Nutritional Biochemistry and Mental Health pt 1 - 046

SPEAKER A The following program presents principles designed to promote good health and is not intended to take the place of personalized professional care. The opinions and ideas expressed are those of the speakers. Viewers are encouraged to draw their own conclusions about the information presented. SPEAKER B Welcome to healthy living. I'm your host, Margot Marshall. Can food change our mood? Can food influence depression? And can food treat depression? Stay tuned. SPEAKER C Healthy Living is a production of 3ABN Australia television focusing on the health of the whole person, body, mind and spirit. You'll learn natural lifestyle principles with practical health solutions for overall good health. SPEAKER B Our topic today is nutritional biochemistry and mental health for adults. My guest is Dr. Andrew Pennington, who is an integrative general practitioner. Welcome Andrew. And would you just again like to tell us what integrative medicine is? SPEAKER D Sure. Thanks again for having me on the program. It's a delight to be here. SPEAKER B Our pleasure. SPEAKER D So just a refresher for those who don't know what integrative medicine is. Essentially it's a combination of using orthodox and traditional medical strategies with evidence based complementary medicine strategies. So it's quite a broad field. There's not a lot of standardized approaches in integrative medicine. But most integrative medicine doctors would have probably a broader understanding of nutrition, of the role of lifestyle, of their role environmental factors. And then some of them are also involved in some other practices such as traditional Chinese medicine or acupuncture or there's a number of other approaches that some integrative doctors will take. SPEAKER B But you have a couple of very special interest areas, don't you? SPEAKER D I do. So my major area of interest is nutrition and lifestyle medicine. And particularly today we're going to talk a little bit about the role of nutrition and brain health and how that impacts on mental health in adults. SPEAKER B Oh, that's great. So let's get started. SPEAKER D Sure. So I think the first thing I'd like to just mention about is the prevalence of mental health conditions. They are very, very common. And I've got a number of slides here that I'll go through with your viewers so that they can see some of this data. So I think the first slide that I've got just shows you the prevalence of mental health disorders. And this comes from data in Australia, the most recent data we've got from 2009. And you can actually see in this data that over a lifetime 45% of us will suffer some form of mental health disorder. So nearly half it's really, really common. SPEAKER B That's incredible. Yeah. SPEAKER D And if you break that down even further in any twelve month period of time, there's about 20% of us who of that 45% who actually have a mental health disorder. So again, pretty much one in five Australians, if you take any twelve month period of time, will have be struggling with some form of mental health. SPEAKER B I would not have realized it was that high. SPEAKER D So I mean that includes a lot of different mental health problems, of course. Well, all mental health problems, but it is very, very common. And particularly I'm probably more going to focus today on what we call mood disorders. So those are things like anxiety, depression, bipolar disorder, and these things. I'm going to talk a little bit about symptoms because some of your audience may be wondering about, well, what are the symptoms of these? Yes, and in particular, if we have a little look on the screen, if we can see that this shows some of the different symptoms that can be present in anxiety and depression. And I think probably just to emphasize with depression we all will have sadness through our life. At times that's quite normal. Human beings are emotional and that's normal. But to have feelings of ongoing sadness and worthlessness and not enjoying things that you normally enjoy doing for any prolonged period of time, we would usually say certainly over two weeks, but probably more like over six to eight weeks. If that's happening to someone, then they may well fit the criteria for a depressive episode. And anxiety has a lot of links, and I'll show you the links shortly. But there are symptoms, particularly with anxiety, where people feel very tense and trembling. Their breathing rate can be up, they may actually feel palpitations in their heart and feeling nervous, or there's this just sense that something's wrong and going to happen to them and the world's going to be an impending sort of doom and obviously they can sweat and have high heart rate. Now, again, we've probably all experienced these symptoms at some point in life, maybe when we're standing in front of public speaking, maybe when we're talking on the video camera. But this is something that happens very occasionally to an individual who does not suffer from anxiety. But for someone who has anxiety, this is happening very frequently and it's really how much they're of these symptoms they're having rather than whether they're having them at all. And there is a combination. And the next slide should show us different shared symptoms. So just excessive worrying. SPEAKER B You mean shared between anxiety and depression. SPEAKER D So people can have these symptoms in both. And I think a really big one is just brain fog and concentration, poor ability to concentrate. And I think if you ask that to people and they're not sharp at their work or they're not sharp at home, they just can't make good decisions and they're struggling to concentrate, they can be signs of anxiety, depression. So I guess if we looked at traditionally, how do we actually treat