The USA want screening for diabetes and pre-diabetes to start at age 35

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Adapted from JAMA Editorial August 24/31 2021 by Edward W Gregg and Tannaz Moin

The point for screening for diabetes is that early treatment will prevent complications.

In this article, the US Preventative Services Task Force (USPSTF) discusses its Recommendation Statement and its Evidence Review on screening for pre-diabetes and type two diabetes. They now recommend that adults aged 35 – 70 who are overweight or obese should now be screened and that those with pre-diabetes are referred for effective prevention interventions. Previously the age to start screening was 40 and they have also suggested that the drug metformin is used as a preventative intervention.

A recent study by Wang et al shows that 14% of the US population have diabetes and that there have been no consistent improvements in glycaemic control and risk factor management for 10 years. There has been also no improvement in diabetes care and outcomes.

The USPSTF actually found that there was little direct evidence that screening improves health outcomes for people diagnosed with diabetes. The rationale from screening relies largely on the 25 year old UK Prospective Diabetes Study Group which showed that glycaemic and blood pressure control in new diabetics reduced micro and macro vascular complications, myocardial infarction, diabetes mortality and all cause mortality. This was without the advantages of new drugs and monitoring techniques to boot.

More than 40% of the adult population will now be eligible for screening and a third of these are expected to be referred to an intervention programme. Young adults have had the biggest relative increase in diabetes prevalence, yet they get proportionately the lowest degree of preventative service and risk factor control and not surprisingly this has resulted in an increase in diabetes related complications.

An estimated 24.3% of young adults aged 18-44 have pre-diabetes. Only 44% of these reported being tested in the previous 3 years and they were less likely to be referred and to take up prevention services. Young adults also have more problem affording food, housing and medication. The new screening recommendations are an opportunity to improve this dire situation. Without effective intervention the burden of future diabetes complications will be immense.

Sorting this problem out calls for new ideas, new science and perhaps new frameworks. Metformin has shown to be cost saving, and most effective for pre-diabetes among younger, more obese patients and those with gestational diabetes but it tends not to be prescribed to these groups. More personalised prevention programmes may help. We must address the barriers to accessing effective risk factor management and this must be done throughout the lifespan of the affected group.

Human Papilloma Vaccination has almost eliminated cervical cancer in women born since Sept 1995

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Adapted from BMJ 13 Nov 2021 and 19 Feb 2022

The HPV vaccination programme was started in England in 2008 on 1st September. According to an observational study vaccination has almost eliminated cervical cancer.

The women who have benefitted are now 26 years old or younger. 13.7 million years of follow up of women aged 20 to 30 showed that vaccinated women had much lower rates of cervical cancer compared to unvaccinated women in previous cohorts.

The reduction ranged from 34% in those who were offered the vaccine aged 16-18, 62% for 14-16 year olds and 87% for 12-13 year olds. There were even greater reductions in grade 3 cervical intraepithelial neoplasia and the trend was similar regarding vaccination age.

The results would suggest that the earlier the age of vaccination, the better.

Although this is great news for younger women, those over the age of 26 are still at risk of cervical cancer. Despite this 30% of women who were eligible for screening did not take this up in 2021.

A survey of 3,000 patients asked “Why?”

Embarrassment was the most common reason for 42%. Difficulty fitting in appointments was the reason for 34% and concerns about it being painful was the reason for 28%.

My comment: In my experience as a GP, all of these reasons have validity. However, losing your life or fertility to cervical cancer is devastating. Most cases are avoidable by regular screening and early treatment of cervical lesions, since we don’t know which ones will go onto cause cancer in any individual. Well woman clinics and family planning clinics are often open in the evenings if Practice Nurse clinics are not suitable. Remember that (almost) every woman has a vagina, including the nurse or doctor who does your smear. She knows what it is like! Muscle tightening can cause pain and to reduce this I would suggest putting a pillow under your bottom and possibly getting 5-10mg of diazepam from your GP. You would then need someone to drive you to and from your appointment.

