Postpartum mood disorders….dietary strategies

postpartum depressionIt’s time to take on Postpartum Mood Disorders….

Having a baby is the most beautiful, exciting moment of your life, right?  Not for some.  Postpartum depression, anxiety, OCD and psychosis – a collection of mental illnesses particular to the circumstances of pregnancy and mothering –  are estimated to affect about 10-15% of women (1).

That some moms go through this is nothing short of tragic.

The Canadian Mental Heath Association and The Mayo Clinic offer counselling, meditation and medication as the appropriate treatment for postpartum mental illness (2), however I want to spread the word that new and exciting research suggests that maternal diet might also play a profound role.

While I am NOT suggesting that any mother avoid medication or that she discontinue it after starting, I AM suggesting that paying attention to diet and supplementation can be helpful in stabilizing a mother’s mood. 

Every mother suffering from postpartum mood disorder should seek the advice of a medical expert.  The intention of this article is to explain some of the research around how food and nutrients can be related to postpartum mood changes and offer strategies that can help, as part of a more comprehensive plan, to get a mom back on her feet.

What causes postpartum mood disorders?

What makes one woman’s experience with her baby delightful and another woman’s gloomy? There is some debate as to what causes postpartum mood changes – likely because no two women have the same physiology. 

According to the Mayo clinic some possible factors could be post pregnancy drops in estrogen, progesterone and/or thyroid hormones.  They also point to changes in blood volume, blood pressure, immune system, metabolism, sleep deprivation, and stress as causal factors for mood changes.

If we draw on some of the emerging brain research, however, we can look to metabolic, immune, inflammatory and nutrient changes particular to pregnancy to explain postpartum mood changes.  Diet can play a significant role in stabilizing mood because it can help mediate each one of these underlying factors.

Here are five dietary strategies that can help stabilize mood postpartum

  1. Increase nutrients that are supportive of the brain
  2. Stabilize blood sugar
  3. Increase antioxidants to combat oxidative stress
  4. Reduce inflammation
  5. Screen for autoimmunity and food allergy

Increase Brain Nutrients:

Low levels of B12, folate (B9) and B6 have been shown to promote inflammation and mood conditions, likely because they are critical players in the methylation cycle.  It is via the methylation cycle that mood hormones are activated, toxins are neutralized and oxidative stress is managed.   

Take note that long term stomach acid suppression can block the absorption of B12.  So if you have been on medication for reflux or heartburn (Nexium, Dexilant, Prilosec, Zegerid, Prevacid, Protonix, and AcipHex), ask your doctor to check your B12 levels.

If you have a genetic variant known as MTHFR your ability to convert folate from food can be up to 70% impaired.  In this is the case, taking an activated folate supplement (known as 5-MTHF) is the way to get sufficient folate.  Note also that folate is different from synthetic folic acid.  Choose a supplement that contains either folate, Methylfolate or 5-MTHF.  Not folic acid.

According to Dr Ray Pataracchia, my colleague in Toronto who specializes in orthomolecular treatment of mental illness, other nutrient deficiencies that have been implicated in mood disorders are: D, Calcium, zinc, magnesium, copper (deficiency or toxicity), Omega 3 fatty acids, B3, protein.

It is plausible that in some cases, the physical stress of pregnancy coupled perhaps with other factors that impair absorption such as poor digestion or medication, leaves the mother depleted of critical nutrients needed for proper brain function and results in altered mood.  Furthermore, estrogen during pregnancy can promote retention of copper which then interferes with the production of serotonin (the “feel good” neurotransmitter).

Stabilize Blood Sugar

Regardless of whether a mother suffered from gestational diabetes, stabilizing blood sugar in the postpartum months is an important factor to regulating mood.  It can be particularly difficult to do this because of sleep disturbances and demands on your time.  Asking friends or family to help you keep a steady supply of nutrient dense snacks handy can be helpful.

When blood sugar is awry, insulin levels spike causing a cascade of events and resulting in inflammation and undue stress on the adrenal and thyroid glands.  The result can be profound changes in mood.

Here are a few suggestions to keep blood sugar stable.

