If you’ve spent any time at all researching diet and nutrition online (and if you’re reading this I’m almost certain you have), you know how much contradictory information there is out there.

Vegetarian? Vegan? Raw food? Low-carb? Zero-carb? Eat right for your type? Ornish? Esselstyn? Rosedale? Paleo? Zone? Atkins?

And even within the context of a Paleo diet, there’s still a lot of disagreement on what should – and shouldn’t – be included. Are dairy products allowed, or not? Should you eat low-carb, or is “safe starch” okay? What about nightshades like potatoes? And FODMAPs?

It’s enough to make your head spin.

If you’re like most of my patients, you’ve tried a lot of these diets. Some of them failed, some did nothing at all, and some even worked – at least for a little while. Or maybe they solved some problems (being overweight) but caused others (low energy, hair loss, cold hands and feet).

But after a while, you noticed some of your old problems creeping back in. Or maybe you’ve had trouble losing that last 10 pounds that won’t seem to go away no matter what you do.

Sound familiar? Don’t worry. You’re not alone.

The reason this keeps happening, of course, is that when it comes to diet, there’s no one-size-fits-all approach.

We share a lot in common as human beings, and there are certain guidelines applicable to all of us. But we’re different in important ways too. We have different genetics, consitutions, health status, activity levels, lifestyles and goals. And all of these factors determine what an optimal diet is for each of us.

What if you could stop relying on canned approaches and rigid prescriptions, and create your own highly customized diet – one that works for your body?

My new online program, the Personal Paleo Code, will help you do just that. And it’s available now!

I’ve condensed over 10 years and thousands of hours of research and my experience working with hundreds of patients into a simple – yet highly effective – 3-step approach that will help you discover your own ideal diet and finally end confusion about what to eat.

And as a special gift to readers of my blog, I’m offering 2 exclusive bonuses to the first 150 people that purchase the Personal Paleo Code:

• The Smart Fat Loss Code. This ain’t your daddy’s weight loss course. It’s a bleeding-edge, scientifically proven and clinically validated approach I’ve been fine-tuning with people just like you in my private practice. If you’ve tried everything – including Paleo – and haven’t lost weight, or haven’t been able to keep it off, this course is for you. It will be offered as an online class/webinar over a 6-week period in early 2012.
• Restore Your Gut. 2,500 years ago, Hippocrates said “All disease begins in the gut.” We’re only now beginning to understand how right he was. This step-by-step guide will teach you practical strategies for fixing your gut and promoting optimal digestive health. It will be offered as a PDF, multimedia presentation, or both (I’m not sure of the format yet, but it will be awesome no matter what!) in early 2012.

These bonuses aren’t available anywhere else, and together they’ll eventually sell for 2-3 times the cost of the Personal Paleo Code.

I hope you have as much fun using the Personal Paleo Code as I’ve had creating it. I really think it has the power to change your life.

CLICK HERE to check it out and scoop up the free bonuses.

P.S. I’d love to know what you think of the program after you get inside. Leave me a note on Facebook or Twitter (with the hashtag #paleocode)!

In this “Grab Bag Q&A” episode of the podcast, I discuss the role of nutrition in healing, obstacles to optimal health, macronutrient ratios and more.

Questions include:

• Do you feel with the right nutrition the body is capable of healing itself?
• In your practice, what do you find to be the biggest barrier stopping people from reaching their optimal health?
• Should I eat low-carb, low-fat, or do macronutrient ratios not matter?
• Do you have anything you could teach on the problem of developing gastritis AFTER going paleo?
• Does the food combining theory have any scientific merit?

As part of the recent re-branding of the site from The Healthy Skeptic toward Chris Kresser, I will also be changing the name of the podcast soon. I haven’t settled on a name yet, but keep an eye out for the change.

Dr. Emily Deans’ Evolutionary Psychiatry blog has quickly become one of my favorites over the past year. It’s rare to find a psychiatrist that acknowledges the role of nutrition in mental and behavioral health at all, much less one that approaches these topics from an evolutionary perspective.

