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Sugar, Mood, and Mental Health: Interview with a Nutritional Therapist

Sugar, Mood, and Mental Health: Interview with a Nutritional Therapist

December 2, 2022

The holiday season is a time of gatherings, gifts, and of course, a gluttonous indulgence in sweet treats.


While some sugar consumption is perfectly normal and healthy, a high-sugar diet, even temporarily, can negatively impact one’s mood and mental health. As a result, it’s important to be mindful of your sugar intake during the holidays and as you carry on afterward with your regular diet.


To learn about sugar’s connection with mood and mental health and how to adopt healthier habits, we sat down with Austin, Texas-based Registered Dietician Nutritionist Sally Twellman. She is our in-house nutritional therapist here at Heading Health, and she shared experience supporting mental health treatments with dietary and lifestyle changes.

Q & A with Sally Twellman RDN, LD

Are Sugar Rushes and Crashes Real? If So, What Causes Them?

Yes, for sure, and this goes for carbohydrates in general. When we have a large amount of carbohydrates, our blood sugar rises rapidly, which causes an equally sharp increase in insulin. This increase in insulin causes a rapid drop in blood sugar, and that’s when you get that slump, which can make you feel tired, lethargic, and even a little bit irritable. In turn, this can cause sugar cravings and, ultimately, a vicious feedback loop of sugar consumption followed by a crash followed by more sugar consumption, and so on. 

Are There Long-Term Mental Health Consequences of a High-Sugar Diet?

Very much so.


For example, a high-sugar diet is correlated with depression. One of the many ways it might contribute to depression is through frequent and erratic fluctuations in blood sugar levels. Some fluctuations are normal, but when the peaks become too large and too frequent, it is very stressful for the body and can contribute to chronic inflammation, which is associated with adverse mental health outcomes.


Another way that having a lot of sugar in your diet can impact mental health is through its connection with diabetes. Over time, people who eat a carbohydrate-heavy diet are disproportionately more likely to develop insulin resistance, predisposing them to depression.

The third way having lots of very sugary foods can impact mood is that it changes the gut microbiome. Your body adapts to whatever you eat, and if you mostly eat high carbohydrates and low-fiber foods, the bacteria you will grow more of will be the kind that thrives in that environment. And those bacteria are typically not the ones that are beneficial for maintaining good neurotransmitter production, which your brain needs to send messages chemical messages and, ultimately, to produce good feelings.

Is the Damage Reversible?

Yes. Even a dietary change of two weeks to a Mediterranean-based diet, for example, can have a profoundly positive impact on your gut microbiome. This means that if you’re experiencing a low mood resulting from a high-sugar diet, it’s possible to undo the damage and experience benefits after just a few weeks on a low-sugar, high-nutrient diet.

Does the Sugar Source Matter?

Absolutely. The source matters for a variety of reasons. For one thing, some sources make it much easier to consume lots of sugar than others, which is why I highly recommend people avoid sugar-sweetened beverages. We don’t really get that fullness factor like we do when we eat the same amount of sugar or calories in, say, a cookie. So, we can consume a lot of sugar just by drinking regular amounts of liquid without realizing it.

Also, some sugar sources contain ingredients that help to balance out the sugar and help our bodies break it down. Protein, fiber, and fat are good examples. When sugar comes from a source with sufficient amounts of fat or protein, it’s released incrementally into your bloodstream, which helps to avoid the kind of spikes and dips that are particularly unhealthy. So, if you want a cookie, try having it alongside some yogurt with protein and fat to help balance out your blood sugar.

Does the Type of Sugar Matter (e.g., Glucose vs. Fructose)?

In theory, it should matter because our liver is what’s primarily responsible for breaking down fructose. So, part of why food and drinks containing high fructose corn syrup are dangerous is because they can cause the liver to overwork, resulting in all sorts of problems. For example, nonalcoholic fatty liver disease can be caused by a high carbohydrate diet and insulin resistance. Over time, a fatty liver becomes inflamed, which can cause inflammation throughout the body, which, again, is associated with adverse mental health outcomes.

