Feeding MindsThe impact of food on mental health

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CONTENTS

i) Foreword 3ii) Acknowledgements 4iii) Summary 5iv) Methods 9v) KeyFindings 10vi) Recommendations 12

1. Introduction 15

1.1 Mentalhealthofthenation 151.2 Anholisticapproachtomentalhealth 151.3 Theroleofdietinmentalhealth 151.4 Exploringtheevidence 181.5 References 18

2. Trendsinfoodconsumptionandmentalhealth 19

2.1 Changingpatternsoffoodconsumption 192.2 Whatweareeatingnow 222.3 Trendsinthehealthofthenation 272.4 Conclusion 302.5 References 30

3. Theroleofdietinrelationtomoodandwellbeing 31

3.1 Ahealthybrain 313.2 Ahealthybrainforlife 323.3 Foodandmoodinthegeneralpopulation 353.4 Foodsthattrickthebrain 383.5 Foodsthatdamagethebrain 393.6 Foodsthatnourishthebrain 403.7 Conclusion 453.8 References 46

4. Theroleofdietinrelationtospecificmentalhealthproblems 48

4.1 ADHD 484.2 Depression 514.3 Schizophrenia 544.4 Alzheimer’s 574.5 Conclusion 604.6 References 60

5. Recommendations 63

6. Furtherreadingandsupport 66

7. AppendixA–NOPSurvey 67

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Thetimeisnowrightfornutritiontobecomeamainstream,everydaycomponentofmental health care

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FOREWORD

Thebrainistheplatformforthemindandthereforetheplatformforourmentalhealth.Whileourunderstandingofhowthebrainworksislessadvancedthanourunderstandingofthebody’sotherorgans,muchofthepracticalknowledgewedohaveofthebrainhasyettobeembracedandputtogooduse.Thisrepresentsaspectrumofwastedopportunitiestopromotementalhealthandpreventmentalill-healthinoursociety.

Oneoftheclearestexamplesistheroleofnutritioninrelationtomentalhealth.Weknowthatthebrainismadeupinlargepartofessentialfattyacids,waterandothernutrients.Weknowthatfoodaffectshowwefeel,thinkandbehave.Infact,weknowthatdietaryinterventionsmayholdthekeytoanumberofthementalhealthchallengesoursocietyisfacing.Yetwerarelyinvestindevelopingthisknowledge,andarelativelytiny-butgrowing-numberofprofessionalsareputtingittoeffectiveuse.

Butthereisagrowingbodyofevidence,andanumberofsignificantvoicesarechampioningtheroleofdietinthecareandtreatmentofpeoplewithmentalhealthproblems.ThepotentialofdietaryinterventionsintreatingdepressionandAttentionDeficitHyperactivityDisorder,forexample,arebeingincreasinglyrecognised.Wewouldbefoolishtounderestimatetheirimportance.

Anintegratedapproach,recognisingtheinterplayofbiological,psychological,socialandenvironmentalfactorsiskeytochallengingthegrowingburdenofmentalill-healthinwesternnations.Dietisacornerstoneofthisintegratedapproach.

Thetimeisnowrightfornutritiontobecomeamainstream,everydaycomponentofmentalhealthcare,andaregularfactorinmentalhealthpromotion.Butthiswon’thappenwithouttherecognitionandcommitmentofthemajorstakeholdersoutlinedinthisreport.

Thepotentialrewards,ineconomicterms,andintermsofalleviatinghumansuffering,areenormous.

Dr Andrew McCullochChiefExecutiveTheMentalHealthFoundation

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ACKNOWlEDgEMENTS

ThisreportwaswrittenbyDr.DeborahCornah,ConsultanttotheMentalHealthFoundation,basedonresearchbyCourtneyVanDeWeyer,ProjectOfficeratSustain:theallianceforbetterfoodandfarming�.TheworkwascommissionedbyIainRyrie,ResearchProgrammeDirectorattheFoundation,andwaseditedbyJeanettelongfield,Co-ordinatoratSustain,CeliaRichardson,DirectorofCommunicationsattheFoundation,andIainRyrie.

TheMentalHealthFoundationandSustainwouldliketoacknowledgethefollowingfortheircontributionstotheproductionofthisreport:

MaddyHalliday,formerDirectorofUKPolicyandScotlandDevelopment,MentalHealthFoundation

TobyWilliamsonandIsabellagoldieattheFoundation,fortheircommentsandUKperspectiveduringthedevelopmentoftherecommendations

Theservicesusingdietandnutritiontopromotementalhealthortomanagementalhealthproblems,illustratedinourcasestudies

Expertsinthefieldwhoreviewedanearlierdraftofthisreport.

1Thereisacompanionreporttothisvolume,producedbytheFoundation’spartnerintheFeedingMindsCampaign,Sustain:theallianceforbetterfarmingandfood.“ChangingDiets,ChangingMinds:howfoodaffectsourmentalwellbeingandbehaviour”isavailableatwww.sustainweb.org

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SUMMARY

Introduction

Thereappearstobenorespiteinthepaceorimpactofthegrowingburdenofmentalill-healthonusasindividualsandasanation.TheUKcostsofmentalill-healtharenowapproaching£100billionayear.Manyexplanationshavebeenofferedforthistrend–fromglobalisationandchangesineconomicstabilitytochangingsocialtrendsanddiminishinginterpersonalnetworks.

Mentalhealthproblemsarebelievedtobetheresultofacombinationoffactors,includingage,geneticsandenvironmentalfactors.Oneofthemostobvious,yetunder-recognisedfactorsinthedevelopmentofmajortrendsinmentalhealthistheroleofnutrition.Thebodyofevidencelinkingdietandmentalhealthisgrowingatarapidpace.Aswellasitsimpactonshortandlong-termmentalhealth,theevidenceindicatesthatfoodplaysanimportantcontributingroleinthedevelopment,managementandpreventionofspecificmentalhealthproblemssuchasdepression,schizophrenia,attentiondeficithyperactivitydisorder,andAlzheimer’sdisease.

Increasingly,thelinksbetweendietandmentalhealtharegatheringsupportfromacademicandclinicalresearchcommunities.Studieshaverangedfromexaminingindividualresponsestodietchangesinrandomisedcontrolledtrials,topopulation-basedcross-culturalcomparisonsofmentalhealthandfoodintake.

Buttheroleofdietinthenation’smentalhealthhasyettobefullyunderstoodandembraced,andshiftsinpolicyandpracticehavebeenslowtomaterialise.Possiblereasonsincludealackofawarenessoftheevidence,scepticismastoitsqualityandvestedinterestsinothertreatmentsandapproaches.

Fordecadestheprevailingtreatmentformentalhealthproblemshasbeenmedication(andpsychotherapytoalesserextent),andmentalhealthpromotionmethodshavecentredaroundinformationandeducation.Thetreatmentimplicationsofresearchintonutritionandmentalhealthhaverarelybeenacknowledgedbymainstreammedicine,yetthepotentialreturnsareenormous.Thementalhealthpromotionimplicationsarealsooftheutmostimportance,anddeservemuchgreaterattention.

How food and food production are implicated in mental health

Mostofthebrainisderiveddirectlyfromfood.Thelastfiftyyearshavewitnessedremarkablealterationstowhatweeat,howweprocessandrefineit,foodadditives,useofpesticidesandthealterationofanimalfatsthroughintensivefarming.Changestoourdietinrecentyearsmeanthatwhatweconsumedailyisverydifferentinitsnutritionalcontentfromthatofevenourclosestancestors.

IthasbeenestimatedthattheaveragepersonintheUKandotherindustrialisedcountrieswilleatmorethan4kilogrammesofadditiveseveryyear.Theimpactofthissituationisstillcontroversialasgovernmentshaveappearedreluctanttofund,conductorpublishrigorouslycontrolledstudiesexaminingtheeffectsofadditives.

Changingmethodsoffarminghavealsointroducedhigherlevelsanddifferenttypesoffatintoourdiet.Forexample,chickensnowreachtheirslaughterweighttwiceasfastastheydidthirtyyearsago,whichhaschangedthenutritionalprofileofthemeat.Whereasachickencarcassusedtobe2%fat,itisnow22%.Also,thedietfedtochickenshaschangeddramatically,whichhasreducedomega-3fattyacidsandincreasedomega-6fattyacidsinchickenmeat.Similarly,thedietfedtofarmedfishischangingtheratiooffattyacidsinthefishweeat.

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How fats and amino acids work in our brains

Becausethe‘dryweight’ofthebrainiscomposedofabout60%fat,thefatsweeatdirectlyaffectthestructureandsubstanceofthebraincellmembranes.Saturatedfats–thosethatarehardatroomtemperature,likelard–makethecellmembranesinourbrainandbodytissuelessflexible.

Twentypercentofthefatinourbrainismadefromtheessentialfattyacidsomega-3andomega-6.Theyaretermed’essential’astheycannotbemadewithinthebody,somustbederiveddirectlyfromthediet.Eachfattyacidperformsvitalfunctionsinthestructuringofbraincells(orneurons),ensuringthatsmoothcommunicationispossiblewithinthebrain.Botharefoundinequalamountsinthebrain,anditisbelievedtheyshouldbeeateninequalamounts.

Unequalintakesofomega-3andomega-6fatsareimplicatedinanumberofmentalhealthproblems,includingdepression,andconcentrationandmemoryproblems.ExpertssuggestthatmostpeopleconsumingWesterndietseatfartoomuchomega-6andnotenoughomega-3.

Therecentandwidespreadappearanceoftrans-fatinthedietraisesgreatconcern,primarilybecausethesefatsassumethesamepositionasessentialfattyacids(EFAs)inthebrain,meaningvitalnutrientsarenotabletoassumetheirrightfulpositionforthebraintofunctioneffectively.Trans-fatsareprevalentandpervasive,foundinprocessedfoodslikecommercially-madecakes,crispsandreadymeals.

Neurotransmittersaremessengerspassedbackandforthwithinthebrain.Theyallowneuronstocommunicateinformationamongstthemselves.Neurotransmittersaremadefromaminoacids,whichoftenmustbederiveddirectlyfromthediet.Forexample,theneurotransmitterserotonin,whichisassociatedwithfeelingsofcontentment,ismadefromtheaminoacidtryptophan.Adrenalineanddopamine,the‘motivating’neurotransmitters,aremadefromphenylalanine(seetablesforfurtherinformationabouttheirsources).

The role of diet in relation to mood and mental wellbeing

Justliketheheart,stomachandliver,thebrainisanorganthatisacutelysensitivetowhatweeatanddrink.Toremainhealthy,itneedsdifferentamountsofcomplexcarbohydrates,essentialfattyacids,aminoacids,vitaminsandminerals,andwater.

Anyonewhohaseversmoked,drankalcohol,teaorcoffeeoreatenchocolateknowsthatsuchproductscanimproveone’smood,atleastalittleandtemporarily.Whatseemstobelesscommonisanunderstandingthatsomefoodscanhavealastinginfluenceonmoodandmentalwellbeingbecauseoftheimpacttheyhaveonthestructureandfunctionofthebrain.

Asufficientbalanceofneurotransmittersisessentialforgoodmentalhealth,astheyareinfluentialinthefeelingsofcontentmentandanxiety,memoryfunctionandcognitivefunction.Somefoodsareperfectattemporarilypromotingtheneurotransmitterthatwelackand,aswecraveandthenconsumethem,they‘trick’usintofeelingbetter,forawhile.

Bymakingthebrainlesssensitivetoitsowntransmittersandlessabletoproducehealthypatternsofbrainactivity,thesesubstancesencouragethebraintodown-regulate.Down-regulationisthebrain’sinstinctivemechanismforachievinghomeostasis:whenthebrainis‘flooded’byanartificialinfluxofaneurotransmitter(forexample,adrenalinetriggeredbyastrongcoffee),thebrain’sreceptorsrespondby‘closingdown’untiltheexcessismetabolisedaway.Thiscancreateaviciouscircle,wherethebraindown-regulatesinresponsetocertainsubstances,whichinturnprompttheindividualtoincreasetheirintakeofthosesubstancestogetthereleaseoftheneurotransmitterthattheirbrainislacking.Thisisonereasonwhypeoplesometimescravecertainproducts.

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The role of diet in relation to specific mental health problems

Depression

Anumberofcross-countryandpopulation-basedstudieshavelinkedtheintakeofcertainnutrientswiththereportedprevalenceofdifferenttypesofdepression.Forexample,correlationsbetweenlowintakesoffishbycountryandhighlevelsofdepressionamongitscitizens–andthereverse-havebeenshownformanytypesofdepression.

Complexcarbohydratesaswellascertainfoodcomponentssuchasfolicacid,omega-3fattyacids,seleniumandtryptophanarethoughttodecreasethesymptomsofdepression.Thosewithlowintakesoffolate,orfolicacid,havebeenfoundtobesignificantlymorelikelytobediagnosedwithdepressionthanthosewithhigherintakes.SimilarconclusionshavebeendrawnfromstudieslookingattheassociationofdepressionwithlowlevelsofzincandvitaminsB1,B2andC.Inotherstudiesstandardtreatmentshavebeensupplementedwiththesemicro-nutrientsresultingingreaterreliefofsymptomsinpeoplewithdepressionandbi-polaraffectivedisorder,insomecasesbyasmuchas50%.

Onewaythatvitaminsandmineralsmayimprovementalhealthandcognitivefunctionisthroughtheirroleinthebrain’sconversionofaminoacids.Muchhasbeensaidinpublicforaabouttheimportanceoftheneurotransmitterserotonin,anditspresenceinlowerlevelsbeinglinkedtodepression.Becauseofthis,theprecursortoserotonin–theaminoacidtryptophan–hasbeenthefocusofmuchresearch.Somestudieshavefoundthatcombiningtryptophanwithselectiveserotoninreuptakeinhibitor(SSRI)antidepressantsgivesbetterresultsthanSSRIsalone.Otherdietaryalterationscaneaseorhindertheentryoftryptophantothebrain.

Schizophrenia

Studieshavelookedattheimpactofspecificnutrientsontheratesofschizophreniainthegeneralpopulation,focusingonfatsandantioxidants.Epidemiologicalevidencehasshownthatpeoplewithschizophreniahavelowerlevelsofpolyunsaturatedfattyacidsintheirbodiesthanthosewithnoexperienceoftheillness.Otherresearchhasshownthatantioxidantenzymesarelowerinthebrainsofpeoplewithschizophrenia.

Furtherworkisneededinthisareatoidentifyspecificmechanismsthroughwhichdietcanworkalongsideothercareoptionstoalleviatethesymptomsofschizophrenia.

Alzheimer’s Disease

SpecificconnectionshavebeenfoundbetweentheoccurrenceofAlzheimer’sanddifferentintakesoffoods,includingsaturatedfat,vitaminsandminerals.Althoughtherehavebeenfewcontrolledclinicaltrialstestingtheeffectsofnutritionaltreatments,mostevidencepointstotheroleofnutritioninthepreventionof,ratherthanthetreatmentofAlzheimer’sDisease.Manyofthestudieshaveshownapositiveassociationbetweensaturatedfatintakeandtheincidenceofdementia,andanegativerelationshipbetweentheincidenceofdementiaandintakeofpolyunsaturatedfattyacid.OnestudylookingatthetotalfatintakeofelevencountriesfoundacorrelationbetweenhigherlevelsoffatconsumptionandhigherlevelsofAlzheimer’sDiseaseamongstover65’s.

OtherstudieshaveexploredtheprotectionfromAlzheimer’sthathasbeenlinkedwithhighvegetableconsumption.Onelongtermpopulation-basedstudyfoundthathighintakesofvitaminsCandEwerelinkedtoalowerriskofAD,particularlyamongsmokers,andthisfindinghasbeenreplicatedinotherstudies.

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Attention Deficit Hyperactivity Disorder (ADHD)

Manyparents,teachersandothershavereportedgreatimprovementswhendietarychangesareintroducedtochildrenwithADHD.Twofoodgroupsthathavebeenimplicatedthroughclinicalresearchareessentialfattyacids(EFAs)andminerals.StudieshavefoundsomeEFAstobesignificantlylowinhyperactivechildren.AsimilarrelationshiphasbeenfoundwithlevelsofironinchildrenwithsymptomsofADHD.

Conclusion

Thebodyofevidencelinkingdietwithmentalhealthisgrowingatarapidpace.Aswellasitsimpactonfeelingsofmoodandgeneralwellbeing,theevidencedemonstratesitscontributiontothedevelopment,preventionandmanagementofspecificmentalhealthproblems.

Theimplicationsarefar-reachingforallthosewithastakeinthecare,treatmentandpreventionofmentalillness.Theymustbeembracedbystakeholdersifcurrentandfuturegenerationsaretoeasethegrowinghealth,economicandsocialburdenofmentalill-health.

Thereisanurgentneedforpolicy-makers,practitioners,industry,serviceusersandconsumerstogivepropercredencetotherolethatnutritionplaysinmentalhealth.

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METHODS

Amulti-methodologicalapproachwasadoptedintheproductionofthisreport,inordertoreflectthebreadthanddepthofevidenceinthefield.Methodsincluded:

Areviewofexistingliteratureandevidencerelatingtonutritionandmentalhealth.Althoughafullsystematicreviewwasbeyondthescopeandpurposeofthisreport,evidencewascollectedfrompeer-reviewedjournalsinadditiontonon-reviewedliterature,theinternet,personalcommunicationsandconferenceproceedings

ANationalOpinionPoll(NOP)surveywasconductedwith2122adultsaged15yearsandover,throughouttheUK.Thesamplewascontrolledforage,sexandemploymentstatus.Questionsaskedconcernedfoodwastage,frequencyofconsumptionofdifferentfoodsanddrinks,theperceivedimpactofdifferentfoodsonmood,reasonsforfoodconsumptionandexperienceofmentalhealthproblems(seeAppendixA)

Sitevisits/liaisonwithsixinnovativeservicesthatusedietandnutritiontopromotementalhealthortomanagementalhealthproblems

Peerreviewofthereportthroughareferencegroupofnutritionandmentalhealthspecialists

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KEYFINDINgS

Food consumption

Whatweareeatingnowisverydifferentfromthatofourrecentancestors.Foodproductionandmanufacturingtechniques,coupledwithchanginglifestylesandincreasingaccesstoprocessedfoods,meanthatourintakeoffresh,nutritious,localproduceismuchlower,atthesametimeasourintakeoffat,sugar,alcoholandadditivesismuchhigher.

Upto40%offoodweproduceiswasteddirectlybecausewebuyitandthenthrowitaway,orindirectly,becausesupermarketsrejectproducethatisthe‘wrong’sizeorshapeorpastits‘sell-by’date.

Overthelast60yearstherehasbeena34%declineinUKvegetableconsumptionwithcurrentlyonly13%ofmenand15%ofwomennoweatingatleastfiveportionsoffruitandvegetablesperday.

PeopleintheUKeat59%lessfishthantheydid60yearsago.

Mental health

Somenutrientstrickthebrainbytriggeringanover-releaseofneurotransmittersandsomefoodsdamagethebrainbyreleasingtoxinsoroxidantsthatharmhealthybraincells.Therearemanymorenutrientsthatservethebrainwithoutdeceptionordamage,whichcanimprovemoodandmentalwellbeing.

Abalancedmoodandfeelingsofwellbeingcanbeprotectedbyensuringthatourdietprovidesadequateamountsofcomplexcarbohydrates,essentialfats,aminoacids,vitaminsandmineralsandwater.

Thereisaplethoraofanecdotal,clinicalandcontrolledstudiesthatpointtotheimportanceofdietasonepartofthejigsawinthepreventionofpoormentalhealthandthepromotionofgoodmentalhealth.

Researchindicatesthatgoodnutritionalintakemaybelinkedtoacademicsuccess.Anumberofstudiesreportthatprovidingchildrenwithbreakfastimprovestheirdailyandlong-termacademicperformance.

Amongsomeyoungoffenders,dietssupplementedwithvitamins,mineralsandessentialfattyacidshaveresultedinsignificantandremarkablereductionsinanti-socialbehaviour.

Mental health problems

ThereisgrowingevidencethatdietplaysanimportantcontributoryroleinspecificmentalhealthproblemsincludingAttentionDeficitHyperactivityDisorder(ADHD),depression,schizophreniaandAlzheimer’sdisease.

ThepresentationofdepressionintheUKpopulationhasincreaseddramaticallyoverrecentdecadesandthishasbeenaccompaniedbyadecreaseintheageofonset,withmorecasesbeingreportedinchildren,adolescentsandyoungadults.

Acorrelationbetweenlowintakesoffishbyacountryandhighlevelsofdepressionamongstitscitizens,aswellasthereverse,hasbeenshownformajordepression,post-nataldepression,seasonalaffectivedisorderandbipolaraffectivedisorder.

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Theincidenceofschizophreniaissimilaracrosstheglobe,althoughtherearedifferencesinoutcomesbetweencountries.Thisimpliesthatenvironmentalfactorshavesomeroleindeterminingthedurationandseverityofsymptoms,andtherolethatdiethastoplayisattractingincreasingscientificinterest.

