Nutrition for Caregivers
Part 1: Nutrition and Mood
by Lacy Ngo MS, RD
Caregivers…The secret heroes of the world. I see you. You stayed awake all night because your loved one needed water, comfort, or just company. Yet the next day, you still woke up and worked all day.
With all the medications, doctors’ visits, scheduling, and planning, you want to be clear-headed, focused, and patient. You want to get everything done AND treasure precious time with the one you love. And you also feel sad…
Some days you may feel like you can’t do it, and yet you somehow keep going, one moment at a time. How do you take care of your loved one when you have been up all night, and you are emotionally drained? You know you need sleep, energy, focus, strength, and patience to be at your best, but you don’t know how to get everything you need.
I’m Lacy Ngo, a registered dietitian, and you inspire me. I wish I could fix everything, and yet I know I can’t.
But I hope to help in the one way I know how and that is with food. Food can nourish the mind, body, and spirit; give energy; help with sleep; support the immune system; promote brain focus and alertness; and even help with mood.
This is the first installment of the “Nutrition for Caregivers” series. For today’s installment, let’s go into nutrition and mood, but since this is written with caregivers in mind, let’s more specifically look at how what we eat can help with sadness, depression, and anxiety.
The Mediterranean-Style Diet
It has been well established by research that a high-antioxidant Mediterranean diet reduces the risk of depression and anxiety. A review done by members of the International Society for Nutritional Psychiatry Research concluded that a Mediterranean diet; which is a heavily plant-based diet, high in whole foods, vegetables, fruit, omega-3-rich fish, whole grains, lean meats, nuts, legumes, and low in processed foods, refined grains, and refined sugar; is more likely to provide protection against mental and emotional conditions like anxiety, stress, and depression. (1). According to another review of 25 studies, those with higher quality diets (like the Mediterranean diet) are less likely to experience depression. (2)
Antioxidant-Rich Foods: Fruits, Vegetables, Green Tea, Nuts, Seeds, and Dark Chocolate
Fruits, vegetables, green tea, nuts, seeds, and dark chocolate are all high in antioxidants, and antioxidants have been shown to improve general mood and symptoms of depression (3). A meta-analysis looked at 10 studies consisting of 227,852 participants and found an inverse association between fruit and vegetable intake and risk of depression. Consistently eating an antioxidant-rich diet may help your mood over time, and one study suggests that eating antioxidant-rich foods, especially fruits, may improve your mood immediately. In this study, children and young adults were given a flavonoid-rich blueberry drink. Their mood was assessed before and after the drink. The participants reported a more positive mood after the drink. Although these results are interesting, more research is needed to determine if antioxidants can improve moods this quickly (5).
Nuts and seeds have a lot of anti-depressant and anti-stress nutrients going for them. They are a good source of anti-inflammatory antioxidants and healthy fats. They are also a source of tryptophan, which is a precursor for serotonin (the happy hormone). Studies suggest that adding nuts to your regular diet may improve depressive symptoms for some (12).
Dark chocolate is rich in antioxidants and serotonin and has been shown to even act as an anti-depressant. (6)
Green tea (a good source of polyphenols) has been associated with a decrease in the prevalence of depression. In fact, individuals who drank 4 cups or more per day had a 51% lower prevalence of depression compared to those who drank 1 cup or less per day (7). Moreover, green tea contains L-theanine, which may have a calming, anti-anxiety effect without making you feel drowsy. In fact, green tea may help with mental alertness.
According to The Yale Journal of Biology and Medicine, over the past decade, research has shown that gut health appears to affect symptoms of depression and anxiety (8). Ninety-five percent of serotonin, the neurotransmitter that helps regulate mood, sleep, appetite, and pain, is found in the gut (9). Probiotics are healthy bacteria for your gut. Studies show that Probiotics (this good bacteria) may help reduce anxiety and stress (4). Probiotics are found in yogurt, kombucha, sauerkraut, fermented pickles, and kimchi. You can also find drinks and foods fortified with probiotics in your local grocery stores.
