Depression

Collagen and gelatin lower serotonin: does this increase your anxiety and depression?

September 29, 2017 By Trudy Scott 228 Comments

I see everyone raving about gelatin and collagen – and rightly so – they have amazing health benefits. However, no-one is addressing the fact that gelatin is actually used in tryptophan-depletion studies to lower serotonin (gelatin is derived from collagen: when collagen breaks down, it becomes gelatin). When I first discovered this fact it really concerned me that this very important aspect is ignored so I added it to my long list of topics to investigate.

I posted the above on Facebook last month as part of a fact-finding exercise and appreciate all the feedback and questions. Today I share some of the feedback and research and I’d love to hear from you what your experiences have been.

The health benefits of collagen

In case you’re new to collagen, Dr. Josh Axe provides an excellent overview of the health benefits of collagen

Improves Health of Skin and Hair
Reduces Joint Pains and Degeneration
Helps Heal Leaky Gut
Boosts Metabolism, Muscle Mass and Energy Output
Strengthens Nails, Hair and Teeth
Improves Liver Health
Protects Cardiovascular Health

Gelatin is used in tryptophan depletion studies

Tryptophan-depletion studies have been done for years, as a way to study the relationship between low serotonin and depression. Often a tryptophan-deficient amino acid mixture is used for this purpose. More recently, collagen and gelatin are being used.

Collagen and gelatin are an excellent source of these amino acids: proline, glycine, glutamine and arginine, but they do not contain the amino acid tryptophan.

This paper, Pharmacokinetics of acute tryptophan depletion using a gelatin-based protein in male and female Wistar rats summarizes what we find in a number of studies that use gelatin for the purpose of lowering serotonin levels, in order to study the relationship between serotonin and behavior:

The essential amino acid tryptophan is the precursor of the neurotransmitter serotonin. By depleting the body of tryptophan, brain tryptophan and serotonin levels are temporarily reduced. In this paper, several experiments are described in which dose and treatment effects of acute tryptophan depletion (ATD) using a gelatin-based protein-carbohydrate mixture were studied in male and female Wistar rats.

My experience with collagen – flat and worried until I added tryptophan

When I recently injured my back and sprained my ankle, I decided to add collagen to speed up the healing and very quickly had to take a deeper dive into the topic because I noticed it affected my mood right away! I was using just one big scoop of collagen in a protein shake (pea protein) and yet I felt flat and slightly anxious within a day. It was the worried low-serotonin kind of anxiety in the early hours – something I haven’t felt in quite some time.

I wondered if it was due to the injury and inflammation my body was dealing with or if it was related to the effects of tryptophan depletion. I stopped the collagen and then added it back and had the same experience. I did this a few times and experienced similar feelings each time.

When I used tryptophan mid-afternoon and at bedtime I felt fine and was able to continue taking the collagen with no problems. I am prone to low serotonin – it was one of the root causes of my big anxiety issues in my late 30s – so I may be more affected than the average person.

Wondering if collagen causing mood issues and an increase in anxiety?

Here is feedback from someone who is wondering if collagen is causing her mood to dive:

I have wondered if it affects my mood so I haven’t been using it lately. Interested to see what other people say. I was using about a table spoon in a drink that I would sip on throughout the morning. My moods just take dives now and then. I have isolated gluten as a HUGE factor. I am forever wondering what else causes the dives and I began to wonder if collagen was causing problems so I haven’t used it in several months.

Stephanie feels moody when using collagen:

I have found that the days I take collagen that I’m moody. I’ve kept trying, but am always surprised by the reaction. I even mentioned it to my naturopath recently. Curious to see if there’s a connection.

Here is feedback from someone also reporting mood dives and feeling on edge (although as I pointed out to her the feeling on edge is very likely due to or partly due to the coffee):

I take collagen (grass-fed and grass-finished) in my coffee every morning. I’ve also had some mood dives consistently the last few months and feel more on edge. I’ve honestly never made the connection and actually thought it was hormones. Something to think about!

Melissa shared it affected her sleep:

As soon as I started taking gelatin daily I have had difficult falling asleep.

Katinka began having strange night time anxiety:

I did [Vital Proteins grass fed beef gelatin] for 2 weeks in bone broth. My nails grew like crazy, but at the same time I begun having strange night time anxiety: worry, obsessive, but not any of the other symptoms like depression and cravings. It is interesting to me because this was the only time I had anxiety at night since going gluten free.