Alzheimer’sdiseasehasbecomemorecommoninthepastfiftyyearsandisbelievedtobetheresultofacombinationoffactors,includingtheagingpopulation,geneticsandenvironmentalfactors.

growingepidemiologicalevidencesuggeststhatdietmaybeoneofthoseenvironmentalfactorswithassociationsbeingreportedbetweentheoccurrenceofAlzheimer’sandtheamountofsaturatedfats,vitaminsandmineralsconsumed.

Complementarymentalhealthcareservicesthatfocusondietandnutritionreportpromisingresults,particularlyamongthosewhoexperienceADHDanddepression.Onthewholehowever,theyarepoorlyresourcedandhavereceivedinsufficientresearchattentiontodrawfirmconclusions.

National opinion poll findings (NOP)

Womenreporteatinghealthyfoods,includingfreshvegetables,fruitorfruitjuiceandmealsmadefromscratch,moreoftenthanmen,whotendtoeatmoretakeawaysandreadymeals.

Youngerpeoplereporteatinglesshealthyfoods(freshfruitandvegetables,organicfoodsandmealsmadefromscratch)andmoreunhealthyfoods(chipsandcrisps,chocolate,readymealsandtakeaways)thanolderpeople.

29%of15-24yearoldsreporteatingamealmadefromscratcheveryday,comparedwith50%ofthoseagedover65.

Youngerpeoplearemorelikelythanolderpeopletoreportdailymentalhealthproblems,asarethoseinsocialclassDE,thoseonalowerincome,thosewhoarenotinpaidemploymentandthosewhoarenotmarried.

Nearlytwothirdsofthosewhodonotreportdailymentalhealthproblemseatfreshfruitorfruitjuiceeveryday,comparedwithlessthanhalfofthosewhodoreportdailymentalhealthproblems.Thispatternissimilarforfreshvegetablesandsalad.

Thosewhoreportsomelevelofmentalhealthproblemalsoeatfewerhealthyfoods(freshfruitandvegetables,organicfoodsandmealsmadefromscratch)andmoreunhealthyfoods(chipsandcrisps,chocolate,readymealsandtakeaways).

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Stakeholders:DepartmentofHealthNHSHealthScotlandHealthandSocialCareDepartmentDepartmentofHealth,SocialServicesandPublicSafetyFoodStandardsAgency

Stakeholders:DepartmentofHealthNHSHealthScotlandHealthandSocialCareDepartmentDepartmentofHealth,SocialServicesandPublicSafety

Stakeholders:PrimaryCareTrustslocalAuthoritiesNHSHealthBoardslocalHealthBoardsHealthandSocialServicesBoards/Trusts

Stakeholders:HealthcareCommissionCommissionforSocialCareInspectionCareCommissionNHSQualityImprovementScotlandMentalWelfareCommissionHealthInspectorateWalesCareStandardsInspectorateNorthernHealthandSocialServicesCouncilDepartmentofHealth,SocialServicesandPublicSafety

�.TheUKpopulationandparticulargroupswhoareatincreasedriskofmentalhealthproblemsshouldbeprovidedwithinformationaboutfoodsthatpromotetheirmental,emotionalandphysicalwell-being

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UnitedKingdomHealthDepartmentsshouldreviewandimprovefoodandnutritionstandardsforthementalhealthandsocialcaresectorsinlightoftheevidencethatarangeofnutrientscontributetomentalhealthandwellbeing

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Organisationsthatcommissionmentalhealthservicesshouldincludewithincommissioningcriteriaandservicespecificationsfoodandnutritionstandardsforanyservicesthatprovidefood

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Annualmonitoringoffoodandnutritionstandardsacrossthehealthandsocialcaresectorshouldbeincorporatedintocurrentperformanceassessmentmechanisms

RECOMMENDATIONS

Thegovernmentasawhole,andallrelevantdepartmentsandagencies,shouldofficiallyrecognisethelinksbetweendietandmentalhealthandincorporatethisrecognitionintoallfoodandmentalhealthrelatedpolicyandpractice.Forinstance,generalhealthyeatingcampaignssuchasfive-a-dayshouldalwaysincludeamentalhealthcomponent.

Becausethedietthatisgoodforthebrainisalsothesamedietthatisgoodforthebody,governmentshouldincreasefinancialandpoliticalsupportformeasurestoensurethatsustainable*suppliesofawidevarietyofnutrient-richfoodsareavailable,affordableandattractiveforpeopletoobtainbothnowandinthefuture.

Specifically:

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Stakeholders:PrimaryCareTrustsNHSHealthBoardslocalHealthBoardsHealthandSocialServicesBoards/Trusts

Stakeholders:MentalHealthTrustsNHSHealthBoardslocalHealthBoardsHealthandSocialServicesBoards/Trusts

Stakeholders:StrategicHealthAuthorities(ortheirsuccessor)localHealthBoardsNHSHealthBoardsHealthandSocialServicesBoards/TrustslocalAuthorities

Stakeholders:HomeOfficeScottishExecutiveNorthernIrelandOffice

Stakeholders:DepartmentofHealththroughitsResearchFundersgroupScottishExecutiveHealthDepartmentandNationalProgrammeforImprovingMentalHealthandWell-beingHealthandSocialCareDepartmentDepartmentofHealth,SocialServicesandPublicSafetyFoodStandardsAgency

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Primarycareshouldhavereadyaccesstoinformationonthelinkbetweendietandmentalhealthaswellasaworkingknowledgeoftheinformationandexpertiseavailabletosupportpeoplethroughdietarychange

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Secondarymentalhealthservicestaffshouldhavereadyaccesstonutritionalspecialistsforliaisonandconsultation

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AllexistingNHSandsocialcarefacilitiesthatprovidemealstoserviceusers,includingtheindependentandnotforprofitsector,shouldinstigatesustainablefoodpoliciesandpractices,sothatallserviceusersandstaffareencouragedtochoose,orbeprovidedwithifunabletochoose,diverseandculturallyappropriatemeals,snacksanddrinksthatpromotetheirmental,emotionalandphysicalwell-being

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Allprisonfacilitiesshouldinstigatesustainablefoodpoliciesandpracticessothatallresidentsandstaffareencouragedtochooseculturallydiverseandappropriatemeals,snacksanddrinksthatpromotetheirmental,emotionalandphysicalwell-being

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Researchfundingbodiesshouldco-ordinatetheirstrategiesandincreasethegrantsavailabletoinvestigatetherelationshipbetweendietandmentalhealth,particularlytheeffectivenessofinterventions

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Regulationsshouldbeintroducedtosupportthepromotionofhealthyfoodtochildren,andtoprotectthemfromallformsofbroadcastandnon-broadcastmarketingofunhealthyfood

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Practicalfoodskills,includingcookingandgrowing,shouldbereintroducedasacompulsorypartofthenationalcurriculum

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Theprogressiveapproachtoensuringbetterfoodinschoolmealsshouldbecontinuedandinadditionaccesstofreewaterdispensersshouldbeavailabletoallchildrenby2007

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Targetsshouldbeintroducedtoreduceunhealthylevelsoffat,sugarandsaltinprocessedfood,andtoremovedamagingtrans-fatsfromfoodingredientsandfoodproducts.Asaninterimmeasure,manufacturersshouldbeencouragedtolabelclearlythenutritionalqualityofandingredientsintheirproducts

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Agriculturalpolicydevelopmentshouldbeinformedbywhatisknownofitsnutritionalimpactanditssubsequenteffectuponourmentalaswellasphysicalhealth.Specifically,supportmustbeincreasedfororganicfarming,theproductionandpromotionoffruitandvegetables,othermicro-nutrientrichfoodandforalternativesourcestooilyfishofomega-3fats.Moreover,governmentpolicyonpromotingfishconsumptionneedstochangetopromotingonlysustainablesourcesofoilyfish,withlowlevelsoftoxicity

Stakeholders:DepartmentforCultureMediaandSportOfcomTheDepartmentofHealth’sAdvertisingForumDepartmentofHealthNHSHealthScotlandScottishExecutiveHealthandSocialCareDepartmentDepartmentofHealth,SocialServicesandPublicSafety

Stakeholders:DepartmentforEducationandSkillsHealthPromotingSchoolsScottishExecutiveEducationDepartmentDepartmentofEducation

Stakeholders:TheSchoolFoodTrustDepartmentforEducationandSkillsHealthPromotingSchoolsScottishExecutiveEducationDepartmentDepartmentofEducation

Stakeholders:FoodStandardsAgency

Stakeholders:DepartmentfortheEnvironment,FoodandRuralAffairsFoodStandardsAgencyDepartmentofEnvironmentandRuralAffairsDepartmentofAgricultureandRuralDevelopment

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1. INTRODUCTION

1.1 The Mental Health of the Nation

InSeptember1999,theDepartmentofHealthsetouttheirblueprintfortacklingmentalhealthproblemsinEngland,givingprioritytomentalhealthalongsidecoronaryheartdisease(CHD)andcancer.Fiveyearslater,mentalhealthproblemsarenowthenumberonereasonforpeopletoclaimIncapacityBenefit,witharoundonemillionpeopleunabletoworkandmillionsofothersaffectedintheirrolesascarers,friendsorcolleagues�.Manymoresufferawayfromthelimelightofstatistics,withoneinfourpeoplelikelytoexperienceamentalillnessatsomepointintheirlifetime,andthereappearstobenorespiteinthepaceandimpactofthegrowingburdenofmentalill-healthonusasindividualsandasanation.latestfiguresestimatethattheeconomicburdenofthisisnowapproaching£100billionayearintheUK�.Therearemanyexplanationsforthisincreaseinmentalhealthproblems–fromglobalisationandchangesineconomicstabilitytochangingsocialtrendsanddiminishinginterpersonalnetworks.Anholisticapproachtomentalhealthrecognisesthecomplexityoffactorsthatcontributetoaperson’ssenseofwellbeingandacknowledgestherealbutpartialanswerofferedbyanyoneapproachtotreatment.

1.2 An holistic approach to mental health

Fordecades,theprevailingtreatmentforthosewithmentalhealthproblemswasmedication,prescribedlargelybyprimarycarepractitionersand–onoccasions–inconsultationwithotherprofessionals.Inthe1990s,thiswasoftengiveninconjunctionwithsomepsychotherapeuticintervention(e.g.counselling,cognitivebehaviouraltherapy),althoughformanyinanoverstretchedsystemofcare,thisoftenwastoolittle,toolate.TheNHSImprovementPlan(2004)signalledashiftinthegovernment’sapproachtotreatmentformentalhealthproblemsbyemphasizingwhatmanyhadalreadydiscoveredforthemselves:thateffectiveandsustainablecareinvolvesafocusonthewholeofhealthandwell-being.Withthisinmind,anintegrativeapproach,whichembracescomplementarytherapiesandrecognisestheinterplaybetweenthephysical,emotionalandmentalaspectsofaperson’slife,canoftenbemoreeffectivethananyonesinglerouteoftreatment.

In-depthqualitativeresearchshowsthatmanyfactorsareimportantinpromotingwellbeingandpreventingmentalill-health,includingmedication,relationshipswithfriends,familymembersandprofessionals,complementarytherapies,religiousandspiritualbeliefs,self-helpstrategies,sportandphysicalexercise,andcreativeexpression�.Itisnotsurprising,therefore,thatpublicationsdescribingandendorsingnon-conventionalapproachesinmentalhealthhaveincreasedinthelastfewyears.Bothanecdotalandclinicalevidencehavesupportedthelinksbetweenexercise�,acupuncture�,andspirituality�withmentalhealth,tonamebutafew.Forsomeindividuals,complementaryoralternativetherapiesworkintandemwithconventionalmethods,helpingmedication(forexample)toworkmoreeffectivelyandwithfewersideeffects.Forothers,alternativetherapiesreallyarejustthat–analternativetoprescribedorconventionaltreatmentsthataresufficientinthemselves.Oneareathatisreceivingincreasingattentionfromarangeofcommunitiesistheroleofdietinmentalhealth.

1.3 The role of diet in mental health

MostpeopleintheUKareawareofthewell-establishedassociationbetweendietandphysicalhealth�.Forexample,adiethighinsaturatedfats,saltandsugarandlowinfibre,freshfruitandvegetablesisheavilyimplicatedincoronaryheartdisease(CHD)andsomecancers-theleadingcausesofmortalityinindustrialisedcountries.DietisalsoimplicatedinobesityandType2diabetes,amongstmanyotherphysicalhealthproblemsintheUKandbeyond(seeFigure1).

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lesscommonintheUKisanawarenessofasimilarassociationbetweendietandmentalhealth.Althoughthecontributionmadebydiettoourmentalhealthiscomplexandunquestioninglyaffectedbyotherissues,thereisasimpleprinciplerecognisedbythosewhoadoptanintegrativeunderstandingofhumanlife.Weknowthatdietaffectsphysicalhealthandweknowthatphysicalhealthaffectsmentalhealth(forexample,thereisanincreasedincidenceofdepressioninthosewhohaveheartdisease),thereforeeveniftherewasnodirectlinkbetweendietandmentalhealth,wecanunderstandthatthereisanindirectlink.However,asthisreportexplains,thereisalsoanincreasingunderstandingintheresearchcommunityofthedirectassociationbetweenwhatweeatandhowwefeelandbehave(seeFigure2).

Althoughimplicatedinanumberofmentalhealthproblems,includingdepression,AttentionDeficitHyperactivityDisorder(ADHD)andAlzheimer’s,theroleofdietinthenation’smentalhealthhasyettobefullyembraced.Potentialreasonsforthisincludebeingunawareoftheevidence,scepticismofitsqualityand/orvestedinterestinothertreatments.Addedtothisisthecomplexinterplayoffactorsthatcanaffectourmentalhealth.

Figure �: The association between diet and mental health

Figure �: The association between diet and physical health

Physical healthWhat we eat

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Evenrestrictingourselvestothegrowingbodyofresearchthatillustratestherelationshipbetweenourdietandourfeelingsandbehaviours,itbecomesobviousthatwhatweeatisaffectedbywhyandhowweeat,bothofwhichmayalsohaveanimpactonourmentalhealth.Forexample,ifweseefoodpurelyasameansof‘re-fuelling’,ourmealtimeswillaffectusdifferentlythanifweseefoodasavitalsourceofnourishmentforourbodyandmind.Similarly,ifweeatalone,thepsychosocialbenefitsoffoodmaybedifferentthanifweeatwithothers.Thisisreflectedbytheimportancethatfoodisgivenacrossadiverserangeofculturalandreligioustraditions.Manyfaithcommunitiesobservetraditionsinvolvingfood,suchasfastingandsubsequentbreakingoffastswithothersorregularcommunalmealtimes.Forothers,manyfoodshavespiritualsignificanceandareconsumedoravoidedasanexpressionoffaith.

Themultitudeofpsychosocialfactorsthatinfluencewhyandhowweeat,contributeto–andareaffectedby–thechoicesconcerningwhatweeat.Akeyfactorthatisassociatedwithbothmentalhealthanddietispoverty(seeRogersandPilgrim2003�).Thisiscloselytiedtoemploymentandlevelsofearningsandtheseissuesalsorelatetowhat,whyandhowpeopleeat.Addtothisthereciprocalnatureofmanyoftheserelationshipsandthepicturebecomesincreasinglycomplex(seeFigure3).

Inadditiontotheassociationdiethaswithspecificmentalhealthproblems,therearegeneralisedanxietiesamongsttheUKpopulationconcerningtheimpactofcertainfoodproductiontechniquesonourmentalhealth.Forexample,inrecentyears,hundredsofthousandsofcowswereincineratedinresponsetothethreatofBovineSpongiformEncephalopathy(BSE).WhencowsinfectedwithBSEareconsumed,peopleeatingthemareatriskofcontractingavariantofCreutzfeldt-Jakobdisease(CJD),whichcausespsychiatricandbehaviouralsymptomsand,eventually,leadstodeath.Otherrecentanxietieshaveariseninresponsetotheimpactofschooldinnersonchildren’shealthandwellbeing,thethreatofE.coliandSalmonellapoisoning.

WithoneinfourpeopleintheUKlikelytoexperienceamentalillnessintheirlifetime,theneedforeffectiveapproachestounderstandingandimprovingmentalhealthhasneverbeengreater.Identifyingandevaluatingdifferentpiecesofthejigsawenablesindividuals,practitionersandpolicymakerstomakeinformedchoicesaboutpromotingandmaintaininggoodmentalhealth.Itisinthiscontextthattheevidencelinkingdietwithmentalhealthisexplored.

Figure �: What, how and why we eat all affect, and are all affected by, mental health

Physical healthWhat we eat

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1.4 Exploring the evidence

Anecdotalevidenceoftheconnectionbetweendietandbrainfunctioninghasbeenpresentandgrowingformanyyears.Beyondgrandmotherlyadviceon‘brainfood’,anumberofhealthprofessionals,parents,teachersandpatientorganisationshaverepeatedlyassertedthatchangestodietaremirroredinbothpositiveandnegativechangesinfeelings,behaviourandcognitivefunction.Increasingly,however,thesepersonalexperienceshavegatheredsupportfromtheacademicandclinicalresearchcommunity.Studieshavevariedintheirmethodologicalapproach,rangingfromtheexaminationofindividuals’responsestodietarychangesinrandomisedcontrolledtrialstopopulation-based,cross-culturalcomparisonsofmentalhealthandfoodintake.

Thisreportprovidesanoverviewoftheimpactoffoodonmentalhealth.Itrecognisesthatsomementalhealthproblems,suchasanorexianervosaandbulimia,areassociatedspecificallywithissuesaroundfoodconsumption.Italsoacknowledgesthecross-cuttingimpactofpovertyonmentalhealthandalsouponwhatandhowpeopleeat.Whilstanexplorationoftheseissuesisbeyondthescopeofthisreport,furtherresearchiswarrantedtoaddresstheircomplexityandimportance.

Toplacetheevidenceincontext,historicalpatternsoffoodproductionandconsumptionandcorrespondingtrendsinmentalhealtharepresentedinSection2.Section3discussestheimpactofdietongeneralwellbeinganddailymood,withparticularemphasisonthephysiologicalimpactofdietonthebrain.Section4examinestheevidencelinkingdietwithfourspecificmentalhealthproblems:ADHD,depression,schizophreniaandAlzheimer’s.Finally,Section5recommendsstepsthatneedtobetakenbypolicy-makers,practitionersandthebroaderresearchcommunitytoensurethattheroleofdietinmentalhealthisgiventheattentionitdeserves.Throughoutthereport,casestudiesofservicesorusergroupsandNationalOpinionPoll(NOP)surveydataarepresented.Thesearedesignedtoillustrateandsupporttheacademicresearchdatapresentedinthetext.

1.5 References

1. NationalStandards,localAction:HealthandSocialCareStandardsandPlanningFramework2005/06–2007/08.london:DH.

2. FundamentalFacts.MHF:london(inpress)

3. Faulkner,A.&layzell,S.(2000)Strategiesforliving:areportofuser-ledresearchintopeople’sstrategiesforlivingwithmentaldistressMentalHealthFoundation:london.

4. UpandRunning?Exercisetherapyandthetreatmentofmildormoderatedepressioninprimarycare.(2004).london:MentalHealthFoundation.Availableat:http://www.mentalhealth.org.uk/html/content/up_and_running.pdf

5. Servan-Schreiber,D.(2005).HealingwithoutFreudorProzac:Naturalapproachestocuringstress,anxietyanddepression.london:Rodale.

6. InspiringHope:Recognisingtheimportanceofspiritualityinawholepersonapproachtomentalhealth.(2005).london:NIMHE.

Availableat:http://www.mentalhealth.org.uk/html/content/spirituality_project.pdf

7. Choosingabetterdiet:foodandhealthactionplan.(2004).london:DH.

8. Rogers,A.&Pilgrim,D.(2003).MentalHealthandInequality.PalgraveMacmillan:Basingstoke.

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2. TRENDSINFOODCONSUMPTIONANDMENTAlHEAlTH

2.1 Changing patterns of food consumption

Althoughwedependonfoodlikewealwayshave,ourrelationshipwithithasundergoneatransformationofremarkablemagnitude.Whilstourhunter-gathererancestorswouldhavebeenentirelydependentuponsmallamountsoflocalwildfoods,manypeople(althoughnotall)intheUKnowhavetheluxuryofeatingmorecaloriesthanthebodyphysicallyrequires,sourcedfrommanycountriesaroundtheglobe.

Recentstatistics�showthatupto40%offoodweproduceiswasteddirectly(becausewebuyitandthenthrowitaway)orindirectly(becausesupermarketsrejectproducethatisthe‘wrong’sizeorshapeorpastits‘sell-by’date).AsshowninFigure7,thistrendismorepervasiveamongstyoungeragegroups,perhapsindicatingachangeinrecentdecadesinthewaywerelatetofoodandconsumption.

Box1:Food–whyweeatandwhatwethrowaway

RespondentstotheNOPsurveywereaskedtoidentifythemaininfluencesontheirfoodconsumptionfromthefollowinglist:time,habit,diet,cost,health,socialreasonsorconvenience.Themostcommonlycitedreasonidentifiedwashealth(40%ofthesample),followedbytime(30%),diet(29%)andconvenience(23%).However,someoftheseresponsesvariedaccordingtotheage,socio-economicstatus,incomeormaritalstatusofthepersonbeingasked*.

