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The Modern-Day Dietary Craze: A Mental-Health Perspective

There are many branches on the therapeutic tree; that is, there are multiple paths we can take to improve our health, the quality of our lives, and our sense of well-being. And, it may be argued that one of the most important branches on that tree relates to our diet. In the past few years, I have observed an increase in the number of clients who are at least contemplating some sort of dietary intervention in an effort to feel better. On one level, I find this encouraging; on another, I am concerned. While diet and healthier eating is, without question, an important component to living a longer, healthier life, I suspect that many people may be overlooking another important variable impacting their overall health and sense of well-being.

Personally, I have been very interested in nutrition and dietary sciences for about 20 years, and it’s a topic I very much enjoy exploring. I have read numerous books, watched countless documentaries, and listened to many hours of podcasts with a variety of dietary and nutritional experts. I have done my best to sort through some of the stark discrepancies and counter-claims proposed by conflicting camps (veganism vs. paleo, for example) in an effort to find the most effective way to optimize my health. Firmly believing in the merits of personal experience, I have also committed myself for extended periods of time to a myriad of different diets and eating plans, including: vegetarian, vegetarian with a focus on positive prana foods (some yogis and meditators will know what this means), gluten-free, grain-free, paleo, Whole30, modified Atkins, and ketogenic, to name a few. Additionally, this past year, I have further researched and experimented with extended fasting (7-day, water-only) and intermittent fasting (eating only within 8-hour windows, and fasting for 16-hours), and have found some profound results with these interventions as well.

After all these years of educational exploration and personal experimentation, I believe I have uncovered some truths in the mad world of nutritional science and dietary advice. However, in an effort to not veer too far off track from my primary intention here, I will simply summarize and say that I believe maintaining a real, whole-foods diet, which is rich in nutrient-dense vegetables, and is as free of chemical agents and other adulterants as possible, while avoiding refined sugars and preservatives, will almost certainly help improve one’s health and sense of well-being.

In my clinical practice, I have noticed a marked increase in clients who are currently exploring and/or practicing some type of dietary intervention. Most commonly, they are hoping to relieve a variety of symptoms: depression, anxiety, ADD and ADHD, to name a few, as well as a whole host of physical ailments, including various aches and pains, for which there is no medical explanation (I am currently getting more referrals from physicians as a result of this). I have also observed an increase in the number of parents who are exploring dietary interventions and nutritional supplementation for their children, sometimes working alongside naturopathic doctors or functional-medicine practitioners, in an attempt to resolve various physical and psychological symptoms.

Slowly, the role of diet appears to be gaining popularity when it comes to exploring solutions to a host of mental and physical-health ailments. Again, I am generally pleased to witness such a trend take place, especially in light of the recent CDC (Center for Disease Control) report that states: “More than 100 million Americans have diabetes or prediabetes”[1]; that is nearly one-third of the US population! In light of such terrifying news, certainly taking control of our physical health is paramount. And, if diet and nutrition can simultaneously address a potential source of many of the mental-health conditions plaguing our society at the same time, what an incredible bonus!

It is clear then: many people are sick, and improving physical health is imperative, with substantial evidence that changes in eating habits are necessary for many people. However, there is also substantial evidence that diet may not be solely responsible for such an epidemic, and therefore not a clear path out of this problem. With dietary changes appropriately on the minds of many, we may fail to see another major health saboteur lurking in the bushes: psychological distress!

Diet and psychology are certainly related and influence one another. What we eat impacts our mood, how we feel physically, and how we perform in general, but it is also true that psychological stressors may impact us in the same way, independent of diet, and in such instances, dietary and nutritional interventions alone often fall short of providing the overall improvements we may be seeking. It is also worth mentioning that I find those with the most extensive trauma histories have the hardest time sticking with dietary changes. For many people, once the psychological stressors have been mitigated, it’s less challenging to succeed with dietary changes.

To illustrate, if someone experienced a significant trauma and developed PTSD (Post-Traumatic Stress Disorder) as a result, or they recently lost a loved one, a pet, a job, a home, etc., it is unlikely that dietary changes or nutritional supplementation alone will resolve that psychological wound. Yet today, it certainly appears that many people are attempting just that (albeit unconsciously most of the time). In such instances, it is highly unlikely (no matter how perfect a diet one follows), that they will fully realize improved mood and functioning from dietary changes alone. As I’ve explained to numerous clients in the past, including one recently who was wanting to explore the ketogenic diet: “It’s going to take a lot of coconut oil to replace the loss of a parent,” something which was relevant for this client.

