Integrative Medicine for Mental Health – Part 2 – Nutrition

Although any new information on food and nutrition deserves everyone’s attention, in this article, the emphasis will be on diet/nutrition in relationship to mental health. This aspect of diet and nutrition is not usually discussed because the main emphasis on diet/nutrition is traditionally in relationship to the body’s health

A familiar example of how food affects the mind is when we feel that warm, contented feeling of drowsiness after a big Thanksgiving turkey dinner. Turkey contains tryptophan, an amino acid that is converted into 5-hydroxytryptophan (5-HTP) which is then converted into the neurotransmitter serotonin, the “feel good” neurotransmitter. Turkey also boosts melatonin production, a hormone that signals the body for sleep. Neurotransmitters are the brains chemical messengers that send signals throughout the other parts of the mind and body to initiate certain actions or no action. Some neurotransmitters are excitatory, and some are inhibitory, meaning some neurotransmitters will cause reactive and exited changes in the body and mind and some will cause calming changes to the mind and body. These neurotransmission actions (excitatory and inhibitory) parallel our body’s two divisions of the central nervous system, the sympathetic and parasympathetic. This description of how the body and mind is affected by eating turkey is just one small example of how food can have an impact on how we feel, both physically and mentally. One way to think about diet and nutrition is to consider that every item of food/drink we put into our mouths will have some affect on our mind and body, so choose carefully.

Newer research into food and human functioning has revealed a complex communication between the gut and the brain that has multiple effects on affect, motivation, and higher cognitive functions. Some experts believe that digestive dis-ease and what goes on in the digestive process (the gut microbiome) is a fundamental factor in mental dis-ease because of this interactive communication between the gut and the brain. New dietary buzzwords are being discussed because of these newer discoveries about the gut microbiome, such as inflammation, free radicals, antioxidants, pre/probiotics, detox, gluten, omega-3’s and 6’s, and superfoods. Below is a quick definition of these terms and their impact on mental health.

Inflammation – Inflammation is a defense mechanism triggered in the body when it recognizes an attack and gathers special resources in response. Inflammation is a requirement for survival. However, chronic inflammation can be extremely damaging your arteries, organs and joints. Left unchecked, it can contribute to chronic diseases, such as heart disease, blood vessel disease, diabetes, obesity, cancer, Alzheimer’s disease and other conditions. Inflammation in the body is also correlated with depression, aggression, and impulsivity (Oddy et al., 2018). Those with schizophrenia and other psychotic disorders commonly have biomarkers of high inflammation and newer anti-inflammation treatments for schizophrenia and other psychotic diseases have shown promising results for reductions in symptoms (Khandaker et al., 2015). Inflammation can be caused by many factors, including chronic stress, but there is no doubt that some of the foods we eat cause inflammation as well. Sugar, trans fat, omega-6 fatty acids, gluten and refined carbohydrates are among these.

Free radicals/Oxidative Stress – Free radicals are created when oxygen in the body splits into single atoms with unpaired electrons. While not all free radicals are bad, free radical atoms scavenge the body to seek out other electrons so they can become a pair. This process causes damage to the cells, proteins, and DNA causing a condition called oxidative stress. Oxidative stress can occur when there is an imbalance of free radicals and antioxidants in the body. Free radical production is associated with the following foods/diet: alcohol, fried foods, processed meats, high glycemic foods, foods that are rich in refined carbohydrates and sugars, and preservatives used in foods. Oxidative stress is implicated in several mental disorders including depression, anxiety disorders, schizophrenia and bipolar disorder (Salim, 2014).

Antioxidants – While it sounds like something you might put into your washing machine; antioxidants help defend your cells from damage caused by harmful free radical molecules. Eating a diet rich in antioxidants can help increase your blood antioxidant levels to fight oxidative stress. Some examples of foods that are rich in antioxidants are many fruits and vegetables, but some specific examples of high antioxidant foods are: dark chocolate, blueberries, pecans, raspberries, goji berries, artichokes, kale, beans, and beets.

Omega-3 & 6 – Since the human body can’t produce omega-3 or 6 fats, these fats are referred to as “essential fats,” meaning that you have to get them from your diet. Omega-6’s are found in vegetable oils, and other more common foods, like corn, soybeans, and meats, nuts and seed so they are much easier to include in the diet. Omega-3’s are harder to include in diet so it is common that people do not get enough Omega-3’s. Omega-3 fatty acids come in some fish (salmon, mackerel, anchovies, sardines, trout), avocados, eggs, walnuts, spinach, chia seeds. Omega-3’s are anti-inflammatory and good for heart and brain health by lowering levels of blood fats called triglycerides. Omega-6 fats play an important role in regulating our genes and promoting immune health and blood clotting.  It is recommended that those that don’t eat enough Omega-3 fish or have high risk of heart disease supplement their diet with Omega-3 fish oil supplements.

Pre/probiotics – Prebiotics are specialized plant fibers that act like fertilizers to stimulate the growth of healthy bacteria in the gut. Probiotics are live beneficial bacteria that helps to eliminate bad bacteria’s in the gut which aids in a healthy digestive tract and a healthy immune system. Most people get enough prebiotics from their diets. Prebiotics are found in foods like garlic, onions, asparagus, bananas, oats, apples, wheat bran. Probiotics are less common in people’s diet, so including foods high in probiotics is important for healthy digestion. Foods high in probiotics are yogurt, sauerkraut, kefir, kombucha, miso. Keep in mind that it is estimated that almost 90% of the body’s serotonin is made in the digestive tract. Inflammation, leaky gut, irritable bowel syndrome are all correlated with multiple mental health problems, such as depression, anxiety, ADHD, and other psychotic disorders. Pre/probiotics play an important role in keeping the digestive system healthy.

Superfoods – The term “superfood” is a fairly new term referring to foods that offer maximum nutritional benefits for minimal calories and are loaded with vitamins, minerals, and antioxidants. For instance, one superfood, Acai berries because they contain 19 amino acids and many antioxidants. Raw honey, another superfood, has antibacterial and antiviral properties that can help boost your immune system and fight sickness. Honey contains ascorbic acid, pantothenic acid, niacin and riboflavin; along with minerals such as calcium, copper, iron, magnesium, manganese, phosphorus, potassium and zinc. Some other superfoods are leafy greens, like kale, spinach, and Swiss chard, berries, berries, such as blueberries, goji berries, soy, teas (favorites are green, matcha (a type of green tea), white tea, peppermint, chamomile, hibiscus), salmon, dark chocolate, beets, wheatgrass, chia seeds, algae. Incorporate superfoods into your regular diet when you can. For instance, use honey as your sweetener for coffee or tea instead of sugar or artificial sweetener. Many of these foods are great to add to smoothies, or to sprinkle on cereal or oatmeal (also a superfood if there is no sugar or additives).

The above descriptions are simple overviews of how just some of the components of an extraordinarily complex digestive system connects nutrition and the mind/body. Suffice it to say that what we eat and drink can have profoundly positive or negative affects on how we feel, move, and think, both physically and mentally. Diets high in refined sugars, for example, are harmful to the brain. In addition to worsening your body’s regulation of insulin, poor diets also promote inflammation and oxidative stress. Multiple studies have found a correlation between a diet high in refined sugars and impaired brain function — and even a worsening of symptoms of mood disorders, such as depression and bipolar disorder. Finally, don’t forget that the foods that we eat can inhibit or promote the production of neurotransmitters. Neurotransmitters are the chemical messengers that get directed throughout the brain/body to create the conditions for mental health wellness. For instance, serotonin production, the “feel good” neurotransmitter, can be boosted by eating eggs, cheese, turkey, nuts and seeds, and pineapple. Dopamine, the “reward” neurotransmitter, can be increased by eating protein rich foods, bananas, dark chocolate, and dairy foods. Foods that can boost energy and metabolism are eggs, coffee, green tea, water, garlic, spinach, beans and avocado. And food that can help curb stress and anxiety are asparagus, avocado, blueberries, turkey, almonds, yogurt, spinach, and salmon.  

Luckily, finding out information about good nutrition is readily available on the internet. But do your research, because there is a lot of misinformation on the internet as well. If you are not sure if you are eating correctly and have been feeling down or sluggish lately, consider a visit to your local nutritionist to get some ideas on improving your diet. Feeling moody, fatigued, foggy, or down could be a case where improving diet could make a significant positive change. For mental health practitioners, including dietary assessments should be part of client assessment when considering overall treatment planning with clients. There has been considerable anecdotal evidence of dietary interventions completely eliminating some mental disorders, like depression and offering significant relief of symptoms in others, like schizophrenia and bipolar disorders (Marx, Moseley, Berk, & Jacka, 2017).

Below are some practical guidelines for good nutritional health. Please consider seeing a professional nutritionist or dietary physician if you feel additional support or guidance is needed.  

