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    The Importance of Nutrition for Mental Health: Dr. Alex Richardson - The Importance of Nutrition for Mental Health: Dr. Alex Richardson - Presentation Transcript

    • The Importance of Nutrition for Mental Health Dr Alex Richardson Senior Research Fellow, Centre for Evidence Based Intervention. University of Oxford Founder Director of the UK Charity, Food and Behaviour (FAB) Research
    • The Shape of Things to Come The Economist, Dec 11 2003 © A.J.Richardson, Food And Behaviour Research 2012
    • Many nutritional features of modern western diets areevolutionarily novel and pathological• High Glycaemic Load Sugar• Altered Fatty Acid Composition Fat• Altered Macronutrient Composition• Reduced Micronutrient Density Vitamins,• Acid-Alkaline Balance Minerals etc• Sodium-Potassium Ratio Fruit & Veg• Dietary Fibre Cordain et al. (2005) Origins and evolution of the western diet: health implications for the 21st century. Am J Clin Nutr 81:341-54. © A.J.Richardson, Food And Behaviour Research 2012
    • “A Rotten Way to Feed the Children” 16 Apr 2004 - Times Educational Supplement By Stephanie Northern“The physical risks to children froma nutritionally poor diet are nowacknowledged, but the damagebeing done to their behaviour,learning abilities and mood is not.” • The UK Government has been forced to pump £342 million into school behaviour improvement programmes. • The WHO predicts a 50 per cent rise in child mental disorders by 2020. • Dyslexia, hyperactivity, autism and related conditions all appear to be on the increase. © A.J.Richardson, Food And Behaviour Research 2012
    • Childhood Behavioural and Learning Difficulties – The Overlap Dyslexia ADHD Dyspraxia Autistic Spectrum• These diagnoses are descriptions – they are not explanations.• Difficulties are dimensional, affecting > 20% of UK school children © A.J.Richardson, Food And Behaviour Research 2012
    • Psychiatric Disorders – The Overlaps Depression Anxiety DisordersBipolar Disorder SchizophreniaDiagnoses are descriptive – based on behaviour, not etiologyConditions are dimensional – i.e. continuous with normal functionComorbidity is high, adding to heterogeneity within each © A.J.Richardson, Food And Behaviour Research 2012
    • Increasing Cost Burden of Mental Health DisordersUK (Government’s own figures)• In 2007: £77 billion• In 2010: £105 billionEurope 201038% of Europeans (≈165 million) have a fully developed mental or neurological illnessWitchens, Jacobi et al (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neurospychopharmacol, 21, 655-679 © A.J.Richardson, Food And Behaviour Research 2012
    • Most Common Mental Health DisordersEurope Prevalence (Annual)• Anxiety disorders 14.0%• Insomnia 7.0%• Major depression 6.9%• Somatoform 6.3%• Alcohol and drug dependence 5.4%• ADHD 5.0% in the young• Dementia 1–30%, depending on age Witchens, Jacobi et al (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neurospychopharmacol, 21, 655-679 © A.J.Richardson, Food And Behaviour Research 2012
    • The role of Nutrition?• Appropriate nutrition is essential for: – The growth and development of brains and bodies – Building, maintaining, fuelling and repairing every cell in every part of the brain and body• At least 39 essential nutrients must be provided by our food – These include vitamins and minerals, essential amino acids, and omega 3 and omega 6 fatty acids• Many of these are lacking from modern diets• Individual differences affect dietary requirements – Specific nutrients may be needed in unusually high quantities – There may be allergies or intolerances to certain foods © A.J.Richardson, Food And Behaviour Research 2012
    • Nutrition and Antisocial Behaviour (Gesch et al, 2002 Brit. J. Psychiat.)• Randomised controlled trial of dietary treatment• 231 young offenders imprisoned at a high- security unit in the UK took part• Each received either a Could diet help to multivitamin + fatty reduce violence and acid supplement, or a matched placebo cut crime? © A.J.Richardson, Food And Behaviour Research 2012
