If you’ve ever wondered, “Should I take a supplement for this?” this is the post for you. We’ll walk through a decision-making tool to help you figure out when you should take a vitamin/mineral supplement, and when you probably shouldn’t (or simply don't need to).
Let’s note up front that I’ll be speaking generally in this post, because there’s no way we could cover everything in one blog. I’m also specifically talking about vitamin and mineral supplements here; some of this can be generalized to other categories of supplements, but not all of it.
And as always, I highly recommend talking to a doctor or dietitian about your specific history and concerns!
So – when should I take a supplement?
There’s a growing body of evidence that people with mental health issues specifically may have higher needs for various nutrients. As one small example, there are some connections between genetic B vitamin processing disorders and mood disorders, which means that some people with depression, bipolar disorder, and schizophrenia may need more or different forms of various B vitamins to meet their individual needs.
Often, when someone’s labs show a less-than-optimal level of a vitamin or mineral and they have substantial dietary changes to make, I’ll recommend a supplement temporarily and continue to monitor their intake of that nutrient until I feel they’ve reached a point where they are consistently getting enough from their diet alone.
OK then, so when shouldn’t I take a supplement?
In general (with some notable exceptions), the nutrients we make into supplements are contained in foods we could be and should be eating.
And typically, the packaging of those nutrients within a food are more “friendly” to our bodies because:
I think there’s also an argument to be made that we just don’t know all the nutrients that are out there yet! We are constantly discovering new phytochemicals and nutraceuticals that turn out to be incredibly important for optimal health and disease prevention. We certainly don’t want to miss out on these nutrients by thinking that we can just take supplements and then we don’t have to eat our fruits and veggies.
The bottom line:
The main questions when deciding whether to take a supplement are:
Interested to learn more? If you have any questions, feel free to comment below or message me directly. If you’d like more personalized guidance, schedule an appointment or a free 15-minute discovery call with me! I’d love to work with you.
Erica Golden, RDN
In the realm of nutritional psychiatry, some of the best evidence is for the ability of omega-3 fatty acids, and specifically fish oil (which contains fatty acids called EPA and DHA, among others) to help treat depression.
So what exactly is the evidence, and what do we do with it?
To start, let’s first define what we mean by fish oil. Out of all the different types of fats and oils, there are just a couple that are considered essential for our bodies – meaning that we can’t make them on our own. One of those essential fatty acids is ALA, or alpha linolenic acid, an omega-3 fatty acid. (The other is LA, or linoleic acid, an omega-6 fatty acid.) ALA is considered essential because it is the precursor to two very important fatty acids: DHA and EPA.
However, a relatively small percentage of ALA is actually converted to either of these in most people. So while we can certainly eat flax seed, chia seeds, and walnuts and get a fair amount of ALA from these foods, the most efficient way to get EPA and DHA is to eat fish, especially the cold water oily fish like salmon, sardines, anchovies, herring, and mackerel, or sea vegetables like nori (seaweed) or dulse (kelp).
The average healthy person can meet their needs for EPA and DHA by eating a serving of fish twice a week (preferably fish that is responsibly sourced and low in mercury).
But for some people, that may not actually be enough to meet their needs for optimal health. Some mental health conditions appear to make this list.
I want to preface by saying that a fish oil supplement is not for everyone. Decisions about supplements should always be made in discussion with a doctor or dietitian, because there may be interactions with other medications or concerns about other conditions that could actually make taking some supplements dangerous. For example, fish oil can increase bleeding risk and interact with some medications, like blood thinners. There also has been some evidence that for some people and some conditions, the risks can outweigh the benefits, so a conversation with a knowledgeable professional is always a good idea.
For major depressive disorder specifically, however, the evidence is mounting that routine supplementation with EPA can make a significant difference in depressive symptoms. There’s a good chance that one day soon, fish oil supplements may be standard of care either as a first-line therapy or an adjunctive treatment (meaning, alongside standard medication).
The dosages looked at in most studies is around 2 grams per day (for reference, you can get about 2 grams from a 4-ounce serving of salmon). Some of the mixed results in the research seem to come from varying amounts of EPA and DHA in the supplements the studies used. For major depression, most of the evidence seems to point to either pure EPA or at least a 2:1 ratio of EPA to DHA.
