In this informative webinar, with expert nutritionist Dr Nina Bailey, you will learn about how we can optimise our diet to help manage depressive symptoms: - Foods the brain needs to function: what we should be eating - Foods that starve the brain of nutrients: what foods we really need to avoid - Food, mood and money: how to eat well on a budget - Supplements: the best nutrients for depression, backed up by science By making some relatively simple dietary changes that may, in some cases, include the use of dietary supplements, it is possible to see significant improvement in symptoms.

1. Nina Bailey
BSc (hons) MSc PhD ANutr
Managing Depression Through Diet

2. Mental health problems are extremely common!
1 in 4 British adults experience at least one diagnosable mental health
problem in any one year, and 1 in 6 experience this at any given time
NHS expenditure on mental healthcare is high!
NHS and local authorities spent about £5 billion on adult mental health
services in 2006/07 and the total cost of antidepressants was over £276
million in 200 7
Around 46.7 million prescriptions for antidepressants were dispensed in
England in 2011 (a 9.1% increase on 2010 )
Costs for antidepressant prescribing rose by £49.8 million to £270 million
(a rise of 22.6% on 2010)
http://www.nhs.uk/news/2012/08august/Pages/becoming-nation-of-happy-pill-poppers-fears.aspx)

3. And yet:
Food directly influences brain function and mood
Living with depression can have a significant impact on our appetite
and eating habits
Some people lose interest in cooking and don't have the energy to
prepare meals whilst others have physical or emotional symptoms that
can be linked to either over-or-under eating
Standard antidepressant drugs, such as commonly prescribed SSRIs,
(whilst providing relief for some suffers) can also present with side
effects that affect appetite, leading to undesirable weight gain or weight
loss
GP’s & mental health specialists do not generally give advice on nutrition!

4. Does the food we eat influence our risk of
developing depression?

5. “Whereas the role of diet in the prevention of other noncommunicable
diseases, such as cardiovascular disease (CVD), has been widely
investigated for the last 50 years, the relationship between diet and
depression is so far a novel and interesting field that has only emerged
in the last five to ten years”

6. “Whereas the role of diet in the prevention of other noncommunicable
diseases, such as cardiovascular disease (CVD), has been widely
investigated for the last 50 years, the relationship between diet and
depression is so far a novel and interesting field that has only emerged
in the last five to ten years”

7. “Long term exposure to unhealthy dietary habits
independently predisposes to depression over the
life course”

8. “Chronic inflammation may underlie the
relationship between diet and depression”

9. Understanding diet quality - what is an inflammatory diet?
Pro-inflammatory foods
Lower-quality foods include highly processed snack foods, sugar-sweetened
beverages, refined (white) grains, refined sugar, fried foods, foods high in
saturated and trans fats, and high-glycemic foods such as potatoes, white bread
and pasta
Anti-inflammatory foods
High-quality foods include unrefined, minimally processed foods such as
vegetables and fruit, wholegrains, healthy fats and healthy sources of protein

11. Packaged and processed foods have become the norm in most industrialised
countries and increasingly throughout the world
Since the 1950s here has been a 70% decline in the purchase of flour – directly
attributed to the availability of ready prepared foods
There are now approximately 320,000 different packaged food and drink products
in the marketplace
In an average supermarket, there are approximately 25,000 + different products on
the shelves - yet fresh food makes up a very small percentage
At the end of 2004, total sales of the top products in the main processed food
categories (such as ‘bagged’ snacks and canned drinks) accounted for over £62 billion
in the UK alone
Changing Diets, Changing Minds: how food affects mental well being and behaviour

18.
Fish consumption and rates of depression
Prevalence of major depression decreases with apparent fish consumption in nine
countries (HIBBELN JR. Fish consumption and major depression.
Lancet 1998; 351: 1213)

19. The agricultural and industrial revolutions, followed by the globalisation
of world food trade, mean that most people in rich countries (and
growing proportions in poor countries) eat:
Small amounts of a few types of vegetables and fruit
Very few wholegrain products - our carbohydrates are mostly refined
(such as sugar and products made from white flour) - and from a very
narrow range of cereals (90% of the calories from cereals eaten in the UK
are from wheat)
Very little oily fish, but large quantities of intensively produced meat,
meat products and dairy products

20. Food
MicronutrientsFatProteinCarbohydrate
How does food affect mood?

21. Food
MicronutrientsFatProteinCarbohydrate
Vitamins &
minerals
Fatty acidsAmino acids
Complex &
simple sugars

22. Vitamins &
minerals
Fatty acidsAmino acids
Complex &
simple sugars
memory
concentration
learning
behaviour
attention
appetite
mood
sleep
sexual function
Chemical messengers
(neurotransmitters)
Brain
(structure and function)

23. ?

