By Marika Sboros
Nutritional psychiatry is an idea whose time has come. That raises a question: What took the medical profession so long to embrace it?
Among global leaders of nutritional psychiatry is US psychiatrist Dr Georgia Ede. In a recent article in Psychology Today, Ede explores optimum nutrition for mental health. She looks at why we humans can’t thrive on plants alone and why our brains must have animal fats for optimum functioning.
Dietary fat is not just for insulation and energy storage, Ede writes. It’s also for “nutrient absorption, cell signalling, immune function, and many other critical processes”.
Yet many people are still fat-phobic. They also think that animal-sourced foods contain more (and dangerous) saturated fat than plant foods.
Ede offers a few “fun, fatty facts”. One is that all whole plant and animal foods naturally contain a mixture of saturated and unsaturated fats. And that some plant foods are higher in saturated fat than animal foods. By way of example, coconut oil tops the charts at 90% saturated fat.
“That’s more than twice the saturated fat found in beef fat (tallow),” she says.
Despite that, public health officials regularly tout plant fats as “magically” rich in important PUFAs (polyunsaturated fatty acids, Ede writes. They claim that the human body cannot manufacture and, therefore, we must get them from our diet.
Ede explains why science doesn’t back that up. In particular, she looks at the crucial role of DHA. She calls it “a very special essential omega-3 fatty acid called docosahexanoic acid”.
Ancient molecule for modern times
It’s an ancient molecule, she says. It “so useful to us and our fellow vertebrates (creatures with backbones) that it has remained unchanged for more than 500 million years of evolution”.
DHA’s job description is “a lengthy one”, she says. Among many other functions, DHA participates in the formation of myelin, the white matter that insulates our brain circuits, she says. “It also helps maintain the integrity of the blood-brain barrier, which keeps the brain safe from unwanted outside influences.”
DHA is also critical to the development of the human cortex. That’s the part of the brain responsible for higher-order thinking. Without DHA, the brain cannot form all highly sophisticated connections necessary for sustained attention, decision-making and complex problem-solving, she says.
It’s also possible “that without DHA, consciousness and symbolic thinking—hallmarks of the human race—would be impossible”.
US paediatric specialist Dr Tom Brenna, of the Dell Pediatric Research Institute at the University of Texas, is similarly expansive in praise of DHA. He has said that DHA is “to the brain what calcium is to the bones”.
And on Twitter recently, US cardiovascular researcher, Dr James DiNicolantonio offered a neat “trick” to eating the “most bioavailable form of DHA”. That’s one that gets directly into the brain, he says. It is wild salmon eggs that he takes “swallowed and chased down with sparkling mineral water”.
Nutrition alone won’t do it?
DiNicolantonio has written elsewhere on the powerful anti-inflammatory benefits of DHA, including in the BMJ. In another tweet, he also says that nutrition is just one element of future treatment. He cites too much stress, lack of sunlight, exercise, and meaningful employment as other factors contributing to low mood.
If you still doubt that nutritional psychiatry really is the future of mental health treatment, US psychiatrist Dr Ann Childers dispels it in an instant. Childers is a child, adolescent and adult psychiatrist. She has done extensive research into food and mood.
Yet another fan of nutrition in psychiatry is UK academic Dr Joyce Cavaye, a senior lecturer in the Open University School of Health, Wellbeing and Social Care. Here is an article she wrote on nutritional psychiatry in The Conversation:
A lack of essential nutrients is known to contribute to the onset of poor mental health in people suffering from anxiety and depression, bipolar disorder, schizophrenia and ADHD. Nutritional psychiatry is a growing discipline that focuses on the use of food and supplements to provide these essential nutrients. It is part of an integrated or alternative treatment for mental health disorders.
But mainstream medicine does not widely accept nutritional approaches for these debilitating conditions. Official National Institute for Care Excellence (NICE) guidelines tend to be the limit of treatment options. The guidelines recommend talking therapies and antidepressants.
Use of antidepressants
Antidepressant use has more than doubled in recent years. In England, doctors issued 64.7m prescriptions for antidepressants in 2016 at a cost of £266.6m. This is an increase of 3.7m on the number of items that doctors prescribed in 2015 and more than double than the 31m they issued in 2006.
