For the second episode of Psyched for Mental Health‘s second season we explore how nutrition can impact mental health. Host Dr. Ed Bilotti speaks with Dr. Laura LaChance and Dr. Monique Aucoin, who are working together to unravel the intricacies of this connection. Dr. Laura LaChance is a psychiatrist practicing in Toronto, Ontario, and a researcher at the Canadian College of Naturopathic Medicine. Dr. Monique Aucoin is a naturopathic doctor, a Senior Research Fellow at the Canadian College of Naturopathic Medicine, and an adjunct professor at the University of Guelph in the Department of Human Health and Nutritional Sciences. These two Canadian researchers are beginning to unlock the secrets of how the foods you eat can affect things like anxiety, depression, and other mental health conditions.
Related Links:
Protocol for the clinical trial: https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-023-01414-y
Diet/anxiety study website with handouts and resources for dietary counselling: www.ccnm.edu/anxiety
Diet and Anxiety scoping review: https://www.mdpi.com/2072-6643/13/12/4418
Case report: https://www.hindawi.com/journals/crips/2016/7165425/
Dietary counseling tool-creation project: https://link.springer.com/article/10.1186/s12888-021-03575-7
Episode Transcript:
Intro:
Can the foods we eat also be medicine? Could our meals affect our mental health? In terms of dietary recommendations for anxiety, protein is important for blood sugar regulation, for neurotransmitter synthesis. What type of diet is best for good mental health? There is some early evidence to support beneficial effects of nutrients like magnesium, vitamin D, B12, folate, selenium, iron, and zinc as a supplement form for the treatment of mood or anxiety disorders. We will explore the answers to these questions and more in this episode. I’m Dr. Ed Bilotti, and we are Psyched for Mental Health.
Dr. Ed Bilotti:
Food. We all need it. We all eat it. Most of us know that what we eat impacts our health. Fatty fried foods, for example, can cause heart disease. Too many sweets and desserts can lead to obesity, diabetes, and other big health problems. But what about our mental health? Could our food choices really impact things like depression and anxiety? Could changing what’s on your plate give you better overall mental health? In this episode, we’re gonna find out what’s known about how what we eat can affect our mental health. How changes in our diet can be used as an add-on, or in some cases, even an alternative to traditional treatments for mental health conditions. We’re gonna learn about the role of vitamins and supplements and how food choices can even help manage the side effects from mental health medication. It turns out that there is an emerging field known as nutritional psychiatry that seeks to study this exact topic.
Dr. Laura LaChance:
Nutritional psychiatry is the use of nutritional approaches in the prevention and also the treatment of mental disorders, also in the management of treatment adverse effects.
Dr. Ed Bilotti:
Dr. Laura LaChance is a psychiatrist practicing in Toronto, Ontario, and a researcher at the Canadian College of Naturopathic Medicine. She has special interests and expertise in nutrition and mental health. She received her medical degree from Queens University in Kingston, Ontario. She’s held academic positions at the University of Toronto and McGill University.
Dr. Laura LaChance:
From a research perspective, nutritional psychiatry is the study of how diet impacts the development of mental disorders and then also how diet can be used as a treatment.
Dr. Ed Bilotti:
Dr. LaChance and Dr. Monique Aucoin, a naturopathic doctor and researcher, sought to discover what is known about nutrition and mental health. To find the answers, they conducted what is called a scoping review of the scientific literature.
Dr. Monique Aucoin:
So our first project we decided would be literature synthesis to look at what was known about diet and mental health because this was this very young field.
Dr. Ed Bilotti:
Dr. Aucoin is Senior Research Fellow at the Canadian College of Naturopathic Medicine and an adjunct professor at the University of Guelph in the Department of Human Health and Nutritional Sciences.
Dr. Monique Aucoin:
We started off by doing a scoping review, which is a systematically conducted literature review done on a topic that’s more broad or heterogeneous and not well suited for a systematic review. The goal was to capture what is known and what kind of gaps existed.
Dr. Laura LaChance:
Scoping reviews are trying to summarize a large body of research at a high level, which is different from a classic systematic review where you have this really focused question. So you have a smaller number of papers.