While refined carbohydrates can have a negative impact on our mood, long term, nutrient-dense carbohydrates, such as whole grains, may boost mood. These healthy carbohydrates prompt the brain to make more serotonin and stabilize blood sugar levels. Research suggests that eating carbohydrates may help tryptophan get into your brain. Tryptophan is the precursor for serotonin, a happy hormone.
Salmon, Tuna, and Other Fatty Fish
Salmon, tuna, and other fatty fish are excellent sources of Omega-3, vitamin D, and vitamin B12. All of which are helpful in regards to our mood.
Omega-3 may help regulate neurotransmitters, which can cause a calming or relaxing effect (10). Fish is one of the best sources of Omega-3 fatty acid. One review looked at 31 studies, which totaled 20,000 cases of depression and found fish consumption decreased depression symptoms. Other reviews had similar results. In one study, women who ate fish two times per week had a 25% lower risk of developing depression (4). One meta-analysis looked at 14 studies and found that patients who were suffering from depression who took their prescribed anti-depressants along with Omega-3 supplements significantly reduced their symptoms of depression compared to those who were taking their anti-depressants only. In a few studies, Omega-3 supplements even appeared as effective as anti-depressant medications for some individuals (4). In another study, people who ate salmon 3 times per week for 5 months reported less anxiety than those who ate chicken, pork, or beef. Measurable anxiety-related conditions like heart rate even improved in these participants (13).
Vitamin D, which is also found in salmon and tuna, has been shown to improve calming neurotransmitter levels possibly and have beneficial effects in Major Depressive Disorder by protecting our brain from the depletion of dopamine and serotonin. Deficiencies in Vitamin D can increase the risk of mood disorders, including depression and anxiety (11).
Vitamin B12 is another nutrient found in salmon and tuna. It has been well established that decreased levels of vitamin B12 are associated with a higher risk of depression. In fact, a severe deficiency in vitamin B12 can increase the risk of severe depression by 2-fold (4). Animal foods, including salmon and tuna, are rich in vitamin B12, but you can also find vitamin B12 in fortified foods like nutritional yeast and fortified cereals.
Feeding Our Spirit
Sometimes our spirit wants a food that may not be as nutrient-rich, and that is okay. My grandmother and I loved getting “cheese” (also frequently referred to by many as plastic cheese) fries every time we went to the mall. Still to this day, cheese fries feed my spirit. When I see them, smell them, and taste them, suddenly it’s as if my grandmother is right there with me. So, if you and your loved one have a special food that you want to enjoy together, ENJOY! Enjoying that food IS healthy for your spirit, even if it’s not the most nourishing food.
Foods to Eat Occasionally
With that being said, I do want to mention a few foods that, if eaten in excess, could negatively affect moods, according to research.
Several studies have found a link between depression and anxiety and the western-style diet. The western diet consists of energy-dense, pro-inflammatory, refined carbohydrates and sugar, and ultra-processed foods with a high glycemic load. Western diets are also low in fiber. One study looked at 8,964 participants and found an increased risk of depression associated with the western diet (12)
Sugar and sugar-sweetened beverage intakes are associated with a higher risk of depression. One study found that children who consumed sugar soft drinks for 1 time/week or more had significantly higher depression scores. Another study found similar results when participants consumed over 2 cups/day (4)
What is The Take Home Message?
Eat vegetables, fruits, whole grains, green tea nuts, seeds, dark chocolate, salmon, tuna, and other fatty fish and probiotic-rich foods to promote a positive mood. Eat nostalgic foods that soothe the spirit. Limit refined sugars, refined carbohydrates, and ultra-processed foods.
