Mental Health is Health Too

Health is often thought of as the outcome of food and fitness, but mental health is health too. If your behaviors around food and fitness are damaging to your mental health, then it's not actually healthy.

When I was in school to become a dietitian, I had a very narrow view of what health looked like. It became even more narrow after I graduated, started practicing as a dietitian, and discovered the extremely disordered world of healthy living blogs and clean eating.

At the time, I thought of health in terms of food and fitness, both for myself and for the patients at the hospital I worked at. In hindsight, I can see that my anxiety latched on to the suffering and trauma I saw in the hospital, and started to focus on health as a way of controlling those fears. I became intensely focused on food and exercise. Thankfully, my behaviors never rose to the level of an eating disorder or compulsive exercise - I would joke that I was perfectionist in my expectations rather than my follow through. Still, the obsessions over food, exercise and my health created quite a bit of stress in my life.

On the surface, I appeared “healthy,” or at least, according to our extremely superficial cultural conception of health. Because my behaviors around food and exercise were never extreme, most people would think of me as someone who had healthy habits. I exercised the recommended amount. I ate plenty of fruits and vegetables. I watched my portion sizes and cooked most of my meals at home. So I was healthy, right?

Looking back, healthy is not the word I would use to describe myself. I was struggling with pretty debilitating anxiety, felt constantly exhausted despite getting enough sleep, and my stomach was always in anxious knots, sometimes intensifying to the point where I was crippled over in pain. I felt lonely and unfulfilled in most of my relationships. I struggled with low self worth. At this point in my life, not only was I unhealthy, but I would describe myself as a bit of a hot mess.

While I was intensely preoccupied with my physical health, I overlooked the fact that mental health is health too, and may even be more important for physical health than food and fitness. I spent so much headspace obsessing over eating and exercising the “right” way that I didn’t have any mental energy left over for things like therapy, healthy communication and social connection, or engaging in hobbies. Both my physical health and my mental health suffered.

While western culture tends to view the brain and body as two separate entities, most other cultures think of the brain and body as being interconnected. This is borne out in research, especially in the ever evolving field of microbiota and the gut-brain connection. In my experience, most people understand that physical health can impact mental health, that if someone is struggling with physical health conditions it could contribute or lead to depression or anxiety. But that connection works two ways, and depression, anxiety, and trauma can have an impact on physical health.

We see this with psychosomatic conditions (now called psychophysiological, to validate the fact that symptoms are real and not in someone’s head). While these conditions have psychological roots rather than physical causes, the physical symptoms are very much real. Psychophysiological disorders can include chronic migraines, chronic fatigue, fibromyalgia, and IBS (I’ll note that these conditions can all have physical roots, or a combination of physical and psychological roots).

The connection between brain and body doesn’t have to rise to the level of a diagnosis for it to have an impact on one’s physical health. Another example of where mental health can impact physical is through the HPA axis and allostatic load. The HPA axis is the connection from the hypothalamus, pituitary, and adrenal glands, which is how the body regulates and responds to stress. The result is the release of cortisol, a stress hormone that while important in response to acute stress, can add to allostatic load, or the cumulative “wear and tear” on the body. This high allostatic load can have more “minor” affects on physical health, like frequent headaches, fatigue, and stomach issues, but also chronically high levels of cortisol have been linked to more significant chronic diseases like diabetes, cardiovascular disease, and cognitive decline.

*This is an image I often use with clients to help explain the concept of allostatic load.*

There’s even thought that mental health and related areas, like social connection vs loneliness and spirituality can have as much if not more of an impact on longevity as physical health markers. People with serious mental illnesses have reduced life expectancy, and mental illness can speed up the aging process. When you look at the social determinants of health, it’s clear to see that health goes well beyond food and fitness, and that overlooked stressors like experiences of oppression and poverty make up a significant portion of health.

All that said, I think it’s worth noting that even if mental health didn’t impact physical health, it’s still important as it impacts quality of life. And what is the reason for pursuing physical health if not for improving perceived quality of life?

When Food is Stressful…

For most of my clients, food is a significant source of stress in their life, and not only for those who have an active eating disorder. Discourse around food and fitness can make it seem like if you eat the wrong thing, you’ll immediately keel over. Ok, so that’s a bit exaggerated, but the power that food, exercise, and weight are given in how we conceptualize health is completely overblown, leading many to feel intensely preoccupied with what and how much they eat.

Rarely is the mental health impact of all that stress considered. Diet advice is given as if humans were machines with no relationship to food to consider. Do the “right” thing and you’ll be guaranteed health, we are told. The reality is even if there were legitimate “good” and “bad” foods or a “healthiest” diet to follow (there’s not), telling someone to eat that way doesn’t account for the stress that doing so might cause. For example, let’s say I knew for certain that cutting out dairy would make me 5% healthier (not that health is a quantifiable thing, but ya know, examples sake). Cutting out cheese or even just trying to restrict it would cause me quite a bit of stress! There goes half of my favorite meals, one of my favorite get togethers with girlfriends (cheese board and a glass of wine!), and honestly, as we have established I am perfectionist in vision vs. follow-through, would probably lead to pretty chaotic restrict-binge behaviors with cheese rather than actually eating less of it.

Since my early days as a dietitian, I have learned to look beyond food and nutrition and appreciate the wholeness of the incredible humans I work with. I am still a dietitian, and as such I fully appreciate the role of good nutrition in improving one’s health and wellbeing. However, I also have seen how if trying to eat a certain way isn’t good for someone mentally, then it is not actually healthy, no matter the supposed physical health benefits.

At Rachael Hartley Nutrition, when we work with clients we are just as conscious of evaluating their mental health as we are their nutrition status. And when we talk about making eating changes, we are always asking about how the change feels mentally, because people are not machines – they have relationships with food that must be considered. As I often remind my clients…

Going to a trendy exercise class could be considered healthy....unless you're spending the whole hour comparing your body to the people around you and leave feeling like shit.

Spending some time on the weekend prepping nutritious meals could be considered healthy...unless doing so means you don't have time to relax and connect with your family.

Eating a big, bright and colorful kale salad could be considered healthy...unless it leaves you feeling sad and deprived.

The Bottom Line

If this post connected with you, I encourage you to take a step back and think about how you approach nutrition and health. How much thought do you put into what you eat versus how you feel? In considering things you do for health, ask yourself how you feel before and after, both physically and mentally. How much headspace does it take for you to engage in this behavior? Is it something you have to put a lot of time and thought into, or is it fairly effortless? Remember, even if something has legitimate positive impacts for physical health, it may be negated if there are negative impacts on your mental health.

Mental Health is Health Too