Health: have you been affected by the recession? We
would welcome your views.
This leaflet is for everyone who wants to eat healthily. It is
particularly for people who feel that their mental health problem
or its treatment has affected them in the way they eat.
Eating well – what does it mean?
This can actually mean a lot of different things to different
people. Broadly speaking it means eating in a way so that:
- our weight remains normal – not too low and not to high
- our weight remains stable – not going up and down all the
- all necessary food groups and vitamins are available
- eating becomes and remains an enjoyable experience.
Why is eating well important?
Eating well helps us to prevent many diseases which are linked
with being overweight. Diseases include high blood sugar, high
blood pressure, heart problems, stroke, cancer joint problems and
sleeping difficulties just to name a few. Eating well also makes us
feel emotionally well.
Why is eating well important for people with mental health
People with mental health problems are more likely to have a
weight problem. The reasons for this are not fully clear. For
instance, some people always feel tired and just not up to any
activity. Others always feel hungry.
Some of this may be related to the mental health problem itself;
however it has increasingly become clear that weight problems may
also be a side-effect of some treatments. This does not mean one
should stop treatment because one might become mentally unwell
again. Sometimes it is possible to swap to another medication.
Alternatively, one can try to become more physically active or
switch to better eating habits.
In this leaflet we look at eating habits. Let’s start with
finding out what foods there are.
Foods can essentially be divided into three groups:
- carbohydrates or sugar based foods
A word of advice
We can only give general information but not
consider individual cases. If in doubt, you should discuss your
diet with your nurse, a doctor or a dietician. Also, the guidance
given here applies to adults only and not to children who have
different dietary needs. If you are pregnant or suffer from certain
physical health problems your dietary requirements may also be
Carbohydrates: what are they?
Carbohydrates are essentially made up of sugar. There are simple
carbohydrates made up of just one or several sugar units (glucose
or fructose) and there are complex carbohydrates made up of long
chains of sugars. These long sugar chains are called starch.
Complex carbohydrates often contain a lot of fibre. Simple
carbohydrates are broken down easily in the body and may give an
instant but short-term effect. Complex carbohydrates take longer to
break down but have a longer effect. Each gram of carbohydrate
provides approximately four calories of energy.
What are they used for?
Carbohydrates are the main fuel of the body. For instance,
muscles work most effectively on glucose although they can also
burn fat. Under normal conditions, the brain also operates on
glucose as its main fuel.
- Simple carbohydrates are found in foods like glucose, sugar,
jam, honey, sweets etc. They are also found in many fizzy drinks
and sports drinks. Complex carbohydrates are found in foods like
fruits, root vegetables, beans and potatoes, grain products such as
bread, pasta, rice and couscous. Breakfast cereals also contain
complex carbohydrates, but many brands also contain considerable
amounts of sugar.
What is the glycaemic index?
This is a measure of how fast a food is broken down into single
sugar units, i.e. glucose. The longer it takes, the lower the
glycaemic index (GI). The glycaemic index does not only depend on
the length of the sugar chain, but also on the fibre content. That
is why white rice and white bread, where the outer layer is removed
from the grain, have a much higher glycaemic index than brown rice
and brown bread. Foods with a low glycaemic index are often called
“good carbs” and foods with a high glycaemic index are called “bad
What happens if I eat too many carbohydrates?
If you eat more carbohydrates than your body needs to burn as
fuel then the excess will be converted into fat and stored.
Which carbohydrates should I eat?
Try to eat “good carbs” with a low glycaemic index. Goods carbs
include fruits, vegetables, and legumes such as beans, pasta, brown
rice, basmati rice, whole meal bread and potatoes.
There are many way to use low GI fruits in your
Whole grains should be preferred.
Fats: what are they?
Fats are made up of chains of fatty acids.
There are three different types of fatty acids which are defined by
their chemical structure and by their ability to take up additional
hydrogen atoms. This sounds very theoretical but has very important
health applications as they differ in their ability to promote bad
(LDL) or good (HDL) cholesterol. One gram of fat yields
approximately eight calories.