The link between omega-3s and depression seems to lie in the inflammatory nature of depression. Studies have shown that people with higher levels of chronic inflammation linked to depression are more likely to respond to treatment with EPA.
Again, before starting any new supplement, it's always prudent to talk to a health professional familiar with your personal needs and conditions, as well as with expertise in mental health treatment. It's often a good idea to use foods first to improve your nutritional status, rather than jumping straight into supplements. You might consider starting with increasing your intake of oily fish and trying sea vegetables first. If you do decide to take a supplement, collaborate with a healthcare professional to help you make an informed decision about which supplement type and brand to take.
Interested to learn more? If you have any questions, feel free to comment below or message me directly. If you’d like more personalized guidance, schedule an appointment or a free 15-minute discovery call with me! I’d love to work with you.
The pervasiveness of diet culture in the world today teaches us that we must create rigid rules around our consumption of food, and we must feel guilt and shame when we break those rules. We certainly must not allow ourselves to enjoy food (unless it checks all the boxes of what we believe counts as “healthy”).
On the other hand, the intuitive eating approach tells us that for the sake of our health, we must reject all diets and the limiting food rules that cause us to distrust our bodies' innate sense of our needs. Instead, we are told to eat when, where, and we want.
On the other-other hand, the mindful eating approach tells us that we must focus more on food while we eat, tune into our hunger and fullness cues and learn to truly appreciate our food for the nourishment it gives us, as well as the taste, texture, scent, etc.
Yet we all know that there are some nutrients that we need more of, and some nutrients that are better for us to eat less of. We all know that some foods are filled with more of the nutrients we need more of, and those are the foods we consider "nutrient-dense," while others are just kind of empty of most of those nutrients, and others are pretty high in the nutrients we know we should be eating less of. Other foods might be processed in a way that, when eaten regularly, is known to be harmful to our health.
So does being anti-diet mean that we are also anti-health? Does intuitive eating mean that we believe that we can really subsist on Oreos all day, every day if that’s what we’re craving? And where does mindful eating fit in? Is it okay to diet as long as we’re eating mindfully?
Sometimes having so many different terms wrapped around a topic can create a lot of confusion. There is a lot of overlap, for example, between mindful eating and intuitive eating, and there actually can be a fair amount of overlap between mindful eating and diet culture, as well. The terms themselves can be useful to help us understand the concept, but just like labeling your diet as “plant-forward,” “vegetarian,” “vegan,” or “pescetarian,” the terms can become somewhat limiting. There are often reasons to incorporate multiple approaches and to be flexible in our lives and in our diets.
It can be helpful to use terms and labels to learn about a topic or to explain it to others, but it can also be helpful to lose the terms sometimes, and just explain things as we see them. So, here’s how I see it.
I believe that rigid rules and restrictions around food can be harmful to the mental and physical health of the people who believe in them (whether or not they actually adhere to them). I think these rules can damage their relationship with food, with their own bodies, and their relationships with others.
I believe that good nutrition includes nourishing the body and the mind – both from a biological perspective and from an experiential and psychological one.
We nourish ourselves by eating food that contains the nutrients that our bodies and brains need for good health.
But we also nourish ourselves by spending time eating food with others – we build relationships through and around food and eating.
We also nourish ourselves by listening to our bodies’ cues of hunger and fullness; respecting our bodies enough to give them energy and nutrients when we feel those cues of hunger and sitting back from the table to allow comfortable digestion of those nutrients when we feel that sensation of fullness.
We also nourish our bodies and minds through mindful enjoyment of the experience of eating and being fully present in the moment, without the accompanying guilt and shame of over-attentiveness to food and eating that is often present when dieting. (When I first started teaching classes on mindful eating, I used to use the formula Mindfulness = Awareness – Anxiety to explain this concept.)
We also nourish ourselves through the gratitude that we feel and express when we eat mindfully, as we recognize all that went into bringing our food into existence and onto our plates, and the incredible process by which our bodies will use the components of that food to rebuild, grow, and fuel the living of our lives!
As Thanksgiving approaches this year, I encourage you to try to shift your focus away from “shoulds” and “shouldn’ts,” and towards gratitude for the food in front of you, the people around you, and the body that carries you through the world.
