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Role of Nutrition in Mental Healthcare

Afia’a Mohammed Al-Masri
Dietitian at Al  Ahli Hospital

Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. As countries introduce measures to restrict movement as part of efforts to reduce the number of people infected with COVID-19, more and more of us are making huge changes to our daily routines.

The new realities of working from home, temporary unemployment, home-schooling of children, and lack of physical contact with other family members, friends and colleagues take time to get used to. Adapting to lifestyle changes such as these, and managing the fear of contracting the virus and worry about people close to us who are particularly vulnerable, are challenging for all of us. They can be particularly difficult for people with mental health conditions. Mental health remains a neglected part of public health agendas, even though mental health conditions account for nearly 20% of years of life lost due to disability and are associated with up to US$ 1 trillion per year in economic losses. Over 300 million people worldwide suffer from depression (and almost the same number from anxiety disorders), while global suicide (up to 800 000 deaths per year) is a leading cause of death in young people.

The statistics for common mental disorders are increasing because populations are growing, and more people live to the age when depression and anxiety most commonly occur. Mental health problems have a big health and social impact on societies.  It has recently been estimated that mental, neurological and substance-use disorders (i.e. schizophrenia, depression, epilepsy, dementia, alcohol dependence) account for 13 % of the global burden of disease placing mental illness as the greatest burden, exceeding both CVD and cancer. 

While sobering, these figures are perhaps unsurprising since there is now one new case of dementia diagnosed every 4 s, or 7•7 million cases per year. More than 300 million people are now living with depression, an increase of more than 18 % between 2005 and 2015. By 2020, it is estimated that between 15 and 30 million people will attempt suicide and approximately 1•5 million per year will die by suicide each year. Depression is ranked by WHO as the single largest contributor to global disability (7.5% of all years lived with disability in 2015). 

Mental health problems are believed to be the result of a combination of factors, including age, genetics and environmental factors. One of the most obvious, yet under-recognized factors in the development of major trends in mental health is the role of nutrition. The treatment implications of research into nutrition and mental health have rarely been acknowledged by mainstream medicine, yet the potential returns are enormous. 

The role of diet in relation to mood and mental wellbeing

Just like the heart, stomach and liver, the brain is an organ that is acutely sensitive to what we eat and drink. To remain healthy, it needs different amounts of complex carbohydrates, essential fatty acids, amino acids, vitamins and minerals, and water. Anyone who has ever smoked, drank alcohol, tea or coffee or eaten chocolate knows that such products can improve one’s mood, at least a little and temporarily. What seems to be less common is an understanding that some foods can have a lasting influence on mood and mental wellbeing because of the impact they have on the structure and function of the brain. 

The last fifty years have witnessed remarkable alterations to what we eat, how we process and refine it, food additives, use of pesticides and the alteration of animal fats through intensive farming. Diets high in refined sugars, for example, are harmful to the brain. In addition to worsening your body’s regulation of insulin, they also promote inflammation and oxidative stress. Multiple studies have found a correlation between a diet high in refined sugars and impaired brain function — and even a worsening of symptoms of mood disorders, such as depression.

It makes sense. If your brain is deprived of good-quality nutrition, or if free radicals or damaging inflammatory cells are circulating within the brain’s enclosed space, further contributing to brain tissue injury, consequences are to be expected. 

How fats and amino acids work in our brains

Because the ‘dry weight’ of the brain is composed of about 60% fat, the fats we eat directly affect the structure and substance of the brain cell membranes. Saturated fats – those that are hard at room temperature, like lard – make the cell membranes in our brain and body tissue less flexible. Twenty per cent of the fat in our brain is made from the essential fatty acids omega-3 and omega-6. 

Each fatty acid performs vital functions in the structuring of brain cells (or neurons), ensuring that smooth communication is possible within the brain. Both are found in equal amounts in the brain, and it is believed they should be eaten in equal amounts. Unequal intakes of omega-3 and omega-6 fats are implicated in a number of mental health problems, including depression, and concentration and memory problems. The recent and widespread appearance of trans-fat in the diet raises great concern, primarily because these fats assume the same position as essential fatty acids (EFAs) in the brain, meaning vital nutrients are not able to assume their rightful position for the brain to function effectively. Trans-fats are prevalent and pervasive, found in processed foods like commercially-made cakes, crisps and ready meals. 

Amino Acids are the building blocks for Neurotransmitters

Neurotransmitters are messengers passed back and forth within the brain. They allow neurons to communicate information amongst themselves. Neurotransmitters are made from amino acids, which often must be derived directly from the diet. For example, the neurotransmitter serotonin, which is associated with feelings of contentment, is made from the amino acid tryptophan. Adrenaline and dopamine, the ‘motivating’ neurotransmitters, are made from phenylalanine.

