As the connection between nutrition and mental health continues to gain attention, more people are turning to Medical Nutrition Therapy (MNT) in hopes of finding relief for mental illness.
It’s exciting to see this shift toward using food and nutrients as a tool for mental well-being, but it’s also important to set clear expectations about what MNT can and cannot do. While improving diet can certainly play a powerful role in supporting mental health, it’s not a standalone cure or a quick fix.
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Defining Medical Nutrition Therapy (MNT) in Mental Health
What is MNT?: Medical nutrition therapy (MNT) is a form of treatment that uses nutrition education and behavioral counseling to prevent or manage a medical condition. It is a personalized and evidenced-based process that is uniquely within the scope of registered dietitians.
MNT and Mental Illness: Many, but not all, studies that involve targeted dietary interventions for psychiatric conditions involve sessions with dietitians, often involving motivational interviewing techniques.
Scope of MNT in Mental Health: Most research regarding nutrition interventions looks at depression and/or anxiety. However, small studies have shown positive results for bipolar disorder and schizophrenia as well.
In addition to primary psychiatric symptoms, nutrition interventions can address common somatic complaints of psychiatric illnesses, such as various GI issues.
Realistic Expectations of MNT for Mental Illness
It’s easy to get excited when a new (to us) treatment option pops up. Hearing someone talk about a nutrition approach to a condition you struggle with makes you feel like you can have more control over what happens than you can with medications and therapy.
This is something that comes up with my clients a lot.
However, I’ve had conversations with dietitians who are ready to proclaim nutrition as the only approach needed to manage mental health, at least depression and anxiety.
And let me tell you, I am NOT here for that!
Complementary, Not Standalone Treatment: MNT can support mental health. However, it should be considered complementary to primary treatments like therapy and medication.
As dietitians, we can do a lot to improve our clients’ responses to medications and manage side effects. We can even improve their response to talk therapy!
Additionally, we can learn and utilize some techniques therapists use, such as cognitive behavioral therapy (CBT), motivational interviewing, and even dialectical behavioral therapy (DBT), to help our clients achieve long-lasting behavioral changes.
However, we CANNOT address non-food or body-image-related traumas, get to the root cause of depression or anxiety, or other impacts that a therapist is trained to address. And even within the realm of food and body image, a therapist is usually needed.
Any practitioner who thinks that nutrition can treat mental illness alone is dangerous.
So, how do we set expectations for our clients and us?
Timeline for Benefits: Medical nutrition therapy often requires long-term changes, and improvements in mental health may take weeks or months to manifest. A lot of this depends on the individual’s ability and willingness to make changes.
Impact Varies by Individual: Like any other condition, the response to intervention depends on the individual’s baseline nutrition, overall health, severity of mental illness, support system, monetary constraints, physical ability, and more.
Common Misconceptions About MNT in Mental Health
“Food as Cure” Myth: The food as medicine trend bothers me. Food is food; medicine is medicine. Nutrition can do a LOT, but it can’t do everything, even when there are no barriers to whatever dietary pattern we decide is perfect.
You aren’t going to cure severe depression or bipolar disorder with food alone. Medicine and talk therapy may always be needed. Telling someone that food is medicine (for ANY condition) only blames them when they aren’t “cured” after following your directions.
This idea also diminishes food’s role in joy, connection, and cultural importance. Relegating food to only medicine or nutrition completely ignores the other roles food plays in our lives.
We can use food and nutrition to improve the response to medications and other therapies, psychiatric or not.
I know AND has been on this train lately, but it is definitely an area that I disagree with, at least in its current presentation.
Overemphasis on Specific Foods or Nutrients: The idea that just adding that ONE food will fix everything is alluring. It’s also not real, despite the claims of wellness culture and influencers. Or the opposite, that removing that ONE thing will solve all your problems.
This ignores tons of research that shows that variety is super important. Part of supporting mental health through nutrition is avoiding or resolving all-or-nothing or perfectionist thinking.
All the blueberries in the world won’t help if the rest of your diet is unbalanced, overly restrictive, or otherwise lacking in nutrients.
Nutritional Supplements vs. Whole Foods: Research consistently shows that micronutrient interventions are more effective when nutrients are increased with food rather than supplements.
These studies are usually observational and do not provide reasons for this. However, I firmly believe this is because it’s not just the one nutrient the study is focused on that is helping.
Take magnesium, for instance. You can take a supplement that just has magnesium. Or, you can increase your intake of nuts, seeds, whole, grains, yogurt, and beans. Now, you have also increased your volume and variety of fibers, added probiotics, and taken in a whole host of phytochemicals.
While both can correct inadequate magnesium intake, food can also help improve gut function!
What MNT Can and Cannot Do for Mental Illness
What MNT Can Do:
- Address any nutrient deficiencies that may be causing or worsening depressive and anxious symptoms.
- Address any GI issues that are damaging to mental and physical health.
- Support cognitive function, mood stabilization, and energy levels.
- Enhance the effectiveness of other treatments (medication, therapy).
What MNT Cannot Do:
- Serve as a primary treatment for severe mental health conditions.
