Melanie Cole, MS (Host): Welcome to Wellness Waves, the essential podcast source for in-demand healthcare information from the specialists at New Jersey's largest hospital, Bergen New Bridge Medical Center. Today, we are talking about nutrition and mental health.

We have a panel for you today with Christina Norman. She's the Director of Integration and a healthcare leader at Bergen New Bridge Medical Center, where she works at the intersection of medical, behavioral, and social care. And Patricia Kalosieh, she's a clinical registered dietician who works at Bergen New Bridge Medical Center in both the long-term care and behavioral health units.

Thank you both for joining us today. So Christina, I'd like to start with you because this is a really great topic, and we're learning so much more these days about that intersection between mental health and nutrition. So, tell us a little bit about the connection. What do we know about it right now?

Christina Norman, MA: I think we're finally starting to recognize that mental health and physical health are deeply connected, and nutrition is a big part of that. We often think about food in terms of physical health, but the brain also needs the right nutrients to function well. You know, what we eat can affect our energy levels, our concentration, our mood, our sleep, and just overall, like, how we manage stress.

At the same time, nutrition isn't just about making healthy choices. You know, it's also about having access to that, you know, as well. In my work, with individuals experiencing homelessness and behavioral health conditions and substance use, I firsthand found that it was difficult for someone to focus on, you know, these challenges in recovery when they're facing, you know, insecurity with basic things like accessing food, right?

So when a person is worried about where their next meal is coming from, or dependent on a system to provide them that meal, managing things like depression and anxiety or recovery often becomes secondary to simply getting through the day. My career began with working with individuals experiencing homelessness in New York City and those experiences continue to shape how I think about healthcare.

You know, here every day in Bergen New Bridge Medical Center, we see patients facing food insecurity, financial strain, housing instability, transportation barriers. My team and I are at the frontline of that. And when folks have to choose between paying rent or getting a prescription, right, or buying groceries, healthy eating just is not, you know, a luxury that they have and is not a choice.

So, that's why I often say that food is more than nutrition. It's a foundation for health and wellness and recovery. And nutrition alone isn't a cure for mental illness, but it's a powerful tool that supports treatment and healing. And I think that we just in healthcare and the healthcare world have to look beyond the diagnosis and treat the whole person and understand that if someone doesn't have access to food or other basic necessities, we're only addressing part of their problem and not the whole problem.

Patricia Kalosieh, MS, RD: I agree with Christina, and I just wanted to also add that the connection between nutrition and mental health is honestly best described as an interdependent relationship. This means that your nutritional status can be affected by your mental health just the same way as your mental health status can be affected by your nutritional status. What you eat can directly affect how you feel, and how you feel can directly influence the choices that you make regarding your food.

Melanie Cole, MS: So true. Both of you made such great points. And when we think of, you know, comfort foods, we think sometimes they're going to make us feel that much better. But then, certainly we women and all the negative self-talk that we do on a daily basis, those comfort foods can then turn into that negative self-talk for us and go, "Why did I just eat that? Why did I do that?" I mean, this is a really great topic, and there's so many levels to it.

Now, Patricia, we hear the term gut-brain connection, and we've been hearing this for a while in the media. Tell us, what does that mean?

Patricia Kalosieh, MS, RD: So, the vagus nerve is the longest cranial nerve in your body. It runs from your brain stem all the way through your abdomen, and it acts as the main communication between your brain and your internal organs. When specifically talking about the gut-brain connection, I like to use the example whenever you get nervous or feel anxious. So, think about when you were younger, it was the first day of school, or you're about to public speak. You get those butterflies in your stomach. It doesn't necessarily mean that there's anything wrong with your stomach. You don't have an unsettled stomach. It's the anxiety and the nerves that's in your brain manifesting that feeling in your stomach, and that just goes to show how strong that connection is.

Melanie Cole, MS: Well, it certainly is. So now, Patricia, sticking with you for just a second. People are going to hear us talking, and then they're going to say, "But what foods are really optimal for helping me to improve my mental health and wellness outcomes?" We know that food can be medicine, and we know that food can affect our moods.

And depending on our hormone levels, and again, women specifically, we know that food can really affect those. So, tell us specifically what foods, when we think of our mental health and the stress that we're all going through, what foods are we talking about here?

