In the same week that I was speaking at the Australasian Turf-grass Growers Conference on rethinking mental health, with my nutrition colleague Jamie Scott, we happened to be interviewed by Press writer John McCrone. He was writing a piece on ancestral health and I discovered that John is a very knowledgable man on the topic, having authored books on evolution (like this which I would quite like to read). He was great to talk to, and we spoke for over an hour (while Jamie the ancestral fiend talked over coffee and his Lux meter for at least three). Indeed there is a lot to talk about on this topic and if you get any of us in the Ancestral Health Society of NZ started you'll quickly discover the passion for this framework to New Zealand's health challenges. Anyway, John did a stellar job of compiling our respective rants into something cohesive, and included the perspective of respected GP trainer Dr Les Toop (Otago School of Medicine). So I'm sharing this here for anyone who missed it on the day.
Submission for the Mental Health Inquiry, June 2018
Dear Members of the Panel,
I am a clinical psychologist in private practice in Wellington where I work with adult clients using a nutritional and lifestyle approach. I have previously worked in the addiction field as an AOD practitioner, then as an intern and post-intern psychologist in the Palmerston North Addiction and Mental Health Service. My doctorate evaluated an attachment-based therapy for sexual “addiction.” Since my internship I have focused my professional development on integrating mindfulness-based therapies and motivational approaches with an emerging area called nutritional psychology and the Cytokine Theory of depression. I have tried to be a conduit of this information to the NZ public, freely, via an online blog (www.theintegrativepractice.com) and by providing public speaking events with the Ancestral Health Society of New Zealand (https://ancestralhealthnz.org/society/)
The focus of my submission is on two of the questions:
1) “WHAT’S NOT WORKING WELL?”
The current medical paradigm – disease model/chemical imbalance theory and therefore the expected solutions that people place hope and expectation either on 1) something “fixing” them = medication or 2) having to live with disease. This is perpetuated by locating mental health within a hospital setting headed by psychiatrists.
Maintaining the societal expectation that human emotional responses to life are to be 1) numbed, avoided, medicated, and 2) to be got rid of quickly – preferably with a magic bullet pill.
Insufficient focus on diet and gut/micro-biome functioning – no assessment of nutrition which provides ingredients for our brain and physical health (e.g., adequate protein provides precursors for neurotransmitters, the multitude of micronutrients that are required to create energy in mitochondria, common deficiencies like B12, Zinc, and Iron which can cause anxiety and depression in and of themselves). When diet is in disarray, as is the case for anyone eating a standard western diet, then psychological symptoms like racing thoughts, negative thoughts, poor stress tolerance, cravings and urges, and impulsive action can become pronounced, especially when coupled with chronic stress from modern lifestyle (rushing, being sedentary, screen-based, poor sleep, lack of meaning) and as gut function is insulted over years.
Failing to address complex trauma and difficult early relationship experiences, and the effects of these on psychological and relational functioning across the lifespan. Failing to leverage off the fact that the relationship with a health provider is a powerful intervention in itself – IF this is provided in an attuned manner to that person’s needs. The relationship is also a powerful detractor from psychological wellbeing when handled poorly in this clientele (being invalidating, disempowering, or non-compassionate) as this can raise an individual’s risk level significantly by activating trauma and insecure attachment patterns. I have observed this occur within crisis and DHB settings many a time.
2) “WHAT COULD BE DONE BETTER?”
Focus on the basics first. Communicate that mental health is not separate from physical health and that many things in modern society hijack this in an insidious way. Humans have evolved to require good sleep, good diet, good connections, being able to switch off from “busyness,” and finding a sense of purpose to their existence. Could our system work on motivating and helping people to enhance these vital areas first, as they look to us health professionals for guidance and to inspire and impact on their belief in the solutions. (There may be other needs for an individual depending on their experiences, circumstances, and level of ability to interact with difficult thoughts, feelings, and sensations and comfort themselves/seek support when in distress).
GP’s could slow their process down, validate emotional responses to difficult circumstances, and not prescribe first use of psychiatric medication without a comprehensive assessment by a mental health specialist. Instead GP’s could be viewed as an important check in point to provide options and then refer out to these options based on that person’s choice – these could include dietary recommendations to support optimal functioning, sleep information to promote deep sleep (including information about stopping caffeine and screen exposure in the evening). They should always rule out common nutritional deficiencies that can cause anxiety and depression via blood test (e.g., B12, Zinc, Iron, Vitamin D). They should be able to recommend exercise to improve stress and mood. And they should provide therapy or peer support options when it’s clear someone needs something different to a GP’s skill set. Access to this latter option needs to be better facilitated – through funding, provision of services etc. Ideally there would be an integrated facility working outside of the hospital (to take away the disease model association).
