Nutrition and mental health

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Nutrition and mental health

VAMFEW has made a rapid preliminary literature search into the broad area of nutrition and mental health. More resources are required to expand insight here. If you are interested in contributing to this area of the site please get in touch.

The plan in the near future would be to distil some clear messages from the current body of research to inform a non-academic audience and identify research gaps. An assessment of the strength of evidence is also required.

A selection of studies on nutrition and mental health. Author’s abstracts.

Akhondzadeh, S., Gerbarg, P. L., & Brown, R. P. (2013). Nutrients for prevention and treatment of mental health disordersPsychiatric Clinics36(1), 25-36.
http://www.ncbi.nlm.nih.gov/pubmed/23538074

The choice of nutrients for review is based on clinical evidence of efficacy in neuropsychiatric disorders and biochemical effects that are neuroprotective or reparative. Vitamins, minerals, amino acids, and metabolites have been shown to augment antidepressants, improve symptoms in anxiety disorders, depression, neurodegenerative diseases, brain injury, ADHD, and schizophrenia, and to reduce medication side effects. Detection and correction of vitamin and mineral deficiencies can be essential for recovery. Generally low in adverse effects when taken in therapeutic doses, nutrients can be combined for greater benefits. Further studies are warranted to validate these promising treatments.

 

Zell, M., & Grundmann, O. (2012). An orthomolecular approach to the prevention and treatment of psychiatric disordersAdvances in mind-body medicine26(2), 14-28.
http://www.ncbi.nlm.nih.gov/pubmed/23341413

Orthomolecular medicine is based on the use of endogenous and naturally occurring substances to supplement deficiencies in vitamins, minerals, and other essential substances in the human body. Although the medical community has long regarded it as a nonscientific approach to healing, scientific and clinical evidence is emerging for the supplemental use of orthomolecular medicine in the treatment of schizophrenia, depression, bipolar disorder, generalized anxiety disorder, and attention deficit hyperactivity disorder. Psychiatrists currently treat these common psychiatric disorders using a wide range of pharmacological approaches that often have significant side effects, resulting in patients’ noncompliance. With newly gained knowledge about the neurophysiology and neuropathophysiology of psychiatric disorders, researchers now can link potential mechanisms for both pharmacological and orthomolecular treatments to physiological processes. In many cases, the use of orthomolecular supplements may provide a feasible addition to conventional drug therapy.

 

Jacka, F. N., Mykletun, A., Berk, M., Bjelland, I., & Tell, G. S. (2011). The association between habitual diet quality and the common mental disorders in community-dwelling adults: the Hordaland Health studyPsychosomatic medicine73(6), 483-490.
https://www.ncbi.nlm.nih.gov/pubmed/21715296

Recent evidence suggests a role for diet quality in the common mental disorders depression and anxiety. We aimed to investigate the association between diet quality, dietary patterns, and the common mental disorders in Norwegian adults. This cross-sectional study included 5731 population-based men and women aged 46 to 49 and 70 to 74 years. Habitual diet was assessed using a validated food frequency questionnaire, and mental health was measured using the Hospital Anxiety and Depression Scale. After adjustments for variables including age, education, income, physical activity, smoking, and alcohol consumption, an a priori healthy diet quality score was inversely related to depression (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.59-0.84) and anxiety (OR = 0.77, 95% CI = 0.68-0.87) in women and to depression (OR = 0.83, 95% CI = 0.70-0.99) in men. Women scoring higher on a healthy dietary pattern were less likely to be depressed (OR = 0.68, 95% CI = 0.57-0.82) or anxious (OR = 0.87, 95% CI = 0.77-0.98), whereas men were more likely to be anxious (OR = 1.19, 95% CI = 1.03-1.38). A traditional Norwegian dietary pattern was also associated with reduced depression in women (OR = 0.77, 95% CI = 0.64-0.92) and anxiety in men (OR = 0.77, 95% CI = 0.61-0.96). A western-type diet was associated with increased anxiety in men (OR = 1.27, 95% CI = 1.14-1.42) and women (OR = 1.29, 95% CI = 1.17-1.43) before final adjustment for energy intake. In this study, those with better quality diets were less likely to be depressed, whereas a higher intake of processed and unhealthy foods was associated with increased anxiety.

