12 Keys to Nutritional Psychiatry

What is nutritional psychiatry?

Nutritional psychiatry uses food and supplements instead of, or in addition to, pharmacological drugs, to manage mental health issues such as depression, anxiety, insomnia, poor attention, poor memory, exhaustion, mood swings, irritability. 

Evolution of nutritional psychiatry

Nutritional psychiatry is based on similar principles as orthomolecular medicine, a term coined by the two time Nobel Prize winner and molecular biologist, Linus Paulin, Ph.D, who first mentioned it in his 1968 article Orthomolecular Psychiatry in the journal Science. “Orthomolecular medicine describes the practice of preventing and treating disease by providing the body with optimal amounts of substances which are natural to the body”.  http://www.orthomolecular.org/

Dr. Abraham Hoffer, a Canadian psychiatrist, was an enthusiastic proponent of orthomolecular psychiatry, however found that he (and Linus Pauling) were often violently criticised by the establishment for their work. He said: “I have lived a full, interesting and creative life supported by my family and many friends and irritated and spurred on by the hostile criticisms of a group of psychiatrists representing APA and NIMH. Since they did not know me personally I never took it personally although I must admit I would have preferred had they been supportive. I give my critics full credit for having delayed the full introduction of orthomolecular medicine into the medical world and for having denied life, health and happiness for innumerable patients. Supporters of old paradigms never realize how much damage they do by their remarkable rigidity and adherence to old theories”. http://orthomolecular.org/history/hoffer/index.shtml

What many scientists seem to forget is that the existing scientific paradigm is merely a consensus, not an absolute truth. Fortunately, more recently, nutritional psychiatry is starting to gain some traction in mainstream psychiatry, as the scientific evidence continues to mount.Marx, W., Moseley, G., Berk, M., & Jacka, F. (2017). Nutritional psychiatry: the present state of the evidence. The Proceedings of the Nutrition Society, 76(4), 427–436. https://doi.org/10.1017/S0029665117002026 https://pubmed.ncbi.nlm.nih.gov/28942748/ [accessed 13th July 2020], Jacka F. N. (2017). Nutritional Psychiatry: Where to Next?. EBioMedicine, 17, 24–29. https://doi.org/10.1016/j.ebiom.2017.02.020, https://pubmed.ncbi.nlm.nih.gov/28242200/ [accessed 13th July 2020]

One of the breaks to the progress of nutritional psychiatry is the fact that very little nutrition is taught in medical schools. Nutrition education lacking at most medical schools. (2018, July 09). Retrieved July 28, 2020, from https://www.hsph.harvard.edu/news/hsph-in-the-news/nutrition-education-lacking-at-most-medical-schools/, Adams, K. M., Lindell, K. C., Kohlmeier, M., & Zeisel, S. H. (2006). Status of nutrition education in medical schools. The American journal of clinical nutrition, 83(4), 941S–944S. https://doi.org/10.1093/ajcn/83.4.941S, Hyman, M. (2019, November 13). Why don’t they teach nutrition in medical school? Retrieved July 28, 2020, from https://drhyman.com/blog/2018/09/07/why-dont-they-teach-nutrition-in-medical-school/, American Heart Association News (2018, May 03). How much does your doctor actually know about nutrition? Retrieved July 28, 2020, from https://www.heart.org/en/news/2018/05/03/how-much-does-your-doctor-actually-know-about-nutrition

This is recognised by the integrative and functional medicine communities as a real challenge to the development of vital nutritional approaches to health.  However, as scientific evidence continues to mount for the effectiveness of nutrition in treating chronic disease, this will hopefully continue to evolve in the right direction.

How can nutritional psychiatry help you?

There is increasing awareness that our current dietary patterns and lifestyles of processed foods and eating on the run, coupled with the environmental and social impacts of climate change, urbanisation, 24/7 technology, increasing noise, light, air, water and soil pollution, are all detrimental to our mental health Logan, A. C., & Jacka, F. N. (2014). Nutritional psychiatry research: an emerging discipline and its intersection with global urbanization, environmental challenges and the evolutionary mismatch. Journal of physiological anthropology, 33(1), 22. https://doi.org/10.1186/1880-6805-33-22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131231/ [accessed 13th July 2020].