Collagen caused a racing heart for Beverly:

Used to take Vital Proteins products. Was woken up several times in the night with racing heartbeat and out of breath. This went away when I stopped the collagen. I have symptoms of low serotonin but have not tried tryptophan

No noticeable problems

Many people shared that they didn’t notice any obvious mood issues so it’s clearly not a problem for everyone:

Jaime: Interesting, I use it almost daily for protein at breakfast. I will pay attention better. No obvious problems now (used for 9 months).
Angela: …I don’t think I have any side effects and I do have serotonin issues. I think I will have to do more research
Courtney: I just started using collagen peptides but not every day. Maybe once or twice a week. I haven’t noticed any difference in mood but I also just started taking it a few weeks ago.
Debra: I take 1bsp of Great Lakes Collagen Hydrosylate every day and take it to help heal my leaky gut….haven’t noticed any particular side-effects. I alternate it with the normal gelatin. I suffer from complex PTSD, anxiety and depression…I haven’t noticed any difference in that either

Jessica Drummond, nutritionist and physical therapist, and an expert on female pelvic pain and women’s health shared:

I use collagen regularly and I also eat quite a lot of meat and fish. For me both help me to feel very grounded and less anxious. I think of collagen as balancing for all of the muscle meat that we eat. I eat anywhere from 10-20 grams 4-5 days per week.

Feels anxious using gelatin, stop using it and anxiety is gone/less

Laura’s anxiety got worse within a few months of adding daily gelatin:

Wow, I never heard that gelatin can lower serotonin. I started using [Puritan’s Pride brand], 650mg, daily about 6 months ago to strengthen my nails. It’s worked very well for that. About a couple months ago my anxiety started to get worse again. My anxiety shows up as fear and worry mostly and not being able to quiet my mind. I had gotten it under control for almost 2 years now. I wonder if there is a connection. I’m going to stop taking the gelatin and see if my anxiety improves. I have not tried tryptophan, but I have found GABA helped quiet my mind and let me sleep better.

She decided to stop taking it to see if her anxiety symptoms would reduce and when I checked back with her she shared this:

I was surprised to find after about 2 weeks of stopping the gelatin, I began to feel more calm again and it’s been a lasting change. I still take zinc, vitamin b6 and lysine in the morning and GABA in the evening. This combination works well for me. I’m so grateful for all the information you share! Thank you!

Toni experienced something similar:

I’ve been using Organic collagen for about 8 months now… love the hair and skin results. My tummy felt better at first but not currently. My anxiety and panic attacks are off the charts: panic attacks, heart racing, sweating, brain fog. I want to escape -like fight or flight. Definately obsessing and fears. Memory difficulty. I have an upcoming GI appointment to check for Candida /SIBO… but I had no idea this could add to my anxiety. I’ll be looking forward to more information, Seriously.

And a few weeks after stopping the collagen she shared this:

I stopped using the collagen. Since then, my anxiety and panic are decreased by less than half. Mild in comparison. I’m definately taking a long break.

Keep in mind I’m not suggesting we should not be using collagen – just that if it seems to lower serotonin and increase anxiety/depression doing a trial with tryptophan may be the solution (more on that and some other possible causes of anxiety below).

When used with tryptophan – no mood issues

Karen uses collagen and tryptophan at night:

I use collagen every day. But hey, I also take L-tryptophan every night for anxiety. It runs in the family and a small amount of Tyrptophan at night helps resolve mine. No clue there was a connection

Maxine uses it every morning and takes 1 tryptophan before bed and reports no mood issues

I take it [Great Lakes gelatin and Vital Choice collagen] every morning in my tea and at night in my bone broth for my skin and joints and I take one tryptophan before bed. The tryptophan with GABA before bed is for better sleep. No mood issues.

Used ‘therapeutically’ to lower serotonin

Misty reports using it ‘therapeutically’ to lower her high serotonin levels. This application is new to me and I find it quite fascinating:

I use it to reduce tryptophan because I have a tendency toward high serotonin. I have suffered my entire life with ADD, tics as a child, grinding teeth, general anxiety, lack of motivation and later, IBS. In my quest to maximize my health, I finally came to these web pages for help. In my 53 years I’ve never been as calm as I am now. If I’m not careful, I can get a bout of IBS (not food related and trust me, from GAPS to AIP, nothing really affects me). I reduce tryptophan and I’m balanced. It seems contrary but it works for me and so many others

She links to these articles Tryptophan, Sleep, and Depression and The Sadder Side of Serotonin which both refer to the work of Ray Peat who I recently discovered is very much against the use of tryptophan.

I agree with the premise of too much serotonin causing issues (often the same symptoms we see with serotonin that is too low) but not the general message that tryptophan supplements and foods high in tryptophan are harmful and should be avoided by everyone. Based on the clinical results myself and other practitioners see boosting low serotonin with tryptophan and/or 5-HTP -and the wonderful results they experience – in my opinion, this is really all about biochemical individuality.

