What makes some of us more likely to drive over the speed limit, participate in extreme sports or make decisions that can impact health over time? Risk-taking behavior has distinct subtypes (for example disinhibition, sensation seeking, calculated risks, impulsivity) that develop due to the complex interplay of different factors: our lifestyle and environment, our personal susceptibility (genetic and biological variants) and a wide range of psychological effects.

In the study of Strawbridge and colleagues (2018) the goal was to identify genetic determinants of this trait. This approach has the potential to improve our understanding of impulsive behavior across different psychiatric disorders. It can also help later on to explore the possible overlap between mental illnesses and physical health.

„Would you consider yourself a risk taker?” This was the question posed to 116,255 participants, aged 40 to 69, from the UK Biobank project, a large population cohort containing a wide range of sociodemographic and medical information. Roughly one-quarter answered yes, they were the ’risk takers’ group.

A subset of participants took part in a prolonged follow-up occasion as well, where the same question was asked enabling an assessment of response consistency. Reproducibility was quite good, 81% of all participants responded consistently, 13% inconsistently, while in 6% the data was missing.

Genetic loci associated with risk-taking behavior were explored using the genome-wide association study approach. The authors identified one potential locus on chromosome 3 (CADM2) consistently, which was previously implicated in cognitive and executive functions.

Considering the entire genome using the polygenic risk score approach, the authors found, that the genetic variants that make us risk-prone also make us more likely to develop mental illnesses, such as bipolar disorder, schizophrenia, attention-deficit hyperactivity disorder, and post-traumatic stress disorder.

This trait has not only significant positive genetic correlations with a range of mental health disorders, but also with smoking, lifetime cannabis use and body mass index (BMI). The latter implies the possibility that this finding could be followed up in a study exploring the nutritional aspects of impulsivity as well.

Overall, using dimensional approach for traits (from “normal” to pathological) rather than discrete diagnostic categories could be helpful for finding the common ground in the neurobiological underpinnings across psychiatric disorders. From this point of view, risk-taking behavior is also a complex and important phenotype for investigations.

You can find the full research article here.

Strawbridge, R. J., Ward, J., Cullen, B., Tunbridge, E. M., Hartz, S., Bierut, L., Horton, A., Bailey, M. E. S., Graham, N., Ferguson, A., Lyall, D. M., Mackay, D., Pidgeon, L. M., Cavanagh, J., Pell, J. P., O’Donovan, M., Escott-Price, V., Harrison, P. J., & Smith, D. J. (2018). Genome-wide analysis of self-reported risk-taking behaviour and cross-disorder genetic correlations in the UK Biobank cohort. Translational Psychiatry, 8. https://doi.org/10.1038/s41398-017-0079-1

This was co-authored by  Tünde Kilencz, a psychologist and research assistant at Semmelweis University, Department of Psychiatry and Psychotherapy in Budapest, Hungary.

Food is addictive. It has been an addiction that has kept mankind alive for thousands of years. Today, hunger is no longer a problem in the developed world; it is quite the opposite. According to the World Health Organization, worldwide obesity has nearly tripled since 1975. Obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese.

In order to maximize the nutritional value, humans are hard-wired to prefer foods that have either a high sugar or fat content. The amount of energy obtained from food is measured in kilocalories (kcal) per gram. Fats have the most energy (9 kcal) and carbohydrates (sugars and starches) have the same amount of energy as proteins (4 kcal). However, these nutrients differ in how quickly they supply energy. Sugars and starches have the advantage of being converted into energy faster than fats and protein. Protein is preferentially used for building and repairing different tissues, not as an energy source.

Once a beneficial adaptation of preferring fast digesting or the most energy-rich nutrients, has now become a risk factor for both physical and also mental health (1), making it an inevitable research focus.

In a recent study at the Yale University School of Medicine (2) it was determined that people not only favour fatty or sugary foods, but place the highest value on those that combine both. Participants (tasked to make monetary bids on different food items) were ready to pay the most for cookies, chocolate, cake and other treats that had both high sugar and also fat content. Equally familiar, liked and caloric fatty (e.g., cheese, salami) or sugary foods (e.g., lollipops) were assigned lower values.

Based on surges of activity, brain scans revealed that foods high in both fat and sugar were more rewarding than foods rich in only one category of nutrient.

