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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Apples vs Oranges – Which is Healthier?
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Our Verdict
When comparing apples to oranges, we picked the oranges.
Why?
In terms of macros, the two fruits are approximately equal (and indeed, on average, precisely equal in the most important metric, which is fiber). So, a tie here.
In the category of vitamins, apples are higher in vitamin K, while oranges are higher in vitamins A, B1, B2, B3, B5, B6, B7, B9, C, and choline. An easy win for oranges this time.
When it comes to minerals, apples have more iron and manganese, while oranges have more calcium, copper, magnesium, phosphorus, potassium, selenium, and zinc. Another easy win for oranges.
So, adding up the sections, a clear win for oranges. But, by all means, enjoy either or both! Diversity is good.
Want to learn more?
You might like to read:
From Apples to Bees, and High-Fructose Cs: Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
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Before You Eat Breakfast: 3 Surprising Facts About Intermittent Fasting
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Dr. William Li is well-known for his advocacy of “eating to beat disease”, and/but today he has advice for us about not eating to beat disease. In moderation, of course, thus: intermittent fasting.
The easy way
Dr. Li explains the benefits of intermittent fasting; how it improves the metabolism and gives the body a chance to do much-needed maintainance, including burning off any excess fat we had hanging around.
However, rather than calling for us to do anything unduly Spartan, he points out that it’s already very natural for us to fast while sleeping, so we only need to add a couple of hours before and after sleeping (assuming an 8 hour sleep), to make it to a 12-hour fast for close to zero effort and probably no discomfort.
And yes, he argues that a 12-hour fast is beneficial, and even if 16 hours would be better, we do not need to beat ourselves up about getting to 16; what is more important is sustainability of the practice.
Dr. Li advocates for flexibility in fasting, and that it should be done by what manner is easiest, rather than trying to stick to something religiously (of course, if you do fast for religious reasons, that is another matter, and/but beyond the scope of this today).
For more information on each of these, as well as examples and tips, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Intermittent Fasting: What’s the truth?
- 16/8 Intermittent Fasting For Beginners
- Meal Timings & Health: How Important Is Breakfast?
Take care!
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How To Avoid Self-Hatred & Learn To Love Oneself More
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Alain de Botton gives a compassionate, but realistic, explanation in this video:
The enemy within
Or rather, the collaborator within. Because there’s usually first an enemy without—those who are critical of us, who consider that we are bad people in some fashion, and may indeed get quite colorful in their expressions of this.
Sometimes, their words will bounce straight off us; sometimes, their words will stick. So what’s the difference, and can we do anything about it?
The difference is: when their words stick, it’s usually because on some level we believe their words may be true. That doesn’t mean they necessarily are true!
They could be (and it would be a special kind of hubris to assume no detractor could ever find a valid criticism of us), but very often the reason we have that belief, or at least that fear/insecurity, is simply because it was taught to us at an early age, often by harsh words/actions of those around us; perhaps our parents, perhaps our schoolteachers, perhaps our classmates, and so forth.
The problem—and solution—is that we learn emotions much the same way that we learn language; only in part by reasoned thought, and rather for the most part, by immersion and repetition.
It can take a lot of conscious self-talk to undo the harm of decades of unconscious self-talk based on what was probably a few years of external criticisms when we were small and very impressionable… But, having missed the opportunity to start fixing this sooner, the next best time to do it is now.
We cannot, of course, simply do what a kind friend might do and expect any better results; if a kind friend tells us something nice that we do not believe is true, then however much they mean it, we’re not going to internalize it. So instead, we must simply chip away at those unhelpful longstanding counterproductive beliefs, and simply build up the habit of viewing ourselves in a kinder light.
For more on all this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Escape From The Clutches Of Shame
- To Err Is Human; To Forgive, Healthy
- How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
Take care!
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Tourette’s Syndrome Treatment Options
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Is there anything special that might help someone with Tourette’s syndrome?❞
There are of course a lot of different manifestations of Tourette’s syndrome, and some people’s tics may be far more problematic to themselves and/or others, while some may be quite mild and just something to work around.
It’s an interesting topic for sure, so we’ll perhaps do a main feature (probably also covering the related-and-sometimes-overlapping OCD umbrella rather than making it hyperspecific to Tourette’s), but meanwhile, you might consider some of these options:
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The Autoimmune Cure – by Dr. Sara Gottfried
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We’ve featured Dr. Gottfried before, as well as another of her books (“Younger”), and this one’s a little different, and on the one hand very specific, while on the other hand affecting a lot of people.
