery increase the risk of needing further interventions.  For example, a medical induction (medication to start labour) increases the risk of needing a C-section.  Of course, there are absolutely cases when medical treatment is needed and midwives are trained to identify these situations and refer to an obstetrician for treatment.  I’m incredibly grateful for this as a friend who was due at the same time needed emergency medical care and was transferred from her midwife to an obstetrician for medical treatment resulting in the safe delivery of her baby and her own safety as well. 

While medical care is vital and life-saving, knowing when it is not needed is also important.  In my case, I was very lucky to have a healthy, normal pregnancy (apart from some very unpleasant heartburn!) and planned to have a home birth with a midwife.  To my surprise, my due date (August 13th) came and went with no sign of baby.  And no sign of her for the following week either.  When she was 10 days past her due date most obstetricians would have scheduled a medical induction – the use of synthetic hormones to tell my body to begin contractions.  However, I wasn’t too keen on this option - as I’d mentioned above, this increases the risk of needing other treatments.  However, my midwife was reassuring that going past the due date by at least one week is actually very normal in a first pregnancy and does not create any risks for a while.  We waited patiently and sure enough, my labour started on its own shortly before reaching two weeks past my due date.  My labour progressed well and I was able to deliver a healthy baby girl at home as planned. 

This approach of allowing the body to work naturally is similar to naturopathic medicine.  Naturopathic medicine acknowledges that most of the time the body has the capacity to heal and flourish when provided with the right conditions.  When you break your arm, you don’t walk around with a broken arm the rest of your life, the bone heals.  Of course we can encourage this by putting on a cast and resting and taking a break from playing volleyball, but ultimately it’s the body that does the actual repair work.  Naturopathic treatments seek to provide the body with what it needs (more of a nutrient, appropriate activity or rest, improved function of an organ such as the liver) and remove factors that might be interfering with the healing process (such as an offending food allergen, a toxin or an emotional stress) and allowing the body to heal and restore balance.   The benefit of this treatment is that it’s very safe and often associated with fewer side effects.  Like midwives, NDs are trained to use modern medical testing, identify serious conditions that require medical treatment and to refer to a medical doctor appropriately and this care is extremely important.  When we were 1 week past my due date I was sent for an ultrasound to confirm that the baby was doing well and that intervention was not needed.   If you have a heart attack, an emergency room doc and a cardiologist can provide life-saving care.  But if your cholesterol is slightly elevated, there are huge advantages to working with diet and lifetyle changes before opting for medication.  By choosing naturopathic medicine, you’re giving your body the opportunity to heal itself in the context of safe and appropriate modern care.

I'm Back!

I’m happy to announce that after a few weeks off I’m back to clinic and very excited to be connecting with all of my patients to continue to work towards their health goals as well as taking on new patients looking to use naturopathic medicine to improve their health.

As you may know, the reason for my absence was the birth of my daughter, Rose, a sweet little bundle of joy born on August 25th.  I’ll be sharing a bit more about her birth in another post – stay tuned!

To schedule a time to connect, please call the clinic at 416 498 8265.

Photo credit: http://www.tomasmakacek.com/

Maternity Leave Notice

Please note that as I am expecting the arrival of my baby, I will be away from the office for a short maternity leave from August 8th to September 30th. Dr. Lindsey White ND will be providing back up care while I am away and will be happy to assist patients with any concerns. Please contact the clinic for more information on booking with Dr. White (416-498-8265). You can also contact the clinic to schedule an appointment in October.

I look forward to connecting with you in a few weeks and I hope you have a very enjoyable and healthy conclusion to your summer!

Lyme Disease – What you need to know

With the weather really warming up it’s a great time to get outdoors and soak up the many benefits of spending time in nature.  However, one thing that we want to be cautious about is ticks and tick-borne disease. I recently went on a two day hiking and camping trip with my husband and dog and was shocked to find a tick on my dog on the drive home. 

What is Lyme Disease?

Lime Disease is caused by a parasite borrelia burgdorferi that is spread to humans by ticks.  The tick must be attached to the skin for many hours (typically 24-36) in order for the parasite to be transferred. 

What are the symptoms?

When someone is infected they may experience fevers and chills, fatigue, headaches or a bull’s eye rash.  The long term effects if left untreated many include any of these symptoms as well as muscle and joint pain, difficulty concentrating and sleep disturbances. 

What to do if you are bitten by a tick?

If you have been bitten by a tick remove it carefully using tweezers (click here for more details on how to do this) and keep it – bring it to your family doctor in order to test if the tick was infected with the parasite.  Antibiotic treatment may be prescribed to prevent infection. 

How can I minimize the risk?

When you are spending time outdoors try to wear close-toed shoes and socks, light coloured clothing (it makes the brown ticks easier to spot) and perform a “tick-check” after you return.  This involves running your hands over your skin to check for any ticks that may have attached so that they can be promptly removed.  Also, check any pets as they are much more likely to come in contact with ticks.  Be cautious of areas that are known to contain tick populations including Kingston and more recently the east end of Toronto (click here for a more complete list). 

Does this mean I shouldn’t spend time outdoors?

Absolutely not! We know that spending time in nature decreases stress, improves mood and boost immune function (click here to read more!) Get out doors and enjoy these great benefits but take precautions to make sure that you stay safe.

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