Silent Insulin Resistance Increases Your Risk of Depression

What do your blood sugar, cholesterol levels and triglycerides have to do with your mental health? They’re all quite connected, as it turns out. 

Gone are the days of us treating mental health issues as a purely psychological phenomenon. We now know that biological factors like inflammation, hormones and blood sugar greatly influence our state of mind. 

Insulin resistance is common and often ignored until it progresses to diabetes. This is unfortunate because science tells us that insulin resistance can impact our wellbeing even before it leads to diabetes. Research consistently shows a connection between insulin resistance and mental health. A 2021 study by Rasgon et. al. found that those with insulin resistance had an increased risk of developing major depressive disorder over the 9 year follow up period of the study–even for those who never had depression or anxiety in the past.

What is insulin resistance?

Insulin resistance is not a specific disease in the same way that we think about diabetes. Insulin resistance is a state that the body can be stuck in long before diabetes shows up. When the body is in a state of insulin resistance, it means that it’s ignoring (or resisting) the instructions that insulin is trying to give to your body: make use of that sugar! When the body ignores those instructions from insulin, sugar is not used well by various parts of the body so it remains floating in the blood stream leading to elevated blood sugar. 

It can be tricky to measure early stages of insulin resistance because it can fluctuate easily from moment to moment. There are many ways to test it and it’s common for some tests to come back normal and for others to show signs of insulin resistance. 

In the study mentioned above, researchers measured insulin resistance in three validated ways:

• They calculated the ratio of triglycerides to HDL

• They measured abdominal fat 

• They assessed fasting plasma glucose levels 

An increase in the triglyceride-HDL ratio, an increase in abdominal fat and rising plasma glucose levels over the years all suggest insulin resistance and they were all associated with a higher risk of developing major depressive disorder. 

How do we treat insulin resistance?

Causes of insulin resistance include:

• Being sedentary 

• Consuming more calories than your body needs

• Not getting enough sleep

• Poor stress management

So in many cases, the way to manage insulin resistance is the same old, simple advice we’ve all heard over and over: 

• Exercise

• Eat healthy and keep moderation in mind (culturally appropriate Mediterranean Diet principles are a great way to do this)

• Go to bed on time and get help addressing any sleep issues

• Work on stress management

• Some supplements can play a role in managing insulin resistance but they can’t replace lifestyle changes

The thing is, we may all know about these lifestyle changes but the challenge becomes motivating ourselves to do them and dealing with life situations that make it difficult to implement these healthy changes. Depression is serious and devastating, hopefully more awareness about how these lifestyle changes can prevent depression will help keep us all motivated to take care of ourselves in the best way we can. If you need help coming up with a practical plan to manage insulin resistance and your mental health, book an appointment and I would be happy to help.

Depression and L-Carnitine: What's the evidence?

L-Carnitine has been filling up our Tik Tok and other social media feeds a lot lately. You’re seeing it light up the fitness industry with strong claims about its ability to increase muscle mass and promote weight loss. While the evidence around L-carnitine and weight loss is not strong (yet), the research around depression is promising. 

L-Carnitine is a substance that occurs naturally. The majority of it can be found in the diet and the body produces some as well. You can find L-carnitine in red meat like beef or lamb. If you’re not a fan of red meat, it’s also in white meat and fish like chicken, turkey and tuna. It’s also found in dairy products like yogurt and milk but to a lesser extent. 

The body can convert L-carnitine into something called acetyl-L-carnitine (ALC) which has many different roles in our bodies–including acting as an anti-oxidant and preserving nervous system health and function. It’s important to note that ALC crosses the blood brain barrier which means it has access to the brain and can influence brain activity. 

Research has shown that people with depression have lower levels of ALC than those without. This pattern was also observed in patients with treatment-resistant depression which sheds light on a very frustrating and frightening problem. It’s also interesting that lower levels of this chemical have been found in women with a history of childhood trauma and childhood trauma is a well known risk factor for the development of depression. 

Low ALC may not be related to all cases of depression but there may be some subtypes of depression that are related to low L-carnitine or ALC levels. It’s an interesting observation but does this mean that treating with ALC can actually help with depression symptoms? 

Studies have been giving us some answers to this question. Reliable research has shown that ALC supplementation can improve symptoms of depression. 

A meta-analysis of 9 studies (over 400 patients) examined the effect of ALC on depression and found that it significantly improved depression symptoms. ALC was also found to be just as helpful as anti-depressants with fewer side effects. It’s still not clear what doses are optimal for depression management but, in general, doses of this supplement typically range from 500-2000 mg daily.  