What do you think about these terms and other common terms surrounding our relationships with food? Leave me a comment and let me know! And if you’d like more personalized guidance, schedule an appointment with me! I’d love to work with you.
(To get some background on this topic, you may want to start here with my post discussing the gut-brain axis in more detail.)
Assuming we're all on the same page that the health of our "second brain" is vital to our mental health, let's jump right into some of the factors that influence the gut-microbiota-brain axis, and the places where we can have an impact through nutrition and lifestyle.
The Microbiome, Probiotics and Prebiotics
One of the most dramatic changes in the perspective of medical science in the past 20 years has been the shift in the way we view bacteria. We’ve shifted from the hygiene model (where the more sterile we could make our environment, the better) to understanding that we not only have massive numbers of microbes (bacteria, fungi, and viruses, etc.) inside and outside of our bodies at all times, but that we actually need and benefit from them.
Unfortunately, the traditional Western-style diet is pretty deficient in the favorite foods of those healthy gut bacteria: fibers (also called prebiotics).
While there are lots of things that influence our gut microbiome that we don't have much control over, there are also some pretty substantial things that we do have control over, and research has shown that the impact of some dietary changes can be seen as soon as 2-4 days - though it takes much longer to have a substantial and lasting impact.
The foods we eat and the types of fibers that they contain can have a direct impact on which kinds of microbes flourish in our intestines, and which types don't. Eating foods that contain healthy bacteria (also called probiotic foods – things like yogurt with live and active cultures, sauerkraut, and miso) can also have a positive impact.
And in turn, promoting the growth and flourishing of these healthy bacteria has been shown to increase their production of the neuroprotective short-chain fatty acid butyrate, improve our stress response, optimize immune function, impact neurotransmitter function in the brain, decrease symptoms of depression, alleviate anxiety in children with autism spectrum disorder, and more.
The importance of nutrition - adequacy of energy (calories), vitamins, minerals, amino acids, fiber, essential fats, and carbohydrates - really can't be understated when it comes to mental health.
When it comes to good nutrition, calories are just the beginning. Even the macronutrients (carbohydrates, protein, and fat), while very important, are just the beginning. Most of us get enough of these things in general (though we’ll talk more about the specifics of types of protein and types of fat in a minute).
But what about vitamins and minerals? Many of us tend to eat diets that are full of a lot of processed foods which are energy-dense (plenty of calories) but nutrient-poor (depleted of a lot of the vitamins and minerals that whole foods, like produce, meats, fish, beans, nuts and seeds, etc. contain). We often don’t eat enough fruits and vegetables - and especially vegetables.
Eating diet rich in whole plant foods (and maybe even growing our own when we can, for optimal nutrient quality and a healthy connection to nature) goes a long way towards getting us the essential vitamins and minerals that we need, as well as the fiber to feed that lovely gut microbiome.
But for some people, it seems that even a nutrient-dense diet doesn't go far enough to meet their nutrient needs. For a variety of reasons, some people have higher needs for certain vitamins and minerals than we might think based on the estimates of the RDAs (i.e., the percentages listed on the nutrition label).
A growing body of research is showing that increased needs for certain vitamins and minerals, especially things like B vitamins, vitamin D, magnesium, and zinc, might be linked to certain mental health conditions.
Amino acids are the building blocks of protein molecules, and there are 9 that are considered essential – meaning that we have to eat them in our diets because our bodies can’t make them.
Amino acids are also the precursors for neurotransmitters in the brain. Seven of the essential amino acids are also essential for making neurotransmitters: valine, leucine, isoleucine, lysine, phenylalanine, histidine, and tryptophan. Diets that are deficient in these amino acids can cause deficiency of neurotransmitters – things like GABA, serotonin, and dopamine – and can cause mental illness-like behavior.
It’s worth noting that amino acids are also the major fuel of the cells of the intestines, so deficiency in amino acids not only affects the brain and neurotransmitter levels directly, but also via the gut-brain axis, as poorly-nourished intestinal cells aren’t able to continually replicate and renew the gut lining the way that they need to.
