Slowly, the world of mental wellbeing is evolving to become more holistic.
While mental illness has historically been attributed to ‘demonic possession’, or an ‘imbalance in bodily fluids’, modern mental health services have expanded into a widely accepted ‘biopsychosocial’ approach; that is to say, that our mental health is affected by our psychology, our social environment, and biological factors, such as nutrition and exercise .
There is some dispute between mental health professionals between the biopsychosocial model, and models that are strictly biological and neuroscientific, however, both agree that in order to sustain a healthy state of mind and mood, the body must also function healthily.
As such, the relationship between diet, exercise, social support and mental wellbeing is integral to both theories of mental health.
Why Not Just Pop A Pill?
The way our brain functions is affected by certain hormones; for example, serotonin, dopamine and acetylcholine. All of these chemicals must be in balance to achieve optimal mental and physical health.
Serotonin is known as the ‘happy’ hormone, however, too much of it may cause serotonin syndrome (usually caused by an overdose of SSRI anti-depressant medication) – an excess of serotonin which can lead to seizures among the more serious side effects.
Similarly, dopamine, in its correct amounts, also causes you to feel happy, and contributes to feelings of romantic and familial love, but too much of it has been linked to the development of psychosis and schizophrenic spectrum disorders.
Selective Serotonin Reuptake Inhibitors (SSRIs) are often the first medical treatment to be tried for clinical depression and anxiety, but ideally, it is recommended that lifestyle changes are tried first, to avoid possible complications of medication, such as side effects or dependence.
Lifestyle changes may include a combination of diet and exercise, and social changes. It is also important to remember the difference between mental illness, appropriate reactions to stressful events, and reactions to poor lifestyle conditions.
James, 32, lives with his supportive girlfriend in a home environment, which is appropriate for his needs. He generally has a good diet, exercises regularly, rarely drinks and does not take any drugs. He reports being generally content with his work situation. Despite this, he suffers from excessive levels of anxiety, leading to panic attacks and reluctance to go out.
James is living in an appropriate social environment, and is eating well. His neurochemistry is not disturbed by drugs or alcohol. This anxiety may therefore be caused by a natural imbalance in neurochemistry, making him an appropriate patient to receive SSRIs.
Amari, 36, eats takeaway and microwave meals most nights after getting home from work without eating anything during the day. She reports high levels of stress from her job as a teacher, and admits to drinking ¾ of a bottle to a whole bottle of wine each night. She feels depressed and has overslept most mornings, causing her difficulties at work. She rarely exercises, stating that she ‘cannot find the time’.
Amari is an example of somebody who would benefit from lifestyle changes before resorting to medication. Alcohol is known to be a depressant and can also contribute to feelings of stress and anxiety; it can also disturb the sleep cycle, which may be contributing to her oversleeping. Her difficulties with alcohol may cause difficulties if combined with taking a regular SSRI, as it can lead to heightened side effects of the drug and may also cause the alcohol to be more potent. She may also be more sensitive as a result of only eating one meal a day, as her stomach may not be lined properly for the absorption of alcohol.
In addition, takeaway and microwave meals often do not contain appropriate levels of nutrients, as they are often improperly nutritionally balanced, so she will not be consuming as many endorphin-releasing foods. Her blood sugars may also be dipping midday as a result of not eating until dinnertime. This may result in anxiety, irritability, mood swings and depression.
Amari may be suffering stress from her job as a result of a combination of external influences (ongoing OFSTED inspections, pressure from other members of staff, ‘difficult’ students and/or parents), and/or poor emotional regulation skills.
When a person is anxious, the body releases epinephrine (adrenaline) to trigger the ‘flight-or-fight’ response (link to previous article on Anxiety). When you exercise or meditate, the body absorbs more oxygen to go to the muscles through deeper breathing. This triggers the parasympathetic nervous system to kick in, which regulates the amount of epinephrine in the body. By engaging in exercise and/or meditation, we can essentially trigger the parasympathetic nervous system to help to regulate anxiety.
Before treating Amari with an anti-depressant, the GP should consider suggesting changes to her lifestyle and diet; this may include treatment for alcohol addiction, changes to diet, examining her work environment and schedule, and the introduction of exercise and meditation into her daily routine.
Andres, 76, has been struggling with a high level of depression since the loss of his wife last year. He does not participate in drugs, and rarely drinks. He struggles to feed himself properly; partly due to his depression, partly due to decreasing mobility as he ages. He is not receiving any social support currently, and although his family is supportive and brings food over for him, he struggles to prepare it. His family work full time so struggle to spend extended periods with him. His memory is decreasing and he struggles with his concentration; it is unclear whether this is related to natural ageing or depression.
Andres is an example of someone who would benefit from social support above pharmaceutical treatment. Loneliness in the elderly is an enormous issue, with over 2 million people over 75 living alone, more than a million of whom can go over a month without speaking to a friend or family member. Help from a professional care assistant would help him to prepare food, which is more nutritionally balanced. A more balanced diet may help to improve his depressive symptoms overall and may even assist in improving memory and preventing Alzheimer’s disease. Another helpful addition to his package of care may be a bereavement counsellor and/or support group, which may help to further reduce feelings of loneliness and assist in adjusting to life without his partner. These changes are preferable to pharmaceutical medication, as many older people are on medications which may conflict with psychiatric drugs (for example, blood thinners such as warfarin. Older people may also be more sensitive to psychotropic medications, with older adults up to 3.5 times more likely than young adults to be admitted to hospital for an adverse reaction. As such, social, dietary and lifestyle changes are preferable to psychotropic medication in this group.
