Why isn’t nutrition making it into mainstream mental health care?
By Jeanette Longfield
To coin a cliché, it’s a no-brainer. Of course what we eat and drink affects the brain; after all, it is one of the body’s largest organs. But unlike with organs like the heart or liver, the links between diet and the brain—and hence how we think and act—are still not widely recognized by governments and health professionals.
To raise awareness, Sustain, an organization in the United Kingdom that advocates food and agriculture policies and practices that enhance health and welfare, partnered with the Mental Health Foundation (MHF). The Food and Mental Health Project examined peer-reviewed research in an effort to show, convincingly, that our diets affect how the brain is made and how it works. Our goal was to persuade policy makers to integrate knowledge about diet and mental health into mainstream advice about diet and physical health.
In 2006, we published our findings for our respective audiences (Sustain for a food-policy audience, the MHF for people working in mental health). They generated widespread, positive media coverage. The reports confirmed that there is no magic bullet nutrient for mental health and well-being. There are important nutrients for brain development and function, but they only work if a wide range of other nutrients are also available in the right amounts and in proportion to one another. These nutrients include polyunsaturated fats, particularly the omega-3s; minerals, such as zinc, magnesium and iron; and vitamins, such as folate, a range of B vitamins and the antioxidant vitamins C and E.
These are elements of the balanced diet that has long been recommended to reduce risk of developing chronic diseases such as coronary heart disease, stroke, some cancers and diabetes. It makes evolutionary sense that this diet would be good for both physical and mental health. A healthy diet can also help to relieve symptoms of some mental illnesses; improve the effectiveness of medication; and reduce unpleasant medication side-effects.
However, our review made it clear that evidence so far does not show that mental illnesses can be prevented or cured by diet alone. What the evidence does reveal is that people who miss one or more elements of a healthy diet or who eat too much saturated fat or other harmful elements seem to be at higher risk of developing attention-deficit/hyperactivity disorder, Alzheimer’s disease, schizophrenia, depression and antisocial behaviour.
Unfortunately, this is the type of diet followed by most people in rich countries (and growing proportions in poor countries). It features few vegetables and fruit; few whole grain products and from a very narrow range of cereals; little oily fish; large quantities of saturated fat from intensively produced meat, meat products and dairy products; and unknown (and possibly unknowable) combinations of food and agricultural chemicals, either as intentional additives or accidental residues.
This unhealthy diet is one of the main reasons why rates of chronic diseases remain high and rates of mental illness seem to be rising. Despite the evidence we marshalled, the positive media it attracted and the growing volume of evidence that has accumulated since, we generally failed to catch the attention of policy makers. There were some mildly favourable government comments at the time, but more recent Google searches on relevant UK government websites produced only one result, which undermined a 2009 media story linking junk food to bad behaviour among adolescents. It is a similar story with many health professionals, whose websites either ignore or underplay the role of diet in mental health.
But a more positive response has come from many self-help groups and mental health charities in the United Kingdom, who have produced excellent plain language guides and run projects for people with mental health issues keen to improve their diets. So why the difference?
Partly, it is our fault. We made the common mistake of believing policy makers when they say they base their decisions on scientific evidence. A cursory look at any government policy will show, at best, only a tenuous link with evidence. Much more influential are money, the lobbying power that comes with it and the desire of most politicians to keep their jobs.
So, despite some 40 years of research that links poor physical health to our junk food diets, policy makers remain in thrall to the junk food industry, unwilling, for example, to protect our children from junk food marketing or tackle the subsidies that make sugar and fat so cheap. They are even less willing to acknowledge the smaller body of evidence on food and mental health.
Worse, the nutrition and mental health field has been tainted by accusations of quackery. The same Google searches that revealed official indifference also found an astonishing range of commercial websites, usually for supplements, promising everything from the vaguely miraculous to the downright ridiculous. One site has so enraged independent commentators that a dedicated watch site to debunk its claims has been established.
Clearly, no politician wants to be associated with this kind of controversy; hence the policy vacuum. So what next? While more evidence will always be helpful, citizens will need to use their experiences and their voices—loudly—to exert countervailing pressure on policy makers so that linking food and mental health becomes a no-brainer for them, too
Jeanette Longfield is co-ordinator of Sustain: the alliance for better food and farming in the UK. Read Sustain’s report, Food and Mental Health. Read Feeding Minds, the companion report from the Mental Health Foundation.
Eat ’em and reap: The mental health benefits of good nutrition
- Good nutritional intake may be linked to academic success. Studies report that providing children with breakfast improves daily and long-term academic performance.
- Among some young offenders, diets supplemented with vitamins, minerals and essential fatty acids have resulted in significant reductions in anti-social behaviour.
- A correlation exists between a country’s fish intake levels and rates of major depression, postpartum depression, seasonal affective disorder and bipolar disorder among its citizens.
- Growing epidemiological evidence suggests that diet may be an environmental factor linking Alzheimer’s disease with the amount of saturated fats, vitamins and minerals consumed.
Adapted from Feeding Minds.
In our consumer nutrition survey, our 167 respondents told us how food affects their mental health—and vice versa—and about the challenges they face to eating healthy. Here’s what consumers, and some mental health professionals who work with them, said:
How does food affect your mood?
“When I eat poorly, I have low energy, confusion, indecisiveness, lower mood, and I feel bad about myself for not eating better.”
“Many clients don’t connect to how they feel after eating certain foods. When you ask how eating that food makes them feel, they can’t answer. Due to trauma and other issues they don’t connect mind and body.”
“Knowing you are eating healthy can relieve a lot of mental stress, especially if you’re worried about providing for dependants.”
“Food is linked with how people interact with one another and the world. Food sharing alleviates feelings of isolation and despair. Emotional food relationships can be destructive, but they can also be constructive, for example, the relaxation of preparing a meal and the satisfaction of eating and sharing it.”
Do you think you eat healthy?
In terms of eating habits, 55% of respondents said they had a bad diet, and 25% said they ate healthy “sometimes.” Among the 55% who ate poorly, microwaveable meals, fast food, pop and double-double coffee topped the list. Some respondents reported eating relatively well but eating large portions and a lot of carbohydrates. Here’s what some respondents told us about the challenges to eating healthy:
“I eat many hamburgers and fries because they cost less than a salad.”
“I go through phases of eating well and exercising. Typically, when change occurs in my life, causing a disruption in structure or a trigger into anxiety and depression, I stop the healthy routine; I eat more sugar and bad food and go into isolation. My energy gets depleted and it’s hard to get out of the spiral.”
“I take a multivitamin. Fruit is expensive and vegetables spoil easily, so if you don’t eat or process them immediately, for example when I’m depressed, they go to waste.”
“I’m on welfare: after rent/hydro, I have $150 left for food and other necessities. I go to a food bank, but the food is generally no good and some of it means I need oil, butter, milk, eggs, and so forth.”
“What do I eat? Yesterday: beer. Today: watery soup from a community kitchen. Tomorrow: probably beer because I’m meeting someone. I can’t remember the last time I had an apple or orange or milk for my tea.”