As described in my previous post, I was keen to apply my clinical knowledge working with new patients in America. Waiting for the wheels of bureaucracy to grind into place and grant me a licence was frustrating, so to prevent myself ossifying I contacted a former acquaintance, Dr. James Gordon, founder of the The Center for Mind Body Medicine (CMBM), to see if he needed any volunteers.

I first met James in 2004 during an earlier stint in DC as a newlywed with my husband, a journalist who was based here. Unable to get a work visa I dabbled in various pursuits including enrolling in the Acting Conservatory at the wonderful Studio Theatre to pursue a long held passion of theatre acting. But I also spent time keeping up to date on areas of interest, one of which was the brain.

In the years since I studied neuroscience in Edinburgh, my interest had not waned. The science had moved on tremendously, and initiatives such as the Decade of the Brain meant research had proliferated. However, in keeping up with the major breakthroughs and developments and reading some of the media reports on this research, it sometimes seemed science was being used to rationalise treatments with insufficient evidence for safety or efficacy.

Even more troubling were the often hostile reactions towards scientists, with equally rigorous training as those conducting the research, who raised concerns. Blithe dismissals, ad hominem attacks or convoluted language crafted to bamboozle any lay person hoping to understand the controversies, were the weapons of choice. An unwillingness to listen to critical peers is worrying in any academic pursuit, but especially in the sciences, which I’d learned from studying Karl Popper, depended in large part on allowing your conjectures to be refuted!

At the same time journalists with little interest in their subject matter, or simply lacking sufficient grounding in science, were sometimes content to publish the prevailing wisdom with little intellectual curiosity. This is particularly troubling because although scientists have the time, motivation and collegial support to delve deeper, the public rarely do, relying for the most part on accurate media reports. Debates in science are often far more nuanced and multi-faceted than can be easily represented in an article restricted by word counts, but when it comes to understanding an issue, especially if it’s controversial and can be used to further a political or ideological agenda, this stuff matters.

Spotting articles of this sort comes not only from caring deeply about an issue, but in part from being married to a journalist. I met my husband while we were both working in the Balkans, and considered him to be one of the most trustworthy and reliable reporters in the profession. It also comes from working with skilled colleagues and mentors in the media departments of the United Nations Protection Forces in Zagreb, Croatia, and the Office of the High Representative (OHR) in Sarajevo, Bosnia and Herzegovina. Learning to differentiate between propaganda, half-truths and politically expedient articles, as well as lazy or unprofessional journalism in general, is par for the course working in a post-war media landscape.

It was with this mindset that James and I sat on his porch in 2004 discussing the latest media reports and research on the brain, as well as the direction mental health care was going in general. We also talked about nutrition and mental health and I was inspired by his breadth of interests, energy and passion. He was then, as now, busy training medical doctors and other health professionals in evidence-based techniques that address the root causes of trauma. The CMBM has been running programs since 1991, and has helped medical professionals both nationwide and internationally better support their communities in the aftermath of trauma.

As a Harvard trained psychiatrist, James’ approach is naturally science led. Like any seasoned practitioner he is also informed by the observation of his patients, as well as his own personal experiences. He takes seriously the guiding maxim of medicine and founding principle of bioethics: First Do No Harm.

Taking calculated risks in medicine is not unusual, indeed it can often be a matter of life or death. We could quibble all day about what constitutes harm, or doctors’ ethical promises but it wouldn’t detract from the fact that too often the ‘no harm’ principle is ignored to the serious detriment of an individual’s health or society’s wellbeing. In a territory as complex, fragile and unknown as the brain, where side effects can change who you are, how you perceive the world and how you treat others, it seems even more important to exercise wise, cautious, judgement.

James and I had been in touch sporadically throughout the years. In 2014 I contacted him with a view to setting up a programme to support trauma recovery in Vukovar, Croatia – a city torn apart following the brutal war. But the costs in time and finances, as well as the ongoing volatility at that time, made it unfeasible to begin anything that would be usefully sustainable in the long term.

