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YHM 073 - Researching Diet Change & Omega-3s for Anxiety
62 Plays1 year ago
Welcome to Your Health Minute! Join hosts, Max & Calvin as they delve into the fascinating world of naturopathic medicine and its impact on mental health. Today's episode explores the intersection of diet and anxiety, featuring Dr. Monique and Dr. Kieran, naturopathic doctors with a passion for holistic wellness.
Learn about the journey that led Dr. Monique and Dr. Kieran to investigate the effects of diet on mental health. Discover how anxiety manifests in daily life and why this area became a focus of their research. Explore the pivotal role of diet in nurturing mental well-being.
Hear about the groundbreaking clinical trial on diet change and omega-3s for anxiety. Delve into the holistic philosophy of naturopathic medicine and the innovative approach of their intervention. Get a sneak peek into the study's design, intervention, and exciting findings.
Stay tuned as Dr. Monique and Dr. Kieran share their insights, promising a brighter future for mental health care through the power of holistic medicine.
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Transcript
Introduction and Guest Backgrounds
00:00:11
Speaker
Hello, everyone. Welcome to another episode of Your Health Minute, brought to you by Aqua Omega. I'm your host, Max Marion, and with me, as always, is my co-host and moderator, Calvin Morrow. Hello, everybody. Today, we have a very special episode where we're going to be touching on a very hot topic, and that is mental health. And with us to do that today are two special guests, Dr. Monique Aucoin and Dr. Kieran Cooley. Welcome to the show, guys. Thanks so much for having us.
00:00:38
Speaker
It's great to be here.
Journeys into Naturopathic Medicine
00:00:40
Speaker
It's really great to have you guys here. I know you've been doing some very exciting work, but before we dive into that work, I would love for you to give our listeners a little more background on yourself and maybe even a little anecdote of why you got into naturopathic medicine and this important research.
00:00:59
Speaker
Sure. So my name is Monika Coyne. I'm a naturopathic doctor and I'm a senior research fellow at the Canadian College of Naturopathic Medicine. I have a small clinical practice, but I spend most of my time doing research and education. And I'm also an adjunct professor at the University of Guelph.
00:01:16
Speaker
In terms of how I got into naturopathic medicine, I grew up in a family that used naturopathic medicine as its main approach to healthcare, and I explored a few options as healthcare careers, but really naturopathic medicine was what made sense to me in terms of my views about healthcare and most closely aligned with my personal approach to health.
00:01:39
Speaker
an emphasis on prevention and wellness rather than managing symptoms, but helping people to be as healthy as they can. So it resonated with me. Cool.
00:01:50
Speaker
I'm Kieran Cooley. I'm also a naturopathic doctor. I'm director of research at the Canadian College of Naturopathic Medicine. I also do some instructing at the University of Toronto and have some adjunct research appointments at Southern Cross University as well as the University of Technology, Sydney. My background, I wasn't really exposed to naturopathic medicine growing up, but I grew up in a small rural town where services to healthcare were somewhat limited.
00:02:16
Speaker
And the importance of lifestyle factors for both primary and secondary prevention and also to treat health care concerns was part of the culture in my community. It was always there. And so everything from food, plants in your garden, time spent connecting with nature, physical and mental activity, the social connections, you were all considered medicine growing up in my family. And when I discovered naturopathic medicine later in life, there was just an immediate fit with my beliefs, right?
00:02:46
Speaker
everything from the importance of educating patients about how to understand their body and make some of those healthy choices, as well as the tailoring things to individualized close, individualized approaches to health. This is, this is all, you know, it just made sense
Naturopathic Community and Research Focus
00:03:04
Speaker
for me. And, and then, yeah, explored coming to school and getting training. And it was, it's a nice story after that.
00:03:11
Speaker
Love that. And now you guys work together, which is great. Did you both graduate from CCNM? Yes. That's awesome. I love it. And we were just there last week. And it's such a great culture. Every time we go there, there's such a good vibe. And everybody's always such a good mood. It's just a vibe from that place and energy. And the graduates, they're so dedicated to this.
00:03:39
Speaker
medicine to this like this craft that's so important and it's like and just both of like what you both just said like getting down to the root cause and not being reactive. I'm not treating symptoms but really getting to that root cause and we love it which brings us to this this what we're going to be talking today and that's mental health. And maybe just Monique tell us like what why you wanted to get or set up this study in the first place and why you feel it's so important today's day and age.
00:04:09
Speaker
Sure, yeah, so my interest in this topic goes back to sort of the beginning of my clinical practice when I graduated. I've always been interested in mental health, so my practice started off mainly based on supporting people with mood and anxiety disorders.
