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Translator: Mayumi Oiwa-Bungard
Reviewer: Queenie Lee In 1847, a physician by the name of Semmelweis advised that all physicians
wash their hands before touching a pregnant woman, in order to prevent childbed fever. His research showed that you could reduce
the mortality rates from septicemia, from 18% down to 2%, simply through washing your hands
with chlorinated lime. His medical colleagues refused to accept that they themselves
were responsible for spreading infection. Semmelweis was ridiculed
by his peers, dismissed, and the criticism and backlash
broke him down, and he died in an asylum,
two weeks later, from septicemia, at the age of 47. What I’m going to talk about today
may sound as radical as hand-washing sounded
to a mid-19th century doctor, and yet it is equally scientific. It is the simple idea that optimizing nutrition
is a safe and viable way to avoid, treat, or lessen mental illness. Nutrition matters. Poor nutrition is a significant
and modifiable risk factor for the development of mental illness. According to the 2013
New Zealand Health Survey, the rates of psychiatric
illnesses in children doubled over the last five years. Internationally, there’s been
a 3-fold increase in ADHD, a 20-fold increase in autism, and a 40-fold increase
in bipolar disorder in children. And this graph here shows
there’s been a 4-fold increase in the number of people
who are on disability as a direct consequence
of an underlying psychiatric illness. The rates of mental illness
are on the rise. So how are we dealing with this problem? Currently, our healthcare system
operates within a medical model. Now, this means that you would typically
be offered psychiatric medications first, followed by psychological therapies, and other forms of support. Our reliance on medications
as a front-line form of treatment is evident from the increasing
rates of prescriptions. For example in 2012, half a million New Zealanders –
that’s one-eighth of us – had been prescribed an antidepressant; that’s 38% higher
than five years previously. Similarly, the rates of prescriptions
for antipsychotics doubled, from 2006 to 2011. Given that this medical model is fairly universal
across all Western societies, you would rightfully expect
that it was working well. And indeed, in some cases,
these treatments save lives. And I’m not here to dismiss it altogether. However, if a treatment
is truly effective, then shouldn’t the rates of disorder and disability as a direct
consequence of that illness be decreasing rather than increasing? That’s why we need to consider the role
that medications might be playing in some of these outcomes. If we take any class of medication:
antipsychotics, anti-anxiety medications, antidepressants; the pattern is the same. In the short-term, these treatments are often very effective,
but in the long-term, they aren’t. And in some cases,
they’re making life worse. If we look at, for example, studies that are being done on ADHD children
treated with stimulants or Ritalin, in the short-term, they are better, and responding – better responders
than any other form of treatment, but in the long-term, they fare less well than children who were
never prescribed these medications. Another study showed that despite our ever-increasing
reliance on antidepressants, the recovery rates and relapse rates are no better now
than they were 50 years ago, prior to the advent of these medications. And children with depression who were treated with antidepressants are three times more likely
to convert to bipolar disorder than children who were never
given these medications. And people who were randomized to stay on their dose
of antipsychotic medications are less likely to recover
from schizophrenia in the long-term than people who had been randomized to a dose reduction
or complete elimination of the drug. And I can show you more and more studies all highlighting the same bleak picture. So, pretty depressing. (Laughter) Is there another way forward? Almost two decades ago, my PhD supervisor at the time,
Professor Bonnie Kaplan, told me about some families who were treating themselves
with nutrients, in Southern Alberta, Canada. Now, they had bipolar disorder,
psychosis, depression. These are serious conditions,
and my education in clinical psychology had taught me that nutrition and diet were
of trivial significance for mental health, and that only drugs or psychotherapy
could treat these serious conditions. But she and others
were publishing preliminary data in the earlier part of this century, showing people getting well
and staying well. And so, I decided to study the nutrients, and that’s what I’ve done
for the last decade. In 2009, I received some funding to run
a randomized placebo-controlled trial, using minerals and vitamins,
also known collectively as micronutrients, for the treatment of ADHD in adults. And this study was published
in the British Journal of Psychiatry in April of this year, and here’s what we found. Within just an 8-week period, twice as many people responded
in the micronutrient group compared to placebo; twice as many people went
into remission in their depression, in the micronutrient group. Hyperactivity and impulsivity reduced
into the normal, non-clinical range, and those who were taking
the micronutrients were more likely to report that their ADHD symptoms
were less impairing and less interfering in their work and social relationships than people who were on the placebo. And one year later, those people who stayed
on the micronutrients maintained their changes
or showed further improvement, and those who switched to medications
or stopped the micronutrients actually showed worsening
of their symptoms. Now, I need to tell you something here, and that is, when I say micronutrients, I’m actually referring to
a dose higher than what you’d get out of a vitamin pill
purchased on the supermarket. In this study, we gave participants up to 15 pills a day with 36 nutrients. So it would be unlikely that if you went and got
an over-the-counter supplement, you would unlikely
see these positive benefits, both because the dose is lower,
and the breadth of nutrients is lower. Now, these positive benefits
are not confined to a single study. My lab at the University of Canterbury is the Mental Health
and Nutrition Research Group, and we’ve published
over 20 papers in medical journals, all documenting the benefits
of micronutrients. For example, this study here showed that we could reduce the symptoms
of bipolar disorder in children by 50% with a simultaneous reduction
of medications. This study here showed that we could reduce rates
of probable posttraumatic stress disorder from 65% down to 18%, following the Christchurch earthquakes, with a one-month intervention
of micronutrients, with no change in those not
taking the nutrients. Even one year later, those people
who had received the nutrients were doing better than those who didn’t. And we’ve just replicated these findings in collaboration with researchers
at the University of Calgary, following the floods of June 2013,
in Alberta, Canada. To me, the message is clear, that a well-nourished body and brain is better able to withstand ongoing stress
