Navigating Nutrition's Role in Combating Depression
May 23, 2024
Dr Journal Club
Are your food choices influencing your mood? Uncover the startling connections between your diet and your mental well-being as we scrutinize a pivotal study from BMC Psychiatry. Delve into the realm of low-grade chronic inflammation and its potential role in depression, with a special focus on healthcare professionals. We dissect the use of the innovative Empirical Dietary Inflammatory Index (EDII) and how it could revolutionize your approach to combatting depressive symptoms through diet.
Join the conversation with us, Dr Journal Club, as we navigate the latest in research and evidence-based medicine, integrating thinkers at the forefront of clinical practice. Your input is vital to our discussions, so link up with us on social platforms and share your thoughts on this complex topic. Whether you're seeking to refine your clinical practice or simply curious about the impact of diet on mental health, this episode promises insights that could very well reshape your daily habits.
Are your food choices influencing your mood? Uncover the startling connections between your diet and your mental well-being as we scrutinize a pivotal study from BMC Psychiatry. Delve into the realm of low-grade chronic inflammation and its potential role in depression, with a special focus on healthcare professionals. We dissect the use of the innovative Empirical Dietary Inflammatory Index (EDII) and how it could revolutionize your approach to combatting depressive symptoms through diet.
Join the conversation with us, Dr Journal Club, as we navigate the latest in research and evidence-based medicine, integrating thinkers at the forefront of clinical practice. Your input is vital to our discussions, so link up with us on social platforms and share your thoughts on this complex topic. Whether you're seeking to refine your clinical practice or simply curious about the impact of diet on mental health, this episode promises insights that could very well reshape your daily habits.
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Introducer:
Welcome to the Dr Journal Club podcast, the show that goes under the hood of evidence-based integrative medicine. We review recent research articles, interview evidence-based medicine thought leaders and discuss the challenges and opportunities of integrating evidence-based and integrative medicine. Continue your learning after the show at www. drjournalclub. com.
Dr. Joshua Goldenberg:
Please bear in mind that this is for educational and entertainment purposes only, Talk to your doctor before making any medical decisions, changes etc. Everything we're talking about that's to teach you guys stuff and have fun. We are not your doctors. Also, we would love to answer your specific questions on drjournalclub. com. You can post questions and comments for specific videos, but go ahead and email us directly at josh at drjournalclub. com. That's josh at drjournalclub. com. Send us your listener questions and we will discuss it on our pod.
Dr. Joshua Goldenberg:
Hello everybody, this is Dr Joshua Goldenberg for the Dr Journal Club podcast. Today it is just me lonely here in the studio. You might have noticed, the past couple of weeks we've released super speedies. We haven't had our normal back and forth with Adam, we've just had a lot of technical issues. It's almost like the universe didn't want us to record. Every time we'd meet There'd be some new problem. Anyway, it has just been so many of these so far that I just felt like I should go ahead and try to record the article that we had planned to talk about before all these issues, so you would hear something from us during this time. So I'm going to talk about a study that came out just a little bit ago Pro-Inflammatory Diet and Depressive Symptoms in the Healthcare Setting. And this is a study that came out in BMC Psychiatry and we will link to it in the show notes. I just feel so sad doing this without Adam. It just feels so weird. It's like speaking out into the ether. I miss you, buddy. All right, so hopefully next week we'll all be together, but let's do this.
Dr. Joshua Goldenberg:
So essentially, it's a cute little study that tries to look at the association between diet and depression. So let me kind of walk you through this here. So there is the way they set this up. Is there's this sort of background, rationale or methodology that might connect depression with diet? So, for example, they kind of talk about all the issues that there is with depression in general. But oh, you know, meds aren't perfect and they're limited and so much of the effect seems to be placebo and we need, you know, more interventions for depression. Fair enough.
Dr. Joshua Goldenberg:
And they also argue that there is growing rationale or growing evidence that inflammation, low-grade chronic inflammation in particular, may lead to a role in the development of depression. And they argue sort of different potential mechanisms such as pro-inflammatory cytokines, dnf-alpha, all the things right. So they're basically saying, look, we have some evidence connecting depression and diet. It's probably through the inflammatory cascades, and so it makes sense to study it further. Okay, and they have some clinical evidence that they point to in the background, suggesting that pro-inflammatory dietary patterns are associated with an increased risk of depression. Right, and then they say, okay, and then on the flip side, you know, regularly eating anti-inflammatory foods can reduce the risk of depression and reduce this inflammation, et cetera, et cetera. So they're setting up this argument and there was a previous instrument, the Dietary Inflamm dietary inflammatory index, that had been previously validated in other studies. That basically shows, you know, the amount of inflammatory foods that one is eating and that had been used in correlated with depression levels in people.