these medical conditions, and there's certainly some very helpful strategies within traditional medicine. So with mild to moderate symptoms, we usually try to avoid medications and we try to look at counseling based strategies through cognitive behavioral therapy and other psychology strategies. And exercise is also a useful strategy. And there's various other things. Some people find that having some quiet time or spending time out in nature or whatever it might be. Those things are all important strategies, and many people manage their symptoms with those things alone. But when they become a bit more severe and you meet the criteria for a major depressive episode or significant anxiety condition like OCD, you may well require traditionally drug therapies. And these are usually in the order of different types of antidepressant medications. Now, the trouble with this, although they're helpful for many people, they're not helpful for everyone. And I'm sure that there are some of your listeners out there who have experienced one of these conditions, possibly been placed on one of these medications by either their GP or a psychiatrist, and have had an adverse reaction to this medication, to one of the medications they were put on. And it's very common to get adverse reactions to the medications. SPEAKER B Is this correct? I don't think there's a single drug that doesn't have side effects. SPEAKER D Look, I think that's a fair comment. I guess it's how manageable the side effects are. But you're right, drugs will affect more than one body system. But look, of course, the role here is to try and recorrect what's going on in the brain. SPEAKER B Yes. And there's a place there is. SPEAKER D And out of this conversation, I do not want anyone to go off their medication. Please do not understand that, okay? Without talking to a medical practitioner who is monitoring your mental health. However, we need to be aware of the limitations of the medications. And as I said, one of them is side effects and not infrequently. It can create problems with sleep. It can create gut problems and nausea and vomiting, headaches, sexual dysfunction. There's a number of side effects that people will experience from antidepressants, potentially. Now, of course, that's not all. There's some that I've used these medicines with who are very, very happy and pretty much say, listen, you've made a massive difference to my life. I'm feeling a lot better. But I'll tell you, one other side effect that's interesting is that some people will tell me they flatline with their mood. So you may have removed their negative side effects of worthlessness feeling down and what we call the negative or aspects of the mental health, but they don't have any joy in their life. They're not happy. They're just flatlining their mood. And you could probably tell them that, look, your dog's died and they might go, oh, yeah, they're just flatlining. They're not going up or down and move. And many people do not like that at all. Now, the other aspect of the problems with medication, of course, is that some people, they just don't work in. And we've found that to be the case. Antidepressant medicines probably work in about 50% to 60% of patients for depression, and that's not certainly not 100% and nowhere near it. So there are problems with these strategies that call us to look deeper and more holistically. Can we help people not just by using drug medications? And the answer is yes, we absolutely can. And I want to talk a little bit perhaps to understand more deeply what causes these problems in the first place. And the next slide I'm just going to put up there comes from Beyond Blue's website, which I would recommend if people are interested in looking further. And the answer is we don't know exactly what causes these problems, but we certainly got a lot of clues, certainly life events. I've had numerous patients who've had a traumatic life event that has pushed them into depression or anxiety. There are personal factors. We talked a little bit about this in an earlier program where family history of mental illness is very important and that's probably because of inherited different biochemistries in the brain that are passed on that predispose one to a certain behavior traits and certain personality traits. And we've just mentioned that as another issue. We certainly know, for example, that perfectionist behaviors can be associated with increased depression and eating disorders. So that's a personality trait that some of us have and if it gets out of control, it can cause a problem. Clearly having a serious mental, serious medical illness. We know that people who've had a heart attack and have a bypass or stent are more likely to have depressive episode afterwards. So is diabetes, people with diabetes are more likely. And clearly things like substance abuse of various drugs can impact on mental health. And then there's obviously brain changes where can be related too. It's a combination of a lot of factors that can come to play, that can perhaps cause it, but we don't always know exactly what it is. And I should add just one more thing. We're also understanding that the brain being inflamed is a part of this process too. And it's probably a combination of these factors that causes a systemic inflammatory response in the brain that's associated with any of these mental illnesses. SPEAKER B Lots of reasons why it can happen. No wonder so many people are experiencing absolutely. SPEAKER D So one of the questions that I have, and maybe some of your listeners has is can food influence our mood? SPEAKER B Yes. Well, this is the question we've been waiting to hear the answers to. SPEAKER D I suspect that many of your listeners will be very intuitively aware that the answer is yes. And I think we all understand