    • Gesch et al 2002: RESULTS All Disciplinary Incidents - Intent to treat (ITT) =231. Ratio of Rate of Disciplinary Incidents 1.4 1.2 Supplementation/Baseline 1 0.8 Activ e Placebo 0.6 Error bars drawn at 0.4 two standard errors to indicate the 95% 0.2 conf idence interv al 0 Bef ore Supplementation During Supplementation Activ e 1 0.737 Placebo 1 0.9931133 offences: Active vs Placebo: -26.3 % (p ‹ 0.027)Supplementation for at least 2 weeks: Active vs Placebo: -34.0% And for violent offences only: “ -37.0% © A.J.Richardson, Food And Behaviour Research 2012
    • The unbalanced diet… © A.J.Richardson, Food And Behaviour Research 2012
    • Many nutritional features of modern western-type diets are evolutionarily novel and pathological• High Glycaemic Load Sugar• Altered Fatty Acid Composition• Altered Macronutrient Composition• Reduced Micronutrient Density• Acid-Alkaline Balance• Sodium-Potassium Ratio Cordain et al. (2005) Origins and evolution of the western diet: health• Dietary Fibre implications for the 21st century. Am J Clin Nutr, 81:341-54. © A.J.Richardson, Food And Behaviour Research 2012
    • Sugar and‘Refined Carbs’Blood glucose metabolism © A.J.Richardson, Food And Behaviour Research 2012
    • Sugary foods and drinks cause rapid swings in blood sugar (affecting mood, behaviour and cognition) Optimal range for brain function © A.J.Richardson, Food And Behaviour Research 2012
    • ‘Slow-release’ foods at breakfast help to keepblood sugar levels stable (minimising fluctuations in mood, behaviour and cognition) Optimal range for brain function © A.J.Richardson, Food And Behaviour Research 2012
    • Sugar addiction? • Evidence that intermittent, excessive sugar intake causes endogenous opioid dependence. Colantuoni C, et al (2002) Obesity Research,10(6):478-88. • Opiate-like effects of sugar on gene expression in reward areas of the rat brain. • Spangler R, et al (2004) Brain Research and Molelcular Brain Research, 19;124(2):134-42. © A.J.Richardson, Food And Behaviour Research 2012
    • Sugar – the new poison? Robert Lustig Prof of Pediatrics at UCSF: Interview with New Scientist, 2011 on his Youtube lecture, "Sugar: The bitter truth“ Q: Why Do We Consume so much Sugar?• One reason is that its addictive. The food industry knows that when they add fructose we buy more. Thats why its in everything.• There are five tastes on your tongue: sweet, salty, sour, bitter and umami. Sugar covers up the other four, so you cant taste the negative aspects of foods.• You can make dog poop taste good with enough sugar. In essence, that is what the food industry has done © A.J.Richardson, Food And Behaviour Research 2012
    • Glucose vs Fructose• Glucose – Used by all living cells as a source of energy – Absorbed directly into the bloodstream• Fructose – Requires processing by the liver before its energy can be used (technically – a ‘toxin’) – NO PROBLEM if consumed via eating fruits and sweet vegetables (nature provides the antidote..) – NOT HEALTHY if consumed as a ‘white powder’ – i.e table sugar or High-Fructose Corn Syrup (both approx 50% glucose, 50% fructose. © A.J.Richardson, Food And Behaviour Research 2012
    • All Calories are NOT equal (Lustig 2006 Nature Endocrinology)• ‘Energy in, energy out’ – Consuming more calories than are burned for energy leads to fat storage. Yes, BUT:• Conventional advice to ‘Eat Less, Exercise more’ does not work – because: – Consuming excess sugar can increase appetite and reduce energy• Excessive calories from sugar (fructose) affect the balance of key hormones that regulate energy metabolism and appetite • Insulin resistanc, leptin resistance, increased ghrelin etc © A.J.Richardson, Food And Behaviour Research 2012