I’m excited to announce that Dr. Deans will be joining us on the podcast to discuss nutrition and mental health and answer your questions. We’ll be recording the episode on Friday, June 24th so make sure to leave your questions here by Thursday afternoon PST.

What determines our health?

On this blog we’ve discussed a number of answers to that question. In fact, I just wrote a series called 9 Steps to Perfect Health in which I listed what I consider to be the most significant lifestyle factors contributing to health and disease.

Then we have the contribution of genes – the DNA we inherited and how it shapes our development and health. Chris Masterjohn is writing an excellent series on genetics over at his blog, The Daily Lipid.

But recent research suggests another powerful influence on lifelong health: your mother’s nutritional status during (and even before) her pregnancy. In fact, some researchers now believe the 9 months of pregnancy are the most consequential period of our lives, permanently influencing the wiring of the brain and the function of organs like the heart, liver and pancreas. They also suggest that the conditions we encounter in utero shape everything from our susceptibility to disease, to our appetite and metabolism, to our intelligence and temperament.

You’re only has healthy as your mother’s womb

The idea that the nutritional environment we encounter in the womb affects not only our health at birth and during infancy, but throughout the rest of our adult lives, has come to be known as the Developmental Origins of Health and Disease theory, or DOHaD (gotta love that acronym).

The theory was first proposed by British researcher David J. Barker in the 1980s to explain a seeming contradiction: as British prosperity increased, so did heart disease. Yet geographically, the highest rates of heart disease were found in the poorest places in Britain. Barker found that rather than smoking, dietary fat or some other lifestyle cause, the factor that was most predictive of whether an individual would develop premature heart disease (before the age of 65) was their weight at birth.

Barker found that infants carried to full term with birth weights between 8.5 and 9.5 pounds had a 45 percent lower risk of developing heart disease later in life than infants born at 5.5 pounds. (They also had a lower risk of stroke, a 70% lower risk of insulin resistance and a slightly lower risk of blood pressure later in life.) As the chart below demonstrates, the risk declined in a linear fashion between 5.5 and 9.5 pounds, but started to increase again as birth weight rose above 9.5 pounds.

How the first nine months shapes the rest of your life

Over the last 25 years, Barker’s original work has been reproduced and expanded. If you do a quick search on Pubmed.org for “developmental origins of disease”, you’ll find references to the fetal origins of cancer, heart disease, allergies, asthma, autoimmune disease, diabetes, obesity, mental illness and degenerative conditions like arthritis, osteoporosis, dementia and Alzheimer’s.

The following list is just a small sampling of the literature on the subject:

• The metabolic syndrome. In a 2011 paper, Bruce et al showed that the onset of metabolic syndrome is “increasingly likely following exposure to suboptimal nutrition during critical periods of development”.
• Heart disease & diabetes. In 2002, Barker, the father of the DOHaD hypothesis, published a paper suggesting that slow growth during fetal life and infancy – itself a consequence of poor maternal nutrition – predisposes individuals to coronary heart disease, type 2 diabetes and hypertension later in life.
• Breast cancer. Hilakivi-Clarke, et al . “Thus, maternal diet and environmental exposure might increase the risk of breast cancer by inducing permanent epigenetic changes in the fetus that alter the susceptibility to factors that can initiate breast cancer.”
• Polycystic ovary syndrome (PCOS). Dumesic et al 2007. This paper suggested that insulin resistance and resulting increases of testosterone during pregnancy promotes PCOS during adulthood.
• Obesity. Kalliomaki et al 2008. These researchers found that simply by studying the composition of the maternal gut flora (influenced by nutrition, medications, stress, etc.) they could predict which children will be overweight by age 7!

There are literally hundreds of similar papers in the literature, all pointing to the same conclusion: the nutritional environment in the womb has a significant effect on our health later in life.

Why does Mom’s diet play such a crucial role in determining our future health?

The idea that the nutritional, hormonal and metabolic environment provided by the mother permanently programs the structure and physiology of her offspring was established by Barker back in the 80s.