Is Fruit Okay?

You might think, “well, I shouldn’t eat fruit because fruit is high in sugar fruit and it’s high in fructose, which is harder to process,” but naturally occurring fructose isn’t the same as high fructose corn syrup. It’s also coupled with fiber and many other nutrients your body needs to break it down. So, for example, your body can break down the amount of sugar and carbohydrates in an apple in a healthy way because it also comes with things like magnesium and fiber, which it needs to support the good bacteria that help process sugar. So, fruit is not bad. It’s separate from things like gummy bears and other high-fructose snacks.

What About Artificial Sweeteners?

I’m not a fan of artificial sweeteners. They have been linked to things like migraines and changes in the microbiome, and they have to be detoxified by our overworked livers.


Also, even though artificial sweeteners have zero calories, they can still cause an increase in insulin. This is because part of what causes your body to release insulin is the sweet taste of sugar on your tongue.


Whenever you have something sweet, your brain will send signals down to your pancreas saying, “something sweet’s coming down. You better start pumping up insulin.” As a result, your insulin levels will increase, and these spikes can be just as significant as they would be with natural sugar.

So, if you feel like you need to add some sweetness to your beverages, try more natural sweeteners like honey and maple syrup. These may not taste as sweet as table sugar, but over time your taste preferences will adjust to the lower sweetness levels. Another option is to add natural sugar alternatives, like monk fruit or stevia if you like those.


You might think, “well, I shouldn’t eat fruit because fruit is high in sugar fruit and it’s high in fructose, which is harder to process,” but naturally occurring fructose isn’t the same as high fructose corn syrup. It’s also coupled with fiber and many other nutrients your body needs to break it down. So, for example, your body can break down the amount of sugar and carbohydrates in an apple in a healthy way because it also comes with things like magnesium and fiber, which it needs to support the good bacteria that help process sugar. So, fruit is not bad. It’s separate from things like gummy bears and other high-fructose snacks.

What’s a Good Tip for Managing Our Sugar Intake During the Holidays?

My basic recommendation is to be picky about the added sugar you take into your diet. As the holidays continue, it’s important to choose things that you thoroughly enjoy, like really delicious cookies or a great pie. Don’t waste it on sweethearts (unless you really like those, of course). It’s also best to choose something with nutritional value, like dark chocolate, which has antioxidants.

What’s the Best Way to Get Off of a High-Sugar Diet?

The best way is just to go cold turkey. Weaning yourself off incrementally by decreasing the amount of sugar you add to your coffee is generally less effective. Because you get such a robust physiological reward when you have sugar, your body will want more, and you’ll have to endure intense sugar cravings every time. So, it’s best to tough it out for a little while, and you will begin to crave it less.


People in Austin, Texas as well as Texans across the state connect with Sally to supplement their mental health care with nutritional support. Those interested in working with Sally are encouraged to reach out to Heading to set up a consultation.

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Alternative Treatments for ADHD

Alternative Treatments for ADHD

November 14, 2022

Over 1.6 million U.S. adults have attention deficit hyperactivity disorder (ADHD). Characterized by symptoms such as a short attention span, distractibility, forgetfulness, and impulsivity, the condition can pose a significant challenge to maintaining a successful job, managing relationships, and accomplishing personal goals.


Stimulants such as Adderall, Ritalin, and Concerta are the standard treatments for ADHD. These medications work by increasing chemical messengers called dopamine and norepinephrine in the brain’s central nervous system. While highly effective, these medications aren’t the best choice for everyone. Some individuals have other conditions that stimulants can exacerbate, such as:


  • Heart problems
  • Glaucoma
  • An anxiety disorder
  • Tourette’s syndrome
  • A history of psychosis


Even when there are no conflicts with other conditions or difficult side effects, stimulants may not be fully effective. Studies have found that 10 to 30 percent of patients do not respond adequately to stimulants


As a result, it’s important for individuals with ADHD to be aware of the alternatives that can either replace or supplement stimulants.

