Food and exercise can treat depression as well as a psychologist, our study found. And it’s cheaper
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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.
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How Are You?
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Answering The Most Difficult Question: How Are You?
Today’s feature is aimed at helping mainly two kinds of people:
- “I have so many emotions that I don’t always know what to do with them”
- “What is an emotion, really? I think I felt one some time ago”
So, if either those describe you and/or a loved one, read on…
Alexithymia
Alexi who? Alexithymia is an umbrella term for various kinds of problems with feeling emotions.
That could be “problems feeling emotions” as in “I am unable to feel emotions” or “problems feeling emotions” as in “feeling these emotions is a problem for me”.
It is most commonly used to refer to “having difficulty identifying and expressing emotions”.
There are a lot of very poor quality pop-science articles out there about it, but here’s a decent one with good examples and minimal sensationalist pathologization:
Alexithymia Might Be the Reason It’s Hard to Label Your Emotions
A somatic start
Because a good level of self-awareness is critical for healthy emotional regulation, let’s start there. We’ll write this in the first person, but you can use it to help a loved one too, just switching to second person:
Simplest level first:
Are my most basic needs met right now? Is this room a good temperature? Am I comfortable dressed the way I am? Am I in good physical health? Am I well-rested? Have I been fed and watered recently? Does my body feel clean? Have I taken any meds I should be taking?
Note: If the answer is “no”, then maybe there’s something you can do to fix that first. If the answer is “no” and also you can’t fix the thing for some reason, then that’s unfortunate, but just recognize it anyway for now. It doesn’t mean the thing in question is necessarily responsible for how you feel, but it’s good to check off this list as a matter of good practice.
Bonus question: it’s cliché, but if applicable… What time of the month is it? Because while hormonal mood swings won’t create moods out of nothing, they sure aren’t irrelevant either and should be listened to too.
Bodyscanning next
What do you feel in each part of your body? Are you clenching your jaw? Are your shoulders tense? Do you have a knot in your stomach? What are your hands doing? How’s your posture? What’s your breathing like? How about your heart? What are your eyes doing?
Your observations at this point should be neutral, by the way. Not “my posture is terrible”, but “my posture is stooped”, etc. Much like in mindfulness meditation, this is a time for observing, not for judging.
Narrowing it down
Now, like a good scientist, you have assembled data. But what does the data mean for your emotions? You may have to conduct some experiments to find out.
Thought experiments: what calls to you? What do you feel like doing? Do you feel like curling up in a ball? Breaking something? Taking a bath? Crying?
Maybe what calls to you, or what you feel like doing, isn’t something that’s possible for you to do. This is often the case with anxiety, for example, and perhaps also guilt. But whatever calls to you, notice it, reflect on it, and if it’s something that your conscious mind considers reasonable and safe for you to do, you can even try doing it.
Your body is trying to help you here, by the way! It will try (and usually succeed) to give you a little dopamine spike when you anticipate doing the thing it wants you to do. Warning: it won’t always be right about what’s best for you, so do still make your own decisions about whether it is a good idea to safely do it.
Practical experiments: whether you have a theory or just a hypothesis (if you have neither make up a hypothesis; that is also what scientists do), you can also test it:
If in the previous step you identified something you’d like to do and are able to safely do it, now is the time to try it. If not…
- Find something that is likely to (safely) tip you into emotional expression, ideally, in a cathartic way. But, whatever you can get is good.
- Music is great for this. What songs (or even non-lyrical musical works) make you sad, happy, angry, energized? Try them.
- Literature and film can be good too, albeit they take more time. Grab that tear-jerker or angsty rage-fest, and see if it feels right.
- Other media, again, can be completely unrelated to the situation at hand, but if it evokes the same emotion, it’ll help you figure out “yes, this is it”.
- It could be a love letter or a tax letter, it could be an outrage-provoking news piece or some nostalgic thing you own.
Ride it out, wherever it takes you (safely)
Feelings feel better felt. It doesn’t always seem that way! But, really, they are.
Emotions, just like physical sensations, are messengers. And when a feeling/sensation is troublesome, one of the best ways to get past it is to first fully listen to it and respond accordingly.
- If your body tells you something, then it’s good to acknowledge that and give it some reassurance by taking some action to appease it.
