can we prevent depression by improving diet?€¦ · • total food and beverage costs per person...

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Can we prevent depression by improving diet?

Professor Felice Jacka

DEAKIN UNIVERSITY ALUMNI SEMINAR15 August 2018

CAN WE PREVENT AND TREAT DEPRESSION USING DIET?

Prof Felice N JackaFood & Mood Centre, Deakin UniversityMurdoch Childrens Research Institute

The University of MelbourneThe Black Dog Institute

f.jacka@deakin.edu.au

OUR DIETS HAVE CHANGED

Image sourced from Depositphotos

AND IT IS KILLING US

Screenshot from sciencedaily.com

Poor diet?• Diets low in:

– Fruits– Vegetables– Wholegrains– Nuts and seeds– Fibre– Omega 3 fatty acids– Monounsaturated fatty acids

Poor diet?• Diets high in:

– Red meat– Processed meat– Added sugars– Sugar Sweetened Beverages– Trans fats– Sodium

Image sourced from Depositphotos

Costs linked to poor diet

30 TRILLION DOLLARS by 2030

But aren’t we forgetting something?

Diet and nutrition = mental health?

Mental Health

Leading cause of global disability

Whiteford et al. Lancet 2013

Diet and mental health are linked

Screenshot from American Journal of Psychiatry

WESTERN DIET

Image sourced from Pixabay

WESTERN DIET

50% MORE LIKELY TO HAVE DEPRESSIVE DISORDER

‘TRADITIONAL’ DIET

Image sourced from Depositphotos

TRADITIONAL DIET

35% LESS LIKELY TO HAVE DEPRESSIVE DISORDER

32% LESS LIKELY TO HAVE ANXIETY DISORDER

Images sourced from Pixabay

HALF OF ALL MENTAL DISORDERS START

BEFORE THE AGE OF 14

What is the possible contribution of early life nutritional exposures to the mental health of children?

Image sourced from Pixabay

EXTERNALISING BEHAVIOURS

INTERNALISINGBEHAVIOURS

Images sourced from Pixabay

UNHEALTHY FOODS = HIGHER EXTERNALISING BEHAVIOURS!!

PRENATAL DIET (during pregnancy)

Image sourced from publicdomainpictures

WHOLESOME FOODS =

LOWER INTERNALISING AND EXTERNALISING BEHAVIOURS

UNHEALTHY FOODS =

HIGHER INTERNALISING AND EXTERNALISING BEHAVIOURS

HIPPOCAMPUS

Image sourced from Wikimedia Commons

Images sourced from Pixabay

Screenshot from munchies.vice.com

Dietary improvement as a treatment strategy in major depression:

the SMILES trial

Jacka et al. BMC Medicine (2017) 15:23 A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial)

ModiMedDiet: Top 10 TipsSelect fruits,

vegetables and nuts

as a snack

Include vegetables with every

mealEat leafy greens and tomatoes

every day Select whole grain breads and cereals

Servings should be based on your activity levels

Eat legumes

3 to 4 times per

week

Eat salmon 1 to 2

times per week

Eat lean red meat 3 to 4 times per

week Limit serve sizes to

65 – 100g

Include 2 to 3 serves of

dairy every day

Select reduced fat products and

natural yoghurt

Use olive oil as the main added fat

60mL (3 tablespoons) of extra virgin olive

oil daily

Sweets for

special occasions

only

Water is the best drink

Opie, R. S., et al. (2017). "A modified Mediterranean dietary intervention for adults with major depression: Dietary protocol and feasibility data from the SMILES trial." Nutr Neurosci: 1-15.

RESULTS

N=67

Jacka et.al. 2017 BMC Medicine

Effect size: Cohen’s d = -1.16 (95% CI -1.73, -0.59)

NNT= 4.1

• Trial participants spent an estimated mean of $138 per week on food and beverages for personal

consumption at the start of the trial

• Total food and beverage costs per person per week for the recommended modified Mediterranean diet

was estimated at $112

• The modified Mediterranean diet at $1.54 per mega-joules (MJ) was cheaper per energy unit than the

cost of the current dietary intake of the SMILES participants at a mean of $2.35 per MJ

Is it cheaper to eat an unhealthy vs a healthy diet?

