GUT HEALTH and MENTAL HEALTH

When I started exploring lifestyle interventions a few years ago, I thought that interventions like coaching clients toward healthy eating and more physical exercise (among at least ten or twelve others!) were useful and interesting additions to my clinical skills.

I even put together an online class to share with other therapists what I’d been using.

I figured that some therapists would find it useful, but I didn’t think all therapists would have to master these new tools.

I was wrong.

There is a new study out: “The Emerging Field of Nutritional Mental Health: Inflammation, the Microbiome, Oxidative Stress, and Mitochondrial Function.” All thanks to Ken Pope for calling this to our attention. (I subscribe to several services that give me heads up about new studies. And practically every week, I see another study on nutrition and brain health, emotional health, and even recovery from mental disorders.)

Changing eating habits is turning out to be a vital, perhaps even an irreplaceable skill for both general physicians and for mental health specialists.

That brings us (finally!) to the core questions of this post. Will healthier eating make us happy? Will it make us healthy?

Ten years ago, I would have said, “Nonsense. It makes little or no difference what you eat.”

I am constantly amazed at how stupid I was a year ago, let alone, ten years ago. Food makes no difference? It has turned out that was a foolish belief. Maybe delusional! Perhaps I needed medication ten years ago.

Fortunately I learned in grad school, “Don’t fight with the data.” If the data keep telling me I am wrong, that is an exciting development. It means I am about to learn something new!

OK, let’s get into some of the recent data.

First, this new article points out that the so called “serotonin hypothesis” or the notion that depression is caused by a chemical imbalance is “impossibly superficial and vague by 21st-century standards.”

The authors are being too polite, say I. The chemical imbalance theory is inadequate. There is actually little-almost no- solid evidence supporting it.

Instead, the study points out that it appears that many (perhaps not all) individuals with depression are suffering from elevated inflammation. There are good data that suggest the inflammation rise comes before the onset of the depression. It seems to be a cause-and-effect relationship.

Gut health, the presence of helpful organisms in the digestive tract, is vital for keeping inflammation under control, but today’s diet damages these friendly critters. So to really impact inflammation, you have to start with food. You have heard of “probiotics.” Probiotics are friendly and helpful organisms that can live in our gut and help our body function better. You can replenish them with homemade yogurt, homemade sauerkraut, and other fermented foods. When they are present, our inflammatory response is quieted, quenched, you might say.

At the same time, the food we eat is “prebiotic,” that is, will either support or damage our helpful probiotics. Bad prebiotic foods are sugars and simple carbohydrates. Nearly all prepared convenience foods are bad prebiotics. They are bad because they feed bad organisms in our gut. On the other hand, the “healthy” foods, that is, the Mediterranean diet, seems to support and energize our healthy gut bacteria, the microbiome.

(A fairly good overview: http://www.independent.co.uk/life-style/health-and-families/features/gut-bacteria-prebiotics-and-the-link-between-helping-stress-anxiety-and-depression-9964530.html)

In another recent article, changing how you eat will reduce your risk of developing Alzheimer’s. Fairly small changes reduce risk by about half. That means, instead of 100 people developing Alzheimer’s only 44 will, but 56 of them dodge that horrible bullet. This is the MIND diet, a modified Mediterranean diet with an emphasis on more green vegetables than the DASH or Mediterranean diets.

http://www.hcplive.com/news/Alzheimers-New-Diet-Associated-with-Lower-Incidence

In yet another study, a diet rich in Omega 3 PUFAs (Polyunsaturated fatty acids, especially the long-chain omega 3s) clearly reduce your risk of developing depression. Ironically, depression earlier in life turns out to be a risk factor for Alzheimer’s.

http://www.sciencedaily.com/releases/2010/06/100621111238.htm

In a fairly recent study from New Zealand, eating at least 6 to 7 helping of vegetables and dark or colorful fruits (strawberries and blueberries, for example) boosts mood at least as well and perhaps better than taking an antidepressant. (Here is the actual article: http://www.otago.ac.nz/psychology/otago057493.pdf)

Well, I can go on and on. All of this leads to my very recent article asking, “Is nutrition a core intervention in psychiatry?” https://drlynnjohnson.com/nutrition-and-mental-health/

Many non-medical therapists argue against this focus. “We are not trained in nutrition,” they point out.

They are precisely correct. It is the very rare graduate program in mental health that includes a section on nutrition. I have yet to find one where nutrition’s impact on mental health is emphasized.

Recently I went to an all-day workshop by a psychiatrist on the role of food in mental wellness and recovery from mental disorders. He confessed that in med school, there was one day of nutrition and health.

He missed school that day.

Nutrition? There was nothing about it in his residency. How does he now dare to coach nutrition with his patients?

He pointed out that his skills came entirely from post-graduate education. That is right. Post-grad keeps us up to date on new research and techniques. So don’t be too impressed with the M.D. degree. They have to find their way out of the wilderness of ignorance just as we do. If you put the time and effort into lifestyle interventions, you are much more helpful to clients and patients. Plus, M.D.s have a handicap: Much of their continuing education is sponsored by Big Pharma where nutrition is discounted and devalued. There’s no money in food retail! Especially fresh and natural foods.

Learn, incorporate, and offer nutrition coaching as a valid, evidence-based intervention for greater health and happiness.

It is my conviction that non-medical therapists are ideal coaches for lifestyle interventions. That is because therapists are trained in one area that nutritionists and nurses and even medical doctors are not. We are experts at influence.

We learn and cultivate skills for influencing people. So much of the benefits people get from therapy depend on doing behavior experiments.

Also, we therapists and counselors have more time to work with clients. We usually work on a 45 minute session, plus or minus. Most MDs are trying to work on a 15 minute per patient or less basis. Some aim for ten minutes or less. That gives us more leverage. We have time to figure out motivational strategies for each unique patient. Frankly, we can do quite well with a 25 minute session per patient and have a huge positive impact.

It is true that we shrinks are generally woefully unprepared to coach lifestyle changes. But that is a temporary condition. With some study and hard work, we all can get very, very good at promoting those lifestyle habits of the happy and healthy.