By returning to more traditional diets and nutrition patterns, and by making sure that we are obtaining optimal nutrients from better diets consumed in healthier emotional and physical environments, we can have a substantial positive impact on our mental health.

For instance, in research studies, the Mediterranean diet has been associated with less depression and cognitive decline. Skarupski, K. A., Tangney, C. C., Li, H., Evans, D. A., & Morris, M. C. (2013). Mediterranean diet and depressive symptoms among older adults over time. The journal of nutrition, health & aging, 17(5), 441–445. https://doi.org/10.1007/s12603-012-0437-x https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454450/ [accessed 21st July 2020], van den Brink, A. C., Brouwer-Brolsma, E. M., Berendsen, A., & van de Rest, O. (2019). The Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diets Are Associated with Less Cognitive Decline and a Lower Risk of Alzheimer’s Disease-A Review. Advances in nutrition (Bethesda, Md.), 10(6), 1040–1065. https://doi.org/10.1093/advances/nmz054, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855954/ [accessed 21st July 2020], Lassale, C., Batty, G. D., Baghdadli, A., Jacka, F., Sánchez-Villegas, A., Kivimäki, M., & Akbaraly, T. (2019). Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Molecular psychiatry, 24(7), 965–986. https://doi.org/10.1038/s41380-018-0237-8, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755986/ [accessed 21st July 2020]

There is ongoing research about the benefits of a ketogenic diet on mental health, cognitive decline and psychosis, though more research is required to be conclusive. Vinciguerra, F., Graziano, M., Hagnäs, M., Frittitta, L., & Tumminia, A. (2020). Influence of the Mediterranean and Ketogenic Diets on Cognitive Status and Decline: A Narrative Review. Nutrients, 12(4), 1019. https://doi.org/10.3390/nu12041019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231139/ [accessed 21st July 2020], Kovács, Z., D’Agostino, D. P., Diamond, D., Kindy, M. S., Rogers, C., & Ari, C. (2019). Therapeutic Potential of Exogenous Ketone Supplement Induced Ketosis in the Treatment of Psychiatric Disorders: Review of Current Literature. Frontiers in psychiatry, 10, 363. https://doi.org/10.3389/fpsyt.2019.00363, https://pubmed.ncbi.nlm.nih.gov/31178772/ [accessed 21st July 2020], Palmer, C. M., Gilbert-Jaramillo, J., & Westman, E. C. (2019). The ketogenic diet and remission of psychotic symptoms in schizophrenia: Two case studies. Schizophrenia research, 208, 439–440. https://doi.org/10.1016/j.schres.2019.03.019, https://pubmed.ncbi.nlm.nih.gov/30962118/ [accessed 21st July 2020]

Eating the right diet and digesting and absorbing the right nutrients can improve our mental health by reducing inflammation, aiding detoxification, balancing our blood sugar, balancing our hormones, improving our gut health, and providing the right building blocks to make the right hormones and neurotransmitters for better mental health.

How does nutritional psychiatry fit into integrative mental health and functional medicine psychiatry?

Nutritional psychiatry is only one aspect of integrative mental health and functional medicine psychiatry, but it is probably the most basic and important one.

Other aspects of integrative mental health and functional medicine focus more directly on improving detoxification and getting rid of heavy metals, plastics, and other toxins, balancing hormones and neurotransmitters, healing the gut, dealing with infections and pathogens, improving lifestyle habits such as sleep, exercise, breathing, and practicing mind-body therapies.

However there is no integrative or functional medicine therapy for mental health that does not include nutrition as a cornerstone of optimal mental health.

12 keys to nutritional psychiatry

Follow these 12 essential guidelines to nutritional psychiatry in order to improve your mental health. Following these will reduce inflammation, improve hormonal balance (including adrenal, thyroid, insulin and sex hormones), encourage neurogenesis (neuronal regeneration), and improve gut health, digestion and absorption.

You can start small and work up to the 12 steps at your own pace. Implementing any one of them will already be helpful, so do what you can, and gradually make these a lifestyle habit that you practice daily.

