SHOE LEATHER: Reported Stories
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Mood Food

Therapists use nutrition to treat anxiety and depression.

By Carina Wolff

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The cure for mood disorders might be found in food rather than pills.

The cure for mood disorders might be found in food rather than pills.

The medicine cabinet may give way to the trash can for Prozac, Xanax, and Zoloft, the antidepressants prescribed to the one in 10 Americans who suffer from depression. A small but growing number of experts have come to believe that instead of pills, a refrigerator and pantry stocked with the right foods may well turn out to be better therapy than prescription drugs. The science supporting this alternative approach is surprisingly persuasive.

Results so far are promising in people with depression and anxiety who manage their condition with food and supplements, deterred from submitting to a drug regimen by the potentially deleterious side effects. Research has shown that certain foods, like animal proteins, foods rich in omega-3 fatty acids, complex carbohydrates, and fruits and vegetables, can boost mood. Other studies indicate that foods high in sugar, caffeine, or trans and saturated fats can increase anxiety and depression. Armed with this growing body of information, nutritional therapy attempts to treat mood issues by prescribing a change in diet.

That viable alternatives to prescription medication should emerge as effective treatment in mood disorders is an important development. Depression now ranks as the No.1 cause of disability for people ages 15 to 44. Statistics vary, but at least 10 percent of the U.S. population suffers from depression and another 18 percent from some form of anxiety.

Doctors have been quick to prescribe antidepressants for treatment, but what many patients don’t realize is that the pills might not actually be working. Researchers at Harvard University who have studied the use of antidepressants found that the placebo effect can have as much impact on patient improvement or recovery as the drugs.

And yet, regardless of whether their effect is placebo or actual, the pills can mean weight gain, loss of emotional range, and even the risk of suicide -- side effects made familiar by the litany of warnings spewed out in television ads night after night. No wonder many sufferers from depression or anxiety would want to look elsewhere for treatment.

Dancer Krystal Ellsworth avoided panic attacks by fixing her diet.

Dancer Krystal Ellsworth avoided panic attacks by fixing her diet.

26-year-old Krystal Ellsworth is one such individual. Distraught from a bad breakup with her boyfriend, the dancer, who lives in Los Angeles, found herself struggling to breathe during panic attacks that left her “wanting to jump out of her own body.” She did not want to go on antidepressants. “I didn’t want to feel nothing,” she said. “I wanted to feel emotions where it was appropriate, and I was afraid antidepressants wouldn’t allow me that.”

Part of her reticence, she said, came not from the foreboding disclaimers in television ads, but from watching the way anxiety medication turned her mother into a “numb zombie.” On top of everything else, Ellsworth was experiencing digestive issues. Her mother came from a Mexican family, and the home cooking during her formative years was what she called “unhealthy, typical Mexican,” consisting of cheesy dishes and very few vegetables. The issues showed up after she left home, as she continued to eat poorly, but her family doctor‘s advice was of no help. The panic attacks and digestive troubles persisted.

“I didn’t realize that food can be your medicine. And that’s all the medicine you need.”

Then a friend introduced her to super foods -- fruits, vegetables, and select grains that contain many health benefits and few negative properties. After she began incorporating these foods into her meals, Ellsworth noticed a small difference both in her body and her moods. With this new awareness that her food choices could be the root of her frequent panic attacks, she started seeing a holistic nutritionist who offered up a different kind of prescription -- a mood altering diet. Ellsworth started taking herbal supplements and cut out sugar. She started eating even more vegetables, added in complex carbohydrates, and drank less caffeine. In the space of a month, her digestive problems went away. And so did her anxiety.

“I didn’t realize that food can be your medicine,” she said. “And that’s all the medicine you need.”

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Therapeutic diets have roots in antiquity: "Let food be thy medicine," was Hippocrates’s declaration in 431 B.C., emphasizing his belief that the body could cure itself. The concept goes even farther back into the much older practices of the East where physical and mental ailments were often healed with food and herbal supplements. Still practiced today, Traditional Chinese Medicine regards food an essential element. Disciples of this holistic practice believe that emotional problems result from imbalances in the internal organs and their pathways. Since nutrient deficiencies cause imbalances, food can restore equilibrium.

