Dietary Treatment Options for Depression among Diabetic Patient, Focusing on Macronutrients
Relationship of depression to diabetes types 1 and 2: epidemiology, biology, The few randomized, controlled studies of treatment of depression in patients. Untreated depression in diabetics is costly to the health care and economic Relationship of depression to diabetes types 1 and 2: Epidemiology, biology, and . Relationship of Depression to Diabetes Types 1 and 2: Epidemiology, Biology, and Treatment Dominique L. Musselman, Ephi Betan, Hannah Larsen, and.
Both diets were similar in their carbohydrate, protein, saturated fatty acids SFAsand cholesterol content. After 12 months, participants in ADA group consumed significantly more carbohydrate but decreased GI. Both diets showed significant improvement in metabolic markers after 12 months.
In spite of a slight improvement in both dietary interventions, changes in depressive symptoms did not reach significant difference comparing the two interventions. The association between dietary GI, GL, the amount of consumed carbohydrate and depression are also inconsistent among nondiabetic patients [ 59 — 61 ].
Some reports showed that higher dietary GL decreases the risk of depression [ 5960 ], while others failed to reach such findings [ 61 ]. However, most of available studies have not linked dietary GI to depression [ 5961 ].
Totally, few studies were conducted among diabetic to assess the effect of dietary carbohydrate on depression symptoms. Available studies are inconsistent. While a clinical trial did not approve the effect of GI and GL on depression, observational studies showed significant association. Moreover, benefits and disadvantages of low-carbohydrate diets are still on debate and should be noted in the treatment of depression. While some clinical trials have advocated the beneficial effects of low carbohydrate diets LCD on metabolic markers and weight loss, their long term effects on psychological features have been poorly studied.
Some short-term studies have shown that dietary composition could not significantly affect mood state [ 62 — 64 ]; however, there are some long-term evidences that showed adverse effects of LCD on mood state compared with low fat diet LFD among nondiabetic patients. More studies should be conducted to illustrate the beneficial and adverse effects of LCD on psychological function. Dietary Protein Renal disease, another complication of diabetes, has been widely claimed that is associated with depression [ 67 — 69 ].
Low protein diet 0. However, a low protein diet provided lower amount of tryptophan which could interact with the beneficial effects of low protein diet. The effect of dietary protein intake on depression is unclear, and only two studies assessed the effects of low protein diet on depressive symptoms among diabetic patients in short and long term [ 3940 ]. In a randomized clinical trial, Ciarambino et al. Before the beginning of study, all patients consumed a normal protein diet 1.
In the other long term study [ 40 ], Ciarambino et al. The probable reason of such findings may be related to the lower content of thiamine, folate, iron, and Trp which induces cognitive changes consistent with depressive mood [ 77 — 79 ].
The proportion of dietary macronutrients must also be taken into account when interpreting the findings. We found very limited studies among depressed patients without diabetes which assessed the effect of different amount of protein consumption on depressive symptoms. The results of a year follow-up study showed that higher protein intake is associated with lower but higher risk of depression among men and women, respectively [ 80 ].
The results of our search did not show any study in relation to assess the effect of various types of protein on depression.
More studies are necessary to illustrate the exact and clear effect of the amount and kind of dietary protein intake on depressive symptoms among diabetic and nondiabetic patients. Dietary Fat Dietary fat intake has a strong role in determining stress oxidative and inflammation. Furthermore, both diabetes mellitus and depression are associated with lower n-3 polyunsaturated fatty acids n-3 PUFA concentrations [ 82 — 84 ] and disturbed lipid profile [ 85 — 87 ].
The favorable effect of n-3 PUFA consumption has been approved either by epidemiological studies which assessed fish consumption and or by ones which assessed the red blood cell concentrations of n-3 PUFA [ 89 — 93 ]. However, the results of a meta analysis on 28 randomized and placebo controlled clinical trial showed that the efficacy of n-3 PUFA in depression is related to eicosapentaenoic acid EPA not docosahexaenoic acid DHA [ 94 ].
We did not find any epidemiological study regarding the association between n-3 PUFA consumption and depression among diabetic patients. We just find two clinical trials which assessed the effects of EPA consumption on depressive symptoms in diabetic [ 4295 ].
Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment.
A randomized clinical trial by Bot et al. However, because of the strong link between EPA intake and some similar biological disturbances in diabetes and depression, such as hypothalamus-pituitaryadrenal HPA -axis hyperactivity [ 4 ] and one-carbon-cycle alterations [ 41 ], authors also assessed the effect of EPA on more biological markers [ 95 ]. They did not find any significant effects of EPA supplementation on oxidative stress, inflammatory, or one-carbon-cycle parameters compared with placebo.