1. Eat whole foods, rather than processed ones

Whole foods are foods that are not, or are minimally, processed. Fresh vegetables, fruits, meats, legumes and whole grains. A whole foods diet improves mental health by:

• Reducing inflammation thanks to the natural antioxidants, polyphenols, vitamins, minerals, healthy fats in natural foods, and the absence of processed and refined carbohydrates
• Increasing nutrient density thanks to the high antioxidant, polyphenol, vitamins, minerals, healthy fats found in whole foods
• Improving gut health, as the presence of fibre, and diversity of nutritional, prebiotic and probiotic compounds found in whole foods nourish gut health

2. Eat plenty of good fats

Our brains constitute 60% fats. Healthy fats are essential to brain health.

Healthy fats include essential fatty acids such as omega 3s, 6s and 9s from plant foods such as olive oil and olives, nuts, seeds, and oily fish, but also healthy saturated fats from grass fed, free range meats, coconut sources and eggs.

• It is estimated that the brain requires as much as 25% of our energy intake per day. Brain fuel can come either from glucose, or fats in the form of ketones, which are made in the liver from fats. Ketones are often easier for the brain to use than glucose (which can be hampered by insulin resistance and low estrogen, for instance)
• Good fats such as omega 3s, some omega 6s and 9s help to reduce inflammation in the brain
• A certain amount of cholesterol and saturated fats are needed for optimal hormone production, and balanced hormones are essential to mental health

3. Cut out refined carbohydrates

Refined carbohydrates such as sugars and white flour products are highly processed foods, meaning that much of the goodness has been removed from them. What is left are substances which can be detrimental to mental health because they:

• increase insulin resistance — every time refined carbohydrates are consumed, our pancreas has to release insulin to escort the glucose into our cells. If we consume too many refined carbohydrates which turn into glucose, our cells can become resistant to the insulin’s requests to enter our cells, and then the glucose gets stored as excess fat which can put a strain on our liver
• Insulin resistance can block glucose uptake into the hippocampus, a brain structure which requires glucose to help defend a person against depression Frisardi, V., Solfrizzi, V., Capurso, C., Imbimbo, B. P., Vendemiale, G., Seripa, D., Pilotto, A., & Panza, F. (2010). Is insulin resistant brain state a central feature of the metabolic-cognitive syndrome?. Journal of Alzheimer’s disease : JAD, 21(1), 57–63. https://doi.org/10.3233/JAD-2010-100015 [accessed July 14th, 2020]
• Insulin resistance can undermine blood flow around the brain, making it more difficult to get nutrients in, and waste products out of the brain
• Excess fat cells can cause further hormonal imbalances by increasing cortisol levels and causing leptin resistance (leptin is our hormone of satiety, which helps us to feel full, and leptin resistance prevents us from feeling full), and by increasing estrogen levels
• Refined carbohydrates can cause inflammation
• Refined carbohydrates can be addictive because sugar impacts our dopamine (pleasure and motivation) receptors, and white flour can have gliadorphins like effects which can act on our opiate receptors
• Instead of refined carbohydrates, you can eat complex carbohydrates from starchy vegetables, fruits and whole grains

4. Eat plenty of vegetables and some fruit

Try to eat organic vegetables and fruit so as to lessen the toxic load from herbicides and pesticides. Plants foods such as vegetables, herbs and fruits can help with mental health due to their:

• Anti-inflammatory, anti-oxidant properties, due in part to their polyphenols which are plant compounds which can help to reduce inflammation.
  • Ironically, polyphenols are midly toxic, but they cause hormesis, which is mild stress to the body, so that the body then produces its own endogenous antioxidants.
• The fibre in plant foods is essential for gut health and to ensure proper gut motility, detoxification, the balance of good gut bacteria, and the integrity of the gut lining
• Focus on fruits that have digestive enzymes (papaya, mango, pineapple) and low sugar, high anti-oxidant fruits (such as berries)

5. Eat more herbs and spices

Herbs such as parsley, coriander, rosemary, thyme, dill, oregano, and spices such as turmeric, pepper, ginger, chilli, cinnamon, cumin, are all packed full of anti-oxidants, anti-inflammatory compounds, polyphenols, vitamins and minerals.

