Nutrition and eating for the brain and mental health are topics I have written about regularly here.  Our mood can have powerful influences on many aspects of life and eating for a healthy body naturally impacts the brain.  A recently published study (1) highlights the importance of eating for mental health by demonstrating that there is an association between diet quality and the prevalence of mental disorders in women.  The study is preliminary and certainly warrants further investigative trials but the data is important to note.

The study authors wanted to examine the extent to which the high prevalence of mood disorders are related to diet/eating habits.  The research involved 1,046 women between the ages of 20 and 93 who were randomly selected.  A diet quality score was devised and the habitual eating patterns of the women were analysed.  The women also underwent a specialised questionnaire and clinical interview to assess their psychological health.  Current depressive and anxiety disorders were recorded.  The researchers found that a traditional western diet which includes processed/fried foods, refined grains, sugary products and beer was associated with anxiety and depression.  The results were not confounded by age, education or a variety of other behaviours, indicating that diet was having a very real impact on mood (1).

Eating a ‘traditional western diet’ was associated with more than a 50% increased likelihood for depressive disorders in the women involved in the study.  Depression and anxiety disorders were around 30% less likely among women who ate a healthier diet which consisted mainly of vegetables, fruits, fish and unrefined wholegrains (1) 

The authors suggest that further investigations are needed to determine whether unhealthy eating leads to declining mental health or whether declining mental health leads to unhealthier eating.  It is probable that these events are not mutually exclusive.  Feeling good often means that a better quality diet is eaten, self-esteem is high and we tend to look after our bodies and feed them healthfull foods.  Feeling ‘low’ may lead to lowered self-esteem and poorer quality food choices at a time when high quality foods would probably make a difference to mind and body.

As my previous posts relating to mood and mental health aim to highlight, a healthy diet and lifestyle which includes some regular exercise really can go far in impacting mental health.  Diets rich in vegetables, fruit, unrefined meats, fish, and wholegrains are a good basis health.  Omega 3 fats from oily fish and/or supplements seem particularly important for the brain and mood elevation.

(1) Jacka FN et al.  2010.  Association of Western and Traditional Diets With Depression and Anxiety in Women.  Am J Psychiatry (published online January 4, 2010; doi:10.1176/appi.ajp.2009.09060881)

Written by Ani Kowal

Exercise and healthy eating are great ways to vitalise life.  This month two new studies (1,2) published in the Archives of Neurology add to the evidence which suggests that regular exercise can help prevent the problems that often occur in thinking and memory that can come with age and also may help to turn back the clock on brain aging.

The first study(1) was set up to examine the effects of exercise on cognition (mental function) and other factors associated with Alzheimer’s disease in older adults suffering with mild cognitive impairments. 

Mild cognitive impairment typically means the individual will have some memory difficulties such as forgetting names or forgetting where things have been placed.  Around 10-15% of individuals with this kind of mild cognitive impairment will go on to develop dementia – this is in contrast to about 1-2% of the general population.

The study(1) was small but well designed.  Participants were assigned to either a high-intensity aerobic exercise or stretching group (the control group).  The exercise group were under the supervision of a fitness trainer and exercised at 75% to 85% of heart rate for 45 to 60 minutes, 4 days per week for 6 months.  The exercise was done using a treadmill or an exercise bike. The control group carried out supervised stretching activities according to the same schedule but maintained their heart rate at or below 50%.  At the start of the study and then at 3 months and 6 months blood was collected and cognitive tests were taken. 

The results(1) at 6 months found that there were sex-specific positive effects, in women,  on cognition as well as various blood-results (mainly related to blood sugar and stress hormones).  6 months of intense aerobic exercise was found to improve cognitive abilities of attention and concentration, organization, planning, and multi-tasking.  In the stretching ‘control group’ cognitive function test scores continued to decline.  Women seemed to benefit a little more from the exercise than men – the reason is not entirely known although in women the exercise also seemed to improve the cells sensitivity to the hormone insulin, men did not show the same improvement in insulin sensitivity.

This is a preliminary study into exercise and brain function and it may well be that the brain can benefit from lower intensity aerobic exercise – current research is underway to find out how much exercise is deemed to be ‘enough’ to benefit the brain.
 

