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Nutrition and Mental Health

DOI:10.1177/2167702616641050
Authors:
Julia J Rucklidge at University of Canterbury
Julia J Rucklidge
Bonnie J Kaplan at The University of Calgary
Bonnie J Kaplan
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Clinical Psychological Science
2016, Vol. 4(6) 1082 –1084
© The Author(s) 2016
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DOI: 10.1177/2167702616641050
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Short Communication/Commentary
This series is intended to showcase the diversity of stud-
ies being conducted in a new, rapidly emerging field of
nutrition and mental health, coined by leaders in the field
as nutritional psychiatry (Sarris, Logan, etal., 2015). The
series begins with an article by Sánchez-Villegas,
Ruiz´-Canela, Gea, Lahortiga, and Martínez-González
(2016) that fits into the field of nutritional epidemiology
but expands it significantly. Over the past decade, there
has been a steady increase in epidemiological studies
investigating the relationships between dietary patterns
and mental states. Both cross-sectional and longitudinal
studies have shown that the more one eats a Western or
highly processed diet, the more one is at risk for develop-
ing psychiatric symptoms such as depression and anxi-
ety. Conversely, the more one eats a diet rich in fruits and
vegetables, high in healthy fats, nuts, and fish, and low in
processed food (a Mediterranean-style diet), the more
one is protected from developing a mental disorder
(Akbaraly etal., 2009; Jacka etal., 2010; Jacka etal., 2011;
Sánchez-Villegas et al., 2009; Sánchez-Villegas et al.,
2012). In several studies, the dietary pattern has been
shown to precede the onset of psychiatric symptoms,
clearly supporting the direction of causality (dietary pat-
tern does influence mental health, although we tend to
attribute poor dietary patterns to being carbohydrate
craving induced by low mood).
Sánchez-Villegas and colleagues broaden their analy-
ses beyond the Mediterranean diet to Mediterranean life-
style variables. What they report is of great relevance to
our understanding of how lifestyle variables fit together:
Dietary pattern, physical activity, and social activities were
all independently and inversely associated with risk of
depression. Taken together, the reduction in risk for those
at the highest levels on all three variables was about 50%.
If a drug with no side effects were to be associated with
that significant a reduction in risk, it would be prescribed
often. Is it time for our health professionals to prescribe
Mediterranean diet, physical activity, and social activities?
Although some of the research in clinical patients
involves intervention (changing dietary habits and exam-
ining associated changes in cognitive function and
mental symptoms), other studies, such as the article by
Chang, Jingling, Huang, Lu, and Su (2016) in the current
series, evaluate correlations between some aspect of
dietary intake in relation to mental health. In a small
group of 21 children diagnosed with attention-deficit/
hyperactivity disorder (ADHD) and 21 non-ADHD con-
trols, three types of variables were compared: n-3 fatty
acid intake based on a food frequency questionnaire for
the prior 3 months, the physical signs and symptoms
known to indicate a deficiency in essential fatty acids
(e.g., dry skin or hair, dandruff, brittle nails), and perfor-
mance on some laboratory tasks of cognitive function
and inhibition. One intriguing finding was that although
there were no group differences in omega 3 intake, there
were group differences in signs of essential fatty acid
(EFA) deficiency. Does this finding mean that children
with ADHD might require more EFA intake than normal
children to prevent signs of deficiency? This possibility
does require further exploration but may tie into Bruce
Ames’s hypothesis that some people may inherit an in-
born error of metabolism that results in the need for a
greater intake of the nutrient(s) not being well metabo-
lized (Ames, 2004; Ames, Elson-Schwab, & Silver, 2002).
The study by Chang etal. also found that greater ADHD
symptoms were correlated with lower n-3 fatty acid
intake and higher severity of symptoms indicative of EFA
deficiency. EFA deficiency was also correlated with higher
delay aversion in the laboratory tasks of inhibitory
control.
