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Analysis by Dr. Joseph Mercola
January 09, 2020
- Increasing research shows that maintaining healthy levels of body fat and greater muscle mass has an effect on your brain health and may slow your rate of cognitive aging
- People with higher amounts of abdominal fat had worse fluid intelligence with age, while those with greater muscle mass were more protected against such declines
- Women who had greater muscle mass tended to have better scores in fluid intelligence during the study period
- Past research has linked midlife obesity with an increased risk of mild cognitive impairment, changes in short-term memory and executive functioning and dementia
- In addition to regular exercise to increase muscle mass, eating a ketogenic diet to maintain a healthy body weight and avoid obesity may support your brain health as you age
Staying fit as you age is about far more than aesthetics. Increasing research shows that maintaining healthy levels of body fat and greater muscle mass has an effect on your brain health and even your rate of cognitive aging. It’s known, for instance, that being obese in midlife and early late-life is associated with worse cognitive aging.1
What’s more, the amount of muscle and fat you have may be a more important factor in how your level of fluid intelligence decreases over time than your chronological age. Your chronological age, i.e., your age in years, is just a numerical measurement, but your real age is your biological age as dictated by your choices and habits, as well as your modifiable risk factors like levels of muscle and fat.
While many people tend to gain fat and lose muscle mass as they age, this can be largely combated by staying active and eating right — lifestyle choices that will influence your cognitive function significantly.
More Muscle, Less Fat Protects Your Brain
In a study by Iowa State researchers, data from 4,431 adults were examined to compare levels of lean muscle mass, abdominal fat and subcutaneous fat with changes in fluid intelligence — the ability to solve problems in new situations — over a six-year period.2,3
Those with higher amounts of abdominal fat had worse fluid intelligence with age, while those with greater muscle mass were more protected against such declines. In fact, women who had greater muscle mass tended to have better scores in fluid intelligence during the study period.
Study co-author Auriel Willette, assistant professor of food science and human nutrition at Iowa State University, said in a news release, “Chronological age doesn’t seem to be a factor in fluid intelligence decreasing over time. It appears to be biological age, which here is the amount of fat and muscle.”4
What’s more, the study revealed a link between the immune system and how changes in fat levels affect cognition. Previous research suggests a higher body mass index (BMI) leads to greater immune system activity in the blood, which in turn activates the immune system in the brain, with a negative outcome on cognitive function.5
The featured study also found that changes in white blood cells called lymphocytes and eosinophils explained the link between abdominal fat and worsening fluid intelligence in women. In men, basophils, another type of white blood cell, were linked to about half of the link between fat levels and fluid intelligence, the study found.6
“Lymphocytes, eosinophils, and basophils may link adiposity to cognitive outcomes,” the researchers explained.7 Similar research has revealed that overweight and obese individual have greater brain atrophy in middle-age, corresponding with an increase in brain age of 10 years.8
How Obesity Affects Your Brain
Obesity has multiple effects on the brain, including anatomically speaking. Obese individuals may have reduced gray matter in brain regions such as the hippocampus, prefrontal cortex and other subcortical regions. Atrophy in the hippocampus, in turn, has been linked to Alzheimer’s disease.9
Gray matter is the outer layer of the brain associated with high-level brain functions such as problem-solving, language, memory, personality, planning and judgment. Even in elderly people who are otherwise cognitively normal, obesity is associated with measureable deficits in brain volume in the frontal lobes, anterior cingulate gyrus, hippocampus, and thalamus compared to individuals with a normal weight.10
Further research published in Radiology found that obesity may lead to alterations in brain structure, shrinking certain regions.11 Among men, higher total body fat percentage was linked to lower brain gray matter volume. Specifically, 5.5% greater total body fat percentage was associated with 3,162 mm3 lower gray matter volume.
Among men, 5.5% greater total body fat was also associated with 27 mm3 smaller globus pallidus volume, an association also seen in women. In women, 6.6% greater total body fat percentage was associated with 11.2 mm3 smaller globus pallidus volume.
The globus pallidus is a brain region that plays a role in supporting a range of functions, including motivation, cognition and action.12 Obesity was also associated with changes in white matter microstructure, which may be related to cognitive function.13
Cognitively speaking, there’s also a strong link between obesity and deterioration in cognitive function, as well as to other brain disorders such as dementia, anxiety and depression. Further, past research has linked midlife obesity with an increased risk of mild cognitive impairment, changes in short-term memory and executive functioning and dementia.14
Obesity-Associated Health Problems Also Harm Your Brain
Obesity’s effects on brain health are also due to its associated health problems, including heart disease, diabetes and atherosclerosis, each of which can have its own deleterious effects on your brain. For instance, as noted in Frontiers in Neuroscience:15
“Obesity-derived vascular problems, such as atherosclerosis and arteriosclerosis, which are systemic diseases, are known to affect the steady blood flow of vessels that feed the brain, thus contributing to cognitive impairment or even stroke, where large areas of the brain die due to the stop in the blood flow of a major brain artery caused by a blood clot.”
In terms of diabetes, of which obesity is a key risk factor, having this condition in midlife is associated with a 19% greater cognitive decline over 20 years compared with not having the condition.16 Even those with prediabetes had significantly greater cognitive decline than those without.
Indeed, “Epidemiological studies have linked type-2 diabetes mellitus with cognitive impairment and dementia, with insulin resistance and hyperglycemia as the probable mechanistic links,” researchers noted.17
Coming full circle, eating a highly processed, junk food diet not only increases obesity risk but also can lead to normal but elevated blood sugar levels that, in turn, can lead to impaired glucose metabolism and Type 2 diabetes. Both diabetes and higher fasting glucose levels are linked with lower total brain volume.18
Impaired glucose metabolism is then associated with neurodegeneration that impairs cognitive function. This connection begins not in old age but much earlier, such that following a healthy lifestyle in young adulthood may be protective against cognitive decline later.19
The Inflammation Connection
Obesity can trigger chronic inflammation in your body, and chronic inflammation in your brain (neuroinflammation) is known to impair neurogenesis, your brain’s ability to adapt and grow new brain cells. It’s also linked to neurodegenerative disorders such as Alzheimer’s disease (AD), and it’s been suggested that “Obesity may serve as an amplifier or initiator of the chronic inflammation observed in AD patients.”20
Further, higher levels of inflammatory markers have also been associated with lower brain volume, including “greater atrophy than expected for age.”21 Excess body fat, particularly visceral fat, is also related to the release of proteins and hormones that can cause inflammation, which in turn can damage arteries and enter your liver, affecting how your body breaks down sugars and fats.