Unsaturated fats are made up of fatty acids
that can store additional hydrogen atoms. If only one hydrogen atom
can be taken up they are monounsaturated, and if several can be
taken up they are called polyunsaturated. Unsaturated fats are
usually liquid, this means they are oils. They can lower blood
Saturated fats cannot store an additional
hydrogen atom. They are already fully loaded, in other words
saturated. They are solid and they raise cholesterol.
Trans-fats are unsaturated. They can be
produced from oils by introducing some hydrogen atoms into oils so
that they become solid. Trans-fats are mainly used for industrial
What are they used for?
Fats serve many different purposes. They are an important energy
store which can be activated when the body has run of
glucose. Fat deposits insulate the body against the cold.
Fatty acids are also important components for cell membranes and
hormones and may even have a role in keeping us mentally
stable. Fats are needed to make use of some vitamins such as
vitamin A, D, E and K.
- Unsaturated fats are found in foods like
vegetable oils, for instance sunflower- and olive oil, olives,
nuts, seeds and avocados.
- Saturated fats are mainly found in animal
products such as milk, butter, cheese, cream and meats and dairy
products such yoghurts, puddings or ice cream. Note that coconut
products including coconut paste or milk are also high in saturated
- Trans-fats are found in hardened vegetable
oils such as margarine and spreads. Trans-fats can also be found in
instant soups and sauces and cake mixes. Mass-produced foods
like cakes, biscuits and chips may contain large amounts of
What happens if I east too many fats?
The fact deposits of the body will be extended.
Which fats should I eat?
Try to eat unsaturated fats such as vegetable oils, seeds and
nuts. Remember that even “good fats” have a lot of calories and
thus need to be eaten in moderation. Try to use skimmed and
semi-skimmed milk instead of whole milk and whole-milk
Vegetable oils are a healthier choice than solid
What about omega-3 fatty acids?
Omega-3 fatty acids are unsaturated fatty
acids which cannot be produced by the body itself. This means that
they are so-called “essential “fatty acids. Omega-3 fatty acids are
supposed to have a range of health benefits such as lowering
cholesterol, prevent heart and joint disease and improving
Omega-3 fatty acids may also keep us mentally
more stable and may be tried as supplements in people who suffer
from mood problems and schizophrenia. They may help prevent
relapse in bipolar disorder. However, there is not enough evidence
to recommend them as an alternative to antidepressants or
Note: Omega-3 fatty acids taken as supplements
may interact with blood thinning drugs.
Which foods contain omega-3 fatty acids?
Omega-3 fatty acids can be found in oily fish such as cod,
salmon and mackerel. They can also be founds in plant sources such
as flaxseed and walnuts.
How safe is omega-3 from fish
For most people the benefits will outweigh any concern about
possible contamination. However, if you are pregnant make sure to
check with a health professional about how many portions of fish
you can eat in a week.
We have produced further information on
Oily fish is a good source of omega-3 fatty
Proteins: what are they?
Proteins are made of amino acids. They can be divided in
essential amino acids which the body cannot produce itself and
non-essential amino acids which the body can manufacture itself.
Complete proteins contain essential amino-acids whereas incomplete
proteins do not contain essential amino acids. One gram of protein
yields approximately four calories.
What are they used for?
Proteins are the main building blocks of the body and make up
our muscles. They form enzymes and hormones which are the key to
virtually all body functions. Last but not least amino acids are
the basis of our genes and the underlying script of our individual
genetic information. Proteins can also be used as an energy source
but this is not very effective and may lead to muscle wasting. This
is usually the body’s last resource.
- Complete proteins are derived from animal products such as
meat, fish and milk.
- Incomplete proteins can be derived from vegetable sources such
as grains, pulses and nuts.
What happens if I eat too many proteins?
