When you need a mood lift, what do you eat? Comfort foods? Treats?
Whole grains & veggies? 🙃
In Episode 03 we talk about the SMILES trial and the daily mood food diet that can help over time.
When you need a mood lift, what do you eat? Comfort foods? Treats?
Whole grains & veggies? 🙃
In Episode 03 we talk about the SMILES trial and the daily mood food diet that can help over time.
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[00:00:15.390] - Leesa
It works. okay, so now let's see how they did the study and why we think this is a good one.
[00:00:19.260] - Lindsay
[00:00:34.680] - Leesa
Hey, so I found this really cool study. And it's funny because when I found out about it in January 2018, I was like, "Oh my god, this is an amazing new nutrition study that came out. I have to share with everyone." And I shared it on Instagram and I shared it with everyone. And I really am so glad that we have this podcast where I can actually talk about it. There are so many reasons why I love this study. One of which, of course, is because this is a very high quality study. It is a--get this--a randomized control trial of dietary improvement for adults with major depression. This is so innovative in so many ways because very, very few nutrition--and, you know, Lindsay--very few nutrition trials are actually trials.
[00:01:21.060] - Lindsay
[00:01:21.390] - Leesa
That are actually randomized, that are actually placebo-controlled, and that actually use people--not healthy adults--but people who actually have the condition that we're trying to look at.
[00:01:33.220] - Lindsay
Well, cause it's so hard to do that with nutrition studies.
[00:01:36.120] - Leesa
[00:01:36.150] - Lindsay
They found a way!
[00:01:37.710] - Leesa
I know and that why this blew my mind and like, "Oh my god, we have to talk about this," because it is really, really cool. So I'll dive in that this is an amazing trial. This was done in people. So A), it's done in people. Second of all, it's only people with depression. And third of all, which I forgot to mention, was they're free living adults. So this isn't done in people who are, for example, hospitalized or somehow institutionalized. This is done on people who are literally living their lives. And they can grocery shop if they want to, and they can follow recipes if they want to, and punch line: they did. And this is so cool when people get support, they can make the changes that they need and it can actually help them; legitimately help, not just, "People who tend to eat more broccoli tend to have [whatever]," this is legit, okay. So I'll dive into the conclusion here. The conclusion is that this trial, which I'll talk about in more detail in a few minutes.
[00:02:32.580] - Lindsay
[00:02:33.210] - Leesa
Actually targets depression. And it found that people who had poor quality diets, which they measured, this wasn't subjective, and they had major depressive disorder. They split them into two groups. So one group had a 60 minute nutrition consultation with a dietitian over the course of 12 weeks. And they used this special diet, the modified Mediterranean diet. The second group--again, this is a randomised trial--had instead of nutrition consultations, they got these 60 minute support or "befriending" sessions over 12 weeks. Because we know that sometimes, especially when there's a mental health concern, having somebody to talk to, who cares about you, who cares about your health, who you can relate to, can sometimes help you--forget about the diet.
[00:03:23.100] - Lindsay
It can be a game-changer. Yeah.
[00:03:24.270] - Leesa
So what we want to do is we don't want to think that the nutrition people alone got that relationship-building opportunity with the dietitian they had; the [other group of] people who also had a relationship.
[00:03:37.830] - Lindsay
Because either way, both groups are interacting with a health professional, getting that one-on-one support. So it's a really good way to offer that control.
[00:03:47.070] - Leesa
So the befriending was--and I just learned this in the study because I don't study psychology--but befriending is used as a control for clinical trials of psychotherapy.
[00:03:58.320] - Lindsay
I did not know that either, that's really cool.
