Nutrition and mental health: obvious, yet under recognised

This content mentions depression and anxiety, which some people may find triggering.

One of the most obvious yet under-recognised factors for mental health is nutrition. What we eat and drink affects how we feel, think and behave.

With the recent Adult Psychiatric Morbidity Survey (APMS) finding that one in six people have experienced a common mental problem such as anxiety or depression in the last week, the need for effective approaches to understanding and improving mental health has never been greater.

The Mental Health Foundation has published a new policy briefing which focuses on how nutrition can be effectively integrated into public health strategies to protect and improve mental health and emotional wellbeing. It discusses what we know about the relationship between nutrition and mental health, the risk and positive factors within our diets and proposes an agenda for action.

It is common knowledge in the UK that there is a well-established link between diet and physical health, especially for non-communicable diseases such as type 2 diabetes, coronary heart disease and some cancers. Less understood is the contribution made by diet to mental health.

This is due in part to the complexity of the relationship, and the need to take into account the effects of other factors. Research has already provided evidence that there is a strong relationship between physical health and mental health, such as the increased incidence of depression in those with heart disease, establishing that there is an indirect link. The evidence is now building about the direct association between what people eat and how they feel.

The role of diet in the nation’s mental health has yet to be fully understood and embraced. The messages about nutrition can appear to be changeable and contradictory, and shifts in policy and practice have been slow to materialise. A general lack of awareness of the evidence base, as well as scepticism about its quality, has limited progress in embracing the role of nutrition in people’s mental health.

Recent evidence

However, this is beginning to change. The Foundation's message is not that nutrition is a silver bullet for mental health problems, but it does have a part to play in prevention, treatment and recovery.

A good example of this emerging evidence base is a recent randomised controlled trial study called the SMILES trial. It looked at dietary improvement for adults with depression and reported positive results for a group who were given a diet intervention in terms of remission criteria. But importantly, the intervention was not just to tell people to eat better, it involved a considerable amount of support from a dietician and resources such as nutrition material and recipes.

Some might argue this is too resource-heavy when compared to other treatments available, especially given that it would most likely be a complementary treatment as opposed to a replacement, but given the lack of negative side effects and potential positive side effects to physical health to this type of intervention, it is worth exploring further. (The Mental Elf has published an excellent easy-read summary of this paper, Diet and depression: can we eat our way out of clinical depression? The 'SMILES trial.)

We are calling for an integrated mind-body approach to supporting mental health that equally reflects the interplay of biological factors, as well as broader psychological, emotional and social conceptions of mental health, which is vital in order to reduce the prevalence and the distress caused by mental health problems: diet is a cornerstone of this integrated approach.

Nutrition is more than the sum of individual choices and behaviours. Public policy is vital to ensuring that healthy food is understood, available and affordable for all, and we have laid out some foundational steps in the briefing's policy recommendations that include increasing nutritional literacy, promotion of community-level schemes that provide access to affordable nutritious foods, training on nutrition for mental health professionals and access to dieticians for mental health teams, among others.

It is necessary for individuals, practitioners and policymakers to make sense of the relationship between mental health and diet so we can make informed choices, not only about promoting and maintaining good mental health but also increasing awareness of the potential for poor nutrition to be a factor in stimulating or maintaining poor mental health.

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