The series includes two articles that explore micronu-
trient treatment, one looking at a single nutrient (Sarris,
Oliver, Camfield, & Dean, 2016) and one exploring the
potential of multinutrient treatment (Lothian, Blampied,
& Rucklidge, 2016). When examining the potential of any
new therapy, a question often emerges: Who might be
most likely to benefit from this approach? Using data
641050CPXXXX10.1177/2167702616641050Rucklidge, KaplanNutrition and Mental Health
research-article2016
Corresponding Author:
Julia J. Rucklidge, University of Canterbury, Psychology Department,
Private Bag 4800, Christchurch 8140, New Zealand
E-mail: julia.rucklidge@canterbury.ac.nz
Nutrition and Mental Health
Julia J. Rucklidge1 and Bonnie J. Kaplan2
1University of Canterbury and 2University of Calgary
Received 2/22/16; Revision accepted 3/2/16
by guest on November 14, 2016cpx.sagepub.comDownloaded from
Nutrition and Mental Health 1083
from a previously published clinical trial of N-acetyl-cys-
teine (NAC) in the treatment of obsessive compulsive dis-
order (OCD; Sarris, Oliver, etal., 2015), Sarris etal. asked
whether there were any meaningful variables that pre-
dicted responsiveness to NAC. Their analyses uncovered
the role of age, type of OCD, and duration of illness as
potential moderators of treatment response. It is not sur-
prising that the younger someone is and the shorter the
duration of illness, the more likely one will respond to
this one nutrient, advocating for early intervention as
well as possibly using this approach before trialing medi-
cations. Certainly there is room for much greater explora-
tion of determining who might benefit from directed
nutrients: Epigenetic research and studies of biomarkers
of inflammation may begin to illuminate this potential.
The article by Lothian etal. (2016) serves a dual pur-
pose in this series. First, it introduces the use of broad-
spectrum micronutrients (by which we mean having a
large number of dietary minerals and vitamins) as a
treatment modality for mental health problems. And
second, it also displays innovations in the analysis of
the data. Insomnia is an interesting symptom to target
for treatment as it is associated with so many mental
health problems, exacerbating them all. Many other
studies have shown alleviation of other psychological
symptoms with micronutrient treatment: depression,
anxiety, explosive rage, irritability (another symptom
that crosses many diagnosticcategories), and attentional
problems (Rucklidge & Kaplan, 2013). So in that sense,
this contribution, showing substantial improvements in
sleep in this sample, adds to the growing evidence that
many forms of psychological distress can be amelio-
rated by nutritional therapies. They also presented the
data in an innovative way, using modified Brinley plots,
to permit both idiographic individual and group out-
comes to be evaluated concurrently.
There is an increasingly vast literature on mechanisms
of action related to oxidative stress, mitochondrial dys-
function, gastrointestinal dysbiosis, and inflammation
(Kaplan, Rucklidge, McLeod, & Romijn, 2015). In fact, our
journey toward editing this special series began with our
article published in this journal last year that attempted to
present a simple explanation of how the framework that
depends on these functions inevitably relates to nutrients
and their critical role in health and disease.
The final article in the series, by Akbaraly and colleagues
(2016), adds to the growing literature on mechanisms by
providing some intriguing insights into the complex rela-
tionships among biomarkers and diets identified as being
proinflammatory. In terms of epidemiologic findings, their
data reinforce the relationship between dietary patterns
and expression of depressive symptoms 5 years later
(observed only in women, not men). But in addition, they
describe the “dietary inflammatory index,” which was
correlated at baseline with biomarkers of inflammation
(CRP and IL-6). Perhaps surprising, these markers of inflam-
mation did not influence the long-term association between
the dietary inflammation index and recurrent depressive
symptoms. Such a finding reinforces the complexity in
understanding the role markers might play in the expres-
sion of illness. These relationships are not straightforward
and require much additional research.
We hope this series brings further attention to this
growing field of research. We are pleased to be a part of
this new venture and hope that other scientists see the
relevance to their own work.
Author Contributions
Both authors worked collaboratively on this introduction and
both approved the final draft.
Declaration of Conflicting Interests
The authors declared that they had no conflicts of interest with
respect to their authorship or the publication of this article.
Funding
No external funding supported this work.
