Huge thanks to student dietitian, Kristi Brown for this guest post.
“Gut health” is a term that you will have heard if you are remotely interested in nutrition, health and/or science. But what does it mean and why is everyone talking about it?
The gut microbiome refers to the trillions of bacteria that reside in the GI tract, particularly, the large intestine. These good bacteria influence the health of the gut and play a role in helping to regulate the body’s systems, such as the digestive and immune system. There is also very interesting emerging research being done surrounding the role of the microbiome in mental health conditions and the “gut-brain axis” – a bidirectional communication between the microbiome and the brain.
So, (hopefully!), it is a bit clearer why good gut health is being promoted but what might not be as clear is – how do we achieve it?
One such way is fibre. Fibre cannot be completely broken down by digestive enzymes in the stomach and so, passes through to the large intestine where it acts as food for the bacteria there.
The current fibre recommendation is 30g, however, it has been noted that people in the UK do not usually consume that much. Below are some ideas on how to easily increase your fibre intake. Please remember to consume to tolerance and to build up over time, as too much fibre too quickly can have effects such as bloating. Try adding in one extra fibre rich food a week and see how you go. (Yes I know, pun intended, fibre makes you go to the toilet too ;))
Practical tips to keep your gut happy
Variety is key – different bacteria enjoy different foods, so varying what you eat is a good way to keep them all healthy. Think of the colours you eat and the types of vegetables and fruit. Rotate what you eat, so if you usually enjoy broccoli, try asparagus. This way, you increase the chances of feeding all the bacteria in the gut and most importantly, you don’t get bored.
Buy frozen – I still hear people say that frozen isn’t as good for you as fresh. This is a myth – in fact, the nutrients are locked in the food when frozen and it’s cheaper than fresh (double yay!)
Reduce waste, eat the stalks and skin – we generally throw the stalks from broccoli/cauliflowers and leave the skin when eatin a baked potatoes, when this is where the most fibre is. Leave the skin on (but wash and scrub veggies first). You can add to things like – soups, stir fries, curries, chilli’s – you name it!
Beans, beans good for your heart – again, go for variety. Baked beans are good but try kidney, butter and borlotti beans for a change. High in fibre, inexpensive and they bulk out your meal. Add to fajitas, chilli’s, make into burgers, add to a pasta dish, soups – the list goes on…
Add seeds and nuts to your snacks, cereal, yoghurt and main meals. Cashew nuts on a stir fry, sesame seeds on bolognaise, linseeds in your porridge, pumpkin seeds on yoghurt. It all helps, plus seeds provide a whole host of nutrients.
Go wholegrain when you can – switching to brown and wholegrain versions of foods can make a big change to your fibre intake. You could use 50/50 bread, wholemeal seeded wraps or brown rice.
I hope that has given you some ideas on how to up your fibre intake; keeping your gut healthy and providing a range of benefits from the other nutrients in the food (win-win!)
Many thanks to Naomi Leppitt, dietitian, for this blog post. You can find her blog here.
☕️ What is caffeine and what does it do?
Caffeine is a natural stimulant, meaning it temporarily activates your brain and central nervous system. The effects of caffeine depend on how much you have, how sensitive you are, what medications you take and even time of day. For example, someone might be kept up all night with one cup of decaf coffee, whereas someone else might sleep soundly after a double espresso!
☕️ What contains caffeine?
Coffee
Tea (more depending on how long you leave the teabag in!)
Green Tea and Oolong
Cocoa and chocolate 🍫
Caffeine is also added to:
Soft drinks like cola
Energy drinks
Smedicines (read the label!)
Caffeine can:
☕️ make you feel more awake and alert
☕️ improve learning, memory and mood
☕️ increase heart rate and blood pressure
☕️ cause intestinal discomfort
☕️ increase rate of urine production
☕️ be addictive
Feeling more awake sounds great, but some of those other effects might outweigh the positive effects for you. You don’t have to quit your morning coffee entirely, but you may find it helps to switch to decaf coffee.
☕️ How is coffee decaffeinated?