Forexample,healthbecameanincreasinglyimportantconsiderationwithage,withnearlyhalfofpeopleagedover65reportingthathealthwasamaininfluenceonwhattheyate,comparedwitharoundonefifthofpeopleaged15-24*(seeFigure4).

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Figure �: Those reporting that health was a main influence on what they eat, across age groups

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Conversely,nearlyhalfofpeopleagedunder24reportedthattimewasanimportantinfluenceontheirchoiceofdiet,comparedwithlessthanonetenthofpeopleagedover65*.Thiscorrespondstothenotionthateatingforconvenienceisincreasinglycommoninyoungeragegroups(seeFigure5).

Ageisnottheonlyfactorthatinfluencesourdecisionsaboutwhattoeat.HouseholdincomeandSocio-economicStatus(SES)haveasignificantimpacttoo.Costisanimportantconsiderationinchoicesaroundfoodconsumption,andbecomesincreasinglysoashouseholdincomedecreases.Approximatelyonethirdofpeoplewithahouseholdincomeunder£7,500reportthatcostisanimportantinfluenceonwhattheybuy,comparedtoonetenthofpeoplewithahouseholdincomeofover£50,000.ThepatternissimilarforSES(seeFigure6)andforthosewhoarenotinpaidemployment*.

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Figure �: Those reporting that convenience was a main influence on what they eat, across age groups

Figure �: Those reporting that cost was a main influence on what they eat, according to income and class

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Theapparentshiftinourattitudetowardsfood–seeminglyfromoneofrespecttooneofconvenientnecessity–hasitsrootsinchangestofoodproductionthathaveoccurredinwesternsociety.Ashumansevolvedanddevelopednewtechniquesforgatheringfood,thehumandietchangedfrombeinghunter-gathererbasedtobeingdependentonagriculture.Aspeopleshiftedfromnomadicgroupstofarming-basedcommunities,thepreviousdietofwildmeat,fruitsandvegetableswasreplacedwithadiethighlydependentoncerealgrains.Archaeologicalevidenceshowsthatthesechangeswereaccompaniedbyamarkeddeclineinhealth� �.

Theonsetoftheindustrialrevolutionledtomoredramaticdietarychanges.Thearrivaloflargenumbersofworkersintotownsandcitiesrequiredreliablequantitiesofcheapfoodtosustainthem.Thisnecessityled,inpart,toavarietyofchangesbothtothewayfoodwaspreparedandwhereitcamefrom.Thesechangesincludedtheadventofcanningandfreezing,moreefficientandcheapergrindingofflour(whichhadtheunintendedconsequenceofremovingmostofthenutrients),therefiningofsugarandimprovedmethodsofextractingvegetableoils.Moreover,developmentsintransportallowedfoodstobetransportedvastdistances,bothquicklyandcheaply.Thetwentiethcenturysawthepaceofchangequicken.Aftertheexperienceofrationingduringtheworldwars,Britishagriculturalpolicywasdrivenbytheneedtoincreasetheamountoffoodproduced.Farmingwasindustrialisedandprocessedfoodbecamemoreandmorecommonplace.

Theresultofallthesechanges,alongsideincreasingwealthandshiftinglifestyles,isthatwearenowconsumingadietdifferentinbothquantityandqualitytothatofourancestors�,withfurthervariationinfoodconsumptionthathasariseninresponsetothechangingethnicandculturaldiversityintheUK.

Peopleoftenbuyfoodthattheydonotconsume.Forexample,nearlyaquarterofthesamplereportthattheythrowaway10%ormoreofallthefoodtheybuyeachweek.However,somegroupsinthesamplereportedthattheythrewnothingawayatall.Thosewiththelowesthouseholdincome(under£7,500p.a.),andthoseinclassDE,fallintothatgroup(21%and19%respectively),comparedtoonly6%ofpeoplewithahouseholdincomeofgreaterthan£50,000or12%ofpeopleinclassAB.Similarly,22%ofthosewhoarenotinpaidemploymentthrownofoodaway,comparedto9%ofpeopleinfull-timeemploymentand6%ofthoseworkingpart-time.Thoseleastlikelytothrowanyfoodawayarepeopleagedover65,asshowninFigure7*.

*Alldifferencesp<.05

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Figure �: Those reporting that they throw no food away, across age groups

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2.2 What we are eating now

AccordingtotheFoodandAgricultureOrganisationoftheUnitedNations,productionoffoodwithinthelastthirtyyearshasgrownfasterthantheglobalpopulation.Countingonlythefoodavailabletohumans,theworldnowproducestheequivalentof2,700caloriesperpersonperday,whereasonlythirtyyearsagotheamountavailablewas2,300calories�.Whatthismeansisthattheexistingfoodproductionsystemprovidesenoughfoodtotheoreticallymeeteveryoneonearth’scalorierequirementseverysingleday(althoughthisisclearlynothappening).

Thisincreaseinquantityisnottheonlychangetoournation’sfood.Thelastfiftyyearshavealsowitnessedremarkablealterationstothetypesoffoodweeat,thewayweproduceit,thewayfoodispreparedandthewayitisconsumed.Since1942,theUKgovernmenthascollecteddataontheweeklyconsumptionoffoodinBritishhouseholds,whichisthencompiledintheannualNationalFoodSurvey(nowtheExpenditureandFoodSurvey)�.Fromtheserecordsandothersurveys,itispossibletodescribethetypesoffoodeatenbytheBritishpopulationinthelastfiftyyears.Figure8showsthechangesinthetypeandquantityofsomepopularfoodsconsumed,onaverage,byanadultintheUKoverthatfiftyyearperiod.Whilsttheconsumptionoftwostaplefoods–breadandpotatoes–hasdecreased,consumptionoffruitjuice,frozenvegetablesandchickenhaveincreasedinthepastfiftyyears.Thisprobablyreflectschangesinincomeandlifestyleinadditiontotheincreasedavailabilityofsuchproducts.Althoughitisinitiallyappealingtoassumethatconsumptionof‘healthy’productshasrisen,whatthesestatisticsdisguiseistheimpactoffoodproductiontechniquesonthequality–andnutritionalbenefit–offood(seebelow).

Figure �: Changing patterns of food consumption in the UK over the past fifty years

TheExpenditureandFoodSurveyalsorevealssomechangesintheintakeofotherfoodproducts(seeBox2)aswellasextensivedataontwoothercontributionstoournationaldiet:sugarandalcohol.TheaverageconsumptionofsugarintheUKis44kgofsugarperpersonperyear,consumeddirectly(addedtodrinksormeals)orindirectly(throughsweets,chocolateandsoftdrinks).Inaddition,60%ofmenand44%ofwomenexceedthe(then)recommendedalcoholintakeof21and14unitsperweek,respectively�.

Poultry

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19991990198019701960

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Differencesinconsumptionbetweenmenandwomenarenotlimitedtoalcohol.InthemostrecentNationalDietandNutritionSurvey(NDNS,2004),adultsaged19to64yearslivinginprivatehouseholdswereselectedatrandomtodescribetheirfoodandnutrientintake,physicalmeasurements,nutritionalstatusandphysicalactivity.TheNDNSshowsthatwomentendtoeatmorefruit,yoghurtsandlow-caloriedrinksthenmen–whoconsumemorealcohol,fats&oils,meat,sugarsandfullsugarsoftdrinks.Agealsohasanimpactonthetypeandquantityoffoodconsumed.Forexample,peopleaged19to24yearsconsumefewerportionsoffruitandvegetablesthanthoseaged50to64years.Thoseintheyoungeragegroupconsumeanaverageof1.5portionsoffruitandvegetablesperday,comparedwith3.7portionsformenandwomenintheoldestgroup.Povertycreatesanotherdivision.Menandwomenlivinginhouseholdsinreceiptofstatutorybenefitsconsumefewerportionsoffruitandvegetables(about2perday)thanthoseinnon-benefithouseholds(about3perday).SimilardifferencesbetweengroupswerefoundintheNOPsurveyconductedforthisreport(seeBox3).

Box2:PatternsofFoodConsumption

Cereals

IntheUK,theaveragecalorieintakeofcerealsperpersonperdayis849–or25%ofthetotaldailydiet.Thevastmajorityofthiscomesfromwheat,whichprovidesnearly90%ofthosecalories�.

Meat

Oncerationingwaswithdrawnintheearly1950s,theconsumptionofmeatintheUKbegantorise,apatternrepeatedintherestoftheworld.In1961,theworldate71millionmetrictonnesofmeat,butby2002thishadrisentoover245million-morethanathree-foldincrease�.TheaverageconsumptionintheUKisapproximately81kgperpersonperyear,orabout13%ofthetotaldailydiet�.

Fruit and Vegetables

SincethefirstNationalFoodSurvey,therehasbeena34%declineinUKvegetableconsumption.Althoughthecurrentrecommendationistoeatatleastfiveportionsoffruitandvegetablesperday,themostrecentNationalDietandNutritionSurveyfoundthatonly13%ofmenand15%ofwomendidso,withmosteatingbarelyhalfofthatamount�.

Fish

PeopleintheUKeat59%lessfishthanwhenNationalFoodSurveyfirstbegan�.Nutritionaladviceistoeatatleast140gofoilyfishperweek,butmuchoftheUKpopulationfailstodoso.Onaverage,seafoodcontributesonlyaboutonepercentofthenation’sdailycalories�.

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Box3:DifferencesInFoodConsumptionintheGeneralPopulation

RespondentsintheNOPsurveywereaskedhowoftentheyatethefollowing:breakfast;chipsorcrisps;chocolate;amealmadefromscratch;organicfoods;vegetablesorsalad;takeawaymeals;fruitorfruitjuiceandreadymeals.

Womenreportedeatinghealthyfoods,includingfreshvegetables,fruitorfruitjuiceandmealsmadefromscratch,moreoftenthanmen,whoatemoretakeawaysandreadymeals.Thispatternwasreplicatedforolderpeople,halfofwhomreportedeatingamealmadefromscratcheveryday(comparedwithlessthanathirdofpeopleundertheageof24)and87%ofwhomreportedeatingbreakfasteveryday(comparedto39%ofpeopleundertheageof24).Olderpeoplewerealsolesslikelytoeatunhealthier(or‘junk’)foodsliketakeawayorreadymeals,chocolateandchipsorcrisps(seeFigure9)*.

Thedatashowsthatolderwomenarethosemostlikelytobeeatinghealthyfoods(e.g.organicfoodandmealsmadefromscratch)moreoftenandunhealthyor‘junk’foodslessoften.Thispatternisalsotrueforthosewhohavehigherhouseholdincomes,thosewhoaremarriedandthoseinfull-timeemployment(forexample,seeFigure10andFigure11)*.

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Figure �: Those eating ‘junk’ foods �-� times per week, across age groups

Figure �0: Those eating organic food �-� times per week, according to household income

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Disguisedamongstthestatisticsarethecontributionsmadetoourdietbydifferencesinfoodmanufacturingtechniques,includingthewayitisprocessedandrefined;foodadditives;useofpesticidesandthealterationofanimalfatsthroughintensivefarming.Table1summarisestheeffectofthesecommonfoodproductiontechniquesonourdietaryconsumption.

Table �: The impact of food production techniques on the diet

Technique Impact

Processing Manypackagedandprocessedfoodsarehighincalories,fat,saltandsugar.Forexample,softdrinkscontainanaverageof160caloriesand1.5ouncesofsugarpercan�.IntheUK,intheyear2000,theaveragepersondrank186litresofsoftdrinks.Inaddition,75%ofsaltinthedietcomesfromprocessedfoods,withwhitebreadoftenthesinglelargestsourceofsaltinanindividual’sdiet�0.

Processedfoodsarecommonlydevoidofnutritionalelements,suchasvitamins,mineralsandessentialfats(seeSection3).

Processedfoodshavealsoledtoadamagingtypeoffattobeintroducedmorewidelyintothediet.Trans-orhydrogenatedfathasnonutritionalbenefit,butmountingevidencesuggeststhatitismuchlesshealthythanevenstandardsaturatedfat.Althoughitexistsnaturallyinsmallquantitiesinsomeanimalproducts,itsavailabilityhasincreasedduetothegrowthofprocessedfoods.TheimpactofthesefatsonbrainfunctionwillbeexaminedinmoredepthinSections3and4.

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•

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Additives Thereisalonghistoryofaddingsubstancestofoodtoimprovetastesorpreventspoilage,includingsmoke,salt,alcohol,spicesandvinegar.However,the1950ssawanexplosionintheuseofchemicaladditionstofoodand,bythebeginningofthe1960s,therewere2,500differentchemicalsbeingusedinfoodproduction��.

Figure ��: Those eating a meal made from scratch every day, according to marital status

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Thewidespreaduseoffoodadditivesmeansthatanyonewhoeatsanyamountofprocessedfoodwillingestthem.IthasbeenestimatedthattheaveragepersonintheUKandotherindustrialisedcountrieswilleatover4kgofadditiveseveryyear��.

Theimpactofthissituationisstillcontroversial.Somegovernmentshaveappearedreluctanttofund,conductorpublishrigorouslycontrolledstudiesexaminingtheeffectsofadditivesandthisisparticularlythecaseregardingthe‘cocktaileffect’whendifferentadditivesarecombined.

Industrialised Farming

SincethedrivetoincreaseagriculturaloutputbeganinearnestaftertheSecondWorldWar,therehavebeenanumberofchangesincropproductionthatareinfluencingboththequantityandqualityofthefoodconsumedinthe21stcentury.Thesechangesaffectthecompositionofthefoodweconsumeanddecreasetherangeoffoodsfromwhichwecanobtainthenutrientsvitaltoourphysicalandmentalhealth.Forexample:

Thegeneticdiversityofcropsisdeclining.Onlyninecropsarenowresponsibleforoverthree-quartersoftheplantseatenand97%ofthevarietiesoffruitsandvegetablesfoundinNorthAmericain1900arenowextinct��,alongwith83%ofthevarietiesofwheatdevelopedintheMiddleEast��.

Alsoaffectingthemicro-nutrientcompositionofthefoodweeatisthedistanceittravelstogettoourplate.“Foodmiles”isthetermoftenusedtodescribehowfarafoodtravelsfromtheplaceitisgrowntotheplaceitiseaten.Itisdifficulttoestimateaccurately,butonestudycalculatedthatthefoodpurchasedinanaverageUKshoppingtripwillhavetravelledover3,000kilometres��.VitaminsA,C,E,riboflavin,folateandthiaminecaneasilybelostthroughlongstorage,exposuretolight,oxygenandheat��.

Severalstudieshavesuggestedthatthecontinuousreplantingandtheninadequatere-fertilisationofthesoilisleadingtopoorsoilquality.Ifthisisthecase,theresultwouldbealossofminerals,whicharethenabsentfromfoodgrowninthatsoil.

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Intensively reared animals

Changingmethodsoffarminghavealsointroducedhigherlevelsanddifferenttypesoffatintoourdiet.Forexample:

Theworldwideproductionofchickenin1961wasbelow9millionmetrictonnes–in2002,thatfigurehadrisentoover73million�.Thisdramaticriseinproductionhasonlybeenpossibleduetoconsiderablyintensifiedproductiontechniques.Chickensnowreachtheirslaughterweighttwiceasfastastheydidthirtyyearsago,whichhaschangedthenutritionalprofileofchickenmeat.Whereasachickencarcassusedtobe2%fat,itisnow22%.Inaddition,thedietfedtochickensisnolongerbasedoninsects,seedsandplants,butcommerciallygrowncerealsandsoya-basedfoods.Thishasreducedlevelsofomega-3fattyacidsandincreasedomega-6fattyacidsinchickenmeat��(seeSection3).

Thesameissuewasreportedincattleoverthirtyyearsago.Acomparisonofdomestic,intensivelyrearedcattleandwildbovidsfoundthatthecarcassofthedomesticanimalcontained30%fat,whereasthewildspeciescontained5%��.

Asimilarpatternhasbeenshownwithfish.Dueinparttoconcernsaboutfallinglevelsofwildfishstocks,modernfishfarmingwasdevelopedinthe1960s.Itisnowthefastestgrowingformoffoodproductionintheworld��and,becauseofthedietthatfarmedfisharefed,isleadingtochangesintheratioofessentialfattyacidsinfarmedfish,similartothatofchicken(moreaboutthisinSection3).

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Pesticides About350differentpesticidesarepresentlyusedinconventionalfarming,with31,000tonnessprayedeveryyearintheUKalone��.Althoughthereareconcernsaboutthehealtheffectsofpesticides,weregularlyconsumetheminthefoodweeat.TestingforresiduesbythePesticideResiduesCommittee(PRC)in2002foundthatnearly43%ofallthefruitsandvegetablestestedcontainedresidues,withsomeexceedingtheapprovedlimit�0.Thisincluded78%ofapplesand50%oflettucestested��andsimilarpatternshavebeenfoundincerealsandbread��.ThepotentialimpactofpesticidesontheveryyoungandasapossiblefactorintheonsetofAlzheimer’sDiseasewillbeexploredfurtherinSections3and4,respectively.

Itisclearthatwhatweareeatingnowisverydifferenttothatofevenourveryrecentancestors.Foodproductionandmanufacturingtechniques,coupledwithchanginglifestylesandincreasingaccesstoprocessedfoods,meanthatourintakeoffresh,nutritious,localproduceistoolow,atthesametimeasourintakeoffat,sugar,alcoholandadditivesistoohigh.Thequestionthisbringstomind,therefore,iswhatimpactthisdietaryshifthasuponournation’shealth?

2.3 Trends in the Health of the Nation

Oneresultofthechangesoutlinedaboveisariseinseriousphysicalhealthproblemsdirectlyattributedtothemoderndiet,includingobesity,coronaryheartdisease,diabetes,somecancers,osteoporosisanddentaldiseases��.Risingbloodpressurewithageisnowsocommonitisconsiderednormal,yethumansaretheonlyanimalstoexperienceitanditdoesnotoccurinmodernhunter-gatherersocieties��.

Ourphysicalhealthhasnotbeentheonlyaspectofourhealthtosufferoverrecentyears.Problemsinmentalhealthhavealsobeenincreasing,withdepressionpredictedtobecomethesecondhighestcauseoftheglobaldiseaseburdenwithinthenext20years��.latestfiguresalsoshowthat,worldwide,450millionpeoplesufferfrommentalhealthproblems,includingdepressivedisorders,bipolaraffectivedisorder(“manicdepression”),schizophrenia,Alzheimer’sandotherdementias,obsessivecompulsivedisorderandpanicdisorder.Mentalillnessesrepresentfourofthetenleadingcausesofdisabilityworldwideandaffectmorethan25%ofpeopleatsomepointintheirlives.Atanyonetime,about10%oftheadultpopulationissufferingfromamentalorbehaviouralproblem.Inpracticalterms,oneinfourfamiliesisaffectedbyamemberwithapsychologicalorbehaviouralproblem��.ThesefiguresarereflectedintheNOPsurveyconductedforthisreport(seeBox4).

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Box4:MentalHealthandDiet

RespondentstotheNOPsurveywereaskedtoidentifythenumberoftimestheyhadexperiencedproblemswithdepressingthoughtsorideas,anxietyorworryorproblemswithconcentrationandforgetfulnessinthepastmonth.Theresponsescouldrangefrom“notatall”to“atleastonceaday”.

Overall,halfofthesamplereportedthattheyhadexperiencedproblemstosomeextent,withoveraquarterofthesample(28%)indicatingthattheyhadexperiencedproblemsinoneoftheseareasatleastonceaweek.

Thesefiguresvarybetweengroups*.Forexample,youngerpeoplearemorelikelythanolderpeopletoreportdailymentalhealthproblems,asarethoseinclassDE,thoseonalowerincome,thosewhoarenotinpaidemploymentandthosewhoarenotmarried(forexample,seeFigure12).

Thisisconsistentwiththeevidenceshowingtheassociationbetweenmaterial,psychologicalandsocialdeprivationandmentalhealthproblems.Weknowthatdifferentaspectsofsocialstructureaffectmentalhealthandthosewhoareeconomicallyorsociallydisadvantagedarealsoatgreaterriskofexperiencingarangeofmentalhealthproblems,creatingacycleofinequality(foracomprehensivereviewofmentalhealthandinequality,seeRogersandPilgrim,2003��).

Therearealsosomeassociationsbetweenmentalhealthandpatternsoffoodconsumption*.Forexample,nearlytwothirdsofthosenotexperiencingmentalhealthproblemseatfreshfruitorfruitjuiceeveryday,comparedtounderhalfofpeoplewhoreportdailymentalhealthproblemsandthepatternissimilarforfreshvegetablesandsalad(forexample,seeFigure13).

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Figure ��: Those reporting daily mental health problems, according to marital status

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Figure ��: Difference in consumption of fresh fruit or fruit juice according to mental health status

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Theimpactofthesechangesinthementalhealthofthenationisnotisolatedtotheindividualexperiencingmentalhealthproblems,devastatingastheycanbeforthoseaffected.OnestudyintheUKshowedthatexpenditureoninpatientmentalhealthserviceswas22%ofthetotalinpatienthealthcarespending��,andin2000/1,thetotalcostofmentalhealthproblemswasover£77billioninEnglandalone(thiswastwicetheprojectedcost)��.Ofthis,£23.1billionwasduetolostemployment,as39%ofadultswithmentalhealthproblemsarenotinpaidemployment,andnearly£400millionwasspentdirectlyonantidepressantmedication,asprescriptionscontinuetoriseeveryyear(seeFigure14).latestfiguresestimatethatthecostiscontinuingtorise,withtheeconomicburdenfortheUKapproaching£100billionayear��.

