By Prof Julia Rucklidge, Professor of Clinical Psychology, University of Canterbury.
Mental illness affects one in five New Zealanders and, despite the wide availability of solid empirically supported therapies, these statistics are not getting any better. We appear to have reached an impasse improving outcomes, despite improvements in other areas of medicine.
We need to explore new avenues.
There has been a small explosion in research using nutrients for the treatment of mental illness over the last decade. The general premise is that our brains need nutrients to function and chemicals that are essential for good mental health, like dopamine and serotonin, require micronutrients, like vitamins and minerals.
Preliminary clinical trials are putting micronutrients and goo d nutrition on the map as essential for optimal mental health. These trials show that giving more nutrients than what is obtained through diet alone can have a positive impact on serious conditions, like Attention-Deficit/Hyperactivity Disorder (ADHD), autism or anxiety. Along a similar vein, other studies are highlighting that improving diet alone can also improve mental health. By showing that manipulation of the amount of nutrients one consumes can influence mental health, the research demonstrates that the nutrients these participants were receiving prior to these interventions were not adequate to meet their mental health needs.
For the past several decades, this idea that nutrients might treat mental illness was received with great scepticism and even ridiculed. Some continue to believe that vitamins kill us, despite evidence to the contrary. However, the tide is slowly changing and scientists are researching the importance of nutrition for mental health. Importantly, the first international meeting on the subject is being held in Washington this year. Nutritional medicine is starting to become mainstream medicine.
Beyond a ‘shotgun’ solution
At the moment though, in the area of nutrient supplementation research, we are taking a ‘shotgun’ approach to the problem. We give everyone a broad array of nutrients and see who gets better. That’s been a good start in that significant changes in many areas of functioning have been observed in many people, but the problem is that we each have unique nutrient requirements.
This approach of “one size fits all” will only go so far. Some people don’t respond. Some people only get marginally better. Why? Can we use genetic and nutrient testing to determine the optimal dose and nutrients that someone may require to get better based on their individualized profile? Can we use microbiome analyses to determine what microbial strains are required to best heal the gut to optimize absorption of nutrients? Current and future technologies should allow us to greatly expand the number of people who benefit from a nutritional approach.
Can this research also be used to target our food choices? To date, nutritional value is not the primary motivator in food processing. Agricultural practices tend to prioritize food storage, growth rates, transportability, shelf life, colour, shape and size above nutrient content. Could scanning of nutrient levels of fruits and vegetables using your mobile phone bring focus to the importance of the nutrient quality of our food such that this becomes the priority of consumers over aesthetic qualities or price?
Food or medicine?
Some challenges lie ahead in access to nutrients. As soon as nutrients are proven to have therapeutic benefit, NZ legislation requires that they be treated as medicines. In other cases, dose alone can affect classification as a supplement or medication. This means as the evidence for efficacy increases, accessibility to the general public will be reduced as the ministry may insist that nutrients be accessible only by prescription.
Based on the medical model, there is a belief that pills that improve health comes with side effects that must be carefully monitored and controlled. To date, our research has shown minimal to non-existent side effects from the nutrient combinations we have studied. Moreover, physicians are currently not well placed to prescribe nutrients because so few have training in nutrition.
The government has the power to ensure legislation allows easy access to nutrients and permits health claims to be made based on good science. Such legislation could ensure that nutrients are easily available due to the very low risk associated with consuming nutrients as compared with pharmaceutical drugs. On the surface, the proposed Natural Health Products Bill appears to offer a middle ground; however, delving into it, it seems more intent on protecting drug company interests than improving public access to affordable and effective nutrients.
How bold politicians are with the legislation will depend partially on market forces but also on whether the public want to ensure that nutrients don’t get classified as medicines unnecessarily. If people can be empowered to look after their own health and not have to visit a professional to get started on recovery, then it is possible to reduce health care costs. Something has to. We simply can’t afford our current health care model, as costs continuing to spiral.
Some companies sell nutrient products that optimize profit over health benefit. This may result in cutting corners, not using minerals that have been well chelated, not using the most bioavailable forms of vitamins. This will impact efficacy. It will be a challenge to ensure that nutrients designed for improving mental health are not compromised. Snake oil salesmen are never too far away.
Ensuring good access to nourishing food will also be a challenge. The prevailing mindset is that good food is expensive. However, this is true only if one doesn’t count the costs associated with eating poorly. We need attitudes towards food to change from providing calories to providing the essentials of health. Perhaps one day we will all come to realize that so many packaged and highly processed foods are nutritionally depleted. Ideally, if consumers would stop buying these products, changes would follow.
It is encouraging that some people can have better mental health and more fulfilling lives simply by ensuring their brains receive adequate nutrients and that they will not have to experience the side effects associated with so many medications. Perhaps mental illness will be viewed as being at least partially caused by improper nutrition, as our ancestors knew. Could such a shift influence the stigma associated with mental illness?
Valuing the role of nutrition as part of addressing our mental health statistics is part of our future. How well we can ensure that access is optimized and price is affordable will depend on good legislation, a re-evaluation of our current health care model and ensuring competing market forces don’t compromise the acceptability and efficacy of this solution.
The Sciblogs Horizon Scan
This post is part of the Sciblogs Horizon Scan summer series, featuring posts from New Zealand researchers exploring what the future holds across a range of fields.