By the time I contacted him again in 2017 I had become increasingly frustrated with the way mental health was being discussed in the media. The pathologising of certain mental states that might represent a normal response to an abnormal situation didn’t make sense to me. My patients’ experiences of trauma, as well as my own, fired a curiosity to better understand the underlying mechanisms. So when, after catching up over a cup of tea, James asked how I felt about helping him carry out some research on his new book, I jumped at the chance to become one of his more senior ‘interns’.

A serious flaw in the understanding of many holistic healthcare approaches has been the belief that there is no science to back it up. This may have been the case 20 – 30 years ago when it was hard to fund studies, but as evidence accumulates justification for further research gets stronger. My research was aimed at finding evidence for therapies previously seen as being on the fringes of neuroscience:- meditation, EMDR (eye movement desensitization treatment), nutrition, bio-feedback (neurofeedback), virtual reality and hypnosis.

The subtle but powerful effects of such therapies, as well as theories for their mechanism of action, have been brought to light with the help of sophisticated non-invasive but sensitive imaging techniques. Their combined use with emergent disciplines such as epigenetics, systems biology and nutrigenomics have helped clarify our understanding of the structural and biochemical changes that take place in the brain in response to its psychological, chemical and nutritional environment.

One area of focus in my research was looking at the neural pathways of implicit and explicit memory and evidence for trauma related epigenetic changes in their structure, as well as evidence of any changes to these areas corresponding with a particular therapy (for example, meditation). Another area we looked at was the effect of trauma on mirror neurons. These neurons are crucial for empathy and helping us to form normal social relationships.

The work was interesting and brought me up to date with the very latest in the field of neuroscience. A lot of the validating research we found (now already 3 years old) was too detailed and complex for inclusion in a practical self-help book, but would be worth exploring in a future blog.

Overall, the work was hugely interesting. It was inspiring to see how many scientists are out there seeking evidence for those safer yet still effective therapies that maintain respect for the fragility, sensitivity and complexities of our brains. Techniques once seen as hippy-dippy are finally being studied with serious intent. I’m sure that Mr. Popper would also be pleased to see science being used a self-correcting tool for discovery, rather than an excuse on which to hang old and tired hypotheses.

Transformation: Discover Wholeness and Healing after Trauma by James S. Gordon MD is published by Harper One in September 2019 and available at most bookshops, as well as public lending libraries in DC and Fairfax.

It’s been three and half  years since my family and I moved back to the USA, where I hoped to put my UK training and experience into immediate practice in Washington DC. It’s no exaggeration to say that this country is screaming out for for preventive care. Of the 11 countries evaluated by The Commonwealth Fund it ranked last in 2017.  Reports are compiled every three years with a new one is due this year. The USA also currently ranks 37 in the world, nestled between Costa Rica and Slovenia, and way below the UK, which ranks significantly better at 18, (in close company with the Netherlands and Ireland)  – thank you NHS! But no Government can afford to rest on its laurels when it comes to healthcare, and not just because of an increasing ageing population. Our children are suffering too. American children overall are eating a poor diet and more than 13.7 million of them are obese.  American babies are 76% more likely than babies in other wealthy nations to die in their first year of life. Armed with this knowledge I was keen to start work.

But my good intentions were thrown a curveball by a series of unforeseen events that eventually come crashing into all of our lives one way or another and consign us to a form of hell on earth. If it hasn’t happened to you yet, it will. It’s called being human – and knowing it’s coming sooner or later is no help either.

More headaches (metaphorical and literal) followed. Trying to register as a Nutritional Therapist from the UK meant I had to deal with petty, mindless bureaucracy, ineptitude and apathy, as well as ridiculously slow communication by the relevant authorities (7 months to reply to a letter). I was expected to pay exorbitant costs to retrain (as a dietitian, mind you) or just study at my own expense and then pay (of course) to sit the (dietitian) exam. I explained that if I had wanted to be a dietitian I’d have trained in dietetics in the first place, not nutrition. (Is there a difference? Yes, and I’ll write about that in a future blog). I was frustrated; two science degrees, excellent references and 3 years of clinical practice under my belt wasn’t enough. It’s not like I wanted to wield a scalpel or prescribe drugs … I just wanted to help people eat better. The final straw came in a bizarrely specific Act of God when a basement flood completely destroyed all my notes and files on nutrition. Nothing else was damaged by the deluge.

