Can diet cure your depression?
The world of food and mental health is a messy one.
On one side, we have lots of evidence suggesting that food does have an impact on mental health. On the other side we have people suggesting that avoiding sugar will cure your depression. Oh boy.
Enter Dr. Nicole Lippman-Barile. She’s a clinical psychologist who’ll help you cut through the noise and figure out what the relationship between diet and mental health ACTUALLY is.
Jono: Welcome back to the bite me nutrition podcast. I'm very excited to jump into a very important topic today with a guest who has I've been following her for a while and have been loving the way that she approaches this. We're going to be talking about diet and mental health essentially, which is a bit of a dumpster fire. And the way that it's talked about and communicated and it is nice to see someone talking about it in a evidence based way which shouldn't be different to the norm, but apparently it is. So we are talking to, well, you're not, I am talking to the wonderful Dr. Nicole Lippman-Brill today who, yes, welcome. Thank you so much for giving us your valuable time.
Nicole: Of course, thank you so much for having me.
Jono: Yeah. Yeah, I've got my questions lined up. We're gonna talk about lots of wonderful things, but before we do that, who are you? What do you do and why do you do it?
Nicole: Sure, so I am a clinical psychologist. I live in New York, that's where I'm licensed, so that's where I can practice. As far as my own practice and what I specialize in, I'm trained in cognitive behavior therapy, and I specialize in the treatment of OCD, so obsessive compulsive disorder, and other kinds of anxiety and mood disorders. A while ago, I don't even use this title anymore, I received a nutritional therapy practitioner certification through nutritional therapy association. So I technically have that, but I don't use it because I was not taught accurately. So a lot of what I do now is really because of that kind of journey and where that's brought me to.
Jono: Yeah, great. You read my mind. I was going to ask where the well, I guess because you're talking about and you mentioned one of the things you treat is anxiety and mood disorders. And obviously, there is a lot of there's a lot of impact on nutrition. But sometimes, what we're gonna dive into that. Yeah, so is that where these this interest in mental health and nutrition came about?
Nicole: So I got interested in this space because I was experiencing, this was like 10 years ago at this point, but I was experiencing some health issues of my own. I was diagnosed with PCOS. And at the time, I really didn't pay attention to my diet. Absolutely at all. I was eating, now what I know is kind of terribly, which is like a lot of fast food. I rarely cooked for myself. I was also finishing grad school at that point, so I was like really busy. And then I got to a point where I stopped menstruating for like nine or 10 months and that started worrying me. So at the time I started following people that I now know as sort of like part of the wellness industry and I happened to come across an account that randomly sort of advertised to do a 21 day food elimination challenge. So I ended up doing it and not really thinking anything of it. But what came out of it was on the 21st day, I ended up getting my period. So like that blew my mind actually. And the next day, I spent like half of the day researching this connection between PCOS and dietary modifications. And I found a lot of information online. And that just like really drew me in. So about three months later, I signed up to get the certification, nutritional therapy certification. And since I was already like a psychologist at that. it just made sense to me that I became more interested in this connection because I started seeing more of that information online, like sort of the potential relationship between diet and mental health. And then I was contracted to start writing as a primary author for a course for the Center for Nutritional Psychology. And as I was doing that, I was just reading article after article, paper after paper, and started realizing that I was like... the information I was reading online very much contradicted what I was reading. And so that's why I started actually putting out content. That's really why I started making, like made my account is because I wanted to really accurately put out information from the studies that I was reading and address some of those claims that I was seeing.
Jono: Yeah, that's an awesome origin story. That realize that, yeah, they're obviously getting interested in it for their own personal reasons and then combining that with your practice. But then looking at, oh, hang on, what I'm seeing online doesn't match up with the papers, which is pretty common, to be honest, isn't it? That seems to be a very,
Jono: that's either just completely unreferenced or my favorite is when an account. puts up references, they reference their post, and then you follow those references and you go, hang on a minute, like this actually either doesn't support what you're saying at all, or at times like, actively contradicts what you're saying, but
Nicole: Yeah, yeah.
Jono: that's a whole other topic, I guess.
Nicole: No, definitely. It was kind of a, like, it was just a weird experience to like see all these people that I was like respecting online, talking about this relationship and the claims and then reading what I was reading and I was like, this doesn't, this doesn't line up. This doesn't match.
Jono: Yeah, yeah. Well, so potentially big question. So feel free to answer it piece by piece. What were the main discrepancies, I guess, between what you're seeing online versus what you're reading in the paper? What's like, how much of a role does diet actually play in mental health? And how is that maybe different from what we're hearing online?
