Nutrition and Mental Health: The Times They Are a-Changin’

You said it Bobby D... Photo: © Sony
You said it Bobby D… Photo: © Sony

So for those of you who aren’t aware of my day job, my long-winded title is “Clinical Inpatient Dietitian in Complex Mental Illness at the Centre for Addiction and Mental Health (CAMH)”. I’ve been working at CAMH just shy of 3 years now. When I first started working at the hospital, my background in mental health was extremely limited. Working in downtown Toronto in community health gave me a bit of exposure, but I was far from an expert. And I will remind you all that I am STILL by no means an expert. Working in mental health is a continuing learning experience, and I learn something new every day on the job.

Recently I was extremely lucky to speak at a conference in Ottawa for the Family Health Team (FHT) Dietitian network. It was such a fantastic learning experience for me, and a great opportunity to share my knowledge with others and increase exposure to the exciting world of nutrition and mental health.

Photo credit: my wonderful friend Katie Hortobagyi
Photo credit: my wonderful friend Katie Hortobagyi

I explained during my presentation that when I was in school for Applied Human Nutrition (back in the day kids), I don’t recall learning ANYTHING about mental health. The only thing I can really think of is learning about the management of dementia/Alzheimer’s. But working in the field, it honestly shocks me how much there is to know, and how the role that nutrition plays is always changing. For example, nutrition-related interventions can pop up in many of the following scenarios (and this list is not exhaustive!):

-Managing metabolic side-effects with antipsychotic medications (weight gain, increased appetite, insulin resistance)

-Helping clients cope with food-related delusions, hallucinations and phobias

-Managing macro/micronutrient deficiencies after abstaining from substances or recovering from an acute psychotic episode (many of my clients come into hospital really malnourished because they do not eat or take care of themselves)

-Teaching basic life skills around shopping, storing and cooking food

-Helping clients on a budget make healthier choices within their budgets

-Helping clients manage other chronic diseases (diabetes, heart disease, high blood pressure, cancer, kidney disease) that they may have ON TOP OF their mental illness

-Education and research on how food affects mood, depression (such as the mind-gut connection)

-Keeping updated on current research and what is emerging around nutraceuticals (e.g. there is research going on right now looking at nutritional supplements as adjunct therapy to medications used to treat schizophrenia)

-Debunking myths around food fads and the evidence on what works/doesn’t (e.g. I have educated patients and families on the relationships between gluten and schizophrenia symptoms)

As you can see, there is a lot coming down the pipe! It makes me very excited to be involved in this area of healthcare. Recently I’ve been having some feelings of doubt related to my position at CAMH. Mostly these feelings are in my own head, after a particularly bad day where I wonder “am I really making a difference, am I actually helping anyone?” The answer I have to keep telling myself is YES, YES a million times YES. As you can see above, a Dietitian can play a HUGE part in mental health, and the part is just going to get better as more knowledge emerges. So rather than feeling bad and wondering whether my job makes any impact, I’m going to embrace my unique role and do as much as I can to learn, grow and help those with a mental illness thrive 🙂

October Unprocessed 2015

october-unprocessed-cubes

ZOMG. It has been waaaaay too long since I’ve posted on my blog. For my readers (RE: 5 of them, probably all of them family) I do sincerely apologize. I’m so excited to get back to it, setting myself a reasonable goal of 2-3 blog posts per week.

Anyways I am excited to take on the October Unprocessed Challenge again this year! For more information, see my description here. This challenge was such a great learning experience for me last year. It brought me back into the kitchen, really reflect on where my food comes from and remembering the importance of “less is more” when it comes to food.

This year I want to add another layer into my challenge by reducing my consumption of meat and other animal products (cheese, milk, yogurt). I’ve always toyed with the idea of becoming vegetarian or vegan, for a variety of reasons (which I won’t get into today). However after much thought and deliberation, I don’t think that could be a reality for me (cheese and lobster would be things I would miss way too much in my life). However I am very interested in the concept of being a “reducetarian“, meaning a person who significantly decreases the amounts of animal products consumed. During October Unprocessed month, I’m looking forward to trying more vegan and vegetarian dishes and experimenting in the kitchen. This added challenge will definitely get me out of my comfort zone!

So if you are interested in taking the October Unprocessed challenge, just visit the site www.eatingrules.com and sign the pledge today! The website has lots of great resources, tips and tricks for the month. But make sure to also set your own rules. The challenge will not be successful if your expectations are too complex or restrictive. I will be updating you throughout the month, so make sure you comment and hold me accountable! xo Kelly

Let’s Cool it on the Coconut

Photo credit: pazoo.com
Photo credit: pazoo.com

Hello lovely readers, I’m back 🙂 I took a hiatus from blogging as the summer is now in full swing. And you know what that means: weddings, showers, weddings, showers, bachelorette parties, weddings, showers…. repeat!

