Better nutrition. Better health. Better wellbeing.
Hello! Today it is the World AIDS Day. Since 1988, the 1st of December is dedicated to raising awareness of the AIDS pandemic. However, I am not going to talk about AIDS today; I am going to focus on nutrition instead.
From obesity to orthorexia to anorexia
In 1997, the World Health Organization formally recognized obesity as a global epidemic. The same year, the term ‘orthorexia nervosa’ was also introduced. It was the American physician Steven Bratman who coined the term from the Greek words ορθο- (ortho, “right” or “correct”) and όρεξις (orexis, “appetite”). He described orthorexia as an unhealthy fixation with what the individual considers to be healthy eating. Unlike anorexia nervosa (an eating disorder and serious mental illness where people are of dangerously low weight due to limiting their energy intake and/or exercising excessively), orthorexia nervosa is not recognized as an eating disorder by the American Psychiatric Association. As a doctor myself, nutrition is something that I am really passionate about, since I believe it plays such an important role in both our physical and mental health, as well as our overall wellbeing. It is an exciting field where new information constantly comes to light; however, this has resulted in a plethora of often confusing and contradictory information coming from various sources: scientific research, as well as online articles, blogs, social media and books.
10 tips for better mental health & wellbeing
As a Psychiatrist, I have been trained in the use of the ‘biopsychosocial’ model or approach to the assessment and management of my patients. According to this model, mental illnesses (but also mental health difficulties) are rarely due to a single cause; mental illness usually develops through the complex interaction of biological (i.e. genes and chemical imbalances), psychological (i.e. personality and coping skills) and social factors (i.e. employment or financial problems). For this reason, the biopsychosocial approach is very helpful in the management of mental health difficulties and mental illness. In fact, I often advise my patients to pay particular attention to their lifestyle and biological factors (i.e. lack of sleep, lack of physical activity and non-nutritious diet) that may be contributing to their difficulties. Small improvement in these areas can have a big positive effect on their overall health and wellbeing. Two months ago, I published the post ‘10 tips for better mental health & wellbeing (part 1)’, where I looked into 10 key areas of daily life (nutrition being amongst them). I also made a number of simple yet effective recommendations, which can maximize our wellbeing and contribute to a happier and healthier life. I have based these recommendations on the scientific knowledge acquired during my under- and post-graduate medical training, as well as online courses and some (non-medical) books that I’ve recently read and which have helped me crystallize and expand this knowledge.
Gene Eating: The Science of Obesity and the Truth about Diets
In this book, due to get published on the 27th of December 2018, Dr Giles Yeo explores the biological basis of obesity. A geneticist at the University of Cambridge, he explains how our genes can affect both our eating habits and our metabolism, often resulting to obesity. Yet, he acknowledges the complex interactions between our genes and the environment, and argues the multifactorial nature of obesity. He then discusses a number of famous diets, such as Paleo, Atkins, Dukan, plant-based, gluten- and dairy- free diets. These diets focus on weight loss, and/or improvement of health. Dr Yeo then explains why, even though these diets may be successful in the short term (weight loss), they fail in the long term (weight regain). He also explains the health risks associated with some of these diets. He convincingly demonstrates that these diets are based on pseudo-scientific premises, and follow a simplistic reductionist approach.
From Hippocrates to the Mediterranean diet
On the contrary, he endorses intermittent fasting and the Mediterranean diet, which is widely considered one of the healthiest in the world. The Mediterranean diet includes relatively high consumption of fruits and vegetables, olive oil, grains, legumes and nuts, moderate consumption of fish and poultry, as well as red wine, and low consumption of dairy products and red and processed meat. It has been linked to reduced risk for cardiovascular disease, certain types of cancer, Parkinson’s and Alzheimer’s diseases, and increased longevity. On that note, I would like to point out that even though a moderate consumption of red wine can be beneficial to our health, alcohol is a double-edged sword, since a higher consumption is associated to a number of physical and mental illnesses. For this reason, in the UK, guidelines recommend not to drink more than 14 units of alcohol a week. Higher consumption of alcohol can exacerbate both the physical and the mental health, and may render other interventions ineffective. Recreational drugs can also have a negative effect on mental health (so avoid them completely). Dr Yeo highlights the problems associated with excluding certain food groups from our diet and depriving ourselves of certain nutrients; instead, he supports a more holistic and balanced approach where all foods are allowed. Moderation is the key, and I couldn’t agree more. Here Dr Yeo quotes the ‘Father of Medicine’, Hippocrates:
If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.