Unexpectedly, it was also observed that participants were very accurate at estimating the energy density (kcal) of fatty foods, but poor at estimating the energy density of sugar-containing foods.

Once rare, but nowadays common and abundant treats high in both fat and sugar are most rewarding and therefore can very likely contribute to overeating. In addition, it has turned out to be difficult for people to assess the amount of calories in foods with a high sugar content. These findings taken together can help to understand and also hopefully find new treatment options for people struggling with obesity.

  • Hoare E et al (2015) Systematic review of mental health and well-being outcomes following community-based obesity prevention interventions among adolescents. BMJ Open 2015;5:e006586. doi:10.1136/bmjopen-2014-006586
  • DiFeliceantonio et al (2018) Supra-additive effects of combining fat and carbohydrate on food reward. Cell Metabolism 28, 1–12. doi:10.1016/j.cmet.2018.05.018

The reason why I look at impulsive behavior is because mental disorders are the single largest contributors to disease burden in Europe. Impulsivity and compulsivity increase the risk of psychiatric disorders, especially Attention Deficit Hyperactivity Disorder, alcohol and drug abuse disorders, conduct disorder and antisocial disorders (including aggression). The urgency of addressing impulsivity and compulsivity is additionally strongly supported by the fact that these problems increase the risk for mortality.

My name is Yvonne Willemsen and I have started my PhD track at Radboud University in the Netherlands in October 2017. For my project I will assess the association between nutrition, gut microbiota composition and impulsive behavior in toddlers and young adolescents. In the following paragraphs, I will explain the first study that I am currently conducting.

Many previous studies have examined the association between nutrition and executive functions. Executive functions are cognitive processes in the brain that contribute to regulating thoughts and behaviors. Executive functions can be roughly divided into three core functions, namely: inhibitory control, working memory, and cognitive flexibility. Inhibitory control, which can be interpreted as the opposite of impulsivity, is necessary to suppress impulses. It is also an important core function of executive functions, as it supports working memory and cognitive flexibility.  To date, studies have examined the association between nutrition and executive functions in general (1). Whether nutrition is related to inhibitory control specifically (in toddlers and young adolescents) is something that still needs to be investigated.

The next step of my study is to understand how nutrition is associated with inhibitory control. To explain a possible mechanism, we will look at the gut microbiota. The reason why the gut microbiota is a point of interest is because gut microbiota can secrete molecules that may influence brain function, and thus may influence inhibitory control (2). This connection between the gut and the brain is also known as the gut-brain axis. Gut microbiota composition can change according to nutritional intake, and can therefore play a role in the gut brain axis (3). To assess the association between nutrition, gut microbiota and behavior in toddlers and young adolescents, we will use questionnaires and different behavioural measures.

  1. Cohen, J. F. W., Gorski, M. T., Gruber, S. A., Kurdziel, L. B. F. & Rimm, E. B. The effect of healthy dietary consumption on executive cognitive functioning in children and adolescents: a systematic review. Br. J. Nutr. 116, 989–1000 (2016). Link
  2. Rogers, G. B. et al. From gut dysbiosis to altered brain function and mental illness: mechanisms and pathways. Mol. Psychiatry 21, 738–748 (2016). Link
  3. Oriach, C. S., Robertson, R. C., Stanton, C., Cryan, J. F. & Dinan, T. G. Food for thought: The role of nutrition in the microbiota-gut–brain axis. Clin. Nutr. Exp. 6, 25–38 (2016). Link

The human gut is colonized by microorganisms in a similar number as the cells of the human body.

“Microbiota” refers to these microorganisms, and it maintains a symbiotic relationship with the host, contributing to essential functions such as food digestion, energy harvest and storage, the function of the intestinal barrier, and the immune system and protection against pathogenic organisms. Prenatal and postnatal factors can alter the composition of the microbiota, such as stress and diet or the use of antibiotics (see image).

Prenatal and Postnatal factors influence gut-brain axis and mental healthFor instance, stress during pregnancy can alter the composition of vaginal microbiota, which affects the composition of the microbiota of the newborn and is related to gastrointestinal (GI) symptoms and allergic reactions. Interestingly, there is a bidirectional communication between the GI tract and the central nervous system (the gut-brain axis) that involves neuronal and metabolic pathways, immune and endocrine mechanisms. Changes in the composition of the microbiota can lead to altered development of the brain and increased risk of psychiatric and neurodevelopmental disorders, such as anxiety, depression and autism (see image).

