Food and Mood project report
The Food and Mood Project:
a practitioner-guided self-help programme for groups
Founder of The Food and Mood Project
The Food and Mood Project started as an 18-month project funded by the Millennium Commission working in conjunction with Mind, the mental health charity. The recipient of the Award, a nutritional therapist registered with the British Association for Nutritional Therapy (BANT), devised a six-session, practitioner-guided self-help programme for small groups of self-referring women who wished to explore the relationship between the food we eat and the way we feel. The programme was repeated six times during the 18-month funded period and attended by a total of 54 women. This report provides details of the original programme, together with the rationale behind the inclusion of each aspect. Consideration is also given to promoting adherence to the self-help methods offered.
The Food and Mood Project aimed to increase awareness of a range of dietary and nutritional self-help approaches with proven ability to relieve symptoms of mental and emotional ill health. The programme also taught relaxation and breathing techniques chosen for their potential benefits in treating hyperventilation syndrome which can include mental/emotional symptoms (Anthony et al, 1997; Bradley, 1998). At the end of the programme each participant completed a questionnaire to assess their individual progress and give feedback on the programme structure.
The importance of the group setting
A ‘helping relationship’ is an important factor in changing behaviour and support may come from community sources other than health care professionals who are limited in the time they have available (HEA, 1994). In addition to the obvious economic benefits afforded by a self-help programme delivered in a group setting, group work also has the advantage of being able to address some of the social determinants of ill health which include social isolation, lack of social support and poor social networks (Meyrick & Sinkler, 1999) and there is a tendency for individuals to seek out the potential benefits of learning and sharing in a group (Pietroni, 1996). Another benefit of sharing similar experiences in a group setting is that feelings of compassion which may be lacking towards oneself can be generated towards others and, ultimately, be reflected back on oneself (Orbach, 1993).
Self help and personal responsibility
The Food and Mood Project was a practitioner- guided self help programme which from the outset generated a high level of interest. The demand for places on the programme could be attributed, in part, to the rise of what is being called a ‘consumer health movement’ which is emphasising the demystification of expertise, the individual’s right to know about their body and the sharing of power in health care decision making (Reidel, 1981), an attitude that concords with the holistic approach to health care that is characteristic of complementary medicine (Sharma, 1994).
Nutritional therapists are trained in naturopathic philosophy (SPNT, 1996). The key to the success of naturopathic treatments is the high level of involvement of individuals in their own healing process ( Murray & Pizzorno, 1990). A feature of complementary medicine is the emphasis on self-healing which requires the individual to do what he can to help him/herself, with the therapist taking the role of partner (Fulder, 1996). Studies have considered the importance of so-called ‘brief interventions’ of advice, information and counselling commonly used to help people adopt healthier behaviours (HEA, 1994) and have found that an emphasis by the therapist on personal responsibility for change is a common and important element in determining effectiveness (Miller & Rollnick, 1991).
Providing guidance about practical self-help strategies is dealing with sickness - the consequences of illness in the social world (Mitchell & Cormack, 1998). However, it also needs to be recognised that too great a focus on the personal responsibility of the individual can obscure the structural differences in society that affect health. Relatively disadvantaged individuals appear to have little choice about their lifestyles which may be contributing to poor health. Caution is advised when assuming that all individuals have equal access to the resources necessary for them them to be able to implement the desired changes (Mitchell & Cormack, 1998).
The Food and Mood programme aimed to address two such potential inequalities by providing a lending/reference library (with photocopying facility) and by including food/drink tasting as part of each session. Both aspects were well used and popular, the food tasting not only providing new ideas for drinks and snacks but also removing the financial risk of purchasing unknown food to try and possibly not enjoy.
Encouraging self motivation
Practical advice and access to information are necessary to help individuals regain a sense of control and mastery over their illness (Mitchell & Cormack 1998) and providing this was an important component of the Food and Mood Project. Clear information and an educational component have also been associated with increased adherence to treatment protocols (Stewart et al, 1999). In addition, the combination of advice with an active role for the recipients of that advice is recommended to support individuals’ self motivation (Miller & Rollnick, 1991). Therefore, each session included time for group discussion arising from the information presented and also from exercises aimed at raising awareness of the emotional and social determinants of food choices (Ledwards et al, 1992). A participatory learning approach was adopted which recognises that involving adults to share their experience enhances the effectiveness of learning (Pretty et al, 1995). It was also considered important to establish a secure therapeutic frame (Gray, 1994), which included requirements for confidentiality and valuing each other’s contributions, to optimise the therapeutic benefit of these discussions.
