|Year : 2022 | Volume
| Issue : 1 | Page : 1-5
Do food and nutrition have therapeutic value for disorders of mood and conation?
Jyoti Prakash1, Suprakash Chaudhury2, Kaushik Chatterjee1, Sanjeev Kumar3
1 Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
2 Department of Psychiatry, D. Y. Patil Medical College, Pune, Maharashtra, India
3 Department of Family Medicine, Armed Forces Clinic, New Delhi, India
|Date of Submission||19-Apr-2022|
|Date of Web Publication||20-May-2022|
Prof. Jyoti Prakash
Armed Forces Medical College, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Prakash J, Chaudhury S, Chatterjee K, Kumar S. Do food and nutrition have therapeutic value for disorders of mood and conation?. Ind Psychiatry J 2022;31:1-5
| Introduction|| |
The use of psychotropic medication in psychiatric disorders has brought significant reduction in mental health morbidity and related mortality. However, over the years, we have realized that the benefit of these medication on mental health are overshadowed by many important side effects, necessity of medication for an uncomfortably long period, and inadequate compliance requiring significant adherence-oriented efforts.,, Additionally, medication may be effective in a third of the population and end up in relapse, regardless, in significant half of the population.,
Off late, there has been growing interest toward lifestyle-related factors, which appears to be of both prophylactic and therapeutic value in mental well-being. Research evidence for the role of physical exercise, sleep,, mindfulness,, social connectedness,, environmental mastery,, and so on, have been adequate and growing. Among these factors, diet have attracted lot of attention by researchers off late.,,,,,,,
Growing body of researches indicates significant role of diet not only in promoting positive mental well-being, but also in treatment of mental illness. Few of the concluding theories that have churned out of researchers in this direction are as follows:
Most of the mental illnesses are due to neurotransmitter disturbances/deficits, which are synthesized primarily by amino acids. The amino acids provided by the diet addresses these deficits and imbalances, leading to desired therapeutic effect.,,
Adult hippocampal neurogenesis
Some area of the brain have potential for neurogenesis lifelong, important few of them are in hippocampus and neocortex. These areas have active role in emotion and cognition and the defect in these often leading to mental illnesses. Considering that these areas are still capable of adult neurogenesis, an appropriate diet conducing of neurogenesis will improve our cognitive reserve and dispel any mental illness likely to arise.,
Gray matter constituents
Brain gray matter consists of 50% fatty acid, which is polyunsaturated. Of which, around 33% belong to the family of omega-3 fatty acid, which is found abundant in whole fish. The diet, thus, rich in omega-3 fatty acid is a conducive resource for neurogenerative process and mental well-being.,
Diet have also been found to affect mental health though the gut-brain axis, the effect may be either direct through neural axis or indirect through inflammatory or hormonal changes in the gut and associated vascular system. Many evidences have come in support of gut-brain axis involvement in mental health morbidity, few of which are important and as follows: -
- Mediterranean diet, an unprocessed and fiber-rich diet, is anti-inflammatory in nature and protective against mental illnesses. Whereas, Western diet, a highly processed diet has pro-inflammatory action, resulting in many inflammatory illnesses, which is detrimental to cognition, hippocampal function, and blood–brain barrier. This hypothesis is further reinforced by efficacy of anti-inflammatory agents in symptom reduction in mental illness.,,,,,,,,
- Diet low in fiber and rich in refined sugar, artificial sweeteners, and saturated fats carbohydrate are more likely to trigger inflammatory process affecting the gut mucosal layer adversely and increased epithelial permeability. This may lead to spread of inflammatory agents through blood stream to distant areas including brain.,,
- Western diet by its being processed diet, are primarily acellular in nature. Thus, it gets digested and converted easily and early in the gut. This early conversion and in excess to the expected affects the microbial milieu adversely, leading to significant loss of bacteria vital for microbiome function and may induce heritability by epigenetic changes. Mediterranean diet, which is unprocessed plant and animal products, are cellular with intact cell walls or cell membrane. These traverse through intestinal lumen in the intended speed, gets digested across the span of digestive tract and reaches colon, rich in fiber. This diet appears to maintain balance and promote growth of fiber degrading bacteria in colon and generation of beneficial metabolites.,,,,,,
- Advanced glycation end products (heat-treated food preparation high in processed fat and carbohydrate, breakfast cereals, etc) promote growth of harmful microbes, reduce helpful microbes, and increases colonic permeability. These diets induced inflammation also causes food craving and hyperphagia, generating a vicious circle of bad diet and bad effects.,,,,,
| Diet and Nutrients in Specific Mental Illnesses|| |
Role of diet and nutrients have been researched in few specific mental illnesses, commonly being depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder.