at some point in time that we feel better after eating. If we're a bit ratty sometimes, maybe our blood sugars are a bit low and we have a decent meal, we feel a bit better. And we also know that there are a lot of people who comfort eat. Why? No, because they feel when they comfort eat yeah, briefly, exactly. That can be a destructive behavior to their long term. But that term comfort eating implies that they are feeling comforted by eating and they are. And we're understanding a bit more about how that's happening at the brain level. So intuitively, we know that food can affect mood, but is there any literature or evidence to prove this? And the answer is yes. And I've got a couple of slides there that we can look at. And I think this particular slide I'd like to just focus on briefly because I think it's very profound. And this actually comes even though it's published in the American Journal of Public Health, it actually comes from Australian data. So the researcher who put this together was a public health clinician. And what I'd like you to just notice here is that he was interested in what are the role of eating fruits and vegetables? Does that actually have any influence over our mood? And so he did a big retrospective analysis of the eating habits of a number of thousands or hundreds of Australians I can't remember the exact numbers in the study and looked at the food eating behaviors and fruits and vegetable intake and then looked at mood. Now, up this sort of Y axis here, you can see a change in life satisfaction. He developed I can't tell you the details of how he developed this. It's in the paper. But he's developed a score of how satisfied one is with life. SPEAKER B Okay. SPEAKER D And on the bottom you can see is the change in how many fruits and vegetable portions one is eating. From zero up to 80, up to eight. SPEAKER B They're all fruit and veg portions, correct portions. SPEAKER D So zero to eight, they're going up in a steady so you can see that it's almost a linear increase between satisfaction in life and the amount of fruits and vegetables that one is eating. Isn't that interesting to give you? What does this scale sort of mean in a realistic term? The difference between zero and, say, 00:23, which is, I think, the top value there for eight vegetables and fruits, is about equivalent to someone going from being unemployed to employed in terms of their satisfaction of that life experience. And about half the significance of someone getting divorced. So that about half is, if that makes any sense, it's working the other way. Yeah, that's right. So let's say getting divorced made such an impact negatively on one's life satisfaction. About half of that is the difference here between eating one or eight fruits of vegetable intakes per day. SPEAKER B And the recommended amount is two fruit. Five. SPEAKER D That's right. SPEAKER B And that's baseline. SPEAKER D Absolutely. SPEAKER B That's totally baseline. SPEAKER D You can certainly do more than that. SPEAKER B Oh, yeah. Brenda Davis, who's a world renowned dietitian, says that we should have ten serves of fruit and veg and three should be green. SPEAKER D Yeah, I like to aim for that. SPEAKER B Yes. And that's quite challenging. SPEAKER D But look, we know about most of us know oh, yeah. More fruits and veggies prevent heart disease and diabetes. But did you know that it can help you with mood? Maybe not. SPEAKER B Maybe not. SPEAKER D But then there's actually a different question to ask on top of that, it's well, but that might be just an association. Can you actually use food to treat depression? So someone's clinically got depression. Can we actually tailor their diet to actually influence their depressed mood? And we had a lot of clues before, including this. And there's actually a number of other studies that have shown an impact on poor diets and more likelihood of getting depression. Unfortunately, I did have a slide for that, but it wasn't clear enough to show on the graphics here. But there was a metaanalysis of I think it's about 13 different studies that looked at diet quality and chance of depression, and almost all of them showed that poor diet quality was associated with an increased risk of depression. So that's a really key point for our listeners today, is that don't think that diet has nothing to do with depression or mood. It certainly does. And the better quality diet you have, the more likely you were not to have depression. SPEAKER B I think that one you've got on the screen now is amazing. It's an excellent it's profound, isn't it? SPEAKER D Is very profound. But then, as I say, the next clinical question is, well, okay, we've got associations here between mood and diet, but when someone has depression, can we treat them with diet? And as I say, the answer is yes. And this is just recently, again, Australian data, and I want to show you this randomized control trial that was done by Felice Jacker and her colleagues at Deakin Uni in Melbourne. And I think this is really important. So what they actually did in this trial was they sourced a group of patients who had clinical depression and they graded them according to diet quality and they've got a standardized way to do this. And essentially, they took the cohort of people that answered their questionnaires, who had what they viewed as a poor quality diet and depression. And then they took that group and they randomized them and they said, all right, this group, we're going to give dietary advice and you'll go into that arm and we're going to improve your diet. This group will just give you standard sort of social support care that anyone would get normally. Now, have a look at what happens in the two groups here. And this is the estimate means, and this score here is a depression sort of