24. The combination of nutrients that is most commonly associated with good
mental health and wellbeing:
Polyunsaturated fatty acids (particularly the omega-3 types found in oily
fish)
Quality (organic-grass fed) animal protein
Minerals, such as zinc (in wholegrains, legumes, meat and milk),
magnesium (in green leafy vegetables, nuts and wholegrain) and iron (in red
meat, green leafy vegetables, eggs and some fruit)
Vitamins, such as folate (in green leafy vegetables and fortified cereals), a
range of B vitamins (wholegrain products, yeast and dairy products), and
antioxidant vitamins such as C and E (in a wide range of fruit and
vegetables)

25. Eat protein-rich foods to boost alertness
Try to include a protein source in your diet several times a day, especially
when you need to clear your mind, boost your energy, lift mood,
promote relaxation and help deal with stress
 Protein is broken down into amino acids
Amino acids provide the building blocks for the production of
neurotransmitters
Combine protein with complex carbohydrates (protein slows down the
absorption of sugars found in carbohydrates)
Vegetables (and fruit) provide vital ‘cofactors’ required to modify
proteins and amino acids into neurotransmitters

26. L-Tryptophan
5-HTP
Serotonin
Melatonin
Tryptophan is an
amino acid
High tryptophan foods
include nuts, seeds,
tofu, cheese, red
meat, chicken,
turkey, fish, oats,
beans, lentils, and eggs
Magnesium, zinc & B6

27. L-Tryptophan
5-HTP
Serotonin
Melatonin
Tryptophan is an
amino acid
High tryptophan foods
include nuts, seeds,
tofu, cheese, red
meat, chicken,
turkey, fish, oats,
beans, lentils, and eggs
Magnesium, zinc & B6
Mood
Sleep

28. Choose your carbohydrates wisely!
The brain needs fuel, but at a constant rate
Glycaemic index
GI is a the measure of the effect that carbohydrates have on blood
sugar levels
Carbohydrates that break down quickly during digestion releasing
glucose rapidly into the blood stream will have a ‘high’ GI
Carbohydrates that break down more slowly, releasing glucose more
gradually into the bloodstream will have a ‘low’ GI

29. Sugar is inflammatory!
The more processed and refined the carbohydrate, as a rule, the faster
it breaks down in the digestive system, and the bigger the sugar rush it
delivers
 That’s why refined flours, sugars and sugar syrups pose such a problem
for our systems
Sugar plays a direct role in inflammatory diseases
Poor regulation of glucose and insulin is a breeding ground for
inflammation

30. L-Tryptophan
5-hydroxy tryptophan
Serotonin
Melatonin
Magnesium, zinc & B6
Mood
Sleep
High levels of
Inflammatory products
(cytokines) and cortisol
(stress hormone) can
disrupt the normal
production of serotonin
affecting both mood and
sleep

31.  Pro-inflammatory carbohydrates include sugar of all sorts, white rice
and refined carbohydrates made from refined or “enriched” flour (such as
pizza crust, bagels, most breads, crackers, most packaged cereals, biscuits,
cakes, etc.)
 Anti-inflammatory carbohydrates are the unrefined “whole”
carbohydrates that come packaged just the way nature designed them
including all fruits, vegetables, beans, legumes, and unrefined non-flour
wholegrains
 All anti-inflammatory carbohydrates are also brimming with nutrients,
including vitamins & minerals, phytonutrients and antioxidants

33. Optimise your gut health!
Complex carbohydrate are also a good source of fibre
Fermented foods such as fermented vegetables are also important for
optimal mental health as they are key to optimising your gut health
(prebiotics and probiotics)
Your gut is literally your ’second brain’, and can significantly influence
your mind, mood, and behavior
Your gut actually produces more mood-regulating serotonin than your
brain does!

34. 60% of our brain is comprised of fat
Deficiencies in specific kinds of fats can have a negative impact on
intelligence, behaviour and mood
Omega-6 and omega-3 fats in particular are required for brain structure
and function
Deficiencies in omega-3 are associated with a number of neurological
conditions
- Developmental disorders (i.e., ADHD)
- Depression
- Bipolar
- Schizophrenia
- Dementia

35. Choose good fats!
Fats
Include Avoid
Coconut oil Margarine
Olive oil Sunflower oil
Rapeseed oil Canola oil
Butter (grass fed is optimal)
Flaxseed oil
Fish oil
Vegetable oil

36. 1:1 25:1
Omega-6 to omega-3 ratio

37. Omega-3Omega-6
Hunter-gatherer

38. Omega-6 Omega-3
Westernised diet

39. Omega-6 Omega-3
High inflammation!!!!

40. Marine products offer a unique nutritional package
 Rich source of essential micronutrients acting as
cofactors for neurological processes
• Neurotransmitters
• Methylation
 Rich source of protein
• Tryptophan - serotonin
• Phenylalanine - dopamine
 Major source of EPA and DHA

41. Fish vs Fish oils

42. What about supplements?

43.  High strength pure EPA fish oils
 1g EPA daily for a minimum 3 months
 Effectively raise the ‘omega-3 index’ and reduce inflammation
 As effective as SSRI’s (fluoxitine) for managing depressive symptoms !!

