Ask the expert: Diabetes, mental health and nutrition

We know how closely diabetes and mental health are connected, but how does nutrition fit into that? 

At the recent Integrative Mental Health Symposium, Bridget McNulty sat down with Dr Adrian Lopresti, Clinical Psychologist, Research Scientist and International Authority on Integrative Mental Health to ask about diabetes, mental health and nutrition.

When I mention ‘diabetes and mental health’, what springs to mind?

The fact that they are so connected. There’s so much comorbidity between diabetes and mental health (you often see both conditions in the same person).

Most of us understand the behavioural side of mental health, but not so much the nutritional side – could you explain that? 

We speak about biological disturbances in mental health. There’s  a whole range of physiological aspects of mental health, even though we often view it as a psychological condition. We know that the relationship with one affects the others… Inflammation and stress hormones are the biggest ones. Think about when we’re stressed: what happens to the way we think? What happens in our body, our physical sensations, our heartbeat, how much we sweat – those are physical symptoms but also psychological.

What is integrative mental health?

Integrative mental health looks at the person as a whole. We recognise that multiple small steps on their own might only make a tiny difference, but together they are very effective.

Dr Adrian Lopresti

Think about each intervention as contributing 5% positive to your life. It’s not one thing that will make you feel hugely better, it’s a few small things that each make a small difference.

So nutrition is just part of it: integrative mental health is psychological (often using Cognitive Behavioural Therapy) and diet, sleep, exercise, supplements and social components. Instead of looking at depression and anxiety as something that should just be treated with medication and therapy, we look at various aspects of your life:

• Diet: is it inflammation based?
• Sleep: how deeply and consistently are you sleeping?
• Exercise: are you regularly moving your body? It doesn’t have to be going for a run, it could be taking the stairs instead of the lift. 
• Supplements: are you taking any supplements? Certain natural supplements (botanicals, vitamins or minerals) can help with depression and anxiety
• Social components: how is your social interaction? Do you have family and friend support?

How are inflammation and diabetes linked, in your mind?

Inflammation is your immune system’s response to protect your body from injury, infection, or harmful irritants. But sometimes inflammation becomes chronic. People with diabetes are probably going to have excess levels of inflammation, either as a result of excess weight or blood sugar disturbances – the research strongly links the two. 

Chronic inflammation → insulin resistance → higher blood glucose → metabolic stress → more inflammation.

So that means it’s important for people with diabetes to look at an anti-inflammatory diet  – what you eat – but also exercise, sleep and stress management. An anti-inflammatory diet is often called the Mediterranean diet. The basic idea is lots of fresh fruit and vegetables, fish and nuts, wholegrains and legumes and healthy fats like olive oil, and reducing soft drinks, processed foods and refined carbs. 

The most important thing is to identify those things that don’t agree with you. That’s about becoming aware of how you feel after eating. It’s not always easy to identify what agrees with you and what causes inflammation. You might feel generally unwell or sluggish, it could be gut related, or you could feel joint pain. The most important question is: how do I feel after eating a specific type of food?

How do you think holistic dietary and lifestyle interventions can help people with diabetes deal with their mental health?

The way to think about it is: here’s a toolkit of different interventions. Which ones do you think that you can do, even if it’s just a little bit?’ If can’t go for a run, but can go for a walk – do that. If you can’t change your diet completely, but can eat more vegetables, do that. Choose those interventions that work for you and that you feel capable of doing. Once you feel better, you’ll be able to do more. An important thing to consider is that low mood often leads to low drive, and low enthusiasm for doing anything. So just start somewhere.

If you could recommend one small change to a person living with diabetes, what would it be?

I think the most useful small change is self-care. What is it that you can do to help improve your own self-care? That will be different for every person. That’s something you have to do for yourself. 

How good are you at self-care? Let’s talk about it!