Positive Health Online

Improving nutrition can transform a person’s mental state when suffering from conditions such as depression. Studies are increasingly showing that a poor diet can be detrimental to mental health and proving that lower rates of mental illness can be linked to healthy diets. The brain demands a constant supply of nutrients and energy in order to function optimally, and some simple changes to diet can considerably improve and maintain good mental health.

Many mental health conditions are accompanied by changes to food intake for example, loss of appetite or binging on sugary snacks. It has also been noted that various unhelpful food patterns that occur during depression may also precede depression. These can include poor appetite, skipping meals, and an overwhelming desire for sweet foods. As a result, inadequate consumption of vitamins, minerals, and healthy fats can have a negative effect on mood and brain function.

Image Courtesy of Chroma Conference Optimising Outcomes 2018

Research has shown that deficiencies in nutrients can also disrupt normal brain function.[1,2,3,4] For example, when someone sustains a trauma or mental health episode, it is necessary to eat enough of the right foods to help the brain function efficiently.

If a patient is not nutritionally stable, their therapeutic potential is squandered. A patient’s non-compliance with diet, a lack of oral intake, altered gastrointestinal function, decreased muscle mass or poor hydration may result in a less than optimal therapy process due to the patient being poorly or undernourished.

Additionally, recovering from surgery or critical illness, such as cancer, stroke or brain injury, takes time and requires energy and good nutrition. Ensuring that the body has enough of what it needs to heal and build strength is a vital part of the rehabilitation process.

Studies have shown that for the body to begin to heal, it requires abundant sources of energy and protein to support tissue growth and development. This includes a good fat profile to help balance inflammation plus all the myriad of supplementary molecules, sourced from a spectrum of flavonoids, live enzymes, phytonutrients, antioxidants, vitamins and minerals, crucial to balancing the body’s biochemistry to make it all happen effectively.

The scenario of any intensive rehabilitation programme is very much on a par with any other kind of high intensity training with regard to nutrition and should be treated in the same way as it is for elite athletes. Neurorehabilitation settings such as Steps Rehabilitation in Sheffield who offer a fully integrated approach to rehabilitation post brain injury, include interventions around diet, nutrition and neurologic music therapy. These provide a holistic ‘wellness promoting’ approach to rehabilitation that continues to show great results for patients there. Their experience clearly shows that improving nutrition can transform a person’s mental state and physical function when suffering from traumatic conditions recovering from life changing injuries.

Ways to help Increase Brain-Healthy Food Intake

Consuming at least five portions of fruits and vegetables daily will help to prevent cellular damage as well as provide the body with essential vitamins and minerals. This is because a diet high in fresh fruits and vegetables, whole grains and lean protein nourishes the brain whilst protecting it from oxidative stress. Oxidative stress can lead to the production of free radicals which damage cells, including brain cells.

Refined, processed foods such as saturated fats and trans-fats such as butter, cheese, fatty meats, high fat dairy products and processed foods, provide no nutritional value to the brain at all, hindering the brain’s health via its inability to protect brain cells from damage - further contributing to brain tissue injury.

Numerous studies show that those who consume a diet high in refined processed foods are more likely to suffer from depression compared to those who consume higher quality diets.[1,6,7,8]

Carbohydrates such as oats, brown rice, whole grains and vegetables support the production of chemicals in the brain that encourages a greater sense of wellbeing, including serotonin. Carbs with a low glycaemic index will also slowly release energy to fuel the brain.

Refined carbohydrates have a high glycaemic index. High GI foods do not create a steady release of energy to the brain and therefore blood sugar levels remain unstable, contributing to mood swings and increasing incidences of anxiety and depression.[9]

Fibre is key. There is a growing body of evidence suggesting good mental health is directly correlated with a healthy gut. Whole grains, fruit, vegetables, legumes, nuts and seeds as well as probiotics, feed the bacteria in your gut, helping support good mental health. Balanced levels of good and bad bacteria in the gut are crucial for supporting a healthy intestinal flora.[7]

This is due to the fact that neurotransmitters (or chemical messages) such as Serotonin, a chemical that helps regulate mood, is produced in the GI Tract. Its production is based highly on optimal levels of good bacteria in the gut, as such bacteria activates neural pathways that travel directly between the gut and the brain.[1]

An imbalance of bacteria in the microbiome can lead to poor mental health.[3,7]

The brain has one of the highest levels of lipids (fats) and essential fatty acids will help fuel the brain. It is advised to consume healthy fats such as olive oil, nuts, seeds and avocado. Oily fish is a great source of omega-3 fatty acids and the most important for supporting brain health.

Omega 3s act to reduce inflammation within the body. Inflammation in the body especially in the gut, continues to be considered a key antagonist to poor mental health. Inflammation has been found to adversely impact immune functioning.[7]

The immune system originates in the gut. A healthy gut with good levels of good and bad bacteria is required for good health as this means the gut can function optimally – absorbing nutrients and keeping out harmful bacteria. If inflammation is found in the gut, this can lead to depression.