    • Many nutritional features of modern western-type diets are evolutionarily novel and pathological• High Glycaemic Load• Altered Fatty Acid Composition Fat• Altered Macronutrient Composition• Reduced Micronutrient Density• Acid-Alkaline Balance• Sodium-Potassium Ratio Cordain et al. (2005) Origins and evolution of the western diet: health• Dietary Fibre implications for the 21st century. Am J Clin Nutr, 81:341-54. © A.J.Richardson, Food And Behaviour Research 2012
    • Getting the Fats RightQuality, not QuantitySome Fats are Essential Omega-3 and Omega-6 Polyunsaturates © A.J.Richardson, Food And Behaviour Research 2011
    • Dietary advice last century was focused on Physical Growth requirements – especially for babies and children (weight, height etc) This placed undue emphasis on Dietary Protein © A.J.Richardson, Food And Behaviour Research 2012
    • Human development isabout the growth of theBRAIN, not the body –and Nutrition is simply Critical © A.J.Richardson, Food And Behaviour Research 2012
    • The human brain is 60% FAT and it matters what kindDietary advice has not been taking this into account © A.J.Richardson, Food And Behaviour Research 2012
    • © A.J.Richardson, Food And Behaviour Research 2007
    • Getting the Fats Wrong Margarines and commercially baked or fried foods usually contain high levels of hydrogenated and trans fats These are artificially saturated and ‘twisted’ fats, which have • no known nutritional benefits • many health risks. Trans fats compete with the essential fatty acids (omega-3 and omega-6) needed for brain and body health © A.J.Richardson, Food And Behaviour Research 2012
    • Trans fats – a real poisonIn 2009, the W.H.O. declared that trans fats (from hydrogenated vegetable oils) really are toxic – and sensible countries now ban them.• These artificial ‘plastic fats’ raise the risks for Inflammation Obesity Type II Diabetes Cardiovascular Disease• They are also associated with: Depression Anxiety Memory problems Irritability and Aggression © A.J.Richardson, Food And Behaviour Research 2012
    • Dietary Sources of Omega-6 omega-6 Vegetable oils,Shorter- LA (Linoleic) 18:2Chain nuts, seeds, grains GLA 18:3 Evening primrose DGLA 20:3 * oil AA (Arachidonic) 20:4 * Meat, eggs, dairyLong-Chain products (milk cheese,(LC- Adrenic 22:4 butter, yogurt etc)PUFA) DPA(n-6) 22:5 © A.J.Richardson, Food And Behaviour Research 2012
    • Dietary Sources of Omega-3 omega-3Green leafy vegetables, Shorter-seaweed, & some nut & ALA (α-linolenic) 18:3 Chainseed oils (flax, walnut,canola) 18:4 20:4 Long- EPA 20:5 * Chain (LC-Fish PUFA)and DPA(n-3) 22:5seafood DHA 22:6 © A.J.Richardson, Food And Behaviour Research 2012
    • What are omega-3 essential for?1. The structure of all cell membranes – Omega-3 (and omega-6) LC-PUFA increase membrane fluidity, essential for optimal cell signalling – 6-10% of the dry mass of the brain should be DHA – DHA is particularly concentrated in nerve terminals, where chemical signals between cells are exchanged – Concentrations of dopamine, serotonin, noradrenalin etc are influenced by omega-3 status © A.J.Richardson, Food And Behaviour Research 2012
    • Regulatory Substances made from Omega-3 and Omega-6 LC-PUFA Resolvins DGLA DocosanoidsEndocannabinoids(2-AG, Anandamide) AA EPA DHA © A.J.Richardson, Food And Behaviour Research 2012
    • What are omega-3 essential for?1. The structure of all cell membranes – Omega-3 (and omega-6) LC-PUFA increase membrane fluidity, essential for optimal cell signalling2. Brain development – Omega-3 and Omega-6 LC-PUFA make up around 20% of dry brain mass, and affect brain growth and connectivity – Supplementing infant formula with LC-PUFA (found naturally in breastmilk) can improve visual and cognitive development © A.J.Richardson, Food And Behaviour Research 2012