- Replace the need for medication or therapy in most cases.
- Deliver immediate results—progress is often gradual and incremental.
- Dictate client or patient behavior.
How to Manage Client Expectations as a Dietitian
Effective Communication: It’s sometimes hard for dietitians to switch from vigorous scientific studies to effective health communication.
We have to learn to speak to clients where they are. How I talk to someone with a business background differs from how I would educate someone who is a physician’s assistant. Effective intake questions can give you an idea of your client’s/patient’s health literacy before starting.
But you still need to take the time to understand their knowledge and understanding. Otherwise, you may speak down to your client or go way over their head and not even know it!
Setting Realistic Goals: I feel like SMART goals were practically beat into us in school. And while I do believe they can be effective, many of the goals my clients are working on are too abstract for this model.
For example, how do you measure mindful eating?
Some clients don’t like mindful eating as a goal and instead want to “think about it.”
Others want to set a specific goal, such as slowing their eating pace to 20 minutes for meals by our next session.
Both are acceptable approaches. An unacceptable approach would be something like, “I will be a mindful eater in 2 weeks.”
Feeling motivated and excited, clients may set too high goals, leading to a major letdown when they cannot achieve them in the time set. However you and your clients set the goals, ensure they are realistic. They can always be readjusted later.
Collaboration with Mental Health Providers: Work closely with therapists, psychiatrists, and other healthcare providers to create a holistic treatment plan.
Resources and Support for Patients
When working with clients who are managing mental illness, providing them with the right resources is key to their success with Medical Nutrition Therapy. It’s not just about creating a meal plan—it’s about offering ongoing support, education, and tools that help them stay committed to their nutritional goals while addressing the complexities of mental health.
- Educational Materials: Clients often need easy-to-understand guides that explain how different nutrients can support their mental health. Handouts on topics like omega-3s, magnesium, and anti-inflammatory foods can be invaluable. Resources from trusted organizations such as the Academy of Nutrition and Dietetics or the American Psychological Association can also help provide evidence-based insights.
- Consider supporting other dietitians by looking for done-for-you materials at Well-Resourced Dietitian.
- Support Groups: Encourage clients to join mental health support groups, especially those focusing on holistic wellness approaches. Whether in-person or online, these groups offer a sense of community and motivation. Look for options through local mental health organizations or platforms like NAMI (National Alliance on Mental Illness) and Mental Health America.
- Collaboration with Other Healthcare Providers: MNT works best when integrated into a broader mental health care plan. Encourage clients to communicate with their therapists, psychiatrists, and primary care physicians to ensure everyone is on the same page. Some clients may feel overwhelmed by the idea of coordinating their care, so offering to write summary reports or attend team meetings (with consent) can make a big difference.
- Regular Follow-Ups: Consistency is crucial when managing both diet and mental health. Schedule regular check-ins with clients to review progress, adjust their nutrition plan as needed, and provide encouragement. These follow-ups also serve as a space for clients to ask questions and address any new concerns or barriers that arise.
- Mind-Body Resources: Since anxiety, depression, and other mental health conditions often affect more than just diet, sharing mindfulness or stress-relief techniques can be beneficial. Resources like guided meditation apps (Calm, Headspace), progressive muscle relaxation, self-hypnotherapy apps (Nerva, Claria), or yoga and breathing exercises can support mental well-being and complement MNT.
By offering these resources and support systems, you help your clients feel empowered in their journey toward better mental health. Nutrition is just one piece of the puzzle, but when combined with the right tools and a holistic approach, it can be a powerful part of the healing process.
Case Studies or Examples
Mild to Moderate Depression and MNT: My client, “Jessica,” initially came to me for weight loss. She had been working with a personal trainer and started a vegetarian diet about a month prior because someone told her she’d lose weight that way.
We’re in Texas; she did NOT want to be on a vegetarian diet.
As we talked, it turned out that she had actually eliminated a ton of foods, not just meat. She wasn’t eating enough protein to produce the muscle growth her trainer expected, and she wasn’t eating enough calories overall. She felt foggy and exhausted most of the time, and her long-time antidepressant didn’t seem to be working anymore.
The first thing we did was liberalize her diet. We put meat back in, focusing on fish and poultry. We added all fruits, vegetables, and beans. I gave her calorie and protein goals that would meet her needs.
Two weeks later, she wasn’t “cured.” However, she had more energy, her brain fog had cleared, and she had lost about 3 lbs.
Now, I’m not one to spend a lot of time on weight management, and I’m also not one to make those types of decisions for my clients.
Excitingly, she disclosed that adding meat back into her diet allowed her to resume her weekly girls’ night, which involved beef fajitas, queso, and a couple of margaritas. She had dieted herself right out of social interactions! I didn’t know that after our first meeting, but she recognized how significant that was and how much her stress management and mood had improved just from that.
As we continued to meet, every couple of weeks at first, she started to notice gains in her strength from her training sessions. She also worried less about weight loss, though she still had some body image concerns. After about 6 months, I asked her how depression was.
