Whenever I ask my patients, if they are eating their “5 a day”, the immediate answer is “Yes, sure”. However, sometimes I´m not sure if their “Yes, sure” belongs to their real eating behavior or if it is more like wishful thinking. This question applies for a broad range of behavior, like taking the stairs instead of the elevator, having enough sleep, walking the 10.000 steps a day etc.. But how can we be sure what people really do in their everyday life?

The answer is: Ambulatory Assessment

Ambulatory Assessment is the state of the art method for assessing current emotional states, feelings, and behavior in the natural environment of an individual’s everyday life. Equipped with smartphones and accelerometers, it is feasible to track how individuals feel at specific moments, what they are eating across a day and how they physically behave in real time and real life. Electronic e-diaries, provided by an App, prompt individuals whenever an event occur or randomly several times a day. Especially in patient groups with attention deficits, prompting short questionnaires several times a day show better recall than an extensive end-of-day questionnaire.

In the past, food-diaries were based on unhandy and retrospective paper-pencil-questionnaires or computer input. Nowadays, new technological opportunities pave the way to e-food-diaries on smartphones, enabling an immediate and flexible input capability. The design of e-food-diary-apps may be different, i.e., by photos, drop-down-menu, text, or voice records. Important is the documentation of what and how much the participants eat and drink and a database that can be connected to an international or national food code for data analysis.

In the Eat2beNICE research project, we assess food intake every time participants eat or drink by a drop-down-menu that leads from general to very detailed food-items and asks for general meal portions and amounts every time participants eat and drink across the day. If a participant cannot find a particular food-item, he or she has the opportunity to enter a free text message or to record a voice message. If participants forget to enter some foods and drinks across the day, they will receive a reminder in the evening to add forgotten items. This procedure enables very accurate tracking of participant’s food intake in our study.

To sum up, thanks to modern technology we can now accurately measure what a person feels, does and eats throughout the day. Of course, the design of an e-food-diary on the smartphone depends on the projects’- and samples’ requirements. Overall, it has to be easy to use, easy to implement in daily life and to be fun for the participants to obtain a high level of compliance and a high-quality database.

REFERENCES:
Ebner-Priemer, U. W., & Trull, T. J. (2009). Ambulatory Assessment: An Innovative and Promising Approach for Clinical Psychology. European Psychologist, 14, 109–119. https://doi.org/10.1027/1016-9040.14.2.109.

Engel, S. G., Crosby, Ross, Thomas, G., Bond, D., Lavender, J. M., Mason, T., . . . Wonderlich, Stephen. (2016). Ecological Momentary Assessment in Eating Disorder and Obesity Research: a Review of the Recent Literature. Current Psychiatry Reports, 18, 37. https://doi.org/10.1007/s11920-016-0672-7.

Fuller, N. R., Fong, M., Gerofi, J., Ferkh, F., Leung, C., Leung, L., . . . Caterson, I. D. (2017). Comparison of an electronic versus traditional food diary for assessing dietary intake-A validation study. Obesity Research & Clinical Practice, 11, 647–654. https://doi.org/10.1016/j.orcp.2017.04.001.

Smyth, J., Wonderlich, S., Crosby, R., Miltenberger, R., Mitchell, J., & Rorty, M. (2001). The use of ecological momentary assessment approaches in eating disorder research. The International Journal of Eating Disorders, 30, 83–95.

Stein, K. F., & Corte, C. M. (2003). Ecologic momentary assessment of eating-disordered behaviors. The International Journal of Eating Disorders, 34, 349–360. https://doi.org/10.1002/eat.10194.

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The more diverse we eat, the more diverse our gut microbiome (i.e., the composition of trillions of microbes in our intestine) will become. Sounds reasonable, right? But – why is that a good thing?

Well, research has shown that a diverse gut microbiome is less susceptible to diseases, such as the well-known western lifestyle associated diseases like diabetes or Crohn’s disease (1). This might be because one’s microbiome and one’s immune system are closely linked. A healthy and diverse microbiome thus might support proper functioning of our immune system and help keeping us healthy.

Eating a variety of different food items also enhances the odds that your body gets all the nutrients like vitamins or minerals it needs for proper functioning. This can have an effect on our well-being as well as on our physical appearance, like shiny hair, strong fingernails and healthy-looking skin.

