Depression and Suicide as Chronic Inflammatory Disease Processes and the Effect of the Standard American Diet versus the Mediterranean Dietary Pattern for Treatment

Depression and suicide are very personal for me. On September 11, 2015, my oldest son, Oscar, died of pediatric suicide after being diagnosed with depression in April of the same year. He was 15 years old when he died. We had followed the widely accepted formula of therapy (weekly even) and antidepressant medication to no avail. In the months following his death I was devastated and confused, yet motivated to find answers. The language commonly used when people talk about others who die of suicide didn’t sit well with me, I felt myself revolting at a cellular level every time I heard someone try to comfort me by saying that “he had a choice”. I had seen how hard he had tried to live. I had seen how he had treated his little brother and sister so kindly and with such concern and compassion, I would often refer to him as “my little mother hen”. He was always so concerned about everyone around him and their safety and well being. And as I started to research depression and suicide more deeply, both scholarly articles and the lived experiences of other suicide loss survivors and suicide attempt survivors, I became more and more convinced that he didn’t have a choice, that suicide is a disease process not understood.  

Earlier this year I read an article online that approached depression and suicide as a chronic inflammatory disease process and I was fascinated! I felt a complete eureka moment and decided to buy the cookbook mentioned in the article, Anti-Inflammatory Eating for a Happy, Healthy Brain by Michelle Babb, MS, RD, CD. I felt a difference in not just my mental health, but in my body as well, after implementing the suggestions and recipes in the cookbook on a limited basis (my family has been slow to adjust to and embrace the new lifestyle recommended by this cookbook). Research repeatedly states variances of: “The Western dietary pattern…has been associated with higher cardiovascular disease (CVD) risk and worse levels of biomarkers of endothelial dysfunction and inflammation. Moreover, physiological and biological links between CVD, inflammation and depressive disorders have been repeatedly suggested. Therefore, it is plausible that some mechanisms implicated in the genesis of CVD could be also shared by depression.” (Sánchez-Villegas, Almudena, et al.) Moreover, the standard American diet (SAD), is, indeed, making us not just sad, it is making us suicidal. The SAD is known for high amounts of inflammatory producing ingredients, namely refined sugar, saturated fat, sodium and processed grains, i.e. easy to eat processed foods. And who can blame us when it is cheaper and easier to go through the drive through at a fast food restaurant than it is to grocery shop and cook at home? One of the characteristics of our Western culture is the desire for instant gratification and nothing is as quick and easy as the SAD. The SAD provides us empty calories which are low in antioxidants because it is a dietary pattern that lacks fresh fruits and vegetables. The result is inflamed brains that are depressed and suicidal. “In one study, researchers discovered an association between oxidative stress and suicide attempts. Those who had attempted suicide had significantly higher levels of oxidative metabolites in their blood as well as lower antioxidant levels.” (Babb, Michelle) A very recent study utilizing positron emission tomography (PET) shows a positive correlation between markers for inflammation and depression with suicidal ideation. “…we have replicated the first PET findings of increased translocator protein (TSPO) availability…in the anterior cingulate cortex (ACC) of medication-free patients in a major depressive episode (MDE). Our findings add support for the presence of a neuroinflammatory process in major depressive disorder (MDD) and for TSPO as a therapeutic target. Trials of anti-inflammatory agents in MDD have indicated that they might be most effective in a subset of individuals with heightened inflammation, suggesting that a more targeted ‘personalized’ strategy might be a successful approach to treating depression.” (Holmes, Sophie E., et al.) It seems obvious that our diets affect our brains.

An anti-inflammatory diet is basically the Mediterranean Diet Pattern (MDP), and so that has become the lens through which I frame educating my loved ones about the changes we are making to our diet. The Mediterranean Dietary Pattern (MDP) emphasizes the consumption of vegetables, fruit and nuts, cereal, legumes, and fish. Because of this the MDP has a healthy monounsaturated- to saturated fatty acids ratio of 1:2. “The MDP is associated with better glucose metabolism, reductions in blood pressure, and protection against abdominal obesity, the metabolic syndrome, and higher high density lipoprotein cholesterol levels.” (Sánchez-Villegas, Almudena, et al.) The importance of omega-3 fatty acids for protection against inflammation is profound. Omega-3 fatty acids are polyunsaturated fatty acids (PUFA). In Western countries over the past one-hundred years our intake of omega-3 fatty acids has declined significantly. Currently, our intake of omega-6 fatty acids (which are found in abundance in processed foods and vegetable oils) is twenty times that of our average omega-3 intake. “Given that approximately 20% of the dry weight of the brain is made up of PUFA and that one out of every three fatty acids in the central nervous system (CNS) are PUFA, the importance of these fats cannot be argued. Considering that highly-consumed vegetable oils have significant omega-6 to omega-3 ratios, it is quite plausible that, for some individuals, inadequate intake of omega-3 fatty acids may have neuropsychiatric consequences. While far from robust at this time, emerging research suggests that omega-3 fatty acids may be of therapeutic value in the treatment of depression.” (Logan, Alan C.) This is more evidence that we are on the right track to changing our mental health by changing our diets.