outcome on the left. So the social support group, this is their baseline, as in blue. And after the intervention, at three months time of social support, they had improved too. You can see that they've improved their depression scores. But look at the diet group. It's a much bigger improvement in their scores. SPEAKER B It's double the difference. SPEAKER D Exactly right. Well, so this was a randomized control trial that proved, probably for the first time, that a good quality diet. And I should say that the style of diet that was used in this was a Mediterranean style diet where they used a lot of fruits and vegetables, lots of plant foods, whole grains, whole foods, good oils, fish. So that's the style of diet that was done here and that showed this kind of effect. SPEAKER B I don't know what your next slide is, actually, but I'm wondering whether they did another study using both diet intervention and social support. Wouldn't it be interesting? SPEAKER D Yes, it would. SPEAKER B And look, that had an effect and that had twice the effect. SPEAKER D Absolutely. SPEAKER B I think you could safely assume, or as a layperson, I could safely assume that you'd get an even better outcome. SPEAKER D Look, I must say, I can't remember I'd have to reread the study, but I can't actually remember if they actually did do that in the study. It may well have been that the diet intervention also got social support, but as I say, I just can't remember from the detail of the study. But the study is there at the bottom there for any who's a studious person and wants to look it up. And I should say that you can Google Food and Mood Centre in Deakin Uni and they've got quite an interest in looking at these sort of constraints and looking at how we improve people's moods using so now I do often get sorry, did you? SPEAKER B Oh, it's just a little something that came to mind, as you said that, and I'm thinking, probably everyone's thinking, do you mean I have to eat broccoli or something? But do you know what? One time my daughter and I were running a program for a big convention and I think we had maybe 100 children between the ages of seven and nine, and we decided to promote Fruit and veggies. It was about fruit of the spirit from the Bible. So we promoted fruit and veggies and we did it in interesting ways with games and what have you, and it only went for about over the Easter break. It wasn't very long, but where we were sitting there, probably on the second last day, having lunch a little bit late, out under a tree, and a little boy in our group was standing a bit of a way off, sort of looking at us, a bit shyly. And then after a while he said, Can I say something? SPEAKER A Come on, you can talk to us. SPEAKER B Came over, he said, well, when I came to camp, I hated broccoli and now I love broccoli. And I'm thinking, how's that possible in that time, just from the fun effect? SPEAKER A I don't know. SPEAKER B I don't know. It was just a lot of fun and games and all sorts of things that we did around the fruit and veg. And he decided he loved it. SPEAKER D I was astounded well. I mean, that's a lovely story, but you'd be surprised how many people I come through and talk to about mental health stuff. And when I actually ask them about their diet. They're not eating very many fruits and vegetables. They have a quite poor quality diet. SPEAKER B We're going to be doing a bunch of programs on how to make where is it? Where healthy gets delicious. Because usually you can find if you're creative enough or you're persevering enough, you can find a way to enjoy a fruit or a vegetable that you might not if you just ate it the way it's traditionally served. You can incorporate it or do something interesting with it and really love it. SPEAKER D No, that's fantastic. SPEAKER B I've seen this happen. I've actually seen this happen. SPEAKER D Well, I think really what this teaches us as well is that you can have the knowledge around this kind of knowledge, but there are a number of people who don't have the skills of food preparation. They haven't been taught or they've grown up on a very bread or rice or pasta or meat diet, and they haven't realized the necessity of how important fruits and vegetables are for us. And I think what's becoming even clearer and perhaps to just join some of these mechanisms together at a very broad level, we're understanding more and more about the gut and its role and importance in health in general. And what I want to really get out to you is that when your gut is healthy, you are healthy. And so the effect of these fruits and vegetable portions is really the effect on the gut microbiota that is the bacteria in our gut, because they thrive on fiber. And where do you get fiber exclusively? SPEAKER B Vegetables, plant foods. SPEAKER D Okay. Exclusively, obviously, whole grains as well, and nuts, et cetera. But fruits and vegetables are one of the biggest components. And I should also put a plug in for the variety that we have in the diet. Because just eating one or two, I mean, that's great, but the Good Lord designed a lot of these foods to have different types of fibers, soluble insoluble, and have different roles in feeding different bacterial species. It was very interesting. I was just that's one of the. SPEAKER B Dietary guidelines for Australians is to it used to be eat a wide variety of nutritious foods. And they changed one word I won't quiz you on camera, but they changed the first word from eat a wide variety to enjoy. SPEAKER D Yes. SPEAKER B Enjoy a wide variety. And we meant to enjoy our food, but a wide variety is really, really important because they don't all have exactly the same nutrients absolutely right. In the same proportion. SPEAKER D Absolutely right. So they're feeding your gut microbiota, which are in turn giving