00:04:24
Speaker
And one of the first things that I did with people typically is improved diet quality. I love food. I love working with, helping people include more healthy food in their diet. So as, and I really saw in clinical practice that as people improve the quality of what they were eating, their mental health symptoms improved.
00:04:41
Speaker
And when I looked like 12 years ago, when I started practice, when I looked at the scientific evidence, there was so little on this topic. It was very like this field was really in its very much in its infancy. There was so little that was done. And I this really motivated me. So my research was really aimed at addressing this gap, this, you know, enormous gap in the literature about the relationship between food and mental health. I can tell you like about a case. Why do you think why do you think there was why do you think there was so little?
00:05:10
Speaker
Like why do you believe that is? Oh gosh. I don't know. I think historically psychiatry has been a very separate domain from the rest of
Integrating Nutrition and Psychiatry
00:05:21
Speaker
medicine. It's been thought of in a silo. I think there's some movement away from that now and there's definitely some psychiatrists who are looking at
00:05:30
Speaker
more looking at mental health through a lens that involves the body and the mind and nutrition certainly falls into that category. The health and physiology and functioning of every aspect of our body impacts our mental health.
00:05:45
Speaker
You hear so much more of like that gut brain access and like your gut being your second brain and you can just feel it, right? Like if you don't eat well or you go like, you just feel crappy and your mood is crappy too, right? So it's, you would, it just, I'm kind of stunned that they're like, there really wasn't much there before, before.
00:06:06
Speaker
Yeah, I think you're totally right. People intuitively get that when they feel well, they feel a difference. And I think also the public has caught on to this term hangry. I don't know. Have you heard that term? Oh, yeah. So I'll talk about the piece that I had. My wife gets that honor. You're a little cranky and then all of a sudden you get some food and you just feel better.
00:06:29
Speaker
better. Yeah, you know, the public kind of gets that concept. So I'll tell you about a case that I had. This was back in 2017. There was a 15 year old girl who came to see me in private practice.
00:06:39
Speaker
And she had severe anxiety symptoms. And when I asked her about what she was eating, she was eating like white bread and pasta and rice and toast and gummy bears and fruit, just simple carbs. And she's also getting these episodes of hypoglycemia, so low blood sugar. And then she would just eat the simple sugars again and feel better. But this was constantly happening. So I asked her.
00:07:04
Speaker
So I asked her to add some protein and some fiber to her diet. And sure enough, her anxiety symptoms improved and her hypoglycemia episodes subsided. And when I looked at the literature, there was nothing that was published on this. So I wrote a case report and published that case. And it also really helped to inspire some of the work that I'm doing now. So you were like breaking new ground with that. That's amazing.
00:07:30
Speaker
Yeah, well, you know, it's not really that novel, but it was that the scientific literature wasn't really paying attention to it. So getting it out there and published was something that was really important and my other research has then built on it.
00:07:45
Speaker
That's cool. So it's a, it's important, right? It takes the first person to really take a look at that and say, wow, there's like a direct link here and no one's talking about it. And let's, we need to share this with people. We need to document this because there are a lot of cynics, right? When it comes to this, it's like, whereas we were talking about just before we jumped on the show, it's like, well, where's the literature? Where, where, where's the proof? Like you need to show me this.
00:08:09
Speaker
without a shred of a doubt that this will have a significant amount of impact. And so you need to put this in the literature for people to, I mean, it's irrefutable proof, right? Like it's there, it's documented and you can see it. So was that what really got the wheels turning for your study? It was one piece, but there are also others. Kieran, I'll let you jump in too.
00:08:35
Speaker
So Kieran has some background noises, so he's going to be jumping in and out as he hits mute and unmute because they're doing, of course, of all days, they're doing some yard work today where he is. I think I'm good now. Brilliant. So one of my very first studies actually was in a workplace setting. It was on people with chronic pain.
00:08:56
Speaker
It involved a multi-component naturopathic intervention that also included a focus on dietary education and advice. And as we were going through this study and treating the participants in it, it was very clear how pervasive stress and mental health needs were, how it affected their chronic pain. And it also just highlighted some of those complex factors around diet and mental health that have made this maybe a challenging area to study before.
00:09:25
Speaker
So, people have a complex relationship with food. Studying diet can be difficult to isolate the effects of either one constituent or a whole diet as well. We also recognize that trying to affect change in this population was also stressful to people. So, getting people to change their diet can be really challenging.
00:09:49
Speaker
It also came through very clearly that stress and mental health were contributing to most of the other health concerns and quality of life and the people of the people in the study. So when their mental health was worse, their pain was worse. And that was also a bit of a struggle. They turned to maybe less positive approaches to handling it. And yeah, it was very clear that we needed to both study this, but also pay a little bit more attention to it.
