PsychoNutriologic Person

An Emerging Theory

         
If an individual has issues relating to both nutrition and mental health that have the potential for interactions which may negatively influence physical or mental functioning, this individual can be classified within the domain of PsychoNutriologic Person. The individuals who come within this domain are the concern of practitioners in the fields of both nutrition and mental health.

         
The theory of PsychoNutriologic Person: Nutritional status and mental health/mental illness are often interrelated in ways that can be assessed and treated for improvement of health and quality of life.

         
Scientific evidence and clinical observations demonstrate the not uncommon relationship between nutritional status and mental status. The following vignettes, from observations of the author, practicing as a registered dietitian caring for psychiatric or medical patients, serve as illustrations. Linking Nutrition to Mental Health: A Scientific Exploration by Ruth Leyse-Wallace PhD, RD reports on scientific research either as case reports on individuals, reports of clinical research on selected groups, or as epidemiological evidence on populations.

Scenarios Illustrating PsychoNutriologic Person

Scenario 1. A patient admitted to the hospital with a history of schizophrenia had been resisting taking the medication that will cause his symptoms and his behavior to subside and allow him to remain at home. In an effort to ensure the medication is taken, the family had begun to hide it in foods. This leads to paranoia about food, added to the paranoia often experienced related to schizophrenia. The individual is afraid to eat most foods, though he believe that a few unopened foods that are “safe.” The nutritionist must work with the individual and the physician to provide enough foods considered “safe” to prevent malnutrition while other treatment is begun and the paranoia diminishes. Sometimes this takes several weeks, while trust is developed between the patient and health care providers. This is a case in which the mental status is influencing the food and nutrient intake, which has the potential for further influencing the mental status.
Scenario 2. A patient comes for an outpatient nutrition consultation after a referral from her primary-care physician. Her mother, aunt, and sister all have pernicious anemia. Her own blood work indicates abnormal red cells related to low vitamin B12 status. The appearance of her tongue also reflects possible nutritional deficiency. She wants to prevent the mental and physical symptoms she knows are associated with long-term pernicious anemia and damage to the central nervous system caused by reduced availability of vitamin B12. She is willing to have the standard treatment of injections of vitamin B12, which circumvents the compromised absorption process, but also wants to make sure she has vitamin B12 in her diet. This illustrates prevention of mental consequences using a combined pharmaceutical and nutritional approach.
Scenario 3. A patient is admitted to the intensive care unit for major depression. She has felt extreme fatigue the past several months, which in not uncommon with major depression. She feels she can hardly drag herself to work, to the gym, and home each day. For the past several months, she has been trying to lose weight by eating a low-carbohydrate diet (about 50–60 grams/day) and exercising at a gym after work. She wondered if changing her diet would help her feel better and asked her physician for a referral to the dietitian while she was in the hospital. The registered dietitian plans a calorie intake that will result in weight loss and have adequate carbohydrate to support an exercise routine as well as supply energy during the day. She helps the patient work out a schedule for meals and snacks that coincides with her work schedule and suggests foods that she can include when she is away from home. This is a case where the diet is contributing to the symptoms associated with mental status. When the nutrition issues are resolved, the symptoms of depression and the individual’s response to treatment can be assessed more accurately.
Scenario 4. A patient with a history of gastric bypass (bariatric) surgery has been involuntarily vomiting persistently for several years. She attends an outpatient cognitive therapy program mainly for treatment of depression. She has been trying to lose weight, which she fears she gained because of her medications. She takes no vitamins or mineral supplements. Due to decreased absorption surfaces, reduced intake related to the bypass surgery, and dieting, she has a decreased availability of nutrients. Her persistent vomiting decreases an already-low supply of water-soluble vitamins. Low vitamin B1 (thiamin) levels are described in the literature as being deficient in these circumstances in selected individuals. Inadequate vitamin B1 is related to altered mental status as well as inefficient energy metabolism. This a case in which a physical state changes a nutrient supply, which has high potential for altering mental status.
Scenario 5. An individual does not respond as well as anticipated to antidepressant therapy and often eats poorly. Biochemical nutritional evaluation indicates a below-normal level of essential fatty acids. A therapeutic supplement of appropriately balanced essential fatty acids restores the biochemistry to normal levels. The patient is advised to include at least 6 oz. of high-fat fish in his weekly diet and possibly supplements of EPA and docosahexaenoic acid (DHA) to maintain the improved mental status. This illustrates a nutritional diagnosis being based on a biochemical determination of a nutrient deficiency with treatment focused on the deficiency found. Recommendations include both food and supplement sources of the deficient nutrient. Treatment is followed by biochemical and psychological assessment of response to the recommended treatment.
Scenario 6. An underweight patient is admitted with a diagnosis of alcohol addiction. A nutrition physical examination reveals swollen, red gums; splinter hemorrhages under the fingernails; and hair follicles on the arm that are red at the base (petechiae). These hairs are also observed to be curved or coiled. A diet history indicates rare intake of fruits and vegetables for months. Response to treatment with a supplement of vitamin C produces improvement in biochemical vitamin C status within a week. The patient is assisted in planning for improved nutrient intake after discharge. This case demonstrates nutritional diagnosis based on physical examination for nutrient-based lesions as well as a diet history. Reassessment of physical lesions, along with assessment of biochemical vitamin status confirms that the suspected cause of lesions are indeed the lack of vitamin C and that the supplement prescription is adequate for reversing observable signs. Treatment also includes education to prevent recurrence of the problem.

         
Scenarios one through four illustrate the principle of PsychoNutriologic Person at the level of food and diet linked to mental status. Scenario five and six illustrate how, as nutritional science develops and is applied to individuals, diagnosis may be nutrient-specific, based on nutrition-focused physical examination and biochemical tests. Interventions and recommendations can evolve from diet and foods to specific nutrients at specified doses. Response to treatment is assessed by the same methods used to diagnose. These methods are known as biomedical nutritional care.