44. Neurotransmitter precursors - tryptophan and 5-HTP
 Serotonin is made in the body and brain from the amino acid 5-HTP
which is derived from tryptophan
 Both can be found in the diet; tryptophan is found in many protein-rich
foods such as meat, fish, beans and eggs
 Tryptophan supplements are available as 500mg to 1000mg
 The highest immediate form of 5-HTP is the African Griffonia bean
(100mg-200mg dose)
 Not advised to take alongside SSRIs

45. S-adenosylmethionine (SAMe)
 SAMe is an important co-factor involved in the biosynthesis of several
hormones and neurotransmitters which affect mood, such
as dopamine and serotonin
 Supplementing the diet with SAMe increases levels of serotonin and
dopamine
 Usual dose is 100-200mg daily
 Cannot be taken alongside standard antidepressants

46. St John's Wort
St John's Wort is a herbal antidepressant containing the active ingredients
hyperforin and hypericin
Scientific studies of the herb suggest that it acts to increase the activity
and prolong the action of serotonin and noradrenalin, in a similar manner to
standard antidepressants, but with far fewer reported side effects (dry
mouth, dizziness, gastrointestinal problems, increased sensitivity to sunlight,
and tiredness)
The ‘dosage’ is 300 mg of an extract (0.3% hypericin)
Cannot be taken alongside standard antidepressants

47. Vitamin D3
 Vitamin D deficiency has long been associated with Seasonal
Affective Disorder(SAD), as well as clinical depression
 British National Diet and Nutrition surveys from 2008/2009 to
2011/2012 indicate that 25% of British adults have low vitamin D
status (and more so in Winter months)
 High dose vitamin D3 may be effective in treating symptoms (doses
have ranged from 800 IU [20µg] to 4000 IU [100µg] day)
Vitamin B-complex
 The B vitamins, especially vitamin B6, B12 and folic acid and can be
helpful in mild depression

48. Eat well, spend less
Cutting down on unhealthy food items such as ready meals, sweets, cakes,
crisps and fizzy drinks will free up more money for healthier items
Many unhealthy food items offer little or no nutritional benefit and can
actually exacerbate feelings of depression
“Let food be thy medicine and medicine be thy food.”
― Hippocrates c. 460 – c. 370 BC

49. Eat well, spend less
Get organised and try meal planning so that when you go shopping, you
can write a list and buy only what you need
We can spend a lot of our precious budget on ‘impulse’ purchases because
supermarkets are very clever at making us spend more than we want!
This also helps to avoid supermarket promotions, which are seldom
related to good foods and often only encourage spending
Shopping with a friend can be a good idea (or buy on line), if you do want
to take advantage of the healthier ‘buy one get one free’ offers!

50. Eat well, spend less
The nutrient content of fruit and vegetables begins to diminish as soon as they
are picked, so ideally you should try to only pick/buy the quantities you really
need for the next few days/meals
Frozen fruit and vegetables can be much better value than buying fresh
Frozen vegetables also tend to offer more nutrients, because they are frozen
within a very short time of being harvested
‘Fresh’ vegetables, on the other hand, are sometimes transported thousands of
miles, so aren’t always fresh when you finally eat them
Local markets or greengrocers often offer better value for money and are more
likely to sell locally sourced produce
Grow your own veg or forage for ‘free’ food!

51. Eat well, spend less
Whilst organic, grass-fed animal products (meat & dairy) are the healthiest
option when choosing a protein source, pulses and soy products can be much
cheaper than meat, and offer additional nutrients not found in meat
Cuts of meat such as skirt, flank and shin (and offal) are cheap and nutritious
Tinned sardines, mackerel, pilchards etc offer very good value for money and
are packed with omega-3!
Try cooking in bulk and freezing portions for when you don’t feel like cooking
Remember – it doesn’t have to be expensive to eat well in order to look after
not only your brain, but your whole body
Eating the right foods can improve memory, mood and energy levels as well as
improve sleep patterns

52. Top tips for managing mood
Adopt an anti-inflammatory diet
Eat at least 5 portions of fruit and vegetables a day (4 veg and 1 fruit)
(raw fruit and vegetables provide the biggest nutrient hit)
Choose whole foods, not refined foods (and anti-nutrients i.e. sugar)
Choose good fats (limit omega-6 and increase omega-3)
Choose quality protein
Eat small portions regularly
Use supplements where appropriate

53. Pure EPA – 1g daily
Good quality B-complex
Prebiotics & probiotics
Magnesium (glycinate)
Vitamin D3
My top supplement recommendations
ninab@igennus.com