Ultra-Processed Foods and Depression

Dr. David Wiss

December 18, 2022

Mental Health

Ultra-Processed Foods and Depression     

Many articles about ultra-processed foods contain intense food-negative energy and food-punitive messaging, pointing to these foods as the culprit in global increases in BMIs, diabetes, and cardiovascular disease. This article is different because I will explore depression as the outcome of interest. This is an article about mental health.

Mental health necessitates a gentle approach. Those who have struggled with mental health know that behavior change is not always a matter of choice. Part of nutrition for mental health is being realistic and meeting people where they're at. Nothing super aggressive is coming here today, just an innocent plug for an anti-inflammatory diet for those with depression. 

Discussion around nutrition for mental health is only beginning to get adequate attention in the press and appears more prevalent in countries outside the US. I have seen incredible work from Australia, the UK, Canada, and South America (still waiting for the interest to pique here in the US). It is likely inevitable that nutrition for depression will make the headlines eventually. 

The term ultra-processed food is defined using the NOVA classification system, which breaks food into four categories:

1) Unprocessed or minimally processed foods can be altered by removing inedible or unwanted parts and drying, crushing, grinding, powdering, roasting, boiling, pasteurizing, freezing, vacuum packaging, etc.

2) Processed culinary ingredients, which are substances derived from group one foods or else through processes such as refining, grinding, milling, drying, and pressing. Examples include oils, butter, sugar, and salt.

3) Processed foods are made by adding group two foods (e.g., salt, sugar, oil) to group one food (usually to increase their durability or enhance their sensory qualities). Examples include canned vegetables, fruit preserved in syrup, and canned fish preserved in oil.

4) Ultra-processed foods are formulations of ingredients typically created by various industrial techniques and processes. Examples include soft drinks, packaged snacks, cookies/pastries/cakes, sweetened cereal, cheese, frozen pizza, chicken/fish nuggets/sticks, reconstituted meat products, etc. (the list can go on and on). Ultra-processed foods frequently include flavors, colors, emulsifiers, thickeners, and bulking or glazing agents, all designed to create highly profitable products.

A recent systematic review and meta-analysis pooled data from 260,385 participants from twelve countries, reporting a dose-response positive linear association between ultra-processed food consumption and depression risk [1]. The link between depression and diet is bi-directional, meaning that highly palatable foods can alleviate depressive symptoms, and low-quality diets can increase depressive symptoms. This has been shown in longitudinal studies where cohorts are followed for many years, and we see that ultra-processed food increases the risk for depressive symptoms [2,3]. Learn more about the biology of diet for depression. 


What is Depression?

 Depression is a mood disorder with different terms and types:

  • Major Depressive Disorder (MDD) is also called clinical depression.

  • Depression has been broken into unipolar (same as major depressive disorder) versus bipolar (formerly known as manic depression), which is associated with mood swings to manic states.

  • Depressive Symptoms are captured when you measure symptoms using a research tool like the CESD or the PHQ-9. This is not a diagnosis of depression, but rather, someone is showing signs of depressive symptoms.

 Symptoms of depression include:

  • Depressed mood (anhedonia which can be the inability to feel pleasure).

  • Feelings of worthlessness or guilt.

  • Suicidal ideation (could be a plan or an attempt).

  • Fatigue or loss of energy.

  • Sleep decreases or increases (many people with depressive symptoms will sleep too much).

  • Weight or appetite could either decrease or increase.

  • Decreased ability to think or concentrate.

  • Psychomotor agitation.


Is Ultra-Processed Food Addictive?

The impact of ultra-processed foods is not just about added ingredients (salt, sugar, fat, flavors, colors, emulsifiers, binders, etc.) but also about the removed food components. The fiber content is generally stripped from ultra-processed foods to prevent spoilage and increase palatability. We know that adequate fiber is strongly linked to gut health, affecting mental health and addiction vulnerability. Therefore, considering the potential contribution of food addiction when discussing ultra-processed foods is wise. Meanwhile, we must be careful with this language because it can trigger people with some forms of disordered eating.

 Some of the questions that have emerged from the food addiction debates are:

  • Is the food addiction concept valuable in the treatment of eating disorders?

