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It’s official: diet FIRST for anxiety and depression – but is it the right diet?

 

Depression is now one of the main reasons for people visiting their doctor.

Many of our readers, like this one, find that the diet we recommend can help with depression:

“I’m 17 years old. I was diagnosed with depression at the age of six. I tried to kill myself 3 times. My mum found the failsafe diet. She put me on it and within a week we saw a change. I wasn’t as sick, my depression basically vanished, I’ve been really happy ever since. It basically saved my life…”  (watch 2 min video)

Vsarah01

Which components of the Western diet cause depression? 

Our readers often say their doctors don’t believe they are affected by diet, so I was surprised that Professor Felice Jacka, head of the Food and Mood Centre at Deakin University and a Black Dog Institute external fellow, recommends diet first for treating anxiety and depression:

“… we know that we can change diet and exercise and very quickly, according to the evidence, have an impact on mental health …”

Studies by Professor Jacka’s team have shown that "traditional" dietary patterns characterized by vegetables, fruit, meat, fish, and whole grains are associated with lower odds for major depression or anxiety disorders whereas a "western" diet of processed or fried foods, refined grains, sugary products, and beer is associated with higher depression and anxiety scores (Jacka et al, 2010).

Her latest study found that improving the diets of those with major depressive disorder had a "substantial beneficial impact" on their mood (Jacka et al, 2017).

Updated clinical recommendations for the treatment of mood disorders by the Royal Australian and New Zealand College of Psychiatrists now include diet. Professor Jacka says:

"They are now recommending that the first thing that happens when a doctor has a patient with a mood disorder, is to address diet, exercise, smoking cessation and sleep"

Since doctors, psychiatrists and psychologists have no training in nutrition during their degrees, Professor Jacka recommends that patients be referred to a dietitian.  She says:

“Psychiatrists and psychologists are quite astonished to learn that nutrition might be important to mental and brain health. They will always say to me: 'it's because we never learnt anything about it in our medical degrees'”

Nutrients or food chemicals?

But what is it exactly in those diets that causes such a quick change? Professor Jacka thinks the diet-depression link is due to lack of nutrients, although a recent review of nutrient treatments from Murdoch University in Western Australia was less certain. 

The science for nutrients

Dr Adrian Lopresti examined studies of omega-3, s-adenosylmethionine, vitamin C, vitamin D, zinc, iron and B-vitamins for paediatric depression and concluded that there is a lack of high-quality studies examining the antidepressant effects of these nutrients: “before nutritional treatments are accepted as validated treatments for paediatric depression, further high-quality studies are required.”

The science for food chemicals

For people who are affected only to additives, it is true that a “healthy” diet will help because it involves avoiding many of the foods that contain additives.  But my major concern is that a Mediterranean-style diet may not help a lot for patients who are sensitive to natural food chemicals such as salicylates and/or amines or who are affected by additives.

So we would say it is not a lack of nutrients that cause problems, but the presence of certain artificial and natural food chemicals

For example, in success story [1372], below, probiotics and fish oil capsules (as an omega-3 supplement) that were supposed to relieve depression turned out to be part of the problem because they were high in natural food chemicals called amines.

Back in 1965, Californian allergist Dr Ben Feingold saw a woman with painful and unsightly hives on her face. “She looked, and obviously felt, miserable,” he said. Since allergy tests were negative, he thought that the new – as they were then – artificial food additives and high salicylate artificial flavours may be causing problems, and put her on an additive free, low salicylate elimination diet.

Ten days later, he received a call from the hospital’s chief of psychiatry asking what he had done, because the woman’s psychiatric problems had vanished:

Ten days of elimination diet had achieved what two years of psychotherapy could not 

The diet we recommend today is an updated version of Feingold’s diet. Depressive effects of food chemicals have been confirmed by careful placebo-controlled challenges at Sydney’s RPAH (Royal Prince Alfred Hospital) Allergy Clinic. A study in 1986 found that food reactions could include:

“transient depression that is sometimes sufficiently intense to provoke suicidal thoughts” (Loblay and Swain, 1986)

As our readers report, this improves within days when the provoking food chemicals are avoided. Everyone is different, but a 3 week trial of the RPAH elimination diet followed by challenges –supervised by a knowledgeable dietitian - can show scientifically which foods are causing the problem.