Essentially, it works like this. Like all living beings in their early lives, humans are able to adapt to their environment. If we couldn’t, we would die. There is a critical period early in life where that adaptation happens, and once that period passes, we become less “plastic” and able to adapt. Our programming is set.

For humans, that critical period when a system is plastic and sensitive to its environment occurs in utero. This makes perfect sense in evolutionary terms. It enables the production of genetic phenotypes that make us better matched to the environment we are likely find ourselves in after we’re born.

For example, if the mother’s nutritional status is poor during pregnancy, the fetus might develop metabolic adaptations that would allow it to store more calories (the “thrifty phenotype” hypothesis). This would have been a protective mechanism that could increase the chances of survival if that fetus was born into an environment where calories were scarce. G

Gluckman et al extended this concept of developmental plasticity by showing that fetal programming operates across the range from undernutrition to overnutrition with a U-shaped curve. This means that the future health of the baby will be affected when Mom gets either too little of the right nutrients or too much of the wrong ones.

Roseboom et al found that undernutrition during pregnancy affects different organs of the body and increases the risk of disease independent of birth weight. Other researchers have theorized that maternal diet may regulate blood flow to developing organs (i.e. to the brain vs. the liver) which in turn causes changes in fetal programming that affect body composition at birth and even later in life.

The nutritional conditions in the womb start before conception

We’ve now established that the nutritional environment of a mother’s womb affects her baby’s health not only at birth and during early infancy, but for the rest of his or her life. This leads us to the obvious conclusion that proper maternal nutrition is crucial for the lifelong health of her offspring.

But what determines the mother’s nutritional status during pregnancy? Certainly, the obvious answer is her diet and lifestyle after she has conceived. But I hope it’s also obvious that the mother’s diet in the months and even years leading up to conception is also important.

This is why traditional cultures have sacred fertility foods they feed to mothers-to-be and even fathers-to-be. These include nutrient dense foods like fish eggs, liver, bone marrow, egg yolks and other animal fats. For example, the Masai tribe in Africa only allowed couples to marry and become pregnant after spending several months drinking milk in the wet season when the grass is lush and the nutrient content of the milk is especially high.

Unfortunately this traditional wisdom has been largely lost in the modern world. The role of nutrition during pre-conception is scarcely even mentioned in the media or conventional medical settings. Yet as we’ve seen in this article, a mother’s diet prior to conception and during pregnancy may be one of the most important factors in determining the lifelong health of her baby.

Another problem is that many women are (understandably) confused about what constitutes proper nutrition during the pre-conception and pregnancy period. There’s so much contradictory information out there, and it can be difficult for the layperson to know what to believe and who to trust.

As many of you know, I’ve been teaching a seminar called Grow a Healthy Baby on nutrition for fertility, pregnancy and breastfeeding locally in the Bay Area for the past several months. I’m excited to announce that this material will soon be available as an online home study course. I’m shooting for mid-May as a launch date.

To learn more about the course and sign up to be notified when it becomes available, click here to join the mailing list. I’ll be making a special limited-time offer to people on this list, so be sure to sign up early if you’re interested in the course.

This week’s episode is all about nutrition for fertility, pregnancy and breastfeeding. I answer common questions like:

• What do you see as the biggest factor keeping women from getting pregnant these days? What one factor, if optimized, has the biggest effect on fertility?
• How important is the father’s nutritional status pre-conception?  What should a man be eating to improve the chances of conception?
• Do you recommend significantly different diets during the times a couple is trying to get pregnant versus after she becomes pregnant?
• Can I continue my paleo/low-carb lifestyle if I fall pregnant? Is it safe to practice a paleo diet while pregnant? Most doctor’s say it isn’t.
• When I was pregnant in the past, I had TERRIBLE morning sickness. How can I maintain a healthy eating plan and deal with food aversions/ morning sickness/ sheer exhaustion?
• What prenatal vitamin (with DHA?) would you recommend? Are generic supplements targeted at pregnant woman worth taking?

We also discuss appropriate weight gain during pregnancy, how to avoid gestational diabetes, how long to breastfeed and how to ensure adequate milk supply.