The essential components for proper balance are yin and yang, with yin representing low energy and yang representing high energy. According to TCM, foods take on these properties. The high-strung are advised to consume foods with yin properties, like vegetables, to calm them. Yang foods such as meats have the opposite effect, giving energy to those who are lethargic or down.

Proper balance in the body is also a theme of Ayurveda, an ancient traditional Indian medicine. It divides food into three categories. Coffee, tea, and sweets comprise Rajasic foods, which energize and stimulate. Clean foods like fresh fruits, vegetables, and legumes are Sattvic foods, which encourage balance, calmness, and contentment. Tamasic foods, which are heavy and processed, lead to dullness and irritability. Knowing this, people can increase their consumption of Sattvic food, for example, when they are stressed and Rajasic foods when they feel depressed, just like in TCM.

All of these traditions, buttressed by progressive research, have influenced the emerging nutritional therapy movement. In the West, especially in the United States, natural remedies have been popular, but mostly as a complement to a primary course of treatment. Slowly, the present introduction of nutritional therapy is working towards change, striving to alter the treatment focus from simply alleviating symptoms to addressing the issues that underlie the imbalances.

Before the 1950s when antidepressants became the regimen of choice, the prescriptions favored by American doctors tended to be highly addictive synthetic drugs like opioids and methamphetamine. As soon as the Food and Drug Administration approved Prozac in 1987, use of the drug took off and continued to skyrocket. From the period between 1998 and 1994 to 2005 and 2008, the number of people taking antidepressants increased by a stunning 400 percent.

The astounding number of patients being medicated for conditions such as major depressive disorder, bipolar disorder, and generalized anxiety made the unwelcome side effects all the more evident: over-dependence, extreme weight gain, risk of suicide, and even murder. Eric Harris, one of the two gunmen of the Columbine shootings, was taking Fluvoxamine, a Selective Serotonin Reuptake Inhibitor antidepressant, at the time of the shooting. In 2001, high schooler Jay Johnston, after being prescribed the antidepressants Zoloft and Prozac, attempted suicide, permanently disfiguring himself. He was awarded $5 million after suing his doctor for improper monitoring.

A review of FDA studies testing for the placebo effect in antidepressants showed that when results of the pills were successful, medical journals published the conclusions 94 percent of the time. Unsuccessful trials, however, were only published 50 percent of the time. The controversial findings led independent researchers to look further into the placebo effect, including the Harvard researchers whose study was published in the American Psychological Association Journal in 1998. The search for alternatives, which some scientists had been experimenting with since as early as the 1950s, became more pressing.

Two Canadian doctors at the time, Abram Hoffer and Humphry Osmond, experimented with vitamins to cure schizophrenia, research that validated the ancient connection between nutrients and mental illnesses. Nobel-prize winning biochemist Linus Pauling, who also worked in the 1950s, advocated the use of nutritional therapy, as he worked on treating certain conditions using high doses of Vitamin C. Now researchers have expanded their exploration into the power of amino acids, minerals, and other vitamins present in food. In 1998, a scientific journal devoted exclusively to the topic appeared. Nutritional Neuroscience began spreading new findings about the connection of mental illness and diet.

One of the major studies that supports the influence of diet on mental health comes from the work of Malcolm Peet. A professor at the University of Sheffield in England, Peet researches the connection between food and behavior, including dietary intake and mental illnesses across different nationalities. Using data from the Food and Agriculture Organization, Peet found that a high intake of sugar leads to depression, as does a low intake of fish.

Fish consumption is especially important, and this research is supported by additional studies focusing on the healing properties of omega-3 fatty acids. In another study by Harvard researchers published in 1999, omega-3 supplements helped patients so much that the researchers halted the study so that all depressives in their sample could take the supplements.

With the compelling nature of the research to date, it’s reasonable to ask why general practitioners haven’t taken the lead in encouraging dietary change in such cases. Blame their own training. A study by the University of North Carolina Chapel Hill in 2010 found that out of the 127 accredited U.S. medical schools surveyed, only a quarter offered even one course on nutrition.

