To investigate whether nutrition plays a role in inhibitory control and executive functioning early in life, we collected data on behavior using different tasks (see previous blog). To perform these tasks, we choose to visit the children at home with the aim 1) to burden the families less, and 2) to test the children in their home environments where they are probably more at ease. Testing 3-year-old children is very fun a

October 1

nd can also be challenging at the same time. I will share some anecdotes and experiences of my data collection as inspiration for others testing young children.

Attention
Some tasks had lengthy instructions and required the child to perform several practice trials, resulting in the child losing his/her attention. The sequence of the tasks was constructed in such a way that the child’s attention was maintained as long as possible. For example, the tasks that required more attention, focus and instructions were performed first.

Sometimes children said to be not in the mood to play anymore, or that they didn’t know what to do despite passing the practice trials. Repeating the rules is not possible, because it means that some children will receive more instructions than other children. I solved this problem by telling the child that he/she would be rewarded if he/she finished the task. Rewards could be a fun game they can play next, or some snacks that the parents agreed to giving.

Parents
Parents sometimes tended to help their child. To prevent this, it is very important to instruct the parents not to help their child. Another way to prevent the parent from helping is to keep them busy by having them fill in a questionnaire, or to turn to the child and say things like: “are you a bit nervous because Mum is looking?” Sentences as these work very well, as you are not telling the parent directly what to do, but they understand the hint immediately.

Siblings
Toddlers often have siblings; sometimes younger siblings and sometimes older siblings. If possible, parents are asked to arrange the situation this way that the siblings are not at home and/or are asleep. When not possible, an assistant accompanying the experimenter can take care of the siblings, for example by taking the sibling outside and play soccer in the neighborhood. Everything for science!

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Have you ever done your weekly grocery shopping and ended up with more than actually written on your grocery list?
Everybody has at least once experienced how it is to buy food in a supermarket with hunger and buy much more than planned. The widely known recommendation: Never go grocery shopping when you are hungry!!!

But is it only a myth or is there a grain of truth in that advice?
What exactly is the issue with going grocery shopping when you are hungry? If you do you probably buy more food than you need and planned to buy. Additionally, unhealthy food might be much more attractive for you than healthy food. The consequence: you have more food at home, so you might eat more and unhealthier. Imagine you are hungry and are coming home from work after a stressful day and now you get to choose between a frozen pizza and a healthy meal that has not been prepared yet – What would you choose? In that situation, I think I would definitely choose the frozen pizza.

High-calorie food and unhealthy food are associated with obesity. Obesity research found a moderate relationship between obesity and emotional disorders like depressive disorder and anxiety disorder (1). Thus, having fast food frequently might not only affect your physical, but also your mental well-being.

Let’s rewind to grocery shopping, but now consider you are not hungry. You probably would only buy the things that are on your grocery list, and also rather healthy food than an unhealthy one. So now you come home hungry from a stressful day at work and you don’t have the choice between healthy and unhealthy food, and the temptation of the frozen pizza isn’t there. So you would start to prepare your healthy food and thus automatically eat healthier.

Coming back to the question if these scenarios are devised or true, and thus representative for weekly grocery shopping.
Research has shown that impulsivity, obesity, and food buying behavior are related. People with obesity are more impulsive than slim people. Also, impulsive people eat more than less impulsive people. Hunger influences food buying behavior and food consumption, especially of high caloric food. The relationship between impulsivity and buying food might be state dependent: researchers have found that impulsive people bought more calories, especially from snack food, but only when they were feeling hungry. This means that impulsivity and hunger interact in their influence on consumption. Obese people are found to show a preference for energy-dense, high-fat food and eat more of these foods, compared to slim people (2).

So what’s the conclusion?
Yes, hunger influences your grocery shopping, especially in interaction with impulsivity. If you consider yourself an impulsive person, you might be more prone to buying more than intended when you go shopping hungry.

So if you have the chance: only go shopping for groceries when you are full and focused. If you accidentally get into a hungry grocery shopping situation, keep this blog in mind and try to focus on your grocery list.

REFERENCES:
Scott, K. M., Bruffaerts, R., Simon, G. E., Alonso, J., Angermeyer, M., de Girolamo, G., … & Kessler, R. C. (2008). Obesity and mental disorders in the general population: results from the world mental health surveys. International journal of obesity32(1), 192.

Nederkoorn, C., Guerrieri, R., Havermans, R. C., Roefs, A., & Jansen, A. (2009). The interactive effect of hunger and impulsivity on food intake and purchase in a virtual supermarket. International journal of obesity33(8), 905.