According to a study in the Annals of Neurology, “[A]dipose-tissue derived hormones, such as adiponectin, leptin, resistin or ghrelin, could also play a role in the relation between adipose tissue and brain atrophy.”22 Further, obesity may also be associated with lower volume in brain regions that regulate food-reward circuitry,23 possibly influencing overeating.
Strength Training Is Good for Your Brain
While obesity takes a toll on your brain, increased muscle mass protects it, which is likely one reason why strength training has been found to be beneficial for your brain. In other words, your body’s physical strength may serve as a marker of your brain power.
In fact, strength training is known to trigger beneficial neurobiological processes,24 leading to positive functional brain changes, including in the frontal lobe, with corresponding improvements in executive functions. One systematic review even found that strength training led to less white matter atrophy in the brain, with researchers noting:25
“Taken together, during aging processes, a substantial decline in muscular strength, especially in lower limb muscles, occurs, and accumulating evidence suggests that lower muscular strengths are linked to poorer cognitive performance.
Hence, resistance (strength) exercises (a single bout of resistance exercise, also referred to as acute exercise) and resistance (strength) training (more than one resistance exercise session, also referred to as chronic exercise … ) seem to be promising activities to ensure the preservation of physical functioning and cognitive functions with aging.”
Regular strength training, in addition to other forms of exercise and daily activity, is an important strategy for keeping your brain sharp and may help to offset some of the cognitive decline that occurs with age.
Avoid Obesity and Protect Your Brain With a Ketogenic Diet
While obesity may accelerate neurodegeneration, regular exercise to increase your muscle mass will be protective. Further, eating a ketogenic diet will help protect your brain from free radical damage and will supply the cells with preferred fuel while also helping you to lose weight and avoid obesity.
A ketogenic diet is high in healthy fats and low in net carbohydrates (total carbs minus fiber), prompting your body to start burning fat as its primary fuel, rather than sugar. This produces ketones, which not only burn efficiently but are also a superior fuel for your brain. Ketones also generate fewer reactive oxygen species (ROS) and less free-radical damage.
One of the simple strategies you can implement is to take ketone precursors like refined MCT oils of caprylic acid (C-8). The eight-chain carbon fats are readily converted to ketones. I personally use up to 5 ounces of our Ketone Energy when I have maxed out my protein and carb intake and need a source of healthy clean fat. This keeps my ketone level around 1 to 2.0 mmol/l. Just recognize that you have to build up to a high dose of MCT oil slowly or you will have problems with loose stools.
Recent studies have also demonstrated the benefits of nutritional ketosis for brain health. In one, researchers found a ketogenic diet improved neurovascular function, in part by improving your gut microbiome.26
In a second study, the researchers concluded a ketogenic diet acted as a veritable “fountain of youth” in their animal study by significantly improving neurovascular and metabolic functions, compared to the animals eating an unrestricted diet.27 Releasing ketones into your bloodstream helps preserve brain function and protects against cognitive impairment and other neurodegenerative diseases.28
KetoFasting, the program I developed and detail in my book, “KetoFast: A Step-By-Step Guide to Timing Your Ketogenic Meals,” combines a cyclical ketogenic diet and intermittent fasting with cyclical partial fasting to optimize health and longevity.
Not only can KetoFasting help you to lose weight, but your cognition typically improves thanks to the biological cleansing and regeneration that occurs throughout your body, including your brain.
- 1, 7 Brain, Behavior, and Immunity November 2019, Volume 82, Pages 396-405
- 2, 5, 6 Science Daily December 17, 2019
- 3 Brain, Behavior, and Immunity Volume 82, November 2019, Pages 396-405
- 4 Newsweek December 20, 2019
- 8 Neurobiol Aging. 2016 Nov; 47: 63–70.
- 9, 14, 15, 17, 20 Front Neurosci. 2019; 13: 513.
- 10 Hum Brain Mapp. 2010 Mar; 31(3): 353–364.
- 11, 23 Radiology. 2019 Apr 23:181012.
- 12 Front. Neuroanat., 10 April 2017
- 13 Neuroscientist. 2013 Feb; 19(1): 8–15.
- 16 Ann Intern Med. 2014;161(11):785-793
- 18 Diabetes Care. 2011 Aug;34(8):1766-70.
- 19 Frontiers in Neuroendocrinology June 6, 2019
- 21 Neurology. 2007 Mar 27;68(13):1032-8.
- 22 Ann Neurol. 2010 Aug; 68(2): 136–144.
- 24, 25 European Review of Aging and Physical Activity volume 16, Article number: 10 (2019)
- 26 Scientific Reports, 2018; 8(6670)
- 27 Front. Aging Neurosci., 26 July 2018
- 28 Neurobiol Aging. 2012 Feb; 33(2): 425.e19–425.e27
Reproduced from original article:
- Research has linked sweetened beverages — both sugar- and artificially-sweetened beverages — with an increased risk of depression, the highest risk being associated with diet fruit drinks and diet soda
- Another study found adolescents who had elevated levels of sodium and low levels of potassium in their urine — two factors indicative of a diet high in junk food and processed food — had more frequent symptoms of depression
- A 2019 study found dietary intervention can effectively treat depression in young adults. Those who ate a Mediterranean-style diet reported a significant reduction in depression symptoms after 21 days
- A recent meta-analysis also concluded that “Dietary interventions hold promise as a novel intervention for reducing symptoms of depression across the population”
- As a general guideline, eating a whole food diet can go a long way toward lowering your inflammation level and thus your risk of depression. A cornerstone of a healthy diet is limiting sugar of all kinds, ideally below 25 grams a day
Foods have an immense impact on your body and your brain, and eating whole foods as described in my nutrition plan is a good way to simultaneously support your mental and physical health. Avoiding sugar and artificial sweeteners is in my view, based on the evidence, a crucial aspect of preventing and/or treating depression.