[00:03:59.370] - Leesa
I know. So when they're testing out psychological treatments, they'll have people who get the psychological treatment (whatever it is--CBT is one: Cognitive Behavioural Therapy) or they'll get a friend, a befriending. And with that, you don't get the psychotherapy, you get a friend. And they discuss neutral topics and they play board games, or whatever. And there is no dietary advice in this group. Okay, so what they did was they measured people who had depression. They measured what their scale of depression was, and they used the standard scale called the Montgomery Asberg Depression Rating Scale the MADRS and it gives you a score from 0 - 60. So the people who were randomized to the dietary group at baseline (at the beginning), their score on average was 26.1. That was their depression score. And then the social befriending group, their average was 24.7. When you randomize, you kind of eliminate a bunch of other variables that could go in and you just make sure that these two numbers are fairly the same. And then after 12 weeks--12 weeks of these seven, 60 minute sessions with a skilled person and modifying the Mediterranean diet slightly--the average depression score of these people went from 26.1 to 14.8!
[00:05:23.730] - Lindsay
Wow. That's a huge drop.
[00:05:25.230] - Leesa
Amazing. This is amazing because when you're measuring things this way, you're supporting them and helping to change their diet. They're still free living, they can listen to you or not. And then the other group is still getting befriending, but no dietary advice. And you can drop the Montgomery Asprey Depression Rating Scale from 26.1 to 14.8.
[00:05:46.570] - Lindsay
Wow. That's big.
[00:05:48.440] - Leesa
It's big. It's great. Think about having major depression. And over 12 weeks of literally changing your diet. You can get better. Now, the other group, the social baseline (the group who got the befriending at baseline) they were 24.7, you'll recall. After 12 weeks, they improved too, they improved to 20.5.
[00:06:07.900] - Lindsay
Okay, so there was a bit of improvement, which makes sense.
[00:06:11.040] - Leesa
Exactly. And the whole idea with randomising to two groups is you can look at the differences between the groups knowing that a bunch of steps were taken so that the only difference between the groups, was the diet. Of course, there are other confounding things that could happen, but when you're doing an experiment like this, you're really eliminating a lot of those other variables that could play into the results.
[00:06:35.600] - Lindsay
[00:06:36.310] - Leesa
So that was the primary endpoint, that was the first thing they measured. So, #GoingWithTheModifiedMediterraneanDietFromHavingAPoorDietCanAndHasImprovedDepressionInManyPeople, in a randomized control trial.
[00:06:52.420] - Lindsay
[00:06:52.580] - Leesa
Yay, for nutrition science. Yay!
[00:06:54.250] - Lindsay
Wow, this is what we believe in and this is what we're here for.
[00:06:58.300] - Leesa
And, this study is amazing. So the secondary endpoint they measured was how many people got remission? How many people had their score go to what they consider to be a remission, which is getting less than 10? So we know the average went from 26.1 down to 14.8. And that's the average of all people.
[00:07:17.740] - Lindsay
Sorry did you say? How many people were in the trial?
[00:07:20.950] - Leesa
They recruited 67, but not everybody finished the 12 weeks. So at the end of the 12 weeks they ended up with 26 in the modified Mediterranean diet and 24 in the befriending placebo/control group.
[00:07:38.680] - Lindsay
Those are pretty good numbers.
[00:07:39.820] - Leesa
Yeah. So it's not bad. And these are people with depression, mind you, which is great because you're actually studying this in people who you want to help, as opposed to many studies just recruit healthy people.
[00:07:52.810] - Lindsay
[00:07:53.810] - Leesa
So at 12 weeks in that group that changed their diet, 32% of them ended up in remission.
[00:08:01.360] - Lindsay
[00:08:02.430] - Leesa
Thirty two percent.
[00:08:04.270] - Lindsay
[00:08:06.220] - Leesa
Exactly. So a third of people ended up with remission of their Montgomery Aspect Depression Rating Scale. So their scores at the end of 12 weeks were less than 10.
[00:08:15.210] - Lindsay
[00:08:15.670] - Leesa
A third of people who started with 26 on average, ended up under 10
[00:08:22.030] - Lindsay
That's fantastic, I mean I wonder if we were to compare to pharmaceuticals, what the comparison would be.
[00:08:26.950] - Leesa
That's a great question! Exactly. We would want to compare this with other treatment effects as well. This was a breakthrough study. This had not been done before. So this still, needs to be looked at again, looked at bigger population, etc. But the fact that this was a really high quality trial is definitely good evidence. Now, when they looked at how many people went into remission in the social group--the people who were befriended--8% of them did. So again, a few people who were befriended in the social group improved their depression scores. On average it did improve a bit, but not as much as with the diet and the consultations. And 8% of them actually went into remission versus 32% of the group that changed their diet.
