Take Ten Blueberries and Call Me in the Morning

Would you believe that a bowl of blueberries can help to lessen feelings of depression or anxiety? (I thought only chocolate ice cream did that until you stepped on the scale the morning after.) Did you know that some physicians and researchers believe that spices such as saffron and turmeric can help to improve your mood?

Are you aware that what you put into your body (think strawberry shortcake versus whole strawberries) can significantly affect emotional well-being and physical health?

In March 2023, the American Psychiatric Association, in partnership with the American Society for Nutrition, highlighted the interconnectedness of nutrition and mental health. 

They polled 2,200 adults to see how the public views that connection; 66% of adults surveyed said they felt knowledgeable about the relationship between diet and mental health and 81% said they'd be willing to change their diet to impact their mood positively.

According to Drew Ramsey, MD, a psychiatrist, assistant clinical professor of psychiatry at Columbia University College of Physicians and Surgeons, founder of the Brain Food Clinic in New York City, and the author of several books about food and mental health, nutritional psychiatry is a subset in the mental health field which looks at how food impacts our brain and helps to prevent or treat mental health conditions.

"Years ago, there was little attention paid to the way in which food intake influences mood, and psychiatrists didn't necessarily appreciate the relevance of looking at diet as part of a comprehensive assessment. As data emerged about how lifestyle factors such as how we eat, along with exercise and adequate sleep, affect our mental health, we became more interested in optimizing health through nutritional medicine," says Ramsey.

The International Society for Nutritional Psychiatric Research has advocated for the integration of nutritional medicine with mainstream psychiatric practice, emphasizing the need for research, education and health promotion to support this holistic approach to mental wellness.

Uma Naidoo, MD, a psychiatrist, Harvard professor, professional chef and culinary instructor, is the Director of the Nutritional and Lifestyle Psychiatry program at Massachusetts General Hospital, which highlights how evidence-based nutritional practices can be part of a comprehensive treatment plan for mood disorders, depression and anxiety. 

Her 2020 book, "This is Your Brain on Food," reviews the mood-food connection, in which she discusses her six pillars of Nutritional Psychiatry including: 

• Be whole, eat whole. She recommends the mainstay of your diet should focus on natural, high-fiber foods such as vegetables, fruits, nuts, seeds and healthy protein sources.
• Eat the rainbow. Different color plant foods contain brain-boosting nutrients called flavonoids, phytonutrients which help to reduce oxidative stress in brain cells. Low glycemic vegetables such as leafy greens (kale, spinach, collard greens, watercress), radishes, eggplant and tomatoes give you essential nutrients, including vitamins K and C, folate, magnesium and calcium.
• The greener, the better. Greens contain folate, an essential vitamin that has a critical role in the functioning of the central nervous system. Low levels of folate have been shown to increase the risk for depression, as well as sometimes reducing the effectiveness of antidepressant medications.
• Tap into your body's intelligence. Be aware of how certain foods make you feel (sluggish? hyper?) and modify your intake in response to any mental health symptoms.
• Consistency and balance are key. Create sustainable dietary and lifestyle changes rather than looking for "quick fixes" with restrictive or non-nutritious diets.
• Avoid anxiety-producing foods. Inflammatory foods with refined or added sugar or nitrate-containing processed foods and meats can increase anxiety as well as depression.

Ramsey says, "nutritional medicine encourages us to pay attention to the relatively new science of brain health, which looks at the significance of neuroplasticity, the ability of our brains to grow and change even in adulthood. We integrate that with our understanding of psychotherapy and personalized medicine and the ways in which we treat and prevent mental health disorders."

Understanding the connection between the brain and the gut, called the gut-brain axis, is also essential. The gut microbiome, consisting of all the microorganisms (bacteria, fungi and viruses) that reside in our bodies, has a complex interaction with the brain, affecting mental health in several ways. 

Research has shown that various nutrients and micronutrients such as tryptophan, Vitamin B6, Vitamin B12, folate, tyrosine, zinc, magnesium and others are essential for the synthesis of neurotransmitters such as serotonin, dopamine and norepinephrine, which travel from the gut to the brain via the vagus nerve. 

"Serotonin is crucial in maintaining and regulating positive mood, clarity of thought and appetite. There can be no mental health without serotonin," says Ramsey.

Wondering what dietary interventions or foods are helpful if you struggle with mental health issues? Avoiding highly processed foods, refined carbohydrates, trans fats, soybean and corn oil, food dyes and foods with many preservatives can undoubtedly help. 

So can eating plenty of complex carbohydrates, such as whole grain bread and pasta, quinoa and oatmeal, which help tryptophan cross the blood-brain barrier. Hands down, experts agree that the Mediterranean diet, with its emphasis on fruits, vegetables, fish, whole grains and healthy fats, is the most beneficial way to eat to optimize both physical and mental health.

Moreover, studies over the years have suggested that for a subset of patients with depression, chronic inflammation may play a role in reducing neuroplasticity and inhibiting the brain's reparative mechanisms.

"Especially for people with treatment-resistant depression, we want to encourage the avoidance of pro-inflammatory foods, particularly those with excess sugars, trans fats, food dyes and preservatives," says Ramsey. 

Increasing your consumption of cruciferous vegetables such as broccoli, which act as powerful anti-inflammatory agents, is helpful. To protect brain health, Ramsey suggests including these foods in your diet:

• Olive oil
• Lentils: High in fiber and folate
• Pesto: Contains concentrated greens like basil or kale, olive oil, garlic, nuts and greens.
• Salmon or fatty fishes with long-chain omega-3 fatty acids (EPA and DHA)
• Potatoes: Full of fiber, potassium and phytonutrients; they have iodine and vitamin C. Most vitamins and minerals are in the potato's skin, so small ones are great because you get a lot of skin.
• Kefir (a fermented dairy product) or yogurt containing probiotics to increase the diversity of your microbiome.
• Wild blueberries contain anthocyanins, blue pigment molecules that reduce inflammation by affecting gut bacteria.

And, for anxious individuals who may have some sensitivities to food-related substances, Ramsey says that certain types of foods (maca powder, green tea extracts, caffeine or even dark chocolate, which contains theobromines that can cause rapid heart rate and palpitations) may increase anxiety and should be avoided or used sparingly.

Author Karen Salmansohn's quote makes me smile every time I read it. "Eating healthy food fills your body with energy and nutrients. Imagine your cells smiling back at you and saying thank you!" 

And the Buddha, in his infinite wisdom, wrote, "To keep the body in good health is a duty. Otherwise, we shall not be able to keep our mind strong and clear." I think I'll eat an apple now.

Barbra Williams Cosentino RN, LCSW, is a psychotherapist in Queens, N.Y., and a freelance writer whose essays and articles on health, parenting and mental health have appeared in the New York Times, Medscape, BabyCenter and many other national and online publications. Read More