Diet and Mental Health
Vitamins and Minerals
The relationship between vitamins, minerals and mental health has been widely researched, but we are still in the process of learning how diet affects mental and cognitive functions.
There are, however, several ways in which we can easily improve our mental wellbeing through looking at our diet:
We all know that our 5-A-Day is important for our physical health, but not many people know that it also improves mental wellbeing. Foods containing high levels of B Vitamins especially B6 (found in spinach and bananas) help to raise serotonin levels and therefore improve mood. Fruits and vegetables such as tomatoes and bananas also contain high levels of potassium – a crucial factor in maintaining a healthy nervous system.
The NHS has recently released guidance suggesting that eating more fruits and vegetables is conducive to good mental health.
Studies on Omega-3 have shown it to have multiple benefits for mental health and cognition; for example, evidence suggests that there may be a link between low levels of Omega-3 and melatonin deficiency. Melatonin is the hormone that causes you to fall – and stay – asleep. Poor intake of Omega-3 may therefore contribute to insomnia, which may increase the likelihood of developing Alzheimer’s later in life. Omega-3 also reduces the amount of amyloid plaques that the brain produces. These are waste products, which accumulate in the brain as we age and are known to contribute to Alzheimer’s Disease.
Increasing the amount of Omega-3 in the diet is therefore an easy way to improve the likelihood of healthy cognitive functioning in later life and help to prevent dementia.
Other age groups may also benefit from increased Omega-3 levels; in young children, higher maternal levels of Omega 3s are linked to better cognitive function, language skills and IQ, in teens, better academic and overall cognition, and in adults, improved mood and behaviour.
Drops in blood sugar can cause multiple issues such as anxiety, irritability, depression and mood swings. A cross-sectional analysis in 2017 found that there was a positive association between sugar intake and the development of mental health problems insofar as men among the higher tertile of sugar intake had up to a 23% higher chance of developing a common mental health problem after 5 years.
There is a strong link between gastrointestinal disorders and mental health difficulties. Evidence suggests that cortisol levels, which increase under stress, help to speed up digestion to enable the individual to get ready for ‘fight or flight’. At the same time, the corticotropin-releasing factor (CRF) hormone leads to the suppression of appetite.
During the flight-or-flight response, the gut’s digestive processes slow down again in order to divert blood to the arms and legs. This leads to uncomfortable feelings in the abdomen where food may not have been fully digested.
Just as anxiety may contribute to GI problems, GI problems may be interpreted as anxiety. Difficulties digesting food can lead to nausea, loss of appetite and stomach cramping and discomfort – all symptoms that are common in anxiety disorders.
Many people may therefore attribute their GI symptoms to anxiety, when they may be suffering from disorders such as IBS.
Introducing more probiotic foods (such as yoghurt, kefir and sauerkraut) helps to increase the amount of ‘good bacteria’ in your gut, helping to break down food and therefore alleviating GI distress associated with high anxiety levels; there is even evidence to suggest that eating foods high in probiotics can help to improve cognitive functions and memory through the enteric nervous system, which connects the gut with the brain.
There is substantial evidence to suggest that hydration also has an impact on mental health, including both cognitive function and mood state.
Another study in 2018 on 3327 Iranian adults found that drinking five or more glasses of water daily was associated with a lower risk of depression, while drinking only two glasses led to a 73% increase in the likelihood of developing a depressive disorder for men, and 54% for women. In 2014, another study on 53 adults also found that increasing hydration levels to 2.4 litres per day increased alertness and cognitive function.
Most people are aware that illegal drugs can lead to mental health conditions such as drug induced psychosis, where an individual has a reaction to a drug causing them to misinterpret their surrounding environment. Some of these drugs include cocaine, ecstasy, ‘magic mushrooms’, LSD, methamphetamine and ketamine, as well as cannabis.
However, most people don’t realise that even perfectly legal drugs can affect their mental health significantly. For example, many people suffering from low mood fall into the trap of ‘self-medicating’ with alcohol in order to relieve their symptoms, as it may temporarily help to ease anxiety and depression. However, the alcohol works as a depressant, depleting the brain of serotonin in the long run and leading to a cycle of drinking. Alcohol may also lead to aggression, anxiety, disinhibition and psychosis… much like any other drug.
Even your morning brew may be having effects on your mood. While there is some limited evidence that caffeine may have a positive impact on symptoms of depression, this link is not fully understood and data may be unreliable as much of the report relied on self-reported evidence.
On the other hand, the link between caffeine and anxiety is well documented, and the NHS recommends cutting down on caffeine if you struggle with feelings of anxiety. It is known to disrupt the sleep cycle and speed up your heart rate, both factors in feelings of anxiety.
Recent studies suggest that caffeine can be a contributor to worsening psychotic symptoms, and even cause psychotic symptoms in otherwise healthy people who may be sensitive to its effects. Caffeine can also reduce the effects of antipsychotic medications such as clozapine, and symptoms of caffeine overdose may correlate with certain symptoms of psychosis.
Although psychotropic medications are efficacious in treating mental ill-health, they should be considered a secondary line of treatment due to potential side effects and their impact upon physical health. Recovery from mental health difficulties should be considered a longer-term change; as such, it is important to investigate further into contributing lifestyle factors that may be impacting upon the individual’s behaviour. This may include dietary factors, drug and alcohol abuse, and social factors.
In the next blog, we will discuss the impact of exercise on mental wellbeing, and the ways in which physical activity can assist with issues such as anxiety and depression.