FOOD FOR THOUGHT: HOW NUTRITION CAN IMPROVE MENTAL HEALTH

Story by EHN Guest Writer MedComms Solutions Inc.

Many people struggle with their mental health. In fact, anxiety and depression are some of the most common and debilitating illnesses.^1,2 While you’re probably aware that medication and therapy can be effective, there’s another promising approach that you may have overlooked for mental health: your diet.

WHAT’S THE CONNECTION BETWEEN DIET AND MENTAL HEALTH?

How you think and feel depends a lot on what you eat. Just like a car needs a certain type of fuel to operate, the brain needs nutrition in order to work properly.³ With rising depression rates over the past few decades, diets have been worsening.⁴ Is that a coincidence? Science says no.

There are a few main ways in which subpar nutrition can contribute to poor mental health. First, countless studies have shown that certain vitamins, minerals, and amino acids (building blocks for proteins) are depleted in people with a mental illness.⁵ This makes sense because the brain needs these nutrients to produce mood-regulating chemicals, like serotonin.⁶ So, if you don’t provide enough material to build these substances through your diet, your brain won’t be able to stabilize your mood as effectively.

Besides nutrient deficiencies, mood disorders are also associated with oxidative stress and inflammation.⁷ As the brain uses oxygen, it generates waste products. Oxidative stress occurs when these waste products have built up and caused damage to nerve cells.⁸ An adequately nutritious diet allows the body to mop up these waste products and get rid of them, as needed. However, people with clinical depression have higher oxidative stress levels, as they’re less able to eliminate harmful waste material from the body.⁹ Inflammation is also a natural bodily process that is usually kept in check – this time by the immune system. But, when a person’s diet doesn’t contain enough immune-regulating foods, inflammation can persist for long periods of time in the brain, leading to depression.¹⁰

There is also growing evidence that tiny organisms living in the gut can contribute towards anxiety and depression.^11,12 Depressed individuals have been found to have distinct types and amounts of gut bacteria compared to healthy individuals.¹³ Interestingly, these differences have been linked to oxidative stress and inflammation levels in the brain.^14,15 

All this to say that nutrition not only has a major influence on your gut composition, but also directly impacts oxidative stress and inflammation.^16,17 Combined with the fact that a good diet can make anti-depressants and other therapies more effective, diet is an important, and yet often overlooked, consideration for both the prevention and treatment of mental health disorders.¹⁸

IS THERE SUCH THING AS A “BRAIN HEALTHY DIET”?

We’ve just learned that good nutrition can boost your mental well-being by:

• Providing sufficient nutrients to regulate mood¹⁹
• Reducing oxidative stress and inflammation^20,21
• Balancing your gut bacteria levels²²
• Boosting your medication’s effects²³

But what exactly is a “brain healthy diet”? Does it even exist? 

Research suggests that traditional Mediterranean, Japanese, and Norwegian diets can boost happiness and lower anxiety.^24-26 The Mediterranean diet has also been found to bolster the effects of anti-depressant drugs.²⁷ One thing’s for sure, all these diets contain plenty of nutrient-dense foods, like fruits and vegetables, fish, dairy or soy, and whole-grain.^28,29

In contrast, consuming too much fat, sugar, and starch means you are more likely to suffer from depression.^30-32 Scientists believe that this type of eating behaviour – often linked to food addiction – is an unhealthy stress coping strategy that promotes obesity and mood dysfunction in the long run.³³

WHICH NUTRIENTS ARE GOOD FOR MENTAL HEALTH?

