How the Food in our Fridge can affect our minds. Article first published in ‘Mental Health Today’ journal, September 2008.

Whenever I listen to debates about the benefits of drug and behavioural therapies in treating mental health problems, I am astonished that nobody mentions the most obvious therapy of them all. ‘Diet!’ I yell at the radio in frustration, ‘Why isn’t anyone talking about diet?’ Well, why isn’t anyone?

I must confess right here that I am neither a psychologist nor a psychiatrist but a nutritional therapist. My own path has been littered with mental health `episodes’. I experienced depression in my teens and early 20s, and for years my PMS was simply legendary. One of my sons used to be hyperactive and was subsequently diagnosed with Asperger’s syndrome. My husband, a mild- mannered type who wouldn’t hurt a fly, turns into a raging maniac whenever his blood sugar levels drop. These personal experiences provided the motivation to learn more about the effects of our modern diet and environment on our mental and physical health — and what we can do about it.

Are we really what we eat?

Can what we eat or drink really affect how we feel and behave? Consider that the human brain is 85% water and that a mere 2% drop in water intake affects short-term memory, focus and basic maths. Consider that the Food Standards Agency at long last admitted, in September 2007, that there is a definite link between food additives and hyperactive behaviour in children. Finally, consider what happens after consuming too much alcohol. These are just some examples of how what we ingest affects us much more profoundly than we realise. Mental ill health is at epidemic levels and, according to the World Health Organization, will become the second highest cause of the global disease burden by 2020. That is why we should be looking much more closely at some of the driving forces behind it. Two recent reports, one from Sustain (`Changing Diets, Changing Minds’), the other from the Mental Health Foundation (‘What to Eat — a guide to the foods and nutrients that affect our mental health’), revealed that intensive farming practices, along with food manufacturing, production and storage have significantly altered the amount and balance of nutrients in our food, thereby potentially affecting the function and structure of the brain.

In the UK, we eat small amounts of a few types of fruit and vegetables, few wholegrains and little oily fish. Instead, we consume vast quantities of sugar and refined carbohydrates, salt, caffeine, altered fats, intensively reared meat and dairy products and unknown combinations of synthetic chemicals and residues. This diet cannot be compared with that of our ancestors, who were genetically almost identical to us. Pre- agricultural hunter-gatherers depended on good ‘brain food’ for survival: plenty of different fresh fruit and vegetables, wholegrains, nuts, seeds, legumes and some oily fish and lean meat. Epidemiological evidence shows that in populations with low intakes of fish there is an increased risk of depression. There is also a correlation between higher intakes of fish and a lower incidence of postnatal depression.

Increasingly, health practitioners, from both the orthodox and alternative communities, are realising the huge health benefits of nutritional therapy. Nobody would argue that poor dietary habits cause mental health problems, or that a healthy diet can cure them. However, a nutritious diet and a well-functioning digestive system may relieve the symptoms of mental illness, reduce the side-effects of antidepressants and other drugs and improve their effectiveness.

Unwelcome additions

Dr Brian McDonogh, a GP from Crawley, East Sussex, with more than 20 years of experience in medicine, is an expert on the nutritional management of ADHD. He believes it is important to look at every other possibility before resorting to drugs with potentially harmful side- effects. Dr McDonogh points to the sheer volume of scientific research now supporting the importance of diet and nutrition. He says: ‘There is ample evidence that diet can have significant effects on mood and behaviour, and must be taken seriously. Assessing a child’s medical history and diet will often provide us with vital clues.’

Dr McDonogh is particularly concerned about the use of unnecessary chemicals that permeate children’s foods. Artificial additives found in soft and diet drinks, cakes, confectionery, lollies, barbecue dips and a host of other foods and snacks do not introduce nutritional value to foods. ‘The only reason they are added’, he says, ‘is because they make foods visually more appealing and taste artificially more attractive.’ The dyes sunset yellow (E110), tartrazine (E102), carmoisine (E122) and Ponceau 4R (E124), the flavour enhancer monosodium glutamate (E621) and the preservative sodium benzoate (E211) are some of the worst offenders.

Modern agricultural practices have depleted the nutrient content of our produce

Replacing junk food with meals that are higher in the basic raw materials required by the body is the first step in managing children with behavioural problems. Added supplementation may also be necessary because the quality of the food we put into our bodies each day is substandard. Modern agricultural practices have depleted the nutrient content of our produce, soil quality is declining, fruit and vegetables are harvested before they are ripe and they are stored for prolonged periods. Food is far from fresh by the time it is eaten. This is compounded by frantic lifestyles and hastily eaten snacks that supply excessive amounts of salt, sugar and altered fats.

If that’s not enough to depress you, toxic elements from industrial sources, such as aluminium, mercury, cadmium and lead, have long been associated with behavioural problems, delinquency and violence. Not only are toxic metals poisonous, they block the utilisation of the essential trace elements, such as calcium, iron, magnesium and zinc, required for the normal development of the brain and immune system.

Many children also suffer from enzyme deficiencies, malabsorption problems and food intolerances. Such is the complexity of possible mechanisms involved, that each case of ADHD (and associated disorders) should be examined on its own merits by a consultant in nutritional medicine. Yet a nutritional consultant or nutritional therapist is not currently a member of the multidisciplinary team that assesses these children or indeed anyone else with mental health problems.