Nicole: Yeah, so one of the biggest discrepancies that was kind of immediate to me was using diet as like a sole independent intervention to quote unquote treat symptoms. So one thing we got the outset to determine and discern between is that treating symptoms is very different than trying to, let's say, increase one's mental well-being as an example. So to make that distinction, if we're looking at treating a clinical disorder, something like take depression and as a multitude of kinds of symptoms, behavioral, cognitive symptoms, emotional symptoms. And if we're looking to treat symptoms, right, that means from a clinical perspective, get those symptoms down to a place where people are practically almost like not really experiencing those symptoms anymore versus trying to enhance mental wellbeing. That could be something like generally feeling more content or maybe more alert, less fatigued, more energetic. that's very different than treat. So that's one thing to sort of determine and discern between, because that's really important. So with regards to how much influence diet has on our mental health, I wanna highlight some important variables. So if we're looking at the current research related to depression and diet, and seeing if diet has any sort of independent way of, let's say treating depression, actually treating depressive symptoms. So there's more research with food and depression than there is with any other sort of mental health conditions. So let's stick with this just as a talking point. So there's a few studies that have used a clinical population. So that's really important to understand first. The current research that we have examining this kind of relationship, there's only a handful of studies that have used a clinical population, which means there's a diagnosed condition versus healthy participants which have no depressive condition. So that's an important variable. The other things that exist in the research that are important variables that determine whether or not there is an impact between diet and mental health is also within the methodology. Is the dietary intervention being administered by a nutrition professional? That's one thing that makes a difference when we're looking at outcomes in the research. if you do use a nutrition professional, there's actually a much larger decrease in depressive symptoms pre and post. That's an interesting variable to take note of. The other thing to pay attention to in the research is whether or not it's compared to an active control. So what that means is, let's say there's one group that's using a dietary intervention to modify depressive symptoms, and the control condition, It's just doing treatment as usual. There's no other intervention being introduced there that matters versus looking at another intervention, let's say exercise as a comparison sort of group, right? So that also matters because that determines are there larger differences between depression outcomes, let's say pre and post. Other variables that are really important are whether or not... repressed people in these studies have an additional inflammatory medical condition. If you do, that there seems to be a that mediates the relationship between diet and depressive outcomes. So that's also another variable to pay attention to that has an effect. So there's all these variables that exist within the current research that provide a lot of context as to does diet even make any sort of right, modification, let's say, on depressive symptoms alone. So it's so hard to answer that question because it's very much tied to all of these conditions. Another thing just to put out there is where, what intensity are we talking about with respect to depressive symptoms? Are we talking subclinical symptoms? So like that means we are not really meeting criteria for a diagnosis, but there's like some level of impairment that's going on versus. are we like moderately to severely depressed and using diet alone as an intervention? So basically like what has been shown is that maybe there seems to be some kind of effect between using diet. If you have subclinical or mild symptoms of depression and you don't have an inflammatory medical condition and you don't have an extensive history with depression, then maybe using diet as an intervention can potentially help. with depression. That was a lot.
Jono: Come on, where's the black and white answer? It's like,
Jono: know What's the yes or no? No, I think but I think that's one of the most important takeaways with this though is Firstly that you can't just broadly say oh you're depressed improve your diet and will cure it and we also can't well, I like I think all the things you're talking about of the The variables that play a part like you need to know where someone's at So with the inflammatory condition, is that, sorry, does that in show that diet can be more positively impactful in that space or is it less correlated?
Nicole: So it's an interesting question that I almost don't know how to answer because there's only like I only have found like these two studies that have actually looked into this with more detail because there is a hypothesis. This is another claim that's found online a lot is that inflammation is one of the causes of depression and so therefore there's this thinking that if you eat an anti-inflammatory diet let's say that lowers your inflammation and therefore that will lower your depression. There was one study that actually looked at depressed people and measured their levels of inflammation, their biomarkers. And what they found was there was discrepancies. So there were some people who did have higher levels of inflammation and some people who had lower levels of inflammation. And they also categorized them based on whether or not they did have an inflammatory medical condition or not. So it's just interesting to think about because potentially for people maybe who don't have an inflammatory medical condition, maybe diet plays even less of a role with
Nicole: to depression.
Nicole: Just because like if you're looking this in the context of other research that looks at this question, looks at inflammation, that's what I think, based on all that, that's what I think. I don't really know because I don't think I found a really good study that looks at that exactly.
Jono: Yeah, yeah. I mean, we all know inflammation causes everything though, right? It's the root of all evil. It's the root of all sickness. You just inflamed.