Besides, research suggests that the more diverse we eat, the better our cognitive abilities might be at older age (see my blog on this topic here:
http://newbrainnutrition.com/four-easy-rules-for-healthy-eating-and-lifestyle/)! Well, how about that!? Research supports the notion that our gut and our brain are more closely linked than we would have assumed. This would mean that our food choices can actually have an effect on our mental health. Great, right?

So let’s have a look at a few simple tips with which you can easily enhance your dietary diversity, and can have fun along the way, too!

1. Add seeds and nuts to your meals
2. Eat a set menu
3. Grow your own fresh herbs
4. Enlarge the variety of what you drink
5. Try alternatives to your staple foods
6. Try new dishes, restaurants and cuisines
7. Join a food cooperative
8. Distribute your homemade meals across different days
9. Experiment with seasonings
10. Try smoothies and soups
11. Share your meals
And the golden rule you should keep in mind:
12. Avoid antibiotics

Add seeds and nuts to your meals
By keeping a variety of seeds and nuts at home, you can easily add them to your meals. If you tend to overeat on nuts (and believe me, many people do), make sure to buy unsalted ones, and simply sprinkle them on top of your muesli, salad or sandwich. Nuts (like peanuts, walnuts, hazelnuts) and seeds (like sesame or flaxseed) are a great source of very healthy fats, important vitamins like B-vitamins and vitamin E, and they contain fibres, which our gut simply loves!

Eat a set menu
Yes, you heard me. This is my advice to select a sequence of dishes, instead of only one.
This will definitely result in a larger variety of what you eat. Of course, you should be aware of the overall amount of food – listen to your gut feeling! And I’m serious, this also includes dessert! If you have a little soup, a colorful salad, a light main course and a small treat, you’ve supplied your body with a variety of different nutrients it needs to stay healthy. My extra tip: Keep in mind to include your ‘five a day’ to make sure you eat enough fruit and especially enough vegetables.

Grow your own fresh herbs
Do you notice that food pictures look more appealing when the food is sprinkled with fresh herbs? It will also appeal to your gut! Adding one or two fresh herbs to a dish will give it that little extra twist that it deserves. All it takes is a plant pot on your window sill. Some herbs can be harvested throughout the whole year, and for even more diversity, you can experiment with different plants as you go.

Enlarge the variety of what you drink
Tea or coffee? Both, please! When we think of nutritional diversity, let’s not only consider solid food. Imagine having your coffee and a glass of orange juice (or even a multivitamin drink) with your breakfast. How about some green or black tea as the day goes by? Or an apple spritzer? Herbal teas also offer a great range of different ingredients, and can be soothing in the evening. Just keep in mind that if you taste a few different lemonades, you well might enhance your variety of drinks, but you will consume a lot of sugar, too. The world health organization recommends that maximally 10% of your energy should come from sugar (2), which should be considered when ordering a drink.

Try alternatives to your staple foods
Are you a muesli guy? Or more of a bread person? Do you prefer pasta as your everyday dish or is your menu dominated by rice? Most of us tend to eat the same basic food items every day. But even here is the chance to enhance diversity: Instead of rice, try couscous, amaranth or millet. Buy a different type of bread every time you go to the bakery. Muesli offers a great chance of variety, you can add honey, yoghurt, marmalade, berries, spices… Talk to your friends to get more ideas.

Try new dishes, restaurants and cuisines
Every cuisine has its own flavours, specific components, and style. So why not raiding cook books and food blogs for inspiration? If you go out to eat, just be curious and pick the restaurant you always wanted to try, yet ending up at the same place you always went. This doesn’t only increase your daily diversity, but also the one across days, which is especially important: Imagine you create a super diverse menu and then eat it day after day after day… Sounds boring, right? Your gut will share this opinion! My extra tip: Choose restaurants that offer a buffet every now and then. This is specifically handy around lunchtime because you don’t have to wait for your food. Again, take a bit of everything, but be careful not to overload your plate. This gives you the chance to try out what you like when you taste a novel cuisine. And imagine the looks you get when you say “Hey, I’m doing this for my microbiome!”