you back good quality organic acids and things which the gut cells love. And they also actually they build for you various neurotransmitters, and they will also provide certain vitamins and minerals. That's incredible, isn't it? SPEAKER B You're saying what's happening in the gut builds neurotransmitters. Absolutely. Wow. SPEAKER D So I'll give you one example. SPEAKER B So that's an incredible connection. It is. With depression and absolutely. SPEAKER D Well, here's the example. We've all heard, probably a lot of us have heard of the bacteria E. Coli. It's probably one of the best studied bacterias around, probably most notoriously for giving urinary tract infections to people. But E. Coli is actually really important in our gut. And if it's fed well and in good proportion, it will give you tyrosine, tryptophan and phenylalanine, which are three amino acids that build neurotransmitters. SPEAKER B Whoever would have thought that E. Coli. SPEAKER D Would that actually does that for you. And it also provides folate and a vitamin called vitamin K two, and probably a number of others. That's just one. And I'm certainly no expert in the microbiology, but these bacteria are doing good stuff for us. And if we provide the healthy ones that are supposed to be there in the right ratios, they will pay us back. And you'll have a function at the gut level. So those neurotransmitters like serotonin help those gut cells to be functioning, but they will probably some will also cross into the brain and then help you to feel a bit happier. So I think it's a very, very profound benefit to be understanding what these nutrients or what these bacteria do when they're fed the right food. And I think that's one reason why this certainly works. Giving good quality foods helps mood. SPEAKER B I love the way your whole approach to this and that you have various different approaches. You've got the traditional and you've got the lifestyle approaches. If someone wanted to come and see you or they wanted to contact you, how would they do that? SPEAKER D Sure. So my clinic's in Sydney, it's called Sanctuary Lifestyle Clinic. SPEAKER B I love the name you like. Beautiful name. SPEAKER D Yeah, I think it's a good name too, but I'm biased. But yeah, the website you can see on camera now is Sanctuaryclinic.com. Au. I also have a Facebook page, which you're welcome to like. And I've just started a YouTube channel. Oh, people can see some educational videos as I put those up over time. And that's a service for you'll be able to put this on your maybe. And so I'd be delighted to help you. We also have a nutritionist who also focuses on a lot of this kind of stuff. Good gut health, providing good quality nutrients to the gut. And I also have a naturopath who's also interested in this style of things. And I have a psychologist who is wonderful with counseling people. SPEAKER B That's fantastic. So you've got a range of people who are just coming from different perspectives to help people absolutely right with their concerns. SPEAKER D So I'd also like to talk a little bit further and this will have to be part two for our next discussion, a little bit about individual biochemistry of the brain and how we can actually target and use different dietary and nutrient strategies for specific individuals. And I think this talk today in part one has been around looking at whole food approaches and the role of food in general and good quality foods and how that actually impacts at a biochemical level on the brain and at a clinical level, which you've seen from the data. But there are situations where we actually have to use particular targeted approaches where the general approach is still valid, but we kind of hone the approach within that general approach. And unfortunately, we also recognize that there is different soil qualities around the world. And in Australia, some of the soils where we grow our fruits and vegetables don't always contain as many vitamin and mineral nutrients as we may like for optimal health. So in some situations, we actually have to consider supplementing in order to get to the levels in the blood and brain that we want for optimal mental health. SPEAKER B And are you getting very positive results by using that targeted approach? SPEAKER D Absolutely. So the approach that I'm going to talk about in the next section is something that I've learned through a lovely, I guess, medical doctor approach in the United States, dr. Bill Walsh. And he's looked at biochemical individuality of people with mental health problems and he's actually figured out how to manipulate their mental health for the better using supplemental and dietary approaches. And I've found probably about 75, maybe even 80% of my patients will actually improve. And I don't even need to use a medication with them. So it's enormous. SPEAKER B Say that one more time. SPEAKER D 75, probably about anecdotally 75% to 80% of my patients would improve. That's not all of them. No, obviously I react according to what extent? Some dramatically, some modestly, but most of them will improve. And occasionally we need to use some medication to supplement. They work both very well. SPEAKER B Isn't that interesting? By using some extra nutritional supplements in certain cases as needed. And you obviously test for that. That's wonderful. I'm looking forward to the next program because I'm sure many people are, because it's not a nice way to live when you have these problems. Well, our goal is to support you on your journey through life. And we trust that today's program has been helpful to you or to someone that you love. Remember, you can watch our programs on demand. Just visit 3abnaustralia.org.au and click the watch button. God bless you. SPEAKER C You’ve been listening to a production of 3ABN Australia Television.