If you talk to Staci Shacter about nutrition for just a few minutes, it quickly becomes evident that she’s a passionate believer in the power of food to heal. She’s also a reservoir of information on the subject. As a registered dietician serving FHE Health, Shacter regularly educates patients about how healthy nutrition can boost recovery and mental health, including sustainable ways to improve one’s diet. Shacter is also clinically trained with a M.S. in nutrition and says she takes a “holistically minded” approach to nutrition. In a recent interview, she shared some useful insights about nutrition in recovery and how to eat better for the sake of your mental health.
The Role of Nutrition in Recovery
What role does nutrition play in recovery? Here is how Shacter answered that question:
The brain is king when it comes to recovery. We used to think in modern times that we just needed a pill or prescription drug to impact our brain chemistry, but we were also impacting our physiology, including neurophysiology, through our lifestyle … We often only focus on the medication that’s found to impact one small pathway of the brain, whereas the nutrients that we consume have a systematic impact. I focus on the nutrients that give the brain what it needs (neurotransmitters like serotonin and dopamine, motivation, energy, and the ability to cope and deal with stress).
“Medicine has its place and can help us, but we also need other supports like therapy and 12-step groups; and lifestyle and nutrition are a big piece of the puzzle,” Shacter continued. She used the example of blood sugar levels and how their fluctuation can impact mood. (High blood sugar is also associated with increased depression.)
Shacter therefore makes a point of teaching patients how to keep their blood sugar stable—”without having to go on a low-cal diet.” She recommends a Mediterranean diet for depression and teaches patients about “what nutrients are needed to boost neurotransmitters” that can in turn help buffer the brain against depression.
Nutritional Deficiencies That Occur with Drug or Alcohol Addiction
Not surprisingly, nutritional deficiencies are common with drug or alcohol addiction. “People are usually deficient with a lot of things,” according to Shacter. “They’re either not eating a lot or eating candy or fast food—and that’s if they’re eating at all.”
People can also be “deficient in things that are contributing to depression, anxiety, or low motivation that can lead to relapse,” Shacter said. When teaching groups at FHE, she often takes a quick inventory to see whether anyone there has ever tried a healthy lifestyle of diet and exercise and noticed the positive effects. Invariably, some patients will share that when they were exercising and eating healthier, they were also sleeping better and had less anxiety and depression.
“A lot of people think that if they do bloodwork and it’s fine, they don’t have nutritional deficiencies,” Shacter said, but that’s not the case.” She said standard blood tests can reveal deficiencies in B12, folate, and iron but are less reliable at telling us whether we are deficient in other nutrients like calcium or potassium.
Food sensitivities and mental health are another area where there can be misconceptions. Though common these days, food sensitivities tend to only be thought of as allergies, but they can have a mental health link, according to Shacter. She gave the example of gluten sensitivity and its relationship to mood disorders, citing these findings from a systematic review of studies in 2018:
- Gluten made depressive symptoms worse in those with a gluten sensitivity. (Shacter added that “many people have gluten sensitivity and do not know it.”)
- Patients with bipolar, major depressive disorder, and schizophrenia had raised gluten-related antibodies.
Commonly Seen Deficiencies with Alcoholism
With alcoholism, people are typically deficient in many nutrients, particularly folic acid and thiamine, Shacter said. She noted that the protocol at FHE Health is to give these two vitamins in addition to a multivitamin, whenever alcohol use disorder is a diagnosis.
What about foods that are high in folic acid and thiamine? Shacter said dark leafy greens are a good source of folic acid and beans are a good source of thiamine. Her “nutritional advice is about what your plate should look like.” A good rule of thumb to follow, she said, is quantity and variety of nutrient-dense foods in diet.
How do we know if we are getting the right quantity and variety? Instead of telling people to eliminate all sugar and white flour, Staci takes a gentler approach by suggesting ways to increase fruits, vegetables, nuts, seeds, beans, and whole grains in the diet. She points out that you will naturally eat less flour and sugar when you have increased these other foods in the diet.
Nutritional Deficiencies That Occur with Mental Health Disorders
Similar nutritional deficiencies can occur when a person’s primary diagnosis is a mental health condition and they, much like the person with the substance addiction, are not exercising self-care. Shacter said she frequently sees patients who are not eating because their anxiety is so severe—or they are not eating well.