00:10:16
Speaker
Sometimes that relationship with food might be cause and effect as well. We weren't quite sure what was going on, whether it was because people were eating poorly, that they were having these problems or vice versa. It was just noticeable how challenging it was for people to make sustainable, healthy food choices and habits. Breaking that mold was difficult for the people in our study.
00:10:40
Speaker
So during it, I really gained an appreciation for the power of food as medicine. And I was really grateful for my training as an MD because this whole practice delivery of a multi-component intervention really, that is our niche of bringing together multiple aspects in a holistic care for patients.
00:11:01
Speaker
And yeah, as you said, because we look for that root cause and use therapies that support healing to treat health and health concerns and prevent disease, we just wanted to study it a little bit more. And yeah, we just recognize that in most cases, food is the fuel that feeds us and it's a crucial component to all
Cultural and Lifestyle Impacts on Mental Health
00:11:25
Speaker
those aspects. That's right. Food be that medicine, right? That's right.
00:11:29
Speaker
But what, so how do you determine that? Like if it's a, if it's an eating disorder or if it's vice versa, like if the, if, how do you determine that relationship with the food? Like if it's the anxiety that's causing the eating disorder or if it's the eating disorder that's causing the anxiety, is that just through interview? Like we're just talking to the patient and getting them to know them and understanding their lifestyle. Manik, you want to jump in?
00:11:52
Speaker
Well, when we look at the research, we know that it's what's called a bi-directional relationship, that both mental health impacts food choices and food choices impact mental health. And that's one of the reasons it makes it so hard to study this relationship. So when we look at what are called cross-sectional studies that are, these are studies that happen at one time point and they look at how are people eating? Do they experience mental illness or not? We see this huge relationship very consistently. People with mental illness are eating worse.
00:12:21
Speaker
but those kinds of studies don't help us to understand which came first. So thankfully there are studies that can help us to answer this question, which are called prospective or cohort studies. These are ones where they recruit healthy people and measure their diet. And then they follow them over a period of time. So there was one really big one. I think it was 15,000 people that were recruited didn't have depression. And then they measure their diet and assess their diet quality. And then they followed them for a 10 year period.
00:12:50
Speaker
And in that 10 year period, there were a thousand cases of depression that were reported. And when they looked at what was the relationship between people's baseline diet and their likelihood of depression, the people eating the highest quality diet had a significantly lower risk of developing depression. So that helps us to know that yes, mental illness can impact what people are eating, but also what people are eating can impact the risk of developing mental illness. So we know that that relationship does go both ways.
00:13:19
Speaker
So are they looking at like, like things that had occurrences in their life that may have caused them to eat poorly or is I like stresses in their life or like, I'm just wondering, like, like, you know, I'm thinking Calvin, I'm going to use you as an example. Okay. So Calvin's on this crazy health kick and doing really good.
00:13:38
Speaker
And all of a sudden he blew his Neo. And when he blew his Neo, all of a sudden his diet kind of took a downturn. A big time downturn. I went from going to the gym at lunch to going to McDonald's, you know? Yeah, because he had this high endorphin kick from going to the gym and kind of feeling great and then, you know, eating salads and bringing his lunch to like going to Subway, going to McDonald's, maybe hitting the Toucan Dine at Burger King. You know, it's like it was and I saw it and it's like, you know, Calvin's got, you know, I'm not going to say you
00:14:05
Speaker
or mental health, but like that, are you looking at those types of life outside factors or is it just direct correlation diet, mental health?
00:14:16
Speaker
often research is looking at sort of a relationship between two variables, such as what people are eating and whether or not they develop a mental health condition. But I think there is a big movement within research to look at things like social determinants of health and look more broadly at people's lives and why they make the choices that they do. But I think we're still probably a long way to go there. Cause like, like today, like I was in a weird, just happened to be when Calvin and I were in up in Toronto a few weeks ago,
00:14:44
Speaker
It was a big article in the Toronto Star and it was like, mental health is up 60%. It was anxiety specifically. Anxiety. Anxiety depression up 60% since 2012. And then I was like, wow. 20, 2020. Since 2020? No, it could be. Anyway, and then since then you look at it and it's 20% year over year since the pandemic started.
00:15:08
Speaker
And I look at that and you're talking about like, you know, diet and, and, uh, but I'm looking at that. I'm like, it has to correlate with like sedentary behavior. You know, like when everybody was kind of locked down, start binging shows, start eating poor foods, maybe just, what's this new trend kids have, Calvin? It's called bed rotting. Like that, like bed rotting now. Yeah. It's like a new thing. Like they just.
