If like me you are an insatiable and unabashed fan of the mighty (formerly. Sniff.) Mary Berry-fronted The Great British Bake Off, a stalwart on the screens of British homes, you may recognize Kimberley Wilson as a finalist from 2013. Her mouth-watering bakes (pecan & rosemary caramel apple pie anyone?) and sunny disputation made her a favourite from the get-go, and when I recently came across her work in nutritional psychiatry, I was extremely interested to find out more.
You may know Kimberley as being an incredible baker, but with a Bachelor's Degree in Psychology, a Masters in Counselling Psychology, a second Masters in Psychotherapy, the former manager of Primary Care Mental Health Service at HMP & YO Holloway (Europe's largest women's prison, closed 2016), and currently working privately in London as well as at her independent practice, Monumental Health, there's a lot more to Kimberley then a well-executed Victoria Sponge.
Kimberley is doing some incredible work around exploring the effects of what we eat on our mental and physical health. According to the Mental Health Foundation, 1 in 4 people in the UK will experience a mental health problem in any given year, and mental health problems are one of the main causes of the burden of disease worldwide. In the UK, they are responsible for the largest burden of disease - 28% of the burden, compared to 16% each for cancer and heart disease. I am so excited to talk to Kimberley in a topic close to my heart, cognitive & physical wellbeing and nutrition, and gut health. Exploring the link between what we eat and our mental health, how a good diet can ward off depression, and how we can implement changes to our own day to day lives, kick back for a thought provoking read with Kimberley Wilson.
NUTRITIONAL PSYCHIATRY: WHAT IS IT?
Nutritional Psychiatry is an emerging field in the treatment and prevention of mental illness. It looks at how particular nutrients impact brain function and uses nutritional interventions (changes in diet and/or the use of supplements) to prevent or treat mental health problems.
The short version is that what you eat has an effect on brain function.
Those effects manifest as changes in mood, behaviour and/or can exacerbate mental health problems. When you think about it it makes intuitive sense; your organs rely on nutrition to function properly. For example we are all told as children to eat carrots because they are good for our eyes but we seem to forget that the brain is an organ too.
Your brain makes up only about 2% of your total body weight but it uses about 25% of the energy from your diet; that’s a massively disproportionate demand and – for better or for worse – your brain is soaking up at lot of whatever it is you choose to eat and drink.
I think the focus for so long has been on how diet influences how you look and your physical health that the role of diet on brain health has been hugely neglected. The research, though, is so compelling that last year The Lancet Psychiatry published a paper stating that nutrition is as important to psychiatry as it is to cardiology and that professionals working in mental health should understand the role that a patient’s nutritional status might be playing in their psychological problems. In my practice I combine this nutritional research with psychological therapy so that my patients get a complete approach to their problem.
THE LINK BETWEEN WHAT WE ARE EATING AND OUR COGNITIVE WELLBEING
The link between what we eat and how we think or behave is fascinating and complex. So, for example, there are compounds in raw cocoa that increase profusion, which is the amount of blood that flows through your brain, which could affect alertness or reaction times.
Compounds in rosemary have been shown to significantly improve memory performance. The most surprising research, though, is looking at how changes in the gut microbiome can have profound effects on brain function and behaviour. There are strains of bacteria that have been shown to reduce anxiety in both animal and human trials.
Similarly, several large cohort studies have shown that people who have a healthy diet (plenty of vegetables, fruit, wholegrains, oily fish, nuts, seeds and beans) have a reduced risk of developing depression, even when you control for other factors in their lives.
A healthy diet is protective against depression.
There are a few ways that diet could influence the brain in this way. First, we know that the bacteria in the gut produce some useful compounds as a by-product of their digestion (fibre is their favourite food!). They can produce helpful vitamins, minerals and fatty acids. One strain Bifidobacterium dentium produces a molecule called GABA, which functions in the brain as an inhibitory neurotransmitter. You can think of GABA as having a calming effect on the brain and nerve cells, which is why it is linked to pain management, anxiety and ADHD. GABA produced in the gut can travel in the blood stream and enter the brain. Another route of action is via the vagus nerve, a long nerve that connects the brain and the gut. Most of the serotonin (the neurotransmitter associated with good mood) in your body is produced in your gut. While this serotonin doesn’t cross in to the brain (your brain produces a small amount too) it thought that it might signal via the vagus nerve important information to the brain from the gut.
