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:

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.

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.

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:

Well, I can go on and on. All of this leads to my very recent article asking, “Is nutrition a core intervention in psychiatry?”

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.

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  1. Margaret Cole April 10, 2015 at 9:52 pm - Reply

    I work in the inpatient hospital program as a clinical therapist. I have been touting the life style intervention in treating and preventing depression for 3 years but receive little peer support. So glad that the wind is blowing my way and that the research is coming in this direction. Your article is so informing. I forwarded it to many people I care about. Thank you for this gift.

    • Dr.J April 11, 2015 at 7:18 am - Reply

      You are doing the right thing! If we share this info, it will become more “current practice” rather than early adoption as it is now.

  2. Kim April 15, 2015 at 5:44 am - Reply

    Nutrition and lifestyle choices are absolutely the future of medicine. If you are looking for allies in the “medical” community, seek out a naturopathic physician trained at an accredited school (there are only 8 in the US and Canada – see We are trained as primary care docs, but our focus for intervention is based in restoring health, not suppressing symptoms. And it all starts with the things Dr. Johnson mentions here!

  3. Arlene Nelson May 1, 2015 at 9:48 am - Reply

    I have found many authors you would be interested in reading to help with research. They are amazing health researchers. Matt Stone, 12 Paleo Myths and 180 Degree Health. Joey Lott, Chris Sandal, and Evelyn Tribole. However, they all go about promoting health by going through the back door to get there. Start with Matt’s book. He knows and understands hormonal, neurological system like no one I’ve ever read. His stuff on sleep, metabolism and inflammation is genius. He focuses on getting omega 6 out of the diet and not adding omega 3. We have remained constant in our consumption of omega 3 over the last century, but omega 6 has gone up 1450%. I read about 2 hours a day on health. And I can attest that the advice doled out by our current health care system makes everyone fatter and sicker, mentally and physically. You can get Matt Stone on Audible, which I highly recommend. He is also funny as heck with excellent comedic humor and timing.

  4. Tamara May 15, 2015 at 5:48 am - Reply

    Glad to see this blog post from you as I saw your recent clip mentioning Mediterranean diet and hoped you would add the importance of fermented food and organ meats into your philosophy. As far as the Med diet goes, research shows that a lot of people take it as carte blanche to smother foods in olive oil. Important to understand that the olive oil is not to be overdone! Working as I do around a psychiatric in-patient environment the food served to the patients profoundly saddens and frustrates me. Patients fed nutrient poor food, with no Omega 3 and no sign of fermented foods, plus kept inside so no chance to manufacture vitamin D – they really don’t have much a chance to get properly better under those conditions.

    • Dr.J May 15, 2015 at 7:09 am - Reply

      I quite agree. I posted a YouTube video recently on making one’s own yogurt, since the commercial yogurts are high in sugars and bad for the microbiome. I also posted a blog article last year “Sauerkraut time” where I talked about making fermented vegetables at home.

      People will eat yogurt but likely do more harm than good with the sugar. Few people eat fermented vegetables, yet they occur in most cultures. There is instinctive wisdom in fermenting vegetables, and I’d hope more of us would do it.

      And if you are not a vegetarian, consider the organ meats.

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