    • Omega-3 and VisionOmega-3 fatty acids from fish oils are absolutely essential to the visual system• 30-50% of the retina should be made of the omega-3 DHA• At the earliest stages of visual processing, DHA deficiency can reduce retinal signalling by more than a thousand-fold• Omega-3 deficiency is associated with poor night vision and other problems with visual, spatial and attentional processing. © A.J.Richardson, Food And Behaviour Research 2012
    • Growth of Brain Cells Enhanced by DHA Control 25 E2 E18 6 DIV (Number of Neurons) + DHA 20 Frequency ±1.5 µM DHA 15 Culture and Neurite 10 Chow Diet fatty acid measure- analysis ments and fatty acid analysis 5 Control + DHA 0 Total Neurite Length/Neuron (mm) (Number of Neurons) 20 Frequency 15B 10 5 0 Number of Branches/Neuron Calderon and Kim, J. Neurochem. 2004 © Joe Hibbeln, NIH
    • ‘NUTRITIONAL PROGRAMMING’Adverse Mental Health Effects from ‘Western-Type’ Dietary Fat Intake in Early Life• Sullivan et al. (2010) Chronic Consumption of a High-Fat Diet during Pregnancy Causes Perturbations in the Serotonergic System and Increased Anxiety-Like Behavior in Nonhuman Primate Offspring. J Neurosci. 30(10) 3826-30.• DAsti et al (2010) Maternal dietary fat determines metabolic profile and the magnitude of endocannabinoid inhibition of the stress response in neonatal rat offspring. Endocrinology. 151(4) 1685-94.• DeMar et al (2006) One generation of n-3 polyunsaturated fatty acid deprivation increases depression and aggression test scores in rats. J Lipid Res. 47(1): 172-80.• Trevizol et al. (2011) Comparative study between n-6, trans and n-3 fatty acids on repeated amphetamine exposure: a possible factor for the development of mania. Pharmacol Biochem Behav. 97(3) 560-5.• Mathieu et al (2008) Synergistic effects of stress and omega-3 fatty acid deprivation on emotional response and brain lipid composition in adult rats. Prostaglandins Leukot Essent Fatty Acids, 78(6):391-401. © A.J.Richardson, Food And Behaviour Research 2012
    • Omega-3 deficiency in Early Life and Mental Disorders: Evidence for mechanisms Omega-3 deficiency during pregnancy leads to behavioural deficits in the offspring consistent with anxiety and depression . Mechanisms now identified include:• Permanent impairment of endocannabinoid-mediated neuronal plasticity in hippocampal networks Lafourcade et al (2011) Nutritional omega-3 deficiency abolishes endocannabinoid-mediated neuronal functions. Nature Neuroscience 14(3): 345-50• Permanent disruption of BDNF, neuropeptide Y-1 & glucocorticoid receptors, and insulin signalling in frontal cortex, hypothalamus and hippocampus Bhatia et al (2011). Omega-3 Fatty Acid Deficiency during Brain Maturation Reduces Neuronal and Behavioral Plasticity in Adulthood, PLoS One, 6, 12, e28451. © A.J.Richardson, Food And Behaviour Research 2012
    • Maternal Fish Intake During Pregnancy andChild Developmental Outcomes Evidence from the ALSPAC (‘Children of the ‘90s) study Hibbeln et al, The Lancet, 2007 © A.J.Richardson, Food And Behaviour Research 2012
    • Figure 1 Suboptimal verbal IQ, 8 y Suboptimal fine motor score, 42 m 34 40 32 % children suboptimal % children suboptimal 30 35 28 Mother Mother concordant concordant 30 26 24 25 22 exceeds 20 exceeds 20 18 n= 724 n=4203 n=1593 n=938 n=5197 n=1897 16 None 1-340 g/w >340 g/w None 1- 340 g/w >340g/w Maternal seafood consumption Maternal seafood consumption Suboptimal prosocial score - SDQ, 7 y Suboptimal social development score, 42 m 16 28 % children suboptimal% children suboptimal 14 Mother 26 concordant Mother 12 concordant 24 10 22 exceeds 8 exceeds 20 n=753 n=4337 n=1618 n=1140 n=6018 n=2178 6 18 None 1-340 g/w >340 g/w None 1-340 g/w >340 g/w Maternal seafood consumption Maternal seafood consumption © A.J.Richardson, Food And Behaviour Research Feb 17 2007 Hibbeln et al, The Lancet, 2010