Jono: Yeah, yeah. I guess This is hypothesis everyone, this is just me spit pulling. But I could imagine that if you're also suffering from another inflammatory condition, that is going to make managing your depressive symptoms harder because you're juggling comorbidities. And then if you've got a dietary intervention that maybe helps manage that inflammatory condition, I can imagine that might allow you to manage your, have more mental and physical resources to. approach the treatment of the depression. But so correct me if I'm wrong, to like the most critical thing initially is separating out this population that are maybe subclinical depression. So like you said, they don't necessarily meet the diagnostic criteria to be labeled with clinical depression, but maybe still struggling with some of the symptoms slash people who are just looking to improve their feelings of wellness and wellbeing, mood, affect, that sort of stuff. there's more support for diets to improve those things versus someone who has been diagnosed with clinical diet, clinical depression and is managing that. Is that the important thing
Jono: to differentiate between?
Nicole: that's pretty fair. The other thing to throw in there, here's another aspect of nuance, is also where's their baseline diet start starting from? So that when
Nicole: you just
Jono: of course.
Nicole: write someone who's subclinical, subclinically depressed, mildly depressed, if their baseline diet is really poor, and they're basically eating like what would you consider an unhealthy dietary pattern, and then right, you start including more things that would consist of a healthier dietary pattern. that within itself even more so, even with the context of like being mild or subclinically depressed. That's sort of where diet can be probably most useful, like under that context.
Jono: Gotcha. Do we see the, have we got studies seeing the same thing in the clinically depressed population? So if their baseline diet is pretty nutrient poor and we improve the diet quality, do we see any improvements there?
Nicole: I think, so I would say generally, I think that's sort of what is basically demonstrated like so far. And I think what's interesting, because I think these are the studies that need to sort of like continue is that is these like more longer term studies. So like more these cohort studies looking at if you keep a diet, right? If you keep a healthy dietary pattern for this period of time, and you're also still. like maybe mildly depressed, like what does that look like over time as you're doing other sort of other interventions? Like I don't think we exactly know the answer to
Nicole: that yet because there's so many things that affect depression and things like that. So it's really hard to like isolate this as a variable to even really make it meaningful. But I think that's probably the biggest takeaway is for people who already their baseline diet is pretty poor, they're already like... subclinical mild stuff going on, potentially changing that alone may have some kind of benefit.
Jono: Yeah, yeah. Alone is the key word there. So I mean, you mentioned earlier, like using nutrition as a sole intervention. I think that in particularly in the clinic, again, the clinically depressed group, what is what are the main interventions we should be looking at then, you know, if nutrition is not going to cure everything, which as a dietitian, I'm obviously very passionate about the power and role that food plays, but also it has limitations. Like it
Jono: do everything.
Jono: So what does, what do we have evidence for in those populations?
Nicole: So for looking for depression, so in America we have the American Psychological Association. Other places will have their governing bodies related to the psychological associations or psychiatric associations. And using their guidelines is really important because these are organizations that are really dedicated to the advancement of the research behind all of this and understanding clinical disorders and advancing treatment. So, In America, it's very clear the guidelines really state that specific modes of psychotherapies are recommended as first-line treatment. Sometimes psychiatric medication is recommended as first-line treatment as well. Again, that depends on severity of symptoms, level of impairment that depression is causing in a person's life as well. So it's typically some form of psychotherapy for extended period of time and then potentially coupled with psychiatric medication. The other thing that the guidelines will discuss and in the American Psychological Association guidelines highlight this very clearly, is that they also cover potential alternative therapies. So not psych meds don't work for everybody and psychotherapy doesn't work for everybody. Some people also have like treatment resistant depression and other things that are very complicated. So in the guidelines, they state that exercise can be used as a monotherapy. exercise for depression, there's pretty good outcomes there. So that seems to be pretty legitimate. They also mention potentially St. John's Ward. So if you're a person who doesn't respond really well to psych meds and psychotherapy hasn't been doing so much, and also you have to understand St. John's Ward's complicated because it interacts with a lot of other medications. But,
Jono: Yeah, I was just thinking.
Nicole: like, Maybe, but again, but like the guidelines state that under these specific contexts and circumstances, this may make sense, right, to explore. So that's like basic, basic guidelines for people if they're really struggling to really access a mental health professional first.
Jono: Yeah, yeah. Therapy, meds, well, sorry, I'm not ranking those. Those are
Nicole: Oh yeah.
Jono: first line defense, depending on the person, and then yeah, lifestyle, which is not a popular thing for a lot of people, is it? For some strange reason, I think everyone thinks that if they just eat right and exercise,
Jono: that'd be killer, which not that there's anything wrong with eating right and exercising, like obviously we're all about that, but I think
Jono: it's really important that, because I think... the big issue is what happens if you are suffering with even subclinical like any of those sorts of things and you improve your diet, you exercise more frequently and you're still struggling. Like you failed, right? You're a failure. You're a terrible person. You obviously need to eat better and exercise even harder, right? And I think that's one issue. What dangers do you see with the narrative out there of like, no, you don't need meds. No, you don't need therapy. It's all lifestyle.