Non-Stimulant Medications

While stimulants are the most common type of medication used to treat ADHD, they aren’t the only option. Some examples of non-stimulant ADHD medications include:


  • Straterra
  • Clonidine
  • Intuniv
  • Qelbree


As Heading Health Psychiatrist Dr. Arif Noorbaksh notes, while these medications may be less effective, they are “generally safer and better tolerated than stimulants.”


Talk with your physicians to determine whether these non-stimulant alternatives are right for you.

Talk Therapy

Medications aren’t the only way to treat the symptoms of ADHD. For example, research has found that cognitive behavior therapy (CBT) can help with procrastination, time management, and planning.


Aside from addressing the symptoms of ADHD, therapists can also help with some of the stressors it can cause, such as job losses or relationship problems. They can also treat other mental health conditions, such as anxiety and depression, which can exacerbate the symptoms of ADHD. 


Therapists are not the only types of professionals who can help individuals with ADHD overcome their symptoms. ADHD coaches work closely with clients to help them carry out their daily activities in a focused and organized fashion. They provide feedback and suggestions to help them out with tangible goals. They can also help with accountability by checking in on clients to see their progress.

Behavioral Strategies

Even without a professional to guide you, you can make a range of simple changes to your environment and routine that can help you stay focused. Here are a few suggestions.


  • Create a checklist: Having a clear list of what needs to get done can help keep you on track and ensure you don’t forget essential tasks.
  • Decrease distractions: Make a point to limit easy distractions. Make a list of common distractions and avoid them while working on important tasks. Some common anti-distraction strategies may include setting your phone and computer to do-not-disturb mode and avoiding working around your TV. 
  • Try out a fidget device: ADHD can result in excessive fidgeting. Devices designed to channel that fidgeting (e.g., a fidget spinner) can channel it in a healthy way and prevent it from interfering with your ability to concentrate.
  • Set time limits: Though ADHD is associated with distractibility, it can also cause hyper-focused states where individuals zero in on one task for prolonged periods of time. While this can be useful, it can pose a problem if it happens at the expense of other goals. Setting a timer is a quick way to avoid this problem.
  • Create your personal reward system: Positive reinforcement is a well-established technique promoting desired behaviors. Try to give yourself simple rewards, such as a walking break, gold star on a tracking system, or a tasty snack like a piece of chocolate, when you’ve completed a task.  

Support Groups

As with any mental health condition, talking with others who have ADHD can be helpful. Learning that other people experience similar difficulties can mitigate the sense of shame and guilt that individuals with ADHD can experience. Success stories can be a powerful motivator and provide unique strategies for coping with their symptoms and improving overall functioning. Like coaching, support groups can also be helpful for accountability purposes. Knowing that you’ll meet with a group to discuss how you’ve been managing your ADHD may provide additional motivation to stick with your tools and strategies.

Nutrition and Lifestyle Changes

While nutrition and lifestyle habits may not cause ADHD, specific diets and behaviors can help mitigate the symptoms. Sally Twellman, nutritional therapist at Heading Health, recommends:


  • A high-fiber plant-rich diet
  • Brightly colored fruits and vegetables that are high in antioxidants
  • Avoiding processed foods, especially those high in preservatives and artificial dyes
  • Checking for food sensitivities (e.g., gluten allergies).

Aside from diet, exercise has been investigated as a potential tool for alleviating the symptoms of ADHD. For example, a recent meta-analysis found that exercise improves executive function (i.e., mental abilities associated with memory, organization, planning, attention, etc.). Importantly, they found that exercise intensity did not impact the therapeutic effects of exercise, meaning even moderate exercise can help with ADHD.