There are hundreds of success stories from our readers in our Depression Story Collection about how long people have suffered unnecessarily – and the ones who haven’t survived - because doctors, paediatricians, psychiatrists and psychologists do not understand the effects of food chemicals.

“I am a 42 year old male … I have suffered depression/anxiety, obsessive thoughts and have been very unhappy since my mid to late teens … By not eating or drinking foods with color (artificial colors and natural color annatto 160b) I am happier and can find joy. I only wish I had known this 30 years ago” - David, USA [1434]

When psychiatric drugs don’t work

A case report in a medical journal (Parker and Watkins 2002, see below) describes a 25 year old patient with generalised anxiety, social phobia, panic attacks, obsessive-compulsive disorder and five years of severe depressive episodes which were ”non-responsive to a range of psychotropic drugs”. He turned out to be so sensitive to salicylates (in “healthy” foods like tomatoes, citrus, most fruit, some vegetables, herbs and spices) that his salicylate challenge had to be stopped early. 

The researchers concluded: 

“Clinicians should be aware of the possible syndrome (food intolerance) and that it may be worsened by psychotropic medication”

Which diet: “healthy” or “low food chemical”?

For people who are affected only to additives, it is true that a “healthy” diet will help because it involves avoiding many of the foods that contain additives - although they may need to know that healthy-looking wholegrain breads can contain hidden preservatives.

My major concern is that a Mediterranean-style diet may not help a lot for patients who are sensitive to natural food chemicals such as salicylates and/or amines.

Many of the diet-related depression stories we receive involve avoidance of natural food chemicals - salicylates (e.g. in fruit, vegetables and others) and amines (in most fish, cheese, chocolate, supermarket meats and others) that can be exceptionally high in “healthy” diets, for example:

“The fog lifted” – due to dietary salicylates

“I was on anti depression medication for 7 years - once on failsafe & eliminating sals I found my fog lifted & I'm no longer dependant on tablets. While my overall diet was a healthful one by anyone’s standards the sals were in fact detrimental to me” – Jennifer [1326]

“Major depression” – due to dietary amines (including fish oil supplements)

“I experienced a Major Depression for 8 months. I was feeling so low, so hopeless, and crying all the time, it was the darkest time in my life … (through food challenges with a highly experienced dietitian) I have discovered that salicylates trigger anxiety and restless sleep … and amines cause depression” – Rachel [1372]

Self harming – due to preservative in a “healthy looking” bread

“During the melt downs, she (4 yo daughter)would tear at her skin all up her arms until it bled, bite her arms until she bruised them and rip her hair out. I had been buying a 'healthy looking' gluten free commercial sliced bread (with bread preservative 282) … I threw it in the bin. The meltdowns and self harming stopped the next day “ – Kylie [1296]

(Bread preservative 282 can also be called calcium propionate, “cultured dextrose” or “cultured”anything, “no artificial preservatives” and is also used in “organic” breads and wraps - see more)

Onset of depression in a 6 yo – due to additives in school canteen food

“This year upon starting school my normally bright, happy six year old son became depressed, aggressive and hyperactive …. To my horror, the slushy he was ordering from the school canteen contained two artificial colours and two preservatives (benzoate preservative 211 and potassium sorbate 202).” – Leesa [875]

Anxiety, sleep disturbance - due to Mediterranean style high salicylate foods

“My husband and I are both Italian Mediterranean descent. I was quite an anxious child … my daughter was basically eating all of the fruits and vegetables listed in the very high category of salicylate foods. Since taking away salicylate foods I am seeing an increase in sleep and a much more settled baby …” – Danielle [1368]

How to do a trial of the RPAH elimination diet

For people with a personal or family history of food intolerance (see more below) or depression that does not respond to psychiatric drugs,  we recommend a trial of the RPAH elimination diet supervised by a supportive dietitian who specialises in food intolerance. You can see our list of supportive dietitians below or ask for recommendations on our facebook group:

“I began to reduce my food chemicals … and saw a slow but steady improvement in my depression! … I booked a dietitian to help me through the RPAH Elimination Diet only to quickly realise she didn’t have enough experience or knowledge in this area … a member on your forum recommended a marvellous failsafe dietitian to me. It was such a relief to have her support … with anxiety and depression being triggered during my challenges … The results of my elimination this time were much clearer and more accurate than last time, and this was mostly due to her attention to detail, and ongoing support. “ – Rachel from [1372]

My wish …

I would like to say thank you to Professor Jacka for her hard work helping people to understand the diet and depression link. I hope that some day, the Food and Mood Centre, the Black Dog Institute and Beyond Blue will acknowledge and spread the word not only about “healthy” diets, but also about the effects of additives and natural chemicals – because this kind of information could help so many people.

Read more

Sarah Berry , Your mental health involves your whole body and starts with diet, SMH http://www.smh.com.au/lifestyle/health-and-wellbeing/your-mental-health-involves-your-whole-body-and-starts-with-diet-20170912-gyfq4b.html

Our list of supportive dietitians https://www.fedup.com.au/information/support/failsafe-friendly-dietitians-and-other-health-professionals

Our 51 page collection of readers’ success stories about depression, anxiety,  panic attacks and self-harm  https://fedup.com.au/images/stories/SCdepression.pdf

Symptoms of food intolerance can include: headaches, migraines, itchy rashes (eczema, hives ), asthma or rhinitis, irritable bowel symptoms, irritability, restlessness, inattention, insomnia, depression, anxiety, panic attacks, restless legs, night terrors and many more Introduction to food intolerance

Blog post: the suicide report  https://fedup.com.au/news/blog/the-suicide-report-this-diet-is-freaking-amazing 

Factsheet: depression https://fedup.com.au/factsheets/symptom-factsheets/depression

Factsheet: suicide prevention by diet

References

Jacka FN et al, Association of Western and traditional diets with depression and anxiety in women. Am J Psychiatry. 2010;167(3):305-11. “These results demonstrate an association between habitual diet quality and the high-prevalence mental disorders ...” 
https://www.ncbi.nlm.nih.gov/pubmed/20048020

Jacka FN et al,  A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial). BMC Med. 2017;15(1):23 A group of 33 adults with major depressive disorders  over 12 weeks of diet therapy showed significantly greater improvement in depression scores than a similar control group on social support therapy. The diet was a modified Mediterranean recommending consumption of the following 12 key food groups): whole grains (5–8 servings per day); vegetables (6 per day); fruit (3 per day), legumes (3–4 per week); low-fat and unsweetened dairy foods (2–3 per day); raw and unsalted nuts (1 per day); fish (at least 2 per week); lean red meats (3–4 per week), chicken (2–3 per week); eggs (up to 6 per week); and olive oil (3 tablespoons per day), whilst reducing intake of ‘extras’ foods, such as sweets, refined cereals, fried food, fast-food, processed meats and sugary drinks (no more than 3 per week). Red or white wine consumption beyond 2 standard drinks per day and all other alcohol (e.g. spirits, beer) were included within the ‘extras’ food group. Individuals were advised to select red wine preferably and only drink with meals. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5282719/

Lopresti  AL. A review of nutrient treatments for paediatric depression. J Affect Disord. 2015;181:24-32. https://www.ncbi.nlm.nih.gov/pubmed/25913919

Feingold, B. Why your child is hyperactive, Random House, 1974.

