Q: I don’t have a degree in nutrition, but I think many of my clients could improve their moods by incorporating some basic ideas about healthy eating into their self-care. How can I help them do this?
A: After working as a psychotherapist and a behavioral medicine specialist for more than 35 years with diverse populations of depressed and stressed clients, I’ve found that the standard North American diet—which includes a large proportion of refined foods, such as breads, rice, pastas, and sugary drinks—is a prime contributing factor in many clients’ presenting complaints. Of course, just as there’s no one correct psychotherapeutic intervention for everyone, there’s no one diet for everyone, but I’ve developed two basic dietary requirements for helping clients better integrate wellness, self-care, and nutrition. One is to eliminate refined carbohydrates and sugars from their diet, and the other is to increase their protein intake.
Mood follows food, and mood swings follow blood-sugar swings. Refined carbohydrates, such as sugar and white flour, cause blood sugar to rise sharply and then drop; hence the quick pickup when we grab sugar, followed by the just-as-quick letdown within an hour or two as glucose levels drop and fatigue and irritability return. To balance mood, stabilizing blood sugar is the first nutritional action to take.
People under chronic stress are vulnerable to reactive hypoglycemia, which occurs as a result of an excessive release of insulin following a meal high in refined carbohydrates. The resulting drop in blood glucose leads to a drop in mood as well as irritability, nervousness, panic, confusion, and shakiness. Thus, with the increase in diagnoses of attention and mood disorders and the overmedication of their symptoms, it behooves us to include simple questions in our intake sessions with clients about their use of sugar—specifically, how often they drink sodas and energy drinks and eat refined carbohydrates, such as cookies, white bread, and pizza. Many children with apparent attention problems who regularly eat sugary cereals in the morning would have more sustained and focused energy if they simply ate more protein for breakfast.
For adults and children alike, withdrawing from sugar and refined carbohydrates can be done by going on a protein-rich diet for 7 to 10 days. This process involves eating small amounts (two to four ounces) of protein six times a day (every three to four hours) and one to two servings of a root vegetable—such as a sweet potato or carrots topped with butter or olive oil—along with raw salads or cooked green vegetables. Vegetarians, whose diets are typically carbohydrate heavy and protein light, will benefit from eating more eggs and dairy, along with vegetables and legumes, to ensure that their protein sources provide a complete mix of amino acids, the chemical building blocks of mood and focus.
Following this change in diet, most people will lose their craving for refined carbohydrates and sugars.
From there, small amounts of additional carbohydrates, like fruit and grains, can be restored to their diet each day. But the basic principles of using protein to enhance mood and attention should persist. For example, hard-boiled eggs make a great snack, and baked or roasted chicken or fish can easily be packed for lunch.
To help clients make changes in their diets to improve mood stability, I often share information about alternatives to sugar and artificial sweeteners, such as aspartame. A significant body of research has shown that aspartame, along with other food additives, has been linked to neurological, psychiatric, and behavioral disorders and is associated with headaches and panic among vulnerable individuals, including people with a history of depression. Stevia, a plant indigenous to South America and now readily available in powder or liquid form, is a great sugar substitute.
To get a mild mood boost, many clients, especially women, eat a lot of dark or milk chocolate, yet most chocolate has high levels of sugar in it. So I recommend that clients obtain pure organic cocoa, mix it with a favorite liquid (almond, hemp, or rice milk, or organic cow or goat milk), and add stevia to sweeten it. This becomes a nutritious and medicinal drink, which eases the challenge of going cold turkey on sugar.
Digestion and Mental Health
The intestinal tract, or the gut, is often called the “second brain” because it’s a major source of neurotransmitter
production in the body. It’s therefore unsurprising that people with chronic digestive problems are often anxious and depressed. Healthy bacteria, known as probiotics, help lower the stress response by regulating GABA, the relaxation neurotransmitter, via the vagus nerve. Probiotics may be bought in capsule or liquid form in a healthfood store, but fermented foods are among the best foods for intestinal health. In fact, most traditional diets of the world include fermented foods, such as sauerkraut, kimchi, kefir, natto, miso, and yogurt. Where fermented foods are not available, yogurt and sauerkraut can be made at home easily and inexpensively and are a wonderful food preparation and “science experience” to share with children.
Inflammation, a healing process that normally occurs as a result of an injury or infection, is another nutritional issue for therapists to consider, as it can also occur as a result of poor diet, physical inactivity, obesity, smoking, increased gut permeability, lack of sleep, and vitamin D deficiency. In these cases, inflammation can become a chronic condition, causing the sustained production of inflammatory cytokines, which contribute to depression and the breakdown of nerve cells, negatively affecting neurotransmitter function. A 2007 study by Zhang and An in International Anesthesiology Clinics demonstrates that counterregulating the production of inflammatory cytokines may even increase treatment response to conventional antidepressant medication. Certain foods, such as refined sugars, trigger inflammatory cytokine responses, so eliminating these foods helps stabilize mood and reduce systemic inflammation over time.
When discussing diet and nutrition with clients, I usually ask them to use a food, mood, and exercise diary to keep detailed track of what they eat, how they feel, and when they exercise for three days. This diary is a valuable tool for revealing clients’ self-care routines—or lack of them—and can greatly enhance awareness of what they eat and how it affects their energy and mood. Ultimately, recognizing that mood is a mind–body experience and not just based on personal history or mental processes can be crucial in increasing clients’ sense of self-efficacy and broadening their perspective on the many pathways to change.
Photo by Ella Olsson/Pexels
Leslie Korn, PhD, MPH, LMHC, ACS, RPP, NTP, NCBTMB, is a renowned integrative medicine clinician and educator specializing in the use of nutritional, herbal and culinary medicine for the treatment of trauma and emotional and chronic physical illness. Her clinical practice focuses on providing clients effective alternatives to psychotropics. She is licensed and certified in nutritional therapy, mental health counseling, and bodywork (Polarity and Cranial Sacral and medical massage therapies) and is an approved clinical supervisor. She is the author of the seminal book on the body and complex trauma Rhythms of Recovery: Trauma, Nature and the Body (Routledge, 2012), Nutrition Essentials for Mental Health (W.W. Norton, 2016), Eat Right Feel Right: Over 80 Recipes and Tips to Improve Mood, Sleep, Attention & Focus (PESI, 2017), Multicultural Counseling Workbook: Exercises, Worksheets & Games to Build Rapport with Diverse Clients (PESI, 2015) and The Good Mood Kitchen (W.W. Norton, 2017). Her latest book, The Brainbow Blueprint: A Clinical Guide to Integrative Medicine and Nutrition for Wellbeing, will be out the spring of 2023. To learn more, go to her website: drlesliekorn.com.