When people are suffering from a mental illness, eating healthily often falls by the wayside. But what if nutritional deficiencies are a contributing cause in the first place? Nursing Review talks to psychology professor Julia Rucklidge about the links between nutrition and mental illness.
Claims about wonder foods that can soothe nerves, enhance mood and reduce stress have been around since time immemorial.
Julia Rucklidge is no believer in there being one magic ingredient or wonder food. “I just don’t think it’s out there,” says the professor of clinical psychology at the University of Canterbury.
But the researcher is increasingly convinced that there are strong links between nutrition and mental illness. For the past decade she has been running randomised controlled trials (RCT) to investigate the impacts of a cocktail of micronutrients on mental health issues, from ADHD (attention deficit hyperactivity disorder) to the anxiety, stress and trauma associated with the Canterbury earthquakes.
Her findings, which have been published in the British Journal of Psychiatry, saw her receive the New Zealand Psychological Society’s Ballin Award in 2015 for contributions to psychology and a 2014 TEDx talk on her work has been viewed more than 350,000 times – and that number is still growing.
Rucklidge was initially very sceptical that nutrients could be effective in helping to treat mental illness. “I thought if it was that simple we would have figured this out already.”
But prompted by initial positive findings by her PhD supervisor back in her native Canada – and frustration at poor outcomes from conventional treatments for ADHD – she began her own research in the field upon arriving in New Zealand (see box).
“I’ve now been running clinical trials over the last 10 years and all our data are very robust in finding that, over and over again, giving broad-spectrum micronutrients – 36 vitamins and minerals in combination with no one magic ingredient – can help many people (experiencing mental illness). Certainly not everyone is cured by nutrients, but we can help a lot.”
No single answer
Rucklidge is quick to point out that she does not see nutrition as a standalone treatment for mental illness. Neither does she believe that bad diets, or nutritional deficiencies, are the root causes of mental illness, but are instead just one more contributing factor.
Her research trials focus on the impact of that one variable – taking micronutrients – but in the ‘real world’ she advocates a multi-layered, evidence-based approach to preventing and treating mental illness, including lifestyle factors such as exercise and eating healthily (adding supplements when required), and using stress reduction techniques such as mindfulness and psychological therapies such as cognitive behaviour therapy (CBT).
She is also not advocating that people who are currently on medications should stop taking them and swap to micronutrients (any change of medication should always be discussed with the patient’s prescriber and, if undertaken, done slowly and under close professional monitoring).
But she would like to see a shift to people being prescribed, or seeking out, medications such as antidepressants only when other approaches have been deemed unsuccessful, and says, “I think we need to stop seeing them [medications] as frontline treatment.”
She, for one, believes that many medications are over-subscribed, with one in eight New Zealand adults currently taking antidepressants and about a quarter of a million Kiwis being on prescription sleeping pills.
“We know that the data is very clear that medications (like antidepressants) are very effective in the short-term,” she says.
But people are often on medications long-term and it is the long-term efficacy data published within the past decade that Ruckledge believes people should be concerned about, as this indicates, for example, that in the long-term antidepressants are having little impact on depression recovery and relapse rates.
So if taking a cocktail of micronutrients is having an effect on some people’s mental illnesses, it begs the question: why does it work?
“That is the million-dollar question,” says Rucklidge. “We are trying to figure that one out – we have lots of ideas and hypotheses about why [micronutrients] might work.”
One hypothesis is that people aren’t eating diets as rich in nutrition as they once did. Epidemiology studies have indicated that the more that people eat a modern western diet – high in processed foods, refined grains and sugary drinks and low in vegetables and fruits – the more likely it is that mental health issues will emerge.
Rucklidge points out there are a host of other factors contributing to the rise in mental health issues – including poverty, genetic predisposition, the stress of modern life and domestic violence – but eating a sensible, whole-food diet that is high in fruit and vegetables may contribute to curbing the trend.
She adds that even people who do eat well may not be getting the nourishment they did a century ago because of factors such as mineral depletion in the soil resulting in less nutrient-dense plants, and an emphasis on appearance and shelf-life over the nutrient values of food.
So some people, she argues, because of their genetic programming, may be more vulnerable to developing mental illnesses because they are getting insufficient nutrients for their metabolisms – even if they are eating what are considered ‘good’ diets. Supplementing those people’s diets with micronutrients may potentially correct that nutrient imbalance.
Rucklidge points to the work of Bruce Ames, a biochemist and emeritus professor at the University of California, Berkeley, whose research has included looking at the role that the 30 essential vitamins and minerals play in the formation of proteins and enzymes.
Ames’s findings include that high doses of some vitamins could successfully treat more than 50 genetic diseases, particularly inherited metabolic diseases caused by defective enzymes, and he believes that eliminating vitamin and mineral deficiencies in the general population may restore what he calls “metabolic harmony”.
