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Chapter 3 - The Mediterranean Diet and Mental Health

Published online by Cambridge University Press:  17 August 2023

By
Mary I. Butler  and
Sabrina Mörkl
Edited by
Ted Dinan
Ted Dinan
Affiliation:
Emeritus Professor, University College Cork, Ireland
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Summary

The Mediterranean diet is widely acknowledged as one of the best nutritional approaches for improving health and longevity. In recent years, the evidence for such beneficial effects has extended beyond the realm of metabolic and cardiovascular health to include the brain and mental health. At a population level, adherence to a Mediterranean diet is associated with lower risk of depression and cognitive disorders. In people suffering with depression, switching to a Mediterranean-style diet is an effective treatment strategy. The Mediterranean diet is a safe and sustainable dietary pattern which should form part of the toolkit of any mental health professional wishing to incorporate nutritional approaches. In this chapter, we review the evidence for the use of the Mediterranean diet for mental health and explore the biological mechanisms involved. We provide practical advice for mental health professionals wishing to use this nutritional approach as part of a treatment plan.

Type
Chapter
Information
Nutritional Psychiatry
A Primer for Clinicians
 , pp. 39 - 54
Publisher: Cambridge University Press
Print publication year: 2023

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References

Keys, A., Menotti, A., Aravanis, C., et al., 1984. The seven countries study: 2,289 deaths in 15 years. Preventive Medicine, 13(2), pp. 141–54.Google Scholar
Ministry of Health and Welfare, s.s.h.c., 1999. Dietary guidelines for adults in Greece. Archives of Hellenic Medicine, 16, pp. 516–24.Google Scholar
Bach-Faig, A., Berry, E. M., Lairon, D., et al., 2011. Mediterranean diet pyramid today: science and cultural updates. Public Health Nutrition, 14(12A), pp. 2274–84.Google Scholar
Estruch, R., Ros, E., Salas-Salvado, J., et al., 2018. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine, 378(25), p. e34.Google Scholar
Sánchez-Villegas, A., Martinez-Gonzalez, M. A., Serra-Majem, L., et al., 2013. Mediterranean dietary pattern and depression: the PREDIMED randomized trial. BMC Medicine, 11, p. 208.Google Scholar
Valls-Pedret, C., Sala-Vila, A., Serra-Mir, M., et al., 2015. Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Internal Medicine, 175(7), pp. 1094–1103.Google Scholar
Martínez-Lapiscina, E. H., Clavero, P., Tolego, E., et al., 2013. Virgin olive oil supplementation and long-term cognition: the PREDIMED-NAVARRA randomized trial. The Journal of Nutrition, Health and Aging, 17(6), pp. 544–52.Google Scholar
Martínez-Lapiscina, E. H., Clavero, P., Toledo, E., et al., 2013. Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. Journal of Neurology, Neurosurgery, and Psychiatry, 84(12), pp. 1318–25.Google Scholar
Molendijk, M., Molero, P., Sanchez-Pedreno, F. O., et al., 2018. Diet quality and depression risk: a systematic review and dose-response meta-analysis of prospective studies. Journal of Affective Disorders, 226, pp. 346–54.Google Scholar
Lai, J. S., Hiles, S. M., Bisquera, A., et al.,2014. A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. The American Journal of Clinical Nutrition, 99(1), pp. 181–97.CrossRefGoogle ScholarPubMed
Lassale, C., Batty, G. D., Baghdadli, A., et al., 2019. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Molecular Psychiatry, 24, 965–86.Google Scholar
Firth, J., Marx, W., Dash, S., et al., 2019. The effects of dietary improvement on symptoms of depression and anxiety: a meta-analysis of randomized controlled trials. Psychosomatic Medicine, 81(3), pp. 265–80.Google Scholar
Madani, S., Ahmadi, A., Shoaei-Jouneghani, F., et al., 2022. The relationship between the Mediterranean diet and Axis I disorders: a systematic review of observational studies. Food Science & Nutrition, 10, 3241–58.CrossRefGoogle ScholarPubMed
Chocano-Bedoya, P. O., O’Reilly, E. J., Lucas, M., et al. 2013. Prospective study on long-term dietary patterns and incident depression in middle-aged and older women. The American Journal of Clinical Nutrition, 98(3), pp. 813–20.Google Scholar