I finally got the message: take stock – readjust – roll with the punches.

The decision was made one sunny spring day while out walking with my son and husband; I’d learn silversmithing. At first, I felt like I’d caved – was I giving up? Doubts haunted me. But hindsight is a valuable friend. I wouldn’t have had the stamina to give my best to therapy work back then. I kept up with my CPD (continuing professional development) but stepped back from seeing patients. Learning new practical and creative skills challenged me in all the right ways and gave me some space and clarity.

In the caring professions we are constantly reminded by our mentors to take care of ourselves before taking care of the needs of others. Who wants a burnt-out nurse, a stressed doctor, a psychologist on the edge of a breakdown?  They can’t give their best, though to their credit, many still try, and manage to work wonders. The problem is that most of us (I’m being an optimist) are in these professions not just to make a living, but because helping others makes us feel good too.

I’ve thought about my patients many times over these past few years. Recalling their stories and re-reading my reflective notes, was more supportive during this time than I – or they –  could ever have imagined. A majority of them had taken back control of their lives – and health – after they had been floored, and  I remembered feeling humbled by their resilience, patience, and self- belief at the time.

Some of them had experienced a personal bombshell prior to a major illness, and had already made that connection. Not all did though, even when the timing showed astounding synchronicity. And sometimes there’s no connection to make.

All of my patients fill out a lengthy health history questionnaire. This allows me to pinpoint the times in their lives when illnesses struck. In the first 90min session I refer to this timeline when asking about any severe emotional upheavals they’ve been through. Any health ‘whiteouts’ that may (note, MAY) be associated with trauma or acute bouts of stress, grief, sadness etc. tend to  pop up like beacons. I admit it’s a crude and laborious tool that would never pass muster as ‘serious scientific investigation’ (way too many variables). But it costs nothing and has proven really useful.

Science begins with observation, so here’s what I observed. Stress related flare ups of gut or skin conditions, as well as dramatic weight changes. Headaches, infertility, symptoms of OCD, mood swings, immune disorders … the list goes on, and all too often alongside these health issues on the timeline were episodes of profound sadness, loss, depression, fear, stress, anxiety. The patterns mirrored those being observed in recent research. There were other examples …

The middle aged man with a suboptimal diet may well have been courting a heart attack for years, but its timing closely followed the death of his wife. A vibrant young woman’s disabling PTSD was likely related to unavoidable trauma in her demanding work in the emergency services, but we both had little doubt it was severely exacerbated by the misogynistic bullying she endured in the primarily male workforce. Thyroid imbalances are common in peri-menopausal women, but all of my patients so afflicted presented with anxiety, stress, or loss of life purpose caused by marital discord, career burnout or years of stressful therapy for other health conditions. Breast cancer was often accompanied by deep rooted sadness, in at least three cases following the breakdown of a primary relationship, and in two cases, spousal abuse. One patient believed her child’s autism was associated with her cripplingly stressful pregnancy that, again, involved physical and mental spousal abuse, as well as the distress caused by racism and lack of emotional support at the hands of her health carers. Cases of Type 2 diabetes popped up suddenly in otherwise healthy people after a major shock. For one middle aged man, it surfaced six months after the tragic death of his only child. A much younger man succumbed to the same disease a few weeks after the death of his father, and hot on the heels of a messy break-up with his long-term girlfriend. People with eating disorders invariably had histories of parental conflict that engendered feelings of inadequacy or a loss of meaning in life (sometimes not recognised until much later on). The list goes on.

Of course, all of these stories are anecdotal; causality cannot be proven. But that doesn’t stop the patients themselves wondering, and it’s my job to listen.