  • Reduce sugar and grains while increasing fat and protein – this reduces insulin levels and forces your body to use fat as an energy source
  • Get enough calories in and eat never “go hungry”.  Don’t skip meals.  It can be easy to forget to eat when you are busy with an infant.  Asking your friends to stock your freezer with easy to access high calorie nutrient dense snacks can be helpful.  See recipes section in my free members area for ideas.
  • Eat coconut oil every day – this dietary fat, high in medium chain fatty acid, does not require pancreatic enzymes or bile for digestion (like other fats do).  This means it can be used directly as a source of energy without stimulating insulin.
  • Choose honey as your sweetener as it has been shown to help stabilize blood sugar
  • Chia seeds are a nourishing, filling food that can also help stabilize blood sugar. You’ll find it in my recipe archives.
  • Ask your doctor to test your A1C or fasting glucose levels

Reduce Inflammation

A fairly new area of study is looking at the connection between high inflammation markers and altered mood states.  This article reviews some of this research and this article nicely outlines the connection between inflammation and postpartum mood disorders.

Nutritional researchers are still trying to come to some consensus about how to use foods to modulate inflammation however, here are some ideas to try:

  • Adopt a diet that is lower in grains and sugar while being higher in protein and healthy fat – this reduces the insulin load of the body and stabilizes blood sugar, both of which are drivers of inflammation.
  • Meditation and relaxation have been shown to significantly reduce inflammation levels (3)
  • 3 hours a week of exercise has been shown to improve the mood of women with Postpartum Depression, possibly because it  reduces inflammatory cytokines (4)
  • Improve digestion by increasing probiotic foods like sauerkraut and yogurt. Probiotic bacteria can promote anti-inflammatory responses and alleviate anxiety (5) Here’s a post I wrote all about incorporating good bacteria into your life.  It’s VERY IMPORTANT TO MOVE SLOWLY when introducing good gut bacteria, particularly if you suffer from mood disorders.  They can backfire if you introduce too much too quickly.  
  • Screen for food allergies.  Eating foods you are sensitive to, stimulates the immune system and causes inflammation.
  • Fish oil supplements have been shown to reduce inflammation because Omega 3 fatty acids are precursors to anti-inflammatory prostaglandins  There is also enough evidence that low levels are associated with postpartum mood disorders to give this supplement a go (6-9).  

Increase Antioxidants

Oxidative Stress is the term used to explain damage to tissues that comes about when the biproducts of metabolic functions are not effectively neutralized.  This is also known as “free radical damage”.   The stress of pregnancy increases a mother’s oxidative stress, particularly if she is malnourished.

Antioxidants are chemicals that neutralized free radicals and thus reduce oxidative stress.  While the most powerful of antioxidants, such as glutathione, are created by the body, a significant amount also comes through diet.  Vitamins A, C, E, and minerals zinc and selenium are well know antioxidants.

One study suggests that selenium supplementation, in particular, may protect against the development of postpartum depression (10).  Fish oil has also been associated with a reduction of oxidative stress in pregnancy (11).   Magnesium deficiency also seems to be inversely related to oxidative stress.

Screen For Autoimmunity

Models such as this one and this one for understanding postpartum mood disorders as related to immune function are starting to be proposed. 

Postpartum moms are particularly prone to autoimmune expression after the stress of pregnancy.  More research here is needed but it is certainly worth asking your doctor to rule out autoimmune conditions, particularly Hashimoto’s Thyroiditis and Celiac, as they have been shown to deeply affect the mood.    