You may be wondering whether some nutrients are more beneficial than others when it comes to mental health. Yes, this is certainly the case. Most research into the relationship between diet and mental health has focused on the following nutrients:

• Omega-3s
• B vitamins (B12, B9)
• Minerals (zinc, iron, magnesium, selenium)
• Vitamin D
• Antioxidants
• Amino acids (tryptophan, NAC)
• Probiotics and prebiotics

The strongest evidence by far exists for omega-3 fatty acids. These mood-regulating compounds are found almost exclusively in fish and seafood (vegans can look to seaweed, walnuts, and flaxseed).^34,35 Scientists have observed that people with depression have lower omega-3 levels.^36-38 What’s more, omega-3 supplements, taken alone or with anti-depressants, significantly improve symptoms in patients with clinical depression.^39,40 However, omega-3 is unlikely to help if you’re pregnant, or have heart, metabolic, and neurological conditions.⁴¹

Like omega-3, vitamins B12 (cobalamin) and B9 (folic acid or folate) are involved in mood regulation.⁴² Deficiency of these B vitamins leads to depression, fatigue, and poor memory.⁴³ While vitamin B9 supplements has boosted the effects of anti-depressants in several clinical trials, these results were mostly seen at high doses and in people who weren’t previously responding well to their medication.^44-45

Similarly, zinc, iron, magnesium, and selenium are all required for optimal brain function.^46-47 Therefore, insufficient intake of any of all of these minerals is associated with more severe depression and anxiety.^48,49

Low vitamin D levels can also cause depressive symptoms.^50,51 Although present in some foods, we make most of our vitamin D internally, after being exposed to sunlight.⁵² At the moment, there’s not much high-quality data to support whether vitamin D supplements can be used to treat depression.^53-55 

Antioxidants are the body’s natural defense against oxidative stress, which, as we know, promotes depression.⁵⁶ Dietary antioxidants, namely vitamins C and E, mostly come from plant foods and cocoa products.^57,58 In terms of supplements, the utility of vitamin C or vitamin E therapy for depression is still up for debate.^59,60

Our bodies can also make antioxidants from the amino acid, NAC (N-acetyl cysteine). Exciting, emerging evidence supports NAC supplements as part of a multi-pronged approach to treat clinical depression.⁶¹ To add to this, another amino acid, tryptophan, is gaining attention because it’s needed to make the “feel-good” brain chemical, serotonin. That being said, tryptophan supplementation isn’t recommended if you’re already getting enough protein from your diet.^62,63

Last, but certainly not least, are pro- and prebiotics. Probiotics are live bacteria that may offer health benefits when consumed – including alleviating depression.^64,65 Prebiotics, derived from fruit and vegetable fibres, are probiotics’ food source, allowing them to thrive and replicate in our gut, wherever they can be useful.⁶⁶ A higher prebiotic intake is also associated with a reduced risk of depression^.67-69 Probiotics and prebiotics can be taken in supplement form, or consumed within naturally fermented, high-fibre foods.

TOP FOODS TO EAT FOR BETTER MENTAL HEALTH

Which foods are abundant in the brain-nourishing nutrients we’ve just discussed? 

A diet that best supports mental health and well-being needs to include a balanced combination of:^70-77

• Fish (e.g. sardines)
• Shellfish (e.g. mussels)
• Seaweed
• Lean red meat (e.g. beef, lamb)
• Fortified nutritional yeast
• Dairy products
• Soy products (e.g. tofu)
• Nuts
• Seeds
• Legumes (e.g. lentils, chickpeas, peas, beans)
• Whole grains (e.g. brown rice, oats)
• Extra virgin olive oil
• Cruciferous vegetables (e.g. broccoli, cabbage, Brussels sprouts)
• Leafy vegetables (e.g. spinach, kale)
• Green vegetables (e.g. asparagus, avocado)
• Citrus fruits
• Berries
• Bananas
• Melons
• Strawberries
• Fermented products (e.g. yogurt, sauerkraut, kefir)
• High-fibre foods (e.g. onion, chicory root, wheat)
• Cocoa products (e.g. dark chocolate)

It’s important to keep in mind that dietary protection against depression and anxiety most likely stems from the cumulative effects of multiple nutrients.⁷⁸ In other words, no one nutrient is going to be a magic, quick fix when it comes to mental health. With this in mind, it’s the whole foods listed above that will always offer more health benefits than supplements ever could.⁷⁹

Then, why not just take multiple nutritional supplements to support mental health? While combining different supplements might seem like a simple workaround, this won’t actually generate the same benefits of an overall healthy diet.⁸⁰ That being said, if you have a specific nutrient deficit, supplementation can certainly be a great (and often necessary) option.⁸¹

