NUTRITIONAL PSYCHIATRY - The connection between the food you eat and your mental health

Today we celebrate World Mental Health Day to highlight the importance of taking care of this often neglected aspect of our overall health. Mental Health is defined by the World Health Organization (WHO) as “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community” (1). Whether facing stress and anxiety from the uncertainties caused by the COVID-19 pandemic, difficulty processing emotions, coping with loss, or feeling a sense of inadequacy, challenges to our mental health can come in many forms and lead to poor mental health - or even mental illness - if not managed properly.

Before COVID-19, mental illness affected close to 1 in 7 worldwide (over 1 billion) and experts are forecasting an increase in anxiety and depression as a result of the pandemic (2, 3, 4). 

The leading cause of mental illness worldwide is major depression, impacting approximately 300 million individuals globally (4). Currently, the two main treatments used for major depression are antidepressants and psychotherapy. Unfortunately, only half of those suffering from depression respond to these treatments (5). This has led researchers to look at other ways to help prevent and treat depression, including nutrition interventions.

As a dietitian who works with individuals with a wide range of physical and mental health conditions, research showing the positive impact of dietary change on mental health is both exciting and promising. A meta-analysis of 13 observational studies has suggested that individuals with diets higher in fruits, vegetables, legumes, whole grains, and fish have a reduced risk of developing depression (6).

Only recently has this observational data been confirmed with a randomized controlled study called the SMILES trial, which tested a dietary intervention group against a social support control group to determine if diet could influence depression (7). This study found that 33% of individuals following a modified Mediterranean diet went into clinical remission from moderate to severe depression (7). 

The individuals in the dietary intervention group received personalized advice and nutritional counselling support from a dietitian, including motivational interviewing, goal setting, and mindful eating. In total, they received seven counselling sessions over the 12-week intervention, with the first four sessions occurring weekly, and the remaining 3 sessions occurring every 2 weeks (7).

The goal of the nutrition counselling was to increase the consumption of the following 11 food categories that have been shown in observational studies to reduce the risk of depression:

1.     Whole grains (5-8 servings/day)

2.     Vegetables (6 servings/day)

3.     Fruit (3 servings/day)

4.     Legumes (3-4 servings/week)

5.     Low fat/unsweetened dairy foods (2-3 servings/day)

6.     Raw/unsalted nuts (1 serving/day)

7.     Fish (2 servings/week)

8.     Lean red meats (3-4 servings/week)

9.     Chicken (2-3 servings/week)

10.  Eggs (up to 6/week)

11.  Olive Oil (3 Tablespoons/day)

The individuals were also counselled to decrease ‘extras’ foods, such as desserts, candies, refined cereals, fried food, fast food, processed meats, and sugary drinks.

This research is especially encouraging for the over 50% of individuals with depression who do not respond to antidepressants and psychotherapy (5). Hopefully, this paves the way for family doctors to also consider a referral to a dietitian for individuals experiencing depression.

Although these changes can be much easier with the support of a dietitian, individuals can take the information from this research and start making small, meaningful changes to their diet on their own. I would encourage those interested to begin by choosing one of the 11 food categories listed in the modified Mediterranean diet above that they enjoy eating the most, and once they are consistently reaching the goal servings listed, start incorporating another category. 

When it comes to any lifestyle or nutrition change, I always encourage my patients to start small and act now. Remember, this is intended to be a lifestyle change to support your mental health, not to add ‘food rules’ to follow or stress to your life.

If you are looking for support to reach your health and nutrition goals, please feel free to contact me at info@colleenrempel.com. I would be honoured to support you on your journey.

In good health,

Colleen

P.S. Mental Health is such an important issue in today’s current global environment that the WHO is hosting its first ever global advocacy event for mental health, which you can access here: https://www.who.int/news-room/events/detail/2020/10/10/default-calendar/the-big-event-for-mental-health)

References:

              1.        World Health Organization (2018). Mental health: strengthening our response.https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

              2.        Whiteford, H. A., Ferrari, A. J., Degenhardt, L., Feigin, V., & Vos, T. (2015). The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PloS one, 10(2), e0116820. https://doi-org.umlwrha.idm.oclc.org/10.1371/journal.pone.0116820

              3.        World Health Organization (2020).Substantial investment needed to avert mental health crisis.https://www.who.int/news-room/detail/14-05-2020-substantial-investment-needed-to-avert-mental-health-crisis

              4.        GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. https://doi.org/10.1016/S0140-6736(18)32279-7

              5.        Casacalenda, N., Perry, J. C., & Looper, K. (2002). Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy, and control conditions. The American journal of psychiatry, 159(8), 1354–1360. https://doi-org.umlwrha.idm.oclc.org/10.1176/appi.ajp.159.8.1354

              6.        Lai, J. S., Hiles, S., Bisquera, A., Hure, A. J., McEvoy, M., & Attia, J. (2014). A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. The American journal of clinical nutrition, 99(1), 181–197. https://doi-org.umlwrha.idm.oclc.org/10.3945/ajcn.113.069880

              7.        Jacka, F. N., O'Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M. L., Brazionis, L., Dean, O. M., Hodge, A. M., & Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial). BMC medicine, 15(1), 23. https://doi-org.umlwrha.idm.oclc.org/10.1186/s12916-017-0791-y