WELCOME CANBERRA ALUMNI Can we prevent depression by improving diet? Professor Felice Jacka DEAKIN UNIVERSITY ALUMNI SEMINAR 15 August 2018 Deakin University CRICOS Provider Code: 00113B
CAN WE PREVENT AND TREAT DEPRESSION USING DIET? Prof Felice N Jacka Food & Mood Centre, Deakin University Murdoch Childrens Research Institute The University of Melbourne The Black Dog Institute f.jacka@deakin.edu.au
OUR DIETS HAVE CHANGED Image sourced from Depositphotos
AND IT IS KILLING US Screenshot from sciencedaily.com
Poor diet? • Diets low in: – Fruits – Vegetables – Wholegrains – Nuts and seeds – Fibre – Omega 3 fatty acids – Monounsaturated fatty acids
Poor diet? • Diets high in: – Red meat – Processed meat – Added sugars – Sugar Sweetened Beverages – Trans fats – Sodium Image sourced from Depositphotos
Costs linked to poor diet 30 TRILLION DOLLARS by 2030
But aren’t we forgetting something?
Diet and nutrition = mental health?
Mental Health Leading cause of global disability Whiteford et al. Lancet 2013
Diet and mental health are linked
Screenshot from American Journal of Psychiatry
WESTERN DIET Image sourced from Pixabay
WESTERN DIET 50% MORE LIKELY TO HAVE DEPRESSIVE DISORDER
‘TRADITIONAL’ DIET Image sourced from Depositphotos
TRADITIONAL DIET 35% LESS LIKELY TO HAVE DEPRESSIVE DISORDER 32% LESS LIKELY TO HAVE ANXIETY DISORDER
Images sourced from Pixabay
HALF OF ALL MENTAL DISORDERS START BEFORE THE AGE OF 14
What is the possible contribution of early life nutritional exposures to the mental health of children? Image sourced from Pixabay
EXTERNALISING BEHAVIOURS INTERNALISING BEHAVIOURS Images sourced from Pixabay
PRENATAL DIET (during pregnancy) UNHEALTHY FOODS = HIGHER EXTERNALISING BEHAVIOURS!! Image sourced from publicdomainpictures
WHOLESOME FOODS = LOWER INTERNALISING AND EXTERNALISING BEHAVIOURS UNHEALTHY FOODS = HIGHER INTERNALISING AND EXTERNALISING BEHAVIOURS
HIPPOCAMPUS Image sourced from Wikimedia Commons
Images sourced from Pixabay
Screenshot from munchies.vice.com
Dietary improvement as a treatment strategy in major depression: the SMILES trial Jacka et al. BMC Medicine (2017) 15:23 A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial)
Mod i MedDiet : Top 10 Tips Select fruits, Include vegetables Use olive oil Water vegetables and nuts as the main Eat salmon is the with every as a snack added fat 1 to 2 best meal 60mL (3 times per Eat leafy greens drink tablespoons) of and tomatoes week extra virgin olive every day Select whole oil daily grain breads Eat Include 2 to 3 and cereals legumes Eat lean red Servings should be serves of based on your 3 to 4 meat 3 to 4 dairy every Sweets activity levels times per times per day for week Select reduced fat week special products and Limit serve sizes to occasions natural yoghurt 65 – 100g only Opie, R. S., et al. (2017). "A modified Mediterranean dietary intervention for adults with major depression: Dietary protocol and feasibility data from the SMILES trial." Nutr Neurosci: 1-15.
