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Cheryl L. Green, MD, is a lifestyle psychiatrist based in Southern California. She is an assistant professor of psychiatry at the Loma Linda University School of Medicine and she has a private practice based in the greater Los Angeles area. Green holds degrees from Harvard University, Princeton University and the Stanford University School of Medicine. She is board certified in psychiatry, child and adolescent psychiatry, and lifestyle medicine and is the author of Heal Your Daughter: How Lifestyle Psychiatry Can Save Her from Depression, Cutting and Suicidal Thoughts. Here she discusses child and adolescent mental health and how lifestyle psychiatry can help.
Question: What health issues are you seeing with children at your practice?
Answer: Those of us in the mental health care professions have known about the deepening crisis in adolescent mental health in the U.S. for many years. However, the U.S. Centers for Disease Control and Prevention (CDC) just released a report, the Youth Risk Behavior Survey (YRBS; CDC, 2023), that quantifies the problem: In 2021, 42 percent of high school students experienced persistent feelings of sadness or hopelessness during the past year, 22 percent seriously considered attempting suicide, 18 percent made a suicide plan, and 10 percent attempted suicide. For teen girls, the figures are even higher: 57 percent felt persistently sad or hopeless during the past year, 30 percent seriously considered suicide, 24 percent made a suicide plan, and 13 percent attempted suicide.
Other than depression and self-injury, the most common types of mental health issues I see in children and adolescents are anxiety, eating disorders, cannabis use, attention deficit hyperactivity disorder (ADHD) and, increasingly, gender dysphoria. The most common types of physical issues I see are weight problems, allergies and asthma. Recent estimates suggest that some 54 percent of our youth—that is, those under 18—have a chronic medical condition.
Question: One of your offices is based in Beverly Hills, CA. Do children in less affluent areas experience similar mental health problems?
Answer: Unfortunately, no socioeconomic group is spared. Whether wealthy Beverly Hills or Palo Alto, or one of the poorest counties in the country, nearby San Bernardino County, the statistics are about the same.
Question: What lifestyle approaches do you recommend for children, and how do children comply?
Answer: Lifestyle Medicine arrived as a board-certified branch of medicine very recently, in 2017. Its premier textbook is Lifestyle Medicine (Rippe, 2019). Lifestyle Medicine provides evidence-based recommendations for how to improve health, including mental health, in six domains. Lifestyle Psychiatry, emphasizing evidence-based recommendations specific to mental health, has also arrived very recently; its first textbook is Lifestyle Psychiatry (Noordsy, 2019).
I recommend the same lifestyle changes for children and adolescents as for adults, but the caregivers of the kids have to help them to implement those. If the caregivers establish a family culture of healthy living, the kids usually will go along with that.
The recommendations are in a state of dynamic change as evidence increasingly becomes available. But for now, the key recommendations in each of the six domains of lifestyle medicine are as follows:
1. For optimal nutrition to prevent, reverse and treat deficiencies associated with depression and other mental health concerns, implement the whole food plant-based diet. “Whole” means natural and unprocessed, with nothing added and nothing taken out of the plant. “Plant-based” means 90 to 95 percent plants, rather than animal products. I do recommend quite a few nutritional supplements for my patients, depending upon the kinds of mental and physical issues they are dealing with. At a bare minimum, since everyone is under stress and needs good brain function: a good broad based micronutrient supplement, extra B-complex vitamins including vitamin B12, green powders such as grass juice extract powders, seaweeds (for the iodine and trace elements), and certain other superfoods.
2. For optimal fitness and to guard against a sedentary lifestyle, which can contribute to both depression and anxiety, teens should exercise 300 minutes each week. This could be 30 minutes five days each week, or 150 minutes each weekend day, or any combination of these that still adds up to 300 minutes per week.
3. For adequate sleep, adolescents require anywhere between seven and 10 hours each night. “Sleep hygiene” is the set of evidence-backed guidelines that promote restful, refreshing sleep. Research shows that the most important of these is getting adequate sunlight, which is between 20 and 30 minutes depending upon the time of day, followed by avoiding blue light in the few hours before bed. Why avoid blue light at night? Because it interferes with melatonin production. I do recommend melatonin supplementation, especially for kids that aren’t willing to address this fundamental problem.
4. Stress Reduction, which consists of four things: decreasing the stressful events and requirements in teens’ lives down to manageable levels, increasing their resilience to stress with coping strategies, decreasing their perceptions of stress with therapies such as mindfulness based stress reduction (MBSR) and cognitive behavioral therapy (CBT), and increasing their awareness of support from family and friends.
5. Soical and emotional connectedness, which involves increasing the amount, depth and/or number of one’s close emotional relationships, in order to combat isolation and feelings of loneliness and to enhance one’s feeling of being supported.
6. Avoidance of, or detoxification from, chemical substances, such as alcohol, nicotine, cannabis and other substances that have been shown to be harmful to the adolescent brain.
Question: Can health care providers integrate these recommendations into their practices?
Answer: Definitely. They can recommend or provide one of several popular books and/or workbooks on lifestyle psychiatry to the parents of their teen patients with mental health issues. They can obtain board certification themselves. Or, they can refer their patients to a board-certified lifestyle medicine practitioner or lifestyle psychiatrist nearby.