A further element, found to be important in effective brief counselling and also incorporated into the Food and Mood programme design, was that of offering a ‘menu’ of alternative strategies for change. The advantage of providing a range of options allows individuals to select strategies that match their particular needs and situations. Through empowering individuals by offering choice their sense of control is enhanced and it is more likely they will persist, and then succeed, in a course of action (Miller & Rollnick, 1991; Orbach, 1993; Sharma, 1994).
The philosophy of naturopathy includes a triad of interdependent factors which are seen as influencing health. This triad comprises structural [or biomechanical], biochemical and emotional [or psychosocial] influences (Newman-Turner, 1990) which are interconnected so that a change in one aspect will also influence the other aspects (Chaitow, 1998). According to naturopathic philosophy these three major categories of influence upon health are interacting with an individual’s unique inherited and acquired homeostatic functioning (Chaitow, 1998). Homeostasis describes the body’s self-regulating mechanisms (Newman-Turner, 1990) and normal functioning of homeostasis can be potentiated by appropriate interventions (Seyle, 1976). Naturopathy works primarily in a ‘catalytic’ fashion, aiming to promote the body’s ability to restore its own equilibrium. This contrasts with the orthodox approach which tends to be ‘confronting’ and usually involves strategies such as the removal of degenerative tissue or the destruction of bacteria (Heron, 1987).
The first session of the Food and Mood programme explained two practical models deriving from the naturopathic model of health which underpinned the self-help programme: The General Adaptation Syndrome which illustrates how humans adapt to stress and the Total Load Theory which describes the ‘total load’ of stressors in the environment impacting on an individual. Health is seen as the ability to adapt and disease as the sign that an individual’s adaptive capability is being exceeded (Seyle, 1976; Randolph, 1978). The menu of options presented to participants during subsequent Food and Mood sessions therefore emphasised some of the options recommended (Anthony et al, 1997; BAENM 1994; BSAENM, 1995; Colbin, 1986; Holford, 1995; Holford, 1997; Mackarness, 1976; Murray & Pizzorno,1990; Pfeiffer & Holford, 1996; Werbach, 1987) for reducing the body’s exposure to stressors within this Total Load, with the stages of the General Adaptation Syndrome used as an indicator of recovery (Randolph, 1978).
In addition, one session of the Food and Mood programme was spent introducing a model of health which offers a perspective on food cravings, considering them as signals of an imbalance of bodily systems (Colbin, 1986). The aim of this session was simply to introduce the idea of the range of possible explanations for food cravings (e.g. cravings which result from an imbalance in the quantity of ‘expansive’ or ‘contractive’ foods described in Macrobiotics or an excess/deficiency of one of the ’five phases’ described in Traditional Chinese Medicine and applied to foods) all of which share the theme of imbalance in the body. Those participants interested in researching this further were then supported in doing so.
To support individuals in finding the diet that is right for them was a key objective of the Food and Mood programme also made explicit in the first introductory session. The rationale for this approach was explained by reference to the concept of ‘biochemical individuality’, an idea which recognises that individuals’ needs vary, depending on genetic, physiological, lifestyle and other influences. (Holford, 1997).
The information and advice presented in each session had a different focus based on the ‘four pillars of mental health’ approach (Pfeiffer & Holford, 1996) (Holford, 1995) of eliminating allergies, maintaining blood glucose balance, avoiding pollution and achieving optimum nutrition. Other healthy eating recommendations including those for achieving optimum function of the gut, also considered important for mental health, were incorporated into the sessions as appropriate (Anthony et al, 1997; BSAENM 1994; BSAENM, 1995; Braly, 1992; Brostoff, 1989; Colbin, 1986; DesMaisons, 1998; Erasmus, 1993; Holford, 1995; Holford, 1997; Joneja, 1998; Mackarness, 1976; Murray & Pizzorno,1990; Pfeiffer & Holford, 1996; Schmidt, 1997; Werbach, 1987).
