Dietary help for depressed athletes

Although athletes may benefit from an exhilarating endorphin rush on exertion that elevates their mood and suppresses feelings of pain it will not stop them from experiencing, at times, anxiety and bouts of depression just like the rest of us.

What is depression?

Depression is a mental health issue that Wikipedia defines as “a low mood and aversion to activity that can affect a person’s thoughts, behaviours, feeling and sense of well- being. Depressed mood is not necessarily a psychiatric disorder. It can be a normal reaction to certain life events, a symptom of a medical condition or a side effect of drugs or medical treatment ”

There are many dietary factors that can speed recovery if time is first taken to understand the origins of the depression, recognise those most at risk from it and the treatment options that are available.

Generally mental health issues are more common than you might think.

Facts on mental health disorders in NZ

• These affected 20% of the NZ population within the past year.
• Women suffer more from anxiety and depression, whilst substance abuse is more common in men.
• All mental health disorders are more common in the 16-24 year olds and decline with age.
• Pacific islanders, young people and those with more than one physical complaint are more susceptible.
• Only 39% of people with mental disorders visit medical centres for help.
• 3% of the population over the last year reported days when their life or their work was affected.

Athletes at risk

Athletes may be particularly at risk of mental health issues because of the nature of their sport:

• The desire to surpass their “personal best times/ targets” can result in athletes setting goals that place them physically at risk of injury and also mentally at risk of self-doubt if their goals are not realized.
• The media hype and the pressure of expectations for success from themselves, fans, coaches and parents, particularly as competition becomes fierce, can be extreme leading to loss of sleep and increased tension.
• Over training can lead to fatigue, muscle strain and loss of condition.
• The down times associated with recovery from injury and non-selection can lead to feelings of isolation and falling confidence in their ability to perform.
• The limited time span and earning capability of sporting careers along with the financial pressures of finding and maintaining contracts and sponsorships can  feed anxiety.
• The pressures of studying and/or supporting a family during the day as well as managing a training program in-between these commitments can lead to meals on the run and fatigue.
• Equipment failure (often very expensive/irreplaceable) as well as keeping up with technological developments in order to maintain “the edge” can add to the hype of an athletes daily existence.
• Separation from family and friends when touring can lead to loneliness and self-doubt.

Symptoms

Depression can take many forms, but in the early stages the sufferer may notice:

• Extreme fatigue or loss of energy
• Poor concentration and judgement and difficulty in making decisions
• Sleep problems despite extreme tiredness
• Sexual dysfunction and lack of sex drive
• Anxiety, feeling upset about little things, feeling sad and like crying
• Restlessness and boredom
• Feelings of doom and gloom “I can’t get motivated to do anything”, or” I’ve let the side down”
• Feelings of worthlessness, loss of confidence and guilt
• Appetite disturbance, cravings for carbohydrate or chocolate, compulsive eating, weight gain
• Addictive behaviour excessive consumption of food, alcohol, or drug abuse or alternatively loss of appetite altogether
• In the extreme, thoughts of self harm or suicide

Possible causes of depression

Athletes, like the rest of us, may also become depressed by life itself.

Hereditary

Research is focusing on identifying genes for depression that may be passed on from one generation to the next. One explanation is that if the genetic capacity for stress is low there is a greater risk of depression developing.

Biochemical

Research is looking at the way in which mood is affected by electrical activity and certain chemicals within the brain. It is thought that high levels of stress may lead to chemical imbalance which can in turn lower the functions and effectiveness of some brain activities and lead to mood imbalance. The effects of the over use of caffeine and alcohol on mood and behaviour are just some example where tolerance to chemicals can vary. For more information refer to Lea’s articles “Alcohol and Sport” and “Can caffeine fix performance”?

Physical

Depression can accompany physical illness, such as following chronic fatigue syndrome, glandular fever, thyroid and liver disease. Research has found, for instance, that being diabetic doubles the odds of having depression. Severe vitamin and mineral deficiencies e.g. iron deficiency, along with sensitivity to low levels of sunlight (seasonal affective disorder) have all been found to contribute to depressive states.

Concern regarding weight control is of particular relevance to athletes. Especially when individuals are trying to “make-weight” for selection or the success of the team is reliant on a weight category such as in rowing, rugby, equestrian or gymnastics. Anxiety and depression can certainly result if goals are not realized.

Anxiety

It is very common for people to experience high levels of anxiety in the early stages of depression. Feelings may include unrealistic worrying, panic, fear, sleeplessness, irritability and excessive tiredness.

Studies have found that anxiety levels in athletes can be reduced and performance during competition enhanced, when athletes learn how to improve and maintain their levels of self-confidence.

Psychological

Psychological theories of depression tend to look to the sufferers early experiences and again genetic reasons.  Personality traits particularly an individual’s ability to cope with change and tolerance to stress may lead some people to react more negatively than others when responding to life events. This has led researchers like Martin Seligman to define this as a state of” learned helplessness” where the sufferer begins to believe that nothing they can do will alter the situation they are in. Motivation to change their circumstances is lost and depression can set in.