- If your emotions are telling you something, then it’s good to acknowledge that and similarly take some action to appease it.
There is a reason people feel better after “having a good cry”, or “pounding it out” against a punchbag. Even stress can be dealt with by physically deliberately tensing up and then relaxing that tension, so the body thinks that you had a fight and won and can relax now.
And when someone is in a certain (not happy) mood and takes (sometimes baffling!) actions to stay in that mood rather than “snap out of it”, it’s probably because there’s more feeling to be done before the body feels heard. Hence the “ride it out if you safely can” idea.
How much feeling is too much?
While this is in large part a subjective matter, clinically speaking the key question is generally: is it adversely affecting daily life to the point of being a problem?
For example, if you have to spend half an hour every day actively managing a certain emotion, that’s probably indicative of something unusual, but “unusual” is not inherently pathological. If you’re managing it safely and in a way that doesn’t negatively affect the rest of your life, then that is generally considered fine, unless you feel otherwise about it.
If you do think “I would like to not think/feel this anymore”, then there are tools at your disposal too:
- How To Manage Chronic Stress
- How To Set Anxiety Aside
- How To Stop Revisiting Those Memories
- How To Stay Alive (When You Really Don’t Want To)
Take care!
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Olfactory Training, Better
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Anosmia, by any other name…
The loss of the sense of smell (anosmia) is these days well-associated with COVID and Long-COVID, but also can simply come with age:
National Institute of Aging | How Smell & Taste Change With Age
…although it can also be something else entirely:
❝Another possibility is a problem with part of the nervous system responsible for smell.
Some studies have suggested that loss of smell could be an early sign of a neurodegenerative disease, such as Alzheimer’s or Parkinson’s disease.
However, a recent study of 1,430 people (average age about 80) showed that 76% of people with anosmia had normal cognitive function at the study’s end.❞
Read more: Harvard Health | Is it normal to lose my sense of smell as I age?
We’d love to look at and cite the paper that they cite, but they didn’t actually provide a source. We did find some others, though:
❝Olfactory capacity declines with aging, but increasing evidence shows that smell dysfunction is one of the early signs of prodromal neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease.
The loss of smell is considered a clinical sign of early-stage disease and a marker of the disease’s progression and cognitive impairment.❞
Read more: Neurons, Nose, and Neurodegenerative Diseases: Olfactory Function and Cognitive Impairment
What’s clear is the association; what’s not clear is whether one worsens the other, and what causal role each might play. However, the researchers conclude that both ways are possible, including when there is another, third, underlying potential causal factor:
❝Ongoing studies on COVID-19 anosmia could reveal new molecular aspects unexplored in olfactory impairments due to neurodegenerative diseases, shedding a light on the validity of smell test predictivity of cognitive dementia.
The neuroepithelium might become a new translational research target (Neurons, Nose, and Neurodegenerative diseases) to investigate alternative approaches for intranasal therapy and the treatment of brain disorders. ❞
~ Ibid.
Another study explored the possible mechanisms of action, and found…
❝Olfactory impairment was significantly associated with increased likelihoods of MCI, amnestic MCI, and non-amnestic MCI.
In the subsamples, anosmia was significantly associated with higher plasma total tau and NfL concentrations, smaller hippocampal and entorhinal cortex volumes, and greater WMH volume, and marginally with lower AD-signature cortical thickness.
These results suggest that cerebral neurodegenerative and microvascular lesions are common neuropathologies linking anosmia with MCI in older adults❞
- MCI = Mild Cognitive Impairment
- NfL = Neurofilament Light [Chain]
- WMH = White Matter Hyperintensity
- AD =Alzheimer’s Disease
Read more: Anosmia, mild cognitive impairment, and biomarkers of brain aging in older adults
How to act on this information
You may be wondering, “this is fascinating and maybe even a little bit frightening, but how is this Saturday’s Life Hacks?”
We wanted to set up the “why” before getting to the “how”, because with a big enough “why”, it’s much easier to find the motivation to act on the “how”.
Test yourself
Or more conveniently, you and a partner/friend/relative can test each other.
Simply do like a “blind taste testing”, but for smell. Ideally these will be a range of simple and complex odors, and commercially available smell test kits will provide these, if you don’t want to make do with random items from your kitchen.