Sheri Colberg: Key exercises to help you age well

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Adapted from Diabetes In Control Jun5 2021

Exercises can help maintain your physical abilities and independence during the aging process.

Aging successfully needs a lot of work. If you don’t use it, you lose it! Our body system peaks at 25 and declines thereafter. Even if you exercise diligently you will lose aerobic capacity as you age.

Balance also worsens from the age of 40. Bones also thin, particularly for women post menopausally. Muscles get smaller and weaker, reflexes get slower and recovery from workouts takes longer.

Although you can’t do that much about neurological decline but by regular physical training, nutrition, enough sleep, and stress management you can delay or prevent a lot of normal aging and even sometimes reverse damage done from inactivity.

These are my top tips for exercises to reduce aging:

Cardio workouts with faster training intervals. Apart from walking, cycling and swimming add in faster intervals lasting 10 to 60 seconds at a time. You can walk up hills deliberately or do a hill programme on a cardio machine. High intensity interval training can be done up to once a week but start low and build up.

Resistance exercises covering your upper body, core and lower body will help your muscles. Do 8 to 10 exercises covering these groups two to three days a week. You can use your body weight, dumbells, kettlebells, resistance bands. You should be able to get in and out of a chair without using your arms at the very least.

Standing on one leg at a time helps balance. My comment: one of my friends says doing this helped her not feel dizzy when riding on the London Underground.

Stretches for all of your joints helps your joint mobility and cartilage health. Do this two or three days a week. Diabetics are particularly prone to stiffness from glycation. Hold the stretch for up to a minute for each one.

Hopping up and down on one leg helps bone mineral density and so does carrying shopping in both hands. Press ups, against a door or kitchen counter are a good start.

Pelvic floor exercises are good for the prevention of stress incontinence.

If you need to communicate that you are in pain to a health care professional you need to show it in your facial expression

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Adapted from Human Givens Vol1 2013 Journal of Health Psychology 2013.

Facial expression is the best way to communicate to health care professionals if you are in pain and how severe the pain is.

Patient vignettes were assessed by health care professionals. Sometimes they were told that the pain source was due to arthritis or cancer and sometimes that the pain source was unknown.

When asked to assess pain levels from facial expression, what the person said and how they said it, avoidance of movement and posture, and interpersonal contact, doctors, nurses and health care assistants all paid much more attention to the patient’s facial expression than to the other factors, particularly if the pain source was unknown.

My comment: I have come across this situation myself as a patient. Being very factual and stoical doesn’t seem to work!

NICE: all adults and children with type one diabetes to have real time continuous glucose monitors

Abbott’s Freestyle Libre

The fantastic news this spring is that ALL type one adults and children are to be offered real time blood sugar monitors in the NHS.

These machines encourage testing without the finger pricks, tell you the trend of your blood sugars, and make it much more accurate, easier and less painful to adjust your insulin to your blood sugar.

The monitors will also be offered to type two patients who use insulin.

NICE estimates that a quarter of a million type one patients alone will be put on the device. Research suggests that HbA1c levels tend to drop when using the technology without increasing the risk of hypoglycaemia.

My comment: My son Steven, was an early adopter or this method of blood sugar monitoring. I paid for the device and sensors for the first 18 months because it gave me more peace of mind, especially as he was living on his own away from home. It seemed crazy to me that he was excluded from NHS funding by virtue of having very tight blood sugar control mainly from his own efforts. Although it is a charge on the NHS for the sensors, the benefit is that there should be less hospitalisation from hypos and fewer complications later on.

Currently the NHS spends ten billion pounds a year on diabetes, which is ten percent of the total budget.

For those type ones or type twos on insulin who do not yet have this device they are asked by NICE to approach their diabetes teams.

Changing daily habits can have a calculated effect on your life expectancy

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Adapted from BMJ 22 Dec 2012

Cambridge University professor of biostatistics, David Spieghalter, has produced an easy to understand tool that can help you quantify your daily habits in terms of added or reduced life expectancy.

