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An evidenced based approach to addressing mood disorders like depression and anxiety by utilizing Functional Medicine and Clinical Nutrition

If you’re struggling with low mood, brain fog, lack of motivation, fatigue, food addictions, mental and emotional burnout then you’re not alone. Depression, anxiety, alcohol and food addictions are the number one reason why people visit their local GP and this trend is increasing year after year. It’s estimated that almost half (45%) of Australians 16–85 will experience a mental disorder such as depression, anxiety or substance use disorder at some stage in their life; an estimated 20% of the adult population and 14% of children have experienced a mental health disorder in the last 12 months1.

Depression has been defined as; “A mood disorder with prolonged feelings of being sad, hopeless, low and inadequate, with a loss of interest or pleasure in activities and often with suicidal thoughts or self-blame”1.

Anxiety is often defined as; “A group of mental disorders marked by excessive feelings of apprehension, worry, nervousness and stress. Includes generalised anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder and various phobias”1.

Depressive disorders are now the most disabling illnesses in Australia2 and are associated with fatigue, brain fog, suicide, memory issues, injury and cardiovascular disease. Females are more prone than males to developing depression and anxiety. The triggers for depression appear to differ, with women more often presenting with depression and anxiety, whilst men often present with anger and aggression. For example, in a study of dizygotic twins, women displayed more sensitivity to interpersonal relationships, whereas men displayed more sensitivity to external career and goal-oriented factors. Women also experience specific forms of depression-related illness, including premenstrual dysphoric disorder, postpartum depression and postmenopausal depression and anxiety, that are associated with changes in ovarian hormones and could contribute to the increased prevalence in women.

ADRENAL FATIGUE AND DEPRESSION
Depression and anxiety can often be related to chronic stress and the resulting imbalances in cortisol. Anxiety, ongoing job – related and perceived stress often presents with an elevated cortisol awakening response (CAR). Whilst a high amount of psychosocial burnout, chronic fatigue and PTSD can often manifest with a blunted CAR3. The DUTCH testing as offered by our clinic can measure cortisol levels over 24 hours and importantly your CAR.

Stress is therefore intricately linked with depression and anxiety, yet in most cases it is rarely tested. The result being that it is poorly managed by most health practitioners. A recent summary/meta-analysis of the last 40 years of research confirmed that increased activity of the HPA axis during depression is one of the most reliable findings in biological psychiatry3. By measuring cortisol levels and your CAR it is possible to personalize your program to help improve your metabolic resilience and balance stress hormones such as cortisol4-7.

NUTRITION
The connection between nutrition and depression is poorly understood by the general public at large, in fact you may be surprised to know that nutrient replacement has been shown to have positive results on mood disorders. The link between nutritional deficiencies and physical illness such as heart disease and cancer are widely known and accepted. However, the impact that nutrient deficiencies can have on your mood is not widely recognized. Nutrition plays a huge role in mood disorders, recent and robust research has also illustrated that the microbiome, which is the bacteria within your digestive system can also have a huge impact on your mood8. One of the most powerful ways to change your microbiome is via your diet.
 
Dr. Clegg has a particular interest in mood disorders and the impact stress and nutrient deficiencies can have on conditions such as depression and anxiety. The dietary intake of the majority of Australian’s is deficient in many nutrients, especially essential vitamins, minerals, and omega-3 fatty acids9. It has long been established that nutrient deficiencies can lead to mood disorders10. Depression is often thought of as strictly biochemical-based or emotionally rooted. On the contrary, nutrition can have an extremely powerful role to play in the onset as well as the severity and duration of depression. Many of the easily noticeable food patterns that precede depression are the same as those that occur during times of depression. These often include poor appetite, skipping meals, and a dominant desire for sweet foods.

Diet alone is often not sufficient to improve depression and anxiety. Evidence shows that supplementing specific micronutrients in the correct dosage can greatly help certain people suffering with mood disorders11-16. Supplementation has also been found crucial as certain amino acids which have been found to be affective in combating depression aren’t available in therapeutic levels in food and must be taken in supplement form17.

The long-held theory of depression and anxiety as a neurotransmitter imbalance has given rise to the use of medications such as SSRI’s SNRI’s and TCA’s. Imbalances in serotonin, dopamine and noradrenaline have been cited as central to the development of depression and anxiety18. Through Organic Acid Testing Dr. Clegg can identify nutritional deficits that have arisen and possibly impacting on the delicate balance of your neurotransmitters19. Restoring these nutrients can be effective for improving depression and anxiety16.

