Nutritional Therapy to Support Emotional Health

LRM: Thanks so much for being here, Sara.

SR: Thanks for opening up this conversation and cross-pollination about nutritional therapy and emotional therapy. 

LRM: Collaboration between a psychotherapist and a nutritional therapist wouldn’t be the first thing that people would think of, but I actually think it’s really important. We can’t just go to one hour of therapy a week and expect it to change our life. There has to be a more holistic approach to creating positive change in your life and improving your mental health. I really believe nutrition can be a cornerstone of that positive change and I’m glad you’re here to talk about it because I’m not qualified to give nutritional advice to my clients, as it’s out of my scope of expertise and practice. It’s so wonderful to have a mental health informed and aware nutritionist to talk to. I would love to hear whatever introduction you have for when you work with people around mental health and how the nutritional therapy supports that.

SR: I feel exactly the same way about emotional therapy in the sense that nutritional and emotional work are so interconnected and feed off each other in incredible ways. There’s an incredible synergy between the two where good emotional health and good nutritional status reinforce and enrich each other in a positive snowball effect. I love for people who come to me for nutritional therapy, especially if they are struggling with emotional issues or longer term issues, to be working with someone who is supporting their emotional health. I do not see good nutrition as a substitute for emotional therapy. I personally am of the conviction that almost everybody should have a therapist. You have a dentist, you have a mechanic, and you should have a therapist. Don’t wait to break down, just like you don’t want to wait to see your dentist until your teeth break down. You definitely don’t want your emotional health to break down before you find a good therapist. I love to work with people who have emotional health needs who are being supported by a good therapist, and I also refer people often to therapy. That’s the first thing I wanted to say: they really enrich each other mutually. I also want to say that eating is something most of us are doing every day, most of us three times a day, and it’s an incredible opportunity to nourish our bodies, not just with nutrients, but with positive emotion around eating. If you are eating in a shared context - and some people right now are in the struggle of eating along, and not having that shared context - whether or not you are alone, you are in relationship, either with yourself or with others.

LRM: Food is often very social. I frequently see people who have anxiety around food, and it is almost always paired with a social anxiety around food because food is so often enjoyed in community.

SR: Absolutely. Additionally, eating and nourishing your body can help you be more vibrant around people. Food, symbolically, takes us back, primally, to the first relationship that we had, often to our mom or whoever fed us. The first act of love we receive as human beings is being fed.

LRM: And there’s so much attachment there. It’s not just about nourishing the body. When you think about what emotional needs are met when a little baby is being held and nourished, it’s also the social aspect: “when I cry, my need is met, I’m responded to, I’m cared for, I’m safe.” That’s a very deep, primal experience.

SR: And when we eat socially, it’s really nice for there to be an implicit, shared message that “you matter, and I care.” I think that’s important in all relationships, and I think this is a diadic relationship that we have with ourselves. We shouldn’t just be looking to outside people. Our first relationship with eating and nurturing is the care that we receive from our mothers when we’re vulnerable and needy, and as grow we become more independent and autonomous and more able to give ourselves that.

LRM: We have to feed ourselves!

SR: Nourishing and nurturance are etymologically and symbolically, on all levels, inextricable from each other.

LRM: They really are! The more you talk about it the more it makes sense. No wonder there’s emotional eating, no wonder there’s anxiety around food, no wonder people have such strong memories and emotions tied to specific foods. It’s wired into us from day one. 

SR: Yeah.

LRM: So when someone comes to you and they’re struggling with a mental health issue, what are some of the pitfalls and common things you see that are needing some alteration or guidance from you?

SR: The biggest things that I see on a macro level are: Is the person eating enough? Is the person in a way that is conducive to good digestion and absorption? So important! You could be eating the best foods, but if you’re eating on the run, eating in your car while you’re in traffic, talking on your phone and trying to multitask, you’re not going to digest and absorb the food because your nervous system is in a state of alarm. Fight or flight, you can’t digest and assimilate as well.

LRM: Or enjoy!

SR: Yeah. And the other piece is, Is your body digesting and assimilating? Even if you are eating a good variety of nourishing foods, sitting down for your meals, taking a deep breath, relaxing. If you have some kind of physical health issue like Crohn’s disease that is unmanaged, that’s preventing you, in spite of all your best efforts, from absorbing your nutrients.

LRM: Yeah, and other autoimmune issues. We have an epidemic of autoimmune issues that do affect your experience with food, whether it’s a rise in allergies or other digestive issues, they’re becoming more prevalent, and it really does alter your relationship with food.