Either the beans are directly soaked in a solvent (methylene chloride or ethyl acetate), which keeps the flavour in, while removing most of the caffeine. (Don’t worry: they rinse the beans so none of the chemical remains in what you’re drinking!) Or the beans are soaked first, and that water is treated with the solvent to take out the caffeine, so the solvent never touches the beans. Sometimes solvent isn’t used at all, just water or carbon dioxide. Whichever way is chosen, there’s no evidence to say one method is safer than the other.
☕️ What about tea?
Both green and black tea come from the plant Camellia sinensis 🌿, and the difference is that black tea is fermented. Black tea contains more caffeine than green tea, unless you’re more of an Earl Grey drinker. Matcha tea contains more caffeine than regular green tea (because it’s ground, so you consume the whole leaf). Overall tea has less caffeine than coffee, so it won’t stimulate your heart as much.
Green teas contain a substance (L-theanine) that has been shown to reduce anxiety and have a relaxing effect without any drowsiness, so people often find they get the benefit of the pick-me-up without the jitters. Not only that, but green tea contains anti-inflammatory catechins, which are being shown in research to have anti-cancer properties.
Tea can be decaffeinated with carbon dioxide or just hot water (for green tea), and these processes keep in most of the catechins, so you won’t lose out on the positive effects. Tea also can be decaffeinated with solvents, but again, there won’t be any solvents in what you’re drinking.
☕️ Are decaffeinated drinks caffeine-free?
Even after decaffeination small amounts of caffeine remain (usually 1-2%, but sometimes up to 20%!). Even though it’s a small amount, it’s still enough that some people may still feel the effects.
And, even if you’re having decaffeinated drinks, be mindful that over the day, those small amounts of caffeine add up to the equivalent of a caffeinated drink.
☕️ So should I switch to decaf?
You may benefit from switching if you suffer with IBS, incontinence or anxiety. And if you’re pregnant, 🤰🏼 you should limit caffeinated drinks to 2-3 cups per day (as lots of caffeine has health risks to the baby or could result in miscarriage), so switching to decaf means you get the flavour without the risk!
Note that if you tend to drink a lot of coffee or tea, and decide to switch to decaf, you may feel withdrawal symptoms such as headaches 🤕, feeling drowsy 😴 or not being able to concentrate as well 🧠.
If you have an anxiety disorder, high blood pressure, an irregular heartbeat, or kidney disease, you may have been advised to cut out caffeine, but, be aware that switching to decaf drinks won’t mean you’re entirely caffeine-free! Alternatively, you could substitute with a non-caffeinated drink such as herbal or fruit tea, hot sugar-free squash or malted drinks.
References:
Butt, M. S. et al. (2015) ‘Green Tea and Anticancer Perspectives: Updates from Last Decade’, Critical Reviews in Food Science and Nutrition, 55(6), pp. 792–805. doi: 10.1080/10408398.2012.680205.
Decaffeination 101: Four Ways to Decaffeinate Coffee. Available at: http://coffeeconfidential.org/health/decaffeination/.
Green Tea vs. Black Tea: Which One is Healthier? Available at: https://www.cupandleaf.com/blog/green-tea-vs-black-tea (Accessed: 20 June 2019).
Kimura, K. et al. (2007) ‘l-Theanine reduces psychological and physiological stress responses’, Biological Psychology. Elsevier, 74(1), pp. 39–45. doi: 10.1016/J.BIOPSYCHO.2006.06.006.
Liang, H. et al. (2007) ‘Decaffeination of fresh green tea leaf (Camellia sinensis) by hot water treatment’, Food Chemistry. Elsevier, 101(4), pp. 1451–1456. doi: 10.1016/J.FOODCHEM.2006.03.054.
Lieberman, H. R. et al. (2002) ‘Effects of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy SEAL training’, Psychopharmacology, 164(3), pp. 250–261. doi: 10.1007/s00213-002-1217-9.
McCusker, R. R. et al. (2006) ‘Caffeine content of decaffeinated coffee’, Journal of Analytical Toxicology, 30(8), pp. 611–613. doi: 10.1093/jat/30.8.611.
NHS. Water, drinks and your health. Available at: https://www.nhs.uk/live-well/eat-well/water-drinks-nutrition/.
Ohishi, T. et al. (2016) ‘Anti-inflammatory Action of Green Tea’, Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry, 15(2), pp. 74–90. doi: 10.2174/1871523015666160915154443.