Figure ��: Number of prescriptions for antidepressants in England and Wales from ���� to �00� (millions)

Similarly,65%ofpeopleinthegroupthathavenotexperiencedanymentalhealthproblemsoverthepastmontheatbreakfasteveryday,comparedto59%ofthosewhoexperiencementalhealthproblemsatleastonceaday.

Althoughthedirectionofcausationisdifficulttoestablishinasurveyofthisnatureandtheinterplayofotherfactors(suchasincomeandage)drawsacomplexpicture,twoelementsofthesurveyarereasonablyclear.Firstly,justoveraquarterofthepopulationindicatesomelevelofmentalhealthproblemandthisismostpronouncedintheyoungeragegroups.Secondly,thosewithmentalhealth

problemsarealsothosewhoareeatinglesshealthyfoods(freshfruitandvegetables,organicfoodsandmealsmadefromscratch)andmoreunhealthyfoods(chipsandcrisps,chocolate,readymealsandtakeaways).Furtherresearchisrequiredtoexplorethenatureandinteractionofthesepatternsandtodevelopstrategiestoempowerandencouragevulnerablepeoplegroups(especiallytheyoungandthoseonlowincomes)tomakechoicesthatwillbenefittheirmentalhealth.

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2.4 Conclusion

TheincreasingburdenofmentalhealthproblemsismirroringchangesinfoodproductionandconsumptionintheUK.Theevidencesuggeststhatthisisacontributorypartofthepicture.Asfarmingbecomesmoreintensiveandthenutritionalcompositionofsomeofthenation’sbest-lovedfoodsdeteriorates,stress-relatedillnessesarebecomingmorecommonandthegeneralmoodofthenationappearstobedeclining.Althoughsomenutritionistsandmanyinthementalhealthfieldhavelongbeenawareoftheimportanceofdietwithinanholisticapproachtoimprovingmentalhealth,shiftsinpolicyandpracticehavebeenslowertomaterialise.Inlightofthegloomypicturepaintedofthestateofthenation’shealth,whathopeisthereforreversingthetrendandexploringalternativemethodsforimprovinggeneralwellbeingandturningthetideofgrowingmentalhealthproblems?Itistothisquestionthatwenowturn.

2.5 References

1. Miller,C:garbagebythenumbers.NSWMAResearchBulletin,01-02,2001

2. OrtnerDJ,Theobaldg:PaleopathologicalEvidenceofMalnutrition,inTheCambridgeWorldHistoryofFood,vol1.EditedbyKipleK,OrnelasKC.Cambridge,TheCambridgeUniversityPress,2000

3. CohenMN:History,DietandHunter-gatherers,inTheCambridgeWorldHistoryofFood.EditedbyKipleK,OrnelasKC.Cambridge,TheCambridgeUniversityPress,2000

4. TudgeC:SoShallWeReap:Howeveryonewhoisliabletobeborninthenexttenthousandyearscouldeatverywellindeed;andwhy,inpractice,ourimmediatedescendantsarelikelytobeinserioustrouble.london,Allenlane,2003

5. WorldAgriculture:Towards2010(AnFAOStudy).EditedbyAlexandratosN.Chichester,FoodandAgricultureOrganisationoftheUnitedNationsandJohnWileyandSons,1995

6. TheNationalFoodSurvey.EditedbyDEFRA,HerMajesty’sStationaryOffice(HMSO),2002

7. HoareJ,Hendersonl,BatesCJ,PrenticeA,BirchM,Swang,FarronM:TheNationalDietandNutritionSurvey:adultsaged19to64years.EditedbyResearchTOfNSaTMRCHN,HerMajesty’sStationeryOffice(HMSO),2004

8. FAOSTATdata,2004,UNFoodandAgricultureOrganisation,2004

9. NestleM:FoodPolitics:Howthefoodindustryinfluencesnutritionandhealth.Berkeley,UniversityofCaliforniaPress,2002

10. Bread,Crisp,BeansandSoup-asSaltyasEver,inTheFoodMagazine,JanuaryMarch2003

11. FoodAdditives.NewYork,MarcelDekker,Inc,2002

12. HumphreysJ:ThegreatFoodgamble:Adevastatingindictmentofwhatwearedoingtoourfoodandhowitaffectsourhealth.london,HodderandStoughton,2001

13. MonocultureversusDiversity:TheIllusionofChoice,inFatalHarvest:TheTragedyofIndustrialAgriculture.EditedbyKimbrellA.Sausalito,FoundationforDeepEcology,2002

14. MillstoneE,langT:TheAtlasofFood:WhoEatsWhat,WhereandWhy.london,Earthscan,2003

15. JonesA:EatingOil:Foodsupplyinachangingclimate.london,Sustain:theallianceforbetterfoodandfarming,2001

16. CrawfordM,MarshD:TheDrivingForce:FoodinEvolutionandtheFuture.london,Mandarin,1989

17. CrawfordMandS:WhatWeEatToday.london,NevilleSpearman,ltd,1972

18. CloverC:TheEndoftheline:Howoverfishingischangingtheworldandwhatweeat.london,EburyPress,2004

19. PesticidesinYourFood,PAN-UK,2004

20. AnnualReportofthePesticideResiduesCommittee,2002

21. ThePesticidesinOurFood.london,FriendsoftheEarth,August2004

22. FerroluzziA,JamesWPT:EuropeanDietandPublicHealth:TheContinuingChallenge,Eurodiet,2001

23. UngarPS,TeafordMF(eds):TheHumanDiet:ItsOriginsandEvolution.london,Bergin&garvey,2002

24. MurthyRS,BertoloteJM,Epping-JordanJ,FunkM,PrenticeT,SaracenoB,SaxenaS:TheWorldHealthReport2001-MentalHealth:NewUnderstanding,NewHope.geneva,WorldHealthOrganisation,2001

25. TheEconomicandSocialCostsofMentalIllness.london,SainsburyCentreforMentalHealth,2003

26. Rogers,A.&Pilgrim,D.(2003).MentalHealthandInequality.PalgraveMacmillan:Basingstoke.

27. FundamentalFacts.MHF:london(inpress)

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3. THEROlEOFDIETINRElATIONTOMOODANDgENERAlWEllBEINg

3.1 A healthy brain

Atsomepointinourlives,mostofushaveexperiencedthatnauseousfeelingthatleavesusasking“…maybe it was something I ate…?”.Wesuspectthatourstomachmightrecoilafterbadly-cookedchicken,orourliverwillprotestaftertoomuchalcohol,but,forsomereason,wedon’talwaysapplythisintuitiontoanotherphysicalorganofthehumanbody–thebrain.

Maybeoneofthereasonsthatthehealthofourbrainisrarelyanimportantfactorinourdietaryconsiderationsisbecauseithasanauraofcomplexityunlikemanyofourothervitalorgans.Itdoesn’tcauseimmediatedistressinthewaythatourstomachmightwhenwegetfoodpoisoning,sowerarelylearntoconnectwhatweeatwithhowourbrainreacts.Yet,liketheheartorthestomachortheliver,thebrainisacutelysensitivetowhatweconsumeinourdailylives.Toremainhealthy,itneedsdifferentamountsofthefollowingessentialnutrients:

1. Complexcarbohydrates2. Essentialfattyacids(EFAs)3. Aminoacids4. VitaminsandMinerals5. Water

Inordertounderstandhowthesenutrientscontributetothehealthofthebrain,itishelpfultosummarisewhatthebraindoes,whatitismadefromandthemechanismsitusestoworkeffectively.

Thebrainispartlycomposedofbillionsofnervecells,knownasneurons.Neuronsusetheiruniquephysicalstructuretoallowthebraintocommunicatewithinitselfandthroughouttherestofthenervoussystem.Eachneuronisconnectedtothousandsofotherneuronsbybranchescalledaxonsanddendrites.Eachneuron,axonanddendriteispredominantlycomposedoffat,or‘lipid’andthesearederivedfromthediet.Specifically,theyaremadefromhighlyunsaturatedfats,whichensuresthattheyarehighlyflexibleandcanworkrapidly.Betweeneachbranch,thereisagapwheremessages(calledneurotransmitters)arepassedbackandforth.Thesemessagesallowneuronstocommunicateinformationamongstthemselves(seeFigure15).Neurotransmittersaremadefromaminoacids,whichoftenmustbederiveddirectlyfromthediet.Forexample,theneurotransmitterserotonin,whichisinvolvedinfeelingsofcontentment,ismadefromtheaminoacidtrytophan.Adrenalineanddopamine,neurotransmittersthatareinvolvedinhelpingusfeelmotivated,aremadefromphenylalanine.

Figure ��: How the brain communicates information between neurons

Neuron

Dendrites

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Inadditiontothecombinedrolesofgenesandenvironmentinbraindevelopment(especiallycriticalduringfetaldevelopmentandinfancy),dietisanotherfactorthatinfluencesthehealthofthebrain.Thisispartlybecausemuchofthebrain’sstructureisderiveddirectlyfromfood.Thereforeitiseasytoseethatwhatweeatwillhaveadramaticeffectonourthoughtsandfeelings.Justastheproductsthatweputintoacaraffectitsperformance,sotheengineofourthoughtsandfeelingsisdesignedtoworkmosteffectivelywhencertainnutritionalrequirementsaremet.Theserequirementspersistthroughoutthelifetimeand,asevidenceincreasinglydemonstrates,areimportantevenfrombeforeweareconceived.

3.2 A healthy brain for life

Thefoodweeathasthepotentialtoaffectourmentalhealthandwellbeingateverystageoflife.Thedevelopmentofthebrainatconception,duringpregnancyandthroughoutthefirstthreeyearsoflifearecriticalstagesinthisprocess�.Babiesbornatfulltermandatahealthyweight(i.e.thosewhosebrainsarefullyandhealthilydeveloped)havephysicalandcognitiveadvantagesoverotherpre-termorlow-weightbabies�,withdifferencesrecordedinIQ,languageandreadingability� � �.Studieshavealsoshownthatinfantswithlowbirthweightsarelessco-operative,lessactive,lessalertandlesshappythannormal-weightinfants�.

lowbirthweightcanariseformanyreasons,includingthedietofthemotherduringpregnancyorababybeingdeliveredpre-term.Exposuretosomepesticideswhilepregnantcanincreasethelikelihoodofapre-termbirth�.Alinkhasalsobeenfoundbetweenpesticideexposureduringpregnancyandasmallerinfanthead.Becauseheadsizehasbeenlinkedtolatercognitiveability,theremaybealinkbetweenpesticideexposureandsubsequentcognitivedevelopment�.

Thetrendcontinuesthroughoutinfancy.Thenutritionalintakeofaninfantaffectsitsneurodevelopment,whichaffectscognitiveoutcomesbothintheshortandlongterm� �.Manystudieshavefoundthatbabieswhoarebreastfedhaveaneurophysiologicaladvantageincomparisontobabiesfedwithformulamilkandexplanationsforthesefindingspointtotheincreasedlevelsofessentialfattyacids(EFAs)inbreastmilk.EFAsarecrucialelementsofthebrain’sstructureandarevitalforgoodbrainfunction(seepage42).OnetrialconductedtotestthistheoryfoundthatinfantsfedonformulamilksupplementedwithoneparticularEFAcalleddocosahexaeonicacid(DHA)inthefirstweeksoftheirlives,performedbetteroncognitive,languageandmotorabilitytestswhentheyhadreachedeighteenmonthsthanthosefedonstandardformulamilk�0.Anotherstudy,whichfollowedinfantsonsupplementedformulamilkuntiltheyhadreachedoneyear,foundcognitiveandlanguagebenefitsatoverthreeyearsofage��.

Asthechildcontinuestogrow,dietandnutritioncontinuetohaveacontributoryinfluenceonmentalhealth.Manyresearchers(alongwithparents,teachersandcampaigners)havesuggestedthatthechangesinnutritionprovidedinschoolandathomeoverthepast20yearsmaybeacontributingfactortotheriseofmentalhealthproblemsinchildhoodandadolescenceoverthattime��.MuchoftheresearchexploringtheconnectionbetweendietandmentalhealthintheseagegroupsfocusesonAttentionDeficitHyperactivityDisorder(ADHD)andthereisalsogrowingconcernabouttherisinglevelsofdepressionintheyoung.BothofthesespecificmentalhealthissuesareexploredinSection4.However,dietisalsoimplicatedinotheraspectsofmentalhealth,well-beingandbehaviourinyoungpeople.

Oneaspectthathasreceivedmuchattentionhasbeenacademicattainment,withmanystudieslinkingchildren’snutritionalstatustoachievementintheclassroom.Researchhasshownthatgoodnutritionalintakeislinkedtoacademicsuccess.Inparticular,severalstudieshaveshownthatprovidingchildrenwithbreakfastimprovestheirdailyandlong-termacademicperformance�� �� ��.Schoolsthathavebreakfastclubsalsoreportimprovedbehaviourintheclassroom(seeBox5).

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AimsMagicBreakfastaimstoensurethatnochildstartsaschooldayfeelinghungryandthereforeunabletoconcentrateorlearn.

Target groupMagicBreakfastdeliversbreakfastitemstothirteeninner-cityprimaryschoolsinlondon,UK.Approximatelyfortychildrenperschoolreceivetheservice.

History of organisationMagicBreakfastwascreatedwhenitsfounder,CarmelMcConnell,discoveredthatasignificantnumberofyoungchildrenintheUKarriveatschoolhungry.Herfirstreactionwastopersonallydeliverbreakfastfoodstofiveschools.Whenteacherssubsequentlyreportedthattheyhadseenapositivedifferencetotheschoolasaresultofthedonatedfood,CarmelcreatedtheMagicBreakfasttoformalisetheservice.Itbecamearegisteredcharityin2003.

Key ActivitiesDistributionofprotein-enrichedbagelsandhealthycerealstochildreninneedviabreakfastclubs(althoughsomeschoolsdistributethroughoutthemorningifrequired).

Provisionoffreezerstostorebagelsbetweendeliveries.

Deliveryofhealthyeatingeventstopupils,theirteachersandparents.Theseinclude:tryingnewfoods,learningnewrecipesandfunquizzesonnutritionalknowledge.

Offeringcompaniesarangeofdevelopmentopportunities(e.g.leadershipskills,team-building,mentoringprojects,websitedevelopment,financialstructuring)foremployeeswhowishtoassistinner-cityschoolcommunities.ThishappensthroughMagicBreakfast’ssisterorganisationMagicOutcomes.

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AchievementsAswellasthebenefitofendingimmediatechildhunger,teachershavereportedthatchildrenconcentratebetterandaremoreabletosettledownintheclassroom.Inaddition,theirabilitytosocialisewithotherchildrenhasalsoimproved(see‘Testimonies’below).Recently,MagicBreakfastwasawardedanUnltdMillenniumCommissionlevelThreeaward.TheseareawardedtosocialenterpriseorganisationsthatUnltdrecognisesashavingthepotentialtohaveanimpactatanationallevel.

Testimonies“It is noticeable that the children who are eating bagels before school or at playtime are more focused during the following lesson and find it easier to follow school rules.”

Headteacher, Kingsmead Primary School, Hackney, East London

“[An improvement in the children’s capacity to concentrate and learn has been] particularly noticeable in individual children who are known for unsettled behaviour and limited concentration spans.”

SHINE Academy co-ordinator, Millfields Community School, Clapton London E�

BarriersFunding.MagicBreakfastdoesnotchargeforanyofitsservicestoschools.AlthoughitdoeshaveasmallincomefromMagicOutcomes,itderivesmuchofitsfundingfromgrantsandcharitablegiving.

Time.Duetothebreadthanddepthoftheschoolcurriculum,findingtimetoimprovenutritionaleducationcanprovedifficult,regardlessofaschool’senthusiasm.

lackofawareness.Manyparents,organisationsandmembersofthegeneralpublicareunawareoftheimportanceofnutritionortheextentoftheprobleminschools.Therefore,supportfortheorganisationcanbelimited.

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Box5:MagicBreakfast-FuelForLearning

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Anumberofpublishedstudieshaveshownthathungrychildrenbehaveworseinschool,withreportsthatfightingandabsencearelowerandattentionincreaseswhennutritiousmealsareprovided�� �� ��.Severalstudieshavealsolookedattheimpactofnutritiononyoungerpeoplewithanti-socialbehaviourproblems.Onestudy,conductedinayoungoffenders’unit,foundthatsupplementingdietswithvitamins,mineralsandessentialfattyacidsresultedinsignificantandremarkablereductionsinanti-socialbehaviour��(seeBox6).

Box6:NaturalJustice

Aims NaturalJusticeisaregisteredcharitythatworkstodeterminethecausesofantisocialandcriminalbehaviour.Itdevelopsandpromotestechniquesforcareandrehabilitationthataddressthesocial,biologicalandenvironmentalinfluencesoncriminalbehaviour.

Target groupsThoseinvolvedincriminaloranti-socialbehaviourandthoseworkinginthecriminaljusticesystem.

History of organisationNaturalJusticebegan(underadifferentname)inCumbriawhereitsdirector,Bernardgesch,providedsupervisiontoyoungoffendersinthecommunitywhowouldhaveotherwisebeensentintocustody.Duringthistime,Mr.geschnotedthepoordietsofthoseinhischargeandin1988,heconvincedmagistratesinCumbriatolethimtesttheeffectsofdietonajuvenileoffenderwhohadfailedatallotherattemptsofrehabilitation.Theresultwasaswiftimprovementintheyoungman’sbehaviourandtheprogrammerapidlyattractedacademicandmedicalsupport.Individualdietaryandsupplementationprogrammeswerethendevisedandaround20youngpeoplewentthroughthenutritionprogramwiththeapprovalofthecourts.Somecasesresultedindramaticimprovementsinbehaviour.

ActivitiesNaturalJusticebringsexpertsfromdifferentscientificdisciplinestogethertotestempiricallywhetherdietcanchangeanti-socialandcriminalbehaviour.

Examinationoftheevidencethatlinksoffendingbehaviourwithpoornutritionandexposuretotoxicpollutants.

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AchievementsThecharityhasextensiveresearchcollaborationsandisnowbasedatOxfordUniversity.In2001,NaturalJusticeconductedadouble-blindrandomisedcontrolledtrialtoexaminepotentialbenefitsofimprovednutritioninayoungoffendersprison.231youngadultswereeitherprovidedwiththedailyrecommendedamountofvitamins,mineralsandessentialfattyacidsorplacebosandthenevaluatedforanti-socialbehaviour.Offendingratesofthosereceivingthenutrientswerereducedbyanaverageof35percent.

InMay2004theDutchMinistryofJusticeevaluatedtheresearchlinkingdietandantisocialbehaviour.Itconcludedthatthedietaryapproachwassufficientlycost-effectivethatitwouldallowthemtoimproveserviceswhilstachievingan18%costsaving.NaturalJusticehassincebeenaskedtoassisttheWorldHealthOrganisationinpreliminaryestimatesofhowmuchglobalviolencecouldbeattributedtopoordiet.

BarriersFunding.NaturalJusticegetsbyonscarceresources.Thefundingforitsinitialcontrolledresearchcamefromthecharitablesector,butitbelievesthatamorecostlyin-depthstudywillrequirepublicfunds.

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Itisnotonlychildhoodandadolescenceduringwhichfoodconsumptioninfluencesourmentalhealthandwellbeing.Theprotectiveeffectthatdiethasontheageingbrainisalsogrowinginevidenceandrecognition.Severaldementia-relatedorganisationspromotehealthydietsasapreventativemeasureagainstage-relatedcognitivedecline(forexample,theAlzheimer’sSociety’s“MindYourHead”campaignandtheAlzheimer’sAssociation’s“MaintainYourBrain”Campaign)andanincreasingnumberofstudiesshowthatadiethighinessentialfattyacidsandlowinsaturatedfatsslowstheprogressionofmemorylossandothercognitiveproblems.

ManystudieshavealsoexaminedtheimpactofpesticideexposureontheonsetofParkinson’sDisease(PD).Followingareviewofoverfortystudiesthatshowedanincreasedriskofthediseasefollowingexposuretoanumberofdifferentpesticides,theUKgovernment’sAdvisoryCommitteeonPesticideshasrecentlycalledformoreresearchintothisassociationandtoclarifywhichpesticidescreatethehighestrisk�0.Apreviousmeta-analysisofmanyofthesestudieshadalsoconfirmedarelationshipbetweenPDandpesticideexposure��.Exposurehasrangedfromthosewhoworkinagriculture��,thosewholiveinthevicinityofsprayedareas��,andeventhosewhohaveeatenlargeamountsofsprayedfruit��.