Omega-3 Fatty Acids
One widely-studied nutrient group is the polyunsaturated fatty acids, including omega-3 and omega-6 fatty acids. While some amounts of each are essential for our health, omega-3 fatty acids are known to decrease inflammation, and they also seem to play a role in promoting a healthy gut microbiome.
Most of us eat far more omega-6 than omega-3 fats. Eating more nuts (especially walnuts), seeds (especially flax seed), and low-mercury fatty fish (like anchovies, salmon, or halibut) can help us improve our omega-3 fatty acid intake.
While supplementing with omega-3 fatty acids (like DHA and EPA) has produced mixed results in clinical trials, we do see a clear benefit to mental health from eating foods that contain omega-3s.
In the case of supplements, there does seem to be a benefit to supplements with the right ratio of EPA to DHA for some people with major depressive disorder, schizophrenia, and bipolar disorder, but it’s always a good idea to consult with a doctor, psychiatrist, or dietitian with expertise in nutritional psychiatry to help decide whether a supplement is right for you, what dosage, and what ratio of EPA to DHA, as this varies depending on the person and depending on the diagnosis.
Polyphenols are anti-inflammatory compounds found in plant foods such as grapes, pears, berries, cherries, tea, cocoa, legumes, grains, coffee, and apples. Resveratrol and curcumin are two well-known examples of polyphenols.
The majority of these compounds are actually fermented by the gut microbiota first to allow our bodies to absorb and use them, and they play a role in preventing dysbiosis - promoting a healthy balance of bacteria in our intestines.
Polyphenols have been shown to reduce inflammation, protect the brain from cellular damage, play important roles in learning and memory, and balance neurotransmitter levels in the brain.
Inflammation and mental illness are inextricably linked. While we used to think that inflammation in the rest of the body had no impact on the brain, shielded as it is by the blood-brain barrier, we now know that systemic inflammation (both acute and chronic) has a significant impact on the functioning of the brain. So, managing inflammation with tools like the Mediterranean or other anti-inflammatory eating patterns is important in managing mental illness.
Several wonderful studies have been done on variations of the Mediterranean diet in improving mental health and reducing symptoms of depression. It’s worth noting that polyphenol-rich olive oil is a key component of the Mediterranean diet, which may be part of why it’s so effective in improving mental health, along with the emphasis on nutrient-dense foods, omega-3-rich fish, nuts and seeds, and plant fibers.
Food Allergies and Sensitivities
For some, food allergies and sensitivities can be significant causes of inflammation, both in the gut and in the body as a whole.
When we eat foods to which we are allergic, our bodies respond as if we’re at war, with a massive inflammatory cascade that seeks to destroy the enemy invader - and ends up damaging our own body tissue and possibly even threatening our lives.
While less severe, food sensitivities have been found to have some negative long-term health impacts on people who eat significant amounts of these foods to which they are sensitive. The gut can become inflamed and irritated, which can cause some obvious side effects like diarrhea or abdominal pain for some, in addition to causing the tight junctions between the intestinal cells to open up and allow molecules that are a bit too big to come through. (This is called intestinal permeability, though it’s been nicknamed “leaky gut.”)
This can contribute to inflammation throughout our bodies and brains, change the composition of our gut microbiome, and possibly even contribute to a “leaky” blood-brain barrier.
Rates of food allergies and sensitivities are known to be increased in children with ADHD and individuals with schizophrenia, for example, and there are also high rates of depression and anxiety in people with severe food allergies – though the cause or connection is still unclear.
Though it doesn't totally fall under the umbrella of the gut-brain axis, exercise is worth mentioning anytime we talk about mental health and lifestyle change. Exercise has been dubbed by some the "best anti-depressant." It doesn't require skill, money, or even much of a time commitment. Anyone can do it from anywhere, and it's incredibly effective in improving mood, reducing symptoms of depression and anxiety, improving sleep (which itself is important in stabilizing mood), and more.
Along with its many, many other health benefits, exercise also influences the gut microbiome. Exercise can increase the numbers of "good" bacteria, as well as boost the diversity of microbes in your gut.
While there are lots of dietary and lifestyle factors that we already know influence our gut microbiome, it’s a relatively new field, and we're probably only just scratching the surface so far!
But if you want to make some concrete changes to improve your gut health and mental health, here are some ideas for where to start.