I decided to share this story here, even with the controversial tryptophan articles, because it illustrates that it is highly likely that the collagen is lowering her serotonin levels and making her feel better. I’ll tackle the above negative articles about serotonin and tryptophan in a separate blog post.

Why are some people adversely impacted by acute tryptophan depletion/ATD while others are not?

UPDATE: Dec 22, 2017. This section adds additional evidence or possibly some theories for why some people are adversely impacted when consuming collagen, while others are not impacted mood-wise – all related to the lowering of serotonin levels. These are called ATD or acute tryptophan depletion studies.

This paper: The effect of raising and lowering tryptophan levels on human mood and social behavior explains that effects of ATD can vary based on susceptibility of the study participants to clinical depression:

Acute tryptophan depletion (ATD) studies indicate that low serotonin can lower mood and also increase aggression, although results vary somewhat between studies with similar participants. Lowering of mood after ATD is related to the susceptibility of the study participants to clinical depression, and some participants show no effect on mood.

In healthy individuals, there is little or no lowering of mood, although results can be quite variable between studies, with some lowering of mood seen more often in women than in men.

The author reports the following variable responses:

In healthy participants with a family history of depression, there is a lowering of mood although mood remains within the normal range of mood.

In newly recovered depressed patients on antidepressants that act on the serotonergic system, 50 per cent or more of the patients show a temporary reappearance of the depressed mood they experienced before recovery.

In recovered depressed patients off antidepressants, only a small percentage of the patients show a marked lowering of mood.

In recovered depressed on noradrenergic antidepressants, there is no lowering of mood.

The results of the ATD studies suggest that lowering serotonin synthesis can lower mood in some circumstances, and that the magnitude of the effect tends to be greater in people with a greater susceptibility for depression.

Other studies report on these groups of people that were adversely affected with a lowered mood after ATD:

OCD / obsessive compulsive disorder: Patients with OCD experienced a decrease in control and an increase in interfering thoughts after acute tryptophan depletion. There was no effect on anxiety in this group.

Genetic polymorphisms: A number of papers show some genetic polymorphisms make some individuals vulnerable to increased depression after acute tryptophan depletion, such as MAOA and 5-HTTLPR (the serotonin transporter gene). In one 5-HTTLPR polymorphism study differences were seen between men and women: healthy men became more impulsive, whereas healthy women showed a mood reduction after ATD. Keep in mind that having a polymorphism doesn’t mean there will always be an issue, instead, it means there may be a predisposition.

Smokers: The moderating influence of nicotine and smoking on resting-state mood and EEG changes in remitted depressed patients during tryptophan depletion.

Comorbidity between depression and tobacco use may reflect self-medication of serotonergically mediated mood dysregulation [and acute tryptophan depletion or ATD] increased self-ratings of depressed mood [in certain smokers].

Although this study was looking at the role of nicotinic receptors in disordered mood and the self-medication of mood by smoking, we may be able to extrapolate this for our purposes because it was this one subset of smokers who were more depressed after tryptophan depletion. Could it be that smokers or even former smokers are more likely see increased depression after consuming collagen because it contains no tryptophan? Or is it that smokers tend to be drawn to smoking because they are prone to low serotonin?

Women ecstasy users: The effect of acute tryptophan depletion on mood and impulsivity in polydrug ecstasy users.

Women polydrug ecstasy users appear to be more susceptible than men to the effects of lowered serotonin levels [when they] received a tryptophan-deficient amino acid mixture and a control amino acid mixture containing tryptophan, at least 1 week apart.

The women who were impacted – with a lowering of their mood – used a tryptophan-deficient amino acid mixture and not collagen. The authors suggest this could be due to the drug-use causing progressive damage of serotonin neurons. Could this also happen with collagen consumption in current and possibly prior drug users? What about users of other street drugs or even medications that may also damage serotonin neurons?

Interestingly, in a study looking at five chronic fatigue/CFS patients, none of them showed any significant differences in fatigue, depression and concentration when subjected to acute tryptophan depletion /ATD. Was this group of patients too small or were none of them susceptible to low serotonin?

This is just a small selection of studies looking at the effects of acute tryptophan depletion or ATD but they give us much to think about when it comes to considering the varied effects we are seeing when individuals consume collagen.

If collagen affects you adversely and makes you feel more depressed, more anxious and experience worse sleep, can you relate to any of the above scenarios?

Time magazine: ketamine is NOT the solution for treatment resistant depression!