Onemechanismthroughwhichdietprotectsagainstcognitivedeclineistheprocessofmethylation,theprocessourbraindependsontocreate,maintainandrepairbraincellsandtheneurotransmittersthatpassbetweenthosecells.Technically,themethylationprocessinvolvesmethylgroups–madeofonecarbonatomandthreehydrogenatoms–beingaddedtoorsubtractedfromothermolecules.Inthisway,thebodyisabletomakethesubstancesitrequires(orbreakdownthoseitdoesn’t)andkeepawell-balancedandhealthycollectionofcells.Metaphorically,methylationislikethebrain’smechanic–monitoring,fixingandkeepingeverythingworkingasitshould.Thebetterthemechanicworks,thebetterthebrainworks.TheimpactofpoormethylationwillbeexaminedinmoredetailinSection4.

3.3 Food and mood in the general population

ThemajorityoftheUKpopulationareawareoftheconnectionbetweendietandobesityordietandcoronaryheartdisease.Similarly,anyonewhohaseversmoked,drankalcohol,teaorcoffee,oreatenchocolateknowsthatsuchproductscanimproveone’smood,atleastalittleandatleasttemporarily.However,whatseemstobelesscommonisanunderstandingthatsomefoodscanhavealong-lastinginfluenceongeneralmoodandmentalwellbeingbecauseoftheimpacttheyhaveonthestructureandfunctionofthebrain.

Whatweeat(anddrink)affectshowwethinkandfeeleverydayofourlives,regardlessofourage,genderorfamilybackground.Thisisreflectedinthestatistics:notonlyistheUKanationoftea-drinkers–inanaverageweekwedrink1billioncups–weareanationaddictedtomany‘feel-good’fares,includingcoffee,softdrinks,alcoholicdrinks,cigarettesandchocolate��.Althoughit’stemptingtoassumethatweallknowwhat’sbadforourhealthandthattheproblemiswiththetranslationfromthatknowledgetobehaviour,thepictureislessstraightforwardthanthat.Notonlyismuchofthepopulationunawareoftheconnectionbetweenunhealthyfoodproductsandmentalhealth,evenmoreareunawareoftheimpactofhealthyfoodsonourmoodandfeelings(seeBox7).

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Box7:TheAssociationBetweenFoodAndMood

RespondentstotheNOPsurveywereaskedtoindicatetheextenttowhichtheythoughtanumberoffoodsanddrinksaffectedtheirmoodorfeelings.Allofthefoodsareknowntoinfluencemoodandfeelingstosomeextent,althoughitwashypothesisedthatpeoplewouldbemoreawareofthelinkbetweenunhealthyfoodsandmoodthanbetweenhealthieralternatives.AsshowninFigure16,amajorityofrespondentsreportedthatbrownriceorpasta,fishandfruit&vegetablesdidnotaffecttheirmoodatall.

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Figure ��: The extent to which different healthy foods are perceived to affect mood and feelings in the general population

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However,similarpatternswerealsodemonstratedforfoodproductsthat,whenconsumedinlargeamounts,areunhealthyintermsofourmental(aswellasphysical)health,includingalcohol,fastfoodmealsandsomecarbonated,caffeinateddrinks(seeFigure17).

Statisticaltestsonthedatacollectedbythesurveyrevealthatahigherpercentageofthosereportingthatthesefoodproductsdonotaffecttheirmoodandfeelingsatallaremaleandareintheyoungeragegroups*.Thereareanumberofexplanationsforthisfinding,includingthepossibilitythattheirperceptionisaccurateortheirreportingisbiasedinsomeway.Analternativeexplanationisthatagenerationofyoungpeopleisbecomingincreasinglyunawareoftheconnectionbetweenwhattheyconsumeandhowtheyfeelandperhapsthatthereareunderlyingreasonswhymalesareparticularlyvulnerabletonotaccessingthatknowledge.

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Figure ��: The extent to which different unhealthy food products are perceived to affect mood and feelings in the general population

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Beforewelookatfoodsthatservethebrain–and,therefore,ourmentalhealth–it’simportanttounderstandhowsomeproductsinourdiethaveadetrimentaleffectonourthoughtsandfeelings,includingthosethatwethink‘boost’ourmoodfromtimetotime.Broadlyspeaking,therearetwogroupsoffoodsthatcanhaveanegativeeffectonmoodintheshortand/orlongterm.Onegrouptrickthebrainintoreleasingneurotransmittersthatwemaybelacking,therebycreatingatemporaryfixtothedeficiency,andonegroupdamagethebrainbypreventingthenecessaryconversionofotherfoodsintonutrientsthebrainrequires.Thethirdgrouparethosethatnourishandreplenishthebrainand,wheneatenregularlyandinsufficientquantities,areassociatedwithimprovementsinmoodandfeelingsofwellbeing.

3.4 Foods that trick the brain

Therearefourneurotransmittersthatareparticularlyimportantwhenitcomestoourthoughtsandgeneralmood:acetylcholine,serotonin,dopamine/adrenaline/noradrenalineand4-aminobutyrate(gABA).Asufficientbalanceoftheseneurotransmittersisessentialforgoodmentalhealth,astheyareinfluentialinfeelingsofcontentmentandanxiety,memoryfunctionandcognitivefunction.Thisbecomesapparentwhenpeoplehaveneurotransmitterimbalancesordeficiencies,whichcancreatemanysymptoms,rangingfromdifficultiesinsleepingtofeelingunmotivatedoranxious.

Somesubstancesaregoodattemporarilypromotingtheneurotransmitterthatwelackand,aswecraveandthenconsumethem,they‘trick’usintofeelingbetter,forawhile.Forexample,ifanindividualislowinlevelsofadrenaline,theymayfindthemselvescravingcaffeine,whichgivesashort-termboosttolevelsofadrenaline.Similarly,productscontainingnicotinetriggerthereleaseofgABAanddopamine,responsibleforreducingfeelingsofstress.Chocolateisanotherclassicexampleofthis‘trick’effect:itcontainssubstancesthatboostlevelsofnoradrenaline,whichsubsequentlyboostourfeelingsofwellbeingandenthusiasmforlife.Whilstwecanallprobablytestifytotheperceivedimmediatepsychologicalbenefitoftheseproducts,theprocessis–byandlarge–oneofdeceptionoverthelongterm.

Bymakingthebrainlesssensitivetoitsowntransmittersandlessabletoproducehealthypatternsofbrainactivity,thesesubstancesencouragethebraintodown-regulate��.Down-regulationisthebrain’sinstinctivemechanismforachievinghomeostasis:whenthebrainis‘flooded’byanartificialinfluxofaneurotransmitter(forexample,adrenalinetriggeredbyastrongcoffee),thebrain’sreceptorsrespondby‘closingdown’untiltheexcessismetabolisedaway.Thiscancreateaviciouscircle,wherethebraindown-regulatesinresponsetocertainsubstances,whichinturnprompttheindividualtoincreasetheirintakeofthosesubstancestogetthereleaseoftheneurotransmitterthattheirbrainislacking(seeFigure18).Thisisonereasonwhypeoplesometimescravecertainproducts.Thesectiononfoodsthatnourishthebrainwilllookatwaysofpromotingthereleaseofthebrain’sownneurotransmittersthroughfoodsthatdonottrickthebraininthisway.

Figure ��: How foods affect the regulation of the brain

More transmitters less receptors Less transmitters more receptors

Normal Down-regulation Up-regulation

Neurotransmitter Receptor Closed receptor

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3.5 Foods that damage the brain

Aswellasfoodsthattrickthebrainintoreleasing(orsuppressing)vitalneurotransmitters,certainfoods(anddrinks)dotheirdamagebyincreasingtheamountoftoxic‘free-radicals’oroxidantsinthebody.Oxidantsareunstablemoleculesthataremissingacriticalatom.Inordertostabilisethemselves,theysearchtofindandstealthatmissingatomfromanothermolecule.Unfortunately,inacquiringthesemissingatoms,oxidantsinjurehealthycells,damagingtheirDNAandcreatingthepotentialfordiseasebydamagingthetissuethatisbuiltfromessentialfats,proteins,andvitaminsthatarerequiredforoptimumbrainfunction.Althoughnormalcellfunctionsproduceasmallpercentageofoxidants,somefoodscanincreasetheiremissiontoalevelthatthebodycannotcopewithalone.Saturatedfats(e.g.butter,lard,wholemilk,coconutandpalmoils)andhydrogenated-ortrans-fats(unsaturatedvegetableoilsthathavebeenrefinedandhardened)aretwooftheworstculpritsinthiscategory.

Becausethebrainiscomposedofabout60%fat(whenwaterisremoved),thefatsweeatdirectlyaffectthestructureandsubstanceofthebraincellmembranes.Saturatedfats–thosethatarehardatroomtemperature,likelard–makethecellmembranesinourbrainandbodytissuelessflexible.Ifweeatlargequantitiesofsaturatedfats,theirrigidityisreflectedintherigidityofthebraincells.Althoughmostauthoritiesnowagreethatnomorethan11%ofourtotalcalorificintakeshouldbederivedfromsaturatedfats,theaverageadultpopulationintakeofsaturatedfatisapproximately13.3%offoodenergyandthatisbeforeweaddthecaloriesweconsumethroughtrans-fats��.

Therecentandwidespreadappearanceoftrans-fatinthedietraisesgreatconcern,particularlybecauseofitsimpactonthebrain,whereitassumesthesamepositionasessentialfattyacids(EFAs)inthebrain.Thisblocksthebrain’sconversionofEFAsintodocosahexaeonicacid(DHA)andeicosapentaenoicacid(EPA)sothatthosevitalnutrientsarenotabletoassumethepositiontheyneedtoforthebraintofunctioneffectively(seeFigure19).Trans-fatsareprevalentandpervasive,foundinprocessedfoodslikecommercially-madecakes,crispsandreadymeals.

Figure ��: How oxidants (e.g. trans-fats) affect the structure of the brain

Vitamin E

Essential fats

Oxidante.g trans-fats

Disarmedoxidante.g trans-fats

Vitamin E

Damaged fat

�0

Friedfood,smoking,alcoholandstressalsointroduceoxidantsintothebody.Waysofincreasingthebody’snaturalabilitytofightthesetoxinsareexploredbelow.

3.6 Foods that nourish the brain

Wehaveseenthatsomenutrientstrickthebrainbytriggeringanover-releaseofneurotransmittersandsomefoodsdamagethebrainbyreleasingtoxinsoroxidantsthatdamagehealthybraincells.Bothoftheseprocessesareimplicatedinlongtermmentalhealthissues.Fortunately,therearemanymorenutrientsthatservethebrainwithoutdeceptionordamage,andcanimprovemoodandmentalwell-being.

Firstly,therearesomefoodsthatcanhelpthebraintoreleaseanefficientbalanceofneurotransmittersthatwon’tleadtodown-regulation.Asmentionedearlier,therearefourneurotransmittersthatareparticularlyimportantwhenitcomestoourthoughtsandgeneralmood:acetylcholine,serotonin,dopamine/adrenaline/noradrenalineandgABA.Table2summarisestheeffectsofdeficiencyineachoftheseneurotransmitters,thefoodsthatwillmakethedeficiencyworseandthosethatwillimproveit.

Table �: Neurotransmitters and their effects (from Holford, �00���)

Neurotransmitter Effectsofdeficiency Foodstoavoid Foodstoconsume

Acetylcholine DeteriorationofmemoryandimaginationFewerdreamsIncreasedconfusion,forgetfulnessanddisorganisation

SugarDeep-friedfoodJunkfoodsRefinedandprocessedfoodsCigarettesAlcohol

Organic/free-rangeeggsOrganicorwildfish–especiallysalmon,mackerel,sardinesandfreshtuna*

Serotonin lowmoodDifficultysleepingFeeling‘disconnected’lackingjoy

Alcohol FishFruitEggsAvocadoWheatgermlow-fatcheeselean,organicpoultry

Dopamine lackingdrive,motivationand/orenthusiasmCravestimulants

Tea&coffeeCaffeinateddrinks&pills

Regular,balancedmealsFruitsandvegetableshighinVitaminCWheatgermYeastspread

gABA HardtorelaxCan’tswitchoffAnxiousaboutthingsIrritableSelf-critical

SugarAlcoholTea&coffeeCaffeinateddrinks

DarkgreenvegetablesSeeds&nutsPotatoesBananasEggs

*Recentandcurrenttrendsinthefishingindustryhaveledtosignificantconcernsaboutsocial,economicandenvironmentalsustainabilityoffishstocks.Ifyoudoeatwildfish,chooseonlythosesourcesthatarecertifiedwiththeMSC-label,whichensuresyourfishcamefromasustainablymanagedsource.Ifyouchoosetopurchasefarmedfish,makeitorganicallyfarmedfish��.

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Secondly,asidefromavoidingpollutantslikecigaretteandexhaustfumesandlearningtomanagestresseffectively,itispossibletocombattheeffectsofoxidantsbyensuringthatourdietisfullofanti-oxidants,thatis,foodscontainingthenutrientsthatdisarmtoxinsanddecreasebrainpollution.Themainsourcesarefruitandvegetables,whicharerichintheantioxidantsvitaminsA,CandE.

Accordingtostudiesusinghumanandanimalblood,certainfoods–thosehighinanantioxidantassaycalledORAC(oxygenradicalabsorbancecapacity)–mayprotectcellsandtheircomponentsfromdamagebyoxidants�0.Figure20demonstratesthevalueof14topsourcesofantioxidants.Otherantioxidantsincludeselenium(foundinoysters,brazilnuts,seeds,tunaandmushrooms);glutathione(tuna,pulses,nuts,seeds,garlicandonions);lipoicacid(redmeat,potatoes,carrots,yams,beetsandspinach)andco-enzymeQ(sardines,mackerel,nuts,seedsandsoyaoil).

Figure �0: the ORAC value of �� antioxidant foods�0

Inadditiontofeedingthebrainwithfoodsthatwillregulateneurotransmitteractivityandprotectingthebrainfromtheeffectsofoxidants,moodandfeelingsofwellbeingwillbeimprovedbyensuringthatone’sdietprovidesadequateamountsofcomplexcarbohydrates,essentialfats,aminoacids,vitaminsandmineralsandwater.

3.6.1 Complex Carbohydrates

Thebrainrunsonthefuelofglucose,usingmoreofthisnutrientthananyotherorganinthebody.Itisderivedfromcarbohydrates,whichareturnedintoglucoseupondigestionanddeliveredtothebrainandcellsinotherpartsofthebody.However,somecarbohydratesarebetteratfuellingthebrainthanothers,becausetheyarelessrefinedandthereforereleasetheglucosemoreslowly.Slow-releasing–orcomplex–carbohydrates,infoodslikewholegrains,vegetablesandbeans,takelongertodigestthanrefinedequivalentssuchaswhitebread,processedcerealsandsugar,thathave,inasense,been‘pre-digested’bytheprocessingtechniques.Choosingfoodsthattakelongertobeconvertedfromtheirrawstatetoglucosemeansthatyourbrainreceivesamorestableandconsistentflowoffuelwithwhichtofunction.

0 1 2 3 4 5 6

Prunes

Amount of ORAC units per 100g (in thousands)

Beets

Broccoli

Steamed spinach

Alfafa sprouts

Plums

Tenderstem broccoli

Raw spinach

Raspberries

Strawberries

Kale

Blackberries

Blueberries

Raisins

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3.6.2 Fats: Essential Fatty Acids (EFAs)

Althoughsomefatisoftenconsideredunhealthy,itisvitalforproperbrainfunctioning.The‘dryweight’ofthebrainiscomposedofabout60%fat,includingsaturatedfatandcholesterol,withapproximately20%ofthatmadefromtheessentialfattyacids,omega-3andomega-6.Omega-3andomega-6aregroupsofessentialfattyacids,ofwhichthereareanumberofdifferenttypes.Forexample,referenceisoftenmadetoarachidonicacid(AA),docosahexaeonicacid(DHA)andeicosapentaenoicacid(EPA).

Omega-3andomega-6aretermed‘essential’becausetheycannotbemadewithinthebody,somustbederiveddirectlyfromthediet.Eachfattyacidperformsvitalfunctionsinthestructuringofbraincells(orneurons),thereforeensuringthatsmoothcommunicationispossiblewithinthebrain.Oneoftherichestsourcesofomega-3fattyacidsareoilyfish.Fishconsumptionhasbeenreportedtohaveanassociationwithbettermoodsandahigherself-reportedmentalhealth��,evenafteradjustmentforfactorssuchasincome,ageandothereatingpatterns.Arecentstudyhasalsofoundfishconsumptiontobeassociatedwithareducedriskofcognitiveimpairment(includingmemory)inmiddleage��.Thestudyalsofoundaincreasedriskofimpairmentassociatedwiththeconsumptionofcholesterolandsaturatedfat,whichimpairstheefficientconversionoffattyacidsintobraincellmembranes.Omega-6fatsarefoundinarangeofseeds,vegetablesandvegetableoils.Althoughscientistsarestilluncertainofthereasonswhy,evidenceshowsthatunequalintakesofomega-6andomega-3fatsareimplicatedinanumberofmentalhealthproblems,includingdepressiveandaffectiveproblemsandconcentration/memorydifficulties.ThisevidenceisexaminedinmoredetailinSection4.

3.6.3. Amino acids

Neurotransmitters(the‘messengers’inthebrain)aremadefromaminoacids,someofwhichcanbemadeinthebodyandsomeofwhichneedtobederivedfromproteininthediet(thereforecalledessentialaminoacids).Someaminoacidsconvertdirectlyintoneurotransmittersmeaningthatifthedietdoesnotprovideadequateamountsoftheseaminoacids,sufficientneurotransmittersmaynotbeproduced,potentiallycreatingproblematiccommunicationbetweenneurons.

Adeficiencyincertainaminoacidsmayleavesomeonefeelingdepressed,apathetic,unmotivatedandunabletorelax��.Perhapsthemostwidelystudiedindiet-behaviourresearchhasbeentheconnectionbetweentryptophan(anaminoacid)andserotonin(aneurotransmitter).Tryptophanisfoundineggs,leanmeat,free-rangepoultry(especiallyturkey)andbeansandisfirstconvertedto5-hydroxytryptomine(5-HTP)beforebeingconvertedtoserotonin.Stableandsufficientlevelsofserotoninareimplicatedinmood,wellbeingandsleeppatterns.Aswellasincreasingone’sintakeoffoodsrichintryptophan,carbohydrates(eventhoughtheycontainnotryptophan)alsoincreaseitsavailability,becausetheinsulinreleasedondigestionputsthecompetingaminoacidstoadifferentuse,easingtryptophan’sentryintothebrain.Otheraminoacidshavealsobeenthefocusofacademicresearch,withpromisingresults.Forexample,tyrosine(whichconvertstodopamine,noradrenalineandadrenaline)improvesmentalandphysicalperformanceunderstressbetterthancoffee��andgABAhasbeenshowntobehighlyeffectiveagainstanxiety��.Forfoodsthatwillsupplyyourbrainwithsufficientamountsoftheseaminoacids,pleaserefertoTable2onp40.

3.6.4. Vitamins and Minerals

Vitaminsandminerals(calledmicronutrients)performanumberofessentialfunctionsinsupportofalltheprocessesdescribedabove,includingassistingessentialfattyacidstobeincorporatedintothebrainandhelpingaminoacidsconvertintoneurotransmitters.largeamountsofsomemineralsareneededwithinthebody,whilesomeareonlyrequiredinverysmallamounts(called‘traceelements’).Allvitamins,withtheexceptionofvitaminE(whichthebodyisabletosynthesise),mustbederivedfromthediet.

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Deficienciesinvitaminsandmineralsaresometimesimplicatedinanumberofmentalhealthproblems.Onoccasions,thefirstsymptomthatabodyisdeficientinacertainmicronutrientispsychological��(seesection4).Inaddition,somevitaminsworkasanti-oxidants,whichprotectthebrainfromthedamagingprocessofoxidation(seeabove).Vitaminsandmineralsalsoplayacrucialpartintheconversionofcarbohydratesintoglucose,fattyacidsintohealthybraincellsandaminoacidsintoneurotransmitters.Assuch,theyarevitalinpromotingandmaintainingpositivementalhealth.ThishasbeenobservedforvitaminsC��,B12��andB2��andhasledtoresearchonthemoodeffectsofdepletingorsupplementingvariousmicronutrients.

Onedoubleblind,placebostudysupplementedparticipants’dietswithnineseparatevitamins,atovertentimestherecommendeddailylevel,foroneyear.Attheendoftheyear,bothmenandwomeninthesupplementedgroupreportedbettermentalwellbeingthanthecontrolgroup�0.Thesamestudyalsofoundbetterperformanceonarangeofcognitivetestsamongstthefemalestakingthesupplement��.Thiamine,orvitaminB1,hasalsobeenthesubjectofanumberofstudies.Severalcontrolledtrialshavedemonstratedthatparticipantsexperiencelowmood,irritabilityandfatiguewhentheyhavealowthiaminestatus–andthattheirmoodimproveswhentheirstatusisincreased�� �� �� ��.Alowseleniumstatushasalsobeenassociatedwithpoormood��andthatsupplementingthedietwithseleniumleadstoimprovementsinmentalhealthandfeelingsofwellbeing��.Anotherstudy,whichdepletedseleniumfromsomeofthestudyparticipants’diets,recordedincreasedlevelsofhostilityanddepressedmoodswhenstatuswaslow��.Similarresultshavebeenfoundinstudieslookingatirondeficiency��.

