‘Pizza and coke is a vegetarian diet’: How to get patients to eat better in pursuit of good mental health

While the public tends to flock to “eat this, not that” content, good nutrition advice for better mental health is not click-bait fodder. It’s actually a bit dull.Dr. Uma Naidoo, a psychiatrist and author of This Is Your Brain On Food, is often asked for her take on various food trends. When speaking at the University of Toronto’s Food as Medicine Update 2024, she harnessed click-bait language and put up a slide entitled: “My controversial takes.” But then she followed with this: “Just a heads up, I’m not that controversial. That’s where it gets boring for people.” Dr. Naidoo serves as the director of nutritional and lifestyle psychiatry at Massachusetts General Hospital in Boston and also wrote Calm Your Brain With Food. While her books might talk about the properties of specific foods, her focus in clinical practice is to work with patients to get them to slowly adopt a diet of moderation that will help them with their mental health. She promotes a healthy diet with fruits and vegetables, clean proteins, healthy fats, fibre, low in sugar and saturated fats. The idea is to target metabolic disturbances (i.e., insulin resistance), inflammation and dysbiosis that may contribute to anxiety and other psychiatric disorders, a strategy she and her colleague Nicholas Norwitz outlined in a 2021 review in Frontiers in Psychiatry.Helping her patients eat well is not easy. “Habit reversal is one of the hardest things,” she said. She encourages patients to move slowly towards moderation, one thing at a time.Instead of providing messages in an all-or-nothing way, like “never eat meat” or “never drink coffee,” she encourages people to make small changes. For example, she suggests “cleaning up their coffee” or “cleaning up their cocktails.” This means trying to limit extra fats and sugars in these beverages, like switching from cream to milk in coffee and using citrus to flavour cocktails instead of simple syrups.She also gets people to understand food labels and serving sizes. For example, she tells patients that four grams of sugar is a teaspoon, and gets them to calculate how many teaspoons of sugar is in their yoghurt or other food. She also makes sure people know all the names for sugar that appear on American ingredient lists, from “brown rice syrup” to maltodextrin.Her clinical recommendations are evidence-based and meaningful but also personalized to reflect how the person already eats. While she may try to shift a person towards a Mediterranean or portfolio diet, she uses it as a continuum of their existing eating patterns, not as a hard switch.“I’m not here to change what people eat, I’m here to guide them,” she said.Read: What is the Portfolio Diet?When counselling about nutrition, make sure to remember the nuances, Dr. Naidoo advised. For example, increasing fibre intake can be problematic for people with irritable bowel syndrome or Crohn’s disease. Similarly, fermented food has health benefits, but not everyone can tolerate it. Also, be clear in your instructions. As one patient said, “You know Dr. Naidoo, pizza and coke is a vegetarian diet.” Keep the patient’s context in mind, as not everyone has easy access to food for various reasons.Lifestyle is important too. Eating as part of a social group helps, as does getting outside for at least ten minutes a day, she said.Relying on nutrition and lifestyle alone doesn’t always get patients to a place of better mental health. “I still prescribe medications but it is a very thoughtful and mindful way,” Dr. Naidoo said, noting that medications have saved the lives of many of her patients.Dr. Naidoo said she “remains extremely humble on nutrition and medicine” because research is always evolving, and “you can always be proven wrong.” Dr. Naidoo and colleagues are working on a new book called Clinical Nutrition in Healthcare for medical learners. The University of Toronto Food as Medicine Update 2024 was held in early November.Read: QUIZ: Test your knowledge of nutrition and the mind

‘Pizza and coke is a vegetarian diet’: How to get patients to eat better in pursuit of good mental health

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