NUTRITION IS AN ALLY TO MENTAL HEALTH TREATMENT

While there is certainly a lot of evidence to support nutrition’s key role in mental health, having a healthy diet is not a replacement for other treatment forms (i.e. medication and therapy).⁸² Rather, eating well is an effective strategy to support these traditional treatments and improve your overall health.⁸³ 

That being said, if you’re taking medication to help you manage anxiety or depression, you’ll need to make sure you avoid certain foods and supplements that may interfere with its effectiveness. Here are some of the common ones to steer clear of:^84-88

• Excess chocolate, caffeine, and aged cheese or meats
• Grapefruit juice
• Alcohol
• Tryptophan supplements
• Folic acid supplements
• St. John’s Wort

The goal here is to maintain a well-balanced diet consisting of diverse, whole foods. Nutrition is a great way to support mental health, when considered appropriately alongside therapy and other treatments.⁸⁹ If you’re ever uncertain about how your diet may be helping or hindering your ability to regulate your mood and energy levels, be sure to speak to a medical professional, such as a Registered Dietitian or trained healthcare practitioner, who understands the holistic approach needed and is able to support you in your decision-making.

CALL EHN

Whether you’re an individual who needs help with your mental health or substance use disorder, or you’re an employer who has employees who need help—we’re here for you. Call us 24/7 at one of the numbers below to start a conversation about how we can help you.

• Bellwood (Toronto, ON): 866-281-3012
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• Sandstone (Calgary, AB): 866-295-8981
• Gateway (Peterborough, Ontario): 705-874-2000
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• Outpatient Services (Multiple locations): 866-345-8192

