Because your physical and mental health are intertwined, the standard advice to improve your physical health—eat well, exercise, get plenty of sleep, don’t drink too much alcohol—also applies to your mental health.
We’ll look at several lifestyle factors here. Changes can both decrease the risk of developing new mental health symptoms and reduce the severity of existing ones. Many people try changing their diet, exercising, or limiting their alcohol use before trying other strategies to deal with their mental health problems. Such lifestyle changes may be all you need to treat mild symptoms. Even if they’re not enough by themselves, lifestyle changes can reduce the time, dose, or effort you put into other treatments.
Negative lifestyle factors can worsen mental illness. They may become unhealthy means of coping, including comfort eating, smoking to relieve stress, or drinking alcohol in excess to forget problems.
Optimizing your physical health is a good idea at any time. Though difficult, most people at least know what’s needed to improve their diet, increase exercise, or quit smoking. These changes can also be cost-effective. Few other mental health treatments are both as familiar and affordable.
There are some obvious links between diet and your mental health. From a psychological perspective, many people tie their body weight to their self-worth, a factor in depression. Taken further, eating disorders such as anorexia and bulimia are onerous mental illnesses. A fixation on body image can result in dangerous dietary changes. At a physical level, you can notice the effect that food has on your mood. You’ve likely experienced feeling happy and energetic after a light, nutrient-packed meal or sluggish and maybe even depressed after a large heavy meal. Food can literally affect your brain. There is a reason why you may crave chocolate. Chocolate can improve your mood or cognition because it ultimately increases serotonin.
A well-balanced diet consists of a broad range of whole foods along with good hydration. It contains many vitamins, minerals, proteins, carbohydrates, fats, and more. These provide your body with all the necessary building blocks it needs. As you’ve read, this includes your nervous system. It relies on multiple nutrients to assemble neurotransmitters and the right level of elements such as sodium and calcium to keep them moving.1
If you are severely deficient of a critical nutrient or can’t absorb it, nothing but correcting the deficiency will fix the resulting problems. However, as you’ve read, tests for many deficiencies are not available or practical. Deficiencies in some nutrients have physical signs that your doctor or a naturopath may recognize. Trial and error with diet changes or supplements is sometimes the only way to know for sure.
Again, deficiencies to consider are iron, all B vitamins (especially B12), vitamin C, vitamin D, electrolytes, certain minerals (zinc, selenium, iodine, and chromium), and Omega-3 fatty acids. We’ll discuss supplements in the next chapter.
But food is more than a collection of nutrients. Peoples’ bodies have evolved to rely on whole foods in a variety of ways, such as helping with waste removal. Your digestive system processes whole foods at a pace that absorbs nutrients gradually. Too much simple sugar at once causes a spike in levels of the hormone insulin. That affects the brain and results in swings in energy and mood. Insulin production also frees up tryptophan which can be converted into serotonin. Very limited fad diets that focus on one ingredient, nutrient, or food group disrupt the body’s normal functioning and can have their own effects on mood.
A well-balanced, nutrient-rich diet is an excellent way to protect or improve your mental health. If you need help with your diet, you can start by speaking with your doctor or a dietician. There are also many high quality books available.2
A properly functioning digestive system is needed to absorb nutrients for use elsewhere. Illnesses in your digestive tract can interfere with absorption. Changes in diet and health can affect your gut bacteria, which break down food into usable nutrients. That changes how well different nutrients are absorbed. For example, gut changes as people age lead to more problems absorbing vitamin B12. Different parts of the digestive tract absorb different nutrients, so surgeries removing parts of the digestive system can affect this.
Some illnesses lead to inflammation of the digestive system and elsewhere. Flare-ups of diseases such as Crohn’s or ulcerative colitis often cause brain fog. This also happens to those with celiac disease who ingest gluten. These illnesses often start with vague symptoms. It can take years before they are diagnosed. The effect these have on absorption may not be the only factor. Researchers are also investigating how inflammation may affect mental health directly. The recent rise in food sensitivities and intolerances likely has mental health consequences.
Like diet, exercise can reduce the incidence and severity of many physical illnesses. That, in turn, affects mental health. However, exercise can also directly affect mental health, especially depression. It both prevents symptoms from emerging and treats them when present.
On the prevention side, several recent large studies and systematic reviews are encouraging. As little as one hour of physical activity per week can reduce the risk of developing mild to moderate depression. Physical activity means not only exercise like running or lifting weights at the gym. Activities such as gardening, vacuuming, and dusting count, as long as your heart rate rises to a moderate level. People who are active, even if they are not fit, are at less risk for depression than fit people who are not active.
