Around 3.2 million Australians live with depression.

At the same time, few Australians meet recommended dietary or physical activity guidelines. What has one got to do with the other?

Our world-first trial, published this week, shows improving diet and doing more physical activity can be as effective as therapy with a psychologist for treating low-grade depression.

Previous studies (including our own) have found “lifestyle” therapies are effective for depression. But they have never been directly compared with psychological therapies – until now.

Amid a nation-wide shortage of mental health professionals, our research points to a potential solution. As we found lifestyle counselling was as effective as psychological therapy, our findings suggest dietitians and exercise physiologists may one day play a role in managing depression.

What did our study measure?

During the prolonged COVID lockdowns, Victorians’ distress levels were high and widespread. Face-to-face mental health services were limited.

Our trial targeted people living in Victoria with elevated distress, meaning at least mild depression but not necessarily a diagnosed mental disorder. Typical symptoms included feeling down, hopeless, irritable or tearful.

We partnered with our local mental health service to recruit 182 adults and provided group-based sessions on Zoom. All participants took part in up to six sessions over eight weeks, facilitated by health professionals.

Half were randomly assigned to participate in a program co-facilitated by an accredited practising dietitian and an exercise physiologist. That group – called the lifestyle program – developed nutrition and movement goals:

• eating a wide variety of foods
• choosing high-fibre plant foods
• including high quality fats
• limiting discretionary foods, such as those high in saturated fats and added sugars
• doing enjoyable physical activity.

The second group took part in psychotherapy sessions convened by two psychologists. The psychotherapy program used cognitive behavioural therapy (CBT), the gold standard for treating depression in groups and when delivered remotely.

In both groups, participants could continue existing treatments (such as taking antidepressant medication). We gave both groups workbooks and hampers. The lifestyle group received a food hamper, while the psychotherapy group received items such as a colouring book, stress ball and head massager.

Lifestyle therapies just as effective

We found similar results in each program.

At the trial’s beginning we gave each participant a score based on their self-reported mental health. We measured them again at the end of the program.

Over eight weeks, those scores showed symptoms of depression reduced for participants in the lifestyle program (42%) and the psychotherapy program (37%). That difference was not statistically or clinically meaningful so we could conclude both treatments were as good as each other.

There were some differences between groups. People in the lifestyle program improved their diet, while those in the psychotherapy program felt they had increased their social support – meaning how connected they felt to other people – compared to at the start of the treatment.

Participants in both programs increased their physical activity. While this was expected for those in the lifestyle program, it was less expected for those in the psychotherapy program. It may be because they knew they were enrolled in a research study about lifestyle and subconsciously changed their activity patterns, or it could be a positive by-product of doing psychotherapy.

There was also not much difference in cost. The lifestyle program was slightly cheaper to deliver: A$482 per participant, versus $503 for psychotherapy. That’s because hourly rates differ between dietitians and exercise physiologists, and psychologists.

What does this mean for mental health workforce shortages?

Demand for mental health services is increasing in Australia, while at the same time the workforce faces worsening nation-wide shortages.

Psychologists, who provide about half of all mental health services, can have long wait times. Our results suggest that, with the appropriate training and guidelines, allied health professionals who specialise in diet and exercise could help address this gap.

Lifestyle therapies can be combined with psychology sessions for multi-disciplinary care. But diet and exercise therapies could prove particularly effective for those on waitlists to see a psychologists, who may be receiving no other professional support while they wait.

Many dietitians and exercise physiologists already have advanced skills and expertise in motivating behaviour change. Most accredited practising dietitians are trained in managing eating disorders or gastrointestinal conditions, which commonly overlap with depression.

There is also a cost argument. It is overall cheaper to train a dietitian ($153,039) than a psychologist ($189,063) – and it takes less time.

Potential barriers

Australians with chronic conditions (such as diabetes) can access subsidised dietitian and exercise physiologist appointments under various Medicare treatment plans. Those with eating disorders can also access subsidised dietitian appointments. But mental health care plans for people with depression do not support subsidised sessions with dietitians or exercise physiologists, despite peak bodies urging them to do so.

Increased training, upskilling and Medicare subsidies would be needed to support dietitians and exercise physiologists to be involved in treating mental health issues.

Our training and clinical guidelines are intended to help clinicians practising lifestyle-based mental health care within their scope of practice (activities a health care provider can undertake).