6. Eat grass fed, free range meats, wild, sustainably caught fish, and eggs

Our brains need adequate levels of healthy proteins due to the fact that amino acids are the building blocks of key neurotransmitters such as serotonin, dopamine, noradrenaline and GABA. Trypotphan for instance, is an amino acid which is found largely in foods such as eggs, turkey, fish, but also in seeds, beans and oat bran.

Furthermore, free range meats have been shown to have higher levels of omega 3s which are beneficial to the brain, as have fish and eggs. Free range eggs have been shown to have much higher levels of both vitamin E and omega 3s. Karsten, H., Patterson, P., Stout, R., & Crews, G. (2010). Vitamins A, E and fatty acid composition of the eggs of caged hens and pastured hens. Renewable Agriculture and Food Systems, 25(1), 45-54. doi:10.1017/S1742170509990214 [accessed July 14th, 2020]

Also, meats which are free range and grass fed have no antibiotics, which can be disruptive to the gut microbiome.

Make sure to eat smaller, wild-caught fish and avoid tuna, shark and swordfish due to high levels of mercury. Go to sustainable fisheries for a list.

7. Keep your BMI within a healthy range

BMI which is too high (above 24.9) or too low (below 18.5) can be detrimental to mental health. There is a correlation between obesity and mental health problems Rajan, T. M., & Menon, V. (2017). Psychiatric disorders and obesity: A review of association studies. Journal of postgraduate medicine, 63(3), 182–190. https://doi.org/10.4103/jpgm.JPGM_712_16, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525483/ [accessed 12th July 2020] 

Indeed, high BMI:

• Can lead to insulin resistance, which as we have seen, can compromise the delivery of glucose (energy) to the brain
• Fat cells can be a source of inflammatory cytokines and cause systemic inflammation and neuroinflammation
• Can cause an imbalance in hormones, both in terms of insulin resistance, leptin resistance, cortisol increase, and estrogen increase. Insulin resistance can lead to testosterone and thyroid imbalances.

8. Keep your blood sugar stable

Fluctuating blood sugars can be detrimental to mental health, and low blood sugar can cause high cortisol (which can eventually lead to insulin resistance as it will cause blood sugars to rise) irritability, and anxiety, and sustained high blood sugar can lead to fatigue, insulin resistance and eventually diabetes.

Keep your blood sugars smooth by combining the three macronutrients — proteins with complex carbs and fats at every meal. Ketogenic diets (high fats, low carbs, moderate protein) can be particularly good for blood sugar regulation and to improve insulin sensitivity.

9. Eat for gut health

The gut-brain axis is increasingly recognised as fundamental to mental health. Support your gut with a variety of whole foods, but also foods that focus on plant fibre, prebiotics and probiotics. A healthy gut can help maintain a healthy brain by:

• Enabling the absorption of key vitamins and minerals, such as vitamins B, K, A, D which are building blocks for key neurotransmitters such as serotonin and dopamine.
• Maintaining the integrity of the gut lining so that no inflammatory molecules (such as LPS, food molecules) can cross the gut barrier causing systemic and eventually neuroinflammation.
• Maintaining the health of the vagus nerve which allows vital communication between the gut and the brain.

10. Consider cutting out common allergens such as gluten and dairy

Gluten and dairy have been found to provoke high intolerance levels, which can cause systemic inflammation, and lead to intestinal permeability and neuro-inflammation.

You could do an elimination diet and keep a record of what you eat for 2 weeks to see if you feel any better when you eliminate gluten and dairy. And/or you could take a food intolerance test.

11. Stay hydrated, limit alcoholic beverages

Be sure to drink 2 litres of pure, filtered water every day. This will help:

• detoxify toxins and hormones
• help keep your blood and lymph circulating
• help optimise your brain function

Limit alcoholic beverages due to the high sugar content of alcohol, as well as its hormone-disrupting compounds. Alcohol can raise cortisol and increase insulin resistance, and it can hamper healthy sleep architecture.