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In times of stress, there are mainly two eating patterns in which people react: some tend to eat less, some eat more (Yau & Potenza, 2013). The latter then, unfortunately, develop a desire for more salty, sweet and fatty foods, leading to negative health consequences such as weight gain (Groesz et al., 2012) which in turn may influence their mental health.

But why does this happen? What is the science behind this?

The brain controls our body functions and continuously adapts to new situations. For the survival of humans, it is essential that the brain is sufficiently energized at all times. Under stress, the brain needs more energy than under normal circumstances leading the brain to act in a selfish manner. The selfish brain theory by the German scientist Achim Peters (2011) describes the relationship between the brain’s energy requirement and food intake: according to this concept, the brain is given a priority role in the hierarchy of energy metabolism. Therefore, the brain takes care of itself first and claims the energy it needs from the body. The brain pull mechanism is the underlying instrument to request the energy needed, by limiting glucose flow into muscle and fat tissue, so that glucose is primarily available to the brain. If the body can’t provide the necessary energy immediately, the brain forces us to eat. And this results in eating the above-mentioned food. It delivers quickly available glucose to the brain.

Why do some people react to stress by eating more and others by eating less?

Stress responsiveness is thought to be related to different adaptation processes. Exposure to long term stressors may lead to an increased adaptation, reducing the ability of the brain pull mechanism to draw the energy needed directly from the body, thus producing the need to eat. Not adapting to stress and keeping your stress response high will probably lead to less eating.

Why does the brain eat first?

The privileged role of the brain can be explained by the evolutionary past. In life-threatening situations, highest attention was required to react quickly. So, our body has a mechanism to keep our brain functioning: It is assigned a priority role so it can continuously fill its energy needs in order to protect us from possible dangers. It is proven that during inanition the mass of the brain remains constant compared to other organs, which lose about 40% of their mass.

So, what can help us not to eat in an unfavorable manner under stress?

Since everyday stress can hardly be avoided, it is advisable to eliminate temptations and avoid snacking, such as donuts, pizza or any kind of energy-dense foods. For example, in the office: make sure that healthy food is available and prefer fresh unprocessed food, like moderate portions of berries, bananas, nuts (walnuts, almonds), dried fruits (e.g. figs) or perhaps a non-sweetened granola bar. Nuts contain good omega 3 fatty acids and are good for your nerve cells.  When stressed, 5-6 small meals spread throughout the day help to keep the energy level constant. In the office a good lunch could be a mixed salad with chicken breast stripes. Take a break and eat mindfully. Try not to eat hastily, the loss of time spent eating will be rewarded by being able to concentrate better. Drinking lots of water or green tea and avoiding too much coffee and sugared soft drinks will help to prevent a lack of concentration. Water is a healthy way to regulate thirst and has absolutely no calories.

REFERENCES:
Groesz, L. M., McCoy, S., Carl, J., Saslow, L., Stewart, J., Adler, N. et al. (2012). What is eating you? Stress and the drive to eat. Appetite, 58(2), 717–721. https://doi.org/10.1016/j.appet.2011.11.028

Peters, A., Kubera, B., Hubold, C. & Langemann, D. (2011). The selfish brain: Stress and eating behavior. Frontiers in Neuroscience, 5, 1-11. https://doi.org/10.3389/fnins.2011.00074

Schlieper, C. A. (2010). Grundfragen der Ernährung. Hamburg: Büchner.

Yau, Yvonne H. C.; Potenza, Marc N. (2013). Stress and Eating Behaviors. Minerva Endocrinol, 38(3): 255–267. Link: https://www.ncbi.nlm.nih.gov/pubmed/24126546

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Recently I had a great chance to participate in the 19th WPA World Congress of Psychiatry which took place in Lisbon 21-24 of August 2019. Such an international scientific event summarizes recent findings and sets a trend for future research.

The effect of lifestyle on mental health was one of the topics discussed at the conference. Focusing on nutritional impact in psychiatry I will review here some of the studies – research done in animal models or patients and literature reviews – which were presented at the Congress.

All the poster presentations can be viewed on the conference website https://2019.wcp-congress.com/.

Dietary patterns and mental health

  1. Sanchez-Villegas and colleagues from Spain1 presented research on the Mediterranean diet’s effects in patients recovered from depressive disorders. They found that adherence to Mediterranean diet supplemented with extra-virgin olive oil led to the improvement of depressive symptoms. This new study supports previous reports about positive effects of traditional dietary patterns compared to so-called “Western diet”, and this topic was nicely reviewed in the poster presentation of M. Jesus and colleagues (Portugal)2.