Ramalakshmi, K. and Raghavan, B. (2005) ‘Caffeine in Coffee: Its Removal. Why and How?’, Critical Reviews in Food Science and Nutrition, 39(5), pp. 441–456. doi: 10.1080/10408699991279231.
Huge thanks to Sophie Richmond (find her on instagram @balancing_bambi) for this amazing series of posts on Recovery from an Eating Disorder. Sophie is not currently a nutritional professsional or therapist but is going to be studying an MSc in Clinical Nutrition and Eating Disorders at UCL from September. I am sharing these posts as inspiration and because I think it is important to show that recovery is possible and happens.
There is the common (and incorrect) assumption that people with anorexia ‘don’t get hungry’ or ‘don’t like food.’ In my case neither were true; of course I got hungry and I had, until I became ill with anorexia, really enjoyed food. In ‘recovery’ it is always important to be aware of who is in control of your preferences in relation to food. When you say you don’t ‘like’ a dish – is that true or does your eating disorder dislike it. For me, I had always detested butter and creme fraiche so it was normal for me not to want those foods. However, from a very young age I had always loved really good quality cheeses such as ‘Stinking Bishop’ and ‘Epoisses’. When I told people ‘I don’t like cheese’ it was actually my eating disorder.
You may find it helpful to delve into your childhood memories of food and consider what you enjoyed before your eating disorder – before you knew about calories or diet culture. I always loved fruits and vegetables but anorexia made me obsessive about weighing quantities and avoiding fruits (and some vegetables) that were deemed too high in carbs. I grew up in the countryside and had idyllic memories of eating countless apples, pears and plums in the orchards with my Grandpa with a freedom I could only dream of in the midst of anorexia. Our fingers would be stained with purple juices as we picked blackberries for jam whilst devouring our fair share – not thinking of snacks or allocated portions (I don’t think much jam ever got made!). Was I happy during these times? Yes. Did I want that enjoyment and pleasure back? Yes. I had to make that choice and challenge the rules I had made for myself in order to recapture that freedom. These countless happy food memories would all be impossible to revisit whilst I clung to my ‘comfort blanket.’
I remember sharing ‘Dip Dip Eggs’ with so much pleasure with my Grandpa, loving the molten yolk oozing out over the ‘soldiers’. Anorexia made me hard boil the egg in order to carve out the yolk and only eat the white. During my recovery I found topping my meals with poached eggs (like a shakshuka) helped me capture that happiness and love from someone who cared about be so deeply – someone who bought every colour of Joules bed socks to keep my feet warm when my starved body could not warm itself, someone who wanted me to be happy and healthy, not sad and starving.
Anorexia makes you associate food with calories, diets and weight; confining it purely to ‘fuel’. But it is so much more than that. You WILL need to eat more too nourish and repair your body – but you are allowed to like food and enjoy tasting and cooking as you slowly overcome your fears. I love Moroccan and Indian cuisine for the bursts of flavour in the spiced sauces. I love tomato dishes, vegetables, fish, quinoa, lentils – all foods deemed ‘healthy’ – equally I love baked Camembert with red onion chutney or a homemade apple crumble with custard (although I cannot stand bread and butter pudding). The key is I am in charge of these choices.
I cannot stress the importance of articulating how you feel about food. Externalising and discussing your thoughts allows you to ‘rationalise’ your fears (a registered nutritionist or dietitian is ideal). My mother sat through every meal with me, listening to my worries and showing me that a potato was nothing to fear. She, like my Grandpa, helped me see that food would help repair my thinning hair, my chipped nails, keep me warm and let me think clearly. She wanted me to live, she needed me in her life. The only way I would still be here for her is if I ate.
EXERCISE
Many people will find that their eating disorder spiralled into obsessive exercising and therefore, in recovery, it can be daunting to learn how to enjoy exercise and value the movement of your body – rather than seeing it as a punishment for what you have eaten. I would suggest that you get rid of all trackers and calorie counters (this is really difficult but I promise that you will feel better) and look to gentle activities that you do not do on your own.
