From time to time, people ask me whether diet really can have an effect on mood.
The answer is yes, though diet doesn’t usually provide a quick fix for depression. It may seem silly to say it, but — as a rule — the healthier your diet (and your lifestyle), the healthier your brain will be. And a healthy brain often means a healthy mind.
The brain is a very complicated machine, however, so there are a lot of little details that go into keeping it healthy. Getting enough of the right vitamins is one of the details.
Folate, a B-vitamin found in leafy green vegetables, citrus fruits, and beans may be particularly useful when it comes to helping people with depressed mood and other psychiatric symptoms. Folate (also known as folic acid and vitamin B9) is already known to be important for health. Pregnant women need it to prevent miscarriage and birth defects, and although there is no proof, some think that it provides protection against heart disease, stroke, and certain cancers. Since 1998, the FDA has required the addition of folate to enriched flour and other grain products. The recommended dose is 400 mcg (0.4 mg) a day — 600 mcg for pregnant women. Older people may also need higher doses because they don’t absorb folate well.
Along with vitamins B6 and B12, folate helps break down the amino acid homocysteine. High blood levels of homocysteine are associated with Alzheimer’s disease and depression, although a cause-and-effect relationship hasn’t been proven. The breakdown of homocysteine generates SAMe, a major constituent of brain cells and, some think, a possible treatment for depression. Low levels of SAMe might explain any connection between folate and depression.
Some people carry a variant gene that prevents them from making full use of the folate in their diet. A meta-analysis published in 2006 suggests that this variant is associated with schizophrenia, depression, and bipolar disorder. There’s also some evidence that people with low blood levels of folate are less likely to get relief from antidepressant drugs.
Folate supplements have been tested as a treatment for depression, but the results have been mixed:
- One review and meta-analysis found that folate by itself had no effect, but supplements might give a boost to antidepressant drugs.
- In one placebo-controlled study, 500 mcg of folate added to fluoxetine (Prozac) showed no clear added benefit. Although the combination appeared to improve the response by more than 30% compared to the drug alone among women, that could have been a chance effect. In men, folate levels increased, but homocysteine levels did not fall.
- Another study found that added folate was helpful for depressed patients who had been taking fluoxetine unsuccessfully for two months.
Longer-term research may be needed, because some believe folate acts gradually and cumulatively to relieve or prevent depression. The required dose, too, is still uncertain. Further trials are under way.
The main risk of folate supplements is disguising the symptoms of a vitamin B12 deficiency. Apart from that, doses much higher than the daily recommended allowance — up to 15 mg a day — haven’t been shown to cause serious side effects.
Given the mixed results, there is no reason to go out and load up on folate, but it might help to make sure you’re getting enough in your diet. Or you can take a multivitamin that provides the minimum requirements.
The research does cue us all to mind our diet as a way to stay mentally healthy.
Some people think changes in diet lead to mood changes, but the differences may be hard to notice. Has this been true for you? Or have you seen a more obvious effect of diet on your mood? How? What works and what doesn’t?
Dr. Michael Millerhas been on staff of the Beth Israel Deaconess Medical Center, a large teaching hospital in Boston, for more than 25 years. He is also an Assistant Professor of Psychiatry at Harvard Medical School.
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Comments: 17
and junk food makes me feel sluggish and down
How would taking folate supplements disguise B12 deficiency? Aren't they different vitamins with different symptoms for deficiency? What ARE the symptoms of B12 deficiency?
I think you're right to underscore the lack of magic in folate as a treatment for depression. The take home message about folate: Make sure you have enough of it in your diet — it's a simple thing to tick off on the daily checklist.
Even if adding folate helps just a few people, there is very little downside to trying it — it causes virtually no problems, is fairly cheap and is easy to add to your diet. Good luck with it!
You all allude to an idea that's very important regarding the activities we pursue to promote our health. If they help us, they do so in ways that are hard to define.
You use some of the relevant language: We feel droopier, or sharper; we have subtle changes in our energy level; or we just feel healthier, which leads us to feel a little more capable of getting through the stress of life.
My view is, every little bit helps, including having adequate "doses" of vitamins in your diet.
You point out how difficult it is to take care of yourself when you're depressed — a healthy diet or regular exercise — they're easy to let go when you're down. It's a chicken and egg problem, isn't it?
There are so many things that people suggest you should do to improve your mood. But you have to have the energy or the motivation to do them. And depression saps you of the energy and the motivation to get started. Sometimes getting a small ball rolling can make a difference. The little efforts you make (like minding the vitamins in your diet) can lead to feeling more motivated.
You ask a good question about vitamin B12 deficiency — let me try to clarify that comment about Folate and B12.
If someone is has a deficiency of folate, it's not unusual for them to have a B12 deficiency as well.
I am not an expert on vitamin deficiency, but I can tell you that two key problems that occur in B12 deficiency are anemia (low red blood cell counts) and nerve cell damage. Folate can partially correct the anemia, but it won't do anything for the nerve damage. The bottom line is, you need both vitamins. If you just replace folate, it could be easy to overlook the nerve problems that are still lurking as a result of B12 deficiency.
If you're interested in reading more about this topic, the Office of Dietary Supplements at the National Institutes of Health (NIH) has lots of information about vitamins and vitamin deficiencies. The link is http://ods.od.nih.gov/
The question raised in this article is, if you take EXTRA folate, will it improve your mood? It may work for a few people, but the key is to look at vitamins as a part of overall nutrition. Understanding what vitamins do can help you work toward your nutritional goals.