I presented a poster3 on a study done in a mouse model of Western diet feeding. We found that genetic deficiency of serotonin transporter exacerbates metabolic alterations and such behavioural consequences of the Western diet as depressive-like behaviour and cognitive impairment. In human, carriers of a genetic variant that reduces serotonin transporter expression are known to be more susceptible to emotionality-related disorders and prone to obesity and diabetes.

Vitamin D and Mental Health

Nutritional psychiatry was traditionally focused on the effects of vitamins and micronutrients on mental health. Several presentations at this conference were dedicated to the role of vitamin D in mental disorders.

Scientists from Egypt (T. Okasha and colleagues)4 showed their results on the correlation between serum level of vitamin D and two psychiatric disorders: schizophrenia and depression. They found lower serum vitamin D levels in the patients with schizophrenia or depression compared to healthy volunteers. These findings indicate a role of vitamin D in the development of psychiatric disorders.

However, the team from Denmark (J. Hansen and colleagues)5 did not find any effect of 3 months vitamin D supplementation on depression symptoms in patients with major depression. The contrariety of the studies on vitamin D benefits in mental health was presented on the review poster by R. Avelar and colleagues (Portugal)6.

Microbiome and Mental Health

There is increasing evidence that microbiota-gut-brain axis influences behaviour and mental health. N. Watanabe and colleagues (Japan)7 presented the results of a study on germfree and commensal microbiota-associated mice. They found increased aggression and impaired brain serotonin metabolism in germfree mice.

  1. Dias and colleagues (Portugal)8 performed a literature review on this topic exploring possible effects of microbiome and probiotics in mental disorder development. The most robust evidence was found for the association of microbiome alterations and depression/anxiety. Up to date literature is lacking replicated findings on proving positive effects of probiotics in mental disorders treatment.

Diabetes Type 2 and Mental Disorders

Risk factors for type 2 diabetes include diet and lifestyle habits. It is getting more obvious that there is an association between type 2 diabetes and the development of mental disorders.

  1. Mhalla and colleagues (Tunisia)9 reported a study done on patients with type 2 diabetes. They found a high prevalence of depression in women with type 2 diabetes. Also, depression in these patients was associated with poorer glycemic control.

Depression is an important factor influencing insomnia. H.C. Kim (Republic of Korea)10 found insomnia in one-third of patients with diabetes type 2.

The group from Romania (A. Ciobanu and colleagues)11 created a meta-analysis of the medical literature showing an association of diabetes type 2 with Alzheimer’s disease. They highlighted the role of insulin signaling in cognition and proposed glucose blood level control as a therapeutic approach in Alzheimer’s disease.

 

Thus, a lot of studies were recently done on the role of nutrition in psychiatric disorders development and therapy. However, there is still room for future discoveries!

REFERENCES:
From 19th WPA World Congress of Psychiatry proceedings:

  1. Sanchez-Villegas, B. Cabrera-Suárez, M. Santos Burguete, P. Molero, A. González-Pinto, C. Chiclana, J. Hernández-Fleta. INTERVENTION WITH MEDITERRANEAN DIET IN THE IMPROVEMENT OF DEPRESSIVE SYMPTOMS IN PATIENTS RECOVERED FROM DEPRESSIVE DISORDER. PREDI-DEP TRIAL PRELIMINARY RESULTS;
  2. Jesus, C. Cagigal, T. Silva, V. Martins, C. Silva. DIETARY PATTERNS AND THEIR INFLUENCE IN DEPRESSION;
  3. Veniaminova, A. Gorlova, J. Hebert, D. Radford-Smith, R. Cespuglio, A. Schmitt-Boehrer, K. Lesch, D. Anthony, T. Strekalova. THE ROLE OF GENETIC SEROTONIN TRANSPORTER DEFICIENCY IN CONSEQUENCES OF EXPOSURE TO THE WESTERN DIET: A STUDY IN MICE;
  4. Okasha, W. Sabry, M. Hashim, A. Abdelrahman. VITAMIN D SERUM LEVEL AND ITS CORRELATION WITH MAJOR DEPRESSIVE DISORDER AND SCHIZOPHRENIA;
  5. Hansen, M. Pareek, A. Hvolby, A. Schmedes, T. Toft, E. Dahl, C. Nielsen7, P. Schulz8. VITAMIN D3 SUPPLEMENTATION AND TREATMENT OUTCOMES IN PATIENTS WITH DEPRESSION;
  6. Avelar, D. Guedes, J. Velosa, F. Passos, A. Delgado, A. Corbal Luengo, M. Heitor. VITAMIN D AND MENTAL HEALTH: A BRIEF REVIEW;
  7. Watanabe, K. Mikami, K. Keitaro, F. Akama, Y. Aiba, K. Yamamoto, H. Matsumoto. INFLUENCE OF COMMENSAL MICROBIOTA ON AGGRESSIVE BEHAVIORS;
  8. Dias, I. Figueiredo, F. Ferreira, F. Viegas, C. Cativo, J. Pedro, T. Ferreira, N. Santos, T. Maia. EMOTIONAL GUT: THE RELATION BETWEEN GUT MICROBIOME AND MENTAL HEALTH;
  9. Mhalla, M. Jabeur, H. Mhalla, C. Amrouche, H. Ounaissa, F. Zaafrane3, L. Gaha. DEPRESSION IN ADULTS WITH TYPE 2 DIABETES: PREVALENCE AND ASSOCIATED FACTORS;
  10. Kim. FACTORS RELATED TO INSOMNIA IN TYPE 2 DIABETICS;
  11. A. Ciobanu, L. Catrinescu2, C. Neagu3, I. Dumitru3. THE CONNECTION BETWEEN ALZHEIMER’S DISEASE AND DIABETES

 

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Mens sana in corpore sano – healthy mind and healthy body

Food insecurity – defined as an individual or household lacking access to sufficient, safe, and nutritious food that meets individuals’ dietary needs – has been linked to children’s behavioral, academic, and emotional problems and an increased risk of the development of mental health disorders [1, 2].

In a Canadian study on food insecurity in young children, researchers found that children from food-insecure families were disproportionately likely to experience persistent symptoms of hyperactivity and inattention. These results were still true after controlling for immigrant status, family structure, maternal age at child’s birth, family income, maternal and paternal education, prenatal tobacco exposure, maternal and paternal depression and negative parenting [3].

Accordingly, a systematic review on food insecurity and attention-deficit hyperactivity disorder (ADHD) symptoms in children reported a predictive and inverse relationship between the two, with possible lasting impacts into adulthood. Authors concluded that evidence exists to hypothesize that childhood food insecurity is associated with predisposing or exacerbating ADHD symptoms in children [4].

In 2017 Dr. Raju, President of the Indian Psychiatric Society concluded in a speech on medical nutrition in mental health and disorders that there is growing evidence for a relationship between quality of diet and mental health. According to Raju, the importance of nutrients as important agents for prevention, treatment, or augmentation of treatment for mental disorders has been established. “Empathic interactions and rational nutrition along with specific pharmacological and physical interventions could form an ideal and humane patient-friendly package in psychiatric practice” [5].

Therefore, identifying families in risk of food insecurity and getting children and adolescents the best possible food supply could result in fewer children with ADHD symptoms.

REFERENCES:

  1. Althoff, R.R., M. Ametti, and F. Bertmann, The role of food insecurity in developmental psychopathology. Prev Med, 2016. 92: p. 106-109.
  2. Shankar, P., R. Chung, and D.A. Frank, Association of Food Insecurity with Children’s Behavioral, Emotional, and Academic Outcomes: A Systematic Review. J Dev Behav Pediatr, 2017. 38(2): p. 135-150.
  3. Melchior, M., et al., Food insecurity and children’s mental health: a prospective birth cohort study. PLoS One, 2012. 7(12): p. e52615.
  4. Lu, S., et al., The Relationship between Food Insecurity and Symptoms of Attention-Deficit Hyperactivity Disorder in Children: A Summary of the Literature. Nutrients, 2019. 11(3).
  5. Raju, M., Medical nutrition in mental health and disorders. Indian J Psychiatry, 2017. 59(2): p. 143-148.
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Neurodevelopmental disorders such as attention deficit disorder (ADHD), autism spectrum disorder (ASS) and different types of anxiety disorders are associated with a higher risk of poor dietary, physical activity and sleep habits. Shaping behavior in children with neurodevelopmental symptoms can be challenging. How do parents experience shaping healthy habits in these children? What are tips and tricks to encourage your child to live healthy? We took together the results of a recent study conducted in Boston and our own results from a qualitative interview with parents of children that followed the TRACE-diet to help you encourage your child to be healthy.