00:15:28
Speaker
spend an entire weekend in bed just binge eating and watching shows and stuff like that. I'm like, that can't be good. And that's, that has to tie into like how, how you're eating and, and, and what you're doing, because when I'm exercising and I'm feeling good, I'm getting out, going for hikes, spending, you know, spending some time outside with the, you just want to eat better your body because it's what it's craving. But if you're just doing nothing and you're lounge around, you're kind of feeling crappy and icky, you're going to eat some of those more processed foods. Um, so I'm just wondering like,
00:15:57
Speaker
I guess where I'm going with that is your, your perspective on it is like, is, is anxiety and depression getting worse and over time and progressing like this because of the lifestyle choices people are making or because of how, you know, society.
00:16:12
Speaker
is now
Food as Medicine and Study Highlights
00:16:13
Speaker
like versus the way it was, you know, like where it's really set up to be sedentary. Like you, you know, you go, you go, you drive throughs basically everywhere. You drive, drive through bed. You don't have to do anything. You can do store dash, everything, right? Like convenience. You can do all your shopping online. You can do like, if I want to do nothing and have everybody do it for me, I can. And then the foods that you're choosing when you're doing that, it's like, they're not, they're not exactly great, you know, and there's a lot of,
00:16:40
Speaker
hydrogenated oils, food preservatives, sugars, collars, dyes, and all these foods. And I'm sure that all has a direct impact on how your body processes it and your overall mental health.
00:16:53
Speaker
Yeah, absolutely. Like we know that the determinants of mental health are really complex. And I think you touched on quite a few of them there, things like sedentary behavior versus being active. We know that that has an impact on mental health, the food quality that people are eating. That's certainly my area of passion. So that's the area that I know the most about. But I think also other things, things like social media and the news and sort of what's going on in the world are also other factors that are probably impacting some of that change that we're seeing even more quickly.
00:17:23
Speaker
and things that have changed in the past few years. And yeah, when you're absolutely nailed it, when you're not feeling well, when your health is compromised, you are looking for things that make you feel good, that might be convenient. And often that can be people reaching out for either the ultra-processed foods or maybe the less helpful choices. They kind of distance themselves from the time spent appreciating food that can be really important as well.
00:17:48
Speaker
And when you were talking and also remind me, do you remember the movie Super Size Me many years ago? I think that cultural phenomena has also lifted people's appreciation of how important diet might be for people, but also starting to make that connection around unhealthy food choices that might
00:18:08
Speaker
tend to solve your problems or make you feel better in the short term, but in the long run, it really is setting you up for greater challenges in that mental health space. You can get into a rut very quickly. Tell me about the study. What were the parameters for this really important study that you put together?
00:18:29
Speaker
Right, yeah. So when we looked at the research about nutrition and mental health, we see that there's quite a lot that's been done on depression. There have been lots of observational studies and there have been four experimental studies. So that's where they used diet as a treatment approach for depression. So they recruited people with depressive disorders, randomized them to either a control arm or to receive a dietary intervention.
00:18:56
Speaker
And the people receiving the dietary intervention in all of the studies, there was an improvement in their depression symptoms. So that was really exciting. But nobody has asked this question and involved people with anxiety disorder. So our study was really the first in that respect to explore this area involving people with anxiety. So our study was a randomized weightless controlled study, which means that we randomly assigned people to either do the intervention right away
00:19:20
Speaker
or to wait 12 weeks. And we use that 12-week wait list as a comparison so that we can compare people's change during the intervention to something. And we provided dietary counseling plus omega-3 supplementation. We used the aqua-omega high EPA capsules. And we recruited people, 50 women with generalized anxiety disorder. So they did seven sessions over 12 weeks of dietary counseling plus taking the omega-3 supplement.
00:19:49
Speaker
And because it was the first of its kind, it was a pilot study. So we were primarily concerned with feasibility and acceptability. So could we do this study? Could we recruit people who met these criteria? Would they be willing to participate in the intervention? Would they come? Would they take the supplement? Would they fill out the questionnaires? And they did. That was the answer. But then our secondary objectives were to look at things like, did they change their diet? Was there an improvement in diet quality? Was there a change in anxiety, symptom severity? Did people feel better?
00:20:17
Speaker
Also looking at quality of life, mindful eating behaviors, self-efficacy where people feel like more empowered, and then also some blood work. So we looked at was there a change in their omega-3 status and some other blood tests related to things like blood sugar regulation and inflammation and cholesterol.
00:20:35
Speaker
And just one other really novel point just to expand on what Monique said is we chose to do this study in women. So this has typically been an understudied group in research. They've often left out of research historically speaking. We also know that women tend to experience how more common
00:20:54
Speaker
complex relationship around food, both as provider for their household, maybe they're doing their shopping. There is a higher incidence of emotional eating and eating disorders in that population. And so we chose them as that population of interest because we think there is a real need to focus on that group and learn from them as co-contributors to our research on that feasibility study point.