Nicole: It's exactly what you said because I have people messaging me now all the time, really, saying thank you because I'm a person who has done all these things. I've got sucked into all these messages and nothing got better, right? So there is a level of blame on the individual that is so counterproductive. And it's also not accurate. It's also not their fault. If they're doing all of the things in their power and they're still not getting better, this is not on the individual. So that's a really harmful message. And then also because it really also inaccurately simplifies complex mental health disorders. Even for like, and I treat anxiety disorders and sometimes I will, you know, someone comes in and there's like a very specific phobia as an example, someone has like a fear of flying, right? Even with something like that. it doesn't mean that it's so straightforward. Like some things could be very straightforward, but most things are not straightforward whatsoever. So the problem I also have with this kind of messaging online is that it reduces these mental health disorders into something that seems like it's so easy to just fix. Like if you just do this for a certain period of time, you won't have depression anymore. You won't be anxious anymore, right? But our brain, first of all, none of our brains are the same and even... there's differences within families in terms of what helps one and what helps another. So it's absurd to really communicate to people that you just need to do these four or five different things and your clinical symptoms will basically disappear. It's so unrepresentative of what actually happens for people in real life.
Jono: Yeah, that blame game drives me mad. I think it's such a cheap way for the... I want to say practitioner, that's way too kind. The
Jono: person, the influencer, I think, because then if it doesn't work, it's like, oh, well, you didn't follow my system properly. Like you, you were the one that failed. Like if you'd just done what I said, that said properly, you'd be quote unquote cured.
Nicole: Exactly. And
Nicole: also, I think there's a lot of assumptions behind whether or not a person can exercise so often and then not and completely overhaul their diet. I mean, you have to have financial resources in order to do that. You have to have support in your life, right, and space in your life in order to do that. There's so many things that have to also be in place in order to do all of that. And that's also not talked about. Also, you know, like I think that that's also a very like a privilege point that's sometimes really disguised and that's also I think a really kind of a dangerous message for people to receive too.
Jono: Yeah, yeah. Yeah, but we've all got the same 24 hours. We've all got the same. Yeah.
Jono: I think it makes selling a course, not that there's anything wrong with the right courses, obviously, but it makes selling a course or a framework or a program easier. If you just boil it down to these four salient points that you just need to do this and everyone will be fixed. And then I can just replicate that process over and over again and sell it to hundreds of thousands of people,
Jono: which good for marketing. But like you said, everyone's so unique, even within families. So even if they're genetically relatively similar, the fact that there's all of those other variables to take into account.
Jono: Yep. Where do you? Why do you think this has come about, I guess? Why do you think this move away from, or this push-filled diet and lifestyle as a primary therapy or soul therapy for mental health? Where do you think that's come from?
Nicole: I think it's very attached to the larger narrative of like, natural is better, like natural is superior and. I think, I mean, look, as a clinician, I would love food diet to be another, to be really effective. I would love that because it would be another wonderful tool that I could advise people to do. But I do, I think it's very much tied to that sort of narrative. Like the natural is better and it's superior compared to quote unquote conventional mental health treatments. And I think... what it actually represents is that there's just a really large misunderstanding about, A, what psychotherapy even is, and then also like psych meds too. Like I think, you know, there's still large stigma and there's a large misunderstanding related to them and their effectiveness and what they're able to do. And I think that it's being, those things are actively being demonized. And also I think for people who are profit off of the natural is better narrative. you know, they're trying to create a divide, right? They have to create a problem. And so if they label conventional stuff as a problem and then their solution as the thing to achieve and it's more superior.
Jono: They're the savior.
Nicole: Yeah, like I think a lot of that is what that's about, you know, and also so they can drive their own profits and their own agenda. So that's my guess, yeah.
Jono: Yeah. And that first point is so important because I feel like a lot of the time we can come across as like a bit negative, you know, because we're like, kind of trying to downplay the role of nutrition and mental health, like, you know, in certain circumstances and downplaying all of these things. Whereas we would, I would freaking love if it was unbelievably like, I wish they those people were right. Like, I think that's the other, I feel like a party pooper a lot of the time, but like the reality is, like, I'm going I'm not glad that diet doesn't cure depression. How awesome would that be? That'd be amazing. And if diet cured cancer and diet cured like, I'd be all for that, but
Nicole: it's so true. It's so true. I try to emphasize this point, but I know it gets lost in the ether sometimes, which is like, there's a million good reasons to consume a healthy dietary pattern outside of mental health. Millions of
Nicole: groups, whether it's your cardiovascular health, your mortality risk. So do that, like don't not do that, but like let's just be realistic, right, about like what we're actually seeing as it relates to diet and mental health, right? Like that's where I'm trying to come from.
