This is Part 3 of a series, summarising Felicity Leahy’s part of a talk for a Men's Mental Health Event in Wellington 2017, hosted by The Ancestral Health Society of New Zealand. Felicity will cover nutritional, movement, and herbal recommendations.

DIET: HAPPY FOODS

Recent science tells us that food does affect mood, and a healthy diet can help treat depression. The Australian SMILES trial put participants on a modified-Mediterranean diet, encouraging the consumption of whole grains, vegetables, fruit, legumes, nuts, fish, low-fat dairy, lean meats, eggs and olive oil. Participants on the diet showed significantly greater improvements in mood than the control group. Over only 12 weeks, remission was achieved for 32% of participants on the diet compared to 8% in the control group  – an amazing testament to the power of nourishing food.

Overall, when we look at population studies we see a trend that diets higher in REAL FOOD like that found in nature, such as vegetables, fruits, legumes and whole grains, and lean proteins, including fish, are associated with a reduced risk for stress and depression, whilst dietary patterns that include more processed food and sugary products are associated with an increased risk of depression.

This is because we need nutrients to drive all of our bodily processes and they are the essential building blocks of our neurotransmitters. Our diets also drive the state of our gut bacteria, and we’re starting to see more research and discussion reflecting this ancient idea of the gut being central to the health of every bodily system, including our brain and mental state. A happy gut equals a happy brain.

LOOKING CLOSER: INDIVIDUAL NUTRIENTS

We can also look more closely and find evidence that specific nutrients are crucial to mental and emotional wellbeing. A deficiency of certain nutrients can be associated with worsening mental health problems, such as anxiety, depression and fatigue – some of the key ones are listed here:

• The B-Vitamins are the prime molecules for making mood-boosting chemicals (b1, b2, b3, b5, b6, b9, b12). A 2010 study from Rush University looked at 3500 adults and showed that higher intakes of B6, B9 and B12 was associated with a decreased likelihood of depression for up to 12 years of follow up.

• A recent study showed a cerebral folate (Vitamin B9) deficiency was the most common metabolic abnormality in a group of subjects with treatment-resistant depression. Folate is derived from the word “foliage”, so you’ll find the best sources of folate in green leafy vegetables such as spinach.

• Lower intakes of dietary magnesium are correlated with depression.

• Zinc is a crucial mineral, responsible for over 300 enzymatic reactions in the human body. The highest concentration of zinc is in the brain. Zinc deficiency has been shown to be involved in depression, ADHD, difficulty with learning and memory, even aggression and violence. A meta-analysis reviewed zinc levels in both depressed and non-depressed populations, concluding that a minimum of 14mmol/L was required to protect against depression. That’s at the mid to upper end of our range in New Zealand.

• Vitamin D deficiency has been associated with major psychiatric diagnoses and we know that seasonal affective disorder is a form of depression caused by a lack of sunlight. We’re starting to understand through animal studies that Vitamin D modulates inflammation, so it may be having its beneficial effects by down-regulating the inflammatory response and thus benefiting the brain.

COMMON FOOD MISTAKES & HOW TO RECTIFY THEM

These are the most common food stories I hear from male clients who are stressed & depressed:

• Leaving the house without breakfast – due to being in too much of a rush to get to work, not usually out of excitement of getting to work but out of fear, obligation, and mounting deadlines.

• A lack of appetite. I see this in the exhausted people in Stage 3 of stress. Traditional medicine would say this is due to compromised digestive function that occurs after long periods of stress. Magnesium and zinc deficiencies can also contribute to lack of appetite, so that’s worth investigating.

• Not stopping during the day to eat or eating at your desk while working. Remember the discussion on the nervous system (see Part 1) – the parasympathetic nervous system controls the body’s resting & digesting functions. If you’re working and trying to eat at the same time, its unlikely you’re going to experience optimal digestion and absorption of crucial mood-boosting nutrients.

• Too much caffeine – this is a controversial one, since there’s quite a bit of science singing the benefits of caffeine to men’s performance. That is not what we’re seeing in stressed men though – almost every man experiencing stress, anxiety, and exhaustion feels better with less caffeine. I suggest sticking to 1 cup a day before 11am. If someone is really wired and tired then I suggest keeping caffeine for weekends until they’ve recovered their health. Many people with anxiety have already worked out that caffeine makes their anxiety worse – because caffeine drives adrenalin production.

• Not enough protein during the day – eating more protein earlier in the day can make a big difference in a short amount of time, especially if there is fatigue or blood sugar imbalances triggering anxiety. Protein is the building block for your happy neurotransmitters such as serotonin, GABA, dopamine.  Without it you simply cannot make these beneficial substances and your mental health will be affected. It can be rectified easily by having eggs for breakfast, or some leftover dinner.  

ONE WAY OR ANOTHER - MOVE

There’s a huge amount of evidence indicating that exercise is an effective treatment for depression—in many cases as effective or more effective than antidepressant drugs. It has also been shown to prevent depression in healthy people with no pre-existing symptoms.

How Does it Work?

Interestingly enough, while exercise initially produces the same inflammatory cytokines that are associated with depression, that is quickly followed by induction of anti-inflammatory substances.  This is known as a hormetic effect, where an initial stressor provokes a compensatory response in the body that has positive, long-term consequences for our health.

