Do Not Attempt To Adjust The Picture
OnAccording to UK Biobank data, excessive television-watching raises the risk of depression, dementia and Parkinson’s disease. Not just CNN, Fox News and the BBC, all of which are obviously neurotoxic, but TV in general (1). And what about computers? A screen is a screen is a screen, no?
Maybe not. While full-time computer work does seem to make folk more prone to depression (2-4), moderate daily recreational computer use appears to protect against developing dementia (1). This is rather odd, especially when you consider that depressive illness is associated with an increased risk of dementia (5).
How does this all fit together? And, if we could untangle cause and effect, could we design a TV dinner to make binge watching less hazardous to your health?
Probably yes. So let’s ask a few more questions, and see where they lead. How might watching TV create depressive illness and / or dementia? Is it more harmful, for example, than the similarly sedentary but more old-school activity of reading?
A recent and rather nuanced study examined just this question (6). A multinational team of researchers, working with subjects drawn from the 1958 UK National Child Development Study, looked at the differential impact of mentally active vs passive sedentary activities on mood. They found that whereas mentally passive activities such as channel surfing were linked to a 43% increased risk of depression, mentally stimulating activities such as reading, office work involving computer usage or driving a car were not.
(If you think that driving a car is mentally stimulating try commuting on a bicycle through heavy London traffic, as I did for many years. This travel routine, which combined enforced mental agility with intermittently high-level exercise and occasional trips to the ER, arguably made me the husk of a man I am today.)
Television may not always have been a depressant. From the perspective of an early consumer (since 1958), the nature of television and the culture in which it is consumed have both changed radically. I remember when families watched together, programs were widely discussed at school and at work, and the medium was effectively communal. But as late capitalism broke down family structures and pushed us into progressively smaller spaces, TV flooded into the resulting social vacuum and became a force for separation.
Now post-series depression (PSD) is a thing (7). We bond parasocially with on-screen characters, and find it hard to fill the void they leave when studio executives bark and the carnival moves on.
This helps to explain why TV binging today tends to create a cycle of aloneness, passivity / social defeat and social isolation. This is intrinsically saddening, because social connectivity is one of the most protective factors against depression (8). TV can also disrupt circadian rhythms and sleep patterns, causing insomnia and anxiety (9).
The National Child Development team speculated that the health-protective effects of mental exercise might overlap with those of physical exercise (see below); and identified two possible pro-inflammatory links between TV consumption and neurodegeneration (6). Compared to readers, TV watchers had higher levels of c-reactive protein (CRP) and larger waist sizes, both of them possibly related to the omnipresent TV commercials for ultra-processed foods (10).
The relationship between depression and dementia is not yet fully configured, however. In some cases, depression could just be an early symptom of incipient dementia. However, given that depression in early life almost doubles the risk of developing dementia decades later (ie 11, 12), those blues would have to be very early symptoms indeed.
I lean towards a simpler model of depression being a directly contributory cause of dementia.
Depression has been shown to exert neurotoxic effects (13), which already seems like a smoking gun to me. Depression is also an emerging risk factor for cardiovascular disease (14), and this increases the risk of dementia via the multiple infarct route (15). Depression and chronic stress are profoundly interlinked (ie 16), and chronic stress has long been known to be both neurotoxic (ie 17, a nice review article) and cardiotoxic (18).
So, if we go back to the UK Biobank study, one possible mechanism might be: excessive TV watching over long periods of time → dietary change + weight gain + psychological + neuroinflammatory stress → depression and neurodegenerative disease.
Caution. The relationship between screen time and dementia likely includes a reverse element. As cognitive faculties fade you may start to enjoy TV game shows, and even party-political broadcasts.
You’ll forget to be concerned that spending more time sitting in front of a TV screen (and being sedentary in general) causes metabolic skewing, with increased serum triglycerides, obesity and hypertension (19), and the accelerated development of heart disease (20).
As activity triggers an array of metabolic benefits involving multiple cardioprotective (21, 22) and neuroprotective mechanisms (23, 24), and has significant anti-depressant effects of its own (25), it is not surprising that physical exercise is protective against dementia (1). But why should the mental activity involved in reading, office work and driving be protective?
Although the idea that active mental activity is an exercise for the brain is seductive (ie 1), it is a hard case to make. The acquisition of reading skills, for example, is linked to changes (presumably positive ones) in brain structures in children (ie 26), but does this happen in adults to anything like the same extent?
Illiteracy triples the risk of developing dementia in older adults (27), but perhaps illiterates started with a lower cognitive reserve, and were therefore already closer to diagnosis (28)?
In this last study, being literate did not affect the rate of cognitive decline. In the modern era, cognitive decline appears to be largely driven by multiple metabolic (and therefore nutritional) factors (ie 29), and one would therefore not expect literacy to affect the rate of synaptic and neuronal loss in mid- to later life. Conversely, this supports the idea that a neuro-supportive diet will make TV less hazardous for your health; see below.
What then of gamers, those couch athletes who fiddle with joysticks and tracker pads rather than javelins and running spikes, and who live (allegedly) on chips and soda?