SUMMARY… what to do if your mood starts heading down the toilet

  • Avoid chemicals and toxins as much as possible – they increase oxidative stress and inflammation.  This includes household cleaners, soaps, detergents, perfumes, body washes, food additives.  Remember that whatever goes onto your skin and into your nose also goes into your body.
  • Eat good quality protein every day – about 30% of your calories should come from protein. This protein helps create neurotransmitters and hormones that improve mood and sleep.
  • Eat coconut oil and olive oil every day – about 30% of your calories should come from healthy fat like these.  That’s likely more fat than your are used to!  But fat is the brain’s preferred source of energy and creating a baby can deplete a mom’s stores. 
  • Take dessicated liver or eat organ meats – these are full of brain supportive nutrients.  I like this brand if you are looking for a supplement
  • Take 2-4 ml Fermented Cod Liver Oil for essential fatty acids, and vitamins A and D.  This one is the best on the market.
  • Eat nuts and seeds every day.
  • Fix the Gut – inflammation in the digestive tract along with poor elimination and absorption that occur along side result in altered brain function.  Get support for this.
  • Eat several servings of fresh greens every day.  Try juicing your greens to get a concentrated nutrient boost.  If you can’t get that much greens in consider a supplement like this one.
  • Cut out refined sugar and refined flour.  These stimulate insulin spikes and inflammation
  • Eat wild fish and sardines 2-3 times a week for the fatty acids and antioxidants
  • Drink “Golden Milk” every day for the anti-inflammatory benefits of curcumin
  • Add epsom salts to your bath for extra magnesium.  Also consider a magnesium oil like this one.
  • Ask your doctor to check iron, zinc, folate, B6 and B12, D levels
  • Screen for autoimmune conditions (such as celiac and hashimotos)
  • Screen for food sensitivities
  • Incorporate fermented food into your diet to improve gut health – at least take a probiotic (start slowly). 
  • Take evening primrose oil or fish oil.  For 3 months postpartum I suggest this fish oil which is high in DHA.  After that I suggest switching to one that is higher in EPA.
  • Increase dietary antioxidants – fresh fruits and vegetables, brazil nuts, shellfish, sardines
  • Exercise at least 3 hours per week

As with all illnesses, while a group of women may share the same symptoms, no two women’s physiology is the same and therefore there can not be a one sized fits all explanation or treatment for postpartum mood disorders.  Each mother should work with a qualified practitioner to determine the most appropriate course of action she should take.  But can you see now how there can be multiple causes and multiple solutions?  

One thing is certain…. we all need to help moms feel good so they can take care of their babies.  When a mother suffers from a postpartum mood disorder, she needs support from every direction to implement these strategies.

If you’re looking for help here’s what to do:

It’s time to feel good again.

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NOTE: For a great run down on what PPD, PPA and PPP look like, check this article out.

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References

(1) http://www.babycenter.com/0_postpartum-depression-and-anxiety_227.bc.

(2) http://www.cmha.ca/mental_health/postpartum-depression/#.VBBxBhbTGnc

(3) http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0002576

(4) Mokhber N, Namjoo M, Tara F, Boskabadi H, Rayman MP, Ghayour-Mobarhan M. Effect of supplementation with selenium on postpartum depression: a randomized double-blind placebo-controlled trial. J Matern Fetal Neonatal Med 2011 Jan;24(1):104-8.

(5) Messaoudi M, Lalonde R, Violle N, Javelot H, Desor D, Nejdi A. Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Br J Nutr 2011 Mar;105(5):755-64.)

(6) Hibbeln JR . Seafood consumption, the DHA content of mothers’ milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. J Affect Disord 2002 May;69(1–3):15-29.

(7) Golding J, Steer C, Emmett P, Davis JM, Hibbeln JR. High levels of depressive symptoms in pregnancy with low omega-3 fatty acid intake from fish. Epidemiology 2009 Jul;20(4):598-603.

(8) De Vriese S, Christophe AB, Maes M. Lowered serum n-3 polyunsaturated fatty acid (PUFA) levels predict the occurrence of postpartum depression: further evidence that lowered n-PUFAs are related to major depression. Life Sci 2003 Nov 7;73(25):3181

(9) Otto S, De Groot RH, Hornstra G. Increased risk of postpartum depressive symptoms is associated with slower normalization after pregnancy of the functional docosahexaenoic acid status. Prostaglandins Leukot Essent Fatty Acids 2003 Oct;69(4):237-43.

(10) Heh S, Huang L, Ho S. Effectiveness of an exercise support program in reducing the severity of postnatal depression in Taiwanese women. Birth 2008 Mar;35(1):60-5.

(11) http://www.ncbi.nlm.nih.gov/pubmed/24274816

Osborne LM, Monk C. Perinatal depression—the fourth inflammatory morbidity of pregnancy? Theory and literature review. Psychoneuroendocrinology 2013 Apr 19;S0306–4530(13):00114-5.

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