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The Best Diet for Depression

Depression affects more than 150 million people worldwide, making it a leading cause of losing healthy years of life as a result of disability. By 2020, depression may be second only to heart disease as the leading cause of healthy years of life lost. Why is depression so common? Well, it’s said, “Nothing in Biology makes sense except in the light of evolution.” Why would we evolve to get depressed?

Depression presents a baffling evolutionary puzzle. Despite its negative effects, it remains common and heritable, meaning a large part of the risk is passed through our genes. Presumably, there must be some kind of adaptive benefit or it would have been naturally selected against. Could depression be an evolutionary strategy to provide a defense against infection? Infection has been the leading cause of mortality throughout human history, making it a critical force in natural selection. Indeed, because of infections, our average life expectancy before the industrial period was only 25 years, and it was not uncommon for half of our children to die without reaching adulthood.

When we become infected, there is a surge of inflammation as our body mounts a counter-attack. Our body responds by feeling lousy, sick, weak, tired, and slow. We don’t want to socialize. The only thing we do want to do is sleep. These symptoms are similar to the ones we experience during depression and are great for fighting infection. Slowing down not only helps us conserve energy to put up a good fight; it also reduces social contact so we don’t infect others. We see this protective phenomenon in other social animals, like honeybees and mole rats, who feel compelled to crawl off and die alone to reduce the risk of infecting the rest of their community. Humans have even evolved to think poop and decaying flesh don’t smell particularly good to keep us safe from infection.

To explore the relationship between inflammation and mental health, we have to look back to 1887, when this connection was first noted by Dr. Julius Wagner-Jauregg, the only psychiatrist to ever win the Nobel Prize. What evidence have we accumulated in the past century that inflammation causes depression? We know that people who are depressed have raised inflammatory markers, such as C-reactive protein and that inflammatory illnesses are associated with greater rates of major depression. Indeed, we find depression in even more benign inflammatory conditions such as asthma and allergies. This is important as it suggests that the mood symptoms may be directly tied to the inflammation and are not simply the result of “feeling bad about having a terrible disease.”

We also know that you can induce depression by inducing inflammation. For example, when we give interferon for certain cancers or chronic infection, up to 50 percent of people go on to suffer major depression. Even just giving a vaccine can cause enough inflammation to trigger depressive symptoms. Taken together, these studies “are strongly suggestive of inflammation being a causative factor of mood symptoms.”

Can an anti-inflammatory diet help prevent depression? We didn’t know until researchers followed the diets of about 43,000 women without depression for approximately 12 years. Those who ate a more inflammatory diet, characterized by more soda, refined grains, and meat, became depressed. “This finding suggests that chronic inflammation may underlie the association between diet and depression.”

Normally, we think of omega-3s as anti-inflammatory, but researchers found fish to be pro-inflammatory, associated with increased C-reactive protein levels. This is consistent with recent findings that omega-3s don’t seem to help with either depression or inflammation. As I discuss in my video Anti-Inflammatory Diet for Depression, the most anti-inflammatory diet is a plant-based diet, which is capable of cutting C-reactive protein levels by an impressive 30 percent within two weeks, perhaps because of the anti-inflammatory properties of the antioxidants found in plants. I talked about this in my Anti-Inflammatory Antioxidants video, but never explained why antioxidants are anti-inflammatory.

When free radicals cause oxidative damage, it may cause an autoimmune response in the body by changing the chemical structures of otherwise ubiquitous molecules to generate new structures that the body attacks as foreign. For example, when LDL cholesterol gets oxidized, our body creates antibodies against it that attack it. Likewise, clinical depression can be accompanied by increased oxidative stress and the autoimmune inflammatory responses it creates. Free radicals may thus lead to autoimmune inflammation.

Where else does inflammation in our diet come from? Endotoxins. It’s worth reviewing my videos on the subject—The Leaky Gut Theory of Why Animal Products Cause Inflammation, Dead Meat Bacteria Endotoxemia, and The Exogenous Endotoxin Theory—to see how the endotoxins in animal products can cause a burst of inflammation within hours of consumption. What does this burst do to our mood? Within a few hours of injecting endotoxins, inflammation shoots up, increasing feelings of depression and social disconnection.

