1in 4 people in the UK will experience a mental health problem each year (Mind, 2013). Mental illness encompasses a broad spectrum of conditions from anxiety (4.7 in 100 people) to schizophrenia and bi-polar disorder. They can arise at any age, to any individual and can be triggered for many reasons including socio-economic, environmental, financial and genetic influences.
What does diet have to do with mental health?
There are many possible influences on food intake for someone suffering severe anxiety and depression and these are;
– self-neglect, apathy, lack of interest in food and/or erratic eating habits
– abdominal pain secondary to severe anxiety
– lack of support to help individuals improve their intake (lack of assistance with shopping, lack of clarity on what they need to buy to improve diet)
– lack of understanding of the importance of diet
– financial constraints
Many nutritional consequences of mood disorders such as anxiety and depression and having witnessed these, they are potentially as mild as a patient requiring a multivitamin due to poor intake to a patient neglecting their food intake so badly that they have become at-risk of something called re-feeding syndrome. This syndrome is due to metabolic adaptations that take place in the body as a result of starvation and the consequences of this can be fatal. This is an all too-common syndrome that many inpatients within a mental health ward present with and as a Dietitian, it is important to understand why it has presented.
Food and nutrition is usually the last priority for someone suffering anxiety or depression and ironically, it the one thing that may also help to reduce symptoms.
Anxiety and Depression
Anxiety is a form of depression therefore both are thought to be due to an imbalance in neurotransmitters in the brain that carry messages between brain cells. Both these terms tend to be used loosely in modern society and many people think that anxiety is “just a bit of worry over nothing” and that depression is “just a low mood, chin up!”… and this could not be further from the truth. Many patients admitted to mental health units are admitted for either anxiety, depression or both. They can also be referred as outpatients since once they become stable on medication, they then may require continuous support with weight management and improving nutritional status.
Weight management for depression often tends to be a particularly sensitive area to tackle since often, the trigger for the individual’s depression may have arisen from bereavement and changes to personal life which tend to have huge ramifications on diet. Sometimes an individual can present with weight gain due to overeating for comfort in order to fill a void or suffer weight loss due to self neglect as a result of emotional trauma. A study by Peet (2004; cited by Mackintosh and Lawrie) showed that increasing levels of mood disorders were partly attributed to changes in diet in terms of increased consumption of processed foods, sugar, trans fat and reductions in fibre. Therefore the challenge is working with individuals to set realistic goals to improve diet whilst being mindful of the enormous barriers a Dietitian must help them over come. Many of the strategies i’ve tried involve helping the individual to find a non-food related coping strategy or hobby so finding out about lifestyle will have a particularly beneficial impact on goal-setting and positive outcomes.
Both ends of the spectrum in weight management are particularly sensitive areas that require a holistic approach and collective and realistic goal-setting. Many Dietetic students tend to find the field of mental health difficult since as students, we’re so keen to showcase all our fantastic knowledge only to be met with even more barriers than you might expect from a patient in a general health setting. The key for anyone helping someone overcome a condition is to build up a trusting relationship and a little bit of thinking outside the box helps too. There have been many occasions where i’ve created some Blue Peter style tick box resources or made Champion certificates in order to help my patients reach even the smallest of goals but to them, it’s an enormous triumph and huge step towards improved mental health.
Food and mood
There has been a great deal of interest in the area of food and mood, particularly in relation to serotonin (this helps contribute to feelings of happiness) and neurotransmission. Studies have suggested that serotonin production is affected by blood glucose levels and Wurtman (1993) suggested that a high carbohydrate load leads to increased transport of tryptophan into the brain. Which loosely translates as there is good stuff (tryptophan) that might help improve your mood by eating certain foods!
Foods containing tryptophan:
Needless to say, the above pretty much looks like a balanced, healthy and varied diet, nothing super fancy. So the key is, aim for a diet rich in fruit, vegetable, breads, pasta, meat and dairy and the other most important lifestyle change you can make to improve your mood is to exercise as this is often the most under-utilised anti-depressant and probably one of the most effective treatments.
The only other fundamental necessity in helping and supporting those with a mental health condition is understanding along with a good attitude so read, learn and do your best to understand.
For further advice on Depression and diet, please take a look at:
British Dietetic Association ‘Depression and diet’ – http://www.bda.uk.com/foodfacts/Diet_Depression.pdf
Peet, 2004, cited by Mackintosh, A and Lawrie, S (2004). Cross-national differences in diet, the outcome of schizophrenia and the prevalence of depression: you are (associated with) what you eat. The British Journal of Psychiatry (2004) 184: 381-382. Available at: http://bjp.rcpsych.org/content/184/5/381
Wurtman, 1993. Depression and weight gain: the serotonin connection. Journal of Affective Disorders. Oct-Nov; 29 (2-3); 183-92. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8300977
Young and Leyton, 2002. The role of serotonin in human mood and social interaction. Insight from altered tryptophan levels. Pharmacology, Biochemistry and Behavior 71 (2002) 857–865