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LETTER TO THE EDITOR
International Society for Nutritional Psychiatry
Research consensus position statement: nutritional
medicine in modern psychiatry
In recent years, there has been an unprecedented growth
in both the quantity and methodological quality of research
directed at exploring the relationship between nutrition and
mental health. Indeed, the strength of data has now afforded
nutritional medicine a place in the mainstream psychiatric
discourse (1).
Robust associations have been established between nutri-
tional quality and mental health, with the bulk of this evi-
dence indicating a protective effect of healthy diets on
depressed mood (2), and the newest research supporting a
detrimental impact of unhealthy diets on the mental health
of young people (3,4) and adults (5,7).
There are also convincing data supporting the applica-
tion of certain nutrient-based supplements (nutraceuti-
cals) as monotherapy or combined therapy (8), or as aug-
mentation therapy (9).
Although the growth in scientific research related to nutri-
tion 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 psy-
chiatry whereby nutritional considerations (both education-
al and prescriptive) can be considered “mainstream” (1). To
this end, we present a consensus position statement from the
International Society for Nutritional Psychiatry Research
(ISNPR).
In brief, the ISNPR was formed in 2013 with the aim to
advance research and communication on nutritional med-
icine in the field of psychiatry. One of its first goals was to
formulate a position statement that embodied the princi-
ples of the organization, allowing for codification of the
society’s underpinning tenets.
In order to develop this, we employed a Delphi-based
model by which ISNPR researcher and clinician members
could vote on a select list of 110 statements created by an
expert steering committee.
The committee provided a list of sub-statements con-
cerning three main topics/areas: the current general needs
and challenges in psychiatry; key elements of diet and
nutraceutical evidence related to mental health/psychia-
try; potential public health and clinical applications. These
were transcribed and tabulated in Survey Monkey for online
voting by the wider ISNPR membership.
A Likert scale (0–10) was used for each statement
(05don’t include, 55don’t know/depends, 105definitely
include), and statements that received a mean score of
>6.5/10 by ISNPR members were reviewed by the steer-
ing committee for inclusion in the position statement,
which is presented below.
Present treatment of mental disorders is achiev-
ing sub-optimal outcomes; in addition little atten-
tion 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 preven-
tion of mental disorders and have a fundamental
role in the promotion of mental health.
Epidemiological data, basic science, and clinical
evidence suggest that diet influences both the risk
for and outcomes of mental disorders. As such, we
advocate that evidence-based nutritional change
should be regarded as an efficacious and cost-
effective means to improve mental health.
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 (particu-
larly folate and B12), choline, iron, zinc, magne-
sium, 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.
Ongoing research (including randomized con-
trolled trials) in the area is recognized as critical,
using methodologically rigorous designs. Further
explication of the biological pathways affected by
nutritional modification is also required. Clinical
trials of nutraceuticals should include assessment
of biomarkers in tandem with clinical outcomes.
Global research and health promotion activities
focused on improving population health should
also include mental health parameters as priority
targets and measured outcomes.
Importantly, the activities of the food industry need
to be examined at a governmental level and relevant
policies designed to reduce the global burden of physi-
cal and mental ill-health attributable to poor diet.
Such policies are advised to stimulate significant pub-
lic change in dietary habits back towards a traditional
wholefood diet (dependent on the culture). Further,
there is now a vital need for better public and clinician
education to communicate current research findings
from the field.
In summary, nutrition and nutraceuticals should
now be considered as mainstream elements of psychi-
atric practice, with research, education, policy, and
health promotion reflecting this new paradigm.
370 World Psychiatry 14:3 - October 2015
As detailed in our consensus statement, we advocate for
the pursuit of an integrative psychiatric model, with diet as a
key element. Further, the select use of evidence-based nutra-
ceuticals should be a mainstay of treatment as either stand-
alone therapies (mainly in cases of less severe mental disor-
ders, non-tolerance to medication, nutrient deficiencies, or
patient choice), or as adjunctive interventions with psycho-
tropic medications to augment treatment efficacy. We recog-
nize the importance of clinician and public education regard-
ing evidence-based nutrition and nutraceuticals to drive
mainstream acknowledgement of their impact on mental
health.
It is the intention that this position statement and the
ongoing work of ISNPR will assist in facilitating a trans-
formation in psychiatry to better address the substantial
global burden of mental illness, recognizing and embrac-
ing diet and nutrition as central determinants of both
physical and mental health.
Jerome Sarris
1,2
, Alan C. Logan
3
, Tasnime N.