Problems usually only occur if you eat excessive amounts or if
the main organs which process proteins, i.e. the liver and the
kidney, do not work properly. Then the body may get overloaded.
Many protein products also contain saturated fat and may lead to
weight gain and high cholesterol.
Which proteins should I eat?
Try to eat a varied diet of proteins which provide you with a
source of essential amino acids. Even most vegetarian diets are
suitable but people eating a strict vegan diet may not get all
amino acids they need. Try to stick to lean protein options such as
fish, lean meat, skimmed or semi-skimmed milk or dairy products and
whole grains and pulses. Note that refined wheat and white rice are
low in protein because the outer layer of the grain which contains
the proteins is removed.
Eating a balanced diet
UK Food Standards Agency defines a balanced diet as a diet of
varied foods. You find examples of recommend foods in the previous
respective sections under the question which carbohydrates, fats
and proteins should I eat.
The Agency recommends:
- basing the diet on starchy foods, such as potatoes, cereals,
pasta, rice, couscous and bread
- five portions of fruit and vegetables
- meat, poultry, fish, eggs, nuts and pulses as good sources of
- milk and dairy products as a good source of protein and
- at least two portions of fish a week
- cutting down on saturated fat and sugar
- eat less salt, no more than 6 grams a day for adults and
children over 11 years.
Watching your weight
Some of the recommended foods are not always good options if you
want to slim down. For instance avocados and nuts have a low
glycaemic index and contain unsaturated fatty acids. Nevertheless,
they are high in calories. For instance, one medium sized avocado
has about 230 calories. That is as much as eating twelve
Avocados have about 12 times more calories than
Avoid processed foods whenever you can but stick to the original
food source. For instance, one serving of chips (French fries)
(100g) has about 360 calories. This is as much as eating ten
medium-sized boiled potatoes (500g).
Chips have about five times more calories than
Many patients with mental health problems always feel thirsty.
Part of the problems may be medications leading to a dry mouth.
However drinks can have a lot of calories too.
Low calorie choices include:
- tea and coffee (without sugar)
- skimmed milk (in moderation)
- “lite” diet soft drinks
- sugar-sweetened fizzy drinks
What is it about fruit juice?
It is usually better to eat the whole fruit rather than fruit
juice. You may also feel less hungry if you eat the fruits rather
than drinking the juice.
One large glass of apple juice (300 ml) contains as many
calories as three apples.
Fruits are a better choice then
Note: It may come as a surprise, but alcohol also has a lot of
calories. One gram of alcohol contains about seven calories.
That is nearly as much as one gram of fat which contains about
eight calories. One gram of carbohydrate or protein only have about
What about vitamins, trace elements and
Many people like to use supplements but very few people need
them to correct a clear-cut deficiency having resulted in poor
health. Most people who take supplements do so in the hope that
these carry substantial health benefits, e.g. protecting against
cancer, improving the immune system and supporting mental health.
However, scientific evidence about the benefits of supplements
remains mostly ambiguous with a few exceptions. Note that
supplements are not a substitute for a healthy balanced diet. If
you decide to take a supplement do not exceed the recommended daily
intake regarded as safe. If you are smoking do not take
beta-carotene since the combination may increase your risk of
What are antioxidants?
Most processes in the body require oxygen. But oxygen can do
good as well as harm such as damaging body cells. Antioxidants are
substances which neutralize such harmful substances. They are
contained in many vitamins such as vitamin A, C and E and some
trace elements such as selenium. They are contained in many fruits
and vegetables such as oranges, strawberries, spinach, tomatoes,
carrots and broccoli just to name a few. Green tea is another good
source of antioxidants. Selenium can be found in pasta, bread,
eggs, poultry, beef and some fish such as cod.
What about calcium?
Calcium is important to keep bones and teeth healthy. This is
particularly important in people with mental health problems
because some medications increase the risk of osteoporosis. Calcium
may also be helpful to prevent or alleviate premenstrual stress.