The other study (2) showed that engaging in moderate physical activity such as brisk walking, swimming, or yoga in midlife or later could cut the risk of developing mild thinking problems.  The study involved over 1300 people without dementia who completed a Physical Exercise Questionnaire.  The frequency of physical exercise among 198 individuals with mild cognitive decline was compared to 1126 with normal cognition.  The results showed that, in both men and women, any frequency of moderate exercise performed in midlife or late life was associated with a reduced risk of having mild cognitive impairment.  Specifically moderate exercise in midlife was associated with a 39% reduced likelihood of developing mild cognitive impairment, and moderate exercise in late life was associated with a 32% reduced likelihood of mental decline.

These two studies support the growing body of evidence showing the benefits of a physically active lifestyle on the brain.  In conjunction with good nutrition I believe that there really are tangible ways to keep the brain healthy.  Please read my previous posts relating to brain health.

(1)Baker LD et al.  2010.  Effects of aerobic exercise on mild cognitive impairment: a controlled trial. Arch Neurol.  67(1):71-9.
(2) Geda YE et al.  2010.  Physical exercise, aging, and mild cognitive impairment: a population-based study. Arch Neurol.  67(1):80-6.
Written by Ani Kowal

A new study (1) has found that taking a daily fish oil supplement that is rich in long-chain omega 3 fatty acids may help to prevent against psychotic disorders.

The study(1) was carried out to see whether a daily long chain omega 3 fatty acid supplement could help reduce the rate of progression to psychotic disorders in adolescents and young adults, aged 13-25 years old, who were at high risk of developing a psychiatric condition.  Long chain omega 3 fatty acids, EPA and DHA, are naturally found in oily fish such as salmon, trout, mackerel and sardines.  There have been numerous studies linking these fatty acids to reduced incidence of depression and other mood related disorders. 

This study (1) was well designed and carried out between 2004 and 2007 and involved 81 individuals at, what the authors describe as, ultra-high risk of psychotic disorder.  The researchers included people who met at least one of the following three criteria: having low-level psychotic symptoms; having transient psychotic symptoms; or having a schizophrenia-like personality disorder or a close relative with schizophrenia, along with a sharp decline in mental function within the past year.  These are individuals which may have weak or transient psychotic symptoms, and already show schizophrenia-like brain changes.  Psychiatrists now know how to identify these at-risk individuals but at the moment they don't really know how best to treat them in order to prevent disease progression. Prescribing antipsychotic medications is often the course of action and could be helpful, however, these medications have serious side effects, and can also be stigmatizing.  Many individuals also do not wish to take these kinds of medications and look for safer, more natural alternatives.  Also this kind of preventative anti-psychotic medication may not be necessary, since only about a third of people at high risk for psychotic disorders will go on to develop full-fledged mental illness in a given year.  For these reason the authors of the study (1) tested fish oils, a natural and safe option.  The authors of the study note that there is considerable evidence that abnormal fatty acid metabolism may contribute to the development of schizophrenia – that is why they designed the trial

Participants (1) received either 1.2g per day of long chain omega 3 fatty acids or a placebo (inactive dummy pill) for 12 weeks.  This was followed by 40 weeks of monitoring.  Blood tests were used to look at the level of fatty acids in the red blood cells before and after treatment.  At the end of the study 2 out of the 41 individuals (4.9%) in the omega-3 supplement group had transitioned to having a psychotic disorder compared to 11 out of the 40 (27.5%) in the placebo group.  Individuals taking fish oil also showed significant reductions in their psychotic symptoms and improvements in function.

The authors(1) conclude that long chain omega 3 fatty acids reduce the risk of progression to psychotic disorder in young people at risk of developing these disorders.  The researchers note that fish oil could also potentially be used to prevent or delay the onset of chronic depression, bipolar illness, and substance abuse disorder, all of which are far more common than psychotic illness.  They also say that these fatty acid supplements are safe and effective and are now planning a large, multicenter trial, of fish oil supplementation for the prevention of psychotic illness in 320 at-risk people.

It is not exactly known how the fatty acids are working to prevent psychotic illness, however readers of this blog will already be aware of the mounting evidence for the essential health benefits of omega 3 fatty acids.  These fatty acids are essential for the structure and proper functioning of the brain.  They are also key to the proper functioning of two specific brain chemical signalling systems: the dopamine and serotonin systems, which have been implicated in schizophrenia.  Fish oil also boosts levels of the antioxidant glutathione.  Glutathione protects the brain against oxidative stress.

In a BBC News article (2), Alison Cobb, of the mental health charity Mind, said: "If young people can be treated successfully with fish oils, this is hugely preferable to treating them with antipsychotics, which come with a range of problems from weight gain to sexual dysfunction, whereas omega-3s are actually beneficial to their general state of health.  These are promising results and more research is needed to show if omega-3s could be an alternative to antipsychotics in the long term."

