Introduction to Nutritional Psychiatry

    Over one billion people globally are affected by mental illness,1 and this number continues to grow.

    While prescription medications can provide relief for many, they are often not sufficient on their own. However, when paired with lifestyle medicine — a branch of medicine that incorporates environmental and behavioural principles — the success rates of treatment appear to increase.2

    This approach not only enhances treatment outcomes but also empowers patients by giving them a greater sense of control over their condition, a crucial aspect often missing in traditional treatments.

    An essential component of lifestyle medicine for mental health disorders involves nutritional psychiatry. Nutritional psychiatry is a rapidly growing field that explores how our diet impacts our mental health. Numerous pathways have been identified through which diet could plausibly affect mental health. These include modulation of pathways involved in inflammation, oxidative stress and mitochondrial dysfunction, epigenetics, and the gut microbiota. It's all about understanding that what we eat doesn't just affect our bodies — it also has profound effects on our brains and mood.

    INFLAMMATION

    Inflammatory dysregulation has been linked to mental health disorders. Blood tests for C-Reactive Protein (CRP) and Interleukin-6 (IL6) can often help identify if this is the case.

    Research indicates that diets high in calories and saturated fat (like the typical Western diet) increase inflammation and may have detrimental effects on brain health, including cognitive decline, hippocampal dysfunction, and damage to the blood-brain barrier.3

    Consuming high amounts of sugar and refined carbohydrates is linked to inflammation due to their association with insulin resistance. Diets high in anti-inflammatory fats, like those found in avocado and extra virgin olive oil, can directly influence these markers.

    OXIDATIVE STRESS

    Oxidative stress occurs when there are too many harmful molecules called free radicals in the body and not enough antioxidants to neutralize them. This can damage cells and is associated with many chronic health conditions, including mental health issues. Oxidative stress damages biomolecules (proteins and fatty acids), which can lead to mitochondrial dysfunction.

    Introduction to Nutritional Psychiatry

    MITOCHONDRIAL DYSFUNCTION

    Mitochondria maintain the normal physiological function of nerve cells by producing cellular energy and performing crucial roles. Damaged mitochondria aggravate alterations in the brain microenvironment, promoting neuroinflammation and energy depletion, thereby exacerbating mood disorders.4

    Running an Organic Acid Profile and measuring 8-OHdG (8-hydroxy-2’-deoxyguanosine*) can help determine levels of oxidative stress and mitochondrial dysfunction. Diet quality directly influences oxidative stress and mitochondrial function. Phytochemicals, present in a wide range of foods and medicinal plants, play a pivotal role in preventing oxidative stress and supporting mitochondrial function. Plant foods — like vegetables and fruits — are high in phytochemicals. Incorporating at least four cups per day is critical, and for those with mood disorders, at least six cups is ideal.

    EPIGENETICS AND NUTRIGENOMICS

    The risk for mental health conditions is both genetically and environmentally determined. Epigenetics involves how your environment and lifestyle can affect which genes are active. Factors such as diet, stress, and exercise can influence gene activity without changing your DNA. Nutrigenomics specifically looks at how the food and nutrients you eat interact with your genes. It studies how different nutrients can affect your gene activity and how your genes can influence the way your body responds to certain foods. It's about finding the best diet for you based on your genetic blueprint.

    Nutrigenomic profiles, which are available in South Africa, help identify which foods and nutrients may be beneficial to your genetic makeup. They can form a crucial part of a lifestyle medicine approach.

