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

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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.)

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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.

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Is there any evidence for using micronutrients for the treatment of mental illness?

The notion that good nutrition is good for the brain is not a new idea. What is relatively new is that, until recently, there were very few well conducted studies examining whether a broad spectrum approach using doses of nutrients higher than what you could get out of a daily diet, could treat a mental disorder.

At my lab at the University of Canterbury, we have been studying the impact of micronutrients (vitamins and minerals) on mental health for the last decade. With more and more people suffering from a mental illness and not enough people getting better with conventional treatments, we need to investigate new ideas. We appear to have reached an impasse improving outcomes for mental health, despite improvements in other areas of medicine.

Mental illness and micronutrientsFor the past several decades, this idea that nutrients might treat mental illness was received with great scepticism and even ridiculed. Some continue to believe that vitamins kill us, despite evidence(1) to the contrary.

And why would this approach even work? Many readers might consider the idea is too simple to be taken seriously. But 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. Agricultural practices have changed dramatically over the last 50 years such that our food is just not as nourishing as it was for our ancestors. Perhaps some people are genetically prone to need more nutrients than what they can get out of their food. Maybe giving nutrients in higher doses than what is present in the diet can correct metabolic errors that some people may have inherited. It isn’t that farfetched an idea; don’t forget, a million sailors died from scurvy in the 18th century, before Vitamin C was introduced as a treatment.

Scientific advancements in knowledge of micronutrients

Over the last decade the field has grown substantially. No single study should be interpreted in isolation. There are now over 30 double blind randomised controlled trials (RCT) using a variety of combinations of nutrients and doses across a variety of mental health conditions showing that we can induce a substantial and clinically meaningful change in symptoms just by using nutrients.

It takes two RCTs to put a drug on the market. There are enough RCTs completed internationally that this approach should already be mainstream for the treatment of stress, anxiety, low mood and aggression in prisoners. Sadly, good nutrition and additional nutrients are not on the menu in prisons and if you present to your GP with stress or low mood, chances are pretty good that you will be put on a medication. Most data across the world consistently show that about 10% of the populations are taking an anti-depressant. In some countries, this number is even higher.

There is a long way to go to improve the effectiveness of this approach. More research is required to determine if we can enhance outcomes with a more tailored approach. We are in the infancy of figuring out the mechanism of action. Can we use genetic and nutrient testing to determine the optimal dose and nutrients that someone may require to get better, based on their individual profile? Can we use microbiome analyses to determine what microbial strains are required to best heal the gut to optimise absorption of nutrients? Current and future technologies should allow us to greatly expand the number of people who benefit from a nutritional approach. Eat2BeNice plans to investigate all these mechanism of action.

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. Could such a shift influence the stigma associated with mental illness?

We could continue to ignore the data. Or we can embrace the idea, properly fund it, and see how far it can take us in curbing the national trends. Valuing the role of nutrition as part of addressing our mental health statistics must become part of our future. Thanks to the European Commission, this might just happen.

(1) Helen Macpherson, Andrew Pipingas, Matthew P Pase; Multivitamin-multimineral supplementation and mortality: a meta-analysis of randomized controlled trials, The American Journal of Clinical Nutrition, Volume 97, Issue 2, 1 February 2013, Pages 437–444, https://doi.org/10.3945/ajcn.112.049304

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