The purpose of this research proposal is to distinguish the therapeutic
effects of antidepressant medication compared to the effects of a healthy,
modified diet in depressed patients. Various research has been conducted
which has validated the correlation between certain nutrient deficiencies and
increased rates of mental illness, as well linking healthy diets such as the
Mediterranean diet to lowered incidences of mental illness. However, there
is a lack of research which compares the effectiveness, benefits and risks
between treating depression nutritionally versus pharmacologically.
Several research studies have linked an association between adverse
health effects and mental illness. There is evidence that both individuals
with schizophrenia and other psychotic mental disorders1 and individuals
with anxiety and mood disorders2 have high incidences of heart disease. In
their study of veterans in the US, Dr. Amy Kilbourne et al elaborated that not
only were their study participants with schizophrenia, bipolar disorder and
other psychiatric disorders more likely to have heart disease but were also
more likely to die from heart disease than were veterans without mental
disorders. Based on our knowledge of heart disease, it is not surprising that
this study also revealed that these heart disease-related mortality
participants were linked to behaviors of smoking and inadequate physical
activity3. Additionally, it was found by researchers Faith B. Dickerson et al
that their study participants were in worse overall general health, based on 5
composite health behaviors, compared to the general population. The
criteria of health status, rated on meeting 5 composite health behaviors of
being a nonsmoker, teeth in good condition, having a non-obese BMI, free of
injury in the past 90 days, and no serious medical comorbidity, found that
only 1% of individuals with schizophrenia and other major mood disorders
met this health parameters compared to 10% of the general population 4.
While these studies do tell us that there is an inverse relationship between
psychiatric mental disorders and health status, they provide little insight as
to the how and why the relationship exists. Based on the existing
1, 3 Kilbourne AM, Morden NE, Austin K, Ilgen M, McCarthy JF, Dalack G, Blow FC.
Excess heart-disease-related
mortality in a national study of patients with mental disorders: identifying modifiable risk factors. Gen Hosp
Psychiatry. 2009; 31(6):555-563.
2 Scott KM, de Jonge P, Alonso j, Viana MC, Liu Z, ONeill S, Aguilar-Gaxiola S, Bruffaerts R, Caldas-de-Almeida JM,
Stein DJ, de Girolamo G, Florescu SE, Hu C, Taib NI, Lepine JP, Levinson D, Matschinger H, Medina-Mora ME, Piazza
M, Posada-Villa JA, Uda H, Wojtyniak BJ, Lim CCW, Kessler RC. Association between DSM-IV mental disorders and
subsequent heart disease onset: beyond depression. Int J Cardiol. 2013; 168(6):5293-5299
34 Dickerson FB, Brown CH, Daumit GL, LiJuan F, Goldberg RW, Wohlheiter K, Dixon LB.
with serious mental illness. Schizophrenia Bulletin. 2006; 32(3):584-589.
Health status of individuals
available research, it is hard to determine whether environment, genetics,
psychiatric medication, or a combination of these, is the root cause of the
deteriorated health conditions of individuals with psychiatric disorders. Much
research has been conducted linking a depressed or other psychiatricdisordered individuals diet with their mental health status. Based on the
findings of these research studies, there is an apparent and undisputed
inverse correlation between the nutritional value of an individuals diet and
the degree of psychological disorder severity. However, in an evaluation of
essential fatty acids, micronutrients and carotenoids in depressed women
during pregnancy, no statistical significance was found linking the nutritional
biomarkers and depression level5. As previously seen in individuals with
depression and other psychiatric disorders, these individuals tend to be in
lower overall health than those without psychiatric conditions. However,
research from Julie Kreyenbuhl et al revealed that type 2 diabetic patients
with mental illness had better blood glucose control than individuals without
mental illness, although there was no indication of better hypoglycemic
medication adherence with either experiment group6. Despite both studies
revealing some important information, neither studys findings were able to
be applied to the general population of mental illness and/or non-mental
illness, as both studies focused on a very specific target sample population.
Additional studies were not found to corroborate the findings of these two
studies.
Numerous studies have been conducted linking a correlation between the
human diet and psychological health. In a generalized study comparing
healthy to unhealthy diets against rates of depression, the Iranian study
by Maryam Khosravi et al linked healthy diets, comprised by high fruits,
cruciferous, yellow, green leafy and other vegetables, low fat dairy, whole
grains, nuts, and olives, with decreased odds ratio of depression, when
compared to unhealthy diets, comprised of high in refined grains and breads,
high fat dairy, solid oils, liquid oils and mayonnaise, pickle, snacks, soft
drinks, industrial fruits and juice, red meats, poultry, processed meats, and
sweets7. Additionally, a Japanese study found coffee consumption to be
inversely associated with rates of depression in type 2 diabetics8. These
findings are of great insight and resourcefulness since diabetic patients have
5 Bodnar LM, Wisner KL, Luther JF, Powers RW, Evans RW,Gallaher MJ, Newby PK.
An exploratory factor analysis of
nutritional biomarkers associated with major depression in pregnancy. Public Health Nut. 2012; 15(6):1078-1086.
6 Kreyenbuhl J, Leith J, Medoff DR, Fang L, Dickerson FB, Brown CH, Goldberg RW, Potts W, Dixon LB.
A comparison
of adherence to hypoglycemic medications between Type 2 diabetes patients with and without serious mental
illness. Psychiatry Res. 2011; 188(1):109-114.
