The food and mood connection

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By Kellie Blake, RDN, LD, IFNCP

Most of my patients understand the connection between food and their overall health, but many seem unaware of the powerful impact food can have on their mood. I recently had a patient who sought nutrition therapy for significant digestive distress, but also mentioned that her family had complained about changes in her mood. She admitted to feeling hostile, even toward strangers, which had forced her to change her usual activities like grocery shopping. She was staying home more to avoid potential confrontation.

According to the U.S. Centers for Disease Control and Prevention, mood disorders are the most common of mental health disorders and affect an estimated ten percent of U.S. adults. In addition, mood disorders are the third leading cause of hospitalization in youth and adults ages 18 to 44 years old. Mood disorders may require pharmaceutical intervention and psychotherapy, but food should also be considered a first-line treatment approach. The relationship between food and mood is multifaceted and a personalized plan to address micronutrient status, blood sugar regulation, inflammation and immunity, and the gut microbiome can offer impressive results.

Micronutrient deficiency and insufficiency has been associated with an increased risk of mood disorders. As reported in the World Journal of Psychiatry, optimizing folate, iron, magnesium, potassium, selenium, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin C, and zinc can be important in the prevention and treatment of depression and other mood disorders. While there are specific foods that may promote a balanced mood, the diet overall is the more important consideration. I tailor meal plan recommendations and generally encourage a whole-foods diet rich in plant foods to maximize micronutrient intake. I prescribe food sources of mood-boosting nutrients, but often use targeted nutritional supplementation as well.

Blood glucose regulation is another important consideration in patients with altered mood. Even in patients without diabetes mellitus, blood sugar dysregulation can wreak havoc on mood. A standard Western-type diet, high in refined carbohydrate can lead to quick changes in blood glucose levels. As reported in the BMJ, these shifts in blood sugar lead to the secretion of hormones such as cortisol, adrenaline, growth hormone, and glucagon as a compensatory strategy. Changes in the levels of these hormones can cause anxiety and irritability, increase hunger, and negatively impact mood. As part of the whole-foods meal plan I recommend patients avoid refined carbohydrate and consume routinely timed meals containing adequate protein and fiber to stabilize blood glucose levels.

Chronic inflammation and an altered immune response are also common in patients with mood disorders. Normally, when there is an immediate threat, the immune system releases both pro- and anti-inflammatory mediators to restore homeostasis. When the anti-inflammatory mediators are no longer able to quench the pro-inflammatory response, sustained inflammation can occur. In the central nervous system (CNS), this neuroinflammation can induce mood alteration. Mood disorders themselves may also alter the inflammatory response creating a vicious cycle. Diets high in processed foods and inflammatory fats can fuel chronic inflammation and alter the immune response. An anti-inflammatory meal pattern high in phytonutrients and omega-3 fatty acids has been shown to help reduce inflammation, normalize the immune response, and improve mood disorder symptoms.  

The gut microbiome is another target when addressing mood alteration. The bidirectional communication along the microbiota-gut-brain axis is often compromised in those with mood disorders. As reported in the World Journal of Gastroenterology, dysbiosis leads to increased intestinal permeability and a subsequent increase in pro-inflammatory lipopolysaccharides (LPS) into the systemic circulation. LPS are toxins that can regulate the CNS but can also increase the production of pro-inflammatory cytokines that negatively affect brain function. To balance the gut microbiome, I remove inflammatory and sensitive foods, often with a full elimination diet. I assess and address the health of the gut lining and digestive function, add in healthy probiotic bacteria, and help patients balance their lifestyle to maintain a healthy gut.

Case Study

Selena is a 52-year-old female seeking nutrition counseling for weight loss, painful joints, digestive issues, and fatigue. She had gained weight recently which had significantly affected how she felt about herself and she reported having no energy. She admitted she felt angry often and her husband and three teenage children complained about her poor mood and her tendency to come home from work and lay on the couch until bedtime.  

Selena is five foot five inches tall and initially weighed 168 pounds. As a child, she was not breastfed and she had significant exposure to second hand smoke. She has a history of migraines, severe digestive distress, peptic ulcer disease, and erosive gastritis. Selena had her gallbladder removed, a total hysterectomy, and reported a small hernia. She was eating 75 percent of her meals out each week and said she craved bread, potatoes, and sweets.