To reduce the consumption of caffeine
Caffeine is present in coffee, tea, chocolate and cola drinks and is an addictive central nervous system stimulant widely consumed for its positive effect on mood, well-being and performance. Its pharmacological effect is due to its ability to compete for absorption with adenosine, an inhibitory neurotransmitter, and override this natural sedative. The negative effects on mood of excess caffeine include restlessness, nervousness, anxiety, irritability and poor concentration. Excess caffeine can also encourage glucose intolerance through its stimulatory effect on the adrenals. Withdrawal symptoms are a consequence of the detoxification process and can be unpleasant but are usually complete following five day’s total abstinence. It was suggested that a gradual withdrawal may be preferable for some people. (Anthony et al, 1997; BSAENM, 1995; Colbin, 1986; Holford, 1995; Holford, 1997; Murray & Pizzorno,1990; Pfeiffer & Holford, 1996; Werbach, 1987)
To reduce the consumption of refined sugars and increase consumption of foods with a low glycaemic index
Sugar is highly addictive and potentially allergenic. The brain is the organ most sensitive to a change in blood glucose level - too little produces fatigue, confusion, irritability and aggression while too much may result in loss of consciousness. Glucose intolerance, gut dysbiosis and mineral and vitamin deficiencies, all of which impact on mental functioning, are also risks associated with a diet containing too much refined sugar. The main recommendation was to replace foods containing concentrated sugars with those of a low glycaemic index (a measure of the degree to which blood sugar is raised relative to consumption of pure glucose) which release their energy slowly and do not cause such rapid increases in insulin release from the pancreas. Other suggested dietary strategies for improving blood glucose metabolism were to include protein and fibre for their ability to reduce the glyceamic index of a meal and to consume regular meals to avoid becoming hypoglyceamic (Anthony et al, 1997; BSAENM 1994; BSAENM, 1995; Colbin, 1986; DesMaisons, 1998; Holford, 1995; Holford, 1997; Leeds et al, 1996; Murray & Pizzorno,1990; Pfeiffer & Holford, 1996; Werbach, 1987)
To reduce the consumption of common allergens
The term ‘allergy’ usually describes a response of the immune system involving antibodies to a component of food, usually a protein, that the immune system recognises as foreign to the body whereas food intolerance can be defined as an adverse reaction to food that results in clinical symptoms but which is not caused by a reaction of the immune system. Reactions involve a series of specific events and can result in clinical symptoms which include depression, anxiety, aggressive behaviour, hyperactivity and schizophrenia. Identification of problem foods is best achieved through a dietary process known as ‘elimination and challenge’ whereby suspect foods are avoided for a period of 7-21 days and reintroduced, one at a time, to determine the individual’s level of sensitivity. Once problem foods have been identified the maintenance diet may exclude the foods completely or take the form of a ‘rotation diet’ where foods are eaten only once in a period of, usually, five days.
Those interested in investigating the possibility of hypersensitivity reactions to foods without the guidance of a health care professional were cautioned that any foods suspected of having produced a severe reaction in the past should not be reintroduced without medical supervision. The most common problems foods which have been found to be linked with symptoms of mental illness are wheat, milk and milk products, yeast, eggs and citrus fruit. The general recommendation was simply to reduce the consumption of suspect foods by rotating a variety of suggested nutritious alternatives. (Anthony et al, 1997; BSAENM 1994; BSAENM, 1995; Braly, 1992; Brostoff, 1989; Colbin, 1986; Holford, 1995; Holford, 1997; Joneja, 1998; Mackarness, 1976; Murray & Pizzorno,1990; Pfeiffer & Holford, 1996; Werbach, 1987).
To support the body with nutritional supplements (paying attention to safe levels of supplementation, bioavailability, contraindications and cost)
Nutritional supplements are expensive for many people and a multi mineral and vitamin supplement may be all that can be afforded, although if it is of a high quality it may be sufficient to redress nutritional imbalances, correct faulty biochemistry and support detoxification processes. Other supplements recommended as being beneficial for symptoms of mental illness include an omega 3 essential fatty acid supplement. The main dietary sources are oil rich fish and linseed/flax oil and both are available in supplement form. Other beneficial nutrients include the B group vitamins, and the minerals magnesium and zinc. (A simple zinc taste test taken by Food and Mood participants showed that over 90% were low in zinc). The herbal supplements St John’s Wort and Kava Kava are also recommended for symptoms of depression and anxiety respectively (Anthony et al, 1997; BSAENM 1994; BSAENM, 1995; Erasmus, 1993; Holford, 1995; Holford, 1997; Murray & Pizzorno,1990; Pfeiffer & Holford, 1996; Schmidt, 1997; Werbach, 1987).
In summary, the project evaluation showed that most women reported that their health had improved as a result of making changes to their diet or taking nutritional supplements during the programme. Attendance on the programme was high (an average of almost 70% over the life of the project), with the demand for places exceeding the number of places available. A Food and Mood Project Workbook will be available in the spring of 2000 containing self-help information together with contributions from some of the 50 women who took part.