Patricia Kalosieh, MS, RD: We always want to choose whole foods. They are best for improving overall health, whether that be physical, mental, emotional. We want to avoid ultraprocessed foods as they tend to irregulate our blood sugars and increase inflammation in the body. Whole foods, especially high fiber plant foods, so vegetables, fruits, beans, legumes, they feed our diverse gut microbiome, which communicates directly with the nervous system, again, through that gut-brain connection, to lower anxiety and depression risk.

Christina Norman, MA: Yeah. And if I could just add, Melanie, you know, I think just in this question, I took a look at it, like, through the equity lens, which just, you know, how I see a lot of this work. And I think that all those things that Patricia's saying are valid points, but do we think about folks that don't have access to that, right? That don't have access to healthy food choices, right? Think about our communities that we serve and affordability. I mean, I just bought grapes the other day, and they were like $12. And I was like, "Whoa." So, imagine someone who is really just struggling financially and has to make that choice between, you know, "Do I get grapes or do I get grape soda that's maybe $1.25?" And, you know, and what that does to a person. So, I just always like to look at that question just in the health equity lens as well, and really having folks understand that not everyone has that same access or availability, or even our folks that don't have close by supermarkets who live in rural areas, who have to, you know, drive miles to the closest supermarket.

Melanie Cole, MS: And we're going to talk about the social determinants of health because those food deserts and those rural areas, I mean, there's so much that goes into play here. And Christina, along those lines then, and you mentioned this a little bit in our first question, when you come across somebody who has mental health issues, anxiety disorders, whatever they may be, but they're also food insecure, what can they do? How do you help them? What do you want them to know about being able to find that access or separate out these things, you know, because that's a tough situation.

Christina Norman, MA: Yeah. I mean, you know, if you're worried about where your next meal is coming from, it's difficult to focus on therapy, on medications, right? On working towards recovery goals, just managing life stressors in, general, right? Food insecurity just creates stress, can actually worsen someone's mental health condition.

And many patients that present here don't just present with one challenge, right? They present with housing instability, transportation barriers, financial hardship, you know, in conjunction with food insecurity. So, you know, screening for these things and connecting people to the right resources is just a really important part of the care that we do here, really just understanding, you know, the whole person.

Patricia Kalosieh, MS, RD: Absolutely. And I'd like to add too something that I see as a behavioral health dietician. When your nutrition is not optimal, it actually does reduce how well your psychotropic medications work. So, the medications that they're on for depression anxiety, if their nutrition is not up to par, it's not beneficial for how well that medication will work for them.

Melanie Cole, MS: I'd like to ask you both for some resources here. Christina, starting with you, what resources are out there to help patients looking to improve their overall nutrition, but also may be struggling with food insecurity and mental health issues as they intersect?

Christina Norman, MA: Yeah, good question. So, you know, here at the medical center, I am the director of integration. So, we have frontline workers who are engaging patients in all areas, right, in the ED and our behavioral health outpatient. And really, a lot of their work is surrounded around the connection and making sure that folks are landing, you know, to these community resources.

You know, sometimes when you're in the hospital setting, in a medical care setting, you're worried about the care that's happening within, you know, those walls. And a lot of our work is dedicated, you know, to making sure that folks land to the right community resources because they have to stabilize their lives in order to then return back here for care, right?

So, there's lots of resources available. We're always on the hunt for resources. You know, there's programs like SNAP and WIC and, you know, local food pantries and just community meal programs. There's a lot of nutrition education initiatives. I know over the summer there was, you know, free meals for children. So, I think that's where community health workers just play an essential role.

Here at the medical center, we're very big in connecting our patients to resources, but we also have onsite resources as well, right? So, we have our food pantry that's onsite, you know, stocked with canned goods and kind of easy perishable items, right? You know, we issue ShopRite gift cards to some of our patients as well. We receive some funding to give our patients who screen out for food insecurity ShopRite gift cards. We've recently partnered and received some Instacart funding as well, just, you know, to supplement some of that for our patients and for folks who have mobility issues as well.

And we're really excited about an upcoming initiative to bring SNAP navigation actually on site. So, we are looking forward to that initiative and being able to help our patients navigating that complex system. So, we love a good resource. We're always on the hunt for resources. It's just essential that the community aspect of people's lives are really a big part of, you know, whole person care.