I have not often used ALC in my practice but this year I’ve been recommending it a bit more and I plan to start discussing it more with patients. As always, interactions and risks are possible with any supplement, so speak to a naturopathic doctor or other regulated healthcare provider before starting any new supplements. 

Thyroid Antibodies, Depression, and Anxiety

We all know that low thyroid hormones can lead to feelings of sadness and anxiousness. One of the most common causes of low thyroid hormones is an auto-immune condition called Hashimoto’s thyroiditis. With this condition, your body attacks and injures your thyroid gland which contributes to reduced thyroid function.

One of the hallmarks of this conditions is elevated thyroid antibodies—anti-thyroperoxidase and anti-thyroglobulin antibodies. For the longest time, these were viewed as markers of Hashimoto’s thyroiditis but not much attention was paid to them in the doctor’s office.

Now, more research is showing that high thyroid antibodies may be playing a role in mental health regardless of thyroid hormone levels. In other words, we should be paying attention to antibodies in addition to hormone levels.

A 2024 meta-analysis by Wang et al. examined 11 studies on this topic. Patients had normal thyroid hormone levels but high thyroid antibodies, a state known as euthyroid Hashimoto’s thyroiditis. Most patients were from Europe and China and there were over 1300 patients with depression and over 1000 patients with anxiety across all of these studies.

Those with normal thyroid hormones but elevated thyroid antibodies had 2.5 times higher odds of having an anxiety disorder. They were also more likely to experience depression symptoms based on validated questionnaires.

But why might the thyroid antibodies themselves impact mood? What could they be doing to the body? Researchers think that thyroid antibodies may negatively impact the nervous system. They may impact nerve cells or brain function—scientists aren’t completely sure yet.

It’s important to note that some studies show no link between thyroid antibodies and mental health. That being said, this assessment of multiple studies provides illuminating insight into the potential link between thyroid antibodies and mental health. In my practice, I regularly test thyroid antibodies for my patients with anxiety and depression because there are natural ways to address this issue. I wrote another article on this topic a couple years ago, before this new paper came out. You can read it HERE.

If you’re in Ontario and you need help uncovering the underlying factors impacting your mental health, book a free 15 minute phone consultation and we can chat about it.

What Causes Depression?

Depression does not discriminate. It can affect people who seem to have great lives while sparing others who have faced a lot of hardships. It makes you wonder what factors are at play when it comes to the cause of depression. 

This article won’t attempt to cover all possible factors that contribute to depression. Things like socioeconomic status, genetics, intergenerational trauma, political stability, access to resources, family dynamics and so much more all play a role. I’m going to dive into common contributing factors that I see in my practice with my patients.

Chronic Stress

Chronic stress changes your brain - literally. It changes the structure and health of your nerve cells and the way your brain operates. It also leads to chronic inflammation which is quite stressful to the nervous system. For this reason, chronic stress can eventually alter the brain in such a way that it leads to symptoms of depression. 

Negative Thinking Patterns

We all have moments when we see life through a grim lens. 

“I mess everything up.”

“I don’t have anything useful to offer.”

“Nobody likes me.”

“I don’t know what I’m doing with my life.”

These are negative thought patterns that pass through our minds all the time. But when your mind gets stuck on these thoughts and you can’t think past them, it can lead to depression. Over time, as your mind gets used to ruminating on these negative thoughts, you spend more and more time thinking this way and it becomes difficult to control. It becomes harder to shift to more positive thoughts. This is why telling a depressed person to “just think positive” is so unhelpful. It feels like trying to get a crease out of a piece of paper that’s been folded - negative thinking just feels baked in. This is where the help of a trained professional like a therapist becomes important.

Chronic Diseases and Blood Sugar Regulation 

Medical issues like diabetes, celiac disease, insulin resistance and severe arthritis have been associated with an increased risk of depression. This could be because it’s difficult to cope with certain chronic medical conditions. It’s also because chronic conditions can impact the nervous system and brain in a negative way. Poorly managed blood sugar in diabetics alters the nervous system and the mood. Inflammation from undiagnosed celiac disease and poorly managed arthritis impacts the brain and worsens anxiety and depression. Addressing your overall health is so important for your mental health.

Poor Gut Health

Your digestive health may have a big impact on your mental health. Irritable bowel syndrome and celiac disease, for example, have been associated with depression. Your gut bacteria might play a big role in the production of chemicals that influence your mood and emotional regulation. Whether you have IBS, ulcerative colitis, GERD or an undiagnosed gut issues, treating your gut health can improve your depression.