    • Short-chain omega-3* are NOT an effective substitute ISSFAL consensus statement - Brenna et al 2009• This has implications for non-fish eaters, whose diets provide little or no preformed long-chain omega-3*alpha-linolenic acid (ALA) – as found in flax and rapeseed/canola oils, green leafy vegetables etc © A.J.Richardson, Food And Behaviour Research 2012
    • What are Omega-3 essential for?1. The structure of all cell membranes – Omega-3 (and omega-6) increase membrane fluidity, essential for optimal cell signalling2. Brain development – Omega-3 and Omega-6 LC-PUFA make up around 20% of dry brain mass, and affect brain growth and connectivity – Supplementing infant formula with LC-PUFA (found naturally in breastmilk) can improve visual and cognitive development3. Maintenance of optimal brain function throughout life – Cell signalling depends on membrane fluidity – Omega-3 and omega-6 fatty acids and their derivatives have very powerful effects on most brain signalling systems – The substances we make from them can profoundly affect hormone balance, blood flow and immune system function © A.J.Richardson, Food And Behaviour Research 2012
    • Omega 6 and Omega-3 ‘functional fats’ – a matter of balance The omega-6 AA The omega-3 EPA(from meat, eggs and dairy (from fish and seafood – orproducts – or converted from converted from ALA in greenLA in vegetable oils) leafy vegetables, flax seed etc)gives rise to substances that gives rise to substances that• promote inflammation • reduce inflammation• promote blood clotting • reduce blood clotting• narrow blood vessels • relax blood vesselsA few simple dietary changes can make a big difference• Eat more: fish and seafood, green vegetables, nuts, seeds• Eat less: meat, dairy products, refined vegetable oils © A.J.Richardson, Food And Behaviour Research 2012
    • If dietary intakeof omega-3 is increased, will it help? Evidence from Randomised Controlled Trials © A.J.Richardson, Food And Behaviour Research 2012
    • Dysfunctions of Body and Mind thatOmega-3 from Fish and Seafood can help to prevent or ameliorate• Cardiovascular Disease – Heart Disease and Stroke• Inflammatory / Auto-immune Disorders – e.g. Rheumatoid Arthritis• Visual Problems – ‘Retinopathies’ of Prematurity, Diabetes, Old Age• Disorders of Behaviour, Learning and Mood? – Depression and other mental health problems – ADHD / Dyspraxia / Dyslexia etc © A.J.Richardson, Food And Behaviour Research 2012
    • Depression: Food and Mood?Depression shows strong associations with diet in both cross-sectional and prospective studies• High sugar consumption is associated with depression (over time and across countries)• Omega-3 fatty acids (found in fish and seafood) seem to be a protective factor © A.J.Richardson, Food And Behaviour Research 2012
    • Depression and Omega-3 Evidence for an Association• Across countries, rates of depression are inversely related to seafood consumption• Within countries, individuals consuming less fish and seafood are more likely to become depressed• Patients with depression have lower blood concentrations of the omega-3 found in fish and seafood © A.J.Richardson, Food And Behaviour Research 2012
    • Fish Consumption and Major Depression Annual Prevalence by Country 6% Hibbeln, The Lancet 1998; 351-1213Annual prevalence, (rate /100 persons) New Zealand (5.8%) Canada (5.2%) 5% France (4.5%) W. Germany - r = 0.84 Major Depression, (5.0%) 4% p <0.005 3% United States Puerto (3.0%) Rico (3.0%) Korea (2.3%) 2% 1% Taiwan (0.8%) Japan (0.12%) 0 20 40 60 80 100 120 140 160 Apparent Fish Consumption (lbs./ person/year) © A.J.Richardson, Food And Behaviour Research 2012
    • RCTs of Omega-3 for Mood DisordersIn Adults• Five recent ‘meta-analyses’ show: – Significant benefits for depression (+ bipolar disorder) • American Psychiatric Association recommends >1g/day EPA+DHA as an add-on treatment for mood disorders (Freeman et al, J. Clin Psychiat. 2006) – Mixed results from studies including more varied populations and treatments (Appleton et al 2006, Rogers et al 2008)In Children• One pilot RCT to date, showing significant benefits for children with depression (Nemets et al, Am.J.Psychiat. 2006) © A.J.Richardson, Food And Behaviour Research 2012
