The Nutrition for Mental Health Revolution
David Wiss PhD, MS, RDN
Founder, Wise Mind Nutrition; @drdavidwiss
I was born in 1981, right around the time that the average BMI in the United States began to rise. By the 1990s, obesity had been declared an epidemic. During this time, there was a societal push toward low-fat and nonfat products, and “diet” products with artificial sweeteners were considered “healthy choices.” I remember choosing “fruit snacks” made from corn syrup because they were “fat-free” and choosing snow cones over ice cream because saturated fat had such a bad reputation. But don’t worry — this article is not about obesity!
My father, a surgeon (now retired), knew very little about nutrition. My mother did the best she could with the information she had. A low-fat snack cake, Twinkie Light, or Top Ramen were regular snack foods in my home. I can recall wanting to spend time at friends’ houses who had even better snacks (e.g., Captain Crunch cereal, because Cinnamon Toast Crunch was as far as my mother was willing to go). Nutrition researchers now identify this era as a negative turning point in the health of Americans and much of the developed world.
As a teenager, I never would have predicted that I would become a registered dietitian nutritionist and PhD candidate, with 19 peer-reviewed journal articles and book chapters on topics related to nutrition, body image, eating disorders, food addiction, drug addiction, alcohol, trauma, depression, and organizational change. I would not have been able to predict the creation of Wise Mind Nutrition. When I was an undergraduate student, I enrolled in a nutrition class but dropped it because the class project was to track calories and body weight changes throughout the semester. I simply was not in the mood at that time!
In recent years, documents have revealed efforts by the sugar industry to demonize fat and thereby exonerate sugar. This deceit has been described in detail by various journalists. The main argument in favor of sugar and against fat was based on the calorie model, which relies on the concept of “energy balance” (i.e., calories in, calories out) in the “war against obesity.” The gist was that per gram fat has more than twice the calories of sugar; therefore, efforts to control caloric intake should be primarily focused on reducing fat. However, low-fat foods generally do not taste great; they need some added sugar to make them palatable. The focus on “low calorie” has been relentless ever since. However, more people are now aware of deceitful practices by Big Food and other emerging nutrition frameworks, which is the focus of this article.
Nutrition as a field has a bad reputation because it is challenging to study, relative to medicine, and because many of the effects of food on human health are generally slow (think lifetime), conducting randomized controlled trials on large groups is costly. Therefore, most of the evidence is retrospective and cross-sectional, leading to associations and not causal conclusions. There are lots of mixed findings. Additionally, there is a wide range of different approaches that can work for people. For example, one person might thrive on a vegan diet while another will run into nutritional deficiencies (e.g., anemia) and become lethargic. While a restrictive diet may be helpful for some, others might develop an eating disorder from dieting.
Furthermore, since everyone eats, most people have an opinion about food, many of which are socially constructed. Diet culture has led to nutritional “tribes” that help people form a social identity. In the world of fitness, the focus on calories evolved into a focus on macronutrients (carbohydrates, protein, and fat) to achieve goals related to body composition. Other nutritional frameworks have focused on micronutrients, which were accompanied by rapid growth in the dietary supplement industry. Emphasizing vitamins and minerals is important, but other food components, such as dietary fiber and polyphenolic (i.e., antioxidant) compounds work in synergy to promote health. Therefore, we need to promote food first and then consider the role of supplements.
The United States Department of Agriculture retired the Food Pyramid in 2011 and replaced it with MyPlate, which was a step in the direction away from focusing only on calories. However, MyPlate is not without criticism. For example, the relentless promotion of dairy products reeks of conflict of interest. Many experts believe that not everyone needs to consume dairy (I personally enjoy certain yogurts and cheeses).
Food group systems can be beneficial as an alternative to highly computational processes (which many apps like MyFitnessPal automate for consumers). Unfortunately, many people use the food group system to identify which foods to avoid rather than which to eat. As a practicing dietitian, I have run across many people who eliminate fruit from their diet and use artificial sweeteners to control calories and sugar intake throughout the day. I honestly cannot think of a nutritional strategy that is more misguided! Translation: stop using MyFitnessPal!
There are newer frameworks for understanding nutrition that are finally receiving the attention they deserve. One example is the anti-inflammatory model, which relies on data from the Dietary Inflammatory Index, the first attempt at relating intakes of inflammation-modulating foods relative to global norms. However, the population-level data cannot be applied to all individuals (this is known as the ecological fallacy). A person can be highly reactive to foods considered anti-inflammatory at the population level. Meanwhile, efforts to evaluate the immune system’s role in nutrition frameworks have started a long-overdue revolution. To date, the most studied anti-inflammatory approach is the Mediterranean Diet, which has been shown to reduce depressive symptoms. This is where the conversation needs to be headed!
The most notable progress in the evolution of nutrition frameworks is the gut health model, which is related to the anti-inflammatory approach. Research on the microbiome (the collective genome of microorganisms living inside us, particularly the gastrointestinal tract) has exploded in the past decade. It has become evident that gut bacteria influence our health across various domains, and nutrition profoundly influences the human microbiome. This has led to an explosion of interest in probiotics, prebiotic fibers, and reduction in gut-harming substances such as artificial sweeteners. I have used this model to explain to people why there is more to nutrition than calories, macronutrients, and micronutrients. In a nutshell, what we eat is not only food for us, but it is food for the microbes inside of us. We feed them, and then they feed us back through the production of short-chain fatty acids, vitamins, neurotransmitters, and more (this is now referred to as “postbiotics”).
The era of personalized nutrition is here! Nutrition is not just about body weight and fitness — nutrition links to mental health. There are now ways to test blood, saliva, and stool to determine how to use nutrition (and supplements) to optimize mental health. The burgeoning field of Nutritional Psychiatry is focused on the gut-brain axis and the use of micronutrients for mental health disorders (e.g., ADHD and anxiety). New treatment options are emerging for individuals with depressive symptoms, and research has uncovered the role of adverse childhood experiences on weight outcomes over time. Nutritional psychology considers how individuals think about food and the experience of living in their bodies. We are now talking about the role of weight stigma as an overlooked driver of the obesity epidemic.
It is time to go beyond calories in nutrition conversations. As someone who has worked one-on-one with people over the last ten years, I have never used calories as a metric or goal in my work. The focus is always on one’s relationship to food (sustainable behavior change) and the changes that can improve gut health and thereby change the brain and mind. Sometimes it is just a cognitive reframe based on the science introduced in this article. Nutrition counseling needs to be trauma-informed, which aims to ensure that people are not re-traumatized. Calories and “macros” have left a legacy of trauma. Too many people have relied on tracking them and have experienced obsession, a sense of failure, and often both. Some people have counted calories for so long they see numbers when they look at food. This is not the way forward. When I look at food, I see nutrients! Next up: Nutrition for Mental Health. This is an even more stimulating conversation. I invite you to join!
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