Join a food cooperative
You know that homemade cooking is great. You are in charge of what goes into the pan, you control the ingredients’ quality. But, of course, it requires planning, shopping, cooking – not to forget cleaning the kitchen. An easy step towards a diverse, regular cooking habit is joining a cooperative or booking home delivery from organic farms nearby. You get a box full of seasonal, fresh, local fruit and veg delivered to your door weekly. If you know where it comes from, you might be more reluctant to throw it out, hence you might actually cook it and eat it! The surprising variety of what a season has to offer will boost your cooking creativity and enhance your nutritional diversity even further.

Some might object now and remark that when they look at the back of their ready-to-eat supermarket meals, is states that there are so many ingredients in one package, that there is no need to enhance nutritional diversity even more. Sure, there is a point there! But keep in mind that these foods are massively processed, thus having lost many of the original ingredients’ benefits like vitamins, etc. Also, if you look closely, you might detect declarations you don’t even know what they mean! Those different additives, like E-numbers, are mostly artificially produced, and there is long-term research missing what they actually do to our bodies – especially in interaction with all the other additives found in processed food. Don’t get me wrong – every now and then I also grab a bag of ready-to-eat food from the counter.
But what I personally do is to subtract the artificial ingredients from my daily diversity calculation (and now you also know that I like math).

Distribute your homemade meals across different days
This is the same approach as eating a set menu. Imagine you make yourself a nice pasta dish for the evening, and prepare a mixed salad for lunch the next day. How about splitting both in half? That way you expand your food across days, yet adding more daily eatables at the same time. Your microbiome will like the variety that goes along with this. Plus, you don’t have to buy canteen food the next day and might save some money – money that could be spent at the fancy restaurant we talked about earlier on!

And yes, distributing food across days also applies to cake and desserts. If you baked a cake (consider adding lots of fruit), have one piece now and one tomorrow! And remember to send your mum a picture of your delicious achievements, she will love it!

Experiment with seasonings
If you go through the seasonings in your kitchen cupboard, you will notice that some seasonings provide a literal boost for your nutritional diversity. I just found a curry powder with 13 ingredients! Of course, if you start and mix different seasonings, a few compounds will be redundant. But when you cook – or simply heat up a bought dish – add that little extra. That way, you can even reduce the amount of salt without giving up on flavour. The world health organization recommends 5 grams of salt per day (2). Simply use high-quality seasoning and herb mixtures instead, maybe add a drop of fine oil for flavour, and let it surprise you!

Try smoothies and soups
For a quick energy boost in the morning, I recommend a smoothie. What I love about smoothies? You can virtually throw everything in there, and by adding just a few ingredients for flavour (like oranges) and texture (like bananas) you can create a tasty and always different vitamin shot. Again, remember seasoning like curcuma or cinnamon to increase variety and diversity. For later meals, there are great recipes for soups – even some that don’t require cooking! If you blend your soup, you can easily ‘hide’ some leftovers in there, or some bits of a vegetable you don’t really like.

Share your meals
This is my favourite tip. Have you noticed that also during lunch with colleagues, the grass is always greener on the other side? In our lab, we have switched to a food sharing concept where everybody can take a bit of everyone’s meal. In some cultures, like Corea, it is common to place all the food one orders in the middle of the table. They know that sharing is caring – especially caring about one’s microbiome diversity!

And last, not least: Avoid antibiotics!
Of course, there are some illnesses where antibiotics are essential. But did you know that animals are fed large amounts of antibiotics, and that we consume them, too, when we indulge into our chicken breast or piece of veal? These antibiotics not only kill unwanted microbes, they also heavily disrupt the ecology of our microbiome (3). So in order to keep your gut happy and to get the most out of your nutritional diversity experiment, think twice before you buy or order conventionally produced meat. Consider organic meat or vegetarian alternatives – hence adding even more possibilities for a diverse menu.

(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577372/
(2) http://www.who.int/news-room/fact-sheets/detail/healthy-diet
(3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831151/

Want to learn more? Visit http://www.bbc.co.uk/guides/zpf27hv#z8qrg82 for a little quiz and some more information and https://experiencelife.com/article/your-microbiome-the-ecosystem-inside/ to find out more about your microbiome.