Although previous research has demonstrated that inflammatory activity contributes to depressive symptoms, only recently did research show the effect of experimentally induced inflammation on anhedonia, the lack of reaction to pleasurable stimuli. In the study, subjects were injected with endotoxin. Within hours of the endotoxin hitting their bloodstreams, they began feeling depressed and had significant activity reductions in the reward center of the brain. The subjects, for example, were less excited about winning money playing video games. But as I discuss in my Plant-Based Diets for Improved Mood and Productivity and Antioxidants and Depression videos, we may be able to treat or even prevent depression by eliminating animal products and eating antioxidant-rich diets.


If you’re as much of a sucker for evolutionary biology theory as I am, you can learn more about it by checking out my High Blood Pressure May Be a Choice, The Problem with the Paleo Diet Argument, and Why Do We Age? videos. 

I have several videos on inflammation, including: 

And in Biblical Daniel Fast Put to the Test, I discuss a study that shows a dramatic decrease in inflammation within weeks on a plant-based diet.

For more information on the effect diet can have on mental health, check out:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


51 responses to “The Best Diet for Depression

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  1. According to Evolutionary Psychology depression is a normal emotional response in humans so that we get appropriate feedback to our performance in important value added exchange arenas such as friends, trading partners (business), and mates. One could add being depressed over one’s general health to this list in the modern world as a result of our knowledge in this area and our longer lifespans when compared to our ancestors in the stone age. The depression serves an important function in improving our performance in these areas and is thus biologically useful. Improve your performance in these areas and you will eventually reduce and even eliminate your depression.




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      1. If anyone is interested in learning more regarding Evolutionary Psychology concepts there is an excellent Podcast available in which Dr Doug Lisle discusses various ideas including topics such as depression called “Beating Your Genes” which some might find useful.




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        1. Anyone interested should also consult critics of the “field”. Basically, it seems to be no more than highly speculative “just so” stories, i.e. there is no real science behind it. Cf. from

          https://en.wikipedia.org/wiki/Evolutionary_psychology#Testability_of_hypotheses

          Testability of hypotheses
          See also: Just-so story
          A frequent critique of the discipline is that the hypotheses of evolutionary psychology are frequently arbitrary and difficult or impossible to adequately test, thus questioning its status as an actual scientific discipline, for example because many current traits probably evolved to serve different functions than they do now.[5][152] While evolutionary psychology hypotheses are difficult to test, evolutionary psychologists assert that it is not impossible.[153] Part of the critique of the scientific base of evolutionary psychology includes a critique of the concept of the Environments of Evolutionary Adaptation. Some critics have argued that researchers know so little about the environment in which Homo sapiens evolved that explaining specific traits as an adaption to that environment becomes highly speculative.[154] Evolutionary psychologists respond that they do know many things about this environment, including the facts that present day humans’ ancestors were hunter-gatherers, that they generally lived in small tribes, etc.[155]

          Sounds to me like EP is just a new playground for some academics like Pinker.




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    1. Dr. Michael,
      I agree that depression is part of “normal” human response to … stress. Specifically, it goes nicely as part of the stress response to “learned hopelessness” and “learned helplessness” and to accepting things that are “not acceptable” but not changeable by the individual. I belive you will find research to support this notion.

      But, if you can’t find it, let me know and I will point you in the right direction.

      Dr. Mike
      Mfmascia@veritasHC.org
      Co author The Stress Management Workbook: An action plan for taking control of your life and health




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    2. Armand- you spout that out like someone who has never had to deal with clinical depression. While depression can be in response to feedback from the environment, that explanation doesn’t have any bearing on many cases of depression. You can have a wonderful life in every objective way and still feel so awful that death looks like preferable option compared to the pain of living.

      I’m not saying that you’re wrong, but I am definitely saying that your line of thought is not the whole story.




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      1. I would agree with you. Just thought that this line of reasoning would be useful to some people. Didn’t mean to sound like I was spouting off.