You may be thinking, upon reading the subtitle, “this sounds like Dr. Gabor Maté’s ideas” (per: “When The Body Says No”), and 1) you’d be right, and 2) Dr. Gottfried does credit him in the introduction and refers back to his work periodically later.
What she adds to this, and what makes this book a worthwhile read in addition to Dr. Maté’s, is looking clinically at the interactions of the immune system and nervous system, but also the endocrine system (Dr. Gottfried’s specialty) and the gut.
Another thing she adds is more of a focus on what she writes about as “little-t trauma”, which is the kind of smaller, yet often cumulative, traumas that often eventually add up over time to present as C-PTSD.
While “stress increases inflammation” is not a novel idea, Dr. Gottfried takes it further, and looks at a wealth of clinical evidence to demonstrate the series of events that, if oversimplified, seem unbelievable, such as “you had a bad relationship and now you have lupus”—showing evidence for each step in the snowballing process.
The style is a bit more clinical than most pop-science, but still written to be accessible to laypersons. This means that for most of us, it might not be the quickest read, but it will be an informative and enlightening one.
In terms of practical use (and living up to its subtitle promise of “cure”), this book does also cover all sorts of potential remedial approaches, from the obvious (diet, sleep, supplements, meditation, etc) to the less obvious (ketamine, psilocybin, MDMA, etc), covering the evidence so far as well as the pros and cons.
Bottom line: if you have or suspect you may have an autoimmune problem, and/or would just like to nip the risk of such in the bud (especially bearing in mind that the same things cause neuroinflammation and thus, putatively, depression and dementia too), then this is one for you.
Click here to check out the Autoimmune Cure, and take care of your body and mind!
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Protein-Stuffed Bell Peppers
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Hot, tasty, meaty, and vegan! You can have it all. And with this recipe, you’ll want to err on the side of overcatering, because everyone will want some. As for healthiness, we’ve got lycopene, lutein and a stack of other carotenoids, a plethora of other polyphenols, and a veritable garden party of miscellaneous phytochemicals otherwise categorized. It’s full of protein, fiber, vitamins, and minerals, relatively low-fat but the fats present are healthy. It’s antidiabetic, anti-CVD, anticancer, antineurodegeneration, and basically does everything short of making you sing well too.
You will need
- 4 large bell peppers, tops sliced open and innards removed (keep the tops; we will put them back on later)
- 1 cup quinoa, rinsed
- 1 can black beans, drained and rinsed
- 1 small zucchini (diced)
- 1 small eggplant (diced)
- 1 small red onion (finely chopped)
- ½ bulb garlic, minced*
- 1 tbsp tomato paste
- 1 tbsp chia seeds
- 2 tbsp extra virgin olive oil
- 2 tsp dried basil
- 2 tsp dried thyme
- 2 tsp black pepper, coarse ground
- 2 tsp ground cumin
- 1 tsp smoked paprika
- ½ tsp MSG or 1 tsp low-sodium salt
*we always try to give general guidelines with regard to garlic, but the reality is it depends on the size and strength of your local garlic, which we cannot account for, as well as your personal taste. Same situation with hot peppers of various kinds. This writer (it’s me, hi) would generally use about 2x the garlic and pepper advised in our recipes. All we can say is: follow your heart!
Method
(we suggest you read everything at least once before doing anything)
1) Combine the quinoa with the chia seeds, and cook as per normal cooking of quinoa (i.e. bring to a boil and then simmer for about 15 minutes until cooked and fluffy). Drain and rinse (carefully, without losing the chia seeds; use a sieve).
2) Heat your grill to a high heat. Combine the zucchini, eggplant, onion, garlic, and olive oil in a big bowl and mix well, ensuring an even distribution of the oil. Now also add the herbs and spices (including the MSG or salt) and mix well again. Put them all to grill for about 5 minutes, turning as necessary.
3) Heat your oven to a high heat. Take the grilled vegetables and combine them in a bowl with the quinoa-and-chia, and the black beans, as well as the tomato paste. Mix everything well. Spoon the mixture generously into the bell peppers, replacing the tops (it can be loosely), and bake for about 5–10 minutes, keeping an eye on them; you want them to be lightly charred, but not a burnt offering.
4) Serve! This dish works well as a light lunch or as part of a larger spread.
(before going in the oven with lids replaced to keep moisture in)
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- A Spectrum Of Specialties: Which Color Bell Peppers To Pick?
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- The Tiniest Seeds With The Most Value: If You’re Not Taking Chia, You’re Missing Out
- Chickpeas vs Black Beans – Which is Healthier?
- The Many Health Benefits Of Garlic
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
Take care!
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