Theseresults–ahandfulamongsthundreds–indicatetheimportanceofensuringregularandsufficientamountsofthesevitaminsandmineralsareconsumedinthediet.Table3liststhemajornutrientsthatthebodyneedsandwherebesttofindthem.

Table �: Table of essential vitamins and minerals and where to find them (from Holford, �00���)

Nutrient Effect of deficiency Food sources

VitaminB1 poorconcentrationandattention wholegrainsvegetables

VitaminB3 depression wholegrainsvegetables

VitaminB5 poormemorystress

wholegrainsvegetables

VitaminB6 irritabilitypoormemorystressdepression

wholegrainsbananas

VitaminB12 confusionpoormemorypsychosis

meatfish*

dairyproductseggs

VitaminC depression vegetablesfreshfruit

Folicacid anxietydepressionpsychosis

greenleafyvegetables

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Magnesium irritabilityinsomniadepression

greenvegetablesnutsseeds

Selenium irritabilitydepression

wheatgermbrewer’syeastliverfish*

garlicsunflowerseedsBrazilnutswholegrains

Zinc confusionblankminddepressionlossofappetitelackofmotivation

oystersnutsseedsfish*

*Recentandcurrenttrendsinthefishingindustryhaveledtosignificantconcernsaboutsocial,economicandenvironmentalsustainabilityoffishstocks.Ifyoudoeatwildfish,chooseonlythosesourcesthatarecertifiedwiththeMSC-label,whichensuresyourfishcamefromasustainablymanagedsource.Ifyouchoosetopurchasefarmedfish,makeitorganicallyfarmedfish��.

3.6.5 Water

Watermakesupabout80%ofthebrainandisanessentialelementinitsfunctioning.Inadequatehydration–eitherbecauseofinsufficientwaterintakeorasaconsequenceoftakingsomepsychiatricmedicines–hassignificantimplicationsformentalhealth.Theearlyeffectsofevenmilddehydrationaffectfeelingsofwellbeing,performanceandlearningandinthelongtermcarryahigherriskofanumberofhealthproblems.Forexample,initialsymptomsofdehydrationincluderestlessorirritablebehaviour,weaknessandfeelingunwell.Moreseveresymptomsincludelowbloodpressure,fainting,severemusclecontractionsinthearms,legs,stomachandback,convulsionsand,onoccasions,heartfailure.DuringanaveragedayintheUK,anadult’sbodylosesapproximately2.5litresofwater.Thiscanbethroughthelungsaswatervapour,throughtheskinasperspiration,orthroughthekidneysasurine.Ifsufficientfluidsarenotconsumedtoreplacethiswater,symptomsofinadequatehydration–includingincreasedirritability,lossofconcentrationandreducedefficiencyinmentaltasks–canappear.

Poorhydrationalsoadverselyaffectsachild’sabilitytoconcentrate,payattentionandremainalert.Waterconsumptioncanhaveanimmediatealertingandrevitalisingeffectonchildren,afactnotignoredbythegovernment,whoseguidanceforCaterersforSchoollunchStandards�0expectsthat“drinkingwatershouldbeavailabletoallpupilseverydayfreeofcharge”.However,theseareguidelinesonly,notrequirements-andtherearenoguidelinesforprovisionofwaterduringtherestoftheschoolday.AlthoughtheWelshAssemblyhasprovidedfreemains-fedwatercoolersandpersonalwaterbottlesto384schoolsinCommunitiesFirstareasandTheScottishExecutivehasfundedmains-fedwatercoolers,modernwaterfountainswithswannecksandpersonalwaterbottlesforallprimaryandsecondaryschools,schoolsinEnglandarestillawaitingsuchdevelopments.

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3.7 Conclusion

Thecontributionofwhatweeattohowwefeelisgainingevermorepublicrecognition.Thisisdue,inpart,totheincreasingbodyofacademicresearchdemonstratingtheassociationbetweenfoodandbrainfunction.Itisalsoduetohigh-profilecampaignsonthetelevisionandamongstmentalhealthorganisations.OneprojectthatexploredindepththeassociationbetweenfoodandmoodisdescribedinBox8.

AimsTheFoodandMoodProject(www.foodandmood.org)isaweb-based,user-led,self-helpservicethataimstohelpindividualsexploretherelationshipbetweendiet,nutritionandemotionalandmentalhealth.Italsofacilitatesthesharingofexperiencebyenablingpeopletorunworkshops,andthroughemaildiscussiongroups.

Target groupsTheFoodandMoodProjecttargetsthegeneraladultpopulation,althoughmuchoftheirinformationisappropriateforchildren.Individuals,voluntaryandstatutorysectororganisations,nutritionaltherapists,dieticiansandmentalhealthprofessionalsallusetheProject’sresources.

History of project TheProjectwasfoundedin1998withaMindMillenniumAwardbyformerregisterednutritionaltherapistAmandagearyafterherownexperienceofrecoveryfromill-healthusingdietaryself-help.TheFoodandMoodProjectcontinuedbeyondtheMillenniumAward-fundedperiod,workshopsweredeliveredthroughouttheUKandaquarterlynewsletterproduced.In2000a‘MindMeal’waslaunchedinconjunctionwithMind,andtheMindguidetoFoodandMoodwasalsopublished.TheProject’sapproachwasthendevelopedintoaself-helpbook,TheFoodandMoodHandbook(Thorsons,2001).In2002,aFoodandMoodSurveywasconductedandthesurveyreport,TheFoodandMoodSelf-HelpReport,waspresentedatanationalFoodandMoodconference,withthefindingspublicisedbyMindinthenationalmedia.

Key ActivitiesSince2003theProjecthasbeenaninternet-basedserviceprovidingFoodandMoodself-helpresourcessuchastheguideforWorkshopleadersdesignedfornon-nutritioniststofacilitatetheirownDIYFoodandMoodWorkshops.Moreresourcesarecurrentlyinproduction.

AchievementsTheFoodandMoodProjecthasgeneratedincreasedawarenessofanaccessibleandaffordableself-helpstrategy.TheFoodandMoodHandbookhasremainedinprintwithsteadysalescontinuing.WiththehelpoftheMindpressoffice,theProjecthasreceivedwidemediacoverageinthenationalprintandbroadcastmedia.

The2002FoodandMoodSelf-helpSurveyaskedasampleof200womenandmenquestionsabouttheirexperienceofusingthisformofself-help.80%saidthechangeswerebeneficial,withaquarterofrespondentseachspecificallyreportinglargeimprovementsto,oreventhedisappearanceofmoodswings(26%),depression(24%)andpanicattacks/anxiety(26%).

Box8:TheFoodAndMoodProject

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Wehaveseenthatfoodandmentalhealthareintrinsicallylinked,bothatspecifictimesinthelifecycleandamongstthegeneraladultpopulation.Justastheassociationbetweendietandphysicalhealthtooksometimetounderstandandembrace,sohasbeenthepatternfordietandmentalhealth.However,theplethoraofanecdotal,clinicalandcontrolledstudiesallpointtotheimportanceofdietasonepartofthejigsawinthepreventionofpoormentalhealthandthepromotionofgoodmentalhealthandwellbeing.Alsoincreasinginquantityandpaceisthecollectionofevidencethathighlightstheimportantroledietplaysinspecificmentalhealthproblems,suchasdepression,ADHD,Alzheimer’sandschizophrenia.Itistothisevidencethatwenowturn.

3.8 References

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Barriers

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44. BentonD,griffithsR,HallerJ:Thiaminesupplementationmoodandcognitivefunctioning.Psychopharmacology(Berl)1997;129(1):66-71

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46. BentonD,CookR:Theimpactofseleniumsupplementationonmood.BiolPsychiatry1991;29(11):1092-8

47. HawkesWC,Hornbostell:Effectsofdietaryseleniumonmoodinhealthymenlivinginametabolicresearchunit.BiolPsychiatry1996;39(2):121-8

48. RanganAM,BlightgD,BinnsCW:Ironstatusandnon-specificsymptomsoffemalestudents.JAmCollNutr1998;17(4):351-5

49. leytonM,YoungSN,PihlRO,EtezadiS,lauzeC,BlierP,BakergB,BenkelfatC:Effectsonmoodofacutephenylalaninetyrosinedepletioninhealthywomen.Neuropsychopharmacology2000;22(1):52-63

50. guidanceforCaterersforSchoollunchStandards,DepartmentforEducationandSkills,2001

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4. THEROlEOFDIETINRElATIONTOSPECIFICMENTAl HEAlTHPROBlEMS

Theprevioussectionshowedthatthereisgoodevidenceofanassociationbetweenthefoodweeat,ourbraindevelopmentandourgeneralmoodandwell-being.Thereisalsogrowingevidencethatdietplaysanimportantcontributoryroleinspecificmentalhealthproblemsanddiagnosedmentalillnesses.ThissectionpresentstheevidenceforthelinksbetweendietandAttentionDeficitHyperactivityDisorder(ADHD),depression,schizophreniaandAlzheimer’sdisease.

4.1 ADHD

ADHDisprevalentinapproximately4%ofthepopulation,mostcommonlyinchildhoodoradolescence,andmoreofteninboysthangirls.Itisacollectionofsymptomscharacterisedbyoveractivity,impulsivenessandaninabilitytosustainattention.lowself-esteem,underachievementanddifficultiesinsocialisingarealsooftenexperienced,alongwithahighoverlapwithotherlearningdisabilities,suchasdyslexia,dyspraxiaandautisticspectrumdisorders.Itcanpersistintoadulthood,resultingincontinuedproblemsofunderachievementandsocialdifficulty.

Alongsidebehaviouralmanagementstrategies,onewidely-usedtreatmentforADHDismedication,usuallyintheformofmethylphenidate(commonlyknownasRitalin).However,concernsaboutthelong-termimpactofthisandotherdrugshaveencouragedsupportgroupstolookatalternativeapproaches,includingdietarychanges.Manyparents,teachersandothershavereportedgreatimprovementswhendietarychangesareintroducedtochildrenwithADHD.Twofoodgroupsthathavesubsequentlybeenimplicatedthroughclinicalresearchareessentialfattyacidsandminerals.

4.1.1 Essential Fatty Acids (EFAs)

Theideaofalinkbetweenhyperactivityandessentialfattyacids(EFAs)wasfirstproposedbythefoundersoftheHyperactiveChildren’sSupportgroup(HACSg)overtwentyyearsago�(seeBox9).Throughsurveyingthechildrenknowntothegroup,similaritieswerefoundbetweenthechildren’sphysicalsymptomsandthesymptomsofEFAdeficiency.Theseincludedabnormalthirst,eczemaandasthma.FurtherstudiesconfirmedthatchildrendiagnosedwithADHDcommonlysharecharacteristicsofEFAdeficiency,whichincludedry,roughskin,dullhairandfrequenturination�.Followingthis,anumberofcontrolledtrialshavecomparedthelevelsofEFAsinchildrenwithADHDtothosewithout.

Oneoftheearliertrialscomparedthebloodof48hyperactivechildrenwith49non-hyperactivechildren,findingthatthelevelsofsomeEFAsweresignificantlylowerinthehyperactivechildren�.ThisfindinghasbeenreplicatedseveraltimesintrialsofchildrendiagnosedwithADHD,aswellasinadults.SometrialsalsonotedaninverselinearrelationshipbetweenlevelsofEFAsinthebodyandthedegreeofthedisorder(i.e.thelowerthelevel,theworsethesymptoms).Onefoundthisparticularlyassociatedwithdeficienciesoftotalomega-3fattyacids�.Arecenttrial,whichwastestingchildrendiagnosedwithdevelopmentaldyspraxia,alsofoundthattheoften-accompanyingADHDsymptomsdecreasedsignificantlywhenthechildrenweregivenanomega-3supplement�.

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AimsTheHACSgaimstoraiseawarenessanddisseminateinformationabouttheconnectionbetweenachild’sdietandhisorherbehaviour.

Target groupsTheHACSgtargetsparentsandcarersofchildrenandyoungpeoplewhoarehyperactiveordiagnosedwithADHD.Italsotargetstheprofessionalschargedwithdiagnosingorprovidingcareforchildrensufferingbehaviouralproblems.

History of organisationTheHACSgwassetupin1977bySallyBunday,whoseson’shyperactivitygreatlyimprovedinresponsetothedietarychangesrecommendedbytheFeingoldDiet*.Thefamily’shealthvisitorbegantopasstheinformationontootherinterestedparents,atwhichpointamoreformalorganisationwascreated.

ActivitiesPromotingawareness.TheHACSgemploysanumberofactivitiestoincreaseawarenessofthelinkbetweendietandbehaviour.Theseincluderunningawebsite,writingarticlesforpublication,arrangingpresentations(toschoolsandotherinterestedgroups)andnetworkingwithanumberofrelatedorganisationsandresearchers.

Publications.Approximately1,000newslettersaresentoutthreetimesayear.OtherpublicationsincludeHyperactivityintheClassroom,whichwasaimedatteachersandschooladministrators,asummaryoftherelatedresearchandacollectionofcasehistories

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Support.TheHACSgprovidesaninformationservice,viaemailandtelephone,whereparentsandcarerscangetindividualinformationandsupportonbeneficialdietarychanges.Itcanalsoreferparentsorcarerstolaboratorieswhereachildcanbetestedfornutritionaldeficienciesorfoodallergies.Regularworkshopsareheldinlondon,normallyfourperterm,whereanutritionistcanofferhelpondietarychangesandstrategiesforcopingwithhyperactivity.

AchievementsSincerecordsstartedbeingkept,theHACSghashadapproximately250,000members.Itestimatesthateverypersonwhojoinsismultipliedbytenmorewhoreceiveitsinformation.TheHACSgregularlyreceiveslettersfromparentswhohaveseenremarkablechangesintheirchildren’sbehaviouroncedietarychangeshavebeeninstituted.ParentshavecreditedtheHACSgforeverythingfromachild’sabilitytogainentrancetouniversitytostoppingproceedingstotakeachildintocare.Mostrecently,founderSallyBundaywasawardedanMBEforherworkforparentsandchildrenoverthepast27years.

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Box9:TheHyperactiveChildren’sSupportGroup(HACSG)

4.1.2 Minerals

AsimilarinverserelationshiphasbeenfoundwithlevelsofironinchildrenandsymptomsofADHD�anddeficienciesinmagnesiumandzinchavealsobeennoted� �.OnestudyfoundthatathirdofthosewithADHDshowedamarkedzincdeficiency,whichcouldnotbeaccountedforbydietaryintake�,andthishasledtoseveraltrialstestingtheefficacyofzincsupplementation.Findingshaveconsistentlyshownsignificantimprovementswithzincwhencomparedwithplacebo,alongsidenormalmedication�0orasastand-alonetreatment��.Similarresultshavebeenrecordedwithmagnesiumsupplementation��.

Twoissueswithresearchinthisareaarethedifficultyinestablishingcauseandeffectandthelackofstudiesexaminingthecollectivecontributionofcombinednutritionalsupplementation(individualnutrientsareusuallyexaminedinisolation).Furtherresearchisrequiredtodisentanglethecomplexinterplayoffactorsthataredescribedabove.

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Testimonies“After following the diet changes you sent us and daily Zinc drops, Charlie** is a different child. After just a few weeks at the diet and drops, the change in him was noticeable...the difference was truly staggering...”

“Lapses in diet result in such lapses in behaviour that sceptical relatives and friends have been convinced. Have successfully recommended the diet to other parents.”

“For years, Peter was a real Jekyll and Hyde character. Sometimes he was lovely and charming and other angry and argumentative...I constantly asked myself ‘What am I doing wrong?’ worried it was down to poor parenting...Then, three years ago, I started to realise that Peter’s moods were affected by things he ate. So I began to keep a record of everything that he ate and the effect it had on his mood. Seeing a link between the additives in these foods and his bad behaviour I contacted [the HACSG] and they sent me information about e-numbers and the effect they can have on some children. I cut them out of Peter’s diet and the change in him was incredible. He was so much more relaxed, no longer hyper...his concentration both at home and school is so much improved and he’s a real pleasure to be around.”

“The response was almost immediate (three days) and the improvement sustained. When zinc was taken out, the symptoms reappeared, when zinc was reintroduced, the symptoms reduced again.”

BarriersFunding.TheHACSgreliesonmembershipfeesandsmallgrantsanddonationstosurvive.grantsaretypicallyfromtrustsandfoundations,withverylittlefundingfromgovernmentsources.Withthepopularityoffundingbodiespreferringtofundproject(asopposedtonormalrunning)costsandthegrowthoffreeinformationontheinternet,theHACSgstrugglestocontinuetooperate.

Integrationintomainstreammedicalpractice.TheHACSgreportsthatwhenparentstakehyperactiveandproblematicchildrentotheirgP,littlementionismadeofthelinkbetweendietandbehaviour.

*TheFeingolddietfocusesontheinfluenceoffoodadditives(preservativesandcolourings)onchildren’sbehaviour.

**Nameshavebeenchangedthroughoutto protectidentity.

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4.2 Depression

DepressionisthemostcommonmentalhealthproblemintheUK,characterisedbythepresenceofoneormoreofthefollowingsymptoms:feelingsofworthlessnessorguilt;poorconcentration;lossofenergyandfeelingfatigued;thoughtsofsuicideorpreoccupationwithdeath;lossorincreaseofappetiteandweight;disturbedsleep;physicalandmentalslowingdownandrestlessnessoranxiety.Thepresentationofdepressioninthepopulationhasincreaseddramaticallyoverrecentdecades��andthishasbeenaccompaniedbyadecreaseintheageofonset,withmorecasesreportedinchildren,adolescentsandyoungadults��,andmirroredbytheincreasingprescriptionsforantidepressantmedicationoverthepastdecade(seeSection2).Antidepressantsstillremainthefirstchoiceoftreatmentinprimarycare,despitenon-chemicalinterventionssuchasexerciseandacupuncturebeingaseffectiveformildtomoderatedepression�� ��.Athirdnon-chemicaltherapeuticapproachfocusesonthediet(seeBox10).

Box10:DietAndDepression

Complexcarbohydrates,aswellascertainfoodcomponentssuchasfolate(folicacid),omega-3fattyacids,selenium,andtryptophanmaydecreasesymptomsofdepression.

complex carbohydrates Consumingfoodsthatarehighintryptophanalongwithfoodshighincomplexcarbohydrateswillhelpenhancetheproperabsorptionoftyptophanmoreeffectively.Carbohydratesmayalsoboostserotoninactivityinthebrain.

leadingfoodsourcesofcomplexcarbohydrates:broccoli,brownrice,potatoes,pasta,wholewheatandgrains.

folic acid Becausefolicacidisoftendeficientinpeoplewithdepressivesymptoms,gettingmoreofthisvitaminthroughfoodsmayhelp.Thevitaminappearstohavetheabilitytoreducethehighlevelsofhomocysteineassociatedwithdepression.

leadingfoodsourcesoffolicacid:asparagus,spinach,avocados,Brusselssprouts,Savoycabbage,beans,chick-peas,soybeans,lentils,oranges,peas,turkey,broccoli.

omega-3 fatty acids Certainomega-3fattyacidsmaybebeneficialfordepression.

leadingfoodsourcesofomega-3fattyacids:salmon*,trout*,tuna*,flaxoil,rapeseedoil,pumpkinseeds,soyabeans,almonds.

tryptophanleanprotein,containingtryptophanandl-phenylalanine,encouragesthebraintoproducetheendorphinsserotoninandnoradrenaline.

leadingfoodsourcesoftryptophan:organicleanmeat,organicpoultry(especiallyturkey),gameandfree-rangeeggs.

*Recentandcurrenttrendsinthefishingindustryhaveledtosignificantconcernsaboutsocial,economicandenvironmentalsustainabilityoffishstocks.Ifyoudoeatwildfish,chooseonlythosesourcesthatarecertifiedwiththeMSC-label,whichensuresyourfishcamefromasustainablymanagedsource.Ifyouchoosetopurchasefarmedfish,makeitorganicallyfarmedfish��.

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Therearethreekeynutrientgroupsimplicatedindepression:EFAs,vitamins&mineralsandaminoacids.

4.2.1 Essential Fatty Acids (EFAs)

Anumberofcross-countryandpopulation-basedstudieshavelinkedtheintakeofcertainfoodsornutrientswiththereportedprevalenceofdifferenttypesofdepression.Severalstudieshavelookedattheintakeofessentialfattyacids,measuringintakebytheamountoffishorseafoodconsumed.Correlationsbetweenlowintakesoffishbyacountryandhighlevelsofdepressionamongstitscitizens–andthereverse–hasbeenshownformajordepression��,post-nataldepression(PND–seeFigure21)��,seasonalaffectivedisorder�0andbipolaraffectivedisorder��.Epidemiologicalresearchhasalsobeenconductedwithspecificpopulations.AstudylookingatthechangingdietsofpeopleslivingintheArcticandSubarcticregionsfoundthatlevelsofdepressionwererisingatthesametimethattraditionaldiets,whichwerehighinEFAs,werebeingabandonedformoreprocessedfoods��.

