The current approach to depression involves drug therapy and/or psychotherapy. These are like ‘hardware’ and ‘software’ paradigms. The brain, nervous system and neurotransmitters are all made from nutrients. A lack of essential nutrients affects mood, behaviour and mental performance. Correcting underlying nutritional deficiencies can alleviate depression, reduce side-effects of medication and improve response to psychotherapy, argues Patrick Holford.
This article is reprinted from Patrick Holford's website
The current approach to depression involves drug therapy and / or psychotherapy. These are like 'hardware' and 'software' paradigms. The brain, nervous system and neurotransmitters are all made from nutrients. A lack of essential nutrients affects mood, behaviour and mental performance. Correcting underlying nutritional deficiencies can alleviate depression, reduce side-effects of medication and improve response to psychotherapy, argues Patrick Holford.
At the age of 20 I thought I had it all sussed. I'd read Jung, Freud, studied Gestalt, transactional analysis, transpersonal psychology and was shopping in the spiritual supermarket, from gurus to zen. I was in my final year as an undergraduate in experimental psychology, but didn't give much heed to the biochemical models of mental illness. I was destined for the world of psychotherapy and a career helping people (and myself) unravel the self-imposed limitations of the mind and attain higher levels of consciousness.
Then I changed my diet and, with that, my world changed. I had met two maverick nutritionists who sold me on the idea that 'you are what you eat' and that changing what goes in has a fundamental effect on how you think, feel and function. I didn't really believe it, but the logic was good. So, in 1977 I quit the student diet, became an avid fruit and vegetable eater and swallowed a handful of supplements each day, shipped from the US. Within 30 days I lost 14lbs, my skin, which had looked like a lunar landscape, cleared up, my migraines went, but what really convinced me was a rapid improvement in energy, mental clarity and concentration. All this from a change in nutrition? I wanted to know more.
I headed to the library and soon found studies, including double-blinds, on the effects of large amounts of vitamins and minerals on mental illness. Two names stood out - Dr Carl Pfeiffer, director of the Brain Bio Center in Princeton, and Dr Abram Hoffer, director of psychiatric research in Saskatchewan, Canada. I read everything I could and was astounded by the claims - 80 per cent cure of acute schizophrenia, said Hoffer (whose diagnosis of cure was free of symptoms, able to socialise and paying income tax), dramatic results with depression, said Pfeiffer. Within months I was on a plane to America and arrived in Princeton to find a 10,000 sq ft outpatient facility with over 50 staff and 5,000 patients per year. The essence of their approach was to objectively evaluate if a person had any abnormal biochemistry that would predispose them to, say, depression and then change the body's biochemistry by giving a personalised nutrition programme. "If there's a drug that can alter the brain's biochemistry, there's usually a combination of nutrients that can achieve the same thing without side-effects" said Pfeiffer, who had spent most of his life researching biochemical aspects of mental health, funded by the US government. Now, after thirty years of positive research and good clinical results I believe the time has come for another option, nutrition counselling, to be made available to those with mental health problems.
Depression - not all in the mind
Depression isn't a disease with a one cause, nor one treatment. For some the problem may be purely psychological, for others purely biochemical. Common biochemical balances that can induce depression include:
Blood sugar imbalances (often associated with excessive sugar and stimulants)
Allergies and sensitivities
The presence of one or more of these factors may worsen a person's ability to cope with stress and thus be an underlying contributor to what might otherwise be considered depression of a psychological origin. Conversely, many depressed people fail to adequately nourish themselves. It's a chicken or egg situation. What is known is that nutritional deficiency is more common in those with mental illness, especially in the elderly population. For example, research at Kings College Hospital found that 33 per cent of those with psychiatric disorders were deficient in folate(1), while a survey of 93 elderly patients found 73 were deficient in iron or B vitamins, especially folic acid (2). There is suggestion that those with mental health problems may need more, or absorb less nutrients. It has been demonstrated, for example, that schizophrenia patients require more vitamin C to attain
normal blood levels than controls(3) and more niacin to induce the normal vasodilation response than controls (4).
The Great British vitamin scandal
The most promising nutrients to date are vitamins B3, B12 and folic acid, then vitamin B6, zinc and magnesium and essential fatty acids (EFAs). The first three are involved in the vital biochemical process known as methylation, which is critical for balancing the neurotransmitters dopamine and adrenalin.
Research on folic acid have shown improvement in both depression and schizophrenia. Giving those with borderline or low folate status 15mg a day alongside standard psychotropic treatment significantly improved clinical and social recovery in patients with depression and schizophrenia in a double-blind controlled trial at Kings College Hospital and the Department of Psychiatry(1).