If you’d like to use a clinical diagnostic tool, you can check out:
Clinical assessment of patients with smell and taste disorders
…and especially, this really handy diagnostic flowchart:
Algorithm of evaluation of a patient who has olfactory loss
Train yourself
“Olfactory training” has been the got-to for helping people to regain their sense of smell after losing it due to COVID.
In simple terms, this means simply trying to smell things that “should” have a distinctive odor, and gradually working up one’s repertoire of what one can smell.
You can get some great tips here:
AbScent | Useful Insights Into Smell Training
Hack your training
An extra trick was researched deeply in a recent study which found that multisensory integration helped a) initially regain the ability to smell things and b) maintain that ability later without the cross-sensory input.
What that means: you will more likely be able to smell lemon while viewing the color yellow, and most likely of all to be able to smell lemon while actually holding and looking at a slice of lemon. Having done this, you’re more likely to be able to smell (and distinguish) the odor of lemon later in a blind smell test.
In other words: with this method, you may be able to cut out many months of frustration of trying and failing to smell something, and skip straight to the “re-adding specific smells to my brain’s olfactory database” bit.
Read the study: Olfactory training: effects of multisensory integration, attention towards odors and physical activity
Or if you prefer, here’s a pop-science article based on that:
One in twenty people has no sense of smell—here’s how they might get it back
Take care!
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7 Steps to Get Off Sugar and Carbohydrates – by Susan Neal
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We will not keep the steps a mystery; abbreviated, they are:
- decide to really do this thing
- get knowledge and support
- clean out that pantry/fridge/etc and put those things behind you
- buy in healthy foods while starving your candida
- plan for an official start date, so that everything is ready
- change the way you eat (prep methods, timings, etc)
- keep on finding small ways to improve, without turning back
Particularly important amongst those are starving the candida (the fungus in your gut that is responsible for a lot of carb cravings, especially sugar and alcohol—which latter can be broken down easily into sugar), and changing the “how” of eating as well as the “what”; those are both things that are often overlooked in a lot of guides, but this one delivers well.
Walking the reader by the hand through things like that is probably the book’s greatest strength.
In the category of subjective criticism, the author does go off-piste a little at the end, to take a moment while she has our attention to talk about other things.
For example, you may not need “Appendix 7: How to Become A Christian and Disciple of Jesus Christ”.
Of course if that calls to you, then by all means, follow your heart, but it certainly isn’t a necessary step of quitting sugar. Nevertheless, the diversion doesn’t detract from the good dietary change advice that she has just spent a book delivering.
Bottom line: there’s no deep science here, but there’s a lot of very good, very practical advice, that’s consistent with good science.
Click here to check out 7 Steps to Get Off Sugar, and watch your health improve!
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Holding Back The Clock on Aging
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Holding Back The Clock on Aging
This is Dr. Eric Verdin, President and CEO of the Buck Institute of Research on Aging. He’s also held faculty positions at the University of Brussels, the NIH, and the Picower Institute for Medical Research. Dr. Verdin is also a professor of medicine at University of California, San Francisco.
Dr. Verdin’s laboratory focuses on the role of epigenetic regulators (especially the behaviors of certain enzymes) in the aging process. He studies how metabolism, diet, and chemical factors regulate the aging process and its associated diseases, including Alzheimer’s.
He has published more than 210 scientific papers and holds more than 15 patents. He is a highly cited scientist and has been recognized for his research with a Glenn Award for Research in Biological Mechanisms of Aging.
And that’s just what we could fit here! Basically, he knows his stuff.
What we can do
Dr. Verdin’s position is bold, but rooted in evidence:
❝Lifestyle is responsible for about 93% of our longevity—only about 7% is genetics. Based on the data, if implementing health lifestyle choices, most people could live to 95 in good health. So there’s 15 to 17 extra years of healthy life that is up for grabs❞
~ Dr. Eric Verdin
See for example:
- From discoveries in aging research to therapeutics for healthy aging
- Optimism, lifestyle, and longevity in a racially diverse cohort of women
- Well-being, food habits, and lifestyle for longevity—evidence from supercentenarians
How we can do it
Well, we all know “the big five”:
- Good diet (Mediterranean Diet as usual is recommended)
- Good exercise (more on this in a moment)
- Good sleep (more on this in a moment)
- Avoid alcohol (not controversial)
- Don’t smoke (need we say more)
When it comes to exercise, generally recognized as good is at least 150 minutes per week of moderate intensity exercise (for example, a brisk walk, or doing the gardening), and at least three small sessions a week of high intensity exercise, unless contraindicated by some medical condition.