If you have got to 35 years of age, you could reasonably expect to live till age 80 if you are a man and age 83 if you are a woman.

For men this is how to live a shorter life:

Smoke 15-24 cigarettes a day cut 7.7 years For women cut 7.3

have one drink of alcohol a day ADD 1.1 years For women ADD 0.9 years

have another one up till six more CUT 0.7 years per drink For women CUT 0.6 years

For every 5 units above a BMI of 25 cut 2.5 years For women cut 2.4 years

for every 5kg above your optimal weight cut 0.8 years For women cut 0.9 years

Spend two hours watching the television cut 0.7 years For women cut 0.8 years

For every red or processed meat portion you eat, equivalent to a burger 3 oz cut 1.2 years Same for women

Now for the good news:

If you eat 5 or more fruit or vegetable portions a day men add 4.3 years For women add 3.8 years

If you drink 2-3 cups of coffee a day add 1.1 years. For women add 0.9 years.

For the first 20 minutes of exercise add 2.2 years. For women add 0.81 years.

For the next 40 minutes add 0.7 years. For women add 0.5 years.

Take a statin add 1 year for men. For women add 0.8 years.

If you live in a relatively unpolluted area, less than London for example, add 0.6 years for both genders.

How does this work out for you?

Your glass of wine may have more sugar in it than you think

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Adapted from BMJ 19 Feb 2022

The Alcohol Health Alliance UK has called for better labelling on alcoholic drinks after an analysis found that wine from the ten leading brands contained as much as 59g of free sugars per bottle.

None of the bottles had the sugar content on the label.

Government guidelines recommend no more than 30g of free sugars a day for an adult (My comment: they conveniently forget about starch though!) This is equivalent to 6 teaspoons of sugar and it can be contained in just two medium glasses of wine.

In February at the Low Carb USA conference in La Boca, Florida, Gemma Kochis, who is a qualified Sommelier, who works at Keto-Mojo, presented information for those on a ketogenic diet who would still like to drink wine.

She says that for the most part, wines with the highest alcohol content will tend to have the highest sugar content. If you want to drink wine and stay in ketosis, you will need to test your blood ketones about 2 hours after trying a new wine.

In general she recommends wines that grown in cooler climates, mainly old world compared to new world. She thinks that you have to stick below 12.5% alcohol wines and that even then you may have to go lower.

Red wines that can be fruity and have a low alcohol content include Beaujolais and Gamay.

Reisling, Vinho Verde and Muscadet are good white wine choices and Champagne Brut is a good sparkling wine choice.

Type 2 diabetes produces more severe complications than type 1

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Adapted from BMJ 11 March 2017

In an observational study reported in JAMA 1,746 type one patients were compared with 272 type two patients. All had developed their diabetes before the age of 20. My comment: It is not clear whether the duration of diabetes was adjusted for, as the onset of type one diabetes tends to cluster around puberty, although it can occur as early as soon after birth, and the onset of type two diabetes tends to arise in later teenage years. Thus if average 30 year olds were compared head to head in the study, for instance, one would expect the type 1 patients to have more complications purely based on having had the condition much longer on average than the type 2s.

Nevertheless, the prevalence of diabetic kidney disease, retinopathy and peripheral neuropathy was significantly greater in the type two group compared to the type one group, even after they adjusted for differences in glycated haemoglobin, body mass index, waist to height ratio, and mean arterial blood pressure.

This study provides information that early age of onset of type 2 diabetes is a real problem, as once established, it does a lot of damage, that is difficult to control with standard therapies.

New exercise update for type two diabetics

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Adapted from Update on Advice for Physical Activity in Type 2 Diabetes by Marlene Busko 11 Feb 2022

The American College of Sports Medicine has updated advice from The ACSM/ADA joint statement in 2010 for type two diabetics. Their recommendations have been published in full in the February issue of Medicine and Science in Sports and Exercise.

