In our previous blog, we discussed research highlighting the role that dietary patterns may play in mental health outcomes, with some fairly convincing relationships across different studies and different countries showing that 1) traditional diets may play a protective role in mental health outcomes, and 2) that the Western diet (usually defined as eating more packaged/processed foods) appears to be a risk factor for poorer mental health outcomes.
One conclusion we could draw from this research is that if we would simply eat more raw foods, 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.
Many questions emerge from this research….and the primary one we focus on today is this: is it possible that a change in diet is sufficient to prevent illness? But we also need to question, can such widespread changes in eating patterns occur 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 (our blog topic), 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 showing that fresh vegetables and fruit have lower levels of nutrients than they did 50 years previously. 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, an eminent Professor of Biochemistry at Berkeley, has written about how a third of the genetic mutations called in born errors of metabolism result in the production of less efficient enzymes and slower metabolic processes. But research has demonstrated that high doses of key vitamins can restore enzymatic activity to normal levels in people who have 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 nutrients required for the brain to function effectively and optimally. We have been building a story over our blogs, showing that there is evidence for the benefits to people with mental illness of taking additional nutrients. Nevertheless, we have both been accused over time of simply giving patients expensive urine. So we 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, just published in Expert Review of Neurotherapeutics, 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 the “gold standard” 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. There is even some research to support that in nonclinical populations, positive changes occur in general wellbeing.
So the next time someone claims that we are simply giving people expensive urine, we challenge them to get up-to-date on the research! Watch this space, there is more to come.
- Ames BN, Elson-Schwab I, Silver E. High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased Km): relevance to genetic disease and polymorphisms. Am J Clin Nutr. 2002;75:616-58.
- 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.
- Mayer AB. Historical changes in the mineral content of fruits and vegetables. British Journal of Food. 1997;99:207-11.
- Rucklidge JJ, Kaplan BJ. Broad-spectrum micronutrient formulas for the treatment of psychiatric symptoms: a systematic review. Expert Rev Neurother. 2013;13(1):49-73.
“Watch this space. There is more to come.”
I say, “Thank you! Bring it on!”
Mental Health Treatment That Works:
Bill Maher before he completely sold out:
I tried to understand the logic of the people who say, “Massive supplements and chelation therapy can cure both autism and mental illness.” I worked with one lady real hard to track down the science and kept running into dead ends where she couldn’t explain stuff. Anything she couldn’t explain, she said, “Well, that’s a conspiracy theory. The powers that be are hiding that data.”
Here are some real simple scientific questions to the supplement and chelate advocates:
1. How do you think chelation or detoxification works? What toxic thing is being removed and by what mechanism?
2. How does the chelation or detoxification agent tell the difference between heavy metals like mercury or lead which are harmful are light metals like calcium and potassium and iron which are needed? How does it not strip those metals (which have the same electrical charge and are thus very similar chemically) all out of the body, too?
3. Why do we say that emotional distress doesn’t have a chemical fix for pharma, but it’s OK to have a chemical fix for a naturopath? Like, why not look at life situations?
Now, I’m not denying that some people got sucked into the mental health system due to a vitamin deficit. But it’s a small percentage. And also, I know the standard American diet is pretty deficient.
But I always say, before you worry about a whole bunch of micronutrients (vitamins), look at macronutrients (carbs, proteins, fats, etc.) Tons of people don’t eat protein in each meal and then wonder why they are crabby, hungry, depressed, etc. Just start adding some protein and veggies to your meals and don’t get suckered into the megavitamin scams.
How to tell a scam: 1) they say the solution is simple or easy 2) eveyone gets the same solution 3) the solution is fast 4) the solution must be the correct brand name
Very good questions and some good advice.
Thanks for your interesting questions. Julia and I can legitimately claim to know a wee bit about nutrition and mental health (which is why we write this blog), but frankly, I don’t think either of us would claim to know enough about chelation and detoxification (the 2 other items you raised) to offer a knowledgeable comment.
Regarding your comment about paying attention to macronutrients before paying attention to micronutrients — I don’t think we should consider it to be an ‘either-or’ choice — all are extremely important. And for those who do not have sufficient funds to get good quality food, all of these deficiencies are huge problems.
You certainly are raising a popular line of argumentation. For the reasons below, though, I would argue that it is a confused argument.
“I tried to understand the logic of the people who say, “Massive supplements and chelation therapy can cure both autism and mental illness.” ”
>>You are using an opaque shorthand by saying “people who say” – there are highly published researchers who have Ph.D.s in the biochemical relationships of nutrients and illness. To equate them with a Medical Doctor pushing chelation or a line of supplements to all comers is a disservice to the former, and to readers.
You are similarly generalizing in saying that “they” claim a cure for both autism and mental illness. Who is this “they”? It’s fair to leave autism out of the discussion, since anyone making any claims about curing and treating that is much further outside the mainstream than those who point to published research on diet, nutrients, and mental illness.