Dr. Ed Bilotti:
That Drs. LaChance and Aucoin are research partners is not surprising. They each have had a longstanding passion and curiosity about nutrition and mental health that has influenced their respective career paths but they might never have met, if not for some mutual colleagues and a little bit of luck.
Dr. Laura LaChance:
We started collaborating back in 2014.
Dr. Monique Aucoin:
We connected 10 years ago. It was a total fluke, really. A colleague of mine knew her and said, you two are both really interested in the same topic, you should connect. And here we are 10 years later.
Dr. Laura LaChance:
We initially wanted to ask the question, what’s known about diet and mental health? But we found that was too big. So instead, we focused it a little bit. And we did one scoping review on diet and psychosis and one on diet and anxiety. And these were still really large. The diet and anxiety study included 1,500 articles that we analyzed.
Dr. Ed Bilotti:
The researchers compiled this information looking for common threads and patterns. The goal was to then design a diet that could be tested in a clinical trial, similar to the way medications are tested, as a treatment for generalized anxiety disorder.
Dr. Monique Aucoin:
There were few clinical trials and even fewer in psychiatric populations. Lots of them looked at diet change and impact on mental health outcomes in healthy populations or people with physical illness. When we finished those reviews, we knew that we wanted to do two things to build on that work. First, we wanted to conduct high-quality clinical trials to help to address some of those gaps. We’ll let Dr. LaChance talk about the second thing.
Dr. Laura LaChance:
We want to get it out to clinicians. We want to publish it in a way that’s more accessible. In 2021, we published an evidence-based worksheet and a company and clinician guide to facilitate a conversation about dietary change with your patients that is designed for mental health professionals who don’t have any background in nutrition training. So this is two parts. There’s a handout that’s very user-friendly and then an actual clinician guide that gives the step-by-step how to use it.
Dr. Ed Bilotti:
Since most mental health professionals, including psychiatrists who’ve gone to medical school, don’t really have much training or experience in nutrition, Doctors LaChance and Aucoin have created an easy-to-use tool for advising our patients and clients.
Dr. Monique Aucoin:
When we were developing it, we did a little bit of pilot testing. We recruited psychiatrists and people with lived experience, and we asked them questions about the tool and got their feedback on how to make it more approachable at the right level of complexity, make it interesting and engaging, and we incorporated that feedback into the design.
Dr. Laura LaChance:
The clinical tool itself is a worksheet that’s one page back and front. On the front, there are basically five simple recommendations to follow, and they’re presented a little bit like a shopping list. And then the back is the more interactive part. There we have a picture of what a sample plate could look like. Some examples of sample meals and snacks, some goal setting tips, a couple of questions to get you thinking about how you could actually implement dietary changes in your life, who could help you. And then a little bit about options for healthy food when you’re on a budget.
We recommend that patients put it on the fridge, take a picture of it, have it on their phone. Basically the idea is that somebody with no nutrition training, so mental health provider, could read our clinician guide, which tells you how to work through this handout, gives you a little bit of scientific rationale for each of those five recommendations so that if the patient asks you some questions, you’ve got something to say in terms of why.
And it’s meant to really be like an opening five to seven minutes where you just get the conversation started and there’s a little bit of back and forth where the patients can write down a few points and at the end they’ll have some kind of a goal to take home with them and an actual tool which is the handout that can help them with the how.
Dr. Ed Bilotti:
The diet that turns out to be the most beneficial pretty much across the board for mental health is something akin to the Mediterranean diet.
Dr. Laura LaChance:
Mediterranean diet, there’s a lot of convergence in the physical health literature. It’s been found to improve a number of health conditions. In nutritional psychiatry as a whole diet intervention, it’s only really been studied as a clinical trial in depression. Dr. Aucoin and I have published a number of review articles together at this point and separately. And it doesn’t really matter how you slice it, the same elements of healthy or traditional diets keep coming out over and over. And I think the Mediterranean diet is just a nice package. It’s familiar. It’s not so far off from a diet that many of us are familiar with. It’s not the only healthy diet that exists, but I do think it exists in a nice package.