 

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A little while ago, this blog featured an entry by Annick Bosch on the TRACE study, an amazing intervention study using the Elimination Diet to treat ADHD in kids (https://newbrainnutrition.com/adhd-and-elimination-diet/). Very shortly summarized, the Elimination Diet entails that participants can only eat a very restricted set of foodstuffs for several weeks, which can greatly reduce the number of ADHD symptoms in some kids. Subsequently, new foodstuffs are added back into the diet one by one, all the time checking that ADHD symptoms do not return. This ensures that every child for which the Elimination Diet proves successful ends up with a unique diet which suppresses their ADHD symptoms.

Now this is a fascinating study, since it indicates a direct influence of diet on ADHD behavior. What we know from the neurobiology of ADHD, is that it is caused by a myriad of relatively small changes in the structure, connectivity and functioning of several brain networks 1. For the most common treatments of ADHD, like medication with methylphenidate 2, we can quite accurately see the changes these interventions have on brain functioning. However, for the Elimination Diet, this has not been studied before at all. This is why we are now starting with the TRACE-MRI study, where kids that participate in a diet intervention in the TRACE program, are also asked to join for two sessions in an MRI scanner. Once before the start of the diet, and once again after 5 weeks, when the strictest phase of the Elimination Diet concludes. In the MRI scanner, we will look at the structure of the brain, at the connectivity of the brain, and at the functioning of the brain using two short psychological tasks. We made a short vlog detailing the experience of some of our first volunteers for this MRI session.

 

 

With the addition of this MRI session, we hope to be able to see the changes in brain structure and function over the first 5 weeks of the diet intervention. This will help us establish a solid biological foundation of how diet can influence the brain in general, and ADHD symptoms specifically. It can also show us if the effect of the Elimination Diet is found in the same brain networks and systems which respond to medication treatment. And lastly, we can see if there is a difference in the brains for those participants for whom the diet has a strong effect versus those where the diet does little or nothing to improve their ADHD symptoms. This can then help us identify for which people a dietary intervention would be a good alternative to standard treatment.

We will update you on the TRACE-MRI study and on the developments in this field right here on this blog!

 

REFERENCES
Faraone, S. V et al. Attention-deficit/hyperactivity disorder ­­­. Nat. Rev. Dis. Prim. 1, (2015).

Konrad, K., Neufang, S., Fink, G. R. & Herpertz-Dahlmann, B. Long-term effects of methylphenidate on neural networks associated with executive attention in children with ADHD: results from a longitudinal functional MRI study. J. Am. Acad. Child Adolesc. Psychiatry 46, 1633–41 (2007).

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Tips Against Overeating

Have you ever noticed that the type of food you eat can affect how you feel afterwards? Some food might make you wish to rest and relax, some food might give you the little extra energy you just needed. Evidence is accumulating that also in the long run, diet may play a pivotal role for your mental health. For example, it might have an effect on impulsive and compulsive behaviour [1].
But it’s not only the diet that affects our body, mind and brain – it’s also the amount of what we eat. Research shows that people don’t necessarily know what a suitable amount of food might be. Sure you can imagine that this can easily lead to obesity – which in turn can impair our general health.

A meta-analysis (that is, a study that investigates an effect among many independent studies that have been conducted so far) from 2018 came to the conclusion that serving size and the size of the tableware has an effect on the amount we eat: When offered larger-sized portions, packages or tableware, participants ate or drank more than when offered smaller-sized versions [2].

British nutritional scientists now developed a guideline for the British Nutrition Foundation (BNF) to help people estimate the suitable serving size. For example, they recommend that when having a pasta dish, you should take as much pasta for one person as fits into both of your hands (before cooking). A portion of fish or meat should be about half the size of your hand. However, this does not mean that when you eat more than one portion, you are an overeater.

According to their tipsheets, which can be found here,
https://www.nutrition.org.uk/healthyliving/find-your-balance/portionwise.html
one should compose his or her daily menu based on a mixture of different portions. For example, 3-4 portions of starchy carbohydrates (such as the above-mentioned pasta) are recommended daily. Their guidelines, however, offer a few handy (literally!) advises to help you get a sense of how much food you should consume, thus preventing you from overeating. With a few simple tips kept in mind, you can do some good for your physical and mental health, daily.