    • Meta-analysis of omega-3 for Depressive symptoms,Randomized placebo controlled trials, Effect size = 0.54, p<0.008 Omega-3 EFA in Affective Disorders Study name Statistics for each study Hedgess g and 95% CI Hedgess Standard Low er Upper g error Variance limit limit Z-Value p-Value Marangell 0.096 0.346 0.120 -0.582 0.774 0.277 0.782 Peet 0.496 0.362 0.131 -0.214 1.205 1.370 0.171 stoll 0.974 0.386 0.149 0.217 1.730 2.523 0.012 Keck 0.030 0.187 0.035 -0.337 0.396 0.159 0.873 Su 1.887 0.542 0.293 0.826 2.949 3.485 0.000 Nemets 0.892 0.512 0.263 -0.113 1.896 1.740 0.082 Silvers -0.342 0.234 0.055 -0.799 0.116 -1.462 0.144 Frangou 0.645 0.245 0.060 0.165 1.126 2.630 0.009 Hallahan 1.020 0.327 0.107 0.379 1.660 3.120 0.002 0.538 0.203 0.041 0.140 0.936 2.648 0.008 -1.00 -0.50 0.00 0.50 1.00 Fav ours Placebo Fav ours Omega-3 Eff ect Size g, SE, Variance 95% CI Z and P (Best Case) Freeman M, Hibbeln JR, Davis JM et al. American Psychiatric Associations treatment recommendations for omega-3 fatty acids in psychiatric disorders. J Clin Psychiatry 2006 © A.J.Richardson, Food And Behaviour Research 2009
    • American Psychiatric Association Treatment Recommendations• All adults should eat fish at least 2 x week• Patients with mood, impulse control or psychotic disorders should consume 1g/day of EPA+DHA• A supplement may be useful in patients with mood disorders (1-9g/day). Use of > 3g/day should be monitored by a physician.NB: these recommendations are in addition to standard treatments for psychiatric disorders (not as a substitute) Freeman MP et al (2006) Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. Journal of Clinical Psychiatry, 67(12): 1954-67. © A.J.Richardson, Food And Behaviour Research 2012
    • Omega-3 for Depression - EPA vs DHA? Sublette et al (2011) J Clin Psychiat © A.J.Richardson, Food And Behaviour Research 2012
    • Omega-3 for Schizophrenia• Cochrane & American Psychiatric Association Reviews (Joy et al. Cochrane Database Syst Rev. 2006; Freeman et al, J. Clin Psychiat. 2006) – No clear benefit for psychiatric symptoms BUT – Any dose of omega-3 (E-EPA or EPA) vs placebo • need for neuroleptics reduced • mental state may improve – Benefits greater for acute/unmedicated vs chronic patients• ‘High Risk’ groups – prevention of schizophrenia – Fish oil > placebo for prevention of breakdown into psychosis (Amminger & Schafer, 2006) © A.J.Richardson, Food And Behaviour Research 2012
    • Prevention of Psychosis (Schizophrenia) Amminger et al (2010) Archives of General Psychiatry 67(2) 146-54• 81 young people at ultra-high risk for psychosis – Age 13-25 yrs• 12 weeks treatment with 1.2g long-chain omega-3 – 700mg EPA, 500mg DHA from fish oils• Assessments over 12 months – Baseline, 1, 2, 3, 4, 8, 12 weeks, then 6 & 12 months• Primary outcome: – Transition to psychosis• Secondary outcomes: – Measures of symptoms & functioning – Blood fatty acids © A.J.Richardson, Food And Behaviour Research 2012
    • RESULTS at 12 month follow-upPrimary outcome: transition to psychosis (p=0.007, NNT=4). – Omega-3: 2 /41 (4.9%) – Placebo: 11/40 (27.5%) 100% 90% 80% 70% 60% 29 50% Stayed well 39 40% 30% 20% 10% 11 Developed 0% psychosis 2 Placebo Long-chain Omega-3 © A.J.Richardson, Food And Behaviour Research 2012
    • Other psychological / psychiatric conditions in adults?• Self-harm• Borderline Personality Disorder• Anxiety Disorders• Stress / Hostility /Aggression• Age-related Cognitive Decline• Alzheimer’s Disease (early stage) In each case, pilot RCTs have provided some preliminary evidence of possible benefits, but more research is needed © A.J.Richardson, Food And Behaviour Research 2012
    • Omega-3 for ChildBehaviour and Learning Evidence from RCTs