Dr. Joshua Goldenberg:
But the problem is what? What is the issue here? What is the issue that the authors are trying to solve or the researchers are trying to solve? They're trying to say, look, that was awesome that the authors are trying to solve. Or the researchers are trying to solve. They're trying to say, look, that was awesome, but that instrument is very difficult to use in practice, it's very cumbersome, it'll take forever, et cetera, et cetera. And other researchers had developed a sort of more quick and dirty version called the Empirical Dietary Inflammatory Index and it has been validated. But what they, what these authors want to say is okay, what if we use this instrument and try to look for association with depression as well, and the utility there would be that this is an instrument, in my opinion anyway, that is very easily used in clinics. So if we do see an association here, it might be something that providers out there might be interested in using, or even non-providers kind of assess their own diets, if you will. And this Empirical Dietary Inflammatory Index, this EDII, is really based on the weekly consumption of 16 foods that are either pro or anti-inflammatory food groups, and that's sort of the main thing that it asks about.
Dr. Joshua Goldenberg:
And then, based on that score that you get, then you say, okay, is this associated with increased risk of depression? And so that was what they tried to do. So they used my favorite REDCap software. I believe that this was done at a medical school I think a doctor of osteopathy school, I believe. But basically they went and got all of their cohort to fill out this survey that they ran through REDCap, which is the same software we use for surveys. In fact, right before this recording, I was crazily updating our RED-CAP survey for a study we're doing on teaching evidence synthesis with neurotrauma, all sorts of fun stuff We'll talk more about that later. And so basically they went ahead and they got all these patients, these participants, and they had them do this score and then they gave them the PHQ-9, which essentially measures their depression. So that's what we're looking at here.
Dr. Joshua Goldenberg:
Look, the thing is we don't do this for money. This is pro bono and, quite honestly, the mothership kind of ekes it out every month or so, right? So we do this because we care about this, we think it's important, we think that integrating evidence-based medicine and integrative medicine is essential and there just aren't other resources out there. The moment we find something that does it better, we'll probably drop it. We're busy folks, but right now this is what's out there, unfortunately, that's it. And so we're going to keep on fighting that good fight. And if you believe in that, if you believe in intellectual honesty in the profession and integrative medicine and being an integrative provider and bringing that into the integrative space, please help us, and you can help us by becoming a member on Dr Journal Club. If you're in need of continuing education credits, take our NANSEAC approved courses. We have ethics courses, pharmacy courses, general courses. Interact with us on social media, listen to the podcast, rate our podcast, tell your friends. These are all ways that you can sort of help support the cause.
Dr. Joshua Goldenberg:
So so we talked about the, the this, this instrument. Looking at 16 foods, eight were pro-inflammatory, eight anti-inflammatory. So let's just just for curiosity, let's go through this. So the pro-inflammatory foods in this instrument are red meat, processed meats, organ meats, non-oily fish, so like white fish, eggs, sugar-sweetened beverages like soda, tomatoes and refined grains. So these would all count as pro-inflammatory, meaning not good. And the anti-inflammatory foods that are asked about in your weekly intake over in this instrument are leafy green vegetables, dark yellow vegetables like carrots, pumpkins, et cetera, fruit juice, oily fish, like salmon and sardines. Coffee my dad will be happy to hear about the sardines, I will be happy to hear about the salmon Coffee, tea, wine and other beer or alcoholic beverages. So again, this is interestingly. You know, not all of these would be immediately intuitive, but this is sort of based off the Mediterranean diet. So if you think about it that way, the idea of having some alcohol and coffee as anti-inflammatory makes sense. And we do have evidence, of course, that these are anti-inflammatory, they're chock full of antioxidants, et cetera.
Dr. Joshua Goldenberg:
Ok, so you get this. You basically get this score and you get a score of, you know, pro-inflammatory foods, based on your frequency of eating them, will give you a score of like zero, one or two. And then you get negative points for your anti-inflammatory foods. They sort of cancel it out and at the end of the day you try to see you know what's your net score at the end of that. And then they're looking for an association between that and the PHQ-9. So what is the PHQ-9? That, if you're a clinician, you're probably very familiar with that, very commonly used instrument to measure depression.
Dr. Joshua Goldenberg:
Where 0 to 4 is there's basically no depression, 5 to 9, mild depression, 10 to 14, moderate, 15 and above we're talking about moderate to severe and then 20 and above severe depression. So what did they find? They have results from 631 participants. So this is a decent, pretty more than decent. This is a very large sample size.