REFERENCES
[1] Sarris J, Logan AC, Akbaraly TN, Amminger GP, Balanzá-Martínez V, Freeman MP, et al. Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry. 2015; 2(3):271-4.
View here:
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/fulltext

[2] Hollands GJ, Shemilt I, Marteau TM, Jebb SA, Lewis HB, Wei Y, Higgins JPT,
Ogilvie D. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic
Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2
View here:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011045.pub2/full

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We have talked before about how ADHD has been associated with obesity and the mechanisms implicated on it. I would like to explain more about this important subject so you can understand what dietary changes you can make to avoid the risk of weight gain. Most of the authors attribute the presence of obesity in ADHD individuals to disorder eating patterns, especially overeating, that means that these people are eating a higher amount of calories per day in comparison of individuals without ADHD. When a person consumes more calories or food than their body needs they start to gaining weight and this happens to all kind of people, I’m not talking only about those who have ADHD, and that becomes a health problem.

Nevertheless, there is a recent study that suggests that ADHD-obesity relationship was linked to unhealthy food choices, rather than overeating behavior (1). This means that ADHD individuals are eating the same amounts of calories per day as healthy ones, but their food choices are not good enough to meet the dietary recommendations and can lead to nutritional deficiencies that have been observed on these patients (2,3). These kinds of patients tend to eat more processed meat, unhealthy snacks, and refined cereals; instead of consuming healthy food choices like vegetables, fruits, whole grains, nuts, and fish.

We can suggest that this problem it may be due to the fact that there is a lack of information related to nutrition, so it is easy to get confused on which food products are healthy and which are not.

When you go to the supermarket, you will find a lot of food options that have a label that says “light” or “healthy,” and you may buy them without analyzing if they are genuinely healthy.

So the question is “how can you know if a product is healthy or not?”

First of all, you should opt to buy fresh products such as fruits, vegetables and fish (foods that are rich in vitamins and minerals needed to maintain our mental health in good shape). And avoid consuming fast, packaged or canned food because these kinds of products contain a lot of sodium, sugar, fat, preservatives, additives and components that in high amounts can lead to health issues.

Second, if you need to buy food products that are packaged or canned, you should be able to read and understand the nutritional information and ingredients before you buy them to be sure they are the healthiest options on the market.

Here I share an example on what to search on nutrition facts labels of food products to make the right selection.

For more information on how to understand and use the nutrition facts label you can visit: www.fda.gov/food/labelingnutrition/ucm274593.htm#see3

This was co-authored by Josep Antoni Ramos-Quiroga, MD PhD psychiatrist and Head of Department of Psychiatry at Hospital Universitari Vall d’Hebron in Barcelona, Spain. He is also a professor at Universitat Autònoma de Barcelona.

REFERENCES
1. Hershko S, Aronis A, Maeir A, Pollak Y. Dysfunctional Eating Patterns of Adults With Attention Deficit Hyperactivity Disorder. J Nerv Ment Dis [Internet]. 2018;206(11):870–4.

2. Kotsi E, Kotsi E, Perrea DN. Vitamin D levels in children and adolescents with attention-deficit hyperactivity disorder (ADHD): a meta-analysis. Atten Defic Hyperact Disord [Internet]. Springer Vienna; 2018.

3. Landaas ET, Aarsland TIM, Ulvik A, Halmøy A, Ueland PM, Haavik J. Vitamin levels in adults with ADHD. Br J Psychiatry Open [Internet]. 2016;2(6):377–84.

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When Alice’s mother first contacted our team to get more information on the dietary intervention at New Brain Nutrition, she mentioned that her daughter seems to be on edge all the time. On a typical day, Alice would be triggered easily over seemingly small things and stay upset for a long time. She told us that these emotional problems caused not only very strained and cheerless moments on the weekends and evenings, they also interfered notably with Alice’s social life. In between her angry or sad moments, Alice seems to be a perfectly happy and energetic 11-year old. Alice’s attention problems didn’t obstruct a healthy didactic development since she started ADHD-medication. However, the emotional problems were still present and seemed to cause severe impairment in social interactions, within the family and with peers. Therefore, her mother asked: Could we please try a dietary intervention to see if Alice’s nutrition may play a role in these problems?

Faraone[1] distinguishes two features in these kind of emotional problems: Emotional Impulsivity and Deficient Emotional Self-Regulation. Some children may experience explosive anger but also recover quickly from it. These children experience high Emotional Impulsivity but low Deficient Emotional Self-Regulation. Alice however, based on her mother’s narrative, seems to experience both high Emotional Impulsivity and high Deficient Emotional Self-Regulation.