SR: It really does, and there can be an increased need for nutrients [when autoimmune issues are present] depending on what kind of chemical imbalance. I sometimes see people who have an increased need for vitamin B6 and magnesium, and it can make a world of difference in people’s anxiety, or people who need more zinc to balance their omega 3 and omega 6 fatty acids. Sometimes just that tweaking can make a huge, huge difference to a person’s entire mental functioning. 

LRM: You mentioned something about people not eating enough, and I’m so curious about that, because as an American, there’s this caricature of Americans being overfed, eating all this fast food, very rich foods, not nutrient dense, but certainly calorically dense. It’s fascinating to me that one of the first things you said is that some people are not eating enough, and I’d love to hear you speak about that. 

SR: Yeah, well, there are different types of not eating enough. One of them could be feeding myself with lots and lots of calories but very little variety, and very little nutrient density, so there is this phenomenon of being stuffed to the brim with food but really lacking in nutrients. That is one form of it, and the other form can be a spinoff of fear of being in that place: “What if I get fat?” So you overcorrect by not eating often enough, not eating enough food, not eating enough  of a variety of foods and nutrients. 

LRM: Which absolutely will affect your mental health. If you’re on a calorically restricted diet, you are not going to feel good. Your body is having to use its reserves. You will feel fatigued, you will feel sluggish, as toxins are released you will feel bad. 

SR: Oh yeah. And unfortunately there’s a vicious cycle where if you’re restricting your calories and nutrients, your body will go into starvation mode and your thyroid gland will lower your basal metabolism and you will actually likely gain more weight on less calories instead of achieving the objective of being fit and healthy metabolically.

LRM: Which can be very frustrating. 

SR: Yeah. You definitely don’t want to put your body in an alarm state connected with fear of starvation that can genetically reprogram the system to do things that you don’t necessarily want metabolically. 

LRM: I feel like we’re veering toward talking about weight loss which is a totally different topic that I’m certainly not qualified to speak on, though I’m sure that you are. I’m more interested in the mental health aspect here. The other direction we were going is more toward that survival state, that’ panic state, and I think that a lot of people are in it right now. Here in America we are, many of us, two months into shelter-in-place. I know in Italy you’ve been sheltered in place for longer and when we are in that survival state, protecting ourselves and our loved ones, getting our basic needs met is how the majority of our energy is spent. I have seen a lot with my loved ones and my clients experiencing anxiety around food is really spiking. I’m wondering if you can speak to that a little bit. What happens when we go into that panic state, and what happens when we get very anxious about food? How does that affect the body and how does that affect our choices around food and nutrients?

SR: Such a great question and a big question.

LRM: I think that was five questions!

SR: I definitely think that people are going in different directions right now, depending on our context, where we live and what kind of setting we’re in, and what kinds of networks are around us. Our context and our possibilities may be very different. For example, someone living in the county - a lot of people here in the Tuscan countryside have started hunkering down at home and gardening and planting trees. All these berries, all this stuff. A lot of people are burgeoning with their food production. 

LRM: There’s kind of an abundance mindset: “now I have the time, I’m going to nurture the land, and in doing so, myself. 

SR: Yes. So some people are able to have this adaptive response. For example, in my family, we were on the one hand a little bit compressed, because school has disappeared and we have less structure, but we already had chickens and ducks, and we currently have duckling that are going to be hatching in a few weeks. We have some baby chicks… everything is growing! We built a kiwi pergola and planted a whole bunch of stuff. Even other people around us have been very dedicated to growing things and producing more of their own food, not necessarily from a place of anxiety, but from a place of ease.

LRM: And abundance.

SR: I have more time to go pick wild herbs and cherries. Your rhythms can be different. If you live in an urban environment, I realize there is not the same potential to do this. If you live in a food desert, you might feel very anxious; “What will my next trip to the grocery store look like?”

LRM: And will they have this thing I so badly want to nurture myself? Will they have my favorite food? Will they have the staples we need to be able to cook? Tons of anxiety there. The scarcity anxiety is very real right now.

SR: Absolutely. Even access to fresh foods. Balancing your need for fresh foods with foods that have a longer shelf life. What if I get sick? What if someone in my household gets sick? What if I can’t go to the store for a long time?

LRM: And anxiety around going to the store in general, even if you’re not in a food desert and you yourself are health. Going to the grocery store can feel like one of the most dystopian experiences that we have on a semi-regular basis right now. There is such hypervigilance in people that are shopping, trying to get in, get what they need, and get out with as little contact as possible. It’s what we should be doing, but the hypervigilance that comes with it is very taxing on the body.

