One thing that amazes us is that even though information linking nutrition to physical health is quite advanced, and generally very prominent in the media as well as in public awareness, people seem to be surprised when told that nutrients are essential for brain function. This disconnect is so great that we want to address it in today’s blog.
It may be silly to remind everyone of this, but we need to begin with this simple fact: the brain is part of the body. But to add some heft to this point, let us also recall that the brain is the organ of the body with the greatest metabolic demands (the heart is second).
What does it mean to say that the brain is metabolically the most demanding organ that we have? It means that even though the brain of an average adult is only 2% of his/her weight, that brain consumes at least 20% of the energy generated by that person’s mitochondria and various metabolic processes. And we all know that our energy is dependent on the quantity of nutrients that we consume.
So isn’t it interesting that more than 11 years ago, JAMA published the following statement: “…it appears prudent for all adults to take vitamin supplements” [Fletcher & Fairfield, 2002]. This statement is in the abstract of the second part of an excellent 2-part article by Fairfield and Fletcher, which focused particularly on whether vitamin supplementation could reduce the risk of cardiovascular disease, common cancers (lung, colon, breast, and prostate), neural tube defects, and osteoporosis. Their answer was YES. They included 9 vitamins (no minerals) in their review, because of evidence that they are particularly important for physical (not mental) disease prevention in adults: folate, vitamins B6 and B12, vitamin D, vitamin E, the provitamin A carotenoids, vitamin A, vitamin C, and vitamin K.
We won’t review all their findings here because the focus of our blog is on mental disorders, and these two articles were entirely devoted to physical health, but you can download the scientific review for free here:
And you can download the second article, a clinically-applied commentary here:
In a nutshell, what they found in their review can be summarized in a few points:
Suboptimal levels of several vitamins are risk factors for cardiovascular disease, cancer, and osteoporosis.
Blood/serum levels are not reliable measures of suboptimal levels (as any nutrition researcher will tell you) for various reasons. One example they cite is a study that showed folate supplementation resulted in a significant decrease in serum homocysteine levels in a group of seniors who began the study with serum folate levels within the conventionally-accepted ‘normal’ range. So having a ‘normal’ level of a nutrient did not mean they were getting an optimal amount: supplementation still had a beneficial effect.
Many studies show low folate levels are associated with coronary heart disease and ischemic stroke. In fact, folate appears to be the key nutrient in determining plasma homocysteine levels, which is associated with inflammation and cardiovascular disease.
Folate supplementation has been associated with prevention of various types of cancers (especially colorectal and breast), although continued folate supplementation after a cancer diagnosis has been more controversial.
There are 3 ways to correct suboptimal levels of vitamin intake in the population: 1) Counsel patients to eat better (and your bloggers would add: and work on eliminating poverty so that they *can* eat better), 2) increase food fortification — we now have milk fortified with vit D, and many breads fortified with folate, and 3) take supplements.
Their conclusion was: “We recommend that all adults take one multivitamin daily” (and your bloggers would add: make sure your multivit has lots of minerals too). They also suggest that seniors take either two multivitamin tablets/day, or one multivit with additional B12 and D on the side.
So if your concern is cardiovascular disease, cancer, or osteoporosis, one really cheap, simple public health intervention would be to hand out supplements to the whole population.
Even at a simpler level of health, there are many clinical trials showing that vitamin and mineral supplements in communities of seniors (e.g., retirement homes, nursing homes) reduce flu, colds, and other communicable disease. So the bottom line is that in the realm of physical health, we have known for over a decade that everyone should be taking supplements.
And what if your concern is prevention of mental disease? We’ll address that topic in our next blog.
Barringer TA, Kirk JK, Santaniello AC, Foley KL, Michielutte R., Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2003 Mar 4;138(5):365-71.
Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: scientific review. JAMA. 2002 Jun 19;287(23):3116-26. Review. Erratum in: JAMA 2002 Oct 9;288(14):1720.
Fletcher RH, Fairfield KM. Vitamins for chronic disease prevention in adults: clinical applications. JAMA. 2002 Jun 19;287(23):3127-9.
Dehydration is considered to be a “silent” epidemic. If it was up to me, I would change the upcoming year’s “color of the year” from intended purple to a pale yellow, in effort to RAISE AWARENESS of dehydration.
I think nutritional deficiency, plus dehydration, can and does cause mental and emotional suffering. I think there *IS* such a thing as chemical imbalance and that, in it’s worst form, it is a combination of vitamin and mineral deficiency PLUS toxicity.