    • RCTs of Omega-3 forDyslexia / Dyspraxia / ADHD symptoms• Five ‘negative’ studies* No benefits for unselected ADHD populations found in • two studies using DHA (Voigt, 2001, Hirayama et al, 2004), • one using pure EPA, Gustafsson et al 2010 • two using a combination Johnson et al 2008 Matsudaira et al 2008) *NB: two of these did report benefits for particular subgroups• Five ‘positive’ studies • Significant benefits for children with Dyslexia, Dyspraxia, and/or ADHD-type symptoms from supplements providing both EPA and DHA (Richardson & Puri, 2002; Stevens et al 2003; Richardson & Montgomery 2005, Sinn and Bryan 2007, Vaisman et al 2008) © A.J.Richardson, Food And Behaviour Research 2012
    • Omega-3 from fish oils are effective in reducing ADHD symptoms Bloch and Qawasmi 2011, JAACAP © A.J.Richardson, Food And Behaviour Research 2011
    • THE OXFORD-DURHAM STUDY: A randomised controlled trial of dietary supplementation withfatty acids in children with developmental coordination disorder. Richardson AJ & Montgomery P. Pediatrics, 2005, 115:1360-6 117 underachieving children aged 5-12 years from mainstream schools• All showed specific difficulties in motor coordination (DSM-IV DCD)• 40% were behind expected achievement in reading and spelling• Over 30% scored in the clinical range for ADHD-type symptoms (>2SD above population means)
    • Motor skills Richardson AJ & Montgomery P. Pediatrics, 2005, 115:1360-6 Movement ABC Centiles 0-3m by Treatment Group 14 Movement ABC Centile 12 10 8 6 Active (N=60) 4 Placebo (N=57) 2 0 0m 3mThis shows why a placebo control group is simply essential © A.J.Richardson, Food And Behaviour Research 2012
    • Behaviour RatingsRichardson AJ & Montgomery P. Pediatrics, 2005, 115:1360-6 Reduction in ADHD-related Symptoms DSM Combined-type DSM Hyperactivity DSM Inattention Conners Global IndexCG Emotional LabilityCG Restless-Impulsive Conners Index Social Problems Perfectionism Placebo (N=52) Anxiety Active (N=50) Hyperactivity Cognitive Problems Opposition -0.10 0.00 0.10 0.20 0.30 0.40 0.50 0.60 Treatment Effect Size (Mean change 0-3m / Pooled Baseline SD) © A.J.Richardson, Food And Behaviour Research 2012
    • Reading and Spelling Richardson AJ & Montgomery P. Pediatrics, 2005, 115:1360-6Active treatment Improvements in Literacy Skills• Compared with expected Reading Age Gain 0-3m progress for normal children, 12 Reading / Spelling gain (months) Mean +/- 1SE Spelling Age Gain 0-3m gains were > 3 x normal rate for reading, > 2 x for spelling 9Placebo• Gains were 1 x normal rate for reading, < 0.5 x for spelling 6Group Differences 3• Reading p < 0.004 Active (N=55) Placebo (N=57)• Spelling p < 0.001 0 © A.J.Richardson, Food And Behaviour Research 2012
    • The DHA (Docosahexaenoic Acid) Oxford Learning And Behaviour (DOLAB) Study © A.J.Richardson, Food And Behaviour Research 2012
    • DOLAB Study – Basic Design Richardson et al 2012, PLoS One, 7(9): e43909. doi:10.1371/journal.pone.0043909• RCT: 16 weeks of supplementation with DHA (600mg/day) or placebo Population: • 360 healthy children aged 7-9 years from mainstream schools • Normal ability range, but reading < 33rd centile Primary outcomes: • Reading • Behaviour (ADHD-type symptoms) • Working Memory © A.J.Richardson, Food And Behaviour Research 2012
    • ReadingRichardson et al 2012, PLoS One, 7(9): e43909. © A.J.Richardson, Food And Behaviour Research 2012
    • Implications / Practical Relevance Richardson et al 2012, PLoS One, 7(9): e43909.Reading Age changes• Improvements for Active treatment over Placebo during the 4-month treatment period 33rd centile (n=362) - 0 months 20th centile (n=224) - 0.8 months (≈20% improvement) 10th centile (n=105) - 1.9 months (≈ 50% improvement) © A.J.Richardson, Food And Behaviour Research 2012
    • Parent-Rated Behaviour – Sub-Scales Richardson et al 2012, PLoS One, 7(9): e43909. © A.J.Richardson, Food And Behaviour Research 2012