RESULTS Effect size: Cohen’s d = -1.16 (95% CI -1.73, -0.59) NNT= 4.1 N=67 Jacka et.al. 2017 BMC Medicine
Is it cheaper to eat an unhealthy vs a healthy diet? • Trial participants spent an estimated mean of $138 per week on food and beverages for personal consumption at the start of the trial • Total food and beverage costs per person per week for the recommended modified Mediterranean diet was estimated at $112 • The modified Mediterranean diet at $1.54 per mega-joules (MJ) was cheaper per energy unit than the cost of the current dietary intake of the SMILES participants at a mean of $2.35 per MJ $138 vs $112 per week
Mood Study: study design Mediterranean diet group (n=75) - Nutrition education session, goal setting - Fortnightly group cooking workshops for 3 months - Fortnightly food hampers; shopping/budgeting activities - Recipes and online resources (website with links, recipes, cooking videos: helfimed.org ) - Fish oil capsules for 6 months (1g DHA + EPA) Social group (n=77) - Movie vouchers at each round of assessments - Fortnightly social groups for 3 months – share holiday stories, play games, personality tests, sharing of books, watch a movie, etc.; nibbles provided - Received nutrition education and resources after final assessments Image sourced from Pixabay Zarnowiecki , Cho, Wilson, Bogomolova, Villani, Itsiopoulos, Niyonsenga, O’Dea, Segal … Parletta (2016) BMC Nutrition 2:52
HELFIMED study: effect of Mediterranean diet on mental health in people with depression 30 25 20 Baseline 15 3 months 10 5 0 MedDiet Social group DASS Depression Score ( P =0.027 for treatment interaction, N=152) Parletta, Zarnowiecki, Cho, Bogomolova, Wilson, Villani, Itsiopoulos, Segal, Niyonsenga, O’Dea et al., under review
Images sourced from Depositphotos and Pixabay
Gut microbiota 100 trillion microbes live in & on us 50% of our cells are microbes 99.5% of our genetic material is microbial (21,000 human genes vs 4.4 million microbial genes) metabolism and body weight immune system mood and behaviour
Microbiota and mental and brain health
‘GERM FREE MICE’ Altered stress response Altered brain plasticity Altered BBB Altered levels of neurotransmitters Altered immune system Altered behaviours Image sourced from Pixabay
Experimental evidence Images sourced from Pixabay
Stool transplants (FMT) Images sourced from Pixabay
EbioMedicine • RCT in 423 NZ females • Lactobacillus rhamnosus HN001 • Significantly lower depression and anxiety scores postpartum
Main factors influencing microbiota Age Diet Medication use Stress Geography Infection
Diet is critical to gut health • Plant-based diets increase microbial diversity and SCFA production • Carbohydrate and fibre intake influences microbial diversity and SCFA concentration • Detrimental influence of the western diet
‘Plant based diet’ = grains, legumes, fruits and vegetables or ‘Animal-based diet’ = meats, eggs and cheeses Consumed for five days (n=10) David et al. (2014) Nature
• Animal proteins and fats 2-3 times higher in Western diet • Carbohydrates and fibre far higher in African diet • Profound differences in gut microbiota composition African Americans switched to a high fibre/low fat diet for 2 weeks = significant reductions in mucosal inflammation and biomarkers of cancer risk (Africans switched to Western diet showed the opposite) O’Keefe SJD, Li JV, Lahti L, Ou J, Carbonero F, Mohammed K, et al. Fat, fibre and cancer risk in African Americans and rural Africans. Nature Communications. 2015;6:6342.
Reduced Diversity of the Microbiome in Modern Westernized Diet Changes in Diet & Food Production/Preparation - accompanied by fundamental shifts in microbiota composition Sonnenburg ED et al. Starving our microbial self: the deleterious consequences of a diet deficient in microbiota-accessible carbohydrates. Cell metabolism. 2014
‘Microbial accessible carbohydrates” (MACS) derived from plant fibre are reduced in western diet. Over several generations, Low-MACS diet in mice resulted in progressive loss of diversity, which was not recoverable by reintroduction of MACS Fecal transplant required to recover species diversity
Dramatic Increase in Allergic Disease since 1980 Devereux G. The increase in the prevalence of asthma and allergy: food for thought. Nat Rev Immunol. 2006
Image sourced from Pixabay
Good for Guts • Fermented foods • Olive oil • Fibre • Omega 3 fatty acids • Polyphenols Image sourced from Depositphotos and Pixabay
Bad for guts • Saturated fats • Processed foods • Added sugars • Refined carbohydrates • Binge drinking Images sourced from Pixabay
+ + ≠ ≠ Images sourced from Pixabay
Screenshot from foodandmoodcentre.com.au
CURRENT STUDIES
Image sourced from Depositphotos
Gut Feelings Project – Microbiome Can the gut microbiome predict response to prebiotic, probiotic and synbiotic interventions for low mood? • Gut Feelings Project – collaboration with University of Melbourne & Melbourne Clinic (Tanya Freijy, Prof Jerome Sarris, Dr Chee Ng). • RCT of psychobiotics for low mood • Currently recruiting at Melbourne Clinic • Funding applications under review for 16S sequencing of gut microbiome Dr Amy Loughman
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