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... The selection of respondents for the study was based primarily on the unit/department where they work, supported by data obtained from the unit/department head. The exclusive use of health professionals from the psychiatric unit was informed by recent evidence which supports the essential role of mental health workers in nutritional care of their clients (Alshwaiyat et al., 2013;Freeman, 2013;Gill et al., 2017Gill et al., , 2021Offor et al., 2021;Rossa-Roccor, Richardson et al, 2021;Rucklidge & Kaplan, 2016;Strassnig et al., 2013). ...
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Full-text available
  • Mar 2022
Las enfermedades mentales y los tras-tornos neurológicos se encuentran entre las principales causas de discapacidad a nivel mundial. En los últimos años, múltiples estudios epidemiológicos han investigado la relación existente entre los patrones dietéticos y el estado mental, con énfasis en la influencia de factores genéticos y ambientales en el desarrollo de dichos trastornos. Asimismo, se ha reconocido que el desarrollo neuronal está ciertamente influenciado por factores nutricionales, dependientes de una ingesta adecuada de nutrientes esenciales, vitaminas y minerales, y la vitamina D, el complejo B, los ácidos grasos omega 3, el yodo, el hierro, los prebióticos y los probióticos son nutrientes indispensables tanto en la estructura como en el desarrollo cerebral, cuyas alteraciones pueden comprometer negativamente la salud mental. Por una parte, se ha postulado gran variedad de vías patológicas implicadas en el desarrollo de dichos trastornos; entre ellas se destaca la inflamación crónica de bajo grado, la cual se ve influenciada por ciertos estresores psicosociales que, en conjunto, estimulan la red de citocinas proinflamatorias, lo que resulta en cambios neuroconductuales. Por otra parte, la microbiota intestinal (MI) desempeña un papel importante en múltiples vías neurobiológicas debido a su rol en la modulación del factor neurotrófico derivado del cerebro, así como en el metabolismo del triptófano, y su desregulación es un factor importante en el comporta-miento del individuo.
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Mengoptimalkan Asupan Zat Gizi sebagai Upaya Preventif dalam Mengatasi Masalah Kesehatan Mental
Article
Full-text available
  • Nov 2022
Latar Belakang: Zat gizi memiliki peranan penting untuk menjaga kesehatan mental seseorang. Hasil studi menjelaskan bahwa ketika seseorang dengan kondisi kesehatan mental yang tidak baik, akan sering mengalami kekurangan zat gizi tertentu, vitamin essensial, mineral, asam amino dan asam lemak omega-3. Dalam beberapa penelitian juga membuktikan bahwa semakin banyak seseorang mengonsumsi suatu makanan yang kaya akan buah-buah dan sayuran, tinggi lemak sehat, kacang-kacangan dan ikan serta rendah makanan olahan, maka semakin seseorang akan terlindungi dari gangguan mental. Tujuan: Studi ini dilakukan untuk mengetahui upaya preventif dalam mengatasi masalah kesehatan mental dengan mengoptimalkan asupan zat gizi. Metode: Literatur yang digunakan dari referensi article, e-book dan research selama 10 tahun terakhir, yaitu 2013-2021, dengan menggunakan kata kunci asupan zat gizi, kesehatan mental, peranan dan upaya preventif. Ulasan: : Berdasarkan literatur yang digunakan dari referensi article, e-book dan research selama 10 tahun terakhir, yaitu 2013-2021, didapatkan hasil bahwa adanya pengaruh pengaturan pola konsumsi makanan yang sehat dengan menambah asupan-asupan zat gizi, seperti asam lemak omega-3, asam folat, asam amino (protein), vitamin B12, vitamin A, C, D dan E, Selenium, Zinc, dan Probiotik terhadap kesehatan mental seseorang. Kesimpulan: Kofaktor zat gizi dalam mikronutrien dapat memainkan peran penting dalam mengarahkan proses metilasi DNA dan regulasi epigenetik telah banyak terlibat dalam perkembangan otak dan kesehatan mental. Dengan demikian, pengoptimalan asupan zat gizi, seperti asam lemak omega-3, asam folat, asam amino (protein), vitamin B12, vitamin A, C, D dan E, Selenium, Zinc, dan Probiotik, dapat menjadi salah satu alternatif yang dapat dilakukan oleh masyarakat sebagai upaya preventif dalam mengatasi masalah kesehatan mental.