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    1. Hi Margie,
      Thank you for asking questions! I hope you find yourself welcome here. Unfortunately, ketogenic and low-carb diets are fad diets that do not have any health benefits. Ketosis is one of the body’s starvation responses, and any product claiming to give you “instant ketosis” is being fraudulent.

      I think you will find interesting info in the topic linked below.
      https://nutritionfacts.org/topics/low-carb-diets/




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    2. Nobodt really knows what the long term effects of ketosis diets are. However, we do know that low carb diets generally are associanted with higher mortality risk.

      Keto diets have been shown to successfully treat intractable paediatric epilepsy. However, even there and under strict medical supervision, there are side effects and even some risks of serious comlications. It is not a diet for the faint hearted.

      “RESULTS: The most common early-onset complication was dehydration, especially in patients who started the KD with initial fasting. Gastrointestinal disturbances, such as nausea/vomiting, diarrhea, and constipation, also were frequently noted, sometimes associated with gastritis and fat intolerance. Other early-onset complications, in order of frequency, were hypertriglyceridemia, transient hyperuricemia, hypercholesterolemia, various infectious diseases, symptomatic hypoglycemia, hypoproteinemia, hypomagnesemia, repetitive hyponatremia, low concentrations of high-density lipoprotein, lipoid pneumonia due to aspiration, hepatitis, acute pancreatitis, and persistent metabolic acidosis. Late-onset complications also included osteopenia, renal stones, cardiomyopathy, secondary hypocarnitinemia, and iron-deficiency anemia. Most early- and late-onset complications were transient and successfully managed by careful follow-up and conservative strategies. However, 22 (17.1%) patients ceased the KD because of various kinds of serious complications, and 4 (3.1%) patients died during the KD, two of sepsis, one of cardiomyopathy, and one of lipoid pneumonia.

      CONCLUSIONS: Most complications of the KD are transient and can be managed easily with various conservative treatments. However, life-threatening complications should be monitored closely during follow-up.”
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198735/




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  2. Biology is complicated. Prolonged exercise is associated with 1) oxidative stress and inflammation, and 2) runners high (understood to be hormonal). It will be interesting to learn how this squares with the inflammation-depression theory.




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      1. Blair, Dr. Gregor is only addressing fish oil supplementation as it relates to cardiac disease, not depression.
        I have seen changing omega 6, omega 3 ratio in patients make a big difference.
        And perhaps that is the problem even with the cardiac studies.
        They weren’t looking at the ratio of oils in the diet, and most people get way too much omega 6’s (vegetable oils, not including olive and avocado).
        Also, most people who supplement fish oil take capsules which sat on a shelf getting oxidized. Not helpful.
        That is the problem with all unsaturated fats, they easily oxidize. So even nuts should be bought not roasted, and kept in the frig.




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    1. Yes, some studies find that fish oil prevents or relieves the symptoms. However, others find no effect.

      A 2010 meta analysis of randomised controlled trials found

      “Meta-analysis demonstrated significant heterogeneity and publication bias. Nearly all evidence of omega-3 benefit was removed after adjusting for publication bias using the trim-and-fill method (SMD=0.01, 95% CI: -0.13, 0.15). Secondary analyses suggested a trend towards increased efficacy of omega-3 fatty acids in trials of lower methodological quality, trials of shorter duration, trials, which utilized completers rather than intention-to-treat analysis, and trials in which study participants had greater baseline depression severity,

      Current published trials suggest a small, non-significant benefit of omega-3 fatty acids for major depression. Nearly all of the treatment efficacy observed in the published literature may be attributable to publication bias.”
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625950/




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      1. The problem with these single-supplement studies regarding complex pathologies is that they fail to account for all the other factors that drive the symptoms that are being measured. Most severe psychiatric symptoms, including depression, are driven by neuroinflammation and disruption of neuronal function and communication that results, to say nothing of death of neurons and the release of neurotransmitters contained within those brain cells.

