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

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 are
evolutionarily 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 Rotten Way to Feed the Children”
16 Apr 2004 - Times Educational Supplement
By Stephanie Northern

“The physical risks to children from
a nutritionally poor diet are now
acknowledged, but the damage
being 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.

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

Psychiatric Disorders – The Overlaps
Depression

Anxiety Disorders

Bipolar Disorder Schizophrenia
Diagnoses are descriptive – based on behaviour, not etiology
Conditions are dimensional – i.e. continuous with normal function
Comorbidity is high, adding to heterogeneity within each

Increasing Cost Burden of Mental
Health Disorders
UK (Government’s own figures)
• In 2007: £77 billion
• In 2010: £105 billion

Europe 2010
38% of Europeans (≈165 million) have a fully
developed mental or neurological illness
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


Most Common Mental Health
Disorders
Europe 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

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

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?


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 0.993

1133 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%

The unbalanced diet…


Many nutritional features of
modern western-type diets are
• High Glycaemic Load Sugar
• Altered Fatty Acid 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.


Sugar and
‘Refined Carbs’

Blood glucose metabolism


Sugary foods and drinks cause rapid swings in
blood sugar (affecting mood, behaviour and
cognition)

Optimal range for
brain function


‘Slow-release’ foods at breakfast help to keep
blood sugar levels stable (minimising fluctuations
in mood, behaviour and cognition)

Optimal range for
brain function


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.


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 it's addictive. The food industry
knows that when they add fructose we buy more. That's
why it's in everything.
• There are five tastes on your tongue: sweet, salty, sour,
bitter and umami. Sugar covers up the other four, so you
can't 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

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.

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

Many nutritional features of
modern western-type diets are
• High Glycaemic Load
• Altered Fatty Acid Composition Fat
• 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.


Getting the Fats
Right
Quality, not Quantity
Some Fats are Essential
Omega-3 and Omega-6
Polyunsaturates

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

Human development is
about the growth of the
BRAIN, not the body –

and Nutrition is simply
Critical

The human brain is
60% FAT
and it matters what kind

Dietary advice has not been
taking this into account


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

Trans fats – a real poison
In 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

Dietary Sources of Omega-6
omega-6
Vegetable oils,
Shorter- LA (Linoleic) 18:2
Chain nuts, seeds, grains
GLA 18:3 Evening
primrose
DGLA 20:3 * oil
AA (Arachidonic) 20:4 * Meat, eggs, dairy
Long-
Chain products (milk cheese,
(LC- Adrenic 22:4 butter, yogurt etc)
PUFA)
DPA(n-6) 22:5

Dietary Sources of Omega-3
omega-3
Green leafy vegetables, Shorter-
seaweed, & some nut & ALA (α-linolenic) 18:3 Chain
seed oils (flax, walnut,
canola) 18:4

20:4
Long-
EPA 20:5 * Chain
(LC-
Fish PUFA)
and DPA(n-3) 22:5
seafood
DHA 22:6

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

Regulatory Substances made from
Omega-3 and Omega-6 LC-PUFA

Resolvins

DGLA Docosanoids

Endocannabinoids
(2-AG, Anandamide) AA EPA DHA


What are omega-3 essential for?
– Omega-3 (and omega-6) LC-PUFA increase membrane
fluidity, essential for optimal cell signalling
2. 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


Omega-3 and Vision
Omega-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.


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
15
B
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.
• D'Asti 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.

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.

Maternal Fish Intake During
Pregnancy and
Child Developmental Outcomes
Evidence from the ALSPAC
(‘Children of the ‘90s) study

Hibbeln et al, The Lancet, 2007


Figure 1

Suboptimal verbal IQ, 8 y Suboptimal fine motor score, 42 m
34
40
32
% 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


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

What are Omega-3 essential for?
– Omega-3 (and omega-6) increase membrane fluidity, essential
for optimal cell signalling
2. 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
3. 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

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 – or
products – or converted from converted from ALA in green
LA 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 vessels
A 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

If dietary intake
of omega-3 is increased,
will it help?

Evidence from
Randomised Controlled Trials


Dysfunctions of Body and Mind that
Omega-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

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


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

Fish Consumption and Major Depression
Annual Prevalence by Country
6%

Hibbeln, The Lancet 1998; 351-1213
Annual 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)


RCTs of Omega-3 for Mood Disorders
In 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)

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 Hedges's g and 95% CI
Hedges's 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


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.

Omega-3 for Depression - EPA vs DHA?
Sublette et al (2011) J Clin Psychiat


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)


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

RESULTS at 12 month follow-up
Primary 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


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

Omega-3 for Child
Behaviour and Learning
Evidence from RCTs

RCTs of Omega-3 for
Dyslexia / 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)

Omega-3 from fish oils are effective
in reducing ADHD symptoms

Bloch and Qawasmi 2011, JAACAP

THE OXFORD-DURHAM STUDY:
A randomised controlled trial of dietary supplementation with
fatty 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

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 3m

This shows why a placebo control group is simply essential


Behaviour Ratings

Reduction in ADHD-related Symptoms
DSM Combined-type
DSM Hyperactivity
DSM Inattention
Conners Global Index
CG Emotional Lability
CG 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)


Reading and Spelling

Active 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
9
Placebo
• Gains were 1 x normal rate for
reading, < 0.5 x for spelling 6

Group Differences 3

• Reading p < 0.004 Active (N=55) Placebo (N=57)

• Spelling p < 0.001
0


The DHA (Docosahexaenoic Acid)
Oxford Learning And Behaviour
(DOLAB) Study


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

Reading


Implications / Practical Relevance

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)


Parent-Rated Behaviour – Sub-Scales


Parent-Rated Behaviour – Global Scales


Dietary need for Omega-3 (EPA/DHA)*
*Available evidence does not show similar health benefits from
shorter-chain omega-3 (ALA), derived from plant sources
Recommendations 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

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?


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


Nutrition in disorders of mood,
behaviour and cognition
– key issues
1. Blood sugar regulation problems
2. Fatty Acid deficiencies / imbalances
3. Micronutrient deficiencies or imbalances
4. ‘Anti-nutrients’ and toxicity issues
5. Food allergies / intolerances
6. Gut dysbiosis / digestion & malabsorption issues


Artificial Food Colourings and Hyperactivity
Schwab, D.W., Trinh, N.H. (2004) J Dev Behav Pediatr 25(6) 423-434


Food Additives affect Child Behaviour
in the General Population
Two 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

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


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.


Further Information
For details of this and related research see

Food And Behaviour (FAB) Research
www.fabresearch.org

and the book
They Are What You Feed Them


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

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