Anxiety, Depression, and Other Mental Health Disorders
THE FOOD-MOOD CONNECTION
Human beings are amazingly complicated. Our behaviors and moods can be influenced by so many different factors. We experience an extensive array of emotions, come from varied backgrounds with a wide array of adverse childhood experiences and traumas, all of which may contribute to anxiety, depression, and other mental health disorders. We have diverse skills and abilities that are important to consider when adopting healthy lifestyle changes to improve mental well- being. Human beings are very resilient and with the right treatment plan, lifestyle changes, and support system, have an impressive ability to overcome and improve symptoms of anxiety, depression, or other mental health disorders.
What you eat is so important that for some people, healthy diet changes alone have the potential to be effective to improve mood and energy levels. This may be especially helpful for those with few or no adverse childhood experiences, or other factors related to depression and anxiety, but still experience low energy and occasional depressed moods. Even if you are aware of non-dietary reasons that contribute to anxiety or depression, optimizing your dietary intake can give you more energy, improve your mood, and strengthen your immune system to better fight off infections, and overall may improve your sense of mental well-being.
In recent years, many people are realizing that what they eat has a direct impact on their physical health. However, not as many people realize (they may perhaps ignore) the impact that food choices and nutrition can have on their mood, energy level, and overall mental health. In fact, eating a nutrient-depleted diet, such as the “standard American diet”, is more likely to affect your mood, stamina, irritability, and ability to concentrate much sooner than it will affect the health of your eyes, heart, or bones. This is your day-to-day health and brain health is especially dependent upon a steady supply of nutrients. How you feel in the afternoon is partially dependent on the nutrients you eat or don’t eat in the morning. Your mood and energy level in the evening is partially dependent on what you eat or don’t eat at breakfast, lunch, and dinner. Similarly, sleep quality and how you feel in the morning is somewhat dependent on what you eat the few hours before bedtime.
It’s not just the food choices that are important, adequate hydration is one of the most basic, cheap, and simple steps you can do to promote good health. Hydration is important for too many reasons to discuss here. With regard to promoting a positive mood, we already discussed the importance of getting plenty of nutrient-rich whole foods in the diet. Well, all these important vitamins and minerals need water to help carry and deliver these nutrients to all the working cells in the body and the brain. Excessive alcohol or large daily doses of caffeine from coffee, soda, energy drinks may also be another important behavior to modify in order to find greater results from other diet changes. This is particularly important for those with sleep problems along with mental health problems. Too much alcohol or caffeine not only contributes to dehydration and depletion of important nutrients in the body, but it can also affect your sleep quality. So be aware of how your usual intake of fluids affects your hydration and sleep.
COMMON MENTAL HEALTH DISORDERS LINKED WITH DIET
Although there are over 250 different mental health disorders (according to the DSM-5), I’ll mention some of the more common and well-known conditions that are linked with diet. Keep in mind that nutrition for mental health disorders is still a relatively new specialty of nutrition science and so there are still many questions left unsettled. However, this doesn’t mean we shouldn’t discuss all the potential improvements to many of these mental health disorders that may be achieved through diet and lifestyle changes. Among other developing areas of science, the emerging specialties of neuropsychiatry, nutrigenomics, and metabolomics will help us answer many questions in the years to come. Perhaps these fields of science may even lay the groundwork for future improvements in psychiatry and mental health outcomes.
Mood disorders: depression and bipolar disorder
One of the more established links between nutrition and mental health is that of the essential fatty acids called omega-3 fats and different types of depression and bipolar disorders. We cannot say yet that by simply increasing intake of omega-3 fats we will effectively treat or improve depression. It can be said with a little more certainty that by increasing intake of omega-3 fats in those who are deficient, it is likely to help improve outcomes of current treatments or improve symptoms of major depression or bipolar disorder. However, there are still some inconsistencies found in research about how effective this can be. Part of the explanation for inconsistent findings among studies likely depends on the severity of the depression of those included in the study and the total amount and relative amounts of different types of omega-3 fatty acids used in various studies. Research suggests that it’s the EPA type of omega-3 (rather than DHA) that is more important and offers the beneficial anti-inflammatory and, therefore, antidepressant effects desired. It may be the EPA type of omega-3 that future studies need to focus on as we learn more about the potential benefits of increasing intake of omega-3 fats, whether through foods or a dietary supplement.
