What We’re Doing Wrong About Nutrition and Mental Health

Patel-Dunn is a psychiatrist.

A growing body of evidence links the consumption of unhealthy and ultra-processed foods to an increase in mental health conditions such as depression and anxiety. A 2022 study found that the more ultra-processed foods a participant consumed, the more likely they were to report anxiety and depression. Other studies have linked poor diet to conditions such as ADHD and dementia.

This research has sparked a broader discussion about the impact of diet on mental health and the risks of eating ultra-processed foods, which make up 57% of the diets of American adults and 67% of the diets of children and teens.

The relationship between nutrition and mental health is complex and multifaceted. It is important to view this relationship in the context of other behaviors that can promote mental health, while also being aware of how access to nutritious food is determined by socioeconomic factors.

Mental health clinicians have an important role to play in contextualizing this discussion, educating patients, and working with primary care physicians to better promote both mental and physical health.

Reframe the relationship between nutrition and mental health

There is undoubtedly a connection between diet and mental health. But there is also a strong correlation between diet and larger socio-economic factors that limit people's access to whole foods. More than 54 million Americans live in low-income areas and have limited access to healthy food; Inequities in access to certain foods continue to be driven by race, income and geography. For example, research has shown that predominantly Black neighborhoods have more limited access to grocery stores, making it more difficult and expensive to obtain certain food products.

It is important to recognize these inequities and avoid blaming in conversations about nutrition. Instead, mental health clinicians can reframe nutrition as an important part of an overall healthy life that can positively impact mental health, along with other critical factors such as social connection, good sleep hygiene, and moderate exercise.

Another complicating factor is that a patient's diet can be influenced by mental health in several ways. For example, some patients experiencing depression may not have the energy to prepare a meal from scratch, while others use food as a way to cope with feelings of anxiety or depression. Disordered eating can also be symptomatic of mental illness.

Ultimately, clinicians need to be aware of these factors and how they can influence the relationship between diet and mental health. Only then can we begin to address the root cause of these conditions.

How to talk to patients about nutrition

There is a full spectrum of eating habits that can impact a patient's mental health and vice versa, from extreme eating habits to restrictive eating. For this reason, it is important that physicians have honest and ongoing conversations about nutrition with patients.

This can be a very sensitive topic to discuss, especially as it relates to behaviors such as binge eating or restrictive eating, but it is an important conversation. In my experience, patients often do not bring up the subject of eating habits without a second thought. Clinicians should ask intentional, open-ended questions to better understand how these behaviors relate to mental health. For example, ask patients about diet and eating habits, as well as sleep, exercise, and substance use as part of an initial evaluation. From there, continually monitor these habits.

Doctors can also play a role in educating patients about nutrition and good eating habits, while taking sensitivities into account. Going back to the basics - like the food pyramid, eating and drinking in moderation, and buying seasonal fruits and vegetables - can go a long way. The most important thing is that you start a conversation. Patients may not realize that their late-night snacking habit can have an impact on their overall mental health. By educating them about this connection, doctors can help patients find more ways to take control of their overall well-being.

Collaboration with general practitioners

Nutrition is a good example of the need for an integrated approach to patient care. Collaboration between mental health clinicians and primary care physicians can help ensure a holistic treatment approach and a unified message to patients about the correlation between diet and health.

One way to achieve this is by making mental health care an extension of primary care. For example, PCPs can monitor factors such as diet, sleep, and exercise as part of annual wellness visits, connecting the dots between behavioral changes and the associated mental health impacts. Ideally, every primary care practice would have at least a part-time mental health clinician available as a member of the treatment team, or willing to make referrals to quickly facilitate treatment when needed.

Both mental health physicians and primary care physicians can discuss with patients how nutrition affects overall health, and identify cases where a patient may need more targeted care, including for eating disorders. This integrated approach can ensure that no one falls through the cracks and patients are quickly connected to the care they need.

A holistic approach to patient care

Amid a broader discourse on the impact of nutrition on mental health, physicians can help balance these conversations with context at both the industry and individual patient levels to avoid stigmatizing patients. While it is tempting to point to a single factor, such as ultra-processed foods, as the cause of anxiety or depression, it is not accurate or helpful to do so. Instead, diet should be viewed as one of many factors that can influence mental health.

By considering the socio-economic factors that influence nutrition, talking openly with patients about their eating habits, and collaborating with primary care physicians, mental health clinicians can take an informed and holistic approach to patient care.

Anisha Patel-Dunn, DO, is a practicing psychiatrist and Chief Medical Officer at LifeStance Health, a mental health company offering evidence-based outpatient treatment services.

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