Good sources of calcium include milk, dairy products and fish such
as sardines where the bones are eaten. Broccoli and kale also
contains calcium. However, calcium can only work if it is combined
with vitamin D. Good sources of vitamin D include oily fish, some
cereals and eggs. Getting out and about and being exposed to
sunlight is another good way to get vitamin D (as long as you take
care not to burn).
Recently there has been a lot of talk about vitamin D and
depression. It seems that people with low levels of vitamin D may
be more depressed. But taking a supplement may not make things
better after all. We still do not know how the link between
depression and low vitamin D levels really works.
We have produced a leaflet on supplements commonly
suggested for mental health problems. You will find further about
vitamin E, omega-3 fatty acids, selenium, folic acid and
Diets for mental health problems
What is the best diet for schizophrenia?
There is no specific schizophrenia diet but you should eat a
balanced varied diet according to the above recommendations.
Ensuring that you eat enough foods rich in omega-3 fatty acids
seems a good idea. If you tend to gain weight or have experienced
weight gain as a side effect of your medication you should try to
eat “good carbs”, i.e. carbohydrates with a low glycaemic index,
which are not easily broken down into glucose. Make sure that you
also get calcium in your diet by including dairy products ideally
based on skimmed milk to keep the fat intake down.
What is the best diet for mood disorders?
The same principles as above apply. Ensuring enough omega-3
fatty acids may help to keep your mood stable. If you take lithium
you should not drink too many caffeine containing drinks such as
tea and coffee since this may reduce your lithium levels. Some
vegetables such as artichokes and celery may do the same if eaten
in large amounts.
Selenium, folic acid (folate) and tryptophan are substances
which have all been implicated in keeping one’s mood stable.
Tryptophan is needed to make serotonin. However, it is not clear
how good they are when taken as supplements and you should seek
medical advice if you want to use such supplements. Particularly
avoid taking too much selenium as this can lead to poisoning.
Instead of using a supplement right away, you may try to eat a
balanced diet which contains these substances in sufficient
Selenium is found in cereals, meats, fish and egg. Selenium is
also found in Brazil nuts. These can be extremely rich in selenium
so that one should only eat them occasionally. Folic acid can be
found in cereals and breads which have been enriched with folic
acid. This is also called fortified. Folic acid is also found in
brown rice, leafy green vegetables, peas and broccoli as well as
orange juice and bananas. Finally tryptophan can be found in
poultry, meats, some fish such as salmon and halibut and also
Chocolate contains tryptophan but dark chocolate is better than
milk chocolate and is even thought to lower cholesterol. However,
chocolate of whatever sort is high in calories and should only be
eaten in small amounts.
What is the best diet for epilepsy?
A so-called ketogenic diet maybe of help in children with
epilepsy which cannot be controlled. A ketogenic diets is a diet
high in fat and low in carbohydrates. The most widely diet used of
this type is the Atkins diet. Such a diet can be quite hard to
sustain long term though. The idea of the ketogenic diet is to
switch the main fuel of the brain from glucose (sugar) to ketones,
which are produced when fat is broken down. Some adults who suffer
from uncontrollable epilepsy may also benefit but research findings
are much less clear. Seek specialist advice before going on such a
What is the best diet for ADHD?
Again, there are no clear recommendations as research is only
just developing in this area. Some research has shown that people
with ADHD have lower levels of omega-3 fatty acids or may not be
able to tolerate gluten. Gluten is a protein found in wheat, rye
Many other different food items have been thought to trigger
ADHD, but we do not know how well and for whom such diets work.
Diets that exclude specific foods thought to be harmful are called
elimination diets. These diets may be also difficult
to stick to in the long-term in every day life. They
can be expensive and take time to prepare. Also, people may get
tired of them. Others may use them on and off.