        Factors driving neuroinflammation include nutrient deficiencies (such as omega-3, B-vitamins, certain amino acids and fatty acids, electrolytes, etc.), traumatic brain injury, infections and their metabolites, breach of the blood brain barrier, genetic SNP’s having to do with pathways for synthesizing, activating, or detoxifying nutrients, gut dysbiosis, lack of sleep, exposure to toxins, and psychological stress, just to name a few conditions off the top of my head.

        It stands to reason that the only patients that will benefit from supplementing a nutrient, such as omega-3 fatty acids, are those who are suffering from a deficiency or imbalance at the time of supplementation. It could well be that most people suffering from a given mood or anxiety disorder are not lacking in omega-3 at the time they are inducted into a study — but some are. Those who are deficient may show some improvement in the near term unless some of the other conditions I mentioned above, overwhelm or prevent the beneficial effect.

        Over time, chronic neuroinflammation will increase and decrease as various drivers of the condition worsen or improve. Accordingly, bouts of depression usually come to an end only to resume later, regardless of treatments. When other drivers of neuroinflammation worsen, they may overwhelm whatever benefit is being provided from ongoing supplementation. That is consistent with the diminishing efficacy recorded as the durations of studies are extended.

        To make these studies meaningful, it is necessary to measure the levels of omega-3 within the cells of participants and use that as part of the criteria for selecting sample groups as well as a measure of the response to supplementation. To increase the likelihood that anything of value will come of the studies, measures of all the other confounding variables should also be measured at induction and again at study end points. That is very expensive and requires researchers to account for the vast web of knowledge accumulating about the multifactorial drivers of complex conditions like depression, psychosis, schizophrenia, etc. Moreover, in many, if not most, instances the institutions funding these studies have an interest in concluding that cheap, over the counter supplements do not work. Thus, there is no incentive to go to great expense and effort to find out that the opposite finding has merit. Instead, a terribly flawed research design gets the result they are after and no one seems to object to the obvious shortcomings of the studies. Mission accomplished!




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        1. Possibly but I am not entirely sure what is in it for institutions (as opposed to say pharmaceiutcal companies).

          Of course, this argument works the other way too. Many people and websites publicising positive studies of fish oil have a financial interest in promoting supplement sales.

          The point surely is that there are no good quality trials unequivocally demonstrating the benefit of fish oil/omega 3 supplements in treating depression? And that there is some evidence of inefficacy.

          Note that I take a daily omega 3 supplement myself.




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    1. Hi June, WFPBLiisa is correct – the best way to contact us is to use the support button on the bottom of the page and your message will get sent to the appropriate person!




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  3. I became a vegan about ten years ago, but I was still not 100% convinced that my prior health problems were the result of eating meat. So one day I went out to lunch and had a nice chicken salad with friends. A bit later in the day I went for a walk, and during the walk I got so very depressed that I felt like crying. Nothing sad had happened during that day. That experience convinced me for good to not touch animal products again.

    So if you are depressed, try a vegan diet and see how you feel!




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    1. Maybe you were upset or felt guilty for breaking your vegan diet. Vegan’s seem to be a bit cult-ish about their eating habits and feel they are part of a special society. Their entire life seems to revolve around what they eat as it also involves social issues that they hold dear. There was an singer recently who told her fans that she was getting off her vegan diet because it was making her feel worse. She reported that she received death threats and they were going to boycott her music.




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      1. Life revolves around all types of food diets regardless of what we eat. This is an example of one person that in my opinion does not provide for a good study of vegans as a whole.




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    2. I had the same experience although worse because the inflammation did not just affect my mood but my entire GI tract. it was awful. I persevered because I was told this is just the body having to make new intestinal flora and it will resolve itself. It did not. That last encounter with animal products was enough for me. I am not here to add years to my life but to ensure the years I do have are quality ones, and being vegan WFPB appears to be the only thing we can do to help achieve that.




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  4. I find this info of great interest and don’t discount it at all. But I also firmly believe that the increase in cases of depression comes from so many people being cut off from the natural world. We evolved over millennia embedded in nature, intimately interacting with it. Our “recent” past has us trying to prove that we don’t need it, can control it, etc. As we degrade and destroy the living systems that keep us all alive, we pay the price. And will likely pay the ultimate price as a species if we don’t come to that realization very soon.