On the treatment side, studies show that exercise can be as effective as an antidepressant for mild to moderate depression. Exercise further combats depressive symptoms when added to an antidepressant. The results are pretty good for anxiety, too. There, exercise has been found as effective as cognitive behavioural therapy.
Exercise and physical activity improve serotonin levels. They release endorphins (neurotransmitters having an opioid-like effect) and cannabinoids (which enhance some neural receptors). They also lower the stress hormone cortisol. Exercise and physical activity also strengthen a part of the brain that helps with memory and emotion.
Recommendations for the type and amount of exercise vary. Both cardiovascular and resistance exercise have shown clear mental health benefits. A good target is 30 minutes of moderate intensity exercise per day, but even small amounts of physical activity help. This is good news, particularly if you’ve not been very active. Start small and increase at a pace that works for you. Your doctor can help with any concerns about increasing your activity.
Interestingly, there is mixed evidence about high-intensity exercise for mental health. Some studies support it while others are more cautious. High-intensity exercise does increase cortisol levels, albeit briefly. Injuries from high-intensity exercise can cause longer-term cortisol increases. Prolonged high cortisol leaves you activated, in a low-grade fight-or-flight mode, which creates many adverse effects, including anxiety.
Finally, some recent work has shown that time spent outdoors in a natural environment benefits mental health. Countless walkers, hikers, runners, and cyclists find that the combination of physical activity in the great outdoors is hard to beat.
Like poor diet and lack of exercise, poor sleep is implicated in multiple physical and mental health problems. Insomnia (difficulty falling or staying asleep) is a symptom of several mental illnesses. Many sleep disorders are considered forms of mental illness in their own right. Addressing sleep problems reduces the risk of developing some mental illnesses and can treat existing ones. Poor sleep and illnesses such as depression or anxiety create a mutually reinforcing feedback loop.
Poor sleep, even for a short while, can lead to increased irritability, anger, stress, and depression. It also affects short- and long-term memory, attention, planning, and motivation. Extreme sleep deprivation can lead to paranoia and hallucinations. For those with a bipolar disorder, poor sleep increases the risk of developing hypomania or mania.
If you have difficulty falling asleep or staying asleep, aren’t rested upon waking, or if you are tired during the day, poor sleep is likely an issue. Do you snore, sometimes wake up choking or gasping, or has your partner noticed you sometimes stop breathing for a few seconds? You may suffer from sleep apnea, reducing oxygen to your brain and body. That can lead to memory problems, trouble concentrating, and mood swings. An overnight sleep study at a dedicated sleep lab can tell you a lot about your sleep. You can also borrow equipment to test for sleep apnea at home.
Depending on the exact problem, there are many effective treatments available. The first option is usually improving your sleep hygiene, a term for various behavioural and environmental factors. These include avoiding naps or caffeine late in the day, keeping a consistent schedule, developing sleep rituals, not consuming media in bed, and so on. Other treatments may include mechanical devices, cognitive behavioural therapy, and for occasional use, some herbal, over-the-counter, or prescription medications.3
If you suspect poor sleep may be a factor in your mental (or physical) health, speak with your doctor.
Caffeine is highly addictive, yet legal and virtually unregulated. It’s the most widely consumed psychoactive drug in the world, regularly used by more than 80% of adults. We’re both happy to be included in this group.
Not to put too fine a point on it, excessive caffeine is anxiety in a cup (or can, pill, candy, or gourd). It causes jitteriness, restlessness, palpitations, nausea, dizziness, and insomnia. These are indistinguishable from symptoms you’d experience during a panic attack. Caffeine increases adrenaline and cortisol, decreases the calming neurotransmitter GABA, increases blood pressure, and decreases blood flow to the brain. Yet, modest amounts of caffeine can reduce fatigue and tiredness. It can improve concentration, coordination, and athletic performance. It even reduces the risk of depression or suicide by about 15-20%.
What is a modest amount depends on your weight and tolerance. On average, an 8 ounce cup of brewed coffee contains about 100 mg of caffeine but may have up to double that. Typical cup sizes in most North American coffee shops range from 50–150% larger than that. This can put one drink at close to 500 mg of caffeine. Both Health Canada and the FDA suggest a maximum of 400 mg per day is safe for average adults. Most people will experience the effects of caffeine at less than a quarter of that amount.
