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The Impact of Healthy Living on Mental Health
Lifestyle factors like diet, exercise, exposure to green spaces, and social connections can reduce depression and anxiety risk. Intensive lifestyle changes may also slow early Alzheimer's disease progression, demonstrating the broad mental health benefits of lifestyle and environmental factors.
One of the questions we ask ourselves is whether our lifestyle changes make a difference, and if so, what the best interventions are. These studies below shed some light. This first study found that long-term exposure to residential greenness is linked to a decreased risk of depression and anxiety and that reduced air pollution was a significant factor. There is increasing evidence that air pollution negatively affects mental health and is associated with an increased risk of type 2 diabetes.
I found the second study interesting because it suggests that even with genetic risk factors, lifestyle changes could prevent depression. The third study was a small study (N=51) exploring whether intensive lifestyle change over 20 weeks can improve early-stage cognitive decline in Alzheimer's disease. The study was conducted by Dean Ornish, who is well-known for advancing plant-based medicine for cardiovascular health.
As you know, what occurs in the heart occurs in the brain. This study found that some cognitive scores and the Aβ42/40 ratio improved. The aβ42/40 ratio is a biomarker of amyloid plaque in Alzheimer's. In contrast to the previous multivitamin research I reviewed, this research used high-quality and appropriately dosed vitamins and fungi like Lions Mane. The findings showed that in the intervention group, some improved, some were unchanged, and some worsened. Higher adherence to the "lifestyle plan" resulted in more improvement, though not always.
I also wonder if enrolling participants between the ages of 45 and 65 with cognitive decline/AD brings into the equation the rare early-life Alzheimer's disease, which is genetically driven. If the mechanism for this is different, the response to lifestyle changes may also be, but the study did not address this.
This study is worth reading through to understand the challenges of conducting this type of research. While I am not a fan of a vegan diet in the long term—rich in carbs and low in fat and protein—there may be times when short-term adherence catalyzes change and shakes up those amyloid deposits.
Tags: depression, anxiety, Alzheimer's disease, lifestyle, nature, mental health
Interested in Learning More?
- Course(s): Mental Health Disorders
- Course(s): Diabetes Type 2, Cognitive Decline, and Alzheimer’s
- Book(s): The Brainbow Blueprint
Research Glossary
Research has its own vocabulary. To help you decipher research, I created a Glossary to ease the way. You may access it here: Research Glossary
Referenced Research Publications
Nature Mental Health
2024, March 28
DOI: https://doi.org/10.1038/s44220-024-00227-z
Long-term exposure to residential greenness and decreased risk of depression and anxiety
Abstract
Residential greenness is considered a unique and potentially modifiable exposure construct to reduce physiological stress and improve human health. Here this study aims to investigate the longitudinal relationships of residential greenness with incident depression and anxiety and to explore and compare the pathways in which greenery may influence mental health. After excluding participants with depression or anxiety at baseline, a family history of severe depression, loss to follow-up or missing information on greenness exposure, we analyzed data of 409,556 participants from the UK Biobank. Residential greenness was assessed utilizing the normalized difference vegetation index (NDVI) within a buffer region of 300 m, 500 m, 1,000 m and 1,500 m. Incident depression and anxiety cases were identified by linking to records on the death register, hospital admissions, primary care and self-report. Time-varying Cox proportional hazards models were used to analyze the associations between greenness and incident depression and anxiety. During a median follow-up of 11.9 years, 14,309 (3.5%, 306.9/100,000 person-years) and 16,692 (4.1%, 358.0/100,000 person-years) patients were diagnosed with depression and anxiety, respectively. The hazard ratios and 95% confidence intervals (CIs) for depression and anxiety were 0.84 (95% CI, 0.82–0.85 and P < 0.001) and 0.86 (95% CI, 0.84–0.87 and P < 0.001) in the highest quartile compared with the lowest quartile of NDVI 300 m, respectively. Similar trends were shown for NDVI 500 m, 1,000 m and 1,500 m. Air pollution (particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5), NO2, NOx, SO2 and O3) played a major mediator role in the associations. For example, the association between NDVI 300 m and depression was 52.9% (95% CI, 31.6–73.1%), 28.4% (95% CI, 13.4–50.3%), 30.9% (95% CI, 17.8–48.1%), 2.4% (95% CI, 1.4–4.1%) and 27.7% (95% CI, 19.4–37.9%) mediated by the reduced PM2.5, NO2, NOx, SO2 and O3, respectively. This national study highlights that long-term exposure to residential greenness was linked to a decreased risk of incident depression and anxiety. Reduced air pollution was a significant mediator linking green environments to depression and anxiety.