The second week into the Elimination Diet treatment, the researcher checks in with the family: She’s still edgy and irritable for most of the time, her mother says, but she seems to break out of it a whole lot sooner. The other day her brother Daniel came home, telling Alice he ate lots of non-elimination diet snacks at his friend’s house. Understandably, Alice became upset but it didn’t last as long as her parents expected. In other words: The Emotional Impulsivity hadn’t decreased yet, but the Deficient Emotional Self-Regulation had.

By the end of the first 5 weeks of the dietary intervention, Alice’s parents reported a convincing decrease in emotion regulation problems. The teacher also reported that the attention problems had stabilized, as much as they did with the ADHD-medication that Alice had before. The family decided to continue the Elimination Diet and start with the re-introduction phase. Every two weeks a new product was re-introduced to see if this may elicit symptoms. This was probably the most interesting period for the family, as emotion regulation problems and attention problems arose and subsided over different phases.

After one year, Alice and her family had figured out a set of foods that, when eliminated from her diet, helped diminishing both the attention problems and emotional problems. Alice is less responsive to emotional triggers and more balanced during social interactions. Alice’s personalized diet or personalized nutrition is based on her experiences and symptoms during the dietary intervention. Her mother is very glad that they discovered this lifestyle intervention as an alternative to their previous treatment with ADHD-medication.

Writers note: This is the story of one individual participating in the New Brain Nutrition study. Evaluating the role of nutrition in treatment of mental health with scientific evidence is part of our future.

More information can be found in [1] Faraone S.V., Rostain A.L., Blader J., Busch B., Childress A.C., Connor D.F., & Newcorn J.H. (2018). Practitioner Review: Emotional dysregulation in attention‐deficit/hyperactivity disorder – implications for clinical recognition and intervention. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.12899

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In my previous blogs, I explained the research questions of my study. This study will be performed in two cohorts which I will elaborate on in this current blog about early life nutrition and studying gut microbiota. The cohorts are called BIBO and BINGO.  

BIBO stands for ‘Basale Invloeden op de Baby’s Ontwikkeling’ (in English: basal influences on  infant’s development). Recruitment of this cohort started in 2006, and a total of 193 mothers and their infants were included. At age 10, 168 mothers and their children still joined the BIBO study; the attrition rate is thus low. The majority of the mothers are highly educated (76%). The number of boys (52%) and girls (48%) in this cohort are roughly equally divided. A unique aspect of the BIBO study is the number of stool samples collected in early life. Also, detailed information about early life nutrition has been recorded during the first six months of life (e.g. information on daily frequency of breastfeeding, formula feeding, and mixed feeding). Together, these stool samples and nutrition diaries provide important insights in the relations between early life nutrition and gut microbiota development. Data about children within the BIBO cohort will be collected at age 12,5 years and 14 years. At 12,5 years, the participants will be invited to the university for an fMRI scan (more information about the fMRI scan will be given in a future blog). At age 14, children’s impulsive behavior will be assessed by means of behavioral tests and (self- and mother-report) questionnaires.

BINGO stands for ‘Biologische INvloeden op baby’s Gezondheid en Ontwikkeling’ (in English: biological influences on infant’s health and development). When investigating biological influences on infant’s health and development, it is important to start before birth. Therefore, 86 healthy women were recruited during pregnancy. Recruitment took place in 2014 and 2015. One unique property of the BINGO cohort is the fact that not only mothers were recruited, but also their partners. The role of fathers is often neglected in research, and thus an important strength of this BINGO cohort. Another unique property is that samples of mothers’ milk were collected three times during the first three months of life, to investigate breast milk composition. As for many infants their diet early in life primarily consists of breast milk, it is interesting to relate breast milk composition to later gut microbiota composition and development. Currently, 79 mothers and children, and 54 fathers are still joining the BINGO study. The average age of the participants at the time of recruitment was 32 years for mothers and 33 years for the father. Majority of the parents within this cohort are highly educated (77%) and from Dutch origin (89%). The number of boys (52%) and girls (48%) in this cohort are roughly equally divided. At age 3, children’s impulsive behavior will be assessed by means of behavioral tests and mother-report questionnaires.