Depression is one of the most recurrent stress-related disorders that highly impacts the quality of life. Fecal samples of patients with depression have a decreased microbial richness and diversity than controls. The use of probiotics have been shown to help with sad mood and negative thoughts, which may be a potential preventive strategy for depression.

Autism is characterized by impaired communication, poor social engagement and repetitive behaviours, with frequent GI symptoms. We know that the bacteria composition is more diverse in autistic individuals than in unaffected subjects.

For other psychiatric disorders, such as Attention deficit/hyperactivity disorder (ADHD) and Schizophrenia, there is indirect evidence for a role of the microbiota, but more studies are needed.

This connection between the gut and brain is two way communication, and is known as “The Gut-Brain Axis.”

Our knowledge of the impact of gut microbiota on brain function is growing fast, which may pave the way to possible applications for the treatment of psychiatric and neurodevelopmental disorders.

Authors Judit Cabana, Bru Cormand, and Noelia Fernandez Castillo are in the Department of Genetics, Microbiology & Statistics, University of Barcelona, Catalonia, Spain

More information can be found in: Felice VD, O’Mahony SM. The microbiome and disorders of the central nervous system. (2017) Pharmacol Biochem Behav. Sep;160:1-13.
https://www.ncbi.nlm.nih.gov/pubmed/28666895

It must have been mid-October 2017 that Oliver (8 years of age) and his family were referred to us by one of our co-workers. “Parents would like to know more about a dietary intervention for Oliver’s ADHD as opposed to medication. Oliver is falling behind at school due to attention difficulties and impulsivity. In addition to that, he has difficulty maintaining friendships and gets into fights every other day.” After screening Oliver’s behavioural problems both at home and at school, we concluded that Oliver fulfilled all inclusion criteria and none of the exclusion criteria: he and his family were most welcome to participate in our dietary intervention at New Brain Nutrition.

Oliver’s family consists of his mother, father and younger sister Liz (6 years of age). In addition to that, his grandmother and grandfather are closely involved in raising Oliver and Liz: they take care of their grandchildren two days a week (after school). One of the major difficulties that parents had to deal with in implementing the diet was that the grandparents were somewhat sceptical about the intervention. While grandfather had this ‘Well, boys will be boys’ kind of view on Oliver’s behaviour, his grandmother was more into a ‘The way to a man’s heart is through his stomach’ perspective, which led to pampering Oliver and Liz with candy on a daily basis. This called for some extra support from our researchers (who are also clinicians) in explaining the treatment to the grandparents. Eventually, all were on the same page and well-instructed before the start of the dietary intervention.

chocolate gooey browniesAt the start, parents filled out a baseline questionnaire on the behavioural problems (i.e. hyperactivity, impulsivity, attention deficits), physical problems (i.e. headache, stomach-ache, changes in appetite) and emotional difficulties (i.e. tantrums, mood swings) that Oliver dealt with. These measures were monitored by his parents on a daily basis (on a 5-points scale) for the following five weeks. These data were collected by our dietician on a weekly basis, while the dietician also monitored their adherence. In the first week, Oliver and his grandmother made a few dietary mistakes, but from the second week onwards, all became accustomed to the dietary protocol. Oliver’s mother encouraged all family members by setting shared goals on a weekly basis. For example, if the children earned a certain amount of stickers, they would go to the swimming pool by the end of first week, to a play-farm by the end of the second week, and so on.

After three weeks, a drop in behavioural problems was seen (from an average of 5/5 at baseline to an average of 3/5 after 3 weeks), while emotional difficulties (and the related fights with peers) were diminished after three weeks (from 5/5 on average at baseline to an average of 1/5 after 3 weeks). Physical complaints were not reported (1/5 on average at both baseline and after 3 weeks). His attentional problems however remained severe (4/5 on average at both baseline and after 3 weeks).

The decrease in problems persisted until the end of the first five weeks of the dietary intervention. Since the attentional problems kept interfering with Oliver’s school performances, school provided Oliver with a noise-cancelling headset after the fifth week.

The overall results led Oliver and his family to decide to proceed with the re-introduction of eliminated foods. This however was done after the holidays (Saint Nicholas, Christmas), which parents considered too much of a challenge to combine with a strict diet. Today (mid-February), Oliver and his family are in the midst of the re-introduction of foods. Every two weeks one new product is re-introduced in bulk. Oliver’s mother turns out to be a genius in creating attractive snacks and dishes that adhere to the dietary protocol. And Oliver? He is very proud of himself for sticking to the diet!

