"Let food be thy medicine and medicine be thy food.” -Hippocrates
Collectively as a society, recent times have witnessed an all-time exigency as it relates to our food consumption. As increases in obesity and weight-related diseases continue to skyrocket, we are becoming sicker by the generation. Currently in the US, more than one-third (34.9% or 78.6 million) of adults are obese; with estimated annual medical costs of obesity-related illnesses exceeding $190 billion (Cawley & Meyerhoefer, 2012; Ogden et. al, 2014). Almost overnight this trend has gone from bad to worse.
To glean answers, one must look no further than the current unsavory conditions of our food production systems; from the widespread usage of antibiotics and hormones in meat processing, to the use of herbicides and insecticides in the care of agriculture, to the proliferation of processed, energy-dense foods in supermarkets and retail stores, our once plentiful food supply has become our biggest detriment in terms of overall health. In addition, as modern food systems become more corporatized and less and less people are able to afford healthy options, the problem is only expected to exacerbate.
More importantly, as we continue to learn more about the complex connection between food and disease, new research has uncovered a number of other potential underlying factors connected to poor diet. In particular, one area that has garnered attention lately (predominately within the realm of the alternative medicine community) is the connection between unhealthy eating habits and depression/anxiety. Generally speaking, most people do not associate our worsening food supply with the growing number of mental health diagnoses and psychotropic drug prescriptions being written annually. Particularly in the overmedicated climate that we now live in, prescription medications for patients have become so normalized that we view them as the end-all-be-all for treating symptoms, to the point where we avoid asking pertinent questions such as: their true legitimacy, why they have become so prevalent, and if any alternatives exist. For the majority of society, this correlation is merely coincidental.
However, if we blindly adopt this way of thinking, we are left with a litany of questions. For one, how and why have we become so over-medicated in recent times? If we look back in history only 65 years, the first anti-depressants were not discovered until 1952, and the term “major depressive disorder” was not coined until the mid-1970s (Ramanchandraih et al., 2011). Yet if we fast forward to 2015, almost 1 in 10 Americans are currently taking an antidepressant, with usage rates among teens and adults showing increases by almost 400% between 1988-1994 and 2005-2008 (Pratt et al., 2011). So what happened over that short time period? Have we all of a sudden become more genetically pre-disposed to bouts with depression? Who is to blame for this sudden rise?
Bearing these questions in mind, in today’s post I take an in-depth look at how depression and other anxiety-related diseases have sparked the prescription drug revolution, and look for answers. More specifically, I offer my critique on how depression and anxiety have been constructed through dominant cultural frameworks, as well as examine the relationship that exists between diet and depression-related symptoms. To begin, I examine the dominant western medicine approach as it relates to depression.
[Re]Examining Dominant Ideologies of Depression
In today’s society, depression has become one of the biggest social problems facing us. Nowadays, it is almost impossible to not know someone who is affected by depression or currently taking medication for it. According to the CDC (2012), depression affects over 8% of the US population annually. And the problem is only expected to get worse. As noted by the Reddy (2010), depression is estimated to be the second leading cause of disability worldwide by 2020. As a society, we have become obsessed with the concept of depression, garnering interest whenever our favorite celebrity or athlete is admitted to rehab for depression-like symptoms. To fully understand the cultural impact of depression, look no further than the commercials you see on daytime television, where advertisements for antidepressant drugs have become so commonplace that they are now weaved into the fabric of popular culture. Today everything from golf tournaments, to magazine covers, to various radio shows and podcasts are all sponsored by antidepressant drug companies.
However, while we have cultivated this hyper-awareness towards depression, we never fully investigate why it has become so normalized within society. We never look to understand how we have become so overmedicated and reliant on prescription medications in such as short time. Our approach has always been to adopt western medicine ideology when it comes to issues pertaining to health as an end-all-be-all solution. However, if we are to truly gain insight and properly critique this approach, we first have to take a closer look at how depression has been framed by western medicine over the years.
Western Medicine Approach to Treating/Understanding Depression
For decades, the dominant ideology behind interpreting and diagnosing depression has always been that it was caused by an imbalance of chemicals in the brain (mainly serotonin and norepinephrine). Since the early stages of research, the majority of medical literature examining depression has defined it as a physical disease, one that is located at the biological level, and one that is highly contingent on an individual’s genetic pre-disposition. This theory, informally referenced as the “chemical imbalance” theory, has always asserted that it was supported by “science” and could be proven true through randomized clinical trials. Over the years, as more information became available about how to treat depression, the “chemical imbalance” theory gained traction both within the medical community and mainstream society as a viable explanation for the depression phenomena.
