Nutritiously and deliciously, the food we eat impacts how we feel. Nutritional psychiatry continues to deepen understanding of the complex ways in which food and nutrients influence the brain, mood, and mental health. However, it is just one element of the whole. The simple act of eating shapes overall health, for better or for worse. Food choices directly influence the gut, with ripple effects on mood and hormones, key areas for women’s health.

Women and the Food-Mood Connection

Many women want to make healthier choices yet despite their best efforts, a myriad of internal and external factors can stand in the way of regular, healthy wholefood meals. Food and mood are interconnected through a complex web of factors as women respond to individual, environmental, cultural and social cues (See Figure 1).¹ Low mood is associated with unhealthy food consumption, food addiction and overeating, while improved mood supported healthier eating patterns.¹

Figure 1: Women & the Food-Mood Connection.¹

A Downer of a Western Diet

Sadly, the Western diet is associated with depression and anxiety.² Examining habitual diet quality and mental disorders in an epidemiological study of Australian women, a Western diet (incorporating processed or fried foods, refined grains and sugary products) was associated with a greater likelihood of psychological symptoms and disorders. The ‘traditional’ dietary pattern (vegetables, fruit, meat, fish, and wholegrain foods) was linked with lower rates of depression and anxiety.²

The consumption of ultra-processed food may directly affect long-term mood. After adjusting for confounding factors, those with higher intakes of ultra-processed foods at baseline had increased odds of higher psychological distress (an indicator of depression) 13-17 years later, compared to those with the lowest intake.³ Similarly, a recent British study showed high intakes of ultra-processed foods correlate with increases in recurrent depressive symptoms.⁴

Healthier Foods to help you SMILE

Challenging women to eat healthier eating, the SMILES (Supporting the Modification of lifestyle in Lowered Emotional States) randomised controlled trial showed that food can in fact improve mood.⁵ Using a modified Mediterranean diet, increased fibre intake and improvements in overall diet quality were shown to reduce symptoms in individuals with clinical depression.^5,6

In the “Gut Feelings” randomised trial, a high-prebiotic dietary intervention improved mood, anxiety, stress, and sleep in adults with moderate psychological distress and low prebiotic intake.⁷

An inverse association was found between depressive symptoms and overall diet quality scores in female university students (p=1.017), a population at risk of both depression and unhealthy lifestyle habits.⁸ Considering the impact of the whole diet, rather than individual nutrients/food groups, may account for the combined effects of nutrients on brain health and neurotransmitter formation.⁸

The Gut-Brain Interface

Gut-derived factors influence mood via the microbiota-gut-brain axis. The Western diet contributes to altered gut microbiota and amplifies intestinal permeability, interfering with gut-brain communication.⁹ Research suggests that the gut bacterial-induced inflammatory response from exposure to lipopolysaccharide (LPS) may be implicated in the pathogenesis of depression in humans.⁷

Adherence to a Mediterranean diet correlates with lower inflammation whereas Western diets and those high in refined carbohydrates are associated with higher levels of C-reactive protein, a marker of low-grade inflammation.²

Nutritional factors exert a direct and potent influence on neural physiology. The Western diet lowers brain-derived neurotrophic factor (BDNF) which helps protects neurons from oxidative stress and promotes neurogenesis. Modulating BDNF expression may influence psychiatric status.²

Hormones and Diet in the Spotlight

Premenstrual symptoms negatively impact women cognitively, socially, emotionally, and physically in the 7-14 days before menstruation. A primarily Westernised diet is positively associated with worsened symptoms of both premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD).⁹ An Iranian study examined the effects of three dietary patterns: the Western diet was positively linked to PMS, while the healthy diet (rich in dried fruits, spices and nuts) and traditional diet (high in eggs, tomato sauce, fruit and red meat) had an opposite correlation.¹⁰

Gut health and Hormones

Variations in the gut microbiome that occur cyclically may be associated with PMS, however further research is required to fully understand this connection.¹⁰

The increased load of gut commensal Gram-negative bacteria at the end of the menstrual cycle is associated with premenstrual symptoms including fatigue, physio-somatic and anxiety symptoms, breast swelling and food cravings. This increased LPS load (peaking at day 28) may play a role in the pathophysiology of premenstrual symptoms by inducing low grade immune-inflammatory responses.¹¹

Changes in hormones levels during the menstrual cycle can impact the function and composition of the gut microbiome.¹⁰ For example when diversity of the gut microbiome decreases, this negatively affects β-glucuronidase (responsible for the breakdown of oestrogen conjugates, leading to a reduction in oestrogen levels.¹⁰

Interestingly, the gut microbiota also influences appetite and food intake by modulating nutrient sensing and appetite and satiety-regulating systems.¹¹