Both contribute to chronic inflammation and can wreak havoc with your brain function. Recent research also shows how swapping processed junk food for a healthier diet can significantly improve depression symptoms, which really shouldn’t come as a great surprise.
The Sugar Trap
Research1,2 published in 2014 linked sweetened beverages — both sugar- and artificially-sweetened beverages — with an increased risk of depression. Those who drank more than four cans or glasses of soda had a 30% higher risk of depression compared to those who did not consume sweetened beverages of any kind.
Interestingly, fruit juices were even more hazardous. The same amount of sweetened fruit drinks (four glasses) was associated with a 38% higher risk of depression.
Overall, artificially sweetened so-called “diet” drinks were associated with the highest risks of depression, compared to beverages sweetened with sugar or high-fructose corn syrup. More specifically, compared to those who did not drink sweetened beverages:
- Those who drank primarily diet soda were 31% more likely to suffer with depression, whereas regular soda was associated with a 22% increased risk
- Those who drank primarily diet fruit drinks had a 51% higher risk for depression, while consuming regular fruit drinks was associated with a more modest 8% increased risk
- Drinking primarily diet iced tea was associated with a 25% increased risk for depression, whereas those who drank regular sweetened iced tea actually had a 6% reduced risk
Similarly, recent research3 detailed in “The Link Between Fast Food and Teenage Depression” found adolescents who had elevated levels of sodium and low levels of potassium in their urine — two factors indicative of a diet high in junk food and processed food — had more frequent symptoms of depression.
According to the authors,4 “Given the substantial brain development that occurs during adolescence, individuals in this developmental period may be particularly vulnerable to the effects of diet on the neural mechanisms underlying emotion regulation and depression.”
Why Sugar Takes a Toll on Mental Health
There are at least four potential mechanisms through which refined sugar intake could exert a toxic effect on mental health:
- Sugar (particularly fructose) and grains contribute to insulin and leptin resistance and impaired signaling, which play a significant role in your mental health
- Sugar suppresses activity of a key growth hormone called brain derived neurotrophic factor (BDNF), which promotes healthy brain neurons. BDNF levels are critically low in both depression and schizophrenia, which animal models suggest might actually be causative
- Sugar consumption also triggers a cascade of chemical reactions in your body that promote chronic inflammation. In the long term, inflammation disrupts the normal functioning of your immune system, which is linked to a greater risk of depression5
- Sugar impairs the microbiome and its influence on the modulation of stress response, immune function, neurotransmission and neurogenesis
In 2004, British psychiatric researcher Malcolm Peet published a provocative cross-cultural analysis6 of the relationship between diet and mental illness. His primary finding was a strong link between high sugar consumption and the risk of both depression and schizophrenia. According to Peet:
“A higher national dietary intake of refined sugar and dairy products predicted a worse 2-year outcome of schizophrenia. A high national prevalence of depression was predicted by a low dietary intake of fish and seafood.
The dietary predictors of … prevalence of depression are similar to those that predict illnesses such as coronary heart disease and diabetes, which are more common in people with mental health problems and in which nutritional approaches are widely recommended.”
One of the key predictors of heart disease and diabetes is in fact chronic inflammation which, as Peet mentions, is also associated with poor mental health. Sugar is a primary driver of chronic inflammation in your body, so consuming excessive amounts of sugar can truly set off an avalanche of negative health events — both mental and physical.
Three-Week Dietary Intervention Lifts Depression
Most recently, a study7,8,9 published in the October 2019 issue of PLOS ONE said to be the first of its kind, found dietary intervention can effectively treat depression in young adults. The researchers enrolled 101 individuals aged 17 to 35, whose stress and depression scores indicated moderate to high levels of depression.
Participants were divided into two groups. One received dietary intervention while the other (controls) received no intervention. Dietary instructions were provided to the treatment group by a registered dietician via a 13-minute video, which could be revisited at will.
The dietary recommendations were based on the 2003 Australian Guide to Healthy Eating protocol “with additional recommendations to increase concordance with Mediterranean-style diets … and diet components (e.g., omega-3 fatty acids, cinnamon, turmeric) that have beneficial effects on neurological function.”10 More specifically, the treatment group was instructed to eat:
|Five servings of vegetables per day|
|Two to three servings of fruit per day|
|Three servings of wholegrain cereal per day|
|Three servings of protein (such as lean meat, poultry, eggs or legumes) per day|
|Three servings of unsweetened dairy per day|
|Three servings of fish per week|
|3 tablespoons of nuts and seeds per day|
|2 tablespoons of olive oil per day|
|1 teaspoon of turmeric and cinnamon on most days|
Refined carbohydrates, sugar, processed meats and soft drinks were to be avoided as much as possible. According to the authors:11
“There is strong epidemiological evidence that poor diet is associated with depression. The reverse has also been shown, namely that eating a healthy diet rich in fruit, vegetables, fish and lean meat, is associated with reduced risk of depression …
There was good compliance with the diet intervention recommendations assessed using self-report and spectrophotometry. The Diet group had significantly lower self-reported depression symptoms than the Control Group …
Reduced DASS-21 depression subscale scores were maintained on follow up phone call 3 months later. These results are the first to show that young adults with elevated depression symptoms can engage in and adhere to a diet intervention, and that this can reduce symptoms of depression.”
Dietary Intervention Significantly Lowers Depression Scores
The first graph below illustrates the difference in primary depression scores (based on Centre for Epidemiological Studies Depression Scale or CESD-R) between the two groups. The second graph illustrates the difference between the two groups based on DASS-21 depression subscale scores.
