Good morning! Today in honour of Bell Let's Talk I thought I'd write a post focusing on postpartum depression (PPD). The onset of PPD can be insidious and hard to distinguish from the so-called "baby blues" for a new parent, but the effects can be severe and frequently go untreated. Although the symptoms of fatigue, sadness, irritability, and disinterest in parenting can show up as early as 4 weeks, it's not uncommon for parents to not be diagnosed until 3 months after their baby arrives. If this resonates with you please reach out to both your MD and ND, as soon as you can.
The direct causes of PPD are not entirely clear but there are obvious contributing factors: increased stress in the early postpartum period, lack of social support, sleep deprivation, postpartum thyroiditis, or a personal and/or family history of mental health concerns.
However there's another important aspect of postpartum health that can contribute to PPD that often goes unchecked: nutritional deficiencies.
Although the research available is equivocal with respect to the ability of supplementation to treat PPD, overall the evidence suggests that certain micronutrient deficiencies contribute to the development of postpartum depression. Here are a few to be aware of:
There's a good possibility you have experienced iron-deficiency anemia before as it's the most common nutrient deficiency effecting over 30% of the world's population in countries both rich & poor. Chances are then that you are aware of the symptoms of iron-deficiency, e.g. fatigue, altered cognition, and depressed mood.
One of the strongest predictors of postpartum anemia is anemia during pregnancy, as iron stores tend to remain low for several months after childbirth. This is compounded if you experienced significant blood loss during delivery.
Take home message: Ensure that if you are diagnosed with low iron or have iron-deficiency anemia during pregnancy that in addition to increasing iron-rich foods in your diet you diligently take your iron supplement. The #1 reason I find people stop taking their iron supplements is due to digestive upset so make sure you choose one that is well absorbed and better tolerated, e.g. a ferrous bisglycinate vs. the variety found in something like Palafer (#constipationcity).
2. Omega-3 fatty acids
Do you eat 2-3 servings (8+ oz) of fatty fish (sardine, mackerel, herring...) a week? If you're like most of us living in middle Canada, I'm going to guess no. If I'm right, then you are probably not getting enough omega-3 fatty acids (a.k.a. DHA & EPA) in your diet. Add to this that when you're pregnant, maternal stores of DHA decrease by 50% and do not return to pre-pregnancy levels until 6 months postpartum.
What does that mean for you? Well, the association between depression and omega-3's is well-established: the less a population has in its diet, the higher the incidence of depression. And though the research is varied with respect to how effective omega-3's are as a treatment for PPD there is no doubt that it is worth your while to ensure you have enough in your diet during the perinatal period
Take home message: If consistently eating fatty fish doesn't feel like an option for you, start supplementing with a therapeutic grade, third party tested omega-3 supplement that provides at least 1250 mg of omega-3s (EPA & DHA) per dose through the perinatal and postpartum periods.
3. Vitamin D
If you are living in Canada and are not already supplementing with vitamin D, I'm hoping to sell it to you right now: this Statistics Canada 2012-2013 survey found that nearly 40% of adult Canadians do not have adequate levels of vitamin D to maintain bone health (≥ 50nmol/L). And vitamin D does way more than just keep your bones healthy; it prevents and treats autoimmune conditions, can help you get rid of that nasty & lingering sinusitis, and contributes to healthy mood.
And specific to our conversation here: it plays an important role in preventing and PPD. One study even found that low vitamin D levels tested in mid-pregnancy can be predictive of postpartum depression.
Take home message: Take vitamin D. Take it every day. Take a variety that is emulsified or encapsulated with oil as it is a fat-soluble vitamin. And don't forget to continue taking it after childbirth.
4. Vitamin B12, B6, Folate, Selenium, Zinc...
Deficiency or inadequate intake of other vitamins and minerals may also impact the incidence of PPD. To fill in any nutrient gaps in your diet, take a good quality prenatal vitamin, take it every day, and take it through the "fourth trimester" as well.
Take away message: Pretty much what I said above, but here's a few more details about what to look for when choosing a prenatal vitamin:
Increase absorbability and get more bang for your buck by choosing a multivitamin that requires several capsules/day vs just 1 enormous pill
Choose capsules over tablets, because they are easier for your digestive system to break down than pressed tablets
Choose a product that uses active forms of the B-vitamins