Diet and depressive disorder
Available research in this direction suggests that diet has significant therapeutic effect and may be promising as supplement or adjunct with standard medication in future.
Omega-3 fatty acids,, vitamin Bs, minerals, and neurotransmitter precursor amino acids (tryptophan,, tyrosine, phenylalanine, methionine) have been found to reduce incidence of mental illnesses as well as helpful in treatment of mood disorder and depression. High fish diet that is rich in omega-3 fatty acid is psycho-protective. It leads to production of prostaglandin, leukotriene, and other brain chemicals of antidepressant value. Its action through peroxisomal proliferator-activated receptors leading to inhibition of G protein, protein kinase C, and various ion channel receptors (Ca, Na and K) was also been proposed to reduce the depression.
Serotonin precursor tryptophan restores serotonin and alleviates depression. Tyrosine and its precursor phenylalanine restore dopamine and noradrenaline, the substrate for alertness and arousal. Methionine product S-adenosyl methionine promotes production of neurotransmitters in the brain. Folate and vitamin supplements have been found to reduce depressive symptoms. Magnesium salts (glycinate and taurinate) has shown quick recovery in many a depressed patient within a week's span. Available research suggests that Mediterranean diet alone reduces the risk of depression by 30%.
Biochemical abnormalities seen in bipolar disorders, which can be corrected with diet are as follows,,,,:
- Oversensitivity to acetylcholine
- Increased vanadium
- Decreased vitamin B, taurine, omega-3 fatty acid, or vitamin C
Vitamin C has protective effect on vanadium-induced brain damages. In association with natural supply of body lithium, it is found to reduce manic and depressive symptoms. Taurine made from cysteine in liver has soothing effect on brain and also block excess of acetylcholine effect. Other nutrients found to be effective are L-tryptophan and choline. Lithium orotate, a nonprescriptive, diet supplement, in contrary to pharmaceutical lithium, is required in much lesser dosage and crosses blood–brain barrier.
High-dose glycine has shown to improve social withdrawal, affective flattening, and apathy., Omega-3 fatty acid product, especially eicosapentaenoic acid, as an adjunct with medication, has shown to reduce symptoms of schizophrenia significantly.,,,,,,
Obsessive compulsive disorder (OCD)
Tryptophan and tryptophan supplement has shown to increase serotonin level and improve obsessive-compulsive symptoms. St Johns wort as an adjunct with selective serotonin reuptake inhibitor has shown significant reduction in recurring thoughts and compulsive behavior.
Recommended dosage of nutrients in psychiatric illnesses based on proposed deficiency is shown in [Table 1].
|Table 1: Recommended dosage of nutrients in psychiatric illnesses based on proposed deficiency|
Click here to view
| Dietary Scoring|| |
A study by LaChance and Ramsay ranked antidepressant foods by calculating antidepressant food score based on their antidepressant nutrient density. Nutrient rich in antidepressant value were vitamins (vitamins A, B1, B6, B12, C, and folate), minerals (potassium, magnesium, iron, zinc, and selenium), and long-chain omega-3 fatty acids. Antidepressant food scoring of various food items is shown in [Table 2].
| Conclusion|| |
Available evidence supports that Mediterranean diet, unprocessed food, omega-3 fatty acids, nutrients rich in essential amino acids, and vitamins have therapeutical potential in many mental illness. It has been used as supplement as well as adjunct with favorable outcome. However, whether it will be good substitute or adjunct for psychotropic medication, it will be evident with further research and empirical evidences over time. The very fact, of its utility, with prudent use, brings optimism amidst the afore-mentioned concerns and complications of psycho-pharmacy.
| References|| |
Waring WS. Management of lithium toxicity. Toxicol Rev 2006;25:221-30.
Vieta E, Rosa AR. Evolving trends in the long-term treatment of bipolar disorder. World J Biol Psychiatry 2007;8:4-11.
Lakhan SE, Vieira KF. Nutritional therapies for mental disorders. Nutr J 2008;7:2. doi: 10.1186/1475-2891-7-2.
van Zoonen K, Buntrock C, Ebert DD, Smit F, Reynolds CF 3rd
, Beekman AT, et al
. Preventing the onset of major depressive disorder: A meta-analytic review of psychological interventions. Int J Epidemiol 2014;43:318-29.
