A patient comes in for a physical and clearly they\u2019re 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\u2019s time to get proactive and refer your patient to a psychologist \u2013 someone who specializes in depression. That in turn, you hope, will make space for healthier lifestyle choices.<\/p>\n\n\n\n
But wait! Did depression cause the poor eating habits or\ndid an unhealthy diet cause the depression? Which came first, the chicken or\nthe egg? <\/p>\n\n\n\n
Food for Thought<\/strong><\/p>\n\n\n\n It\u2019s a fair question \u2013 since the link between behavior, mood, and food is a relatively new discipline. It\u2019s 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<\/sup> 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. <\/p>\n\n\n\n In response to the blossoming topic, a\nnew career was born: the nutritional psychiatrist, sometimes called a nutritional\npsychologist or food psychiatrist. (The specialty is so new, a definitive name and\ntextbook definition haven\u2019t yet been nailed down.) But we do have a theoretical\ndefinition: nutritional psychiatrists focus on how food \u2013 and in some cases\nsupplements \u2013 provide essential nutrients as part of an integrated or\nalternative treatment for mental health disorders. <\/p>\n\n\n\n A Deeper Dive<\/strong><\/p>\n\n\n\n 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<\/sup> Through therapy, nutritional psychiatrists\u2019 goal is to use food to help prevent or reverse these mental and emotional conditions \u2013 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<\/sup><\/p>\n\n\n\n \u201cNutrition affects how we feel, think, and interact.\nTake away a healthy diet and so many physical, emotional, and mental parts of\nus can fall apart,\u201d says Merrill\nElias, PhD, MPH, a psychologist and professor of epidemiology. \u201cIn the past, to get the\npatient healthier, you needed a nutritionist and<\/em> a therapist. But any time you can combine two experts \u2013 as with\na nutritional psychiatrist \u2013 the patient benefits. The result\nis more likely to be a coordinated, patient-centered care plan. And I think\npatients are more comfortable with one plan \u2013 instead of juggling two plans\nfrom two experts.\u201d<\/p>\n\n\n\n This combo-approach is a simple concept with potentially\nprofound results, says Ephi Lu, Dip.C.N, M.S., and co-founder of The Center for Nutritional\nPsychology. \u201cA registered dietitian or\nnutritionist is trained to make individualized food recommendations. But they don\u2019t\nsee food as it applies to mental health. So I would say that\nnutritional psychology focuses on a subset of nutrition, dealing specifically\nwith how food impacts behavior, mood, and brain function.\u201d <\/p>\n\n\n\n The Learning Curve<\/strong><\/p>\n\n\n\n Despite still being in its infancy, several recent\nstudies support the concept of nutritional psychiatry. <\/p>\n\n\n\n All Good Things Take Time<\/strong><\/p>\n\n\n\n As the medical community continues to show interest in\nnutritional psychiatry, there\u2019s one commonly cited criticism: the science is so\nyoung that regulation hasn\u2019t caught up with enthusiasm, which makes it easy for\njust about anyone to hang a nutritional psychologist shingle. <\/p>\n\n\n\n For that reason, Dr. Elias emphasizes that physicians need to be careful about referrals.\n\u201cYou want someone qualified in psychiatry or psychology and who\u2019s also completed\nextensive research in nutrition or has a masters specific to nutrition.\u201d<\/p>\n\n\n\n It\u2019s also important to note that this is not yet a\nwell-defined and conclusively proven discipline. So. many studies focused on\nnutritional psychiatry close with a familiar form of, \u201cFuture research is\nrequired to determine\u2026\u201d <\/p>\n\n\n\n In addition, Lu stresses, nutritional\npsychiatry does not apply to patients with eating disorders. \u201cPeople\nwith a history of eating disorders should seek other recommended means of\ntreatment, such as working with a therapist trained in disordered eating.\u201d<\/p>\n\n\n\n With the concept of nutritional\npsychiatrist\u2026or nutritional psychologist\u2026or food psychiatrist\u2026officially out in\nthe world, it\u2019s time for the world to do something with the concept, Lu says.\n\u201cThe hope is that universities will create nutritional psychology masters\nprograms, build nutritional psychology courses into their medical school\ncurriculum, and offer a 4-year nutritional psychology degree. This is the\nbeginning of a new discipline that can spawn a new way of thinking and a new\ngroup of licensed professionals who can put this concept into action going\nforward.\u201d<\/p>\n\n\n\n Resources<\/p>\n\n\n\n 1) Jacka FN. Nutritional Psychiatry: Where to Next?.\u00a0<\/a>EBioMedicine<\/a><\/em>. 2017;17:24\u201329. doi:10.1016\/j.ebiom.2017.02.020; <\/a><\/p>\n\n\n\n 2) (n.d.). OUR MISSION.<\/a> <\/p>\n\n\n\n 3) Goodwin GM. Depression and associated physical diseases and symptoms.\u00a0<\/a>Dialogues Clin Neurosci<\/a><\/em>. 2006;8(2):259\u2013265. <\/a><\/p>\n\n\n\n 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. <\/a>Psychosom Med<\/a><\/em>. 2019;81(3):265\u2013280. doi:10.1097\/PSY.0000000000000673 <\/a><\/p>\n\n\n\n 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.\u00a0<\/a>Brain Behav Immun<\/a><\/em>. 2011;25(8):1725\u20131734. doi:10.1016\/j.bbi.2011.07.229<\/a><\/p>\n\n\n\n