The researchers also report that the dietary intervention resulted in lower levels of anger. In the Discussion section of the paper, the authors make the following observations:14
“The results of this RCT provide support for improving diet as a useful adjunct treatment to reduce depressive symptoms … One of the most interesting findings is the fact that diet change was feasible in this population.
As the participants were young adults and university undergraduate students, we anticipated several potential barriers such as the perceived cost of the diet, the time demands of preparing food and/or reliance on others for food preparation (particularly if they lived at home).
Additionally, the participants were recruited based on self-reported symptoms of depression. We anticipated that the symptoms of depression, including low energy, reduced motivation and apathy, would present as barriers to eating well.
Despite these factors, there was a significant increase in the recommended foods and decrease in processed foods for the diet change group but not the habitual diet group.
Furthermore, within the diet change group, increase in recommended foods was associated with spectrophotometer readings. This provides objective evidence to support the participants’ self-reported compliance with the diet …
Even in the general population, adherence to diet advice is typically very poor, with over 80% of Australians reporting that they do not comply with dietary recommendations.
As a result, there is substantial nihilism regarding the ability to change people’s diets. The current study simply provided a brief 13-minute video, paper resources and minimal phone support.
The fact that this relatively low-cost intervention can result in a population of young adults adhering to diet recommendations is very promising. Furthermore, it is important to consider that participants in the current study did not need to adhere strictly to the diet recommendations to derive benefit.”
Other Studies Support Dietary Intervention for Mental Health
Another recent paper found similar results. The meta-analysis,15 published in the April 2019 issue of Psychosomatic Medicine, looked at 16 randomized controlled trials with outcome data — based on a variety of depression scores — for 45,826 participants ranging in age from 21 to 85. Interventions ranged from 10 days to three years.
While all but one examined nonclinical depression, dietary interventions were still found to significantly reduce symptoms of depression. Interestingly, women appeared to reap the greatest benefits, not only for depression but also anxiety. According to the authors, “Dietary interventions hold promise as a novel intervention for reducing symptoms of depression across the population.”
Interestingly, studies specifying the involvement of a nutritional professional had significantly better results than those in which the dietary advice was delivered without a professional’s involvement.
However, as shown in the featured PLOS ONE study, this doesn’t necessarily have to be a complicated affair. There, participants simply viewed a video in which a dietician gave the instructions.
Mechanisms of Action
In the Implications and Recommendations section of the Psychosomatic Medicine meta-analysis, the authors point out a number of possible mechanisms of action allowing depressed patients to benefit from nutritional intervention:16
“… diet may act via several pathways that are implicated in mental health. These include pathways related to oxidative stress, inflammation, and mitochondrial dysfunction, which are disrupted in people with mental disorders.
Gut microbiota dysbiosis has also been implicated because of emerging research demonstrating involvement of the microbiome in the modulation of stress response, immune function, neurotransmission, and neurogenesis. A healthy diet typically contains a wide variety of bioactive compounds that can beneficially interact with these pathways.
For example, vegetables and fruits contain, in addition to beneficial vitamins, minerals and fiber, a high concentration of various polyphenols that seem to be associated with reduced rates of depression … potentially because of their anti-inflammatory, neuroprotective, and prebiotic properties.
Furthermore, vitamins (e.g., B vitamins), fatty acids (e.g., omega 3 fatty acids), minerals (e.g., zinc, magnesium), and fiber (e.g., resistant starch) as well as other bioactive components (e.g., probiotics), which are typically abundant in healthy dietary patterns, may also be protective from mental illness.
Along with increasing the intake of beneficial nutrients, dietary interventions may also impact on mental well-being by reducing the consumption of unhealthy food associated with increased risk for depression, such as processed meats, refined carbohydrates, and other inflammatory foods.
Unhealthy diets are also high in other compounds that may negatively affect these pathways. For example, elements commonly found in processed foods such as saturated fatty acids, artificial sweeteners, and emulsifiers may alter the gut microbiome, which may activate inflammatory pathways.”
Nutritional Advice for Mental Health
Keeping inflammation in check is an important part of any effective mental health treatment plan. If you’re gluten sensitive, you will need to remove all gluten from your diet. A food sensitivity test can help ascertain this. Reducing lectins may also be a good idea.
As a general guideline, eating a whole food diet as described in my optimal nutrition plan can go a long way toward lowering your inflammation level. A cornerstone of a healthy diet is limiting sugar of all kinds, ideally to no more than 25 grams a day.
In one study,17 men consuming more than 67 grams of sugar per day were 23% more likely to develop anxiety or depression over the course of five years than those whose sugar consumption was less than 39.5 grams per day. Certain nutritional deficiencies are also notorious contributors to depression, especially:
•Marine-based omega-3 fats — Omega-3 fats have been shown to improve major depressive disorder,18 so make sure you’re getting enough omega-3s in your diet, either from wild Alaskan salmon, sardines, herring, mackerel and anchovies, or a high-quality supplement.
I recommend getting an omega-3 index test to make sure you’re getting enough. Ideally, you want your omega-3 index to be 8% or higher.
•B vitamins (including B1, B2, B3, B6, B9 and B12) — Low dietary folate can raise your risk of depression by as much as 304%.19,20 A 2017 study21,22 showing the importance of vitamin deficiencies in depression involved suicidal teens. Most turned out to be deficient in cerebral folate and all of them showed improvement after treatment with folinic acid.
•Magnesium — Magnesium supplements have been shown to improve mild-to-moderate depression in adults, with beneficial effects occurring within two weeks of treatment.23
•Vitamin D — Studies have shown vitamin D deficiency can predispose you to depression and that depression can respond favorably to optimizing your vitamin D stores,24 ideally by getting sensible sun exposure.
A double-blind randomized trial25 published in 2008 concluded that supplementing with high doses of vitamin D “seems to ameliorate [depression] symptoms indicating a possible causal relationship.” Research26 published in 2014 also linked low vitamin D levels with an increased risk for suicide.