A sufficient balance of neurotransmitters is essential for good mental health, as they are influential in the feelings of contentment and anxiety, memory function and cognitive function. Some foods are perfect at temporarily promoting the neurotransmitter that we lack and, as we crave and then consume them, they ‘trick’ us into feeling better, for a while. By making the brain less sensitive to its own transmitters and less able to produce healthy patterns of brain activity, these substances encourage the brain to down-regulate. Down-regulation is the brain’s instinctive mechanism for achieving homeostasis: when the brain is ‘flooded’ by an artificial influx of a neurotransmitter (for example, adrenaline triggered by a strong coffee), the brain’s receptors respond by ‘closing down’ until the excess is metabolized away. This can create a vicious circle, where the brain down-regulates in response to certain substances, which in turn prompt the individual to increase their intake of those substances to get the release of the neurotransmitter that their brain is lacking. This is one reason why people sometimes crave certain products. 

Acetylcholine is a neurotransmitter that, if deficient, causes deterioration of memory and imagination, fewer dreams, increased confusion, forgetfulness and disorganization. In order to ensure getting enough from this neurotransmitter, we need to avoid sugar, deep-fried food, Junk foods, refined and processed foods, Cigarettes and Alcohol. We get good levels of Acetylcholine through consuming organic/free-range eggs, organic or wild fish – especially salmon, mackerel, sardines and fresh tuna.

Serotonin is a neurotransmitter that helps regulate sleep and appetite, mediate moods, and inhibit pain. Since about 95% of your serotonin is produced in your gastrointestinal tract, and your gastrointestinal tract is lined with a hundred million nerve cells, or neurons, it makes sense that the inner workings of your digestive system don’t just help you digest food, but also guide your emotions. What’s more, the function of these neurons — and the production of neurotransmitters like serotonin — is highly influenced by the billions of “good” bacteria that make up your intestinal microbiome. These bacteria play an essential role in your health. They protect the lining of your intestines and ensure they provide a strong barrier against toxins and “bad” bacteria; they limit inflammation; they improve how well you absorb nutrients from your food; and they activate neural pathways that travel directly between the gut and the brain. Serotonin deficiency affects the body by lowering the mood, inducing insomnia, feeling ‘disconnected’ and lacking joy. Consuming Alcohol decreases the amount of serotonin in the brain, whereas taking more fish, fruits, Eggs, avocado, wheat germ, Low-fat cheese Lean, and organic poultry increases its level.

Dopamine deficiency symptoms include lacking drive, motivation and/or enthusiasm, and to crave stimulants. To ensure getting enough amount we need to avoid or limit consumption of Tea & coffee, caffeinated drinks & pills. While eating regular, balanced meals, increasing fruits and vegetables that are high in Vitamin C, Wheat germ and Yeast spread in our diet ensures that we are getting enough of this neurotransmitter.

Last one is GABA, its deficiency in the brain makes the person hard to relax, can’t switch off, anxious about things, Irritable, and self-critical, deficiency might be induced if we consume high amounts of sugar, alcohol, tea & coffee and caffeinated drinks. This neurotransmitter availability increases if we consume more dark green vegetables, seeds & nuts, potatoes, bananas and Eggs.

Deficiencies in vitamins and minerals are sometimes implicated in a number of mental health problems. On occasions, the first symptom that a body is deficient in a certain micronutrient is psychological. In addition, some vitamins work as anti-oxidants, which protect the brain from the damaging process of oxidation. Vitamins and minerals also play a crucial part in the conversion of carbohydrates into glucose, fatty acids into healthy brain cells and amino acids into neurotransmitters. As such, they are vital in promoting and maintaining positive mental health.

Vitamin B1 (Thiamin) deficiency causes poor concentration and attention, it is available in wholegrains and vegetables, whereas Vitamin B3 deficiency causes depression, but it can be avoided if we consume more from the wholegrains and vegetables, soymilk, and watermelon.

Vitamin B5 deficiency is related to poor memory and stress, B5 is highly available in chicken, whole grains, broccoli, avocados, and mushrooms as well.

If Vitamin B6 (pyridoxine) is deficient, it causes irritability, poor memory, stress as well as depression. B6 is available in wholegrains, meat, fish, poultry, legumes, tofu and other soy products, and bananas 

Vitamin B12 deficiency causes confusion, poor memory, and psychosis. B12 is found in Meat, poultry, fish, milk, cheese, fortified soymilk and cereals. 

Vitamin C limited consumption causes depression but it can easily avoided if we consume Citrus fruit, potatoes, broccoli, bell peppers, spinach, strawberries, tomatoes, Brussels sprouts that are considered as very good sources. 

The last vitamin we will mention is Folic acid that is highly available in fortified grains and cereals, asparagus, spinach, broccoli, legumes (black-eyed peas and chickpeas), orange juice, but if deficient in the body it will cause anxiety, depression and psychosis. 

From all the essential minerals, three are more related to mental health which are Magnesium, Selenium and Zinc.

Magnesium deficiency causes irritability insomnia and depression, it is found in rich sources are Spinach, broccoli, legumes, seeds, whole-wheat bread. Also Selenium deficiency is related to irritability and depression, Selenium is found in organ meat, fish, and seafood, walnuts, wheat germ, brewer’s yeast, liver, garlic, sunflower seeds, Brazil nuts, and wholegrains. The last mineral is Zinc, once deficient it will cause confusion, blank mind, depression, loss of appetite, and lack of motivation. We can get enough Zinc from meat, shellfish, legumes, whole grains, oysters, nuts, seeds and fish.

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