SR: Absolutely, yes. I think a lot of people are bringing out the best in themselves in this situation. People are feeling anxious, and there’s a lot of consciousness and respect for other people. People are aware; they think about what they’re going to get, don’t touch anything, keep it short. I want people to acknowledge the work they’re doing to respect themselves and their families and others because it’s huge. I have a niece who works at a Wal Mart and it really makes a difference, the level of respect, and even gratitude that people have, even towards shoppers and people who are essential workers in grocery stores. It makes a huge difference. Smile, thank, and be respectful.

LRM: Tapping into that gratitude can ease the anxiety. We’re having a definitely varied but collective experience here, and the things I’m shopping for may not be the things you’re shopping for, and you may be shopping for someone who’s immunocompromised, and I may be shopping for an elderly neighbor, but we are all just trying to get our shopping done, so let’s be as conscientious as possible.

SR: Yeah, absolutely.

LRM: One of the things that I specialize in is working with food anxiety; people who most often have a genuine reason to be anxious around food, whether it’s a gut condition, an autoimmune issue, or a genuine anaphylactic allergy to a food, or a a traumatic incident like choking on some food or other food-related trauma where they genuinely don’t feel safe around it. I’ve been working with that set of issues for a while, and I’m seeing it really shift during COVID. Either they have less anxiety because there’s no pressure to eat in restaurants, they have total control over their food now and there can be more intentionality around the way they nourish their body because they’re not eating in the car the way they used to. They’re not cobbling together some calories to keep themselves going. And then on the other hand I’m seeing people that are highly anxious, that are not sure if it’s safe to order takeout or have someone else prepare their food, or around not knowing the source of the food. I’m wondering what you would say to someone struggling with that anxiety that is heightened by COVID.

SR: Well first, if you’re feeling any kind of anxiety around this time, definitely reach out to a therapist who is specialized in anxiety, and ideally experienced with food anxiety such as yourself. That’s the first thing, giving yourself that space. 

LRM: And compassion. 

SR: Yes. The space, the time, the compassion, and the resources to deal with the issue as it is, without judgment. It’s easy to tell yourself, “Oh, snap out of it.” For a lot of us, that’s what we’ve heard, even people with genuine issues. I have a few genuine anaphylactic reactions that have decreased over time doing specific types of work. I have been able to retrain my immune system, which is very exciting and empowering. And there are some things you can’t shift, you know; a peanut and wheat allergy. They’re just there.

LRM: But you can learn to work with them. Not necessarily to eliminate them, but to work with them in a way where you don’t have crippling anxiety, like, “what if this cookie has a tiny bit of a nut in it?” You can instead get to a place of “ya know, I think I’m gonna pass on the cookie” or, “I’m gonna take that risk.” But you can learn to not have it control your relationship with food. 

SR: Yes, and I feel really fortunate because even though I have had these allergic struggles in the course of my life, I’ve never had heightened anxiety associated with those reactions, so I feel like that has helped me keep things low grade. My anxiety has come more from other people’s reactions saying, “Oh, you’re not really allergic to that food.”

LRM: Ugh, being dismissed. 

SR: Yeah. Random relatives, etc. So that is a really interesting dynamic. Sometimes the problem is the relationships around a healthy relationship you have with food and your knowledge of your body and how it interacts with you. Different people have different scenarios. I also work with people who have a lot of fear, justifiably so, around reactions they have. Sometimes it’s hard to pinpoint what’s causing what in yourself or in a child, especially when you have a small child who isn’t able to articulate because of their developmental stage or verbal development, or a disability. You have to tried to figure it out based on what they ate and what you see.

LRM: That’s very hard. I see a lot of people struggle to identify what’s causing their symptoms because the symptoms may not arise until the food gets to a certain point in their digestive tract, and they’re left wondering what they ate 14 hours ago, and that can be really hard. You have to be meticulous in your tracking. It can be confusing, it can be anxiety-provoking, and it can be discouraging, but you don’t have to go through it alone. There are highly trained, really qualified nutritionists that will work through that with you, and Sara is one of them.

SR: And I really think that helping people with the right tools at the right time is incredibly empowering. If you track at the wrong time or in the wrong way it can increase anxiety, but with the right structure and timing and support, it can be incredibly empowering and it can reduce anxiety. It’s not just “oh, here’s a tool.” There’s a context and person and a timing and all those things have to go together for the tool to be helpful. 

LRM: And support and resources. You’re not just trying to figure it out on your own.