Further research is needed to verifiably correlate the SAD with TSPO in the human brain to diagnose suicide. This is my main focus of interest considering my personal experience as a suicide loss survivor. Once TSPO has been isolated and identified in brains of those with suicide reliably, forward progress can be made in researching specific modulations to those individuals’ diets and the effect of the MDP on what we expect to see as a decrease in TSPO, and therefore, a decrease in the symptoms of suicide. I think it is important to focus on TSPO since it is possible to isolate that particular protein and visualize it via a PET scan. It is important to choose one diagnostic criteria and utilize it until a standard of care can be established with the evidence provided by repeated clinical applications. 

Another point that needs to be addressed is education. When we are constantly bombarded by mass advertising campaigns showering us with all of the latest techniques in marketing it is impossible to resist grabbing that soda, hamburger, or candy. This is why a massive public health education campaign must be developed to combat the modern advertising efforts of major corporations who are more interested in their bottom line than the health of the general public. These efforts will change the conversations we are having about depression and suicide. It has never been more clear to me that depression and suicide are chronic inflammatory disease processes. How exciting that we have the opportunity to treat these diseases of chronic inflammation with simple dietary changes! By choosing vegetables, fruit and nuts, cereal, legumes, and fish we are choosing a happy, healthy brain.  

My favorite cookbook is Anti-Inflammatory Eating for a Happy, Healthy Brain by Michelle Babb, MS, RD, CD. One of my favorite things about this cookbook is that the author wrote it with the symptoms of depression in mind and how they would affect a person as they are attempting to make such a massive change in their life. She did this by rating each one of the recipes in the cookbook on a difficulty meter of one to five. Most of the recipes in the cookbook are on the low end of the difficulty meter, which puts a large number of different recipes at your disposal right away. One of my favorite recipes from this cookbook is Southwestern Burrito Bowl  (Difficulty Meter of 2). It has quinoa and black beans as the main protein ingredients, baby kale (or spinach), fire-roasted peppers (which I was able to purchase at Costco!), frozen corn, green chiles, pico de gallo, shelled pumpkin seeds, and an avocado.

Another reason I love this cookbook is because she gives you a complete guide in the first pages of the book on not just why an anti-inflammatory diet is important to brain health, but how it works to change your brain. She discusses the benefits, uses and also storage tips of each of the ingredients she suggests for your pantry. And then to top it off she offers three different menu plans with shopping lists, each for a full week of happy, healthy eating!!  The following recipe is easy, incorporates fairly common ingredients, and it tastes great. What do you have to lose by trying it?

References

Babb, Michelle. Anti-Inflammatory eating for a happy, healthy brain: 75 recipes for improving depression, anxiety, and memory loss. Sasquatch Books, 2016.

Holmes, Sophie E., et al. “Elevated Translocator Protein in Anterior Cingulate in Major Depression and a Role for Inflammation in Suicidal Thinking: A Positron Emission Tomography Study.” Biological Psychiatry, 2017, doi:10.1016/j.biopsych.2017.08.005.

Logan, Alan C. “Omega-3 fatty acids and major depression: A primer for the mental health professional.” Lipids in Health and Disease, Biomed Central, 9 Nov. 2004, lipidworld.biomedcentral.com/articles/10.1186/1476-511X-3-25.

Sánchez-Villegas, Almudena, et al. “Fast-Food and Commercial Baked Goods Consumption and the Risk of Depression.” Public Health Nutrition, vol. 15, no. 3, 2012, pp. 424–432., doi:10.1017/S1368980011001856.

Sánchez-Villegas, Almudena, et al. “Association of the Mediterranean Dietary Pattern With the Incidence of Depression.” Archives of General Psychiatry, vol. 66, no. 10, Jan. 2009, p. 1090., doi:10.1001/archgenpsychiatry.2009.129.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s