References

1. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
2. Muscaritoli M. The Impact of Nutrients on Mental Health and Well-Being: Insights From the Literature. Frontiers in Nutrition. 2021;8:10.
3. Adan RAH. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. 2021;29:1321-1332.
4. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
5. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
6. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
7. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
8. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
9. Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proceedings of the Nutrition Society. 2017;76:427-436.
10. Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proceedings of the Nutrition Society. 2017;76:427-436.
11. Adan RAH. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. 2021;29:1321-1332.
12. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
13. Taylor AM. A review of dietary and microbial connections to depression, anxiety, and stress. Nutritional Neuroscience. 2020;23(3):237-250.
14. Adan RAH. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. 2021;29:1321-1332.
15. Taylor AM. A review of dietary and microbial connections to depression, anxiety, and stress. Nutritional Neuroscience. 2020;23(3):237-250.
16. Adan RAH. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. 2021;29:1321-1332.
17. Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proceedings of the Nutrition Society. 2017;76:427-436.
18. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
19. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
20. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
21. Leyse-Wallace R. Nutrition and Behavioral Health/Mental Health/ Neurological Health. In: Noland D, Drisko J, Wagner L. Integrative and Functional Medical Nutrition Therapy. Cham Humana Press. 2020.
22. Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proceedings of the Nutrition Society. 2017;76:427-436.
23. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
24. Adan RAH. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. 2021;29:1321-1332.
25. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
26. Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Jacka FN. Dietary recommendations for the prevention of depression. Nutritional Neuroscience. 2017;20(3):161-171.
27. Fond G. Improving diet for psychiatric patients: High potential benefits and evidence for safety. Journal of Affective Disorders. 2020;265:657-569.
28. Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Jacka FN. Dietary recommendations for the prevention of depression. Nutritional Neuroscience. 2017;20(3):161-171.
29. Fond G. Improving diet for psychiatric patients: High potential benefits and evidence for safety. Journal of Affective Disorders. 2020;265:657-569.
30. Adan RAH. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. 2021;29:1321-1332.
31. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
32. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
33. Adan RAH. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. 2021;29:1321-1332.
34. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
35. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
36. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
37. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
38. Harbottle L, Schonfelder N. Nutrition and depression: A review of the evidence. Journal of Mental Health. 2008;17(6):576-587.
39. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
40. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
41. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
42. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
43. Adan RAH. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. 2021;29:1321-1332.
44. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
45. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
46. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
47. Harbottle L, Schonfelder N. Nutrition and depression: A review of the evidence. Journal of Mental Health. 2008;17(6):576-587.
48. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
49. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
50. Adan RAH. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. 2021;29:1321-1332.
51. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
52. Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Jacka FN. Dietary recommendations for the prevention of depression. Nutritional Neuroscience. 2017;20(3):161-171.
53. Adan RAH. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. 2021;29:1321-1332.
54. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
55. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
56. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
57. Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proceedings of the Nutrition Society. 2017;76:427-436.
58. Katz DL, Doughty K, Ali A. Cocoa and Chocolate in Human Health and Disease. Antioxidants and Redox Signaling. 2011;15(10):2779-2811.
59. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
60. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
61. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
62. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
63. Harbottle L, Schonfelder N. Nutrition and depression: A review of the evidence. Journal of Mental Health. 2008;17(6):576-587.
64. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
65. Taylor AM. A review of dietary and microbial connections to depression, anxiety, and stress. Nutritional Neuroscience. 2020;23(3):237-250.
66. Taylor AM. A review of dietary and microbial connections to depression, anxiety, and stress. Nutritional Neuroscience. 2020;23(3):237-250.
67. Adan RAH. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. 2021;29:1321-1332.
68. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
69. Taylor AM. A review of dietary and microbial connections to depression, anxiety, and stress. Nutritional Neuroscience. 2020;23(3):237-250.
70. Bodnar LM, Wisner KL. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biological Psychiatry. 2005;58:679-685.
71. Harbottle L, Schonfelder N. Nutrition and depression: A review of the evidence. Journal of Mental Health. 2008;17(6):576-587.
72. Katz DL, Doughty K, Ali A. Cocoa and Chocolate in Human Health and Disease. Antioxidants and Redox Signaling. 2011;15(10):2779-2811.
73. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
74. Leyse-Wallace R. Nutrition and Behavioral Health/Mental Health/ Neurological Health. In: Noland D, Drisko J, Wagner L. Integrative and Functional Medical Nutrition Therapy. Cham Humana Press. 2020.
75. Mayo Clinic. Folate (folic acid). Accessed June 25, 2021. https://www.mayoclinic.org/drugs-supplements-folate/art-20364625.
76. Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Jacka FN. Dietary recommendations for the prevention of depression. Nutritional Neuroscience. 2017;20(3):161-171.
77. Taylor AM. A review of dietary and microbial connections to depression, anxiety, and stress. Nutritional Neuroscience. 2020;23(3):237-250.
78. Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Jacka FN. Dietary recommendations for the prevention of depression. Nutritional Neuroscience. 2017;20(3):161-171.
79. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
80. Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019;18:308-324.
81. Kris-Etherton PM, Petersen KS, Hibbeln JR, et al. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2020;79(3):247-260.
82. Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Jacka FN. Dietary recommendations for the prevention of depression. Nutritional Neuroscience. 2017;20(3):161-171.
83. Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Jacka FN. Dietary recommendations for the prevention of depression. Nutritional Neuroscience. 2017;20(3):161-171.
84. Muscaritoli M. The Impact of Nutrients on Mental Health and Well-Being: Insights From the Literature. Frontiers in Nutrition. 2021;8:10.
85. Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proceedings of the Nutrition Society. 2017;76:427-436. 
86. Leyse-Wallace R. Nutrition and Behavioral Health/Mental Health/ Neurological Health. In: Noland D, Drisko J, Wagner L. Integrative and Functional Medical Nutrition Therapy. Cham Humana Press. 2020.
87. Mayo Clinic. Folate (folic acid). Accessed June 25, 2021. https://www.mayoclinic.org/drugs-supplements-folate/art-20364625.
88. U.S. Food and Drug Administration. Avoiding Drug Interactions. Accessed June 25, 2021. https://www.fda.gov/consumers/consumer-updates/avoiding-drug-interactions.
89. Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Jacka FN. Dietary recommendations for the prevention of depression. Nutritional Neuroscience. 2017;20(3):161-171.