If you have any questions, feel free to comment below or message me directly. If you’d like more personalized guidance, schedule an appointment with me! I’d love to work with you.
In order to talk about the gut-brain axis, we have to start with a basic understanding of the gut and of the brain.
(As an aside, I believe health literacy, or understanding what's going on inside your body, is so, so important in understanding when and why things go wrong, making educated decisions on how to manage things on your own, and knowing how and when to seek treatment when it's needed. So try to stick with me if you can!)
In case it's been a minute since biology class, let's start with a brief review of the process of digestion.
When you eat, food moves through your mouth, where the process of digestion starts, down your esophagus, and into your stomach.
While there, acidic digestive juices work on breaking it down chemically, while the rhythmic motions of your stomach work on breaking it down physically. When it's ready, it moves next into the small intestine.
The small intestine is narrow, but it's incredibly long (approximately 22 feet!) and covered in microvilli, small hair-like projections on the surface of the intestinal epithelial cells that make its surface area somewhere in the neighborhood of 2700 square feet. All this surface area is vital to getting as many nutrients as possible absorbed from your food into the blood, including broken-down carbohydrates (monosaccharides), amino acids, fatty acids, vitamins, and minerals.
What isn't absorbed in the small intestine keeps on moving and ends up in the large intestine - which is a comparatively measly foot-and-a-half in length, but much wider. In the large intestine, the body focuses on absorbing water and a few last nutrients, like electrolytes, biotin, and vitamin K.
Most of the digested food that enters the large intestine has been reduced to fiber, water, and waste products. Fiber is actually a type of carbohydrate that our bodies cannot digest.
Fortunately, our large intestines are filled with critters that can digest that fiber - our intestinal microbiota. Our bacterial friends ferment (break down) fibers from plant foods that we eat into energy for themselves, and into short-chain fatty acids (SCFAs) for us. These short-chain fatty acids, like butyrate, proprionate, and acetate, are things that we can't produce for ourselves, but that become the main source of energy for the cells lining our large intestines (among other important functions).
By the time the continued rhythmic movements throughout your intestines have brought the waste products to the end of the line, it's been a couple of days - approximately 5 hours in the stomach, 5 hours in the small intestine, and anywhere 10-70 hours in your large intestine.
While you are focused on chewing and swallowing, your body and brain are hard at work sending and receiving messages. Multiple hormones are released by the stomach, the small intestine, and the large intestine as the food you're eating moves through your digestive system. Other digestive organs, like the pancreas and liver, are activated, and send in enzymes to help with the process of breaking down foods into their nutrient components.
After you eat, the vagus nerve, the longest and most complex of all the cranial nerves, lights up with communication between your brain and your gut, as your digestive system reports back to the brain on the meal you are digesting.
The nutrients absorbed into the body, including vitamins, minerals, amino acids, glucose (sugar), short-chain fatty acids, etc., as well as the hormones produced in the gut, can also themselves send messages to the brain. Some nutrients are able to pass through the blood-brain barrier (the "wall" separating the brain from the rest of the body and protecting it from harmful substances) into the brain, directly impacting brain function (things like increasing or decreasing levels of different neurotransmitters, increasing or decreasing inflammation in the brain, increasing or decreasing different hormones... etc.).
Additionally, problems in the gut (such as irritation and inflammation) are communicated to the brain and can lead to some pretty dramatic shifts in mood, cognition, stress, and anxiety.
This connection between the gut and the brain is obviously very complex - much more so than we can address in this one blog. But the constant two-way communication happening between these two important body systems is part of why the gut has begun to be called the "second brain" or the "gut brain" - technically known as the enteric nervous system.
It's clear from the research that we have to stop thinking about mental illness as being "all in the brain." The gut-brain axis is just one example of how interconnected all of our body systems are.
Say it with me:
Mental health is HEALTH.
Want to learn more? Reach out. I'd love to work with you. And if you're interested in future posts, be sure to sign up for updates or check back soon for more to come on strategies for using our "gut brain" to improve the health of our "main brain."
Inflammation has become a buzz word in our modern health landscape. In the biochemical reality of our bodies, it's actually a pretty complex thing, but the benefit of thinking of things from an inflammation perspective is that we can see the relationships between many conditions and diseases that we never would have connected otherwise - from depression to diabetes to arthritis.