August 11, 2017 By Trudy Scott 25 Comments

Seen at LAX airport en route back to Australia – this cover of Time magazine:

The Anti Antidepressant. Depression affects 16 million Americans. One third don’t respond to treatment. A surprising new drug may change that.

It’s scary to think that ketamine and ketamine-like drugs are being considered the solution to “treatment resistant depression”. I’ve never liked this term and in my opinion, what it really means is that the root cause of the depression has not been found. To me it looks like the mainstream medical mental health community is desperate!

It really is time to get all the well-researched nutritional psychiatry approaches to the forefront! They do work! The timing of this article is even more interesting since I was returning from the first international meeting of the International Society for Nutritional Psychiatry Research in Bethesda, MD.

Lead food mood researcher Professor Felice Jacka presented her SMILES paper where dietary changes from a junk food diet to a real whole foods diet reduced depression in 30% of the participants.

Microbiome researcher Professor John Cryan discussed the gut brain connection. This paper: Recent developments in understanding the role of the gut microbiota in brain health and disease, was published just last week:

recent preclinical and clinical evidence suggest that targeting the microbiota through prebiotic, probiotic, or dietary interventions may be an effective “psychobiotic” strategy for treating symptoms in mood, neurodevelopmental disorders, and neurodegenerative diseases

And research on sulforaphane for psychosis, and depression and anxiety was presented: Sulforaphane produces antidepressant- and anxiolytic-like effects in adult mice

these findings demonstrated that SFN [sulforaphane] has antidepressant- and anxiolytic-like activities in stressed mice model of depression, which likely occurs by inhibiting the hypothalamic-pituitary-adrenal (HPA) axis and inflammatory response to stress. These data support further exploration for developing SFN [sulforaphane] as a novel agent to treat depression and anxiety disorders.

I presented on the benefits of a gluten-free/grain free/Paleo diet for certain individuals for depression and anxiety, and did a poster presentation on GABA for eliminating anxiety.

As you can see from the TIME Magazine article the only approaches that have been considered (and have failed) are medications in various different combinations:

Every week, when Ian Hanley sits down with his therapist, he goes through a list of depression treatments he’s been researching online. The best-known treatments at the top of the list–half a dozen antidepressants and known combinations of those drugs–are all crossed out….

Most diagnoses do not come with 20-plus medicines approved by the Food and Drug Administration to treat it–and yet with depression, more options don’t always mean better outcomes. Ever since the first antidepressants were introduced 60 years ago, doctors have had patients like Hanley–people who don’t seem to get better even after they’ve worked their way through the lengthy list of available drugs. About 30% of all people with depression don’t respond adequately to the available treatments. That’s a dismal failure rate for a class of drugs designed to improve a person’s basic ability to function.

According to this article in Time magazine:

The biggest development has been the rediscovery of a promising, yet fraught, drug called ketamine. It’s best known as a psychedelic club drug that makes people hallucinate, but it may also have the ability to ease depression–and fast. In a race to shape the next generation of antidepressants, Johnson & Johnson and Allergan are fast-tracking new medicines inspired by ketamine.

I encourage you to read the entire article and take note of the following: the side-effects seen with medications over the years and the fact that doctors “don’t know the consequences and potential side effects of taking tiny doses of ketamine over and over again”; “she tried nearly everything” (you’ll read this in all the articles advocating for ketamine but unfortunately they are only referring to medications); the ketamine effects are temporary and cost $15,000 per year (and are not covered by insurance); and ketamine “is thought to stimulate an opioid receptor in the brain” and is already known to be addictive.

When I shared this image and article on my Facebook page I discovered that is a pretty divided topic with a number of people feeling really strongly about the fact that this approach needs to be researched further and considered. I acknowledge their concern for the individuals who have not found a solution for their depression. BUT my question is this: have all the dietary and nutritional approaches been considered and looked into with these people who have not responded to antidepressants?

I strongly believe that ketamine is NOT the solution and that nutritional psychiatry is!

Have you used this ketamine approach personally or with patients?

Would you consider using ketamine personally if the antidepressants didn’t work for you? Or would you be more willing to work with a functional medicine or functional nutrition practitioner to find your true root causes and address them with diet, nutrients and a functional medicine approach?

Migraines, Anxiety and Antiphospholipid Syndrome: on the Chronic Headache & Migraine Summit

June 12, 2017 By Trudy Scott 39 Comments

The autoimmune condition called Antiphospholipid Syndrome (APS) is one of many possible contributing factors for both migraines and anxiety. I came across this condition when researching the links between migraine and anxiety in preparation for my interview with Erin Knight, one of the hosts of The Chronic Headache & Migraine Summit, starting July 10. This is one of the reasons I love presenting because I get to learn so much too!