Caffeine is often combined with other stimulants such as tobacco or sugar in energy drinks and many popular beverages at chain coffee shops. Mixing caffeine and alcohol (a depressant) can mask the body’s normal reaction to consuming too much alcohol, leading to significant intoxication. Caffeine can also interact with many medications.
If you suffer from significant anxiety, reducing your caffeine intake will likely help. Large decreases can have profound effects. Like any drug that creates physical dependence, decrease slowly and gradually. Withdrawal symptoms include headaches, irritability, poor concentration, and fatigue.
Start by accurately determining your caffeine intake. Then discuss with your doctor if reducing it might help your symptoms.
Tobacco contains the addictive stimulant nicotine. It has some of the same benefits as caffeine, particularly improving concentration. However, it can also play havoc with your mental health. Biologically, nicotine affects the transmission of the excitatory neurotransmitters glutamate and acetylcholine. This, in turn, releases norepinephrine, epinephrine, serotonin, and dopamine. All of this leads to the pleasure that smokers and other nicotine users crave. Unfortunately, the effect doesn’t last. Nicotine is associated with an increased risk of developing depression long term.
Many people smoke as a coping mechanism during times of stress. Yet, tobacco users have higher levels of stress and anxiety. This grows with time and as tolerance increases. Short-term improvements (“I need a cigarette to relax”) are fleeting. They don’t offset the elevated anxiety levels caused by nicotine use. Nicotine interacts with many medications including some used in mental health. If your smoking habits change, ask your doctor if this could affect the dose of your medications. Even in small amounts, the long-term risks to your mental and physical health outweigh any benefits.
Alcohol is primarily a depressant, though it also has some stimulant effects on neurotransmitters. That makes for a careful balance between enjoyment and discomfort that can easily swing from one to the other. Experiences vary. Alcohol tends to decrease the activity of neurotransmitters, including glutamate, and binds to GABA receptors, increasing transmission. This results in relaxation, but also impaired balance and memory. It raises the activity of other neurotransmitters, including dopamine (pleasure) and norepinephrine (energy and motivation). It also raises serotonin, but unfortunately, the serotonin receptor affected increases nausea.
Alcohol temporarily reduces anxiety. It provides the “liquid courage” that helps you overcome social anxiety. Afterwards, however, anxiety is increased, and alcohol metabolites increase anxiety levels and remain in the brain for several days. Anxiety worsens as dependence increases. Alcohol can bring on temporary but severe depressive symptoms. Longer-term use starts looking like a depressive disorder. In some people, these symptoms will resolve after several weeks without drinking. In people with a bipolar disorder, however, alcohol can be enough to trigger mood episodes.
Consuming alcohol amounts to consuming low nutrient liquid calories. It either replaces healthy food or adds unneeded calories to your diet. Diets associated with alcohol use increase the risk of protein and energy deficiencies. They also lead to decreases in multiple B vitamins, as well as elements such as magnesium and zinc. These affect mood. Alcohol decreases the absorption and storage of thiamine (vitamin B1). Severe thiamine deficiency can lead to permanent brain damage and even death.
Like caffeine and nicotine, alcohol can produce physical dependence. This leads to intense withdrawal symptoms including seizures if abruptly discontinued. The family and societal costs of excess alcohol are devastating and well known. If alcohol is an issue for you, your doctor or a local support line can discuss resources in your area.
Using cannabis for mental health purposes is both widely promoted and criticized. Some claim it is a cure for every physical and mental problem under the sun. Others are equally quick to proclaim the incredible danger and condemn it out of hand.
What do we know? Not as much as we should. First, legal availability is rapidly shifting and varies by jurisdiction. It ranges from outright prohibition to legalized recreational use with minimal restrictions. In between are a range of restrictions on medicinal usage, types of products, distribution channels, and so on. Policy decisions are often based on politics more than evidence. The legal framework has made it extremely difficult for health researchers. That leaves a lack of high-quality, rigorous data. Solid evidence supports use only for chronic pain, some types of seizures, and nausea from chemotherapy. These legal issues and limited evidence affect health professionals including doctors. Most regulatory bodies now err on the side of caution. Except in specific cases, they recommend doctors not endorse cannabis use with their patients.