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  5. So, long chain omega-3 fatty acids are the raw materials from which resolvins and protectins are made in vivo (which resolve inflammation) but they are PRO rather than ANTI-inflammatory? Is this a consensus of the data on long-chain fatty acids, or derived from a limited amount of evidence? And could depression not simply result from the realization that we’re now living in a country that has a cartoon character for a leader?




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  6. Recently I read A diet for The mind. By professor Morris. Research on Diet correlations were strongly made for dementia. The speculation of diet and depression seems also logical. Basically the mind diet was based on the Mediterranean diet. Depression seems complicated and likely multifactorial. Diet may be helpful with some patients with depression.




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  7. Depression is a ‘conscious choice’.
    And in an instant, you can chose to not be depressed.
    And yes, I am speaking from experience.




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  8. Is depression adaptive or cultural?

    I suspect most of it, these days where it has become institutionalised, is the latter, as it serves so many profit making interests and also helps turn us into victims, people things happen to, rather than effective individual agents of change.

    That said I do not dispute that there are many cases of depression/mood disorder linked to inflammation, and that orthodox treatment which ignores the nutritional angle and instead feeds a person drugs and words, does not help.




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  9. The study you mentioned about fish being pro-inflammatory doesn’t seem to portray that…It actually shows “other vegetable” such as aubergine and celery to be similar to fish in raising inflammation, but neither have significant impacts on inflammation when compared to red meat for example.The article even states “With the exception of other vegetables and fish, all food groups were significantly correlated with at least two inflammatory markers.”
    I am vegan and I really appreciate your work but but I feel your statement is misleading and it’s making me question other studies you cite that I haven’t read :/




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  10. I know this is about diet but a simple remedy for those with a form of depression, SAD-Seasonal Affective Disorder-suffer their depression from lack of sunlight. Early morning activity in the sun is the most effective, but exercising in the sun later helps as well. Because SAD is most common in very northern, dark, cold climates, eating breakfast, meditating, etc., in front of certified SAD lamps for 20 minutes 1-2 times/day is also effective. I surf at sunrise and eating a WFPBD is very effective.




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  11. Is there any information on homeopathic mouth spray diets? Someone tried to swindle me on this and from what I can find- its all HcG….is there factual truths to HcG diets? they seem dangerous to me




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    1. Caitlin, HCG diets are illegal in the US.
      https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm281333.htm

      *” And then there are reckless ways to shed pounds—fads and diet aids that promise rapid weight loss, but often recommend potentially dangerous practices. These include HCG weight-loss products marketed over-the-counter (OTC) that are identified as “homeopathic” and direct users to follow a severely restrictive diet.”*




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  12. I’m pretty excited. I’m working with a professional designer who is a friend of my wife to build a nutritionfacts for depression and mental health. It’s going to go over the latest and most applicable research in multiple fields as they relate to mental health.

    There will be information to help people get the most out of their therapists and psychiatrists (comparisons of the effectiveness of different medications, therapies, etc.) as well as the multitude of lifestyle techniques (including nutrition!) that people can use to improve emotional well-being on their own.

    It’s going to go up at riseabovedepression.com once the design stage is done unless I find a wonderful patron who could help sponsor the 1600 dollars for the domain name depressionfacts.org Either way I want to give my son and others the resource that I wish I had growing up.




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    1. Ryan, that is cool.

      Having the full scope of research studies is critical.

      I remember researching depression for someone whose child was depressed related to bullying and being shunned at school and they were being pushed on meds and his mother still has no idea what to do.

      There was one study where people briefly got better, then got worse than they had started after.

      Still pondering the Omega 3 and Bill W having results with B3. I think he said something like 80-something percent of the alcoholics who took B3 succeeded at getting off the booze. It was a long time ago, when I read it, but he said that it helped his schizophrenic alcoholics, who had tended to rebound, because the alcohol was masking the schizophrenia.