Also, and now I’m moving on to a pet peeve of mine – why do some opinionators expend so much oxygen on the relatively harmless hawkers of misinformation on harmless natural remedies, when the relatively murderous hawkers of bad-science-pharmaceuticals are given a pass. (Granted, there are plenty of people hammering them, too, but it is rare for someone to point out that both are trying to make their dime and dollar, but that Pharma leaves behind scorched earth while the effect of the subset of under- or mis-informed natural medicine folks pales in comparison?
“I worked with one lady real hard to track down the science and kept running into dead ends where she couldn’t explain stuff. Anything she couldn’t explain, she said, “Well, that’s a conspiracy theory. The powers that be are hiding that data.””
>> Ask a legitimate question of a legitimate source, and you may well get a better answer. For starters, anyone who claims a cure of anything, they are unlikely to be a legitimate source, so you’d be wasting your energy. Also – you only need to read the newspaper to know that, yes, Big Pharma and the FDA do indeed hide data, while people suffer and die as a result. That doesn’t mean that there is a cure for autism and mental illness – but to deny that billion dollar concerns obfuscate science is to deny reality.
“1. How do you think chelation or detoxification works? What toxic thing is being removed and by what mechanism?”
>> Chelation is one thing, and detoxification could be another (depending on what you or “they” mean.) But you could do an hour or so of research into DMSA, DMPS, or EDTA and get your answer. Chelation is basic biochemistry and works in humans, test tubes, soil.
Unfortunately – and perhaps this is your point – the marketing of chelation and “detoxification” runs far ahead of the evidence. I believe readers of this blog will recognize this syndrome from their familiarity with SSRIs, benzodiazapense, anti-psychotics, and indeed the whole history of Big Pharma psych meds (at a minimum.)
However, if you don’t believe there are any toxins in humans, then there is a whole field of literature that you may be unaware of. But, as a for instance, alpha-lipoic acid, n-acetyl cysteine, sulfurofanes, and other glutathione up-regulators all assist in glutathione reductase binding of xenobiotics which are then excreted primarily in stool (via bile.) Saunas and colonics are believed to have similar effects, and you can find the published data on this –what little there is on topics for which there is no billion dollar underwriter – with some digging.
“2. How does the chelation or detoxification agent tell the difference between heavy metals like mercury or lead which are harmful are light metals like calcium and potassium and iron which are needed? How does it not strip those metals (which have the same electrical charge and are thus very similar chemically) all out of the body, too?”
>> They don’t tell the difference, and they do chelate the good and the bad together, though the valence of the metal matters. Scientific practitioners supplement with minerals when they use chelation. However, chelation and detoxification for mental illness would be second or third tier treatments, in my opinion, compared to diet, supplements, and counseling / support.
And – in my opinion – practitioners treating autism with natural medicine have an unfortunate tendency to be capitalizing on people’s desperation. While there are cases where diet and nutritional supplementation can help with function and behavior, there is little to no evidence that autism itself is reversible (though, like mental illness, it may often be misdiagnosed!)
“3. Why do we say that emotional distress doesn’t have a chemical fix for pharma, but it’s OK to have a chemical fix for a naturopath? Like, why not look at life situations?”
>> I’d be interested to know what you are referring to, but I can’t understand what you mean here.
And – complicated topic – there are naturopaths and then there are naturopaths. I am a licensed naturopathic doctor (N.D.) who completed a 4 year medical program, passed rigorous medical board exams, and am licensed by the state of California to diagnose and treat disease. In my community, there are “naturopaths” with little to no formal training, but because of their money and political power, they were able to force the California legislature to let them practice and call themselves “naturopaths” when our law was passed. In popular perception, as your post demonstrates, the two camps are often lumped together. And, unfortunately, in my opinion, the profession and practice of natural medicine, whether it’s M.D.s, chiropractors, or N.D.s – much like conventional medicine and big pharma – proceed on the basis of insufficient evidence.
“Now, I’m not denying that some people got sucked into the mental health system due to a vitamin deficit. But it’s a small percentage.”
>> There is no data to support that “ small percentage.” In fact, no one actually knows, because it’s barely been studied, so this is speculation. A more likely speculation would be that “ a combination of psychosocial stressors, genetic susceptibility, improper diet and nutrition including food allergies and gluten intolerance, relative micronutrient deficiencies, use/abuse of recreational and pharmaceutical drugs, incorrect diagnosis, and brain-altering entertainment technologies account for the majority of mental illness”
“Just start adding some protein and veggies to your meals and don’t get suckered into the megavitamin scams.”
>> Good advice, though for people with actual mental illness, a little flip. Just adding protein and veggies won’t do much, and might be the wrong prescription. But if what you mean is “unbalanced blood sugar and undiagnosed reactive hypoglycemia account for an underappreciated but vast amount of mental-emotional morbidity”, I couldn’t agree with you more.
