The history of our attempts to understand and treat mental problems recapitulates and reflects our social, philosophical and economic development. How could it be otherwise?
Through the detail, one can discern five broad, paradigmatic shifts. The first major shift from a spiritual / religious model to one based on moral character emerges in (roughly) the mid-17th century, and the latter prevails up to the second half of the 19th century when psychological models start to coalesce. It is not long before these are partially displaced by initially neurological and subsequently neurophysiological and biochemical systems, with the sociological / sociopolitical theories starting to emerge in the mid-20th century.
The last three models and hybrids thereof co-exist today in sometimes uneasy alliances, and while the biochemical / neurophysiological model remains dominant, one at least partially valid criticism of this system is that its main function appears to be an economic one. It certainly suits the (large) vested interests of the pharmaceutical industry, which earns prodigiously from psychotropic drug sales. The striking weaknesses of these drugs (they are variously toxic, addictive and / or ineffective) bears witness to the model’s mechanistic fragility and monetary importance.
I submit, however, that while the biochemical / neurophysiological model may have been coopted by economics, its latest version, the nutritional / environmental model, is highly relevant today as it provides both an explanation for ongoing (negative) trends in mental health, and at the same time a series of evidence-based, effective, safe and low-cost interventions.
There is a good deal of evidence that CNS integrity is being increasingly adversely affected by environmental and specifically nutritional issues. Within the general category of CNS integrity are included neurodevelopmental disorders, neurodegenerative diseases, cognitive functions and disorders of affect. There are also mounting pre-clinical and clinical data indicating that many of these problems respond positively to pharmaco-nutritional treatment.
Furthermore, given the prevailing trend of declining nutrient density (43, 44), we predict that the numbers of individuals afflicted with these problems, and at the same time likely to respond to pharmaco-nutritional intervention, will continue to increase.
CNS damage/dysfunction affected by environmental / dietary factors.
- Neurodevelopmental problems.
ADD, ADHD, dysphasia, dyspraxia, autism, Asperger’s, other.
About 1 in 6 children in the U.S. had a neurodevelopmental disability (ND) in 2006–2008. The prevalence of parent-reported NDs increased 17.1% from 1997 to 2008 (1).
There is evidence that children with ADD and ADSD have low levels of omega 3’s and correspondingly high omega 6:3 ratios (2). There is also evidence that many children with these and related conditions respond favourably to omega 3 HUFA treatment (3, 4), and to extended forms of nutritional intervention (47). In the author’s experience further improvements are often achieved by microbiotal modulation, using ancillary pharmaconutritional tools.
- Neurodegenerative diseases.
Alzheimer’s, Parkinsonism, SWEDDS, MND, other.
In the USA, numbers of neurodegenerative deaths in men over 65 have tripled since 1995, while deaths in women have increased 5-fold (5). The author believes that the increase in the USA is related to American citizens’ high consumption of processed and ultra-processed foods, and is connected in this way to the decline in life expectancy witnessed by the CDC over the last 3 years (6). As US dietary patterns have shifted to the UK, life expectancy has started to fall there also (7), and the incidences of neurodegenerative deaths, and deaths associated with Alzheimer’s, have also increased significantly (8).
Adherence to the anti-inflammatory Mediterranean Diet appears to be protective against Alzheimer’s and probably Parkinsonism and its variants also (9). Initial work by Dale Bredeson at UCLA and the Buck Institute indicates that early onset dementia can be reversed using a multi-component nutritional intervention (10), derived in part from the Mediterranean diet. Further clinical results are expected from this lab within the next two years.
There is hard (neurological) evidence that average IQ levels have fallen in ‘healthy’, young to middle-aged subjects at least since 1900 (11, 12), and also since 1950 (13, 14). The picture among seniors appears to be similar. Among seniors there is no sign of improvement in cognitive function in recent decades, and some analyses find poorer function in the newer cohorts (15). The main reasons for this are considered to be lifestyle, metabolic and nutritional factors which prevail in the US and are increasingly part of the UK and European pattern.
The evidence that we can reverse this decline with dietary enhancement in at least some groups, though circumstantial, is persuasive (16, 48, 49).
