How Come They're Happy and I'm Not? (4 page)

Generally, high-quality whole foods, including varied types of vegetables and fruits as well as adequate fiber and protein sources, are crucial to physical and mental health. stressed-out systems like those of depressed patients require these even more.

So are people getting the nutrients they really need? Sadly, the answer is a clear no. Most of us consume the standard American diet, which can be shortened to SAD. Aptly named, this diet fails to provide the high-quality nutrients (such as B vitamins) necessary for metabolic processes, the antioxidant protection (such as vitamins E and C) you need to protect your cells, or the necessary protein and amino acids (like tryptophan) needed to make mood neurotransmitters. In SAD, vegetable intake is low, grains are stripped of valuable nutrition, produce is laden with pesticides, and food comes in plastic containers that release toxins into the food. Highly processed foods are missing nutrients and cannot deliver the same healthy messages to your body that whole foods can. Pesticides and plastics increase the likelihood of diabetes, cardiovascular disease, and inflammation—all of which raise the likelihood of depression (more about toxins and depression in
chapter 4
).

Research shows that even people who try to eat healthy are in trouble. A 2006 study by the American Dietetic Association reviewed approximately seventy diets from a cross section of people ranging from elite athletes who watched their dietary intake carefully to sedentary people who didn't exercise or take care of themselves. Researchers concluded that all diets in the study fell short of the recommended 100 percent recommended daily allowance of micronutrient levels. Furthermore, the more active the person, the greater the tendency toward deficiency. It seems that even when people eat healthy, the foods are fairly devoid of the nutrients they used to have years ago.

I'm often asked: “Dr. Peter, which is the best diet?”

To answer that question, I would like to share a personal story with you:

Despite the fact that medical school should be a place to learn about health, my first year of medical school at the naturopathic program at Bastyr University in Seattle was filled with stress as I did my best with a volume of information that appeared beyond my capacity. The choices I made included spending more hours studying at the expense of exercise and sleep. There was lots of reading and memorizing, and my eating focused on quick foods, usually in the form of carbohydrates to feed a brain that was looking for glucose. While the brain makes up about 2 percent of the mass in our body, it burns through about half the calories the body uses. This is why frenetic students (and stressed-out people in general) love to eat cookies, bagels, and cakes. Ironically, while I was studying health, I was becoming less healthy. By my second year, I had insomnia, anxiety, and regular bouts of heart palpitations and irritability. Although I was not depressed, my mood gradually lowered as the months of insomnia continued.

In the early summer, my Italian immigrant parents booked a trip to Sicily in the early summer. Knowing I was not feeling well, they asked me to join them. My mother said: “You will feel better—you should come.” I was feeling so awful, I was sure taking a trip to Sicily and being five thousand miles away from my Seattle home would only make me worse. Luckily, Italian mother guilt got to me, and I agreed to go.

I met my parents in Sicily near my father's coastal hometown after a sixteen-hour trip via New York, Rome, and Palermo. Worried about me, the first thing my mother did—like any loving Italian mother—was make me a meal. This one featured Sicilian olive oil, fresh fish, locally grown vegetables, a small slice of fresh artisan bread, and a little wine. The fish there is so fresh, it's not even kept on ice—it's caught in the waters nearby, wrapped in seaweed, and sold within hours. After I ate, I did what any Sicilian man would do: I took a nap in the sun.

By the next day, I was sleeping like a baby, and my anxiety and physical symptoms had vanished! Now, this is no double-blind placebo controlled study—the kind modern research uses to validate a particular treatment. But when I look back now, I often wonder if all I needed was some good Mediterranean sun and food—the kind of food that kept my ancestors healthy, the kind of food Hippocrates gave to his patients.

Think about it: I had been living through the dark gray Seattle days for over a year and had not seen much sun or been converting vitamin D. Plus my food intake was primarily bready foods for quick energy. That was the first time I'd had sun, healthy oils, fresh fish fatty acids, and vibrant green nutrients in all that time—it was like telling my body, “Don't worry; you are going to be all right.”

So, to answer the diet question, if I didn't know a particular individual or her history, I would probably recommend the Mediterranean diet. While no diet is perfect for every individual, there's reason to believe the Mediterranean diet may be the choice for treating mood problems.

The Mediterranean Sea is the body of water bordering Spain, France, Italy, and the northern coast of Africa. The region touts many beautiful foods and eating rituals associated with a healthy mood.

In 2009, the Spanish government funded a detailed study of the Mediterranean diet. After four and a half years of studying ten thousand people, researchers concluded that those who ate a Mediterranean diet were about half as likely to develop depression. Specifically, the more fruits and nuts a person ate, the less depression was likely. This was also true for beans and healthy oils like olive oil. According to these researchers, aspects of this diet improve blood vessel lining and its function, lower inflammation, and reduce the risk for heart disease. All these effects can decrease the chances of developing depression.

According to researchers:

The membranes of our neurons are composed of fat, so the quality of fat that you are eating definitely has an influence on the quality of the neuron membranes, and the body's synthesis of neurotransmitters is dependent on the vitamins you're eating . . . . We think those with lowest adherence to the Mediterranean dietary plan have a deficiency of essential nutrients . . . . However, the role of the overall dietary pattern may be more important than the effect of single components. It is plausible that the synergistic combination of a sufficient provision of omega-three fatty acids together with other natural unsaturated fatty acids and antioxidants from olive oil and nuts, flavonoids, and other phytochemicals from fruit and other plant foods and large amounts of natural folates and other B vitamins in the overall Mediterranean dietary pattern may exert a fair degree of protection against depression.