00:21:18
Speaker
And then we were also really fortunate that we brought together a really interprofessional team in the design of the study. So it involved psychiatrists. We think there are a lot of different healthcare backgrounds that can play an important role in shifting someone's diet, referring people to receive dietary counseling to address their mental health needs. And so our study does showcase that naturopathic doctors can be one group of people, one group of providers who can be
00:21:48
Speaker
was really novel in that perspective. So there was therapy involved as well? So they were getting dietary counseling, supplementation. No, they were able to continue to receive any care that they were already receiving. Okay. So whether it was medication, whether they had received counseling, we asked them to
00:22:06
Speaker
be stable on that regimen as they were introduced in the study. But because we were casting a broad net and trying to learn how people were putting together these packages of care and working with them to expand on what they were already receiving, I thought that was part of a conscious choice in the design of the study as well. I think that's great, right? Because if something's working, you don't want to stop at cold turkey. And it's kind of like this is like additional care that you're receiving to what you're already doing.
00:22:34
Speaker
And then that's what you want to measure and see how much of an impact that has, because if you take everything else away, then it could really skew the results of what you're, you're hoping to achieve. It was interesting when you, when you talk, were you talking about the women, because I was hoping you were going to go there because I was wondering, you know, my mind and I'm sure the listeners was like, why, why women are there, are there more hormonal
Understanding Anxiety in Research
00:22:54
Speaker
issues? There's more hormonal, like a bigger change that happens when you affect the diet overall versus, versus men. Right. Um, so I thought that was really,
00:23:03
Speaker
really interesting that you've done that. So what was the biggest challenge getting the study off the ground? Was it, is it the approvals for the study themselves or was it recruitment, finding people that were willing to participate in the study?
00:23:17
Speaker
Yeah, recruitment is always a challenge when you're doing clinical research. We had to be a little bit creative and some of the ways of getting the word out there that we thought we were going to be effective weren't as effective. And we had to sort of think on our feet and come up with some different strategies. So we used a variety of ways, including like media and social media to try and get the word out there to potential interested participants. But we were able to recruit enough people to take part
00:23:46
Speaker
You mentioned the criteria that was involved in how some of these people had severe anxiety. Could you maybe explain what does severe anxiety look like for any of our listeners who don't know?
00:23:57
Speaker
So anxiety, sort of broadly speaking about the word anxiety, it means this nervousness or fear or worry. And that's part of normal life. You know, if you're walking down a dark alley at night and you hear some scary sounds and your heart beats faster and you feel worried, that's a normal experience. But in contrast, anxiety disorders, the symptoms are stronger. They're more persistent, so they're there a lot more of the time. And they impact people's life. So they impact people's ability to either work or study or
00:24:27
Speaker
carry on normal relationships and socialize or go about their daily life. So when it meets those criteria of interfering with someone's functioning, that's when we're talking about an anxiety disorder.
00:24:37
Speaker
Okay, so that's the line. Interesting. Yeah. And then in terms of the criteria for our study, we recruited people who met criteria for moderate to severe anxiety. So we gave them all a standardized questionnaire. And based on their score, we could see what category they fell into. And we wanted to recruit people who had moderate to severe because we wanted to see room for an improvement.
00:25:01
Speaker
This is a challenge in research. When people don't have high enough levels of a symptom, it can be hard to see a reduction because the symptoms were low at the beginning. And this is, you know, some of the studies that have been done so far in this field about nutritional psychiatry were done in populations that were not people with clinical anxiety disorders. So somebody, you know, did a study on people with heart disease and gave them a dietary intervention or an omega three supplement, and then
00:25:28
Speaker
they measured a bunch of things related to heart disease, but they also threw in some anxiety questionnaire. And sometimes they didn't see a significant difference. They didn't see a decrease in the anxiety questionnaire, but sometimes those levels were so low to start with that there wasn't room to see a difference. So that's a challenge when we're looking at the literature is that a lot of the dietary interventions for anxiety and a lot of the omega-3 supplements for anxiety studies were just done in different populations.
00:25:57
Speaker
Nice to know, nice to know type of thing, right? It's like, oh, well, maybe we'll ask this as well. But if you're not targeting the right population, it doesn't. What's someone that like, I don't have any anxiety. Like, and so if you if you ask me, it's like, do you feel more?
00:26:11
Speaker
I guess. I don't know. Maybe, right? Yeah, if we measured your anxiety and then gave you an intervention and remeasured your anxiety, it might not have changed, but it's because it wasn't elevated to start with. And that's a challenge when we're looking at the research is sometimes this gets interpreted as, oh, you know, dietary intervention doesn't help with anxiety, but it wasn't the right patient population to start with. And that's why we need to be really critical when we're reading studies and think about
00:26:36
Speaker
how might the people who were recruited for that study, how might that have impacted the outcome that we saw? So what type of diet were you, what type of diet did you focus on when you're doing your dietary counseling? Yeah, so it was mostly related to the Mediterranean diet, which involves, you know, fish and seafood, vegetables, fruits, olive oil, nuts and seeds, legumes, lentils, beans, chickpeas.