Loblay RH and Swain AR.  Food Intolerance. In: Recent Advances in Clinical Nutrition' Vol 2, 1986. Libbey, London. Eds: Wahlqvist ML and Truswell AS, pp169-177. https://fedup.com.au/images/stories/LoblaySwain1986.pdf

Parker G, Watkins T, Treatment-resistant depression: when antidepressant drug intolerance may indicate food intolerance, Aust N Z J Psychiatry, 2002:36(2):263-5. Describes the case of a 25 year old patient from a stable and caring family. A university graduate, the patient had a history of attention deficit disorder without hyperactivity, motor tics, generalised anxiety, social phobia, panic attacks, obsessive-compulsive disorder manifested mainly in checking compulsions and five years of severe depressive episodes which were non-responsive to a range of psychotropic drugs. After four weeks on the RPAH elimination diet, his mood and other symptoms had improved considerably. Double blind placebo controlled testing revealed that the patient was severely affected by salicylates and later tests showed effects of food additives. While staying on the diet, the patient was able to remain symptom free. When reviewed after a year, he had been able to return to full time work. http://www.ncbi.nlm.nih.gov/pubmed/11982551

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Food intolerance

Some of the many symptoms of food intolerance that can be helped by diet:

Airways: Asthma, Stuffy blocked or runny nose/ nasal polyps, Frequent nose bleeds, Catarrh, chronic throat-clearing, Sinusitis, Frequent ear infections, Frequent tonsillitis, Frequent colds and flu, symptoms of Samter's Triad, hayfever, allergic rhinitis Skin: Eczema, Urticaria (hives), Cradlecap, Other skin rashes, Angioedema (swollen lips, eyes, tongue), Geographic tongue, Pruritis (itching), Rosaceae, Allergic shiners (dark circles under eyes), Pallor (pale skin), Flushing, Excessive sweating, Body odour, Sore vagina in children, Alopecia (patchy baldness) Digestive system: Irritable bowel symptoms (IBS), Recurrent mouth ulcers, Indigestion, Nausea, Bad breath, Vomiting, Diarrhea, Stomach ache, Bloating, Reflux in babies, adults, Constipation, Colic in babies, adults, Sluggish bowel syndrome (feeling of "more to come"), Encopresis, Soiling (sneaky poos), Dairy intolerance, Gluten and wheat intolerance, Eating disorders (ed), anorexia nervosa, bulimia nervosa, binge eating disorder (BED)  Bladder: Bedwetting, Daytime incontinence, Urinary urgency, Recurrent inflammation (cystitis) Skeletal: Growing pains, Arthritis, joint pain, arthralgia Eyes: Nystagmus (involuntary movement), Blurred vision Muscles: Low muscle tone, Myalgia (muscle pain), Tics (involuntary movement), Tremor, Leg 'jiggling', Heart: Rapid heart beat, Heart palpitations, Cardiac arrhythmias, Pseudo heart attack (feeling of impending doom, chest pressure, pain down arm), Tachycardia (fast heart beat), Angina-type pain, HHT Central nervous system: Headaches or migraines, unexplained tiredness, Chronic fatigue, Feeling 'hung-over', Confusion, Dizziness, Agitation, Tinnitus (noises in ear), HyperacusisAuditory sensory processing disorder (ASPD), Paraesthesia (pins and needles), Dysaesthesia (numbness), Hypoglycemia, Salicylate-induced hypoglycemia, Epileptic seizures, Fits, Sensory symptoms of multiple sclerosis, Symptoms of lupus Anxiety: Panic attacks, Depression, Obsessive ruminations (repetitively focusing on bad feelings and experiences from the past), Self harm, Suicidal thoughts, actions, teeth grinding (bruxism) Impaired memory: Vague or forgetful, Unable to concentrate, Won't persevere, Unmotivated, Disorganised, Easily distracted, Difficulty reading and writing Speech: Loud voice (no volume control), Speech hard to understand, Speech delay, Selective mutism, Stuttering, Repetitive noises, Talks too much (empty chatter) Coordination: Poor handwriting, Poor coordination, Frequent accidents, Vertigo Sleep: Difficulty falling asleep, Restless legs syndrome (RLS), Persistent night waking, Insomnia, Nightmares/night terrors/sleepwalking, Sleep apnoea Mood: Brain snaps, Mood swings, Premenstrual tension, Grizzly or unhappy, Cries easily or often, Irritable, Uncooperative Oppositional defiance: ODD, Loses temper, Argumentative, Refuses requests, Defies rules, Deliberately annoys others, Blames others for own mistakes, Touchy, easily annoyed, Angry, resentful Other behaviour: ADHD, ADD, Autism, Aspergers, Inattentive, easily bored, unmotivated, 'Unable to entertain himself', Restless, fidgety or overactive, Head banging, Hyperactivity, Fights with siblings, Difficulty making friends, Destructive, aggressive, Unreasonable, Tantrums, Demanding, never satisfied, Disruptive, Discipline is ineffective, Pervasive Development Disorder

