Nutrition and Mental Health

Picture this cartoon: a squirrel is lying on a psychoanalyst’s couch, a bearded bespectacled man with a notepad sitting next to it. The squirrel is saying “When I learned that you are what you eat, I realized I was nuts!” There is no doubt that what we eat affects our mood, energy, and cognitive function. The nutrients and/or chemicals in our food influence how well we sleep, how efficiently we burn calories, how well our cardiovascular system functions – in other words, our overall health and longevity. So it really is true that “you are what you eat.”
 

When we eat poorly, it can put us on a roller-coaster of mood and energy fluctuations, which sets us up for continued poor choices of “quick fix” foods and beverages. Over time, we become trapped in a vicious cycle of needing caffeine and sugar to start the day, craving fatty foods and sweets to keep us going throughout the day, and then needing alcohol or medications to calm down at day’s end. Sound familiar?
 

Is your SAD diet making you sad? As Leslie Korn writes in Nutrition Essentials for Mental Health, “the standard American diet, consisting of overly processed foods containing refined sugars, leads to chronic inflammatory states and neurotransmitter imbalances. Inflammation is now understood to underlie most mental illness, including depression. Chronic low-level inflammation contributes to depression and cognitive decline.”
 

The Gut Brain: There is increasing scientific evidence that many illnesses, from diabetes to depression, may in fact be the product of an unhealthy gut and digestive system. You may have had a “gut feeling” about this, as the gut is now being referred to as “the second brain.” Did you know that 95% of the body’s serotonin is produced in the gut?
 

Rebecca Carey, a pediatric GI doctor, wrote in a recent blog, “I have witnessed repeatedly across the age continuum that when intestinal health improves, other seemingly unrelated things such as behavior, development, and temperament also improve.”
 

Rest and digest: “Digestion occurs in a state of relaxation. Stress can slow down or stop the digestive process.” (Korn, 2016) Mindful eating, which involves pausing to give your full attention to what you are putting in your mouth, while tuning in with all of your senses to the experience of eating, will aid digestion. In fact, just taking a few slow, deep breaths prior to eating can help, because it stimulates the parasympathetic nervous system, which is known as the “rest and digest” system, as opposed to the sympathetic nervous system’s “fight or flight” functions.
 

Sugar is a drug: It acts on the same neurotransmitters in the brain as alcohol, cocaine, and heroin. Regular use leads to increased tolerance, cravings, and addiction; quitting causes withdrawal symptoms. And we know that refined sugars trigger inflammation. There is more than enough evidence, according to journalist Gary Taubes in The Case Against Sugar, that sugar is not only the root cause of today’s diabetes and obesity epidemics, but is a signficant contributing factor in heart disease, Alzheimer’s, and many other long-term, degenerative diseases. Healthy alternatives to sugar include stevia, agave syrup, and locally-sourced honey. Aspartame and other chemical sweeteners are NOT healthy alternatives, as they too have been implicated in obesity and diabetes.
 

The Great Gluten Debate: Twenty five years ago, when I was advised to reduce my gluten intake, it was a challenge to find edible alternatives to the breads, pastas, and cereals I was used to, not to mention becoming aware of all of the hidden sources of gluten, like soy sauce. However today most grocery stores have a section devoted to gluten-free products, many of which are quite tasty, and most restaurants, even fast-food establishments, offer gluten-free options.
 

But while gluten is definitely dangerous for the small percentage of people with Celiac disease, an autoimmune disorder, many others like myself have similar distressing digestive symptoms when they consume gluten, although they don’t have the biomarkers for the disease. Some doctors have mistakenly told these people their symptoms are imagined. Is gluten sensitivity real or imagined? Finally, research has proven that “non-celiac gluten sensitivity is not imagined”, because “although the NCWS group did not have the cytotoxic T cells found in those with celiac disease, they had markers of intestinal cellular damage related to a severe systemic immune activation.”
 

My patients who have reduced or eliminated gluten in their diet notice the same things I did: better mood, better sleep, more energy, as well as significantly improved digestion. So while you may not have to eliminate gluten, you might feel better if you do.
 

Vitamins and supplements: There has always been debate among healthcare professionals on whether or not we get enough of the essential vitamins and nutrients in our diet. I believe most Americans do not, and I include myself, even though I have a healthy diet. So I take a high-potency multi-vitamin, as well other supplements including Omega-3 fish oil and vitamin D. There is extensive research demonstrating the benefits of Omega-3 fish oil supplementation on mood, as well as metabolism and cardiovascular health; vitamin D has also been shown to relieve low mood and low energy. These are the two supplements that I recommend most often to my patients.
 

Healthy eating: It doesn’t have to cost a lot of money or take a lot of time – but it isn’t as cheap or quick as unhealthy eating. Think of it as an investment in your well-being. Decades of research have proven that the Mediterranean diet, and other diets rich in Omega-3 fatty acids and antioxidant-laden fruits and vegetables, while low in sugar and processed food, are highly correlated with good mental health, as well as good health and longevity.
 

I love Michael Pollan’s rubric, from his 2008 book In Defense of Food: An Eater’s Manifesto, which is Eat food, mostly plants, not too much. “Eat food” means eat things that are actually identifiable as animal or vegetable, rather than the highly processed stuff that comes in packages, with a long list of unpronounceable chemicals in the ingredients. Another way to think about this is to shop the perimeter of the grocery store, where the produce, meat, and dairy sections are, limiting what you buy in the middle aisles. “Mostly plants” emphasizes the importance of having the bulk of our diet consist of fruits, vegetables, nuts, and legumes. If you eat meat, poultry, fish, and/or dairy, consume them in smaller quantities. And finally, “not too much” is a reminder to pay attention to portion size. The American diet has been “supersized” to the point that many people consume as many calories in one meal as they actually need for the entire day (where do those extra calories go? Not away!)
 

Add first, then subtract: Although eliminating sugar and gluten in your diet will likely lead to the greatest overall improvement in your health and mental health, it’s not easy to give up the foods you crave and enjoy the most. So make that a long-term goal, and start with adding more healthy items: 1) probiotics to help re-balance your gut bacteria (found in good-quality yogurt, or available in capsules); 2) green, leafy vegetables like kale and spinach to add key nutrients; 3) foods high in anti-oxidants like blueberries and beets; 4) healthy fats like olive oil and avocados; and 5) lean sources of protein like fish and chicken, which contain amino acids, the building blocks of serotonin and other neurotransmitters. It may take a few weeks before you notice improvement in mood and energy, but if you are patient and persist in a commitment to healthy eating, you WILL feel better!