Burcusa SL, Iacono WG. Risk for recurrence in depression. Clin Psychol Rev 2007;27:959-85
Gomez-Pinilla F. Brain foods: The effects of nutrients on brain function. Nat Rev Neurosci 2008;9:568-78
Peluso MA, Guerra de Andrade LH. Physical activity and mental health: The association between exercise and mood. Clinics (Sao Paulo) 2005;60:61-70.
Krystal AD. Psychiatric disorders and sleep. Neurol Clin 2012;30:1389-413.
Germain A, Richardson R, Moul DE, Mammen O, Haas G, Forman SD, et al
. Placebo-controlled comparison of prazosin and cognitive-behavioral treatments for sleep disturbances in US Military Veterans. J Psychosom Res 2012;72:89-96.
Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: A review of empirical studies. Clin Psychol Rev 2011;31:1041-56.
Hayes AM, Feldman G. Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clin Psychol 2004;11:255-62.
Gayer-Anderson C, Morgan C. Social networks, support and early psychosis: A systematic review. Epidemiol Psychiatr Sci 2013;22:131-46.
Wang J, Mann F, Lloyd-Evans B, Ma R, Johnson S. Associations between loneliness and perceived social support and outcomes of mental health problems: A systematic review. BMC Psychiatry 2018;18:156.
Jang Y, Kim G, Chiriboga DA. Health perception and depressive symptoms among older Korean Americans. J Cross Cult Gerontol 2006;21:91-102.
Knight T, Davison TE, McCabe MP, Mellor DJ. Environmental mastery and depression in older adults in residential care. Ageing Soc 2011;31:870-84.
Owen L, Corfe B. The role of diet and nutrition on mental health and wellbeing. Proc Nutr Soc 2017;76:425-6.
Lang UE, Beglinger C, Schweinfurth N, Walter M, Borgwardt S. Nutritional aspects of depression. Cell Physiol Biochem 2015;37:1029-43.
Molendijk M, Molero P, Ortuño Sánchez-Pedreño F, Van der Does W, Angel Martínez-González M. Diet quality and depression risk: A systematic review and dose-response meta-analysis of prospective studies. J Affect Disord 2018;226:346-54.
Rahe C, Unrath M, Berger K. Dietary patterns and the risk of depression in adults: A systematic review of observational studies. Eur J Nutr 2014;53:997-1013.
Martínez-González MA, Sánchez-Villegas A. Food patterns and the prevention of depression. Proc Nutr Soc 2016;75:139-46.
Lai JS, Hiles S, Bisquera A, Hure AJ, McEvoy M, Attia J. A systematic review and meta-analysis of dietary patterns and depression in community dwelling adults. Am J Clin Nutr 2014;99:181-97.
Schefft C, Kilarski LL, Bschor T, Köhler S. Efficacy of adding nutritional supplements in unipolar depression: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2017;27:1090-109.
Rao TS, Asha MR, Ramesh BN, Rao KS. Understanding nutrition, depression and mental illnesses. Indian J Psychiatry 2008;50:77-82.
Buist R. The therapeutic predictability of tryptophan and tyrosine in the treatment of depression. Int J Clin Nutr Rev 1983;3:1-3.
Chouinard G, Young SN, Annable L. A controlled clinical trial of L-tryptophan in acute mania. Biol Psychiatry 1985;20:546-7.
Zhao C, Deng W, Gage FH. Mechanisms and functional implications of adult neurogenesis. Cell 2008;132:645-60.
Stangl D, Thuret S. Impact of diet on adult hippocampal neurogenesis. Genes Nutr 2009;4:271-82.
Eritsland J. Safety considerations of polyunsaturated fatty acids. Am J Clin Nutr 2000;71 (1 Suppl):197S-201.
Firth J, Gangwisch JE, Borsini A, Wootton RE, Mayer EA. Food and mood: How do diet and nutrition affect mental wellbeing? BMJ 2020;369:m2382. doi: 10.1136/bmj.m2382.
O'Keefe JH, Gheewala NM, O'Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol 2008;51:249-55.
Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB. The effect of Mediterranean diet on metabolic syndrome and its components: A meta-analysis of 50 studies and 534 906 individuals. J Am Coll Cardiol 2011;57:1299-313.
Noble EE, Hsu TM, Kanoski SE. Gut to brain dysbiosis: Mechanisms linking western diet consumption, the microbiome, and cognitive impairment. Front Behav Neurosci 2017;11:9. doi: 10.3389/fnbeh.2017.00009.