Yoga is a relaxing, calming form of movement which encourages you to develop a healthy, respectful relationship with your body. I also found walking my dog with my mother (or a friend) was a good way of getting outside, connecting with nature and doing an activity that was focused on helping my boxer not burning calories.
For me, spending time outside in the garden really helped with the mental challenges of recovery. Planting and nurturing our flowerbeds, watching them regrow with enough care and nourishment, was like an analogy of my journey to recovery. Sometimes the roses took a battering from too much rain, or withered slightly with too much sun, but with with a bit of love they would always bloom again.
Be aware of the amount of exercise you are doing – and the reason you are doing it. If you find yourself making excuses to walk a bit further or do a bit more try to find the strength to be honest with yourself and see that your eating disorder is slowly taking over again. Speak to someone you trust about your concerns. Your eating disorder will convince you that you are being ‘healthy’ and that there is nothing to worry about but I cannot stress enough that battling an eating disorder requires support – in the short term giving into the urges to over exercise or restrict your food intake will seem like an ‘easy’ solution. I promise you, the more you listen to the eating disorder, the more trapped you become.
No one will be angry if you ask for help. If you have started exercising on your own then ask someone to come with you. If this is not possible, try to set a time limit (perhaps listen to a podcast and promise you will stop when it finishes) or make an unmovable arrangement afterwards. Gentle exercise should be a pleasure not a punishment. If you do feel the ‘voice’ of the eating disorder becomes too overwhelming, try to find activities to absorb your attention. We set up a 1,000 piece jigsaw which I could go and do when I need to completely to distract myself and become absorbed in a stimulating activity that would silence my eating disorder. Equally you could play music, read a book, go outside, do some mindful colouring or drawing. These may seem simplistic, but it is about altering your focus and not slipping into the vortex of self-loathing created by your eating disorder.
I’m on a personal mission to reduce my biscuit intake. Now there is totally nothing wrong with a biscuit or 2, but these carrot cake energy balls add in variety and nutrition. I find they really hit the spot by giving me something to munch quickly when I’m running from job to job and they are more filling than my usual biccie.
These last for 3 days in the fridge and they also freeze well so why not make a batch and get them out the freezer in the morning, ready for when you need them.
More than excited to share this. I so hope you will share my enthuisiasm too.
25 dietitians have contributed their time and recipes towards a family meals recipe book with the aim of raising money for the Trussell Trust. The Trussell Trust is working to stop UK hunger and poverty. With a network of foodbanks providing emergency food and support to people in crisis. As dietitians we know the importance of great nutrition and access to a range of foods. So this is definitely a charity to support.
This project has been done entirely off our own backs, with no experience so it has been a huge learning curve, but the final product is 50 pages of fabulous recipes that you can use at home to create meals that are easy, delicious and used by ourselves for our own familes.
The cookbook has been endorsed by the British Dietetic Association and is being launched as part of Dietitians Week 2019.
Recipes include curry, pizza, lentil recipes, soups and some sweeter options too.
At only £3.99 it is a complete bargain and 100% of money will be going to charity.
Huge thanks to Sophie Richmond (find her on instagram @balancing_bambi) for this amazing series of posts on Recovery from an Eating Disorder. Sophie is not currently a nutritional professsional or therapist but is going to be studying an MSc in Clinical Nutrition and Eating Disorders at UCL from September. I am sharing these posts as inspiration and because I think it is important to show that recovery is possible and happens.
The first thing to understand about ‘recovery’ is that it is different for everybody. Your experience will be different to mine but neither is ‘right’ or ‘wrong’. Recovering from an eating disorder, in my case anorexia, is not an overnight decision that you make once – it is one that you have to make every single day (sometimes several times). You will probably view your eating disorder as a ‘comfort blanket’ that you cling to when you are frightened or afraid. But imagine if you found out that ‘comfort blanket’ was doing you more harm than good?
TALK
It is really important that you articulate your feelings. Eating disorders are not actually about food – they are a coping mechanism for something deeper. Talk to a trusted healthcare professional, friend or family member about your thoughts. Recovery requires determination, strength and support. Surround yourself with people who you feel able to confide in and don’t be afraid to be honest about what is helpful to you or what something sets you back (for example, if you are at a family gathering and a relative is talking about their 5:2 diet or calories – make sure you talk through your emotions with someone afterwards about how this made you feel and don’t let someone else’s decisions set you back).