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Food Consumption Frequency, Perceived Stress, and Depressive Symptoms Among Female University Students in Dubai, United Arab Emirates
Article
Full-text available
  • Mar 2022
Background This study assessed whether perceived stress and depressive symptoms were associated with the frequency of consumption of specific food groups among female university students. Methods A cross-sectional study was conducted among female university students using a simple random sampling method. The response rate was 97%, with a total number of 385 participants. The associations between stress levels and most/least-consumed food groups, and between depressive symptoms levels and most/least-consumed food groups were assessed. The questionnaire included a 12-item self-administered food frequency questionnaire, Cohen's Perceived Stress Scale, and the Beck Depression Inventory-II. The study was approved by the University Ethical Committee prior to the data collection. One-way Analysis of Variance (ANOVA) and an independent-sample t -test were performed to test the equality of population means across the categories of each independent variable depending on the number of categories of the independent variable. Results Overall, this group of female university students fell under the mild mood disturbance category (depressive symptoms) (BDI-II) and had moderate perceived stress (PSS). Perceived stress was associated with more frequent consumption of salad/raw vegetables and cooked vegetables and less frequent consumption of cake/cookies and meat/sausage products ( p < 0.05). Additionally, depressive symptoms were associated with less frequent consumption of fresh fruits and increased consumption of fast food/canned food and soft drinks ( p < 0.05). Conclusions The data showed that stress and depression were associated with different dietary preferences, which is consistent with the distinctions between stress and depression in human behavior. Specifically, the results revealed associations between soft drinks consumption and higher depressive symptoms and between frequent consumption of salad/raw vegetables and cooked vegetables and higher perceived stress among this group of female university students.
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The Association Between the Mediterranean Lifestyle and Depression
Article
Full-text available
  • Aug 2016
This research assessed the association between the adherence to a Mediterranean lifestyle beyond the Mediterranean diet and the risk of depression in a prospective cohort of Spanish university graduates. Through a dynamic cohort study method, diet was assessed with a validated semiquantitative food-frequency questionnaire. The baseline assessment included a validated questionnaire on physical activity and average time spent with friends (socializing). Mediterranean lifestyle was defined as the joint exposure to Mediterranean diet, level of physical activity, and level of socializing. After a median follow-up of 8.5 years, 806 cases of depression among 11,800 participants were observed. Participants with the highest adherence to the Mediterranean lifestyle showed a 50% relative risk reduction in depression risk as compared to those participants with the lowest adherence (multivariable hazard ratio = 0.50; 95% confidence interval = [0.32, 0.81]). The Mediterranean lifestyle might reduce depression risk in the Seguimiento Universidad de Navarra cohort study beyond the known effects of the Mediterranean diet.
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The Emerging Field of Nutritional Mental Health: Inflammation, the Microbiome, Oxidative Stress, and Mitochondrial Function
Article
Full-text available
  • Jan 2015
We live in a transformational moment for understanding the etiology of mental disorders. The previous leap in understanding occurred 60 years ago, which led us to incorporate psychopharmacology into our curricula to address the chemical basis of neurotransmitter function, especially as explained through the then-popular catecholamine hypothesis. The current revolution is broader, consisting of the rapidly accumulating knowledge of how inflammation, microbiome imbalance (gut dysbiosis), oxidative stress, and impaired mitochondrial output affect brain function. Suitable interventions for fighting inflammation, restoring normal gut function, reducing oxidative stress, and improving mitochondrial metabolism incorporate lifestyle variables, including nutrients and probiotics. This article invites readers to stay abreast of this emerging model of the biological basis of mental illness, given that it has particular relevance for those readers interested in alleviating the suffering of individuals with mental disorders. This overview describes the basis for a new field in mental health: nutritional psychiatry/psychology.