Everything in excess is opposed to nature.
All disease begins in the gut.
There are, of course, notable exceptions, where dietary exclusions are necessary for health reasons; for example, sufferers with diabetes should avoid sugar, sufferers with coeliac disease should follow a gluten-free diet, and people who allergic to certain foods should avoid these foods. Intolerance is, however, something different, and, Dr Yeo argues, does not necessarily require a complete avoidance of the foods we’re intolerant to. Overall, I found Gene Eating: The science of obesity and the truth about diets
The Kefir Solution: Natural Healing for IBS, Depression and Anxiety
A ‘lightbulb’ moment was when I recently read the The Kefir Solution: Natural Healing for IBS, Depression and Anxiety
Can kefir help with mental illnesses, such as depression and anxiety?
In this book, informed by a number of recently published scientific studies, Shann Nix Jones discusses the biology behind IBS and explores the links between the gut and mental health. Although some of these links are long established, this is still an under-researched area and new scientific evidence has come to light in the recent years. Even though she is not a doctor or a scientist, the author provides some very useful insights into the role of nutrition in mental health. I actually felt enlightened reading about the microbiome (the micro-organisms inside the gut), the role of serotonin and tryptophan in gut health, and the role of probiotics and psychobiotics in gut, mental and overall health. Another thing I really liked about this book is that it advocates a holistic approach in the management of IBS. Shann Nix Jones describes five steps – drinking kefir is only one of them. She writes about the importance of fine-tuning to our feelings and emotions, improving our dietary habits and making a number of other lifestyle changes. Since I read the ‘Kefir Solution’, I have recommended it to some of my patients. Although I still don’t know how helpful they’ve found it, I believe it’s a book worthwhile reading whether you suffer from IBS, depression or anxiety, or you want to gain a better understanding of the complex interaction between nutrition and mental health, or you simply want to improve your eating habits.
Happy Kitchen
Like Shann Nix Jones, journalist and author Rachel Kelly also explores the relationship between food and mood, or the interplay between diet and mental health and wellbeing. Having personally experienced (and recovered from) depression and anxiety, Kelly writes from the perspective of somebody who changed her approach to eating, but she also takes into account the scientific research into the role of nutrition in mental illness. Underpinning Kelly’s ‘Happy Kitchen’ are the ’10 golden rules’ that she has formulated. Based on these rules, she advises us to:
1. Eat mostly plants. 2. Use herbs and spices. 3. Eat nuts. 4. Nourish your gut. 5. Eat more omega-3 and less saturated fats/avoid trans fats. 6. Get the right balance of protein – fish should be on top of your list. 7. Avoid sweeteners and additives (i.e. aspartame and MSG). 8. Keep an eye on your (blood) sugar levels. 9. Vary your diet. 10. Relax and enjoy food.
