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Dietitian Advice

Diet and Mental Health – Part 2

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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. 

Resources and Support 

Mind: https://www.mind.org.uk/

Young Minds: https://youngminds.org.uk/

Mental Health Foundation: https://www.mentalhealth.org.uk/

Rethink Mental Illness: https://www.rethink.org/

Samaritans: https://www.samaritans.org

Beat: www.b-eat.co.uk 

References 

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.

Dietitian Advice

Diet and Mental Health PART 1.

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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. 

Resources and Support 

Mind: https://www.mind.org.uk/

Young Minds: https://youngminds.org.uk/

Mental Health Foundation: https://www.mentalhealth.org.uk/

Rethink Mental Illness: https://www.rethink.org/

Samaritans: https://www.samaritans.org

Beat: www.b-eat.co.uk 

References 

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.

Nutrition Education, Other

Blue Monday: the day you are most likely to fall off the wagon?

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Apparently Monday 21st January is Blue Monday, the day you are most likely to fail on those New Years Resolutions. If I’m honest this all seems a bit crazy, can there really be one day where we have a higher likelihood of slipping up? For me this would not be a Monday, it would more likely be a “I’m tired, its the end of the week, I need a treat Friday”. Perhaps thats just me.

What is obvious is that many people do not make it beyond a few weeks of good intentions. I guess there are a number of reasons for that…. perhaps those resolutions are over ambitious, lack of planning, life gets busy after the holidays, willpower slips. It’s happened to me and I’m sure it’s happened to you.

Blue Monday
Blue Monday

 

As a lot of these New Years Resolutions are set around food here are some top tips on how to keep you mood high and your eating healthy, they may just help keep you on track 😉

“Our mood is affected by many things that we are unable to alter, but what we eat is one big variable we can take charge of.  When you eat and what you eat has a big impact on how you feel and on your energy levels,” says Priya.

“Skipping meals leads to low blood sugar levels which can leave you feeling tired, grumpy and craving sugar.  Planning regular meals and small snacks will avoid these danger points in your day.  Choosing foods that have a lower glycemic index will help fill you up and sustain your energy levels for longer as they help your blood sugars stay stable.  Try adding beans and lentils to dishes, choose ‘oaty’ dishes like porridge or muesli and add a low fat yoghurt to your lunch.

“Whole grain carbohydrates are not only lower in glycemic index than the white versions but they increase the amount of tryptophan than enters the brain, resulting in more mood enhancing serotonin being produced,” she added.  “Include wholegrain bread, pasta, oats, and wholegrain cereals at meals, try adding pearl barley to soups and bulgur wheat to salads.

“B vitamins play a vital role in energy release.  Therefore eating more of these will help improve your energy levels, lifting your mood.  121 Females taking a thiamine supplement reported improved mood, a clearer head, increased energy levels and better cognitive function.  Folate is another micronutrient that has been shown to be linked to mood through blood samples taken from 58 men.  Eating more green vegetables, sunflower seeds, cashew nuts, almonds, strawberries, tomatoes and peppers will boost your thiamine and folate levels.  Wholegrain cereals are also fortified with these nutrients.

“Iron is well known to be linked to fatigue and low energy.  It’s lesser known that there is also a link to poor mood and concentration.  Topping up your iron will boost that feel good factor.  Include red meat, dried fruit, green vegetables and wholegrains in your diet.

“The Mediterranean diet contains plenty of fruit, vegetables, nuts, fish, olive oil, cereals and some red wine.  Eating these foods is associated with better mental health scores.  So making sure you are meeting the 5 a day recommendation for fruit and veggies, go wholegrain with your cereals and sticking to healthy fats such as olive oil, oily fish and nuts really can work!”

How are you doing with your  New Years Resolutions? If they are related to weight loss see my tips here.
These tips are take off a press release written for the British Dietetic Association, the full version can be seen here.