The key information is that everyone with type two diabetes should engage in regular physical activity, reduce sedentary time, and break up sitting with frequent activity breaks. Workouts can be modified if necessary. Anyone who wants to lose weight should consider workouts of moderately high volume 4 or 5 times a week.

Regular aerobic exercise improve glycaemic management. Blood sugar spikes are reduced and you can expect a reduction in A1c between 0.5-0.7%.

High intensity resistance exercise, when performed safely, is better than low to moderate intensity resistance exercise for glucose management and to reduce the amount of insulin you need to take. You can expect to an improvement in strength of 10-15%, improved bone mineral density, lower blood pressure, improved lipid profile, higher skeletal muscle mass and improved insulin sensitivity.

Exercise after meals, such as taking an after dinner walk, at an easy pace, helps stabilise blood sugar levels.

You should reduce sedentary time by taking regular activity breaks. These will result in small improvements in post meal blood sugars particularly in those who have more insulin resistance or who are overweight.

To prevent low blood sugars during or after exercise, people who take insulin, or drugs that promote insulin release, should reduce the amount injected if they can, reduce the medication, or if necessary increase carbohydrate intake.

If you are on beta blockers, you can’t rely on a heart monitor to measure your workout intensity. You can use a perceived exertion scale instead, eg Borg. Be guided as to the required intensity by a certified exercise professional.

Weight loss of more than 5% can improve A1c, lipids, and blood pressure. Visceral fat can be reduced by moderate exercise 4 or 5 days a week.

In young people who have type two diabetes, intensive lifestyle interventions plus metformin were no better than metformin alone for blood sugar control. Their physical activity goals should be the same as non diabetic individuals.

Those who did regular exercise before and after bariatric surgery, got better surgical outcomes.

Chris Kresser: There are many factors you can improve if you are depressed

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The Functional Medicine Approach to Depression: Identifying and Treating the Root Cause

by Chris Kresser, M.S.

Published on November 6, 2020

In 2017, more than 17 million American adults reported experiencing at least one major depressive episode. (1) In 2020, as we deal with the COVID-19 pandemic, racial injustice, and increased stress and uncertainty, those numbers appear to be rising. According to one study, stressors related to the pandemic led to a three-fold increase in the rates of depression across all demographic groups studied. (2) If you’re struggling, you’re not alone. Embracing a root-cause-based Functional Medicine approach to depression may help you get relief, potentially without the use of antidepressants.

Functional Medicine depression
The Functional Medicine approach to depression involves identifying the root cause, like chronic stress or sleep deprivation. iStock/PeopleImages

While antidepressants can be life-saving for some people—and, if you’re currently taking antidepressants, you should not stop doing so without the guidance and support of your doctor—they’re not a good fit for everyone. For some people, they don’t alleviate depressive symptoms, and for others, they cause a new set of disruptive side effects. Other people don’t want to take antidepressants long-term or they can’t afford the financial investment to do so. Whatever your reason, there is a way to address the root cause of your depression directly, without long-term antidepressant usage: Functional Medicine.

The Functional Medicine approach to depression—and in fact, the Functional Medicine approach to any chronic condition—is to identify and address the root cause of the problem. That means treatment is focused on fixing the reason for your depression, whether that’s gut dysbiosis, chronic stress, infection, or another of the 10 possible causes I discuss below. Keep reading for more information on what could be causing your depression and how a Functional Medicine-based approach can help.

The Conventional Treatment for Depression: Antidepressants

Depression takes a heavy toll on physical health, day-to-day functionality, and relationships. It causes symptoms like: (3)

  • Profound feelings of sadness
  • Hopelessness
  • Fatigue
  • Feelings of guilt or worthlessness
  • A loss of interest in activities
  • Changes in sleep and appetite patterns
  • Irritability
  • Difficulty concentrating
  • Moving or talking more slowly than normal
  • Restlessness
  • Unexplained aches, pains, cramps, headaches, and even digestive problems
  • Thoughts of death or suicide