Jono: That sounds disgustingly reasonable. And I won't have it.
Nicole: I mean... It's beautiful.
Jono: Yeah, cause I was gonna ask, cause it happens anytime I have this kind of, try and have a nuanced discussion, not with smart people, with other people. Do you find that their response, oh, so diet doesn't even matter then, like diet's not important, is that what you're saying?
Nicole: Yes, yeah, it's
Nicole: right? Because it's like, it's seen such like as a black and white thing and it's like,
Nicole: we're trying to put color in between like the things that are black and white, right? And we're like, no, but
Nicole: like here's where it could matter and like maybe in this circumstance, like it could matter but also like it probably doesn't matter to like the extent where you think it matters. So like that's
Nicole: what we're trying to do, right? But then, but the publication sometimes is just like, well then. you're poo-pooing this because they're on the total opposite side. They're on the gung-ho, this has to be it side. So it totally gets lost in translation.
Jono: Yeah, yeah, yeah. Yeah, I love this. It's a good straw man fallacy really isn't it? Like strawman argument where it's just also you're saying this. But
Jono: yeah, people are so I guess black and white, you find a camp, you find a tribe, you've got that feeling of belonging. You stick to that.
Jono: Anyway, that's a whole
Jono: other that's a whole other podcast.
Nicole: it is. That's true.
Jono: So I guess one specific area of food and mental health that is being talked about a lot is the gut, right? The impact of gut health, the microbiota on our well, I guess health in general, but specifically mental health. And we hear lots of claims about that. So if I fix my gut health, will I cure my depression?
Nicole: No. So
Jono: Black and white though. That's good. Thank you.
Nicole: I'm so sorry, but the answer is
Nicole: no. So let's put some conditions on this. If you have a digestive disorder, IBS, other kinds of stuff, there are higher rates of depression and anxiety for people who have things like IBS and IBD. So for people who do have those things... Actually seeking psychotherapy and learning how to manage your anxiety is actually very helpful for their digestive conditions, right? So there's that. But outside of that, if you don't have any sort of sensitivity, if you have no allergy, if you have no digestive disorder, and you're generally eating what would be considered a healthy dietary pattern, you don't need to do anything additional really to that.
Nicole: There's no evidence right now that suggests that... If you have depression or if you have anxiety as a clinical disorder, that if you quote unquote optimize your dietary pattern, there's nothing right now that suggests that as an intervention alone is going to do anything for your depressive outcomes or anxiety outcomes.
Nicole: I know.
Jono: Yeah, I mean, again, it comes back to, wouldn't that be awesome? I wish you were wrong. I'm sure you wish you were wrong, right?
Jono: but we don't make the rules.
Nicole: Yeah, it's true.
Jono: One big thing that gets talked about in that space is this whole serotonin, the feel good neurotransmitter, and I think slowly crept up. 80% of your serotonin is made in your gut and now 90% knife like the claims that just seem to be like, you know, 105% of the serotonin in your body is made in your gut. And
Jono: it is true, your gut makes a lot of serotonin. And it is true that serotonin is linked, right, correct me if I'm wrong, it is true that serotonin is linked with feeling like mood and positive increases and those sorts of things. So if I improve my gut health, and it makes me more serotonin, why is that making me feel better?
Nicole: So your gut produces lots of neurotransmitters, the same neurotransmitters actually that it produces in your brain. And a neurotransmitter is just a chemical messenger. That's all it is. The difference, but what matters here is sort of where it is located in the body. So your gut can produce neurotransmitters like serotonin, like dopamine, like acetylcholine, and it uses it for other functions and it does not cross into the... into the brain. So we have a blood brain barrier is very selective. The gut-derived neurotransmitters do not cross into the brain. And so therefore those neurotransmitters are not responsible for things like mood, learning, and behavior. The gut-derived neurotransmitters are used for digestive functions. So like serotonin, for instance, is used for things like peristalsis. And your brain-derived neurotransmitters are made in the brain and they are made from other kinds of precursors that can come from... diet, but your gut-derived neurotransmitters are very separate and are very different from our brain-derived neurotransmitters.