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Why 12 genetic markers for ADHD are exciting news for New Brain Nutrition

We are finally here: for the first time, genome-wide significant markers are identified that increase the risk for Attention Deficit / Hyperactivity Disorder (ADHD). This research was conducted by an international consortium of more than 200 experts on genetics and ADHD, and includes several researchers that are also involved in our Eat2beNICE project (the scientific basis of this New Brain Nutrition website). The findings were recently published in the prestigious journal “Nature Genetics” and will greatly advance the field of ADHD genetics research.

Why is this finding so important?

The genetics of ADHD are very complex. While ADHD is highly heritable, there are likely to be thousands of genes that contribute to the disorder. Each variant individually increases the risk by only a tiny fraction. To discover these variants, you therefore need incredibly large samples. Only then can you determine which variants are linked to ADHD. The now published study by Ditte Demontis and her team combined data from many different databases and studies, together including more than 55,000 individuals of whom over 22,000 had an ADHD diagnosis.

We can now be certain that the twelve genetic markers contribute to the risk of developing ADHD. Their influence is however very small, so these markers by themselves can’t tell if someone will have ADHD. What’s interesting for the researchers is that none of these markers were identified before in much smaller genetic studies of ADHD. So this provides many new research questions to further investigate the biological mechanisms of ADHD. For instance, several of the markers point to genes that are involved in brain development and neuronal communication.

Why are our researchers excited about this?

A second important finding from the study is that the genetic variants were not specific to ADHD, but overlapped with risk of lower education, higher risk of obesity, increased BMI, and type-2 diabetes. If genetic variants increase both your risk for mental health problems such as ADHD, and for nutrition-related problems such as obesity and type-2 diabetes, then there could be a shared biological mechanism that ties this all together.

We think that this mechanism is located in the communication between the gut and the brain. A complex combination of genetic and environmental factors influence this brain-gut communication, which leads to differences in behaviour, metabolism and (mental) health.genetic markers for adhd

The microorganisms in your gut play an important role in the interaction between your genes and outside environmental influences (such as stress, illness or your diet). Now that we know which genes are important in ADHD, we can investigate how their functioning is influenced by environmental factors. For instance, gut microorganisms can produce certain metabolites that interact with these genes.

The publication by Ditte Demontis and her co-workers is therefore not only relevant for the field of ADHD genetics, but brings us one step closer to understanding the biological factors that influence our mental health and wellbeing.

Further Reading

Demontis et al. (2018) Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nature Genetics. https://www.nature.com/articles/s41588-018-0269-7

The first author of the paper, Ditte Demontis, also wrote a blog about the publication. You can read it here: https://mind-the-gap.live/2018/12/10/the-first-risk-genes-for-adhd-has-been-identified/

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Breaking news: It has long been assumed that the gut and the brain communicate not only via a slow, hormonal pathway, but that there must be an additional, faster association between gut and brain. Melanie Maya Kelberer and her colleagues from Duke University, NC, now managed to detect this connection. Their paper has just been published in the renowned journal ‘Science’.

By researching a mouse model, they were able to show that the gut and the brain are connected via one single synapse. This is how it works: A cell in the gut (the so-called enteroendocrine cell) transfers its information to a nerve ending just outside the gut. At the connecting nerve ending (the synapse), the neurotransmitter glutamate – the most important excitatory transmitter in the nervous system – passes on the information about our nutrition to small nerve endings of the vagal nerve, which spreads from the brain to the intestines.

Vagal nerveBy travelling along this vagal nerve, the information from the gut reaches the brainstem within milliseconds. The authors now state that a new name is needed for the enteroendocrine cells, now that they have been shown to be way more than that. The name ‘neuropod cells’ has been suggested. The authors interpret their findings as such, that this rapid connection between the gut and the brain helps the brain to make sense of what has been eaten. Through back-signalling, the brain might also influence the gut. In sum, this finding is an important step towards a better understanding of how the gut and the brain communicate. Findings such as this one help us to find ways to positively influence our brain states and our mental health by our food choices.