At the end of the podcast I talk a little bit about the Grow a Healthy Baby Home Study Course, which will be available online by the end of this month or early next month. If you’d like to be notified when it becomes available, click here to join the mailing list. Note that I’ll be making a special offer to people on that list, so sign up so you don’t miss out!

I’m teaching a new 3-hour seminar on February 13th in Berkeley, CA on nutrition for conception, pregnancy and breastfeeding. In March or April I plan to offer the same material as an online class, to make it accessible to those of you that don’t live in the Bay Area. I also intend to record the class and put it all on a DVD for those that won’t be able to attend the live seminar or online class.

I’ll be offering this seminar live in the Bay Area every 2-3 months. If you can’t make this one, but are interested in coming at some point, click here to put your name on a mailing list. You can also sign up for the mailing list if you’d like to be notified when the online class and DVD is ready.

I’m passionate about this topic. There’s no time when a nutrient-dense diet is more important (for both mother and baby) than during pre-conception, pregnancy and breastfeeding. If you or anyone you know is preparing to have a baby or is currently breastfeeding or pregnant, please tell them about this seminar and class series! I’ve included information about the seminar below.

• Download a PDF flyer
• Register online (pre-registration required)

GROWING A HEALTHY BABY

Nutrition for conception, pregnancy and breastfeeding

3-HOUR SEMINAR
Sunday, February 13th from 1:00pm – 4:00pm

Location TBD in Berkeley, CA
$50 per person • $75 per couple
PRE-REGISTRATION REQUIRED • Registration closes Sunday, February 6th
Visit healthybaby.eventbrite.com to register
Click here to download a flyer

EVERY PARENT wants their children to be as healthy as possible. Good maternal nutrition promotes robust, lifelong health and protects children from diabetes, stroke, heart disease, kidney disease and cognitive and behavioral problems as they age.

Traditional cultures around the world provide special pre-conception and pregnancy diets to mothers-to-be, and in some cases, even fathers-to-be. For example, the Masai in Africa only allowed men and women to marry after spending several months consuming nutrient dense foods known to be essential to a healthy pregnancy.

Modern research has identified the essential nutrients in foods emphasized by traditional cultures and expanded on their role in both maternal and fetal health. Fat soluble vitamins, like A, D, K2 & E, are necessary for proper growth and development. The omega-3 fatty acid DHA is crucial for the brain, especially visual acuity and cognitive function. Folate boosts growth and decreases the risk of birth defects; choline causes a lifelong increase in memory and attention; and glycine, an amino acid, is needed for growth.

Unfortunately, many mothers are confused about what to eat before, during and after pregnancy. In the age of the internet, conflicting information abounds. This 3-hour seminar draws on both traditional wisdom and modern research to cut through the confusion and bring you clear and proven nutritional guidelines that will help you conceive, birth and nourish a healthy baby.

By the end of the seminar, you will know:

• The most important nutrients for fertility & conception
• The ideal ratio of protein, carbohydrate and fat
• Essential nutrients for maternal and fetal health during pregnancy
• Which foods should be emphasized
• Which supplements you need, how much, and why
• Which foods should be avoided or minimized

I read a lot about health and nutrition. I mean a lot. Sometimes several books a week, along with papers from the scientific literature. I’m a total research nerd. I admit it.

One complaint I’ve had for a long time is that there hasn’t been a single book I can recommend without reservation to friends and family that reflects my views on nutrition. There are certainly some great books out there, but there’s almost always something relatively significant I disagree with that keeps me from giving my full stamp of approval.

I had come to the conclusion that I’d have to write this book myself, but I simply don’t have the time and don’t anticipate that changing in the near future.

That’s why I was thrilled (and relieved) to discover the Perfect Health Diet by Paul Jaminet, Ph.D and Shou-Ching Shih, Ph.D. Paul was an astrophysicist at Harvard and Shou-Ching is a molecular biologist and cancer researcher at Harvard, and let me tell you, these folks are smart. Of course we know that being smart alone doesn’t cut it in the world of nutrition, but I’m happy to tell you that Paul & Shou-Ching combine broad and deep research, clear thinking and a direct, accessible writing style with a rock-solid grounding in evolutionary biology and nutrition.