Dr. Ed Bilotti:
Foods that we need to eat larger amounts of for energy are called macronutrients. These include proteins, carbohydrates, and fats. We need fats. Fats are not all bad. It seems that within each group, there are good and not so good. For instance, healthy fats and unhealthy fats. Good carbs and bad. You get the idea.
Dr. Laura LaChance:
If we think about food in terms of big categories, the first one being protein. In terms of dietary recommendations for anxiety, protein is important for blood sugar regulation, for neurotransmitter synthesis. And so we recommend eating protein with every meal and snack and choosing fish or seafood as a protein source at least twice a week and beans and legumes at least three or four times a week as a protein source.
The next category is fats. The fats are essential for the brain, especially the long chain ones, the omega-6, and omega-3s. We want to avoid excessive omega-6, and so the recommendations here boil down to switching your cooking oil to olive oil and then adding other healthy fats such as nuts, nut butters, seeds, avocados to meals and snacks. And then fish and seafood come into play here as well.
Dr. Ed Bilotti:
Omega-3 fatty acids are one of the good types of fat. They may help lower the risk of heart disease, depression, dementia, and even inflammation that causes things like arthritis. Omega-3 fatty acids come in several forms. The types found in fish called DHA and EPA seem to have the strongest health benefits. Another form is known as ALA, and this is found in vegetable oils, flaxseed, walnuts, and dark leafy vegetables such as spinach. EPA and DHA have been shown to have mental health benefits. Some examples of fish to eat as a good source of omega-3s include salmon, mackerel, herring, anchovies, and sardines.
Plant sources of healthy fats are flaxseed, chia seed, walnuts, soybeans, and avocado. Olive oils come in a few different forms. There’s extra virgin olive oil, generally cold pressed, and has to meet strict standards set by the USDA. Virgin olive oil is produced in a similar way to extra virgin, but it doesn’t meet those strict standards and may be a bit more acidic. Refined olive oil is made using heat and sometimes chemicals to refine it into a tasteless, odorless, and colorless oil. It’s often mixed with a small amount of extra virgin olive oil to give it some flavor. Typically, if the label just says something like olive oil or pure olive oil, it is most likely a blend of different grades of olive oil.
In general, extra virgin olive oil is best for putting on salads or drizzling over foods as a finish. Regular olive oil is okay for cooking. In recent years, there’s been some media attention given to counterfeit products or oils labeled as olive oil that were actually sourced from other cheaper oils.
Dr. Laura LaChance:
I’ve noticed that olive oils are putting a QR code on the bottle. They’re saying things like traceable. Some of the companies that are actually selling what they say they’re selling are trying to use that as a marketing tool.
Dr. Ed Bilotti:
Check labels carefully, read reviews before deciding which brand of olive oil to put in your shopping cart.
Dr. Laura LaChance:
And thinking about fruits and vegetables. More is better, at least half the plate should be vegetables, and avoiding fruit juice, since it’s a concentrated source of fructose. Complex carbohydrates are super important, so the whole plate is not carbohydrates, but focusing really on complex carbohydrates, so good quality. Having fiber prebiotics to support the microbiome, and thinking about whole grains, starchy vegetables, whole fruits as sources of carbohydrates. And then lastly, caffeine. So there’s a strong literature based on the effects of too much caffeine worsening anxiety. And this is gonna vary from person to person, but since caffeine isn’t in so many of the beverages that we drink, it fits in here with dietary recommendations for anxiety.
Dr. Ed Bilotti:
They put together a diet that appears beneficial for anxiety. But can we be sure it really works? Like any good scientists, they set out to test it experimentally, not unlike medications are tested, to prove they are effective. The researchers designed a study and recruited test subjects.
Dr. Monique Aucoin:
We really looked in detail at the literature about what diet changes might be appropriate for people experiencing anxiety. Our study is called the EASE-GAD trial, which stands for eating and supplementation for generalized anxiety disorder. And it’s a pilot study since it’s the first of its kind. The primary objective was to test the feasibility and acceptability in order to prepare for a larger study. But our secondary objective was to assess for changes in diet quality, anxiety severity, self-efficacy, mindful eating behavior, and quality of life. We recruited 50 adult women with generalized anxiety, which was confirmed in an interview with Dr. Lachance.