The 2017 paper “Depression and Vitamin D Deficiency: Causality, Assessment and Clinical Practice Implications,” published in the journal of Neuropsychiatry, notes:27
“The Third National Health and Nutrition Examination Survey, which enrolled a sample of 7,970 non-institutionalized U.S. residents age 15 to 39, confirmed that people with serum vitamin D ≤50 nmol/L [20 ng/mL] are at a significantly higher risk of showing depression than individuals whose serum levels of vitamin D are greater or equal to 75 nmol/L [30 ng/mL] …
A … large cohort study28 showed an association between low vitamin D levels and both presence and severity of depression, this suggesting the possibility that hypovitaminosis D indicates an underlying biological susceptibility for depression.”
For optimal health, make sure your vitamin D level is between 60 and 80 ng/mL year-round. Ideally, get a vitamin D test at least twice a year to monitor your level.
Keeping your gut microbiome healthy also has a significant effect on your moods, emotions and brain. You can read more in my previous article, “Mental Health May Depend on the Health of Your Gut Flora.”
A number of herbs and supplements can also be used in lieu of drugs to reduce symptoms of anxiety and depression, including the following:
- St. John’s Wort (Hypericum perforatum) — This medicinal plant has a long historical use for depression, and is thought to work similarly to antidepressants, raising brain chemicals associated with mood such as serotonin, dopamine and noradrenaline.29
- S-Adenosyl methionine (SAMe) — SAMe is an amino acid derivative that occurs naturally in all cells. It plays a role in many biological reactions by transferring its methyl group to DNA, proteins, phospholipids and biogenic amines. Several scientific studies indicate that SAMe may be useful in the treatment of depression.
- 5-Hydroxytryptophan (5-HTP) — 5-HTP is another natural alternative to traditional antidepressants. When your body sets about manufacturing serotonin, it first makes 5-HTP. Taking 5-HTP as a supplement may raise serotonin levels. Evidence suggests 5-HTP outperforms a placebo when it comes to alleviating depression,30 which is more than can be said about antidepressants.
- XingPiJieYu — This Chinese herb, available from doctors of traditional Chinese medicine, has been found to reduce the effects of “chronic, unpredictable stress,” thereby lowering your risk of depression.31
Other Helpful Treatment Options
Evidence clearly shows antidepressants are not an ideal choice for most people with depression. For more information about this, see “What Does the ‘Best Evidence’ Say About Antidepressants?”
In it, I also review a number of other treatment suggestions, such as phototherapy, cognitive behavioral therapy, the Emotional Freedom Techniques and the importance of limiting your electromagnetic field exposure.
Aside from diet, which I believe is foundational, the depression treatment with the most solid scientific backing is exercise. I discussed some of the mechanisms behind this effect in “How Exercise Treats Depression.”
I also review the evidence against antidepressants and provide a list of studies detailing the effectiveness of exercise for depression in “The Depression Pill Epidemic.”
- 1 PLOS ONE April 17, 2014 DOI: 10.1371/journal.pone.0094715
- 2 WebMD January 8, 2013
- 3 Physiological Reports August 23, 2019
- 4 Physiological Reports August 23, 2019, Discussion
- 5, 6 British Journal of Psychiatry 2004 May;184:404-8.
- 7 PLOS ONE October 9, 2019 DOI: 10.1371/journal.pone.0222768
- 8 Reuters October 10, 2019
- 9 NPR October 9, 2019
- 10 PLOS ONE October 9, 2019 DOI: 10.1371/journal.pone.0222768, Intervention
- 11 PLOS ONE October 9, 2019 DOI: 10.1371/journal.pone.0222768, Abstract
- 12 PLOS ONE October 9, 2019 DOI: 10.1371/journal.pone.0222768, Figure 2
- 13 PLOS ONE October 9, 2019 DOI: 10.1371/journal.pone.0222768, Figure 3
- 14 PLOS ONE October 9, 2019 DOI: 10.1371/journal.pone.0222768, Discussion
- 15 Psychosomatic Medicine April 2019; 81(3): 265-280
- 16 Psychosomatic Medicine April 2019; 81(3): 265-280, Implications and Recommendations
- 17 Scientific Reports July 27, 2017; 7, Article Number: 6287
- 18 Translational Psychiatry 2016; 6: e756
- 19 Psychother Psychosom. 2004 Nov-Dec;73(6):334-9
- 20 Nutritionfacts.org March 30, 2017
- 21 American Journal of Psychiatry January 1, 2017; 174(1): 42-50
- 22 Vice August 9, 2017
- 23 PLOS ONE June 27, 2017 DOI: 10.1371/journal.pone.0180067
- 24 The Journal of Nutrition, Health & Aging 1999, 3(1):5-7
- 25 Journal of Internal Medicine 264(6); 599-609
- 26 Psychoneuroendocrinology 2014 Dec;50:210-9
- 27 Neuropsychiatry 2017; 7(5)
- 28 Molecular Psychiatry 2014 Apr;19(4):444-51
- 29 Nutrition Review, St. John’s Wort
- 30 Orvosi Hetilap 2011 Sep 11;152(37):1477-85
- 31 BMC Complement Altern Med. 2017; 17: 73.
- 1 in 3 American adults has high blood pressure, which increases your risk for heart disease, stroke, kidney disease and dementia
- 95% of seniors between the ages of 60 and 90 have lesions in the white matter of their brains, and those with high blood pressure tend to have more white matter lesions and a higher risk for dementia in their later years
- Recent research suggests intensive blood pressure treatment to reach a systolic blood pressure goal of 120 mm Hg can limit the progression of age-related brain damage, thereby lowering your risk for dementia
- While those in the intensive treatment group suffered less brain damage (lesions) over time, they ended up losing a greater total volume of brain matter. The cause for this discrepancy is unknown, and it’s unclear what the clinical significance might be
- Clinical blood pressure guidelines now call for a blood pressure goal of 120/80. Elevated blood pressure or prehypertension is defined as a systolic blood pressure between 120 and 129. Stage 1 high blood pressure is 130 and 139 systolic, and 80 to 89 diastolic. Stage 2 high blood pressure is anything over 140 systolic and 90 diastolic
According to the Centers for Disease Control and Prevention,1 1 in 3 American adults (about 75 million people) have high blood pressure, and about 46% have uncontrolled high blood pressure, which increases your risk for a number of serious health problems, including heart disease, stroke,2 kidney disease3 and dementia.4
With regard to dementia, previous research5 has found that high blood pressure disrupts regulatory mechanisms in your brain by impeding blood flow, thereby causing neuronal damage and dysfunction.
