Nutrition Counseling

Ruth Leyse-Wallace, PhD, RD

Point Of View

The mind and brain, as well as the body, need adequate nutritional intake for wellness and optimum functioning. Even though nutrition is only one factor in mental and physical health, it is highly influential for both mind and body. It is also quite easily improved and should be included in any effort to sustain mental health. A complete and sufficient array of nutrients are needed for:

• an energy supply
• transporting and transforming food into the energy form usable by the physical body and brain
• creating enzymes, hormones, bone, muscle, neurotransmitters, and immune system
• facilitating the expression of DNA
• coping with stress

Memory, cognition, attention span, aggression, irritability, feelings of well being, and mental energy may be affected by nutritional status. Consuming too few of the necessary nutrients affects so many bodily systems it is not surprising that poor nutrition decreases the quality of life in both obvious and subtle ways. Nutrients include:

• carbohydrates
• essential fatty acids
• amino acids
• folic acid and other B vitamins
• vitamin C
• minerals such as chromium, zinc, and iron

Bipolar disorder and depression may influence whether an individual consumes an adequate supply of foods and the nutrients they supply. The manic state can lead to distraction in which less attention is given to the preparation of adequate foods. Increased activity during this phase requires additional nutritional needs that are not always met. Depression can lead to a lack of energy and motivation for eating adequately, leading to weight gain or loss and associated health issues.

Medications may interact with nutrient intake or metabolism and affect the body's use of nutrients. Toxicity may result from excess intake of some nutrients, which in turn can affect mental function.

Often, the scientific evidence linking nutrition to mental health is correlational in nature. Cause and effect links are scientifically difficult in both nutrition and mental health research. However, scientists around the world publish new research results monthly that contribute to knowledge in these areas.

Integration With Team

One function of the nutritionist is to determine a client's nutritional status and bring to the attention of the team any potential problems or special needs. Some nutrition issues may need the coordination of the nutritionist, the physician, activity therapist, pharmacist, and other professionals on the team. Family members also support ongoing solutions.

The nutritionist assists a client with setting nutrition goals and creating a plan to attain them. Follow-up meetings generally lead to greater progress than trying to go it alone.

The nutritionist also acts as a resource for the team, the client, and the family. Providing current, scientifically-based, practical information about nutrition can provide the rationale for nutritional goals and plans. For example, in the past a prescription for a monoamine oxidase inhibitor [MAOI] required a low tyramine diet to prevent a hypertensive crisis. Now administration by patch instead of orally, at some doses, does not require following the diet.

Assessment Process

Findings during the initial interview are evaluated by the nutritionist, discussed with the client, and shared with the team members. Assessment of initial nutritional status includes an interview by the nutritionist to gather information concerning:

• usual food, beverage, and supplement intake
• current weight and recent weight changes
• physical problems with eating (dental health for example)
• the need for a nutrition-focused physical examination (and performance of the exam if needed)
• biochemical laboratory testing to validate observations and findings
• presence of diarrhea or constipation
• possible interactions between medications and nutritional status or individual nutrients
• medical issues that may affect or be affected by nutrition
• presence of nutritional risk factors related to family history (bipolar disorder, diabetes, etc)
• subjective symptoms felt by the client to be affecting intake or nutritional status (frequent nausea or extreme fatigue, among others)

Results of laboratory tests will be evaluated and discussed when they are complete. They will then be integrated into goal-setting and determining a treatment plan. The client's priorities and preferences will be an integral part of goals and treatment planning.

Reassessment and follow-up will occur at appropriate intervals for discovering if nutritional status has changed in the desired direction. For example, it may take one to several weeks for a supplement to promote a change in an enzyme level.

Goal Setting

Goals are statements of behavior; actions to be undertaken with commitment for obtaining a nutritional intake that will support the desired mental and physical health. Individualized goals in relation to nutrition will be based on the nutritional assessment as well as each client's personal interests and life situation.

Goals may be short- or long-term. Goals that are stated simply with a single focus are preferable to complex goals. The best goals are those that can be clearly evaluated. "Eating better" isn't as easily evaluated as "eat three times per day instead of one meal per day."

An individual may have a few or several goals. Certain goals may be addressed one at a time and achieved relatively quickly. Other goals entail changing lifelong habits and will require longer periods of time because readiness to change is influenced by many factors. Goals that involve lifestyle may require several interim goals. Simplistically put, if the desired life style goal is to lose 25 pounds, the first interim goal could be to limit sugar intake. To that end, a second interim goal could be to stop buying a candy bar from the vending machine everyday at break.

Treatment

A treatment regimen will reflect an individual's goals and plans for how best achieve them. It will be developed by the treatment team and the client. The nutrition treatment regimen may include a food plan, supplements, self-monitoring, and education. Treatment may also include assistance from family and friends. Decisions regarding activities that involve food may have to be addressed. Consideration regarding activities that don't involve food may also need to be taken into account.

Monitoring an individual's progress in reaching his/her goals and whether they are having the desired effect is important. Regularly spaced appointments with the nutritionist will be important until the treatment regime is going smoothly. During these appointments, acknowledgment of successes is motivating. They also provide an opportunity to make any necessary changes. Over time, the treatment regimen will most likely change as goals are met, new factors emerge, insight and knowledge acquired, and new goals are set. It is hoped that treatment will evolve to where it is no longer treatment but is in fact a new way of life.