12. Make sure you are getting the essential cofactors for mental health from your diet, and if you are not, consider supplementing

Zinc

• Found in meat, poultry, eggs, beans, nuts and seeds
• Essential for mental healthPetrilli, M. A., Kranz, T. M., Kleinhaus, K., Joe, P., Getz, M., Johnson, P., Chao, M. V., & Malaspina, D. (2017). The Emerging Role for Zinc in Depression and Psychosis. Frontiers in pharmacology, 8, 414. https://doi.org/10.3389/fphar.2017.00414, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5492454/ [accessed July 12th, 2020], Grønli, O., Kvamme, J. M., Friborg, O., & Wynn, R. (2013). Zinc deficiency is common in several psychiatric disorders. PloS one, 8(12), e82793. https://doi.org/10.1371/journal.pone.0082793, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868572/ [accessed 12th July 2020], Meihua Piao1 , Xiaoqiang Cong2 , Ying Lu3 , Chunsheng Feng1,†, Pengfei Ge4,† (2017). The Role of Zinc in Mood Disorders, Neuropscychiatry, Volume 7, Issue 4, http://www.jneuropsychiatry.org/peer-review/the-role-of-zinc-in-mood-disorders.pdf [accessed July 12th, 2020]
• Zinc helps to increase BDNF (Brain Derived Neurotrophic Factor) which increases cell density and connectivity in the brain.Manosso, L.M., Moretti, M., Ribeiro, C.M., Gonçalves, F.M., Leal, R.B. and Rodrigues, A.L.S., 2015. Antidepressant-like effect of zinc is dependent on signaling pathways implicated in BDNF modulation. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 59, pp.59-67. Available at: <https://www.sciencedirect.com/science/article/pii/S0278584615000093> [Accessed 18 July 2020].
• Zinc deficiency is a risk factor for diabetes and obesity.Fukunaka, A. and Fujitani, Y., 2018. Role of zinc homeostasis in the pathogenesis of diabetes and obesity. International journal of molecular sciences, 19(2), p.476. Available at: <https://www.mdpi.com/1422-0067/19/2/476> [Accessed 18 July 2020]. There is a higher risk of depression for people suffering from both conditions.González-Castro, T.B., Escobar-Chan, Y.M., Fresan, A., López-Narváez, M.L., Tovilla-Zárate, C.A., Juárez-Rojop, I.E., Ble-Castillo, J.L., Genis-Mendoza, A.D. and Arias-Vázquez, P.I., 2019. Higher risk of depression in individuals with type 2 diabetes and obesity: results of a meta-analysis. Journal of health psychology. Available at: <https://journals.sagepub.com/doi/abs/10.1177/1359105319876326> [Accessed 18 July 2020].
• Be careful to follow manufacturers suggested dose when supplementing zinc, as excess intake has been linked to memory impairment.Yang, Y., Jing, X.P., Zhang, S.P., Gu, R.X., Tang, F.X., Wang, X.L., Xiong, Y., Qiu, M., Sun, X.Y., Ke, D. and Wang, J.Z., 2013. High dose zinc supplementation induces hippocampal zinc deficiency and memory impairment with inhibition of BDNF signaling. PloS one, 8(1), p.e55384. Available at: <https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055384> [Accessed 18 July 2020].