Stemming from this, the past 50 years have witnessed an influx in the number of those diagnosed with depression and anxiety, so much so that an entire industry has been created around our need to diagnose and treat depression. Indeed, as the numbers indicate, our society is becoming more and more medicated, with mood-altering drugs being given out by doctors in record numbers. According to the US Department of Health and Mental Services (2013), “in 2014, expenditures on mental health and substance abuse treatment from all public and private sources exceeded $239 billion, up from $42 billion in 1986 and $121 billion in 2003.” The pharmaceutical industry, in particular, has grown tremendously since the introduction of anti-depressants into the marketplace, as sales of antidepressant drugs now exceed $12 billion annually (Wedge, 2012).
This thriving contemporary market, which has been fueled predominately by direct-to-consumer ad campaigns, has worked to glamorize and normalize the use of prescription medication, and allowed pharmaceutical companies to work in concert with promotion to doctors. The rationale for this sudden influx of diagnoses is based on the claim that anti-depressants (particularly selective serotonin reuptake inhibitors, or SSRIs) lessen symptoms of depression by restoring serotonin deficiencies in the body (Donohue & Berndt, 2004). As noted by Kresser (2014), “serotonin is widely endorsed as the way to achieve just about every personality trait that is desirable, including self-confidence, creativity, emotional resilience, success, achievement, sociability and high energy.” Over time, these western medicine ideals have become so deeply embedded in our collective consciousness that we have been conditioned to correlate high serotonin levels with good health, to the point where we have become obsessed with the need to “boost serotonin levels.” Benefitting from this, Big Pharma has been able to implement an entire framework around this assumed serotonin deficiency and the “chemical imbalance” theory.
However, while the CI theory has become well established across a number of platforms as a viable explanation for depression, there is a growing amount of research that suggests otherwise. In fact, there are a number of recent studies that argue depression is not a “disease” in itself, so to speak, but rather a “symptom” of a larger issue: that issue being chronic systemic inflammation.
The Link between Depression and Systemic Inflammation
Although we normally don’t define it as such, depression on a base level is an inflammatory condition (this is why all antidepressant drugs are also anti-inflammatory). Dating back to the early 1990s, the link between depression and inflammation was first revealed when scientists made the correlation between patients diagnosed with severe depression and increased blood concentrations of inflammatory biomarkers (Maes, 1995). This foundational study, written by Smith (1991), found that depression is associated with an “acute-phase response,” and that pro-inflammatory cytokines are responsible for this acute-phase reaction which cause various clinical aspects of depression, including drops in sleep and energy, decreased neurotransmitter function and disturbed serotonin metabolism.
Since then, numerous researchers have provided evidence linking the symptoms of depression with inflammation. Scholars such as Dantzer et al., (2008) found that “major depressive disorders” are more prevalent in patients afflicted with conditions that lead to chronic inflammation (such as cardiovascular diseases, type 2 diabetes and rheumatoid arthritis) than in the general population” (p.4). Pasco et al. (2010) noted similarly that higher levels of systemic inflammation are associated with an increased risk of major depressive disorder. Along these lines, Licinio & Wong (1999) found that pro-inflammatory cytokines associated with depression can manifest in the body from a number of factors, including: stress, sleep, body weight, body temperature and food intake. Conversely, Hannested et al. (2011) found that remission of clinical depression is accompanied by a normalization of inflammatory biomarkers.
Simply put, inflammation is a nasty condition that is no bueno! In fact, many researchers such as Kresser (2014) believe that inflammation is at the root of nearly all modern disease, including diabetes, Alzheimer’s, cardiovascular disease, autoimmune disease, allergies, asthma, and arthritis. Various studies have supported these claims, indicating just how devastating inflammation can be on the body. So if we are to believe that depression and inflammation are closely connected, then the question we need to be asking is why are we so chronically inflamed? The answer is obviously multi-faceted and hinges upon a number of factors. The simple answer is that our modern Standard American Diet (SAD) and sedentary lifestyle promote a pro-inflammatory environment, but the complex answer is more involved than that.
In an attempt to glean insights, Berk et al. (2013) conducted a comprehensive analysis exploring the role of inflammation and oxidative stress as possible mediators of known environmental risk factors in depression, and found a number of factors which appear to increase the risk for its development, those of which include: “psychosocial stressors, poor diet, physical inactivity, obesity, smoking, altered gut permeability, dental caries, sleep and vitamin D deficiency” (p.1). However, among all of these factors, the majority of research studies have indicated that poor and inadequate diet is the biggest variable in promoting long-term inflammation. This evidence is supported by a recent study by Jacka et al. (2010) which found that a “traditional” dietary pattern characterized by vegetables, fruit, meat, fish, and whole grains is associated with lower odds for major depression, dysthymia and anxiety disorders; while a “western” diet of processed or fried foods, refined grains, sugary products, and beer is associated with higher incidences of these conditions.
