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How to Stay Healthy

A few easy New Year's resolutions to improve or maintain the physical, cognitive, and mental health of ourselves and our patients

In addition to treatment, good psychiatric care includes prevention. Several studies in 2009 show which preventive strategies may work (at minimal cost).

REGULATE GLUCOSE THROUGH EXERCISE, SLEEP, AND DIET

Glucose regulation appears to play a central role in cognitive function and aging. Hippocampal subregions are vulnerable to abnormal glucose levels, and poor glucose control may interact with coexisting disorders, such as dementia or cerebral infarcts, to worsen cognition.

Possibly helpful interventions include exercise, regular sleep, and controlled caloric intake. Exercise improves insulin and glucose regulation, although high (but commonly used) doses of vitamins C and E block these effects. A regular sleep-wake pattern is important, since cycle misalignment can cause abnormalities in blood pressure and in levels of glucose, insulin, and leptin. In healthy elders, caloric restriction (but not increased intake of unsaturated fatty acids) improved verbal memory and lowered fasting insulin and CRP levels. In addition, caloric restriction may extend life span.

The Mediterranean dietary pattern (MDP), when combined with exercise, can decrease the risk for dementia and may also influence depression incidence. The MDP emphasizes fruits, nuts, cereals, legumes, and fish; high monounsaturated to saturated fatty acids ratio; and moderate alcohol consumption. In one study, researchers analyzed the effect of MDP on depression in 10,094 healthy Spanish individuals during a mean follow-up of 4.4 years (Arch Gen Psychiatry 66:1090). After adjustment for confounders, MDP adherence (especially for fruits and nuts, fatty-acid ratio, and legumes) was associated negatively with new incidence of depression and positively with improved glucose metabolism. Similarly, researchers prospectively assessed the relation between self-reported depression and dietary pattern (either "whole food" [highlighting vegetables, fruits, and fish] or "processed food" [emphasizing sweetened desserts, fried food, processed meat, refined grains, and high-fat dairy products]). Of 3468 London-based office workers, those with high whole-food intake were less likely, and those with high processed-food intake were more likely, to report depression (Br J Psychiatry 95:408). This finding held even after adjustment for multiple variables, including exercise; a secondary analysis showed that diet affected depression and not the reverse. With both of these studies, however, we do not know whether individual dietary components or a combination caused these effects.

AVOID STRESS, MULTITASKING, AND CELL PHONES

Stress can impair cognition through effects on the prefrontal cortex, as shown in medical students preparing for a licensing examination. In an animal model of Alzheimer disease, stress combined with amyloid-β deposition seems to produce more impairment than either factor alone.

Although heavy multitaskers might have trouble ignoring irrelevant stimuli, they can miss important ones. In earlier research, speaking or preparing to speak disrupted visual processing. Similar findings have led many to argue against use of hands-free cell phones; New York City recently prohibited hands-free phones by taxi drivers. In a study of attentional diversion among pedestrians on a college campus, cell phone users changed direction and had near-collisions more often than others, and only 25% noticed a clown on a unicycle, compared with 61% of those using music players, 51% of single walkers, and 71% of those walking in pairs (App Cognit Psychol Oct 19). Thus, not only driving but even walking becomes dangerous while one talks on a cell phone (and who knows the effect of texting while walking). It's definitely best to pay attention to where you're going and to wait to text or call.

What can we take from these stories? Explore these factors with your patients (and with yourself). Eat well (and less), exercise, minimize stress, have a regular sleep schedule, and don't use a cell phone when you're doing anything else.

— Jonathan Silver, MD

Published in Journal Watch Psychiatry January 4, 2010

Reader Remarks:

Review and add to remarks on this article

• Depression-Eating turned upside down
  Richard R Thornton, 2 Feb 2010 12:14 PM EST
  Should dietary habits cause depression then WOW!! We have a real thereaupeutic window.

2011 Year in Review