    Introduction to Nutritional Psychiatry

    GUT MICROBIOTA 

    The gut's functioning and the composition of the microbiome significantly influence mental health.5 Effective digestion, absorption, and assimilation of nutrients depend on the gut. The bacteria that comprise our microbiome are also responsible for producing many vitamins, neurotransmitters, and hormones, all vital for our mental health. Certain dietary factors, including high gluten intake, can influence the composition of the intestinal microbiome. These factors can disrupt nutrient absorption, compromise the intestinal barrier's defense against toxins and bacteria, promote chronic inflammation, and subsequently activate neural pathways that directly impact the central nervous system's function.6

    Progast Butyrate Aug 24

    Conducting a functional stool test to identify imbalances within the microbiome can form an essential part of a nutritional psychiatry intervention. Changes in gut microbiota have been observed alongside shifts in food choices or adherence to specific dietary patterns, whether healthy or unhealthy. For example, foods high in fiber feed bacteria in the large intestine, producing butyrate. Butyrate is a main source of energy for your intestinal cells and therefore your gut barrier. A low fiber intake can have a massively detrimental effect on your gut barrier.

    There is also fascinating research on the use of psychobiotics in mental health. These are a group of probiotics that can directly interact with the gut-brain axis. They can inhibit inflammation and decrease cortisol levels, resulting in an improvement in symptoms of anxiety and depression.7

    DIETARY RECOMMENDATIONS

    1. Increase consumption of fruits, vegetables, legumes, whole grains, nuts, seeds, herbs, and spices to boost phytonutrient, fiber, and anti-inflammatory compound intake.
    2. Limit intake of ultra-processed foods and treats, and replace them with minimally processed nutritious foods to reduce the risk of oxidative stress.
    3. Include foods rich in omega-3 polyunsaturated fatty acids and fiber to address inflammation.
    4. Consume red meat in moderation and opt for lean sources rather than processed cuts. Chicken and ostrich are good alternatives.
    5. Include extra virgin olive oil as the main source of oil in your diet due to its high phytonutrient and anti-inflammatory compound content.
    6. Avoid excessive alcohol consumption.
    7. Consume an adequate amount of water.

    Both a Modified Mediterranean Diet and a Ketogenic diet have been found to be beneficial in nutritional psychiatry research. A Modified Ketogenic Diet tends to encompass the best of both and is easier to follow than a purely ketogenic diet in the long term.

    Introduction to Nutritional Psychiatry

    THE WAY FORWARD

    Nutritional Psychiatry is a dynamic field that provides a new outlook on mental health. It explores the complex biochemical aspects of mood disorders and presents a pathway toward achieving optimal health. However, implementing dietary changes can be challenging if you have a mental health disorder. This is why it is crucial to work with a practitioner who can guide you through the process. It is essential to think about how to best nourish the brain and develop a joyful relationship with food, which activates motivation to make dietary changes that will best support both mental and brain health.

    Editor's note: You may be interested in this articles: Maintaining Digestive Health and The Best Dietary Choices for IBS.

    References

    1. World Health Organisation World Mental Health Report. Transforming mental health for all. Executive Summary. 2022
    2. Richardson K, Petukhova R, Hughes S, Pitt J, Yücel M, Segrave R. The acceptability of lifestyle medicine for the treatment of mental illness: perspectives of people with and without lived experience of mental illness. BMC Public Health. 2024; 24:171
    3. Noble E, Hsu T, Kanoski S. Gut to Brain Dysbiosis: Mechanisms linking Western diet consumption, the microbiome, and cognitive Impairment. Front Behav i. 2017; 11:9
    4. Song Y, Cao H, Zuo C, Gu, Z, Huang Y, Miao J, et al. Mitochondrial dysfunction: A fatal blow to depression. Biomedicine & Pharmacotherapy. 2023; 167:115652
    5. Xiong R, Li J, Cheng J, Zhou D, Wu S, Huang S, et al. The role of gut microbiata in anxiety, depression,and other mental disorders as well as the protective effects of dietary components. Nutrients. 2023; 15(14): 3258
    6. Ceppa F, Mancini A, Tuohy K. Current evidence linking diet to gutmicrobiata and brain development and function. International Journal of Food Sciences and Nutrition. 2019; 70:1-19
    7. Cheng L, Liu Y, Wu C, Wang S, Tsai Y. Psychobiotics in mental health, neurodegenerative and neurodevelopmental disorders. J Food Drug Anal. 2019; 27(3): 632-648
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