A study6 published in the August 2019 issue of JAMA concluded intensive blood pressure treatment helped limit the progression of cerebral small vessel ischemic disease — referring to common age-related changes in the small blood vessels in your brain7 — thereby lowering the risk for dementia.
Other common terms for this condition is “white matter disease” and “age-related white matter changes.”8 Previous research9 has found 95% of seniors between the ages of 60 and 90 have lesions in the white matter of their brains, and several studies10 have shown people with high blood pressure tend to have more white matter lesions and a higher risk for dementia in their later years.
Intensive blood pressure treatment may lower dementia risk
In the featured JAMA study,11,12 participants were randomly selected to receive intensive treatment to reach a systolic blood pressure goal of 120 mm Hg, or standard treatment, which required maintaining systolic blood pressure below 140 mm Hg.
The primary outcome was the change in total volume of white matter lesions from baseline. The secondary outcome was the change in total brain volume. Follow-up was scheduled to take place at four-year intervals, but the study was stopped early, after just five years, as the primary outcome benefit for those in the intensive treatment group was deemed to be higher, leaving those in the standard treatment group at a disadvantage. According to the authors:13
“In the intensive treatment group, based on a robust linear mixed model, mean white matter lesion volume increased from 4.57 to 5.49 cm3 (difference, 0.92 cm3) vs an increase from 4.40 to 5.85 cm3 (difference, 1.45 cm3) in the standard treatment group (between-group difference in change, −0.54 cm3).”
Curiously, while those in the intensive treatment group suffered less brain damage (lesions) over time, they ended up losing a greater total volume of brain matter. The cause for this discrepancy is unknown, and it’s unclear what the clinical significance might be.
In the end, the researchers deemed the reduction in brain lesions to be more important, at least in terms of protecting against dementia. As noted in the study:14
“Mean total brain volume decreased from 1134.5 to 1104.0 cm3 (difference, −30.6 cm3) in the intensive treatment group vs a decrease from 1134.0 to 1107.1 cm3 (difference, −26.9 cm3) in the standard treatment group (between-group difference in change, −3.7 cm3).
Among hypertensive adults, targeting an SBP of less than 120 mm Hg, compared with less than 140 mm Hg, was significantly associated with a smaller increase in cerebral white matter lesion volume and a greater decrease in total brain volume, although the differences were small.”
Dr. Walter J. Koroshetz, director of the National Institute of Neurological Disorders and Stroke, which funded the study, commented on the findings in an NIH press release:15
“These initial results support a growing body of evidence suggesting that controlling blood pressure may not only reduce the risk of stroke and heart disease but also of age-related cognitive loss. I strongly urge people to know your blood pressure and discuss with your doctors how to optimize control. It may be a key to your future brain health.”
Do you have high blood pressure?
A blood pressure reading gives you two numbers. The upper or first number is your systolic blood pressure reading. The lower or second number is your diastolic pressure. For example, a blood pressure reading of 120 over 80 (120/80 mm Hg) means you have a systolic arterial pressure of 120 and a diastolic arterial pressure of 80.
Your systolic pressure is the highest pressure in your arteries. It occurs when your ventricles contract at the beginning of your cardiac cycle. Diastolic pressure refers to the lowest arterial pressure, and occurs during the resting phase of your cardiac cycle.
The guidelines for healthy blood pressure appear to be a bit of a moving target, having gone through a bewildering number of changes over the past several years.16 In 2014, the blood pressure goal for healthy patients over 60 was 150/90, and 140/90 for those between the ages of 18 and 59.17,18,19
As of 2017, American College of Cardiology and American Heart Association’s clinical guidelines call for a blood pressure goal of 120/80.20,21,22 Elevated blood pressure or prehypertension is defined as a systolic blood pressure between 120 and 129.
Stage 1 high blood pressure is 130 and 139 systolic, and 80 to 89 diastolic. Stage 2 high blood pressure is anything over 140 systolic and 90 diastolic. Anything over 180 systolic and/or 120 diastolic is considered a hypertensive crisis.
As noted in a 2019 review23 in the Cleveland Clinic Journal of Medicine, the 2017 guidelines increased the number of American adults diagnosed with high blood pressure from 31.9% to 45.6%. The latest guidelines also recommend monitoring your blood pressure continuously with a wearable device during daytime hours. As explained by Harvard Health:24
“This additional monitoring can help to tease out masked hypertension (when the blood pressure is normal in our office, but high the rest of the time) or white coat hypertension (when the blood pressure is high in our office, but normal the rest of the time).”
Lowered blood pressure guidelines have their risks
According to the Cleveland Clinic Journal of Medicine review,25 more intensive blood pressure control — meaning meeting the lower 120/80 threshold — “has the potential to significantly reduce rates of morbidity and death associated with cardiovascular disease.” Alas, this reduction comes “at the price of causing more adverse effects.”
According to this review, “All told, about 3 million Americans could suffer a serious adverse effect under the intensive-treatment goals.” Serious side effects experienced by people receiving intensive treatment were higher rates of:26
- Low blood pressure (hypotension) 2.4% versus 1.4% in the standard treatment group
- Fainting (syncope or temporary loss of consciousness) 2.3% versus 1.7%
- Electrolyte abnormalities 3.1% versus 2.3%
- Acute kidney injury or kidney failure 4.1% versus 2.5%
- Other treatment-related adverse events 4.7% versus 2.5%
How to get a proper blood pressure reading
To avoid a false hypertension diagnosis, keep in mind that your blood pressure reading can vary significantly from day to day, and even from one hour to the next, so don’t overreact if you get one high reading here or there. It’s when your blood pressure remains consistently or chronically elevated that significant health problems can occur. The following variables can also affect the validity of your blood pressure reading:
•The blood pressure cuff size — If you’re overweight, taking your reading with a size “average” blood pressure cuff can lead to a falsely elevated blood pressure reading, so make sure your doctor or health care professional is using the right size cuff for your arm.