Figure ��: Fish consumption and prevalence of post-natal depression (PND) across countries (from Hibbeln, �00���)

ThesefindingshavepromptedmanystudiesinvestigatingtheeffectivenessofEFAsintreatingdepression.Anumberofcasestudieshavebeenpublished,someofwhichshowdramaticeffectsofomega-3supplementationondepressivesymptoms.OneofthesesuppliedEPA,anomega-3fat,asanadditionaltreatmenttoanindividualwhohadpreviouslynotshownimprovementonantidepressants.NinemonthsafterbeginningtreatmentwithEPA,alldepressivesymptomshadgone.TheresearchersalsofoundthattheEPAtreatmentwasaccompaniedbysignificantstructuralchangesintheindividual’sbrain��.SimilarresultshavebeenfoundincontrolledtrialsofEPAforbipolardepression��andchronicclinicaldepression�� ��.

Theproliferationofclinicalresearchhasbeendocumentedinanever-increasingnumberofbooksaimedatinformingthegeneralpublicofthebenefitsofeatingfoodsrichinEPA(namely,oilyfishandflax-seedortheiroils)inmanagingandbeatingdepressiveproblems�� �� �� ��.Oneissuethathasbeenthefocusofresearchinrecentyearsistheneedforbalancebetweenlevelsofomega-3andomega-6inourdiet.Becausetherehasbeenan

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increaseintheuseofrefinedvegetableoilsintheUK(andUSAandAustralia)and,becauseatthesametimelevelsoffishconsumptionhavebeenfalling,expertssuggestthatmostpeopleconsumingWesterndietseattoomuchomega-6andnotenoughomega-3.Someexpertshavelinkedthisimbalancetophysicalhealthproblemssuchasfluidretention,raisedbloodpressureandincreasedbloodclotting��.Inaddition,someresearchhaslinkedtheimbalancetodepressiveandschizophrenicsymptoms�0 �� ��.Theprecisemechanismthroughwhichthisimbalanceaffectsphysicalandmentalhealthisstillunclear.Althoughthereisageneralconsensusthatintakeofomega-6intheUKshouldbereduced(andintakeofomega-3increased),furtherresearchisrequiredtoestablishthewaysthroughwhichthisprocessoperates.

4.2.2 Vitamins and Minerals

Otherresearchhasfocusedontheroleofvitaminsandmineralsandtheirassociationwithdepressivesymptoms.Onestudyofover2,000peoplefoundacorrelationbetweendietaryintakeoffolate,orfolicacid,anddepression.Thosewithlowintakesoffolateweresignificantlymorelikelytobediagnosedwithdepressionthanthosewithhigherintakes��,andthisfindinghasbeenreplicatedinotherpopulations�� ��.

Ofcourse,establishingthedirectionofcauseandeffecthasbeenamoredifficulttask.Nonetheless,trialslookingattheefficacyoffolatesupplementationondepressivesymptomsconcludethataddingthemicronutrienttoexistingtreatmentimprovedoutcomesmoresignificantlythanstandardtreatmentalone��.SimilarconclusionshavebeendrawnfromstudieslookingattheassociationofdepressionwithlowlevelsofzincandVitaminsB1,B2andC.Supplementingstandardtreatmentwiththesemicronutrientsresultsingreaterreliefofsymptomsinpeoplewithdepressionandbipolaraffectivedisorder,insomecasesbyasmuchas50%�� �� ��.Onemechanismthroughwhichvitaminsandmineralsimprovementalhealthandcognitivefunctionistheirsupportingroleinthebrain’sconversionofaminoacids.

4.2.3 Amino acids

Oneofthecharacteristicsofdepressionisareductionintheamountoftheneurotransmitterserotonininthebrain.AntidepressantslikeProzacblockthere-uptakeofserotonin(hencetheirname-selectiveserotoninreuptakeinhibitorsorSSRIs).Oneimpactoftakingsuchmedicationisthatmoreserotoninbecomesavailabletothebraintohelpimprovemoodandfeelingsofwell-being.Becauseofthis,theprecursortoserotonin-theaminoacidtryptophan-hasbeenthefocusofmuchresearch.

Thereisevidenceshowingthatconsumingtryptophanleadstoanincreaseofbrainserotonin,andremovingitfromthedietreducesserotonin�0 ��.However,theresultsoftrialsusingittotreatdepressionhavebeeninconsistent.Ofthestudiescomparingtryptophantoplacebo,onlyasmallnumbershowedtryptophantobesuperior–comparingittoantidepressantsshoweditonlytobeequivalentorinferiortothedrug��.However,controlledstudiesthatcomparedthecombinationofantidepressantsandtryptophantoantidepressantsandaplaceboconsistentlyfoundthattheadditionofthetryptophangavebetterresults��.Reasonsforthismayincludethefactthatthelevelsoftryptophanavailableforconversiontotheserotonintransmitterisnotonlyaffectedbytheamountinthediet.Otherdietaryfactorshelpdetermineitslevels.Forexample,protein(eventhoughitcontainstryptophan)decreasesitsavailabilityinthebrainbecauseitintroducesaminoacidsthatcompetewithtryptophanfortransporttothebrain.Carbohydrates(eventhoughtheycontainnotryptophan)increaseitsavailability,becausetheinsulinreleasedondigestionputsthecompetingaminoacidstoadifferentuse,easingtryptophan’sentryintothebrain.Inaddition,anumberofdifferentenzymes,mineralandvitaminsareessentialtoconverttryptophantoserotonin.Thus,ifanyaremissing,serotoninwillnotbemade,regardlessoftheleveloftryptophanconsumed��.

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AimsTheteamexiststohelpthosewhoareexperiencingtheirfirstepisodeofpsychosis.Thisincludesimprovingtheirnutritionandactivitylevel,withtheaimofpreventingthephysicalcomplicationsofschizophreniaandimprovingthementalstate.

Target group:Youngpeopleexperiencingtheirfirstepisodeofpsychosis.

History of projectThisserviceisprovidedwithintheDoncasterandSouthHumberNHSTrust.AllEnglishmentalhealthservicesarerequiredundertheNationalServiceFrameworktoestablishEarlyInterventioninPsychosisteams.TheseteamsarerequiredtofollowguidanceofthetreatmentofschizophreniapublishedbytheNationalInstituteforHealthandClinicalExcellence,whichfocusesprimarilyonmedicationandpsychosocialtreatmentforschizophrenia.Inadditiontothesecoretreatments,theRotherhamteamhasestablishedlifestyleinterventions,incorporatingnutritionandexercise,fromtheearlieststageoftreatment.ThesehavebeeninplacesinceMay2005.

ActivitiesNutritionalassessment.TheprojectissupportedbyanutritionistemployedbyDoncasterandSouthHumberHealthcareNHSTrust,andbytheTrust’sphysiotherapydepartment.Allnewserviceusershaveafullnutritionalassessmentandanalysis.Nutritionaldeficienciesinthedietareinitiallyincreasedbyusingsupplements(omega-3fattyacids,multivitaminandmineralpreparations)andserviceuserswhohaveanexcessofpoornutrientsareadvisedtoreducetheirintakeofsaturatedfatandsugar.Continuingnutritionalfeedbackisgivenwiththeaimofachievingoptimumnutritionfromabalanceddiet,withouttheneedforcontinuingsupplements.

Physicalexercise.Aphysicalactivityassessmentisalsocarriedoutbythephysiotherapistandaprogrammeofactivitiesdevisedtosuittheserviceuser.Thisissupportedbylocalfacilitiesinthecommunity(gym,swimming,etc.)aswellascommunitysportsstafftakingexercisetogetherwiththeindividual.

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Box11:RotherhamEarlyInterventionTeam:DoncasterandSouthHumberNHSTrust

4.3 Schizophrenia

Schizophreniaisasevereandenduringmentalhealthproblemcharacterisedbyhallucinations,delusionsanddisorderedthinking.Itoccursinapproximatelyoneineveryhundredpeopleandalthoughincidenceratesaresimilararoundtheglobe,therearedifferencesinoutcomesbetweencountries.generally,peoplewithschizophreniainpoorercountriesfarebetterthanthoseinricher,industrialisedcountries.IntheWHO10-countrystudyattwo-yearfollow-up,forexample,thepercentageofcaseswithfullremissionafterasingleepisoderangedbetween3%intheUSAand54%inIndia��.Thisimpliesthatenvironmentalfactorshavesomeroleindeterminingthedurationandseverityofthesymptoms.Oneavenueofresearchhasfocusedontheroleofdietintheoutcomeofschizophrenia(seeBox11).

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TheimportanceofdietintheonsetanddevelopmentofschizophreniaiswellillustratedintheDutchFamineStudy��.TowardtheendofWorldWarII,theNaziblockadeofwesternHollandledtoaseverefamineinthatarea.Sincethefaminewasbothsuddenandtime-limited,andrelativelycompletehealthdataonthepopulationwereavailable,itwassubsequentlypossibletorelatethedegreeandtimingofnutritionaldeprivationtoavarietyofhealthconditions.Resultsshowedthatseverefamineexposureinearlypregnancyledtoatwo-foldincreaseinschizophreniarequiringhospitalisationinbothmaleandfemalechildren.Arecentstudyalsoreplicatesthisfindinginthecontextofthe1960sChinesefamine��.

Otherstudieshavelookedattheimpactofspecificnutrientsontheratesofschizophreniainapopulation,focusingonfatsandantioxidants.

4.3.1 Fats

OneexampleofresearchontheroleoffatanditsassociationwithschizophreniaisaDanishstudythatcomparedtheamountoffatintheaveragenationaldietwithratesofschizophrenia��.Theresearchersfoundsignificantcorrelationsbetweenlowintakesoffatfrombirdsandlandanimals(i.e.saturatedfats)andlowerratesofschizophrenia.Correspondingly,wheretherewerehigherpercentagesoffatfromvegetables,fishandseafood,therewerereducedratesofschizophrenia��.Thisepidemiologicalevidenceisconsistentwiththeobservationthatthepeoplewiththismentalhealthproblemhavelowerlevelsofpolyunsaturatedfattyacids(PUFAs)intheirbodiesthanthosewithout�� ��.AswithdepressionandADHD,oneoftheprimarysuspectsintheassociationistheomega-3fattyacidEPA��,withanumberofstudiesshowingreductionsinsymptomswithhigherintakesofthisfattyacid�� �0 ��.

Theseobservationshaveledtolargerstudies,includingfivedoubleblindrandomisedcontroltrials.Thefirstoftheseattemptedtodistinguishbetweentheeffectsofthetwoomega-3fattyacids,EPAandDHA.Forty-fivepeoplewithschizophreniaweredividedintothreegroupsandreceivedeitherDHA,EPAoraplaceboforthreemonths,inadditiontotheirnormalmedication.AllthosereceivingEPAshowedimprovementintheirsymptomsthatwerestatisticallysignificantoveranyimprovementonDHAortheplacebo�0.ThesecondtrialusedonlyEPAoraplacebowithpeoplewhowerepreviouslynottakingmedication,butgivenantipsychoticsifdeemedclinicallynecessary.Twelveweregiventheplacebo,whilefourteenweregivenEPAforthreemonths.Attheendof

AchievementsTheRotherhamteamhasfoundthisapproachtobeverywellreceivedbyserviceusers.Manypeoplearereluctanttotakeanti-psychoticmedication,butarewillingtostayincontactwiththeservicewhentheyareofferedlifestyleapproaches.Theteamhasfoundthatmodifyingnutritionismucheasierinthisgroupthaninserviceuserswithalongerhistoryofmentalhealthproblems.

Theservicehasnotbeenestablishedforsufficientlylongtoevaluatelong-termeffectsuponphysicalandmentalhealth,althoughshort-termbenefitshavebeenrecorded.Oneserviceuser,seenforjustoveramonth,hasreportedincreasedenergyandagenerallybettersenseofwellbeing.Theteamwillsystematicallyevaluatethelong-termbenefitsoftheapproach.

BarriersStaff.ThemainbarriertoestablishingthisapproachwithintheNationalHealthServiceisthelackofsuitablyqualifiedandexperiencedstaff.Veryfewdieticiansandnutritionistsarealsoskilledindealingwithmentalhealthissues.

lackofsupportwithintheprofession.Asecondbarrierisscepticismfromsomementalhealthprofessionalsandmanagers,althoughtheteamdoesreceiveasympatheticreceptionwithinitsownorganisation.Theteamsuggeststhatscepticismbedealtwithbyhighlightingthatfoodconsideredtobegoodforthebrainisknowntobegoodforthebodyandthereforeanylifestyleapproachesusedtohelpmentalhealthproblemscanalsohelppreventphysicalillnesses.

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thestudy,alltwelvewhohadreceivedtheplaceboneededantipsychotics,whileonlyeightofthefourteenintheEPAgroupweremedicated,andstillshowedimprovementofsymptoms.FurtherresearchisrequiredtotesttherepertoireofEPA’stherapeuticbenefitsamongstthosewithsevereandenduringmentalhealthproblems.

4.3.2 Antioxidants

Furtherstudiesintotheaetiologyofschizophreniahasshownthatantioxidantenzymesarealsolowerinbrainsofpeoplewithschizophrenia,suggestingthattheircellsaremorevulnerabletooxidation��.Inlightofthis,onestudycomparedeighteenpeoplewithschizophreniawithfifteenothers,measuringthelevelsofoxidantsknownassuperoxides.Thosewithschizophreniashowedasignificantlyhigherlevelofsuperoxideswhencomparedtothecontrolgroupandtherewasalinearrelationshipbetweenthelevelofsuperoxidesandthelevelofnegativesymptoms��.Thatsaid,trialstestingtheefficacyoftreatingschizophreniawithantioxidantsandvitaminshaveprovedinconclusive.Onedoubleblind,randomizedcontrolledtrialtestingvitaminB6showednoimprovementinschizophrenicsymptoms��,whileanothercontrolledtrialtestingsupplementationwithvitaminsshowednoimprovementinsymptomsorbehaviouroverthefive-monthtrial,inspiteofraisingvitaminlevelsinthebody��.However,acontrolledtrialsupplementingfolate-deficientschizophrenicpatientswithfolatedidshowimprovementinsymptomsoverthesix-monthtrial��.Additionally,abirthcohortstudyinFinlandfoundanassociationwithvitaminDsupplementationduringearlylifeandalowerincidenceofschizophreniainmales(therewasnoeffectonfemales)��.

ResearchoverthepastdecadehasestablishedpossiblelinksbetweenschizophreniaandAlzheimer’sDisease��,implicatingthe5HTPreceptor2Aasapriorityinbothofthesementalillnesses.Furtherresearchiswarrantedtoidentifythespecificmechanismsthroughwhichdietcanworkalongsideothercareoptionstoalleviatethesymptomsofschizophreniaindifferentpopulations.AnyprogressmadeinsuchresearchcouldalsoinformtheevidenceexploringthelinkbetweenAlzheimer’sanddiet,towhichwenowturn.

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Prevalence of Alzheimer’sLow High

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Figure ��: The relationship between saturated fats (SFAs) and polyunsaturated fats (PUFAs) and prevalence of Alzheimer’s Disease

4.4 Alzheimer’s Disease

Researchintovasculardementia–wheretheindividualsuffersaseriesofministrokes–hasdemonstratedastrongassociationbetweendietandsubsequentcognitivefunction.Inparticular,highbloodpressure–associatedwithhighsaltintake–isknowntoincreasethelikelihoodofvasculardementia��.Tocompoundtheissue,somemedicationsprescribedtolowerbloodpressurearealsolinkedtoincreaseddementiainolderadults�0.Thisevidencesuggeststhatoneofthepreventativemeasuresapersoncantakeagainstdevelopingdementia,alongsideregularexerciseandintellectualstimulation,istolimittheirsaltintakeandconsumeahealthydiet.

Alzheimer’sDisease(AD)isthemostcommonformofdementia.Itisaprogressive,physicaldiseaseofthebrain,inwhichthereisagradualandcontinualdeathofbraincells.Symptomsincludelossofmemory,confusion,moodswingsandwithdrawal.Ithasbecomemorecommoninthepastfiftyyearsandisbelievedtobetheresultofacombinationoffactors,includingage,geneticsandenvironmentalfactors��.growingepidemiologicalevidencesuggeststhatdietmaybeoneofthoseenvironmentalfactors��.SpecificconnectionshavebeenfoundbetweentheoccurrenceofADandtheamountofsaturatedfat��andvitamins&mineralsinthediet.Inaddition,theprocessofmethylation–affectedbylevelsoftheaminoacidhomocysteineinthebody–hasbeenthesubjectofsomeresearchinthisfield.AlthoughtherehasnotbeenawealthofcontrolledclinicaltrialstestingtheefficacyofnutrientsforthetreatmentofAD,theevidencethatdoesexistpointstoaroleinthepreventionofAD(asopposedtoitstreatment).

4.4.1 Fats

MuchoftheevidencelinkingADanddietiseitherepidemiologicalortheresultoflong-termcohortstudies.Manyofthestudieshaveshownapositiveassociationbetweensaturatedfat(SFA)intakeandtheincidenceofdementia,whilstalsoshowinganinverserelationshipbetweenitsincidenceandpolyunsaturatedfattyacid(PUFA)intake��(seeFigure22).

OnestudylookingatthetotalfatintakeofelevencountriesfoundacorrelationbetweenhigherlevelsoffatconsumptionandhigherlevelsofADamongsttheover65s��.IthasalsobeenobservedthatolderJapanesepeople,knownfortheirhighfishconsumption,haveverylowlevelsofAD��andthisfindinghasbeensupportedbycohortstudieswithotherolderpopulations�� ��.Similarly,the“Mediterraneandiet”,characterisedbyhighintakesofmonounsaturatedfattyacids,hasbeenlinkedtolowratesofdementiainItaly��,whilehighintakesofcerealsandfishappearstodecreaseriskinNorthAmericanandnorthernEuropeancountries�� �0 ��.

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OnecontrolledtrialinthisfieldlookedattheeffectofamixedPUFAsupplementon100olderadultswithAD,overaperiodoffourweeks.Ofthe60thatreceivedthesupplement,49reportedimprovementinmood,co-operationandshort-termmemory��.

4.4.2 Vitamins and Minerals

AdifferentfieldofresearchexaminestheassociationbetweenhighvegetableconsumptionanddecreasedincidenceofAD.Forexample,onestudycomparedgroupsofmeateatersandvegetarians,matchedforage,sexandresidence,findingthatthemeat-andfish-eatersweremorethantwiceaslikelytodevelopADastheirvegetariancounterparts.Itisunclearwhetherthisoutcomewastheresultofhigherfatconsumptionbythemeateatersorofhighervegetableconsumptionbythevegetarians��.However,thepossibleprotectionofferedbyvegetableconsumptionhasalsobeenexploredinstudiesonantioxidants.Onelong-termpopulation-basedstudyfoundthathighintakesofvitaminsCandEwerelinkedtoalowerriskofAD,particularlyamongstsmokers��,andthisfindinghasbeenreplicatedinotherlong-termprospectivestudies��.

4.4.3 Methylation & Homocysteine

Methylationistheprocessourbraindependsontocreate,maintainandrepairbraincellsandtheneurotransmittersthatpassbetweenthosecells(seeSection3).Oneaminoacid–homocysteine–determineshoweffectivelymethylationoccurs;thatis,howeffectivelythemethylgroupsinthebrainrespondtothemyriaddemandsplaceduponthemeachsecond.Ifthelevelofhomocysteineislow,themethylgroupsareabletocarryoutrepairsquicklyandeffectively,keepingourbodyhealthyandbalanced.Higherratesofhomocysteineindicatethatmethylationishappeningmoreslowlyandineffectively,leadingtodecliningmemory,moodandcognitivefunction��.

PoormethylationandhighlevelsofhomocysteinearestronglyassociatedwithanincreasedriskofAD.ResearchintheUSmeasuredhomocysteinelevelsin3,766malesand4,918femalesandconcludedthatadietlowinfolate,vitaminB12orvitaminB6canbeacauseforhomocysteinebuild-up��.Assuch,theUnitedStatesDepartmentforAgriculture(USDA)emphasisetheneedforolderadultstoconsumenutrient-densefoods,fibreandwater,recommendingthattheydrinkatleast8250mlglassesofwateraday��.TheAlzheimer’sPreventionPlan��alsosuggestsadietthatimprovesmethylationandreduceshomocysteine,whichincludesessentialfatsandphospholipids,complexcarbohydrates,vitamin-mineral-andantioxidant-richfoodsandprotein.Avoidingharmfulfats,refinedcarbohydrates,sugarandexcessesofcaffeineandalcoholarealsorecommended.ExamplesofthisapproachinthepreventionandtreatmentofADarepresentedinBox12.

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Box12:BrainBioCentre

Aims TheBrainBioCentreisanoutpatientclinicaltreatmentcentre,specialisinginthe‘optimumnutrition’approachtomentalhealthproblems.TheCentreworkstoimprovementalhealthinindividualsbyperformingcomprehensiveassessmentsofbiochemicalimbalancesthatmaybecontributingtotheirmentalhealthproblems.Itthenprovidesadvicetocorrecttheseimbalancesusingdietandnutritionalsupplements.

Target groupTheCentreworkswithanypersonwhohasamentalhealthconcern,withawiderangeofmentalhealthproblemsandlearningdisabilities(e.g.depression,anxiety,bipolardisorder,schizophrenia,fatigue,learningdifficulties,dyslexia,dyspraxia,autism,dementia,andAlzheimer’sdisease)amenabletoimprovement.