One less researched and understood link is that between anxiety-related disorders and diet. Nonetheless, this link has the potential to be further explored and explained. Despite limited conclusive evidence in science on diet and anxiety, don’t underestimate the power of a healthful, balanced diet to control levels of anxiety. In clinical practice, I often hear people explain how much better they feel after significant diet changes, not only with regard to more stable energy levels throughout the day, but also regarding their ability to relax and not feel quite as stressed continuing to face normal day to day stressors and responsibilities. The link between diet and anxiety is mostly explained through a few different mechanisms.
First, we need a steady supply of certain vitamins, minerals, and amino acids in the diet for the body to produce neurotransmitters that regulate mood and sleep, and help us relax. Furthermore, certain strains of gut bugs help to produce serotonin, GABA, dopamine, and acetylcholine within the digestive tract. These are key neurotransmitters that contribute to mood and relaxation, and help regulate sleep schedules.
Secondly, the lack of stable blood sugar control (abrupt spikes followed by rapid drops in blood sugar) is also likely to impact one’s sense of relaxation or anxiety levels. This is discussed more in the next section, Wholesome Foods Promote Healthy Moods. Lastly, an unbalanced microbiome is likely to promote a state of chronic inflammation, along with a disruption in the signaling systems involved in regulating stress hormones. Overall, this state of gut dysbiosis signals from the second brain to the main brain, a state of unease and distress. On the other hand, as stated in The Anti-Anxiety Diet, a balanced and “symbiotic gut drives a happy, mellow mind.” Perhaps it is this chronic disruption of a normal functioning digestive tract accompanied by a diet low in nutrients that is experienced as a sense of anxiety.
Don’t forget to think about what you’re drinking. Excessive intake of alcohol or caffeine may impact your normal regulation of neurotransmitters and contribute to a sense of anxiety or anxiety- related disorders. Although small amounts of alcohol might help some people feel relaxed, with time, or with too much alcohol, this can also impact the regulation of your neurotransmitters and consequently contribute to anxiety in the long run, more than it helps. Caffeine works by inhibiting the release of the calming neurotransmitter GABA in the brain. So, first and foremost, drink plenty of water or other non- caffeinated beverages, and limit the total amount of alcohol or caffeine you drink. For people who have a history of alcoholism or are notably sensitive to caffeine, it is probably best to abstain from alcoholic or caffeinated drinks.
Schizophrenia and related psychotic disorders
A more complex or troublesome group of mental health disorders includes schizophrenia and related psychotic disorders. According to the American Psychiatric Association, “schizophrenia is characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction.” Thankfully, our understanding of these mental illnesses has evolved over the years and researchers are taking a more open-minded, closer look at the role of diet in these disorders. Among many other factors that contribute to these complex mental illnesses, a low-quality diet without adequate intakes of fruits, vegetables, whole grains, and other fibrous foods is a common link found in mental health disorders. Researchers at King’s College London compiled the results from 31 different studies on this topic and found that people who had schizophrenia were more likely to have higher intakes of calories and processed foods that provide unhealthy amounts of saturated fats, salt, and refined sugars.
Consider how a nutritionally poor diet can contribute to metabolic dysfunction and chronic inflammation. People who have schizophrenia may be at higher risk of problems from this dysfunction and inflammation given that they tend to have lower levels of essential fatty acids, higher levels of pro-inflammatory compounds (cytokines) in the blood when tested, and they’re more likely to have increased oxidative stress. Overall, this can have a detrimental effect on the normal functioning of the metabolism and may even disrupt the production and regulation of neurotransmitters. Although the exact cause of schizophrenia and other psychotic disorders is not well understood, leading researchers suggest that it’s a dysregulation of dopamine and other neurotransmitters that is mostly responsible for the troublesome symptoms seen among people who have these disorders.