 

Chen, M. H., Su, T. P., Chen, Y. S., Hsu, J. W., Huang, K. L., Chang, W. H., … & Bai, Y. M. (2013). Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based studyBMC psychiatry13(1), 161.
https://bmcpsychiatry.biomedcentral.com/track/pdf/10.1186/1471-244X-13-161?site=bmcpsychiatry.biomedcentral.com

Background: A great deal of evidence has shown that iron is an important component in cognitive, sensorimotor, and social-emotional development and functioning, because the development of central nervous system processes is highly dependent on iron-containing enzymes and proteins. Deficiency of iron in early life may increase the risk of psychiatric morbidity. Methods: Utilizing the National Health Insurance Database from 1996 to 2008, children and adolescents with a diagnosis of IDA were identified and compared with age and gender-matched controls (1:4) in an investigation of the increased risk of psychiatric disorders. Results: A total of 2957 patients with IDA, with an increased risk of unipolar depressive disorder (OR = 2.34, 95% CI = 1.58 ~ 3.46), bipolar disorder (OR = 5.78, 95% CI = 2.23 ~ 15.05), anxiety disorder (OR = 2.17, 95% CI = 1.49 ~ 3.16), autism spectrum disorder (OR = 3.08, 95% CI = 1.79 ~ 5.28), attention deficit hyperactivity disorder (OR = 1.67, 95% CI = 1.29 ~ 2.17), tic disorder (OR = 1.70, 95% CI = 1.03 ~ 2.78), developmental delay (OR = 2.45, 95% CI = 2.00 ~ 3.00), and mental retardation (OR = 2.70, 95% CI = 2.00 ~ 3.65), were identified. A gender effect was noted, in that only female patients with IDA had an increased OR of bipolar disorder (OR = 5.56, 95% CI = 1.98 ~ 15.70) and tic disorder (OR = 2.95, 95% CI = 1.27 ~ 6.86). Conclusion: Iron deficiency increased the risk of psychiatric disorders, including mood disorders, autism spectrum disorder, attention deficit hyperactivity disorder, and developmental disorders. Further study is required to clarify the mechanism in the association between IDA and psychiatric disorder.

 

Oddy, W. H., Robinson, M., Ambrosini, G. L., Therese, A. O., de Klerk, N. H., Beilin, L. J., … & Stanley, F. J. (2009). The association between dietary patterns and mental health in early adolescencePreventive medicine49(1), 39-44.
http://www.sciencedirect.com/science/article/pii/S0091743509002643

Objective: To investigate the associations between dietary patterns and mental health in early adolescence. Method: The Western Australian Pregnancy Cohort (Raine) Study is a prospective study of 2900 pregnancies recruited from 1989–1992. At 14 years of age (2003–2006; n = 1324), the Child Behaviour Checklist (CBCL) was used to assess behaviour (characterising mental health status), with higher scores representing poorer behaviour. Two dietary patterns (Western and Healthy) were identified using factor analysis and food group intakes estimated by a 212-item food frequency questionnaire. Relationships between dietary patterns, food group intakes and behaviour were examined using general linear modelling following adjustment for potential confounding factors at age 14: total energy intake, body mass index, physical activity, screen use, family structure, income and functioning, gender and maternal education at pregnancy. Results: Higher total (b = 2.20, 95% CI = 1.06, 3.35), internalizing (withdrawn/depressed) (b = 1.25, 95% CI = 0.15, 2.35) and externalizing (delinquent/aggressive) (b = 2.60, 95% CI = 1.51, 3.68) CBCL scores were significantly associated with the Western dietary pattern, with increased intakes of takeaway foods, confectionary and red meat. Improved behavioural scores were significantly associated with higher intakes of leafy green vegetables and fresh fruit (components of the Healthy pattern). Conclusion: These findings implicate a Western dietary pattern in poorer behavioural outcomes for adolescents. Better behavioural outcomes were associated with a higher intake of fresh fruit and leafy green vegetables.

 

Godfrey, P. S. A., Toone, B. K., Bottiglien, T., Laundy, M., Reynolds, E. H., Carney, M. W. P., … & Chanarin, I. (1990). Enhancement of recovery from psychiatric illness by methylfolateThe Lancet336(8712), 392-395.
http://www.sciencedirect.com/science/article/pii/0140673690919424

41 (33%) of 123 patients with acute psychiatric disorders (DSM III diagnosis of major depression or schizophrenia) had borderline or definite folate deficiency (red-cell folate below 200 μg/l) and took part in a double-blind, placebo-controlled trial of methylfolate, 15 mg daily, for 6 months in addition to standard psychotropic treatment. Among both depressed and schizophrenic patients methylfolate significantly improved clinical and social recovery. The differences in outcome scores between methylfolate and placebo groups became greater with time. These findings add to the evidence implicating disturbances of methylation in the nervous system in the biology of some forms of mental illness.