00:27:02
Speaker
not a lot of red meat, not a lot of sugar or sweetened beverages, really a focus on whole foods and limiting processed foods. Is that ideally to help try to balance blood sugars? Like it's designed to try to maintain a stable blood sugar? That's one. Yeah. The Mediterranean diet is higher in fiber, which helps avoid inflammatory foods. Right.
00:27:28
Speaker
Yeah, there's a lot of mechanisms. So blood sugar regulation improves microbiome when we have more fiber that helps to feed those good bacteria. And like you mentioned, gut-brain connection, efficient seafood helps to, and then the omega-3 supplement as well helps to correct omega-3 deficiencies, which might contribute to inflammation. And there's this really emerging body of evidence about how inflammation and mental health are related. That's where I was going to say, like how much, how much of that is a direct correlation to, like,
00:27:57
Speaker
Cause you look at the, like we look at the standard, standard North American diet and like the completely disproportionate balance of omega six to omega three and inflammatory omega six to omega three. Um, and, and this direct correlation to chronic illness and disease and inflammation where almost every one of these chronic illnesses and disease can be tied back to inflammation over time, not immediately, but how much of that pulls
Dietary Impact on Inflammation and Mental Health
00:28:22
Speaker
into this? Like if you have this, this chronic inflammation for a certain amount of time,
00:28:26
Speaker
I mean, I can speak just from personal experience. If I, you know, go out and, and have a guy's weekend, we go, you know, maybe a little bit of a vendor, maybe we didn't need some really good food. I can assure you when I wake up, like on, like, even if it's not the Sunday, you go through Sunday, Monday rolls around or Tuesday, whatever it is. I'm cranky. Like I do not feel awesome. Like, you know, and it's cause it's a combination of things where I haven't slept well.
00:28:54
Speaker
Right. And, and, and I can feel the inflammation that's like in my body at that point. And I'm wondering like, and if that's, and I do whatever I have to, to correct that inflammation kind of like right away going into that. Cause I have enough self-awareness to know like, this is not how I normally feel. But I wonder how many people kind of get stuck in that chronic state where this is like the normal, right? It's like, it's like someone that's drink, drank soda their whole life. And then they have to quit drinking soda. And then it's like.
00:29:22
Speaker
they go through those withdrawals, it's really difficult to stop. And if you stop for long enough and you go back to drink it, it tastes bad to you. It's like, wow, I can't believe I used to crave that so much all the time. So I wonder, the inflammation where I was going with that, how much directly does this tie in and how many people are going around with a ton of inflammation that have no idea that they're dealing with that right now? That's a good question. I don't know that we have the right answer to this. This is something that gets regulated.
00:29:52
Speaker
practices. I think naturopathic doctors might be one health care provider that spends a little bit more time paying attention to it, but I don't think we know exactly how broad these strong inflammatory conditions or underlying inflammatory states can be there in both the mental health population but other populations as well.
00:30:14
Speaker
I want to just also touch on something else that you said, Max, one of the really great components of this study involved a lot of goal setting.
00:30:23
Speaker
and mindful approaches. So being patient with yourself, recognizing the importance of food choices and setting an approachable goal for yourself. And whether that was, you know, a new type of food that you were going to try and pace yourself over, over the duration of the study. We worked with participants to, to self set these goals and help keep people accountable to them. Because we do know that you have a social life. Sometimes you have these, these
00:30:52
Speaker
from that consistent, sustained, healthy dietary habit that might be there. And coming back to it and being patient with yourself is also really important for people. They can't beat themselves up when they've strayed from that, but also you want to reassess that goal and set something that's going to help you make headway at a reasonable pace for yourself.
00:31:19
Speaker
So it's like an 80 20 type of goal where it's like, it's okay. Like as long as you're good 80% of the time, like it's okay to be bad every once in a while. Just kind of, it's got to be a mental health component to that too. Right. It's like, it's like, okay. Cause if you're so strict all the time, it's, it's, it can wear on you. Right. Yeah. I would say that there wasn't even really a number. It was, there was a big focus in the recommendations that we created on what we wanted people to include more often.
00:31:45
Speaker
So we didn't actually have any restrictive goals or recommendations that we made. It was always including more. So we were talking about including more vegetables, including more legumes, more whole grains. I like that. I like that a lot, actually. I think it's a cool approach. Nobody likes to be restricted. I can add it on, but it's like, don't take this away from me. And they know they should restrict themselves. But when it's their own decision, I feel like you have someone who's going to listen more.