Since Omega 3 fatty acids are so vital for health, as I have previously recommended, it may be worth considering a daily fish oil supplement - especially if you do not regularly (at least twice weekly) consume oily fish.  For vegans and vegetarians a flaxseed oil supplement may be considered.  Unfortunately the shorter chain omega 3 fats (alpha linolenic) provided by flaxseeds are not easily converted by the body into the longer chain forms found in fish oils, but having a dietary source of omega 3 is essential to health.  There are now some EPA/DHA supplements available for vegetarians/vegans that are made from algae.

(1)Amminger GP et al.  Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomised, placebo-controlled trial.  Arch Gen Psychiatry.  67:146-154
(2)BBC News.  http://news.bbc.co.uk/1/hi/health/8490937.stm  Fish Oil Supplements ‘beat psychotic illness’.  Tuesday 02 February 2010.
Written by Ani Kowal

Vitamin D has been a major topic of research over the last 2 years.  It seems as though this vitamin is essential to many aspects for health from bone to brain.  Low blood serum levels of vitamin D have been associated with increased risk for several diseases e.g. cardiovascular diseases, diabetes, depression, dental caries, osteoporosis, and periodontal disease.  Today I wanted to look further into the role that vitamin D may play in helping individuals who suffer from low mood or depression.  Previously I mentioned that vitamin D may be helpful to individuals suffering with Seasonal Affective Disorder (SAD) and have also written about vitamin D for healthy brain function and possible prevention of dementia/Alzheimer’s Disease.

There are ‘receptors’ for vitamin D within the brain and this may be the reason why recent research is discovering a link between vitamin D and mood.  In 2006(1) a study found that low levels of vitamin D (serum 25-hydroxyvitamin D) was significantly associated with a high depression score.  Other studies (e.g. 2,3,4) have found similar associations between low vitamin D levels and poor mood.

Vitamin D, acts as a multipurpose steroid hormone within the body and is vital to health.  A lack of vitamin D, or low vitamin D levels, particularly among older adults, have been linked to cognitive (brain) function, depression, bipolar disorder, and schizophrenia.  As mentioned above vitamin D activates receptors on neurons in regions of the brain which are implicated in the regulation of behaviour.  Vitamin D also acts to protect the brain by balancing antioxidant and anti-inflammatory defences (5).

The association studies mentioned above are interesting but don’t prove that vitamin D can help treat depression.  Interestingly, a study took place last year (6) which looked at vitamin D supplementation and depression in overweight and obese individuals.  The study involved over 400 individuals who were given high dose vitamin D supplementation: 20,000iu per week, 40,000iu per week or a placebo for one year.  Depression was rated using a special scale called the Beck Depression Inventory (BDI).  The first observation that was made by the research scientists was that individuals with the lowest vitamin D levels scored significantly higher in the depression scale than those with better vitamin D levels.  After one year of supplementation the two groups given vitamin D had significant improvements in BDI scores, this did not occur in the placebo group.  Vitamin D supplementation seemed to be positively affecting mood.  The authors conclude that “It appears to be a relation between serum levels of [vitamin D] 25(OH)D and symptoms of depression. Supplementation with high doses of vitamin D seems to ameliorate these symptoms indicating a possible causal relationship”. The research was carried out in overweight and obese individuals and further trials are necessary in normal-weight individuals. 

These results suggest that vitamin D deficiency could have the ability to cause depression and that ensuring good vitamin D levels in the body could help to prevent/treat depression.  Here in the UK that would seem particularly vital in the autumn and winter months when there is less sunlight and vitamin D levels tend to drop to their lowest.

Evidence for the use of vitamin D in depression and mood disorders is preliminary and not yet conclusive.  Further evidence is needed to see whether vitamin D is as useful in cases of moderate-to severe depression as it is in mild cases.  However, as I have previously written many of us in the UK have very low vitamin D levels.  If you rarely get out into the sunlight you may wish to consider taking a vitamin D supplement which provides around 12mcg of the nutrient per day (around 500iu).  Only small amounts of vitamin D are found in food sources such as oily fish (mackerel, salmon and sardines) and egg yolks.  Vitamin D supplements may be particularly useful during the autumn and winter months and for individuals who have darker skins or who don’t go outside regularly.  If you think you want to supplement much higher levels (more than 1000iu daily) then please visit your doctor since vitamin D is a fat soluble vitamin and it is possible to take too much.  When looking for vitamin D supplements two forms are generally available.  Cholecalciferol, known as vitamin D3, and ergocalciferol or vitamin D2. Cholecalciferol is generally taken to be the more potent, easily absorbed and preferred form of vitamin D