Nonetheless, the word about nutritional therapy is getting out. Many nutritionists believe the growing national concern for more generalized healthy habits is helping to popularize the idea. “I get a lot of referrals from therapists, psychologists, and psychopharmacologists,” said Barbara Mendez, who runs a nutrition clinic in New York City. “Those doctors are realizing the importance, so maybe stuff is going on behind the scenes.” Mendez is a nutritionist as well as a registered pharmacist.

“Diet can screw up cognitive function and depression. But it won’t make you happy.”

One reason for slow adaptation by clinicians is that the efficacy of stand-alone nutritional therapy is still under debate. Some doctors and psychologists doubt that food alone can have the power to treat a mental illness, especially since depression can range from brief bouts of unhappiness to a sustained, full-blown chemical imbalance. The latter cases, they believe, regardless of diet, require heavy medication and intense psychotherapy. “Diet can screw up cognitive function and depression,” was the way Gary Wenk put it. He is a professor of psychology at Ohio University who specializes in this area. “But it won’t make you happy.”

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While nutritional therapy may not have caught on yet with the average family physician, it has found a place among some scientists, doctors, and psychologists. Julia Ross’s Recovery Systems Clinic is one such place. Ross and her team of nutritionists and psychotherapists at the Mill Valley, California facility work on finding holistic cures through food and supplements. Mood disorders are not the only ailment treated naturally: Ross’s clinic addresses addiction and eating disorders as well. Ross is a clinical psychologist by training and a pioneer in the nutritional therapy movement. Her best-selling book, The Mood Cure, has inspired others to get into the field.

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After her own positive experiences with nutritional therapy, Scott now works as a nutritionist.

After her own positive experiences with nutritional therapy, Scott now works as a nutritionist.

One of Ross’s former staff members, Trudy Scott, joined the team after going through a recovery of her own. She remembered having her first panic attack: her heart was pounding so hard she thought it might explode. Unable to breathe, Scott was petrified. “I thought I was going to die,” she said.

No external cause could account for Scott’s crushing feelings of doom. During the day, worry and fear overwhelmed her, so much so that she avoided social situations. At night she would jolt awake inexplicably, choking on her breath. Although she was working long hours at a computer job, Scott loved outdoor activities like hiking and rock climbing and kept a whole foods, vegetarian diet. She also avoided processed junk foods, a diet influenced by her South African heritage. But from the time she entered her mid-30s, Scott had began to feel increasingly anxious.

Though she was raised not to immediately turn to medication, Scott reluctantly sought help from her doctor, figuring the cause of her incessant anxiety was something biochemical. He prescribed her Prozac, but once she read about the side effects, Scott dismissed taking it.

Instead she saw a nurse practitioner and a naturopathic doctor. She discovered she had pyroluria, a genetic condition that causes social anxiety and inner tension. Through medical advisement, Scott made some dietary changes, eating more protein and stabilizing her blood sugar levels by eating breakfast in the morning and snacking throughout the day. With the addition of zinc, Vitamin B6, and evening primrose oil supplements, she completely resolved her symptoms.

The power of her personal experience sent Scott back to school at the American Health Sciences University to become a nutritionist. Her goal was to educate herself further, but the more she learned, the more she wanted to practice. Eventually, Scott quit her computer job and committed herself to nutrition counseling full time.

As for Ross, she began researching the connection between biochemistry and emotion in 1980. By 2003, she had published The Mood Cure based on her findings that suggest mood disorders result from deficiencies in crucial amino acids. Depressed people require more tryptophan, the amino acid in turkey infamous for causing sleepiness after Thanksgiving dinner. Tryptophan eventually converts into serotonin, the neurotransmitter responsible for pleasant moods.

Julia Ross’s book The Mood Cure has inspired others to treat their anxiety and depression naturally.

Julia Ross’s book The Mood Cure has inspired others to treat their anxiety and depression naturally.

Doctors are well-aware of the connection between serotonin and depression. Most antidepressants are Selective Serotonin Reuptake Inhibitors, meaning they increase the amount of serotonin in the body by blocking reabsorption in the brain. However, we do not need to increase serotonin artificially, as we are able to get serotonin through food, especially in animal proteins like beef, poultry, and eggs.

