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Health & Science

Can what you eat affect your mental

health? New research links diet and the
mind.
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Until recently, the idea that what you put in your mouth could affect your mental
health was met with great skepticism, says researcher Felice Jacka. (Bigstock)

By Gisela Telis March 24

Jodi Corbitt had been battling depression for decades and by 2010
had resigned herself to taking antidepressant medication for the
rest of her life. Then she decided to start a dietary experiment.
To lose weight, the 47-year-old Catonsville, Md., mother stopped
eating gluten, a protein found in wheat and related grains. Within a
month she had shed several pounds and her lifelong depression.
It was like a veil lifted and I could see life more clearly, she
recalled. It changed everything.
Corbitt had stumbled into an area that scientists have recently
begun to investigate: whether food can have as powerful an impact
on the mind as it does on the body.
Research exploring the link between diet and mental health is a
very new field; the first papers only came out a few years ago, said
Michael Berk, a professor of psychiatry at the Deakin University

School of Medicine in Australia. But the results are unusually

consistent, and they show a link between diet quality and mental
health.

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Elaine Gordon, a certified health education specialist, offers her picks for everything
from breakfast to dessert.
-This creamy side dish is unlike other slaws. A medley of fresh vegetables -- including
cabbage, carrots and radishes -- is brought together with a lime-tahini dressing that
packs a bit of cayenne. The dish is high in fiber and rich in vitamins and minerals.
Find the recipe here. (Deb Lindsey/For The Washington Post)

Diet quality refers to the kinds of foods that people eat, how often
they eat them and how much of them they eat. In several studies,
including a 2011 analysis of more than 5,000 Norwegians, Berk
and his collaborators have found lower rates of depression, anxiety
and bipolar disorder among those who consumed a traditional diet
of meat and vegetables than among people who followed a modern
Western diet heavy with processed and fast foods or even a healthfood diet of tofu and salads.
Traditional diets the kinds of foods your grandmother would
have recognized have been associated with a lower risk of mental
health issues, Berk said. Interestingly, that traditional diet may
vary widely across cultures, including wheat for some people but
not for others; the common element seems to be whole,

unprocessed, nutrient-dense foods.

Theres lots of hype about the Mediterranean diet [fruits,
vegetables, whole grains, olive oil, nuts, fish] but the traditional
Norwegian diet [fish, shellfish, game, root vegetables, dairy
products, whole-wheat bread] and the traditional Japanese diet
[fish, tofu, rice] appear to be just as protective of mental health,
he said.
The association between diet and mental well-being may start even
before birth. A 2013 study of more than 23,000 mothers and their
children, led by Berks frequent collaborator and Deakin colleague
Felice Jacka, suggests a link between a mothers consumption of
sweets and processed foods during pregnancy and behavioral and
mental health issues in her child at age 5.
Not clear how it works
Its unclear how diet relates to mental health, said Rif El-Mallakh,
a professor of psychiatry at the University of Louisville School of
Medicine. There seems to be a clear link, but its an association
it doesnt tell you cause and effect, he said. We dont know which
is the chicken and which is the egg.
It could be, he said, that mood disorders change how and what
people choose to eat.
But an alternate theory is that the relationship works the other
way: Certain foods, or their absence, may contribute to poor
mental health. For example, studies in people and rats have linked
zinc deficiency to depression. Also, illnesses that cause deficiencies
including celiac disease, an autoimmune disease in which the
body reacts to gluten have shown associations with mood
disorders.
Theres a two-way street between whats going on in the gut and
whats going on in the brain, said Linda A. Lee, director of the
Johns Hopkins Integrative Medicine and Digestive Center and