A recent Oxford University study found that antidepressants were more effective in treating depression than placebo.
Dr Andrea Cipriani led the study and claimed that depression is undertreated. Cipriani maintains that antidepressants are effective. And that doctors should issue a further 1m prescriptions to people in the UK.
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This approach suggests that simply dispensing drugs easily treats social conditions that cause poor mental health. But many people shun antidepressants despite the benefits. They do so because of the social stigma associated with mental ill-health which leads to discrimination and exclusion.
More worrying is the increase in the use of antidepressants by children and young people. In Scotland, doctors prescribed antidepressants to 5,572 children under 18 for anxiety and depression in 2016. This figure has more than doubled since 2009/2010.
But according to British psychopharmacologist Professor David Healy, 29 clinical trials of antidepressant use in young people found no benefits at all. These trials revealed that instead of relieving symptoms of anxiety and depression, antidepressants caused children and young people to feel suicidal.
Nutrition and poor mental health
Healy also challenges their safety and effectiveness in adults. He believes that doctors over-prescribe antidepressants and that there is little evidence that they are safe for long-term use. Research also shows that antidepressants create dependency and have unpleasant side effects. And that patients cannot always rely on them to relieve symptoms.
In developed countries, such as the UK, people eat a greater variety of foodstuffs than ever before. But it doesn’t follow that they are well-nourished. In fact, many people do not eat enough nutrients that are essential for good brain health. They opt instead for a diet of heavily processed food containing artificial additives and sugar.
Nutritionists working in the complementary health sector have long recognised the link between poor mental health and nutritional deficiencies. However, psychiatrists are only now becoming increasingly aware of the benefits of using nutritional approaches to mental health. They are calling for their peers to support and research this new field of treatment.
Research shows that inflammation in the brain causes many mental health conditions and ultimately causes our brain cells to die. This inflammatory response starts in our gut and is associated with a lack of nutrients from our food such as magnesium, omega-3 fatty acids, probiotics, vitamins and minerals. All are essential for the optimum functioning of our bodies.
Recent research has shown that food supplements such as zinc, magnesium, omega 3, and vitamins B and D3 can help improve people’s mood, relieve anxiety and depression. These can also improve the mental capacity of people with Alzheimer’s.
Magnesium is one of most important minerals for optimal health, yet many people are lacking in it. One study found that a daily magnesium citrate supplement led to a significant improvement in depression and anxiety, regardless of age, gender or severity of depression. Improvement did not continue when patients stopped taking the supplement.
Omega-3 fatty acids are another nutrient that is critical for the development and function of the central nervous system. Research associates a lack with low mood, cognitive decline and poor comprehension.
Psychiatrists and nutritionists have also explored the role of probiotics – the beneficial live bacteria in your digestive system – in improving mental health. Their research associates a daily intake of probiotics with a significant reduction in depression and anxiety. Vitamin B complex and zinc are other supplements found to reduce the symptoms of anxiety and depression.
These over-the-counter” supplements are widely available in supermarkets, chemists and online health food stores, although the cost and quality may vary. For people who have not responded to prescription drugs or who cannot tolerate side effects, nutritional intervention can offer hope for the future.
There is currently much debate over the effectiveness of antidepressants. The use of food supplements offers an alternative approach. It has the potential to make a significant difference to the mental health of all age groups.
The emerging scientific evidence suggests that there should be a bigger role for nutritional psychiatry in mental health within conventional health services. To reduce the burden of mental ill-health, GPs and psychiatrists need to be aware of the connection between food, inflammation and mental illness.
Medical education has traditionally excluded nutritional knowledge and its association with disease. This has led to a situation where very few doctors in the UK have a proper understanding of the importance of nutrition. There is a perception that there is little evidence to support the use of nutritional interventions to prevent or maintain well-being. So it has been left to dietitians, rather than doctors, to advise on.
But as the evidence mounts up, it is time for medical education to take nutrition seriously. That will allow GPs and psychiatrists of the future to know as much about its role in good health as they do about anatomy and physiology. The state of our mental health could depend on it.