Results of a recent meta-analysis on exercise and depression showed that both aerobic and mixed exercises like resistance training and stretching were effective at reducing depression symptoms, but that moderate and vigorous exercises were more effective than those of light intensity. So you really want to be getting your heart rate up if you’re looking for the biggest mood boost. Also those who had training supervised by professionals also fared better than those who exercised on their own.

Decreased Exercise Tolerance

One point about exercise which is a common clinical observation – quite a significant proportion of men will report with distress that their exercise tolerance has decreased. They’re not being able to exercise as long or as frequently, they’re feeling exhausted for sometimes 1-2 days after a workout, and a large number actually report getting sick the next morning after a workout, on a regular basis.

These men have usually hit the final stage of stress – exhaustion. Some of the signs of being in the exhausted stage which reflect shifting adrenal hormones are feeling unrefreshed in the morning and “wired but tired” in the evening; noticing more inflammation and longer recovery times after vigorous workouts; relying more on stimulants during the day and sedatives at night; and crucially, feeling more pain.

Restorative Movement

If this is the case, then I recommend adopting a “yin” or restorative exercise programme – something like yin yoga, tai chi, or walking in nature. The difference is that yin or restorative exercise activates the para-sympathetic nervous system – the “rest, digest, repair” system. More cardio based, or higher intensity workouts activate the sympathetic nervous system because they tend to drive stress hormone production further. This is usually beneficial as I covered earlier, and especially so when you’re in stage 1 or 2 of stress, but by and large, once people are in stage 3 then they need to encourage repair, and restorative exercise does that quicker and will allow your energy reserves to be replenished.

So overall the message is – move – just adapt your movement to your needs. If aerobic or strength based exercises are exhausting you and you’re not recovering well, ease back in the frequency and incorporate restorative exercises like yoga or walking in nature a few times a week. As you recover you can incorporate more intense movement and strength based exercises.

PLANT MEDICINE FOR MENTAL HEALTH

When we’re helping anyone struggling with stress, anxiety or depression, the foundational principles are crucial – healthy diet, sleep, exercise – any good physician will be ensuring these things are in the mix because it is essential to recovery over the long term. However very often I meet people who are so tired, overwhelmed, anxious or depressed that taking action on any of these lifestyle areas is actually very difficult for them.

This is when I would utilise medicinal plants.

Herbalists have a class of plant very specific for stress called an Adaptogen. I think all herbalists would agree that if we have to do our jobs with just one type of herb, it would be an adaptogen. There’s no time in history where they have been needed more than now in our fast-paced, overworked society.

Science has found adaptogenic plants to have 3 basic qualities:

1. Non-toxic – they are very safe herbs, even in relatively high doses.

2. They increase the person’s resistance to a broad spectrum of adverse biological, chemical and physical factors, in a very non-specific way – so it doesn’t matter if it's physical stress, emotional stress, or even temperature stress you’re experiencing – the plant increases your ability to deal with the stressor effectively and appropriately

3. They regulate or normalise organ or system function - it doesn't matter if someone’s response to stress is excessive (such as anxiety) or deficient (as in exhausted), adaptogenic plants help to normalise function regardless.

BEST ADAPTOGENS FOR MEN

Withania: This plant reduces anxiety and enhances healthy sleep, making it useful for insomnia (especially those who cannot “shut off" their mind at night) and generalised anxiety disorder. In India, Withania has the reputation of being a male sexual stimulant. In numerous human clinical trials, the herb has been shown to enhance erectile function, improve sperm count and motility, and stimulate libido. In many of the men we see, their ongoing stress has had detrimental affects on their sex life, and its helpful to know there are safe, natural and clinically trialled plants that can support recovery in this area.

Panax ginseng is the best known and most researched adaptogenic plant in the world. Clinical trials have shown it to improve immune function and normalise an overactive stress response. It increases physical and mental performance, insulin sensitivity and sexual response. It is most appropriate for older, deficient people suffering from stress induced exhaustion or depression.

Siberian Ginseng is similar, but more subtle and I use this more in younger people who are reasonably healthy but are going through a period of intense stress over shorter periods.

Licorice: Some herbs, like licorice, keep stress hormones in the bloodstream longer. This lets the brain know that there’s plenty of response happening, and it doesn’t need to stimulate more stress hormone production. In this way it sets an “upper limit” on the signals the nervous system can send to the adrenal glands. Its best used under supervision if you’re on medication.

Herbs are seldom using singly – traditionally herbs were always prescribed in combinations of 5-15 plants. I almost always prescribe adaptogens together with a nervine, which are calming herbs that are mildly relaxing. This type of herb restores emotional balance and nourishes the nervous system. They’re an essential part of any protocol for treating the effects of chronic stress, anxiety, ADHD, stress-induced insomnia.  The most famous nervine is probably St John’s Wort, which we know when used correctly, is as effective for depression as an SSRI, with fewer side effects.

If you’re wanting to use herbs alongside medication, it’s safest to seek out a registered herbalist who can guide you in choosing the most appropriate plants.