Seven years ago I took on the task of digging through research to figure out what we know and what we don’t know about diet and the brain. Popular books and research papers at the time had a lot of promises and surety, with little real data to back them up. But I knew there must be a connection. We are what we eat, and the brain is the most energy hungry organ in the body, surpassing even the heart. Surely our diets affect our thinking and our moods. But how do we prove it, and then what do we do about it?
This week in Bethesda, all the stars of food, microbiome, and mood came together for the inaugural International Society for Nutritional Psychiatry Research (ISNPR) conference. Dr. Felice Jacka (who burst onto the scene in 2009 and has been burning brightly ever since) pulled the best researchers from the western world together for an amazing conference that was an honor and pleasure to attend. I’ve been speaking on this topic and doing grand rounds for years, and to have the authors of all the studies I’ve been highlighting in powerpoint slides be in the audience…it’s completely overwhelming. The first study we always mention in every talk is the SUN trial, an enormous observational study linking adherence to Mediterranean diet pattern and decreased risk of depression, so when Dr. Sanchez-Villegas introduced herself from the audience, of course I said, “Oh, I know who you are!”
Dr. Alex Richardson of Oxford runs the FAB group and has dedicated her research to the impact of diet and fatty acids on behavioral disturbance, autism, and learning disorders in children. She did a fantastic talk on her successes, ongoing questions, the limits of study and the benefits and dangers of restricted diets for children (gluten free and casein free diets if done carelessly can expose children to more problems with arsenic and highly processed carbs than standard diets, for example). I went to her to congratulate her for her talk, and to my astonishment she knew exactly who I was, thanked me for my blog and its dedication to a broad view combined with an evidence base, and called me a “bright bulb.” You never know how far your reach as a writer has gone.
I had to the pleasure of being introduced to three fantastic researchers in omega 3 and 6 fatty acids, prostaglandins, and behavior, Bill Lands, Michael Crawford (both 87 and going strong) and Captain Joe Hibbeln. Together they are responsible for an incredible elucidation of a complex research subject of prostaglandins, inflammation, endocannabinoids, and behavior. A common theme of theirs along with Dr. Richardson was the knowledge we picked up from veterinary medicine. Dr. Crawford had his own anecdotes of lions being improperly fed and their subsequent behavior and health problems.
Veterinarians had this wisdom long ago. If an animal is out of control, has health issues, a sallow look or less than glossy coat, or is picking or ruminating, you change its feed or environment. The vets at the Cleveland Zoo solved gorilla behavior problems accidentally while trying to improve cardiovascular health for its gorillas by giving them a more species appropriate diet than the “gorilla biscuits” that made up their daily calories. Certainly all medical doctors know when looking at a patient if he or she is terribly ill, and we use particular clues such as skin color and clarity, glossy hair, and the brightness of the eyes and expression. In olden days, the ill would be sent to the seashore for sunshine, seafood, and combinations of rest and bathing. With the right omega 3 fatty acids, sunshine, activity, and rest many ailments could be corrected. We just have to translate this age old wisdom into modern life, research, and appropriate and practical intervention .
We learned just how far mood and mood and behavior research has gone, with many ongoing randomized controlled trials of food and depression, results pending. We also learned about centers in community health who are ahead of the curve, as Scott Teasdale and Joseph Firth are doing with research in dietary and exercise interventions in community mental health centers in young people with first episode psychosis in Australia. They engage patients at the beginning of treatment with healthy cooking, exercise, and other lifestyle interventions to prevent weight gain from the atypical antipsychotics that improve outcomes in mental health but can destroy physical health with diabetes and cardiovascular disease. In countries with socialized medicine, the monetary benefits of such interventions should be clear. In Massachusetts, my chronically ill patients do have access to walking and cooking groups, but the content could be improved to encourage eating a whole foods, minimally processed diet and improving physical health with strength training and high intensity work as tolerated.
At the tail end of the conference, Drew Ramsey, Laura Lachance and I put together a workshop on integrating dietary change with mental health in the typical sort of talk we do for the APA or grand rounds. It was intimidating doing this talk in front of the singular audience who would know and question our findings and research, but also terrific to impart valuable information on the clinical front line practice of nutritional psychiatry.
In a very few years, the research and solid recommendations tying food and mood have come together, but to be honest, we still have a long way to go. It was terrific seeing all the great minds of psychiatry and nutrition come together. Now we just have to convince the American Psychiatric Association and others to release a statement and recommendation on food and mood. Shouldn’t be too hard…
*if you are a psychiatrist or researcher interested in food and mood, it’s time to join ISNPR!