Essential Fatty Acids (EFAs) and phospholipids

• Omega 3 EFAs found in oily fish and algae
• EPA is an omega 3 fatty acid found to be most supportive for people suffering from depression.Liao, Y., Xie, B., Zhang, H., He, Q., Guo, L., Subramaniapillai, M., Fan, B., Lu, C. and Mclntyer, R.S., 2019. Efficacy of omega-3 PUFAs in depression: a meta-analysis. Translational psychiatry, 9(1), pp.1-9. Available at: <https://www.nature.com/articles/s41398-019-0515-5> [Accessed 18 July 2020].
• DHA is an omega 3 fatty acid which can support synapse formation, reduce brain inflammationTalamonti, E., Sasso, V., To, H., Haslam, R.P., Napier, J.A., Ulfhake, B., Pernold, K., Asadi, A., Hessa, T., Jacobsson, A. and Chiurchiù, V., 2020. Impairment of DHA synthesis alters the expression of neuronal plasticity markers and the brain inflammatory status in mice. The FASEB Journal, 34(2), pp.2024-2040. Available at: <https://faseb.onlinelibrary.wiley.com/doi/full/10.1096/fj.201901890RR> [Accessed 18 July 2020]. and protect against brain aging.Echeverría, F., Valenzuela, R., Hernandez-Rodas, M.C. and Valenzuela, A., 2017. Docosahexaenoic acid (DHA), a fundamental fatty acid for the brain: New dietary sources. Prostaglandins, Leukotrienes and Essential Fatty Acids, 124, pp.1-10. Available at: <https://www.sciencedirect.com/science/article/abs/pii/S0952327817300285> [Accessed 18 July 2020].
• Citicoline is a precursor to brain phospholipids and the neurotransmitter acetylcholine. Supports brain energy, oxygenation, and reduces the risk of stroke. Dementia patients are reported to suffer less depression when supplementing citicoline.Secades, J.J., 2016. Citicoline: pharmacological and clinical review, 2016 update. Rev Neurol, 63(S03), pp.S1-S73. Available at: <https://pubmed.ncbi.nlm.nih.gov/28417449/> [Accessed 18 July 2020].

Vitamin Bs

• Required for coenzymes involved in energy production
• B6
  • is an essential cofactor for serotonin synthesis Parra, M., Stahl, S. and Hellmann, H., 2018. Vitamin B6 and its role in cell metabolism and physiology. Cells, 7(7), p.84. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071262/> [Accessed 18 July 2020].
  • B6 deficiency can increase neurotoxic by-products from serotonin metabolism, which are also implicated in insulin resistance Oxenkrug, G., 2013. Serotonin–kynurenine hypothesis of depression: historical overview and recent developments. Current drug targets, 14(5), pp.514-521. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726541/> [Accessed 18 July 2020].
• B9
  • Folate supports the synthesis of serotoninMiller, A.L., 2008. The methylation, neurotransmitter, and antioxidant connections between folate and depression. Alternative medicine review, 13(3). Available at: <https://pubmed.ncbi.nlm.nih.gov/18950248/> [Accessed 18 July 2020].
  • It is estimated that roughly a third of people with depression have a folate deficiencyYoung, S.N., 2007. Folate and depression—a neglected problem. Journal of psychiatry & neuroscience, 32(2), p.80. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810582/> [Accessed 18 July 2020].
  • Several studies have found gene variants which reduce folate metabolism in people suffering from treatment resistant depression. Kandler, C.C.E. and Lam, M.S.T., 2019. Methylenetetrahydrofolate reductase screening in treatment-resistant depression. Federal Practitioner, 36(5), p.207. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530664/> [Accessed 18 July 2020]. For patients with a folate gene variant, it is recommended that they seek advice from a qualified practitioner
• B12
  • Low dietary intake of both B12 and folate are often seen in depression Khosravi, M., Sotoudeh, G., Amini, M., Raisi, F., Mansoori, A. and Hosseinzadeh, M., 2020. The relationship between dietary patterns and depression mediated by serum levels of Folate and vitamin B12. BMC psychiatry, 20(1), pp.1-8. Available at: <https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-2455-2> [Accessed 18 July 2020]. The elderly are particularly at risk.Petridou, E.T., Kousoulis, A.A., Michelakos, T., Papathoma, P., Dessypris, N., Papadopoulos, F.C. and Stefanadis, C., 2016. Folate and B12 serum levels in association with depression in the aged: a systematic review and meta-analysis. Aging & mental health, 20(9), pp.965-973. Available at: <https://pubmed.ncbi.nlm.nih.gov/26055921/> [Accessed 18 July 2020].
• B3
  • Prolonged B3 deficiency can lead to pellaga, a condition where patients present with an array of symptoms, including apathy and depression Harsha, N.S., Suraj, B.M., Kanakavidu, S.S. and Kodali, R., 2019. Pellagra: A forgotten ailment in current clinical practice. Medical Journal of Dr. DY Patil Vidyapeeth, 12(1), p.78. Available at: <http://www.mjdrdypv.org/article.asp?issn=2589-8302;year=2019;volume=12;issue=1;spage=78;epage=80;aulast=Harsha> [Accessed 18 July 2020]. Dr. Abraham Hoffer was an advocate of B3 to support patients with schizophrenia.Prousky, J., 2010. Vitamin B3 for depression: case report and review of the literature. J Orthomol Med, 25(3), pp.137-147. Available at: <https://www.researchgate.net/publication/287922529_Vitamin_B3_for_depression_Case_report_and_review_of_the_literature> [Accessed 18 July 2020].

