Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion. This month, RDML Paul Reed is pleased to share a guest post by Susana Calderon, MPH, Regional Women’s Health Analyst, Office of the Assistant Secretary for Health, Region 8; and Traci Pole, MBA, MS, Assistant Regional Director, Substance Abuse and Mental Health Services Administration, Region 8.
There is abundant evidence that good nutrition is imperative to overall physical health, supports disease prevention, and offers cognitive benefits too. But when it comes to our overall mental and emotional health or our sense of well-being, what specific outcomes can we expect from good nutrition? And what negative effects can we expect from inadequate nutrition?
These questions are just a few of many being asked by the Food and Mood Project — an initiative led by the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS). As its name implies, the initiative seeks to uncover how food affects our mood; explore the full range of emotional, mental, and social benefits of eating nutritious and culturally relevant foods; and determine how we might advance nutrition security to help address a range of issues, from substance misuse to psychosocial health and well-being.
As you’ll read below, the project directly proposes that when a person eats well, they feed both their body and their mind. However, much remains to be studied and well-understood about the relationship between nutrition and mental and emotional health, including the many social, physiological, and psychological issues at play. The Food and Mood Project has begun to address these areas and their interplay, exploring a number of different avenues — each revealing not only new answers but also additional questions. This exploration is a critical piece of the broader understanding of nutrition security and efforts to accurately define and employ Food as Medicine concepts.
Thank you, Susana and Traci, for sharing your work with us and for expanding the discussion on nutrition in this important — and fascinating — area of inquiry.
Yours in health,
Paul
Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion
In Officio Salutis — In the Service of Health
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We’ve all heard the popular saying “You are what you eat,” but have you ever paused to think about what that really means for your body, your mind, and your spirit? How can we expand our thinking about the relationship between food/nutrition and physical health care to include emotional health and well-being? Can we develop interventions that move beyond traditional mental health and substance use treatments and incorporate social determinants of health and food/nutrition to better promote mental health, prevent disease, and foster recovery? What policies need to change so that we can prioritize healthy and culturally appropriate food and behavioral health care resources more equitably across the country?
These are the questions that inspired the development of the Food and Mood Project. Over the last several years, regional staff from the U.S. Department of Health and Human Services (HHS) — specifically the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the Assistant Secretary for Health (OASH) — and the U.S. Department of Agriculture (USDA) Food and Nutrition Service have been delving deeply into the impact of food on our mood. The Food and Mood Project aims to promote emotional wellness and reduce the impact of mental health and substance use conditions among the K-12 population by identifying and implementing strategies that address the intersection between behavioral health, food/nutrition security, and cultural food diversity.
A “Gut Check” on Brain Health: The Role of the Gut Microbiome
Of the examples that can be cited for how food may influence our mood, the role of the gut microbiome illustrates the profound interactions that occur in areas of the body that are seemingly far removed from the brain. There is well-documented evidence on the importance and function of the gut microbiome in maintaining our physical health, including metabolic functions and immune system health. There is also a growing body of research on the impact it has on our brain health.
Researchers at Johns Hopkins are examining the brain-gut connection and its effects on mental health. Their work takes a deep dive into the pathways involved in bidirectional communication between the gut microbiota and the brain. They have been examining how the enteric nervous system (ENS), commonly referred to as the “brain in the gut,” is vital to understanding how our food affects our mood — and how our mood can affect everything in our gut. For example, they note that “the gut produces 90 percent of the body’s serotonin and half of its dopamine,” both of which are “powerful neurotransmitters that affect mood, help the mind stay calm and focused, and are natural anti-depressants.” But because this relationship is bidirectional, “changes in our mood can also affect everything in the gut.”