READ
I studied English at university which made me think about the idea of the ‘eating disorder voice.’ I never ‘heard voices’ but I did have a constant narrative of negativity regarding my self-worth and place in the world. I was my own ‘unreliable narrator’ – or rather anorexia was telling me a false narrative. In order to recover I needed to challenge the ‘authorial voice of anorexia’ by controlling my own thoughts in order to take charge of my own story. Consider William Shakespeare’s Othello… anorexia is very similar to Iago – a character who seized upon tokens of truth and manipulated them into a fantasy to destroy a man who believed the lies.
Reading the play left me with a resounding feeling of regret…of what if? What if you challenged your eating disorder thoughts by questioning the feelings of guilt, self-loathing, fear and failure? It is hard to comprehend the power of thoughts in relation to yourself – it is only through novels, plays and characters that we see the motives and misconceptions of others. Reading takes you outside of yourself, distracts you from your worries and asks you to contemplate and question. It allows you to see that everyone behaves in a certain way because they are battling their own issues – it is not always about you. Recovery is about finding the courage to deflect deeply ingrained ‘untruths’ and allow yourself to question the harmful opinions of others. I was always fascinated by young Jane Eyre’s strength in standing up to Aunt Reed saying she was the ‘bad child.’ This is exactly how you need to respond to the ‘voice’ of your eating disorder.
SELF-TALK
Although you might struggle with the ‘self’ part of ‘self-care’ – you probably will be well versed in the power of ‘self-talk.’ Often the eating disorder takes over the ‘self’ and feeds in negative thoughts. To combat this try using, what I call, a ‘puppy analogy’. Take all the terrible, degrading words your eating disorder tells you on a daily (sometimes hourly or minute-by-minute) basis and imagine hearing them spoken to a pet (or person) you really love (I use a puppy because I now have an adorable Frenchie). How would you feel standing in a room hearing someone a loved one being told to starve themselves or that they are a useless failure who doesn’t deserve to live? You would be really angry. You would march the bully out of the room, lock the door and shower your loved one with care. So why not apply that to yourself? Visualise the intrusive thoughts as this external bully who needs to be shown the door – and allow yourself to accept the support and love of others who value the real you.
Big thanks to Georgia Berry for her help with blog post. Georgia is a nutrition student and can be found on instagram as @berry_nutrition
Did you know it is estimated that 17% of the UK suffer from Irritable Bowel Syndrome?
What is Irritable Bowel Syndrome?
IBS is a condition affecting the digestive system (NHS). The exact cause is unknow despite it leaving millions of people feeling embarrassed due to their unpredictable bowel movements. Symptoms differ from person to person; however, the most common symptoms include:
-bloating
-constipation
-diarrhoea
-abdominal cramps
Often sufferers learn what food triggers a bout of symptoms, however IBS is a complex disorder.
What causes IBS
Although the cause of IBS is not fully understood, there are a few theories behind how the condition develops. IBS is a mostly ‘western’ issue, meaning that populations that don’t live a typical western lifestyle have almost no instances of the condition. This has led researchers to believe that it may be due to lifestyle factors.
Many believe that IBS develops after the gut experiences stress, such as from antibiotics or food poisoning. This then causes the gut to be overly sensitive and causes the symptoms of IBS.
Another interesting theory behind the development of IBS is one based on the natural bacteria in the human gut. The human gut is filled with an incredibly diverse range of bacteria, however when the composition of these bacteria becomes unfavourable, it may lead to adverse side effects.
Scientists also believe that there is a huge link between mental health and IBS, with stress often being a huge trigger. In fact, there has been shown to be a placebo rate of 50% in IBS patients, showing the important of mental health in maintaining gut function. This doesn’t mean you are making things up however it just shows the massive link between your gut brain and your brain.
Treatments
A common strategy to combat flare ups is to create a food diary to assess links between food and symptoms. This is a great place to start and good to do before seeing a dietitian for advice as you can take this to talk through.
