Dietary education has been used as a treatment for poor eating practices among adolescents with mental health issues. Critically assess the rationale and effectiveness of this treatment.

 Introduction

There is a wide array of mental health complications and disorders, including depression, anxiety disorders, eating disorders, and bipolar disorders, which are typically categorized on the basis of certain symptoms. These symptoms include abnormal behaviors, emotions, thoughts and social relationships. Mental health issues amongst adolescents tend to cast a negative influence not only on the adolescents but also extend to their adverse effects on their parents and the entire family. The health related quality of life of the patient has a profound impact on his/her risk factors for a mental illness, and this involves the physical, emotional, social and mental wellbeing of the individual. Adolescence is characterized as a period of transition that maps out a child’s journey towards adulthood. This is a time of dramatic changes and development, and adolescence can give birth to a wide range of unhealthy eating patterns.

Adolescents are more likely to consume unhealthy fast food, eating away from home, consume excessive amounts of added sugars, and skip meals and higher intakes of saturated fats. Lack of sufficient nutrition and healthy food items is a significant factor in the development of brain diseases and mental health ailments, particularly cognitive disorders. Unhealthy eating patterns and behaviors are a vital determining factor of some of the most common mental health issues, including depression, conductive issues amongst adolescents, and hyperactivity disorder. (WHO, 2017)

There is well-supported evidence to suggest a link between mental health complications amongst adolescents and unhealthy eating patterns. There is a significant association between hyperactivity or convenient disorder and oppositional disorders amongst adolescents with unhealthy heating habits that involve “convenient snacking” and “junk” food items. Diets that are rich in high amounts of saturated fats, sugars, refined grains, processed meats, excessive amounts of sodium, and a reduced consumption of vegetables, fruits, fiber and omega-3 fatty acids had a higher vulnerability to be diagnosed with attention deficit hyperactivity disorders (ADHD). (Oellingrath et al., 2014)

Multiple other well-supported studies have associated unhealthy eating patterns with anxiety and depressive disorders. Dietary education treatments and nutrition therapies have been used as a medium to bring about enhancements in diet quality and improve healthy eating patterns to bring about improvements in the mental health conditions of adolescents. These dietary improvements focus on reversing the eating patterns of skipping breakfast, and consuming high amounts of sugar through sweets, desserts and beverages, which are associated with multiple mental health ailments. Academics have highlighted the potential link between lack of dietary nutrition and unhealthy eating patterns with a wide array of mental health ailments amongst adolescents. (Jacka et al., 2010)

The association between mental health ailments amongst adolescents and unhealthy eating patterns can be explained through various biological paradigms. First and foremost, an unhealthy diet that lacks nutrient-rich food items can lead to a wide array of mental health challenges. For instance, a diet that lacks sufficient amounts of omega-3 fatty acids, zinc, magnesium, and folate is associated with the onset of anxiety disorders and depression. Secondly, the daily diet of an individual has a direct impact on the biological mechanisms and pathological pathways that given rise to mental ailments and disorders. These mechanisms include the inflammatory parameters, biomarkers that indicate oxidative stress, and immune system markers that lead to mental health complications, such as anxiety and depression. Research reveals that a diet that lacks essential nutrients is directly linked with higher amounts of oxidative stress and inflammation within the body, which eventually lead to the onset of mental health complications and disorders. It is also important to note that eating patterns that involve higher concentrations of saturated fats and sugars can damage the proteins involved in the development of the human brain. (Kafatos et al., 2011)

Multiple studies have indicated a direct association between a healthy diet and the health and life quality of patients suffering from mental health ailments. Dietary education treatments and nutrition therapies that encourage patients to adhere to healthy eating patterns are widely associated with marked improvements in the physical and psychological wellbeing of the patients, alongside reduced levels of obesity. Adherence to a diet that is rich in fruits and vegetables, or a combination diet that provides healthy amounts of low fat dairy products, fruits and vegetables proves effective in bringing about significant improvements in the life and health quality of adolescents combatting mental health disorders and challenges. Adopting healthy eating patterns, such as Mediterranean eating patterns of the dietary approach to stop hypertension (DASH) without causing any nutrient deprivation or hunger can help people combatting mental health challenges to improve their life and health quality. Adolescents who have been educated and underwent therapy to adhere to Mediterranean eating patterns make significant strides in enhancing their life and healthy quality, alongside their physical and psychological wellbeing. (Zervaki et al., 2017)

Literature Review

Changing the dietary patterns and eating habits of an individual or adolescent and encouraging them to adopt nutrient-dense and healthier food choices can be a challenging endeavor. There is a wide pool of research that indicates that treating depressive disorders and other mental health complications by encouraging and modeling healthy eating behavior and home cooking models can prove immensely beneficial, particularly amongst adolescent patients who are transition towards adulthood. Encouraging and celebrating family meals can help encourage healthier eating patterns amongst adolescents who eat lesser meals at home and instead, consume huge amounts of unhealthy food items. Dietary education treatments are focused on increasing the frequency of family meals and nutrient-rich meals prepared at home to reduce the risk factors of obesity and overweight amongst children and adolescents. This measure also serves the purpose of safeguarding them against eating disorders and negative mental health behaviors, particularly amongst children and adolescents.