What is hard?
For parents of children with a neurodevelopmental disorder (ND) it can be challenging to convince their children to make healthy choices. Some parents explain that taking an unhealthy option from a neurotypical child might also lead to an anger meltdown, but this meltdown is not comparable with a ND meltdown, which can last the whole day. Furthermore, children with ND can be more impulsive, which makes it harder for them to think before they choose. Other children with ND are resistant to change, and/or lack intrinsic motivation to change. The parents that tried taking their child to a health professional, reported a lack of clinical expertise among lifestyle experts to level with children with a neurodevelopmental disorder.

What is helpful?
Agency
Both studies found that allowing your kid agency in making choices is critical to create a healthy habit. It is important to limit the choices, otherwise your child will drown in options. Offer, for instance, a healthy snack and an unhealthy snack and let your child decide whether he/she wants the healthy snack now, or later.

Family engagement
Work as a team! This was a helpful strategy that was reported by most parents in the TRACE study. If you follow the diet with the whole family, the child does not feel left out or punished. Also, just not having snacks at home prevents your child from sneaking into the cabinet and taking one.

Positive reinforcement
It is important to define a goal together with your child. What are we working for? And for how long? You can help your child visualize this goal by making a calendar. Will your child only be rewarded at the end of the goal? Or are there also smaller sub-goals? For some children, a long-term goal such as “sleeping better” or “less belly pains” will be rewarding enough, but other children might need short-term goals.

The role of pets
In the Boston study, almost one-third of the parents reported that they used the role of pets to promote healthy habits. Animals can be used as a positive reinforcement for good choices, but they can also help to maintain healthy routines such as physical activity (walking the dog) and family engagement (walking the dog with the whole family).

 

REFERENCES

  1. Bowling, A. Blaine, R.E., Kaur, R., Davison, K.R. (2019). Shaping healthy habits in children with neurodevelopmental and mental health disorders: parent perceptions of barriers, facilitators and promising strategies. International Journal of Behavioral Nutrition and Physical Activity. 16:52.
  2. TRACE-study. For more information visit project-trace.nl
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According to the food and agriculture organization, about 1 billion people in the world were living in hunger or insecurity in the year 2010 (1). Additionally, 5 to 15 % of people in industrial countries experience food insecurity which makes it all the more a public health concern in Europe (2).

But, what exactly is food insecurity about?

Food insecurity means that the access to sufficient food, meeting the dietary and cultural needs and the individual food preferences for a healthy and active life is not possible. It is not only a lack of food, what`s more, is the feeling that the preferred food supply is not available or may be threatened in the future, which has, in turn, an effect on the eating behavior. That means even if food is sufficient, people may be food insecure, but not necessarily undernourished. Two risk groups are students, who do not have the money for buying their preferred food, and refugees, who can´t buy their traditional food in their new home towns. Food insecurity can result in a reduction on micro-and macronutrition intake. Macronutrients are large food components that the body needs to maintain its metabolism; it includes lipids (fats), sugars (carbohydrates) and proteins. Micronutritions, like vitamins, minerals (such as calcium or magnesium), trace elements (such as iron and zinc), are essential because, without them, numerous normal functions such as growth or energy production could not take place.

Effects on mental health

Food insecurity is also found more often in families with low social economic status (4). Researchers have found that food insecurity caused an increase of depression and anxiety symptoms (3). Furthermore the uncertainty of having food in the future produced stress and created desperation and hopelessness in the families. They perceived the situation as shameful and resigned or used drugs and alcohol to compensate. In addition to this ,children from food insecure families were also more likely to develop symptoms of depression/ anxiety, aggression and hyperactivity/inattention (2). However, when you control for many demographical and psychological variables such as immigrant status, family structure and income and paternal depression, only increased impulsive behavior and inattention seem to be specifically linked to food insecurity Another factor is maternal mental health. It has been shown that food insecurity is especially bad for children’s development if the mother has additional mental health problems like depression, domestic violence and psychosis.

Further insights can be derived from Canadian students (5). Here are financial constraints a primary contributing factor. It represents a barrier because often students can´t afford to buy qualitative and expensive food. Another important factor is insufficient time because the effort to buy, prepare and cook healthy meals takes time and requires planning. It may also be the limited access to culturally appropriate food. This could be a barrier especially for people from other countries, who don´t have the opportunity to buy their traditional food and spices in local supermarkets. In urban areas, more exotic and international food supply is possible, due to the higher demand. The consequences for students were feelings of shame, frustration and loneliness. Some have felt socially isolated, and in general the food insecurity was associated with high psychological stress. Nonetheless the students in the reports believed that the situation is temporary and that after university life gets better in terms of food quantity and quality. For now they accepted the current situation.