Inflammation

There is significant evidence that inflammation contributes to symptoms of depression. Studies have shown that people with depression have increased signs of inflammation. Lowering inflammation has also been shown to have a beneficial impact on depression symptoms. Some ways to lower inflammation include the right diet, exercise, good sleep habits, less exposure to environmental toxins, and using natural remedies strategically.

Diet and Nutritional Deficiencies

Diets that are not nutrient-rich and that are high in processed foods, sugar and less healthy fats have been associated with an increased risk of depression. Whole-foods diets that are high in fruits, vegetables, fibre, healthy carbohydrates, lean proteins and healthy fats improve depression symptoms. Alcohol can temporarily relieve symptoms of depression but it also may increase the risk of depression. Certain nutritional deficiencies like being low in iron, B12 or vitamin d are also really important to consider. If you have depression, you need to talk to your naturopathic doctor about your nutritional status and diet.

Hormones

Hormones play a big role in your mood. Hormonal fluctuations contribute to premenstrual symptoms of depression. Low thyroid hormones are known to cause feelings of depression. Other hormones such as testosterone can cause depression in men if levels are low. The hormonal shifts that happen around menopause can cause feelings of depression as well. There are so many complex ways that hormones influence your nervous system and your mood. Balancing hormones and helping your nervous system stay calm amidst hormonal fluctuations can go a long way in improving depression.

Lifestyle

There are a host of lifestyle choices that influence your mood such as the amount of time you spend on social media, the amount of authentic social connections you have in your life, your exposure to sunlight and nature, your sleep habits, your exercise routine etc. In my practice, I don’t only talk about diet and supplements. I also spend a lot of time talking about these types of lifestyle changes that impact mood.

It might feel overwhelming to think of all the factors that contribute to depression. The good news is that we can work on many of these factors to achieve a meaningful difference in your mood. It’s possible to find a way out of depression and it doesn’t have to require an overwhelming plan. Step by step, you can feel better. 

If you are experiencing a mental health crisis please call or text 9-8-8 if you’re in Canada or 9-1-1 to access emergency medical care.

Carbs and Mental Health

Carbs have really taken a hit in the past few decades. They are portrayed as the enemy for everything from weight gain to brain fog to allergies. Most of the trending diets (keto, carnivore, paleo) are anti-carb with heaps of information about why carbs are the enemy and why humans are not meant to eat carbs. 

The reality is that painting carbs as detrimental to health is a dramatic oversimplification of the situation. Stating that our cave-man ancestors mainly ate meat and fat is inaccurate. 

It’s really (really) hard to reconstruct the diet of our prehistoric ancestors. The level of carbohydrate intake varied by the location of a population - some may have had more and some may have had less. The evidence available suggests that carbohydrates were an important part of the development of the human species and played a key role in meeting the energy needs of humans and the development of the brilliant human brains we have today. 

Research shows us that diets rich in complex carbohydrates that are high in fiber and antioxidants are good for mental health. They promote good gut health and less inflammation which is associated with less anxiety and depression. Diets high in refined carbohydrates (white bread, white rice, pastries etc.) are associated with poorer mental health. 

So if you love carbs and dread the idea of dinners that look like chicken breast with a few leaves of spinach, keep this article in mind. In general carbs from sources like whole grains, vegetables and fruit are great for mental health. 

Of course, everyone’s nutritional needs are different depending on their health history. Even certain healthy carbs could be a problem for people with specific medical conditions. Health advice is not one size fits all. If you need help sorting out the right diet for you, get it touch to learn more about how I help patients. 

Anxiety and Depression in Perimenopause and Menopause

Do you feel like there’s been a shift in your mental health? Are you worrying more than usual or having a harder time managing stress and anxiety? Are you feeling more sad or empty lately? Are you noticing an increase in irritability? 

Perimenopause and menopause are both associated with an increased risk of depression and anxiety. There have been a number of studies on this subject that reveal this correlation.

Perimenopause refers to the transition towards menopause which can last several years before periods stop. It often starts in the 40s but it can begin in the 30s for some women. Once the period has stopped for a year, you’re considered in menopause. This usually happens when women are in their 50s. 

Why is there an increased risk? 

The physical changes that happen to women during perimenopause and menopause can be alarming and stressful. Hot flashes, night sweats and insomnia can really strain mental health. A drop in libido is a common symptom that can lead to feelings of emptiness or depression. Difficulty losing weight and changes in physical appearance during this period can be a source of anxiety for many. Brain fog and fatigue can lead to a background feeling of stress all the time. 

