by Food: We can’t live without it, yet it can also be a source of stress. Food can influence our mood and our happiness. Registered Dietitian, Anna Schwartz discusses the complexities and challenges that can surround food as well as the benefits and joys that come from nourishing your body
by Melanie Taussig
Anna Schwartz remembers one day meeting with a patient who had been referred to her by a mental health provider. The patient, a woman with the alias “Jane” was in her 30’s and had been experiencing brain fogginess, depression, and was stuck in an overall funk. She told Ms. Schwartz that she wanted her body ‘to feel normal again.’ Thus, the two began working together to help Jane attain this goal. The aforementioned scenario is not out of the ordinary for Ms. Schwartz, who works at an outpatient psychiatric practice in Denver. The practice that Ms. Schwartz is a part of relies on an integrative medical model, an approach that addresses each person as a whole individual by taking into account aspects of physical, emotional, environmental and social factors. With patients coming to the practice for treatment of primary psychiatric issues, it is natural to presume they would be seeing a psychiatrist but, a dietitian? Some might wonder the role a dietitian has when it comes to mental health issues but according to Ms. Schwartz, the relevance is greater than many might think.
“Mood is directly related to food. We are what we eat,” says Ms. Schwartz as she sips a latte on a summer morning. This is an important consideration at a point in time when mental health issues affect one in five Americans. As the sole dietitian at the practice, Ms. Schwartz works among a cohesive treatment team to meet the comprehensive needs of patients. This includes direct collaboration with therapists, psychiatrists, and social workers. In many instances, healthcare operates in silos, patients seeing independent providers for various reasons. Coordinating medical care among providers to meet treatment goals is beneficial for patients. “Integrative medicine gives the patient a better opportunity to heal and grow,” says Ms. Schwartz.
As the whole body is interconnected, the relationship between food intake and emotional health is undeniable. Ms. Schwartz provides insight about the relationship between the gut and the brain, explaining that serotonin levels are greatly impacted by the food people consume. Approximately 90% of serotonin receptors reside in the gut. Given that serotonin levels are associated with feelings of happiness, this fact is one that should not be overlooked. “Mood can drastically be impacted by how well you take care of your gut. Being able to support the gut is going to support the brain as well,” says Ms. Schwartz.
No one food can prevent mental health issues but there are foods that can minimize the risk for depression as well as provide the brain with better fuel for functioning. “An overall balanced diet is what we aim for,” says Ms. Schwartz. There are many foods that can boost mood, an example are berries. With high levels of antioxidants, berries can improve brain health as well as anti-inflammatory components. “If you eat something, that is what your body is going to use to rebuild with,” says Ms. Schwartz. She recommends fueling the body with a good variety of fruits and vegetables as well as whole grains and fish. In addition, it can be helpful to take a probiotic to help build good bacteria in the gut. If an individual has recently consumed antibiotics (which can kill off good bacteria), Ms. Schwartz suggests subsequently considering a probiotic, which can help re-establish good bacteria in the gut.
The body is equipped to process natural foods. This is why a diet rich in fruits and vegetables will provide better nourishment than a diet consisting of high levels of processed sugars. A healthier diet will ultimately lead to improved physical and emotional health. Earlier this year, The University of California, San Francisco published The UCSF Guide to Healthy and Happy Eating.
The importance of mindful eating, self-attunement, and exercise
Mindful eating is something that Ms. Schwartz often educates her patients about. She discusses scenarios that may feel familiar to many: feeling an urge of hunger in the evening and being pulled toward snacking on crackers or sweets. We have likely all been there. Before you reach for that cracker or that piece of bread, Ms. Schwartz encourages people to ask themselves: “what is this food going to do for me? What did I not get today and what am I missing?’ Giving purpose to food can improve one’s relationship with food. It also can help a person make the connection about why he or she is eating and ultimately allow for enjoyment of food. Although Ms. Schwartz urges use of mindful eating habits, she also encourages her patients to savor the experience of eating. “People should look forward to the meals they are eating, enjoying the food and enjoying the process.”
Ms. Schwartz discusses the importance of being attuned to the messages we are getting from our bodies. For example, when stressed, it is not uncommon for an individual to self-soothe with food. Oftentimes when under stress, people will mindlessly eat without thinking about what they are doing. Conversely, others may deal with stress by feeling averse to food and not considering the consequence of unintentional food depravation. Ms. Schwartz explains how maintaining awareness of what your body needs, especially during moments of hardship, can promote a healthy relationship with food. “We have to work really hard to listen and interpret [those messages from our body]”.
In addition to eating well, the impact exercise can have on health should not be underestimated. Ms. Schwartz consistently speaks to her patients about the importance of being active and how physical activity can be a complement to healthy eating. It is not unusual for those who are battling depression to lack the motivation to exercise and become stagnant. That is precisely why Ms. Schwartz urges patients to incorporate movement into their routine. Physical activity increases oxygen flow, especially into the brain. “Even if you just move your body for 10 minutes, it will release endorphins which will naturally improve your mood and naturally improve your happiness and joy. In addition, it’s going to get the blood flowing. Once people are finished [exercising] they tend to see the benefit,” says Ms. Schwartz. For those who might be challenged with exercising, she recommends exercising during the morning hours. Experiencing a sense of positive accomplishment early in the day can boost overall motivation for the remainder of the day. “If someone is able to check a box early in the day for something as big as exercise, they feel so much more motivated,” says Ms. Schwartz.
