A letter published this month in World Psychiatry, the official journal of the World Psychiatric Association, is titled: “International Society for Nutritional Psychiatry Research consensus position statement: nutritional medicine in modern psychiatry.”
You may recall my interview with Dr. Felice Jacka on season 1 of The Anxiety Summit: The Research – Food to prevent and treat anxiety and depression? Dr. Jacka is one of the authors of this position statement and a co-founder of the International Society for Nutritional Psychiatry Research/ISNPR which was formed in 2013 with the aim to advance research and communication on nutritional medicine in the field of psychiatry.
Here is an excerpt from the position statement from ISNPR:
Although the growth in scientific research related to nutrition in psychiatry may be recent, it is now at a stage where it can no longer be ignored. In light of this, we aim to provide a platform to move towards a new integrated paradigm in psychiatry whereby nutritional considerations (both educational and prescriptive) can be considered “mainstream”. To this end, we present a consensus position statement from the International Society for Nutritional Psychiatry Research (ISNPR).
They state that what we are doing now is not working, that little is being done about prevention, and that nutrition needs to be part of treatment and prevention:
Present treatment of mental disorders is achieving sub-optimal outcomes; in addition little attention is given to preventative efforts. Due to the immense burden of mental disorders, there is now an urgent need to identify modifiable targets to reduce the incidence of these disorders. Diet and nutrition offer key modifiable targets for the prevention of mental disorders and have a fundamental role in the promotion of mental health.
They state that diet and nutrient-based approached approaches need to be included for mental health treatment and for prevention:
In addition to dietary modification, we recognize that nutrient-based (nutraceutical) prescription has the potential to assist in the management of mental disorders at the individual and population level. Many of these nutrients have a clear link to brain health, including: omega-3s, B vitamins (particularly folate and B12), choline, iron, zinc, magnesium, S-adenosyl methionine (SAMe), vitamin D, and amino acids. While we advocate for these to be consumed in the diet where possible, additional select prescription of these as nutraceuticals may also be justified.
They call for ongoing research, changes in food policy, and better public and clinician education (based on all the new research in this field of nutritional psychiatry).
I look forward to the outcome of the RCT dietary intervention for depression / “SMILES” trial later this year, additional dietary studies, and more studies on individual nutrients such as amino acids like GABA and tryptophan, minerals like zinc and others (which we know work so well for so many people). I’d also love to see trials that look at biochemical individuality and diets and nutrients customized to that uniqueness. I know we’re heading in this direction.
The position statement ends with this:
It is the intention that this position statement and the ongoing work of ISNPR will assist in facilitating a transformation in psychiatry to better address the substantial global burden of mental illness, recognizing and embracing diet and nutrition as central determinants of both physical and mental health.
You can read the whole statement here in World Psychiatry
I say bravo to Dr. Jacka, ISNPR and the researchers who are at the forefront of this exciting research. I also say bravo to all the health practitioners who are already using this work with patients and clients. And finally, I say bravo to the anxious and depressed individuals who are implementing these powerful changes and seeing dramatic results.
It certainly is exciting to be part of this change!
The mentally ill or at least those suffering with major mental illness have a tendency to poor dietary habits. This is a result of bearing the burden of symptoms and struggling to keep pace with a healthy lifestyle. They also may not be in the possession of life skills such as preparing food and being able to be sufficiently educated about appropriate food choices. This is a result of the symptoms arising earlier in life during teenage years where they have been denied the opportunity to self sufficiency and autonomy. Many are very marginalised and owing to smoking and drinking habits they buy cheap nutrient empty foods and packet foods that are easy to mix. Add to that being denied access to the information on the net they may not be educated about antibiotics in meats and grain fed cattle as well as pesticide GMO foods which both cause inflammation. Making changes in habits can be hard as they are ingrained and inherited from their socioeconomic. They may not see a pressing need to change – thinking their body will be able to assimilate what it needs. Poor food choices and habits are a big culprit when a sedentary lifestyle does not permit inquiry about alternatives or the required effort needed to change. Its all about finance too. Many mentally ill smoke for “management of symptoms” so there is such a phenomenon known in the business as smokers poverty which does not leave much money left for anything else.
Lynda
It’s very unfortunate that those suffering with major mental illness have a tendency to poor dietary habits. The research is now supporting that poor dietary habits contribute to mental illness too.
Letters like this and the related research will impact public policy, treatment approaches, community education centers, how children are educated at school and more. We’d like to see this happen sooner rather than later. We are already seeing lower socioeconomic communities getting access to fresh produce and a growing awareness of the importance of food.
I’d love to see classes teaching about the importance of food, getting more kids growing food and adding cooking classes again. I actually had the opportunity to do cooking/home economics classes at school and had my mom and granny teach me to cook/sew/knit!
I was not familiar with the term “smokers poverty” but I’ve seen it happen and it’s very unfortunate.
I’m curious – are you working in public mental health? what positive changes have you seen recently?
I think what Lynda says is totally true. I see this, I hear this, I work with this, and it is an *unfortunate* reality. But the facts remain the facts… poor nutritional status, no matter what contributes to it, impacts mental health. These folks are caught in a vicious cycle. Now that we know this we can’t turn our backs on it saying “it’s too hard or impossible to change” (you could draw a parallel to climate change and “an inconvenient truth”, right?). I think the way forward to help is to figure out a way to break the cycle and turn the downward spirals to an upward spirals. I’ve been super inspired by the work being done by the Community Food Centres here in Canada… the idea being to shift the concept of the food bank to a concept of a food centre – a place that brings people together around growing, preparing, sharing food and rather thank handing out donated cans and packages. THAT is an innovative way to address mental wellness amongst the most vulnerable of our culture. I’m also interested in figuring out a way for schools to foster the upward spiral before they become downward spirals. Imaging that? Imagine how many lives we could turn around if kids learned how to be healthy while they’re in school rather than learning to look forward to pizza friday and Halloween?Point being, we know food matters to mental wellness and we even know a lot about how it matters and the shifts that need to be made. So now that we know that, we have no choice but to incorporate it into the solution. Thanks for spreading awareness Trudy.
Jess
Well said – it’s time to start incorporating it and make it part of the solution! I’m liking what I hear about the Community Food Centres in Canada – I’m all for “bringing people together around growing, preparing, sharing food and rather thank handing out donated cans and packages”. I cringe when I see some of the horrible foods donated to and handed out by food banks (as well meaning as it is). And children and their families need to learn to prepare healthy food and actually being part of growing it is a huge step forward!
No mention of Niacin for depression schizophrenia and other mental illnesses? Refer to Andrew Saul for a wealth of information on Niacin in mental health.
Alison
Thanks for mentioning niacin and Andrew Saul – I agree!
This 2012 paper published by Dr Davison and Dr. Kaplan mentions niacin http://www.ncbi.nlm.nih.gov/pubmed/22340148. And this 2014 paper covers pellagra and alcoholism http://www.ncbi.nlm.nih.gov/pubmed/24627570 “Pellagra is caused by deficiency of niacin” and “Depression in pellagra may be due to a serotonin deficiency caused by decreased Trp availability to the brain.”