Akbaraly
4,5
, G. Paul Amminger
6
, Vicent Balanz
a-
Mart
ınez
7
, Marlene P. Freeman
8
, Joseph Hibbeln
9
,
Yutaka Matsuoka
10
, David Mischoulon
11
, Tetsuya
Mizoue
12
, Akiko Nanri
12
, Daisuke Nishi
13
, Natalie
Parletta
14
, Drew Ramsey
15
, Julia J. Rucklidge
16
,
Almudena Sanchez-Villegas
17,18
, Andrew Scholey
2
,
Kuan-Pin Su
19,20
, Felice N. Jacka
21-24
1
Department of Psychiatry, University of Melbourne,
Melbourne Clinic, Melbourne, Australia;
2
Centre for
Human Psychopharmacology, Swinburne University of
Technology, Hawthorn, Australia;
3
CAMNR, Calabasas,
CA, USA;
4
Inserm U1198, Montpellier, France; EPHE,
Paris, France; University Montpellier 2, Montpellier,
France;
5
Department of Epidemiology and Public
Health, University College London, London, UK;
6
Ory-
gen, The National Centre of Excellence in Youth Men-
tal Health, Australia;
7
Teaching Unit of Psychiatry and
Psychological Medicine, La Fe University and Polytech-
nic Hospital, University of Valencia Medical School,
CIBERSAM, Valencia, Spain;
8
Perinatal and Reproduc-
tive Psychiatry, Massachusetts General Hospital, Bos-
ton, MA, USA;
9
National Institute on Alcohol Abuse
and Alcoholism, NIH, Bethesda, MD, USA;
10
Depart-
ment of Clinical Epidemiology, Translational Medical
Center, National Center of Neurology and Psychiatry,
Tokyo, Japan;
11
Depression Clinical and Research Pro-
gram, Massachusetts General Hospital, Boston, MA,
USA;
12
Department of Epidemiology and Prevention,
National Center for Global Health and Medicine,
Tokyo, Japan;
13
Department of Mental Health Policy
and Evaluation, National Institute of Mental Health,
Japan;
14
School of Population Health, University of
South Australia, Adelaide, Australia;
15
Columbia Uni-
versity College of Physicians and Surgeons, New York,
NY, USA;
16
Department of Psychology, University of
Canterbury, Christchurch, New Zealand;
17
Research
Institute of Biomedical and Health Sciences, University
of Las Palmas de Gran Canaria, Las Palmas de Gran
Canaria, Spain;
18
CIBEROBN, Instituto de Salud Car-
los III, Madrid, Spain;
19
Department of Psychiatry and
Mind-Body Interface Laboratory, China Medical Uni-
versity Hospital, Taichung, Taiwan;
20
Graduate Insti-
tute of Neural and Cognitive Sciences, China Medical
University, Taichung, Taiwan;
21
IMPACT SRC, School
of Medicine, Deakin University, Geelong, 3220, Austra-
lia;
22
Murdoch Children’s Research Centre, Parkville,
Australia;
23
Department of Psychiatry, University of
Melbourne, Royal Melbourne Hospital, Melbourne,
Australia;
24
Black Dog Institute, Road Prince of Wales
Hospital, Randwick, Australia
References
1. Sarris J, Logan A, Akbaraly T et al. Nutritional medicine as main-
stream in psychiatry. Lancet Psychiatry 2015;2:271-4.
2. Lai JS, Hiles S, Bisquera A et al. A systematic review and meta-
analysis of dietary pattern and depression in community-dwelling
adults. Am J Clin Nutr 2013;99:181-97.
3. O’Neil A, Quirk SE, Housden S et al. Relationship between diet
and mental health in children and adolescents: a systematic
review. Am J Public Health 2014;104:e31-42.
4. Jacka FN, Ystrom E, Brantsaeter AL et al. Maternal and early
postnatal nutrition and mental health of offspring by age 5 years:
a prospective cohort study. J Am Acad Child Adolesc Psychiatry
2013;52:1038-47.
5. Akbaraly TN, Brunner EJ, Ferrie JE et al. Dietary pattern and
depressive symptoms in middle age. Br J Psychiatry 2009;195:
408-13.
6. Sanchez-Villegas A, Delgado-Rodr
ıguez M, Alonso A et al. Asso-
ciation of the Mediterranean dietary pattern with the incidence of
depression: the Seguimiento Universidad de Navarra/University
of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry 2009;
66:1090-8.
7. Jacka FN, Pasco JA, Mykletun A et al. Association of Western and
traditional diets with depression and anxiety in women. Am J Psy-
chiatry 2010;167:305-11.
8. Rucklidge JJ, Kaplan BJ. Broad-spectrum micronutrient formulas
for the treatment of psychiatric symptoms: a systematic review.
Expert Rev Neurother 2013;13:49-73.
9. Sarris J, Kavanagh D, Byrne G. Adjuvant use of nutritional and
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zodiazepines. J Psychiatr Res 2010;44:32-41.
DOI 10.1002/wps.20223
371