[00:09:14.380] - Leesa
So, almost nothing is either fully 100% or 0%. Everything is shades of grey and everything has a percentage somewhere between 0 and 100. So these are great and these are really encouraging.
[00:09:29.590] - Lindsay
They're very encouraging, especially since this is something people do it multiple times a day. They eat.
[00:09:35.040] - Leesa
[00:09:35.080] - Lindsay
So if we just change our approach to what we're eating and how we're eating, knowing that just small changes over time can have such a huge impact on your mental health, which has a huge impact on this life.
[00:09:50.110] - Leesa
Right. The diet went from poor to a modified Mediterranean diet, in some levels. I mean, again, it wasn't a 0 to 100 [change]. Okay, now that we know that this can help so many people, how do we do it? So here's how we do it. So this modified Mediterranean diet was chosen because the Mediterranean diet has so much research on helping all kinds of things. Right.
[00:10:15.250] - Lindsay
Well, it's been in the news so much about just how fantastic it is.
[00:10:19.840] - Leesa
Fantastic. You know, heart disease, certain cancers, neurodegenerative diseases, even reduced risk for depression. I mean, we knew before the study that there's a correlation based on observations that people who eat better have lower depression. We didn't know if the depression made people not eat better, if the poor food increased your depression. We knew there were all these increased risks. We didn't know if there were other confounding variables, etc. We didn't know this. But that's why this study is a really solid first step to understanding the cause and effect.
[00:10:53.600] - Lindsay
[00:10:54.510] - Leesa
Okay, so for the modified Mediterranean diet, here is what we want to recommend people.
[00:10:58.900] - Lindsay
Okay. Hit me with it.
[00:11:01.230] - Leesa
Yeah. Let's dive into this diet. So what do we say? We're nutrition professionals. It's got 12 food groups. I will list the food groups in decreasing order and I will link to this in the show notes. It has a beautiful giant triangle where it shows the pyramid of foods. The number one of the 12 food groups was whole grains.
[00:11:24.190] - Lindsay
Oh. I did not expect that. I thought it would be vegetables.
[00:11:29.160] - Leesa
Vegetables is next! [Laughter]
[00:11:32.820] - Leesa
The whole grains was 5-8 servings a day and the vegetables were 6 per day. So they're very similar in what they recommend. So whole grains, vegetables, and then fruits. Those are the foundation of this modified Mediterranean diet.
[00:11:45.420] - Lindsay
[00:11:46.260] - Leesa
After that, we want to include legumes.
[00:11:50.270] - Lindsay
[00:11:51.120] - Leesa
And, they also included low fat and unsweetened dairy, just 2-3 per day.
[00:11:57.080] - Lindsay
[00:11:58.200] - Leesa
The next groups are raw and unsalted nuts, fish, lean red meat, chicken, eggs, and olive oil.
[00:12:08.850] - Lindsay
Yeah, that sounds like a Mediterranean diet.
[00:12:11.820] - Leesa
They just modified it to suit. The study was done by Deakin University in Australia. So they wanted it to not be a huge change between what people generally eat there. But they do want to make sure it was also nutritionally complete and wasn't too different for people. So those are the 11 groups. And again, I'll link to it so we don't have to memorize all of these. The 12th Group was "extra foods."
[00:12:37.830] - Lindsay
So what does that mean, though?
[00:12:39.810] - Leesa
Exactly, so extra foods is no more than three a week. So not every day, not even every other day.
[00:12:45.910] - Lindsay
[00:12:46.620] - Leesa
That's where they included sweets, refined cereals, fried food, fast food processed meats, etc.
[00:12:51.630] - Lindsay
So they're not totally depleting these people of the yummy things in life that everybody complains you have to give up when you're trying to eat better. What they're saying is moderation, which is not a novel concept.