Some might even remember the banana-smoking hoax in 1967, when people scraped the insides of the banana peel -- bananas contain serotonin -- in an exuberant but ultimately unsuccessful attempt to get a cheap high.

For anxiety, GABA is the amino acid that comes into play. The inhibitory neurotransmitter, or “your brain’s natural valium,” as Ross calls it, turns off the overwhelming excitatory responses in your brain that result from stress. Yogurt and tea, as well as protein and healthy fats, contain GABA.

GABA supplements also contributed to Scott’s recovery. Even when she weaned herself off of the supplements, while still sticking to her improved diet, she no longer had anxiety or panic attacks. Motivated by her natural recovery and the wisdom of Ross, Scott wrote her own book, The Antianxiety Food Solution. She now runs her own nutrition clinic in Northern California.

After working with Ross, Trudy Scott wrote her own book, The Antianxiety Food Solution.

After working with Ross, Trudy Scott wrote her own book, The Antianxiety Food Solution.

Ross and her associates are not alone in their assertion that low levels of important amino acids can cause anxiety and depression. The Merck Manual of Diagnosis and Therapy, the world’s best-selling medical textbook, also supports the claim that neurotransmitter abnormalities can result in depression. Research at the National Institutes of Health found that a depletion of serotonin could cause a relapse of depression in patients.

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The majority of the serotonin in our body -- 95 percent -- is located in the gastrointestinal tract, which nutritional therapists refer to more commonly as the gut. So it would make sense that the nutrients we put into our bodies have a large effect on how we feel emotionally. Enterochromaffin cells surround the alimentary tract and release serotonin in response to food, creating a connection between digestion and mood regulation.

The gut processes our food from the second we swallow it until we secrete unwanted waste. A damaged gut affects serotonin levels, which in turn negatively affects mood. In the theory behind Dr. Natasha Campbell-McBride’s Gut and Psychology Syndrome Diet, mental health is resolved through healing the gut. She developed her theories while working as a neurologist and neurosurgeon. She eventually earned a postgraduate degree in human nutrition to accompany her degree in neurology.

The gut can become damaged from unhealthy eating, overuse of medication, food intolerances, and stress. Ashley Hathaway, a certified GAPS Practitioner, explains that once damaged, the gut becomes permeable, leaking food particles and other foreign matter into the bloodstream and disrupting normal brain functions. When the gut is sealed, keeping the unwanted particles out of the blood, the patient gets better. Hathaway, also a certified nutritional therapist, came to the field after quitting her job in the television and video business. She decided to train professionally after she healed her own damaged gut through diet. She now runs San Francisco Nutritional Therapy.

When there are digestive issues, the body does not absorb nutrients properly. “People react to that situation differently,” Hathaway said. “In some people their blood sugar regulation is affected. In some people it’s their bowels, skin, hair, or nails. And in some people it’s the brain. There are a lot of different outwardly signs that the body is not getting what it needs from food. “

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Nutritional therapy has also worked for others outside the field. Jillian Harrington, now a life coach, was 13 years old when she decided to become a vegetarian. Bothered by the ethics of eating animals, Harrington ditched meat and switched over to bread products and pasta. “My family would refer to me as a vegetarian who didn’t eat vegetables,” she said.

Once she made the change, Harrington began feeling depressed. At first the sadness was mild, lasting only a couple of days to a week. As she entered her 20s, the depression worsened. At 23, she had a major episode that lasted an entire month. Something was obviously wrong, and Harrington decided to take action.

Like Ellsworth, Harrington had seen the cascading effects of medication in her mother. To avoid the same outcome, she went to a naturopath in hopes of finding the root of her issues and to treat them naturally. To her surprise, the doctor asked how much protein she was eating. Harrington found the inquiry odd. “What does protein have to do with depression?” she thought.

“What does protein have to do with depression?”

A lot, she would soon realize. Although she did not yet understand the science behind it, Harrington followed the advice of her naturopath and upped her intake of protein, adding occasional chicken and fish, which she had previously eaten from time to time. The diet change immediately made a difference. Within a week, her month-long depression faded. A few years later, she read Ross’s book, and the connection between her vegetarianism and her depression clicked. After 15 years, Harrington started eating other meats again. Her routine episodes of feeling down for a couple of days to a week disappeared permanently.