A good night’s sleep can also have a significant on ADHD symptoms. Though ADHD can make it difficult to get a good night’s rest, a few simple techniques can make sleeping well easier. 


Here are some suggestions:


  • Avoid napping within four hours of your bedtime.
  • Don’t consume caffeine within 12 hours of your bedtime.
  • Go to bed around the same time every time.
  • Develop a calming bedtime routine.
  • Use a blue light filter when looking at screens close to bedtime.
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Complete our consultation form and an intake specialist will get in touch.

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The Basics of Transcranial Magnetic Stimulation

The Basics of Transcranial Magnetic Stimulation

October 5, 2022

Transcranial magnetic stimulation (TMS) is a non-invasive, drug-free procedure that uses magnetic coils to stimulate and influence the brain’s activity. Utilizing a unique mechanism entirely different from the standard array of psychiatric medications, TMS represents an important alternative for individuals who have not responded to other treatment options.


Below are answers to some common questions about TMS.

How Does TMS Work?

Most currently available medical treatments for psychiatric conditions require patients to ingest a drug that eventually enters the brain and alters its functioning in ways that alleviate symptoms of mental illness. For example, selective serotonin reuptake inhibitors, such as Prozac, Zoloft, and Lexapro, latch on to parts of neurons (tiny nerve cells in the brain) and prevent them from reabsorbing serotonin, a change which has been linked to improvements in anxiety, depression, and other conditions.


In contrast to these treatments, TMS is drug-free and noninvasive, meaning its active ingredient is not something that must be ingested or implanted. Instead, TMS impacts the brain from the outside. More specifically, it uses magnetic coils placed just above the scalp to send magnetic pulses into specific regions of the brain associated with mood regulation.

In turn, these pulses induce a series of changes in the brain that improve mood and alleviate symptoms of depression. As Latitia McDaniel, assistant TMS program director at Heading Health states:


By targeting these specific areas of the brain, TMS stimulates and strengthens these neural pathways. Like training a muscle, over time, the inactive signals begin firing and reconnecting properly again, thus restoring the emotional control center.

What Is It Used to Treat?

TMS is approved by the U.S. Food and Drug Administration (FDA) to treat the following conditions:


  • Major-depressive disorder (including treatment-resistant depression)
  • Obsessive-compulsive disorder (OCD)
  • Migraines
  • Smoking Cessation


In addition to being FDA-approved, treatment-resistant depression (i.e., depression that has not adequately responded to one or more antidepressant drugs) is now covered by several insurance companies. At Heading, we work with most insurance plans, from United Healthcare to Medicare to Blue Cross Blue Shield. Click here for a full list of participating providers and to schedule a consultation to determine whether TMS is covered for you. 


Aside from the above-mentioned conditions, researchers continue to examine whether TMS might be useful for other mental illnesses not currently approved by the FDA, including:


  • Bipolar disorder
  • Eating disorders
  • Generalized anxiety disorder
  • Panic disorder
  • Schizophrenia
  • Substance abuse
  • Post-traumatic stress disorder.

What Is the Treatment Like?

TMS treatment for Major Depressive Disorder typically consists of three-minute or 20-minute sessions that occur five days a week over six weeks.


Undergoing TMS is a quick and straightforward process. At each appointment, patients sit in a relaxing chair as the practitioner places the magnetic coil in the correct location on their head. As the treatment begins, patients may feel a light tapping on their head that eventually dissipates. While rare, some individuals may feel some discomfort on their scalp, though this can be resolved by rotating or moving the magnetic coil or through other easy modifications.


After the session has ended, patients are free to drive home and continue their day as usual.

How Does Heading Health Do TMS Differently?

At Heading health, we focus on utilizing the best available tools to ensure our treatments are delivered precisely, reliably, and consistently.


One of the ways we accomplish this with TMS is with the Magstim StimGuide, the first navigational system specifically designed for the clinical market. After the target location has been identified, the StimGuide stores the location using four distinct parameters captured by a 3D snapshot of the treatment area. When administering TMS, this tool helps practitioners consistently identify the target area by emitting a green light when all four parameters are aligned.