And then I delivered seven sessions of dietary counseling over 12 weeks, and the participants also took an omega-3 supplement. There were a fair bit of other criteria, and partly this was guided by some of the similar studies that have been done in this area. We looked for people who had moderate to severe generalized anxiety disorder, so they had to have a high enough level of symptoms at baseline. And they had to be eating a suboptimal diet. They couldn’t already be eating really well because we wouldn’t really have any opportunity to make changes. We excluded participants who had other psychiatric conditions like bipolar disorder, psychosis, an eating disorder, substance use disorder, but we included people who had depression given the high level of comorbidity between these. Some people were already using medication or psychotherapy, some weren’t.
And the study is now complete. We’re in the last stages of analysis and manuscript preparation. So unfortunately, we can’t share the findings today, but we’ll definitely share the publication once it’s ready.
Dr. Ed Bilotti:
At the time of this recording, the results of that study have not yet been published. One thing we can pretty much be sure of is that there isn’t any harm in making these dietary changes. So while we await the results, we can get a head start by revising our grocery lists right now.
What about vitamins and minerals? Since these are just as essential for our health, but in much smaller amounts than the macronutrients, they are called micronutrients. They can be taken as supplement, but it’s always better to get them from real food.
Dr. Laura LaChance:
In addition to omega-3s, there is some early evidence to support beneficial effects of nutrients like magnesium, vitamin D, B12, folate, selenium, iron, and zinc as a supplement form for the treatment of mood or anxiety disorders or symptoms.
Things like vitamin D or B12 are common deficiencies that can be easily tested and supplemented. And these nutrients, we know they play a role in things like neurotransmitter synthesis. So it’s not surprising that if people are deficient, it might have a negative impact on their mental health and that if we can correct these deficiencies that we might see some improvement. Things like magnesium and zinc are found in healthy diets, but we know that most of the population is not getting enough of those in their diet related to things like ultra processed foods. So the solution in some cases might be to take a supplement, but ideally we’d love for people to also think about their diet as well, and including more whole foods that are gonna be actually rich in these nutrients.
Dr. Ed Bilotti:
Even the best quality vitamins and supplements you get out of a bottle are not a substitute for real wholesome food.
Dr. Monique Aucoin:
I heard a really interesting statistic, which was that in an apple, less than 1% of its antioxidant capacity is vitamin C. We can take a vitamin C capsule in place of the apple. We might get some antioxidant benefit from that capsule, but eating the whole apple has this enormous broad range of bioactive substances, many of which we don’t fully understand. We’re not there yet to create those capsules that give us everything that we would get from food. You can’t supplement your way out of a bad diet.
Dr. Ed Bilotti:
Supplements are supplementary. They’re not instead, but there’s definitely a place for them. And these products are not approved by the FDA to treat any condition. Many make claims that might not be proven. It’s a good idea to do some research before spending any money on vitamins and supplements. And they can be very expensive. Read reviews and if possible, look for products that have been tested by independent laboratories to verify their ingredients and purity.
Dr. Monique Aucoin:
The most studied natural health product for mental health is definitely omega-3 fatty acids. And at this point, we have the highest level of research support for omega-3 fatty acids in depression, both bipolar and unipolar, in generalized anxiety disorder, in post-traumatic stress disorder, ADHD, borderline personality disorder, early psychosis, and high risk for psychosis. Basically everywhere that you look for some kind of association between omega-3 levels or using Omega-3s as treatment and symptoms of mental illness, it just keeps coming out over and over. It just underscores the essential role, really, of Omega-3s in brain functioning. We can actually test Omega-3 Index now pretty easily with a fingerprick test that’s offered by a number of different companies. That makes it really feasible. You can see where you’re at and you can individualize your dosing.
Dr. Laura LaChance:
In terms of fish oil, there is something called IFOS, I-F-O-S. It stands for the International Fish Oil Standards, and it’s a third-party organization that tests fish oil supplements for quality, purity, and contaminants.