Okubo, R., Matsuoka, Y. J., Sawada, N., et al., 2019. Diet quality and depression risk in a Japanese population: the Japan Public Health Center (JPHC)-based Prospective Study. Scientific Reports, 9(1), p. 7150.Google Scholar
Jacka, F. N., O’Neill, A., Opie, R., et al., 2017. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Medicine, 15(1), p. 23.CrossRefGoogle ScholarPubMed
Parletta, N., Zarnowiecki, D., Cho, J., et al., 2019. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutritional Neuroscience, 22(7), pp. 474–87.Google Scholar
Bayes, J., Schloss, J. and Sibbritt, D., 2021. A randomised controlled trial assessing the effect of a Mediterranean diet on the symptoms of depression in young men (the ‘AMMEND’ study): a study protocol. British Journal of Nutrition, 126(5), p. 730–7.Google Scholar
Francis, H. M., Stevenson, R., Chambers, J. R., et al., 2019. A brief diet intervention can reduce symptoms of depression in young adults: a randomised controlled trial. PLoS One, 14(10), p. e0222768.CrossRefGoogle ScholarPubMed
Lin, K., Li, Y., Du Toit, E., et al., 2021. Effects of polyphenol supplementations on improving depression, anxiety, and quality of life in patients with depression. Frontiers in Psychiatry, 12, 765485.CrossRefGoogle ScholarPubMed
Chen, L. R., Ko, N. Y. and Chen, K. H., 2019. Isoflavone supplements for menopausal women: a systematic review. Nutrients, 11(11).Google Scholar
NHS.2021. Medicines used in mental health – England – quarterly summary statistics April to June 2021. www.nhsbsa.nhs.uk/statistical-collections/medicines-used-mental-health-england/medicines-used-mental-health-england-quarterly-summary-statistics-april-june-2021.Google Scholar
Chatterton, M. L., Mihalopoulos, C., O’Neill, A., et al., 2018. Economic evaluation of a dietary intervention for adults with major depression (the ‘SMILES’ trial). BMC Public Health, 18(1), p. 599.Google Scholar
Opie, R. S., Itsiopoulos, C., Parletta, N., et al., 2015. Assessing healthy diet affordability in a cohort with major depressive disorders. Journal of Public Health and Epidemiology, 7(5), pp. 159–69.Google Scholar
Wu, L. and Sun, D., 2017. Adherence to Mediterranean diet and risk of developing cognitive disorders: an updated systematic review and meta-analysis of prospective cohort studies. Scientific Reports, 7(1), p. 41317.Google Scholar
Liu, X., Morris, M. C. and Barnes, L. L., 2021. Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) study: rationale, design and baseline characteristics of a randomized control trial of the MIND diet on cognitive decline. Contemporary Clinical Trials, 102, p. 106270.Google Scholar
Yang, W., Cui, K., Li, X., et al., 2021. Effect of polyphenols on cognitive function: evidence from population-based studies and clinical trials. The Journal of Nutrition, Health & Aging, 25(10), pp. 1190–1204.Google Scholar
Tsolaki, M., Lazarou, E., Kozori, M., et al., 2020. A randomized clinical trial of Greek high phenolic early harvest extra virgin olive oil in mild cognitive impairment: the MICOIL pilot study. Journal of Alzheimer’s Disease, 78(2), pp. 801–17.Google Scholar
Firth, J., Stubbs, B., Teasdale, S. B., et al., 2018. Diet as a hot topic in psychiatry: a population-scale study of nutritional intake and inflammatory potential in severe mental illness. World Psychiatry, 17(3), pp. 365–7.Google Scholar
Esposito, K., Marfeela, R., Ciotola, M., et al., 2004. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. Journal of the American Medical Association, 292(12), pp. 1440–6.Google ScholarPubMed
Liu, T., Zhong, S., Liao, X., et al., 2015. A meta-analysis of oxidative stress markers in depression. PLoS One, 10(10), p. e0138904.Google Scholar
Andreazza, A. C., Kauer-Sant’anna, M., Frey, B. N., et al., 2008. Oxidative stress markers in bipolar disorder: a meta-analysis. Journal of Affective Disorders, 111(2), pp. 135–44.CrossRefGoogle ScholarPubMed
Flatow, J., Buckley, P. and Miller, B. J., 2013. Meta-analysis of oxidative stress in schizophrenia. Biological Psychiatry, 74(6), pp. 400–9.Google Scholar
Butler, M. I., Cryan, J. F. and Dinan, T. G., 2019. Man and the microbiome: a new theory of everything? Annual Review of Clinical Psychology, 15, pp. 371–98.Google Scholar
Ghosh, T. S., Rampelli, S., Jeffrey, I., et al., 2020. Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status: the NU-AGE 1-year dietary intervention across five European countries. Gut, 69(7), p. 1218.CrossRefGoogle ScholarPubMed