And while some people may experience just one depressive episode in their lives, multiple episodes are common. (4)

Antidepressants are the most common conventional treatment for depression. In fact, between 2011 and 2014, one in eight Americans aged 12 and up reported taking an antidepressant the previous month. (5)

Some research suggests that antidepressants are not as effective as they’re often claimed to be. Initial treatment may be effective at mitigating symptoms only around half the time, and antidepressants may not have any benefit over placebo for mild and moderate depression. (678910) What’s more, these drugs can also cause side effects, like: (11)

  • Anxiety
  • Decreased libido
  • Nausea
  • Weight gain
  • Dry mouth
  • Constipation
  • Dizziness
  • Tiredness and/or insomnia
  • Sweating

I’m not here to say that antidepressants have no place in treating depression. That’s because, for some people, they are effective at alleviating their symptoms without causing worrying side effects. Put simply, they work for them. But unfortunately, that isn’t true for everyone, and even if they do relieve symptoms, antidepressants do nothing to address the underlying cause of depression.

For those of you who haven’t found relief in antidepressants, a Functional Medicine-based psychiatric approach may offer the help you’re looking for. And a key component to that approach? Identifying the root cause of your depression. 

10 Root Causes of Depression

Most of us are familiar with the conventional explanation for depression: the chemical imbalance theory. This theory states that depression is caused by imbalanced neurotransmitters in the brain, and antidepressants are needed to manipulate the levels of those neurotransmitters—which should, in theory, correct the problem.

There’s quite a bit wrong with the chemical imbalance theory—namely, research indicates that only 25 percent of people with depression have low levels of neurotransmitters, and others have high levels of them. (12) It also fails to recognize the link we see between chronic inflammation and depression. This means if you’re not part of that comparatively small group of people experiencing a neurotransmitter imbalance, antidepressants won’t correct the problem. For that, you’ll need to address the real root cause of your depression.

1. Blood Sugar Dysregulation and Obesity

Insulin influences your central nervous system, impacts neuronal circuitry formation, and affects synaptic plasticity—meaning it plays an important role in your mental health. If your blood sugar is dysregulated and you’re experiencing insulin resistance, your brain will feel the effects along with the rest of your body, and anxiety and depression may result. (1314)

Obesity is closely tied with blood sugar dysregulation and depression. This connection is likely multifactorial and complex; but, as obesity is an inflammatory state, and we see evidence that people with obesity have higher levels of inflammatory signaling molecules called cytokines, it’s probable that inflammation plays a critical role in the obesity-depression connection. (1516)

2. Chronic Stress

Chronic stress can also have an inflammatory effect on your body. Your nervous system mediates inflammation and the body’s immune response; if something goes awry, depression, anxiety, and other mood imbalances can result. (171819)

The relationship between your stress levels and your hypothalamus–pituitary–adrenal (HPA) axis is complex. In a healthy relationship, an acutely stressful event should spur your sympathetic nervous system into action, triggering the HPA to release stress hormones to help you respond to the stressor. After that event, your parasympathetic nervous system should take over, decreasing activity in your HPA axis and reducing stress hormone production. (20) However, if you’re experiencing chronic stress, your sympathetic nervous system and HPA axis can remain chronically activated, causing a host of health problems (depression included).

Your HPA axis also acts on your thyroid gland—any stress-related disruption in HPA axis function could lead to problems with your thyroid, which can also cause symptoms of depression.

3. Environmental Factors

Environmental toxins can also impact your mental health. Indoor mold exposure can trigger a complex inflammatory response that leads to several cognitive side effects, including depression. (2122) Mold exposure can trigger the release of inflammatory cytokines and impair neuronal plasticity (which can both lead to symptoms of depression). (232425)

Air pollution is another toxin that can impact mental health (and your overall well-being and longevity). Ambient air pollution can lead to neuroinflammation, which increases the risk of depression. Those effects appear to be especially significant for people who encountered air pollution during the first 10 years of their lives. (26)