Antiphospholipid syndrome occurs when your immune system attacks some of the normal proteins in your blood. It can cause blood clots in your arteries or veins. And it can cause pregnancy complications, such as miscarriage and stillbirth. (Source: Mayo Clinic)

I share some highlights from a 2015 paper: Antiphospholipid antibodies as biomarkers in psychiatry)

Antiphospholipid syndrome (APS) has been implicated in a range of neuropsychiatric presentations
The link between depression, stroke, and cardiovascular disease could be explained in at least some patients by the presence of aPL antibodies
Approximately one in five (20%) strokes in individuals under the age of 45 years are associated with APS
Migraine is one of the most commonly observed symptoms in patients with APS
aPL antibodies are often found to show low or moderately positive levels which makes this syndrome a diagnostic dilemma in psychiatry. The St. Thomas ‘alternative criteria’ for APS may be a useful clinical tool for psychiatrists. These criteria include cognitive impairment, affective disorders [like depression and anxiety], headaches [or migraines], and livedo reticularis, with improvement after aspirin treatment

In case you are not familiar with livedo reticularis, it is a mottled purplish discoloration of the skin. Having this skin condition does not mean you have APS because livedo reticularis can be a normal condition that is simply more obvious when you are exposed to the cold. It can also be an indicator of impaired circulation.

Phospholipids are a class of lipids that are a major component of all cell membranes and also facilitate neurotransmitters communication so this condition affects serotonin, dopamine, glutamate and GABA levels.

Working with my client’s doctor, I would recommend an autoimmune dietary approach and trials of the respective amino acids to support low serotonin, low GABA and low dopamine.

My interview also addresses the prevalence of anxiety with migraine sufferers.

We also cover how effective gluten removal can be for certain individuals. We always start with gluten removal for my clients with anxiety and migraines and find it to be a common underlying factor (whether it’s celiac disease or gluten sensitivity). Since gluten is always an important factor for autoimmunity it should always be explored if APS has been diagnosed or is suspected.

We also cover low serotonin as one possible cause of migraines and the how to do a trial of tryptophan (instead of SSRIs). Erin shares her frightening SSRI experience too. Using tryptophan also addresses the low serotonin that often occurs with APS and is one possible contributing cause of the anxiety, depression, insomnia and migraines.

The Chronic Headache & Migraine Summit will be online from July 10-17, 2017

Hosts of The Chronic Headache & Migraine Summit, Erin Knight, Corey Schuler and Marta Taylor, are familiar with headache pain and migraines; they’ve all experienced severe headache problems. They found functional medicine solutions, which they now share in their health practices each day. Discover in one week what they’ve spent years learning!

You can register for the summit here

Depression as a black dog that comes in and lays down beside you at night

May 26, 2017 By Trudy Scott 18 Comments

Trevor King’s interview about his journey with depression – on That Vitamin Summit – is not to be missed if you are depressed, have ever suffered with depression or if you have a loved one or friend with depression. He shares how he feels a sense of complete hopelessness at times:

It descends like a black cloud that makes me almost sort of retreat into myself. And my eyes will know and I don’t want to take the world in. I don’t want to get out of bed at times. Actually, that’s one of the things that … one of the only things that actually helps me, is going to bed and lying down.

Winston Churchill famously described it as this black dog who’d come in and lay beside him at night.

“From the moment my eyes opened in the morning, I am engaged in a battle. I must protect myself with armor against ongoing, negative, intrusive thoughts that flood into my brain, while sending my prefrontal cortex, which is the home of logical thought, the green light to make decisions and take charge of my brain’s limbic system. That is, before the fear center completely spazzes out. I spend more time and energy chasing and maintaining good health than I do in any other aspect of my life. My marriage, family or work. Because I know that everything meaningful and good around me depends on a stable base. And I hope and pray that one day, I don’t have to fight so hard for my sanity.”

He talks about how he is affected by sugar and low blood sugar, and how he’s found some benefits with niacin, chromium, magnesium and tryptophan (when he’s consistent with taking them!).

Trevor actually talks about the GABA interview I did with him a few days earlier and how he’s very interested in what he learned. He is planning to do a trial of GABA to see if it can help him further.

Here is a snippet from my interview on GABA (so do tune in to this interview if you’re new to my work and the targeted amino acids):

GABA is really quite profound. When I had my anxiety, GABA was my lifesaver. It completely turned my life around. Within three days of using GABA, the panic attacks stopped and the anxiety started to go down, and then I had to look for all the other root causes. It worked immediately so I’m a complete believer, just because I’ve experienced it myself. You’ll hear a lot of people say GABA won’t work. It doesn’t cross the blood/brain barrier so it’s not going to have an impact.