As mentioned, gut health and brain health are linked. If inflammation exists in the gut, then this will negatively affect mental health, as neurotransmitters such as those that regulate mood, won’t travel effectively from the gut to the brain.

Researchers have noted that mental illness is fast becoming a global epidemic and that treatment is typically prescribed medication such as antidepressants. But as these drugs do not seem to be tackling the issue and lessening the global burden,[3] it is plausible that another approach is needed to prevent and treat mental disorders, and nutrition could be that approach.

Numerous studies have found a positive link between nutrition and mental health in both adults and children alike.[1,6,7,8]

Diets have progressively become poorer in the western world, consuming more processed, refined foods compared to healthier fresh alternatives as seen in the Mediterranean. A poor diet would increase inflammation within the body, lower blood sugar levels and inadequately fuel the brain, seeing a rise in poor mental health and developing rates of depression.

Clue: Healthy and Unhealthy Foods are displayed within the Letters of the above image

Nutrition in Rehabilitation

The importance of nutrition in rehabilitation is therefore becoming even more significant.

The bond between nutrition and physical therapy is ever growing. To achieve optimal outcomes while managing underlying medical concerns, nutrition can help in increasing productivity and satisfaction, thus improving individual patient outcomes.

Consider the body like a house and a brain injury like a hurricane which has come though and caused a considerable amount of damage.  To repair this damage, you need high quality supplies, such as lean protein, vegetables, fruit, calcium-rich foods and healthy fats, which are the nutritional equivalent of bricks and mortar. Takeaways, ready meals, toast, biscuits and sandwiches are the nutritional equivalent of duct tape and cardboard, with less ability to support significant lasting repairs.

The brain controls every movement the body performs therefore it requires the best fuel to function optimally. Living with a trauma such as a brain injury can result in depression as it can be difficult to come to terms with the diagnosis. This may mean that a patient's appetite changes and eats less (or more) or craves only sweet foods for an instant blood sugar spike and mood enhancer. Effects of sweet, refined, processed foods are short lived and the effect, once blood sugar levels drop, can be detrimental to mental health. Eating more can cause weight gain, again contributing to poor mental health. Eating less can result in depression as one is starving their brain of essential nutrients required to fuel the brain whilst causing inflammation in the gut through low levels of good bacteria and creating poor neural pathways for neurotransmitters to travel from the gut to the brain.

Additionally, fatigue during recovery, known as Pathological Fatigue, severely impacts on the ability to carry out activities especially those associated with rehabilitation. Causes of pathological fatigue vary from depression and anxiety to poor nutrition and cognitive difficulties. Nutrition and hydration should be the starting point for recovery. These ideas are fast becoming part of best practice in neurorehabilitation centres across the country.

Depression can hinder rehabilitation progress. Low mood equates to low motivation. Therefore it is even more important for those with a brain injury to eat a healthy diet complete with all nutrients previously mentioned. This way, mental health has a chance of influencing a positive outcome for rehabilitation and the need for prescribed drugs such as antidepressants is lessened. A deficiency in iron /b12 /folate /vitamin D, dehydration, blood sugar fluctuations, thyroid problems or electrolyte imbalance can all increase fatigue.

The Importance of Assessment

Nutritional assessment is a simple yet effective way to help educate the client, family and friends on the benefits of healthy eating during recovery as weight gain or loss can adversely affect the recovery progress.

Clients should be assessed for a series of factors including malnutrition at their initial assessment as a client's weight could prevent them from having certain treatments that they may need. The assessments will also help clients understand the consequences of their food choices.

Clients cannot expect the brain and body to heal and recover consuming foods with poor nutritional value. To facilitate effective recovery, patients must consume a highly nutritional, varied, healthy balanced diet to effectively improve recovery time and help progress rehabilitation outcomes.

To ensure that nutrition is as an essential part of clients’ rehabilitation programmes, Chroma works with specialist nutrition rehabilitation dietitians.

References

1. Saris, J et al Nutritional medicine as mainstream in psychiatry Lancet Psychiatry 2: 271–74. 2015
2. Jacka, F et al A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial) BMC Medicine 15:23. 2017
3. Marx, W et al Nutritional psychiatry: the present state of the evidence Nutrition Society 2017
4. Jacka FN et al, The association between habitual diet quality and the common mental disorders in community-dwelling adults: the Hordaland Health Study. Psychosom Med. 2011;73(6):483–90. 
5. Lai JS et al, A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. Am J Clin Nutr. 2013;99(1):181–97 
6. Akbaraly TN et al, Dietary pattern and depressive symptoms in middle age. Br J Psychiatry. 2009;195(5):408–13.
7. Berk et al, So depression is an inflammatory disease, but where does the inflammation come from? BMC Medicine 11:200. 2013
8. 8.      O’Neil A et al, Relationship between diet and mental health in children and adolescents: a systematic review. Am J Public Health. 2014;104(10): e31–42.
9. Gangswisch et al, High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative. American Journal of Clinical Nutrition, Volume 102, Issue 2: 454–463. 2015