Queenie Lee In 1847, a physician by the name of Semmelweis advised that all physicians wash their hands before touching a pregnant woman, in order to prevent childbed fever. His research showed that you could reduce the mortality rates from septicemia, from 18% down to 2%, simply through washing your hands with chlorinated lime. His medical colleagues refused to accept that they themselves were responsible for spreading infection. Semmelweis was ridiculed by his peers, dismissed, and the criticism and backlash broke him down, and he died in an asylum, two weeks later, from septicemia, at the age of 47. What I’m going to talk about today may sound as radical as hand-washing sounded to a mid-19th century doctor, and yet it is equally scientific. It is the simple idea that optimizing nutrition is a safe and viable way to avoid, 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, the rates of psychiatric illnesses in children doubled over the last five years. Internationally, there’s 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 graph here shows there’s been a 4-fold increase in the number of people who are on disability as a direct consequence of an underlying psychiatric illness. The rates of mental illness are on the rise. So how are we dealing with this problem? Currently, our healthcare system operates within a medical model. Now, this means that you would typically be offered psychiatric medications first, followed by psychological therapies, and other forms of support.
Our reliance on medications as a front-line form of treatment is evident from the increasing rates of prescriptions. For example in 2012, half a million New Zealanders – that’s one-eighth of us – had been prescribed an antidepressant; that’s 38% higher than five years previously. Similarly, the rates of prescriptions for antipsychotics doubled, from 2006 to 2011. Given that this medical model is fairly universal across all Western societies, you would rightfully expect that it was working well. And indeed, in some cases, these treatments save lives. And I’m not here to dismiss it altogether. However, if a treatment is truly effective, then shouldn’t the rates of disorder and disability as a direct consequence of that illness be decreasing rather than increasing? That’s why we need to consider the role that medications might be playing in some of these outcomes. If we take any class of medication: antipsychotics, anti-anxiety medications, antidepressants; the pattern is the same. In the short-term, these treatments are often very effective, but in the long-term, they aren’t. And in some cases, they’re making life worse.
If we look at, for example, studies that are being done on ADHD children treated with stimulants or Ritalin, in the short-term, they are better, and responding – better responders than any other form of treatment, but in the long-term, they fare less well than children who were never prescribed these medications. Another study showed that despite our ever-increasing reliance on antidepressants, the recovery rates and relapse rates are no better now than they were 50 years ago, prior to the advent of these medications. And children with depression who were treated with antidepressants are three times more likely to convert to bipolar disorder than children who were never given these medications.
And people who were randomized to stay on their dose of antipsychotic medications are less likely to recover from schizophrenia in the long-term than people who had been randomized to a dose reduction or complete elimination of the drug. And I can show you more and more studies all highlighting the same bleak picture. So, pretty depressing. (Laughter) Is there another way forward? Almost two decades ago, my PhD supervisor at the time, Professor Bonnie Kaplan, told me about some families who were treating themselves with nutrients, in Southern Alberta, Canada. Now, they had bipolar disorder, psychosis, depression. These are serious conditions, and my education in clinical psychology had taught me that nutrition and diet were of trivial significance for mental health, and that only drugs or psychotherapy could treat these serious conditions. But she and others were publishing preliminary data in the earlier part of this century, showing people getting well and staying well.
And so, I decided to study the nutrients, and that’s what I’ve done for the last decade. In 2009, I received some funding to run 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 here’s what we found. Within just an 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 reduced into the normal, non-clinical range, and those who were taking the micronutrients were more likely to report that their ADHD symptoms were less impairing and less interfering in their work and social relationships than people who were on the placebo. And one year later, those people who stayed on the micronutrients maintained their changes or showed further improvement, and those who switched to medications or stopped the micronutrients actually showed worsening of their symptoms. Now, I need to tell you something here, and that is, when I say micronutrients, I’m actually referring to a dose higher than what you’d get out of a vitamin pill purchased on the supermarket.
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 would unlikely see these positive benefits, both because the dose is lower, and the breadth of nutrients is lower. Now, these positive benefits are not confined to a single study. My lab at the University of Canterbury is the Mental Health and Nutrition Research Group, and we’ve published over 20 papers 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 of medications. This study here showed that we could reduce rates of probable posttraumatic stress disorder from 65% down to 18%, following the Christchurch earthquakes, with a one-month intervention of micronutrients, with no change in those not taking the nutrients.