We already know that depression and stress impact health physiologically, emotionally and behaviourally, so we must  keep looking.

There has been an explosion of research focusing on psychological wellbeing and disease in the past 10 years. Most of the research doesn’t make headline news. Maybe because there’s already an assumption that a mind-body connection exists, or maybe because its considered too woolly to be “real science”. Too bad, because assuming this connection, or just ignoring it, will not change public health policy. Providing evidence will.

An increased understanding of stress and its impact on epigenetics  is a case in point. Molecular mechanisms that explain how stress impacts the progression of cancer and diabetes are being discovered. A correlation between breast cancer and grief hasn’t yet been proven, but it is now being taken seriously.  The timing of stressors in pregnancy and links with autism is an active field of research, as is the focus on placental susceptibility to maternal distress and its impact on epigenetic dysregulation. Longterm perceived wellbeing of cardiac arrest survivors is strongly associated with depressive symptoms  – psycho-cardiology now being a recognised discipline, developed from a pressing need to better understand the connection between mind and heart.

I’ve linked to just a few studies, but research abounds.

The crucial importance of the mind in the paradigm shift towards Personalised and Lifestyle Medicine  is already understood, we’re just filling in the details with more research on specific diseases.

I had the privilege of meeting some unforgettable people who revealed to me in practice what I was reading about in theory.

They reminded me that the lessons and challenges we face as individuals may be unique, but we are all part of a whole. We need each other – more than we sometimes know.

You know who you are – thank you!

References:

How Bad Is U.S. Health Care? Among High-Income Nations, It’s The Worst, Study Says https://www.newsweek.com/united-states-health-care-rated-worst-637114

Best Healthcare in the World 2020 http://worldpopulationreview.com/countries/best-healthcare-in-the-world/#dataTable

Diet quality in a nationally representative sample of American children by sociodemographic characteristics https://academic.oup.com/ajcn/article/109/1/127/5266900

Prevalence of Childhood Obesity in the United States https://www.cdc.gov/obesity/data/childhood.html

American babies are 76 percent more likely to die in their first year than babies in other rich countrieshttps://www.washingtonpost.com/news/wonk/wp/2018/01/09/american-babies-are-76-percent-more-likely-to-die-in-their-first-year-than-babies-in-other-rich-countries/

Consequences of Repression of Emotion: Physical Health, Mental Health and General Well Beinghttps://openaccesspub.org/ijpr/article/999

https://www.mentalhealth.org.uk/a-to-z/d/depression

https://www.mentalhealth.org.uk/a-to-z/s/stress

Epigenetic Regulation of the Social Brain https://www.sciencedirect.com/science/article/abs/pii/S0166223619300566

The Influence of Psychological Stress on the Initiation and Progression of Diabetes and Cancer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628619/

Breast cancer: Is grief a risk factor? (de Paula et al, 2018) http://www.scielo.br/scielo.php?pid=S0104-42302018000700595&script=sci_arttext

Timing of Prenatal Stressors and Autism https://link.springer.com/article/10.1007/s10803-005-5037-8

Linking prenatal maternal adversity to developmental outcomes in infants: The role of epigenetic pathways https://www.cambridge.org/core/journals/development-and-psychopathology/article/linking-prenatal-maternal-adversity-to-developmental-outcomes-in-infants-the-role-of-epigenetic-pathways/7A665C6DA3A9E546569DE80CA804C5A7

The impact of psychological distress on long-term recovery perceptions in survivors of cardiac arresthttps://www.sciencedirect.com/science/article/abs/pii/S0883944118313844

Psycho-cardiology https://link.springer.com/chapter/10.1007/978-3-030-27080-3_12

Transgenerational impact of intimate partner violence on methylation in the promoter of the glucocorticoid receptor. https://www.nature.com/articles/tp201121

Prenatal Exposure to Maternal Depressed Mood and the MTHFR C677T Variant Affect SLC6A4 Methylation in Infants at Birth https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0012201