Currently, many people are being sent straight to the low FODMAP diet and it is being suggested they start on this diet by themselves. As a dietitian Priya does not agree with this. There are simpler strategies to try first as the low FODMAP diet is very restrictive, can alter your gut flora and really needs 1-1 dietitian support to do it well.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. This essentially creates a diet low in allergens and common triggers, with foods being introduced back to the diet slowly to assess their role in triggering a flare up. People often report these foods as common triggers:
Dairy
Onion
Garlic
Caffeine
Fatty foods
Certain fruit and vegetables
Lentils, beans and pulses
So cutting out all these foods leaves you with large gaps in your nutrition and the need to really have support planning your meals.
Simpler treatments can be used to manage IBS and these should be tried before the FODMAP diet. Here are 10 ideas for you to try.
Eating smaller, more frequent meals throughout the day may be beneficial as it may be that the process of eating sets off symptoms as eating can stimulate the digestive tract.
Increasing chewing time can ease digestive symptoms. This is because as the mouth breaks down the food more thoroughly it prepares the stomach more for digestion.
Leading on from a theory mentioned above is the reduction of stress to reduce flare ups. Sufferers that report a big increase in symptoms when stressed or suffering with depression may benefit from therapy or relaxation techniques. In more severe cases anti-anxiety drugs may be appropriate.
Another treatment for IBS is based on the theory that a poor gut bacteria composition can lead to symptoms. Giving sufferers both a prebiotic and a probiotic has the ability to affect the gut’s microflora, potentially leading to less flare ups.
Linseeds can be a useful tool for some people suffering from constipation, try 1tbsp a day with plenty of fluid.
Reduce gas producing veggies if you suffer from bloating (cauliflower, cabbage, brussel sprouts).
Fibre rich foods can help constipation but do increase these slowly and drink more fluid too.
Reduce caffeine, alcohol and fizzy drinks.
Cook more meals from scratch as ultra processed foods can cause some of the symptoms.
Be active daily – walking is great exercise and can help with your stress levels too.
Conclusion
IBS is a complex condition which is poorly understood, with symptoms differing hugely between patients. Therefore, successful treatments will vary patient to patient. It is key to get some support to help you work through things. A balanced diet is really important so when you make dietary changes do take care to replace nutrients to stop any deficiencies. It is also important to work with your medical team to test for other diseases such as inflammatory bowel disease or coeliac disease to prevent further issues if undiagnosed. Most importantly, always consult a registered dietitian if you think you may be suffering from IBS. You can ask to be referred on the NHS or seek a freelance dietitian like Priya.
Sundays for us are the one chilled breakfast day of the week. No school run. I don’t teach any Pilates classes so it’s a day to take time over brekkie and have something different. This is one of my favs.
So here is a my super simple recipe for you. These pancakes are easy, quick to make and packed with nutrition too, plus filling due to the seeds.
These are also perfect if you weaning as the pancakes are soft and make great finger foods. My children are always very happy when I decide to cook these.
Drop a serving spoon portion onto the pan/griddle and allow to cook for a couple of minutes, look for the bubbles on the top then flip it. These need a little more TLC than normal pancakes when turning them over.
I served mine with greek yoghurt and fruit.
Enjoy and let me know if you make them, I’d love to see your pics!
Huge thanks for this guest blog post by Bethany Francois. MSc Eating Disorders and Clinical Nutrition. Find her on Instagram: bethany_laura_
As mentioned in Part 1 of this blog post, health is not just a physical concept but involves mental and social wellbeing too. Therefore, by definition it is impossible achieve a healthy status if one of these aspects is jeopardised for the other i.e. regardless of what you are eating, if your dietary choices are negatively affecting your mental wellbeing you cannot reach state of health.
The mass of dietary information available from unreliable and unqualified individuals has made food choices complicated and confusing. We know that social media use is associated with an over-fixation on eating ‘the correct way’, which can have a profound impact on our mental health (2). It is unsurprising that what we eat can often have a psychological impact when words and phrases such as ‘bad’, ‘guilty pleasure’, ‘naughty’ and ‘clean’ are used to describe the food we eat. An overemphasis on our dietary choices as a measure of our self-worth is dangerous and likely to result in low self-esteem and can lead to eating disorders and other mental health conditions.