Even one year later, those people who had received the nutrients were doing better than those who didn’t. And we’ve just replicated these findings in collaboration with researchers at the University of Calgary, following the floods of June 2013, in Alberta, Canada. To me, the message is clear, that a well-nourished body and brain is better able to withstand ongoing stress and recover from illness. Giving micronutrients in appropriate doses can be an effective and inexpensive public health intervention to improve the mental health of a population following an environmental catastrophe.
In my 20-year career, I have rarely seen these dramatic responses from conventional treatments. When people get well, they get well across the board, not only in the symptoms that we treated, but also in other areas, like improved sleep, stabilization of mood, reduction in anxiety, and the reduction in need for 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 to make clinical decisions – showing that we can reduce aggression in prisoners, slow cognitive decline in the elderly, treat depression, anxiety, stress, autism, and ADHD. And, they might 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 inpatient treatment with medications was unsuccessful, he was treated with micronutrients. Not only did the micronutrients completely eliminate his hallucinations and delusions – changes that were maintained six years later – but the cost of the treatment was less than 2% than the cost of the unsuccessful inpatient treatment. The cost savings alone make it imperative that our society pay attention to the wider benefits of this approach. And there is more good news. Treating – Supplementing before mental illness emerges can actually stop these problems from developing in the first place. This fantastic study looked at 81 adolescents at risk for psychosis and randomized them to receive either Omega-3 fatty acids in the form of fish oils – essential nutrients for brain health – or placebo for a 12-week period. One year later, 5% of those who received the fish oil had converted to psychosis versus 28% of those on placebo. That represents an 80% reduction of the chances of you converting to psychosis, simply through giving fish oils.
I wonder if I know what some of you are thinking. I wonder if some of you are thinking, “Hold on! Why don’t I just eat better?” “Why don’t I just tell everyone to eat better?” And indeed, there are some fantastic studies that document the strong relationship between dietary patterns and mental health although we’re still in very early days of scientific investigation. We don’t know who would benefit from dietary manipulation alone, and who may need the additional boost from extra nutrients.
But even in the last five years, there have been 11 epidemiological studies, cross-sectionally and longitudinally, in large populations around the world, all showing the same thing. The more you eat a prudent or Mediterranean or unprocessed type of diet, the lower your risk for depression. And the more you eat the Western diet or processed food, the higher your risk for depression. I know of only one study that has not found this association, and not a single study shows that the Western diet is good for our mental health. (Laughter) What is the Western diet? Well, it’s one that is heavily processed, high in refined grains, sugary drinks, takeaways, and low in fresh produce. And the healthy diet is one that is fresh, high in fruits and vegetables, high in fish, nuts, healthy fats, and low in processed foods. What your grandmother would recognize as food. (Laughter) There are still many questions remaining about the relationship between mental health and nutrition.
What role do genetics play in determining who’s going to respond to nutrients, and who needs additional nutrients than what they can get out of their diet? What role does an infected, inflamed gut play in the absorption of nutrients? It’s not we are what we eat; it’s we are what we absorb. And what role do medications play in determining how effective the nutrients are? Combining medications and nutrients is actually complicated, and we need more research in better understanding these interactions. But ultimately, we need to know how long these good benefits last. So with all of this data, this rich data highlighting the power of nutrition, I think we can make some individual and collective changes now.
We could reconsider our current treatment approach: prioritize lifestyle factors, healthy eating, exercise, supplements, and when necessary, psychological treatments, and save medications for when these approaches don’t work. If nutrients work, then shouldn’t they be covered through our healthcare system? Take universal prevention seriously by optimizing the nutrition of those who are vulnerable. We don’t wait for the heart attack to hit in order for us to modify 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 stated, 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 cash register, then it’s charged to the environment and to the public purse in the form of subsidies, and it’s charged to your health.
All children need to learn how to cook. All children need to know that food doesn’t have to come in a packet. Schools could reflect on the content of their lunch menus. Children are too frequently rewarded with processed foods for good behavior. We need to reflect on whether or not this pairing intuitively makes sense. Ultimately, we have a responsibility to teach them that every time they put something in their mouths, they make a choice: to eat something nourishing, or something nutritionally depleted. In the 19th century, physicians were offended when Semmelweis suggested they wash their hands before delivering babies. We are now asking them to consider whether the medications that they prescribed are contributing to the poor long-term outcome for some people with mental illness. But eating well and when appropriate additional nutrients can improve the mental health of many people. I leave you with one last thought. Randomized trials in the 1600s showed that putting limes aboard ships headed out for long voyages completely eliminated the 40% mortality from scurvy. But it took 264 years for the British government to mandate that all ships must carry citrus for their sailors.
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