This is the title of an article published, of all places, in the Australian and New Zealand Journal of Psychiatry. It draws on research studies looking at the depletion of nutrients in our food supply, exacerbated by poor diets, and inborn errors of biochemical pathways, that may be contributing to the rise in mental illness. Historically, the medical profession is slow to accept nutritional interventions as they do not fit within the existing theoretical framework of the cause of mental disorders.
This is an abridged version of the full article, which you can download from the Australian and New Zealand Journal of Psychiatry.
“We are at a tipping point in psychiatry. With few psychiatric drugs on the horizon and long-term studies suggesting medication may do more harm than good, it is time to revisit the very old idea that nutrition can have a positive effect on mental health.”
“A randomised placebo-controlled trial (RCT) in the British Journal of Psychiatry (Rucklidge et al., 2014), documented that adults with attention deficit hyperactivity disorder (ADHD) consuming a broad spectrum of nutrients showed greater reduction in ADHD symptoms than those taking placebo, with medium-to-large effect sizes. For a subgroup who entered the trial with moderate-to-severe depression, there were twice as many going into remission in the micronutrient group compared with the placebo group. In addition, the benefits of micronutrients continued through the 1-year follow-up.”
“There are now over 20 placebo-controlled RCTs showing the benefit of multinutrients in treating stress, anxiety, aggression in prisoners, low mood, autism and ADHD (Rucklidge and Kaplan, 2013). Other research, especially from Australia and Europe, has supported the link between nutrition and mental disorders by showing that diets higher in vegetables and fruits are associated with lower depression and anxiety, whereas diets low in vegetables and fruits and higher in processed foods are related to higher rates of depression and anxiety (Jacka et al., 2012).”
Why might adding multiple nutrients in combination influence mental health?
“Every neurotransmitter goes through many metabolic steps to ensure its synthesis, uptake and breakdown. Every step requires enzymes, and every enzyme is dependent upon multiple coenzymes (cofactors). A variety of minerals and vitamins are required as cofactors in most if not all of those steps. One possible mechanism underlying psychiatric symptoms is inborn metabolic dysfunction associated with slowed metabolic activity due to suboptimal availability of mineral and vitamin cofactors. Impaired brain metabolic activity connected with other disorders, has been shown to be correctable through nutrient supplementation (Ames et al., 2002).”
“Multinutrient supplementation could provide sufficient cofactors that even enzymes with drastically reduced activity become so supersaturated that near-normal function is restored. Alternative mechanisms have been hypothesised as explanations for the effect of nutrients on brain function, such as improved energy metabolism including increased mitochondrial production of adenosine triphosphate (Rucklidge and Kaplan, 2013).
It is possible that diminished nutrient content of our food supply might play a role in the success of these broad spectrum nutrient formulas (Rucklidge and Kaplan, 2013). Data indicate that the minerals and vitamins of fruits and vegetables have decreased significantly, partially as a result of the poor remineralisation of the soil. It is possible that some individuals are highly sensitive to these nutrient depletions, as biochemical needs are known to vary across people.”
“As micronutrients cannot be patented and regulations on micronutrient formulas are variable, companies have little to gain by funding clinical trials. If there were additional RCTs [Random Controlled Trials] funded of both paediatric and adult psychiatric symptoms, or of children who are at risk of developing psychiatric disturbances, we could generate much more knowledge about the potential value of various combinations of minerals and vitamins for preventing and treating mental illness. The potential societal benefit of this inexpensive treatment is profound: for saving lives, restoring families, preventing job loss and saving our healthcare dollars.”
“Clearly, nutrient supplementation will not benefit everyone, but currently we do not even have sufficient information as to who might benefit. In the largest of our studies thus far, approximately 50% of both adults and children experienced a 50% reduction in bipolar symptoms after 3 months consuming a multinutrient formula, an improvement sustained at 6 months. Although that improvement seems modest, it is comparable (and occurs with no side effects) to the improvements attainable through psychopharmacology. As current estimates are that 30–40% of Western populations will experience a significant mental disturbance at some point in their lifetime, our societies may be missing an opportunity to assist millions of people at little cost.”
Slow Acceptance of Nutritional Interventions
“Slow acceptance of nutritional interventions is not unusual (Berwick, 2003). Captain James Lancaster carried out a cohort study in 1601, which showed that lemon juice prevented scurvy. In a voyage from England to India, sailors on one ship took daily lemon juice and those on the other three did not. Halfway through the voyage, none of those on the ship taking lemon juice had died, whereas 40% of the sailors on the other three ships had perished [Imagine trying to do the same experiment today and getting it through the ethics committee!] The experiment was repeated 146 years later in 1747 by James Lind, a physician. Despite the evidence, practices did not change. It took another 48 years for the British Navy to order citrus fruits be provided on navy ships; however, universal preventive policy was not enacted for another 70 years when the British Board of Trade adopted the innovation (Berwick, 2003). In other words, 264 years passed from the first trial to the change in national policy.”
“One situation that contributes to slow acceptance of new data is the circumstance of new findings not fitting existing theoretical frameworks. The growing body of literature on the effect of nutrients on mental health is compelling enough and consistent enough for us to pay attention. It is time to revisit the role of diet and supplementary nutrients in the treatment of mental illness and to invest in this line of research.”
Wouldn’t it be encouraging if more psychiatrists took note of this type of research rather than treating it as an interesting curiosity. Dr Kelly Brogan is a psychiatrist and a very strong advocate of psychiatry to move away from pharmaceutical prescribing.