Simple Strategies for a Healthier Diet

Improving diet quality with regular intake of healthy wholefoods is a great place to start. The modified Mediterranean diet for depression used in the SMILES trial was rich in vegetables, fruits and wholegrains, with an emphasis on increased consumption of oily fish, legumes, raw unsalted nuts and seeds, and extra virgin olive oil. It included a moderate consumption of reduced fat, natural dairy products and lean red meat (as a source of iron)(see Figure 2).⁶

Figure 2: Modified Mediterranean Diet for Depression.⁶

Tools such as the Dietary Inflammatory Index (DII) and the Antidepressant Food Scale can also help patients make informed dietary choices. The Dietary Inflammatory Index (DII) determines the potential of a diet to cause an inflammatory response in the body based on the balance on pro-inflammatory and anti-inflammatory foods.¹²

With benefits beyond mental health, the Antidepressant Food Score (AFS) profiles plant and animal foods according to nutrient density, based on those shown to support mental health: Folate, iron, long chain omega-3 fatty acids (EPA, DHA), magnesium, potassium, selenium, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin C, and zinc. Top scoring foods include seafood, leafy greens, cruciferous vegetables, and nuts (see Figure 3).¹³

Figure 3: Antidepressant foods based on the Antidepressant Food Scale.¹³

Empowering future health

Diet and nutritional factors affect women’s health via the microbiota-gut-brain axis and other mechanisms that affect mental health, hormonal balance, and overall health. Empowering patients to make consistent healthy dietary choices has the power to improve current and future health.

References

1. Leeds J, Keith RS, Woloshynowych M. Food and mood: exploring the determinants of food choices and the effects of food consumption on mood among women in Inner London. World Nutrition. 2020;11:(1):68-96.

2. Jacka FN, Pasco JA, Mykletun A, Williams LJ, Hodge AM, O'Reilly SL, et al. Association of Western and traditional diets with depression and anxiety in women. Am J Psychiatry. 2010 Mar;167(3):305-11. doi: 10.1176/appi.ajp.2009.09060881

3. Lane MM, Lotfaliany M, Hodge AM, O'Neil A, Travica N, Jacka FN, et al. High ultra-processed food consumption is associated with elevated psychological distress as an indicator of depression in adults from the Melbourne Collaborative Cohort Study. J Affect Disord. 2023 Aug 15;335:57-66. 

4. Arshad H, Head J, Jacka FN, Lane MM, Kivimaki M, Akbaraly T. Association between ultra-processed foods and recurrence of depressive symptoms: the Whitehall II cohort study. Nutr Neurosci. 2024 Jan;27(1):42-54. doi: 10.1080/1028415X.2022.2157927. 

5. Jacka FN, O'Neil A, Opie R, Itsiopoulos C, Cotton S, Mohebbi M, et al. A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial). BMC Med. 2017 Jan 30;15(1):23. doi: 10.1186/s12916-017-0791-y.

6. Opie RS, O'Neil A, Jacka FN, Pizzinga J, Itsiopoulos C. A modified Mediterranean dietary intervention for adults with major depression: Dietary protocol and feasibility data from the SMILES trial. Nutr Neurosci. 2018 Sep;21(7):487-501. doi: 10.1080/1028415X.2017.1312841.

7. Freijy TM, Cribb L, Oliver G, Metri NJ, Opie RS, Jacka FN, et al. Effects of a high-prebiotic diet versus probiotic supplements versus synbiotics on adult mental health: The "Gut Feelings" randomised controlled trial. Front Neurosci. 2023 Feb 6;16:1097278. doi: 10.3389/fnins.2022.1097278.

8. Quehl R, Haines J, Lewis SP, Buchholz AC. Food and mood: diet quality is inversely associated with depressive symptoms in female university students. Can J Diet Pract Res. 2017 Sep 1;78(3):124-128. doi: 10.3148/cjdpr-2017-007.

9. Trezza A, Krabbe JP. A vicious cycle: using nutrition to combat the behavioural impact of premenstrual syndrome and premenstrual dysphoric disorder. Nutritional Foundations. 2022:45(2):14.

10. Rahimi N, Soleimani RA, Milani PG, Vadaei S. The role of diet and microbiome in premenstrual syndrome. Gastrointestinal Nursing. Feb 2024;22(1). doi: 10.12968/gasn.2024.22.1.34

11. Roomruangwong C, Carvalho AF, Geffard M, Maes M. The menstrual cycle may not be limited to the endometrium but also may impact gut permeability. Acta Neuropsychiatr. 2019 Dec;31(6):294-304. doi: 10.1017/neu.2019.30. Epub 2019 Oct 14.

12. Shivappa N, Schoenaker DA, Hebert JR, Mishra GD. Association between inflammatory potential of diet and risk of depression in middle-aged women: the Australian Longitudinal Study on Women's Health. Br J Nutr. 2016 Sep;116(6):1077-86. doi: 10.1017/S0007114516002853.

13. LaChance LR, Ramsey D. Antidepressant foods: An evidence-based nutrient profiling system for depression. World J Psychiatry. 2018 Sep 20;8(3):97-104. doi: 10.5498/wjp.v8.i3.97.