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A Diet to Beat the Blues (SMILES trial)

Are you eating to beat the blues?
The Food-Mood connection got a major boost to it’s reputation with recent completion of the ‘SMILES’ trial, an acronym for ‘Supporting the Modification of Lifestyle in Lowered Emotional States’.
Researchers wanted to see whether a modified Mediterranean style diet (termed the ModiMedDiet) could improve depression scores over just a few short months as compared to a ‘social support’ control group. Those in the diet group received tailored guidance from a trained dietitian, as well as recipes, shopping lists, and support for goal setting. What did the diets of study participants look like before the diet? Similar to the Standard American diet-meaning decreased micronutrient intake, low intake of dietary fiber, fruit and vegetables, and higher intakes of sweets, processed meats, and salty snacks.
So what happened?
The results over a 12-week intervention period:
Remission rate from depressive symptoms in control group: 8%
Remission rate from depressive symptoms in intervention group: 32.3%
(Remission was defined as a Montgomery-Asberg depression rating scale (MADRS) of <10)
The total change in MADRS score was a 7.1 point drop, shown here:
The ModiMedDiet was based off a traditional Mediterranean diet, designed using the Dietary Guidelines for Adults in Greece and Mediterranean diet principles from PREDIMED. The study diet carried an emphasis on whole, nutrient-dense foods with ‘extras’ (sweets, processed meats, cereals) limited to less than three times per week.
Nuts, leafy greens, tomatoes, olive oil and diary were included daily, with fatty fish, legumes, and lean red meat included regularly throughout the week.
SMILE Diet Basics: What You Need to Know
40% fat with over 50% from monounsaturated fats (olive oil, avocado)
36% carbohydrate
18% protein
50 grams of fiber per day
High Antioxidant/Vitamin C content of diet
Met all Recommended Dietary Intake/Adequate Intake (AI) requirements for adults
Researchers tweaked the traditional Mediterranean diet to include moderate consumption of lean red meat, given the leaning in nutrition psychiatry research toward improvements in depression and anxiety outcomes with inclusion of red meat in the diet. One review article of seventeen studies looked at dietary advice themes and compared them to outcomes related to depression and anxiety. Dietary advice to reduce cholesterol and red meat consumption was linked to worse mental health outcomes overall (Source). Lean red meat provides iron, zinc, and Vitamin B12, nutrients which are crucial to optimal mental health, and is more easily absorbed than plant-based sources of these nutrients. In a group of premenopausal women, a nonvegetarian diet was shown to lead to absorption of six times more total iron from a nonvegetarian compared to a lacto-ovovegetarian diet (Source).
Want to effectively apply principles from the SMILES diet into your own life?
Let’s make it happen together!
Here’s a sample menu to get you started
Muesli (1/2 cup) with a Flaxseed, Sunflower Seed & Almond mixture (1Tbsp) and 1oz dried fruit
3/4 cup whole milk yogurt
Handful of Mixed Nuts
Salmon Patties (2) with feta, spinach & sweet potato salad
Lentil & Vegetable Soup
2 Kiwi Fruit

About Sarah Ferreira

Sarah Ferreira,MS,MPH,RD,CDN,CNSC,IFNCP,CHWC is a Registered Dietitian Nutritionist with complementary certification as an Integrative and Functional Nutrition Certified Practitioner and Certified Health and Wellness Coach. She is the owner of Mindfully Nourished Solutions, where she uses a whole-person, whole-food approach to explore the impact of nutrition on mood and cognition. Her individualized approach integrates an assessment of nutritional, genetic, environmental, and lifestyle factors into a collaborative nutrition care plan using cutting-edge research designed to facilitate meaningful and restorative changes based around client goals and priorities.

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