(Editor’s note: New Brain Nutrition is conducting numerous studies on food elimination diets and other nutrition and supplement topics through 2022.  Subscribe to our blog for updates.  We look forward to sharing a lot of information and findings with you.)

Nutrition as part of the solution to the mental health crisis!

Mental illness affects one in five people globally and, despite the wide availability of solid empirically supported therapies, these statistics are not getting any better. We appear to have reached an impasse improving outcomes, despite improvements in other areas of medicine.

We need to explore new avenues.

There has been a small explosion in research using nutrients for the treatment of mental illness over the last decade. The general premise is that our brains need nutrients to function and chemicals that are essential for good mental health, like dopamine and serotonin, require micronutrients, like vitamins and minerals.

Preliminary clinical trials are putting micronutrients and good nutrition on the map as essential for optimal brain health. These trials show that giving more nutrients than what is obtained through diet alone can have a positive impact on serious conditions, like Attention-Deficit/Hyperactivity Disorder (ADHD)(1), autism(2) or anxiety(3). Along a similar vein, other studies are highlighting that improving diet alone can also improve mental health. By showing that manipulation of the amount of nutrients one consumes can influence mental health, the research demonstrates that the nutrients these participants were receiving prior to these interventions were not adequate to meet their mental health needs.

Beyond a ‘sledge hammer’ solution

Nutrition and mental healthAt the moment though, in the area of nutrient supplementation research, we are taking a sledge hammer to the problem. We give everyone a broad array of nutrients and see who gets better. That’s been a good start in that significant changes in many areas of functioning have been observed in many people, but the problem is that we each have unique nutrient requirements.

This approach of “one size fits all” will only go so far. Some people don’t respond. Some people only get marginally better. Why? Can we use genetic and nutrient testing to determine the optimal dose and nutrients that someone may require to get better based on their individualized profile? Can we use microbiome analyses to determine what microbial strains are required to best heal the gut to optimize absorption of nutrients? Current and future technologies should allow us to greatly expand the number of people who benefit from a nutritional approach.

Can this research also be used to target our food choices? To date, nutritional value is not the primary motivator in food processing. Agricultural practices tend to prioritize food storage, growth rates, transportability, shelf life, colour, shape and size above nutrient content. Could scanning of nutrient levels of fruits and vegetables using your mobile phone bring focus to the importance of the nutrient quality of our food such that this becomes the priority of consumers over aesthetic qualities or price?

Food or medicine?

Some challenges lie ahead in access to nutrients. As soon as nutrients are proven to have therapeutic benefit, legislation in some countries requires that they be treated as medicines. In other cases, dose alone can affect classification as a supplement or medication. This means as the evidence for efficacy increases, accessibility to the general public will be reduced as the ministry may insist that nutrients be accessible only by prescription.

Based on the medical model, there is a belief that pills that improve health comes with side effects that must be carefully monitored and controlled. To date, our research has shown minimal to non-existent side effects from the nutrient combinations we have studied. Moreover, physicians are currently not well placed to prescribe nutrients because so few have training in nutrition.

Government has the power to ensure legislation allows easy access to nutrients and permits health claims to be made based on good science. Such legislation could ensure that nutrients are easily available due to the very low risk associated with consuming nutrients as compared with pharmaceutical drugs.

Further challenges

Some companies sell nutrient products that optimize profit over health benefit. This may result in cutting corners, not using minerals that have been well chelated, not using the most bioavailable forms of vitamins. This will impact efficacy. It will be a challenge to ensure that nutrients designed for improving mental health are not compromised. Snake oil salesmen are never too far away.

Ensuring good access to nourishing food will also be a challenge. The prevailing mindset is that good food is expensive. However, this is true only if one doesn’t count the costs associated with eating poorly. We need attitudes towards food to change from providing calories to providing the essentials of health. Perhaps one day we will all come to realize that so many packaged and highly processed foods are nutritionally depleted. Ideally, if consumers would stop buying these products, changes would follow.

It is encouraging that some people can have better mental health and more fulfilling lives simply by ensuring their brains receive adequate nutrients and that they will not have to experience the side effects associated with so many medications. Perhaps mental illness will be viewed as being at least partially caused by improper nutrition, as our ancestors knew. Could such a shift influence the stigma associated with mental illness?