Vitamin B6 and zinc work together. In fact vitamin B6 (pyridoxine) does nothing in the body until it is converted into pyridoxal phosphate, this conversion depending on adequate zinc levels. About one third of the psychiatric population show the excessive excretion of 'kryptopyrroles' in the urine, the formation of which robs the body of B6 and zinc. Giving more of these nutrients corrects this biochemical abnormality and the associated symptoms of depression, anxiety, poor socialisation and ability to cope with stress (5). Giving vitamin C or EFAs also enhances recovery.
But don't we get enough of these nutrients from a well balanced diet? Comparison of the average daily intakes of these nutrients, as calculated by MAFF's National Food Survey, with the current EC Recommended Daily Allowances (known in nutritional circles as the Ridiculous Dietary Arbitraries) reveals a scale of nutritional deficit few health professionals have taken on board.
Nutrient
Average Intake
(EC)RDA
SONA
Niacin (B3)
25mg
18mg
30mg
Pyridoxine (B6)
1.9mg
2mg
20mg
Folic acid
239mcg
200mcg
800mcg
Cyanocobalamine (B12)
4.9mcg
1mcg
3mcg
Ascorbic acid (C)
55mg
60mg
400mg
Magnesium
233mg
300mg
400mg
Zinc
7.6mg
15mg
15mg
The probability that the diet of any one individual meet all these RDAs (being only 7 out of 50 known essential nutrients) is less than 1 in 10. The picture is much worse among the underprivileged. A survey by the Food Commission found that 25 per cent of women claiming income support failed to achieve the Lowest Reference Nutrient Intake (defined as the level at which 95% of people experience overt deficiency symptoms) for 8 out of 13 nutrients analysed. It is, quite simply a myth that today's diet eets all our nutrient needs. As the science of nutrition advances to identify that optimal intakes of nutrients are often ten times higher than RDA levels it becomes clear that most of us are sub-optimally nourished
and functioning, both physically, mentally and emotionally below par as a result. Optimal nutrient amounts, known as Suggested Optimal Nutrient Amounts (SONAs) and not infrequently ten times higher than RDA levels and represent the daily intakes of nutrients that are positively associated with the best health and least risk of disease (6).
Neuroanaylsis or Psychoanalysis?
The major anti-depressants are thought to work by affecting the balance and function of certain neurotransmitters. These include serotonin re-uptake inhibitors such as Prozac, Lustral, Seroxat which are designed to keep serotonin in circulation; adrenalin reuptake inhibitors such as Edronax, designed to keep adrenalin in circulation; monoamine oxidase inhibitors, which again help maintain adrenalin and dopamine levels and the tricyclic anti-depressants such as amitriptyline which also prevent adrenalin breakdown. Notice that most of these drugs block biochemical pathways. That is, they interfere with the body's normal chemistry. The consequence is frequent side-effects and a need to get the dose just right to balance positive effects and the side effects. For example, Prozac, considered to be among the safest anti-depressants, has 45 known side-effects. The most common are nausea, nervousness, insomnia, headache, tremors, anxiety, drowsiness, dry mouth, excessive sweating and diarrhoea. According to a survey by US psychiatrist David Richman 10 to 25 per cent of people on Prozac experience all of these.
An alternative approach to give the nutrients our bodies have evolved to use to make more of these neurotransmitters. Figure 1 shows the symptoms associated with excess and deficiency of neurotransmitters and the co-factor nutrients involved (7).
Serotonin, for example, is made from the protein constituent tryptophan, in the presence of sufficient vitamin B3, B6 and zinc.
Tryptophan was shown to be an effective anti-depressant for some patients and tryptophan depletion can induce depression in recovered depressed patients. This has been well demonstrated by research at Oxford University's Department of Psychiatry, in which 15 women with a history of depression were given a diet excluding or including tryptophan under double-blind conditions (8). Ten out of fifteen experienced clinically significant symptoms of depression on the tryptophan-free diet, while none experienced mood changes on the diet including tryptophan. Tryptophan itself is no longer available as a supplement, but one of its metabolites, 5-hydroxytryptophan (5-HTP) is. Tryptophan-rich foods include fish, turkey, chicken, cottage cheese, avocados, bananas and wheatgerm.