Most Common Deficiencies Among People in Rehab
It is estimated that in general 60-80 percent of people are deficient in magnesium, which is great for stress and anxiety, according to Shacter.
Vitamin D is another common deficiency that FHE patients are tested for. “The people who need it get on it when they’re with us,” Shacter said. “Research has found that many people with depression have low vitamin D, and there is some research showing improvements in depression with vitamin D supplementation.”
Other important nutrient considerations include:
- Vitamin B6 (which is necessary to make every neurotransmitter)
- Omega 3 fats (well-studied for their neurological benefits)
- B12/folate/iron (critical to healthy levels of serotonin and dopamine)
- Amino acids needed to make our neurotransmitters (available in a wide variety of both animal and plant foods)
Healthy Eating Tips for After Rehab?
Because “everything is connected in the body,” and because nutrient-rich foods can go a long way to support the health of the whole person, Shacter devotes a lot of time to empowering good eating habits after rehab. She wants patients to know that a nutritional diet is sustainable, both in terms of budget and lifestyle.
“My job is to come up with solutions that are realistic and doable,” Shacter said. On that note, here are some of the healthy eating suggestions that Shacter gives patients:
- A good multi-vitamin is a good place to start.
- If you don’t get enough fruits and vegetables in your daily diet, (which is the case for 90 percent of us, according to Shacter), supplement with fruit and veggie powders or pills. (The recommended daily portion is three cups of veggies and two cups of fruits a day for adult men.)
- Get plenty of B vitamins. Dark, leafy greens and foods high in sulfur are needed for supporting the liver and are high in nutrients like thiamine. Cauliflower, onion, broccoli, and dandelion greens are good sources. Other things which are great for supporting the liver include milk thistle, glutathione, and the amino acid acetylcystine.
- “Omega 3 is a no brainer, pun intended.” You can find Omega 3s in certain fish such as wild salmon or a good vitamin supplement. When studied, higher levels of Omega 3 tend to predict lower rates of depression and anxiety, according to Shacter.
- Vitamin D is important for neurotransmitters. Try a daily form of vitamin D combined with vitamin K (“which helps get vitamin D to the right places”).
- For better sleep, try kiwi fruit or tart cherry juice before bed. They are sources of serotonin and melatonin.
Dietary Tips for Those Struggling with Their Mental Health
Did Shacter have any dietary advice for those struggling with mental health symptoms? Rather than prescribe the same rigid approach for everyone, Shacter suggested experimenting to see how certain foods may be affecting your mood or concentration. She tells people to ask themselves the following questions after a meal:
- Did you enjoy the meal?
- Are you comfortably full and satisfied?
- How long until you are hungry again?
- Are you able to have energy and focus and concentrate for at least 2-3 hours after the meal?
- How did this meal impact your digestion?
Based on the answers to these questions people can start to determine if certain types, quantities, and ratios of foods as meals are supporting their mental health and can be part of a balanced lifestyle to support physical and mental health.
Shacter shared the story of Melissa Hartwig, who co-created the Whole30 diet. Hartwig was in her eighth year of recovery from drug addiction when she heard a lecture about the hunter-gatherer diet and decided to try it. That is when she noticed that her sleep, energy, and mood improved.
After 30 days on the diet, Hartwig tried reintroducing foods one at a time. With many foods, like rice and beans, she found she was still able to maintain the same benefits as when she was off those foods. However, when she tried gluten and dairy again, she noticed she wasn’t feeling as great as during those 30 days.
Of course, not everyone will have the same experience as Hartwig. Some people may tolerate certain foods and not others. That is where the experimenting comes in.
Shacter takes the approach of “transparency, then free will”: “I share information and try and give people practical tools that enable realistic lifestyle changes.”
Shacter also encourages people to take small steps and avoid extreme dieting. She has found that black-and-white, all-or-nothing thinking about food can be hard to maintain, and the ensuing sense of failure can cause relapse.
“To best support mental health through lifestyle, we must first address what psychological obstacles may be keeping us from making lifestyle changes,” Shacter said. She tries to help people identify what factors may be keeping them from getting proper nutrition on a consistent basis and gives them tools to overcome those obstacles.