She then explores the relationship between six symptoms (fatigue, low mood, anxiety and stress, cognitive difficulties, hormonal imbalance, and sleep difficulties) and different foods; she also discusses lifestyle changes, that have a positive effect on these symptoms, and shares a number of tips. Each chapter of the ‘Happy Kitchen’ also includes a number of recipes that Kelly developed together with nutritional therapist Alice Mackintosh. For example, after examining the relationship between energy and (blood) sugar levels, she talks about the beneficial role that iron-rich foods and a dietary (as well as lifestyle) routine can play on our energy levels, and then shares recipes that contain energy-boosting ingredients. Or, after discussing the role of serotonin and tryptophan in low mood and depression, she talks about serotonin- and tryptophan-rich foods, as well as micro- and macro- nutrients (vitamins B and D, zinc, omega-3 fats and protein) that have a mood-boosting effect, and then shares recipes that contain these nutrients. Like Shann Nix Jones, Kelly pays attention to the relationship between the digestive system (the gut microbiome in particular) and anxiety. She then recommends magnesium- and vitamin B6- rich foods for their calming effects. She also briefly discusses mindful eating. In keeping with the principles of mindfulness, mindful eating is about bringing our awareness to our eating. In other words, it is about giving our full attention to our eating, and focusing on the process of eating and enjoying our meal. Getting rid of distractions and turning off the television/phone etc can help us eat more mindfully.
As a Psychiatrist myself, I’ve found several strengths in the ‘Happy Kitchen’.
First, the premise of the book is the relationship between food and mental health. ‘Happy Kitchen’ raises awareness on this relationship that is sadly not acknowledged and talked about as much as it should be. Second, Kelly’s tips are actually recommendations for healthy eating. She embraces a balanced diet of protein, carbohydrate and fat, which echoes the ‘Eatwell Guide’ and other official nutrition recommendations, as well as the world’s healthiest diets. Third, she recommends three regular main meals: breakfast, lunch and dinner, as well as healthy snacks between the main meals. Fourth, her approach is holistic; even though the book is focused on food, Kelly also discussed complementary approaches to mental health optimization (lifestyle changes as well as medication). If there is one thing I would change, however, this would have to be the distinction between different symptoms. Most nutrients have a positive effect on several symptoms; yet, these symptoms rarely occur in isolation. For example, clinical depression presents with a constellation of symptoms, which does not include just low mood, but also a combination of fatigue, sleep and cognitive difficulties, and anxiety. Having said that, I think that The Happy Kitchen
Simple Ways to Eat Healthy Without Thinking
In his blog, author and blogger James Clear focuses on changing habits to improve our lives. In his post ‘10 Simple Ways to Eat Healthy Without Thinking, Backed by Science’, he shares a few simple ways to eat healthy without thinking:
1. Use smaller plates. 2. Make water more readily available. 3. To drink less alcohol or soda, use tall, slender glasses instead of short, fat ones. 4. Use plates that have a high contrast color with your food. 5. Display healthy foods in a prominent place. 6. Wrap unhealthy foods in tin foil. Wrap healthy foods in plastic wrap. 7. Keep healthy foods in larger packages and containers, and unhealthy foods in smaller ones. 8. Serve meals by using the ‘half plate’ rule: half of your plate should be fruits and vegetables. 9. Use the ‘Outer Ring’ strategy to buy healthier foods: when you go grocery shopping, don’t walk down the aisles, but only shop on the outer perimeter of the store.
Even though James’s suggestions are based on the discredited and subsequently retracted research by Brian Wansink, they should not be dismissed. There is still a body of sound scientific evidence that supports these recommendations. This evidence is actually referenced in Dr Yeo’s Gene Eating: The science of obesity and the truth about diets
The Nordic Guide to Living 10 Years Longer: 10 Easy Tips to Live a Healthier, Happier Life
Scandinavians may be considered amongst the happiest people in the world, but they are also amongst those who live the longest. In this book, Dr Bertil Marklund shares evidence-based lifestyle tips to improve health and wellbeing as well as longevity. The chapter of nutrition is the longest, but also the one I found the most informative. The Swedish doctor, researcher and author talks about foods that strengthen our immune system and protect against, or even cure, inflammation. In short, these are foods that contain:
1. antioxidants (such as fruit and vegetables, as well as herbs and spices), 2. omega-3 and omega-6 in the right proportions (such as fish, shellfish, oils, seeds, nuts and vegetables), 3. fiber (such as wholegrain products, seeds, fruit, and vegetables) and 4. probiotics (such as kefir, yoghurt, tomatoes, onions and sauerkraut), 5. and foods with a low glycemic index (GI) (whole grain products, fruit and vegetables).