Jono: Man, if there was one message I could slot into some influence the brains, it's that one, hey, because that's, I think, one of the most miscommunicated or just misunderstood
Jono: parts because yeah, I think they just see very simply, oh, gut makes a lot of serotonin, serotonin equals feeling good, therefore, and that's, it's a big leap
Nicole: Yes. It's a huge leap. I think the other thing, this is a new level now of what I'm seeing on social media that I do see some people have caught on to that. But then they will take that and then they'll say, but your gut still which is true, like your gut also produces metabolites that can cross potentially cross into your brain and then that could influence brain derived neurotransmitters. Yet again, like how
Nicole: much are we talking about as an influence? Like, sure, like that, we have some research that supports that, but what does that translate to, right, with respect to how are we talking about a clinical difference in mood? Are we talking about a noticeable difference, right, where someone can feel that level of difference, right? So that's another, that's a new thing that I just started seeing online, that they'll take that,
Jono: I haven't
Jono: seen that.
Nicole: say that. And I'm like, that's still misleading for people.
Jono: Yeah, well, I think like you said, it comes down to size of effect. So like, let's say, for example, to absolutely randomly put a number on it, but let's say that it improved symptoms by 5%. Is that worth
Jono: stopping or not seeking therapy, potentially not starting medication if that's recommended, because if you eat more fiber, you'll, you'll have a 5% increase in symptoms, right.
Jono: again, a reason why we wouldn't just say, I don't worry about that. Forget it. It's not helpful. But let's understand the scope and the
Jono: limitations here.
Nicole: Yeah, exactly.
Nicole: So that's usually the thing that people will sort of say next now. And it's like, yeah, but like, compared to
Jono: but no. Yeah,
Nicole: Right? Yeah.
Jono: I love the shifting of the goal posts. That's always there. Yeah. And I'm sure they'll have an answer for, yeah.
Jono: anyway. Are there other, what have I missed? Cause you're more in the diet mental health space than I am like that juxtaposed, or that crossover. Are there other big myths that you see? getting portrayed a lot. The guts that are turned in is probably the main one I've seen, but excuse
Nicole: That is
Nicole: probably the main one I've seen. And just what I mentioned before, just using the diet as a soul intervention. Another one, I think, that I guess just blends into these two things, which is that sometimes I see lists of foods to avoid if you have depression, or foods to avoid if you have anxiety or something. And sometimes these lists consist of like... Okay, like ultra processed foods, caffeine is usually on there. Sometimes there's like other random foods. And the thing about that is that for some people, like let's take caffeine, right? Many people react very differently to caffeine. Some people's anxiety actually does worsen when they consume caffeine. And so if that's you, that means that you just have to modify your caffeine intake, right? Experiment and see where caffeine affects you and make... Modifications based on that but that's not true for every person right? So it doesn't make
Nicole: sense every single person to Eliminate caffeine from their diet just because they feel anxious and again, are we talking about an anxiety disorder? Are we talking about like a temporary? Increase in anxiety That may be an appropriate reaction to something, you know, what are we talking about? So that's one of the things
Nicole: I'm on social media Which is like if there's a list of like foods to avoid for depression or foods to avoid for anxiety are we talking about a disorder? Or are we talking about temporary feelings that are maybe appropriate at times? And also like the foods on there are questionable because that doesn't mean that you have to eliminate food groups just because you experience these emotions at times. Or even if you do have a disorder, there's nothing to suggest that you have to eliminate whole food groups from your diet in order to feel better.
Jono: love a good list. Love a good. Here's five foods causing dot dot. He is fine. Yeah.
Jono: What? And I think apart from anything else, like, it comes up in the anti-inflammatory diet space all the time, right? You know, this food is inflammatory. This food is anti-inflammatory. Like, you know, sugar is inflammatory, of course, as everybody knows, against sarcasm. Like, what if my entire diet is lean? poultry and salmon and fruits and vegetables and grains and I eat one kit cat a week. Like is that still inflammatory? You know, and I think that's what those lists miss. It's like, what's the context here? How frequently am I having these things? And more importantly, like, it's probably, it's probably less about what you're including and more about what you're not including, right? If you're overeating those foods, you're probably not eating enough fruits and veggies, fiber, antioxidants, all that kind of stuff. And so
Jono: a little bit of canola oil, but
Jono: that's it. That's a different one anyway, because
Nicole: No, I know.
Jono: go nuts with the canola roll, but like, you know,
Jono: a little
Jono: bit of ultra processed foods in
Jono: the context
Jono: of a broader diet.
Nicole: The other thing you just triggered something was just to bring this thought into play for people is that if we're talking about depression, and sometimes this happens for people who have anxiety, which is there's a lot of disturbances in a lot of different behaviors. And one of the disturbances can be an appetite. So for some people really, their appetite shuts off and they struggle to eat. For some people,
Nicole: they may overeat. And so again, if we're just telling people to focus on the healthy content of diet, we're also missing out on these behavioral dysfunctions that occur with appetite. And that really matters because if someone is struggling to eat, are we really gonna tell them not to have, like let's say for some reason they can consume bread today, right? And for some reason like that, that just works for them right now and they can do that. Are we really gonna tell someone not to do that, not to eat that because it's like.