Valuing the role of nutrition as part of addressing our mental health statistics is part of our future. How well we can ensure that access is optimized and price is affordable will depend on good legislation, a re-evaluation of our current health care model and ensuring competing market forces don’t compromise the acceptability and efficacy of this solution.

(1) Rucklidge JJ1, Frampton CM, Gorman B, Boggis A. Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. Br J Psychiatry.2014;204:306-15. doi: 10.1192/bjp.bp.113.132126. Epub 2014 Jan 30.

(2) Adams JB, Audhya T, McDonough-Means S, et al. Effect of a vitamin/mineral supplement on children and adults with autism. BMC Pediatrics. 2011;11:111. doi:10.1186/1471-2431-11-111.

(3) Rucklidge JJ1, Andridge R, Gorman B, Blampied N, Gordon H, Boggis A. Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Hum Psychopharmacol. 2012 Sep;27(5):440-54. doi: 10.1002/hup.2246. Epub 2012 Jul 11.

Isn’t it amazing what a regular breakfast habit can do for you?

An old German saying states breakfast as the most important meal of the day. And it might be right! A review by Rampersaud and colleagues (2005)(1) investigated the effect of a regular breakfast habit on a variety of outcomes. They concluded that children and adolescents who typically ate breakfast – irrespective of the quality of the food – tended to have better nutritional profiles, were less likely to be overweight – even though they consumed more calories per day! – and had improved cognitive function (measured by memory assessment and test grades).

These findings are crucial since more than half of the high school students reported having skipped breakfast most days in the previous week. What was a big surpriseMuesli yogurt fruit was even a bowl of ‘unhealthy’ ready-to-eat cereal seems to be superior to not having breakfast at all.  However, to maximize the potential benefits of breakfast consumption, of course, a healthful breakfast should be favoured.

In addition to the effects stated above, children’s psychosocial functioning improved significantly when a school breakfast was introduced, indicating that it’s never too late to change your eating habits and benefit from the positive effects of a regular breakfast. A school breakfast program even had positive effects on measures of child depression and hyperactivity.

Parental Eating Habits Effect Children
Importantly, parental breakfast eating was not only a significant predictor of adolescent breakfast eating. The frequency of family meals was the most significant parental influence on adolescent eating habits and even increased the likelihood that children, as well as adolescents, made more healthy food choices in general. So whether you are a caring parent seeking to support your child’s mental health or whether you are a student seeking to improve your potential – remember the German saying when you enter the kitchen in the morning. Grab that whole grain bread, muesli or fresh fruit and vegetables and start your day with an extra portion of brain food and good nutrition!

(1) Rampersaud GC1, Pereira MA, Girard BL, Adams J, Metzl JD. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc.2005 May;105(5):743-60; quiz 761-2. PMID: 15883552; DOI: 10.1016/j.jada.2005.02.007

Vitamin B and ADHDThere is a well-documented relationship between dietary factors, health and human behavior. Severe malnutrition produces neurological and psychiatric symptoms. It is also assumed that dietary factors play a role in common mental disorders, such as ADHD, but this is less established and more difficult to investigate. A few studies have documented a beneficial effect of dietary interventions and vitamin supplements in ADHD in children and adults. To examine the nutritional status in ADHD, Landaas et al.(1) recently compared blood vitamin levels in 133 adult ADHD patients and 131 healthy controls. In the ADHD group there was a clear overrepresentation in the group with low levels of vitamins B2, B6 and B9.

It is yet unclear whether these vitamin levels are a) associated with ADHD symptoms, or b) whether they are the result of altered dietary intake, or c) metabolism in ADHD patients. However, it is possible that the differences reflect dietary habits that are different in a subgroup of ADHD patients and controls. Dietary habits are established early during life and may last into adulthood. It is possible that suboptimal dietary habits may precipitate, exacerbate or maintain symptoms of ADHD. More research in larger samples is obviously needed to clarify these issues. Over the next five years in our project, entitled “Effects of Nutrition and Lifestyle on Impulsive, Compulsive, and Externalizing behaviours,” we expect to gain much more insight into these connections.  We will share our findings with you.  Stay tuned!!

(1) BJPsych Open. 2016 Nov; 2(6): 377–384. Published online 2016 Dec 13. doi:  10.1192/bjpo.bp.116.003491
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153567/