7 Khosravi M, Sotoudeh G, Majdzadeh R, Nejati S, Darabi S, Raisi F, Esmaillzadeh A, Sorayani M.
Healthy and
unhealthy dietary patterns are related to depression: A case-control study. Psychiatry Investig. 2015; 12(4):434442.
a greater prevalence of depression. Higher rates of depression in diabetic
patients could potentially be a result of poor eating habits and/or higher
consumption of sugar-sweetened foods and beverages. This study found a
link between compounds in coffee other than caffeine, as the study also
tested caffeinated teas such as green tea and black tea, with lowered rates
of severe depression.
Nutritionally sufficient or insufficient foods also play a significant role in
psychiatric disorders. Higher rates and increased levels of severity in
depression and other psychiatric disorders can be linked to nutritional
content of various foods. For instance, Yun-Jung Bae and Soon-Kyung Kim
found an association between higher total calcium and animal calcium intake
with significantly lower depression scores in middle-aged Korean women 9.
Additionally, a Chinese study on an elderly population found that thiamine
deficiency is associated with higher rates of depression.10 In Iran,
researchers concluded that folate and vitamin B12 deficiencies were linked
to increases in depression.11 Similarly, a separate Turkish study revealed
that low folic acid, vitamin B, and serum B12 are associated with increased
rates of obesity and depression.12 Another study out of Iran focused more
generally on overall malnutrition versus specific nutrient deficiencies, and
found a high prevalence of depression in malnourished elderly individuals.13
It is evident from these studies and from our knowledge of other research
that mental health is largely associated with nutritional diet.
Several studies examined the impact of nutritional intake on adolescent and
childhood mental health. A review by Adrienne ONeil et al of 12
8 Omagari K, Sakaki M, Tsujimoto Y, Shiogama Y, Iwanaga A, Ishimoto M, Yamaguchi A, Masazumi M, Kawase M,
Ichimura M, Yoshitake T, Miyahara Y. Coffee consumption is inversely associated with depressive status in Japanese
patients with type 2 diabetes. Journal of Clinical Biochem. 2014; 55(2):135-142.
9 Bae YJ, Kim SK.
Low dietary calcium is associated with self-rated depression in middle-aged Korean women. Nut
Res Prac. 2012; 6(6):527-533.
10 Zhang G, Ding H, Chen H, Ye X, Li H, Lin X, Ke Z.
Thiamine nutritional status and depressive symptoms are
inversely associated among older Chinese adults. The Journal of Nutrition. 2013; 143(1):53-58.
11 Gargari BP, Saboktakin M, Mahboob S, Pourafkari N.
Nutritional status in patients with major depressive
disorders: A pilot study in Tabriz, Iran. Health Promotion Perspectives. 2012; 2(2):145-152.
12 Kaner, G., Soylu, M., Yksel, N., Inan, N., Ongan, D., & Bamsrl, E. (2015). Evaluation of nutritional status of
patients with depression. BioMed Research International, 2015, 521481. http://doi.org/10.1155/2015/521481.
13 Ahmadi SM, Mohammadi MR, Mostafavi SA, Keshavarzi S, kooshesh SMA.
Dependence on the geriatric
depression on nutritional status and anthropometric indices in elderly population. Iran J Psychiatry. 2013; 8(2):9296.
epidemiological studies examining the diet quality and patterns against
mental health in children and adolescents found that such association does
exist at this early stage in life.14 Additionally, a Norwegian study found
similar results in their study on 12 and 13 year old schoolchildren.
Researchers found conclusive evidence that poor quality diets were linked
with higher incidences of mental health problems.15 Lastly, research
conducted by Dr. Melissa W. George et al linked the effectiveness of a health
promotion program to improved family and parenting support, youth selfefficacy and youth physical and mental health.16 Data from this study
supported the idea that improved family support would help improve a
childs health behavior changes, which would be a low-cost, non-intrusive
measure of improving physical and mental health markers. Making these
types of changes and improvements earlier in life could potentially lessen
the physical and mental health care complications later in life.
A good amount of diverse research has been conducted examining the
relationship between nutritional diet and mental health status/psychiatric
disorders, nutritional deficiencies/malnutrition and psychiatric disorders, and
exercise and psychiatric disorders. However, very little research has been
done specifically examining the effectiveness of improved diet as a means of
managing psychiatric disorders, or comparing psychiatric medications to
nutritional diets as effective ways of managing/treating psychiatric disorders.
Thus, the purpose of this research proposal is to fill this research gap and to
examine how improved nutritional diets may work in improving psychiatric
disorder statuses and even potentially replacing the need for psychiatric
medications to manage certain psychiatric disorders.
14 ONeil A, Quirk SE, Housden S, Brennan SL, Williams LJ, Pasco JA, Berk M, Jacka FN.
Relationship between diet
and mental health in children and adolescents: A systematic review. American Journal of Public Health. 2014;
104(10):31-42.
15 Oellingrath IM, Svendsen MV, Hestetun I.
Eating patterns and mental health problems in early adolescence a
cross-sectional study of 12-13-year-old Norwegian schoolchildren. Public Health Nutrition. 2013; 17(11);2554-2562.
16 George MW, Trumpeter NN, Wilson DK, McDaniel HL, Schiele B, Prinz R, Weist MD.
Feasibility and preliminary
outcomes from a pilot study of an integrated health-mental health promotion program in school mental health
services. Fam Community Health. 2014; 57(1):19-30.
