A patient comes in for a physical and clearly they’re struggling with excessive weight gain as well as the high blood pressure and bad cholesterol levels that typically ensue. On top of this, warning bells go off in your head: this patient appears to be exhibiting signs of depression. Your first instinct may be to assume that depression is at the root of all this, since the exam and lab tests show no medical reason for excessive weight gain or unhealthy numbers. It’s time to get proactive and refer your patient to a psychologist – someone who specializes in depression. That in turn, you hope, will make space for healthier lifestyle choices.
But wait! Did depression cause the poor eating habits or did an unhealthy diet cause the depression? Which came first, the chicken or the egg?
Food for Thought
It’s a fair question – since the link between behavior, mood, and food is a relatively new discipline. It’s so new, that the first study to examine and confirm a link between overall diet quality and common mental disorders, depression, and anxiety only goes back 10 years. 1 During the past decade, however, a growing body of research has continued to establish that a poor diet can play a role in physical as well as psychological disease.
In response to the blossoming topic, a new career was born: the nutritional psychiatrist, sometimes called a nutritional psychologist or food psychiatrist. (The specialty is so new, a definitive name and textbook definition haven’t yet been nailed down.) But we do have a theoretical definition: nutritional psychiatrists focus on how food – and in some cases supplements – provide essential nutrients as part of an integrated or alternative treatment for mental health disorders.
A Deeper Dive
The Center for Nutritional Psychology says that this fledgling practice relies on a scientifically-based understanding that nutrient intake impacts mood, stress tolerance, inflammation, energy, sleep, cognition, medication needs, and behavioral dysfunction. 2 Through therapy, nutritional psychiatrists’ goal is to use food to help prevent or reverse these mental and emotional conditions – with the hope to possibly also lower risk for the physical diseases they can trigger, such as diabetes, obesity, heart disease, stroke, and fibromyalgia. 3
“Nutrition affects how we feel, think, and interact. Take away a healthy diet and so many physical, emotional, and mental parts of us can fall apart,” says Merrill Elias, PhD, MPH, a psychologist and professor of epidemiology. “In the past, to get the patient healthier, you needed a nutritionist and a therapist. But any time you can combine two experts – as with a nutritional psychiatrist – the patient benefits. The result is more likely to be a coordinated, patient-centered care plan. And I think patients are more comfortable with one plan – instead of juggling two plans from two experts.”
This combo-approach is a simple concept with potentially profound results, says Ephi Lu, Dip.C.N, M.S., and co-founder of The Center for Nutritional Psychology. “A registered dietitian or nutritionist is trained to make individualized food recommendations. But they don’t see food as it applies to mental health. So I would say that nutritional psychology focuses on a subset of nutrition, dealing specifically with how food impacts behavior, mood, and brain function.”
The Learning Curve
Despite still being in its infancy, several recent studies support the concept of nutritional psychiatry.
- A 2019 meta-analysis 4 concludes that dietary interventions hold promise as a novel intervention for reducing symptoms of depression. Specifically, it’s shown that people who replace high-sugar foods with more nutrient-dense, fiber-rich foods, like vegetables, see a small improvement in depression symptoms.
- An observational study 5 suggests that a diet higher in omega-3 polyunsaturated fatty acids can reduce inflammation and anxiety even among healthy young adults.
- In a small study 6 including 67 severely depressed participants, those who worked only with a dietician achieved an 8 percent remission. Those who worked with a dietician and an educational dietary intervention group, which included learning about how food affects mood and behavior, achieved a near 34 percent remission rate.
All Good Things Take Time
As the medical community continues to show interest in nutritional psychiatry, there’s one commonly cited criticism: the science is so young that regulation hasn’t caught up with enthusiasm, which makes it easy for just about anyone to hang a nutritional psychologist shingle.
For that reason, Dr. Elias emphasizes that physicians need to be careful about referrals. “You want someone qualified in psychiatry or psychology and who’s also completed extensive research in nutrition or has a masters specific to nutrition.”
It’s also important to note that this is not yet a well-defined and conclusively proven discipline. So. many studies focused on nutritional psychiatry close with a familiar form of, “Future research is required to determine…”
In addition, Lu stresses, nutritional psychiatry does not apply to patients with eating disorders. “People with a history of eating disorders should seek other recommended means of treatment, such as working with a therapist trained in disordered eating.”
With the concept of nutritional psychiatrist…or nutritional psychologist…or food psychiatrist…officially out in the world, it’s time for the world to do something with the concept, Lu says. “The hope is that universities will create nutritional psychology masters programs, build nutritional psychology courses into their medical school curriculum, and offer a 4-year nutritional psychology degree. This is the beginning of a new discipline that can spawn a new way of thinking and a new group of licensed professionals who can put this concept into action going forward.”
Resources
1) Jacka FN. Nutritional Psychiatry: Where to Next?. EBioMedicine. 2017;17:24–29. doi:10.1016/j.ebiom.2017.02.020;
3) Goodwin GM. Depression and associated physical diseases and symptoms. Dialogues Clin Neurosci. 2006;8(2):259–265.
4) Firth J, Marx W, Dash S, et al. The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosom Med. 2019;81(3):265–280. doi:10.1097/PSY.0000000000000673
5) Kiecolt-Glaser JK, Belury MA, Andridge R, Malarkey WB, Glaser R. Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain Behav Immun. 2011;25(8):1725–1734. doi:10.1016/j.bbi.2011.07.229