Nicole: not the healthiest food, right? So that's another missing piece here that I, I as a clinician, I know this very intimately, but that's part of the spectrum of people, of what people really struggle with when we're talking about mental health disorders.
Jono: Yeah, 100. Yeah, that's so right, actually, with the appetite in particular, like if someone's especially someone who has a reduced appetite, you know, if I can get, put some honey on that thing, you know, have some, have some fruit loops or like colored cereal for breakfast. Like I just, at this point in time, I don't care what it is. Just get calories, get,
Jono: get energy in. Um, you know, that's going to be more beneficial than, well, fasting for 12 hours accidentally. You know, yeah.
Nicole: Exactly. Yeah, exactly. That's another thing that sometimes kind of drives me a little crazy online. And also things like, you know, for people who have fast food accessible to them, and like that's what they can eat today because for whatever, however their life is constructed, are we really going to tell somebody
Nicole: not to get that, not to eat? that meal, like, you know, that to me, that's just so absurd. And it's so ridiculous. And I feel like that puts things into perspective a lot of the time.
Jono: Yeah, well, and I think it's because not that you tip, I don't think you need lived experience to be a helpful practitioner, but I know that it can help. But I also think influences are so far away. Well, like those people promoting those messages are so far away from any kind of lived experience, any kind of food insecurity or any kind of, you know, any kind of inaccessibility to food, any kind of appetite reduction, any of those sorts of things. If you haven't, either experienced it yourself or worked with many clients who struggle with that. Like I think they just kind of have this rose colored view of everyone sitting at home with their nanny with endless time
Jono: to cook, which is
Nicole: Oh, yeah, exactly.
Jono: would be nice, but
Nicole: No, exactly. And I, that's, yeah, that's, um, I think that that's really a problem. Um, so I know there's like so many other things I feel like I could say about, especially even, even as it relates to some of the, the more decent research that we kind of have, I like, I think there's other things that are going on that are influencing like the outcomes. So yeah, I think it's really complex and complicated and there's things that we need to look at that I think are not really being looked at in some of the studies and are not being acknowledged that are hard factors to control for, but I think it should be part of the conversation.
Jono: Yeah, yeah. How, what are those factors? Are they
Jono: like, like top five, I guess, you know, cause there's probably like 500, right?
Nicole: There's a lot. So if we're looking, like, let's we take the SMILES trial as an example. So the SMILES trial is probably one of the most cited trials in the nutritional psychology space. So basically they looked at participants who did have a diagnosed depressive disorder and they split them into two groups. One group was given instructions by a nutritionist. They met about seven different times in person. and were given instructions to modify their diet to a more Mediterranean style diet. And the control group was a social befriending group. So they met at the same sort of frequency that the other group met with the dietitian, but they just like talked about neutral topics. But the intervention group, what's really important here is, so they had a lot of support. So they were given seven 60 minute one-on-one. meetings with the dietitian who like, you know, you're, that's a lot of handholding with respect to like modifications of diet. They gave them food hampers, they gave them worksheets and videos to watch if they had questions. So a lot was provided to them. A lot was provided. That's one thing to really keep in mind. At the end of the study, they reported that there were significant clinical reductions in symptoms of depression pre to post. And there was. There was statistical significance and there was a lot of clinical significance, even such that about half of the participants in the dietary intervention were considered in remission from their depression. So that's pretty substantial. Now the details of that I think are really important. So what I think is also going on here is, number one, there's rapport building that's going on between the dietitian and the
Nicole: patient. participants. I mean to meet with someone for basically seven hours and to call them whenever you know like once a week also that's a lot of contact that's a lot of therapeutic contact that's number one. You know number two they were provided with a lot of supplies so again if we're thinking about a depressed person right who's usually less motivated usually maybe a little bit more fatigued you know like needs there's more cognitive effort that's needed in order to So again, so if you're giving someone all of this and you're handing them this information, you're giving a depressed person a lot. You're lowering the bar, right, with respect to their ability to engage in this. Other thing I think that's going on is that we're asking people to cook regularly at home for themselves. That's a behavior into intervention, right? So a depressed person is engaging in cooking, which means that they're not engaging in behaviors that would exacerbate their depression. Usually people who are more depressed, there's some withdrawal, there's like social isolation, there's usually less movement going on in general. So again, I think that is huge as an intervention. So there's like, there's these major pieces that are not being really acknowledged and controlled for in these studies that I think are actually driving the results. The problem with this is that the SMILES trial is kind of being used as a template to replicate these results. So if we're doing that, we're missing a lot. I think we're just missing a lot if we're just copying and pasting, right? Like the intervention, because yeah, we'll probably see the same results, like probably. But again, like we need to talk about these other things that I think are like hugely important with respect to what's going on.
