As a kid of the 70s, I grew up on tuna casseroles and Kool Aid. No one talked about the connection between what we ate and our mood back then. These days there is an increasing understanding that diet is important not only for physical health, but also for mental health. So I thought I would finally look more deeply into how we may all be able to encourage healing from trauma and general mental health through what we eat (or don’t).
On a recent sunny Saturday afternoon, I met with Mary Kay Irving at Fresh Thymes (my new favorite restaurant – thank you Mary Kay!). Mary Kay is a certified nutrition therapist and licensed clinical social worker in Boulder. She works at Mental Health Partners, and also has a private practice in which she offers psychotherapy and holistic nutrition coaching. I was intrigued by this combination and excited to learn more about what she had to say about nutrition and mental health.
Please note that Mary Kay is not a medical doctor and cannot diagnose, treat or cure medical illness.
Mary Kay’s Background
Peg: I love that you are combining mental health and nutrition in your work. How did you get started with that?
Mary Kay: I’ve been a social worker for some time, and it was my own struggle with physical and mental health issues that eventually led me to an interest in nutrition as well. I have a history of anxiety, depression and trauma, and I am also now an 11-year cancer survivor. Through therapy I was able to resolve the psychological issues related to my mental health problems quite a while ago, but still sometimes the anxiety and depression would come up. When I eventually learned how to have a healthy diet, that’s when my anxiety and depression were finally resolved. I’ve now been seven years without medication for those problems, and my seasonal affective disorder seems to no longer exist.
Peg: That’s impressive! What would you say are the most important things you’ve learned about how nutrition affects mental health?
The Problem With the Typical American Diet
Mary Kay: So many physical and mental health issues can be addressed with the same general changes to the typical American diet. Because we’re all so stressed for time, we end up often choosing foods that we can get quickly, which are not usually the most healthy foods. Over time, it has become “normal” to eat in a way that is not optimal for our health.
Peg: Can you tell me the basics about what is wrong with the typical American diet?
Individual Components of the Diet
Mary Kay: One of the most significant things is that our diet tends to include far too much sugar. The typical American diet tends to have a high glycemic load, which means that it causes fast changes in blood sugar. This blood sugar dysregulation can have profound effects on mental health. For example, both low and high blood sugar can increase feelings of anxiety. We’ve all heard of kids eating lots of sugar followed by hyper-active behavior or irritability. For some kids, this “out-of-control” high energy might coincide with an internal experience of anxiety. Adults can also experience these symptoms. After the sugar high comes the low blood sugar crash, which can show up with sweating and shaking and may instigate or worsen feelings of anxiety.
A common contributor to the high sugar problem is that it is often hidden in foods we don’t think of as sugar. Bread and pasta for example quickly break down in the body and become sugar almost immediately. Foods labeled as natural, healthy and “low fat” often have high amounts of sugar.
Mary Kay: The typical American diet tends to be deficient in important vitamins like D and B-complex vitamins. Especially deficiencies in the B complex vitamins are related to depression.
Unbalanced fatty acids and lack of protein
Mary Kay: We’ve also been taught that fat is bad, so many processed foods have removed the natural fat, which then makes the flavor unappealing. To make up for that, things are added to boost flavor. Those things tend to be sugar and salt.
Also, in some common foods, natural fats are replaced by highly processed fats which have a different balance of fatty acids. For example, a good balance of Omega fatty acids includes a 1:1 ratio of Omega 3 and Omega 6. The typical American diet has something like a 1:20 ratio. This imbalance of fatty acids promotes inflammation in our bodies, because Omega 3 is anti-inflammatory, and Omega 6 is pro-inflammatory.
Another problem with the inaccurate and outdated lesson that we need to avoid fats is that animal-based fats are naturally nutrient rich, and are associated with foods that contain good protein. Protein is important for mood regulation, as amino acids (the building blocks of proteins) are used in the production of serotonin. Serotonin is the neurotransmitter that most modern antidepressant drugs attempt to increase. So you can see that protein is not just for building and maintaining muscle mass.
Lack of Fiber
Mary Kay: The typical American diet tends to be low in fiber. This ends up resulting in an imbalanced gut biome, which has many consequences for mental health [discussed in the next section].
Mary Kay: Finally, the typical American is dehydrated. This can lead to headaches, fatigue, constipation, inefficient processing of nutrients, and other problems that can affect both physical and mental health.