Social

Stressful life events or sudden change such as divorce, bereavement, financial loss, unemployment or loss of status along with conflict within families and social groups, can all lead to feelings of isolation and depression.

Little wonder then that athletes coping with normal family stresses might experience additional stress if faced with non-selection, injury, or a drop in form.

Who is most susceptible?

Depression can occur at any stage of an athlete’s life.

• Women are twice as likely as men to suffer from depression which may be due to hormonal changes associated with menstruation; pregnancy; postnatal and menopause E.g. female athletes wanting to regain their pre-baby form or athletes coping with stress associated with polycyclic ovarian syndrome or endometriosis during times of major competition are some examples.
• Children may exhibit depression symptoms by failing growth rates or withdrawal from normal social gatherings. In sport, younger athletes who rely heavily on parental support to get to events are particularly vulnerable to changes in family routine bought about by such things as family separation, loss of income or housing. Such pressures can lower a child’s self-confidence.
• Adolescents –particularly those in the 15-18yr age range may develop disordered eating patterns as they try to “make-weight” for their chosen sport or experiment with different dietary regimes in order to aid performance. Manipulating energy intakes in this way can not only lead to fatigue and depression but can also affect growth and performance. For more information read Lea’s article on “Don’t let disordered eating ruin your performance” and “The protein needs of young athletes”
• Senior athletes might show it through malnutrition and severe weight change, especially following retirement, injury or the loss of a friend or spouse. For more information re Lea’s article “Sports nutrition for senior athletes“.
• All age groups may turn to food in excess. Over-eating can become a replacement for love, affection, sexual desire or a way of postponing or delaying the need for life-changing decisions. For more information read Lea’s articles “ Is stress making us fat”; “Making changes” and “Building resilience”

Diagnosis and treatment

The DSM manual

This was published by the American Psychological Association is the most widely used diagnostic manual in USA and many other countries. This manual helps to classify specific disease categories according to the number of symptoms exhibited. This “one size fits all” approach has led some critics to argue that the system fails to take into account the “degree of distress” being experienced, however it does provide a diagnostic tool and baseline from which to work.

Also with regard to depression, critics are concerned that the DSM has led to a “medicalization” of quite understandable expressions of sadness  that may occur  normally off and on throughout people’s lives. The increasing use of antidepressants and prescription rates in New Zealand has raised concerns that depression, like obesity, may be reaching epidemic levels. (Which is not surprising since they can be related). However it may also indicate that more people who once would have “slipped through the net” of the health system are now being picked up and offered help.

Treatment Options

• Medication– discuss this and all treatments with your doctor
• Family therapy– is particularly important for children
• Individual therapy
  –psychodynamic psychotherapy, reviews issues of the past.
  – interpersonal therapy looks at social interactions and relationships such as coping with grief, conflicts and role transitions.
  – Cognitive therapy (CBT) appears to be the most effective means of treatment with or without medication. This therapy challenges self-critical and self-derogatory thinking, replacing these ideas with more rational and helpful alternatives while at the same time acknowledging progress and change.
• Supportive counselling– involves listening and support and is often run as a group session.
• Nutrition support this in combination with any of the above can speed recovery.

Dietary factors and depression

There are a number of avenues of nutritional assessment worth considering when working through mental health issues.

Fatigue

The majority of depression sufferer’s site fatigue as one of their greatest problems and this could be due to the following:

• A failure to balance out energy intake with energy expenditure on a daily basis and when coping with training and competition.
• A lack of sleep for more information read Lea’s article  Sleep deprivation affects nutritional well-being
• A lack of oxygen carrying nutrients (iron, zinc, folate) are linked to fatigue so a nutritional analysis can help to check adequacy.
• Folate, a B group vitamin, is often low in the diet of the men, the elderly and also children. Mainly found in dark green leafy vegetables, legumes, whole grain breads and cereals. A lack of folate results in megaloblastic anaemia causing fatigue. Evidence is also gathering that folate has an anti-depressant effect.
  Young athletes, particularly those living in residential colleges or who may be eating late meals after training at night e.g.rowers, often miss folate rich foods such as green leafy vegetables when these foods are over cooked.  One solution for these athletes is to eat more green salads and also to include berries and bananas into milkshakes, when they can, for a folate boost.
• Thiamine, another B group vitamin, is often deficient in alcoholics, dieters, multiple drug users or those with kidney complaints. Sufferers may experience feelings of depression, fatigue and sleep disorders. Thiamine can be found in the germ of cereals, nuts, peas and yeast extracts.
  Most male athletes eat so much carbohydrate food they are seldom deficient of this vitamin. However athletes who adopt low carbohydrate diets, or those whose dietary fibre is limited due e.g.to gastric conditions such as coeliac disease, may be at risk of deficiency and should contact us about this.

Cognitive Functions

Depressed athletes often complain of being unable to concentrate and remember things. This can be due to nutritional deficiency.