Physical movement can also be an antidote to depression and anxiety. “Exercise can get rid of some energy but also produce some more,” says Ms. Schwartz. It is a healthy and natural way to outlet stress and produces serotonin, which supports positive brain health. Ms. Schwartz indicates that when people are depressed, they may lack the confidence to exercise. Therefore, she will challenge her patients with subtle modifications to their exercise regimen such as walking twenty minutes instead of fifteen. A relatively small change can prove to be extremely beneficial over time.
The battle with food: Weight loss, body image & dieting
It certainly is not uncommon for Ms. Schwartz’s patients to have a desire to lose weight. When she encounters such a situation with a patient, she often will pose the question to the patient: what is the motivating force to lose weight? Is it to fit into a dress for a wedding in six months (short-term) or is it to be around long-term for your grandkids? Ms. Schwartz explains that being cognizant to such things can guide a person accordingly when they embark on the quest for weight loss. Because each person’s situation is unique, Ms. Schwartz recommends consulting with a dietitian or primary care doctor to discuss personal circumstances before starting a new diet or eating plan to promote sustainability.
There is a “give and take” relationship with food explains Ms. Schwartz. Human beings need food in order to function and survive but it can also be the source of considerable internal strife for some. Emotions surrounding food can lead to maladaptive eating patterns and challenges. Because of its necessity to fuel the body, food is not optional. Unlike alcohol, if someone has a problematic relationship with food, it cannot be eliminated. Thus, when Ms. Schwartz encounters patients who have a tempestuous relationship with food, she encourages a reframe, which often means “working with the patient to help them see what food can be to them, that food can be nourishing and fueling rather than just a calorie.”
When an individual views food negatively, there are often accompanying issues that arise such as anxiety, mood disorders, self-esteem, and negative body image. Ms. Schwartz discerns an individual who has “disordered eating” and a person who has a diagnosed eating disorder such as anorexia nervosa or bulimia nervosa. Disordered eating is a broad term and can range from an individual relying on fad diets, to frequently skipping meals and ongoing fluctuation of weight. If she is working with a patient who has a mental health condition, Ms. Schwartz is likely to be coordinating with other healthcare providers in order to approach the situation holistically. She also explains the important role talk therapy can have as a way to address the struggles an individual may have with food.
The high cost of food insecurity
Amid discussion of food in today’s world, the topic of food insecurity is one that naturally comes up in conversation. Food insecurity is when an individual or family has limited access to sufficient food supply. With increasing rates of income inequality in the U.S., food insecurity rates are inevitably affected. Food insecurity is posing a colossal risk to millions of people, particularly to children, who are still developing both physically and mentally.
School aged children are “in a huge stage of emotional growth and development,” says Ms. Schwartz. “It’s so important for them to get the calories and macronutrients that they need [at this stage] because their growth velocity is huge.” Many children who live in households that meet income eligibility guidelines receive free or reduced-cost meals at school through the National School Lunch Program during the school year. The Summer Breakfast Program is in place during seasonal breaks from school. Although eating meals while at school is certainly helpful for millions of children, it is not a total solution for households where food is scarce.
The unfortunate reality is that far too many school-aged children are not eating meals outside of school, usually due to lack of financial resources. “If a child is only eating meals at school, that can be difficult on the brain. If a kid has lunch and then doesn’t eat again until the following morning, they are going to be more irritable and depleted of energy, they’re going to be tired and they’re going to have mood issues,” says Ms. Schwartz. She references the word, “hangry,” a term that has become utilized more in recent years. “It’s a real thing,” says Ms. Schwartz, explaining this pseudo-word was formed by merging the word, “hungry” with the word, “angry.” The convergence of these feelings being exhibited is happening more frequently among school children.
The scarcity of food is not something that only affects children; adults can also experience food insecurity. Parents may sometimes buy fast food, which is cheap and easy to access, yet, lacks many of the nutrients needed to provide nourishment. Other issues that arise with frequent consumption of fast food include being at risk for obesity, diabetes, digestive issues, and disruption in mood.
Although there is a cost associated with eating, Ms. Schwartz explains that it is not impossible to stretch the value of food. For instance, peanut butter and almond butter are both good sources of protein yet, are less expensive than meat. Certain plants, including beans or lentils can also be rich in protein. Because of the high cost of organic fruits and vegetables, Ms. Schwartz often recommends frozen options to those who are managing on a strict budget. “They nutritionally have the same amount of vitamins and minerals but fresh is more expensive,” says Ms. Schwartz. She encourages children to “eat the rainbow” as that can be a “fun way” to teach children how to incorporate healthier choices into their diet from a young age. The rainbow reference derives from the fact that many fruits and vegetables tend to be rich in color. These foods provide greater nutritional value than bland-colored food (think potatoes or chicken nuggets).
