What is Nutritional Psychiatry?
“Let food be thy medicine; and medicine be thy food” – Hippocrates
Last summer, a week before I went into labor with Baby Bee, I attended a day-long continuing education workshop. I was so excited about this workshop, despite the heat of summer, the over-an-hour hour drive through DC, and the ginormous and looming belly, I had to go.
I was telling everyone, “No, I’m not ready to go into labor yet! I have this conference thing…”
It was the annual conference for The International Society for Nutritional Psychiatry Research (ISNPR).
And it didn’t disappoint. The researchers presented solid findings confirming my own reading and beliefs- what, how, where, and when we eat can change our brain structure and function and our risk for depression, anxiety, mood disturbances, and psychosis.
Historically, psychiatrists and mental health workers don’t have dietitians on speed dial. Nutrition status was compartmentalized away from mental health- unless there was overt disordered eating.
So what is changing? What is this Nutritional Psychiatry? It’s an exciting new area of global research evaluating the connection between our forks, our guts, and our minds. I am, quite frankly, giddy about it all.
Dr. Jerome Sarris, a handsome, young Australian and prominent ISNPR member and researcher, wrote an influential opinion paper in 2015, Nutritional Medicine as Mainstream in Psychiatry, in which he argues we should treat nutritional psychiatry with the respect it deserves.
“…emerging and compelling evidence…suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology.”-Dr. Sarris
That’s a powerful statement, because it is widely understood that we should eat a certain way to protect our heart health. So why wouldn’t our food have the same impact on brain health?
The ISNPR position statement paper on nutritional psychiatry further makes the case. Our current treatment modalities- medication first followed by therapy- is missing something, it’s sub-optimal.
Adding nutrition makes it prevention-focused, cost-efficient, and more effective overall. Both in my private practice and my contract position with The Dorm, a treatment center for emerging adults with mental health, eating disorders and substance abuse, I utilize nutritional psychiatry to improve client outcomes.
So how exactly can nutrition impact our mental health?
There are three main paths of impact:
- Medications for mental have side effects that affect physical health
- Mental health, by nature, changes self-care behaviors that impact physical health
- Nutrition content, amount, and variety impacts actual brain structure and function increasing or playing a causal role in anxiety, depression, psychosis, mood disturbances and the like
Typically, there is an interplay of all three, but the third is the preventative-focus of nutritional psychiatry.
The medications to treat mental illness can have harsh side effects, particularly those related to health. For example, depression medications (SSRIs such as Celexa, Prozac, Paxil, Zoloft) can cause weight gain- and this is on top of depression also possibly influencing appetite and activity in a way that might promote metabolic aberrations.
Antipsychotic drugs or mood stabilizers (Risperadal, Seroquel, Clozaril, Zyprexa) are used to treat bipolar or schizophrenia, and they too can influence our appetite and cause weight gain to a large degree (>10 lbs in a matter of weeks). This also in addition to psychosis by nature inhibiting self-care behaviors.
It is a double edged sword- mental illness decreasing good nutrition and health habits AND medications to treat impacting our metabolism and physical health.
The third path to impact, using nutrition as prevention, is my favorite topic: Can we utilize food and supplements to change brain function as it relates to mental health?
All in all the brain needs:
- Carbohydrate for energy
- Fatty acids for structure and function
- Amino acids from protein for neurotransmitters and cellular repair
- Vitamins and minerals as cofactors for neurotransmitters and enzymes
Let’s examine this, starting with everyone’s favorite diet evil-doer: carbs.
Carbs are the brain’s primary fuel source. Too much, too little, or spikes in blood sugar has obvious effects- think of being “hangry”. How does your mood change when your blood sugar drops? I bet there’s irritability, difficulty focusing…Too rapid a drop can even result in death or coma as can occur in Type I Diabetes.
Then there’s fat. Approximately 60% of our brain tissue is fat- our cells are encased by it and it impacts our neural transmissions. Twenty percent is from essential fatty acids, omega-3 and omega-6. If we are deficient, we are more likely to feel sad or anxious.
Protein’s building blocks, amino acids, are major contributors to the 4 main neurotransmitters: GABA, serotonin. acetylcholine, dopamine/norepinephrine. Food can cause up or down regulation of these, and imbalances in neurotransmitters influence mood and brain function as well as cravings.
Vitamins and minerals act as cofactors for enzymes and neurotransmitters. Deficiency or excess has been known to increase risk of dementia, anxiety, depression, and mood disturbances.
Water, of course, is essential. Even slight dips in hydration status can impact our thinking. Headache, anyone? Severe dehydration can result in delusions.
What we eat also affects our gut microbiome which impacts brain function as well. A just wrote a post about mania and probiotics. There is a lot of research there- I’ll continue to write on this topic. So fascinating!
So are doctors on board with Nutritional Psychiatry?
In short, I don’t think so. Not the majority at least, but I’m hopeful more and more every day are waking up to the power of nutrition. At The Dorm, I’m an integral team member which does show an optimistic shift in treatment structure, leaning toward wellness as primary care.
I feel like I have an insight into how psychiatrists think (after all, I married one!). In my conversations with my husband, he was initially slightly uncomfortable with the idea of nutritional psychiatry. Although, he’s come around, and he even recently wrote a chapter in a textbook on wellness and psychiatry. Score!
But there is something very important to understand here:
Nutritional psychiatry is not replacing conventional psychiatry. It doesn’t negate the need for medication.
Dietitians advocates (like myself) are not asking that we shove aside common treatments.
A nutrition assessment followed by individualized education, encouraging appropriate supplements to help balance brain chemistry, an exercise program, and proper sleep and stress management are all adjunctive to the conventional psychiatry.
So in summary, proper nutrition can:
- decrease the negative side effects of medication
- improve ability to manage self-care in mental illness
- possibly decrease symptoms and recurrence of psychosis, depression, anxiety
- improve overall well -being
- decrease disease risk which is often increased in mental illness
- decrease money spent on conventional treatment
- improve outcomes
Psychiatrists, psychologists, mental health workers, and others treating mental illness can look to dietitians and wellness professionals as adjunctive support and team members.
Nutritional Psychiatry rocks.