On January 21st, 2020 we released the podcast episode, Nutrition, brain metabolism, and the root causes of mental illness with Georgia Ede, MD, for our show Mental Horizons. That hour-long conversation provides a foundation for understanding energy metabolism in the brain, 10 nutritional changes you can make to improve your brain and metabolic health, and how dietary changes can support the health of someone with a serious mental illness. As I promised during that podcast, this blog post lists and breaks down the 10 changes that Dr. Ede discussed during the episode.
NOTE: Dr. Ede recommends items 1 - 4 for everyone, regardless of your mental health status. Items 5 - 10 are presented specifically for someone with a mental health disorder.
1. Eliminate processed foods.
What is processed food? Food is considered "processed" after it has undergone mechanical or chemical changes. Examples include grinding grain into flour or combining food elements and preservatives to make hyper-palatable convenience (a.k.a. junk) foods.
The first step to eliminating processed foods is to read ingredient labels. Become familiar with the foods you are putting into your body. If you don't recognize an ingredient, look it up and learn what it is.
Sometimes it's easier to think about what you can eat instead of what you can't. Here is a list of whole foods on which to base your diet:
Meat, fish, eggs, and dairy
A variety of vegetables
Fruit, especially berries
Health oils (minimally processed). Olive oil and avocado oil are two great examples.
Fresh and dried herbs
And as you can tolerate them (these foods can be problematic for some people):
Nuts and seeds
Whole grains that do not contain gluten
Legumes and beans
At the bare minimum, we should all be taking this step. As Dr. Ede urged in the podcast, you don't need the guidance of a doctor to do this one. Everyone will benefit from this simple yet profound dietary shift.
Research: If you want to know more about the science behind hyper-palatable, highly processed foods and their impact on our health, check out this post from Robert Lustig, MD.
More: If you want more guidance on how to make this change, check out Dr. Mark Hyman's website where he writes extensively on how to clean up your diet. He cleverly calls the diet he recommends the "pegan" diet: paleo + vegan. His book, Food: What the Heck Should I Eat? is a readable, actionable guide to helping you make changes and gives you all the science behind how these changes will support your wellbeing.
2. Test for insulin resistance.
"Insulin resistance is a hormonal condition that sets the stage throughout the body for inflammation and overgrowth, disrupts normal cholesterol and fat metabolism, and gradually destroys our ability to process carbohydrates." - Georgia Ede, MD
In the podcast, we also spoke about purchasing a glucometer and the empowering effect that measuring your own blood glucose and ketone levels can have, especially aiding motivation for changing behaviors. There are several inexpensive glucometers on the market today if you're interested in tracking this yourself at home.
Because of our modern, high-carbohydrate diet, many people will test positive for insulin resistance. As Dr. Ede writes on her website,
"We are the unlucky, growing majority—most of us gain weight by simply thinking about a muffin, and if we actually give in to our cravings and consume the aforementioned muffin, we then cannot stop thinking about…another muffin. Mmmm…muffin…muffin…muffin…If you have insulin resistance, then your carbohydrate metabolism is badly damaged."
If you end up testing positive for insulin resistance, see item 7 below.
3. Test for nutrient deficiencies.
Deficiencies in nutrients such as B12, iron, and zinc can lead to a host of brain and metabolic issues. Dr. Ede recommends you familiarize yourself with these nutrients and then ask your primary care physician to test you for them. If you want to learn more, read her article, Your Brain on Plants: Micronutrients and Mental Health.
4. Eat a paleo diet.
The paleo diet is very trendy, so chances are you've heard of it. The term "paleo" refers to the paleolithic era, a pre-agricultural time when humans were hunters and gatherers and subsisted on herbs and berries foraged from vast swaths of land and when they hunted animals for meat.
The paleo diet is very similar to the whole foods diet outlined in item 1 but eliminates agricultural foods such as grains, beans, and most dairy products. Dr. Ede has published an article on Psychology Today titled, 6 Reasons to Go Paleo for Mental Health that will help you get started down this path.
The paleolithic era lasted a couple of million years and preceded human inventions such as agriculture. Our human brains and bodies evolved on the paleo diet. It is how humans fed themselves for hundreds of millennia. We have been eating an agriculturally-based (carbohydrate-based) diet for a comparatively minuscule time and in that minuscule time, have seen a sky-rocketing of chronic physical and mental illnesses. The reasons behind this skyrocketing are not just diet, but diet is a big player.
The paleo diet doesn't mean you return to hunting and gathering (although if you wanted to, hunting and foraging are popular and fun activities!). This is not some rose-colored-glasses romanticizing either of the times gone by. In fact, converting to a paleo diet is not a step back in time, but a step forward towards a more sustainable future that includes sophisticated regenerative agricultural practices.
Learn more: listen to The Doctor's Farmacy podcast with Dr. Mark Hyman, specifically the episode Can Eating Regenerative Meat Help Reverse Climate Change?.
5. Test for immune and autoimmune issues.
Items 1 - 4 were recommendations that Dr. Ede made for everyone. Items 5 - 10 she recommends you look into if you have a mental health disorder.
Testing for immune and autoimmune dysregulation can help you figure out if you're experiencing chronic inflammation. As detailed in the 2-part special report in the Psychiatric Times in 2018, The Inflammation Connection, there are strong links between immune (dys)function and mental health.
Dr. Ede recommends you get tested for high-sensitivity C-reactive protein (HSCRP) to evaluate your risk for immune dysfunction. She also recommends you get tested for celiac disease and thyroid disease.
6. Do a gut check.
The gut lining forms a critical protective barrier between the foods and substances we digest and our internal organs and circulatory system. The gut microbiome is the bacteria living in our mouth, stomach, intestines, and colon.