(1)Jorde R et al.  2006.  Neuropsychological function in relation to serum parathyroid hormone and serum 25-hydroxyvitamin D levels:  The Tromso study.  Journal of Neurology.  253(4):464-70
(2)Wilkins CH et al.  2006.   Vitamin D deficiency is associated with low mood and worse cognitive performance in older adults. Am J Geriatr Psychiatry. 14(12):1032-40.
(3)Murphy PK et al.  2008.  Vitamin D and mood disorders among women: an integrative review. J Midwifery Womens Health.  53(5):440-6.
(4) Hoogendijk WJ et al.  2008.  Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry.  65(5):508-12.
(5)Cherniack EP et al.  2009.  Some new food for thought: the role of vitamin D in the mental health of older adults.  Curr Psychiatry Rep. 11(1):12-9.
(6)Jorde R et al.  2008.  Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomised double blind trial.  J Intern Med.  264:599-609
Written by Ani Kowal

On Monday I wrote about omega 3 fats and how they are important for brain function and in protecting against and treating depression.  Today I wanted to look at a UK study which has just been published in the British Journal of Psychiatry (1).

The study authors (1) wanted to examine the association between overall dietary patterns and depression.  Data from over 3000 participants aged around 55 years was analysed.  Two main dietary patterns were found in the participants.  A ‘whole food’ pattern which was high in vegetables, fruit and fish and a ‘processed food’ pattern which was high in sweetened desserts, friend foods, processed meats, refined grains and high-fat dairy products.  Self reported depression was assessed in the study participants 5 years after the initial dietary analysis.  A special reputable scale, called the Center for Epidemiologic Studies – Depression (CES–D) scale, was used to make the assessment.  The study showed that participants who adhered most strongly to the ‘whole food’ pattern of eating had a significantly lower risk of depression.  Those individuals with the highest consumption of processed foods had the highest risk of depression.  The authors conclude “In middle-aged participants, a processed food dietary pattern is a risk factor for CES–D depression 5 years later, whereas a whole food pattern is protective”.(1)

The study is interesting as it looks at diet as a whole rather than individual nutrients or components.  The study shows that eating healthily and including a high proportion of vegetables, fruits and fish is associated with protection against depression in middle-age.  Processed and refined foods can not only damage our health they also seem to impact our mood.   Specifically, the researchers in the study found that (1) participants whose diet was high in processed foods had a 58% higher risk of receiving a CES-D depression rating five years later.  The study does not prove that a processed food diet causes depression, it simply shows an association or a link, it could be, for example, that people who become depressed become inclined to eat more processed foods or that there is a yet undiscovered factor behind the association.

However, the results of this study show a strong association and are interesting, when added to results from several other studies there is certainly a suggestion that a healthy diet does protect against mental illness.  Eating a high quality, healthy and nutritious diet is important for overall health an wellbeing.  Vegetables, fruits, beans/pulses, unprocessed meats and oily fish are important components to consider.  If you are concerned that your diet consistently falls short then you may wish to consider taking an omega 3 fatty acid supplement together with a good quality food-state multivitamin and mineral supplement.  It is important to be clear that supplements can never be viewed as a replacement for a healthy diet.

(1)Akbaraly TN et al.  2009.  Dietary pattern and depressive symptoms in middle age.  The British Journal of Psychiatry.  195:408-413
Written by Ani Kowal

"Trichotillomania is an impulse control disorder or form of self-injury characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair, sometimes resulting in noticeable bald patches. Trichotillomania is classified in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) as an impulse control disorder. It may seem, at times, to resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual's teenage years. Depression or stress can trigger the condition. Due to social implications the disorder is often unreported and it is difficult to predict accurately prevalence (1)" but it is estimated to affect 2-4% of the population and seems to be more common in women than men.

Usually trichotillomania is treated with SSRI (Selective Serotonin Reuptake Inhibitor) anti-depressant drugs which many people prefer not to take due to the potential side-effects.  Researchers at the University of Minnesota Medical School have just published a study (2) which suggests that NAC (N-Acetylcysteine) a commonly available health food supplement may help to stop the urges of those suffering with trichotillomania.  NAC is an amino acid that acts as an antioxidant in the body.

