by Stephanie Greunke

 If you need immediate help, the National Suicide Prevention Hotline is a free and confidential network of more than 140 crisis centers nationwide. It is available 24/7 to contact in a crisis at 1-800-273-8255. You can call for yourself or someone you care about.

For additional help, call Postpartum Support International’s warmline at 800-944-4773. You’ll get a return call within several hours. You can also visit their website www.postpartum.net. Click here to connect with your closest coordinator to get info, support, resources, and referrals to providers trained to treat PPD in your area.

Are you struggling, mama? You’re not alone! Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth and are a leading cause of  significant short-term or long-term consequences to a woman’s health. At least 1 in 7 mothers experience serious depression or anxiety during pregnancy or postpartum, 1-2 out of 1,000 have postpartum psychosis, and let’s not forget about the 1 in 10 fathers (and other partners) who also experience postpartum depression or anxiety. PMADs can begin any time during or after pregnancy, after a pregnancy loss or after an adoption.

Feeling overwhelmed with how to get help? A treatment plan will be specific to each woman, but a good starting place is an understanding of potential causes. You may need the support of medication, therapy, supplements, group counseling, or a mixture of these modalities. I’m a registered dietitian, so it’s not surprising that I consider food as medicine.  My 4R approach for modifying your diet is an additional support for your mental health.

The 4Rs are as follows:

  1. Reduce inflammation
  2. Regulate blood sugar
  3. Replenish nutrient stores
  4. Restore the gut.

I know this is easier said than done when you’re struggling to get out of bed in the morning and have little to no appetite. The significant benefits of these dietary modifications have been well-documented, however, and I want to see you thrive! I strongly believe what you eat has a significant impact on your overall health. While most people look at the impact of food on physiological/physical health, such as weight and cardiovascular health, we can’t forget about the important role that diet plays on our psychological/mental health. While the content is geared towards addressing your needs, mama, these tips can also benefit partners, caregivers, and adoptive parents.

1. Reduce inflammation.

Why?
Inflammation is associated with the onset of major depressive disorder outside of the context of pregnancy and childbirth. Inflammation is also associated with pregnancy complications such as preeclampsia, preterm birth, and gestational diabetes, and it’s quite possible that inflammation may play a role in perinatal mood disorders. Inflammation from various sources, including refined sugar, stress, and chemical exposures, can cause inflammation in the brain, impacting the production of mood-boosting neurotransmitters, such as serotonin.

How?
Taking a high-quality fish oil is a standard recommendation for treating mood disorders per the American Psychiatric Association. Consuming low-mercury, fatty-fish (such as wild-caught salmon and sardines) on a weekly basis, is also highly encouraged.

Find 18 Whole30 compliant fish recipes here!

Fish oil is one of the most studied and effective dietary supplements for treating mental health conditions. It could be that the EPA/DHA in the fish oil reduces inflammatory cytokines (specifically TNF-x, IL-1, and IL-6) which are often elevated in those with major depression. By reducing systemic inflammation, we may be more able to treat or manage these mood disorders.

Secondly, consider adding turmeric to food, since it contains curcumin—a powerful anti-inflammatory agent that has shown potential antidepressant-like activities in animal studies. An easy way to consume turmeric is in a stir-fry with fresh/frozen vegetables, your protein of choice, and canned coconut milk. It can also be easily incorporated into soups and broths. If you are not breastfeeding  (or get approval from your provider while nursing*), you can consider a turmeric supplement that contains black pepper for enhanced absorption. The typical dose is about 500 mg twice a day.

Finally, focus on a consuming a whole foods diet and reducing sugar, processed foods, and refined grains. If moms are willing and able, I’ve seen great results using the Whole30 to reset their health, hormones, and relationship with food. After the 30 days, you systematically reintroduce potentially triggering foods to understand what works best for your mental and physical health. You then create a style of eating that works for them based on that valuable information.

*Turmeric is given an intermediate safety rating in terms of its breastfeeding risk per InfantRisk

2. Regulate blood sugar.

Why?
There’s an interesting directional relationship between diabetes and depression. Meaning, elevated blood sugar is associated with an increased risk of depression and depression is associated with an increased risk of diabetes. In fact, a study published in 2010 following more than 65,000 women for over a decade showed that women with diabetes were more likely to develop depression, even when other risk factors such as exercise and weight were accounted for. Another meta-analysis found that depression was associated with a 60% increased risk of type 2 diabetes.

There are a few reasons why blood sugar may play a role in the pathology of perinatal mood and anxiety disorders. We know that elevated blood sugar is an inflammatory state. Additionally, individuals with high blood sugar may be eating a diet high in processed grains and sugar, contributing to the body’s inflammatory burden. Excess dietary sugar, especially artificial sugar, can negatively impact gut and brain health and even lead to nutritional losses or deficiencies such as vitamin D, calcium, and magnesium which are extremely important for pregnant/postpartum mamas.

How?
Start the day with a low-glycemic, antioxidant-rich, anti-inflammatory meal. This is a great way to set the stage for stable blood sugar and mood throughout the day. A breakfast consisting of a few eggs, smoked salmon, sautéed greens, and sliced avocado is much more satiating and nutrient-dense than a breakfast consisting of cereal, oatmeal, or processed grains and fruit.

The eggs, smoked salmon, sauteed greens and sliced avocado also contain nutrients that are often depleted during pregnancy, such as omega-3 fatty acids and selenium (in the salmon), B-vitamins, choline, and Vitamin D (in the eggs, especially the yolk), as well as trace minerals and antioxidants spread through that meal.

If breakfast is well-balanced, the next step is to look at lunch and dinner. Assess and determine what simple steps can be made to balance that meal by including protein, carbs, and fat from whole food sources. Something like a piece of fruit or a date bar is a whole food choice, but it may not work well for optimizing mood and blood sugar levels.

Shortcuts, like using frozen vegetables and pre-made condiments from Primal Kitchen, or The New Primal can make things easier. A lower-sugar smoothie or ordering pre-made meals from companies like True Fare and Territory Foods can also help if you’re busy or struggling to eat or prepare meals.

Next week I’ll share the last two Rs, but in the meantime, I’d love to hear from you. How have you noticed the foods you eat affecting your mood? Join the conversation with us on Instagram or Facebook.

All photos are by Sarah Steffens. Click to find the recipes crafted specifically for nourishing postpartum mamas!


Stephanie Greunke is a registered dietitian with a master’s degree in nutrition who specializes in women’s health. She is a certified personal trainer and prenatal and postnatal corrective exercise specialist. Stephanie has guided and supported women locally and globally through her web-based private practice, RockYourHormones.com, and continues to do so in her role as program manager with Healthy Mama, Happy Baby.