Future directions

Our trial took place during COVID lockdowns and examined people with at least mild symptoms of depression who did not necessarily have a mental disorder. We are seeking to replicate these findings and are now running a study open to Australians with mental health conditions such as major depression or bipolar disorder.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Adrienne O’Neil, Professor, Food & Mood Centre, Deakin University and Sophie Mahoney, Associate Research Fellow, Food and Mood Centre, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Do you struggle to eat your fruits and vegetables? You are not alone. Less than 5% of Australians eat the recommended serves of fresh produce each day (with 44% eating enough fruit but only 6% eating the recommended vegetables).

Adults should aim to eat at least five serves of vegetables (or roughly 375 grams) and two serves of fruit (about 300 grams) each day. Fruits and vegetables help keep us healthy because they have lots of nutrients (vitamins, minerals and fibre) and health-promoting bioactive compounds (substances not technically essential but which have health benefits) without having many calories.

So, if you are having trouble eating the rainbow, you might be wondering – is it OK to drink your fruits and vegetables instead in a juice or smoothie? Like everything in nutrition, the answer is all about context.

It might help overcome barriers

Common reasons for not eating enough fruits and vegetables are preferences, habits, perishability, cost, availability, time and poor cooking skills. Drinking your fruits and vegetables in juices or smoothies can help overcome some of these barriers.

Juicing or blending can help disguise tastes you don’t like, like bitterness in vegetables. And it can blitz imperfections such as bruises or soft spots. Preparation doesn’t take much skill or time, particularly if you just have to pour store-bought juice from the bottle. Treating for food safety and shipping time does change the make up of juices slightly, but unsweetened juices still remain significant sources of nutrients and beneficial bioactives.

Juicing can extend shelf life and reduce the cost of nutrients. In fact, when researchers looked at the density of nutrients relative to the costs of common foods, fruit juice was the top performer.

So, drinking my fruits and veggies counts as a serve, right?

How juice is positioned in healthy eating recommendations is a bit confusing. The Australian Dietary Guidelines include 100% fruit juice with fruit but vegetable juice isn’t mentioned. This is likely because vegetable juices weren’t as common in 2013 when the guidelines were last revised.

The guidelines also warn against having juice too often or in too high amounts. This appears to be based on the logic that juice is similar, but not quite as good as, whole fruit. Juice has lower levels of fibre compared to fruits, with fibre important for gut health, heart health and promoting feelings of fullness. Juice and smoothies also release the sugar from the fruit’s other structures, making them “free”. The World Health Organization recommends we limit free sugars for good health.

But fruit and vegetables are more than just the sum of their parts. When we take a “reductionist” approach to nutrition, foods and drinks are judged based on assumptions made about limited features such as sugar content or specific vitamins.

But these features might not have the impact we logically assume because of the complexity of foods and people. When humans eat varied and complex diets, we don’t necessarily need to be concerned that some foods are lower in fibre than others. Juice can retain the nutrients and bioactive compounds of fruit and vegetables and even add more because parts of the fruit we don’t normally eat, like the skin, can be included.

So, it is healthy then?

A recent umbrella review of meta-analyses (a type of research that combines data from multiple studies of multiple outcomes into one paper looked at the relationship between 100% juice and a range of health outcomes.

Most of the evidence showed juice had a neutral impact on health (meaning no impact) or a positive one. Pure 100% juice was linked to improved heart health and inflammatory markers and wasn’t clearly linked to weight gain, multiple cancer types or metabolic markers (such as blood sugar levels).

Some health risks linked to drinking juice were reported: death from heart disease, prostate cancer and diabetes risk. But the risks were all reported in observational studies, where researchers look at data from groups of people collected over time. These are not controlled and do not record consumption in the moment. So other drinks people think of as 100% fruit juice (such as sugar-sweetened juices or cordials) might accidentally be counted as 100% fruit juice. These types of studies are not good at showing the direct causes of illness or death.

What about my teeth?

The common belief juice damages teeth might not stack up. Studies that show juice damages teeth often lump 100% juice in with sweetened drinks. Or they use model systems like fake mouths that don’t match how people drinks juice in real life. Some use extreme scenarios like sipping on large volumes of drink frequently over long periods of time.

Juice is acidic and does contain sugars, but it is possible proper oral hygiene, including rinsing, cleaning and using straws can mitigate these risks.

Again, reducing juice to its acid level misses the rest of the story, including the nutrients and bioactives contained in juice that are beneficial to oral health.

So, what should I do?

Comparing whole fruit (a food) to juice (a drink) can be problematic. They serve different culinary purposes, so aren’t really interchangeable.

The Australian Guide to Healthy Eating recommends water as the preferred beverage but this assumes you are getting all your essential nutrients from eating.

Where juice fits in your diet depends on what you are eating and what other drinks it is replacing. Juice might replace water in the context of a “perfect” diet. Or juice might replace alcohol or sugary soft drinks and make the relative benefits look very different.