    • Parent-Rated Behaviour – Global Scales Richardson et al 2012, PLoS One, 7(9): e43909. © A.J.Richardson, Food And Behaviour Research 2012
    • Dietary need for Omega-3 (EPA/DHA)* *Available evidence does not show similar health benefits from shorter-chain omega-3 (ALA), derived from plant sourcesRecommendations from international scientific & health organisations• General population - cardiovascular health: – ≥ 500mg / day EPA+DHA (ISSFAL Statements 2004, 2009, 15 other International authorities 1989-2009)• Depression or other mental health conditions: – ≥ 1000mg (1g) / day EPA+DHA (APA Freeman et al 2006, Hibbeln & Davis 2009)• In the UK, US, Australia and Canada, most people consume less than 150mg/day © A.J.Richardson, Food And Behaviour Research 2012
    • EPA vs DHA?• EPA and DHA are both essential, and they have different but complementary roles – All natural foods that contain these key omega-3 provide both of them together – Humans show limited conversion of EPA to DHA, and little or no conversion of DHA to EPA• Ideal ratios may vary with age & condition – More DHA than EPA for young infants / pregnant mothers? – More EPA than DHA for mood disorders? © A.J.Richardson, Food And Behaviour Research 2012
    • Fish and seafood provide other essential nutrients that few other foods contain In addition to providing long-chain Omega-3 (EPA and DHA), fish is also an important dietary source of other nutrients important for brain function, including:• Vitamin D• Iodine• Selenium © A.J.Richardson, Food And Behaviour Research 2012
    • Nutrition in disorders of mood, behaviour and cognition – key issues1. Blood sugar regulation problems2. Fatty Acid deficiencies / imbalances3. Micronutrient deficiencies or imbalances4. ‘Anti-nutrients’ and toxicity issues5. Food allergies / intolerances6. Gut dysbiosis / digestion & malabsorption issues © A.J.Richardson, Food And Behaviour Research 2012
    • Artificial Food Colourings and Hyperactivity Schwab, D.W., Trinh, N.H. (2004) J Dev Behav Pediatr 25(6) 423-434 © A.J.Richardson, Food And Behaviour Research 2012
    • Food Additives affect Child Behaviour in the General PopulationTwo randomised controlled trials commissioned by the UK Food Standards Agency:• Bateman et al 2004 - Arch Dis Childhood; 89: 506-11 The effects of a double blind, placebo-controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children.• McCann et al 2007 - Lancet; 370 (9598): 1560-67 Food additives and hyperactive behaviour in 3-year-old and 8/9- year-old children in the community: a randomised, double-blinded, placebo-controlled trial © A.J.Richardson, Food And Behaviour Research 2012
    • The Modern, Western-Type Diet• Modern, ‘junk food’ diets are seriously damaging our physical health – leading to increased rates of: – Obesity • Diet also affects our – Type-II Diabetes brains and behaviour – Heart Disease • Low income groups are – Cancer most at risk – Allergies / Immune Disorders © A.J.Richardson, Food And Behaviour Research 2012
    • The take-home message• Nutrition matters – To brains as well as bodies – This is not an ‘alternative’ approach – it is fundamental• Controlled trials show benefits for mood, behaviour and cognition from some dietary interventions, such as: – Supplementation with Long-chain Omega-3 fatty acids – Withdrawal of Artificial Food Colourings• Modern, western-type diets are not healthy, and are affecting the way our brains develop and function – The issues are not just about obesity and poor physical health – Nutrition affects mental health and performance throughout life, so it’s worth getting the basics right. © A.J.Richardson, Food And Behaviour Research 2012
    • Further InformationFor details of this and related research see Food And Behaviour (FAB) Research www.fabresearch.org and the book They Are What You Feed Them © A.J.Richardson, Food And Behaviour Research 2012