Now that we have a better understanding of the root causes of inflammation, we must investigate the role that diet plays in the equation. To do this, we will examine some of the top food-related causes of systemic inflammation.
The Connection between Diet and Systemic Inflammation
Current research examining the relationship between diet and inflammation is robust. The emerging role of chronic inflammation in the major diseases of today’s society has stimulated inquiry into the role that dietary intake and nutrition play in the dynamic. And while research has attributed chronic inflammation to a number of lifestyle factors, the consensus among health and nutrition professionals posits the role of diet as near the top of the list. Therefore, to gain a better awareness of how our food choices wreak havoc on our body, we will break down some of the top food-related causes of inflammation.
In terms of the most widespread cause for inflammation across populations, this is probably the biggest offender. If we understand how the body metabolizes fatty acids, it is easy to see how our modern diet has become a breeding ground for chronic inflammation. When it comes to fatty acids, omega-6 is pro-inflammatory, while omega-3 is neutral. Research has shown that diets rich in omega-6s will promote chronic inflammation (which can lead to heart disease, cancers, arthritis, etc.), while diets rich in omega-3 will reduce inflammation. In essence, omega-3s have the same effect on the body as OTC and prescription NSAIDs (non-steroidal anti-inflammatory) (i.e. aspirin, ibuprofen), although they occur naturally without any of the side effects.
Indeed, research has made the connection between a decreased omega-6/3 ratio and a decrease in chronic diseases. However, in our modern diets, problems such as poor meat quality, over-consumption of fast foods and processed foods and vegetable oils do not allow our bodies to get enough essential fatty acids, while offering an abundance of pro-inflammatory omega-6 fatty acids (Whole 9, 2014). As noted by Eaton & Konner (2004), today’s industrialized societies are characterized by 1) an increase in energy intake and decrease in energy expenditure; 2) an increase in saturated fat, omega-6 fatty acids and trans fatty acids, and a decrease in omega-3 fatty acid intake; 3) a decrease in complex carbohydrates and fiber; 4) an increase in cereal grains and a decrease in fruits and vegetables; and 5) a decrease in protein, antioxidants and calcium intake. For long term health, it is essential to maintain healthy omega-6/3 ratios, and many recent research studies reflect this. For example, Smith et al. (2006) found that decreasing omega-6/3 ratios by replacing corn oil with olive oil lead to a 70% decrease in total mortality. *For a more in-depth look at this topic, read my post on omega 3-s, which you can access here.
In addition to omega-6/3 ratios, another root cause for systemic inflammation is food intolerances. Particularly in the highly processed, inhumanely raised, genetically modified food landscape that we now live in, food intolerances have become more problematic than ever before. This is due in part to the increased contamination and infiltration of allergens in our food supply, the most common offenders being: soy, wheat, dairy, corn and gluten. These 5 substances have permeated our food systems and become commonplace in virtually all of our grocery products. For proof of this, just look in your kitchen cupboard, and I guarantee you that 99% of the products in there contain at least one or more of these substances.
The main issue with these substances is that a large portion of the population does not possess the enzymes capable of breaking them down properly. We see this commonly in things such as the breakdown of proteins found in grains (gluten and gliadin), the protein and sugar found in dairy (casein and lactose) and the saponins found in beans/legumes. As noted by Caan (2012), when these undigested particles cross through our intestine into our bloodstream, our body treats it like a foreign invader and sends an immune response, and this response causes inflammation. Because the majority of food now contains these substances, it is safe to say that most people are battling with some manifestation of inflammation.
There are a number of research studies that support the underlying role of food intolerances as a cause for both depression itself and chronic inflammation. For example, Carta et al. (2002) found that adults affected by celiac disease (gluten intolerance) tend to show a higher prevalence of panic disorder and major depressive disorder than those unaffected by the condition. In a similar study, Arigo (2011) found that women with celiac disease face a higher risk for depression that the general population. Moreover, these findings correlate with the recent rise in depression diagnoses, as celiac disease is 4 times more common now than 60 years ago (Mercola, 2012). *For more on food intolerances, read my post on the 5 most common, which you can access here.