The relationship between other types of fatty acids and depression has been poorly studied. Second, there are similar pathogenesis for several chronic diseases and depression. Because of similar pathophysiology for such chronic diseases and depression, the harmful effects of SFA and TFA could be also considered for depression. They also showed that PUFA intake is inversely associated with depression, but n-3, n-6, and n-3 from fish and n In this study, a marginal significant inverse dose-response association was found for MUFA consumption.
Most of observational and interventional studies among nondiabetic patients confirmed the health benefit of n-3 fatty acids on depressive symptoms [ 98 — ]. However, the published literature is conflicting.
Psychiatric comorbidity in diabetes type 1: a cross-sectional observational study
For example, in one study, the inverse association between higher consumption of fish, DHA, EPA, and depression were observed only in boys but not girls [ 98 ]. Other study found a cross-sectional, but not longitudinal, association between depression and n-3 consumption [ ].
The results of a clinical trial did not confirm the beneficial effects of n-3 supplementation on amelioration of depressive symptoms [ ]. There are such discrepancies for other fatty acids. Some investigators found a link between the erythrocytes concentration of TFA, short chain SFA, short chain MUF lower than 18 carbonsand depression [ 84], while other study showed higher concentration of SFA decreases the risk of depression [ ].
- Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment.
- Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment
- Journal of Diabetes Research
Higher levels of inflammatory markers in depressed persons may reduce serum tryptophan level and impair neurotransmitter metabolism by inhibition of the gene expression of Brain-Derived Neurotrophic Factor BDNF . Lower level of BDNF has been shown in depressed patients [ ]. Therefore, beneficial subtypes of fatty acids could improve depressive symptoms by modulating serum levels of inflammatory markers.
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Beside the types of fatty acids, the amount of fat consumption is another determinant of depression. It has been shown that low fat diets could adversely affect mood . However, to the best of our knowledge, there is no study assessing the effect of dietary fat amount on depressive symptoms among diabetic patients. Dietary Patterns Depression is associated with unhealthy food choices.
Several studies showed higher consumption of unhealthy foods and lower consumption of fruits and vegetables in depressed mood [ ]. Although dietary patterns and diet quality are a novel area of attention in the lifestyle-mental health research field, there is no study in this field among diabetic patients.
Furthermore, in this study, various dietary determinants of depression such as energy intake, vitamin B2, B6, B12, and n-3 PUFA did not significantly differ between depressed and nondepressed. Conversely, the highest quartile of healthy and traditional dietary patterns were associated with lower odds ratio for depression among women compared with the lowest quartile. In this study traditional diet was loaded on fish and fruit consumption and healthy diet was loaded on vegetables consumption.
Another finding from the SUN cohort study demonstrated an inverse relationship between the adherence to Mediterranean diet and depression, while consumption of fast foods and commercial baked goods increased the risk of depression among Spanish .
Interestingly, the serum concentration of folate, as a determinant of depression, is a marker of diet quality [ ]. With regard to anxiety disorders, panic disorder, a severe and devastating condition marked by recurrent and unexpected attacks of sudden onset and short duration related to physiological anxiety sensations such as subsequent hyperventilation, palpitations, chest pain, nausea, numbness 1415 seems similar to the symptoms of hypoglycemia, frequently observed in type 1 diabetes.
Examining a Bidirectional Association Between Depressive Symptoms and Diabetes
In addition to the signs and symptoms of anxiety and depression in type 1 diabetes, both the physiological changes in the chronic course of the disease: More specifically, taking into account the clinical picture and possible superposition, we found only Thus, we propose that physiological symptoms of hypoglycemia and hyperglycemia, such as, weight gain, pain, hypertension, heart disease, loss of motor skills, or blindness, can be associated with anxiety disorders, due to the generation of sensations similar to anxiety disorders, which can also change the mood of individuals.
The need for accurate assessments for the presence of symptoms related to psychopathology in patients with diabetes is evident, as well as the development of therapeutic protocols that consider the physical, psychological and social conditions of this population. Psychiatric morbidity among diabetic patients: Prevalence of psychiatric disorders in patients with diabetes types 1 and 2.
Relationship of depression to diabetes types 1 and 2: Epidemiology, biology, and treatment. Dysthymia and cyclothymia—serious consequences of rarely diagnosed disorders. The role of depression and anxiety in onset of diabetes in a large population-based study.
Phobic symptoms, particularly the fear of blood and injury, are associated with poor glycemic control in type I diabetic adults. Fear of hypoglycemia in type 1 insulin-dependent diabetic patients. Rom J Intern Med. Agoraphobia, simple phobia and social phobia in the national comorbity survey. Relationship between blood glucose control and psychiatric disorders in type II diabetic patients.
Moclobemide in social phobia: Psychiatric disorders in patients with diabetes type 2 at medical care and training district of Rio Branco-Acre, Brazil.