Research reveals that the creation of family rituals, be it in a cultural capacity or in a ritualistic aspect of a family setting, proves effective in encouraging and celebrating healthy eating behaviors amongst children. By encouraging the additional effort of planning healthy meals, cooking nutrient-dense foods and celebrating healthy eating patterns, adolescents can be encouraged to make smart and healthy food choices that will bring about significant improvements in their physical and mental wellbeing.(Oddy et al., 2009)

Dietary and nutritional education treatments are being used in conjunctions with other mental health interventions to treat depression, anxiety disorders and other mental health ailments. Majority of the mental healthcare professionals are focused on a medicinal approach of treating psychological symptoms with a wide array of pharmaceutical drugs and treatments. However, experts and researchers are rapidly highlighting other treatments and approaches of treating depression, of which the nutritional and dietary approach has gained immense popularity. But the use of anti-depressants continues to be the most common form of mental health intervention in combatting depressive disorders. (Johnson, 2010)

Dietary education interventions focus on nutrition education, counselling, micro and macronutrient supplementation, and food fortification with the agenda of enhancing the eating patterns of the adolescents. There is a wide array of systematic reviews that examine the impact of dietary education and nutrition interventions amongst adolescents suffering from mental health ailments. Multiple systematic reviews and meta-analysis have launched an inquiry into the relationship between nutrient-dense diets and mental wellbeing. Research reveals that an increased consumption of a healthy and balanced diet that is rich in fruits, vegetables, whole grains and fish can effective reduce the risk factors of depression. Experts and mental health professionals are increasingly becoming aware of nutritional interventions as a form of preventive care to help adolescents combat the risk factors of mental health disorders, including depression. (Lai et al., 2014)

Academics reveal that adhering to the Mediterranean diet can help reduce the risk factors of depression. A systematic review of 21 cross-sectional studies and 20 longitudinal studies offers well-supported evidence that a Mediterranean diet can offer effective preventive care against depression. Dietary interventions hold the potential to reduce the incidences of depression. Although the exact effect of the Mediterranean dietary interventions amongst adolescents with depression or depressive disorders needs to be explored in more detail, there is compelling evidence that including dietary education as part of traditional treatments can bring about positive results and improved behaviors. (Lassale, et al., 2018)

There are multiple examples of how dietary education and intervention can prove beneficial in treating patients suffering from a wide array of brain and mental health ailments. For instance, the ketogenic diet for children suffering from epilepsy is a prominent dietary intervention to improve the health of the brain. While the exact mechanisms that make this intervention effective is yet to be known, fasting conditions prove effective at reducing epileptic seizures and provides sufficient levels of energy to fortify the brain. (Neal et al., 2008)

Studies that advocate the need for and effectiveness of dietary education shed light on the need to promote awareness of the cognitive impairments and mental health challenges caused by the deficiencies of various nutrients, particularly vitamins. The strongest association is made with Vitamin B12, and its deficiency can contribute to the symptoms of depression, memory disturbances, fatigue, exhaustion, mania and psychosis. A deficiency of thiamine, also known as vitamin B1, has been associated with CNS symptoms and Wernicke’s encephalopathy. Moreover, a deficiency of vitamin B9 or folic acid can lead to severely adverse impacts on the neurodevelopment of infants, and cause a greater vulnerability for depression during adulthood. (Smith et al., 2018)

The deficiency of niacin, or vitamin B3, can lead to the symptoms of Pellagra with dementia. However, as we continue to study these deficiencies and their correlation with mental health ailments, the impact of mild subclinical or multiple deficiencies on mental health ailments and dysfunctions remains unclear. For instance, multiple studies have examined the impact of Vitamin D on mental wellbeing, and various trials have brought forward varying results. Trials that focused on serums with higher concentrations of vitamin D have been correlated with improved attention spans and enhanced memory performance. (Enderami et al., 2018)

Randomized controlled trials (RCTs) that examine subjects throughout childhood, adolescence and adulthood have provided substantial evidence to understand the impact of vitamin D supplements on treating the symptoms of depression. Academics have also studied the impact of vitamin D supplementation on attention deficit hyperactivity disorder (ADHD).