Social Determinants of Health
The physiology of how gut bacteria influence our well-being is only part of the story. More broadly, there are factors that impact everything from access to food to the specifics of our food choices — long before we even eat. These everyday influences are what we refer to as social determinants of health (SDOH). Formally, Healthy People 2030 defines SDOH as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
National Institutes of Health (NIH) partners are examining one aspect of SDOH in the relationship between cultural foods, healthy gut bacteria, and diet-related chronic disease risks. The health of our gut microbiome is influenced across the life course, as early as in pregnancy. Examining how changes in dietary patterns lead to the increase or loss of healthy gut bacteria may inform the development of guidelines, especially in understanding the influences of “cultural foodways and sociocultural factors (e.g., acculturation).” This understanding can also help in “implementing effective dietary interventions.” Information shared at a recent NIH workshop supports “the notion of diet as a cultural element that is influenced by, among other things, food access, environmental factors, belief systems, history, racial/ethnic identity, and migration.”
Just as positive aspects of SDOH can have positive influences, disparities in SDOH — such as lack of access to nutritious foods — can impact our health and well-being in negative ways. Adverse childhood experiences (ACEs) such as emotional abuse, community violence, and discrimination may have long-term negative consequences on our health. Research indicates that young people exposed to 4 or more ACEs were more than 3 times as likely to experience food insecurity in young adulthood, highlighting the need for interventions to include food assistance programs when supporting people who have experienced ACEs, especially emotional abuse.
In 2021, 33.8 million people lived in food-insecure households and 5.0 million children lived in food-insecure households where children and adults experienced food insecurity. Prior research has shown that food insecurity is associated with psychological distress and other mental health outcomes, including depression. During the COVID-19 pandemic, we witnessed increasing rates of food insecurity and evidence that food insecurity was associated with an increased risk of mental illness. In addition, low-income individuals experiencing food insecurity were 3.6 and 3.5 times more likely to report symptoms of anxiety and depression, respectively, compared to those who were food secure.
Food and Mood Efforts Underway
Federal and state agencies, Tribal Nations, and community-based organizations are already taking steps to promote emotional well-being through food. The USDA Indigenous Food Sovereignty Initiative promotes traditional food ways, Indian Country food and agriculture markets, and Indigenous health through foods tailored to American Indian/Alaska Native (AI/AN) dietary needs. The USDA Farm to School Grant Program awards grants that connect students to the sources of their food through education, taste tests, school gardens, field trips, and local food sourcing for school meals. Additionally, other HHS funding has supported efforts that use horticulture, cooking, and nutrition education to prevent and reduce the occurrence of unhealthy coping patterns and mental and physical illness. These strategies build on the growing research regarding how food affects mood.
A Call to Action
Good nutrition is vital to optimal health and wellness, and children need daily fruits and vegetables for healthy growth and brain development. However, silos exist in our health care system when it comes to prevention, treatment, and recovery services between behavioral health and physical health conditions. How can food-based nutrition interventions be incorporated in our health care system to prevent and treat mental illness and substance use disorders across the lifespan? Below, we pose opportunities and invite you to think about ways to integrate Food and Mood into your efforts:
- Prioritize integrated health care models that are whole person-centered care and culturally affirming
- Screen for hunger and make referrals to improve nutrition security — and do a warm handoff rather than just providing a number or a website
- Remove barriers and improve accessibility for resources that address health-related social needs, including food access, stability, and nutrition
- Integrate culture-centered approaches into the care continuum — emphasize culture as a prevention strategy and a protective factor
- Educate yourself on nutrition — on average, U.S. medical schools offer less than 1 percent of total lecture hours in nutrition education
- Diversify your networks to create interdisciplinary partnerships
- Explore policies such as universal free lunch or Medicaid waivers that address social needs such as housing, food, and education
- Change your language — train your staff and organization on the importance of incorporating the National Culturally and Linguistically Appropriate Services Standards to help ensure that you are providing equitable access to care
We can all take small steps to ensure families and communities are nourished and thriving. That’s good for the body, the brain, and the soul.
Related Healthy People 2030 topics:
