The surprisingly dramatic role of nutrition in mental health | Julia Rucklidge | TEDxChristchurch

Translator: Mayumi Oiwa-Bungard Reviewer: Queenie Lee In 1847, a physician named Semmelweis advised all physicians to wash their hands before touching a pregnant woman, to prevent childbed fever. His research showed that death rates from sepsis can be reduced from 18% to 2% simply by washing your hands with chlorinated lime. His medical colleagues refused to accept that they themselves were responsible for spreading the infection. Semmelweis was ridiculed by his peers, fired from him, and the criticism and backlash broke him, and he died in a nursing home two weeks later of sepsis at the age of 47. What I'm going to talk about today may sound as radical as washing your hands sounded to a mid-19th century doctor, and yet it's just as scientific.

It's the simple idea that optimizing

nutrition

is a safe and viable way to prevent, treat, or lessen

mental

illness. Nutrition matters. Poor

nutrition

is a significant and modifiable risk factor for the development of

mental

illness. According to the 2013 New Zealand Health Survey, rates of psychiatric illness in children have doubled in the past five years. Internationally, there has been a 3-fold increase in ADHD, a 20-fold increase in autism, and a 40-fold increase in bipolar disorder in children. And this chart here shows that there has been a 4-fold increase in the number of people who are disabled as a direct result of an underlying psychiatric illness.

Mental illness rates are on the rise. So how are we dealing with this problem? Currently, our

health

system operates within a medical model. Now this means that you will usually be offered psychiatric medication first, followed by psychological therapy and other forms of support. Our reliance on drugs as a first-line form of treatment is evident from the increasing rates of prescriptions. For example, in 2012 half a million New Zealanders, or one eighth of us, had been prescribed an antidepressant; that's 38% more than five years earlier. Similarly, antipsychotic prescription rates doubled between 2006 and 2011. Given that this medical model is fairly universal across all Western societies, one might rightly expect it to work well.

And indeed, in some cases, these treatments save lives. And I'm not here to rule it out entirely. However, if a treatment is truly effective, shouldn't the rates of disorder and disability as a direct consequence of that disease decrease rather than increase? This is why we need to consider the

role

that drugs might be playing in some of these outcomes. If we take any kind of medication: antipsychotics, anxiolytics, antidepressants; the pattern is the same. In the short term, these treatments are usually very effective, but in the long term they are not. And in some cases, they are making life worse.

If we look at, for example, the studies that are being done in children with ADHD treated with stimulants or Ritalin, in the short term, they are better and they respond better than any other form of treatment, but in the long term, they do worse than children who were never prescribed these drugs. Another study showed that despite our increasing reliance on antidepressants, recovery rates and relapse rates are no better now than they were 50 years ago, before the advent of these drugs. And children with depression who were treated with antidepressants are three times more likely to develop bipolar disorder than children who never received these drugs.

And people who were randomly assigned to stay on their dose of antipsychotic drugs are less likely to recover from schizophrenia in the long term than people who were randomly assigned to a dose reduction or complete elimination of the drug. And I can show you more and more studies, all painting the same bleak picture. So, pretty depressing. (laughs) Is there another way forward? Nearly two decades ago, my PhD supervisor at the time, Professor Bonnie Kaplan, told me about some families being treated with nutrients in southern Alberta, Canada. Now, they had bipolar disorder, psychosis, depression. These are serious conditions, and my clinical psychology education had taught me that nutrition and diet were of trivial importance to mental

health

, and that only drugs or psychotherapy could treat these serious conditions.

But she and others published preliminary data at the turn of this century, showing that people recovered and stayed healthy. So, I decided to study nutrients, and that's what I've done for the past decade. In 2009, I received some funding to conduct a randomized placebo-controlled trial using minerals and vitamins, also known collectively as micronutrients, for the treatment of ADHD in adults. And this study was published in the British Journal of Psychiatry in April of this year, and this is what we found. In just one 8-week period, twice as many people responded in the micronutrient group compared to placebo; twice as many people went into remission in their depression, in the micronutrient group.

Hyperactivity and impulsivity were reduced to the normal, non-clinical range, and those taking the micronutrients were more likely to report that their ADHD symptoms were less disruptive and interfered less with their work and social relationships than people taking the placebo. . And one year later, those people who stayed on the micronutrients maintained their changes or showed more improvement, and those who switched to medication or stopped the micronutrients actually showed worsening of their symptoms. Now, I need to tell you something here, and that is that when I say micronutrients, I am actually referring to a higher dose than what you would get from a store-bought vitamin pill.

In this study, we gave participants up to 15 pills a day with 36 nutrients. So it would be unlikely that if you went and got an over the counter supplement, you are unlikely to see these positive benefits, both because the dosage is lower and the variety of nutrients is less. Now, these positive benefits are not limited to a single study. My laboratory at the University of Canterbury is the Nutrition and Mental Health Research Group, and we have published over 20 articles in medical journals, all documenting the benefits of micronutrients. For example, this study here showed that we could reduce the symptoms of bipolar disorder in children by 50% with a simultaneous reduction in medication.

This study here showed that we could reduce rates of probable PTSD from 65% to 18%, after the Christchurch earthquakes, with a month-long micronutrient intervention, with no change in those not taking the nutrients. Even a year later, the people who had received the nutrients were doing better than those who had not. And we just replicated these findings in collaboration with researchers at the University of Calgary, following the June 2013 floods in Alberta, Canada. For me, the message is clear: a well-nourished body and brain can better withstand ongoing stress and recover from illness. The administration of micronutrients in appropriate doses can be an effective and inexpensive public health intervention to improve the mental health of a population after an environmental catastrophe.

