Mental health and the role of nutrition

Mental health is a huge topic, but this month I’ll take you through the basics of how what we eat can affect our mental health. I know this is a subject very close to peoples hearts as so many of us have either suffered from mental health issues or know someone who is suffering.

An astonishing one in four of us are likely to suffer with some sort of mental health problem in our life time. In real terms this will account for around 300 people out of 1,000 experiencing mental health problems; 230 of these will visit a GP, 102 of these will be diagnosed as having a mental health problem, 24 of these will be referred to a specialist psychiatric service and 6 will become inpatients in psychiatric hospitals. A few years ago Mind embraced the wonderful work Amanda Geary did with her Food and Mood project (www.mind.org.uk for more info), highlighting how what we eat can change our mood and behaviour patterns. Most of this research and information is not new but has been buried and lost somewhere in the passage of time. For those of you who would like more help with food and behaviour ie for dyspraxia, dyslexia, adhd, and autistic spectrum disorders you may be interested in www.fabresearch.org. For the first time I’ve enclosed a brief case history of a sectioned patient of mine, which I hope helps you envisage a little better what can be done to help.(see at end of article)

Todays modern diet has changed beyond recognition. Whilst some people may be more informed as to what is good to eat, it is difficult ploughing through the marketing and hype and getting to the truth about our food. Producing cheap food has been catastrophic for not only peoples health but for the quality of the food produced. This has left us with a diet that is hardly recognisable from that of our grandparents.

Todays diets contain:

• A high concentration of long chain saturated fats
• A high glyceamic load due to the presence of refined sugars and grain products
• A low nutrient density with regards to vitamins, minerals, antioxidants, fibre, phytochemcials, amino acids, and unsaturated fatty acids
• An omega 3 to omega 6 fatty acid ratio thats differs from our ancestors
• Low amounts of pre and probiotics
• A high salt content
• A high level of environmental contaminants such a mercury dioxins, PCB’s phthalates etc
• In short modern diets have all the required characteristics to impair both brain function as well as general health. That’s quite a statement I’m making!

How  can nutrition help with mental health issues?
In my mind modern diets are a  recipe for madness. If, on the most basic level are brains are made of 70% water and 30%  essential fat, is it any wonder with our fast and furious way of living in the 21st century that our mental health is not supported with diets that quiet frankly leave much to be desired. Nutrition can certainly play a supportive role alongside medication from doctors and psychiatrists. One of the most common conditions I see in my clinic is depression, which can range from mild anxiety to bi -polar disorder. It is easy to over generalise and say that all people with mental health problems have bad diets. That is not the case. However a good three quarters of people with mental health issues may well have, poor blood sugar control, vitamin and mineral deficiencies and food allergies. It’s also not the case that eating five portions of fruit and vegetables per day and taking a few supplements is going to “cure” your mental health issue.

Obviously people who have lived through trauma/loss/grief etc will have a cause for their illness, or indeed low levels of serotonin, but these people can still be supported through their process by good nutrition. This is really the time to say that what you eat can change your mood greatly. A fantastic out of print book called Not All In the Mind by Richard Mackarness highlighted this back in the 1970’s. As you can imagine with the growth of processed food, and millions of nutrient deficient people, mental illness appears to be on the increase. Of course our hurried stressed lifestyles do not help, together with the throw away celebrity culture that has ingrained itself into our every days lives, being happy and  contented is sometimes hard in the 21st century.

So how does food affect my mood?
Your feelings are generated by tiny brain chemicals called neurotransmitters. These include dopamine, serotonin and adrenaline, glutamate, GABA and acetylchoine. Neurotransmitters are responsible for dictating your mood and are greatly affected by what you eat. Serotonin is associated with a reduction in stress and tension and feelings of happiness, whereas dopamine and adrenaline have different mood effects by boosting concentration and alertness. The influence of food is extremely relevant when neurotransmitter production is considered. Amino acids found in proteins provide the raw materials needed to make neurotransmitters and a low protein diet is often at the route of neurotransmitter imbalance. You may be interested in the fact that over the last 17 years, in all the thousands of food diaries I have seen, barely any are high in protein, but nearly 70% are high in sugar and caffeine.

Some foods directly stimulate a neurotransmitter response e.g. carbohydrates influence serotonin production and caffeine stimulates adrenaline synthesis. There are many other specific vitamins and minerals that have a powerful effect on your mood. Without proper neurotransmitter balance brain function and mood can be seriously affected. Feelings of anxiety and stress are commonplace in today’s society. The body’s stress response has not yet evolved to deal efficiently with modern life, meaning the slightest emotional stress still causes a powerful release of chemicals. Two minerals, calcium and magnesium play an important role in regulating your nervous system. By making sure you have adequate dietary intake of these two nutrients you can help yourself combat feelings associated with stress and induce calmness and relaxation. Serotonin has received much publicity as a key factor in boosting mood and getting rid of the blues. This neurotransmitter is important to maintain feelings of happiness and positivity. There is now a huge amount of research which links reduced serotonin levels with lowered feelings of self-esteem and poor accomplishments. Serotonin is formed from the amino acid tryptophan, with the help of the ‘good’ omega-3 oil and vitamin B6. Tryptophan is an essential amino acid which means it can’t be made by the body and therefore has to be sourced from food, making the link between food and mood very relevant for this neurotransmitter.

The Brains Neurotransmitters
These are made from protein and if your diet is deficient in the building blocks then you will not be able to make these and mental and neurological problems may result.