Yuan N, Chen Y, Xia Y, Dai J, Liu C. Inflammationrelated biomarkers in major psychiatric disorders: A cross-disorder assessment of reproducibility and specificity in 43 meta-analyses. Transl Psychiatry 2019;9:233. doi: 10.1038/s41398-019-0570-y.
Firth J, Stubbs B, Teasdale SB, Ward PB, Veronese N, Shivappa N, et al
. Diet as a hot topic in psychiatry: A population-scale study of nutritional intake and inflammatory potential in severe mental illness. World Psychiatry 2018;17:365-7.
Köhler-Forsberg O, N Lydholm C, Hjorthøj C, Nordentoft M, Mors O, Benros ME. Efficacy of anti-inflammatory treatment on major depressive disorder or depressive symptoms: Meta-analysis of clinical trials. Acta Psychiatr Scand 2019;139:404-19.
Yahfoufi N, Alsadi N, Jambi M, Matar C. The immunomodulatory and anti-inflammatory role of polyphenols. Nutrients 2018;10:E1618. doi: 10.3390/nu10111618.
Su KP, Lai HC, Yang HT, Su WP, Peng CY, Chang JP, et al
. Omega-3 fatty acids in the prevention of interferon-alphainduced depression: Results from a randomized, controlled trial. Biol Psychiatry 2014;76:559-66.
Borsini A, Alboni S, Horowitz MA, Tojo LM, Cannazza G, Su KP, et al
. Rescue of IL-1β-induced reduction of human neurogenesis by omega-3 fatty acids and antidepressants. Brain Behav Immun 2017;65:230-8.
Osadchiy V, Martin CR, Mayer EA. Gut microbiome and modulation of CNS function. Compr Physiol 2019;10:57-72.
Sonnenburg ED, Sonnenburg JL. The ancestral and industrialized gut microbiota and implications for human health. Nat Rev Microbiol 2019;17:383-90.
Spreadbury I. Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity. Diabetes Metab Syndr Obes 2012;5:175-89.
Grundy MM, Edwards CH, Mackie AR, Gidley MJ, Butterworth PJ, Ellis PR. Re-evaluation of the mechanisms of dietary fibre and implications for macronutrient bioaccessibility, digestion and postprandial metabolism. Br J Nutr 2016;116:816-33.
Grundy MM, Lapsley K, Ellis PR. A review of the impact of processing on nutrient bioaccessibility and digestion of almonds. Int J Food Sci Technol 2016;51:1937-46.
Cohn JS, Kamili A, Wat E, Chung RWS, Tandy S. Dietary phospholipids and intestinal cholesterol absorption. Nutrients 2010;2:116-27.
Pennings B, Groen BB, Dijk JW, Van de Lange A, Kiskini A, Kuklinski M, et al
. Minced beef is more rapidly digested and absorbed than beef steak, resulting in greater postprandial protein retention in older men. Am J Clin Nutr 2013;98:121-8.
Lodish H, Berk A, Zipursky SL, Matsudaira P, Baltimore D, Darnell J. The Dynamic Plant Cell Wall. 4th
Edition. New York: W. H. Freeman and Company; 2000.
Stecher B. The roles of inflammation, nutrient availability and the commensal microbiota in enteric pathogen infection. Microbiol Spectr 2015;3. doi: 10.1128/microbiolspec.MBP-0008-2014.
Goldberg T, Cai W, Peppa M, Dardaine V, Baliga BS, Uribarri J, et al
. Advanced glycoxidation end products in commonly consumed foods. J Am Diet Assoc 2004;104:1287-91.
Seiquer I, Rubio LA, Peinado MJ, Delgado-Andrade C, Navarro MP. Maillard reaction products modulate gut microbiota composition in adolescents. Mol Nutr Food Res 2014;58:1552-60.
Yacoub R, Nugent M, Cai W, Nadkarni GN, Chaves LD, Abyad S, et al
. Advanced glycation end products dietary restriction effects on bacterial gut microbiota in peritoneal dialysis patients; a randomized open label-controlled trial. PLoS One 2017;12:e0184789.
Delgado-Andrade C, de la Pastoriza Cueva S, Peinado MJ, Rufián-Henares JÁ, Navarro MP, Rubio LA. Modifications in bacterial groups and short chain fatty acid production in the gut of healthy adult rats after long-term consumption of dietary Maillard reaction products. Food Res Int 2017;100:134-42.