Their book hasn’t been published yet, but it’s available as a PDF from their website. One of my readers linked to their blog, which I was unaware of. I read their series on healing gut problems, and it was so well done that I decided to check out their book.

I’m so glad I did. It’s broken into three sections: “optimizing macronutrition”, “eat paleo, not toxic” and “nutrition”. They cover everything from the ideal macronutrient ratio, to the finer points of fat metabolism, to the role of chronic infections in modern disease, to which foods are toxic and why, to the benefits of starch and the dangers of fructose.

It’s chock-full of well chosen studies to back up their arguments, but it’s written for the layperson so you don’t need a Ph.D from Harvard to understand it. I have not been this impressed by a book in this genre for a long time, and I’ve never found one that so closely reflects my views on nutrition.

They’ve got an A-list blog, too. Reading a few posts there will give you a good idea of the quality of their writing and research. The book costs about $25. Although it’s not yet in its final version, if you buy it now you’ll receive a hard copy when it’s finished.

Many of you have emailed me in the past asking me what book I would suggest as an introduction to the nutritional principles I write about. Well, this is it. Head over to their website and check it out.

In Part I and Part II of this series, we examined drug-free alternatives to treating depression including exercise, psychotherapy, light therapy, St. John’s Wort and acupuncture. We have learned that all of these treatments are at least as effective as antidepressants in the short term, and some (exercise and psychotherapy) are more effective in the long-term. All of these treatments have far fewer side effects, risks and complications than antidepressants. In fact, the only “side effects” of exercise and psychotherapy are positive ones: improved physiological and mental health!

Today we will look at other lifestyle-based approaches to treating depression without drugs. As I mentioned in the previous article, because 70% of research is funded by drug companies, many of these non-drug approaches have not been studied as extensively as antidepressant medication.

Nevertheless, there is enough data from clinical and epidemiological studies to support the following strategies – especially since they are superior to antidepressants from a “cost/risk – benefit” analysis. In other words, though some of the approaches I will propose in this article have not been exhaustively proven according to the standards of Western science, there are several lines of evidence supporting their effectiveness and without exception they have beneficial side effects and improve the quality of patient’s lives.

What’s more, all of these approaches can be combined together along with the treatments mentioned in the two previous articles to obtain the maximum effect. Based on the available evidence which we have extensively reviewed, these non-drug treatments should without a doubt be the first line of defense (as well as the second, third, fourth, etc.) in treating depression.

Nutrition

At some point in the future, I hope to dedicate an entire post (or perhaps more) to the subject of nutrition and depression. I personally believe that inadequate nutrition is a significant contributing factor to the continuously rising rates of depression in this country. Consequently, I also believe that proper nutrition can be one of the most effective treatments for depression.

For now, I will go over what I feel are the most important aspects of nutritional causes and treatment of depression, and hopefully address the subject in more detail later.

SUGAR

Diabetes is correlated with higher rates of depression. In 2005, researchers discovered a positive connection between higher levels of insulin resistance and severity of depressive symptoms in patients with impaired glucose tolerance, before the occurrence of diabetes. Based on these findings, it was suggested that insulin resistance could be the result of an increased release of counter-regulatory hormones linked to depression; however, this has not been confirmed.

Sugar can increase fasting levels of glucose and can cause reactive hypoglycemia. Sugar can also cause a decrease in your insulin sensitivity thereby causing an abnormally high insulin levels and eventually diabetes. Based on the study results above, this is one mechanism by which sugar could contribute to depression.

There is no doubt that increased sugar intake leads to hormonal changes that can lead to emotional instability. Therefore, people who are depressed (and all people, in fact) should significantly decrease their sugar consumption.

OMEGA-6 / OMEGA-3 RATIO

Anthropological evidence suggests that the intake of omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids (PUFA) during the Paleolithic era was roughly equal, whereas the present n-6 to n-3 PUFA in western countries has ben estimated to be between 10 and 25 to 1. The n-6 to n-3 PUFA imbalance has been due mainly to the increase in vegetable and seed oil use and the rise in consumption of processed foods (which contain these oils).