One such diet is the Feingold diet which avoids foods containing
synthetic food colours and artificial sweeteners, such as aspertame
and preservatives. The Feingold diet also cuts out foods containing
salicylid acid. Examples include some apples, red grapes,
berries, mushrooms, cucumbers and tomatoes. Some nuts and
spices also have high salicyclic acid content. Foods allowed in the
Feingold diet include fruits such as banana, grapefruit, pears and
pineapples. Other food allowed include beef, lamb, plain bread,
some cereals, milk, eggs and vitamins that do not contain
Other elimination diets concern the exclusion of milk, cheese,
wheat cereals, egg, chocolate, nuts and citrus fruits. Such diets
are also called oligoantigenic diets. Oligoantigenic means
that there are only a few substances that cause adverse reactions
and allergies in the body. Foods found in an oligoantigenic
diet include rice, turkey, lamb, some vegetables including lettuce,
carrots, cauliflower, cabbage and beet. Potatoes, fruits, corn and
wheat may be allowed on some days.
Even the ketogenic diet has been suggested, but findings are
only based on animal experiments.
What about grapefruits and grapefruit juice?
Grapefruits are powerful stuff and they can change the way our
body metabolizes medication. Particularly, grapefruits or
grapefruit juice can significantly increase the concentration of
many medications including some types of antidepressants,
antipsychotics and sedatives. Changes are more likely if
grapefruits and grapefruit juice are consumed in large amounts but
one cannot even exclude such changes on occasional use.
What about orthomolecular medicine
Orthomolecular medicine aims at treating or preventing health
problems, including mental health problems, through supplements and
vitamins. Vitamins are often recommended in large doses, so-called
megavitamins. Orthomolecular medicine remains controversial
and very few studies have been conducted in this area. These
largely suggest that orthomolecular medicine may not be helpful.
Large doses of vitamins and supplements may be harmful or even
toxic. That is why the Food Standard Agency has set recommended
levels of daily intake for most vitamins and supplements.
Ten Tips to eat well on a budget
Many people think that eating well costs a lot of money.
However, eating well can be surprisingly cheap. Here are ten tips
which may help you to eat well but cheaply.
- Avoid ready meals and take-ways. They are often rich in fat and
sugars and may not provide good value for money.
- Avoid buying snacks such as crisps, ice creams and sweets apart
from the occasional treat.
- Shop seasonal fruits and vegetables. For instance, oranges and
bananas are winter fruits whereas strawberries and peaches are
summer fruits. Broccoli and parsnips are winter vegetables whereas
and zucchinis (courgettes) and peppers are summer vegetables.
Buying fruits and vegetables out of season can be expensive.
- Buy fresh foods such as fruit, vegetables and meats in small
amounts and more often since they go off easily.
- Avoid canned foods if possible. For instance dried beans and
pasta are less expensive than canned beans and processed pasta.
Also canned fruits can be more expensive than seasonal fresh fruit
but have fewer vitamins.
- Avoid sugar-sweetened fizzy drinks and fruit juices. They
are often quite expensive. Use water and eat fruit
- Compare prices in local shops and supermarkets and take
advantage of special offers.
- Use “generic” supermarket brands instead of classic brands.
They often contain the same ingredients but are cheaper.
- Cook and eat together with others and share the costs.
- Make a shopping list and plan your food budget every week. If
you feel you cannot do this on your own, ask for help. For instance
a key worker may be able to help.
This leaflet was produced by the Royal College of Psychiatrists'
Public Education Editorial Board.
Series Editor: Dr Philip Timms.
Author and Expert: Dr Ursula Werneke
This leaflet reflects the evidence
© Updated: December 2012. Due for review: December 2014. Royal
College of Psychiatrists. This leaflet may be downloaded, printed
out, photocopied and distributed free of charge as long as the
Royal College of Psychiatrists is properly credited and no profit
is gained from its use. Permission to reproduce it in any other way
must be obtained from the Head of Publications. The College does
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For a catalogue of public education materials or copies of our
leaflets contact: Leaflets Department, The Royal College of
Psychiatrists, 17 Belgrave Square, London SW1X 8PG. Tel: 020 7235
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