Mediterranean people also drink a lot of coffee. A 2011 study published in
Archives of Internal Medicine
suggests that the more coffee women drink, the less likely they are to develop depression. A ten-year study of fifty thousand nurses found that women who drank two to three cups a day had a 15 percent lower depression risk. Those drinking four or more cups a day had a 20 percent decrease. However, tea and decaf coffee showed no difference in the rate of depression. While coffee may be preventative, it's unclear whether it can help someone who already has depression, and the effect on men is unknown. Avoid coffee if you have anxiety or insomnia.

Ever know someone who is just in the lousiest mood whenever he is hungry? Are you one of those people? Hunger and low blood sugar are primitive signals known to set off a person's stress response.
Humans are animals—and animals are unhappy when their blood sugar is low. It's an evolutionary mechanism designed to make finding food a priority. While this focus helps us avoid starvation, it also triggers anxiety and depression. For those of you who know your mood is affected by hunger, it's very important to eat small meals every two to three hours. Choose foods and snacks that have protein (like almond butter on an apple slice) as opposed to simple carbohydrates (like a cookie). The simple carbs spike your sugar, which sets off a reaction to surge insulin, which drops your blood sugar even lower than when it started, creating the negative pattern.

This list of ideas for good blood sugar control is a useful reference. I encourage you to copy it and keep it handy.

While generally eating healthily is good for the brain, specific foods can help a person with poor mood feel better more quickly. The following list includes some of my favorites mood-improving foods as well as those that are best researched. Please start bringing these into your life for your best mood.

Do you ever get moody and go to grab a bag of chips? There is a reason why we go for that: crunching noises make us feel better. Research suggests that the crunching sounds reach the brain, allowing pleasure centers to release endorphins. This is probably another evolutionary way to help ensure we eat.

Although chips are not the healthiest option, because crunchy food calms, you can still use this mechanism to your advantage. Carrots, peppers, celery, and other crunchy vegetables have been shown to reduce stress in the same way. Also, there are a number of healthier baked snacks, like flax meal crackers and high bran fiber crackers, that can also fill in for the job. Raw nuts are great too. Roasted nuts may be tasty, but they are not as healthy for the brain and body due to the overcooked oils they absorb. It should also be noted that when people eat too many calories from junky, crunchy foods—their mood darkens.

One 2004 study worked with female mice with both depression and low bone density. Mice that drank pomegranate extract had
significantly improved mood and normalized bone density. The pomegranate is known to have gentle plant versions of estrogen, called phytoestrogens, which may account for the improved behavior and increase in bone strength. The pomegranate may be a great food for postmenopausal women who experience both depression and have bone density concerns.

Eaten by health-conscious people for millennia, raw nuts are chock full of healthy fatty acids, protein, and minerals. Nuts are known for their ability to lower body inflammation. One study found that people who eat nuts regularly have lower blood levels of C-reactive protein (CRP), a marker of inflammation that is strongly correlated with cardiovascular disease. CRP is an even better predictor of heart problems than cholesterol is. Additionally, nuts drastically decrease interleukin-6 (IL-6, an inflammation-causing molecule) and vascular adhesion factors (which cause blood vessel stickiness and clots). CRP and IL-6 are typically quite high in people who are depressed too. The benefit in nuts is probably due to the high levels of fatty acids and magnesium. Healthy raw nuts include almonds, Brazil nuts, chestnuts, and cashews.

our world is abundant with food—so much so that 60 percent of people are obese. Yet, I cannot count how many patients have come into my office deficient in protein. Many of us simply do not eat enough protein—although we eat tons of carbs. And when we do eat protein, it comes from antibiotic- and hormone-filled, grain-fed, sedentary animals whose meat is high in saturated fat.

Protein is made of amino acids, and amino acids are the building blocks of your neurotransmitters. In excessive quantity, however, protein can suppress central nervous system serotonin levels and be problematic for anyone with kidney disease or low kidney function.

So finding the right level of protein intake is crucial. Basically, a healthy adult needs a minimum of 0.8 g of protein for every 2.2 pounds of body weight. For example: say you weigh 120 pounds. Divide 120 pounds by 2.2, to get 54.5. Now multiply that number by 0.8, giving the answer of 43.6 g of protein. If you are an avid exerciser, you need more protein and can multiply by 1 g instead of 0.8. Elite athletes (Olympians or professional athletes) should multiply by 1.2 g.

How much protein do you really need?

weight (pounds) × 0.8 g =_______g of protein you need per day

2.2 (pounds)

The best protein sources include fish, grass-fed beef, free-range chicken, beans and legumes, and some soy (like fermented natto and tempeh).

It's universally accepted that wild fish like salmon, which eat the algae and plankton at the bottom of the sea, are a healthier source of protein than even their coastline fish farm-raised counterparts. Over their life span of eating sea greens, these fish accumulate a wonderful concentration of essential fatty acids in their muscles, contributing to their healthfulness.