Another neurotransmitter deficiency associated with depression is adrenalin. An up and coming class of anti-depressant drugs are adrenalin reuptake inhibitors, such as Edronax. Adrenalin (and dopamine) is made from the amino acid tyrosine and controlled by niacin, folic acid and B12. Associate Clinical Professor of Psychiatry, Dr Priscilla Slagle, from the University of Southern California cured her own depression with such a combination of nutrients, taking tyrosine in the morning (which is more stimulating) and tryptophan in the evening (which is more calming) plus other nutrients. She found this combination to be helpful for many of her patients and wrote it up in a book, The Way Up from Down, published by Random House.
How To Eat Yourself Out Of Depression
Reduce stimulants - tea, coffee, sugar, chocolate
Increase nutrient-rich foods - fruit, vegetables, wholefoods, seeds,nuts and wheatgerm
Have a serving of fish, chicken, turkey or tofu (from soy beans) a day
Supplement a high-strength B Complex formula
Supplement the amino acid l-tyrosine 2,000mg in the morning, available from health food shop
Supplement 5-HTP, 100mg twice a day
For more information on this subject and for references, read Mental Health & Illness.
There's a good rationale for giving a combination of nutrients to help support proper neurotransmitter function as a first line treatment for depression. Of course, not all will respond because not all depression is as a consequence of neurotransmitter dysfunction. No doubt, in the not too distant future, assessment of neurotransmitter status will be measurable before applying either nutrients or drugs.
Individual Nutritional Assessment
Over the past 13 years we have developed a method for assessing if a person suffering from depression has one of a number of nutritional imbalances that may be contributing to such biochemical dysfunction. This we assess by a questionnaire, backed up by biochemical tests. Approximately two thirds of those who consult us do prove to have such balances and improve on specific nutritional strategies involving diet and supplements. For some, this results are dramatic, for others this approach lessens their depression. More often than not we also recommend the client to seek the help of a psychotherapist. There are now 160 nutrition consultants all over Britain trained in this approach.
How do you know when depression has a nutrition connection?
One of the dilemmas facing psychotherapists is knowing when a nutritional imbalance is likely to be a contributor to a particular mental health problem. This subject in not on the curriculum of either schools of psychotherapy or psychiatry. To this end we have devised an intensive one-day training which aims to develop awareness of the practitioners to the symptoms that can indicate that the patients problems aren't all 'in the mind'. This we do by means of the Mental Health Questionnaire, a set of 75 questions, the numbers and pattern of answers indicating the probability of one of eight nutrition-related imbalances.
For psychotherapists the goal is to known when to refer. For psychiatrists we go a step further and train how to augment conventional treatment with tailor-made nutritional support programmes. These trainings are run both at the Institute for Optimum Nutrition and within departments and schools of invitation. We also offer an introductory one hour lecture on this subject to departments and self-help groups to generate awareness of the nutrition connection.
Recommended Reading
Mental Illness - Not All in the Mind, ION Press, £1.95
Mental Health & Illness - The Nutrition Connection, Dr Carl Pfeiffer & Patrick Holford, ION Press, £7.95
Further Details
For further details and dates on trainings send an A5 SAE to the Mental Health Project, ION, Blades Court, Deodar Road, London SW15 2NU.If you are interested in sponsoring a lecture or one day training please call Jan Shepheard on 0181-971-2949.
References
1. Godfrey, P. S. et al (1990). Enhancement of recovery from psychiatric illness by methylfolate. Lancet, 336,392-395.
2. Morgan. A. (1975). Int J Vit Nutr Res, 45,448-462, 43,461-471 (1973).
3. Suboticanec. K. (1990). Vitamin C status in chronic schizophrenia. Biol Psychiatry, 28,959-966.
4. Rybakowski. J.,Weterle. R. (1991). Niacin test in schizophrenia and affective illness. Biol Psychiatry, 29,834-836.
5. Pfeiffer. C. P., LaMola. S. (1980-81). Zinc and manganese in the schizophrenias. J Orthomolecular Psychiatry, 12(3), 215-233.
6. Cheraskin. E. et al (1994). Establishing a sugessted optimum nutrition allowance (SONA). 'What is optimum?' Optimum Nutrition Magazine, 7(2), 46-47.
7. Jaffe. R. et al (1992). The biochemical-immunolgy window: a molecular view of psychiatric case management. Int Clin Nut Rev, 12(1), 9-26.
8. Smith. K. A. et al (1997). relapse of depression after rapid depletion of tryptophan. Lancet, 349, 915-919.
Quote
"The definition of insanity is to keep doing the same thing and expect different results."
- attributed to Albert Einstein