Exposure to Prenatal Psychobiological Stress Exerts Programming Influences on the Mother and Her Fetus https://www.karger.com/Article/Abstract/327017

Prenatal maternal stress predicts autism traits in 6½ year-old children: Project Ice Storm https://www.sciencedirect.com/science/article/abs/pii/S016517811400331X

Prenatal environmental exposures, epigenetics, and disease https://www.sciencedirect.com/science/article/pii/S0890623811000025

Epigenetics, maternal prenatal psychosocial stress, and infant mental health https://www.sciencedirect.com/science/article/abs/pii/S0883941718303297

The Role of Psychoneuroimmunology in Personalized and Systems Medicine https://link.springer.com/protocol/10.1007/978-1-62703-071-7_1

Lifestyle medicine – An evidence based approach to nutrition, sleep, physical activity, and stress management on health and chronic illness https://www.sciencedirect.com/science/article/abs/pii/S2186495019300173

On the first Tuesday of each month I run a small but dedicated Food For Thought Group at the Lighthouse Recovery Centre together with Community Recovery Worker, Lesley Rhodes, and the centre’s food support staff and members

Lesley and I with our offerings of Easy Oat Bites and Guacamole 

The Lighthouse is a referral only service that supports people with a personality disorder living in Brighton and Hove. It is a joint partnership between Sussex Oakleaf, Sussex Partnership Foundation Trust and Brighton and Hove Mind and is open for members 7 days a week.

The Food For Thought group is just one of many activities available to its members. We explore the health properties of particular foods and then try them out in different recipes.

The aim is not only to appreciate just how diverse and nourishing foods can be, but also to develop practical cooking skills through hands on experience – and to gain confidence preparing and eating unfamiliar ingredients. For example, in January’s workshop we focused on fennel (both bulb and seeds) and in February, we embraced the adaptable aubergine.

Hands on Experience – Watercress, walnut, feta and roasted cauliflower salad

Workshops are held in the Lighthouse kitchen, which is a warm, bustling and friendly environment – usually filled with laughter, genial witticisms and delicious smells.

For me, this is the ideal setting in which to prepare food, as it feels more like a social event than a chore! Cooking and chatting together transforms what can often be seen as drudgery, into something fun and rewarding.

As well as the obvious advantage of strengthening social ties, the workshops are also designed to foster an awareness of nutrients crucial for optimal physical and mental health, i.e. health self-empowerment.

Educating people about nutrition and cooking skills can influence food related behaviour, as well as health (1,2,3). Fostering awareness about how the body works, for example the link between balanced blood sugar levels and emotional stability, or the crucial role of the liver, can also help nudge individuals towards making healthier food choices in their daily lives.

Inspired ways to eat your rainbow-a-day – Thai Quinoa Salad with ginger and lime

And while there are no empirical studies looking at the relationship between nutrition and personality disorder, there is abundant evidence that nutrition and eating behaviour impact not only affective regulation (mood and emotion) (4-9) but also conative (motivation, intention, self-control) (10-12) and cognitive processes (13-15) .

The emphasis is on simple, healthy and tasty – Smoked Mackerel Pate with horseradish and spring onions

The Food For Thought Group also offers a safe environment in which to explore individual challenges with food that may have developed in childhood, such as food or texture aversions or fear of specific foods, without any expectation or pressure to share personal experiences – or indeed to cook!

Members can drop in (or out) of the group as they please, though they might well be tempted back by the mouthwatering aromas and entertaining kitchen banter.