Some causes of food intolerance:

Food additives: Artificial colours: (food dyes, artificial colors) tartrazine 102 (E102, FD&C Yellow No.5), quinoline yellow 104 (E104), sunset yellow 110 (E110, FD&C Yellow No.6), azorubine, carmoisine 122 (E122), amaranth 123 (E123), ponceau, brilliant scarlet 124 (E124), erythrosine 127 (E127, FD&C Red No.3), allura red 129 (E129, FD&C Red No.40), indigotine, indigo carmine 132 (E132, FD&C Blue No.2), brilliant blue 133 (E133, FD&C Blue No.1), green S, food green, acid brilliant green 142 (E142), fast green FCF 143 (E143, FD&C Green No.3), brilliant black 151 (E151), brown, chocolate brown 155 (E155)  Natural colours: (colors) Annatto (annatto extracts, bixin, norbixin, 160b, E160b) Preservatives: Sorbates: (sorbic acid 200, E200, sodium sorbate 201, E201, potassium sorbate 202, E202, calcium sorbate 203, E203) Benzoates, hydroxybenzoates, parabens: (including benzoic acid 210, E210, sodium benzoate 211, E211, potassium benzoate 212, E212, calcium benzoate 213, E213, ethyl para-hydroxybenzoate 214, E214, sodium ethyl para-hydroxybenzoate 215, E215, propylparaben 216, E216, propyl 4 hydroxybenzoate 217, E217, methylparaben 218, E218) Sulfites, bisulfites, metabisulfites: (200-228, sulphites, sulphur dioxide, sulfur dioxide 220, E220, sodium sulphite 221, E221, sodium bisulphite 222, E222, sodium metabisulphite 223, E223, potassium metabisulphite 224, E224, potassium sulphite 225, E225, calcium sulphite 226, E226, calcium bisulfite 227, E227, potassium bisulphite 228, E228) Nitrates & nitrites: (249-252, potassium nitrite 249, E249, sodium nitrite 250, E250, sodium nitrate 251, E251, potassium nitrate 252, E252 Propionates: (bread preservative, mould inhibitor 280-283: propionic acid 280, E280, sodium propionate 281, E281, calcium propionate 282, E282, potassium propionate 283, E283, 'natural' preservatives in bread, cultured wheat, cultured dextrose, cultured whey) Synthetic antioxidants: Gallates 310, 311, 312 (E310, E311, E312), tBHQ 319, E319, BHA 320, E320, BHT 321, E321 Flavour enhancers: (flavor enhancers) glutamic acid and all glutamates, MSG monosodium glutamate 620-625, yeast extract, hydrolysed vegetable protein HVP, disodium guanylate 627 (E627, DSG, GMP), disodium inosinate 631 (E631, DSI, IMP), ribonucleotides 635 (E635, I&G, nucleotides)  Flavours: (flavors)  Natural food chemicals: Salicylates: salicylic acid, sodium salicylate, acetylsalicylic acid Biogenic amines: vasoactive amines (tyramine, phenylethylamine, histamine and others) Glutamates:  Natural foods: Dairy: milk, yoghurt, cheese, butter, lactose-free milks Wheat or Gluten: (wheat, rye, barley, oats) Soy: Sugar free sweeteners:Sugar free sweeteners: polyols, sorbitol, mannitol

On this website, failsafe refers to foods that are Free of Additives and Low in Salicylates, Amines and Flavour Enhancers. Note that copyright applies to the commercial use of the term "failsafe" in the food and health context so as to control inappropriate use by the food and health industries.