$138 vs $112 per week

Mood Study: study designMediterranean diet group (n=75)- Nutrition education session, goal setting

- Fortnightly group cooking workshops for 3 months

- Fortnightly food hampers; shopping/budgeting activities

- Recipes and online resources (website with links, recipes, cooking videos: helfimed.org)

- Fish oil capsules for 6 months (1g DHA + EPA)

Social group (n=77)- Movie vouchers at each round of assessments

- Fortnightly social groups for 3 months – share holiday stories, play games, personality tests, sharing of books, watch a movie, etc.; nibbles provided

- Received nutrition education and resources after final assessments

Zarnowiecki , Cho, Wilson, Bogomolova, Villani, Itsiopoulos, Niyonsenga, O’Dea, Segal … Parletta (2016) BMC Nutrition 2:52

Image sourced from Pixabay

HELFIMED study: effect of Mediterranean diet on mental health in people with depression

DASS Depression Score (P=0.027 for treatment interaction, N=152)

0

5

10

15

20

25

30

MedDiet Social group

Baseline

3 months

Parletta, Zarnowiecki, Cho, Bogomolova, Wilson, Villani, Itsiopoulos, Segal, Niyonsenga, O’Dea et al., under review

Images sourced from Depositphotos and Pixabay

Gut microbiota100 trillion microbes live in & on us

50% of our cells are microbes

99.5% of our genetic material is microbial (21,000 human genes vs 4.4 million microbial genes)

metabolism and body weightimmune system

mood and behaviour

Microbiota and mental and brain health

‘GERM FREE MICE’Altered stress response

Altered brain plasticity

Altered levels of neurotransmitters

Altered behavioursAltered immune system

Altered BBB

Image sourced from Pixabay

Experimental evidence

Images sourced from Pixabay

Stool transplants (FMT)

Images sourced from Pixabay

EbioMedicine

• RCT in 423 NZ females• Lactobacillus rhamnosus HN001• Significantly lower depression and anxiety scores postpartum

Main factors influencing microbiota

StressInfection

Medication use

Diet

Geography

Age

Diet is critical to gut health

• Plant-based diets increase microbial diversity and SCFA production

• Carbohydrate and fibre intake influences microbial diversity and SCFA concentration

• Detrimental influence of the western diet

‘Plant based diet’ = grains, legumes, fruits and vegetablesor‘Animal-based diet’ = meats, eggs and cheeses

Consumed for five days (n=10)

David et al. (2014) Nature

• Animal proteins and fats 2-3 times higher in Western diet• Carbohydrates and fibre far higher in African diet• Profound differences in gut microbiota composition

African Americans switched to a high fibre/low fat diet for 2 weeks = significant reductions in mucosal inflammation and biomarkers of cancer risk (Africans switched to Western diet showed the opposite)

O’Keefe SJD, Li JV, Lahti L, Ou J, Carbonero F, Mohammed K, et al. Fat, fibre and cancer risk in African Americans and rural Africans. Nature Communications. 2015;6:6342.

Sonnenburg ED et al. Starving our microbial self: the deleterious consequences of a diet deficient in microbiota-accessible carbohydrates. Cell metabolism. 2014

Changes in Diet & Food Production/Preparation- accompanied by fundamental shifts in microbiota composition

Reduced Diversity of the Microbiome in Modern Westernized Diet

‘Microbial accessible carbohydrates” (MACS) derived from plant fibre are

reduced in western diet.

Over several generations, Low-MACS diet in mice resulted in progressive loss of

diversity, which was not recoverable by reintroduction of MACS

Fecal transplant required to recover species diversity

Dramatic Increase in Allergic Disease since 1980

Devereux G. The increase in the prevalence of asthma and allergy: food for thought. Nat Rev Immunol. 2006

Image sourced from Pixabay

Good for Guts• Fermented foods• Olive oil• Fibre• Omega 3 fatty acids• Polyphenols

Image sourced from Depositphotos and Pixabay

Bad for guts• Saturated fats• Processed foods• Added sugars• Refined carbohydrates• Binge drinking

Images sourced from Pixabay

+ ≠+ ≠

Images sourced from Pixabay

Screenshot from foodandmoodcentre.com.au

CURRENT STUDIES

Image sourced from Depositphotos

Gut Feelings Project – Microbiome Can the gut microbiome predict response to prebiotic, probiotic and synbiotic interventions for low mood? • Gut Feelings Project – collaboration with University of Melbourne &

Melbourne Clinic (Tanya Freijy, Prof Jerome Sarris, Dr Chee Ng).• RCT of psychobiotics for low mood• Currently recruiting at Melbourne Clinic• Funding applications under review for 16Ssequencing of gut microbiome Dr Amy Loughman

A study of health, behaviour, gut microbiota and mental health

1. Observe how health, lifestyle and behaviour relate to the composition of the gut microbiota

2. Identify how compositional changes may be associated with mental health symptoms (depressive and anxious)

3. Explore the effect of the bowel preparation laxative for colonoscopy on the intestinal microbiota

One-week before colonoscopy

(Before laxative)AIM 1 & 2

During colonoscopy(Immediately after

laxative)AIM 3

One-moth post-colonoscopy

(After laxative)AIM 3

Aim (n = 100)To date (n = 70)