•Your arm position — If your blood pressure is taken while your arm is parallel to your body, your reading will be falsely elevated. Blood pressure readings should always be taken with your arm at a right angle to your body.
•Stress — “White coat hypertension” is a term used for when a high blood pressure reading is caused by the stress or fear associated with a doctor or hospital visit. This can be a transient yet serious concern. If this applies to you, stress reduction is key.
To decrease your risk of being falsely diagnosed with hypertension in this situation, take a moment to calm down (be sure to arrive for your appointment ahead of time so you can unwind), then breathe deeply and relax when you’re getting your blood pressure taken.
Common causes for high blood pressure
Several factors have been identified as contributing to high blood pressure, including but not limited to:
|Insulin and leptin resistance — As your insulin and leptin levels rise, it causes your blood pressure to increase.27 As noted in one study:28
|Elevated uric acid levels — Like insulin and leptin, high uric acid is also significantly associated with high blood pressure, so any program adopted to address high blood pressure needs to normalize your uric acid level as well. Tellingly, uric acid is a marker for fructose toxicity, so one effective way to do this is to minimize fructose in your diet.|
|Poor nutrition in childhood has been shown to raise the risk of high blood pressure in adulthood.29|
|Air pollution — Air pollution affects blood pressure by causing inflammation. According to one 2019 study,31 “the enhanced exposure to PM2.5 by 10 µg/m3 leads to an increase of systolic and diastolic blood pressure by 1-3 mmHg and is associated with a hazard ratio of 1.13 for the development of arterial hypertension.”|
|Noise pollution — Noise pollution can also affect your blood pressure, primarily by activating stress responses that affect your autonomic and endocrine (hormonal) systems. As noted in one 2017 study:32
Key lifestyle strategies for lowering your blood pressure
In my experience, elevated blood pressure — even stage 1 and 2 high blood pressure — can be successfully addressed with lifestyle interventions, to where drugs become unnecessary. The key is to be sufficiently aggressive in your diet and lifestyle modifications.
That said, if you have seriously elevated blood pressure, it would be wise to take a medication to prevent a stroke while you implement these lifestyle changes. Below, I’ll review several suggestions that can help lower your blood pressure naturally.
Address insulin resistance
As mentioned, high blood pressure is typically associated with insulin resistance,33 which results from eating a diet too high in sugar. As your insulin level elevates, so does your blood pressure.34
There are several reasons for this. For starters, insulin stimulates magnesium uptake.35 If your insulin receptors are blunted and your cells grow resistant to insulin, you cannot store magnesium so it passes out of your body through urination.
To ascertain whether insulin/leptin resistance is at play, be sure to check your fasting insulin level. Aim for a fasting insulin level of 2 to 3 microU per mL (mcU/mL). If it’s 5 mcU/mL or above, you definitely need to lower your insulin level to reduce your risk of high blood pressure and other cardiovascular health problems.
Keep in mind that the so-called “normal” fasting insulin level is anywhere from 5 to 25 mcU/mL, but please do not make the mistake of thinking that this “normal” insulin range equates to optimal.
Aside from raising your insulin, fructose also elevates uric acid, which drives up your blood pressure by inhibiting nitric oxide in your blood vessels. (Uric acid is actually a byproduct of fructose metabolism. In fact, fructose typically generates uric acid within minutes of ingestion.)
If you’re healthy and want to stay that way, the general rule is to keep your total fructose intake to 25 grams per day or less. If you’re insulin resistant and/or have high blood pressure, keep your total fructose to 15 grams or less per day until your condition has resolved.
Eat real food
Being high in sugar, unhealthy seed oils and synthetic chemicals, a processed food diet is a recipe for high blood pressure. Instead, make whole, ideally organic foods the focus of your diet. This will address not only insulin and leptin resistance but also elevated uric acid levels.
One 2010 study36 discovered that those who consumed 74 grams or more per day of fructose (the equivalent of about 2.5 sugary drinks) had a 77% greater risk of having blood pressure levels of 160/100 mmHg. Consuming 74 grams or more of fructose per day also increased the risk of a 135/85 blood pressure reading by 26%, and a reading of 140/90 by 30%.
According to the authors, “These results suggest that high fructose intake, in the form of added sugar, independently associates with higher [blood pressure] levels among U.S. adults without a history of hypertension.”
Also remember to swap nonfiber carbs for healthy fats such as avocados, butter made from raw grass fed organic milk, organic pastured egg yolks, coconut oil, raw nuts such as pecans and macadamia, grass fed meats and pasture raised poultry. To learn more about healthy eating, please see my optimal nutrition plan, which will guide you through the necessary changes step-by-step.
In addition to what you eat, when you eat can also have a significant impact on your insulin sensitivity (and hence blood pressure). Intermittent fasting is one of the most effective ways I’ve found to normalize your insulin/leptin sensitivity. It’s not a diet in conventional terms, but rather a way of timing your eating in such a way as to promote efficient energy use.
Increase your nitric oxide levels
Nitric oxide helps your vessels maintain their elasticity, so nitric oxide suppression increases blood pressure. A specific food that has been found to have a beneficial effect on blood pressure is beetroot juice,37 thanks to its ability to convert the nitrate in the beetroot juice into bioactive nitric oxide.
In one small placebo-controlled trial,38 one glass (250 milliliters or 8.5 ounces) of beetroot juice per day for one month reduced blood pressure in those diagnosed with high blood pressure by a mean of 7.7/2.4 mm Hg when measured in a clinic setting, and 8.1/3.8 mm Hg when measured at home. The treatment group also saw a 20% improvement in endothelial function. Arterial stiffness was also reduced.