- Affective disorders
The incidence of depression is doubling with every generation (17, 18); and antidepressant use has increased by 65% in the last 15 years (19). The average age of onset of depression has fallen from age 30 in 1988 to 14 today, and 1 in 8 Americans over the age of 12 report recent antidepressant use (19). Similar trends are seen with anxiety states (20, 21).
The Mediterranean diet is linked to a significantly lowered risk of depression (22, 23). More specifically, both omega 3 HUFA’s (24, 25) and the spice saffron (26, 27, 28) have been shown to exert significant anti-depressant and anxiolytic effects. The rapidity of onset of action of saffron has largely replaced monoamine-based theories of depression and confirmed the importance of chronic hippocampal neuro-inflammation in the affective disorders (29); thus providing a reasonably robust explanation for many of the trends reported above.
The above section presents a set of data indicating that the central nervous system is being adversely affected by lifestyle and nutritional factors which are prevalent in the developed nations; and that these negative effects are at least partially reversible using phamaconutritional tools.
Accordingly, I believe that the concept of brain-targetted nutrition not only provides a way of reducing a wide range of morbidities involving the brain that are currently manifesting in prisons, schools, and society at large; it is also socially essential.
As all of these conditions adversely affect individual, inter-individual and group social behaviours, the social and economic impact of pharmaco-nutritional intervention and support programs is likely to be considerable.
It is also highly likely (although for obvious reasons not yet proven) that pre-clinical versions of these conditions exist, and also damage social interactions, in the general population and especially in those sections of the general population known or suspected to be at higher risk of dysnutrition and inflammatory stress, and/or manifesting social disturbance / disruption. This is informed by social class in general (43, 44), but pharmaco-nutritional interventions would probably be more cost-effective if directed at the identified socially and behaviourally disadvantaged groups. These would include prisoners, various categories of psychiatric patients and persons with a record of anti-social behavior.
Based on the available science, I suggest the following three-tier nutritional regime to support a healthy central nervous system:
a) Nutrients known to be essential for baseline CNS function, with existing RNI values
b) Nutrients strongly linked to baseline CNS function, but which do not yet have RNI values
c) Nutrients strongly linked to enhanced CNS function
a) Nutrients known to be essential for baseline CNS function, with RNI values. Ascorbic acid, B6, B12, biotin, copper, folate, iodine, magnesium, niacin, pantothenic acid, riboflavin, thiamine, zinc.
b) Additional nutrients strongly linked to basic neuronal function, but which do not yet have RNI values.
- Omega 3 HUFA’s, at doses sufficient to achieve an omega 6:3 cell membrane ration below 5. Suggested dose 2ml / kg bodyweight, as per Marangoni et al ’04 (41).
- The polyphenol oleuropein, which protects CNS structures by up-regulating NRF-2 (30), inhibiting beta amyloid aggregation (31) and restoring autophagic and mitophagic pathways (32). Suggested dose 25 mg, ie 500% per EFSA LDL claim (42). (The EFSA claim refers solely to the inhibition of LDL oxidation, and is likely insufficient to achieve significant CNS protection. The recommended dose of 25 mg is the amount of polyphenols in approximately 25 olives).
- 1-3, 1-6 beta glucans (yeast-derived) up-regulate microglial function without triggering excessive pro-inflammatory cytokine release (33), but sufficient to enhance neuronal regeneration (34). Suggested dose 2.5mg/kg body weight (45), or less if given in divided doses.
c) Phytonutrients strongly linked to enhanced nervous system function.
Saffron has robust anti-depressant and anxiolytic effects (35-37). These are likely related to its anti-neuroinflammatory effects and ability to up-regulate BDNF, and the downstream neuropeptide VGF (38-40). Dose 28 mg (46).
The above program and variants thereof can be delivered in supplemental form, or in carefully designed food choices.
1.Identify groups likely to benefit from pharmaco-nutritional intervention;
2. Identify the key stakeholders / representatives associated with the above groups. Professional, local and national governmental, other;
3. Prepare backgrounder and initial cost / benefit estimates for those groups which respond positively;
4. Communicate the nutritional message plus comparative economics to stakeholders.
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