Two Big Issues Arising From This Diet
Peg: You’ve mentioned inflammation and an imbalanced gut biome. Tell me more about these issues, and how they’re related to mental health.
Unbalanced Gut Biome
Mary Kay: Yes, these are really the two big ways that nutrition and mental health are linked. An imbalanced gut biome is problematic for mood because most of our serotonin is produced in our gut by helpful microbes. If our gut biome is unbalanced, with too many bad microbes and not enough good ones, then that may be one reason that we have insufficient serotonin in our brains, and therefore depression and anxiety.
One reason that fiber is so important is that it is food for helpful gut bacteria. We typically do not eat the amount of fiber that our bodies (or rather, our helpful gut bacteria) are evolved to require.
Add to this the fact that the high amount of sugar in our diets feeds the unhelpful bacteria, and you can see that the typical American’s gut biome is pretty out of balance. This leads to all kinds of common things that we tend to not take seriously: Intestinal distress, abdominal pain, diarrhea, etc.
Peg: I’ve also heard that breastfeeding is important for developing a healthy microbiome in babies. And I’ve begun to hear people talking about how all of the antibiotics we give kids for things like strep throat and ear infections disrupt development of a healthy biome.
Mary Kay: That’s right. It’s not all diet. It’s our whole lifestyle that tends to work against developing a healthy gut biome.
Mary Kay: Inflammation is promoted by eating lots of sugar, nutrient deficiencies including vitamin D, and not having the correct balance of fatty acids, as we discussed earlier.
An interesting finding about inflammation and mental health is that there is a particular protein, called C-reactive protein that is an indicator of the level of inflammation in the body. Most standard blood tests that you get at the doctor include testing for C-reactive protein. Studies have shown those with higher levels of C-reactive protein, and thus inflammation, are more likely to develop Post Traumatic Stress Disorder upon exposure to distressing events. So keeping the body’s inflammation low in general can apparently help prevent the development of some mental health issues.
Peg: That is huge! I’ve never heard that before. But it makes a sort of intuitive sense to me that a healthy diet and therefore a healthy body might protect us not only from getting sick, but also from developing more problematic mental responses when bad things happen to us.
How to Correct The Typical Diet
Peg: I was expecting that our conversation might cover specific dietary changes that might support specific mental health conditions, but I’m starting to get the sense that it doesn’t work that way.
Mary Kay: That’s partially true. Regardless of a particular mental health condition, in general it is the same baseline of good food and a balanced diet that will help everyone. In my case, the same changes to my diet were helpful for surviving cancer, for controlling anxiety and depression, and for regulating blood sugar levels for pre-diabetes. What I needed – what we all need – is generally a natural foods diet, composed of real foods that our body recognizes. There will, of course, be individual differences for people with food allergies, certain genetic conditions, and diagnoses that will respond better to certain nutrient dense foods. And some conditions may benefit from supplementation.
Really, the solution is to prepare whole, natural foods that have the natural fats intact, and don’t have synthetic materials, highly processed ingredients and added sugar. It definitely requires an investment. Some people have never learned how to cook, and they need to start with that. For some people, the hardest part might be that it takes more time than grabbing a quick, microwaved meal. And unfortunately, healthy food is more expensive than McDonalds. And yet, for most people, I believe it’s well worth the investment.
Genetic Conditions Related to Nutrition and Mental Health
Peg: You mentioned genetic conditions. How can those affect the link between nutrition and mental health?
Mary Kay: There are a few common gene mutations that have a link with nutrition. Usually when these are discovered, it’s by integrated holistic health professionals, as opposed to medical doctors. Often there is no conventional medical prescription or treatment to treat them. But functional medicine doctors will often test for these.
One of the most common is the MTHFR mutation, which affects a person’s ability to process folate (vitamin B9). Folate is an essential nutrient, used in many of the body’s important chemical pathways and people can get quite sick when their body can’t utilize it correctly. There are many symptoms of this condition, including depression and anxiety. The usual treatment involves a particular form of supplement and focusing on a healthy (low stress) lifestyle including eating food naturally high in folate.
Another condition that is thought to be genetic is pyroluria. This one affects a person’s ability to process B6 and zinc. When I see someone who reports lifelong anxiety, along with a family history of anxiety, I usually consider having them do a urine test to check for pyoluria. The nutritional treatment again involves specific supplements.