00:32:13
Speaker
It's a, it naturally shifts. Like if you're focusing on including half your plate vegetables, there's just less room for other stuff. So we focus all of the recommendations were positive recommendations of what we wanted people to focus on. And, um, and I think that people receive that really well. Yeah. Yeah. I mean, I wouldn't see why you wouldn't. It's such an easy thing to do. Um, what about alcohol? Was alcohol kind of like a no-no or were they allowed to have the occasional glass of wine?
00:32:42
Speaker
We didn't make recommendations about alcohol, and that's mostly because we thought it could potentially add an extra variable into the mix. Changes in alcohol can directly impact mental health, and we wanted as much as possible to think about what is the impact of diet quality. So we wanted them as much as possible to keep their exercise the same, their medication the same, their alcohol the same, because we really wanted to focus on
00:33:05
Speaker
If we change their nutrition quality, what is the impact of that and try as much as possible to minimize other variables? Were they still recording what they were having as far as alcohol consumption or no? We didn't follow their alcohol consumption, but we did look at things like exercise. We included an exercise questionnaire at the beginning and at the end.
00:33:29
Speaker
And we look to see, did people change their exercise? Thankfully, they didn't because I would have made it more complicated to interpret. But by checking that, we can be somewhat confident that the changes, if we see changes, it's going to be related to the nutrition and not related to other things like exercise. That's cool. So when you did the initial screening to bring everybody in, was there anything surprising?
00:33:58
Speaker
Were like when it came to their diet or their blood work that kind of screamed out at you like all this these are inflammatory Markers that are causing this anxiety or depression
00:34:10
Speaker
Yeah, I would say a couple things to note. Monique, you can jump in and just a little bit. We did notice that sort of that imbalance in Omega 3 to Omega 6 ratio was really, really poor, I would say, at the baseline for most of our participants. There were some other aspects around vitamin D status as well that I think was relatively low. That's big in Canada, right? Yeah. I mean, like... Yeah. So those were two things that I would say that jumped out from my perspective. Monique, anything to add?
00:34:39
Speaker
No, just to underscore what you said, there were 72 people that we did the Omega 3 screening on. Just to back up, one of our criteria was that they had less than 5% Omega 3 in their blood at baseline. Because again, we wanted to recruit people who had sub-optimal Omega 3 status at the beginning, so that there was room for improvement.
00:35:00
Speaker
If you give an omega-3 supplement to people who already have a great omega-3 status, you're probably not... Nothing's going to change. Yeah. So we wanted to recruit people who are at less than five. So we screened people as part of our eligibility process, and up 72 people that we screened, 70 came back as less than five. And the two that were over five were just over it by a tiny, tiny fraction. Do you remember the average scores? Do you remember the average score?
00:35:27
Speaker
Was it two or less? Maybe like three, 3.5 maybe. I don't know if I calculated that. We've done some of that. Most of the time what we see is like two or less. It's very, very low. Yeah. What percent should people aim to be at so that way they're in good health?
00:35:46
Speaker
Well, so over five is considered better. So under five, not great. Over five is eight to 12, eight to 12 is ideal. That's like your ideal. Yeah. The eight to 12 is like the ideal over five is good. Eight to 12 is the ideal range is like that. That ties into that Harris force study that Dr. Will Harris had done. And that was like that. They took, I think it was like 42 or 44,000 people and they split it up into quint like five different groups. And like they, they follow them.
Future of Nutrition in Mental Health Care
00:36:13
Speaker
And, uh, the group that had the highest percentage versus low lowest, this was, it was close to like 30% reduction of all cause mortality was crazy. Like it was, yeah. And that was just over six. Right. That was the, that's why they get the number of over. And I think there's, there's some data about how that impacts cardiovascular disease risk, but nobody has looked at it for, uh, mood and anxiety disorders. I think that's very important. Right. Cause what is your, your brain hates inflammation. Your brain loves.
00:36:39
Speaker
steady blood flow, lots of oxygen, and steady blood sugars. It seems so obvious. I'm so happy you guys did this work. If I look at something, anytime we do something, what's the big hairy goal? What are you hoping will be the impact of this research? What's the big, your ambitious goal and then maybe your maybe a little more realistic conservative goal?
00:37:06
Speaker
when you release this data? I was going to say, I'll start with the more realistic goal. So this was a small study on feasibility, and we're researchers, so we want to scale this up, right? So we're thinking about larger studies in different populations, maybe expanding across Canada or to US or different groups. We noticed some broad inclusion criteria. There were some people that had some
00:37:30
Speaker
their income security or their food security was relatively low and then we also had people in the study who had relatively high food stability as well and access to food was an important part of it as well. So that's the short-term goal is to
00:37:49
Speaker
form for us. And collecting feedback from participants around what worked well, how we can improve our resources, the design of the study was really valuable for us as that learning curve. And we'll set up future research by us or by others in a really important way. And yeah, we also think it will help health care providers to start to understand this issue in an important way as well.