Qu W, Yuan X, Zhao J, Zhang Y, Hu J, Wang J, et al
. Dietary advanced glycation end products modify gut microbial composition and partially increase colon permeability in rats. Mol Nutr Food Res 2017;61. doi: 10.1002/mnfr. 201700118.
Zinöcker MK, Lindseth IA. The western diet-microbiome-host interaction and its role in metabolic disease. Nutrients 2018;10:365. doi: 10.3390/nu10030365.
Reis LC, Hibbeln JR. Cultural symbolism of fish and the psychotropic properties of omega-3 fatty acids. Prostaglandins Leukot Essent Fatty Acids 2006;75:227-36.
Tanskanen A, Hibbeln JR, Hintikka J, Haatainen K, Honkalampi K, Viinamaki H. Fish consumption, depression, and suicidality in a general population. Arch Gen Psychiatry 2001;58:512-3.
Young SN. Folate and depression—A neglected problem. J Psychiatry Neurosci 2007;32:80-2.
Eby GA, Eby KL. Rapid recovery from major depression using magnesium treatment. Med Hypotheses 2006;67:362-70.
aan het Rot M, Moskowitz DS, Pinard G, Young SN. Social behaviour and mood in everyday life: The effects of tryptophan in quarrelsome individuals. J Psychiatry Neurosci 2006;31:253-62.
McLean A, Rubinsztein JS, Robbins TW, Sahakian BJ. The effects of tyrosine depletion in normal healthy volunteers: Implications for unipolar depression. Psychopharmacology (Berl) 2004;171:286-97.
Ruhé HG, Mason NS, Schene AH. Mood is indirectly related to serotonin, norepinephrine and dopamine levels in humans: A meta-analysis of monoamine depletion studies. Mol Psychiatry 2007;12:331-59.
Psaltopoulou T, Sergentanis TN, Panagiotakos DB, Sergentanis IN, Kosti R, Scarmeas N. Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis. Ann Neurol 2013;74:580-91.
Osher Y, Bersudsky Y, Belmaker RH. Omega-3 eicosapentaenoic acid in bipolar depression: Report of a small open-label study. J Clin Psychiatry 2005;66:726-9.
Wozniak J, Biederman J, Mick E, Waxmonsky J, Hantsoo L, Best C, et al
. Omega-3 fatty acid monotherapy for pediatric bipolar disorder: A prospective open-label trial. Eur Neuropsychopharmacol 2007;17:440-7.
Frangou S, Lewis M, McCrone P. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression. Randomized double-blind placebo-controlled study. Br J Psychiatry 2006;188:46-50.
Javitt DC, Silipo G, Cienfuegos A, Shelley AM, Bark N, Park M, et al
. Adjunctive high-dose glycine in the treatment of schizophrenia. Int J Neuropsychopharmacol 2001;4:385-91.
Rihmer Z, Gonda X, Rihmer A: Creativity and mental illness. Psychiatr Hung 2006;21:288-94. [in Hu]
Peet M. Eicosapentaenoic acid in the treatment of schizophrenia and depression: Rationale and preliminary double blind clinical trial results. Prostaglandins Leukot Essent Fatty Acids 2003;69:477-85.
Emsley R, Myburgh C, Oosthuizen P, van Rensburg SJ. Randomized, placebo-controlled study of ethyl-eicosapentaenoic acid as supplemental treatment in schizophrenia. Am J Psychiatry 2002;159:1596-8.
Puri BK, Richardson AJ, Horrobin DF, Easton T, Saeed N, Oatridge A, et al
. Eicosapentaenoic acid treatment in schizophrenia associated with symptom remission, normalisation of blood fatty acids, reduced neuronal membrane phospholipid turnover and structural brain changes. Int J Clin Pract 2000;54:57-63.
Richardson AJ, Easton T, Puri BK. Red cell and plasma fatty acid changes accompanying symptom remission in a patient with schizophrenia treated with eicosapentaenoic acid. Eur Neuropsychopharmacol 2000;10:189-93.
Richardson AJ. The role of omega 3 fatty acids in behaviour, cognition and mood. Scand J Nutr 2003;47:92-8.
Yao JK, Magan S, Sonel AF, Gurklis JA, Sanders R, Reddy RD. Effects of omega-3 fatty acid on platelet serotonin responsivity in patients with schizophrenia. Prostaglandins Leukot Essent Fatty Acids 2004;71:171-6.
LaChance LR, Ramsey D. Antidepressant foods: An evidence-based nutrient profiling system for depression. World J Psychiatry 2018;8:97-104.
[Table 1], [Table 2]