It is coming: Nutritional Psychiatry. How modern mental health approaches miss on the essential: our diet

“Healthy Mind in Healthy Body” was a literary quote going around late first and second century AD.
Therefore, the concept isn’t new at all.

Perhaps in the run after evidence-based medicine, where the benefit of any traditional remedy or approach got challenged, overturned or minimised due to lack of ‘evidence’, doctors focused exclusively on medication as a means to manage symptoms or conditions. It is easier of course for doctor and patient alike to prescribe or take a ‘pill’ that will solve our problems. Anything else equals ‘hard work’ for everyone.

This approach however is suffering a setback. Patients and doctors are increasingly becoming more integrative and are going back to basics: food and activity levels.
This is not to say that medication isn’t important; of course it is, and it is an absolute must in certain situations. But what is lacking is the integrative approach to an individual’s condition. We are becoming more conscious of the fact that what fuels our bodies has an impact on how we feel and how medicines are metabolised and how effective these are. We are also more aware some individuals will respond different than others, due to variances in their metabolism.

But, how many times have you seen a doctor, let’s say feeling anxious or low and the doctor first said- ‘let’s talk about your diet’? I suspect never or very rarely.
The first conversation nearly always in the traditional medical approach has been let’s talk about medicines and then about anything else you can do to improve your condition. That if there was enough time. Most often the standard doctor approach is ‘does he/she need medication’ and ‘is he/she going to self-harm’. And once these are clarified, patient is left to its own devices perhaps with counselling support.

There has been a well establish linked between mood and foods and drinks. Binging on high carbohydrate foods when feeling low. Excessive alcohol consumption and depression.

But how can a patient further utilise diet to improve their mental health? What we eat can make us feel low but what we eat can also make us feel better or good.
My advice is, that if your doctor isn’t talking about it, you should look into it yourself and consult someone else who will be more receptive, being another doctor, dietician or even a friend.

Some Nutritional Beliefs or Evidence in Mental Health and Wellbeing
The following dietary statements have various degrees of evidence behind them, some have more common sense then evidence.

• DASH (Dietary Approaches to Stop Hypertension) diet recommended for hypertension lowers depression risk.
• Vegetarianism is linked to depression.
• Vitamin B12 and Folic Acid Deficiency are linked with depression.
• Vitamin B12 deficiency, often seen in vegans and vegetarians, causes fatigue, depression and memory problems.
• A diet rich in polyphenols, polyunsaturated fatty acids and nutritional supplements has positive effects on mental health, cognition, mood and stress levels.
• Dark chocolate lower depression risk.
• Pomegranate juice is slowing memory decline.
• Good healthy diet improves cognitive function. This is very important especially as getting older, one develops memory issues or perhaps is recovering from a stroke.
• Vitamin B3 (niacin) deficiency and dementia. Many foods deliver niacin, including fish, poultry, meat, nuts and legumes, although supplementation may be required. Our body does not store Vitamin B3.
• A diet with an increased amount of refined sugars is linked with ADHD or Hyperactivity- whilst fresh fruits and vegetables protect against these conditions.
• Autism and ADHD has been linked with Vitamin D deficiency. In UK, the Department of health has long given the advice that children and at-risk groups (dark skinned, not often outdoors, people in care homes or house bound) take Vitamin D supplements daily. However, in my experience the number of patients who have been advised by their NHS GP or health visitor to take Vitamin D supplements is minimal. Most patients who need the continuous supplementation do not take it and are not advised to take it. Of note that the Scottish Government recommends that everyone should consider taking Vitamin D supplementation between September and April.
• Ketogenic diet of high fat and low carbs reduces seizures in children and adults with epilepsy.
• Psychotic illnesses such as schizophrenia, are well known to reduce one’s lifespan by as much as 20 years. People with these conditions are also known to have very poor nutrition, as well as suffering from obesity related to medications. Although a ‘good balanced diet’ is recommended, these people receive minimal support in implementing long lasting nutritional changes that will ultimately impact on their wellbeing.
• Gut microbiota and mental health link. Trillions of bacteria reside in gut and have been shown to play a crucial role in gut-brain communication. Patients with various mental health disorders have been shown to have significant differences in the composition of their gut microbiome. Enhancing beneficial bacteria in the gut, for example, through the use of probiotics, prebiotics, or dietary change, has the potential to improve mood and reduce anxiety in both healthy people and patient groups.

How Can nutrition help in mental health?

Nutritional therapy alongside modern medicine can help in many ways those who struggle with their mental health. Counselling techniques should reinforce the value of nutritional therapy.
A dietary approach to mental health and wellbeing aims to:

• Give an individual more control over their life by empowering them with the knowledge of nutritional impact on mental health and supporting them in making practical choices
• Advice on food selection for their condition and their likes and dislikes
• Fulfil deficiencies and cravings
• Improve cognitive ability
• Increase self esteem
• Assist in breakdown and absorption of medication

Dietary interventions and physical exercise need be incorporated early on. Early decisions in life affect later in life brain functioning, and therefore what we feed our children has an impact how they will feel when growing up. Focusing on higher intake of raw fruit and vegs early on has a positive long-term benefit on our wellbeing.

It is time for an integrated model of psychiatry, where doctors, psychologists and counsellors incorporate dietary approaches early on in the management of a patient. Nutritional Psychiatry is a hot new title, although the concept goes back centuries.

If you would like to discuss any of these aspects to a healthcare practitioner do get in touch. We have a team of GPs, psychiatrists and nutritionists that will be able to advise.