Calvinists might wish gamers to dement like TV addicts, but that does not appear to be the case, at least in the short term. This is probably because while e-gaming is largely sedentary, it involves active processing in multiple cognitive domains. A recent meta-analysis (30) of trials that measured the impact of computer games on cognitive and functional capacity in MCI/dementia patients produced sufficiently positive results to position them as therapeutic tools to slow neurodegenerative disease.
Some games are already specifically designed to aid cognitive impairment or assist with movement disorders. Known as Serious Games for Dementia Care or SGDC (31), this is a genre all of its own, and one which I find deeply uninteresting. Being ancient, I’ll take Dota-2 any day.
Longer-term, however, I suspect that gaming is not so good for you. The most popular games and game sites are, unsurprisingly, stuffed with ads for junk foods high in sugar, fats and salt. As a result, gamers increase their intakes of these health- and brain-damaging ultra-processed products (32).
The medical complex lurks on the sidelines. Always ravenous for new sources of revenue, groups like Sports Medicine UPMC (ranked number 1 in Pittsburgh!) offer dietary recommendations for professional gamers (33). They aren’t terrible, but they’re far from optimal.
You should instead follow a neuro-protective diet. As it is fundamentally the same diet that protects against most of the chronic degenerative non-communicable diseases, I won’t bother listing it here. But as it is designed to damp chronic inflammation, restore eubiosis, rectify Type B malnutrition and prevent glycemic mis-match, it should make watching TV – and even gaming – significantly safer.
Another thing you could do is find someone who shares your terrible taste in television, and make it a more social activity.
Next week: Master your Mast cells.
References
- Wu H, Gu Y, Du W, Meng G, Wu H, Zhang S, Wang X, Zhang J, Wang Y, Huang T, Niu K. Different types of screen time, physical activity, and incident dementia, Parkinson’s disease, depression and multimorbidity status. Int J Behav Nutr Phys Act. 2023 Nov 3;20(1):130.
- Kim T, Kang MY, Yoo MS, Lee D, Hong YC. Computer use at work is associated with self-reported depressive and anxiety disorder. Ann Occup Environ Med. 2016 Oct 13;28:57.
- Madhav KC, Sherchand SP, Sherchan S. Association between screen time and depression among US adults. Prev Med Rep. 2017 Aug 16;8:67-71.
- Li L, Zhang Q, Zhu L, Zeng G, Huang H, Zhuge J, Kuang X, Yang S, Yang D, Chen Z, Gan Y, Lu Z, Wu C. Screen time and depression risk: A meta-analysis of cohort studies. Front Psychiatry. 2022 Dec 22;13:1058572.
- Elser H, Horváth-Puhó E, Gradus JL, Smith ML, Lash TL, Glymour MM, Sørensen HT, Henderson VW. Association of Early-, Middle-, and Late-Life Depression With Incident Dementia in a Danish Cohort. JAMA Neurol. 2023 Sep 1;80(9):949-958.
- Werneck AO, Owen N, Araujo RHO, Silva DR, Hallgren M. Mentally-passive sedentary behavior and incident depression: Mediation by inflammatory markers. J Affect Disord. 2023 Oct 15;339:847-853.
- Kottasz R, Bennett R, Randell T. (2019). Post-series depression: Scale development and validation. Arts Market 9 132–151.
- Choi KW, Stein MB, Nishimi KM, Ge T, Coleman JRI, Chen CY, Ratanatharathorn A, Zheutlin AB, Dunn EC; 23andMe Research Team; Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium; Breen G, Koenen KC, Smoller JW. An Exposure-Wide and Mendelian Randomization Approach to Identifying Modifiable Factors for the Prevention of Depression. Am J Psychiatry. 2020 Oct 1;177(10):944-954.
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- Kwapong YA, Boakye E, Khan SS, Honigberg MC, Martin SS, Oyeka CP, Hays AG, Natarajan P, Mamas MA, Blumenthal RS, Blaha MJ, Sharma G. Association of Depression and Poor Mental Health With Cardiovascular Disease and Suboptimal Cardiovascular Health Among Young Adults in the United States. J Am Heart Assoc. 2023 Feb 7;12(3):e028332.
- Gottesman RF, Albert MS, Alonso A, Coker LH, Coresh J, Davis SM, Deal JA, McKhann GM, Mosley TH, Sharrett AR, Schneider ALC, Windham BG, Wruck LM, Knopman DS. Associations Between Midlife Vascular Risk Factors and 25-Year Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort. JAMA Neurol. 2017 Oct 1;74(10):1246-1254.
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- Noetel M, Sanders T, Gallardo-Gómez D, Taylor P, Del Pozo Cruz B, van den Hoek D, Smith JJ, Mahoney J, Spathis J, Moresi M, Pagano R, Pagano L, Vasconcellos R, Arnott H, Varley B, Parker P, Biddle S, Lonsdale C. Effect of exercise for depression: systematic review and network meta-analysis of randomized controlled trials. BMJ. 2024 Feb 14;384:e075847.
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- https://share.upmc.com/2021/11/nutrition-for-gamers/#:~:text=A%20Gamer’s%20Diet&text=Experts%20in%20sports%20nutrition%20at,carbs%20like%20pasta%20and%20potatoes.
Great post, thank you!