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Deakin University CRICOS Provider Code: 00113B
WELCOME CANBERRA ALUMNI
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
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
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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