Martina Watts, who both organised and spoke at this conference in December, reports:
Last year, the food campaigner Sustain and the Mental Health Foundation reported how dietary changes may be one of the driving forces behind the rising tide of mental health problems. (see Foods Matter, Feb 2006).
Depression has increased twenty-fold since 1945 and, according to the WHO, is set to become the second highest cause of the global disease burden by 2020. Intensive farming and the way our food is produced and stored have altered the balance of nutrients it contains, thereby potentially affecting function and structure of the brain.
Modern diets and food choices are completely at odds with that of our hunter-gatherer ancestors, who depended on good ‘brain food’ to survive. In the UK, we eat only small amounts of a few types of fruit and vegetables, few wholegrains and little oily fish. Instead, refined carbohydrates, altered fats, intensively reared meat and dairy products, and unknown combinations of synthetic chemicals are consumed on a vast scale. How does this affect the way we feel, think and behave?
On 6th December, a well-attended Pavilion conference in Manchester examined the latest scientific evidence on how diet, lifestyle and environment influence our mood and behaviour. Scientists and clinicians demonstrated cost-effective ways in which nutritional and lifestyle strategies can be used to improve mood disorders, or employed as a viable add-on treatment to drug regimes.
No Cure – but Some Help
Dr Andrew MuCulloch, Chief Excecutive of the Mental Health Foundation, admitted there is little clinical evidence diet can cure or prevent mental health problems. However, a nutritious diet may relieve the symptoms of mental illness, reduce the side effects of antidepressants and improve their effectiveness. A ‘Mood and Lifestyle Clinic’ at Doncaster and South Humber NHS Trust recently found that exercise and diet were as effective as anti-depressants. Although food intake is often restricted in depressive illness, a high intake of EFAs appears to be protective and treatment with micronutrients (eg folate, zinc, vitamins B1, B2 and C) helpful. Andrew suggested it is time nutrition becomes a mainstream component of mental health care and promotion. Diet needs to be a factor in the life style assessment for people with mental illness and services should routinely provide dietary advice.
Link between Fish Eating and Depression
Consultant Dietitian, Dr Lynn Harbottle explained the link between low intakes of fish and high levels of depression and suicide worldwide. Studies suggest that those with depression have lower levels of omega 3 fatty acids in their blood, and that improvements in depressive symptoms may be possible when the essential fatty acid EPA is given together with an antidepressant. A one gram dose has been shown to give the best result, giving more has not been found helpful. However, Lynn warned that studies in genetics suggest fishoils have an anti-inflammatory effect for some, but for others the effect may be pro-inflammatory. She also advised that cod liver oil should be avoided as it is high in vitamin A which is toxic in high doses. Furthermore, many commercial fishoils are contaminated with marine pollutants. Many people who are depressed tend to eat diets high in sugar, stimulants and low in nutrients. The advice was for regular oily fish intake (2-4 portions per week) and to choose purified, vitamin A free supplements. In addition, a healthy diet with baseline nutrients is required, otherwise omega 3 supplementation might do harm rather than good.
Mental Health and Immune Function
The keyspeaker, Michael Ash, Nutritionist and Founder of the Eldon Health Clinic, explained that depression occurs more frequently in those with medical conditions associated with immune dysfunction. Our brain and immune system talk to each other constantly using specialised ‘cell-messengers’ called cytokines which come in two varieties: pro-inflammatory and anti-inflammatory.
Researchers have identified that consistently raised levels of pro-inflammatory cytokines in the body cause lack of energy, appetite suppression, sleep disturbances, changes in mood and loss of interest. If we cannot produce appropriate anti-inflammatory cytokines to restore the balance in response to a psychological factor like stress, or a physical threat in form of a virus or bacteria, some people may develop depressive episodes. This type of depression is not just a reaction to the illness, but caused by cytokines provoking an immune system which has lost its ability to return to a state of neutrality. Anti-depressant drugs may further inhibit the production of these crucial anti-inflammatory cytokines.
Michael believes that one reason for the increase in depressive disorders may be a failure to develop a fully functional and appropriately matured mucosal immune system in the gut and colon, sometimes due to our exposure to antibiotics from an early age. Nutritional programmes that influence cytokines are new but show considerable promise.
Trace Elements, Mood and Behaviour
Conference Chair, Dr Neil Ward, Senior Lecturer in Chemistry at the University of Surrey, explained the impact of trace elements on mood and behaviour. Deficiencies in selenium, zinc and chromium are commonplace and may play an important role in mood disorders. Toxic elements, such as aluminium, cadmium and lead have long been associated with anti-social behaviour. In addition, toxic metals block the utilization of essential trace elements such as calcium, iron, magnesium and zinc which are required for the normal development of the brain and immune system. Many mechanisms are yet unknown, but there is strong evidence of a link between trace element status and human behaviour, and more data and case studies are required.
Excercise, Green Space, and Mental Health
Jo Peacock, leading researcher of the Green Exercise programme at the University of Essex, explained the synergistic health benefits of participating in physical activities whilst being directly exposed to nature and green space. Even short exposure was shown to have mental, physical and social health benefits, such as lowered blood pressure, increased self esteem and mood, and a lowering of feelings of anger, depression and tension. Key challenges are to improve accessibility to all social groups to increase the number of people participating in green exercise, particularly those suffering with ill-health. Wider benefits to the community include reduced public health costs and conservation of our natural resources for investment in good land and group-based projects.
Putting it into Practice
My task, as last speaker, was to take the expert knowledge and put it into practice! Following an internal audit in my own clinical practice, I had found depressed clients responded well to a healthier lifestyle, diet and supplements. Devising an individualised nutritional programme whilst improving digestive function and efficiency is key, but can only work if clients have the motivation to carry out the programme. If a family member or friend is present during consultations (and at home) to deal with the practicalities of shopping and cooking, this task is made much easier. Effective nutritional intervention includes building practical knowledge and skills, explaining how digestion works (eg the importance of gastric juice; the relevance of probiotic therapy) and providing a comprehensive report with strategies and recipes. In addition, a free weekly phone-in helps the therapist to pick up on potential difficulties.
The dietary message is more variety, traditional cooking methods and unprocessed, fresh, local, seasonal food high in nutritional value. Weeding out caffeine, nicotine, alcohol, sugar, hydrogenated fat, additives is best done step-by-step. Clients may find this easier if healthier items are introduced consistently, leaving less room for “unhealthy” ones. Food intolerances, hormone imbalances, dehydration, blood sugar issues, compromised gut immunity, increased essential fatty acid, amino acid or micronutrient requirements, toxic metals or chemical sensitivities are all risk factors and need to be addressed. For some clients, lab testing is useful, for others it is either unnecessary or not financially viable. The considerable challenge for the nutritional therapist remains effective intervention in difficult circumstances. This would surely be easier if we were part of an integrated team. One delegate suggested diet and green exercise should routinely be handed out “on prescription”! A fitting tribute to an informative day.
© 2011 Martina Watts MSc Nut Med, First Published in Foods Matter 2007