Mental health and lifestyle: A perspective from an NHS psychiatrist
As a medical doctor I am interested in the overall health of the body and as a Consultant Psychiatrist with a background in Neuroscience I am especially interested in the health of the brain. I believe that our lifestyles are of paramount importance when it comes to maintaining our health, and that a multi-factorial approach is required: that we eat and sleep well; move regularly; take time to do things we enjoy and that give us a sense of purpose; spend time out in nature and connecting with other people and also take time to relax (what Dr Rangan Chatterjee has conceptualised as his 4 Pillar Plan). I am excited about the emerging fields of Lifestyle Psychiatry and Nutritional Psychiatry and that the growing body of scientific research gives us a sound evidence-base from which to practice psychiatry in a more holistic and preventative way. I support the work of Nutritank to promote the need for greater nutrition and lifestyle medicine training within UK medical schools and I am developing a teaching workshop for my colleagues in primary and secondary care locally to bring lifestyle and nutrition to the forefront of practising clinicians’ minds.
Personally, I have wanted to avoid illness, doctors, medications and operations since my teens and was lucky enough to grow up with very enlightened and health-conscious parents; for me an active childhood with a whole-foods, non-processed, Mediterranean-style diet rich in fruit, veg, fish, grains and olive oil was the norm. This dietary pattern has long been recognised for its benefits for physical health – longevity, low cardiovascular risk, reduced risk of Type II Diabetes – but recent research shows the benefits for brain and mental health too; when my dad called fish “Brain Food” he was not wrong! Fish oils contain long-chain omega-3 polyunsaturated fatty acids (PUFAs), called eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA), which are neuroprotective and have benefits for cognitive function and mood, as well as for improving cardiovascular health and reducing insulin resistance (https://www.ncbi.nlm.nih.gov/pubmed/25954194) The randomised-controlled Supporting the Modification of lifestyle In Lowered Emotional States (SMILES) Trial, showed that a modified Mediterranean diet can significantly reduce symptoms of depression in patients with a diagnosis of major depressive disorder, independent of changes in physical activity or body weight, and those who improved their diet the most experienced the greatest reduction in symptoms (https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y)
There is also substantial research on the gut-brain axis – the bidirectional biochemical signalling pathways between the gut and the central nervous system – and how our gut microbiota (communities of microorganisms) influence our mental health, possibly through immune dysregulation and brain inflammation, with putative roles for pre- and pro-biotics in treatment of mental disorders in which inflammation is thought to play a part, such as mood disorders, autism-spectrum disorders, attention-deficit hyperactivity disorder, multiple sclerosis and obesity (https://www.ncbi.nlm.nih.gov/pubmed/26046241). We truly are what we eat!
I think it is important that clinicians are well-versed in the research literature about lifestyle and nutrition and feel empowered to have conversations about it with patients, thus empowering patients to make conscious changes to their lives to benefit their physical and mental health. This is especially important in psychiatry where many of the medications we prescribe have adverse effects on physical health such as significant weight gain, cardiac arrhythmias, metabolic syndrome and thyroid and prolactin dysfunction, as well as quite often being sedating and contributing to lack of motivation to exercise. Even before we prescribe, patients with serious mental illnesses such as schizophrenia are more likely to smoke, drink excess alcohol or use substances, be sedentary and have poor occupational functioning, and have excess mortality with a life-expectancy 10-20 years lower than the general population. If we can use the scientific evidence and our communication skills to help patients with mental illness to improve their lifestyles, we are reducing their morbidity and mortality, and this is our ethical imperative.
Views shared are my own and are not representative of the views of my NHS Trust
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