Reference
Wang, J., Ma, Y., Tang, L., Li, D., Xie, J., Hu, Y., & Tian, Y. (2024). Long-term exposure to residential greenness and decreased risk of depression and anxiety. Nature Mental Health, 2, 525–534. https://doi.org/10.1038/s44220-024-00227-z
Nature Mental Health
2023, September 11
DOI: https://doi.org/10.1038/s44220-023-00120-1
The brain structure, immunometabolic and genetic mechanisms underlying the association between lifestyle and depression
Abstract
Lifestyle factors have been acknowledged to be modifiable targets that can be used to counter the increasing prevalence of depression. This study aims to investigate combining an extensive range of lifestyle factors, including alcohol consumption, diet, physical activity, sleep, smoking, sedentary behavior and social connection, that contribute to depression, and examine the underlying neurobiological mechanisms. Over nine years of follow-up, a multivariate Cox model was utilized on 287,282 participants from UK Biobank to demonstrate the protective roles of seven lifestyle factors and combined lifestyle score on depression. Combining genetic risk and lifestyle category in 197,344 participants, we found that a healthy lifestyle decreased the risk of depression across a population with varied genetic risk. Mendelian randomization confirmed the causal relationship between lifestyle and depression. A broad range of brain regions and peripheral biomarkers were related to lifestyle, including the pallidum, the precentral cortex, triglycerides and C-reactive protein. Structural equation modeling on 18,244 participants revealed underlying neurobiological mechanisms involving lifestyle, brain structure, immunometabolic function, genetics and depression. Together, our findings suggest that adherence to a healthy lifestyle could aid in the prevention of depression.
Reference
Zhao, Y., Yang, L., Sahakian, B. J., Langley, C., Zhang, W., Kuo, K., Li, Z., Gan, Y., Li, Y., Zhao, Y., Yu, J., Feng, J., & Cheng, W. (2023). The brain structure, immunometabolic and genetic mechanisms underlying the association between lifestyle and depression. Nature Mental Health, 1, 736–750. https://doi.org/10.1038/s44220-023-00120-1
Alzheimer's Research & Therapy
2024, June 07
DOI: https://doi.org/10.1186/s13195-024-01482-z
Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial
Abstract
Background: Evidence links lifestyle factors with Alzheimer’s disease (AD). We report the first randomized, controlled clinical trial to determine if intensive lifestyle changes may beneficially affect the progression of mild cognitive impairment (MCI) or early dementia due to AD.
Methods: A 1:1 multicenter randomized controlled phase 2 trial, ages 45-90 with MCI or early dementia due to AD and a Montreal Cognitive Assessment (MoCA) score of 18 or higher. The primary outcome measures were changes in cognition and function tests: Clinical Global Impression of Change (CGIC), Alzheimer’s Disease Assessment Scale (ADAS-Cog), Clinical Dementia Rating–Sum of Boxes (CDR-SB), and Clinical Dementia Rating Global (CDR-G) after 20 weeks of an intensive multidomain lifestyle intervention compared to a wait-list usual care control group. ADAS-Cog, CDR-SB, and CDR-Global scales were compared using a Mann-Whitney-Wilcoxon rank-sum test, and CGIC was compared using Fisher’s exact test. Secondary outcomes included plasma Aβ42/40 ratio, other biomarkers, and correlating lifestyle with the degree of change in these measures.
Results: Fifty-one AD patients enrolled, mean age 73.5. No significant differences in any measures at baseline. Only two patients withdrew. All patients had plasma Aβ42/40 ratios <0.0672 at baseline, strongly supporting AD diagnosis. After 20 weeks, significant between-group differences in the CGIC (p= 0.001), CDR-SB (p= 0.032), and CDR Global (p= 0.037) tests and borderline significance in the ADAS-Cog test (p= 0.053). CGIC, CDR Global, and ADAS-Cog showed improvement in cognition and function and CDR-SB showed significantly less progression, compared to the control group which worsened in all four measures. Aβ42/40 ratio increased in the intervention group and decreased in the control group (p = 0.003). There was a significant correlation between lifestyle and both cognitive function and the plasma Aβ42/40 ratio. The microbiome improved only in the intervention group (p <0.0001).
Conclusions: Comprehensive lifestyle changes may significantly improve cognition and function after 20 weeks in many patients with MCI or early dementia due to AD.
Reference
Ornish, D., Madison, C., Kivipelto, M., Kemp, C., McCulloch, C. E., Galasko, D., Artz, J., Rentz, D., Lin, J., Norman, K., Ornish, A., Tranter, S., DeLamarter, N., Wingers, N., Richling, C., Kaddurah-Daouk, R., Knight, R., McDonald, D., ... Arnold, S. E. (2024). Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: A randomized, controlled clinical trial. Alzheimer's Research & Therapy, 16, 122. https://doi.org/10.1186/s13195-024-01482-z