She hadn’t thought too much about it (a good sign) but realized that she hadn’t had a depressive episode in about 6 months, without any change in her medication. She had been having depressive episodes every 1-2 months prior!
In a perfect example of how listening to your body allows it to get where it needs to be, Jessica lost weight without ever tracking a single bite of food. In fact, at some point, she had to make a decision. She weighed less than her initial goal weight and was still feeling more energetic and positive.
So, do we add more food? Or should we continue eating mindfully, responding to hunger and fullness cues, monitoring symptoms, and allowing her body to decide its weight?
She went back and forth on this, worried that she had lost too much and wanted to stop losing, and then worried that not listening to her body was going to lead to worsening mood again.
Ultimately, she decided to keep eating mindfully. When she went back to school (grad school at that), she gained a bit of weight, but she was more worried about providing her body with what it needed than the number on her scale. As a result, many of our conversations turned to feeding herself as easily and quickly as possible without losing some of the foods she enjoyed.
At her request, we also increased our sessions from quarterly to monthly so that she could ensure she kept her health top-of-mind as she worked through her courses.
Severe Anxiety and the Role of MNT: Now, let me tell you about a client I worked with, Nina (not her real name).
Nina had been living with severe anxiety for years, and while she was already seeing a therapist and taking medication, she felt something was missing from her treatment plan. She came to me hoping that changes in her diet could help alleviate some of the constant worry, fatigue, and difficulty concentrating that plagued her daily life.
When we first met, Nina’s diet was heavy in processed foods and caffeine and low in the nutrients known to support mental health, such as omega-3s, magnesium, and B vitamins.
Together, we planned to gradually introduce more whole foods, such as leafy greens, fatty fish, nuts, and seeds, while reducing her intake of refined sugar and processed snacks.
I also encouraged her to stay hydrated, focus on regular meals, and incorporate fermented foods to support her gut-brain connection. We also discussed reducing her caffeine habit, as she drank about 6 cups of coffee daily, but she wasn’t receptive.
It wasn’t an overnight fix; MNT rarely is. For the first few weeks, Nina didn’t notice much change in her anxiety levels, and we discussed the importance of patience when it comes to MNT for mental health. Nina struggled with meeting her goals, as she didn’t like to cook, and her family protested the changes.
However, after 2-3 months, she started to feel more emotionally balanced. Her energy levels improved, and she found it easier to focus throughout the day. But she was still anxious.
That was when we revisited her caffeine intake, but she still didn’t want to address that. So, instead, we worked on increasing movement, in particular, “green exercise.” Instead of hitting the treadmill, she decided to walk the green belt near her house. After about two weeks, she noticed a reduction, but not an elimination, of her anxiety.
So, in our next session, she was ready to set a goal to reduce her caffeine intake. She could do this in a few ways.
- Cold turkey – I don’t recommend this, as caffeine withdrawal has its own medley of symptoms.
- Stop drinking coffee after lunch – she didn’t care for this idea.
- Switch to decaf – even bigger objection!
- Mix regular and decaf coffee – this she agreed to, sort of.
She started out by mixing regular and decaf after lunch. Between walking and reducing her caffeine intake in the second half of the day, her sleep improved. This was the final piece to getting the result that she wanted.
What worked for Nina was the combination of MNT and her ongoing mental health care. The dietary changes didn’t replace her therapy or medication, but they provided her with a stronger foundation for managing her anxiety.
And her dietary changes weren’t rigid! If she has a bad night’s sleep, she may lean more on caffeine the next day. If she is particularly busy or doesn’t have the spoons to cook, she’ll have takeout or fast food with no guilt. When it’s brutally hot (again, Texas), she finds something else to stay active.
By the end of our work together, Nina felt empowered by the role food played in her mental well-being and continued making her new habits a priority, alongside her other treatments.
Key Takeaways for Dietitians
MNT is a valuable tool in the holistic care of individuals with mental illness, but it’s essential to set realistic expectations. The process takes time, varies by individual, and requires collaboration with other healthcare providers. Managing client expectations is key to maintaining trust and ensuring long-term adherence to nutritional recommendations.
Key Takeaways for Other Healthcare Practitioners
If nothing else, make sure you can identify when a patient or client should be referred to a dietitian.
Expression of negative body image, diagnosis of a chronic illness, new onset of depression or anxiety, rapid weight changes, and reports of changing appetite are all important to address medically but are also only a few of the reasons a dietitian should be added to the individual’s healthcare team.
Understanding the role of Medical Nutrition Therapy (MNT) in mental illness is essential for both dietitians and their clients. While MNT offers valuable support for mental health, it’s important to approach it as part of a comprehensive treatment plan rather than a standalone solution.
Setting realistic expectations about the time it takes to see improvements, the individualized nature of results, and the need for collaboration with other healthcare providers can help maintain trust and ensure long-term success.
By managing expectations and communicating openly, dietitians can empower their clients to make sustainable dietary changes that complement their mental health journey.
The impact of MNT may be gradual, but with patience and the right guidance, it can play a significant role in enhancing overall well-being. Keep learning, stay connected with the latest research, and encourage clients to see MNT as a valuable piece of the larger mental health puzzle.