 

Kaplan, B. J., Fisher, J. E., Crawford, S. G., Field, C. J., & Kolb, B. (2004). Improved mood and behavior during treatment with a mineral-vitamin supplement: an open-label case series of childrenJournal of child and adolescent psychopharmacology14(1), 115-122.
https://www.ncbi.nlm.nih.gov/pubmed/15142398

Several studies have demonstrated that psychiatric symptoms such as depression, mood swings, and aggression may be ameliorated by supplementation with broad-based nutrient formulas containing vitamins, minerals, and sometimes essential fatty acids. These findings have been reported in young criminal offenders as well as in adults with mood disturbance and other psychiatric disorders. The purpose of the current case series was to explore the potential efficacy of a nutrient supplement in children. Children with mood and behavioral problems (N = 11; 7 boys, 4 girls; 8-15 years old) participated; 9 completed this open-label trial. Parents completed the Child Behavior Checklist (CBCL), Youth Outcome Questionnaire (YOQ), and Young Mania Rating Scale (YMRS) at entry and following at least 8 weeks of treatment. Intent-to-treat analyses revealed decreases on the YOQ (p < 0.001) and the YMRS (p < 0.01) from baseline to final visit. For the 9 completers, improvement was significant on seven of the eight CBCL scales, the YOQ, and the YMRS (p values from 0.05-0.001). Effect sizes for all outcome measures were relatively large. The findings suggest that formal clinical trials of broad nutritional supplementation are warranted in children with these psychiatric symptoms.

 

Rudin, D. O. (1981). The major psychoses and neuroses as omega-3 essential fatty acid deficiency syndrome: substrate pellagraBiological psychiatry16(9), 837-850.
https://www.ncbi.nlm.nih.gov/pubmed/7028146

Pellagra was once a major cause of three behaviorally different mental disorders-schizophreniform, manic-depressive-like, and phobic neurotic – plus drying dermatoses, autonomic neuropathies, tinnitus, and fatigue. In this preliminary study all three of the corresponding present-day mental diseases are found to exhibit, statistically, the same pellagraform physical disorders but to ameliorate not so much with vitamins as with supplements of a newly discovered trace omega-3 essential fatty acid (w3-EFA), which provides the substrate upon which niacin and other B vitamin holoenzymes act uniquely to form the prostaglandin 3 series tissue hormones regulating neurocircuits en block. Since present-day refining and food selection patterns, as well as pure corn diets, deplete both the B vitamins and W3-EFA, the existence of therapeutically cross-reacting homologous catalyst and substrate deficiency forms of pellagra are postulated, the first contributing to the B vitamin deficiency epidemics of 50-100 years ago, the second to the more recent endemic “Diseases of Western Civilization” which express in certain genetic subgroups as the major mental illnesses of today.

 

Simpson, J. S. A., Crawford, S. G., Goldstein, E. T., Field, C., Burgess, E., & Kaplan, B. J. (2011). Systematic review of safety and tolerability of a complex micronutrient formula used in mental healthBMC psychiatry11(1), 62.
https://bmcpsychiatry.biomedcentral.com/track/pdf/10.1186/1471-244X-11-62?site=bmcpsychiatry.biomedcentral.com

Background: Theoretically, consumption of complex, multinutrient formulations of vitamins and minerals should be safe, as most preparations contain primarily the nutrients that have been in the human diet for millennia, and at safe levels as defined by the Dietary Reference Intakes. However, the safety profile of commercial formulae may differ from foods because of the amounts and combinations of nutrients they contain. As these complex formulae are being studied and used clinically with increasing frequency, there is a need for direct evaluation of safety and tolerability. Methods: All known safety and tolerability data collected on one complex nutrient formula was compiled and evaluated. Results: Data were assembled from all the known published and unpublished studies for the complex formula with the largest amount of published research in mental health. Biological safety data from 144 children and adults were available from six sources: there were no occurrences of clinically meaningful negative outcomes/effects or abnormal blood tests that could be attributed to toxicity. Adverse event (AE) information from 157 children and adults was available from six studies employing the current version of this formula, and only minor, transitory reports of headache and nausea emerged. Only one of the studies permitted a direct comparison between micronutrient treatment and medication: none of the 88 pediatric and adult participants had any clinically meaningful abnormal laboratory values, but tolerability data in the group treated with micronutrients revealed significantly fewer AEs and less weight gain. Conclusions: This compilation of safety and tolerability data is reassuring with respect to the broad spectrum approach that employs complex nutrient formulae as a primary treatment.