Despite all this, cannabis is readily available. It is widely used both medicinally and recreationally across a broad demographic range. Here in BC, the province has long embraced cannabis use. It’s known as the best quality producer in North America (we’ve been told). Usage rates are the highest in Canada at 17.3%. Total cannabis use in Canada is on par with tobacco.4 Some consumers are incredibly well informed about the effects of different cannabis strains and products. Most consumers, however, have little appreciation of this. Potential users need more education.
The active agents in cannabis plants are chemicals called cannabinoids. There are over 100 different varieties. Our body naturally produces similar chemicals called endocannabinoids. Both act as neurotransmitters that affect the endocannabinoid system, which controls many bodily and neural functions. The best-known cannabinoids are tetrahydrocannabinol (THC), the primary intoxicating component of cannabis plants, and cannabidiol (CBD), which is not intoxicating. Different species of plants, or strains, contain different amounts of each cannabinoid. This results in often markedly different effects for different strains. Each person also responds to these chemicals differently. Finally, strains are categorized as either indica, sativa, or hybrids of the two. These two main species of cannabis have broadly different physical characteristics. However, these categories tell you very little about the cannabinoid content or even effects of individual strains.
To date, most studies of cannabis use and mental health have not distinguished among different strains. Yet, the majority of recreational strains are bred with ever-increasing amounts of the intoxicating cannabinoid THC. This makes for a more potent high (hence, “this isn’t the same weed your parents were smoking in the 60’s”). THC can cause anxiety, psychosis, and mood symptoms in some users. However, much of the cannabis for medical use has less THC and more of the non-intoxicating cannabinoid CBD. Medical use has been a small segment of the market until recently. We can infer that most cannabis in past studies had high levels of THC.
There are two main concerns about cannabis use. The first is impairment. Cannabis can affect tasks, such as driving, just as alcohol does. The second is its effect on young people, whose minds are still developing (typically, until age 25). Many studies correlate early cannabis use with schizophrenia and an earlier onset of psychosis. This suggests caution is warranted, particularly in those with existing psychosis or where genetic risk is present.
Increased risk has also been suggested for those with bipolar disorder or a genetic predisposition toward it. This includes having close relatives with either depression or a bipolar disorder. These people may have an earlier onset of bipolar disorder, longer or more severe periods of hypomania or mania, and increased risk of suicide attempts.
The depth and breadth of the data supporting these risks is limited and suspect. At the same time, there is no hard data to show that cannabis use reduces the risk of mental health issues.
Continued use despite clinical impairment is considered a cannabis use disorder. It’s associated with more negative outcomes across a range of mental health disorders. Some studies show a modestly larger risk of depression for light users (17% higher), greater with heavy users (to 62% higher). Studies also show higher risks of anxiety disorders, and anxiety is common with (primarily THC-dominant) cannabis. Neurocognitive deficits (e.g., memory, attention) among heavy users are widely seen, during and shortly after use. Nothing conclusively suggests these effects are permanent, especially for those over 25 years old.
Cannabis, like many substances, interacts with many different prescription medications. This includes antidepressants or other psychotropic medications. It may increase or decrease side effects or even the effectiveness of medications. The dosage of some medications is fairly fussy so that a change in cannabis use may be enough to throw things off. If you are using cannabis, let prescribers know that, along with any changes to your usage.
Much of the interest in cannabis for mental health is directed toward CBD-dominant strains or their extracts. Most recreational cannabis, with more THC and other intoxicating cannabinoids, is likely less helpful.
CBD has been widely thought to improve multiple forms of anxiety. This is an area of active behavioural and biological research. CBD has anecdotal evidence for treating depression. Some tentative information points to the use of CBD as an antipsychotic. Other possible effects on brain health are at the early stage of research, and specific mechanisms are unclear. Research in animal models suggests that CBD may affect serotonin transmission.
The lack of rigorous data makes it impractical to draw any definitive conclusions on the mental health benefits of CBD. The relaxing legal climate will lead to more rigorous evaluation in future, both for treating existing conditions and examining its effect on developing mental illness.
One exception to the focus on CBD is for those with insomnia or nightmares. Many find that higher THC strains help with these symptoms. It’s widely used by military veterans with PTSD, who also find it decreases hyperarousal symptoms. Chronic pain is also very common in this group. A variety of strains, some THC-dominant, are reportedly effective here.
We’re still in the “Wild West” stage of cannabis use for mental health. For those who choose to use cannabis, a risk reduction model is advised. The Lower-Risk Cannabis Use Guidelines (LRCUG) available through the Centre for Addiction and Mental Health (CAMH) are a good starting point.5
This topic could fill a book on its own. However, we won’t have a lot to say in this book about illicit drugs and mental health. Many of them have a high potential for addiction. There are often negative effects when coming down from a high. Immediate and longer-term safety concerns are also a factor.