Ross’s theory is fascinating because it goes against the latest trend of giving up meats because of their high fat and cholesterol content and their contribution to heart disease.

But she is not alone in her advice. Most nutrition experts encourage people to eat more animal protein to feel more emotionally stable, but it is important that the meat be organic and grass-fed. When livestock eat grains, their ration of fatty acids is compromised, but when they are fed grass, the nutrients remain. Nutritionists advise people to eat grass-fed and free-range animals to receive more of the benefits and less of the unfavorable health issues, as grass-fed meat is leaner and actually lowers cholesterol levels.

Despite the trendiness factor, Ross may have a point, as studies support that people who don’t eat meat are more likely to have mental disorders. Researchers at two German Universities compared vegetarians to non-vegetarians from the same socio-demographic group and found that vegetarians showed higher rates of depressive and anxiety disorders than meat eaters.

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To incorporate more meat protein, Harrington eventually turned to the Paleolithic diet, based on the food our ancestors ate during the Stone Age before modern agriculture. The diet has helped a number of people with depression because of its high protein and vegetable content, including fish, grass-fed meats, eggs, nuts, and produce. Harrington blogs about her diet change under the moniker "Paleo Lady," chronicling her ups and downs with moods and weight loss using the diet.

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While the Paleo Diet can help with depression, studies have shown that the traditional Mediterranean diet is the most effective in maintaining a positive mood. A typical Mediterranean diet includes high amounts of fruits, nuts, vegetables, legumes, olive oils, cereals, and fish, along with minimal dairy and meat and moderate amounts of alcohol, usually red wine.

Scientists from the University of Las Palmas de Gran Canaria in Spain randomly assigned sufferers of major depression to three diet groups. One, the control group, was fed a standard low-fat diet. The other two groups ate a Mediterranean diet, with one group given additional virgin olive oil and the other group given supplements of walnuts and almonds.

Researchers followed subjects on the three diets for three years, allowing anticipated changes in brain function to take effect. Both of the Mediterranean diets showed the greatest increase in blood levels of brain-derived neurotrophic factor, a protein that elevates mood. But the diet with nuts showed the strongest correlation between diet and high BDNF levels. Low levels of BDNF have been linked to depression, and increasing levels using different foods can help cure it. The Mediterranean diet is also high in fish, which means a higher intake of omega-3s. There are many types of fish with little to no levels of mercury, such as salmon, tilapia, and sardines, that can be eaten once or twice a week without harm.

It was in Spain that Andréa Hammond first happened onto the connection between food and mood. The Michigan native was studying abroad in Madrid and had scrapped her old habits of eating sugar, wheat, and processed foods for local fish, vegetables, and meats. Although the food-mood research is persuasive, feeling better may be attributable to more than the new diet: Rates of depression are lower in Mediterranean countries than in Northern Europe and the United States.

Andréa Hammond discovered the connection between food and mood while in Spain, a Mediterranean country with low rates of depression.

Andréa Hammond discovered the connection between food and mood while in Spain, a Mediterranean country with low rates of depression.

Hammond was just sitting on her bed, doing absolutely nothing, when she experienced what she now describes as a feeling of bliss. Nothing out of the ordinary had happened; no exciting event or arrival of good news. But there was not a question in her mind: Hammond knew the source of her new effervescence had to be change in food habits.

With her newfound discovery that foods had a strong impact on her mind, Hammond began experimenting with diets when she arrived back to the United States. First it was vegetarianism, then eventually veganism. As a vegan, she began to feel off. Although she was working successfully at a business consulting company, Hammond felt unhappy.

“I just knew that something was wrong,” she said. “I felt very burnt out.” She returned to Spain, the last place she had remembered feeling genuinely happy, and took six months off to soul search in hopes of attaining the same emotions she had before.

Bolstering the Mediterranean food hypothesis was another study by the same Spanish university in which researchers followed 10,000 healthy adults for four and a half years, tracing their intake of food. During this time, 480 new cases of depression were diagnosed, but those who ate a Mediterranean diet were more than 30 percent less likely to develop depression that those who ate foods outside of the diet, such as meat and whole-fat dairy.