We’ve now got research showing that there may be ways that it crosses the blood/brain barrier. We’ve also got research showing that we have GABA receptors in various parts of our body. We’ve got a lot in our muscles, and with low GABA symptoms you’ll have physical tension.

The beautiful thing is it works. It works quickly, and if you have these low GABA symptoms, which is the physical anxiety, which could be panic attacks. It could be stress eating, it could be drinking to calm down. If you are the kind of person who needs wine to wind down at the end of the day, that’s a big sign that you may need GABA. You take the GABA and you just feel this physical tension release from you, you know you’re onto something good.

I just wish I’d known about his struggles with depression at the time of our interview – I would have talked more about tyrosine for dopamine support (for curl up in bed depression) and DPA for endorphin boosting (for low endorphins weepy depression).

I did discuss gluten and would consider this especially since his daughter has issues with it. I talked about low serotonin and mentioned Lidtke tryptophan. If someone doesn’t do well on another brand I’d have them trial the Lidtke brand. I’d also look into SIBO – I have SIBO and rice and grains make me feel flat and low and I see this often with clients. Finally I’d look into lithium orotate for keeping an even mood.

Trevor shares these wise words at the end of his interview:

You do find that when you actually bite the bullet and share it with people,

people are very, very understanding. And actually, you’re amazed that many people have been there themselves.

I could not agree more which is why I’ve always shared my journey with anxiety. I appreciate him for being willing to share his story with depression!

If you’re not already registered here is the registration link for That Vitamin Summit

Feel free to post questions or feedback below – and share your story with anxiety or depression if you feel drawn to do so

GABA, toxins, hormones, autoimmunity – encore of The Diabetes Summit

March 28, 2017 By Trudy Scott Leave a Comment

Brain Mowll is host of the 4^th season of the Diabetes Summit and here are all the speakers and topics in the encore replay line-up (including yours truly).

TRUDY SCOTT, CN: Understanding Anxiety: The Connection to Diabetes

Learn about the link between diabetes, anxiety, and depression
Understanding the root imbalances underlying anxiety
Natural solutions and supplemental support for anxiety

We may need to look at low serotonin as well because we’ve got two kinds of anxiety when it comes to neurotransmitters, the low GABA, which is the physical anxiety, and the low serotonin, which is more the ruminating thoughts, the worry in the head, the reprocessing, the negative self-talk. So we often have low GABA, and we often have low serotonin as well. And both of those have a corresponding amino acid that helps to raise it. With low GABA we use GABA. With low serotonin we use tryptophan or 5-HTP. And we’re going talk about that one in a second. But the interesting thing is I was really excited to see that there’s some really new research on how GABA has some pretty promising benefits in terms of diabetes support as well.

Read some additional snippets from my interview: Diabetes, anxiety and GABA

RAZI BERRY: Using Naturopathic Principles to Prevent Diabetes

Learning from Razi’s health experience and journey
How toxins in our environment can disrupt metabolism
Natural solutions to improve blood sugar and overall health

Read some snippets from her interview here: Anxiety, phenibut, toxins and cold showers for detoxification

ANNA CABECA, DO: Creating Hormone Balance to Optimize Metabolic Health

The keys to balancing hormones to burn fat and control sugar
Understanding the connection between menopause and metabolism
How to optimize hormone levels

Dr Cabeca shares this about the ketogenic diet (for women), going keto-crazy and being like a witch when eating too low-carb:

…if you’re working on a ketogenic diet and lifestyle, check to see your urine. And you’re most likely acidic. But now, get that pH up into an alkaline range, and you’ll see your neurotransmitters will balance. You’ll feel calmer. You’ll sleep better. You’ll start to melt fat away which is huge. And that made all the difference in the world, combing those two.

Read some additional snippets from her interview: Menopause: insulin, cortisol, and oxytocin (an interview with Dr. Anna Cabeca)

TOM O’BRYAN: Autoimmune Disease and the Connection To Diabetes

Understanding what drives autoimmune disease
Exploring various toxins that inundate our lives
How to balance the immune response to allow proper healing

SAYER JI: What the Evidence Reveals About Reversing Diabetes

What the peer reviewed, medical literature shows
The best natural strategies to reverse diabetes
The role of supplements and helpful nutrients

BJ HARDICK: Sugar, Detox, and The Brain: Natural Strategies For Healing

Understanding damaging foods and how to remove them
How to properly structure a detoxification program
Type 3 diabetes and how dysglycemia effects the brain

SACHIN PATEL: A New Model for Medicine, Diabetes, and Blood Sugar Health

Re-evaluating the healthcare model and redefining our roles
How to be empowered to control your health as a patient
A new model for caring for the body and optimizing health

This aspect of why we eat is seldom addressed and it’s profound:

When you are living a life that is on purpose – that requires you to be eating healthy because you’re going to do whatever it takes to eliminate things that are going to impact that purpose.