Unexpected deficits

Apart from gaining additives and toxic residues, our food has suffered significant mineral losses. Studies show that over a 51-year period between 1940 and 1991 calcium was reduced by 41% and iron by 54% in meat. Vegetables, on average, lost about half their calcium content and a quarter of the required iron and magnesium content. A study published in 2003 (Nutrition and Health 1785-115) revealed that vegetables introduced between 1960 and 1991 showed a deterioration in our food is bad news for us. Zinc, for example, is required in hundreds of enzyme reactions in the human body and is vital for growth, reproduction,immunity and a healthy brain and nervous system. In certain individuals, a dietary deficiency of zinc alone is known to lead to aggression and depression. In fact, a deficiency in any mineral can have a profound impact on our physical, mental and emotional health.

In one of the first studies of its kind, researchers at Oxford University found that simply adding vitamins, minerals and omega 3 and 6 essential fatty acids to the diet of 231 young offenders at a maximum security institution in Aylesbury caused a 26% reduction in offences. This well- designed trial, published in the British Journal of Psychiatry in 2002 (British Journal of Psychiatry 181, 22-28) was organised by Bernard Gesch, director of a research charity called Natural Justice. The study is also available at http://www.naturaljustice.org.uk

Epidemiological evidence shows that in populations with low intakes of fish there is an increased risk of depression

Gesch explains that the human brain, like any other part of the body, requires adequate nourishment to function normally. Although the brain only makes up 2% of our body mass, it consumes around 20% of available energy, and to use this energy, it needs a range of essential nutrients. If we don’t obtain enough of these from our diet, the regulation of brain neurotransmitters, such as serotonin, are potentially affected. This, in turn, might influence the choices we make and, crucially, the way we behave without us even knowing.

It would be somewhat naive to believe that antisocial and criminal acts are purely due to eating and drinking junk, but one wonders what might have become of the 231 young men, had their brains and bodies been adequately or even optimally nourished. Ironically, some of them are receiving healthier meals than they are normally used to while in HM’s establishment. But even in their cases, a moderate boost in vitamins, minerals and essential fatty acids measurably decreased the incidence of offences. In this particular study, the greatest reduction was for serious offences, including violence, which fell by 37%.

You are what you absorb

A healthy diet is not a panacea for all mental ills. Many people with such problems are already making perfectly good food choices. However, there are a variety of psychological and psychiatric conditions that stem from abnormalities in the human gut.

A famous French food critic from the 18th century, Jean-Anthelme Brillat-Savarin (1755-1826), must have been well aware of this when he wrote `Digestion, of all the bodily functions, is the one which exercises the greatest influence on the mental state of an individual.’

Our digestive tract is coated with a bacterial layer that provides a natural barrier against undigested food, toxins and opportunistic pathogens. Our so-called ‘friendly’ gut bacteria produce antibiotic-like substances and engage the immune system to respond to invaders. They also neutralise ingested toxic substances and maintain the cells lining the digestive tract to prevent it from becoming ‘leaky’.

In certain individuals, a dietary deficiency of zinc alone is known to lead to aggression and depression

Factors such as stress, food intolerances, poor diet, exposure to toxic substances, antibiotics and other drugs (NSAIDs, steroids and the contraceptive pill, for example) all have a detrimental effect on our delicate gut flora. People with abnormal gut flora cannot digest and absorb their food properly, and substances may enter the blood stream, interfering with normal brain function. Important nutrients won’t be absorbed very well either, causing deficiencies that also affect mental (and physical) wellbeing.

Depression and inflammation

One hypothesis for the increase in depressive disorders is that a failure in some individuals to develop a fully functional and appropriately matured gut immune system is sometimes due to our exposure to antibiotics from an early age. In addition to hosting important `friendly bacteria’, the gut and colon are also the principal sites for the production of anti-inflammatory cytokines (specialised `cell-messengers’). Researchers have established that depression occurs more frequently in those with medical conditions associated with immune dysfunction.

Consistently raised levels of inflammatory cytokines in the body will 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 the form of a virus or bacteria, some susceptible people may develop depressive episodes. This type of depression is not just a reaction to illness, but is caused by cytokines provoking an immune system that 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.

Nutritional interventions to improve digestive function and influence gut immunity are new, but show considerable promise. They include targeted probiotic and essential fatty acid therapy.

The time has come for nutritional therapy to take its place alongside pharmaceutical and behavioural approaches, so it can be accessed by those suffering from mental health problems. That should put a stop to me yelling at my radio.

Eating disorder

Inspired by the Aylesbury trial, I worked on a healthy-eating project at a secure unit for young offenders in Warrington, Cheshire. The aim was to improve the quality of nutrition served to the youngsters and reduce sugar, salt, additives, refined carbohydrates and hydrogenated fats within budget. Natural home-cooked ingredients were introduced, gradually replacing ‘unhealthy choices’ and ‘treats’ with healthier alternatives.

The young people started eating noticeably fewer sandwiches and baked goods. Cakes, biscuits and crisps were removed at break times and replaced with a variety of fruit purchased from the local market, guaranteeing them fresh, seasonal and nutritious produce. Instead of supplying sugar bowls and salt cellars at each table, a limited amount of sugar and salt sachets were provided and controlled by staff. A healthy tuck shop offered low-fat crisps, dried fruit and selected fruit juices and confectionary without additives or artificial sweeteners.

Although no nutritional supplements were used in this healthy- eating programme, the results were astonishing. There was a visible change in physical appearance with less weight gain. Staff confirmed that bedtimes and weekends were much calmer, with less aggravated behaviour. A monitoring report by the general manager stated that the use of physical restraints had decreased by 60% in just one year.