Psychiatric medication should be much further down the runway if all the above has not been helpful over time, if used at all. (If used at all based on 1) the fact that the chemical imbalance theory is unsubstantiated, 2) the severity of these medications adverse effects for humans, and 3) research that questions the efficacy and mode of action of these drugs – that 80% of the effect may be due to placebo, that increasing dose is no more effective and only enhances the placebo effect, and that as much as 40% of research is withheld due to unfavourable outcomes for the pharmaceutical industry).
De-pathologize human emotions - there are many therapies that help people with various psychological experiences. In particular an approach called Acceptance and Commitment Therapy (ACT) teaches how to interact with difficult thoughts and feelings in a way that they impact less on the individual. Could we could educate our next generation about emotional health and normality of experiencing feelings like anxiety, sadness, anger, shame. Could we teach skills to allow these experiences rather than try to get rid of them, which makes them increasingly stuck. Can we teach mindfulness and not perpetuate myths of needing not be “tough” and “cool” or promote the fantasy that it’s “normal” to be happy all the time.
SOMETHING I’D LIKE TO ADD are some examples of how I implement a nutritional and lifestyle approach:
In my practice I look at diet at the first assessment with clients and I always check blood work for suboptimal levels or deficiencies. I regularly find B12, Zinc and Iron issues and provide individually tailored supplementation and dietary advice, and I liaise with nutrition experts when required. My clientele frequently report improvements to their mental health for addressing nutrition. Addressing nutrition occurs in the context of a collaborative motivational discussion, based on what the client wants to target, and is provided compassionately and in an attuned way to the individual’s relationship style. Examples of common cases:
OCD: I have had cases of OCD go into sustained remission from providing minimal appointments that focused only on diet, correcting nutritional deficiencies including B12, and teaching a basic mindfulness exercise of accepting unpleasant thoughts and feelings.
NUTRITIONAL DEPLETION FROM PREGNANCY AND BREASTFEEDING: I have had cases of post-natal depletion (diagnosed by others as depression and medicated) be resolved through looking at “rushing”, diet and vitamin/mineral deficiencies, and incorporating movement, relaxation, and restorative sleep to daily life.
THYROID ISSUES MASQUARADING AS PSYCHOLOGY: I have seen cases of undetected thyroid imbalance including Hashimoto’s Thyroiditis and when this is addressed through diet (e.g., gluten removal), psychological functioning has also been restored.
FOOD INTOLERANCE MASQUARADING AS PSYCHOLOGY: I have observed cases of severe acne and anxiety to resolve from removing dairy from the diet.
PANIC ATTACKS: I work on blood sugar stabilisation (protein at each meal, avoiding blood sugar spiking foods) and food sensitivities (these can be individual but often occur from additives in processed foods) when someone is experiencing panic attacks. Once both have been addressed panic attacks go into remission (also providing basic psycho-education of panic attacks and a breathing technique).
INSOMNIA: I discuss screen exposure and circadian rhythms, eliminate caffeine, look at dietary intake (e.g., stabilising blood sugar so this doesn't wake someone overnight), I often use a magnesium supplement as well as teach “unhooking” from thoughts skills, so people’s minds calm enough to allow a relaxation response for sleep.
DEPRESSION: I establish protein and healthy fats at breakfast (replacing cereal or toast with eggs etc). B vitamins, Magnesium, and Zinc are often also enlisted. Discuss sleep as per insomnia above. Establish a movement regime. Unpack emotional experiences and usually find there has been a history of chronic stress prior to mood dropping. Psycho-education about the role of chronic stress activation and cortisol in eventually causing an exhaustion phase so that person is forced to rest and repair. I work towards structuring a lifestyle that is not chronically stressful, with time to switch off from devices, and enhancing values-based activity and meaningful connections. I teach ACT skills and address trauma.
In September (8th/9th 2018) there is a Food and Mood event in Wellington and Auckland that I would like to invite the panel along to. This event will unpack more on the science behind nutritional psychiatry and includes the leading international researchers on nutrition and mental health, Professor Julia Rucklidge (Canterbury University, NZ) and Professor Felice Jacka of the Food and Mood Centre (Deakin University, Australia). I will send a personal invitation to these events in due course.
Thanks for reading my submission and all the best with progressing this important inquiry.
Dr Karen Faisandier - Clinical Psychologist
An introductory blog discussing the rationale for a nutritional and lifestyle approach within clinical psychology.