To illustrate further, while on my way to work recently, I happened to be listening to an episode of the Bulletproof Radio podcast with Dave Asprey, New York Times bestselling author and person responsible for the ever-popular Bulletproof Coffee recipe. This particular episode was #404 and titled, “April Q & A: Chronic Fatigue, Sleep Apnea, & Depression,” posted on April 22, 2017. In the beginning of this episode, Asprey and his colleague, Dr. Mark Atkinson, offer advice to a listener whose symptoms describe someone with severe depression. Asprey and Atkinson proceed to offer a host of nutritional and sleep-hygiene related advice, among other things, but they present it in a way that does not consider any other explanation for the listener’s problems. It’s not that the advice is bad necessarily, just possibly incomplete or potentially missing the root-cause entirely. The listener mentions that they went to the doctor and the doctor told them, ‘nothing is wrong.’ Asprey then states, “There is something wrong; it’s your doctor!” Both continue to insinuate the problem is primarily dietary/nutritional in origin. And at one point, Asprey states, “Depression is inflammation in the brain. It is simply a biological hardware problem.”[2] Yes, it is true: scientific evidence does suggest that inflammation in the brain causes depression, but that is not the only cause as this statement suggests, thereby overlooking any other possible explanations: unresolved trauma, unprocessed grief, failed pursuit of one’s passions, loss of a job, home, or a myriad of other possibilities that could also lead to the symptoms described by the listener. If, for example, you just lost your spouse of 30 years whom you loved dearly, you would likely feel very depressed—and very appropriately so—I might add! A depression spurred from an incident such as this would have nothing to do with inflammation caused from the wrong diet. It would have to do with a deep sadness (which many people now unfortunately label as depression, then proceed to view as a “mental disorder,” and often medicate (sigh), but that’s a whole other conversation…). Again, in an example such as this, an infinite amount of anti-inflammatory foods will not likely resolve that person’s suffering.

Trauma vs. Diet: A Side by Side Comparison

My father-in-law gave my wife and me a book for Christmas this past year: How Not to Die by Michael Greger, MD. My father-in-law is a devout vegan and someone I rather enjoy exchanging dietary opinions with (he’s a good sport), even though we disagree on a lot of what constitutes a “healthy” diet. Unlike myself, he firmly believes in the vegan life-style, and the proposed health-related benefits, which Greger’s book argues for as well. In an attempt to establish the importance of eating a vegan diet, and to cement the evidence to support such a proposition, on page six of the introductory chapter, Greger states the following:

“People who once ate vegetarian diets but then started to eat meat at least once a week experienced a 146 percent increase in odds of heart disease, a 152 percent increase in stroke, a 166 percent increase in diabetes, and a 231 percent increase in odds for weight gain. During the twelve years after the transition from vegetarian to omnivore, meat-eating was associated with a 3.6 year decrease in life expectancy.”[3]

These correlations are pretty high, indicating a strong relationship and therefore something worth paying attention to. At face-value this would lead most to believe that moving to a vegetarian diet would, in fact, be a wise choice. And, that might be so; however, let’s look at one of the largest epidemiological studies ever done in the behavioral sciences in order to see if perhaps variables other than a vegetarian diet better predict poor physical health outcomes.

In 1998, perhaps one of the most important studies ever published in the behavioral sciences appeared in the American Journal of Preventive Medicine. This study is most notably referred to as the, “Adverse Childhood Experiences (ACE) Study.” Similar to the study described by Greger, this study also looked for causes of poor health and premature death, but instead of diet, they used another variable: what’s known as the person’s ACE score. ACE scores are derived from a ten item questionnaire describing various forms of adversity one might experience before the age of 18, such as abuse and neglect, exposure to familial violence, sexual abuse, incarceration or absence of a parent, etc. This was a large-scale study that had 9,508 respondents in its initial sample population (it has grown since then). What this study found was a strong, graded relationship between a person’s ACE score and several of the leading causes of death in adults. In most cases, the relationship between ACE scores and poor physical health outcomes is much stronger than in the research Greger cites in an effort to make his claim regarding the health benefits of eating a vegan diet.

Having an ACE score of 4 (out of 10) would correlate with the following: a 220% increase in ischemic heart disease, a 240% increase risk of stroke, 160% increase in diabetes, and a 160% increase in being severely obese (BMI greater than 35).[4] Moreover, in regards to the final claim regarding life-expectancy, those with an ACE score of six have a decrease in life-expectancy of 20 years,[5] a monumental increase over the 3.6 year correlation offered in the study described by Dr. Greger!