Two major studies have provided direct evidence for the role of the n-6 to n-3 PUFA ratio in depression. The studies found that depression is associated with significantly decreased total n-3 PUFA and increased n-6 to n-3 PUFA ratio (Maes et al. 1996; Maes et al. 1999) . A supporting study carried out in 1998 also found a significant depletion in total n-3 PUFA, and in particular DHA, in the erythrocyte membranes of depressed patients.

Epidemiological data show the trend in decreasing dietary n-3 PUFA consumption and the increasing evidence of depression, both over time and between nations (Hibbeln et al. 1995). Further investigation suggests that the significance lies in the increase in n-6 to n-3 ratio, rather than simply low n-3 intake alone, as these two fatty acids compete in binding to enzyme systems that produce chain elongation and further desaturation. A diet high in n-6 fatty acids prevents the incorporation of n-3 PUFA into cell membranes and phospholipids (Spector et al. 1985).

All polyunsaturated fatty acids – including n-3 PUFA – have been shown to make lipoproteins more vulnerable to oxidative damage (Reaven et al. 1991), and oxidative damage is a significant risk factor for heart disease, cancer and many other conditions. As mentioned above, n-6 consumption actually prevents the incorporation of n-3 into our cells. Therefore, rather than increasing our consumption of n-3 PUFA to treat depression, as is often suggested, it makes more sense to dramatically decrease our consumption of n-6 PUFA. This will help our bodies to incorporate the small, but adequate amount of n-3 PUFA we get in a whole-foods based diet. Avoiding n-6 PUFA (primarily found in vegetable and seed oils, and in animals fed vegetables high in n-6 like pigs and chickens) will not only alleviate depression, but also benefit our health in many other ways.

VITAMIN D

In a 1998 controlled experiment, Australian researchers found that vitamin D (400 and 800 IU), significantly enhanced positive affect when given to healthy individuals. Forty-four subjects were given 400 IU cholecalciferol, 800 IU cholecalciferol, or placebo for 5 days during late winter in a random double-blind study. Results on a self-report measure showed that vitamin D3 enhanced positive affect a full standard deviation and there was some evidence of a reduction in negative affect. The authors concluded: “vitamin D3 deficiency provides a compelling and parsimonious explanation for seasonal variations in mood” (Landsdowne & Provost, 1998).

In another study in 1999, the vitamin D scientist, Bruce Hollis, teamed up with Michael Gloth and Wasif Alam to find that 100,000 IU of vitamin D given as a one time oral dose improved depression scales better than light therapy in a small group of patients with seasonal affective disorder. All subjects in the vitamin D group improved in all measures and, more importantly, improvement in 25(OH)D levels levels was significantly associated with the degree of improvement (Gloth et al. 1999).

According to the Vitamin D Council:

If you suffer from depression, get your 25(OH)D level checked and, if it is lower than 35 ng/mL (87 nM/L), you are vitamin D deficient and should begin treatment. If you are not depressed, get your 25(OH)D level checked anyway. If it is lower than 35 ng/mL (87 nM/L), you are vitamin D deficient and should begin treatment.

Recommended intake is up to 5,000 IU per day of vitamin D through exposure to sunshine and/or supplementation. See this article on vitamin D to learn to calculate how much vitamin D is produced given a certain amount of exposure to sunlight, and to learn more about vitamin D supplementation. It is important to remember that D works synergistically with A & K2, so if you increase your intake of D you must also increase your intake of A & K2 to avoid D toxicity.

Finally, I’d like to share with you a comment I received from a reader about how he/she has cured depression with nutritional intervention. Note that I endorse just about every suggested step, with the exception of the significant increase in n-3 intake. Based on the evidence above, I suspect that his/her improvement was a result of the decrease in n-6 PUFA more than it was the increase in n-3 PUFA.

Following the reader’s advice will not only relieve depression, it will dramatically improve all aspects of your physical, emotional and mental health.

