“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.