So overall, food insecurity may occur in different social classes, with different reasons and effects of varying intensity. It`s interesting to see that it can occur in developing countries and rich countries, and that it can have an influence on whole families and children of food insecure families and students. More studies about people with cultural issues (e.g. refugees) are needed.

So, if you have the chance:

Buy the food you prefer and take time for preparing your meal,                      to live your life as healthy as you want it to be!

REFERENCES

(1) Cole, S. M.; Gelson, T. (2011). The effect of food insecurity on mental health: Panel evidence from rural Zambia. Social Science & Medicine. 73 (7)1071-1079.

(2) Melchior M.; Chastang J.- F.; Falissard B.; Galera, C.; Tremblay, R.E.; Cote, S.M., Boivin, M. (2012). Food insecurity and children’s mental health: a prospective birth cohort study. PLoS One 7 (12).

(3) Weaver, L. J.; Hadley. C. (2009) Moving Beyond Hunger and Nutrition: A Systematic Review of the Evidence Linking Food Insecurity and Mental Health in Developing Countries, Ecology of Food and Nutrition, 48(4), 263-284.

(4) Melchior, M.; Caspi, A.; Howard, L.M.; Ambler, A.P.; Bolton, H.; Mountain, N; Moffitt, T.E. (2009) Mental health context of food insecurity: a representative cohort of families with young children. Pediatrics, 124 (4).

(5) Hattangadi, N.; Vogel, E.; Carroll, L. J.; Cote, T. (2019). “Everybody I Know Is Always Hungry…But Nobody Asks Why”: University Students, Food Insecurity and Mental Health. Sustainability. 11 (6).

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This week, my lab at the University of Canterbury published the first investigation1 into whether a mineral-vitamin supplement could change the bacteria in the microbiome of children with ADHD. Our preliminary data, based on our sample of 17 kids (half of whom were given micronutrients and half were given placebo for 10 weeks), hints at increased diversity and changes in the types of bacteria contained in the microbiome of the children exposed to the micronutrients. This type of study starts to moves us beyond the efforts to show that micronutrients benefit some people with psychiatric symptoms, and towards figuring out why they might exert their influence. So what does this mean?

First off, what is the microbiome?

The gut microbiome is defined as the trillions of microbes that inhabit the human digestive tract. In additional to playing a crucial role in digesting food, they also play pivotal roles in immune and metabolic functioning, gene expression, as well as playing a role in the expression of psychiatric symptoms through the gut-brain connection.2 We also know that they generate essential vitamins. When our microbiome gets into a state of dysbiosis (microbial imbalance), in addition to the physical symptoms like reflux, poor digestion, pain, constipation and/or diarrhoea, it is thought that dysbiosis can also lead to increased permeability of the gut wall, increased production of endotoxins, increased inflammation and decreased nutrient synthesis.

How do we learn about what bacteria are within and on us?

Research on the human microbiome has grown exponentially in the past decade. However, it was only recently that we could fairly cheaply quantify and describe the bugs contained within us. 16S rRNA sequencing (the technology we used) is a key methodology in identifying bacterial populations and allows scientists to easily and reliably characterize complex bacterial communities.3 This methodology is a simple and effective alternative to microbial culture, and provides detailed information about the various species of bacteria that are contained within our microbiome. The sequencing gives information on bacterial diversity, as well as details about the specific family (e.g., Bifidobacteriaceae), genus (e.g., Bifidobacterium), and species (e.g., Bifidobacterium Longom).

What about the microbiome of kids with ADHD?

What scientists are now wondering is whether people who suffer from specific psychiatric symptoms, like those associated with ADHD, have a different bacterial composition than those who don’t have these symptoms and whether these differences can help us understand the severity of the symptoms. In other words, is it possible that our bugs can make us impulsive? And if so, if we changed the bugs, can we become less impulsive?