Recently, the intestinal microbiome has been linked with mood disorders8. This further strengthens the fact that nutrition has a huge role to play in mental health. Dr. Clegg utilizes certain probiotics combined with effective prebiotics to improve microbiome balance which in turn can have the effect of improving symptoms of depression and anxiety20-22. Our programs include testing which can measure imbalances in your microbiome that could be impacting on your mood.

If you would like a nutritionally evidence-based way of improving your mood and decreasing stress levels, our clinic could provide you with the solutions you need via the utilization of Organic Acid Testing, Microbiome testing, Metabolomics, nutrient replacement and supplement programs. 


REFERENCES
1. Australian Government: Australia’s health 2018. Australian Institute of Health and Welfare.

2. 1 Mathers C, Vos T, Stevenson C. The burden of disease and injury in Australia. Canberra: Australian Institute of Health and Welfare, 1999. (AIHW Catalogue No. PHE-17). Available at: http://www.aihw.gov.au/ publications/health/bdia/bdia.pdf (accessed May 2004).

3. Guilliams, T.G. (2015) The Role of Stress and the HPA Axis in Chronic Disease Management. Point Institute

4. F. Tanriverdi et al (2007) The hypothalamo–pituitary–adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome, Stress, 10:1, 13-25, DOI:

5. Liao, L-Y et al (2018) A preliminary review of studies on adaptogens- comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med 13(57) 1-12

6. Panossian, A., Wikman, G. (2010) Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress—Protective Activity. Pharmaceuticals (3) 188-224

7. Starks, M.A et al (2008) The effects of phosphatidylserine on endocrine response to moderate intensity exercise. Journal of the International Society of Sports Nutrition. 5(11) 1-6

8. Sarkar, A. et al (2016) Psychobiotics and the Manipulation of Bacteria-Gut-Brain Signals. Trends Neurosci. 39(11) 763-781

9. healthstats.nsw.gov.au

10. Sathyanarayana RA, T.S. et al (2008) Understanding nutrition, depression and mental illnesses. Indian J Psychiatry. 50(2): 77–82.

11 Benton, D. et al (1995) Vitamin supplementation for 1 year improves mood. Neuropsychobiology. 32(2) 98-105

12. Young, L.M. et al (2019) A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress/ Effects on Healthy and ‘At-Risk’ Individuals. Nutrients. 11:2232 1-19

13. Kennedy, D.O. et al (2017) Cognitive and Mood Effects of a Nutrient Enriched Breakfast Bar in Healthy Adults- A Randomised, Double-Blind, Placebo-Controlled, Parallel Groups Study. Nutrients. 9:1332 1-21

14. White, D.J. et al (2015) Effects of Four-Week Supplementation with a Multi-Vitamin/Mineral Preparation on Mood and Blood Biomarkers in Young Adults- A Randomised, Double-Blind, Placebo-Controlled Trial. Nutrients 7, 9005–9017; doi:10.3390/nu7115451 

15. Lewis, J.L. et al (2013) The Effect of Methylated Vitamin B Complex on Depressive and Anxiety Symptoms and Quality of Life in Adults with Depression. ISRN Psychiatry http://dx.doi.org/10.1155/2013/621453

16. Lakhan, S.E., Vieira, K.F. (2008) Nutritional therapies for mental disorders. Nutrition Journal 7(2) 1-8

17. Sharma, A. et al (2017) S-Adenosylmethionine (SAMe) for Neuropsychiatric Disorders- A Clinician-Oriented Review of Research. J. Clin Psychiatry 78(6)1-27

18. The Journal of Clinical Psychiatry 69 Suppl E1(Suppl E1):4-7 · February 2008

19. Tsoukala, D. et al (2017) Application of metabolomics- Focus on the quantification of organic acids in healthy adults. Int J Molecular Medicine 40: 112-120

20. Akkasheh, G. et al (2015) Clinical and metabolic response to probiotic administration inpatients with major depressive disorder/ A randomized, double-blind, placebo-controlled trial. Nutrition 32: 315-320

21. Messaoudi, M. et al (2011) Assessment of psychotropic like properties of a probiotic formulation lactobacillus helveticus r0052 and Bifidobacterium longum r0175 in rats and human subjects. British Journal of Nutrition. 105: 755-764

22. Huang, R. et al (2016) Effect of Probiotics on Depression/ A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 8, 483; doi:10.3390/nu8080483

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Dr. Adrian Clegg

When I began practicing eighteen years ago, people suffering from multiple debilitating conditions had few places to turn to receive the care they needed to get better. As the years have gone by, I began to realise that more and more people were suffering with chronic health problems—feeling tired, depressed, gaining weight, experiencing digestive problems, allergies and a host of hormone issues.

Over the years I have worked with 1000’s of people to help them overcome chronic health conditions using Functional Medicine and AO.
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