Rucklidge says this makes her team wonder whether Ames’s work also applies to mental illness, because vitamins and minerals are required for the enzymes needed to make neurotransmitters such as serotonin, dopamine and adrenalin.
“So are we [with the broad-spectrum supplement] providing the nutrients necessary for these neurotransmitters? Very potentially, yes.”
Likewise, they hypothesise, they could be helping to feed the mitochondria that are the energy factories of human cells and possibly helping to overcome some people’s issues with the gut absorption of nutrients.
The micronutrient formulas that Rucklidge uses for the trials (she points out that neither she nor the university sells or makes money from the brands they use) take a ‘shotgun’ approach by delivering 14 vitamins, 16 minerals, three amino acids and three antioxidants in much higher doses than you would find on your supermarket shelves. The research team doesn’t know which of the array of shotgun pellets, i.e. ingredients, are making a difference – or what dosage – and she says it may be that different ingredients are important for different people.
In the future, researchers may be able to personalise micronutrient formulas to meet an individual’s needs based on their genetic profile and nutrient levels. “But we are not there yet so we take the shotgun approach that our bodies have evolved to know what to do with nutrients – so those you don’t need you will pee out.”
She says that to date they have observed no side effects from their research participants and are currently monitoring and collecting data on long-term users. Taking high-dose micronutrients poses potential risks for some people – for example, those people with genetic disorders causing copper metabolising difficulties or haemochromatosis (iron overload).
Eating ourselves better
Can we just eat our way to better mental health?
Rucklidge says she can't recommend the perfect diet for better mental health – the clinical psychologist says it isn't her area of expertise. Research into different dietary regimes also indicates that a person's genotype may influence why some lose weight under diet 'x' and others don't – similar effects are likely to apply to any mental health benefits.
"But what I can say very confidently is the more you eat crap food, the worse you are going to feel. And there isn't a single study out there that shows the modern western diet has been of great assistance to us."
So the simple message she would share is for people to reduce the amount of processed food they eat.
"That is a general comment I can feel confident about, as I haven't seen any studies that show eating highly processed, packaged foods is having a wonderful outcome for people."
She also endorses food activist Michael Pollen's simple guide Eat food. Not too much. Mostly plants.
But Rucklidge’s research, and that of others interested in the field, indicates that what people are eating right now might not adequately meet the nutritional needs of those with mental health issues. Some people may be able to meet those nutritional deficiencies by dietary change, but Rucklidge believes, after observing hundreds of people in her studies, that other people may need to take additional nutrients, probably because of their particular genotype.
"I've seen some people on some unbelievably excellent diets – diets that I could not fault – who have made all the lifestyle changes, yet they are still depressed or anxious. But they have had favourable responses to taking broad-spectrum micronutrients.”
Food for thought indeed.
Rucklidge’s largest published study to date, in the British Journal of Psychiatry in 2014, was a blinded, randomised, controlled trial looking at the impact of a nutrient supplements on 80 adults with ADHD who were not currently taking any psychiatric medications.
For eight weeks 42 of the participants took a broad-spectrum micronutrient formula (15 capsules a day of 14 vitamins, 16 minerals, three amino acids and three antioxidants) and the other 38 took 15 placebo capsules (containing a small amount of riboflavin to mimic the smell and urine colour associated with taking vitamins).
The study found significant differences in self and observer ADHD rating scales between those who were taking the active supplements and those who were not. Clinicians did not observe differences between the groups on ADHD rating scales but did rate those taking the micronutrients as being more improved in their global psychological functioning and their ADHD symptoms. Further analysis also found a greater improvement in mood for the participants with moderate to severe depression who were taking the active capsules.
Quake stress study
Another study compared the impacts of two micronutrient formulas on Christchurch adults who were experiencing heightened anxiety or stress two to three months after the February 2011 earthquake.
The 91 adults were randomly assigned to take either an over-the-counter micronutrient formula, a lower dose of a specialist micronutrient formula, or a higher dose of the specialist micronutrient formula. All three treatment groups were monitored during the one-month trial and for one month afterwards.
All participants experienced significant declines in psychological symptoms but those taking specialist micronutrients experienced a greater reduction in intrusive thoughts, with the high-dose specialist micronutrient group reporting greater improvements in mood, anxiety and energy.
A year after completing the study, 64 of the original participants (plus 21 of the 29 non-randomised controls) were re-assessed. The study found that all groups had experienced significant psychological improvements, but treated participants had better long-term outcomes and those who had stayed on micronutrients (or stopped all treatment) reported better functioning than those who had switched to other treatments, including medication.
International Society for Nutritional Psychiatry Research
Lists research published in the area of nutritional approaches to the prevention and treatment of mental disorders www.isnpr.org
Information and contact details for Julia Rucklidge’s research projects
What if nutrition could treat mental illness? by Julia Rucklidge (2014)