and recover from illness. Giving micronutrients in appropriate doses can be an effective and inexpensive
public health intervention to improve the mental health
of a population following an environmental catastrophe. In my 20-year career, I have rarely seen these dramatic responses
from conventional treatments. When people get well, they get well across the board, not only in the symptoms that we treated, but also in other areas,
like improved sleep, stabilization of mood,
reduction in anxiety, and the reduction in need
for cigarettes, cannabis, and alcohol. My research and those around the world have shown that 60 – 80% of people
respond to micronutrients, showing just how powerful
this intervention is. And internationally, there have now been 20 randomized
placebo-controlled trials – this is the gold standard
that we use to make clinical decisions – showing that we can
reduce aggression in prisoners, slow cognitive decline in the elderly, treat depression, anxiety,
stress, autism, and ADHD. And, they might even
be more cost-effective than current conventional treatments. This study here documented the treatment
of a 10-year-old boy with psychosis. When his 6-month inpatient treatment
with medications was unsuccessful, he was treated with micronutrients. Not only did the micronutrients completely eliminate
his hallucinations and delusions – changes that were maintained
six years later – but the cost of the treatment
was less than 2% than the cost of the unsuccessful
inpatient treatment. The cost savings alone make it imperative that our society pay attention
to the wider benefits of this approach. And there is more good news. Treating – Supplementing before
mental illness emerges can actually stop these problems
from developing in the first place. This fantastic study looked at
81 adolescents at risk for psychosis and randomized them to receive either Omega-3 fatty acids
in the form of fish oils – essential nutrients for brain health – or placebo for a 12-week period. One year later, 5% of those who received the fish oil
had converted to psychosis versus 28% of those on placebo. That represents an 80% reduction of the chances of you
converting to psychosis, simply through giving fish oils. I wonder if I know
what some of you are thinking. I wonder if some of you are thinking, “Hold on! Why don’t I just eat better?” “Why don’t I just
tell everyone to eat better?” And indeed, there are
some fantastic studies that document the strong relationship
between dietary patterns and mental health although we’re still in very early days
of scientific investigation. We don’t know who would benefit
from dietary manipulation alone, and who may need the additional boost
from extra nutrients. But even in the last five years, there have been
11 epidemiological studies, cross-sectionally and longitudinally, in large populations around the world, all showing the same thing. The more you eat a prudent
or Mediterranean or unprocessed type of diet, the lower your risk for depression. And the more you eat
the Western diet or processed food, the higher your risk for depression. I know of only one study
that has not found this association, and not a single study shows that the Western diet
is good for our mental health. (Laughter) What is the Western diet? Well, it’s one that is heavily processed, high in refined grains,
sugary drinks, takeaways, and low in fresh produce. And the healthy diet is one that is fresh, high in fruits and vegetables, high in fish, nuts, healthy fats, and low in processed foods. What your grandmother
would recognize as food. (Laughter) There are still many questions remaining about the relationship
between mental health and nutrition. What role do genetics play in determining who’s going
to respond to nutrients, and who needs additional nutrients
than what they can get out of their diet? What role does an infected, inflamed gut
play in the absorption of nutrients? It’s not we are what we eat; it’s we are what we absorb. And what role do medications play in determining how effective
the nutrients are? Combining medications and nutrients
is actually complicated, and we need more research in better
understanding these interactions. But ultimately, we need to know
how long these good benefits last. So with all of this data, this rich data highlighting
the power of nutrition, I think we can make some individual
and collective changes now. We could reconsider
our current treatment approach: prioritize lifestyle factors, healthy eating, exercise, supplements, and when necessary,
psychological treatments, and save medications
for when these approaches don’t work. If nutrients work, then shouldn’t they be covered
through our healthcare system? Take universal prevention seriously by optimizing the nutrition
of those who are vulnerable. We don’t wait for the heart attack to hit in order for us
to modify lifestyle behaviors that we know contribute to heart disease. It should be no different
with mental health. An easy way to implement
universal prevention would be to have pregnant women –
not pregnant women: midwives tell pregnant women
about the importance of nutrition. Nutrient-depleted mothers
produce nutrient-depleted children. Nutrient-poor foods during pregnancy increase the chances that your child
will have a mental health problem. Learn about the risks
of cheap, processed foods. As Michael Pollan stated,
cheap food is an illusion; there is no such thing as cheap food. The price is paid somewhere, and if it’s not paid at the cash register,
then it’s charged to the environment and to the public purse
in the form of subsidies, and it’s charged to your health. All children need to learn how to cook. All children need to know that food
doesn’t have to come in a packet. Schools could reflect on the content
of their lunch menus. Children are too frequently rewarded
with processed foods for good behavior. We need to reflect on whether or not
this pairing intuitively makes sense. Ultimately, we have
a responsibility to teach them that every time they put
something in their mouths, they make a choice: to eat something nourishing,
or something nutritionally depleted. In the 19th century,
physicians were offended when Semmelweis suggested they wash
their hands before delivering babies. We are now asking them to consider whether the medications
that they prescribed are contributing
to the poor long-term outcome for some people with mental illness. But eating well and when appropriate
additional nutrients can improve the mental health
of many people. I leave you with one last thought. Randomized trials in the 1600s showed that putting limes
aboard ships headed out for long voyages completely eliminated
the 40% mortality from scurvy. But it took 264 years
for the British government to mandate that all ships
must carry citrus for their sailors. How long will it take our society
to pay attention to the research showing that suboptimal nutrition is contributing
to the epidemic of mental illness? So this is my idea worth spreading: Nutrition matters, and if we’re really ready to get serious
about mental health, we need to get serious about
the critical role played by nutrition. Thank you. (Applause) (Cheering)

Randall Smitham

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