Julia J. Rucklidge & Bonnie J. Kaplan
University of Canterbury (NZ) and University of Calgary (Canada)
There is a wealth of data emerging showing that 1) traditional diets may play a protective role in mental health outcomes (1-4), and 2) that the Western diet (commonly defined as eating more packaged/processed foods, refined grains, red meat and high fat/sugary foods) as well as early malnutrition appear to be risk factors for poorer mental health outcomes (5-8).
One conclusion we could draw from this research is that if we would simply eat more raw foods, fresh fruits and vegetables, more nutrient dense foods, less processed foods, perhaps more organically grown foods (to eliminate the exposure to herbicides and pesticides that can affect the nutrient status of the crop), and increase our omega 3 intake by eating more fish, then we should all benefit greatly from such a change. We suspect that many people would benefit from an alteration in diet and there is certainly growing evidence that improving diet affects physical health. Whether that is true for mental health needs to be more rigorously tested, and we are encouraged that there are studies currently being conducted around the world attempting to manipulate diet to directly test this hypothesis.
So an important, open question is this: Is it possible that a change in diet is sufficient to prevent mental illness? But we also need to question, are such widespread changes in eating patterns even possible when there are so many powerful forces encouraging us to eat poorly, eat cheaply, and eat fast foods? Could these types of drastic dietary changes come from the grassroots, so to speak; that is, could they be consumer driven? The cultural anthropologist Margaret Mead is credited with saying the following about 60 years ago: “It is easier to change a man’s religion than it is to change the way he eats.” But even if dramatic improvements in dietary intake were achieved, would they really have the effect of remarkably reducing mental and physical outcomes?
Research over the last hundred years has exposed the complex array of risk factors that exist for the various types of mental illness. No one approach is going to effect change for all. Lifestyle changes are just one of a number of modifiable risk factors; a truly huge contribution to improving mental health would be the elimination of poverty and wars. But if we just stick to the issue of diet and mental health, we think that there are people who may have underlying risk factors, perhaps genetic, that lead them to be more vulnerable to changes in diet quality. This possibility means that a change in diet may not achieve the desired effects as compared with someone without such vulnerabilities.
There was an excellent, high quality study in the UK published over 15 years ago (9) showing that fresh vegetables and fruit have lower levels of nutrients than they did 50 years previously (and this research was before the emergence of GMO, which is now being shown to impair plants’ ability to absorb and sequester dietary minerals (10, 11)). If this reduction in nutrient quality is widespread, then even if people choose to eat foods perceived as nutrient dense, they may not be getting as nutritious a diet as they think. Further, add in possible genetic risks that may result in poorer processing or utilization of the nutrients that are consumed, then a dietary change alone may not be sufficient for everyone. Bruce Ames, neurobiologist and biochemist at the Children’s Hospital of Oakland, California, has written about how a third of the known genetic mutations causing inborn errors of metabolism result in the production of less efficient enzymes and slower metabolic processes (12). But research has demonstrated that high doses of key vitamins can restore enzymatic activity to normal levels in people who have any of those genetic mutations.
One solution to this problem would be to not only change diet but also supplement with vitamins and minerals to provide the body with the full complement of micronutrients required for the brain to function effectively and optimally. There is now evidence for the benefits to people with mental illness of taking additional nutrients. We recently scoured the literature and reviewed all trials that had been done using broad-based micronutrient formulas for the treatment of all kinds of challenges ranging from depression to anxiety to autism and ADHD. The results of our systematic review (13) were generally supportive of nutrients reducing these symptoms in people who had the symptoms to begin with. This is an important caveat as there have been some studies that have been done on nonclinical populations that do not show benefit; however, these studies cannot be extrapolated to clinical populations.
This conclusion, showing that there is value to using micronutrients to directly treat psychiatric symptoms, was drawn from all types of studies, ranging from randomized controlled trials (RCTs) to case studies and naturalistic studies. There are numerous RCTs comparing micronutrients to placebo showing that the active groups as compared with the placebo groups had lower rates of rule infractions in prisons, lower stress, better mood, improved behaviours associated with autism, less aggression, etc (14-18). There is even some research to support that in nonclinical populations, positive changes occur in general wellbeing (19). So are we simply creating expensive urine when using micronutrients to treat mental illness? We think the evidence is strong enough to say no. But as always, we need more data to better understand mechanisms, the importance of doses, which combination of nutrients may be essential, and how applicable this approach is across all mental disorders, both for prevention and treatment.
References
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2. Jacka FN, Pasco JA, Mykletun A, Williams LJ, Nicholson GC, Kotowicz MA, et al. Diet quality in bipolar disorder in a population-based sample of women. J Affect Disord. 2011;129(1-3):332-7.
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14. Adams JB, Audhya T, McDonough-Means S, Rubin RA, Quig D, Geis E, et al. Effect of a vitamin/mineral supplement on children and adults with autism. BMC Pediatr. 2011;11(Journal Article):111-2431-11-111.
15. Rucklidge JJ, Frampton CMA, Gorman B, Boggis A. Vitamin-mineral treatment of ADHD in adults: A double-blind, randomized, placebo controlled trial. Br J Psychiatry. in press.
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17. Rucklidge JJ, Andridge R, Gorman B, Blampied N, Gordon H, Boggis A. Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology: Clinical and Experimental 2012;27(5):440-54.
18. Gesch B, Hammond S, Hampson S, Eves A, Crowder MJ. Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Br J Psychiatry. 2002;181:22-8.
19. Long SJ, Benton D. Effects of vitamin and mineral supplementation on stress, mild psychiatric symptoms, and mood in nonclinical samples: A meta-analysis. Psychosom Med. 2013;75(2):144-53.