Another important mechanism is inflammation. Inflammation is your immune system’s response to illness, infection or injury. Immune cells mistaking molecules of peanut or pollen results in the inflammatory allergy response. There is growing evidence that some kinds of depression may be linked to inflammation and this is where diet comes in. A poor diet puts strain on the body in number of ways (too numerous to write here) and can lead to long-term, low level inflammation. For some people depression might be a symptom this inflammation affecting the brain. As a psychologist this is enormously important news for the people I work with, which is why I care about it so much.
WHY THIS HAS COME TO THE FORE IN RECENT YEARS
Over recent years researchers have been confused and frustrated as to why depression and other mental health disorders seem to be on the rise. The development of antidepressants in the 1960s was supposed to bring relief but the results have been modest at best and often come with unacceptable and debilitating side-effects. At the same time we have seen a rise in obesity and ‘lifestyle diseases’ (Type II diabetes, hypertension, heart disease, some cancers) and it lead people to think seriously about the broader role of diet on the mind as well as the body.
Could mental illness and these physical illnesses share a mechanism? The answer seems to be yes.
TOTAL BODY PERSPECTIVES
In my practice I approach mental health from a ‘total body’ perspective. So if someone comes to me troubled with depression, for example, as well as the standard full psychological assessment, I also assess their lifestyle; diet, exercise, injuries, courses of antibiotics, work and relationship stress, sleep. I don’t assume that their psychological issue is ‘all in their heads’ but that it might be associated with other physical and lifestyle concerns. Then I will create a bespoke treatment package to help address the issues identified.
I think diet should absolutely be a first line of defence and treatment for depression. Firstly, it is something that the sufferer can alter immediately and independently, no waiting lists!
Secondly, a healthy diet doesn’t have any negative side effects. It’s hugely empowering.
This isn’t to say that diet can fix everything for everyone but it can certainly have a positive impact and when you are depressed even a 1% improvement in how your feel can make an enormous difference.
THE LINK BETWEEN HEALTHY EATING HABITS AND DEMENTIA
Dementia has just become the leading cause of death in the UK and America. For a while now there have been a group of doctors and researchers who have referred to Alzheimer’s (the leading cause of dementia) as Type III diabetes, they were so sure that uncontrolled blood sugar and disrupted glucose metabolism were having these damaging effects on the brain. I read a paper just yesterday that described the mechanism by which this happens. So a diet high in processed, simple sugars is bad for both the body and the brain.
We also know that B vitamins are essential to optimal brain function. Deficiencies in B vitamins can lead to severe memory problems and other symptoms that mimic dementia. Low blood levels of these vitamins are also a risk factor for later going on to develop dementia and higher dietary intakes of B vitamin containing foods reduces the risk. Similarly, vitamin D has an important role to play in protecting cognitive function. Both of these vitamins are found in highest concentrations in animal products: meat, fish, eggs, dairy, poultry, so vegetarians and vegans should take extra care to ensure they are getting sufficient amounts.
Higher dietary intakes of fruits and vegetables have been linked to reduced risk of dementia while excessive, long-term alcohol consumption can lead to alcohol-related dementia. So what you eat and drink can have serious effects on the way your brain functions as you age.
HOW CAN WE IMPLEMENT BETTER CHANGES TO OUR EATING HABITS, TO KEEP OUR BODY AND MIND HEALTHY.
We tend to struggle with the idea of deprivation and as soon as a food becomes ‘forbidden’ we crave it even more so I work with an ‘additive’ rather than a ‘subtractive’ model. If you focus on making sure you are getting enough of the things your brain and body need by adding in nutrient-rich foods, typically, everything else will balance out.