(Mohammadpour et al., 2018).

As we continue to examine literature and evidence on the effectiveness of dietary education, we notice a scarcity of randomized controlled trials (RCTs) that inquiry the effectiveness of dietary education and changes as part of mental health treatments. One of the most prominent nutrition intervention studies focused on a 12-week Mediterranean diet. This diet succeeded in bringing about marked improvements in mood, and also proved effective in reducing anxiety levels amongst patients suffering from severe depression. (Jacka et al., 2018)

More recently conducted trials have verified the benefits of the Mediterranean diet in mental health treatments, particularly depression. Multiple other trials and studies have revealed that multi-nutrient supplementation did not prove effective at reducing episodes of severe depression amongst obese or overweight patients suffering from the symptoms of subsyndromal depression. (Bot et al., 2019).

This highlights the need for advancements in nutritional psychiatry, and the need to refine and streamline dietary interventions aimed at preventing and treating common mental health disorders and complications. There is a need for more randomized controlled clinical trials that can examine the effectiveness of these dietary education treatments. The aforementioned trials and studies offer a wide array of examples that reveal that specific dietary education and interventions prove effective at improving mental health and altering certain brain functions that cause these complications. There is immense need to highlight and study the metabolic mechanisms and cellular processes that create a connection between the brain health and diseases with nutrition. There is also need to develop specific dietary patterns, nutrient groups and eating habits of whole foods that can exhibit promising effects at elevating the symptoms of mental health disorders. Certain medicinal approaches and experimentation can also prove helpful in examining the impact of dietary interventions, in order to streamline the choice of dietary patterns and nutrients that can prove effective in treating mental health complications amongst adolescents. Nutritional interventions and dietary education can prove immensely effective at reducing the effect of stress on the cognitive and mental wellbeing of adolescents and adults suffering from mental health ailments. However, there have been few randomized controlled trials in clinical groups to validate their effectiveness. (Gibson-Smith et al., 2019).

It is important to note that nutritional interventions and dietary education is much different from medicinal treatments and pharmacological interventions. Medicines work through one or a fewer number of targets for which these medicines have a higher impact. Vitamins are the only type of nutrients or dietary education that has been studied in the same manner as pharmacological treatments. It is important to note that most nutrients and vitamins are consumed in greater quantities than medications. Now, since the quantity of the nutrients and their metabolites boost a much greater concentration, they tend to impact a wide array of targets. In simpler words, nutrients and their metabolites bind and affect multiple targets across several vital organs. There are many studies and clinical trials that have studied the impact of individual nutrients and food items on the brain, and bodily processes, contemporary research on nutritional interventions is now shifting its focus from a single nutrient towards multiple dietary patterns and eating behaviors. This is an important milestone in advancing dietary education as part of mental health treatments because nutrients act together to impact certain organs and functions. Majority of the dietary interventions do not consist of a placebo to control the trial, since it can cause complications and challenges for the trial design. In a controlled situation, it can be much easier to understand the impact of a nutrient deficiency or consumption. (Sarris, 2019).

The body requires a wide array of essential nutrients that cannot be synthesized within the body and are vital to support physiological and cognitive functions. A poor diet that lacks sufficient essential nutrients can lead to a wide array of mental and physical health challenges. There is an overwhelming evidence that dictates that low quantities of essential nutrients and unhealthy eating patterns can increase the vulnerability of cognitive decline. Moreover, there is also a need to examine the individual differences in terms of nutrient requirements and sensitivity amongst adolescents. In order to enhance the delivery of personalized dietary education and advice, there is need to understand the individual requirements of essential nutrients and the complications caused by the deficiencies of certain nutrients. Evidence reveals that there is a direct relationship between nutrition, vulnerability to stress, mental wellbeing and cognitive functions throughout the lifespan of a patient.

However, there is a gap in the understanding of the exact impact of nutritional therapy and dietary education treatments. There have been multiple breakthroughs in understanding the bidirectional association of nutrition and cognitive functioning, but further research is required to create a well-informed and decisive public health and psychiatric strategy focused on dietary patterns. The development of pragmatic and innovative nutritional interventions and research-driven dietary education requires an improved understanding of how nutrients and eating patterns impact cognitive functions and mental wellbeing to promote the health of the brain amongst adolescents. The promotion of dietary education and advocating healthy eating patterns can have a definitive impact on improving mental health and wellbeing. It will also aid in reducing the economic costs associated with lack of mental wellbeing and cognitive decline, and work towards making the healthcare system and mental health treatments more effective and sustainable. (Hebebrand et al., 2018).