Chronic or acute illness with psychological features like anxiety and depression, stress and burnout, fatigue and “brain fog”, fibromyalgia, irritable bowl syndrome, allergies, insomnia and alcohol use, are all growing concerns in todays time unlike ever before in history. But is it true that these are growing epidemics or is there more to this story?
These types of chronic problems provide the individual affected and their health professionals with useful information. Your body may have something to tell you about whether your diet or lifestyle is working for you - and if the message isn't heeded at first it may start to get louder. Messages from your body may include daily fatigue, loss of zest for life, upset stomachs or susceptibility to colds, memory changes, feelings of overwhelm, irritability, or that you are no longer who you used to be.
Your diet and lifestyle form the recipe for everything that occurs in your body. This includes energy activity, the formation of your gut health, and the neurotransmitters which shape your thoughts, feelings, and drive behaviours i.e. psychological functioning. In other words, we are each physically and psychologically constructed by what goes in our mouth/stomach and how well we absorb nutrients from this. Reasons for insufficient functioning can include eating foods that are low in nutrients such refined sugars, poor quality fats, which are often found in highly processed food. In addition, unknown food allergies, sensitivities, and intolerances (e.g. gluten and dairy), and blood-sugar instability will cause suboptimal functioning. In some cases gut dysbiosis can occur – which means that the stomach has become inflamed and has a reduced capacity for digestion, and is thus unable to absorb the vital nutrients that are needed to function well. Improperly digested food particles may pass through into the bloodstream where they are not designed to go, causing unpleasant reactions and symptoms (also known as intestinal permeability or “leaky gut”). Some of these symptoms can present as mood and anxiety difficulties as well as cognitive changes like "foggy" brain functioning and memory impairment.
Long term exposure to suboptimal nutrition for any of these reasons may cause a raft of problems. This may further lower a person's threshold for coping with life challenges or stressors, thus becoming a vicious cycle.
There are also challenges to wellness from daily lifestyle or your environment. This can include exposure to the many toxins in our current society from pesticides on food, ingredients in skin care and cleaning products, alcohol and certain medications (such as recurrent antibiotic use, the pill, and steroids). These too can impact on digestion and absorption of nutrients. The degree of stress as well as exposure to illness can tip the balance from from managing inadequate food intake and toxin exposure to suddenly (or slowly over time) experiencing a range of physical, emotional, and cognitive symptoms. These may leave an individual feeling tired and flat, that they are just not themselves anymore, or in many cases suffering from a chronic health problem.
Traditional considerations of food and nutrient absorption, and steady lifestyle toxin exposure is not usually a significant focus in psychological assessment or treatment. Some areas are considered, such as ruling out thyroid conditions in depression or mania, checking for b12, iron, Vitamin D, and magnesium deficiencies in anxiety and mood difficulties. However there are many other things to consider. There also tends to be a synergistic effect which means that different toxins and deficiencies can compound each other - this can lead to a more serious problem then if just one toxin or deficiency was present alone.
In addition to traditional psychological theories about what causes psychological difficulties, psychological wellness can be produced or worsened by what goes in our mouths and the degree of toxins that we are exposed to. Unfortunately, the "convenience" foods that comprise the staple of many NZ kitchens are far removed from the foods that we have traditionally consumed, and many Kiwi's will not even be aware of what optimal functioning for them could feel like.
The exploration of how to eat for optimal functioning is an area of booming activity amongst many health practitioners and research scientists. This is great, however there are sometimes conflicting messages sent out by various different disciplines or sources, and not all of them are experts in reading and interpreting research. It’s little wonder that many people are confused, overwhelmed, or indifferent to their food choices.
This also applies to health practitioners attempting to use such information to help the clients they want to assist. Many individuals with chronic health symptoms are searching for information and guidance themselves. The area of nutritional and environmental medicine (NEM) is a field attempting to bring an evidence base and skill set to this work, which is happening one step at a time.
NEM asks two important questions which guide the way forward – “how are this persons cells functioning (the absorption of sufficient nutrients for which is vital)?” and “why is this health concern happening for this person?” There are three main aims - to prevent and cure, to be whole-person centred (holistic), and to treat the cause not just manage symptoms.
NEM fits into clinical psychology which considers the evidence base for any intervention applied. Clinical psychologists are experts in assessing the questions “why this person, what and why this problem, why now, and what will help.” Psychologists also have expertise in understanding and effecting motivation and behaviour change as well as a range of therapy techniques for various experiences.
There are many evidence-based low risk nutrition and lifestyle interventions that can be tested out that in many cases will improve psychological functioning. Adding this piece to assessment and therapy may be very important to resolving or improving your current difficulties, whether these are anxiety or mood related, or something else entirely. Are you up for optimising your physical and psychological functioning?