There isn’t a huge literature exploring this topic in ADHD. Preliminary studies suggest that antibiotics in the first 6 months of life may increase risk of ADHD symptoms at 11 years of age,4 although this finding hasn’t been replicated.5 Another study found that the Phylum Actinobacteria is overrepresented in ADHD compared with controls.6 Other research suggests that reduced alpha diversity may exist in young patients with ADHD, specifically that boys with ADHD had more Bacteroidaceae relative to controls, with the species Neisseriaceae identified as a particularly promising ADHD-associated candidate.7 Although this finding of reduced alpha diversity was not observed in treatment-naïve children with ADHD, Jiang and colleagues noted that the more an individual had the species Faecalibacterium, the lower their ADHD severity.8

Overall, there are intriguing signals but the signals are not always replicating. Much more research with larger samples is needed to try to determine if there are reliable bacterial biomarkers. We also need to parse out the effect of diet, medications, age, ethnicity and gender on the results that have been reported. Further, we don’t know whether these differences are causal or a result of ADHD or completely irrelevant to the expression of the symptoms.

We still don’t know if changing the relative amount of a bacteria can change psychiatric symptoms. We know that diet manipulation can change levels of bacteria but whether those changes in bacteria are necessary for improvement in psychological states requires much more research.

So what did we find?

Looking at the microbiome over a short period of time with a small sample is challenging. There is such diversity in the bacteria within us and between us that it is a challenge to explore changes and also whether changes are meaningful. But we did observe some intriguing effects:

  1. The observed taxonomic units (OTU), a measure of community richness, significantly increased in treatment group but not in placebo group. We think this is a good thing.
  2. We observed significant greater decrease in abundance of genus Bifidobacterium from phylum Actinobacteria in active versus placebo and that the more it decreased, the more the ADHD symptom scores dropped. If Bifodobacterium is contributing to the symptoms of ADHD, this is a good thing.
  3. We also observed a significant positive correlation between Actinobacterium abundance and Clinician ADHD IV-RS rating scale before the intervention was introduced, which suggests that Actinobacterium may play a role in the expression of ADHD.

What does this mean?

The small sample makes it difficult to generalize from this study. However, these novel results provide a basis for future research on the biological connection between ADHD, diet and the microbiome. Previous research from our lab has shown that micronutrients do exert some positive effects on ADHD and associated symptoms.9 10 These findings suggest that micronutrient treatment may result in a more diverse microbiome which may in turn, have a positive effect on brain health.

What next?

The field of the microbiome is literally exploding with new studies out every day. The focus currently is trying to find ways to manipulate the microbiome for positive response. This has mainly been explored through either adding in bacteria (in the form of probiotics or psychobiotics if targeting psychological symptoms), diet manipulation, or more recently, fecal microbiota transplants. I do worry a bit that this search for the magic-bullet bacteria that causes distress may turn out to be as disappointing as the search was for candidate genes, but it is worth some effort to figure out if this is an important lead.

Eat2BeNice (New Brain Nutrition) plans to explore the role of the microbiome in multiple ways, including determining whether individuals with high impulsivity/compulsivity have a unique microbiome profile, whether targeted probiotics can improve impulsivity/compulsivity symptoms, and also whether improvement in impulsivity/compulsivity symptoms from diet manipulation and via the use of supplements can be explained via changes in the microbiome. Watch this space!

REFERENCES 

  1. Stevens AJ, Purcell RV, Darling KA, et al. Human gut microbiome changes during a 10 week Randomised Control Trial for micronutrient supplementation in children with attention deficit hyperactivity disorder. Sci Rep 2019;9(1):10128.
  2. Frye RE, Slattery J, MacFabe DF, et al. Approaches to studying and manipulating the enteric microbiome to improve autism symptoms. Microb Ecol Health Dis 2015;26:26878-78.
  3. Ames NJ, Ranucci A, Moriyama B, et al. The Human Microbiome and Understanding the 16S rRNA Gene in Translational Nursing Science. Nurs Res 2017;66(2):184-97.
  4. Slykerman RF, Coomarasamy C, Wickens K, et al. Exposure to antibiotics in the first 24 months of life and neurocognitive outcomes at 11 years of age. Psychopharmacology (Berl) 2019;236(5):1573-82.
  5. Axelsson PB, Clausen TD, Petersen AH, et al. Investigating the effects of cesarean delivery and antibiotic use in early childhood on risk of later attention deficit hyperactivity disorder. J Child Psychol Psychiatry 2019;60(2):151-59.
  6. Aarts E, Ederveen THA, Naaijen J, et al. Gut microbiome in ADHD and its relation to neural reward anticipation. PLoS One 2017;12(9):e0183509.
  7. Prehn-Kristensen A, Zimmermann A, Tittmann L, et al. Reduced microbiome alpha diversity in young patients with ADHD. PLoS One 2018;13(7):e0200728.
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For my research, I measured impulsive behaviour in 3-year-old children. Briefly, impulsivity is the opposite of inhibitory control. There are several forms of inhibitory control, and although there is no official categorisation of different forms of inhibitory control in young children, Anderson & Reidy (2012) defined five categories. The categories are:

