Proper nutrition is the foundation of good health. While we have observed that diet alone is not enough to produce profound changes in mental health disorders, it is an essential part of maintaining stable moods and overall good health. Weight gain and heart disease risk are frequent challenges faced by people taking psychiatric medications. Nutrition addresses these factors as well. Several important nutritional concepts to keep in mind are listed below.
Concept #1: Eat Whole Foods.
Eating whole, unprocessed food is the most important concept in all of nutrition. Whole foods provide more nutrients, fewer chemicals, and no refined products like sugar. Much is learned about whole foods from Weston A. Price, one of the first researches in whole food nutrition. Dr. Price was a dentist in the early 1900’s who heard of the excellent health in traditional cultures who lived off the land. He traveled across the globe studying people eating whole, traditional food and reported in detail about the foods they consumed. His reports are amazing and Dr. Janikula believes his concepts are central to all good diets. The Weston A. Price foundation publishes many good articles on nutrition and lists the basic characteristics of traditional diets.
Concept #2: Blood Sugar Balancing/ Metabolic Syndrome.
A recent review estimated that metabolic syndrome occurs in up to 50% of patients with bipolar disorder. Metabolic syndrome is a blood sugar problem presenting with; weight gain around the abdomen, mildly elevated fasting blood sugar (>100), low HDL cholesterol(<40 in men and <50 in woman), increased blood pressure (>130/>85), and elevated triglycerides (>150).
In addition, many patients with bipolar disorder have a condition called reactive hypoglycemia. Reactive hypoglycemia is when the body overreacts to sugary foods leading to a crash in blood sugar, producing symptoms such as fatigue, anxiety and irritability.
If you have excess weight around your waist and crave carbohydrates/sugar you most likely have blood sugar balance problems. Furthermore, antipsychotics and mood stabilizers alter metabolism to create a blood sugar problem or make existing blood sugar problems worse. If you are taking any of these medications and noticed weight gain, a blood sugar balancing diet is essential to weight management, mood management, and reduction of the long-term risk of heart disease and diabetes.
The best way to manage blood sugar is to control the amount and type of carbohydrate you consume. In general, low carbohydrate diets work well as long as they are based on whole foods. High sugar foods are the worst offenders and should be avoided. When patients limit carbohydrates and avoid simple sugars they notice improved mood, weight loss, and increased energy. Slipping back into a high carbohydrate diet often leads to a mood episode, especially depression. Dr. Janikula has observed this diet to have both mood stabilizing and antidepressant effects.
Finally, if the blood sugar imbalance is large enough, a blood sugar balancing supplement should be used to regain control. (See supplements section.)
Concept #3: Food Allergies
Clinical ecologists have found the connection between food sensitivities and brain reactivity. Past physicians such as Brent Cambell, William Crook, and J.C. Breneman found connections between foods and mood problems. It is hypothesized that when a sensitive food is eaten an immune reaction can happen in the brain causing mood problems. The foods people are sensitive to tend to be the foods they eat the most. These include: wheat and wheat products, dairy, eggs, corn, chocolate, and pork. There is no data on how often these occur, but Dr. Janikula estimates that food allergies trigger mood episodes in a small percentage of patients with bipolar disorder and cause unwanted physical symptoms such as digestive disturbances, sinus infections, and migraines.
There are several ways to detect food allergies. The best (gold-standard) method is to perform an allergy elimination diet. During this diet, all possible food allergens are avoided for 1-2 weeks. If symptoms improve, you have food sensitivity. Then to ascertain which foods are problematic, one food is added in at a time for three consecutive days. If the food is a problem the body reacts more vigorously after an absence. Typically there is no question that the food is problematic. This is done for each food reintroduced and if no reaction occurs, the food can continue to be eaten.
Concept #4: Eat Essential Fatty Acids.
Healthy brain function depends on adequate supply of essential fatty acids, namely DHA and EPA. Patients with bipolar disorder and depression respond well to fish oil supplementation. One Harvard based study on 30 unstable bipolar patients showed fish oil helped patients remain stable and improved depression. From this study, it showed that about 65% of the patients respond well to fish oil supplementation.
Concept #5: Eat Organic Foods.
It is unknown how much chemicals, pesticides, and heavy metals affect the course mental illness, but avoiding them is a good idea. One easy way to avoid pesticides is to avoid the “dirty dozen.” These are the 12 most pesticide laden foods that you would buy at the supermarket. The list was put together by the Environmental Working Group (www.ewg.org) where you can download a pocket list. Purchasing these 12 foods organic is a good way to decrease your pesticide consumption by 90%.
The Dirty Dozen
Sweet bell peppers
Concept #6: Take Supplements
At Fountainhead Clinic, we feel supplementation should be used judiciously and only on an as needed basis. If there is a deficiency that needs to be corrected by supplementation, we will recommend it. While supplementation is not our first line treatment approach, it can be helpful for some individuals.
When necessary, we will prescribe a high dose multivitamin/mineral. Not only does a high dose multivitamin ensure adequate nutrients, the extra nutrients help offset any genetic metabolic deficits. There are two promising open trials that show mood stabilization using a multivitamin/mineral supplement. One by Kaplan showed a 55%-66% symptom reduction in 80% of 14 adolescents. Another trial by Charles Popper showed that 19/22 patients responded. As multivitamins have no negative side effects this option is safe and sometimes effective.
Blood Sugar Support
If blood sugar problems are large enough a blood sugar support supplement is helpful. The supplements listed below have been show to help with blood sugar stabilization and decreasing insulin resistance.
Chromium picolinate – stabilizes blood sugar and decreases insulin resistance, promotes fat loss
Cinnamon – has shown multiple beneficial effects in regards to insulin resistance and diabetes
Omega 3 fatty acids – protects against effects of metabolic syndrome and heart disease
Green tea – shown to increase metabolic rate, slows glucose rise after eating