Dr. Ed Bilotti:
Eating fish, shellfish, meat, grains, eggs, chicken, liver, and garlic will provide you with selenium. Zinc can be found in oysters, meat, poultry, seafood, nuts, and whole grains. Iron can be obtained from eating dark green leafy vegetables like kale and watercress, as well as fish, brown rice, nuts, seeds, and beans. You can get the folic acid you need from broccoli, Brussels sprouts, liver, spinach, asparagus, peas, chickpeas, and brown rice. Good sources of vitamin B12 include salmon, cod, milk, cheese, and eggs.
Let’s talk about the gut microbiome as it pertains to the topic of nutritional psychiatry. Think about a biome as a specialized environment where different types of organisms can live and grow. In the case of the gut microbiome, we’re talking about billions of tiny bacteria that live within our intestines. We’re used to thinking about bacteria as something bad that makes us sick or causes infections. But for the most part, bacteria that live with us in our intestines are friendly. They not only help our bodies function in many ways, but they’re necessary for our health. In order to have the most diverse population of good bacteria in your intestines, you need to give them the best environment.
Let’s say you want a lush green lawn. You have to provide it with nutrients and water that it needs to thrive. But you also have to keep weeds under control because weeds can take over by consuming the nutrients and the water themselves, taking it away from the grass. You can think of your gut microbiome in this way, except instead of growing grass, your intestines are home to billions of tiny organisms, including lots of different species of good bacteria.
The microbiome is known to have many important effects on various systems of the body, including digestion, immune function, glandular function, and nervous system function, and probably more that are still not known. Some of these effects are fairly well understood, but for others, we still have much to learn. What we do know is that having a diverse population of lots of different species of good bacteria is what leads to the best overall health.
And in order to have the most diverse population of bacteria, we need to eat the right foods to create the best environment for them to thrive, much like what we need to do to maintain our lush green lawn. There’s a lot of research currently being done to understand how our gut microbiome affects our nervous systems and can impact things like our moods, anxiety, and other kinds of mental health symptoms.
Dr. Monique Aucoin:
Definitely, it’s a really hot topic in psychiatry research right now. So this research is in its infancy. We don’t know at this point what a healthy gut microbiome even looks like necessarily, which probiotics to take. Is it the bugs themselves? Is it the stuff that the bugs make, the postbiotics? That’s important. There’s just so much still to disentangle there. Probiotic is when you’re consuming the microorganisms directly thinking about probiotics and yogurt or taking a probiotic supplement.
But one thing that’s coming out that I think is actually really exciting for the field of nutritional psychiatry is that when we think about different factors that can modify the composition of the gut microbiome, diet comes up at the top of the list over and over. Sure, you can take a probiotic, it’ll have a temporary effect, which will stop when you stop taking the probiotic. But really, it’s your long-term and short-term dietary pattern that is the strongest predictor of your gut microbiome composition.
Prebiotics are the food for the good bugs. Eating prebiotics and variety of different plants, like lots of different plant species, create the more diverse gut microbiome. There’s an expression that you can’t outrun a bad diet. There’s only so much you can offset with exercise.
Dr. Ed Bilotti:
Exercise is also important, but sometimes we can make the mistake of thinking that exercise can offset or be a substitute for eating a good diet. The fact is both are necessary, and they help in different ways.
Dr. Laura LaChance:
We’ve been focusing on nutrition because that’s our area of expertise as researchers. But if I flip to my clinician hat, certainly there’s strong evidence for exercise in mutating body conditions as well. Both are important. I work with both, with all of my patients. They work through different mechanisms. They’re complementary interventions. They’re also synergistic.
Dr. Ed Bilotti:
Dietary changes work and can be helpful, but. Are they used in place of traditional treatments like psychotherapy or medications? It depends on the condition, the symptoms, and the severity of those symptoms.
Dr. Laura LaChance:
It’s largely a question of severity. If somebody’s looking at a mild to moderate depressive disorder or anxiety disorder, do I think it’s reasonable to start with lifestyle interventions like fixing your diet, exercise, and sleep? Absolutely. I think those are foundational. I think that’s where you should start. When working with my patients, you know, I’m a psychiatrist so often I see people a little bit later in their illness trajectory, they’re maybe more at the kind of moderate to severe end already. But when I do see those mild to moderate severity patients, I give them choices. We always work on diet, exercise, sleep. Those are the foundational interventions. And for some people that’s in conjunction with meds or therapy. And for some people we start there and then see how much benefit they get from that and then look to other interventions if they need them later on.