Then there are the hormonal shifts that impact mental health. The drop in estrogen that happens during this time is believed to cause negative changes in mood for some women. Other hormones like progesterone and testosterone drop too but the impact of these changes on mental health is not well studied (unfortunately). The hormonal shifts may in turn impact neurotransmitter activity. Serotonin is a neurotransmitter that plays a role in mood and it may be impacted by the hormone shifts that happen during perimenopause and menopause. Past history of anxiety and depression increases your risk of symptoms getting worse during perimenopause. 

Some big life changes happen from 40 years old and on. Young kids and teens could be hitting some challenging milestones. Empty nest syndrome could kick in as adult children move out. Caregiver burden often goes up as parents age. Career burnout or dissatisfaction can start to weigh on you. All of these changes combined with the physical changes mentioned above could contribute to the increased vulnerability to anxiety and depression among perimenopausal and menopausal women. 

What to do about it

We can't stop menopause from ever happening but there is a lot that can be done to smooth the transition and reduce anxiety, depression and physical symptoms. This can be done with the help of natural remedies, diet changes and lifestyle changes. If you want to learn more about how I help women through perimenopause and menopause, don’t hesitate to reach out. 

B12 and Depression

There are so many nutrients that play a role in mental health. We can’t accurately test for every nutrient deficiency in a convenient and well validated way. Luckily, B12 is one of the nutrients that we can actually test with a fair amount of confidence about the accuracy of the results in many cases. 

There have been a number of studies about B12 and depression. Studies have found that lower levels of B12 in certain populations may be related to depression symptoms. Higher intake of B12 has been associated with a lower risk of depression. However, it’s unclear how much B12 supplements improve depression symptoms. Some studies have show promise, other have not. B12 may also help with other symptoms that are common among depressed patients such as low energy.

B12 might impact mental health because of its role in producing certain neurotransmitters in the brain which are important for mood regulation. It can also help lower other compounds in the body such as homocysteine which have been linked to depression.  

Vitamin B12 deficiency can happen when you are not consuming enough of the vitamin. Common sources of B12 are chicken, eggs, fish, dairy and meat. It’s also fortified in certain foods like some brands of nutritional yeast and is easily found in supplement form. Deficiency can also happen when you’re not absorbing enough B12 from the foods you eat. This can be due to a medical reason like gastritis or celiac disease. B12 deficiency has also been linked to certain medications. Sometimes we don’t know why the body is not able to absorb B12 well from the diet. 

The easiest way to determine if vitamin B12 deficiency is playing a role in your mental health is to test for deficiency and treat it. Not everyone needs a B12 test but it’s something I do for many of my patients along with other testing to determine if hormones or nutrient deficiencies are playing a role in their mental health symptoms.

Dysthymia (Persistent Depressive Disorder)

Lingering sadness that stretches on for prolonged periods of time without being extremely intense but also not something that’s easy to ignore. This is how people with dysthymia can feel. Dysthymia is now called persistent depressive disorder in the DSM-5. It’s not as well understood as major depressive disorder (MDD). MDD tends to come and go with episodes of depression alternating with periods of remission. With dysthymia, symptoms of depression can persist for years without much remission time. It can start in childhood, making someone feel like they have always been depressed. 

Causes

As with most mood disorders, dysthymia is believed to have a complex web of causes ranging from biological to social to environmental and psychological. Risk factors include family history, high stress, low self esteem, trauma and having other mental health diagnoses. It also appears to be more common in women. 

Symptoms

In order to meet the criteria, adults need to be experiencing a depressed mood that interferes with their life for at least two years. If there is any relief, it does not last longer than 2 months. Other symptoms need to be present such as fatigue, insomnia, increased or reduced appetite, or poor concentration but not all of these are required to be diagnosed with dysthymia. 

Treatment 

Dysthymia is treated much the same way as depression. Antidepressant medication and therapy is often recommended. In addition to these options, I support my patients by improving their diet in a way that improves their mental health, working on lifestyle changes and recommending nutritional supplements and herbal medicines that they can incorporate into their treatment plan without interacting with medications they may be taking. Treatments plans (including diet and lifestyle) need to meet a patient where they are at so that they are realistic and not overwhelming. 

Please remember to speak to your family doctor or psychiatrist to confirm any diagnoses rather than self-diagnosing. If you’re in a state of crisis, contact: 1-855-310-COPE (2673), Suicide Crisis Helpline (9-8-8) or 9-1-1.