I also love the analogy of the right fuel in the car but driving in the wrong direction (like hating your job or not having a purpose):

When you are living a life that is on purpose – that requires you to be eating healthy because you’re going to do whatever it takes to eliminate things that are going to impact that purpose

NIKI GRATRIX: The Mind-Body Connection to Metabolic Health

How to tap into your internal abundance of energy
Understand ACE (adverse childhood events) score and how childhood events impact health
Natural techniques and strategies to let go of limits

PETER OSBORNE: The Autoimmune Connection to Blood Sugar and Diabetes

The connection between autoimmune and blood sugar
How to test and treat autoimmune disease effectively
Natural solutions to reduce inflammation and heal the body

MICHAEL MURRAY, ND: The Four Types of Blood Sugar Problems in Diabetes

Understanding a natural medicine approach to diabetes
Dr. Murray’s four types of blood sugar problems
Natural strategies to address the specific blood sugar issues

JOEL KAHN, MD: A Plant-Based Approach to Heart Health and Blood Sugar Health

Sorting through the confusion about dietary strategies
Understanding the importance of plant-based foods
Key nutrients and supplements for heart health

I’d like to add that while I respect Dr. Kahn’s cardiology diet expertise, I am an advocate of quality animal protein and have found that many people with anxiety and depression typically don’t do very well on a vegan diet. His discussion was professional and very respectful and I do wholeheartedly agree with this:

I think whether grass fed beef, free range, omega 3 rich eggs are healthy or not, and that’s probably not possible to solve that question completely, the data’s here, there, or frankly there’s not enough data, just always add these organic brightly colored fruits and vegetables to whatever you’re eating

He also acknowledged Dr. Hyman’s coining of the term, the Pegan diet, which combines the best of a Paleo and vegan diet saying

It’s a useful term. It’s another way to say eat a very clean, very vegetable rich diet with a little wiggle room [i.e. the addition of quality animal protein]

We really do need a study comparing a real foods diet with feedlot meat and farmed fish – with a real foods diet with grass-fed meat and wild fish!

Here is the link to register for the Diabetes Summit if this is the first you’re hearing about it. You can still sign up to listen!

Enjoy these encore day replays!

SMILES diet depression trial: reduced depression and anxiety

March 24, 2017 By Trudy Scott 16 Comments

The SMILES trial, A randomised controlled trial of dietary improvement for adults with major depression was recently published BMC Medicine. It is the first randomized controlled trial to test whether dietary improvement can actually treat depression. Yes, we’re using dietary improvement and treat in the same sentence!

The objective was to determine if “structured dietary support, focusing on improving diet quality using a modified Mediterranean diet model” would have an impact on mood. The outcome is very exciting:

‘SMILES’ was a 12-week, parallel-group, single blind, randomised controlled trial of an adjunctive dietary intervention in the treatment of moderate to severe depression. The intervention consisted of seven individual nutritional consulting sessions delivered by a clinical dietician. The control condition comprised a social support protocol to the same visit schedule and length.

The results indicate that dietary improvement may provide an efficacious and accessible treatment strategy for the management of this highly prevalent mental disorder, the benefits of which could extend to the management of common co-morbidities.

These encouraging results were seen in participants who switched from a junk food diet to a real foods diet. Of the 67 who were enrolled in the study, the majority were using some form of therapy: psychotherapy and medications combined or psychotherapy only or medication only. There were 31 in the diet support group and 25 in the social support control group. Participants had to have been eating this diet in order to be accepted into the study:

a poor (low) intake of dietary fibre, lean proteins and fruit and vegetables, and a high intake of sweets, processed meats and salty snacks.

The dietary approach followed by participants in the study intervention group was the ‘ModiMedDiet’ which is based on the Australian Dietary guidelines and the Dietary Guidelines for Adults in Greece.

