Science shows we can
by Alan Cassels
Let food be thy medicine and medicine be thy food. – Hippocrates
There are very few golden bullets in medicine, very few. But some pharmaceuticals are extremely useful, especially if you’ve got type 1 diabetes, heart disease, severe pain or asthma. Then your drugs may be saving your life.
But, as I’ve said before, the problem with an overly drug-centric approach to healthcare is that it relentlessly eclipses other options. Much of our medical care is underpinned by research dominated by drug makers with the resources to conduct large, randomized, controlled trials. We need those studies, but we find the treatments that do not fit the profit paradigm are starved for respect and research funds, meaning the bias deepens and we end up with the kind of health care that society has decided to pay for.
Particularly problematic in our pharma-centric world are psychiatric treatments, often studied in questionable trials for short periods of time on people with indeterminate diagnoses. They are then used incredibly liberally even when evidence emerges, as it has with antidepressants and antipsychotics, that many people are being hurt by them.
Increasingly, even though society is swallowing growing amounts of drugs for such conditions as anxiety, depression, ADHD, mood and anxiety disorders, the prevalence of those disorders continues to climb. Where is the kid asking why the Emperor is naked? If we’re spending so much more every year on drugs for psychiatric illness, why aren’t the rates of mental illness dropping? Something is wrong here.
I think about this in the context of some friends of mine. They are having a terrible time with their daughter, who is so anxious she can’t go to school. I’m not sure what’s going on, but it appears she’s in a real rough space. She’s been taken to the hospital on numerous occasions and there have been several attempts to get her to see a child psychiatrist. She hasn’t been prescribed any drugs yet, but I’m pretty sure that when she finally gets in to see the psychiatrist, she’ll begin her entrée into the world of psychiatric drugs.
This is the standard road travelled by many people who are depressed, anxious, sleepless or hyperactive, yet there may be other options worth exploring. Certainly, cognitive behavioural therapy (‘talk’ therapy) and exercise come to mind. We’re also witnessing the growing area in the use of micronutrients – the essential minerals and vitamins we consume in our food and its importance to our mental health.
Bonnie Kaplan, an emeritus professor at the University of Calgary, has spent much of her professional life studying micronutrients, particularly in the context of mental health. The body and brain require a fairly large array of vitamins, minerals and essential fatty acids and when we have deficits it’s possible our brains suffer even more than our bodies. In our phone conversation, Bonnie tells me, “This is all about nutrition above the neck. The brain is the biggest consumer of nutrients.”
Because people have genetic differences, respond to stress differently and, hence, have different micronutrient needs, it is plausible that many of us could have nutrient deficiencies that affect our mood. We have to remember that nutrients are involved in every biologic, chemical and physiologic process.
“There are 50 known genetic mutations in the realm of physical health, where an alteration in the ability of enzymes to grab and hold the nutrients that they need for optimal metabolism is impaired. They need extra nutrients to make the pathways work,” Bonnie says.
She brims with enthusiasm noting there are somewhere in the neighbourhood of 45 clinical trials testing micronutrients in a variety of mental health conditions, including insomnia, ADHD, psychotic disorders, mood and anxiety. And she’s seen the greatest benefits using them to treat irritability, mood dysregulation, bipolar-type symptoms and explosive rage.
As an example of the kind of research out there, she describes an “amazing study from Spain,” best known for studying links between nutrition and cardiovascular disease, but which has also evaluated links to mental health. The researchers took about 9,000 people with no mental disorders and looked closely at what they ate, quantifying their intake of prepared pastries, processed foods and other forms of junk food. They divided the participants into three groups, depending on their consumption of processed foods, and waited about six years to find out who would be diagnosed with a mood or anxiety disorder.
“Those in the study who consumed the least processed food had a very low probability of developing mood and anxiety disorders. The group in the middle were generally ok, too,” Bonnie told me. “But those with the highest intake of processed foods were at high risk of becoming depressed or anxious.”
Bonnie is well aware of the difficulty this research has in making any inroads in the pharma-dominated world of psychiatry. Whether it is Omega-3s, vitamin D or calcium, so much research energy is put into studying single nutrients at a time. Many times she has seen researchers unable to get funding to study broad-spectrum micronutrients because of the central research tendency – and perhaps human nature – to want to find a single magic bullet. One reviewer asked, while looking down the list of 40 or so micronutrients in a nutritional formula proposed for a study, “Which is the important one?”
“They’re all important!” Bonnie exclaims. There is a strong rationale for studying a large batch of micronutrients together, which comes in a ‘broad spectrum formula,’ because the body requires all kinds of vitamins and minerals to work properly.
Another surprising finding came from a study in adults with psychotic disorders. Everyone was initially given a broad-spectrum micronutrient supplement. After a month, they were supposed to be randomized to receive either the supplement or a placebo in a blinded fashion. The wheels fell off the study when the patients refused to be randomized because they didn’t want to take a chance in giving up the formula. If the study participants themselves are that adamant about the effectiveness of the formula, there is probably something there!
There are a number of companies that produce broad-spectrum formulas containing vitamins, minerals and antioxidants and one might wonder how much bias seeps into this research, as we see in the pharmaceutical world, when the manufacturer pays for the research, gives out research grants and otherwise shapes the research in ways that support its product?
Having witnessed the intertwining of the pharmaceutical industry and the mental health world, and the resulting corruption of the mental health scientific literature, Kaplan and her colleagues have insisted on putting a firewall between the manufacturers and the research: they won’t accept research money from those making micronutrient formulas.
Researchers like Bonnie Kaplan are doing exactly the type of research the world needs more of. Most probably, there is a great link between nutrition and mental health. The way we currently treat mental illness needs a complete rethink and it must include better research and a better use of a range of treatments – even things we eat.
Kaplan sees the huge price governments and individuals are currently paying for the relatively ineffective pharmaceutical model of psychiatric care. They need to know that micronutrients, while no magic bullet, could be a very effective and safe way to help many people with mental health challenges. In two published studies, they have shown that micronutrient treatment was not only more effective, but it also cost less than10% of conventional care. It seems that governments could save a bundle if they helped contribute to the research and the treatments.
Kaplan has established two donor-advised charitable funds and has already raised over half a million dollars to support the clinical trials of junior colleagues around the world who are passionate about studying the use of nutrition for mental health. Contact her at firstname.lastname@example.org or donate directly to this kind of research through the Calgary Foundation.
Alan Cassels is a former drug policy researcher, a writer and the author of several books on the pharmaceutical industry.