Here is a table of the above-mentioned data for easier view and comparison:

Health Category:Relationship with diet:Relationship with ACE's:
Heart Disease:146% increased risk220% increased risk
Stroke:152% increased risk240% increased risk
Diabetes:166% increased risk160% increased risk
Weight:231% inc. risk of "weight gain"160% inc. risk of "obesity"
Premature Death:3.6 years earlier20 years earlier

What we see in examining these two reports are strong correlations between diet and both disease and premature death. And, in almost every case, there is an even stronger correlation between adverse childhood events and both disease and premature death. In light of such information, I hope that nutritional science studies in the future will attempt to control for ACE’s and other psychological and psychosocial factors in an effort to better tease out the specific role of dietary interventions. I predict that if such variables are accounted for, we may find similar results to those identified in the above-mentioned comparison, which is that diet and nutrition absolutely matter, and have a significant impact on our overall health, though perhaps not as much as traumatic experiences, especially those suffered early in life.

There is now unequivocal evidence demonstrating the relationship between trauma and physiological malfunction, especially when connected to experiences which occurred early in childhood, when our nervous systems and endocrine systems are most sensitive to environmental input.[6] [7] [8] Perhaps with a wider focus and consideration, to include both diet and psychological stressors, we can achieve a greater impact on overall health and well-being.

What I ultimately hope comes from presenting this information is an increased awareness and recognition of two very important considerations when we begin to explore ways of addressing our physical and psychological functioning. First, what we eat matters! Second, traumatic experiences and significant losses also matter, perhaps even more so! To be our best, we’d be wise to tend to both needs and not fall into the trap of trying to use one to fix problems associated with the other—something I see happening more and more.

In summary, if you are not feeling well, be it from depression, anxiety, etc., definitely consider cleaning up your diet and getting your blood work checked. Once that happens, if you still aren’t feeling well, consider the possibility that diet might not be the root cause of your symptoms. If you’ve suffered a major loss or other traumatic events in your life, you may have suppressed that pain (what we are socially encouraged to do), and it may be wreaking havoc on your body and functional ability. I’ve watched many people fail to realize the clinical progress they desire as they move from diet to diet: gluten-free, to paleo, to keto, to vegetarian, to vegan, to high-carb, to high-fat, and on and on it goes. And, in almost every case like this, there exists a history of trauma, significant losses, or failed pursuit of one’s passions and interests. If this describes you, I recommend that you don’t give up on healthier eating practices—they are still very, very important! Instead, I recommend also considering the possibility that diet may not represent the full problem or fully explain the symptoms you are experiencing. In such instances, working with a trusted therapist may be beneficial.

Thank you very much for reading, and I wish you the very best on your journey to better health!

References:

[1] “CDC Newsroom.” Centers for Disease Control and Prevention. July 18, 2017. Accessed March 03, 2018. https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html.

[2] “April Q&A: Chronic Fatigue, Sleep Apnea, & Depression – #404.” Bulletproof. November 29, 2017. Accessed March 03, 2018. https://blog.bulletproof.com/10635-2/.

[3] GREGER, MICHAEL STONE GENE. HOW NOT TO DIE: discover the foods scientifically proven to prevent and reverse disease. S.l.: PAN BOOKS, 2018.

[4] Felitti, Vincent J., Robert F. Anda, Dale Nordenberg, David F. Williamson, Alison M. Spitz, Valerie Edwards, Mary P. Koss, and James S. Marks. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine14, no. 4 (1998): 245-58. Accessed March 4, 2018. doi:10.1016/s0749-3797(98)00017-8.

[5] “ACE’s by Vincent Felitti, MD.” YouTube. Video File. December 6, 2010. https://www.youtube.com/watch?v=Me07G3Erbw8&t=1723s

[6] Felitti, Vincent J., Robert F. Anda, Dale Nordenberg, David F. Williamson, Alison M. Spitz, Valerie Edwards, Mary P. Koss, and James S. Marks. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine14, no. 4 (1998): 245-58. Accessed March 4, 2018. doi:10.1016/s0749-3797(98)00017-8.

[7] Charmandari, Evangelia, Constantine Tsigos, and George Chrousos. “Endocrinology Of The Stress Response.” Annual Review of Physiology67, no. 1 (2005): 259-84. Accessed March 4, 2018. doi:10.1146/annurev.physiol.67.040403.120816.

[8]Anda, R. F., V. J. Felitti, J. D. Bremner, J. D. Walker, Ch. Whitfield, B. D. Perry, Sh. R. Dube, and W. H. Giles. “The enduring effects of abuse and related adverse experiences in childhood.” European Archives of Psychiatry and Clinical Neuroscience256, no. 3 (2005): 174-86. Accessed March 4, 2018. doi:10.1007/s00406-005-0624-4.

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