The primary focus was on increasing diet quality by supporting the consumption of the following 12 key food groups (recommended servings in brackets): whole grains (5–8 servings per day); vegetables (6 per day); fruit (3 per day), legumes (3–4 per week); low-fat and unsweetened dairy foods (2–3 per day); raw and unsalted nuts (1 per day); fish (at least 2 per week); lean red meats (3–4 per week), chicken (2–3 per week); eggs (up to 6 per week); and olive oil (3 tablespoons per day), whilst reducing intake of ‘extras’ foods, such as sweets, refined cereals, fried food, fast-food, processed meats and sugary drinks (no more than 3 per week). Red or white wine consumption beyond 2 standard drinks per day and all other alcohol (e.g. spirits, beer) were included within the ‘extras’ food group. Individuals were advised to select red wine preferably and only drink with meals.

The dietary composition of the ModiMedDiet was as follows: protein 18% of total energy; fat 40%; carbohydrates 37%; alcohol 2%; fibre/other 3%.

Here are the reasons I’m excited about this research:

It’s the first randomized controlled diet depression study and ONE THIRD of the dietary intervention group saw improvements in their depression symptoms. This was just diet alone and switching from processed/junk food to real food with no specific dietary restrictions!
Participants also reported improvements in anxiety symptoms.
The authors even addressed the cost factor, stating it was more affordable to eat this way ($112 per week vs $138 per week).
The authors address the fact that the dietary intervention group was able to make these dietary changes “despite the fatigue and lack of motivation” that we so commonly see with depression.
I’m optimistic about it paving the way for making dietary approaches part of the standard of treatment for mental health conditions. The paper suggests the addition of “clinical dieticians to multidisciplinary mental health teams.” I’d like to add that these dieticians, together with nutritionists and health coaches would need to be well versed in functional medicine approaches.
According to an article on ABC, one participant continued the Mediterranean diet after finishing the study and is now doing a diploma in health science. How inspiring is this? When we get results like this we want to share them with everyone!

These are very encouraging results and we applaud the positive results of this SMILES study which are truly groundbreaking.

Let’s also be aware of where we are headed with future research and how we can improve on the trial diet. The researchers conclude with this comment about future research:

The scaling up of interventions and identification of the pathways that mediate the impact of dietary improvement on depressive illness are also key imperatives

Professor Jacka recently shared this paper on how personalized dietary interventions successfully lower post-meal glucose i.e. how certain foods can affect two people quite differently because of our unique gut bacteria. She said that she wants to do a similar personalized nutrition study for depression if they are successful in obtaining NHMRC funding.

Here are some questions I’ve been asked about this SMILES trial (and I’m sharing here in case you have similar questions):

why did only one-third of the study intervention group see improvements?
why was wheat and other grains included?
why was low fat dairy and lean meats emphasized?
why was there no mention of grass-fed meat, wild fish, healthy fats like butter and coconut oil, pastured eggs or chickens or quality organic fruits and vegetables?

The ideal dietary approach for anxiety, depression and any health condition is always one that high quality, is personalized and takes into account biochemical individuality. With the removal of gluten, grains and the inclusion of the other dietary changes mentioned above, plus addressing all nutritional imbalances I expect we will see more than one-third of the dietary group experiencing improvements in depression in future trials.

I truly appreciate the work of Professor Felice Jacka and her team and look forward to seeing more studies like the SMILES trial, using a personalized approach and quality foods that include grass-fed red meat and wild fish, plus pastured eggs or chickens, and healthy fats; and organic produce as a baseline.

And then future trials that also look at the impacts of these dietary changes on anxiety and depression: gluten and/or grain removal; removal of high histamine foods and high oxalate foods; a low FODMAPs diet; the specific carbohydrate diet/SCD; a Paleo diet and so on – all based on biochemical individuality. We know these diets works in clinical practice and now we just need the research to back this up. In part 2 of the blog, I share some incredibly inspiring diet-depression and diet-anxiety Paleo success stories.

In summary:

a simple change like switching from junk to real food can have a major impact on your depression and anxiety – ONE THIRD of the dietary intervention group saw improvements in their depression symptoms and many also saw reduced anxiety. This is profound!
you may need to make additional dietary changes (gluten-free, grain-free, low FODMAPs i.e. avoiding or adding certain foods based on your biochemical individuality) and always add healthy fats and focus on quality
you may also need to address brain chemical imbalances with amino acids supplements, address gut health, adrenal issues, low zinc, low vitamin B6, low vitamin D etc. too

Are you encouraged by this research?

And have you made similar dietary changes to those done in the SMILES trial and seen a reduction in your anxiety and depression?

Have you removed gluten or grains and made additional dietary changes, and added supplements and seen even more benefits?

Note: to avoid confusion I’ve used the Australia spelling of “randomised” and “fibre” in the quoted sections and the US spelling “randomized” elsewhere in the blog.