What is physical health?

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