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The Emerging Field of Nutritional Mental Health: Inflammation, the Microbiome, Oxidative Stress, and Mitochondrial Function
Article
Full-text available
  • Feb 2015
We live in a transformational moment for understanding the etiology of mental disorders. The previous leap in understanding occurred 60 years ago, which led us to incorporate psychopharmacology into our curricula to address the chemical basis of neurotransmitter function, especially as explained through the then-popular catecholamine hypothesis. The current revolution is broader, consisting of the rapidly accumulating knowledge of how inflammation, microbiome imbalance (gut dysbiosis), oxidative stress, and impaired mitochondrial output affect brain function. Suitable interventions for fighting inflammation, restoring normal gut function, reducing oxidative stress, and improving mitochondrial metabolism incorporate lifestyle variables, including nutrients and probiotics. This article invites readers to stay abreast of this emerging model of the biological basis of mental illness, given that it has particular relevance for those readers interested in alleviating the suffering of individuals with mental disorders. This overview describes the basis for a new field in mental health: nutritional psychiatry/psychology.
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Nutritional medicine as mainstream in psychiatry
Article
Full-text available
  • Jan 2015
Psychiatry is at an important juncture, with the current pharmacologically focused model having achieved modest benefi ts in addressing the burden of poor mental health worldwide. Although the determinants of mental health are complex, the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology. Evidence is steadily growing for the relation between dietary quality (and potential nutritional defi ciencies) and mental health, and for the select use of nutrient-based supplements to address defi ciencies, or as monotherapies or augmentation therapies. We present a viewpoint from an international collaboration of academics (members of the International Society for Nutritional Psychiatry Research), in which we provide a context and overview of the current evidence in this emerging fi eld of research, and discuss the future direction. We advocate recognition of diet and nutrition as central determinants of both physical and mental health.
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Dietary Inflammatory Index and Recurrence of Depressive Symptoms: Results From the Whitehall II Study
Article
  • Aug 2016
There is a growing interest in understanding the role of inflammation in the diet–depression relationship. The present study examined whether the Dietary Inflammatory Index (DII; a measure of the inflammatory potential of individuals’ diets) is associated with recurrent depressive symptoms (DepS) (Center for Epidemiologic Studies Depression Scale score > 16 or taking antidepressants both at baseline and follow-up) assessed over 5 years in middle-aged men (n = 3,178) and women (n = 1,068) from the Whitehall II Study. For each increment of 1 SD of DII score, odds of recurrent DepS increased by 66% (95% confidence interval [CI] = [1.30, 2.12]) in women, whereas no significant association between DII and recurrent DepS was observed in men (odds ratio [OR] = 1.12; 95% CI = [0.92, 1.36]). This association was little attenuated after adjustment for confounders and after taking into account levels of interleukin-6 and C-reactive protein. In conclusion, there is an association between proinflammatory diet and recurrent DepS in women that seems to not be driven by circulating inflammatory markers.
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Delay Aversion, Temporal Processing, and N-3 Fatty Acids Intake in Children With Attention-Deficit/Hyperactivity Disorder (ADHD)
Article
  • Jun 2016
This study investigates the association between polyunsaturated fatty acid (PUFA) intake and neurocognitive functions in children with attention-deficit/hyperactivity disorder (ADHD). We recruited 21 drug-naïve children diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders and 21 non-ADHD controls. The n-3 intake and essential fatty acid (EFA) deficiency severity were recorded while the children were assessed for inhibitory control, delay aversion, and temporal processing with the Go/No Go Task, Delayed Reaction Time Task, and Finger Tapping Task, respectively. The ADHD group had more EFA deficiency symptoms (p =.02) and poorer performance in delay aversion (p =.02) and temporal processing (p <.001). Moreover, ADHD symptoms correlated negatively with n-3 intake and positively with EFA deficiency. In addition, EFA deficiency was associated with higher delay aversion (p <.001). Children with ADHD had a higher deficiency of EFA, and EFA deficiency had a positive association with ADHD severity and delay aversion.