As for Dr. Verdin’s take on this…
What Dr. Verdin recommends is:
- make it personalized
- make it pre-emptive
- make it better
The perfect exercise plan is only perfect if you actually do it. And if you actually can do it, for that matter.
Prevention is so much better (and easier) than cure for a whole array of maladies. So while there may be merit in thinking “what needs fixing”, Dr. Verdin encourages us to take extra care to not neglect factors of our health that seem “good enough”. Because, give them time and neglect, and they won’t be!
Wherever we’re at in life and health, there’s always at least some little way we could make it a bit better. Dr. Verdin advises us to seek out those little improvements, even if it’s just a nudge better here, a nudge better there, all those nudges add up!
About sleep…
It’s perhaps the easiest one to neglect (writer’s note: as a writer, I certainly feel that way!), but his biggest take-away tip for this is:
Worry less about what time you set an alarm for in the morning. Instead, set an alarm for the evening—to remind you when to go to bed.
Want to hear directly from the man himself?
Here he is speaking on progress we can expect for the next decade in the field of aging research, as part of the 100 Minutes of Longevity session at The Longevity Forum, a few months ago:
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Mediterranean Air Fryer Cookbook – by Naomi Lane
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There are Mediterranean Diet cookbooks, and there are air fryer cookbooks. And then there are (a surprisingly large intersection of!) Mediterranean Diet air fryer cookbooks. We wanted to feature one of them in today’s newsletter… And as part of the selection process, looked through quite a stack of them, and honestly, were quite disappointed with many. This one, however, was one of the ones that stood out for its quality of both content and clarity, and after a more thorough reading, we now present it to you:
Naomi Lane is a professional dietician, chef, recipe developer, and food writer… And it shows, on all counts.
She covers what the Mediterranean diet is, and she covers far more than this reviewer knew it was even possible to know about the use of an air fryer. That alone would make the book a worthy purchase already.
The bulk of the book is the promised 200 recipes. They cover assorted dietary requirements (gluten-free, dairy-free, etc) while keeping to the Mediterranean Diet.
The recipes are super clear, just what you need to know, no reading through a nostalgic storytime first to find things. Also no pictures, which will be a plus for some readers and a minus for others. The recipes also come complete with nutritional information for each meal (including sodium), so you don’t have to do your own calculations!
Bottom line: this is the Mediterranean Diet air fryer cook book. Get it, thank us later!
Get your copy of “Mediterranean Air Fryer Cookbook” on Amazon today!
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The Science-Backed Anti-Inflammatory Diet for Beginners – by Dr. Yasmine Elamir & Dr. William Grist
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We have written about how to eat to beat inflammation, but what we didn’t do is include 75 recipes and a plan for building up one’s culinary repertoire around those core dishes!
That’s what this book does. It covers briefly the science of inflammation and anti-inflammatory diet, discusses experimental elimination diets (e.g. you eliminate likely culprits of triggering your inflammation, then reintroduce them one by one to see which it was), and ingredients likely to increase or decrease inflammation.
The 75 recipes are good, and/but a caveat is “yes, one of the recipes is ketchup and another is sour cream” so it’s not exactly 75 mains.
However! Where this book excels is in producing anti-inflammatory versions of commonly inflammatory dishes. That ketchup? Not sugary. The sour cream? Vegan. And so forth. We also see crispy roast potatoes, an array of desserts, and sections for popular holiday dishes too, so you will not need to be suddenly inflamed into the next dimension when it comes to festive eating.
The recipes are what the title claims them to be, “science-backed anti-inflammatory”, and that is clearly the main criterion for their inclusion. They are not by default vegan, vegetarian, dairy-free, nut-free, gluten-free, etc. For this reason, all recipes are marked with such tags as “V, VG, DF, GF, EF, NF” etc as applicable.
Bottom line: we’d consider this book more of a jumping-off point than a complete repertoire, but it’s a very good jumping-off point, and will definitely get you “up and running” (there’s a 21-day meal plan, for example).
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