• Iron deficiency is often seen in young children, women, adolescents, athletes, the elderly, vegetarians and dieters. These groups may experience tiredness, frequent infections, lack of concentration and depression. The best food sources of iron are red meat, fish, poultry, beans and whole grain cereals. For more information read Lea’s article on “Iron makes us happy” and “Vegetarian athletes face extra hurdles”.
• Omega 3 fatty acids are highly concentrated in the brain and are important for memory, cognition and behavioural functions. Symptoms of deficiency include: fatigue, poor memory, dry skin, circulation problems mood swings and depression. Good food sources which also have low mercury content include salmon, oysters, freshwater trout and sardines.  For more information read Lea’s article “How to increase the “good fats” in your diet

Weight management

Depression often accompanies changes in body weight that can occur when athletes are injured, side lined or touring away from home. For more information read Lea’s article “Facing the down times without weight gain”

Weight gain

•  Chocolate is often highlighted as food that people turn to during times of stress. Research in 2010 by Dr Natalie Rose and colleagues from University of California in San Diego looked at the eating patterns of 931 men and women. They found that participants with high scores for depressive disorders consumed about 12 servings per month of chocolate compared to those with low scores for depression who averaged 8.4 servings and non-depressed subjects who averaged 5.4 servings of chocolate per month.
  The researchers were unable to determine a causal link between chocolate eating and depression. What we do know is that people who screen positive on a depressive scale consume more chocolate than those who do not. This could certainly impact on an athlete’s ability to “make weight”
• Carbohydrate cravings may increase in some people who suffer from depression.It is thought that this may be because as carbohydrate intake increases so too does the level of amino acid L-tryptophan which is associated with an increase in serotonin synthesis. Serotonin is an important neurotransmitter for the regulation of mood and impulsivity of behaviour, eating patterns and the quantities of food ingested. Serotonin tends to suppress appetite and calms the senses. A Dietitian can help athletes to find balance.

Weight loss

• Intentional weight loss, if necessary, can be helpful in improving performance and building confidence provided that weight loss is monitored to achieve a healthy goal which is then maintained.
•  Unintentional weight loss however can begin in an effort to “make weight” for a sport and then get out of hand. This can lead to disordered eating which can not only impair performance but also endanger long-term health. As weight loss can also be a symptom of illness it is important to discuss this with your doctor.

Other addictive behaviours

Depression often accompanies other addictive behaviours such as excessive dieting, cigarette smoking and substance abuse that alone or in combination can impact on some of these nutrients mentioned above as well as eating behaviour.

For instance there is a high correlation with depression and heavy smoking. Smokers have been found to experience greater weight loss, skip meals, eat fattier foods, drink more coffee and alcohol and have lower intakes of folate, iron and anti oxidant vitamins C and E than non-smokers. While it maybe an unhealthy habit, enough athletes smoke to warrant a “smoking zone” to be included in the London Olympics game village.

The Mediterranean diet

According to research from Tuffs University  a study of 10,094 people studied at the University of Navarra found that 42% of those who ate a predominately Mediterranean diet were less likely to suffer from depression. This diet was characterised by moderated intakes of alcohol and dairy products, low intakes of meat, increased consumption of legumes, nuts, fruits and vegetables, cereals and fish.

The B group vitamins folate, thiamine and vitamin B6 present in these foods are important to healthy serotonin levels since the body uses these nutrients to convert tryptophan to serotonin. Serotonin levels also increase with exercise and exposure to sunlight.

Getting started

Many people with mental disorders see the problem as “fixing itself”. The most common reason for not seeking support or stopping treatment was the attitude “I thought the problem would get better by itself” This is not so.

Recognising that you or a family member or friend is depressed is a major step towards recovery

• Seek companionship- talk to a friend or family member or coach
• Start with small steps- set yourself a new goal to achieve each day
• Eat regularly, take exercise, take one step at a time.
• Consider a change- take up a new interest outside of your home such as a social activity, recreational pursuit, voluntary work or renew old friendships and interests
• Talk to your doctor and see if your sporting organisation has access to a sports psychologist who understands the demands of your sport and it’s associated mental health risks and can work these through with you.
• Talk with us. We understand the nutritional needs for different sporting activities and offer practical solutions to achieving your goals. Using nutritional analysis we can help athletes to speed their recovery so do contact us today.

New resources on depression that might be of help:
Depression and anxiety affects us all differently
Well being and mental distress in Aotearoa NZ: Snapshot 2016
How to help athletes recognise the mental health risks of sport

References:

Wikipedia: definition of depression en.wikipedia.org/wiki/Depression_(mood) ‎

Yapko M. Hand me down blues . St Martin’s Griffen New York.July 2000

Tuffs University 2010.  “Health and nutrition letters” Food and your mood. Vol 27 issue 11

Smith G. Depression Explained. How you can help when someone you love is depressed.Cox and Dawes 2002

Bishop L.  Postnatal depression -Families in turmoil. Coping with postnatal depression. A guide for mothers, families, friends and doctors. Halstead Press 1999

Seligman M. Learned Optimism. Random House 2004

Mental Health Foundation of New Zealand. 2013 http://www.mentalhealth.cog.nz/page/128-Mental-Health-Quick -Statistics