On balance

Whether you want to eat your fruits and vegetables or drink them comes down to what works for you, how it fits into the context of your diet and your life.

Smoothies and juices aren’t a silver bullet, and there is no evidence they work as a “cleanse” or detox. But, with society’s low levels of fruit and vegetable eating, having the option to access nutrients and bioactives in a cheap, easy and tasty way shouldn’t be discouraged either.

Emma Beckett, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation – School of Health Sciences, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Olympian Tom Daley is the most decorated diver in Britain’s history. He is also an avid knitter. At the Paris 2024 Olympics Daley added a fifth medal to his collection – and caught the world’s attention knitting a bright blue “Paris 24” jumper while travelling to the games and in the stands.

At the Tokyo Olympics, where Daley was first spotted knitting, he explained its positive impact on his mental health.

It just turned into my mindfulness, my meditation, my calm and my way to escape the stresses of everyday life and, in particular, going to an Olympics.

The mental health benefits of knitting are well established. So why is someone famous like Daley knitting in public still so surprising?

Knitting is gendered

Knitting is usually associated with women – especially older women – as a hobby done at home. In a large international survey of knitting, 99% of respondents identified as female.

But the history of yarn crafts and gender is more tangled. In Europe in the middle ages, knitting guilds were exclusive and reserved for men. They were part of a respected Europe-wide trade addressing a demand for knitted products that could not be satisfied by domestic workers alone.

The industrial revolution made the production of clothed goods cheaper and faster than hand-knitting. Knitting and other needle crafts became a leisure activity for women, done in the private sphere of the home.

World Wars I and II turned the spotlight back on knitting as a “patriotic duty”, but it was still largely taken up by women.

During COVID lockdowns, knitting saw another resurgence. But knitting still most often makes headlines when men – especially famous men like Daley or actor Ryan Gosling – do it.

Men who knit are often seen as subverting the stereotype it’s an activity for older women.

Knitting the stress away

Knitting can produce a sense of pride and accomplishment. But for an elite sportsperson like Daley – whose accomplishments already include four gold medals and one silver – its benefits lie elsewhere.

Olympics-level sport relies on perfect scores and world records. When it comes to knitting, many of the mental health benefits are associated with the process, rather than the end result.

Daley says knitting is the “one thing” that allows him to switch off completely, describing it as “my therapy”. https://www.youtube.com/embed/6wwXGOki–c?wmode=transparent&start=0

The Olympian says he could

knit for hours on end, honestly. There’s something that’s so satisfying to me about just having that rhythm and that little “click-clack” of the knitting needles. There is not a day that goes by where I don’t knit.

Knitting can create a “flow” state through rhythmic, repetitive movements of the yarn and needle. Flow offers us a balance between challenge, accessibility and a sense of control.

It’s been shown to have benefits relieving stress in high-pressure jobs beyond elite sport. Among surgeons, knitting has been found to improve wellbeing as well as manual dexterity, crucial to their role.

For other health professionals – including oncology nurses and mental health workers – knitting has helped to reduce “compassion fatigue” and burnout. Participants described the soothing noise of their knitting needles. They developed and strengthened team bonds through collective knitting practices. https://www.youtube.com/embed/dTTJjD_q2Ik?wmode=transparent&start=0 A Swiss psychiatrist says for those with trauma, knitting yarn can be like “knitting the two halves” of the brain “back together”.

Another study showed knitting in primary school may boost children’s executive function. That includes the ability to pay attention, remember relevant details and block out distractions.

As a regular creative practice, it has also been used in the treatment of grief, depression and subduing intrusive thoughts, as well countering chronic pain and cognitive decline.

Knitting is a community

The evidence for the benefits of knitting is often based on self-reporting. These studies tend to produce consistent results and involve large population samples.

This may point to another benefit of knitting: its social aspect.

Knitting and other yarn crafts can be done alone, and usually require simple materials. But they also provide a chance to socialise by bringing people together around a common interest, which can help reduce loneliness.

The free needle craft database and social network Ravelry contains more than one million patterns, contributed by users. “Yarn bombing” projects aim to engage the community and beautify public places by covering objects such as benches and stop signs with wool.

The interest in Daley’s knitting online videos have formed a community of their own.

In them he shows the process of making the jumper, not just the finished product. That includes where he “went wrong” and had to unwind his work.

His pride in the finished product – a little bit wonky, but “made with love” – can be a refreshing antidote to the flawless achievements often on display at the Olympics.

Michelle O’Shea, Senior Lecturer, School of Business, Western Sydney University and Gabrielle Weidemann, Associate Professor in Psychological Science, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.