How Does Mary Kay Work?
Peg: Let’s switch gears for a minute and talk about exactly how you use your expertise when working with clients.
Mary Kay: Sure. When I start working with a new client, I’ll begin by collecting a lot of information about their medical history, past and current symptoms, previous diagnoses, whether they were breastfed as infants, and their individual goals. Then I have them keep a food diary for 3 to 5 days. That’s not about judging at all---it’s about learning what they like, what their food habits are, and how we can make the biggest impact. With that information, I then create an individualized nutrition plan that accounts for foods the client likes and doesn’t like and their individual symptoms, goals and eating habits. I often offer specific recipes, and sometimes I teach tools for stress management or provide trauma therapy if that is appropriate.
Peg: What are the most common changes that you recommend for people?
Mary Kay: Reduce sugar intake. Often people don’t think they eat a lot of sugar, but then it turns out that they are getting a surprising amount of sugar from “healthy” things like juices or energy bars. The next most common change is to add back in whole food proteins with natural fats for people who have eliminated proteins while trying to eliminate fats. And almost everyone needs to drink more water.
Peg: Do you often recommend vitamins and other supplements?
Mary Kay: I think a lot can be accomplished simply by shifting to a healthy diet. And sometimes supplements also help. I do want to point out that when adding supplements it’s important to work with someone knowledgeable. There are a number of pitfalls. Some supplements interact with each other, and taking too much of some supplements can create problems. Take Vitamin B for example: There is not one vitamin called B but rather a whole complex of B vitamins including Thiamin, which is B-1 and folate, B-9 and several others, each having different roles. A particular B vitamin deficiency, such as B-6, which we spoke about with pyroluri, can increase anxiety. But some genetic conditions make processing of some B vitamins problematic, such as the MTHFR mutation we spoke about earlier. So, simply supplementing with any old B complex could actually increase anxiety for some who need a particular form of the B vitamins. There are many things to consider so you want a provider or team of providers knowledgeable enough to know what to look for in their specialty area and know when to refer to another team member.
Resources for More Learning
Peg: For people who want to learn more, do you have resources that you’d recommend?
Mary Kay: There is a great film about sugar called “That Sugar Film.” You can get it on Amazon. It’s a documentary in which a guy switches from a natural foods, sugar-free diet, to a diet in which he eats the amount of added sugar in the typical Australian diet (very similar to the standard American diet). He eats the recommended daily allowance of sugar, all in the form of foods and drinks that are considered healthy and not as candy, etc. It’s a fun, watchable film.
I also think Dr. Kelly Brogan (a board certified psychiatrist) has a lot of wonderful information out there about food, lifestyle and problems associated with using prescription medications.. She has a book called “A Mind of Your Own” about using food for depression and mental health.
Dr. David Perlmutter also has a couple of good books: “Grain Brain”, and “Brain Maker.”
For people who are into the science of good nutrition, Gary Taubes has written some good books: “Why We Get Fat”, and “Good Calories, Bad Calories.” Finally, there is “Brain Health” by Dr. Daniel Amen.
I am also planning to offer a group near the holidays for those with depression who need support around maintaining a healthy lifestyle.
Aside from that, there are all kinds of Facebook and Meetup groups for all kinds of dietary conditions that can provide helpful support.
Peg: I’ve noticed that there are also many groups for people following all kinds of diets, some of which don’t seem very healthy. Do you have suggestions for how we can make sure groups are based on solid principles?
Mary Kay: Yes, that’s true. I recommend looking for a group that has a licensed or certified health professional involved as well as someone who engages in continuing education to keep up with the ever growing library of nutrition science out there. Additionally, most of the legitimate diets (and by ‘diet’ I mean a ‘way or style of eating’ rather than depriving oneself of calories) focus on eating whole natural foods and do not generally pitch the sale of a particular meal replacement shake.
Conclusions & Contact Info
Peg: Mary Kay, thank you so much for talking to me. I feel like I’ve learned a lot that I can start using right away, and I’m definitely going to check out some of the resources you mentioned.
For anyone who would like to reach out to Mary Kay for more information or to explore working with her, please contact her through her private practice, Boulder Center for Health and Nutrition.
Was this interview helpful to you in your journey to heal or help others heal? Is there anyone else you would like me to interview, or additional information you’d like to see in these posts? Please add a comment below!