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Mental Health & Food Literacy

October 13, 2020

Author: Nelani Balasupramaniam, MHSc (c), Intern at Nutrition Connections

As October 10th was World Mental Health Day, we decided to use our October Newsletter spotlight to explore the connection between food literacy and mental health. In order to find out more, Tracie Burke, a registered dietitian (RD) and psychotherapist working in the Eating Disorder Program at Toronto General Hospital, and Leigh Merotto, a RD working in private practice, and previous full-time RD at the Centre for Addiction and Mental Health in Toronto, working in the area of forensic mental health and addiction, were consulted.

What is the current research saying?

Promoting positive mental health is essential for the wellbeing of Canadians.1 Mental health concerns everyone, with 1 in 5 Canadians living with mental health problems.2 The various determinants of mental health are complex and wide reaching. Treating mental health conditions require interventions addressing various goals to increase patient self-efficacy and confidence.

In recent years, research has started to include the role of nutrition in the prevention and treatment of depression and other mental disorders.3 Studies have associated depression with levels of specific nutrients.5,6 For instance, zinc deficiency has been associated with increased depressive symptoms 7 and folate deficiency has been observed in individuals with poor response with anti-depressants.8 Vitamin D deficiency and low levels of antioxidants have also been linked to depression risk.3

Now research is shifting from analyzing specific micro or macronutrient interactions, to investigating dietary patterns and evaluating diet as a whole. Research has shown that “diet quality plays a part in the presence and severity of depressive symptoms across population groups”3. Higher intakes of fruits, vegetables, whole grains, and fish may reduce the risk of depression in adults.9

Although there is research describing the role of nutrition in the management of mental disorders, there is a disconnect in the number of individuals receiving accurate nutrition resources and counselling.3 A 2018 survey conducted by Dietitians of Canada looked at dietitians working in a primary care setting to assess the scope of practice within this setting.4 In this survey, Ontario RDs revealed that patients were being referred to them for chronic health but not for mental health conditions.3,4 This shows that a large number of patients are not getting the knowledge of how dietary patterns can influence their mental health.3 More often than not, RDs are brought in after patients experience weight gain due to side effects from anti-depressant medication, rather than being involved in early treatment management or prevention.3

As such, RDs can provide beneficial nutrition services in conjunction with a patient’s existing healthcare team to provide effective multidisciplinary mental health treatment, evidenced through the work of Tracie and Leigh.

What kind of food literacy programming is happening in the primary care setting and how does it impact patient’s mental health?

The approach taken for delivering food literacy programing in both Tracie’s and Leigh’s in-patient work was comprised of food and nutrition knowledge; food skills; self-efficacy and confidence; and ecological factors.

Both RD’s ran a cooking groups to help their patients develop self-efficacy and confidence before being discharged, in order to equip them with knowledge and skills that they could draw on in their day-to-day lives once discharged. Patients would sign-up to participate, meet and decide on a dish to make, choose a recipe, and visit the grocery store with their peers and RD in order to purchase required ingredients. Once back at the hospital, patients would make the recipe as a group, allowing them to learn new cooking skills and enjoy a meal together.

How have you seen this programming influence mental health?

The programming conducted by both RD’s resulted in similar positive patient outcomes.

The cooking group at CAMH “removes patients from their usual environment and gets people together enjoying food and building skills” says Leigh. Tracie echoes these effects within her own practice and adds that patients feel a sense of connection and belonging by participating in food literacy programming.

What are some next steps RDs or health professionals could use in their practice to benefit their patients’ mental health?

Getting familiar with resources and tools that are available can help to increase knowledge and confidence to council a patient who may come to you with a mental health concern. Leigh suggests RDs and other health professionals participate in additional mental health training and workshops to help develop their knowledge and skills and allow them to better support their patients. She identifies a gap within training and education on the topic of mental health and nutrition for both professionals and the general public. “I would encourage more RDs with experience in this area to share their knowledge and consider running workshops and courses” says Leigh.