Aside from fish and other sources of protein, the amount of fruits and vegetables Mediterraneans consume has a large impact on elevating mood. Professors in England studied the eating habits of 80,000 people in Britain, and they found that those who ate seven portions of fruits and vegetables a day had the highest rates of happiness and mental health. Ross suggests eating dark leafy greens like kale, spinach, and chard plus fruits like bananas, apples, and berries, although any fruit and vegetable helps.

Fruit and vegetables play a large role in aiding mood disorders.

Fruit and vegetables play a large role in aiding mood disorders.

B vitamins, also found in fish, meat, poultry, and dairy, are likely to account for the mood-boosting properties in fruits and vegetables. While the exact effects the vitamins have on the brain are not fully understood, they are known to upkeep healthy nerve and blood cells and get rid of harmful byproducts. They also assist with the functioning of the neurotransmitter dopamine that, like serotonin, creates a feeling of pleasure.

Hathaway, the GAPS practitioner, suggests that most people could use extra B vitamins such as B6, folic acid, and niacin in their diet, whether they feel slightly down or experience debilitating depression. “There are people who are so depressed that they are literally sitting in the corner of their house,” Hathaway said. “They don’t talk, they don’t move, they don’t do anything. [Doctors] have put these kind of people on high doses of niacin, and they’ve gotten these people completely out of their depression. Completely.”

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After her second stint eating a Mediterranean diet, Hammond returned from Spain feeling refreshed. The mood didn’t last. Not long after her return, Hammond’s mother died suddenly. Realizing she wanted to pursue her passion for food and nutrition, she signed up to attend the National Gourmet Institute, a health-focused culinary school in New York City. Inspired for change, she incorporated meat and dairy back into her diet and added locally sourced produce. For the second time, Hammond felt the overwhelmingly positive effects of her food. “It’s the feeling of being ecstatic and joyful, but nothing’s happened to you” Hammond said.

“I think we need to change our culture and understand how pervasive food is in everything, not only our physical appearance.”

At the institute, she spent half of her time learning the culinary arts, cooking with organic and whole foods. The other half she spent in nutrition class, learning modern nutrition along with Chinese medicine and Ayurveda. Inspired by the teachings of Eastern medicine, Hammond next chose to attend the Academy of Healing Nutrition, where they use ancient practices to teach nutritional therapy. She became a certified health counselor through the program and started her own website, A.H. Nutrition Therapy, to advise others on the benefits of a proper diet. She now works individually with clients, helping them discover this connection. "I think we need to change our culture and understand how pervasive food is in everything, not only our physical appearance," Hammond said.

As a part of therapy, nutritionists suggest not only foods to eat but also what foods not to eat. We know that sugar and fat are bad for our waistline, but they also damage mental health. Scientists have found that sugar and fat have a negative effect on the brain strikingly similar to the effect of drugs, meaning high sugar and fat consumers can experience the same ups and downs of emotion as addicts do.

Professor Wenk wrote his book Your Brain on Food: How Chemicals Control Your Thoughts and Feelings when he started noticing a strange consequence of eating chocolate. After consuming the treat, some people become very angry and aggressive, something Wenk calls "chocolate anger." Intrigued, he began his research and uncovered similarities in the brain between the effects of certain foods and drugs.

Sugar, like chocolate, has a very strong drug-like effect on the brain and plays a big part in mental health. Its intake causes glucose levels to initially spike but then drastically crash soon after, prompting irritability and depressive mood swings, making it imperative to keep glucose levels stable.

Research at the National Institutes of Health showed that regular soda drinkers had a 22 percent increased risk of developing depression over the span of 10 years. Sugar creates chronic inflammation in the body, disrupting the immune system and leading to a greater risk of depression. Sugar also suppresses activity of the protein BDNF, and this is evident in those with a sweet tooth, as they have chronically lower levels of the growth-hormone. However, drinking diet soda doesn’t solve the problem either, as it also increases risk of depression because artificial sweeteners contribute to mood disorders as well.