Gut bacteria play a crucial role in myriad chemical reactions in our bodies, including producing the majority of Serotonin our brains need. Serotonin is a hormone that plays a lead role in mood regulation, according to the American Psychological Association. There are different imbalances that can occur when your microbiome is disrupted or become imbalanced.
If your gut lining is damaged (which can happen after prolonged exposure to gluten, among many other things) then particles that don't normally enter your bloodstream can get through and trigger inflammatory responses in your body.
Dr. Ede briefly touched on the following interventions to address gut issues: omitting certain problem foods, eating foods that can be healing for the gut, and reducing your intake of fibrous foods. So if you feel like you are having gut issues, either due to gut lining being compromised or your microbiome being out of balance, check out Dr. Ede's article Cooling Brain Inflammation Naturally with Food.
More: Chris Kresser, M.S. is a functional medicine practitioner and has an article on his website that outlines 9 things you can do to. heal your gut.
Mark Hyman, M.D. has a great article on his website titled Inflammation: How to Cool the Fire Inside You That’s Making You Fat and Diseased that will provide additional helpful tips and research.
Chris Palmer, MD was on Paul Saladino, MD's podcast, Fundamental Health, in October 2019 and spoke with him for over 2 hours on the topic of diet, inflammation, and mental illness. Listen to that fascinating episode here and fast forward to the 43-minute mark if you just want to hear the bit about inflammation.
7. If you have insulin resistance, try a low-carb high-fat diet.
In item 2, Dr. Ede recommends you get tested for insulin resistance. And if, in fact, you are insulin resistant she recommends you check out her 5-part series on DietDoctor.com.
Start with the article, Low carb and mental health: Getting started and managing medications and then check out the guide, A low-carb diet for beginners.
Dr. Ede recommends you do not start a low-carb high-fat diet without first consulting your prescribing physician. Eating a low-carb diet can cause significant changes to internal levels of hormones and can alter levels of medications in your system. It is important, especially if you're taking medications, to make the changes slowly and do so with professional, qualified guidance. Pay close attention to the side effects of making this change and take it slow!
8. If a low-carb high-fat diet does not get you the results you hoped for, try a simple ketogenic diet.
A simple ketogenic diet is different from a low-carb high-fat diet in that you are mindfully keeping your carbohydrates below a certain level, typically under 30 grams per day (some experts recommend under 50 grams per day) and you are deliberately trying to enter into and stay in a mild to moderate state of ketosis. This requires more self-monitoring than the low-carb high-fat diet that allows for 50-100 grams of carbohydrates per day.
The good news is that there are loads of resources and apps online to help you with this. But as was mentioned by Dr. Ede with item 7, if you are taking medications and want to attempt a simple ketogenic diet, do not do this on your own. Work with your providers, ideally those who are familiar with the research around the benefits of the ketogenic diet, so that they can monitor your blood levels and help you ease into and stay in ketosis.
More: Dr. Ede has a great article on DietDoctor.com titled, Ketogenic diet for mental health: Come for the weight loss, stay for the mental health benefits? to get you oriented to the basics.
Chris Palmer, MD has a wealth of resources on his website, Chris Palmer, MD: Exploring the interface of mental health & metabolic disorders. He has written and speaks extensively on the use of the medical ketogenic diet for mood and psychotic disorders. Be sure to listen to the episode he did with us on. Mental Horizons, where he talks about this topic: Nutritional Psychiatry, Metabolic Disorders, and the Ketogenic Diet as Medical Intervention.
9. Explore possible food sensitivities.
Elimination diets are a tool used by physicians and dieticians to rule out food sensitivities. The idea is to eat a diet free from common problem substances like gluten, dairy, eggs, peanuts, legumes, or artificial dyes and flavorings for a set amount of time, such as 4 weeks. And then at the end of that elimination period, the foods that had been eliminated are added back slowly, one at a time. And as you add back a food, you pay close attention to how it affects your body and mind. Elimination diets require effort and planning but can be incredibly helpful in determining which foods to avoid.
In a 2019 article in the Journal of Clinical Psychiatry, Chris Palmer, MD wrote,
"Elimination diets systematically remove nutrients or substances from the diet, assuming that something in the diet is causing symptoms. In psychiatry, these diets are sometimes used in children diagnosed with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD).14–16 For ADHD, artificial food colors are often eliminated, and for ASD, gluten and/or casein are often eliminated, but other substances can be part of elimination diets.19 A 2013 meta-analysis of dietary interventions for ADHD found a significant effect for the elimination of artificial food colors..."
More: read Dr. Palmer's entire article, Diets and Disorders: Can Foods or Fasting Be Considered Psychopharmacologic Therapies? to do a deep dive into the research.
10. If nothing else works, consider the carnivore diet.
If you have followed Dr. Ede's above recommendations, have tried the low-carb high-fat diet for a long period of time, have also tried the ketogenic diet for a long period of time, and still feel like you have more work to do, then she recommends looking into the carnivore diet. The carnivore diet includes only meat, fish, and other animal foods like eggs and certain dairy products. It excludes all other foods, including fruits, vegetables, legumes, grains, nuts, and seeds.
Dr. Ede writes about this topic on Psychology Today in an article titled, The Carnivore Diet for Mental Health?:
There are many different dietary strategies that can help people achieve [improved mental health ] —removing processed foods, carefully supplementing whole food plant-based diets, ketogenic diets, etc. It's important to emphasize that most people probably don't need to go to the extreme of removing all plants from their diet in order to experience relief, and of course, no diet, including a carnivore diet, will work for everyone.
All that being said, I have consulted with many people who report significant mental health benefits on low-plant and plant-free diets.
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