Food + Mood—A Mental Health Series with Dr. Joseph Feuerstein, M.D. and Chef Daniel Green — an MD that prescribes only food (that’s right, no medicine) and a chef that makes the prescription delicious. In this series, we dig into top mental health conditions and how food can be used to help treat them. “Dr. Joe” is the Director of Integrative Medicine at Stamford Health, CT; Assistant Professor of Clinical Medicine Columbia University. A medical doctor specializing in family medicine, he completed a fellowship in Integrative Medicine at the University of Arizona School of Medicine, where he trained directly under the world-renowned leader and pioneer in the field of integrative medicine, Dr. Andrew Weil. Daniel Green is an internationally known chef, television host, and award-winning author, and is a healthy eating expert and well-known television celebrity cook in England, Thailand, Malaysia, Singapore, Hong Kong, Dubai, and the United States. Together, they share what foods work and why for specific conditions—and how to make that food prescription delicious.

Part 1

Treating Depression: Where Meds Fail

Depression afflicts 16.1 million Americans and counting. One third don’t get better with medical treatment—and drug side effects are unfortunately common. The good news? There are more ways to tackle depression.

Science has shown that food can be a powerful tool for people dealing with depression and anxiety—so much so it has spawned an entire field of medicine called nutritional psychiatry. Yet it’s not typically the first-line approach for managing mood disorders—unless you’re Dr. Joe Feuerstein, M.D. Director of Integrative Medicine at Stamford Health in Connecticut. Dr. Joe has teamed up with internationally renowned Food Network star, Chef Daniel Green, to highlight the huge impact food can have on our bodies and how eating wisely can improve our lives. Psycom spoke to the pair to learn more about their approach to depression. Here Dr. Joe shares the science and Chef Daniel, the recipes.

Some Drugs Target The Wrong Problem

To understand why a food-first approach may be the most prudent for depression, look no further than the medication landscape. Despite the plethora of options approved by the Food and Drug Administration (25 plus and counting!)—it seems that with depression medication more is not better. There is an unfortunately a high failure rate among prescription drugs.

“The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.” – Irving Kirsch, M.D., Associate Director of the Program in Placebo Studies at Harvard Medical School.

According to Dr. Joe, one reason these prescriptions don’t work is that they often target a problem some people with depression don’t actually have: abnormality with their neurotransmitters. This is the equivalent of thinking your car needs more gas when the battery dies. Your solving a problem that doesn’t exist, and in the meantime, ignoring the actual problem.

Placebos Are As Effective As Antidepressants

Another issue that’s been revealed in drug study after drug study is that antidepressants tend to show a great placebo response, which means that these medications are often not statistically superior to the placebo. In fact, there is a disturbing—and growing—body of evidence that the major class of antidepressant drugs, SSRIs, or selective serotonin reuptake inhibitors can scarcely be distinguished from placebo in studies; and it may only be in very severe depression that they show an advantage.

According to Irving Kirsch, M.D., Associate Director of the Program in Placebo Studies at Harvard Medical School, analyses of the  data (including unpublished data that were hidden by drug companies) reveals that most (if not all) of the benefits are due to the placebo effect. “Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin,” he and his colleagues explained in a report published in 2015. “The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.”

Treatment With Medicine Has Become Automatic

Despite these studies and statistics, the market for antidepressants is strong and growing. About 13% of Americans take antidepressants. Global revenue for antidepressants was $14.5 billion in 2014 and is expected to reach $16.8 billion by 2020—big business indeed.

Depression is considered the leading cause of disability in the world—and costs the American economy $210 billion a year in lost productivity, days of work missed, and additional care for the numerous ancillary illnesses connected to depression, like sleep disorders, anxiety, back problems, and more.

Dr. Andrew Weil, M.D., a world-renowned leader and innovator in the field of integrative medicine, has spoken about this paradox between the demand for antidepressants and their therapeutic benefit. From his perspective, part of the problem is a deep-rooted mindset on the part of doctors and patients that medication is the only legitimate way to treat disease

 

Part 2

How Nutrition Can Help

One of the best methods for managing mental health is nutrition—but therein lies a big problem. Most doctors don’t know how to provide information beyond the bare nutrition basics. Why? Because most doctors are not well-trained when it comes to nutritional health. The American Heart Association reports that 71 percent of medical schools provide less than the recommended 25 hours of nutrition education. And these “gaps in nutrition education in medical school go back decades,” said Karen Aspry, the cardiologist who chaired the AHA advisory group. All of which makes the work that Dr. Joe and other integrative practitioners do all the more important.

When we asked Dr. Joe what kind of diet was best for those suffering from mood disorders, he quickly answered: the “anti-inflammatory diet.” A research study published in the British Journal of Psychiatry investigated the dietary patterns and risk of depression among 3,486 participants over a period of five years. It found that individuals who eat whole foods (read: lots of vegetables, fruits, and fish) report fewer symptoms of depression as compared to those who eat mostly processed foods (read: lots of fried food, processed meat, refined grains, high-fat dairy products, and sweetened desserts)—and this finding takes into account confounding factors. Evidence suggests that dietary changes can indeed improve mood and quality of life without the need for medication (which may not be that helpful, anyway).