As for the consumption of saturated and trans fat: In another study conducted in Spain, researchers monitored college graduates’ intake of different types of fat over roughly six years. They found a relationship between trans and saturated fat intake and risk of depression, although the trans fat relationship was much stronger than that of the saturated fat.

Trans fats, also known as hydrogenated oils, are liquid fats that have been transformed to solids via a hydrogenation process. Many staples of the Standard American Diet -- fittingly known as SAD -- contain the harmful fats. Those who turn to junk foods like cookies, pizza, and fries when they are feeling down ultimately end up feeling worse, as their comfort foods actually exacerbate anxiety and depression.

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In addition to their fat-filled content, processed foods also eventually convert into sugar and deplete essential B vitamins. In a study at University College, London, researchers discovered that people who eat a fatty, fried, processed, and refined carbohydrate diet had a 58 percent greater chance of developing depression, while those who ate whole foods were 26 percent less likely to develop the disorder.

But some foods that have other health benefits can actually create problems with mood. Anxious people may want to put away their morning cup of coffee because caffeine is a stimulant that can increase heart rate, raise anxiety levels, and induce panic. It can even instigate anxiety in those who are normally not anxious.

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If the rules of what to eat seem confusing, a nutritionist or doctor can help. They break down and analyze the patient’s current diet when he or she comes in. They perform tests to look for nutritional deficiencies and allergies and ask about the patient’s daily life -- how stressed they feel, what they think about their job, etc.

Each person is analyzed on a case-by-case basis. By looking at specific diet choices, doctors and nutritionists can recommend new foods or suggest additional supplements to combat nutrient deficiencies. Foods that negatively affect mood are removed, and foods that boost mood are added. Many times the diet change comes alongside cognitive therapy, just as is suggested with antidepressants.

The time it takes for the changes to happen vary, depending on individual body chemistry, severity of the mood disorder, and types of food eaten. Fast-acting foods like coffee and sugar affect mood instantly. Foods like carbohydrates, proteins, and vitamins have intermediate effects that last longer than fast acting foods, but not as long as foods that are high in antioxidants, which have the longest lasting impact.

In addition to treating depression, nutritional therapy can help with other minor emotional issues. Health counselor Hammond has clients come to her who have too much aggression, who have problems focusing, or who have irritable moods they cannot shake off.

One client came in looking to solve his extreme insecurity. Hammond suggested he focus on what foods he ate and how they made him feel. Eventually, he found that when he ate a lot of sugar, he started to feel insecure. Once he removed sugar from his diet, the majority of his insecurity disappeared.

Some clients just want more information. Others require moral support through ongoing coaching. Some even go to the grocery store with Hammond, where she helps them choose foods and teaches them how to cook.

But not everyone needs to see a nutritionist or doctor to take advantage of the natural healing mechanisms in food. Numerous books are written on the subject, and a quick Google search yields a list of beneficial foods.

Hammond makes a point to emphasize that overall diet, not just one magical food, can cure mental issues in patients. “People often come to me and say, ‘tell me just one food to eat that will help my brain function,’” Hammond said. “You can eat more wild raised salmon, and it will help, but it won’t transform your life.”

While nutritionists generally agree on the valuable foods for treatment, everyone’s body reacts differently. Just as it should be with prescription medicines, there is no one-size-fits-all regimen. Nutritionists and doctors suggest that patients try cutting foods out and adding some in to see how their body responds to specific shifts in diet.

For example, complex carbohydrates help elevate serotonin levels, but for those who have Celiac’s disease or gluten intolerance, wheat-based carbohydrates can actually cause depression. Patients should get tested for food allergies, as negative reactions cause inflammation in the body leading to lower levels of serotonin. A study at the University of Maryland found that people with severe allergies are twice as likely to be at risk for depression than those without allergies. Depressed people may not even realize they are allergic to certain foods, because instead of breaking into hives, they have a negative emotional reaction.

“Now if I’m exposed to gluten, I know about it. It makes me anxious, and it makes me depressed.”

Unbeknownst to South African Scott, she had an allergy to gluten. Though she experienced digestive issues when she was younger, she ignored it, unaware of any food intolerance. A few years after she got help with her depression, Scott got her adrenals tested and found out she was allergic to the protein composite. Once she got off the allergen, her mood improved.