      Don’t know about all of that, but I do know that not having enough nutrition and having things like homocysteine and not having the neurotransmitters all seemed to have been part of it, when I was depressed as a young person. My hormones were so far off, from eating nothing nutritious at all.




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  13. I am not big into “evolutionary” anything, but I can use the same information and do a whole “evidence of design” theory and still have the same information work for me.

    As far as the Omega 3’s…. if they are just a scam, then are they also a scam for Alzheimer’s, which you recommended them for?

    I keep forgetting to take them, but if they are a scam, I can get rid of the bottle.




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    1. Dr Greger recommends a supplement of 250 mcg per day of EPA/DHA omega 3s. Preferably sourced from algae or yeast to eliminate potential contamination risk.
      https://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

      This is primarily for brain health. There is however doubts about its useful for preventing CVD – which is perhaps what you are thinking of when you refer to a scam?
      https://nutritionfacts.org/video/should-vegans-take-dha-to-preserve-brain-function/




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  14. I bought tickets for tomorrows “Eating You Alive” showing.

    Looking forward to it.

    I am passionate about the concept of saving lives.

    Wondering if those movies could be shown someplace like Senior Centers?

    It seems like Seniors have so much need for understanding diet and reversing health issues.

    I am not a public personality, but I could see showing movies like that to groups like seniors.




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  15. this blog absolutely hit home for me. I am a senior citizen – pretty healthy and very active, but clinically depressed most of my life and on drugs to control it. As a teen and young adult, I was suicidal. I can speak from personal experience how depression is tantamount to a mental paralysis – there is nothing in life that is “worth it”. It is all meaningless. There is no point to anything. I have been on a plant based diet now for almost 3 years. I noticed this last year that I was feeling very good emotionally. I weaned off my meds. And waited for the relapse, as I had tried this before. But it never happened. That was almost 6 months ago. Yes, Ive had some blue periods, but those are normal and passed. But no more bottomless pits that made dive into my meds for relief. For the first time in my life I feel emotionally balanced and healthy. I attributed it to my diet, but couldn’t say why that would have anything to do with my emotional health. So this blog has validated my suspicions and reinforced my motivation to stick to it!




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  16. Dear Dr. Greger,

    Thank you so much for your invaluable research on a topic that we all can benefit from.

    I have never had depression, but I feel happier and stronger since I changed my diet to whole foods. But I do know people who are constantly depressed and on medication whose diets are very poor, consuming mostly animal protein, soda, etc…

    I recently purchased your cookbook and I am at this moment waiting for the “superfood breakfast bites” to cool in the fridge :)

    All the best,

    Elisa




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  17. Overfeeding our brains with modern stimulations (television, newspapers, magazines, internet news, cinemas, books, musics and so on) puts a lot of stress on our sensitive brain and dissipate our energy.

    Sometimes, going well is just a matter of ending or reducing the weight of those stimulations and distractions on our brain, and just closely, silently watching what is, inwardly, without any escape.

    The addiction to brain stimulations, either of work or of distractions, is a factor for not being well psychologically, and once in a while, the brain, as a whole psychological structure, may collapse, and the doctor names it “depression”.

    But really, I think it is just a matter of learning, from time to time, “to do nothing” or “to not always do something”, even if one does it passively when one consumes distractions or entertainments. The burden of modern entertainments on our brain is not being payed much attention in our modern societies.

    The struggle for becoming make people very active in working, and working, working, working puts such stress on the brain and body that it decompresses with entertainments and leisures. But doing so, never is the brain put to rest.

    The brain being caught between the desire to become and the associated need to escape never merely stays quiet with what is.




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    1. When the brain only “rests” at night, it produces dreams, and other “agitated” sleeps. Whereas when it is not overfed during the day by either work or entertainments, so that it can watch, pay attention to what is going on inwardly during the day, then there is a much deeper and repairing rest at night, so that the brain is fresher when it wakes up, with more energy to look.

      On the contrary, the gradual depletion of energy going on day after day when the brain is constantly overstimulated might be one of the causes of depression and also of shrinkage of the brain in the elderlies and, more and more, in the youngest people too, the brain being “dullified” by both work and entertainment, on the long run.




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