Baseline data – cross-sectionalComplete by August 2018

Longitudinal data – repeated-measuresComplete by October 2018

Amelia McGuinness

Images sourced from Pixabay

HEALTHY PARENTS, HEALTHY KIDS STUDY

Samantha Dawson

Screenshot courtesy of Samantha Dawson

THE MOO’D STUDYDOUBLE BLINDED 16-WEEK RCT

n= 160≥18 y≥ 250ml milk/dayLow mood

RECRUITMENT + DATA COLLECTION 2018-2020

Psychological distress (DASS-21 total)

Randomised

ControlConventional milk (≥250ml/day) + cheese

InterventionA2 milk (≥250ml/day) + cheese

Sub scores of depression, anxiety and stress (DASS-21)

Severity of depressive symptoms (PHQ-8)

Cognitive function (CogState)

Primary outcome

Secondary outcomes

Fortnightly

Fortnightly

No other dairy

Meg Hockey

A1A2

A2

Images sourced from Pixabay

Characterisation of gut microbiota (inpatients)

20 days examination 40 days examination = discharge

60 days examination(follow-up)

THE ROLE OF GUT MICROBIOME IN EATING DISORDERS

1) A more comprehensive characterization of the intestinal microbiota in eating disorders 2) How current treatment (nutritional rehabilitation) impacts enteric microbes and SCFA levels? 3) Is GM associated with weight recovery, depressive/anxiety symptoms and eating behavior?

Recruitment from the Geelong Clinic Eating Disorder Unit (aimed n=40)Oct 2018 Apr Jul Oct 2019 Apr

Gut Microbiota in Eating Disorders -project

Inpatients treatment period

Baseline

Dr Anu Ruusunen

MOVING MOODSFMT (crapsules) as an adjunctive treatment for MDD: a pilot RCT

Primary objectiveInvestigate the feasibility of FMT as an adjunctive treatment for depression in adults Secondary objectivesEstablish whether FMT changes biological parameters in depressed adults, including the faecal microbiome, Hypothalamic Pituitary Axis activity, Neurogenesis, inflammation, cardiovascular and metabolic risk factors, cognition, Quality of life, gastrointestinal symptoms and tolerability. Depression symptoms (MADRS) will also be assessed.

+ = ?

Aimn = 40

Primary outcome measure Feasibility

Target population adults with moderate to severe MDD

Dr Jessica Green

Images sourced from Depositphotos and Pixabay

KETOGENIC DIET Glucose is restricted production of ketone bodies Used to manage epilepsy in children since the 1920s Only few case and animal studies in psychotic disorders/ schizophrenia Neuroprotective effects (adenosine and glutamate metabolism, AMPA receptor)?

A 6-week randomized, controlled ketogenic diet pilot intervention study in psychotic inpatients (n=40) Carbohydrates limited to max 20 grams/day Ketone-body levels, blood glucose levels Primary outcome: psychotic symptoms Secondary outcomes: depression, anxiety, functioning

Ketogenic Diet for psychotic symptoms – PsyDiet study

Dr Anu RuusunenImages sourced from Pixabay

Recruit Screen Online Intervention – 8 weeks

1-Sep 2-Sep 3-Sep 4-Sep 5-Sep 6-Sep 7-Sep

Food Mood

Education Modules

Participant Feedback

Smartphone Monitor

An Online Dietary Intervention targeting Gut Health for Improvement of Depressive Symptoms: Development, Optimisation & Feasibility Study

Claire Young

Screenshots courtesy of Claire Young

Global Obesity Collaboration• Based in Centre for Population Health Research• Community-based systems trial WHO STOPS

(n>5000 children, 10 communities)• Primary outcome of interest = childhood (6-12

years) obesity– FAMC (Dr Erin Hoare) will assess the mental

and emotional health outcomes of nutritional and physical activity intervention

– Opportunities to build mental health-related strategies into step-wedge design

Dr Erin Hoare

Images courtesy of Dr Erin Hoare

Image sourced from Depositphotos

International Society for Nutritional Psychiatry Research

“To support scientifically rigorous research into nutritional approaches to prevention and treatment of mental disorders and their comorbidities”

WWW.ISNPR.ORG

Lancet Psychiatry. 2015 Mar;2(3):271-4

Screenshot from isnpr2017.org

Acknowledgements

Catherine Helson

Helene Nauwelaers

Genevieve Mosely

Madi West

Dr Tiril Borge

Prof Michael BerkA/ Prof Seetal Dodd

Dr Olivia DeanDr Rachelle Opie

Tanya Marie Freijy

Prof Bryndís BirgisdóttirProf Jerome Sarris

Dr Adrienne O’Neil

Research assistants and honorary membersAmelia McGuinnessHajara Aslam

Samantha DawsonSara Campolonghi

Claire YoungMeg HockeyJessica DavisJessica GreenMelissa LaneGina Howland

PhD Students

Dr Anu Ruusunen

Dr Tetyana Rocks

Dr Wolfgang Marx

Dr Erin Hoare

Dr Amy Loughman

Dr Sarah Dash

Postdoctoral

Food & Mood Centre

www.foodandmoodcentre.com.au

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