She also encourages RD’s to join professional networks focusing on mental health (e.g. DC’s mental health network) which can provide peer support and help RDs navigate any questions in practice. In addition to professional networks, Leigh suggests RDs to expand their social media network (Instagram, Twitter, etc.) to include dietitians working in the mental health and daily news blasts from Nutrition Connections. Tapping into these resources can help RD’s get a better understanding of their patients’ concerns and develop effective treatment plans.

When speaking with Tracie, she identified gaps in existing resources, stating that there is a need for more practical tools to be developed focusing on mental health and nutrition. One example of a food program designed to support patients living with an eating disorder is Sheena’s Place. Sheena’s Place provides professionally facilitated support groups for individuals, as well as their family and friends, affected by eating disorders.10 As part of their Nutrition Groups, participants of Sheena’s Place develop food skills, enhance their nutrition knowledge, and increase their comfort in the kitchen.9 There is a focus on developing coping skills, expressing emotions, and building a positive self-image before transitioning into conversations surrounding food and nutrition.

The conversations with Tracie and Leigh were insightful and highlighted the work of RDs working as part of an interdisciplinary team, bringing food literacy programming to the forefront in order to support their patients. Thank you, Tracie and Leigh, for your work in contributing to bettering the health and wellbeing of Canadians!

References:

1. Canadian Mental Health Association. Cohesive, Collaborative, Collective: Advancing Mental Health Promotion in Canada. May 2019. https://cmha.ca/wp-content/uploads/2019/05/MHP-Summary-Report-FINAL-EN.pdf

2. The Centre for Addiction and Mental Health. Mental Illness and Addiction: Facts and Stats. https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics

3. Dietitians of Canada. (2019). Dietitians as part of an integrated approach to mental health care in Ontario. BRIDGING THE GAP, 1–10.

4. Werstuck, M., Buccino, J, & Whittington-Carter, L. (2018). Dietitian Workforce in Ontario Primary Health Care Survey Report. Dietitians of Canada. https://www.dietitians.ca/DietitiansOfCanada/media/Documents/Resources/2018-Dietitian-Workforce-in-Ontario-PHC-Survey-Report.pdf

5. Sarris, J., Logan, A. C., Akbaraly, T. N., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Ramsey, D., Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, K.-P., & Jacka, F. N. (2015). Nutritional medicine as mainstream in psychiatry. The Lancet Psychiatry, 2(3), 271–274. https://doi.org/10.1016/S2215-0366(14)00051-0

6. O’Neil, A., Quirk, S. E., Housden, S., Brennan, S. L., Williams, L. J., Pasco, J. A., Berk, M., & Jacka, F. N. (2014). Relationship Between Diet and Mental Health in Children and Adolescents: A Systematic Review. American Journal of Public Health, 104(10), e31–e42. https://doi.org/10.2105/AJPH.2014.302110

7. Lai, J., Moxey, A., Nowak, G., Vashum, K., Bailey, K., & McEvoy, M. (2012). The efficacy of zinc supplementation in depression: Systematic review of randomised controlled trials. Journal of Affective Disorders, 136(1), e31–e39. https://doi.org/10.1016/j.jad.2011.06.022

8. Fava, M., & Mischoulon, D. (2009). Folate in Depression: Efficacy, Safety, Differences in Formulations, and Clinical Issues. The Journal of Clinical Psychiatry, 70(suppl 5), 12–17. https://doi.org/10.4088/JCP.8157su1c.03

9. Lai, J. S., Hiles, S., Bisquera, A., Hure, A. J., McEvoy, M., & Attia, J. (2014). A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. The American Journal of Clinical Nutrition, 99(1), 181–197. https://doi.org/10.3945/ajcn.113.069880 10. Type of Programs. (n.d.). Sheena’s Place. https://sheenasplace.org/