In a society where disordered eating behaviours have become normalised e.g. removal of food groups, calorie counting and earning the right to eat via exercise, it can be difficult to recognise (in ourselves or others) when our dietary habits may be having a detrimental effect on our mental health. Here are some signs to look out for:
Preoccupation with food
Anxiety at the thought of straying from your meal plan or last-minute changes to eating plans
Avoidance of social eating and self-isolation
Feelings of guilt or shame associated with food
Compensating by restricting/skipping meals
Justification of eating with exercise
Basing self-worth on dietary choice
Chronic under-eating
Take Home Messages
Diet is an important part of our overall wellbeing and a poor diet can both be a contributing factor and consequence of mental illness. However, it’s important to recognise that mental illnesses have complex aetiologies and require multicomponent treatment strategies. Whilst diet may be a tool to improve symptoms, it is not a cure (note that in the SMILES study (1), all participants remained on their current treatment plan throughout).
Nourishing yourself properly and eating regular meals are likely to have a positive impact on your mental health. Research suggests that the Mediterranean diet may be associated with a decreased risk of depressive symptoms. However, eating well when struggling mentally can be extremely difficult. Feeling guilt or shame due to being unable to prepare meals will only make things worse. It is so important to be kind and compassionate towards yourself-you are doing the best you can.
Our relationship with food should always allow us to be able to fully engage with other aspects of our lives. Being too anxious to attend a friend’s birthday meal will always be worse for your health than any food you would have eaten.
Please remember you can have poor health as a result of your relationship with food without experiencing weight changes. Health is not just physical and weight should never be solely used as measure of our health. Feelings of anxiety, shame and guilt are never healthy, no matter what your weight and you deserve the support to overcome these feelings.
People often roll their eyes at the word ‘balanced’. It may sound boring and it’s not as eye-catching as celebrity endorsed dietary products but it’s the truth. Regular and healthy meals are likely to have a positive impact on our mental health. But equally, an obsessive and restrictive approach to our dietary choices will never result in happiness.
1. Jacka, F., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M., Brazionis, L., Dean, O., Hodge, A. and Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Medicine, 15(1).
2. Turner, P. and Lefevre, C. (2017). Instagram use is linked to increased symptoms of orthorexia nervosa. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 22(2), pp.277-284.
Huge thanks for this guest blog post by Bethany Francois. MSc Eating Disorders and Clinical Nutrition. Find her on Instagram: bethany_laura_
The 13th-19th May 2019 is Mental Health Awareness Week. In the UK, mental health problems affect 1 in 4 adults and 1 in 10 children and up to 18% of NHS expenditure on treating and managing long-term conditions is associated with poor mental health and wellbeing1. Furthermore, depression is a major contributor to global overall disease burden and is the leading cause of disability worldwide2.
In the media, the term ‘health’ is often represented by an image of a thin person, with a low body fat percentage and visible muscles, but this definition couldn’t be further from the truth. Health is far more complicated than aesthetics and although often not visible, mental illness can have a serious impact on the overall health of an individual. The true definition of health is a state of physical, mental and social wellbeing-all of which can be impacted by our dietary choices.
We’ve probably all heard the term ‘food and mood’, but what does this really mean? This article will take a look at current research and what we know about how our diet can impact our mental state.
What we Know about Food and Mood
The best evidence we have currently, in terms of diet and mental health, is the impact of the Mediterranean Diet (MD). This diet is generally high in fruit and vegetables, legumes, beans, nuts, cereals, grains, fish and unsaturated fat sources such as olive oil and lower in meat, saturated fats and added sugar. The first causal data showing improvements in depression whilst following the MD were seen with the publication of the SMILES trial3. This was a 12-week randomised control trial, where individuals with depression either implemented the MD or received social support (control) alongside their normal treatment programme (such as psychotherapy or medication). Results showed a significantly greater improvement in depressive symptoms in the dietary group compared to the control, with 1/3 reaching remission at 12 weeks. The specific mechanisms by which dietary patterns may impact depressive symptoms is unknown, however, hypotheses include via inflammatory and oxidative stress pathways as well as the gut microbiota and the gut-brain axis. What I think is important to note is, the improvements seen in the study were independent of weight change. Often weight is overly relied on as a measure of health and I think it’s worth making clear that improvements in mood were not a result of weight loss.