Melanie Cole, MS: Certainly. Patricia, same question to you

Patricia Kalosieh, MS, RD: Yeah. She covered most of the federal assistance programs and the community programs. But I would like to add, we always encourage, as clinicians, anyone who is looking for assistance with food security to speak up and to get the help that they need. Because it's available and it's out there. They just might need someone to help them along the way.

Melanie Cole, MS: So Patricia, when we think of stress, and we talked a little bit about this earlier, and emotional eating, how does that factor into our mental health? How do those intersect? Because as you said at the beginning, it can certainly go back and forth, right? and we can berate ourselves and have trouble with our mental health because of what we eat or how much we weigh or how we look, and then vice versa. Tell us how they intersect and what you tell patients every single day about working with you and trying to come to some realistic way of putting these together in the healthiest way

Patricia Kalosieh, MS, RD: Yes. And I'm so glad that you introduced it that way because that is how I view it. You have to meet patients or clients where they're at, or else your recommendations, your interventions, they're ineffective. So, stress or emotional eating behavior often uses food to comfort stress or anxiety. And oftentimes, when our mental health is struggling, we tend to lose the ability to choose or crave nutritious foods and opt for high carbohydrate foods. And the reason why our brain does this is because the high carbohydrate foods will trigger an insulin response, which then triggers a serotonin boost. Serotonin is the happy hormone.

So, it's funny how the brain works. It kind of knows what will make it feel better is that serotonin. So, it will cause us to crave those high carbohydrate foods. However, that will only last a few hours or until the insulin levels in our body normalize. This habit can turn into a never-ending cycle and may ultimately cause us to overeat. For starters, we have to differentiate eating in response to emotional cues, so what we had referred to as distress or emotional eating, and differentiate that from physiological hunger. The practice of mindful eating utilizes all five senses during mealtime to avoid stress and anxiety around mealtime.

So, we have two hormones, ghrelin and leptin Ghrelin is a hormone that tells our body that we are hungry, and leptin is a hormone that tells our body that we are full. Mindful eating encourages us to be aware of the colors, textures, smells, and tastes of our food, motivates us to avoid distractions while eating, and promotes pauses during meals

By practicing mindful eating, we can make better choices on the foods we choose to nourish our body and to avoid overeating. I always approach it very carefully because there are times where people are very sensitive to food, whether that be because of food insecurity or eating an eating disorder. So, I tend to start the conversation as, "How's your appetite been recently?" You know, if they say, "It hasn't been that great," we get into what's causing this. Is it how you feel on the inside? Is it how you feel up here? And differentiating the two. And if it is food insecurity, we then go into all the options that they have for help and outreach.

Melanie Cole, MS: Thank you so much, Patricia, for really giving us that great information. And Christina, we mentioned this a little bit earlier. When we think of the social determinants of health and unhoused people and food insecure people, while patients are treated for mental health or substance use disorders, how does that intersect? What do you do for patients? Tell us a little bit about your role and how you view these social determinants of health, where we think of that intersection of mental health and nutrition.

Christina Norman, MA: I oversee a team here of patient navigators, of community health workers. And we always try to make sure that we come at this work, you know, with a compassionate lens, a supportive lens you know, a non-judgmental and really just trauma-informed as well.

We don't really understand everyone's circumstances, but we try to understand what they're presenting at that moment and really just help navigate a lot of these complex systems. Going somewhere and applying for SNAP benefits is not always the easiest. You know, it's not a system that's easy to navigate, one. And for some, it brings on other, you know, anxiety and just all the other things that come along with that. So, we really just try to be a sense of like comfort and support while they're managing, you know, these things.

Melanie Cole, MS: Thank you both so much for joining us today. This was a really important topic, and you've given us a lot to think about, interesting resources and initiatives. And I thank you both for joining us today and sharing your incredible expertise. And for more information, you can visit newbridgehealth.org.

That concludes this episode of Wellness Waves from the specialists at Bergen New Bridge Medical Center. Please remember to subscribe, rate, and review Wellness Waves on Apple Podcasts, Spotify, iHeart, and Pandora.

The material provided through these podcasts is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.