SR: Even supporting people and seeing how reassuring it can be for them, to have feedback from another person, to have structure that is individualized for them with feedback and advice; you’re not going to find exactly what you need.

LRM: Not in a vacuum. And this really goes back to where started. Any journey toward health, whether it’s physical or emotional, it needs to be holistic. I cannot just be trying one thing. I see so many people that decide they want to take an antidepressant, so they do, and then it doesn’t work; well, okay, did they also do therapy, did they also look at their diet, did they look at other things that can be part of a comprehensive plan? Mindfulness, meditation, exercise -- that’s a huge one I see people not putting effort into -- can have a profound effect on mental health as well as, I imagine, digestion and absorption. If you move your body and your systems are running on a better timeline, you have more energy, you’re able to absorb nutrients better.

SR: Absolutely, yeah. A lot of the time people need an interdisciplinary approach. Physical therapy, emotional therapy, nutritional therapy, occupational therapy, educational therapy, whatever it might be. Sometimes people need at least two, sometimes three or four.

LRM: The more resources, the more efforts that go into uplifting you and resourcing you, the more successful you will be.

SR: Don’t oversaturate!

LRM: No! Don’t do it all at once, because then you won’t know what had the biggest impact. Do things gradually not expecting one thing to be the magic bullet; there is no magic bullet. There is a set of therapies and support systems out there, and figuring out what cocktail of support systems works best for you, well, that’s the work. There are plenty of people that want to support you in that. 

SR: Absolutely. And to go back to a detail that you mentioned earlier: medication. People are all over the map. Some people just want a pill, there are other people on the opposite end of the spectrum. You know what? Sometimes I have worked with people and part of the work is really helping them overcome a bias against medication. And I can’t tell you how many people have thanked me, have written me after I worked with them. Sometimes it saves lives.

LRM: Absolutely. I’ve seen some medications have no effect because they weren’t being supported with other complementary therapies. I’ve also seen medications have a profound effect when other therapies were not doing enough on their own. It can really run the gamut. I too do a lot of work around deconstructing the stigmas around medication. It’s not the only way, but it’s not something we want to rule out.

SR: I completely agree. If you’re doing all the things and you’re not getting to where you should be, you’re putting in all this effort, sometimes there really is a medication that can help you bridge that gap and get things connected, and thank goodness it’s there.

LRM: I’ve seen medication be just enough of a boost so that you can do the rest of the work. If you are profoundly depressed, or you are so anxious that you’re paralyzed, you’re not going to be able to pursue all the complementary therapies that you deserve to be able to access because all your energy is going into being depressed or into your physiological response to anxiety. I’ve seen it be just enough of a boost that you can go on to do the rest of the work; it’s not a substitute, but it is a game-changer sometimes.

SR: It really can be. We live in an interesting era where a lot of people are pronouncing opinions without necessarily knowing what they’re talking about. Don’t form your opinion about  what type of support you should or shouldn’t receive based on influencers. They’re not really the best experts to be relied on.

LRM: Or advertisements. In America we have this weird thing where medications are advertised to the public rather than to doctors who have the training to make a judgment call about what would be a good fit for a client.

SR: Yeah.

LRM: We could keep talking for hours about mental health and nutrition and what holistic care really is, but I know that you are just starting your day and I’m ending mine here. Thank you so much for taking the time to chat with me. If people want to reach out to you to work with you, how can they get in touch with you?

SR: I can be found on my website. I offer a complementary 30 minute discovery call so that people can feel comfortable with whether I’m a good match for them. If I’m not, I’ll refer them to someone who is. 

LRM: Is there a particular population you love working with or do you love variety?

SR: I love variety! That being said, the two specialties I have in my practice are people with complicated health journeys; I love stories and I love listening, and I know not a lot of practitioners really like the deep individualized listening work of putting pieces together, and that’s what I’m very good at. The other area I’ve worked with extensively and really love is the reproductive years; preconception, fertility, and postpartum health. They can be such a time of increased anxiety around food and nourishing. There’s so much pressure, right?

LRM: Yes! Well let’s have another chat about that another time. And as I said, I’m a therapist and I specialize in working with anxiety and trauma, including food anxiety and food trauma. I have a few openings right now. I really love working with motivated young professionals. I’m also trained in EMDR, which is a trauma treatment that’s been proven to be really effective. I also offer a free twenty minute consultation to make sure we’re a good fit because your relationship with your therapist is too important to have a just-okay fit. You deserve a really good fit. Thank you so much for being here Sara!