Cheryl L. Green, MD, is a lifestyle psychiatrist based in Southern California. She is an assistant professor of psychiatry at the Loma Linda University School of Medicine and she has a private practice based in the greater Los Angeles area. Green holds degrees from Harvard University, Princeton University and the Stanford University School of Medicine. She is board certified in psychiatry, child and adolescent psychiatry, and lifestyle medicine and is the author of Heal Your Daughter: How Lifestyle Psychiatry Can Save Her from Depression, Cutting and Suicidal Thoughts. Here she discusses child and adolescent mental health and how lifestyle psychiatry can help.
Question: What health issues are you seeing with children at your practice?
Answer: Those of us in the mental health care professions have known about the deepening crisis in adolescent mental health in the U.S. for many years. However, the U.S. Centers for Disease Control and Prevention (CDC) just released a report, the Youth Risk Behavior Survey (YRBS; CDC, 2023), that quantifies the problem: In 2021, 42 percent of high school students experienced persistent feelings of sadness or hopelessness during the past year, 22 percent seriously considered attempting suicide, 18 percent made a suicide plan, and 10 percent attempted suicide. For teen girls, the figures are even higher: 57 percent felt persistently sad or hopeless during the past year, 30 percent seriously considered suicide, 24 percent made a suicide plan, and 13 percent attempted suicide.
Other than depression and self-injury, the most common types of mental health issues I see in children and adolescents are anxiety, eating disorders, cannabis use, attention deficit hyperactivity disorder (ADHD) and, increasingly, gender dysphoria. The most common types of physical issues I see are weight problems, allergies and asthma. Recent estimates suggest that some 54 percent of our youth—that is, those under 18—have a chronic medical condition.
Question: One of your offices is based in Beverly Hills, CA. Do children in less affluent areas experience similar mental health problems?
Answer: Unfortunately, no socioeconomic group is spared. Whether wealthy Beverly Hills or Palo Alto, or one of the poorest counties in the country, nearby San Bernardino County, the statistics are about the same.
Question: What lifestyle approaches do you recommend for children, and how do children comply?
Answer: Lifestyle Medicine arrived as a board-certified branch of medicine very recently, in 2017. Its premier textbook is Lifestyle Medicine (Rippe, 2019). Lifestyle Medicine provides evidence-based recommendations for how to improve health, including mental health, in six domains. Lifestyle Psychiatry, emphasizing evidence-based recommendations specific to mental health, has also arrived very recently; its first textbook is Lifestyle Psychiatry (Noordsy, 2019).
I recommend the same lifestyle changes for children and adolescents as for adults, but the caregivers of the kids have to help them to implement those. If the caregivers establish a family culture of healthy living, the kids usually will go along with that.
The recommendations are in a state of dynamic change as evidence increasingly becomes available. But for now, the key recommendations in each of the six domains of lifestyle medicine are as follows:
1. For optimal nutrition to prevent, reverse and treat deficiencies associated with depression and other mental health concerns, implement the whole food plant-based diet. “Whole” means natural and unprocessed, with nothing added and nothing taken out of the plant. “Plant-based” means 90 to 95 percent plants, rather than animal products. I do recommend quite a few nutritional supplements for my patients, depending upon the kinds of mental and physical issues they are dealing with. At a bare minimum, since everyone is under stress and needs good brain function: a good broad based micronutrient supplement, extra B-complex vitamins including vitamin B12, green powders such as grass juice extract powders, seaweeds (for the iodine and trace elements), and certain other superfoods.
2. For optimal fitness and to guard against a sedentary lifestyle, which can contribute to both depression and anxiety, teens should exercise 300 minutes each week. This could be 30 minutes five days each week, or 150 minutes each weekend day, or any combination of these that still adds up to 300 minutes per week.
3. For adequate sleep, adolescents require anywhere between seven and 10 hours each night. “Sleep hygiene” is the set of evidence-backed guidelines that promote restful, refreshing sleep. Research shows that the most important of these is getting adequate sunlight, which is between 20 and 30 minutes depending upon the time of day, followed by avoiding blue light in the few hours before bed. Why avoid blue light at night? Because it interferes with melatonin production. I do recommend melatonin supplementation, especially for kids that aren’t willing to address this fundamental problem.
4. Stress Reduction, which consists of four things: decreasing the stressful events and requirements in teens’ lives down to manageable levels, increasing their resilience to stress with coping strategies, decreasing their perceptions of stress with therapies such as mindfulness based stress reduction (MBSR) and cognitive behavioral therapy (CBT), and increasing their awareness of support from family and friends.
5. Soical and emotional connectedness, which involves increasing the amount, depth and/or number of one’s close emotional relationships, in order to combat isolation and feelings of loneliness and to enhance one’s feeling of being supported.
6. Avoidance of, or detoxification from, chemical substances, such as alcohol, nicotine, cannabis and other substances that have been shown to be harmful to the adolescent brain.
Question: Can health care providers integrate these recommendations into their practices?
Answer: Definitely. They can recommend or provide one of several popular books and/or workbooks on lifestyle psychiatry to the parents of their teen patients with mental health issues. They can obtain board certification themselves. Or, they can refer their patients to a board-certified lifestyle medicine practitioner or lifestyle psychiatrist nearby.