Some research also suggests that radiation produced by electromagnetic fields (EMFs) may also have a connection with depression. EMFs may contribute to depression by changing the activity of voltage-gated calcium channels in the brain. This can lead to a host of neuropsychiatric symptoms, like fatigue, headaches, insomnia, irritability, and a depressive mood. (2728)

4. Genetics

Certain genetic variants are potentially associated with depression:

  • The methylenetetrahydrofolate reductase (MTHFR) gene: Variants in the MTHFR gene are linked to depression (as well as anxiety, autism, and schizophrenia). (29)
  • The glutamic acid decarboxylase (GAD) gene: GAD variants may decrease the conversion of glutamate to gamma aminobutyric acid (GABA), which can result in major depressive disorder. (30)

I want to note here that our understanding of the genetic risks associated with depression is far from complete. If you have one of these variants, take that information with a grain of salt—consumer genetic testing has its own potential pitfalls, and your genes aren’t the only factor that influences your health. Often, the exposome (all of those external health determinants like your diet, lifestyle, and environment) is the primary driver behind your overall well-being.

5. Infection

Research suggests that several chronic infections are associated with depression, including:

The mechanism behind this connection could be described by the pathogen-host defense theory of depression (credit to the very forward-thinking Dr. Charles Raison for this theory). According to this idea, some of the behavioral symptoms of depression may actually be behavioral responses to infection, suggesting that human depression evolved out of sickness. (3536) Chronic infections are also associated with chronic inflammation, which is linked to symptoms of depression. (37)

6. Leaky Gut and Gut Dysbiosis

Your gut health impacts your mental health through the gut–brain axis. This axis transmits messages to and from the gut and the central nervous system via inflammatory mediators, gut microbial metabolites, stress hormones, neurotransmitters, and the vagus nerve. (38)

Intestinal barrier integrity and a balanced gut microbiome are two crucial components of a healthy gut—if these are disrupted, your gut health (and, potentially, your mental health) will be impacted.

Leaky gut is a condition where the intestinal barrier allows undesirable and incompatible substances from the gut to “leak” into the bloodstream. This includes endotoxins called lipopolysaccharides, which provoke the release of inflammatory cytokines after entering the bloodstream. (39) Robust research also shows that changes in the makeup of our gut microbiome are associated with major depressive disorder. (40) Factors shown to disrupt the intestinal barrier and gut microbiota may increase the risk of future mental illness. (41)

7. Loneliness, Trauma, and Social Determinants of Health

Our social support system plays an enormous role in our ability to maintain our health. That can include our network of friends, loved ones, and family, and it’s impacted by social determinants of health, like our race and socioeconomic status.

Social isolation is linked with greater incidences of depression (among other serious health conditions), while those who have a strong social support network tend to have better health and lower levels of inflammation. (4243) Loneliness is linked with a higher risk of death, even after controlling for factors like physical health, alcohol consumption, and smoking. (44)

Trauma can also be a trigger for depression. Experiencing trauma during childhood (including even childhood bullying) can strongly predict future risk of depression and other mental health disorders, possibly by altering the function of the HPA axis long-term and contributing to chronic, systemic inflammation. (454647) Trauma experienced during adulthood can also cause depression; that can include things like:

The COVID-19 pandemic can also be defined as a traumatic event in and of itself, and experiencing things like the death of a loved one, job loss, and financial trouble can all certainly be traumatic. (4849)

Social determinants of health also have a major impact on our risk level when it comes to developing depression. These can include:

  • Access to healthy food
  • Local air and water quality
  • Education
  • Neighborhood
  • Socioeconomic status
  • Education
  • Race
  • Gender

It’s well worth discussing these determinants of health now, as we grapple publicly with social justice and racism. Health and social inequality are connected—in fact, research shows that experiencing racism or even anticipating racist encounters contributes to chronic stress and low-grade inflammation, both risk factors for depression. (505152)