She admitted to binge eating during stressful times and she reported feeling stressed often. She was not exercising due to extreme fatigue but was walking one hour twice per week. Her sleep was poor with an average of six hours per night, and she was waking up at least three times each night.  She said she felt tired, sluggish, and depressed, and avoided leaving the house.

Selena also said she preferred to ear whatever was fastest and easiest. She had tried several types of commercial diet programs in the past but struggled to keep weight off. She said she last felt well about six years ago.

Additionally, Selena reported a history of antibiotic, proton pump inhibitor, and acetaminophen use. Her initial medications included escitalopram, lansoprazole, zolpidem, alprazolam, vitamin D3, and vitamin B12. She had several conventional labs tests, and all were within optimal functional ranges. Her initial symptom score of 116 indicated severe symptoms.

Initial goals included:

1. A full elimination diet for a total of eight weeks to determine potential adverse food reactions and allow her gastrointestinal system to begin to heal.
2. Sleep hygiene. Selena was to avoid blue light for at least one hour prior to bed, be in bed by 10:30 p.m., and take 360 milligrams magnesium glycinate 30 minutes before bed to promote restful sleep and optimize magnesium intake.
3. Stress management. I recommended two five-minute meditation sessions daily, one immediately upon waking and one at midday to help normalize the stress response and target anger.
4. Testing to include GI Map stool testing due to her extensive digestive history and salivary cortisol testing to determine stress response; both were declined due to cost.
5. Increase to 5,000 international units (IUs) of vitamin D3 daily with K2 to optimize vitamin D level.

At the three-week follow up, Selena’s symptom score had decreased to 22 indicating still moderate symptoms, but drastic improvement. She said she was having a few cravings, but she was doing well with the elimination diet. Her vegetable intake remained inadequate, and she discovered raw cruciferous vegetables caused significant bloating and digestive distress. Her bowel movements were more normal. Selena said she was still watching television before bed out of habit, but she had started practicing deep breathing techniques and her family noted significant improvement in her mood and anger. Selena also had started strength training with a personal trainer two days per week.

Follow-up goals included:

1. Continue the elimination diet for five more weeks and add in at least four servings of vegetables daily to optimize micronutrient status and continue to allow the gut to heal.
2. Aim to avoid television before bed at least three days per week and consider blue blocker glasses at night to target sleep.
3. Focus on the five-minute meditation immediately upon waking and at mid-day to target stress and anger.
4. A multi-strain probiotic and methylated B complex were added to target gut health and mood.

After five weeks, Selena’s symptom score was 21 and she said she was continuing to follow the elimination diet but had a few slip ups and immediately noticed an increase in her symptoms. Her vegetable intake remained inadequate, but she was drinking 80 ounces of water per day, lifting weights with a trainer two days per week, and she had begun walking after work.

Selena reported having two normal bowel movements every day and said she was amazed as she was previously only having one per week. She was sleeping better overall, but still struggled with falling asleep with the television on. Her emotional health score had improved overall from 16 to six and her family had noticed the positive improvement in her mood. She said her job continued to be stressful but she feels better prepared to manage that stress.

Follow-up goals included:

1. Transition to an anti-inflammatory, low-glycemic, gluten-free, low-grain, high-quality fat meal plan with systematic reintroduction of eliminated foods. Focus on increasing vegetable variety and intake.
2. Gut healing supplement protocol for three months to include an additional probiotic (Bifidobacterium lactis), a prebiotic fiber powder, a GI nutritional support powder, and 2,000 milligrams omega-3 fatty acids per day to target the gut lining and inflammation.
3. An herbal preparation to target the stress response to be taken 30 minutes prior to bed.
4. Remove the television from the bedroom to improve sleep.
5. Continue all other lifestyle goals as previously recommended.

References

Firth, J (2020) Food and mood: how do diet and nutrition affect mental wellbeing? BMJ. Retrieved from: https://www.bmj.com/content/369/bmj.m2382

Kohler, O. (2016) Inflammation in Depression and the Potential for Anti-Inflammatory Treatment. Current neuropharmacology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050394/

LaChance, L. R., & Ramsey, D. (2018) Antidepressant foods: An evidence-based nutrient profiling system for depression. World Journal of Psychiatry. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147775/

Mangiola, F. (2016) Gut microbiota in autism and mood disorders. World journal of gastroenterology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698498/

U.S. Centers for Disease Control and Prevention. Learn About Mental Health Fast Facts. Retrieved from: https://www.cdc.gov/mentalhealth/learn/index.htm