[00:13:04.110] - Leesa
No, I know! You can still have your, sugary drink, fried food, etc. Well, they said no more than three servings per week. So one serving every say two to three days,
[00:13:16.340] - Lindsay
[00:13:17.130] - Leesa
Three a week, so less than one every other day. And this feels to me like something that's more easily attained.
[00:13:25.560] - Lindsay
Oh, for sure.
[00:13:26.700] - Leesa
More balanced. We definitely are starting with whole foods like whole grains, vegetables, and fruits as your foundation. Which are full of fibre and full of vitamins. And they were allowed a little bit of wine, one or two drinks with a meal.
[00:13:46.650] - Lindsay
[00:13:48.020] - Leesa
That's a good question. It's said that more than two a day were considered extra, but they were allowed one or two a day with meals.
[00:13:56.370] - Lindsay
Oh, yeah, that makes sense. I mean, a lot of the Mediterranean cultures, wine is a staple.
[00:14:04.350] - Leesa
[00:14:04.350] - Lindsay
They just have such a different mental approach to wine and the diet.
[00:14:10.390] - Leesa
And enjoying food, enjoying eating, sitting down, taking a break, chatting.
[00:14:15.560] - Lindsay
Yes. It's such a cultural cornerstone.
[00:14:19.700] - Leesa
[00:14:20.100] - Lindsay
Right. Like food is just something really to be enjoyed and sit and linger and socialize. And I love that philosophy around food, that slow food movement and just really enjoying real food on your plate and taking the time out of your life to actually sit and enjoy every bite.
[00:14:38.460] - Leesa
Enjoy it, exactly.
[00:14:39.930] - Lindsay
Yeah. Oh, that's fantastic. And all of these things are so easy to start, including it doesn't have to be an overhaul overnight. OK, maybe tonight we're going to make some pasta. So yeah, make the pasta, but throw a bit of salad on the side.
[00:14:55.230] - Leesa
Whole grain pasta. Exactly. With the fruits and vegetables, yes.
[00:14:59.190] - Lindsay
Yeah. So just start modifying what you're eating and start leaning more towards whole grains, more vegetables, trying to eat fruit for dessert instead of having the treats and saving the treats for more special occasions. This is all easily doable.
[00:15:13.830] - Leesa
These are steps that are not a complete overhaul. And this study shows that it can have a big difference in mental health. You know what else I really was interested in the study is people were allowed to consume it ad libitum, so they could eat as much as they wanted according to their appetite, and it was not a quantity restriction. I mean this wasn't a weight loss. Or calorie count. It wasn't any that. This was not a weight loss study, this was a mental health study, and a nutrition study. But they were still allowed to eat how much they wanted, trying to adhere to this modified Mediterranean diet as much as possible.
[00:15:54.080] - Lindsay
Yeah, I love that approach, I have to say. Because, if you're eating real food and nutrient dense food, you're not really going to gorge on it. It's not like you're going to be like, "Oh my god, salad. I can't stop eating salad." If you make good salads--and I know how to make good salads--and you love it when you're eating it, and it tastes delicious; but you're not going to be like, "Oh my god." It's not like ice cream, right? Where you're just going to eat it until you feel nauseous. It just doesn't work that way.
[00:16:23.240] - Leesa
And you know what, you bring up an amazing point because this is a high fibre diet.
[00:16:27.720] - Lindsay
Yeah. It's going to fill you up.
[00:16:29.780] - Leesa
It's going to fill you up. It also was high in folate, it's high in Vitamin C, you have lots of fruits and vegetables. And this diet was actually created to meet all of the recommended dietary intakes/adequate intake requirements for adults, with the only exception of vitamin D, because vitamin D is so hard to get from food directly, anyway. It isn't in that many foods. This is a topic for another podcast possibly in the future, vitamin D. But this was a nutritionally complete, high fibre diet.
[00:17:02.060] - Lindsay
[00:17:02.780] - Leesa
That was started and was fundamentally based on whole grains, vegetables, fruits, and then, with some legumes and some dairy and some different kinds of meats and eggs. And it still allowed a little bit of "extra" foods and wine.
[00:17:20.090] - Lindsay
Yeah. I think that's fantastic. I love that you shared this one this week.