When children are invested in understanding the origins of the food they eat, the payout can be huge. Being involved in planting and growing their own food can provide feelings of empowerment for children and positive associations with food can serve people well. “Kids take a lot of pride in having the opportunity to grow their own food,” says Ms. Schwartz. She indicates that neighborhood gardens can be educational, cost-effective, and inspire entire communities. Food banks and local food pantries can also be advantageous resources during times of financial hardship.
The importance of moderation
Moderation. Diversity. Variety. By her own account, these are the three words Ms. Schwartz focuses on with patients. “In my opinion those are the three words that are going to help support a positive relationship with food but also doesn’t put restrictions on anything,” says Ms. Schwartz. “For example, I love French Fries,” she says with a smile. “I just don’t eat them every single day but every time I do, I don’t have feelings of guilt about it because I make a mindful choice to consume them.” It is use of moderation in this example that allows Ms. Schwartz to continuously enjoy one of her favorite foods and, she encourages the same of her patients.
Many fad diets lack moderation by eliminating certain food groups completely. Due to their restrictive nature, Ms. Schwartz explains that such diets are difficult for people to sustain over time. She tends to promote the Mediterranean Diet to many of her patients because it includes oils, fruits, vegetables, whole grains, even red wine (in moderation). “I see it [the Mediterranean Diet] as beneficial because it allows for everything and has been supported by research for many years,” says Ms. Schwartz.
It was in fact the Mediterranean Diet that Ms. Schwartz recommended for Jane. The change in eating along with counseling and goal setting allowed Jane to begin feeling more energized and experience greater clarity. This led to making mindful choices about the food she was eating and ultimately experiencing more frequent moments of joy. Jane still checks in with Ms. Schwartz in order to stay on track with her goals. She not only feels better, Jane is now able to advocate on behalf of her own health.
Ms. Schwartz recognizes the importance of empowering her patients. While some people are predisposed to certain conditions that may impact their overall health, she points out that individuals have the power to make changes that will positively influence their well-being in the long run. When an individual is invested in his or her own health, “that gives the power back to the patient,” says Ms. Schwartz. She often says to her patients, “You can do this. You’re able to manage your health and I’m able to support you through this.” Ms. Schwartz seeks to share the same message with every patient that is at the core of why she does this work. It is also the very message she shared with Jane when the two were working together, “you are worth it,” Ms. Schwartz says.
Anna Schwartz, MS, RDN is a Registered Dietitian at Paramount Health Directions in Denver, Colorado. To learn more about the services click here.
**Before implementing any changes in diet, eating patterns, or introducing supplements, it is recommended you consult with a medical provider.
Anna Schwartz, Registered Dietitian.
Photo courtesy of Ms. Schwartz.
Eating tips from Anna Schwartz, Registered Dietitian. The following foods are not only delicious but also healthy:
- Berries – Contain vitamins and minerals important for body functioning and hormone and neurotransmitter processes. Contains antioxidants that protect our cells and reduce inflammation through the whole body.
Examples: blueberries, raspberries, blackberries, strawberries
- Leafy Greens and Green Veggies– Full of antioxidants and B-vitamins for cell protection and cofactors in the production and activation of neurotransmitters such as dopamine and serotonin, supporting brain health.
Examples: mixed greens, spinach, broccoli, asparagus, etc.- Fish – Contains omega 3’s that are supportive in brain cognition, memory and focus, and decreasing inflammation in the body.
Examples: salmon, halibut, sol, tilapia, etc.- Whole grains – Help maintain regularity in the gastrointestinal tract, aids in satiety with high amounts of fiber and can help reduce cholesterol levels.
Examples: whole grain pasta, oatmeal, quinoa, whole grain breads- Plant based proteins – Paired with a whole grain, plant-based proteins can serve as a complete protein (contains all of the amino acids required through the diet) and contains high amounts of fiber. Plant based proteins can aid in reducing cholesterol levels and improving GI health and regularity.
Examples: Beans, edamame, lentils, legumes, chickpeas, tofu, etc.For a quick, yummy, and healthy snack Ms. Schwartz recommends the following recipe for Homemade Trail Mix:
- Pick three types of nuts (1 – 1 ½ cup)
- Walnuts, peanuts, pecans, almonds, cashews, macadamia nuts, Brazil nuts, etc.
- Pick a dried fruit (1/4 – 1/2 cup)
- Craisins, raisins, mango, pineapple, bananas, etc.
- Pick a seed (1/4 – 1/2 cup)
- Pumpkin seeds, sunflower seeds, etc.
- Pick your favorite fun and personal ingredient (1/4 – 1/2 cup)
- Popcorn, dark chocolate chips, whole grain pretzels, coconut shavings, etc.
- Sprinkle some cinnamon on top to your taste preference
- Mix it all together and divide into in snack bags proportioned out in ¼ – ½ cup for quick easy grab bags!
**Before implementing any changes in diet, eating patterns, or introducing supplements, it is recommended you consult with a medical provider.