Eating Well with Mental Illness
Severe mental illness is associated with poorer health outcomes and a significantly reduced life expectancy4. Reasons for this may include decreased income due to an inability to work, self-neglect, poor diet, the effect of some psychotropic medications and the effect of stress and trauma on the immune system. As well as exclusion and stigma within healthcare services and a reduced likelihood of seeking medical help5. In other words, those suffering with mental illness face significant health inequalities.
Research into diets that may improve mental health is incredibly important. However, for somebody in the depths of mental illness, being able to eat an adequate diet and look after themselves in general can feel impossible. Social media is inundated with art-worthy bowls of oats, influencers spending hours making the perfect ‘Buddha bowl’ and green smoothies containing 10+ ingredients. For individuals struggling with their mental health, getting out of bed and showered can be a difficult task, let alone recreating these meals. To be bombarded with images like this and the message that this is what it takes to be ‘healthy’ (not true by the way), can exacerbate feelings of low self-worth and inadequacy. Please know that if all you can manage to do is reach for a sachet of instant porridge or put a piece of toast in the toaster, then you are doing great. Do not let social media or the wellness movement make you feel guilty for this.
Tips for Eating Well when Struggling
Don’t complicate things
Meals do not need to be complicated and require lots of ingredients. Try to aim for a portion of carbohydrates (wholemeal if possible) e.g. bread, pasta, rice or potatoes, a portion of protein e.g. meat, fish or veggie sources (beans, tofu, soy, eggs), a portion of fruit or vegetables and a source of fat e.g. cheese, olive oil or nuts at each meal. It can also be a good idea to freeze meals so that on difficult days they can simply be re-heated.
For example, a simple and balanced meal could be wholemeal pasta with tuna mayonnaise, sweetcorn and grated cheese.
Fresh isn’t always best
Convenience is often seen as a negative connotation when it comes to diet. However, contrary to what we are often told by wellness influencers, convenience doesn’t automatically mean food is unhealthy. For example, it can be really useful to use frozen or tinned vegetables rather than fresh. These are not only cheaper but require less preparation and also means you don’t have to worry about not managing to use something before it’s use by date. Jarred or packet sauces can also help to enhance a meals flavour without considerably adding to preparation time.
Food, family and friends
Often the thought of socialising can be difficult when struggling with mental illness, resulting in isolation and further adding to feelings of low mood. Although it can be difficult to reach out to those around us, food can be a useful way to interact with others, whether that is seeing a friend for lunch or preparing and eating dinner with family members. Social eating is also a key concept of the MD discussed earlier.
Comfort
When we hear the term ‘comfort food’, we automatically associate this with an unhealthy habit. We are told that comfort eating is bad for us, that emotional eating is something that should be avoided. Using food as our only way of coping with our emotions is not ideal, however, eating or cooking your favourite meal in an attempt to boost your mood is not something that should be frowned upon. Nourishment is an act of self-care, something some people with mental health problems struggle with. Often individuals feel underserving of things that make them feel good. Spending time preparing a meal you enjoy or perhaps used to have as a child can be an important way to show yourself some compassion and kindness.
1. The King’s Fund and Centre for Mental Health (2012). Long-Term Conditions and Mental Health. The Cost of Co-morbidities. London.
2. Who.int. (2018). Depression. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/depression [Accessed 12 May 2019].
3. Jacka, F., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M., Brazionis, L., Dean, O., Hodge, A. and Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Medicine, 15(1).
4. Chang, C., Hayes, R., Perera, G., Broadbent, M., Fernandes, A., Lee, W., Hotopf, M. and Stewart, R. (2011). Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London. PLoS ONE, 6(5), p.e19590.
5. Makurah, L. (2019). Health Matters: Reducing health inequalities in mental illness – Public health matters. [online] Publichealthmatters.blog.gov.uk. Available at: https://publichealthmatters.blog.gov.uk/2018/12/18/health-matters-reducing-health-inequalities-in-mental-illness/ [Accessed 12 May 2019].
6. Turner, P. and Lefevre, C. (2017). Instagram use is linked to increased symptoms of orthorexia nervosa. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 22(2), pp.277-284.
Freelance Dietitian specialising in helping those with Eating Disorders and a Media Spokesperson for the profession.