Serotonin
When balanced you sleep well, enjoy food and think rationally. When out of balance, there can be sleep problems, depression, PMS and hormonal imbalances. Sources in foods: eggs, turkey, bananas, yoghurt, milk, cottage cheese and dates.

GABA
(gamma-aminobutyric acid) – Natural valium! Controls the brain’s rhythm so you function at a steady rate. When out of balance you can get headaches, palpitations, seizures and heart problems. Sources: flour and potatoes.

Dopamine
Controls metabolism. Used for, energy excitement, new ideas and motivation. Out of balance can lead to addictive disorders, obesity, severe fatigue and in the long run Parkinsons disease. Sources: in beets, soybeans, almonds eggs, meat and grains.

Acetylcholine-
A brain lubricant that keeps the internal structures moist so that energy and information can pass easily around the system. When balanced you are creative and feel good about yourself. Out of balance you can get memory loss and language disorders. Sources: eggs, liver and soybeans.

Diet and good mental health
There is common ground in most mental health issues that will aid in the person’s recovery. Below I’ve set out a few ideas on how to change your diet for the better.  For more details about food and mood go to www.mind.org.uk  and click the mind guide to food and mood for more information.

• Eat every three hours combining protein with carbohydrate to ensure stable blood sugar levels throughout the day.
• If possible get some exercise – at least half an hour daily – this is particularly important with depression.
• Avoid E numbers, colourings, preservatives, msg and sugar substitutes.
• Keep well hydrated – drink about 1 ½ litres of water daily.
• Always eat breakfast.
• Eat enough complex carbohydrates – the body uses them to make serotonin and they keep blood sugars stable.
• Avoid saturated fat i.e. chips, fried food, too much cheese and red meat.
• Check yourself for food allergies – there is a strong case for certain foods creating certain moods. If in doubt, get a blood test done or do your own food and mood diary, writing down everything you eat and drink and everything you feel mentally and physically.
• Eat whole grains: wholemeal bread, brown, rice and brown pasta.
• Eat a high amount (at least five portions) of fruit and vegetables per day.
• Eat oily fish (salmon, sardines, mackerel at least three time a week.
• Eat adequate amounts of protein at every meal, this is important for building neurotransmitters.
• Keep up with your vitamin and mineral intake – in particular zinc, magnesium, vitamin B and essential fatty acids. These are all important in the production of serotonin. A good multivitamin (with at least 10mg zinc), Omega 3, and a calcium and magnesium supplement would be useful. Get your Vitamin B12, folate and thyroid checked with your GP. Many people with mental health disorders have low levels of B12, B1, B2, B5, B6, magnesium, calcium and zinc. These can all be tested and deficiencies alleviated. Do not self prescribe vitamins and minerals without professional help (particularly if taking medication).

The role of nutrition in mental health isn’t some quack idea. There is overwhelming evidence to the contrary and trials to back up the claims. For those interested, there is a government paper – The Links Between Diet and Behaviour – The influence of nutrition on mental health – a report of an inquiry held by the Associate Parliamentary Food and Health forum in January 2008. Go to www.fhf.org.uk/inquiry to download the document.

Case Story

I don’t usually include case histories in my articles but wanted you see an example of how food and mood works in the real world!

Tom was 26 yrs old and when I saw him, he was sectioned in a psychiatric hospital north of London. He had been diagnosed with schizophrenia – he heard music, not voices, had self harmed, and been in and out of hospital for six years. His mother was very concerned at his overall health – she felt he had got worse in hospital and he was now sedated much of the day. He had been violent and aggressive towards her so when  I visited Tom I had to wear a bleep and have the door open during my visit. I was shocked to see how ill a 26 yr old can look like, when they have not been diagnosed with any physical health problem. He was very pale, very black under the eyes with a face covered in acne, and underweight. Most of his teeth were missing. He looked worn out with a system that was not working for him. It took me three visits to engage with him and to get him to trust me. He was keen to do anything to get better and agreed to some testing. His diet consisted of black coffee, ten cigarettes a day, no water, chips and five Dr Pepper fizzy drinks which seemed to be the only drink on offer. The vending machine in the hallway sold only fizzy drinks and chocolate bars.

With the help of his psychiatrist who was skeptical but helpful we found the following:

Tom had scurvy. Tom was positive to tissue transglutaminase antibodies ie he had coeliac disease. His B12 levels were extremely low. He had very low levels of zinc. His blood sugar was very low at various points of the day. I’m not sure what the psychiatrist actually thought of the results or me (!) but he was immediately on board to correct what we had found. He did not think vitamin B12 injections or zinc would make a difference. But… they did. Tom followed a gluten free diet, cut out coffee, we balanced his blood sugar as much as we could within the confines of hospital food and he drank water instead of Dr Pepper. He was given Vitamin C, B12 injections and high levels of zinc. And little by little.. he got better to the extent that he is now out of the hospital and working part time. He still smokes and he still has bad days but is now off every medication except a low level anti depressant. There have been no violence or aggressive outbursts, and no bouts of self harming for two years. Tom recently visited India and has become vegetarian and meditates for an hour a day. He feels this has pushed him further on the path to recovery.

Clearly, this won’t happen with everyone. Mental issues are complex and multifactorial however in this incidence it was the stepping stone for Tom making a near full recovery.

If you would like to talk through your mental health issue in confidence and how nutrition may help please call on 01323 737814.

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