Welcome to blog post #3 of a 24-part series on Nutrition for Mental Health! We are glad you are here!
Depression arises from chronic stress and systemic inflammation, but nutrient insufficiencies or deficiencies should also be ruled out as a contributing factor. Often the go-to solution for depression is medication, but some individuals have challenges with conventional pharmaceutical therapy, or prefer to not take medication. It is important to discuss your situation with your therapist and physician to develop the best plan for you. In conjunction, working with a dietitian to address lifestyle changes, nutrient depletions, and sources of inflammation can provide a root cause approach to improving symptoms.
Micronutrient deficiencies have been linked to various mental health disorders, including depression. In a 2023 study by Isabella Mader, a precision supplementation approach was utilized to support individuals with treatment-resistant depression (TRD), which involves tailoring nutrient intake to an individual’s specific needs based on comprehensive assessments. This personalized method ensures that individuals receive the exact nutrients they require, potentially enhancing the efficacy of treatment.
Deficiencies in dopamine are well established in the research literature as a contributing factor in depression. For over 50 years there has also been a serotonin hypothesis as well but it has been unclear if low serotonin contributes to depression or depression contributes to low serotonin. Either way, having a look at both pathways from a nutrient stand-point can be beneficial in resolving or improving symptoms, so we will look at both.
Nutrients Supporting Dopamine Production
1. B Vitamins: B vitamins, particularly B6, B9 (folate), and B12, are crucial for neurotransmitter synthesis and regulation. Deficiencies in these vitamins have been associated with depressive symptoms. Genetic variants such as MTHFR (Methyl-tetrahydrofolate-reductase) are very common and can impact the ability to add methyl-groups to folate from say – dark leafy greens – to folate and hand off to B12 for lowering homocysteine. Adequate methylated AND unmethylated B-vitamins is important in mental health. Too much methylation can make anxiety worse, for example so meet with a Dietitian before supplementing.
2. Omega-3 Fatty Acids: Omega-3 fatty acids, found in fish oil and certain plant oils, have anti-inflammatory properties and are essential for brain health. Supplementation with omega-3s has been shown to improve depressive symptoms in some individuals. Overall Omega status can be tested through conventional lab testing from your primary care using a panel called an “Omega Check” which is drawn through Labcorp but sent out to Cleveland Heart Labs for processing. Cost of this test is very low if not covered by insurance (~$48-60) and can identify fatty acid insufficiencies as well as hidden sources of inflammation from imbalances of Omega 6:Omega 3 ratio or ratio of Arachadonic Acid (from animal protein): EPA (one of our Omega-3s. We can provide the specific instructions to your provider in order for them to order this testing panel as it doesn’t show up on Labcorp’s website.
3. Magnesium: Magnesium is involved in numerous biochemical reactions in the brain. Low levels of magnesium have been linked to an increased risk of depression. Most (95% or so) of magnesium is intracellular, meaning it is found inside your cells, so serum (blood) testing magnesium have significant limitations. Most individuals benefit from magnesium supplementation to help with stress, sleep, aches/pains, muscle soreness post-workout and specific forms are used for specific purposes. Magnesium citrate, oxide and malate work well for constipation taken before bed. Magnesium glycinate is well absorbed and can be increased higher without causing GI distress. Magnesium Lactate works well to balance intracellular/extracellular fluid for those with edema, and our personal favorite – Magnesium L. Threonate is well absorbed and works great for anxiety, ADHD and other mental health conditions.
4. Vitamin D: Vitamin D deficiency is common in individuals with depression. This vitamin plays a role in regulating mood and has anti-inflammatory effects. This is typically tested with a 25-hydroxy vitamin D test and a goal value should be around 60ng/mL for Caucasians. Note that African Americans produce less of the vitamin D-binding protein than Caucasians and lab test values should be evaluated in this context.
5. Zinc: Zinc is necessary for neurogenesis and synaptic plasticity. Deficiency in zinc has been associated with depression and anxiety. Zinc and Copper need to be maintained in a ratio of 1.0 – 1.3 ideally. To measure this divide your Copper lab test value by your Zinc lab test value. If too high, add additional Zinc Picolinate around 30mg per day and retest after 3-6 months.
6. Iron: Iron levels should be assessed from several angles including a conventional iron panel that will check Iron, Iron-Binding Capacity, % Iron Saturation. A Complete Blood Count (CBC) will check hemoglobin, hematocrit as well. However; we also need to see Ferritin which a a protein that stores iron and a goal value should be around 80ng/mL – not too high and not too low. Iron absorption also requires Vitamin A (Retinol), Copper, Vitamin D and we often recommend a combination product containing co-factors for absorption. Iron supplementation can be very inflammatory to the body and cause constipation, so working with a Dietitian to make selections for supplementation can mitigate these risks.