Borkent, J., Ioannouet, M., Sommer, I. E. C., et al., 2022. Role of the gut microbiome in three major psychiatric disorders. Psychological Medicine, 52(7), pp. 1222–42.Google Scholar
Valles-Colomer, M., Falony, G., Darzy, Y., et al., 2019. The neuroactive potential of the human gut microbiota in quality of life and depression. Nature Microbiology, 4, pp. 623–32.Google Scholar
McGuinness, A. J., Davis, J. A., Dawson, S. L., et al., 2022. A systematic review of gut microbiota composition in observational studies of major depressive disorder, bipolar disorder and schizophrenia. Molecular Psychiatry, 27(4), pp. 1920–35.Google Scholar
Meslier, V., Laiola, M., Roager, H. M., et al., 2020. Mediterranean diet intervention in overweight and obese subjects lowers plasma cholesterol and causes changes in the gut microbiome and metabolome independently of energy intake. Gut, 69(7), pp. 1258–68.CrossRefGoogle ScholarPubMed
Kishi, T., Yoshimura, R., Ikuta, T., et al., 2017. Brain-derived neurotrophic factor and major depressive disorder: evidence from meta-analyses. Frontiers in Psychiatry, 8, p. 308.Google Scholar
Sánchez-Villegas, A., et al., 2011. The effect of the Mediterranean diet on plasma brain-derived neurotrophic factor (BDNF) levels: the PREDIMED-NAVARRA randomized trial. Nutritional Neuroscience, 14(5), pp. 195–201.Google Scholar
Arjmand, G., Abbas-Zadeh, M. and Eftekhari, M. H., 2022. Effect of MIND diet intervention on cognitive performance and brain structure in healthy obese women: a randomized controlled trial. Scientific Reports, 12(1), p. 2871.Google Scholar
Carvalho, K. M. B., Ronca, D. B., Michels, N., et al., 2018. Does the Mediterranean diet protect against stress-induced inflammatory activation in European adolescents? The HELENA study. Nutrients, 10(11).Google Scholar
Bonaccio, M., Di Castelnuovo, A., Costanzo, S., et al., 2018. Mediterranean-type diet is associated with higher psychological resilience in a general adult population: findings from the Moli-sani study. European Journal of Clinical Nutrition, 72(1), pp. 154–60.CrossRefGoogle Scholar
Shively, C. A., Appt, S. E. and Register, T. C., 2020 Mediterranean diet, stress resilience, and aging in nonhuman primates. Neurobiology of Stress, 13, p. 100254.Google Scholar
Razquin, C., Ruiz-Canela, M., Toledo, E., et al., 2021. Metabolomics of the tryptophan-kynurenine degradation pathway and risk of atrial fibrillation and heart failure: potential modification effect of Mediterranean diet. The American Journal of Clinical Nutrition, 114(5), pp. 1646–54.Google Scholar
Huang, M., Shah, A. and Su, S., 2018. Association of depressive symptoms and heart rate variability in Vietnam war-era twins: a longitudinal twin difference study. JAMA Psychiatry, 75(7), pp. 705–12.Google Scholar
Dai, J., 2010. Mediterranean dietary pattern is associated with improved cardiac autonomic function among middle-aged men: a twin study. Circulation: Cardiovascular Quality and Outcomes, 3(4), pp. 366–73.Google Scholar
Chen, S., Zhang, H., Pu, H., et al., 2014. n-3 PUFA supplementation benefits microglial responses to myelin pathology. Scientific Reports, 4(1), p. 7458.Google Scholar
Gallardo-Fernández, M., Hornedo-Ortega, R. and de Pablos, R. M., 2019. Hydroxytyrosol decreases LPS- and α-synuclein-induced microglial activation in vitro. Antioxidants (Basel), 9(1).Google Scholar
Mörkl, S., Stell, L., Buhai, D. V., et al., 2021. ‘An apple a day’? Psychiatrists, psychologists and psychotherapists report poor literacy for nutritional medicine: international survey spanning 52 countries. Nutrients, 13(3).Google Scholar
Danan, A., Westman, E. C., Saslow, L. R., et al., 2022. The ketogenic diet for refractory mental illness: a retrospective analysis of 31 inpatients. Frontiers in Psychiatry, 13.Google Scholar
Wade, A. T., Davis, C. R., Dyer, K. A., et al., 2018. A Mediterranean diet supplemented with dairy foods improves markers of cardiovascular risk: results from the MedDairy randomized controlled trial. The American Journal of Clinical Nutrition, 108(6), pp. 1166–82.Google Scholar
Oldways. Mediterranean diet pyramid. https://oldwayspt.org/resources/oldways-mediterranean-diet-pyramid.Google Scholar
Cabrera-Suárez, B., Pla, J., González-Pintoet, A., et al., 2022. Effectiveness of a remote nutritional intervention to increase the adherence to the Mediterranean diet among recovered depression patients. Nutritional Neuroscience, 10, 1–10.Google Scholar

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