Besides the nutrient-depleted diet commonly found in the population, factors such as poor nutrient absorption, excessive alcohol intake, or too much of certain medications can also make these problems more likely. Did you know that when certain vitamin deficiencies are left uncorrected over time, symptoms can get so bad that they can even manifest as psychosis? To be clear, psychosis is not a specific mental illness, rather it is a symptom that is related to a variety of different disorders. It’s characterized by “the loss of contact with reality” and can appear in different ways such as “severe confusional state, delusions, hallucinations, and marked impairment in judgment and reasoning.” Thus, psychosis can be caused by a variety of factors, such as different medical conditions or even certain nutrient deficiencies. Specifically, deficiencies of B-vitamins such as B-1 (thiamin) or B-3 (niacin), can result in psychotic symptoms. Other B-vitamins — B-6, B-9 (folic acid), and B-12 — are less well understood regarding the cause of these mental illnesses, yet are still critical for neurological health and in some cases may partially explain the causes of psychosis-related disorders.
Also noteworthy, research has shown that supplementation of B-vitamins (such as folate) can improve troubling symptoms. It may be a far stretch to say that inadequate nutrition causes these complex mental health disorders in most cases, but it is safer to say that a nutritious and balanced diet — and possibly even some dietary supplements in certain cases — can reduce the likelihood of experiencing troublesome symptoms of psychotic disorders.
WHOLESOME FOODS PROMOTE HEALTHY MOODS
The word wholesome is a bit vague and could be misleading when used in marketing to suggest the healthfulness of processed food products, so let’s be clear on what’s meant here. With few exceptions, foods tend to be healthier in their whole, minimally or unprocessed state. For example, a whole apple is healthier (more nutrient-dense, packed with phytonutrients and fiber) than applesauce, and similarly, applesauce is slightly healthier than apple juice. I emphasize the importance of including more of the “good”foods rather than simply avoiding the “bad” foods as many people tend to label foods and mistakenly oversimplify this matter.
Because we are not perfect beings, we should not be aiming for a perfect diet. In my opinion, there’s no such thing. Besides, more popular and rigid types of diets are often limited, become boring, and can easily result in lost interest in eating. So when it comes to eating wholesome foods, one might not aim to avoid all processed foods, rather to focus on eating minimally-processed and whole foods most of the time or as often as possible, and to either avoid or eat few foods that are highly- processed. If you must, have these highly processed food products sparingly as an exception to your daily food choices. It’s important to note that everybody makes changes at their own pace and so we’ll discuss later in the book about how to eat more wholesome foods and how to find your best approach to sustainable, lifestyle changes to ultimately improve your mood and overall mental well-being.
One of the leaders on the subject of nutrition for mental health, Leslie Korn, put it simply: “Mood follows food, and mood swings follow blood sugar swings.” This is especially true for those who drink a lot of sugar-sweetened beverages (soda, juices, energy drinks, etc.) and eat a lot of food products high in refined grains, such as white flours, and added sugars. These food products are typically consumed in large quantities in the “standard American diet”. When you eat a lot of these processed foods that lack fiber, healthy fats, and protein, this produces a rapid rise in blood sugar (blood glucose) which can result in a short-lived feeling or burst of energy and feeling good. However, the body must then compensate for this spike in blood glucose by releasing a surge of insulin (except for a person with type 1 diabetes whose pancreas no longer produces insulin). Over the next few hours, this relatively abrupt release of insulin can result in low energy, increased appetite, and low blood sugars. Not to mention the fat storage also promoted by high levels of insulin.
This scenario of blood sugar dysregulation is more likely to occur following an inconsistent meal pattern or a lack of balance of macronutrients for long periods — in other words, when you are not getting adequate protein, fiber, or fat to slow the digestion of high loads of carbohydrates frequently consumed at meals and snacks. In more severe cases, an unbalanced diet and inconsistent meal pattern can promote what is called reactive hypoglycemia. These unstable fluctuations of blood sugar sometimes have dangerous effects and are likely to have a direct impact on day-to-day mood and energy levels. In many cases, this daily roller coaster ride of blood sugar levels can easily be corrected through following a balanced diet and not skipping meals, which we will discuss in Part III.
Remember the importance of balance and try not to skip your breakfast, lunch, or dinner. It’s okay if once in a while you get too busy and must skip a meal, or perhaps you’re following an informed intermittent fasting practice, but don’t allow this to be your normal daily habit. For those trying to lose weight or better manage blood sugar levels, if you have longer than four to five hours between meals, plan to have a balanced snack.