In my 20-year career, I have rarely seen such

dramatic

responses from conventional treatments. When people get better, they get better overall, not just in the symptoms that we treat, but in other areas as well, like improving sleep, stabilizing mood, reducing anxiety, and reducing the urge to smoke cigarettes, cannabis, and alcohol. My research and those around the world have shown that 60-80% of people respond to micronutrients, showing just how powerful this intervention is. And internationally, there have now been 20 randomized placebo controlled trials, this is the gold standard that we use for clinical decision making, showing that we can reduce aggression in prisoners, delay cognitive decline in the elderly, treat depression, anxiety, stress, autism and ADHD.

And, they could even be more cost-effective than current conventional treatments. This study here documented the treatment of a 10-year-old boy with psychosis. When his 6-month hospital treatment with medication was unsuccessful, he was treated with micronutrients. The micronutrients not only completely eliminated his hallucinations and delusions, changes that were maintained six years later, but the cost of treatment was less than 2% of the cost of failed hospital treatment. The cost savings alone make it imperative that our society pay attention to the broader benefits of this approach. And there is more good news. Treatment: Supplementation before mental illness arises can actually prevent these problems from developing in the first place.

This fantastic study looked at 81 adolescents at risk for psychosis and randomized them to receive Omega-3 fatty acids in the form of fish oils, essential nutrients for brain health, or placebo over a 12-week period. One year later, 5% of those who received fish oil had become psychotic compared to 28% of those who received placebo. That represents an 80% reduction in the chances that you will become psychotic, simply by giving fish oils. I wonder if I know what some of you are thinking. I wonder if some of you are thinking, "Wait! Why don't I eat better?" "Why don't I tell everyone to eat better?" And indeed, there are some fantastic studies documenting the strong relationship between dietary patterns and mental health, although we are still in the early days of scientific research.

We don't know who would benefit from dietary manipulation alone and who might need the added boost of additional nutrients. But even in the last five years, there have been 11 epidemiological studies, cross-sectional and longitudinal, in large populations around the world, all showing the same thing. The more you follow a prudent, Mediterranean, or raw diet, the lower your risk of depression. And the more you eat the Western diet or processed foods, the higher your risk of depression. I know of only one study that hasn't found this association, and no study shows that the Western diet is good for our mental health. (Laughter) What is the Western diet?

Well, it's one that's heavily processed, high in refined grains, sugary drinks, takeout, and low in fresh produce. And the healthy diet is one that is fresh, rich in fruits and vegetables, rich in fish, nuts, healthy fats, and low in processed foods. What your grandmother would recognize as food. (Laughter) There are still a lot of questions about the relationship between mental health and nutrition. What

role

does genetics play in determining who will respond to nutrients and who needs more nutrients than they can get from their diet? What role does an infected and inflamed intestine play in the absorption of nutrients?

It is not that we are what we eat; is that we are what we absorb. And what role do medications play in determining how effective nutrients are? The combination of drugs and nutrients is really complicated, and we need more research to better understand these interactions. But ultimately, we need to know how long these good benefits last. So with all this data, this rich data highlighting the power of nutrition, I think now we can make some individual and collective changes. We could reconsider our current treatment approach: prioritizing lifestyle factors, healthy eating, exercise, supplements, and, where necessary, psychological treatments, and saving medications for when these approaches don't work.

If nutrients work, shouldn't they be covered by our healthcare system? Take universal prevention seriously by optimizing nutrition for vulnerable people. We don't wait for a heart attack to change lifestyle behaviors that we know contribute to heart disease. It should be no different with mental health. An easy way to implement universal prevention would be to have pregnant women, not pregnant women: midwives tell pregnant women about the importance of nutrition. Nutrient-depleted mothers produce nutrient-depleted children. Nutrient-poor foods during pregnancy increase the chances that your child will have a mental health problem. Learn about the risks of cheap processed foods.

As Michael Pollan said, cheap food is an illusion; there is no such thing as cheap food. The price is paid somewhere, and if it's not paid at the checkout, then it's charged to the environment and the public purse in the form of subsidies, and it's charged to your health. All children need to learn to cook. All children should know that food does not have to come in a package. Schools could give some thought to the content of their lunch menus. Children are too often rewarded with processed foods bygood behavior. We need to reflect on whether this pairing intuitively makes sense or not.

Ultimately, we have a responsibility to teach them that every time they put something in their mouths, they make a choice: to eat something nutritious or something nutritionally depleted. In the 19th century, doctors took offense when Semmelweis suggested that they wash their hands before giving birth. We are now asking you to consider whether the medications you have prescribed are contributing to the poor long-term outcome for some people with mental illness. But eating right and, when appropriate, additional nutrients can improve mental health for many people. He left them with one last thought. Random tests conducted in the 17th century showed that putting lemons on board ships going on long voyages completely eliminated 40% mortality from scurvy.

But it took the British government 264 years to order that all ships must carry citrus fruits for their sailors. How long will it take for our society to pay attention to the research showing that suboptimal nutrition is contributing to the epidemic of mental illness? So here's my point worth spreading: nutrition matters, and if we're really ready to get serious about mental health, we need to get serious about the critical role nutrition plays. Thank you. (Applause) (Applause)