Jono: Yeah, yeah, all the underlying factors. But again, it's easy to just hold up a study, hold up an intervention and be like, now this is the cure. This is the fix.
Nicole: Yeah. Yep.
Jono: The, I guess to sum up, what, if you were to give listeners, it feels weird saying that. I forget that people are gonna listen to this. I just feel
Jono: like I'm just having a chat. Well, hopefully someone will listen. Someone will listen.
Jono: Mom will listen. If you've got, if you, she probably wouldn't actually, but if you could give people like, what are like your top red flags? for if you see information similar to this or information communicated in this way on social media, you know, like you see lists of foods to avoid like that. What are some really quick things where they can immediately just go, cool, I should probably not be taking mental health advice from this person.
Nicole: Yeah, so if they are not a mental health practitioner, that's really important.
Jono: I can't
Jono: believe you have to say that.
Nicole: know, but I do have to say it.
Jono: But you do. You do.
Nicole: No, I do have to say it. It's really important because if they're not treating patients, if they're not in the clinical field, if they're not in the research field, they're way outside of, they're out of touch with respect to people who are really struggling with their mental health.
Nicole: So that's a big one. I would say another one is if they're using language that's like to cure depression or anxiety to treat depression or anxiety and they're using food as a sole intervention and they're not talking about what we know are effective interventions for treatment. So if they're not talking about therapy, they're not talking about meds, they're not talking about any of that and they're just being like food cures, that's a huge red flag. I would say probably don't listen to that person. That's a big one. And then, if you're talking also in absolutes, which kind of goes in line with that, if it's more like, you gotta do this, and this will provide you with all of this relief, and if you don't do this, your depression is just gonna continue to get, if it's very sort of extreme language, and it's in absolutes, that's another thing I would say, good to steer clear of. And if there's just a lot of emphasis on food and there's like not a lot of emphasis on other things, you know, that's another red flag too because there needs to be recognition and acknowledgement. There's other interventions that we need to focus on. Food can be an adjunctive intervention just like exercise. So if they're just like talking about food and they're not talking about other things, that's also big red flag.
Jono: Yeah, yeah. So I'm still dying over the first point. This first very important point, but the first very overlooked point of like, oh, are they working in this space? No, oh, why are you listening to them then?
Jono: But anyway, yeah, yeah. Awesome, I'm gonna steal, well not steal, I'm gonna collate those and make that a like, hey, do these things
Jono: or look out for these things. Yeah, cause that's great. So. Dr. Nicole, I never know what to say anyway.
Nicole: No, he's got the car.
Jono: Just Nicole, okay, cool, cool. Some people are funny and I get it, like getting a doctorate is not fricking
Nicole: I think one time I was...
Jono: child's play. So like, if you wanna tell people about it, I get like, I don't have one and there's no, that's for a very good reason because
Nicole: Yeah, yeah.
Jono: I don't have it in me. So Dr. Nicole, saying it anyway, thank you so much for your time
Jono: and for giving so much color between the black and white. It's so important. It's such a frustrating space. I think as well because a lot of the people struggling are very, you know, it's a vulnerable group, you know, that are looking for answers. I guess like a lot of, you know, and these people have, they have answers. They're wrong, but there's still answers, I
Jono: And so it's, yeah, hopefully some people can listen to this and take some. good information away and have a better lens with through which to view all of this stuff. And so if people want to hear lots more information like this, find out what you're doing, follow you, sounds creepy, but that's the language that we're using.
Jono: Yeah, where is the best place to find you?
Nicole: Yes, so I am on Instagram and TikTok at Feed Your Mental. It's all one word. I have a website, it's feedyourmental.com. I have a blog and I have some resources there too if people wanna check out. And yeah.
Jono: Yeah. Awesome. I will of course, link all of those in the show notes because that's what you do. But yeah, definitely if you're not already, make sure that you jump over and I don't know about TikTok. That's fine. If you guys do TikTok follow, but like
Nicole: I don't know
Jono: to TikTok.
Nicole: I'm doing here.
Jono: A place scares me. I'm too old, but definitely I can vouch for her Instagram. It's incredible. It's literally why I wanted to chat to her. today. So thank you so much for giving me all of your valuable time for answering all those questions.
Jono: And yeah, you're doing a good job. Keep
Jono: it up,
Nicole: you so much.
Jono: We need we need it. No,
Nicole: Yeah, no, thank you. Thank you so much.
Jono: awesome. Cheers. See you next time, guys.