Fruits & Veggies Are Key

Both the protective benefits of fruits and vegetables and the harmful effects of animal-derived foods play a role when it comes to diet and mood. Here’s why: research links depression to inflammation in the brain and chemical imbalances of neurotransmitters. Plant-based foods are high in antioxidants and phytochemicals that can help repair damage and decrease inflammation in brain cells—and can also help restore balance to neurotransmitters.

Many people with depression have elevated levels of monoamine oxidase or MAO—an enzyme that breaks down serotonin, norepinephrine, and dopamine, the trifecta of neurotransmitters that support mood regulation. High MAO levels lead to low levels of these neurotransmitters, which can cause depression and other mood disorders.

The phytochemical quercetin, only found in plant-based foods, acts as an MAO inhibitor—which means that it operates much like a natural antidepressant. Quercetin can increase levels of serotonin, norepinephrine, and dopamine in the brain. Foods with high levels of quercetin include leafy greens, onions, apples, grapes, berries, broccoli, citrus, capers, cherries, and green tea.

In contrast—eating lots of foods high in arachidonic acid (a type of fat found only in animals)—such as chicken, eggs, beef, and other animal products, can set off a cascade of adverse chemical reactions inside us. Arachidonic acid is a precursor to inflammatory chemicals in our bodies. The result of too much arachidonic acid in our diet? General inflammation, sometimes coupled with an overreactive immune response. When this inflammation reaches the brain, feelings of anxiety, stress, depression, and hopelessness arise. People who avoid foods high in arachidonic acid—aka vegetarians—report a happier, more positive mood. The message? Eliminating inflammatory animal foods from your diet can improve your mental health (and physical health too).

The Diet-Inflammation Connection

Sweets are not too sweet to our bodies. While sugar may delight our tongues, in higher quantities, it can incite an inflammatory response that can be harmful to our mood and well-being. A growing body of evidence points to a relationship between mood and blood sugar—or glycemic highs and lows.

A 2017 study led by Anika Knüppel, of the Institute of Epidemiology and Public Health at University College London in the United Kingdom, analyzed the sugar intake of over 23,000 people. She and her team found that men who consume the most sugar—67 or more grams a days (equivalent to 17 teaspoons of sugar, or just under two cans of Coca Cola)—were 23 percent more likely to get depression or anxiety over a five-year period as compared to those who consumed less than 40 grams (10 teaspoons) of sugar a day.

More simply put: the higher the sugar, the lower the mood. And if you’re thinking that feeling depressed may cause people to reach for the ice cream and sweets—this smart study took that into account by using a mathematical model to exclude a phenomenon known as reverse causation, a common error where cause is mistaken for effect and vice versa.

All fats are not created equal. Depression is less common in countries where people eat large amounts of fish—inspiring scientists to investigate whether omega-3 rich fish oils may prevent and/or treat depression and other mood disorders. Several epidemiological studies support this connection between fish and seafood consumption and lower prevalence of depression and other mood disorders. And negative correlations between fish and seafood consumption and rates of depression have also been shown.

Two omega-3 fatty acids—EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid)—found in fatty fish, seaweed, and marine algae, are considered to have the most potential to help those with mood disorders. Why? There are a couple of ideas: these omega-3s travel easily through the brain cell membrane, where they interact with mood-related molecules in the brain. They also have anti-inflammatory actions—which can help relieve (and possibly prevent) depression and other mood dysfunctions. In the last century, intake of omega-3s has declined dramatically in Western countries.

These days, our North American diet is skewed towards omega-6 fats by a ratio of up to 20:1 likely due to increased use of vegetable oils that are high in omega-6. Here’s why this is bad: omega-6 fatty acids, while necessary in modest amounts for bodily functions, are inflammatory agents, particularly in higher amounts. Too much omega-6 can raise not only inflammation in the body but also blood pressure—which can increase the risk of heart attack and stroke. The ideal ratio of omega-6 to omega-3? An international panel of lipid experts puts it at 2:1. The takeaway here: use oils rich in omega-3, decrease consumption of fats that are high in omega-6.

Cytokines indicate inflammation. Experts cite cytokines as another piece of inflammatory evidence. Dr. Joe explained that abnormal levels of cytokines in the blood indicate high levels of inflammation in the body. People who suffer from depression typically have high levels of cytokines in their blood—again pointing the finger at inflammation as a critical component of mood disorders.

A surprising anti-inflammatory. As it turns out, aspirin may be an antidepressant. Sounds crazy, right? Dr. Joe shared a study published in the Journal of Neurology & Psychiatry, which found that anti-inflammatory agents like aspirin, ibuprofen, statins, omega-3 fatty acids, drugs that curb production of inflammatory chemicals (cytokine inhibitors), and antibiotics, could all safely and effectively curb the symptoms of major depression. This mind blowing study pooled data from 26 relevant studies, and analysis suggests that anti-inflammatory agents alone are significantly better than placebo and also enhanced the effects of standard antidepressant treatment.