But let's start with the reason inflammation exists. It's actually a healthy process that happens in our bodies in response to injury or infection, for example. There's a trigger, an inflammatory cascade that usually involves redness, warmth, swelling, some loss of function, and some pain, and then resolving of those symptoms as the injury or infection is healed. Inflammation can be visible or invisible, on the surface of the skin or deep within the body. Either can be perfectly normal.
But too often, when the conditions are right, the inflammation happens at the wrong time and/or doesn't do anything productive and/or doesn't go away when it should. And that's what we call chronic inflammation.
Inflammation is often totally hidden from view unless you know where to look. I like to imagine chronic inflammation as a fire, smoldering throughout a person's body, showing up in all kinds of different places and ways. As time has gone by and more and more research has been done on inflammation, we've found it connected with all kinds of diseases we might never have imagined.
All the diseases that end with -itis (arthritis, bursitis, myelitis, hepatitis, sinusitis... you get the idea) are diseases of inflammation. But then there are diseases like heart disease, diabetes, allergies, COPD, chronic fatigue, depression, irritable bowel syndrome (IBS), Crohn's disease, fibromyalgia, and many, many more.
The symptoms of these disease are variable depending on the area that is affected first. But we see a lot of commonalities in them when we start to look inside the person. Just like acute inflammation causes pain, often, so too does chronic inflammation. It may be isolated to one area of the body, or it may be wide-spread. Just like acute inflammation causes loss of function, often, so too does chronic inflammation. Again, it is sometimes specific to one area of the body or brain, and other times to the body as a whole.
From an internal perspective, we often see metabolic abnormalities (changes in the way that energy is created and stored), hormonal imbalances, organ dysfunction, elevated stress indicators (such as cortisol), dysbiosis (imbalance of the bacteria living in the gut), changes in immune function, and changes in the permeability of some of the important membranes in the body (like the intestinal wall and the blood-brain barrier).
All of these diseases are caused by a complex network of triggers. Our genetics often plays a role, but is generally not our destiny. Sometimes, there is one major trigger that sets the whole body ablaze with inflammation. Often, it's a combination of multiple factors: genetics, prenatal and early life triggers, stress (including trauma), environmental triggers, dietary and lifestyle triggers, chronic infections, and more. That means that treating just one of these factors alone is usually not enough. We have to treat holistically (the whole person).
Modern medicine tends to treat the symptoms of all of these conditions, usually with medication. But trying to heal chronic inflammation by merely treating the symptoms of chronic inflammation is like trying to put out a campfire by blowing out your burning marshmallow. It often allows people to be able to function again, which is amazing and wonderful and totally not to be discounted. And medication certainly may be a part of a holistically-built long-term treatment plan. But often, it only masks the problem in one area of the body or mind, only to see it crop up again in another area.
A better approach?
Let's dig down and find the root causes of the chronic inflammation. Let's find the underlying imbalances in the body and mind. Let's treat those, with gentle, compassionate care.
The brain is a complex and incredible thing.
When you think about everything it does, from keeping us breathing to playing the piano to swimming laps to doing complex calculus to learning languages to inventing new electronics to falling in love...
it's easy to imagine why some things go wrong. Why the brain needs so many different nutrients to do all the different things it does. Why it uses an incredible amount of energy to do its job. Why it is so sensititive to changes in the environment.
Nutritional psychiatry and its sister, nutritional psychology, are the new realms of research and clinical practice that are looking into how we can support brain function and treat mental illness with nutrition.
We know that some diet patterns can help to improve symptoms of mental illness, and that while there are some stand-out foods and nutrients, a whole-diet approach seems to be the best approach.
We also know that nutritional deficiencies are common in the US population in general, but that they seem to be even more common in those with mental health challenges.
We also know that the microbiota-gut-brain axis plays a huge role in our mental and emotional wellbeing and resilience.
I believe nutritional psychiatry works best in combination with therapy, exercise, and in some cases, mental health medications that work together with nutritional approaches to treat the mental illness. Because mental illness is often multifactorial in cause, we also need to use multiple modalities to treat it. However, nutrition is an incredibly powerful tool that can benefit everyone working on their mental and emotional wellness.