References:

1. Hartmann, C., Dohle, S., & Siegrist, M. (2013). Importance of cooking skills for balanced food choices. Appetite, 65, 125-131.
2. Harmon, B. E., Smith, N., Pirkey, P., Beets, M. W., & Blake, C. E. (2015). The Impact of Culinary Skills Training on the Dietary Attitudes and Behaviors of Children and Parents. American Journal of Health Education, 46(5), 283-292.
3. Clark, A., Bezyak, J., & Testerman, N. (2015). Individuals with severe mental illnesses have improved eating behaviors and cooking skills after attending a 6-week nutrition cooking class. Psychiatric rehabilitation journal, 38(3), 276.
4. Holt, M. E., Lee, J. W., Morton, K. R., & Tonstad, S. (2015). Trans fatty acid intake and emotion regulation. Journal of health psychology, 20(6), 785-793.
5. Bushman, B. J., DeWall, C. N., Pond, R. S., & Hanus, M. D. (2014). Low glucose relates to greater aggression in married couples. Proceedings of the National Academy of Sciences, 111(17), 6254-6257.
6. Jackson, D. B. (2016). The link between poor quality nutrition and childhood antisocial behavior: A genetically informative analysis. Journal of Criminal Justice, 44, 13-20.
7. Pina-Camacho, L., Jensen, S. K., Gaysina, D., & Barker, E. D. (2015). Maternal depression symptoms, unhealthy diet and child emotional–behavioural dysregulation. Psychological medicine, 45(09), 1851-1860.
8. Jacka F. N., Ystrom E., Brantsaeter A. L., Karevold E., Roth C., Haugen M., Meltzer H. M., Schjolberg S., & Berk M. (2013). Maternal and early postnatal nutrition and mental health of offspring by age 5 years: a prospective cohort study. Journal of the American Academy of Child and Adolescent Psychiatry 52(10): 1038–1047
9. Jacka F. N., Mykletun A., & Berk M. (2012). Moving towards a population health approach to the primary prevention of common mental disorders. BMC Medicine 10(1): 149.
   

   Scrumptious Snacks, gluten, dairy and sugar free – Coconut Cocoa-nut Balls

10. Gailliot, M. T., & Baumeister, R. F. (2007). The physiology of willpower: Linking blood glucose to self-control. Personality and Social Psychology Review, 11(4), 303-327.
11. Tan, C. C., & Holub, S. C. (2015). Emotion Regulation Feeding Practices Link Parents’ Emotional Eating to Children’s Emotional Eating: A Moderated Mediation Study. Journal of pediatric psychology, 40(7), 657-663.
12. Berland, C., Cansell, C., Hnasko, T. S., Magnan, C., & Luquet, S. (2016). Dietary triglycerides as signaling molecules that influence reward and motivation. Current Opinion in Behavioral Sciences.
13. Bellisle, F. (2004). Effects of diet on behaviour and cognition in children. British Journal of Nutrition, 92(S2), S227-S232.
14. Lucassen, P. J., Naninck, E. F., van Goudoever, J. B., Fitzsimons, C., Joels, M., & Korosi, A. (2013). Perinatal programming of adult hippocampal structure and function; emerging roles of stress, nutrition and epigenetics. Trends in neurosciences, 36(11), 621-631.
15. Morley, J. E. (2014). Cognition and nutrition. Current Opinion in Clinical Nutrition & Metabolic Care, 17(1), 1-4.
16. Walker, J. G., Batterham, P. J., Mackinnon, A. J., Jorm, A. F., Hickie, I., Fenech, M., … & Christensen, H. (2012). Oral folic acid and vitamin B-12 supplementation to prevent cognitive decline in community-dwelling older adults with depressive symptoms—the Beyond Ageing Project: a randomized controlled trial. The American journal of clinical nutrition, 95(1), 194-203.

Eat well, feel well (or at least, a bit better…) – Winter Immune Booster Soup

“First Do No Harm” ….so let’s rule out the obvious stuff first

Research increasingly points to the importance of adequate nutrient intake for mental health, especially with regard to inflammation, oxidative stress, gut microbiota and mitochondrial health. Despite this, the first line of approach for individuals suffering from mental health problems is rarely multidisciplinary and even with everything we now know, still gives scant, if any, any consideration to an individual’s diet.