  • How do we know if the food addiction is an actual addiction or a symptom of someone's excessive dieting behavior (pathological restraint)?

  • Should food addiction be better called an eating addiction and viewed behaviorally rather than as a substance addiction?

  • If someone meets the food addiction criteria and doesn't have a history of pathological dieting, how should we treat this person nutritionally?

What if an individual has a restrictive eating disorder that points to increasing their consumption of ultra-processed foods to work through some of their fears? What if that person also has unresolved depression? Should this person continue to eat more ultra-processed foods? Should all people aim to consume less ultra-processed foods? Is ultra-processed food addiction more of a public health and food policy discussion than about individuals?

As you can see, I have more questions than answers. We know that ultra-processed food is addictive, and there are a lot of nuances there [4]. We know that people with depression are more likely to eat ultra-processed foods. And we know that ultra-processed foods make people more depressed. So, what can we do about it?


Dietary Solutions for Depression

The Mediterranean diet is the most evidence-based approach to reducing inflammation and decreasing depressive symptoms [5]. Seven randomized controlled trials (summarized in a systematic review) have examined dietary interventions to decrease depression levels [6]. These were studies not focused on weight (weight and depression can be correlated) but on increasing the intake of fresh produce, whole grains, etc., as well as decreasing the intake of ultra-processed foods. Seven out of seven showed promise for reducing depression!

From my clinical experience, the most crucial target is fiber because most people need more. I'm talking about fiber that comes from foods rather than from supplements. If you have been eating the “western diet” for a long time, it might be challenging to move to 30+ grams of fiber each day (from fruits, vegetables, whole grains, beans, nuts, and seeds), so often the work is making your gut “fiber friendly” by increasing fiber intake very slowly. Sometimes “slow” is the only way to move toward a healthy eating pattern. 

I don't favor overly aggressive dietary interventions unless there is a medical reason. I'm more interested in doing the long-term work, building rapport, taking baby steps together, and encouraging you to become the expert on you. People can have a tough time with dietary changes, especially when there are depressive symptoms. Little things like grocery shopping more often, home cooking, not repeating food in a day, and aiming to get all the colors in the rainbow each day are great places to start.

If you’re looking for an app-based program to help you, you’re in the right place! If you’re looking for food addiction treatment or counseling for food addiction, please reach out and connect. If you’ve struggled with chronic inflammation and think that reducing ultra-processed foods will fight inflammation, and need someone to hold your hand as you eat more fresh fruit and healthy fats, we love to be a part of this journey. If you’re looking for meal plans, the app-based program will teach you how to create your own! 


References 

1. Mazloomi SN, Talebi S, Mehrabani S, Bagheri R, Ghavami A, Zarpoosh M, et al. The association of ultra-processed food consumption with adult mental health disorders: a systematic review and dose-response meta-analysis of 260,385 participants. Nutr Neurosci. 2022;1–19.

2. Gómez-Donoso C, Sánchez-Villegas A, Martínez-González MA, Gea A, Mendonça R de D, Lahortiga-Ramos F, et al. Ultra-processed food consumption and the incidence of depression in a Mediterranean cohort: the SUN Project. Eur J Nutr. 2019;59(3):1093–103.

3. Adjibade M, Julia C, Allès B, Touvier M, Lemogne C, Srour B, et al. Prospective association between ultra-processed food consumption and incident depressive symptoms in the French NutriNet-Santé cohort. Bmc Med. 2019;17(1):78.

4. Wiss D. Clinical Considerations of Ultra-processed Food Addiction Across Weight Classes: an Eating Disorder Treatment and Care Perspective. Curr Addict Reports. 2022;1–13.

5. Lassale C, Batty GD, Baghdadli A, Jacka F, Sánchez-Villegas A, Kivimäki M, et al. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Mol Psychiatr. 2019;24(7):965–86.

6. O’Neill S, Minehan M, Knight-Agarwal CR, Turner M. Depression, Is It Treatable in Adults Utilising Dietary Interventions? A Systematic Review of Randomised Controlled Trials. Nutrients. 2022;14(7):1398.