History of organisation TheBrainBioCentrewassetupin2003bynutritionistPatrickHolford.ItistheclinicaldivisionoftheMentalHealthProject,whichwascreatedin1994bytheInstituteofOptimumNutritiontohighlighttheroleofnutritioninmentalillness.

ActivitiesDirectsupport.TheCentrerunsanoutpatientclinicforanyonewhowouldliketoundergoanutritionalassessmenttoidentifypotentialdeficienciesthatmaybeaffectingtheir mentalhealth.

Raisingawareness.TheBrainBioCentrealsoorganisesandpresentslectures,seminarsandconferencesfornationalandlocalgroups.

Research.Arecentstudymeasuredtheeffectoftransformingdietsataresidentialschoolforautisticchildren.

Website.Informationandadviceisavailableatwww.brainbiocentre.co.uk

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AchievementsPatrickHolfordhaspublishedanumberofbooksonnutritionandmentalhealth,includingThe Optimum Nutrition Bibleand The Alzheimer’s Prevention Plan.BothofthesedocumentresearchconductedthroughtheMentalHealthProject,whichconcludesthatthemajorityofpeoplewhoseektreatmentattheBrainBioCentregainsignificantimprovementinmanyoralloftheirsymptoms.

Testimony*

“Lilly began to suffer from deteriorating memory in her mid-sixties. At 70, she was finally diagnosed with Alzheimer’s. She became progressively disorientated, forgetful, disturbed and unhappy. She realized something was wrong with her brain but refused any overt medical help. Within two years, Lilly required a level of care that could no longer be provided at home, so her husband reluctantly moved her to a nursing home. He meanwhile began researching available literature on Alzheimer’s, and came across Patrick Holford’s Optimum Nutrition for the Mind. He worked with a qualified nutritionist to devise a diet and supplement programme for Lilly along the lines of the Alzheimer’s Prevention Plan, which was implemented with the approval of Lilly’s consultant and the co-operation of the nursing home staff. Within ten weeks Lilly was showing small but encouraging improvements in her memory, so her husband decided to contact the Brain Bio Centre in London. After a series of blood tests and consultations, a supplement programme was devised for Lilly to take account of the test results, which revealed food allergies, neurotransmitter deficiencies and raised homocysteine levels. Within a few weeks, Lilly’s husband, her sons and several friends noticed continuing significant improvements in her short and long-term memories, responsiveness, awareness and lucidity.”

BarriersAccess.Atpresent,treatmentattheBrainBioCentreisnotavailableontheNHSand,assuch,isonlyavailableprivately.

* ThistestimonyisreplicatedverbatimfromPatrickHolford’sbook‘TheAlzheimer’sPreventionPlan’,p209��,withpermission.

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4.5 Conclusion

Thebodyofevidencelinkingdietwithmentalhealthisgrowingatarapidpace.Aswellasitsimpactonfeelingsofmoodandgeneralwellbeing,theevidencedemonstratesitsimportantcontributoryroleinthepreventionandtreatmentofspecificmentalhealthproblemssuchasADHD,depression,schizophreniaandAlzheimer’s.Theimplicationsarefar-reaching,bothinscopeanddepth,forawiderangeofstakeholders.Aspolicy-makerschoosetoincorporatetheevidenceintohealthandeducationguidelines,practitionersbecomemoreequippedtooffertherapeutictreatmentsthattakeaccountofthecomplexitiesofmentalhealthproblems.Nutritionalinfluencescanbeconsideredamongstarangeofcareoptionsofferedtothoseseekingtoimprovetheirmentalhealth.Mostimportantly,perhaps,individualscanberesourcedtobecomemoreawareoftheassociationbetweentheirdietandtheirmentalhealth,enablingthemtoincorporatedietarychangesalongsidetheirrangeofothercareoptions.

4.6 References

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31. PuriBK,RichardsonAJ,HorrobinDF,EastonT,SaeedN,OatridgeA,HajnalJV,ByddergM:Eicosapentaenoicacidtreatmentinschizophreniaassociatedwithsymptomremission,normalisationofbloodfattyacids,reducedneuronalmembranephospholipidturnoverandstructuralbrainchanges.IntJClinPract2000;54(1):57-63

32. RichardsonAJ,CyhlarovaE,RossMA:Omega-3andomega-6fattyacidconcentrationsinredbloodcellmembranesrelatetoschizotypaltraitsinhealthyadults.ProstaglandinsleukotEssentFattyAcids2003;69(6):461-6

33. TolmunenT,HintikkaJ,RuusunenA,VoutilainenS,TanskanenA,ValkonenVP,ViinamakiH,KaplangA,SalonenJT:DietaryfolateandtheriskofdepressioninFinnishmiddle-agedmen.Aprospectivefollow-upstudy.PsychotherPsychosom2004;73(6):334-9

34. Christensenl:Diet-BehaviourRelationships-FocusonDepression.Washington,AmericanPsychologicalAssociation,1996

35. RamosMI,AllenlH,HaanMN,greenR,MillerJW:Plasmafolateconcentrationsareassociatedwithdepressivesymptomsinelderlylatinawomendespitefolicacidfortification.AmJClinNutr2004;80(4):1024-8

36. TaylorMJ,CarneyS,geddesJ,goodwing:Folatefordepressivedisorders.CochraneDatabaseSystRev2003(2):CD003390

37. Nowakg,SiwekM,DudekD,ZiebaA,PilcA:Effectofzincsupplementationonantidepressanttherapyinunipolardepression:apreliminaryplacebo-controlledstudy.PolJPharmacol2003;55(6):1143-7

38. BentonD:DietandMood,inDiet-BrainConnections:ImpactonMemory,Mood,AgingandDisease.EditedbyMattsonMP.Dordrecht,KluwerAcademicPublishers,2002

39. KaplanBJ,SimpsonJS,FerreRC,gormanCP,McMullenDM,CrawfordSg:Effectivemoodstabilizationwithachelatedmineralsupplement:anopen-labeltrialinbipolardisorder.JClinPsychiatry2001;62(12):936-44

40. DelgadoPl,CharneyDS,PricelH,AghajaniangK,landisH,HeningergR:Serotoninfunctionandthemechanismofantidepressantaction.Reversalofantidepressant-inducedremissionbyrapiddepletionofplasmatryptophan.ArchgenPsychiatry1990;47(5):411-8

41. PraagHMv,lemusC:MonaminePrecursorsintheTreatmentofPsychiatricDisorders,inNutritionandtheBrain,Volume7:FoodConstituentsAffectingNormalandAbnormalBehaviors.EditedbyWurtmanJJ,WurtmanRJ.NewYork,RavenPress,1986

42. BarbatoA:SchizophreniaandPublicHealth.EditedbyAbuseDoMHaPoS,WorldHealthOrganisation,1998

43. lumeylH:DecreasedbirthweightsininfantsaftermaternalinuteroexposuretotheDutchfamineof1944-1945.PaediatrPerinatEpidemiol1992;6(2):240-53

44. StClaireDetal:RatesofAdultSchizophreniaFollowingPrenatalExposuretotheChineseFamineof1959-1961,JAMA.2005;294:557-562.

45. ChristensenO,ChristensenE:Fatconsumptionandschizophrenia.ActaPsychiatrScand1988;78(5):587-91

46. glenAI,glenEM,HorrobinDF,VaddadiKS,SpellmanM,Morse-FisherN,EllisK,SkinnerFS:Aredcellmembraneabnormalityinasubgroupofschizophrenicpatients:evidencefortwodiseases.SchizophrRes1994;12(1):53-61

47. PeetM,laugharneJ,RangarajanN,HorrobinD,Reynoldsg:Depletedredcellmembraneessentialfattyacidsindrug-treatedschizophrenicpatients.JPsychiatrRes1995;29(3):227-32

48. MellorJE,laugharneJD,PeetM:Schizophrenicsymptomsanddietaryintakeofn-3fattyacids.SchizophrRes1995;18(1):85-6

49. PuriBK,RichardsonAJ,HorrobinDF,EastonT,SaeedN,OatridgeA,HajnalJV,ByddergM:Eicosapentaenoicacidtreatmentinschizophreniaassociatedwithsymptomremission,normalisationofbloodfattyacids,reducedneuronalmembranephospholipidturnoverandstructuralbrainchanges.IntJClinPract2000;54(1):57-63

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50. PeetM,BrindJ,RamchandCN,ShahS,VankargK:Twodouble-blindplacebo-controlledpilotstudiesofeicosapentaenoicacidinthetreatmentofschizophrenia.SchizophrRes2001;49(3):243-51

51. EmsleyR,MyburghC,OosthuizenP,vanRensburgSJ:Randomized,placebo-controlledstudyofethyl-eicosapentaenoicacidassupplementaltreatmentinschizophrenia.AmJPsychiatry2002;159(9):1596-8

52. MarchbanksRM,RyanM,DayIN,OwenM,McguffinP,WhatleySA:AmitochondrialDNAsequencevariantassociatedwithschizophreniaandoxidativestress.SchizophrRes2003;65(1):33-8

53. SirotaP,gavrieliR,WolachB:Overproductionofneutrophilradicaloxygenspeciescorrelateswithnegativesymptomsinschizophrenicpatients:parallelstudiesonneutrophilchemotaxis,superoxideproductionandbactericidalactivity.PsychiatryRes2003;121(2):123-32

54. lernerV,MiodownikC,KaptsanA,CohenH,loewenthalU,KotlerM:VitaminB6asadd-ontreatmentinchronicschizophrenicandschizoaffectivepatients:adouble-blind,placebo-controlledstudy.JClinPsychiatry2002;63(1):54-8

55. VaughanK,McConaghyN:Megavitaminanddietarytreatmentinschizophrenia:arandomised,controlledtrial.AustNZJPsychiatry1999;33(1):84-8

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57. McgrathJ,SaariK,HakkoH,JokelainenJ,JonesP,JarvelinMR,ChantD,IsohanniM:VitaminDsupplementationduringthefirstyearoflifeandriskofschizophrenia:aFinnishbirthcohortstudy.SchizophrRes2004;67(2-3):237-45

58. Norton,N.&Owen,M.J.(2005).HTR2A:associationandexpressionstudiesinneuropsychiatricgenetics.Ann.Med.,37,121-129.

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68. SolfrizziV,PanzaF,TorresF,MastroianniF,DelParigiA,VeneziaA,CapursoA:Highmonounsaturatedfattyacidsintakeprotectsagainstage-relatedcognitivedecline.Neurology1999;52(8):1563-9

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Stakeholders:DepartmentofHealthNHSHealthScotlandHealthandSocialCareDepartmentDepartmentofHealth,SocialServicesandPublicSafetyFoodStandardsAgency

Stakeholders:DepartmentofHealthNHSHealthScotlandHealthandSocialCareDepartmentDepartmentofHealth,SocialServicesandPublicSafety

Stakeholders:PrimaryCareTrustslocalAuthoritiesNHSHealthBoardslocalHealthBoardsHealthandSocialServicesBoards/Trusts

Stakeholders:HealthcareCommissionCommissionforSocialCareInspectionCareCommissionNHSQualityImprovementScotlandMentalWelfareCommissionHealthInspectorateWalesCareStandardsInspectorateNorthernHealthandSocialServicesCouncilDepartmentofHealth,SocialServicesandPublicSafety

�.TheUKpopulationandparticulargroupswhoareatincreasedriskofmentalhealthproblemsshouldbeprovidedwithinformationaboutfoodsthatpromotetheirmental,emotionalandphysicalwell-being

�.

UnitedKingdomHealthDepartmentsshouldreviewandimprovefoodandnutritionstandardsforthementalhealthandsocialcaresectorsinlightoftheevidencethatarangeofnutrientscontributetomentalhealthandwellbeing

�.

Organisationsthatcommissionmentalhealthservicesshouldincludewithincommissioningcriteriaandservicespecificationsfoodandnutritionstandardsforanyservicesthatprovidefood

�.

Annualmonitoringoffoodandnutritionstandardsacrossthehealthandsocialcaresectorshouldbeincorporatedintocurrentperformanceassessmentmechanisms

5. RECOMMENDATIONS

Thegovernmentasawhole,andallrelevantdepartmentsandagencies,shouldofficiallyrecognisethelinksbetweendietandmentalhealthandincorporatethisrecognitionintoallfoodandmentalhealthrelatedpolicyandpractice.Forinstance,generalhealthyeatingcampaignssuchasfive-a-dayshouldalwaysincludeamentalhealthcomponent.

Becausethedietthatisgoodforthebrainisalsothesamedietthatisgoodforthebody,governmentshouldincreasefinancialandpoliticalsupportformeasurestoensurethatsustainable*suppliesofawidevarietyofnutrient-richfoodsareavailable,affordableandattractiveforpeopletoobtainbothnowandinthefuture.

Specifically:

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Stakeholders:PrimaryCareTrustsNHSHealthBoardslocalHealthBoardsHealthandSocialServicesBoards/Trusts

Stakeholders:MentalHealthTrustsNHSHealthBoardslocalHealthBoardsHealthandSocialServicesBoards/Trusts

Stakeholders:StrategicHealthAuthorities(ortheirsuccessor)localHealthBoardsNHSHealthBoardsHealthandSocialServicesBoards/TrustslocalAuthorities

Stakeholders:HomeOfficeScottishExecutiveNorthernIrelandOffice

Stakeholders:DepartmentofHealththroughitsResearchFundersgroupScottishExecutiveHealthDepartmentandNationalProgrammeforImprovingMentalHealthandWell-beingHealthandSocialCareDepartmentDepartmentofHealth,SocialServicesandPublicSafetyFoodStandardsAgency

�.

Primarycareshouldhavereadyaccesstoinformationonthelinkbetweendietandmentalhealthaswellasaworkingknowledgeoftheinformationandexpertiseavailabletosupportpeoplethroughdietarychange

�.

Secondarymentalhealthservicestaffshouldhavereadyaccesstonutritionalspecialistsforliaisonandconsultation

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AllexistingNHSandsocialcarefacilitiesthatprovidemealstoserviceusers,includingtheindependentandnotforprofitsector,shouldinstigatesustainablefoodpoliciesandpractices,sothatallserviceusersandstaffareencouragedtochoose,orbeprovidedwithifunabletochoose,diverseandculturallyappropriatemeals,snacksanddrinksthatpromotetheirmental,emotionalandphysicalwell-being

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Allprisonfacilitiesshouldinstigatesustainablefoodpoliciesandpracticessothatallresidentsandstaffareencouragedtochooseculturallydiverseandappropriatemeals,snacksanddrinksthatpromotetheirmental,emotionalandphysicalwell-being

�.

Researchfundingbodiesshouldco-ordinatetheirstrategiesandincreasethegrantsavailabletoinvestigatetherelationshipbetweendietandmentalhealth,particularlytheeffectivenessofinterventions

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Regulationsshouldbeintroducedtosupportthepromotionofhealthyfoodtochildren,andtoprotectthemfromallformsofbroadcastandnon-broadcastmarketingofunhealthyfood

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Practicalfoodskills,includingcookingandgrowing,shouldbereintroducedasacompulsorypartofthenationalcurriculum

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Theprogressiveapproachtoensuringbetterfoodinschoolmealsshouldbecontinuedandinadditionaccesstofreewaterdispensersshouldbeavailabletoallchildrenby2007

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Targetsshouldbeintroducedtoreduceunhealthylevelsoffat,sugarandsaltinprocessedfood,andtoremovedamagingtrans-fatsfromfoodingredientsandfoodproducts.Asaninterimmeasure,manufacturersshouldbeencouragedtolabelclearlythenutritionalqualityofandingredientsintheirproducts

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Agriculturalpolicydevelopmentshouldbeinformedbywhatisknownofitsnutritionalimpactanditssubsequenteffectuponourmentalaswellasphysicalhealth.Specifically,supportmustbeincreasedfororganicfarming,theproductionandpromotionoffruitandvegetables,othermicro-nutrientrichfoodandforalternativesourcestooilyfishofomega-3fats.Moreover,governmentpolicyonpromotingfishconsumptionneedstochangetopromotingonlysustainablesourcesofoilyfish,withlowlevelsoftoxicity

Stakeholders:DepartmentforCultureMediaandSportOfcomTheDepartmentofHealth’sAdvertisingForumDepartmentofHealthNHSHealthScotlandScottishExecutiveHealthandSocialCareDepartmentDepartmentofHealth,SocialServicesandPublicSafety

Stakeholders:DepartmentforEducationandSkillsHealthPromotingSchoolsScottishExecutiveEducationDepartmentDepartmentofEducation

Stakeholders:TheSchoolFoodTrustDepartmentforEducationandSkillsHealthPromotingSchoolsScottishExecutiveEducationDepartmentDepartmentofEducation

Stakeholders:FoodStandardsAgency

Stakeholders:DepartmentfortheEnvironment,FoodandRuralAffairsFoodStandardsAgencyDepartmentofEnvironmentandRuralAffairsDepartmentofAgricultureandRuralDevelopment

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6. FURTHERREADINgANDSUPPORT

Belowisaselectivelistoforganisationsofferingadvice,informationorguidanceaboutfoodandmentalhealthintheUK.Furtherorganisationsareeasilyaccessibleviaaninternetsearchusingtherelevantkeywords.

Food and Behaviour Research Box6066NairnScotlandIV124YNwww.fabresearch.org

The Food and Mood Project Box2737lewes,EastSussexBN72gNwww.foodanmood.org

The Hyperactive Children’s Support Group (HACSG)71Whykelane,Chichester,WestSussexPO197PDwww.hacsg.org.uk

Institute of Brain Chemistry and Human NutritionNorthCampuslondonMetropolitanUniversity166-220HollowayRd.londonN78DBwww.north.londonmet.ac.uk/ibchn

Institute of Optimum Nutrition – Brain Bio Centre13BladesCourtDeodarRoadPutneylondonSW152NUwww.brainbiocentre.comNatural JusticeUniversitylaboratoryofPhysiology,ParksRoadOxfordOX13PTwww.physiol.ox.ac.uk/natural.justice

The Schizophrenia Association of Great Britain “BrynHyfryd”,TheCrescent,Bangor.gwyneddll572Agwww.sagb.co.uk

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APPENDIXA–NOPSURVEY

NUTRITIONALL ADULTS 15+ Section Answered------ 01 ASK Q1SElFCOMPlETIONSECTION

Iamnowgoingtoaskyousomequestionsaboutfoodandyourwellbeing

Q.1 Firstly,thinkingaboutfoodyoubuyeachweek,onaverage,howmuchifatalldoyouendupthrowingaway? SINglECODE Morethan50%/half 01 30-50%(betweenathirdandahalf ) 02 10-29%(betweenatenthandathird) 03 lessthan10%(lessthana10th) 04 None/Nothing 05 Notapplicable/donotbuyfood 06 Don’tknow 07

Q.2 Thinkingaboutanaverageweek,howoften,ifatallwouldyousayyoueatanyofthefollowing?CODEAllTHATAPPlY. lessthanonce Onceortwice threetofive Everyday/ Never aweek aweek aweek everymeal

Breakfast 01 02 03 04 05 Chips/Crisps 01 02 03 04 05 Chocolate 01 02 03 04 05 Amealmadefromscratch 01 02 03 04 05 Organicfood 01 02 03 04 05 Freshvegetables/salad 01 02 03 04 05 Atakeaway 01 02 03 04 05 Freshfruit/fruitjuice 01 02 03 04 05 Readymeals 01 02 03 04 05

Q.3 What,ifanything,doyouthinkarethemaininfluencesonwhatyoueat?PlEASECHOOSETWOMAININFlUENCES Time 01 Habit 02 Diet 03 Cost 04 Healthreasons 05 Sociability/whetherotherpeoplearearoundornot 06 Convenience 07 Other(specify) 08 Don’tKnow 09

Q.4 Overthelastmonth,haveyouhadanyproblemswithdepressingthoughtsorideas,anxietyorworry,orproblemswithconcentrationandforgetfulnessatall?SINGLE CODE

Atleastonceaday 01 Atleastonceaweek 02 lessthanonceaweek 03 lessthanonceamonth 04 Notatall 05 Refused 06

Q.5 Andhowmuch,ifatall,doyouthinkthefollowingthingsaffectyourmoodorfeelings? Agreatdeal Quitealot Alittlebit Notatall N/a Donoteat/ Don’tknow drink Alcohol(18+Only) 01 02 03 04 05 06 07 Fish 01 02 03 04 05 06 07 Fizzydrinks 01 02 03 04 05 06 07 Brownriceorpasta 01 02 03 04 05 06 07 Fastfoodmeals 01 02 03 04 05 06 07 Fruitandvegetables 01 02 03 04 05 06 07

About the Mental Health Foundation

Foundedin1949,theMentalHealthFoundationistheleadingUKcharityworkinginmentalhealthandlearningdisabilities.

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About Sustain

Sustain: The alliance for better food and farming advocatesfoodandagriculturepoliciesandpracticesthatenhancethehealthandwelfareofpeopleandanimals,improvetheworkingandlivingenvironment,enrichsocietyandcultureandpromoteequity.Werepresentover100nationalpublicinterestorganisationsworkingatinternational,national,regionalandlocallevel.

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