Not surprisingly, most of them work on neurotransmitters. Cocaine, methamphetamine, and many others work on dopamine. Cocaine, LSD, and ecstasy work on serotonin. Cocaine and methamphetamine work on norepinephrine. Ketamine works on glutamate. Many illicit drugs are chemically similar to other neurotransmitters and bind to their receptors (e.g., opioids, psilocybin).
Interestingly, academic researchers are investigating using various illicit or heavily regulated drugs (e.g., ketamine, GHB, MDMA) as well as hallucinogens (e.g., LSD, psilocybin) to treat depression.6 But, these are still early days.
Lifestyle changes can reduce the chance of developing mental illness and can treat many milder cases of mental illness. These changes are a very common first approach to dealing with mental health problems.
A well-balanced, nutrient-rich whole food diet is the best way for most people to obtain all the necessary building blocks for good mental health.
Even small amounts of exercise can have mental health benefits. Regular exercise may be as effective as an antidepressant for mild depression and anxiety or reduce the necessary antidepressant dose.
Poor sleep can cause serious mental health problems in a short period. Medications or supplements can help for occasional problems, while better sleep hygiene, therapy, or other treatments can be used long term.
Caffeine, tobacco, alcohol, cannabis, and illicit drugs can all play havoc with your mental health. If you have anxiety, seriously consider your caffeine intake.
The CDC in the United States, via The National Health and Nutrition Examination Survey, collected blood and urine samples to measure a wide variety of nutrients and other biochemical indicators.
https://www.cdc.gov/nutritionreport/↩
One book that we continue to recommend is Becoming Vegan by dieticians Brenda Davis and Vesanto Melina. It provides high-quality and extensive information on dietary sources of nutrients. It comprehensively discusses each nutrient, its role in our body, the amount in many different foods, and how deficiency affects us. Carnivores will likely skip past the advocacy chapter. Note that animal products are included “for comparison purposes.” There are now two versions, an “Express” edition and a 600+ page “Comprehensive” edition.
https://becomingvegan.ca↩
Suggestions for improving your sleep hygiene can be easily found online. Here’s one list from the sleep information site Tuck.com:
https://www.tuck.com/sleep-hygiene/↩
This data was from the 2015 Canadian Tobacco Alcohol and Drugs Survey (CTADS). It was collected through telephone interviews of 15,000+ Canadians ages 15 years and older. Of note, those aged 15–24 were far more likely to be current users of cannabis rather than tobacco.
https://mhnav.com/r/canatads
In the United States, the National Survey on Drug Use and Health, directed by SAMHSA, provides detailed information, broken down across various demographic factors. In the 2016 survey, overall cannabis use was 13.7%, peaking at 32.5% in the 18–25 age group. Interestingly, though cannabis use in the USA and Canada were close (13.7% versus 12.3%), tobacco use was much higher in the USA (overall 25% versus 13%).
https://mhnav.com/r/usansduh
Both Canadian and US numbers refer to the percentage of current users. They don’t say anything about the frequency or quantity of use.
For a more international perspective, the 2017 World Drug Report by the United Nations Office on Drugs and Crime is a good source.
https://www.unodc.org/wdr2017/↩
These guidelines were developed by the Canadian Research Initiative in Substance Misuse (CRISM). CAMH has two short brochures summarizing the guidelines, one for the public and one for health professionals. Details on the methodology and sources of data behind the recommendations are also available.
https://mhnav.com/r/lrcugpub
https://mhnav.com/r/lrcugpro
https://doi.org/10.2105/AJPH.2017.303818↩
Research on hallucinogens started in the 1950’s and early 1960’s, but came to an abrupt halt in the mid-1960’s when LSD and other psychedelics were criminalized. There has been a resurgence of research since the late 1990’s. Broadly, the use of some psychedelics during specialized psychotherapy sessions may shorten the overall course of therapy. For those who are curious, a good starting point is the 2018 book by Michael Pollan, How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.↩
Now Available! A MSP-supported live course for BC residents based on the book. [Mar/2023]
While you can read it for free online, there are conditions on sharing it with others (see below). You can also still purchase copies in paperback or e-book (PDF, Kindle, Kobo, etc.).
Now Available! A MSP-supported live course for BC residents based on the book.