Dr. Joshua Goldenberg:
They also looked at if they needed to transform the data for covariates of gender, previous psychiatric diagnoses, physical exercise frequency and also I thought this was interesting spiritual exercise frequency as well, and they built their model off of that and what they found was that overall, there is an association between the higher score, meaning the net pro-inflammatory index there is associated with higher depression scores, and specifically there were several specific components that were associated. So eating fewer leafy greens was correlated with more depression. Okay, that was interesting. Consuming more bread or pasta was associated with more depression. Sugar, sweetened beverages more of those met more depression or associated with more depression. Processed meats as well, and this is sort of interesting overall. So we're talking about an association here. Now. So we know people that are more depressed now are scoring higher on this pro-inflammatory diet.
Dr. Joshua Goldenberg:
The question we always have to ask with these sorts of studies is you know, association doesn't equal causation here, right? Like, is it possible that depressed people eat differently, right? And you know, if you're feeling kind of low, you go and eat a bunch of bread, for example, or maybe you're not craving the salad so much, right? So it's possible that, even though the assumption is that the diet is driving the mood here, it could be that the mood is driving the diet. So it's called reverse causation bias. So that's a concern, of course, that you need to consider with a study like this.
Dr. Joshua Goldenberg:
And it's one of the limitations of this sort of study and they kind of go through this in the discussion. They recognize that that's possible and they say that indeed, some studies have suggested that depression can lead to altered food choices. No duh, but the research being research, we had to apparently study that, et cetera, et cetera, et cetera. So these are sort of the notes that they look at. However, they do note that there are other studies that found that pro-inflammatory diets at baseline increase the risk for depression symptoms over a five-year period, especially among women, and so basically what they're saying is, yes, this could be reverse causation bias. But if you look at similar studies where they looked prospectively at this, they started with, you know, a good diet and then, or a poor diet, and looked at what developed over time with depression, not coexisting depression. They seem to suggest that there is an association there. And then, of course, previously they had given all sorts of rationale about how that could be possible, the different mechanisms through inflammation and inflammatory cytokines that we talked about earlier, and so I think that's the main take home here.
Dr. Joshua Goldenberg:
It's a cute little paper. I mean, I think it's relevant because two things. One, it's a very large survey, so over 600 participants, and I think, even though the methodology is not ironclad, meaning possibility for reverse causation bias, it fits within a narrative, et cetera, and I think the more clinically relevant aspect, at least for me when selecting this article to talk about, was the fact that this is using an instrument that we could all use in clinic. It's just sort of asking about weekly intake of these 18 foods, you know, eight pro-inflammatory, eight anti-inflammatory and I felt like that was interesting in a way to kind of maybe integrate into clinical practice, if you wish. I did run that by Adam and he was like eh, we have enough surveys and questionnaires for our patients to fill out. I don't know that I want to give them another one, so fair enough. So if you have any questions about this, please go ahead and reach out to us at josh at drjournalclubcom. Josh at drjournalclubcom. If you have any recommendations for articles, please send them. We got through our backlog and, honestly, it took me a while to even find this one, and I'm not super jazzed about this one anyway. So it must have been like a slow month in the research world. So if you have a research article that you think would be of interest to our community, go ahead and send it to us Until next time.
Dr. Joshua Goldenberg:
This is Dr Joshua Goldenberg signing off for Dr Journal Club. If you enjoy this podcast, chances are that one of your colleagues and friends probably would as well. Please do us a favor and let them know about the podcast and, if you have a little bit of extra time, even just a few seconds, if you could rate us and review us on Apple Podcast or any other distributor, it would be greatly appreciated. It would mean a lot to us and help get the word out to other people that would really enjoy our content. Thank you, hey y'all. This is Josh.
Dr. Joshua Goldenberg:
You know we talked about some really interesting stuff today. I think one of the things we're going to do that's relevant. There is a course we have on Dr Journal Club called the EBM Boot Camp. That's really meant for clinicians to sort of help them understand how to critically evaluate the literature, et cetera, et cetera Some of the things that we've been talking about today. Go ahead and check out the show notes link. We're going to link to it directly. I think it might be of interest. Don't forget to follow us on social and interact with us on social media at Dr Journal Club Dr Journal Club on Twitter. We're on Facebook, we're on LinkedIn, etc. Etc. So please reach out to us. We always love to talk to our fans and our listeners. If you have any specific questions you'd like to ask us about research, evidence, being a clinician, etc. Don't hesitate to ask. And then, of course, if you have any topics that you'd like us to cover on the pod, please let us know as well.
Introducer:
Thank you for listening to the Doctor Journal Club podcast, the show that goes under the hood of evidence-based integrative medicine. We review recent research articles, interview evidence-based medicine thought leaders and discuss the challenges and opportunities of integrating evidence-based and integrative medicine. Be sure to visit www. drrjournalclub. com to learn more.