Adequate sleep and rest

Recent studies have definitively linked insomnia with depression and increased suicidal behavior. A research abstract that was presented on June 12 at SLEEP 2008, the annual meeting of the Associated Professional Sleep Societies, found a link between poor sleep and suicidal behavior among children and adolescents with depressive episodes. 83.8% of the depressed patients in the study had sleep disturbances, and there was a significant association between suicidal behavior and the presence of sleep complaints.

Another recent study confirmed the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia. According to the study, 17% – 50% of subjects with insomnia lasting just two weeks or longer developed a major depressive episode reported in a later interview.

Other research has indicated that insomnia can cause depressed mood and adversely affect endocrine function (Banks 2007).

Most Americans are chronically sleep deprived. The foundation’s 2001 national “Sleep in America” poll reported that almost seven out of 10 Americans experienced frequent sleep problems, and that most were undiagnosed. The same poll in 2003 found that 67 percent of older adults had frequent sleep problems and only one in eight had been diagnosed.

This alone could explain the epidemic increase in depression over the last several decades. But when sleep deprivation is added to other factors such as increased intake of n-6 PUFA, increased stress, the use of antidepressant drugs, the breakdown of family, community and other social support structures, it isn’t difficult at all to understand why so many of us are depressed.

The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good night’s sleep:

• Follow a consistent bedtime routine.
• Establish a relaxing setting at bedtime.
• Get a full night’s sleep every night.
• Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
• Keep computers and TVs out of the bedroom.
• Do not go to bed hungry, but don’t eat a big meal before bedtime either.
• Avoid any rigorous exercise within six hours of your bedtime.
• Make your bedroom quiet, dark and a little bit cool.
• Get up at the same time every morning.

Stress Management

An increasing amount of evidence (along with common sense) indicates that chronic stress directly contributes to depression. Please see my recent article for more information about this.

I am not aware of any well-designed clinical trials examining the effects of stress reduction on depression. However, logic dictates that since stress is a cause of and contributing factor to depression, managing stress is an important aspect of treating depression.

One study published in 1995 showed that meditation can improve mood. Another small study demonstrated that mindfulness-based cognitive therapy (MBCT) significantly improved depression and reduced relapse. A series of studies and case studies have shown that biofeedback can also be effective for depression and mood disorders.

The reality is that there are many ways to manage and reduce stress, from yoga to meditation to mindfulness-based stress reduction to progressive relaxation techniques. The important thing is not which method you choose, but that you commit to something and do it on a regular basis.

Prayer & Spiritual Practice

You’re not going to see much scientific research into the role of prayer and spiritual practice in treating depression. Nevertheless, for as long as people have been “depressed” they have used their relationship with God, nature, a “higher power” or whatever guiding principles they embrace to get through difficult times.

People who are depressed often feel isolated, alienated or alone. A strong faith in God or in the interconnectedness of all life can re-establish a sense of belonging and support. Prayer and spirituality can also re-frame the depression one is experiencing in a larger and less “personal” context.

In my previous article called The Heart of Depression, we examined how cultural, religious and spiritual beliefs in these traditional societies provide a context in which symptoms of depression and other mental illness can be understood outside of the label of medical disease or pathology. Possession and rites of passage are two examples of such contexts.

The words and labels we use to “frame” our experience have tremendous power. In the U.S. today, depression is viewed as a sickness that must be cured, as a pathology, as a “biological disease”. There is little doubt that the people who seek treatment for depression are suffering. But should psychological and emotional suffering always be viewed as “something to get rid of”?

Great religious and spiritual traditions from around the world view suffering as an avenue to greater understanding of oneself, life and God. Suffering can be viewed as a signal drawing our attention to issues in our life that need to be addressed.

Spirituality and prayer can help people who are suffering to understand their experience in a more empowering and self-validating context than what is offered by mainstream medicine. When one views their suffering as an opportunity for growth and evolution, rather than as a disease requiring treatment with drugs, it is far more likely that lasting, positive change will occur.

In the next and final article (for a while, at least) in my series on depression and antidepressants, I will summarize everything we’ve covered so far and offer my recommendations for treating depression holistically.