Nutrients Supporting Serotonin Production
Some of these same nutrients impact serotonin synthesis, and if low, can be contributing to sleep disruptions, which – let’s face it – makes most people moody!
Importance of Protein
Notice how each of these pathways starts with an amino acid found in protein-rich foods which is why protein is critically important for mental health.
Sources of Phenylalanine include:
- Egg
- Soy
- Cod
- Cheese: parmesan, gruyere, swiss, fontina, gouda
- Milk
- Seeds: pumpkin
- Parsley
- Pork, Beef, Lamb
- Peanuts
- Mung Bean
- Veal
Sources of Tryptophan include:
- Egg
- Soy
- Seeds: sesame, sunflower, pumpkin
- Cod
- Pork, Lamb, Beef, Chicken
- Cheese: mozzarella, cheddar, parmesan, gruyere, swiss
- Game Meats
- Parsley
- Milk
Quality of Life Changes with Precision Supplementation
The results of Mader’s study are promising, demonstrating significant improvements in depressive symptoms among participants who adhered to the lifestyle changes and precision supplementation regimen. Key findings include:
1. Symptom Reduction: Participants reported a substantial reduction in depressive symptoms, with many experiencing remission. The standardized questionnaires corroborated these self-reports, showing statistically significant decreases in HDRS and BDI scores.
2. Improved Quality of Life: Alongside reductions in depressive symptoms, participants noted enhancements in overall quality of life, including better sleep, increased energy levels, and improved cognitive function.
3. Biomarker Improvements: Blood tests revealed significant improvements in nutrient levels and other biomarkers, suggesting that precision supplementation effectively addressed underlying deficiencies contributing to depression.
4. Sustainability: Participants who maintained the lifestyle changes and supplementation regimen continued to experience benefits over the long term, indicating the sustainability of this approach.
Broader Implications for Mental Health Treatment
Mader’s study underscores the potential of an integrative approach to mental health treatment that goes beyond conventional methods. By addressing lifestyle factors and nutrient deficiencies, healthcare providers can offer more comprehensive and personalized care to individuals with depression. This approach aligns with the growing recognition of the gut-brain axis and the impact of overall physical health on mental well-being.
Access to Testing
At Kaizen Nutrition & Wellness, we are strong advocates for having access to the lab testing you need to rule out or rule in factors impacting your health. We encourage you to speak with your provider, site the information in the references below, and this blog post and encourage them to dive deeper into contributing factors impacting your quality of life. Should you run into obstacles, here are two testing options:
Vibrant Wellness Micronutrient Test with Omega Check checks intracellular and serum levels of nutrients and amino acids in addition to checking omega status: https://vibrant-wellness.com/test/MicronutrientPanel.
Order your own individual lab tests through Ulta Lab Tests. There you can add lab panels to your cart, select a blood draw location and for a small draw fee (about $8) get the answers you need: https://www.ultalabtests.com/partners/kaizennutritionwellness
Mosaic Labs Organic Acids profile can provide insight into metabolic pathways not functioning optimally due to low nutrient status or genetic variants: https://mosaicdx.com/test/organic-acids-test/
Genova ION test is arguably one of the more comprehensive test options to gain understanding of your nutrient status, possible genetic influences, amino acid status, heavy metals (low or high) and more. To learn more about this test, search “Genova ION” in your web browser to view their sales flyer.
Discuss any of these options with our team of licensed Dietitians by scheduling an appointment with insurance: https://kaizennutritionwellness.com/appointment/
References
Jauhar, S., Cowen, P. J., & Browning, M. (2023). Fifty years on: Serotonin and depression. Journal of psychopharmacology (Oxford, England), 37(3), 237–241. https://doi.org/10.1177/02698811231161813
Mader, I. M. (2023). Recovery from (treatment-resistant) depression after lifestyle changes and micronutrient precision supplementation: A preliminary field study in patients. BMC Psychology, 11(1). https://doi.org/10.1186/s40359-023-01263-7
Pannu, A., & K Goyal, R. (2023). Serotonin and Depression: Scrutiny of New Targets for Future Anti- Depressant Drug Development. Current drug targets, 24(10), 816–837. https://doi.org/10.2174/1389450124666230425233727
Powe, C. E., Evans, M. K., Wenger, J., Zonderman, A. B., Berg, A. H., Nalls, M., Tamez, H., Zhang, D., Bhan, I., Karumanchi, S. A., Powe, N. R., & Thadhani, R. (2013). Vitamin D-binding protein and vitamin D status of black Americans and white Americans. The New England journal of medicine, 369(21), 1991–2000. https://doi.org/10.1056/NEJMoa1306357
USDA Food Central Database