CoQ10

• Powerful antioxidant which again supports energy production
• Low CoQ10 levels are seen in depression Maes M, Mihaylova I, Kubera M, Uytterhoeven M, Vrydags N, Bosmans E. Lower plasma Coenzyme Q10 in depression: a marker for treatment resistance and chronic fatigue in depression and a risk factor to cardiovascular disorder in that illness. Neuro Endocrinol Lett. 2009;30(4):462-469. [accessed July 14th, 2020]

Magnesium

• Found in green leafy vegetables, seeds, nuts and brown rice
• Low magnesium found in treatment resistant depression Eby GA, Eby KL, Murk H. Magnesium and major depression. In: Vink R, Nechifor M, editors. Magnesium in the Central Nervous System [Internet]. Adelaide (AU): University of Adelaide Press; 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507265/ [accessed July 14th, 2020]
• Low levels of serotonin seen with magnesium deficiency

Vitamin C

• Found in fresh fruit and vegetables
• Deficiency associated with increased risk of depression and mood changes Plevin, D., Galletly, C. The neuropsychiatric effects of vitamin C deficiency: a systematic review. BMC Psychiatry 20, 315 (2020). https://doi.org/10.1186/s12888-020-02730-w [accessed July 14th, 2020]
• Extreme deficiency is known as scurvy – depression and confusion are two symptoms of the disease Léger, D., 2008. Scurvy: reemergence of nutritional deficiencies. Canadian Family Physician, 54(10), pp.1403-1406. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567249/> [Accessed 18 July 2020].

Vitamin D

• Found in oily fish, meat and eggs
• Has a favourable impact on depression ratings of patientsVellekkatt, F. and Menon, V., 2019. Efficacy of vitamin D supplementation in major depression: A meta-analysis of randomized controlled trials. Journal of postgraduate medicine, 65(2), p.74. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515787/> [Accessed 18 July 2020].
• Reduces brain inflammation by stabilising microglia (part of the brain’s immune system) Boontanrart M, Hall SD, Spanier JA, Hayes CE, Olson JK. Vitamin D3 alters microglia immune activation by an IL-10 dependent SOCS3 mechanism. J Neuroimmunol. 2016;292:126-136. doi:10.1016/j.jneuroim.2016.01.015 Available at: <https://pubmed.ncbi.nlm.nih.gov/26943970/> [accessed July 14th, 2020]

Curcumin

• A polyphenol found in the spice turmeric
• Positively interacts with the nervous system to help improve mood regulationKaufmann, F., Gazal, M., Bastos, C., Kaster, M., & Ghisleni, G. (2016). Curcumin in depressive disorders: An overview of potential mechanisms, preclinical and clinical findings. Available at: <https://www.sciencedirect.com/science/article/abs/pii/S0014299916303314> [accessed July 14th, 2020]
• Like zinc, curcumin has been found to upregulate the neurotrophin BDNF Santana-Martínez, R.A., Silva-Islas, C.A., Fernández-Orihuela, Y.Y., Barrera-Oviedo, D., Pedraza-Chaverri, J., Hernández-Pando, R. and Maldonado, P.D., 2019. The therapeutic effect of curcumin in quinolinic acid-induced neurotoxicity in rats is associated with BDNF, ERK1/2, Nrf2, and antioxidant enzymes. Antioxidants, 8(9), p.388. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769626/> [Accessed 18 July 2020].

Further links on correcting your nutrition for better mental health and putting nutritional psychiatry into practice

Read more here about eating and supplementing for better mental health

Read more here about eating more anti-inflammatory, detoxifying and antioxidant foods

Read more here about healing with herbs and spices

Read more here about eating to improve gut health

Read more here about eating the right fats for mental health

Read more here about eating the right carbohydrates

Read more here about eating for better hormonal balance