In addition, our machines come outfitted with MagStim’s E-Z Cool Coil Coil, which has a built-in intelligence cooling system capable of at least a 37-minute protocol.  


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Nutritional Therapy for Mental Health

Nutritional Therapy for Mental Health

October 1, 2022

When trying to treat depression and anxiety, most people turn to psychotherapy, oral medications, or some other medical intervention.


While these treatments are effective and often a vital part of many individuals’ mental health toolkits, they aren’t the only ways to prevent and treat mental illness. In particular, research increasingly suggests that our diets can have a significant impact on our mental health. For example, a 2017 study found that around a third of subjects who switched to a Mediterranean-style diet no longer had symptoms of depression by the end of the trial, compared to eight percent of the participants who made no dietary changes. 


Nutritional therapists utilize these findings to help patients with a wide range of conditions by offering evidence-based, individualized advice on dietary and other lifestyle changes they can make to support their bodies and, in turn, their minds. 


Let’s look at some answers to common questions about nutritional therapy and its role in mental health. 

How Does Nutritional Therapy Impact Mental Health?

It’s common knowledge that what we eat can impact our physical health. For example, it’s well known that eating a diet high in sugar can increases one’s odds of developing diabetes and that high cholesterol, high sodium diets can increase the risk of developing heart disease.


But how can nutrition have an impact on mental health conditions? While the connections between diet and mental health are complex, there are, essentially, two ways in which what we eat can improve or harm our mental well-being.


First, the nutrients in our food get sent to the brain, altering its functioning in various ways that can impact mental health. For example, antioxidants, found in high levels in fruits and vegetables, can make their way into the brain and decrease oxidative stress, which has been implicated in several mental illnesses. Second, they can impact the health of our gut microbiomes. This collection of bacteria, viruses, fungi, and microbes performs a variety of roles, from producing some of the brain’s serotonin to regulating immune function, which can impact brain health and, ultimately, our psychological well-being.

What Conditions Can Nutritional Therapy Be Used to Treat?

From depression to schizophrenia, nutritional therapy can be used to treat a wide range of mental health conditions. This is partly because many mental disorders are caused or exacerbated by a set of common factors one can impact with their diet. As our resident expert and registered dietician, Sally Twellman notes:


Inflammation appears to be a common factor in mental illness, and dysfunction in the gut is often at the root of chronic inflammation. When you look at the research, regardless of the manifestation of mental illness, symptoms typically improve by decreasing inflammation and replenishing the micronutrients that one needs to thrive. And this is really across the board.

How Does Heading Health do Nutritional Therapy Differently?

Heading Health’s approach to nutritional therapy is unique in several important ways.


First, our nutritional therapy can be combined with in-house teletherapy or telepsychiatry. This is critical because nutritional therapy is often best used to amplify the effects of other treatments, like psychotherapy or medications, rather than as a stand-alone solution. Second, we utilize a holistic, evidence-based approach, which encompasses more than the standard dietary changes, like those involving proteins, calories, and carbs. As Sally notes when discussing her approach to nutritional therapy:


Often when we discuss nutrition modification, we only focus on proteins, calories, fat, and carbohydrates. That’s important. But then we often forget that the real medicine in our food comes from vitamins, minerals, and phytochemicals. If we don’t have those basic building blocks and we don’t have those correct signaling molecules, it’s difficult for our brains to function optimally.


Importantly, we don’t stop at dietary changes. We also include lifestyle modifications (e.g., exercise, meditation, journaling, breathwork, etc.), which are known to positively affect mental health and can enhance the effects of dietary alterations.


Overall, we look at the whole person and consider how they can make small but meaningful adjustments that complement other treatments they are receiving to optimize their mental health.

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Want to find out if Heading is right for you? 

Complete our consultation form and an intake specialist will get in touch.

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