Newsletter | Why Comfort Foods Make Us Unhappy

Comfort food is supposed to make us feel better - it’s right there in the name. And indeed, most people choose comfort foods when they want to feel better (see chart, below, from a 2019 survey). But does it actually make us feel better - as in, does it improve our mental health? And are there other foods they might actually do the job better?

First off, let’s agree that most comfort food is not food that’s generally considered healthy, nutrition-wise. It’s typically calorie dense, nutrient poor, and lots and lots of cheese. In surveys, Americans have said their fave comfort foods are mac and cheese, spaghetti and meatballs, mashed potatoes and gravy, pot pies, meatloaf, casseroles, and chili. You know, the stuff that we eat because we crave it. 

One clever study found that, during the stress of the early lockdown period of the COVID epidemic, consumption of comfort foods - fast food and foods high in fat and sugar and salt - rose in close correlation with emotional distress. We get stressed, and our brain craves stuff that makes us happy.

These foods, of course, bring us “comfort” because our brains are primed to crave fat and sugar and salt - those ingredients trigger a dopamine response in the brain, which is why we eat so much of them when they hit the table. Comfort foods, moreover, also often evoke cultural traditions, or nostalgic memories - which doubles down on the emotional reward we get when we eat them. 

But dopamine is a double edged sword, and too much of it doesn’t make anyone feel better - quite the opposite. “The more pleasure you seek, the more unhappy you get,” says Dr. Robert Lustig, one of our heroes at Building H and author of Hacking the American Mind, his 2018 book that explores the national pursuit of dopamine at the expense of true happiness and health.

And many have suggested that suggests that ultra-processed versions of these foods could reasonably be called "addictive." And research out this week raises key questions about the idea of addictive foods (ie, foods that we can't stop eating even though they are bad for us). 

What we do know is that so-called “comfort foods” are actually much more likely to make us unhappy. A 2017 meta-analysis published in Psychiatry Research of studies that explored dietary patterns and depression found that low-quality diets – high fat and sugar and salt intake, and low fruit and vegetable consumption (what this study calls a “western diet,” which everybody in the West should be ashamed of) – are associated with higher psychological distress, increased anxiety, and higher depression rates.

Which suggests that foods that we already know are bad for us are actually doubly bad for us, in both body and soul. And which also suggests that so-called comfort foods actually make us less happy and less comfortable in very real ways. 

But some foods, it seems, actually can make us feel better - and even promote mental health and emotional well-being. 

That same 2017 meta-analysis also found that “high intakes of vegetables, fruits, whole grains, olive oil, fish, soy, poultry and low fat dairy shows an obvious evidence of a decreased risk of depression.” Indeed, the risk of depression was 30% less among people who ate these foods primarily.

Other research, including gold-standard randomized clinical trials, have underscored this potential advantage - and not just for depression. A 2017 study - the SMILES study (short for, ahem “Supporting the Modification of lifestyle In Lowered Emotional States”, researchers will always love their acronyms) provided subjects with dietary coaches who helped them stay on “healthy” diets: lots of grains, veggies, nuts, fruit, and olive oil. “The diet was designed to be easy to follow, sustainable, palatable, and satiating,” the researchers say, a bit boastfully. And sure enough, after just 12 weeks, the test group showed significant improvement in depression scores. (The coaching and the social support may have helped, of course.) 

TheHELFIMED study (not as good an acronym, really) of 2019 focused explicitly on a Mediterranean diet and fish oil supplements and gave test subjects with depression food boxes with healthy foods, combined with cooking instructions. The control group (also with depression), significantly, were invited to social groups. And lo! The food group had better depression scores after three months and after six months.

Other studies took the idea further. A 2015 study found that a Mediterranean diet actually promotes brain health in aging and prevents cognitive decline. And more. And more. 

OK, enough studies. Basically, the evidence argues that diet can play a huge negative and positive role in our mental health - and the actual foods line up neatly with what we already know helps us with our physical health.

In the academic and clinical arena, this is described as the emerging field of “nutritional psychiatry,” which is, in many ways, tremendously exciting, because it offers a scientific foundation for the idea that food can be medicine not just for our physical health (cardiovascular, diabetes) but for our mental health (depression, anxiety) as well as neurological health (cognition, Alzheimers).

[A quick caveat: It’s easy to exaggerate the potential of food and food alone to heal our mental health. It’s notoriously difficult to parse signal from noise in nutrition science, and the temptation to stretch suggestive evidence into a list of 10 Supplements to Take has proven too alluring for many otherwise well-trained scientist types (for a convincing take-down of one of these takes, here’s a good point by point critique by McGill University’s Jonathan Jerry).]

But: Allow us to just flag a concern here, for the propensity of academics to academe. If this is all relegated under the rubric of nutritional psychiatry, it’s worth thinking about why this should all fall to psychiatrists. Should this idea of good food for mental health really live as a pathologized treatment for people already deep inside the clinical system, rather than flourish as a generalizable set of knowledge for people not under clinical care?

Here’s what we mean. In the US, we approach health too often from a clinical perspective, rather than a social perspective - and for mental health, this means that psychiatrists become the optimal provider. Which they may be, for medical purposes!

But it’s also true that there is a profound and prolonged shortage of psychiatrists in the US. Already, today, psychiatrists are among the most difficult of all doctors to schedule a visit. There are only 40,000 psychiatrists in this country today, and that number is predicted to shrink by at least 20,000 by 2030. Which is definitely in the wrong direction. And by the time someone has actually gone through the maze of talking to a therapist or primary care doc about their mental health and they are ready to actually seeking psychiatric help, it’s pretty much a given that problems have manifest for a long while.

Meanwhile, there is a growing awareness of and conversation about the importance of mental health, and the emergence of new ideas - like nutritional psychiatry - that might offer new avenues to treat mental health.

So if we’re talking about something relatively easy for people to do, like adjust their diets for better mental health, why would we relegate that emerging knowledge - that actionable information - to psychiatry?

Which is why we think we should find ways to universalize this information - make it something that doesn’t demand clinical care but is just generally understood as another basic benefit of a healthy diet. Food is a social thing, first and foremost. It exists in our lives long before we go to the doctor. Food is not a pathology.

We hope this has been of some comfort to you.

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