  • Delay of gratification: the ability to resist direct temptation in order to receive a bigger reward after the delay.
  • Impulse control: the ability to inhibit an instinctive response.
  • Verbal inhibition: the ability to inhibit verbal responses.
  • Motoric inhibition: the ability to learn response sets that conflict with an established behaviour.
  • Go/No go: the ability to perform certain behaviour after being shown a certain stimuli but to inhibit that behaviour after being shown a different stimuli.

The Marshmallow test is a famous example of an inhibitory control task (more specifically: delay of gratification). For this task, a marshmallow is placed in front of the child. The child is told that if s/he refrains from eating the marshmallow while the examiner is gone, s/he will receive two marshmallows when the examiner returns. Another example of an inhibitory control task (more specifically: Go/No go) is the Bear/Dragon task. For this test, the child has to obey the commands (e.g. ‘hands on your head’) of the bear hand puppet, but must inhibit obeying the commands of the dragon hand puppet.

When comparing the Marshmallow task with the Bear/Dragon task, similarities and differences can be found. They are similar in the way that both tests require the child to inhibit their impulses. However, the Marshmallow task requires minimal working memory demand, while the Bear/Dragon task requires complex greater working memory demand (Petersen, Hoyniak, McQuillan, Bates, & Staples, 2016). The Bear/Dragon task is thus a complex inhibitory control task, because children are instructed to not only inhibit a prepotent response, but also to respond in a certain way to a salient, conflicting response option.

In my research, I used both behavioural tasks and parental report (both mothers and fathers) to assess inhibitory control. However, results from the behavioural tests and the parental questionnaires correlate poorly with each other; a finding which is also often reported in other studies. While behavioural tests show objective observations of the child’s behaviour, these observations are mostly only carried out at one specific time point (e.g. during a home visit). As such, the child’s performance might be prone to noise, such as that the child slept poorly the past night. Reports of behaviour, on the other hand, reflect the behaviour of the child during daily life. However, these reports can be prone to social desirable answering and parental perceptions of their child’s behaviour. By measuring inhibitory control with both behavioural tasks and parental reports, we obtain the most robust view of the child’s behaviour.

Overall, measuring inhibitory control behaviour in 3-year-olds can be challenging, but also a lot of fun! (Stay tuned for a blog on interesting anecdotes during my data collection.)

REFERENCES:

Anderson, P. J., & Reidy, N. (2012). Assessing Executive Function in Preschoolers. Neuropsychology Review, 22(4), 345–360. https://doi.org/10.1007/s11065-012-9220-3

Petersen, I. T., Hoyniak, C. P., McQuillan, M. E., Bates, J. E., & Staples, A. D. (2016). Measuring the development of inhibitory control: The challenge of heterotypic continuity. Developmental Review: DR, 40, 25–71. https://doi.org/10.1016/j.dr.2016.02.001

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Behavior results from the complex interplay between genes and environment. Our genes predispose us to how we act and feel, by influencing how our brain develops and functions. This way, certain genetic variants in our genome increase the risk of developing mental health problems (while others may decrease this risk). Whether someone actually develops a mental health disorder or not, depends on many other factors in our environment, such as stressors and experiences. Nonetheless, studying these genetic risk factors for mental health conditions is an important aspect of understanding these disorders.

As an example of such research, we have now identified several genetic risk factors that contribute to cocaine dependence. For this we combined genetic data from a lot of studies, including more than 6000 individuals. What’s even more interesting is that we found that the genetic variants that are related to cocaine dependence are correlated with the genetic risk factors for other conditions such as ADHD, schizophrenia and major depression. What this means is that certain small variations in DNA increase the risk for not just cocaine dependence, but actually several psychiatric conditions. Probably, there is a common biological mechanism that underlies all these conditions. Thanks to our genetic research, we are now only a small step closer towards unraveling these mechanisms.

We also wrote a blog post explaining our research findings. You can read it here: https://mind-the-gap.live/2019/07/04/cocaine-dependence-is-in-part-genetic-and-it-shares-genetic-risk-factors-with-other-psychiatric-conditions-and-personality-traits/

The original publication can be found here: https://www.sciencedirect.com/science/article/pii/S0278584619301101?via%3Dihub

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