A brand new paper published by “The Lancet” in March 2015 called “Nutritional medicine as mainstream in psychiatry” suggests that “there is emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders”.
Oh well, I don’t know whether this is really “emerging evidence” because lots of mental health experts that I follow, like for instance Dr Bill Walsh from The Walsh Institute, have been researching and showing evidence in this area for centuries.
It’s great to see, though, that reputable international organisations like the International Society for Nutritional Psychiatry Research (ISNPR) start to acknowledge the link between nutritional deficiencies and mental health. An increasing number of psychiatric doctors are starting to use nutrient-based supplements to address deficiencies.
The field of “nutritional psychiatry” is rapidly growing and includes researchers from around the globe from the fields of nutrition, mental health, population health and epidemiology.’
In the past few years, several links have been established between nutritional status and mental health. Scientifically rigorous studies have contributed to a better understanding of how we can use nutrition in mental health issues.
The mechanisms by which nutrition affects brain health are the following:
- The brain is metabolically very active and requires a substantial amount of energy and nutrient intake.
- It relies on amino acids, fats, vitamins, minerals or other trace elements.
- Nutrients are responsible for the health and function of nerve cells.
- Dietary habits can change the functioning of the immune system, which moderates the risk for depression.
- The antioxidant defence system has been shown to play an important role in mental disorders. It operates with the support of nutrient cofactors and phytochemicals.
Here is an overview of the most recent research findings- for those who are interested in digging deeper:
- There is a connection between healthy dietary patterns and a reduced prevalence of depression and suicide.,
- Maternal and early-life nutrition is crucial for later mental health outcomes in children.
- Severe macronutrient deficiencies during important development periods impact both depressive and psychotic disorders.
- There is a link between unhealthy dietary patterns and poorer mental health in children and adolescents.
- A randomised controlled trial designed to explore the efficacy of dietary improvement as a treatment for major depression is currently underway.
But what does this mean in practice, i.e. how do we best eat for mental health? Again, “a healthy, balanced diet” is usually not the answer most of us are looking for.
A first important step is certainly to remove processed foods and move as rapidly as possible towards a whole foods diet. This means cooking every meal from scratch- or using leftovers or frozen meals previously cooked- and not using any packaged foods with a huge list of ingredients or any ingredient that you don’t recognise.
It can be a huge undertaking for some people and scare them off making any change at all. The expert panel who wrote the paper I mentioned in the opening paragraph of this article therefore calls for governments to take steps to improve food quality and promote healthier dietary practices. Activities of the food industry need to be examined, too.
And, what is very important to know as well when it comes to brain health, we rely on a number of key nutrients that are ideally part of our diet but can also be supplemented. Here is an overview of the most important ones:
Omega-3 fatty acids
- They modulate neurotransmitter (noradrenaline, dopamine and serotonin) re-uptake, degradation, synthesis and receptor binding.
- They have shown to have anti-inflammatory effects, improve cell membrane fluidity and contribute to the growth and development of nerve tissue.
- Best food sources are: oily fish (sardines, mackerel, anchovies, salmon, trout), chia/hemp/flax seeds and grass-fed meat.
S-adenosyl methionine (SAMe)
- SAMe is methionine, an amino acid, bound to an ATP (the “energy currency” of most cells) molecule. It is a natural reuptake inhibitor for serotonin, dopamine and norepinephrine.
- Thanks to epigenetics (the study of how we express our genes- I will come to that topic in the future), we now have a much clearer idea of the importance of methylation therapy in mental health. I have learned a great deal from Dr Bill Walsh in that area.
- Both methionine and SAMe increase histone methylation, which can inhibit gene expression of serotonin proteins. As a result, the amount and activity of serotonin in synapses is increased.
- Methionine is most abundant in eggs, fish, meat and also nuts. SAMe can’t be found in food and needs to be supplemented. In some countries like Ireland, however, the use of SAMe is banned and it can’t be bought in supplement form. One way around this is to supplement methionine in combination with a calcium/magnesium complex.
N-acetyl cysteine (NAC)
- NAC can serve as a precursor to glutathione, which is the master antioxidant in the body composed of three amino acids (glycine, glutamic acid and cysteine). It has been shown to decrease during the ageing process and is particularly low in neurons.
- There is evidence that NAC is effective in bipolar depression, schizophrenia, trichotillomania and other compulsive or addictive behaviour patterns.
- In addition to their functions in the glutathione antioxidant cascade, NAC and glutathione can also serve as inhibitors of pro-inflammatory molecules.
- It is possible to boost glutathione levels naturally by eating nutrient-dense foods. Raw milk and whey protein made from grass-fed, raw milk can be a great source but I don’t recommend them for severely immunosuppressed patients or also for cancer patients.
- Zinc is a trace mineral essential to all forms of life. According to Dr Bill Walsh, zinc deficiency is by far the most frequent chemical imbalance in people with mental health issues. More than 90% of individuals diagnosed with depression, behavioural disorders, ADHD, autism and schizophrenia show depleted plasma zinc levels.
- Zinc metallothionein is a key component of the blood-brain barrier that prevents harmful/toxic substances from accessing the brain.
- Zinc is required for the conversion of dietary Vitamin B6 into PLP, which is needed for synthesis of serotonin, dopamine, GABA and other neurotransmitters.
- It is quite easy to have sufficient zinc in the diet by eating seafood (oysters), pumpkin and sunflower seeds, spinach, Pecan nuts and lamb/beef/turkey. Copper is the antagonist to zinc, so reducing copper levels often helps boost zinc. I personally had very high levels of copper and corrected this by supplementing high amounts of zinc for a good while.
- They are needed for proper neuronal function and for generation of ATP in cells.
- Vitamin B6 in particular is extremely important as it is required for synthesis of serotonin, dopamine and GABA. The chemical form pyridoxal-5-phosphate (PLP or P5P) is the activated form of B6 in the body and brain.
- The role of folic acid is quite complex- undermethylated individuals can get worse on folic acid supplementation. It is important to consult a healthcare practitioner who has a good understanding in epigenetics before starting to supplement in large doses.
- Food sources for good amounts of B Vitamins are nuts, fish, eggs, liver, sunflower seeds and mushrooms.
- This is a hormone-like vitamin with many important functions in the body.
- Data suggests that low maternal concentrations are associated with risk for schizophrenia.
- Deficiency is linked to increased depressive symptoms.
- The best natural source is direct sunlight (often there is no absorption possible in the winter). Food sources are cod liver oil and the flesh of fatty fish (e.g. salmon or mackerel). Small amounts can be found in liver, egg and cheese.
In addition to all these nutrients, I can’t emphasise enough how important the gut flora is for good mental health. Patients with coeliac disease, for instance, have a 51.4% increased risk of developing a neurological disorder. Considering that many people are still undiagnosed with this disease, this can have a huge impact on behavioural disorders.
Recent studies also investigate how and if the ketogenic diet could be beneficial for mental health issues. One recent paper shows that it can be helpful in bipolar disorder, for instance. This makes sense because there is evidence that a significant number of patients suffer from glucose dysregulation. This means that their blood sugars go up and down throughout the day (and night) and that this can trigger a series of symptoms, including anxiety, irritability, poor concentration and depression.
I’ve had a number of reports from patients who experienced a significant improvement in migraines through a ketogenic diet. A whole new area of research is opening up in this area. From a nutritional perspective, blood sugar control certainly seems one of the key factors in managing mental health disorders.