Health

We’re all SMILES!

March 6, 2017

Sometimes when the evidence finally emerges, I get very excited.  There are some things we know through experience or what some might call the “6th sense”. But when a good scientific large-scale study provs the point, you just want to say “Baruch Hashem!”.  And at the time of writing this article, this past week was one of those times.   You see, most educated people know that exercise and proper healthy eating are extremely beneficial to one’s health and quality of life.  And we certainly know this is true in regard to our physical health.  One who engages even in minimal aerobic exercise has more stamina and endurance.  We aren’t exhausted after taking a long walk to shule or climbing a few staircases to visit our friends on Shabbos.  If we need to move some boxes or change around the furniture, we can do it because we work our muscles a few times a week.  And by exercising we have a better quality of life and might even live longer.  This isn’t anything new!  But how exercise and proper eating helps us with our mental well-being is another story.  Now there is new groundbreaking information on that subject. 

Recently, I was going over the Health History forms that my clients fill out upon starting a program.  There are 35 possible items to check off if you suffer from that particular malady. One of these 35 items is depression.  I notices that this is being checked off more often than not.  Most of you reading this probably think of first-line treatment of depression being either medication (something like Prozac or other SSRI drugs) or some type of psychotherapy.  However, before we run for a prescription or to make an appointment with a psychologist, take heed about the two SMILE studies—the newest one just out tells us just how important our diet is when it comes to suffering from depression, the older one, on the positive effects of exercise on mood.

Think about it—you are feeling down about something and you go out for a 20 minute moderate to brisk walk.  No matter how lousy you were feeling, your mood is probably improved to some extent or another.  Some of you might have noticed that after eating junk food, especially instead of eating healthy food your overall mood can go low.  Now we have two studies, both using the acronym SMILE to show us that drugs and therapy are far from the only answer, and may not even be the best answer in some situations.

Two researchers, Felice Jacka and Michael Berk, led a consortium of Australian Institutions based at the Food & Mood Centre at Deakin University in Victoria, Australia. This was called the SMILES study. SMILES stands for Supporting Modification of Lifestyle in Lower Emotional States.

Over 3 years, they recruited several hundred patients with moderate to severe depression and entered 67 into a 12-week parallel group trial. The treatment group received seven 60-minute sessions of dietary counselling. The parallel control group received a matching social support protocol. Other interventions that the people were receiving were left as is.

In the dietary counseling sessions, participants were implored to increase consumption of foods in 12 food categories; whole grains, fruits, vegetables, nuts and legumes, and lean meats, chicken, and fish, and to decrease consumption of foods that are correlated with a higher risk for depression: empty carbohydrates, refined starches, and highly processed foods.

Researchers found a 7.1-point difference on the Montgomery-Asberg Depression Rating Scale (MADRS) that favored the treatment group. They also saw there was a 2.2-point reduction in the MADRS for every 10% adherence to the healthier dietary pattern.  They developed the Modified Mediterranean Diet, or the Modi-Medi Diet.  This is what the researchers are now sure can help depressed individuals. 

Are you worried that his diet will cost you more money?  Think again!  The average Australian spends $138 a week on food. Those who were taking part in the study spent just $112.

It should be noted that the people who entered the trial had a poor dietary quality. Psychiatrist Dr. Drew Ramsey says that that is what we also sees in his clinic: Individuals who have the best response to a brain-food intervention are those who are eating a nutrient-depleted diet, often called the “beige diet” or the “12-year-old boy diet,” consisting of empty carbohydrates, pizza, pasta, baked goods, and few of the brain nutrients that we hope patients will seek out based on the mountain of data we have.

Certain nutrients, such as the omega-3 fats, zinc, magnesium, iron, and vitamin B12, are very effective in terms of preventing depression and are readily found in the right foods. These are the foods that make up traditional diets, and are highly correlated with a lower risk for depression and dementia. With this new randomized controlled clinical trial, this set of foods looks as though it can play a role as an adjunctive treatment for clinical depression and help patients achieve full remission.

But there was another SMILE study done many years ago involving exercise and depression.  The now famous SMILE (Standard Medical Intervention and Long-term Exercise) study at Duke University in 1999 the researchers followed 156 patients between the ages of 50 and 77 who had been diagnosed with major depressive disorder (MDD). They were randomly assigned to one of three groups: exercise, medication or a combination of medication and exercise.

The exercise group spent 30 minutes either riding a stationary bicycle or walking or jogging three times a week. The anti-depressant used by the medication group was Zoloft, which is a member of a class of commonly used anti-depressants known as selective serotonin re-uptake inhibitors.  To the surprise of the researchers, after 16 weeks, all three groups showed statistically significant and identical improvement in standard measurements of depression, implying that exercise is just as effective as medication in treating major depression and it doesn’t have the negative side effects of the various medications.  Not only this, but when rechecked for long-term results, when the participants were rechecked after one year, the researchers were able to conclude that only those who exercise were able to maintain the positive outcomes of the study as opposed to the non-exercise group. 

It is quite evident from both of these studies, both the new one on nutrition and the older one on exercise, that both have a very positive outcome when it comes to treating anything from mild to even severe depression.  Depression is-well-depressing!  Hopelessness, helplessness, sadness and physical symptoms of pain, fatigue, and irritability, can end up greatly impeding normal life.  But taking the right steps such as eating well and exercising can help alleviate depression or act as an intervention to cure it. Now that we know it works, take the proper actions to turn depression into resilience! It will “add hours to your day, days to your year, and years to your life.”