Read the original paper here: http://science.sciencemag.org/content/361/6408/eaat5236.long

Kaelberer, M.M., Buchanan, K. L., Klein, M. E., Barth, B. B., Montoya, M. M., Shen, X., and Bohórquez, D. V. (2018), A gut-brain neural circuit for nutrient sensory transduction, ​Science,
​ Vol. 361, Issue 6408

 

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The topic of adopting healthier diets is increasingly popular due to better awareness of issues like obesity, diet-related health problems and illnesses, and a general pursuit of better life quality. A large, longitudinal study in Estonia investigated how eating patterns have changed over the years, and which factors influence the food choices we make.

The Estonian Children Personality Behaviour and Health Study (ECPBHS) is a multidisciplinary study that has been going on for already 20 years. It started in 1998, when participants were 9 and 15 year-old schoolchildren from Tartu County in Estonia. The 1176 children that were included in the study in 1998 were tested again when they were 18, 25 and 33 years-old.

Through the ECPBHS, we have examined different aspects of both mental and physical health, risky behaviour, physical activity, psychosocial well-being, impulsivity and personality. An additional topic of study has also been nutrition.

To investigate whether the children in the study were eating healthy, we have analysed whether the nutrient and food intake comply with the Estonian dietary recommendations. When we compared our results with the previous studies carried out in Estonia1,2 we discovered that although the deficiency in many nutrient intakes showed fairly unhealthy food habits in Estonian schoolchildren3, there was a shift to a better average energy intake and consumption over time, and especially in comparison to the end of 1980s and the beginning of 1990s4. Throughout the years we have seen the tendency towards healthier food habits, but there is still overconsumption of fats. The consumption of fibre, as well as some of the vitamins and minerals, were below the recommendations3.

We know that the changes in society (including working patterns of men and women)5 can bring changes in the eating patterns, and when we looked at the teenagers’ eating habits6, we saw that the role of family was important in how teenagers’ eating habits were influenced. Although we saw that 18 year olds in 2001 and in 2007 were regularly eating three meals a day, there was a shift among boys to have more irregular breakfast consumption in 2007. This was offset by having school-lunch, which was higher in 2007 than in 2001.

teenage girl eating burger and softdrinkWe have also looked at the consumption of fast food and fizzy drinks and discovered that it was affected not only by age, gender, ethnic and urban environment, but it was also affected by mothers’ income and educational level7. We also found that children with certain gene polymorphism (ADRA2A C-1291G) consumed more ready-made sweet food products and sweet sour milk products.8 (Gene polymorphism (two alleles in one place) can cause abnormal gene expression or abnormal protein production, which may cause or can be associated with disease.)

What is important to remember, is that although our genes, family habits and society affect how we eat, we can still learn to make healthy food choices. So do not forget the basics: eat less sweets, and more vegetables and fruits. Fibres and fats are both important, but again, only to a certain amount.

Whatever diet one follows should be balanced, and combined with physical activity. These principles should also be taught to our children, so that they too could enjoy the benefits of a healthier diet and a more active lifestyle. Though, we have seen the tendency towards healthier food habits, there is still a room for improvement. Hopefully, we will see this improvement in our population study in the next few years.

 

Reference list:

  1. Saava, M., Pauts, V., Tšaiko, L., & Sink, R. (1995). Toitumine ja alimentaarsed ateroskleroosi riskitegurid koolieas. Eesti Arst, 4, 319-325.
  2. Grünberg, H., Mitt, K., & Thetloff, M. (1997). Food habits and dietary Intake of schoolchildren in Estonia. Scandinavian Journal of Nutrition, 41, 18-22.
  3. Gross, K. (2006). Eesti koolilaste toitainete ja toidugruppide tarbimine (BA thesis). University of Tartu.
  4. Villa, I., Alep, J., & Harro, M. (2002). Eesti koolilaste toitumine viimasel 15 aastal. Eesti Arst, 88(9), 607.
  5. Mestdag 2005; Lund & Gronow 2014
  6. Jõers-Türn, K. (2015). „Family factors influencing teenagers eating habit“ (MA thesis). University of Tartu.
  7. Alavere, H. (2007). Kiirtoidu ja gaseeritud jookide tarbimine ning seos insuliinresistentsusega Eesti koolilastel (MA thesis). University of Tartu.
  8. Mäestu, J., Villa, I., Parik, J., Paaver, M., Merenäkk,. L., Eensoo, D., Harro, M., & Harro, J. (2007). Human adrenergic α2A receptor C-1291G leads to higher consumption of sweet food products. Molecular Psychiatry 12, 520-521.
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