Making Sense of Nutritional Psychiatry
Is it all hype? Is there any evidence for it?
Posted September 23, 2019 | Reviewed by Lybi Ma
Can nutrition and diet play a role in the treatment of mental illness? Some would say yes. With 70 percent of the American population now overweight or obese , who doesn’t need a change in diet? For people with chronic mental illness, the rates of obesity are significantly higher . Rates of diabetes are also higher— in some cases, 300 percent higher . People with chronic mental illness die about 25 years earlier than everyone else, often from problems like heart attacks, strokes, and cancer. They are losing one-third of their lives! Presumably, a better diet could help.
But can a diet actually treat psychiatric disorders? Can a change in diet make the symptoms better, or even go away? For disorders like anxiety , PTSD , chronic depression , bipolar , or even schizophrenia? Most people are skeptical. These are serious disorders. They are brain disorders. Many see them as being due to “chemical imbalances,” with medications being the only possible solution. They are almost certainly not caused by a bad diet. Most people know about the biopsychosocial theory of mental illness. There are many factors that lead to the development of mental disorders. A bad diet is usually not listed among them. Sure, given the high obesity rates, a diet might help these people lose weight, but they still need treatment for their brain disorders. Right?
Welcome to the field of nutritional psychiatry. Controversies are abundant. Wild claims of miracle cures are all over the Internet. The dietary interventions recommended are widespread and conflicting. The diet wars are fierce.
Eat meat. Don’t eat meat.
Carbs are the enemy. Carbs are essential.
Low fat is where it’s at.
Take vitamins. Take supplements.
It’s the chemicals in our food supply, eat organic.
It’s inflammation, antioxidants are the answer.
It’s the gut microbiome , probiotics are the key.
How can we make sense of all this hype?
Supporters of nutritional psychiatry often use two famous lines. “Let food be thy medicine and medicine be thy food.” This quote from Hippocrates is inspiring, yet he didn’t offer a recipe to cure schizophrenia or severe depression. “We are what we eat from our head down to our feet.” As nice as this child’s rhyme is, it doesn’t offer specific solutions for crippling anxiety, chronic suicidality , or hallucinations. Again, serious disorders require serious solutions, not trite clichés.
In my recently published article in the Journal of Clinical Psychiatry —" Diets and Disorders: Can Foods or Fasting Be Considered Psychopharmacological Therapies? "—I tried to make sense of all of these claims. I summarized what I consider to be five separate treatment categories within nutritional psychiatry. They are very different from each other. They make different assumptions about the causes of mental illness and the effects of nutritional interventions. The categories are as follows:
Although there is clearly a lot of hype, this field of nutritional psychiatry is moving forward. There are psychiatrists, psychologists, and researchers who are committed to understanding the science of how diet can impact brain health. The International Society for Nutritional Psychiatry Research is one such organization committed to advancing this field. Founded by Felice Jacka , a prominent Australian researcher, this organization will be meeting next month in London to disseminate the latest research.
Over the next few months, I will be publishing a series of articles here, diving into each of these categories to help you make sense of all of this. Real disorders require real solutions. Embedded in all of this hype that we call nutritional psychiatry, there may, in fact, be some real solutions. Separating the science from the frivolous claims is challenging. I hope you will find it useful.
If you have questions or areas of particular interest, please leave them in the comments section and I’ll do my best to add them to the list of forthcoming articles.
DISCLAIMER: Nothing in this article is intended as medical advice. People with health conditions are urged to seek medical care from a competent medical provider. No doctor-patient relationship is created by this article, or by any responses to comments posted in this forum by Chris Palmer, M.D.
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See: The Ketogenic Diet May Help Stop Seizures and Chronic Schizophrenia Put Into Remission Without Medication.
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Christopher M. Palmer, M.D. , is a Harvard psychiatrist and researcher working at the interface of metabolism and mental health. He is the director of the Department of Postgraduate and Continuing Education at McLean Hospital and an Assistant Professor of Psychiatry at Harvard Medical School.
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