8. Sedentary Lifestyle

Regular exercise is linked to good mental health, but a sedentary lifestyle is associated with depression in people of all ages. (5354) As an interesting side note, while exercise initially produces inflammatory cytokines (which are associated with depression), an induction of anti-inflammatory substances quickly follows. (55) This is known as a hormetic effect, where an initial stressor creates a compensatory response in the body—and that has positive, long-term consequences for health. (56)

9. Sleep Deprivation and Artificial Light Exposure

As more and more of us spend most of our waking hours in front of a screen, our modern lives are becoming progressively more marked by increased exposure to artificial light. That has worrying effects on our sleep. Nighttime light exposure suppresses the production of melatonin and leads to increased sleeplessness, and is linked to an increased risk of depression, even after controlling for sleep quality and chronic health conditions. (57585960)

10. Standard American Diet

Research shows that the consumption of ultra-processed foods is associated with depression—and the Standard American Diet is chock-full of them. (6162) The Standard American Diet harms the gut microbiome and can lead to leaky gut. (63) Nutritional deficiencies are also a concern with this diet.

For a deeper dive into this topic, check out “Nutrition and Mental Health: What’s the Connection?” from nutritionist Lindsay Christensen.

Functional Medicine Treatment Options for Depression

Your diet and lifestyle habits impact every facet of your well-being, mental health included, so making adjustments in these areas is an important step if you are struggling with depression. As our understanding of the mechanisms behind depression grows, other potential treatments are coming to the forefront, as well, like bright light therapy, Eye Movement Desensitization and Reprocessing (EMDR), cognitive behavioral therapy, and even psychedelics. Building up your personal resilience can also help weather stressful situations in the future—and this is an especially useful tool for getting through the stress and uncertainty caused by the COVID-19 pandemic.

Change Your Diet

As I mentioned, a diet rich in ultra-processed foods is linked with depression; however, an anti-inflammatory, ancestral diet is associated with robust mental health. (64) An ancestral diet is also nutrient dense, making it a great option for ensuring that you get the nutrients that are beneficial for mental health, like:

  • Vitamin B6 and B12 (65)
  • Balanced zinc and copper (66)
  • Magnesium (67)
  • Omega-3 fatty acids (68)
  • Polyphenols (69)

Supplementation may offer additional benefits if you’re not able to get everything you need through diet alone. This could include:

  • 5-HTP (70)
  • Inositol (7172)
  • Zinc (73)
  • Magnesium (74)

An ancestral diet is also a gut-healthy diet. It’s rich in healthy fiber and free from foods that exacerbate gut conditions—and I recommend adding fermented foods for additional probiotic benefits.

Adopt Healthy Lifestyle Interventions

Picking up healthier habits can also help alleviate your depression. That could include:

Try Other Treatment Options

Cognitive behavioral therapy is a form of talk therapy that is focused on changing patterns of thinking and behaviors that don’t support mental health. People who undergo this form of therapy learn new methods for coping, like: (75)

  • Facing their fears
  • Developing confidence
  • Learning to calm the mind
  • Using problem-solving skills to deal with tough situations

There are also several emerging treatments for depression available, like:

  • Bright light therapy: This involves daily exposure to a full-spectrum, 10,000 lux light, and has been shown to help relieve seasonal affective disorder and depression. (76)
  • EMDR: This form of therapy stimulates the two hemispheres of the brain, often through eye movements or specialized devices. Originally intended as a treatment for trauma, it’s been shown to be effective for recurrent depression. (77)
  • Psychedelics: When used in controlled, therapeutic environments, research suggests that people with depression may experience some benefit from psilocybin, LSD, or ketamine. (787980)

Build Your Ability to Adapt in Any Circumstances

Cultivating more adaptability can be a powerful tool to use in dealing with depression. This is a crucial trait we all need to deal with uncertainty—and clearly, we need it now more than ever. We can each develop the internal and external resources needed for this, often described with the acronym “HERO.” (In positive psychology, this is known as “psychological capital.”) HERO stands for:

  • Hope
  • Efficacy
  • Resilience
  • Optimism