 

Poleszak, E., Szewczyk, B., Kędzierska, E., Wlaź, P., Pilc, A., & Nowak, G. (2004). Antidepressant-and anxiolytic-like activity of magnesium in mice. Pharmacology Biochemistry and Behavior, 78(1), 7-12.
https://www.ncbi.nlm.nih.gov/pubmed/15159129

The antidepressant- and anxiolytic-like effects of magnesium, an N-methyl-d-aspartate (NMDA) glutamate receptor inhibitor, were studied in mice using the forced swim test and elevated plus-maze test, respectively. The doses of 20 and 30 mg Mg/kg, reduced immobility time in the forced swim test exerting antidepressant-like activity. In the elevated plus-maze test, magnesium at the same doses produced anxiolytic-like effect. The doses of magnesium active in both tests did not affect locomotor activity. To evaluate the tolerance to these effects, we also performed experiments on the following acute/chronic magnesium treatment schedule: chronic saline and saline challenge at 0.5 h before behavioral experiments or serum magnesium determination (S+S), chronic saline and magnesium challenge (S+Mg), chronic magnesium and saline challenge (Mg+S), chronic magnesium and magnesium challenge (Mg+Mg). The antidepressant- and anxiolytic-like effect of magnesium was demonstrated in groups treated acutely and chronically with magnesium (Mg+Mg), but not in the Mg+S group. Moreover, these effects seem to be connected with at least 58% increase in serum magnesium concentration. The results indicate that magnesium induces the antidepressant- and anxiolytic-like effects without tolerance to these activities, which suggests a potential antidepressant and anxiolytic activity of magnesium in these disorders in humans.

 

Kiecolt-Glaser, J. K., Belury, M. A., Andridge, R., Malarkey, W. B., & Glaser, R. (2011). Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain, behavior, and immunity, 25(8), 1725-1734.
http://www.sciencedirect.com/science/article/pii/S0889159111004685

Observational studies have linked lower omega-3 (n-3) polyunsaturated fatty acids (PUFAs) and higher omega-6 (n-6) PUFAs with inflammation and depression, but randomized controlled trial (RCT) data have been mixed. To determine whether n-3 decreases proinflammatory cytokine production and depressive and anxiety symptoms in healthy young adults, this parallel group, placebo-controlled, double-blind 12-week RCT compared n-3 supplementation with placebo. The participants, 68 medical students, provided serial blood samples during lower-stress periods as well as on days before an exam. The students received either n-3 (2.5 g/d, 2085 mg eicosapentaenoic acid and 348 mg docosahexanoic acid) or placebo capsules that mirrored the proportions of fatty acids in the typical American diet. Compared to controls, those students who received n-3 showed a 14% decrease in lipopolysaccharide (LPS) stimulated interleukin 6 (IL-6) production and a 20% reduction in anxiety symptoms, without significant change in depressive symptoms. Individuals differ in absorption and metabolism of n-3 PUFA supplements, as well as in adherence; accordingly, planned secondary analyses that used the plasma n-6:n-3 ratio in place of treatment group showed that decreasing n-6:n-3 ratios led to lower anxiety and reductions in stimulated IL-6 and tumor necrosis factor alpha (TNF-α) production, as well as marginal differences in serum TNF-α. These data suggest that n-3 supplementation can reduce inflammation and anxiety even among healthy young adults. The reduction in anxiety symptoms associated with n-3 supplementation provides the first evidence that n-3 may have potential anxiolytic benefits for individuals without an anxiety disorder diagnosis.