00:38:15
Speaker
But I think Monique can speak a little bit more about the broader impact. We want the conversation around food and mental health to be front and center, right? So when you talk to a counselor, a psychiatrist, a social worker, a nurse, a dietitian, or a naturopathic doctor,
00:38:31
Speaker
food is something that comes up, at least at the check-in point. Whether they can deliver the care or refer to someone else to receive some of that support is maybe a next step, but we do want it to be part of the conversation.
00:38:47
Speaker
Yeah, absolutely. So that's, yeah, Kieran gave you the short term and really the big one there. And like the currently diet and nutrition are really not coming up in the context of mental health care. And that's a problem. It's just not being discussed. It's not on people's radars. You know, if you had a heart attack and you went to see a healthcare provider, somebody's going to ask you what, you know, at least one question about why you eat it. You know, it might not be great. It might not be in-depth dietary counseling that you're getting, but it's going to come up.
00:39:13
Speaker
And really the goal here of this work is that nutrition is going to come up in that conversation about mental health. And so part of our research is about, you know, how do we learn more about what's the impact of food and nutrition on mental health? But then part of our work is also how do we get people talking about it and using this information that we already know. So within CCNM, we have an adjunct researcher named Dr. Laura LaShawn. She's a psychiatrist and we've done some work in this area.
00:39:41
Speaker
We put together a clinical tool, like a handout, that's meant to be used by mental health care providers to start a conversation about diet and nutrition within the context of mental health care because we want to see these conversations happening. And the most recent Australian guidelines for mental health, this is really exciting, we came out in 2020 and they actually recommend lifestyle as the first step of treatment. So they recommend talking to people about exercise and sleep and diet and avoiding excessive substances.
00:40:11
Speaker
That's their first step before going on to things like medication or psychotherapy. And our Canadian guidelines aren't there yet. You know what? China is doing something similar to that. Wow. It should be on the intake form. You know what's crazy about what China was reading up on this is like they're there because they have an aging population.
00:40:28
Speaker
And they're seeing a tremendous amount of pressure on their overall healthcare system. So they're revamping their entire kind of like educational system when it comes to diet, nutrition, mental health, everything that will tie in directly to health. And there's this entire reform that's happening from like now until like 2035, where the whole idea is preventative healthcare and preventative measures to help people kind of be healthier and feel better, which is really cool. But I like where you're going with that. I mean, I love it because I think
00:40:59
Speaker
Like you said, someone comes in for either like, maybe they have hormonal issues or weight loss, like, you know, weight issues, heart health issues. They're going to talk briefly about diet, but when someone comes in for mental health issues, anxiety or depression, even if it's kids' behavioral type issues, right? No one's asking what
00:41:20
Speaker
what they're eating. And it's so important, right? This is the fuel that's the, this is what's fueling your body. And if you're fueling your body with junk on a daily basis, of course you're going to get a junk result. That's, it just seems so obvious, but this work is so important to help because you need, there's so many cynics that are out there that are, or, or people that won't believe you have to give them this evidence to say, like, here's the proof it's in the pudding. Like take a look, read, read the research.
00:41:48
Speaker
look at the impact that we've had, that we measured by simply changing people's diet and helping supplement omega-3s, this is really powerful stuff. I can feel your passion through it. I think it's so exciting. I really hope that through this, people start to see and realize the importance of diet, because I think too often it's neglected, right? And then we start to treat symptoms instead of root causes
00:42:17
Speaker
And that's just a band-aid. You're never going to fix the actual problem if that's how you keep treating things. So for all our listeners who have been following along with this episode and they're interested in following along with the study, where can they go? Did they reach out to you or which websites can they reach out to to get updates on this study? So currently, we're in the final stages of data analysis and preparing the manuscript for publication.
00:42:45
Speaker
Once that's published, do you guys have show notes that we could send you a link for them? We'll put it right in the description. Yeah. Yeah. We'll definitely share that with you once those results are ready.
00:42:56
Speaker
Okay, brilliant. That's fantastic. I'd like to thank all our listeners for making it this far. I'd like to thank both Kieran and Monique Doctors of Naturopathic Medicine for being on this episode and talking to us about anxiety and diet and omega-3s and how it all kind of connects together. It's been really fascinating and I think a lot of us have learned so much.
00:43:18
Speaker
So if you made it this far as well and you liked this episode, be sure to like the episode and share it with your friends and give us a five star rating. I want to thank you guys again for being on the show. It was so wonderful. Thank you very much. We'll have to get you on in the next season. We'd love to be back.