A lack of potassium can cause “mental” symptoms. That’s just potassium.
Next time in the mall just look at people you see dining in fast food restaurants, its easy to spot the people that eat that fatty stuff and wash it down with a large 24oz “soft drink” (sugar water) day after day year after year.
There skin is nasty and they are usually way out of shape and tired looking, I’m sure if you went to there houses and looked in the medicine cabinet there would be tons pills for both over the counter stuff and Rx medications for all kinds of problems.
New York Mayor Michael Bloomberg even proposed a controversial ban on large soda drinks. I’m not a fan of govt rules telling people what to do at all, not one bit, but I really liked that soda ban idea. That’s the stupidest thing in the world drinking a quart of sugar water with every meal !
Hi Bonnie and Julia,
Thanks for your post. I believe that nutrition is very important for the brain and I appreciate the research you are doing in this area.
You mention that folate is important in preventing inflammation. I first learned about folate deficiency from reading Dr. Mark Hyman’s book “The Ultra Mind Solution”. In it he states that the folic acid that is added to flour is not the same as the folate found in fruits and vegetables like spinach and oranges and that many people are not able to use this form of folate (folic acid) and that they could be folate deficient despite having high levels of folic acid in their blood. So I stopped eating breads and anything made from flour and increased my fruit and vegetable intake. I felt much less anxious and depressed after making this change.
I told a few doctors about this and they told me that this is not true, that folate and folic acid are the exact same thing. They said that what I am feeling must be placebo and that diet has nothing to do with anxiety and depression. I have felt better for about six months now so I don’t think it is a placebo effect. Every time I do eat something with flour I feel worse about 12 – 16 hours later. Not sure if this is because of the enriched flour, the gluten or something else altogether.
I was just wondering if you think there is a difference between the folate found in fruits and veggies and the folic acid found in vitamin pills and enriched flour. My son and I both tried the EMPower Plus vitamins from True Hope vitamins and they did not work for either one of us. My son has a serious mental illness that is treatment resistant so you can see why I am desparately trying anything. I sometimes think that if he would just eat a healthy diet that might work better than all those drugs, pills, vitamins and supplements that everyone tries to sell you.
Sorry for the long post but I really would like to know if there is a difference between the folate found in plants and the folate found in vitamins and enriched flour.
hi — thanks for your interest. You are correct that folate and folic acid are not the same. Folate is the term for the naturally-occurring form; folic acid is the synthetic form. Folic acid, therefore, is the form found in most multivits, in fortified foods, and in most research articles. My understanding (maybe I should say *assumption*) was that they were absorbed and metabolized the same. I’m sorry, but I can’t offer any evidence on either side of that issue. But if Dr. Hyman’s article said that some people cannot absorb/make use of the synthetic form, that comment is different from the issue you are raising — the possibility of somehow feeling ill from eating folic acid-fortified flour.
I would like to point out that the amount of folic acid in fortified bread is quite small. I found varying estimates on the web, but in Canada where we fortify bread, you would not likely get more than 20-30 micrograms. In comparison, the RDA for adults is in the range of around 400.
So that makes me wonder about the related topic you raised: did you feel better when you stopped eating bread because you are gluten sensitive? That sort of sounds more likely to me, but I suspect you are trying to figure out whether that is the case. Best of luck to you!
This is an uphill climb.
A study released today, announces “case closed” on vitamins:
Pharma money, and fraud… again.
Duane Sherry, M.S.
My flippant answer is: “Yes, it has always been an uphill climb”! But let me be a little more nuanced than that.
In *physical* health, it has been an up-and-down climb. Take a look at the Fairfield and Fletcher articles that mentioned: “…it appears prudent for all adults to take vitamin supplements” —- and the next round of studies will probably show that again. It always depends on the spectrum of nutrients, the dose, the methodological design, etc.
In *mental* health, it think it has been a totally uphill climb, and continues to be. Watch for our next blog, in a few days! And thanks for your comment.
Thank you for your reply. Yes, it is a real challenge sometimes to find out what it is in food that bothers a person because most processed foods have so many ingredients. That is why I am trying to eat more whole foods.
Bonnie and Julia,
Thanks for the research!
Excellent info. Here are some other ways to lower homocysteine, besides folate: https://www.optimallivingdynamics.com/blog/16-proven-ways-to-effectively-lower-homocysteine