The most potent medicine for mental health might be in your pantry
Food influences your brain directly and indirectly. When food is broken down by the microbiota into fermented and digested materials, its components directly influence neurotransmitters, such as serotonin, dopamine, and GABA (gamma-aminobutyric acid), which travel to the brain and change the way you think and feel. When food is broken down, its constituent parts can also pass through the gut wall into the bloodstream, and certain metabolites can act on the brain that way as well.
Food’s most profound effect on the brain is through its impact on your gut bacteria. Some foods promote the growth of helpful bacteria, while others inhibit this growth. Because of that effect, food is some of the most potent mental health medicine available, with dietary interventions sometimes achieving similar results to specifically engineered pharmaceuticals, at a fraction of the price and with few, if any, side effects.
On the other hand, food can also make you sad—certain food groups and eating patterns can have a negative effect on your gut microbiome and your mental health. Eating healthy, whole foods ensures that your brain is working at peak efficiency.
The idea of using food as medicine for mental health is central to nutritional psychiatry, and in my opinion, it’s crucial to find meaningful, lasting solutions to mental health problems through simple and sustainable lifestyle changes.
We’ve come a long way since the seriously mentally ill were confined to asylums or hospitals without much understanding of their suffering. But mental health is still in a crisis. (More than 40 million Americans are dealing with a mental health concern—more than the populations of New York and Florida combined.) Mental disorders are among the most common and costly causes of disability. Depression and anxiety are on the rise. Suicide is a staple on lists of top causes of death, no matter what age group. We’re in a mental health mess, no matter how many people are in denial about it. It has been challenging to find treatments that help people manage their moods, cognition, and stress levels.
Historically, we turned to evidence-based medications and talk therapies that worked for specific conditions. For example, for someone who was depressed, we might have tried a selective serotonin reuptake inhibitor like Prozac. For someone who was panicky, we might have used cognitive behavioral therapy. Those kinds of treatments are still in wide use and can be effective. But for some people, the positive effects last only a short period of time, and they do not completely eliminate symptoms. Sometimes patients develop side effects from the medications and stop taking them. Other times they are afraid of becoming “dependent” on medication and ask to be taken off it. Some patients who come to see me do not meet the criteria for a disorder such as depression or anxiety. They struggle with symptoms but not enough to warrant a medication intervention.
My own view of where we went wrong is this: Psychiatric diagnoses have no statistical validity, and the conditions have no biomarkers of specific diseases. “Diagnoses” are simply lists of symptoms. We assume that when a person presents with psychological symptoms, the problem rests solely on the brain. It is clear that other organs, such as the gut, play a role in how we think and feel. We need to examine the whole person and their lifestyle in order to better treat them.
The problem is bigger than psychiatry, extending to medicine as a whole. Despite the huge number of health issues that relate to diet, it may sound far-fetched, but many patients don’t hear food advice from their doctors, let alone their psychiatrists. Medical schools and residency programs do not teach students how to talk to patients about dietary choices. Nutrition education for doctors is limited.
Thankfully, we are inching toward a moment in health care when the medicine is no longer strictly about prescriptions and a single line of therapy. Thanks to the wealth of medical knowledge accessible to the general public, patients are more empowered and informed than ever. It feels as though all my colleagues are experiencing a similar movement in their specialties, with patients eager to explore a diverse range of ways to feel better. One of my success stories of nutritional treatment was a referral from an infectious disease colleague. Another time, an orthopedic colleague reached out to me to ask more about the data on turmeric as an anti-inflammatory, as his patient with severe knee pain wanted to delay surgery until he’d tried this nutritional intervention.
In psychiatry, we are finally beginning to talk about the power of food as medicine for mental health. The body of research on the microbiome and how food impacts mental health is growing. In 2015, Jerome Sarris and his colleagues established that “nutritional medicine” was becoming mainstream in psychiatry. The goal of nutritional psychiatry is to arm mental health professionals with the information they need so that they can offer patients powerful and practical advice about what to eat. That doesn’t overshadow the importance of working with your doctor, since medication and the appropriate therapy remain a part of the journey to improved mental health. A better diet can help, but it’s only one aspect of treatment. You cannot eat your way out of feeling depressed or anxious (and in fact, trying to do so can make things worse). Food is not going to relieve serious forms of depression or thoughts of suicide or homicide, and it is important to seek treatment in an emergency room or contact your doctor if you are experiencing thoughts about harming yourself or someone else.
It is extremely important to look after your mental health with strategies of mindfulness, meditation, exercise, and proper sleep. The literature on these topics is vast, with methods both ancient and modern (and sometimes a combination of the two!) and I encourage you to explore them on your own. That being said, in addition to taking guidance from your doctor and encouraging mental wellness in other ways, you should support your treatment by paying attention to how and what you eat. The relationship linking food, mood, and anxiety is garnering more and more attention