recent research points to bacteria as possible middlemen in this

back-and-forth. Gut bacteria are known to make most of the bodys
serotonin, one of several chemicals that regulate mood, and the
bugs may even have a hand in shaping behavior. A 2011 study in
mice for example, showed that swapping the gut bacteria of two
strains of mice one known for its daring behavior, the other for
its fearfulness and shyness could make the timid mice more
willing to explore and the bold mice more anxious and hesitant.
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Gut bacteria
Of course, mice are not men, but changing diet has been shown to
change human gut bacteria, and fairly quickly. That suggests its
possible that dietary choices can alter well-being and behavior, Lee
said, but researchers arent yet sure if this complex interplay means
that swapping food in or out of ones diet can ease or cure a mental
illness.
Were not at the point where we can use diet as therapy, especially
when were dealing with someone whose mental health issues
render them very disabled, because we just dont know enough,
Lee said. I think were just on the new frontier, and five or 10
years from now well know more.
Jacka, president of the International Society for Nutritional
Psychiatry Research, echoes these reservations. She notes that
nearly all research on the connection between diet and mental
health has been limited to animal studies and observational studies
in humans.

We cant say [that] if we improve your diet, youll feel better, she
said. We have circumstantial evidence that suggests this could be
true, but we cant say for sure.
The lack of strong evidence and well-designed studies has led to
some resistance to Berks and Jackas work. Until recently, the
idea that what you put in your mouth could affect your mental
health was met with great skepticism, said Jacka, who recalled
colleagues dismissing the idea as rubbish. With more studies,
though, the research community is beginning to come around, she
said.
Even as scientists struggle to understand the link between food
and mood, some patients, such as Corbitt, seem to tap into it
without intending to.
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She saw a link

I changed my diet because I had gastrointestinal issues, said a
32-year-old woman with bipolar disorder who lives in San
Francisco and asked not to be named because she worries about
being stigmatized. Three years ago, at her gastroenterologists
urging, she tried the Atkins diet and found relief not just from
her digestive issues but also from her mental illness, which had at
one point nearly derailed her life.
I noticed within a day or two the marked difference in my head,
she recalled. It felt clear for the first time in years and years.
That may seem like a surprisingly quick turnaround, but Jacka said

it is not out of the question. We know from animal studies and a

human study that a poor diet can impair memory and attention
within a week, she said.
The woman no longer takes the medication prescribed to treat her
bipolar disorder, and she said she has remained stable for the past
three years. She said she has sought out psychiatric and
neurological researchers across the country, hoping to share her
experience and to learn what they know, but has found little
interest and few studies.
It surprised me how little information was out there, because for
me it was life-changing, she said. I wanted to validate the
experience I was having, and to make sure that everything I was
doing was safe. Thats how I found Dr. El-Mallakh.
El-Mallakh had hypothesized in 2001 that a ketogenic diet a
high-fat, moderate-protein and low-carbohydrate diet often used
to control epileptic seizures and nearly identical to the diet adopted
by the 32-year-old woman could be helpful for bipolar disorder,
because many of the medications that work for bipolar disorder
have antiseizure properties.
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After being contacted by the woman, El-Mallakh found several

other people with bipolar disorder who said they were benefiting
from a ketogenic diet. Last year,he published two case studies of its
apparent effectiveness. His report drew interest from people with
the mental illness, but efforts at Stanford University to test the diet

with a controlled trial failed to recruit enough participants.

Without such studies, El-Mallakh acknowledged that no one can
say how the diet might quell the symptoms of bipolar disorder.
With his own patients, herecommends it only alongside moodstabilizing medications. Despite his own willingness to supplement
mental health treatment with dietary changes, El-Mallakh remains
skeptical that diet alone can heal the mind.
There are a lot of people out there who call themselves depressed
who arent actually depressed, he said. I think people confuse low
energy with depression, or sugar crashes with mood swings, but
they probably dont have a mental illness. And those people may do
better with dietary interventions alone.
And even if diet can do the trick, providers dont yet know how to
use it effectively or safely. The problem, El-Mallakh said, is that
mental illness is still poorly understood. Eventually, he hopes, the
connection between food and mental health could benefit
researchers who study mental illness as well as those who live with
it.
Experimenting with change
Berk and Jacka areconducting the most comprehensivecontrolled
study yet, involving 176 people, of whether dietary intervention can
help ease depression, but they dont yet have results. For now,
Berk advocates an integrative approach to treating mental illness
that includes experimenting with changes in diet and exercise
along with more traditional treatments.
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