With Insights from Dr. Christopher Chin, Psychiatrist
“You Are What You Eat.”
It’s a common and cliché phrase, but when it comes to mental health, it’s a cliché that holds more truth than you may expect. But how does nutrition play into disorders like depression? In this blog we’ll take a closer look at the correlation between nutrition, mood disorders, and mental health care, with special insights from Dr. Christopher Chin, Psychiatrist at Mindful Health Solutions – Los Angeles.
Does Diet Cause Depression, or the Other Way Around?
The case of Depression vs Diet is a bit of a Catch-22 – poor nutrition can lead to a depressive mood, but being depressed also makes a person more susceptible to eating unhealthy foods. Therefore, we can assume both to be true, with the caveat that a long-term healthy diet starting from a younger age leads to a lower risk of developing depression over time.
The Mechanisms of Nutrition
What we eat is a vital component for our physical health, and that trickles over into our mental health as well. For example, diets high in inflammatory foods like sugary or fried food can increase the risk of chronic diseases and pain, which may worsen depression or increase the risk of mood disorder struggles. Similarly, diets that lack proper nutrients, such as vitamin B or omega-3 fatty acids, can contribute to depressive symptoms.
So, What Constitutes a Healthy Diet?
“A healthy diet likely is relevant to an individual and their own personal health factors,” says Dr. Chin. These factors include age, activity level, genetic risk factors, current metabolic health, and the presence of metabolic diseases (e.g. diabetes, obesity, metabolic syndrome). “Broadly speaking, eliminating ultra-processed food from one’s diet and focusing on whole foods is a reasonable recommendation for most people.” He notes that an individual with a metabolic disease associated with insulin resistance may require more specific dietary recommendations and guidance to see improvement in depression symptoms.
What Role Does Nutrition Play When It Comes to Mood Disorders Like Depression?
In part, it comes down to insulin, which is a major signaling pathway affecting metabolic health. “For several decades, we have known about the association of mood disorders like depression with insulin resistance. Within the past decade, researchers have homed in on this relationship and have identified insulin resistance as a clear risk factor for depression.”
Related research, Dr. Chin adds, has shown that targeted nutritional approaches like low-carb and ketogenic (very low carb) diets can reduce insulin resistance in some people with a metabolic disease. Emerging data suggests that these nutritional interventions may be potentially therapeutic for some forms of depression associated with metabolic disease, though more research is needed.
Dr. Chin is particularly interested in how such studies on diet can lead to a better understanding of mood disorders and the brain as a whole. “The recent attention ketogenic diets are receiving from both the mental health and academic community has the potential to teach us more about root causes of mood disorders – possibly psychiatric disorders in general – if they are proven to be effective interventions in larger randomized controlled trials.”
He adds, “Interestingly, ketogenic diets are known to improve several biochemical problems in the brain associated with psychiatric diseases, including increased insulin resistance, inflammation, oxidative stress, glucose under-metabolism, and neurotransmitter imbalances.”
The ketogenic diet has long been established as an effective treatment for epilepsy and within the past decade has gained significant popularity to manage and treat metabolic diseases like diabetes and obesity. It stands to reason, then, that ketones (chemicals produced by the liver that provides energy in the absence of glucose) may be an underlying mechanism for improving both neuropsychiatric and metabolic functioning, but more research is needed to elaborate this.
Then, What Foods Should We Eat?
“While diet and nutrition can be highly specific to each individual as mentioned above, we have a far clearer understanding on what is likely to not be conducive to brain functioning and overall mental health.” It’s vital to develop an awareness for how certain food choices impact your physical and mental health, and to seek recommendations from your physician to determine the most appropriate dietary choices for you. Broadly speaking, minimizing ultra-processed foods and optimizing whole foods is a good place to start.
How Important Is Diet in the Depression Treatment Process?
You know to seek more whole foods and avoid processed options to help improve your mental health, but what if you’re currently in treatment for depression? To start, “not every medication, psychotherapy, or treatment is effective for every individual’s depression,” Dr. Chin states. “Similarly, nutritional interventions may not be universally effective for all depression, but are a promising approach available to provide relief for certain people.”
Medical nutrition science is evolving. For example, “the largest trial to date on diet and depression is the SMILES trial from 2017, which demonstrated that a Mediterranean diet (a diet low in ultra-processed carbs/food) could be efficient at improving depression. It was an important study at the time, which demonstrated that diet could play a role in depression.” This trial, though, raised questions like, “What about the diet was effective?” One hypothesis is that it eliminated ultra-processed foods from the diet, which is common in the Standard American Diet (SAD). Could this have improved insulin resistance?
As we have established, depression and insulin resistance are closely linked, with researchers now studying the effects of improving insulin resistance on depression treatment results. These studies within the past decade “have demonstrated improvements of depression in some individuals with major depressive disorder and bipolar disorder when insulin resistance was reversed with medications,” Dr. Chin informs, continuing, “Case studies and now a small pilot trial have suggested a therapeutic effect of ketogenic diets on several psychiatric illness, including schizophrenia, schizoaffective disorder, bipolar disorder, and major depressive disorder. It could be possible that reversing insulin resistance through the diet or a benefit from ketones produced by the dietary approach may be beneficial.”
When it comes to depression treatment, Dr. Chin emphasizes the importance of a nutritional approach. “I have recommended nutritional ketosis as a dietary intervention for a few patients with treatment-resistant bipolar disorders. In those who have been able to successfully sustain the lifestyle dietary change, along with necessary ongoing lab monitoring, I have been impressed by witnessing the improvements in their metabolic and mental health.”
He adds that most of the current available data supporting nutritional ketosis in mood disorders is focused on bipolar disorder. However, Randomized Controlled Trials (RCTs) are currently underway to further reveal the effects of the ketogenic diet in major depressive disorder, bipolar disorder, and schizophrenia, among other clinical trials studying the effects of ketogenic diets on psychiatric conditions.
It’s an exciting time in the field of nutritional and metabolic psychiatry, and we are rapidly learning how specific dietary interventions are helping people with mental illness.
Down to the Diet
The bottom line is, what we eat is important, and we should all make a conscious attempt to understand if and how our dietary choices are impacting our mental health for better or for worse. Make an effort to eat mostly whole foods while minimizing ultra-processed foods high in sugar and refined grains. It’s quality over quantity when it comes to foods that help your mental health, and quality is what truly matters. As always, talk to your doctor or dietitian for specific recommendations if you have any relevant medical factors
If you need extra guidance on your mental health journey, Mindful Health Solutions is here for you. Contact us at (888) 789-6013 or fill out this form to schedule a consultation with one of our health-conscious professionals ready to listen to your story.
Dr. Chin is a board-certified adult psychiatrist with a focus on diagnosing and treating individuals suffering from mood and anxiety conditions, and helping people in the management of clinical depression. He has a significant interest in diagnosing and treating mood disorders, specifically bipolar spectrum disorders, unipolar depression, and treatment-resistant depression, as well as understanding the link between metabolism and brain health. In addition to interventional treatments (TMS, esketamine), he maintains an interest in emerging metabolic and ketogenic therapies to improve mental illness.