Unlike refined grains and added sugars, whole grains are wholesome and more fulfilling since they’re packed with essential vitamins, minerals, fiber, and even provide some essential fats and protein. This better balance of macronutrients in whole grains produces a different, longer-lasting stabilizing effect on the blood sugar, and greater satiety (sense of fullness). Of all of the grain-based foods that you eat (including bread, pasta, cereal, tortillas, rice, pastries, etc.) at least half of them should be whole grains. I personally would argue this is a modest recommendation. For optimal health, perhaps we should be eating far less than 50% of products made from refined grains. With few exceptions for certain people—such as gluten-containing grains for those with celiac disease or following an elimination trial, or for those following a low-fiber diet—whole grains are nutrient-dense food staples and are a part of most healthy dietary patterns.
Although we must not discount the importance of a well-balanced diet by focusing too much on individual nutrients, it’s valuable to know the role some of these nutrients serve for mental well-being. Note that when key nutrients are lacking in the diet, a nutrient deficiency alone may have harmful effects on mood. In certain cases, deficiencies of various nutrients are potentially a key causative factor in a variety of different mental illnesses. Moreover, the “standard American diet” lacks fruits, vegetables, and whole grains which likely results in widespread deficient intakes of critical nutrients, such as essential fatty acids, minerals, and B-vitamins.
KEY NUTRIENTS LINKED WITH MENTAL HEALTH
Essential fatty acids (EFAs)
Besides the protective and energy-providing roles of dietary fats, a certain type of polyunsaturated essential fats — omega-3 fatty acids — have been recently suggested as a complementary mode of treatment (taken with other treatments) for depression. Again, note the word “essential” because without adequate intake of certain types of fats, humans will die and so the importance can hardly be overstated here. This is particularly true when we’re talking about brain health. Inadequate levels of EFAs (particularly omega-3 fats) are linked with quite a variety of mental health disorders, such as depression, bipolar disorder, attention deficit and attention deficit hyperactivity disorders (ADD/ADHD), anxiety-related disorders, and even schizophrenia and other psychotic disorders. However, given the relatively inconsistent or weak links among some of these, let’s briefly focus more on the role of omega-3 fats on depressive disorders. Compared to the relatively limited or inconclusive evidence for using omega-3 fats to improve outcomes for the other neurologic conditions, this is one common and more strongly supported link. So strong that we can even begin to talk about inadequate intakes of omega-3 fats being a potential cause for depression rather than simply a link found in research.
One impressive study from 2014 compiled the results of 19 randomized clinical trials that looked at the relationship between omega-3 supplementation and depressive symptoms in different populations of people with a diagnosis of depressive disorder or without a clinical diagnosis, but having depressive symptoms. This study, published more recently, concluded that omega-3 supplementation resulted in significant clinical benefits in symptoms of depression. However, other studies in the past have reported less impressive results, such as finding no significant benefit in depressive symptoms compared to a placebo. In 2012, another similar study compiled the results of 13 randomized, placebo-controlled clinical trials studying the effectiveness of omega-3 supplementation on depressive symptoms and failed to find any significant effect.14 This 2012 study also researched the reasons why these different clinical trials often result in different conclusions and found a variety of reasons that contribute to the inconsistency of results. For example, shorter durations of trials and whether or not people with other mental illnesses were included in the studies are both factors that can influence the results of such studies. Long story short, the potential of omega-3 fatty acids for treating a variety of different mental health conditions — particularly depression — is only barely beginning to be realized.
ESSENTIAL MINERALS AND VITAMINS
Magnesium is an essential mineral we must get from the diet, required for an impressive variety of physiological processes and biochemical reactions in the body. Similar to essential fatty acids, it’s importance can hardly be overstated. Magnesium is important for the nervous system and brain function because it acts as a common coenzyme (activator of chemical reactions in the body) for more than 300 unique enzymatic processes. This is critical to support smooth and efficient communication between the central nervous system and brain. In turn, adequate magnesium intake — most Americans don’t get enough — may promote a more relaxed, improved sense of mental well-being.
Furthermore, magnesium deficiency is known to contribute to various neurological disorders and so without adequate magnesium for the nerve cells to function effectively, this can contribute to neuronal disturbances, which may ultimately promote a sense of depression, anxiety, or even attention deficit disorder among other conditions......