“How to tell a scam: 1) they say the solution is simple or easy 2) eveyone gets the same solution 3) the solution is fast 4) the solution must be the correct brand name”
>> I tell my patients “if it sounds too good to be true, it probably is.” This is a useful guide, but frequently wrong. For instance, your own (presumed) suggestion to balance blood sugar is simple, easy, and fast acting (a few days.) Furthermore, if you give me 100 people with anxiety, fatigue, depression, irritability, and I give them all a blood-sugar balancing diet, the response rate will be 25-33%. Another for instance: food allergy elimination. Give me those same 100 people, and I have them eliminate wheat and sugar from their diet, this simple, not necessarily easy one size fits all solution would have remarkably positive effects. The same would be true for adequate fish oil supplementation in bipolar people, though not so fast. Another example is magnesium supplementation in people who are deficient, something that is incredibly common (and nearly impossible to verify via labs.)
In fact, I could easily design a one-size fits all diet and supplement and counseling program that wouldn’t be all that difficult, and I’d gladly put it up against a pharmaceutical approach (with a long term metric for the outcome, though some of the results of my approach would in fact be remarkably rapid.) Unfortunately, that just isn’t going to get funded.
Even when you buy fresh vegetables and fruits in your grocery store you may not be getting what you think you’re getting. I used to work in the Produce department of Walmart and one of the things that I learned there was that by the time an orange reaches the shelf in the produce section of a store, it’s lost one-third to one-half of the vitamin C that it first started off with when it was picked off the tree in Florida or California, or some foreign country that we import things from.
Just because it’s supposedly “fresh” and raw doesn’t mean that it’s going to do you great wonders when you eat it, unless you grow and harvest it from your very own garden. Most Americans couldn’t grow a tomato to save their lives these days!
I find your posts informative. What do you all think about the Mediterranean diet that’s talked about so much these days?
Thanks for noting your appreciation of our posts — so far we have had a lot of fun writing them. (Though it is going to become a bit more of a struggle in the next few months because of commitments and travel that both of us are tied up with.)
As we have mentioned in a previous blog, there is excellent nutritional epidemiologic data showing a relationship between the type of food a person eats, and the likelihood that they will report symptoms of depression/anxiety. Some of those studies (references were in that post) specifically use the label ‘Mediterranean diet’ to contrast a healthy, whole foods diet to processed/packaged/western diets. Consistently, the Mediterranean diets have been associated with better mental health.
Having said that, I must also note that all of those particular studies are on large populations — not individuals. So we have a long way to go yet before we can draw conclusions that generalize to everyone.
The message for the individual right now? A Mediterranean diet appears to be generally healthier or mental and physical health than is a diet of processed, saturated fat foods.
Thanks for responding and answering my question!
For anyone interested, this is a good article:
Worked for me in 1982 and has come a long way since then. http://www.arltma.com My eminent psychiatrist made that same crack about expensive urine when I started the orthomolecular program, but soon the government and the tax-payers were able to stop pissing their money away on him and the drug companies he pimped for, at least for me.
Thank you for this post. As a licensed naturopathic doctor in the U.S. (California), I know how much good evidence there is for the approach you suggest – and, how much unsubstantiated fads carry the day with laypeople and the media, sadly and somewhat hopelessly confusing the issue, as Corinna’s reply above demonstrates. Unfortunately, you don’t have the time and space, and readers don’t have the time or bandwidth, to properly review the literature on this topic.
I’d like to point out a couple of small – I’ll call them oversights – in your post. Keep up the good work!
“One conclusion we could draw from this research is that if we would simply eat more raw foods”
>> Raw foods are different from processed foods. Cooked kale is not raw, but it is certainly more nutrient dense than, say, raw celery or iceberg lettuce. Raw food is fad nowadays, with people making all kinds of outsized claims for it, compared to a “consensus” healthy diet.
“perhaps more organically grown foods (to eliminate the exposure to herbicides and pesticides that can affect the nutrient status of the crop)”
>>organic foods likely have greater mineral density due to agricultural practices that do not deplete topsoil. Magnesium supplementation has been suggested as a treatment for depression in multiple published papers (references upon request.)
“increase our omega 3 intake by eating more fish”
>>Mediterranean diet research shows that consumption of walnuts and flax also increase serum omega 3s, though probably not of docosohexanoic acid. Chia seeds likely have the same impact. And if you’re concerned about exposure to herbicides, pesticides, and heavy metals, the suggestion of eating more fish ought to conditional.
“There was an excellent, high quality study in the UK published over 15 years ago showing that fresh vegetables and fruit have lower levels of nutrients than they did 50 years previously.”
>>A likely pointer to top soil quality and depletion.