• Digestion occurs in a state of relaxation. Eat in places that induce relaxation rather than places where one feels stressed. Enjoy your meals and be intentional with your eating/drinking decisions.
• Stress slows down the digestive process. Use relaxation and other favorite coping techniques to keep stress levels manageable.
• Specific oils have higher smoke points. Smoke points refer to the temperature at which an oil starts to burn and smoke, decreasing nutrients. For instance, olive oil’s smoke point is about 374º so may not be a good cooking oil for pan-frying salmon. A better choice is ghee (clarified butter), which has a smoke point of 482º.
• Fresh is always best, but when not available, frozen fruits and vegetables maintain the original nutrients better than canned fruits and vegetables. If you take the canned vegetable route, make sure that you avoid varieties with added sugars or sodium. Also, many of the nutrients from canned vegetables stay in the liquid. If you remove canned vegetables and drain them, you are pouring out a lot of the nutrients.
• Eat “clean”, meaning consume more whole foods such as fruits, vegetables, lean proteins, whole grains and healthy fats — and limit highly processed snack foods, sweets and other packaged foods.
• Avoid high glycemic foods, or foods that are rich in refined carbohydrates and sugars.
• Limit processed meats such as sausages, bacon and salami. They contain preservatives, which leads to the production of free radicals.
• Limit red meat. It is particularly more vulnerable to oxidation because of its high iron content.
• Don’t reuse cooking fats and oils. Heating fats and oils during cooking oxidizes them, generating free radicals which seep into our foods.
• Limit alcohol use.  
• Eat foods rich in antioxidants. Antioxidants are found in a variety of plants in the form of vitamins A, C and E, selenium and certain phytonutrients and polyphenols. Cranberries are loaded with them! Other choices are dark chocolate, blueberries, pecans, raspberries, goji berries, artichokes, kale, beans, and beets.
• Look for foods with β-carotene, lycopene and lutein, which are called carotenoids. Carotenoids act as antioxidants in the human body and research has indicated they have strong cancer-fighting properties (Johnson, 2002). Some carotenoids are converted by the body to vitamin A, which is essential to vision and normal growth and development. Foods high in carotenoids are broccoli flowers, alfalfa sprouts, brussels sprouts, carrots, collard greens, corn, mango and tomatoes. These foods can be incorporated into several side dishes such as vegetable medleys, casseroles and salads.
• Consider fruit for dessert instead of rich pies and cakes.
• Grab some nuts and other foods rich in vitamin E, such as sweet potatoes.
• Plant metabolites called flavonoids also demonstrate antioxidant functions. Some versatile antioxidant-rich flavonoids include onions, eggplant, lettuce, turnip greens, endives, pears, red wine, parsley, citrus fruits, berries, cherries, plums, legumes, soybeans, milk, cheese, tofu and miso.
• Enjoy antioxidant superfoods, or those with high levels of more than one vitamin. These are prunes, plums, raisins, blueberries, cranberries, figs, oranges, pomegranates, sweet red bell peppers, beets, kale, spinach and dark chocolate.
• Try herbal therapy – in your food! Many spices can not only enhance the flavor of your food but also reduce oxidative stress. These include ginger, grape seed extract, ginkgo, rosemary and turmeric.
• Explore supplements/herbals/botanicals for areas of nutrition that could be lacking in diet. Supplements can enhance food and diet performance toward better mental and physical health. Some well-tested and common supplements are Ashwagandha, St. John’s Wort, B-complex, Vitamin C, Turmeric, Magnesium, Fish oil, and a good multivitamin. These recommendations cover everything from depression relief to better immune functioning. Check with your doctor before taking any supplement, especially if you are taking other medications.
• Take time for tea. When the evening comes to an end, you can revel in a gentle and soothing cup of warm green tea and be comforted in knowing that the polyphenols in your brew also combat oxidation.

References

Johnson E. J. (2002). The role of carotenoids in human health. Nutrition in clinical care : an official publication of Tufts University, 5(2), 56–65. https://doi.org/10.1046/j.1523-5408.2002.00004.x

Korn, L. (2018). Certified Mental Health Integrative Medicine Provider (CMHIMP) Training Course: Nutritional and Integrative Medicine for Mental Health Professionals [Online Course].

Khandaker, G. M., Cousins, L., Deakin, J., Lennox, B. R., Yolken, R., & Jones, P. B. (2015). Inflammation and immunity in schizophrenia: implications for pathophysiology and treatment. The lancet. Psychiatry, 2(3), 258–270. https://doi.org/10.1016/S2215-0366(14)00122-9

Marx, W., Moseley, G., Berk, M., & Jacka, F. (2017). Nutritional psychiatry: the present state of the evidence. The Proceedings of the Nutrition Society, 76(4), 427–436. https://doi.org/10.1017/S0029665117002026

Oddy, W. H., Allen, K. L., Trapp, G. S., Ambrosini, G. L., Black, L. J., Huang, R., Rzehak, P., Runions, K. C., Pan, F., Beilin, L. J., & Mori, T. A. (2018). Dietary patterns, body mass index and inflammation: Pathways to depression and mental health problems in adolescents. Brain, Behavior, and Immunity, 69, 428-439. https://doi.org/10.1016/j.bbi.2018.01.002

Salim S. (2014). Oxidative stress and psychological disorders. Current neuropharmacology, 12(2), 140–147. https://doi.org/10.2174/1570159X11666131120230309