Over the past ten years, there have been multiple studies that reveal that dietary education and treatments can play an integral role in the prevention and treatment of depression, mood disorders and other mental health disorders and complications. Studies that examined the impact of dietary interventions also examined the impact on unhealthy eating patterns on the cognitive decline. Researchers highlight that excessive consumption of fast food items or junk food items can lead to mental health challenges amongst adolescents. These food items typically include processed foods, hamburgers, pies, pastries, fried food, pizzas, poultry dishes, French fries and sodas. Research reveals an increased associated between excessive fast food consumption and increased risk factors of mental health complications. (Oddy et al., 2009)

Multiple studies have examined the impact of individual nutrients, such as vitamins B12, essential minerals like selenium, iron, zinc and other nutrients, including omega-3 fatty acids. Dietary intervention trials have also observed the impact of supplementation using more than one nutrients, such as multivitamins, and docosahexaenoic acid, in treating mood disorders.

However, the idea of investigating individual nutrients to ascertain whether that single ingredient is responsible for improving mood is problematic. Mood regulation is influenced by a number of different neurochemical pathways (e.g. serotonin and dopamine), with each requiring several nutrients to supply the metabolites necessary for production of the individual neurotransmitters involved in regulation of mood (20) . An alternative approach has been to explore the effects of the whole diet and eating patterns on mood. In correlational epidemiological studies of adults, an ‘Unhealthy’ and ‘Westernised’ diet was associated with an increased likelihood of mental disorders and psychiatric distress(21-24) , whilst a ‘Healthy’ or ‘good’ quality diet was associated with better mental health (21, 25-28) . However, several other factors such as socioeconomic status (SES), household income and educational levels also influence dietary choice and thus need to be included as potential confounds (29,30) . Overall, studies with adults that have investigated the relationship between diet and mental health suggest that the relationship is complex and potentially, bidirectional (31). Given the development of the brain during childhood and adolescence, and the emergence of depression during adolescence, the impact of diet on mental health may plausibly be greater during this period than later in life (3,4.32) . Additionally, adolescents typically become increasingly independent and make more decisions about the type and amount of food they consume, including ‘junk’ and ‘fast’ foods (33) . Therefore, the relationship between diet and mental health in young people and children therefore warrants specific attention. In a recent review, 12 epidemiological studies were identified and reviewed that examined the association between diet and mental health in young people (34). It concluded that there was evidence for a significant relationship between an unhealthy diet and worsening mental health

Conclusion

There is research to suggest that what we eat may affect not just our physical health, but also our mental health and wellbeing.

Eating well (i.e. a well-balanced diet rich in vegetables and nutrients) may be associated with feelings of wellbeing. One 2014 study found high levels of wellbeing were reported by individuals who ate more fruit and vegetables¹.

A recent study found that a Mediterranean-style diet (a diet high in vegetables, fruits, legumes, nuts, beans, cereals, grains, fish, and unsaturated fats such as olive oil.) supplemented with fish oil led to a reduction in depression among participants, which was sustained six months after the intervention.²

The importance of good nutritional intake at an early age is explored in multiple studies, including a systematic review in 2014, which found that a poor diet (with high levels of saturated fat, refined carbohydrates and processed food products) is linked to poorer mental health in children and adolescents³.

However, there are a range of inequalities that can contribute to the development of mental health problems, and how these factors interact with each other to affect mental health can be complex. Factors such as poorer physical health, and living in poverty, or deprived communities, have been found to be associated with poorer mental health and wellbeing.  Both these inequality factors have also been shown to have a complex relationship with poor nutrition⁴.

Experience of a mental health problem may also be associated with poorer diet and physical health. There have been efforts to close the ‘mortality gap’ for people with severe mental health problems, who on average tend to die 10 to 25 years earlier than the general population.⁵  A number of factors may contribute to this premature mortality, including dietary and nutritional factors, among other things.⁶

Poor nutrition can lead to physical health problems such as obesity, though there are a number of demographic variables that could affect the direction and/or strength of the association with mental health including severity of obesity, socioeconomic status and level of education, gender, age and ethnicity.⁷

The relationship between obesity and mental health problems is complex.  Results from a 2010 systematic review found two-way associations between depression and obesity, finding that people who were obese had a 55% increased risk of developing depression over time, whereas people experiencing depression had a 58% increased risk of becoming obese. ⁸

While a healthy diet can help recovery, it should sit alongside other treatments recommended by your doctor.

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