Protein intake and depression among athletes

Previous blog posts have discussed nutrition strategies for depression.

A recent study looked at depression and protein intake in young student athletes.

What was this study?

97 adolescent elite athletes were recruited for the study. Symptoms of depression were recorded at baseline and again during a follow-up at 10 months (1)

A 3 day dietary intake log was obtained 3 months into the study(1)

What were the results?

Higher protein intake was associated with a reduction in symptoms of depression during the follow-up period (1).

What are some general protein intake guidelines?

This calculator can help get an estimate of protein intake, https://www.nal.usda.gov/human-nutrition-and-food-safety/dri-calculator

However, according to the most recent dietary guidelines for Americans, almost 90 percent do not meet the recommendation for seafood and more than half do not meet the recommendation for nuts, seeds (2)

International Society of Sports Nutrition that the majority of exercising individuals should consume at minimum approximately 1.4 to 2.0 g of protein per kg of bodyweight per day to optimize exercise training induced adaptations. (3)

What are some caveats?

This is a small study showing association not causation.

Study authors call for larger and more in depth assessment and techniques.

Athletes and people who exercise regularly may require protein intake that is higher than the Dietary guidelines for Americans.

An optimized and personalized approach to nutrition can help with both physical and mental health (see resources below like nutrition coaching).

Any other resources to improve nutrition?

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Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References 

1.  Markus Gerber, Sarah Jakowski, Michael Kellmann, Robyn Cody, Basil Gygax, Sebastian Ludyga, Caspar Muller, Sven Ramseyer, Johanna Beckmann. Macronutrient intake as a prospective predictor of depressive symptom severity: An exploratory study with adolescent elite athletes,Psychology of Sport and Exercise, Volume 66,2023,102387, ISSN 1469-0292, https://doi.org/10.1016/j.psychsport.2023.102387. (https://www.sciencedirect.com/science/article/pii/S1469029223000110

2.  https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf

3.  https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0177-8#Sec33

Mindfulness meditation vs escitalopram for anxiety

Mindfulness meditation has been shown to have various mental health benefits. For example, a review of 13 studies showed improvement in ADHD symptoms with mindfulness meditation (1).

Also, 41 trials show mindfulness meditation helped improve stress related outcomes such as anxiety, depression, stress, positive mood, etc. (2)

A review of 14 clinical trials shows meditation being more effective than relaxation techniques for anxiety (3).

A recent study looked at whether mindfulness based stress reduction (MBSR) was as effective as an anti-anxiety medication Lexapro (escitalopram) (4).

Who was in the study? (4)

  • 102 participants in MBSR and 106 participants in the escitalopram group, with a mean age of 33 years (4).
  • Participants were mostly female (4).

How was anxiety measured (4)?

  • Clinical Global Impression of Severity scale (CGI-S) was performed by blinded clinical interviewer at baseline, week 8 end point, and follow-up visits at 12 and 24 weeks (4).
  • Primary patient reported measure was the Overall Anxiety Severity and Impairment Scale (OASIS) (4).

What was the intervention? (4)

  • Participants were randomized 1:1 to 8 weeks of the weekly MBSR course or the antidepressant escitalopram, flexibly dosed from 10 to 20 mg (4).
  • MBSR group was taught MBSR as a manualized 8-week protocol with 45 minute daily home practice exercises, weekly 2.5-hour long classes, a day-long retreat weekend class during the fifth or sixth week (5).
  • Participants were taught several forms of mindfulness meditation, such as breath awareness (focusing attention on the breath and other physical sensations), a body scan (directing attention to one body part at a time and observing how that body part feels), and mindful movement (stretching and movements designed to bring awareness to the body and increase interoceptive awareness) (4,5).

What were the results? (4)

Participants who completed the trial at week 8 showed noninferiority for CGI-S score improvement with MBSR compared with escitalopram (4)—meaning MBSR was as effective as escitalopram.

What are some caveats?