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Effect of Micronutrients on Insomnia in Adults: A Multiple-Baseline Study
Article
  • May 2016
Insomnia is a debilitating condition causing psychological distress and frequently comorbid with other mental health conditions. This study examined the effect of 8 weeks of treatment by broad spectrum micronutrients (vitamins and minerals) on insomnia using a multiple-baseline-across-participants open-label trial design. Seventeen adults were randomized to 1-, 2-, or 3-week baseline periods (14 completed). Self-report measures were the Consensus Sleep Diary–Morning (CSD-M), the Pittsburgh Insomnia Rating Scale (PIRS), and the Depression, Anxiety, Stress Scale (DASS). Baselines were generally stable. Treatment completers reported reliable and clinically significant change in insomnia severity (PIRS), in depression, stress, and anxiety (DASS), and on at least two aspects of sleep measured by the CDS-M. All completers were treatment-compliant, and side effects were minimal. Nutritional supplementation is shown to be a novel, beneficial treatment for insomnia in adults. Follow-up research using placebo-controlled designs as well as comparisons to cognitive-behavioral and other treatments is recommended.
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Participant Characteristics as Modifiers of Response to N-Acetyl Cysteine (NAC) in Obsessive-Compulsive Disorder
Article
  • Apr 2016
We previously reported on a 16-week, double-blind, randomized placebo-controlled trial (RCT) using 3 grams per day of N-acetyl cysteine (NAC) (1.5 grams twice per day) in 44 participants (aged 18–70) with DSM-5-diagnosed obsessive-compulsive disorder (OCD). We now report on an analysis of age, severity and duration of illness, OCD presentation type, baseline anxiety and depression scores, as well as the use of antidepressant medications as potentially modifying factors. Results revealed a significant effect (p = .037) for younger participants (under mean age of 34) responding to NAC. This remained significant using OCD severity as a covariate (p = .044). For those under 34 years of age with less than 17 years of OCD duration, this was also significant (p = .037). Regression analysis within the NAC treatment group also revealed that duration of OCD presentation was a significant predictor of Yale-Brown Obsessive Compulsive Scale (YBOCS) change at study endpoint (p = .019), whereas baseline Montgomery–Asberg Depression Rating Scale scores were also a trend-level predictor (p = .060) of YBOCS change in the NAC group.
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N-Acetyl Cysteine (NAC) in the Treatment of Obsessive-Compulsive Disorder: A 16-Week, Double-Blind, Randomised, Placebo-Controlled Study
Article
  • Sep 2015
Background: Obsessive-compulsive disorder (OCD) is a disabling mental illness for which pharmacological and psychosocial interventions are all too often inadequate. Recent preclinical and clinical studies have implicated dysfunction of glutamatergic neurotransmission in the pathophysiology of OCD. The amino acid-based nutraceutical N-acetyl cysteine (NAC) is a safe and readily available agent that has been found to modify the synaptic release of glutamate in subcortical brain regions via modulation of the cysteine-glutamate antiporter. Objective: The aim of this study was to assess the efficacy and safety of NAC in treating OCD. Methods: A 16-week, double-blind, placebo-controlled, randomised trial using 3 g/day of NAC (1.5 g twice daily) in 44 participants (aged 18-70 years) with Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)-diagnosed OCD, during 2013-2015. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS), conducted every 4 weeks. Results: Analysis of the full sample (intention-to-treat) with repeated measures mixed linear modelling revealed a nonsignificant time × treatment interaction for the YBOCS scale total score (p = 0.39). A per-protocol analysis removing protocol violators also failed to show a significant time × treatment interaction for YBOCS total score (p = 0.15). However, a significant time × treatment interaction was observed for the YBOCS 'Compulsions' subscale in favour of NAC (p = 0.013), with a significant reduction observed at week 12 (dissipating at week 16). At 16 weeks, only four (20 %) participants were considered 'responders' (YBOCS ≥35 % reduction at endpoint) versus four (27 %) in the placebo group. The NAC was well-tolerated, aside from more cases of heartburn occurring compared with placebo (p = 0.045). Conclusion: Further research involving NAC for OCD may require larger samples to detect moderate or small effect sizes, involve dosage or formulation differences, use in concert with exposure therapy, or an additional post-study observational period to mitigate study withdrawal. Trial registration: ACTRN12613000310763.
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