Most people are seriously lacking in two areas: fibre and omega-3s. People are catching on for the need to eat more fruit and veg (although there is still some way to go) but the majority of people are getting nowhere near enough of these two nutrients. Fibre is essential because it is the primary food of the gut microbiome. When gut bacteria break down fibre they produce all the helpful compounds I mentioned above. But of equal importance is what happens where we don’t get enough fibre. When this happens the microbes in our guts begin to starve and will then turn to the next available food source, the mucus lining that protects the wall of the intestine. When this happens the gut wall becomes damaged and broken down bits of food and bacteria cross in to the blood stream. At this point the immune system recognises these particles as intruders and sets of the inflammatory response leaving the body in a state of low-level chronic inflammation, which is linked to a number of health issues such as rheumatoid arthritis, some cancers, inflammatory bowel disease, and other autoimmune diseases.
Omega-3 fats are essential fats. Essential means that the body cannot produce them by itself so they must be taken in from the diet. These fats have an anti-inflammatory effect on the body but, significantly, they are central to proper nerve function. Unfortunately, in the UK very few people are eating the recommended amounts of the main food source of these fats – oily fish – so we are seriously deficient.
The easiest thing to do is to switch to wholegrain or whole wheat versions of your main foods: wholemeal bread (not brown) instead of white, brown rice instead of white rice, whole wheat pasta replaces white pasta. Adding a handful of raw, unsalted nuts as a daily snack is a great step as they contain fibre and essential fats. Then increase the amount of beans and legumes in the diet – have some hummus as a snack, eat a bean-based soup for lunch, order daal when you next go for a curry. And then eat more oily fish and seafood: salmon, trout, herring, sprats, sardines, mackerel, mussels and cockles. All are rich in brain-healthy nutrients and most are very economical (a tin of sardines is about 40p).
I would also recommend topping up your good bacteria with fermented foods – unpasteurised sauerkraut, kimchee, live yogurt, kefir and kombucha - or a good quality, broad spectrum probiotic. But there’s no point in taking a probiotic if there’s nothing for them to eat, so that’s back to the fibre.
Gut health is essential. Immunity starts in the gut. Your health starts in your gut. You are made up of all the things you eat and drink so making sure that they process of digestion and assimilation is functioning optimally is the starting point for everything else.
The ‘second brain’ is another term for the enteric nervous system, the neurones that control the function of the gut. It’s referred to as the ‘second brain’ in part because the GI tract is able to carry out its work of digestion without instruction from the brain. The term also refers to the effects of this complex interaction of nerves, neurotransmitters, the immune system; how all of this can influence our mental and emotional states.
WHAT ARE YOUR RECOMMENDATIONS FOR NUTRITIONAL ADVICE THAT PEOPLE CAN IMPLEMENT TO STAY BETTER BALANCED AND TACKLE THE STRESSES OF MODERN LIFE?
Everyday stress and pressure has a biological effect on the body. When you are about to hit a deadline, or give a presentation the body’s stress response kicks in, releasing adrenaline, cortisol, fats and sugars into the blood stream to provide your body with the energy to ‘fight or flight’. This is fine is small doses and can even help performance but over the long term this can stress the body and lead to a state of low-level chronic inflammation, so it can be helpful to do and eat things that can help to keep inflammation down. That includes plenty of fibre and fermented foods to keep the microbiome happy, omega-3 fats, brightly coloured fruits and vegetables especially berries and leafy greens. Herbs and spices like ginger, garlic and turmeric may also be beneficial. Conversely, cutting back on processed, sweetened and fried foods will help to ease the stress burden. In addition try to get enough sleep for your needs and regular exercise to build physical and psychological resilience. If you feel you still really suffer from stress meditation or seeking advice from a therapist can help you find effective ways to cope.
Thank you Kimberley and to find out more about Kimberley head to:
Stay tuned for our next Expert's Chat with martial arts prodigy and movement coaching renegade, Jamie Ray.