[00:17:25.140] - Leesa
Super excited. Yeah, this was amazing. So of course, knowing that there's evidence--strong evidence--this trial is a randomized control trial. Out of our ranking, it is a six out of seven. It has high-quality evidence, because it was placebo controlled. This is the thing that is interesting, it wasn't connecting the dots. Some philosophies are based on connecting the dots. Right? So you have a nutrient and this nutrient interacts with this enzyme. And then this enzyme is in this biochemical reaction in this cell. And this cell is involved in this disease. And then, of course, with this disease, have these clinical symptoms . . . And you're connecting dot to dot, to dot, to dot, to dot. And you know, every time you connect dot, you are less sure of the connection from A to C than you are from A to B. So this study looked at literally the foods, not individual nutrients, but an entire diet. Because people don't eat nutrients, they eat foods.
[00:18:22.040] - Lindsay
[00:18:23.000] - Leesa
And their clinical outcome directly, which is how they score on these depression scales.
[00:18:28.160] - Lindsay
[00:18:28.410] - Leesa
So it was definitely a 6 out of 7, RCT, [the] protective role of Mediterranean diets are known and now there's evidence that it helps with depression.
[00:18:40.010] - Lindsay
Well I love too that we're looking at the diet as a whole, because when you look at individual nutrients, there are so many other factors missing. The big one in my mind being food synergy. Foods are meant to be whole, complete mixed with other flavours, mixed with other nutrients because they play off each other and they really can enhance each other together, to have a bigger impact. And so, that's really what this comes down to, is looking at how things work together. It's not any one thing.
[00:19:10.460] - Leesa
[00:19:10.460] - Lindsay
It's the culmination of everything that's coming together to have such a big impact.
[00:19:15.500] - Leesa
Right. Including . . . they broke it down to 12 food groups.
[00:19:19.280] - Lindsay
[00:19:19.670] - Leesa
I didn't notice any particular thing that was actually missing. Almost everything was allowed.
[00:19:25.350] - Lindsay
[00:19:25.970] - Leesa
In certain amounts.
[00:19:27.400] - Lindsay
[00:19:27.640] - Leesa
Right. It wasn't like free of this or free of that. I mean of course if you have allergies.
[00:19:32.300] - Lindsay
[00:19:33.230] - Leesa
Celiac, or whatever you have you need to be cutting things out. I'm anaphylactic to Brazil nuts.
[00:19:38.430] - Lindsay
[00:19:39.110] - Leesa
I literally carry an EpiPen. I've had very bad reactions. So I know that it's really nice that this diet works. I can't have Brazil nuts. But that goes for everyone. There are going to be exceptions where you can't have everything. But the beauty of this is that it shows you can include everything.
[00:19:53.900] - Lindsay
Yeah. Thank you for sharing that one, that's awesome.
[00:19:56.130] - Leesa
Yeah, for sure. It was really cool. I mean, we still don't know all the dots to connect. We don't know what does what is affecting what cell and what organ and what tissue and whatever. But I love that this [shows] modified Mediterranean diet does help with depression symptoms in people with depression. Amazing!
[00:20:16.640] - Lindsay
Yep. Considering, as we record this August 4th (2020), we are five months into the pandemic and especially with fall coming, I know mental health issues are going to be forefront of people's minds, so this is fantastic that, there are active ways we can push towards a much healthier state. It's one thing we have control over.
[00:20:43.490] - Leesa
Yes. Thank you so much for bringing that up this is so relevant right now.
[00:20:47.500] - Lindsay
Yeah. Oh, it totally is. Oh, yeah. Definitely. Very, very useful information. Awesome.
[00:20:53.760] - Leesa
Cool! All right. We'll catch you guys in the next episode.
[00:20:59.690] - Lindsay
Catch you then.
[00:21:03.480] - Intro/Outro
Thank you for listening for exploration into more health research, don't forget to subscribe and we'd like to thank Joseph McDade for the music. If you have any comments, ideas or recipes to share, you can reach us at rEATsearch on Instagram and Twitter and rEATsearch podcast on Facebook. That's spelled r-E-A-T-search.