Anthony, H, Birtwistle, S, Eaton, K, Maberly, J (1997) Environmental Medicine in Clinical Practice BSAENM Publications, Southampton, UK.
BSAENM (1994) Effective Allergy Practice British Society for Allergy, Environmental & Nutritional Medicine, Southampton, UK.
BSAENM (1995) Effective Nutritional Medicine British Society for Allergy, Environmental & Nutritional Medicine, Southampton, UK.
Bradley, D (1998) Hyperventilation Syndrome Kyle Cathie Limited, London.
Braly, J (1992) Dr Braly’s Food Allergy & Nutrition Revolution Keats Publishing Inc, USA.
Brostoff, J & Gamlin, L (1989) The Complete Guide to Food Allergy and Intolerance Bloomsbury, London.
Colbin, A (1986) Food & Healing Ballantine Books, New York.
Chaitow, L (1998) Course handout from Natural Therapeutics I module, MSc in Complementary Therapy Studies, University of Westminster, London.
DesMaisons, K (1998) Potatoes Not Prozac Simon & Schuster UK Ltd, London.
Erasmus, U (1993) Fats that Heal, Fats That Kill Alive Books, Canada.
Fulder, S (1996) The Handbook of Alternative and Complementary Medicine. Oxford.
Gray, A (1994) An introduction to the therapeutic frame Routledge, London.
HEA Health Education Authority (1994) (Revised 1997) Helping People Change HEA.
Heron, J (1987) A Paradigm of Well-being in Holistic Medicine 2(2) 101-108.
Holford, P (1995) Mental Illness - not all in the mind ION Press, London.
Holford, P (1997) The Optimum Nutrition Bible Piatkus, London.
Joneja, J (1998) Second Edition Food Allergies & Intolerances J A Hall Publications Ltd, Canada.
Ledwards, C (1992) Women, Food & Health South Manchester Nutrition and Dietetic Service, UK.
Leeds, A, Brand Miller, J, Foster-Powell, K, Colagiuri, S (1996) The GI Factor Hodder & Stoughton, London.
Maberly, J & Anthony, H (1989) Allergy The Crowood Press, Wiltshire, UK.
Mackarness, R (1976) Not All In The Mind Pan Books Ltd, London.
Meyrick, J & Sinkler, P (1999) An Evaluation Resource for Health Living Centres Health Education Authority, London.
Miller, S & Rollnick, S (1991) Motivational Interviewing - preparing people to change addictive behaviour The Guilford Press, London.
Mitchell, A & Cormack, M (1998) The Therapeutic Relationship in Complementary Health Care Churchill Livingstone, London.
Murray, M T & Pizzorno, J E (1990) Encyclopaedia of Natural Medicine Little, Brown & Company (UK), London.
Newman-Turner, R (1990) Naturopathy - The Identity Crisis British Naturopathic Journal 13 (1), 3-8.
Orbach, S (1993) Second Edition Hunger Strike Penguin Books, London.
Pfeiffer, C & Holford, P (1996) Mental Health & Illness - the nutrition connection ION Press, London.
Pietroni, P (1996) Holistic Medicine - New Map, Old Territory in Innovation in Community Care and Primary Health Churchill Livingstone, London, 4-14.
Pretty, J, Guijt, I, Scoones, I & Thompson, J (1995) A Trainer’s Guide for Participatory Learning and Action IIED, London.
Randalph, T (1978) Specific Adaptation in Annals of Allergy Volume 40, May, 333-345.
Reidel, D (1981) Structural Constraints in the Doctor-Patient Relationship: The Case of Non-Compliance in Eisenberg, L & Kleinnan, A (eds) The Relevance of Social Science for Medicine Publishing Co.
Schmidt, M (1997) Smart Fats Frog Ltd, USA.
Seyle, H (1976) The Stress of Life (Revised Edition) McGraw-Hill.
Sharma, U (1994) The equation of responsibility Complementary practitioners and their patients in Budd, S & Sharma, U (eds) The healing bond: the patient-practitioner relationship and therapeutic responsibility Routledge, London.
SPNT Society for Promotion of Nutritional Therapy (1996) ‘Some differences between nutritional therapy and dietetics’ Alternative Factsheet.
Stewart, M, Belle Brown, J, Boon, H, Galajda, J, Meredith, L, Sangster, M (1999) Cancer Prevention & Control 3 (1), 25-30.
Werbach, M (1987) Nutritional Influences on Illness Keats Publishing Inc, USA.
A similar version of this report appeared in Positive Health Issue 56, September 2000: 30-33
© Amanda Geary, 2000