There’s nothing groundbreaking here; like Rachel Kelly’s tips, Dr Marklund’s nutrition tips reflect the official recommendations and the world’s healthiest diets (Mediterranean and Okinawan). The reason why I have included this book here is simply because it was the one that sparked my interest in this field.
Ikigai: The Japanese secret to a long and happy life
So, let’s move now to Japan, the country where people live the longest. Like The Nordic Guide to Living 10 Years Longer: 10 Easy Tips to Live a Healthier, Happier Life
1. Variety seems to be key; Okinawans eat a wide variety of foods, especially vegetables. 2. Okinawans eat at least 5 servings of fruit and vegetables every day. 3. Grains are the foundation of their diet. 4. They rarely eat sugar. 5. They follow a concept called ‘hara hachi bu’, which is based on a Confucian teaching that instructs people to eat until they are 80% full.
On that note, I would like to point out that an average woman needs about 2000 calories a day, whereas an average man needs about 2500 calories a day. Yet, overconsumption of calories has become a major public health problem in the developed world. Like Marklund’s book, ‘Ikigai’ goes well beyond diet and nutrition. At the end of the day, the concept of ‘ikigai’ can loosely be translated to ‘a reason for being’, a ‘purpose in life’ or even ‘the reason for which you wake up in the morning’ (akin to a daily purpose). It usually refers to the source of value in one’s life or the things that make one’s life worthwhile.
The ‘Eatwell Guide’
Let’s now look at some official recommendations. In the United Kingdom, a national food guide, the ‘Balance of Good Health’ was introduced in 1994. Thirteen years later, it was revised and renamed to the ‘Eatwell Plate’. This was a visual representation based on 5 food groups and showed the proportion that each food group should contribute to a healthy and balanced diet. The plate was supported by further advice, the ‘8 tips for healthy eating’. Informed by evidence-based nutrition advice, it was revised and renamed once again in 2016. These are the main dietary messages of the ‘Eatwell Guide’ (as it is now called):
1. Eat at least 5 portions of a variety of fruit and vegetables every day (remember the Mediterranean and Okinawan diets). 2. Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates, but choose wholegrain versions where possible. 3. Have some dairy or dairy alternatives, but choose lower fat and lower sugar options. 4. Eat some beans, pulses, fish, eggs, meat and other proteins (including 2 portions of fish every week, one of which should be oily). 5. Choose unsaturated oils (olive oil) and spreads (smashed avocado) and eat in small amounts. 6. Drink 6-8 cups/glasses of water a day. 7. If consuming foods and drinks high in fat, salt or sugar have these less often and in small amounts.
In conclusion
I hope that this post has helped to make this knowledge a bit more palatable and easier to digest (pun intended). To summarize, here are a few small improvements for better physical and mental health:
1. Have three regular main meals: breakfast, lunch and dinner. 2. Have healthy snacks between the main meals. 3. Eat mindfully. 4. Eat in moderation, not too much. 5. Follow a varied but balanced diet of protein, carbohydrate and fat (use the UK Eatwell Guide or other official recommendations as a guide). 6. Eat your 5 (fruit and vegetables) a day. 7. Drink plenty of water, but drink alcohol in moderation, not in excess.
Alongside a healthy balanced diet, do not forget to exercise and keep physically active. Nutrition and exercise are the two sides of the same coin. Both are equally important for better physical and mental health, and for overall better wellbeing.
Further reading on AIDS and nutrition
To read more about AIDS and the psychiatric manifestations of the HIV infection, check out this clinical overview. Future learn offers a wide number of online courses, including ‘Food as Medicine‘. To read more about the Mediterranean diet, check out the Mayo Clinic website. For my very own Mediterranean recipes, check out my post ‘Watermelon & Feta: Mykonos-inspired recipes‘.
Acknowledgements
I’d like to thank Dr Giles Yeo, Shann Nix Jones and Rachel Kelly for sending me copies of their books for read and review.
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Bon appétit!
Alex
(the Traveling Psychiatrist)
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