Next up in the “Nutrition for Caregivers” series…
- Sarris, J., Logan, A. C., Akbaraly, T. N., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Ramsey, D., Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, K.-P., & Jacka, F. N. (2015). Nutritional medicine as mainstream in psychiatry. The Lancet Psychiatry, 2(3), 271–274. https://doi.org/10.1016/s2215-0366(14)00051-0
- Quirk, S. E., Williams, L. J., O’Neil, A., Pasco, J. A., Jacka, F. N., Housden, S., Berk, M., & Brennan, S. L. (2013). The association between diet quality, dietary patterns and depression in adults: a systematic review. BMC Psychiatry, 13(1), 175. https://doi.org/10.1186/1471-244x-13-175
- Payne, M. E., Steck, S. E., George, R. R., & Steffens, D. C. (2012). Fruit, Vegetable, and Antioxidant Intakes Are Lower in Older Adults with Depression. Journal of the Academy of Nutrition and Dietetics, 112(12), 2022–2027. https://doi.org/10.1016/j.jand.2012.08.026
- Banjari, I., Vukoj, I., Madic, ML. (2014). Brain Food: How Nutrition Alters Our Mood and Behavior. Josip Juraj Strossmayer University of Osijek, Faculty of Food Technology Osijek, Department of Food and Nutrition Research, Franje Kuhaca 20, HR-3100 Osijli, Croatia, 3 (1).
- Khalid, S., Barfoot, K., May, G., Lamport, D., Reynolds, S., & Williams, C. (2017). Effects of Acute Blueberry Flavonoids on Mood in Children and Young Adults. Nutrients, 9(2), 158. https://doi.org/10.3390/nu9020158
- Martin, F.-P. J., Rezzi, S., Peré-Trepat, E., Kamlage, B., Collino, S., Leibold, E., Kastler, J., Rein, D., Fay, L. B., & Kochhar, S. (2009). Metabolic Effects of Dark Chocolate Consumption on Energy, Gut Microbiota, and Stress-Related Metabolism in Free-Living Subjects. Journal of Proteome Research, 8(12), 5568–5579. https://doi.org/10.1021/pr900607v
- Pham, N. M., Nanri, A., Kurotani, K., Kuwahara, K., Kume, A., Sato, M., Hayabuchi, H., & Mizoue, T. (2013). Green tea and coffee consumption is inversely associated with depressive symptoms in a Japanese working population – CORRIGENDUM. Public Health Nutrition, 17(3), 715. https://doi.org/10.1017/s1368980013002012
- Schnorr SL, Bachner HA. Integrative Therapies in Anxiety Treatment with Special Emphasis on the Gut Microbiome. Yale J Biol Med. 2016;89(3):397-422. Published 2016 Sep 30.
- Wright, K. C. (2019, July). Clinical Nutrition: Beyond Food and Mood – Today’s Dietitian Magazine. Today’s Dietitian Magazine, 27(7). https://www.todaysdietitian.com/newarchives/0719p10.shtml
- Lang, U. E., Beglinger, C., Schweinfurth, N., Walter, M., & Borgwardt, S. (2015). Nutritional Aspects of Depression. Cellular Physiology and Biochemistry, 37(3), 1029–1043. https://doi.org/10.1159/000430229
- Harms, L. R., Burne, T. H. J., Eyles, D. W., & McGrath, J. J. (2011). Vitamin D and the brain. Best Practice & Research Clinical Endocrinology & Metabolism, 25(4), 657–669. https://doi.org/10.1016/j.beem.2011.05.009
- Gómez-Pinilla, F. (2008). Brain foods: the effects of nutrients on brain function. Nature Reviews Neuroscience, 9(7), 568–578. https://doi.org/10.1038/nrn2421
- Hansen, A., Olson, G., Dahl, L., Thornton, D., Grung, B., Graff, I., Frøyland, L., & Thayer, J. (2014). Reduced Anxiety in Forensic Inpatients after a Long-Term Intervention with Atlantic Salmon. Nutrients, 6(12), 5405–5418. https://doi.org/10.3390/nu6125405
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