What is nutritional psychiatry? How nutrition supports well-being

We all know that what you eat can affect your gut and improve the appearance of your skin, but did you know that what you eat can also really improve your mental health, too? "Nutritional psychiatry means using food, supplements, vitamins, exercise, meditation, etc. in conjunction with standard psychiatric medications to optimise the potential of all treatments," explained Dr. Sheldon Zablow MD, a nutritional psychiatrist and author based in San Diego.

How does nutritional psychiatry work? 

This area of psychiatry treats mental health conditions such as anxiety, PTSD, eating disorders, insomnia, depression, panic attacks, OCD and addictions. This is not in any way a complete list but many of these conditions are usually treated by seeing a psychiatrist. They can diagnose, prescribe medications and suggest various forms of therapy. Nutritional psychiatry, more specifically, looks at how single foods, nutrients and dietary patterns might prevent and treat psychological disorders.

Diet is as important to psychiatry as it is to cardiology, endocrinology and gastroenterology.

Sarris et.al, 2015

Even though medications for these conditions can be very helpful, there can be quite a lot of side effects, such as gastrointestinal problems, weight gain, nausea, loss of libido, reduced bone density and headaches. These can carry on for years after stopping the medication. A 2016 article in Scientific American publicised the results of a Nordic Cochrane study which suggested that antidepressant treatment could cause increases in suicidality and aggression.

Research published in The Lancet also showed that most anti-depressants on the market are ineffective for children and teens with major depressive disorders and some may even be unsafe for young children. Supporting your teen with other measures should probably be the first port of call before looking at medication, as it was found that only one out of 14 antidepressants was more effective at relieving symptoms of depression in young people than a placebo pill. 

It’s not surprising that people who suffer from various mental health conditions are looking for new types of support, so what are the other options available? 

Eating the rainbow for brain health 

This is where nutritional psychiatry comes in! Looking at food to support mental health, optimising your sleep, consuming specific nutrients that support various stages in life, pregnancy health and nutrition are all ways that could help and support mental health conditions. The use of food supplements and diet has the potential to make a huge difference to the mental health of all ages. 

The link between poor mental health and nutritional deficiencies has long been recognised by nutritionists working in the complementary health sector. Medical education has traditionally excluded nutritional knowledge and its association with disease. This has led to a situation where not many doctors in the UK have a proper understanding of the importance of nutrition. It is now known that many mental health conditions are caused by inflammation in the brain which ultimately causes our brain cells to die. This inflammatory response starts in our gut and is associated with a lack of nutrients such as magnesium, omega-3 fatty acids, probiotics, vitamins and minerals that are all essential for the optimum functioning of our bodies.

Recent research has shown that food supplements such as zinc, magnesium, omega 3, and vitamins B6 and D3 can help improve people’s mood, relieve anxiety and depression and improve the mental capacity of people with Alzheimer’s. One study showed that high intake of zinc correlated with significantly lower rates of depression with a reduction of about 30-50%. Poor levels of B6 and zinc can also reduce our ability to produce GABA (a hormone that calms us) and acetylcholine (a multi-functional hormone particularly related to cognition, memory and brain function). When we are stressed B6, and zinc will be further depleted. 

Various nutrients, such as tryptophan, vitamin B6, vitamin B12, folic acid (folate), phenylalanine, tyrosine, histidine, choline, and glutamic acid, are also essential for the synthesis of neurotransmitters like serotonin, dopamine, and norepinephrine. These neurotransmitters are involved in regulating mood, appetite, and cognition, thus highlighting the importance of adequate nutrient intake for optimal mental health. Growing evidence links a diet that includes high antioxidant components, such as the Mediterranean diet which mainly focuses on unprocessed whole foods, has big benefits to cognitive function.  

Personalised nutrition and functional testing

The next step should be to create psychiatric interventional studies based more on a personalised medicine approach. This uses biomarkers (i.e. nutrient deficiencies, inflammation, genomic assessment, microbiome analysis and a person’s dietary patterns), the needs of an individual macro (i.e. protein, fat, carbohydrates) and micronutrients (i.e. vitamins and minerals).

Dr. William Walsh, the author of Nutrient Power (published in 2012) is a scientist who paved the way for nutrition-based psychiatry and nutritional medicine. His interest in this area began in the 70s when he organised a prison volunteer programme that led to studies researching the causes of violent behaviour.

Over the next 30 years, Dr. Walsh developed biochemical treatments for patients with behavioural disorders, ADHD, autism, depression, anxiety disorders, schizophrenia, and Alzheimer’s disease that are used by doctors throughout the world. His approach recognises that nutrient imbalances can alter brain levels of key neurotransmitters, disrupt gene expression of proteins and enzymes, and cripple the body’s protection against environmental toxins. For example, dysregulated copper can be a leading factor in postpartum depression. In pregnancy, copper rises to compensate for the fetus and after the birth, the mother’s copper should go down. When it doesn’t, this can result in PPD.

Finding the root cause 

Dr. Walsh focuses on methylation – a chemical modification of DNA. DNA methylation is linked to silencing or 'turning off' genes. Overall, increasing methylation reduces the expression of genes, including those that make reuptake proteins. When properly implemented, increasing methylation can serve as a very beneficial therapy for those suffering from undermethylated depression. This method essentially does the same thing that conventional medications do, but they start from the root cause. Antidepressants target and block SERT proteins, but don’t address the underlying methylation issues. 

Dr Walsh also did a lot of study around pyrroles. He found that kryptopyrroles may also bind to biotin, manganese, chromium, magnesium, omega 6s (arachidonic acid) and other important nutrients, excreting them from the body via the kidneys and causing further nutrient deficiencies.

There is plenty of emerging scientific evidence that suggests there should be a much bigger role for nutritional psychiatry in mental health within conventional health services. Trying to figure all this out by yourself can be overwhelming, so support for nutritional intervention from the GP and mental health services is essential if the burden of mental ill health is to be reduced. More information needs to be out there to highlight the connection between food, inflammation and mental illness.

Nutritional psychiatry is not intended to replace prescription medication, but rather to support a treatment plan and help patients heal using every route possible. Working alongside a nutritional therapist can be a start as they can advise about the correct functional testing, supplements and diet.