As many of you know, I like to write about things I see in my everyday practice. Common questions I get from my clients are questions I assume many of us want to know the answer to- especially when it comes to “of-the-moment” foods. Enter the humble coconut. Coconut (more specifically, coconut oil and coconut water) are making a HUGE comeback. When I was in school learning about nutrition, NO ONE used coconut oil and coconut water was often collecting dust on grocery store shelves. We were taught that coconut oil is a “bad” fat, full of saturated fats and can increase the risk for heart disease. Now…

Virgin coconut oil

I’ve heard virgin coconut oil  (coconut oil that has not been processed) being touted for it’s antimicrobial properties, reducing heart disease risk, softening skin/hair, reducing belly fat etc etc. Sounds like the miracle cure right?? Ehhhh…. not so much. Let’s take a look at some of the evidence:

1) One of the reasons why people believe virgin coconut oil is different from other conventional fats/oils (e.g. butter, canola oil, olive oil) is that it contains medium-chain triglycerides (or MCTs). Research around MCTs started in the 1950’s, mostly for people who have difficulties absorbing fats (MCTs are basically full triglyceride fats that have been broken down, making them super easy for the body to absorb and use quickly). The majority of studies out there looking at MCTs do not use the virgin coconut oil you find in the grocery store. They use a super-concentrated, refined derivative of coconut oil, that is liquid at room temperature. Take a look:

MCT oil
Photo credit: Heart Foundation of New Zealand

Virgin coconut oil is a solid. This is because virgin coconut oil is mostly made from saturated fat (92% saturated fat to be exact) and saturated fats are solid at room temperature (think butter, lard, bacon fat etc). Virgin coconut oil only has 4% MCT¹

Therefore, if virgin coconut oil only has 4% MCT, there is no way you can compare a study looking at refined MCTs with the same virgin coconut oil you make your slammin’ stir fry with. For example, many studies² looking at energy expenditure (or the amount of energy we burn to keep our bodies working) show that MCT oil (NOT virgin coconut oil) can increase energy expenditure, which in turn may decrease weight gain risk. You would need to eat A LOT of virgin coconut oil to match the refined MCTs used in clinical trials, which won’t help your weight loss efforts 🙂

2) What about these antimicrobial/antifungal properties? Again, the majority of the evidence³ comes from the following studies:

– Studies that look at super-concentrated MCT oil DERIVED from coconut oil

– Studies in animals or in vivo (aka cell studies), NOT in humans

-Pilot studies where the samples are small and difficult to extrapolate to the general public

Coconut Water

Coconut water is the clear liquid that comes out of a coconut when it is freshly opened (not to be confused with coconut milk, which is the liquid expelled from processing coconut meat). Coconut water has become increasingly popular as an alternative to sports drinks to rehydrate after physical activity. Looking at some of the nutritionals of pure coconut water:

-Relatively lower calorie (about 30-70 calories per cup*)

-Moderate amounts of naturally-occurring sugar (about 10g per cup*, which is pretty low compared to juices, sodas etc)

-Moderately high in potassium (~370mg per cup*, healthy adults need about 4700mg of potassium per day to help lower risk of hypertension and heart disease)

-Low amounts of sodium (~65mg per cup*)

*depending on the brand
Woman-looking-at-the-ocean-and-drinking-Coconut-Water
I wish I was her right about now…. **stares out at dreary rain clouds**

Keep in mind these numbers are for PURE coconut water, not for flavoured kinds (e.g. ZICO© chocolate coconut water, which will have more added sugar). So is coconut water actually superior when it comes to rehydrating during physical activity? Well here is some of the research4:

Sports medicine authorities recommend that sports drinks, especially for exercise in the heat, contain:

  • ~460-690 mg/L of sodium
  • ~78-195 mg/L of potassium
  • ~30-60 grams of carbohydrate/L
Most analyses have found coconut water to have significantly less sodium than sports drinks, considerably more potassium and slightly less carbohydrate. Therefore if you are exercising heavily for greater than one hour (e.g. marathons, cycling, a big soccer game etc) you may not get enough carbohydrate or sodium to replace losses through coconut water. I couldn’t really find any published trials on the efficacy of coconut water for hydration during exercise, but a few small trials5 found that coconut water was as effective as sports drinks for rehydration (especially if the coconut water was enriched with sodium). Similar to the virgin coconut oil studies, most studies looking at coconut water are based on small sample sizes or done in specific populations (e.g. athletes).

Bottom Line

1) Fat is still fat. If you like the taste of virgin coconut oil, by all means keep it in your kitchen. I personally love the taste in stir fries, as well as vegan cooking. However based on the research seen above, don’t expect miracles. Too much fat in our diet (from any source) can increase our risk of weight gain, heart disease and diabetes. Stick with smaller amounts (about 2-3 tablespoons of added fat per day) and use it to enhance the flavours of your foods.

2) Hydration with water is still #1. For the majority of us, the amount of activity we do usually doesn’t warrant specialty sports drinks (coconut water or otherwise) to replace carbohydrate or electrolyte losses. Plain ol’ water before, during and after activity is the best form of hydration. However if you like the taste of coconut water, it can be a fun alternative to juice (as it contains less sugar) and can add a nice tropic punch to smoothies, even piña coladas 🙂 Just make sure to read the ingredients list of coconut waters, and choose ones without any added flavourings or sugars.

References

1. Eyres, Dr. Lawrence. Coconut and the Heart. 2014. New Zealand Heart Foundation: http://www.hearfoundation.or.nz.

2. St. Onge, MP et al. Medium- versus long-chain triglycerides for 27 days increases fat oxidation and energy expenditure without resulting in changes in body composition in overweight women. Int J Obes Relat Metab Disord. 2003 Jan;27(1):95-102.

3. Shilling, M et al. Antimicrobial effects of virgin coconut oil and its medium-chain fatty acids on Clostridium difficile. J Med Food. 2013 Dec;16(12):1079-85. doi: 10.1089/jmf.2012.0303.

4. PEN Nutrition: The Global Resource for Nutrition Practice. Sports Nutrition Evidence Summary. 2014

5. Kalaman, DS et al. Comparison of coconut water and a carbohydrate-electrolyte sport drink on measures of hydration and physical performance in exercise-trained men. J Int Soc Sports Nutr. 2012 Jan 18;9(1):1. doi: 10.1186/1550-2783-9-1.