Optimize your magnesium and sodium-to-potassium level
Magnesium inhibits high blood pressure39 by combating inflammation, relaxing your arteries and helping prevent thickening of your arteries, allowing for smoother blood flow. Magnesium stored in your cells relaxes muscles, including your blood vessels. If your magnesium level is too low, your blood vessels will constrict, thereby raising your blood pressure.
According to one scientific review,40,41 which included studies dating as far back as 1937, low magnesium appears to be the greatest predictor of heart disease, and other recent research42 shows even subclinical magnesium deficiency can compromise your cardiovascular health.
Your sodium-to-potassium level is also a crucial factor.43 According to Lawrence Appel, lead researcher on the DASH diet and director of the Welch Center for Prevention, Epidemiology and Clinical Research at Johns Hopkins, your diet as a whole is the key to controlling hypertension — not salt reduction alone.
He believes a major part of the equation is this balance of minerals — i.e., most people need less sodium and more potassium, calcium and magnesium. In a 2014 interview, he told USA Today,44 “Higher levels of potassium blunt the effects of sodium. If you can’t reduce or won’t reduce sodium, adding potassium may help. But doing both is better.”
Indeed, maintaining a proper potassium to sodium ratio in your diet is very important, and hypertension is but one of many side effects of an imbalance. A processed food diet virtually guarantees you’ll have a lopsided ratio of too much sodium and too little potassium. Making the switch from processed foods to whole foods will automatically improve your ratios.
Optimize your omega-3 index
Research also highlights the importance of animal-based omega-3 fats for healthy blood pressure — especially in young adults.
In one 2018 study,45 those with the highest serum levels of omega-3 also had the lowest blood pressure readings. On average, their systolic pressure was 4 mm Hg lower and their diastolic pressure was 2 mm Hg lower compared to those with the lowest omega-3 blood levels.
The best way to boost your omega-3 is to eat plenty of oily fish that are low in mercury and other pollutants. Good options include wild caught Alaskan salmon, sardines and anchovies. Alternatively, take a high-quality krill oil supplement.
For information about how to measure your omega-3 level, what the ideal level is and how your omega-3 index affects your risk for heart disease, see the hyperlink above.
Optimize your vitamin D level
Vitamin D deficiency, associated with both arterial stiffness and hypertension,46 is another important consideration. According to researchers from the Emory/Georgia Tech Predictive Health Institute,47 even if you’re considered generally “healthy,” if you’re deficient in vitamin D then your arteries are likely stiffer than they should be.
As a result, your blood pressure may run high due to your blood vessels being unable to relax. In their study, having a serum level of vitamin D lower than 20 nanograms per milliliter (ng/ml) was considered a deficiency state that raises your hypertension risk. Less than 30 ng/ml was deemed insufficient.
Previous research48 has also shown that the farther you live from the equator, the higher your risk of developing high blood pressure. Blood pressure also tends to be higher in winter months than during the summer. Exposing your bare skin to sunlight affects your blood pressure through a variety of different mechanisms, including the following:
- Sun exposure causes your body to produce vitamin D. Lack of sunlight reduces your vitamin D stores and increases parathyroid hormone production, which increases blood pressure.
- Vitamin D deficiency has also been linked to insulin resistance and metabolic syndrome, a group of health problems that can include insulin resistance, elevated cholesterol and triglyceride levels, obesity and high blood pressure.
- Research49 shows that sun exposure increases the level of nitric oxide in your skin. This dilates your blood vessels, thereby reducing your blood pressure. (For comparison, and to show how various factors tie together, uric acid, produced when you eat sugar/fructose, raises your blood pressure by inhibiting nitric oxide in your blood vessels — the opposite effect of sun exposure.)
- Vitamin D is also a negative inhibitor of your body’s renin-angiotensin system (RAS), which regulates blood pressure.50 If you’re vitamin D deficient, it can cause inappropriate activation of your RAS, which may lead to high blood pressure.
Exposure to ultraviolet rays is also thought to cause the release of endorphins, chemicals in your brain that produce feelings of euphoria and relief from pain. Endorphins naturally relieve stress, and stress management is an important factor in resolving high blood pressure. To learn more about vitamin D testing, please see “How Vitamin D Performance Testing Can Help You Optimize Your Health.”
A comprehensive fitness program can go a long way toward regaining your insulin sensitivity and normalizing your blood pressure. To reap the greatest rewards, I recommend including high-intensity interval exercises in your routine.
While the nitric oxide dump I previously promoted is OK to do, I have learned a far superior strategy that not only increases nitric oxide but also increases muscle strength. It is called blood flow restriction training and I should have detailed instructions and videos on this in the next month.
Strength training is particularly important if you’re insulin resistant. When you work individual muscle groups, you increase blood flow to those muscles, and good blood flow will increase your insulin sensitivity.
I also recommend training yourself to breathe through your nose when exercising, as mouth breathing during exercise can raise your heart rate and blood pressure, sometimes resulting in fatigue and dizziness. To learn more about this, please refer to my previous article on the Buteyko breathing method.
Address pollution and stress
Smoking is known to contribute to high blood pressure, as are other forms of air pollution, and even noise pollution. To address these, avoid smoking, consider using ear plugs during sleep if you live in a noisy neighborhood (provided you cannot move), and take steps to improve your indoor air quality.
The connection between stress and high blood pressure is also well documented, yet still does not receive the emphasis it deserves. Suppressed negative emotions such as fear, anger and sadness can severely limit your ability to cope with the unavoidable every day stresses of life.
It’s not the stressful events themselves that are harmful, but your lack of ability to cope. The good news is, strategies exist to quickly and effectively transform your suppressed, negative emotions, and relieve stress.
My preferred method is the Emotional Freedom Techniques (EFT), an easy to learn, easy to use technique for releasing negative emotions. EFT combines visualization with calm, relaxed breathing, while employing gentle tapping to “reprogram” deeply seated emotional patterns.
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