  • This is the first study to compare MBSR to medication (4).
  • The study did not use commonly used instruments to measure anxiety in clinical settings such as GAD-7, Hamilton rating scale for anxiety or the Beck anxiety inventory, etc.
  • Participants had any anxiety disorder, not a specific type of anxiety disorder such as generalized anxiety disorder, panic disorder etc (4) which make it difficult to generalize results for other populations.
  • Participants (4) were mostly female in the 30’s which makes it difficult to generalize results for other populations.
  • MBSR is a specific type of manualized meditation taught by qualified instructors (5) and it may be difficult to find qualified instructors or qualified classes in your area.
  • In addition to work, school, and life obligations, people may find it difficult to schedule 45 minutes of daily meditation plus 2.5 hours of weekly class plus a day long retreat.
  • Different people may benefit from different types of meditation, and this area is being further researched.
  • Practicing meditation regularly may lead to improved benefits, and some people may see benefits with shorter duration of meditation.
  • Some people may find that mindfulness or too much mindfulness may worsen their symptoms (6), so you should check with your mental health professional if MBSR is appropriate for you.
  • Some mental health conditions may not be appropriate for MBSR, check with your mental health professional.

Want to learn more about meditation?

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By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. Poissant, H., Mendrek, A., Talbot, N., Khoury, B., & Nolan, J. (2019). Behavioral and Cognitive Impacts of Mindfulness-Based Interventions on Adults with Attention-Deficit Hyperactivity Disorder: A Systematic Review. Behavioural neurology, 2019, 5682050. doi:10.1155/2019/5682050
  2. Goyal M, Singh S, Sibinga EMS, et al. Meditation Programs for Psychological Stress and Well-Being [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Jan. (Comparative Effectiveness Reviews, No. 124.)Available from: https://www.ncbi.nlm.nih.gov/books/NBK180102/
  3. Montero-Marin, J., Garcia-Campayo, J., Pérez-Yus, M., Zabaleta-del-Olmo, E., & Cuijpers, P. (n.d.). Meditation techniques v. relaxation therapies when treating anxiety: A meta-analytic review. Psychological Medicine,1-16. doi:10.1017/S0033291719001600
  4. Hoge, Elizabeth A et al. “Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial.” JAMA psychiatry, e223679. 9 Nov. 2022, doi:10.1001/jamapsychiatry.2022.3679
  5. Santorelli  SF, Kabat-Zinn  J, Blacker  M, Meleo-Meyer  F, Koerbel  L. Mindfulness-Based Stress Reduction (MBSR) Authorized Curriculum Guide. Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. Revised 2017. Accessed December 14, 2017. https://www.bangor.ac.uk/mindfulness/documents/mbsr-curriculum-guide-2017.pdf
  6. Britton, W. B., Lindahl, J. R., Cooper, D. J., Canby, N. K., & Palitsky, R. (2021). Defining and Measuring Meditation-Related Adverse Effects in Mindfulness-Based Programs. Clinical Psychological Science, 9(6), 1185–1204. https://doi.org/10.1177/2167702621996340

Adjusting to college

Starting college or returning to campus can be exciting but also stressful.
A previous post discusses strategies for a successful transition to college.
A recent article by the JED foundation suggests the following strategies (1):
Take Care of Yourself (1)
• Find a lounge or café if you like a cozy place to hang out.
• If you know that a morning workout helps you manage stress, find out how early the gym opens.
• Between classes or activities, try to leave yourself enough time to enjoy a moment of respite before jumping into the next thing. It could be just sitting on a bench in the quad and taking some good, deep breaths.
• Carve out some time every week to talk to someone you trust and can be open with.
• Establish small rituals for yourself in the mornings and evenings that help you reset, such as writing in a journal, taking stock of your schedule and tasks, listening to music, or taking a walk outside.
Get Connected (1)
• One of the most powerful ways to take care of your mental health is to form meaningful connections at school. Examples, including keeping in touch with friends, making new friends, student organizations, recreational leagues, volunteer organizations, affinity groups, etc.
Find your community at college (1)
• Most schools have comprehensive lists of clubs and organizations on their website that you can look at even before you get to campus.
• Talk to staff in the Student Life or Student Activities office. They can often help you find social activities as well as information about internships, leadership roles, work-study programs, and more.
Look at the Big Picture of Mental Health (1)
• While speaking with a mental health professional can be extremely valuable when you are really struggling, it is important to also remember things you can do to promote your mental health—like getting enough sleep, eating well, exercising, engaging with others, mindfulness practices, etc.

Other thoughts:

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

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Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented. Permission to use/cite this article: contact patel.2350@osu.edu

Reference: 1. https://jedfoundation.org/resource/going-to-campus-mindfully/