“Now if I’m exposed to gluten, I know about it,” Scott said. “It makes me anxious, and it makes me depressed.”

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In the data over the past decade, there is a barely perceptible shift in support for nutritional therapy. From 2002 to 2007, use of diet-based alternative and complementary therapy increased from 3.5 percent of the population to 3.6 percent. No new data has been released since 2007, but nutritionists believe that this number has grown in the past six years. Nutritionists receive referrals from psychologists and doctors, and many of the aforementioned are working together to write books and create websites to inform the public about this alternative option.

“I’ve seen how a proper diet can have much more of an effect on someone’s mental health than I would ever think.”

“With the amount of research taking place, doctors and nutritionists are constantly making new discoveries. “As a professional practitioner, I’ve even changed my views,” said Lisa Moskovitz, a registered dietician in New York City. “I’ve seen how a proper diet can have much more of an effect on someone’s mental health than I would ever think.”

The government seems to agree that Americans are becoming more interested in nutritional health. The Bureau of Labor statistics predicted that employment of dietitians and nutritionists is expected to increase 20 percent from 2010-2020, which is faster than the average for all other occupations.

“People are starting to come to grips with the fact we that have veered so far from the way we used to eat as human beings,” said Hathaway. “And we wonder why everyone is so sick.”

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Research is still being conducted to assess whether or not certain diets can sufficiently aid in mood disorder treatment, so opinions are still mixed. The ultimate question is whether or not nutritional therapy works at all, or if like antidepressants, it is just the placebo effect. At this point, the answer is unclear, although research has strongly supported that food does indeed have an effect on the brain.

And even if all those steaks and salads just lead to a placebo effect of their own, most nutritionists and doctors do not mind, so long as patients show improvement. “If it’s not dangerous, who cares if it’s the placebo effect,” said Moskovitz. “If it’s working, it’s working.”

“We learned in pharmacy school that healing is like a pie that’s cut into three pieces” said Mendez, the nutritional therapist and pharmacist. “A third is the treatment, a third is what you think about the treatment, and a third is what you think about the person recommending the treatment. . . . So if you look at it, a full two-thirds is really just the placebo itself.”

So is it the food itself that is essential to providing nutrients? Or is taking supplements an adequate way to receive essential vitamins, minerals, and amino acids? The Mood Cure author Ross is a big advocate of supplements, noting in her book that she has witnessed drastic changes, sometimes instantaneously, in patients after they took even just a single supplement.

Ellsworth also believes supplements help. “My panic attacks are definitely not as strong or frequent if I take them,” she said. “I definitely think I feel better.” But Professor Wenk finds excessive use of supplements to be pointless. “Americans have the most expensive urine in the world,” he joked.

Just like food and meats, supplements should derive from natural sources to avoid ending up going down the bathroom pipes. Store-bought, synthetic vitamins do little to help us, says San Francisco-based nutritionist Hathaway, who suggests buying food-based vitamins online or in health food stores. In general, nutritionists advise their clients to use supplements obtained from natural foods with the attitude that it can only help, not harm.

Since much of the research done on the connections between nutrients and depression is correlational, not causational, it is easy to question what comes first, the serotonin-filled chicken or the tryptophan-rich egg. Are people who eat healthier foods happier because they feel good about themselves, leading them to gravitate towards healthier foods, when on the other hand, depressed people self-medicate with fatty foods and sweets? Or are people happy because they are eating the right things and getting the nutrients they need to feel positive?

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The benefits of nutritional therapy do more than just eradicate side effects; they can also helps reverse them. Since treatment involves a healthy eating pattern, it can also help weight loss, a concern especially important for those who take antidepressants and experience weight gain. Proper emotional balance returns; the bad feelings recede and good ones start to replace them. And increasing nutrient intake does not increase the likelihood of committing suicide. It helps people enjoy life.

“People are starting to look at other people changing their diets, going back to eating real food and coming out of these states of diseases,” said Hathaway. “People are starting to see the results, whether it’s from a friend, a family member, a neighbor, watching a movie. It’s all around us.”

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NYU Arthur L. Carter Journalism Institute