Genetically Modified/Engineered Foods (GMO’s)
Along with omega-6/3 ratios and food intolerances, GMO foods are another cause for concern when it comes to chronic inflammation. When we think of the main causes of inflammation, we typically do not associate it with genetically modified crops and seeds; and this is not by accident. Overarching, the biotech industry has been able to craft a sophisticated control system that largely prevents independent research of their products. We know so little about GM foods that it has been a challenge to attach any negative side effects to them, so much so that most of the studies to date have been done on animals. However, the findings from the studies that have been done were not good, linking GM foods to metabolic damage, kidney/liver failure and inflammation. The seminal research study in this area, conducted by Carman et al. (2013) found that pigs fed GM crops had higher rates of severe stomach inflammation that the control group. Overall, inflammation levels were 2.6 times higher in GM-fed pigs than those fed a non-GM diet. In a similar study, GM peas generated an allergic-type inflammatory response when fed to mice (Smith, 2007).
While current research on GM foods and crops is spotty at best, the reason that this is on the list is because of how much of our food is now genetically modified. According to the Non-GMO Project (2015), in North America over 80% of food now contains GMO ingredients. Among this, 93% of U.S. corn, 94% of soybeans and 96% of cotton (cottonseed oil) is genetically modified. Moreover, recent legislation has been passed laws allowing for more GM patents to be approved for farmers. So if any of these preliminary studies are applicable to humans, we are looking at big trouble in the future. *To learn more about GMO’s in our food supply, read my separate post on the topic, which you can view here.
Indigestion (Mineral Deficiency)
Along with out of whack omega-6/3 ratios, indigestion/mineral deficiencies are probably next in line as the biggest culprits when it comes to promoting systemic inflammation. And the reason for this… our modern SAD and lifestyle. In our existing daily lives, things like increased antibiotic and antibacterial medication use, heavy metals (i.e. mercury, lead, arsenic, nickel), chemo/radiotherapy, and even artificial food coloring have all contributed to the destruction of our natural gut bacteria. Resulting from this, most people become unable to digest their food properly. Consequently, indigestion ensues which creates a vicious cycle in the body, one in which we simultaneously become starved for nutrients, while at the same time overfed due to “empty” calories (J. Tavasolian, personal communication May 18, 2015). Because we are unable to digest our food, we become mineral deficient causing our body to go into survival mode, thus promoting a pro-inflammatory environment.
Correlating with this, current research has found that dietary intake or blood levels of individual micronutrients to be inversely associated with certain biomarkers of inflammation (LPI, 2015). When it comes to mineral deficiencies, magnesium is the most common by Americans. Current research suggests that up to 80% of Americans are not getting enough magnesium and may be deficient (Mercola, 2015). Ingesting enough magnesium is essential to our health because it is found in more than 300 different enzymes in the body and plays a role in the body's detoxification processes (Mercola, 2015). Comparably, various studies have illustrated the role that magnesium supplementation can have on reducing systemic inflammation. For example, in a study on middle-aged women, Moslehi et al. (2012) found that magnesium supplementation had a significant inverse correlation with inflammatory biomarkers. In addition to magnesium deficiency, certain vitamin deficiencies have also been shown to positively affect inflammatory responses. In a study by Friso et al. (2001), researchers found that low vitamin B levels was associated with higher levels of inflammatory biomarkers. Similarly, a study by Woolf & Manore (2008) found that low circulating levels of vitamin B6 is a risk factor for cardiovascular disease and rheumatoid arthritis, both inflammatory conditions.
I hope that this post was able to inspire dialogue and promote critical thinking as it relates to comprehending and shaping our own individual health narratives. Ever since I started writing this blog, my main motivation has always been to push back against many of our commonly held beliefs and assumptions about health and related policy and see things for what they are. Employing my background in communication studies, I have always been fascinated by the ways in which dominant ideologies and beliefs pervade mainstream consciousness and work to normalize the status quo. Particularly in the health field, issues of power and influence are prevalent across most dominant healthcare frameworks. The majority of public policy and healthcare initiatives are highly determined by entities such as Big Pharma and associated lobbying groups, meaning that when it comes to our individual health, there is a conflict of interest on the part of big business. Thus, as a result, we have to take back health in our own hands. We can no longer trust the word of the government, regulatory agencies and advocacy groups when it comes to our vested health interests.
As it relates to our prescription epidemic, I think if we are honest about the landscape of our collective health, it is easy to see the connection between our increasingly unhealthy diets and the overabundance of prescription drugs being handed out. The “chemical imbalance” discourse promoted by dominant power structures have allowed us to overlook the role that we play in determining our own health outcomes, in doing so stripping us of individual agency. By characterizing symptoms like depression as a “physical” disease that takes place at the biological level, it becomes identified as something that we have no control over, thus rendering us powerless and dependant on antidepressants as the only viable solution.
However, if we are ever to truly get a handle on this epidemic, it has to start with us. We have to start being accountable for our own individual food and lifestyle choices, and not allow Big Pharma to determine our health landscape. Because if we leave it up to them, they want things to remain just the way they are.
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