Sometimes this failing can be spectacular, as demonstrated during a talk given by Professor Malcolm Peet, Consultant Psychiatrist (now retired) at a Food and Behaviour Research conference in 2013. A nutritionist, newly recruited to work for the NHS in northern England, joined the discussion by satellite link, and cited the case of a young man in his thirties who had been suffering from auditory and visual hallucinations, apathy, severe depression and suicidal thoughts. This man had been on numerous medications (5 or 6) for a number of years, and had been assigned a number of nursing and support staff over this time to help him deal with not only with the physical problems, but also his emotional and financial challenges. He had never managed to hold down a job for more than a few months and found it impossible to maintain any meaningful relationships, despite his wish for a long-term partner. Nothing was said about his genetic predisposition, possible childhood / adult traumas, stress levels, lifestyle or any other possible known contributors to his mental health problems – but throughout those years in and out of hospital, no one had ever asked him one simple question:

“What do you eat?”

As it happens this was a crucial piece of information.

For breakfast, and throughout the rest of the day, he would eat up to 10 packets of crips, washed down with a 2 litre bottle of sweetened fizzy drink. He also drank about 10 coffees (each with 2tsp sugar), and in the evenings, a bottle of 20% alc. coffee liqueur. His only source of real food came in the form of an occasional kebab.

It wasn’t clear how long he’d been eating like this, which is obviously relevant, but a worst case scenario envisages that his diet had been woefully deficient since he left home 12 years earlier – and possibly before that. Even on a continuum of bad dietary choices, this case may seem extreme, but how would we ever know if we don’t ask?

In dietary analysis it is accepted that food diaries, food frequency questionnaires and 24-hour recalls (even with multiple pass follow up) are only ever “best estimates” (people often misjudge their intake, or just lie) – but as this case shows, you don’t need to spend much time questioning someone to realise there’s a serious problem.

It’s not always easy for people, with or without mental health problems, to accept just how critical good nutrition is for brain function. Changing eating habits is difficult for anyone, even if motivated. For those with mental health challenges this can be especially true, and a vicious cycle can quickly ensue.

Initially, this man didn’t accept that food could be related to his symptoms, and so he resisted any dietary changes. However he did agree to take a daily multi vitamin and mineral supplement, as well as fish oil. All supplements were within the daily recommendations.

After a few months, his situation had dramatically improved. His sense of perception and reality had normalised (no more hallucinations), and he had managed to come off all but one medication. He now also needed only one support person. The changes he saw motivated him, so that he eventually welcomed nutritional counselling. For the first time in his life he realised that what he ate profoundly affected how he felt.

The financial implications for the NHS of cases like this are obvious, but for individuals concerned it can be nothing short of life altering. In this case the young man also managed to find himself a steady job, as well as a stable relationship.

For sure, the answer to the mental health crisis won’t be found in a bottle of supplements – or even three healthy meals a day.

But clearly, ruling out malnutrition and severe deficiencies is a logical and cost-effective place to start.

Offering dietary support and motivational guidance to individuals who may have slipped through the nutritional net, either through lack of knowledge or (self) neglect, is a low-cost but potentially life changing adjunct to talking therapy or targeted pharmaceutical interventions.

Who knows, in some cases, little else may be needed. But one thing is certain – if we don’t ask, we’ll never know.

1. Felicitous Fare

Foods can lift your spirits. Some do so more effectively, and for longer, than others. So while you may be tempted to reach for the usual emotionally comforting suspects (chocolate, crisps, ice cream, doughy products, sweets and deep fried foods) take just 1 minute before doing so, to mindfully connect with why you’re making that choice. If you’ve learned healthy self-regulation at a younger age, aligning your choice with your needs (physical or emotional) is easy. If self-regulation is not your forte, this technique can help promote more helpful habits in an environment where you may have to make as many as 200 food related choices a day! ³²

2. Step Out

Although the UK is not generally blessed with sunny winters, there are some beautiful, bright days to be had in between those dismal grey ones. Make the most of them. It might not have much impact on your Vitamin D levels until the days get longer, but it can still improve your overall feelings of well-being. ³³

3. Infect Others

Happiness and health are natural partners. ^34-37 And as happiness seems to be contagious ³⁸ try to spend time with happy people, and then infecting others with your own happiness.