Dr. Ed Bilotti:
Conditions such as schizophrenia, bipolar disorder, and certain types of psychotic illnesses are considered to be more severe and persistent mental illnesses. And in these cases, the recommendation is generally to use dietary interventions as an add-on to traditional medications and therapies.
Dr. Laura LaChance:
Whenever we’re talking about nutritional approaches to treating psychotic disorders, I think we have to acknowledge that these are severe and persistent mental illnesses and diet is always an adjunct treatment, not an alternative to mainstream treatment in addition to. We’ve published a scoping review in this area and there’s a ton of research in schizophrenia, for instance, is one of those conditions that there’s still a lot of dispute over what the etiology is. It’s actually quite surprising the extent of work that’s been done in this area in schizophrenia.
There’s a few take-homes that we can pull from it. One is Omega-3s and psychosis. There’s definitely considerable clinical evidence to suggest that Omega-3s can play a role in early psychosis in terms of reducing the severity of psychopathology and also some evidence to suggest that Omega-3s can reduce the risk of transitioning to psychosis in an individual with that high risk. Similar to schizophrenia, bipolar disorder in the context of severe and persistent mental illness.
We’re also thinking primarily an adjunctive intervention, thinking about managing medication side effects, comorbidities like cardiovascular disease and diabetes. Also important to emphasize that omega-3s specifically have shown efficacy in both unipolar and bipolar depression. And there we’re usually talking adjunctive treatment, but I do use them a lot. And other types of mood dysregulation that are commonly seen in clinical practice.
So Borderline personality disorder carries a lot of mood lability, explosive anger, and the full gamut. And there’s good evidence for omega-3s. There’s actually meta-analysis as well. Omega-3s and improving mood lability in borderline personality disorder.
Dr. Ed Bilotti:
Sometimes the things that dietary changes can help most with are the side effects caused by some psychiatric medications.
Dr. Laura LaChance:
Thinking about side effects of the medications we prescribe, melanzapine, risperidone – major changes in terms of metabolic dysregulation, weight gain. I think at least clinically, as a psychiatrist, usually I’m using nutritional psychiatry interventions in terms of managing comorbidities and side effects in this population. And at times I’ll see a patient, for instance, with like brief intermittent psychotic symptoms of those sub-threshold and what do I do? It’s too early to start an antipsychotic. There is some literature actually suggesting that an omega-3 could reduce your risk of transitioning to full-blown psychosis.
Dr. Ed Bilotti:
Over the past several decades, we have seen an increase in obesity, type 2 diabetes, and a large increase in mental health diagnoses. All of this also correlates with a rise in diets consisting of highly processed foods. Could there be a common thread? There is still so much we don’t know and so many unanswered questions. Thanks to researchers like Drs. LaChance and Aucoin, we are beginning to fill in the missing pieces. What is clear right now is that changing what we eat will give us better physical and mental health and in turn overall better quality of life.
Dr. Laura LaChance:
If you really want the quick and dirty, it’s more vegetables, fruits, more healthy fats, olive oil, nuts, seeds, nut butters, avocado, fish and seafood, complex carbohydrates, less refined carbohydrates. Those are like the main, baking.
Dr. Ed Bilotti:
You can use the links provided in our show notes to see Drs. Lachance and Aucoin’s research and to download their clinical tool. Once the results of their study are published, we will also publish an update linking to those.
You’ve been listening to Psyched for Mental Health. Psyched for Mental Health is a companion podcast to WebShrink.com, the platform for seekers and providers of mental health.
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This podcast is intended for informational purposes only and nothing in this podcast is intended or should be construed as direct medical advice or mental health advice nor as a substitute for evaluation and treatment by your own health care professional. Do not start any new diet or exercise program without first discussing it with your healthcare provider. Thank you for listening. And a very special thank you to Dr. Laura LaChance and Dr. Monique Aucoin for their participation and contribution.