 

Schmidt, K., Cowen, P. J., Harmer, C. J., Tzortzis, G., Errington, S., & Burnet, P. W. (2015). Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers. Psychopharmacology, 232(10), 1793-1801.
https://link.springer.com/article/10.1007%2Fs00213-014-3810-0

There is now compelling evidence for a link between enteric microbiota and brain function. The ingestion of probiotics modulates the processing of information that is strongly linked to anxiety and depression, and influences the neuroendocrine stress response. We have recently demonstrated that prebiotics (soluble fibres that augment the growth of indigenous microbiota) have significant neurobiological effects in rats, but their action in humans has not been reported. The present study explored the effects of two prebiotics on the secretion of the stress hormone, cortisol and emotional processing in healthy volunteers. Forty-five healthy volunteers received one of two prebiotics (fructooligosaccharides, FOS, or Bimuno®-galactooligosaccharides, B-GOS) or a placebo (maltodextrin) daily for 3 weeks. The salivary cortisol awakening response was sampled before and after prebiotic/placebo administration. On the final day of treatment, participants completed a computerised task battery assessing the processing of emotionally salient information. The salivary cortisol awakening response was significantly lower after B-GOS intake compared with placebo. Participants also showed decreased attentional vigilance to negative versus positive information in a dot-probe task after B-GOS compared to placebo intake. No effects were found after the administration of FOS. The suppression of the neuroendocrine stress response and the increase in the processing of positive versus negative attentional vigilance in subjects supplemented with B-GOS are consistent with previous findings of endocrine and anxiolytic effects of microbiota proliferation. Further studies are therefore needed to test the utility of B-GOS supplementation in the treatment of stress-related disorders.

 

Chen, M. H., Su, T. P., Chen, Y. S., Hsu, J. W., Huang, K. L., Chang, W. H., … & Bai, Y. M. (2013). Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC psychiatry, 13(1), 161.
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-161

A great deal of evidence has shown that iron is an important component in cognitive, sensorimotor, and social-emotional development and functioning, because the development of central nervous system processes is highly dependent on iron-containing enzymes and proteins. Deficiency of iron in early life may increase the risk of psychiatric morbidity. Utilizing the National Health Insurance Database from 1996 to 2008, children and adolescents with a diagnosis of IDA were identified and compared with age and gender-matched controls (1:4) in an investigation of the increased risk of psychiatric disorders. A total of 2957 patients with IDA, with an increased risk of unipolar depressive disorder (OR = 2.34, 95% CI = 1.58 ~ 3.46), bipolar disorder (OR = 5.78, 95% CI = 2.23 ~ 15.05), anxiety disorder (OR = 2.17, 95% CI = 1.49 ~ 3.16), autism spectrum disorder (OR = 3.08, 95% CI = 1.79 ~ 5.28), attention deficit hyperactivity disorder (OR = 1.67, 95% CI = 1.29 ~ 2.17), tic disorder (OR = 1.70, 95% CI = 1.03 ~ 2.78), developmental delay (OR = 2.45, 95% CI = 2.00 ~ 3.00), and mental retardation (OR = 2.70, 95% CI = 2.00 ~ 3.65), were identified. A gender effect was noted, in that only female patients with IDA had an increased OR of bipolar disorder (OR = 5.56, 95% CI = 1.98 ~ 15.70) and tic disorder (OR = 2.95, 95% CI = 1.27 ~ 6.86). Iron deficiency increased the risk of psychiatric disorders, including mood disorders, autism spectrum disorder, attention deficit hyperactivity disorder, and developmental disorders. Further study is required to clarify the mechanism in the association between IDA and psychiatric disorder.

 

Stoll, A. L., Severus, W. E., Freeman, M. P., Rueter, S., Zboyan, H. A., Diamond, E., … & Marangell, L. B. (1999). Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Archives of general psychiatry, 56(5), 407-412.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/204999

ω3 Fatty acids may inhibit neuronal signal transduction pathways in a manner similar to that of lithium carbonate and valproate, 2 effective treatments for bipolar disorder. The present study was performed to examine whether ω3 fatty acids also exhibit mood-stabilizing properties in bipolar disorder. A 4-month, double-blind, placebo-controlled study, comparing ω3 fatty acids (9.6 g/d) vs placebo (olive oil), in addition to usual treatment, in 30 patients with bipolar disorder. A Kaplan-Meier survival analysis of the cohort found that the ω3 fatty acid patient group had a significantly longer period of remission than the placebo group (P=.002; Mantel-Cox). In addition, for nearly every other outcome measure, the ω3 fatty acid group performed better than the placebo group. ω3 Fatty acids were well tolerated and improved the short-term course of illness in this preliminary study of patients with bipolar disorder.