The bottom line: Eating an anti-inflammatory diet that emphasizes fresh fruits and vegetables, whole grains, seeds and nuts, fish, and plant-based protein—and minimizes inflammatory foods like animal products and processed foods—is a delicious way to tackle to depression. Let’s dig in!

Part 3

What To Eat

Protein

Animal protein is full of inflammatory markers, far more than is found in plant or fish protein.

Bad protein: Beef is particularly bad as it contains eicosanoids (a byproduct of arachidonic acid, which can cause inflammation). Chicken, lamb, pork are also all more inflammatory than plant or fish protein.

Good protein: Fish is an excellent choice, from an omega-3 perspective. Plant-based proteins are anti-inflammatory.

  • Plant proteins: Tofu, Tempeh, Pea protein (Beyond Meat)
  • Fish: Salmon—sockeye is healthiest; Tuna—light skipjack tuna is best as it’s smaller and has less mercury; Sardines, Herring, Mackerel, Anchovies

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* Chef Daniel Recipes:

Tofu Guacamole

Cauliflower Pancake with Salmon

 Fish Burger with Eggplant “Bun”

 Sardine Dip

Recipes courtesy of Chef Daniel’s new cookbook: The Gotham Steel Skinny Cookbook.

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Carbohydrates

It is vital to reduce the glycemic index of the food you eat; any food that spikes blood sugar is going to have an inflammatory effect on the body. Sugar will begin to chemically interact with protein—and the lining of our blood vessels has proteins. Too much sugar will cause them to inflame. Dr. Joe recommends steering clear of wheat— even if it is whole wheat—as many of us have sensitivities.

Bad Carbs:

  • Wheat
  • Any carb that isn’t whole grain (it will have a high glycemic index that will spike blood sugars and cause inflammation.)

Good Carbs:

  • Quinoa
  • Brown whole grain rice
  • Whole grain barley
  • Yams
  • Plantains
  • Black beans, Lentils

Fruits

The sweeter the fruit, the higher its glycemic index. Keeping your sugar down also keeps inflammation down.

Bad fruit:

  • Papaya
  • Mango
  • Watermelon
  • Pineapple
  • Ripe bananas (glycemic index goes up as they ripen)

Good fruit:

  • Berries (every color is an antioxidant)
  • Tart cherries
  • Pears
  • Apples
  • Citrus
  • Plums
  • Peaches
  • Fresh apricots
  • Strawberries
  • Green bananas
  • Avocados

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* Chef Daniel Recipes:

Frozen Berry Smoothie

Recipe courtesy of Chef Daniel’s new cookbook: The Gotham Steel Skinny Cookbook.

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Fats

Not all oils are created equally.

Bad oil: Most vegetable oils are high in Omega-6s, which research has shown are pro-inflammatory. These include Corn oil, Safflower oil, and most other vegetable oils.

Good oil: Go for healthy fats, particularly those rich in omega-3 fatty acids, which can help keep inflammation at bay. Omega-3 rich oils include Canola oil, Flaxseed oil; Rapeseed oil; Walnut oil; and Avocado oil.

Vegetables

There aren’t really bad vegetables in the same way.  Some of the best anti-inflammatory vegetables include: Broccoli, Cauliflower, Asian and wild mushrooms (in particular shiitake, reishi, maitake, Lion’s mane, enoki), Spinach, Kale, Cabbage, Bell peppers, Chili peppers

Other inflammation-fighting foods

Seeds and nuts: Omega-3 rich seeds and nuts include:

  • Raw almonds
  • Raw walnuts
  • Chia
  • Flax

Spices:

  • Ginger
  • Turmeric
  • Cinnamon
  • Garlic
  • Black pepper
  • Hot peppers

Herbs:

  • Rosemary
  • Thyme
  • Oregano
  • Sage

Sweets: Dark chocolate (as in more than 75% cacao content)

Green Tea: Green tea has potent anti-inflammatory properties and has some of the highest antioxidants of any plant known. Research has shown that it can help treat diseases caused by inflammation, like arthritis, atherosclerosis, inflammatory bowel disease, and more.

Dr. Joe’s Top 10 Depression-Fighting Foods

  1. Ginger
  2. Turmeric
  3. Fish
  4. Chia
  5. Flax
  6. Berries (colors, every color is an antioxidant)
  7. Green tea
  8. Asian mushrooms
  9. Avocados
  10. Broccoli

Depression is one of the most common mental illnesses. While prescription drugs can be hugely beneficial for some; they don’t work for everyone. That’s where natural remedies, like non-inflammatory foods may help. And, even if you are taking medication to control your depression, this eating plan has no downside, unless you count missing out on some of those sweets! For more information and updates on Chef Daniel Green and Dr. Feurerstein, M.D., see below:

CHEF DANIEL GREEN

Follow him on Instagram and Facebook.

DR. JOE FEUERSTEIN. M.D.

Follow him on Facebook, Twitter, and LinkedIn.

 

 

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Last Updated: Feb 10, 2020