The study(2) was small but well designed involving 50 trichotillomania sufferers, with an average age of around 34, for 12 weeks.  Half were given 1,200mg of NAC each day for 6 weeks.  For the following 6 weeks they were given 2,400mg NAC per day.  The other half were given placebo (inactive) supplements.  After 9 weeks, those taking NAC had a significant reduction in the incidence of hair-pulling.  After 12 weeks 56% of those on the NAC supplement reported feeling much, or very much improved (compared to only 16% of those on the placebo).  No side-effects were found when taking the NAC supplement.
 

The study offers significant hope to sufferers of this distressing self-harming condition and is also an important study as it is one of the first studies of compulsive behaviours to look at lowering levels of glutamate, a chemical that triggers excitement, in the brain to curb harmful behaviours.  NAC seems to affect levels of glutamate in a very specific area of the brain which may be why it seems to help patients curb their self-harmful behaviour.

Dysfunction of glutamate-mediated brain nerve functions has also been implicated in obsessive-compulsive disorder (OCD).  The study authors believe that NAC and other glutamate modulators may be applicable to other disorders, addictions and compulsive behaviours.  Prior to this study a case was documented (3) where NAC was shown to be clinically helpful for a sufferer of OCD (obsessive compulsive disorder).  Further studies are certainly warranted in this area, especially since many individuals are looking for natural alternatives to psychiatric drugs.  It may be that NAC will be useful in conjunction with other known nutritional mood influencing aids, I certainly look forward to further studies being published in this area.

If you are suffering with trichotillomania (or other compulsive behaviours) you may wish to contact the following online support networks and may wish to speak to your doctor or health professional about trying NAC to see if it is useful for you:
UK and Ireland Trichotillomania Support Group  and the Trichotillomania Support Online

(1)http://wapedia.mobi/en/Trichotillomania
(2) Grant JE et al.  2009.  N-Acetylcysteine, a Glutamate Modulator, in the Treatment of Trichotillomania: A Double-blind, Placebo-Controlled Study. Arch Gen Psychiatry. 66(7):756-763
(3) Lafleur DL et al.  2006.  N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder.  Psychopharmacology.  184(2):254-256.

(Written by Ani Kowal)

Following my last post I was interested to read a well researched review paper (1) that looks into the link between vitamin D deficiency and the development of dementia.  The report is published in the May issue of the Journal of Alzheimer’s disease and is written my William B Grant PhD of the Sunlight, Nutrition and Health Research Centre (SUNARC).  SUNARC is an organization devoted to research and education relating to the prevention of chronic disease through changes in diet and lifestyle.  I have previously mentioned SUNARC when reporting on the importance of Vitamin D for health.

Previously I highlighted the link between vitamin D and the brain when I wrote about the potential use of the sunlight vitamin for helping sufferers of SAD (seasonal affective disorder) and also possible link between low vitamin D levels in those suffering from depression and mood disorders.

William Grant, the author of the paper, begins by highlighting the rise in individuals who are suffering with dementia in the Western world.  The condition deserves attention since the number of people living into old age is increasing and it is a worthwhile aim to help individuals achieve lasting health as they age so they may live life to the full.  There are several risk factors for the development of Alzheimer's disease and vascular dementia. Based on an increasing number of studies linking these risk factors with Vitamin D deficiency, the article(1) suggests that further investigation of possible direct or indirect linkages between Vitamin D and these dementias is certainly needed.  Diet and lifestyle are being increasingly researched in relation to their links with dementia prevention and vitamin D is gaining attention for its role in many condition from heart disease, diabetes, bone health, cancer, infections, chronic fatigue and more.

Low blood serum levels of vitamin D have been associated(1) with increased risk for several diseases which are also considered risk factors for the development of dementia  or are often reported to precede the incidence of dementia e.g. cardiovascular diseases, diabetes mellitus, depression, dental caries, osteoporosis, and periodontal disease.  These studies are only observational studies,nproviding medical researchers with links between vitamin D and dementia.  As yet there no randomised controlled trials to draw evidence from.

The way that vitamin D may be working to protect the brain is via several mechanisms.  It seems to be able to act by protecting the neurones in the brain (brain nerve cells), it may also be protecting the blood vessels in the brain and having an effect by protecting against excess calcium entry into the brain.  Vitamin D also seems to act as an anti-inflammatory – an important factor since dementia is often linked to inflammation in the brain and body (1).  There is also plenty of evidence to suggest an important role for vitamin D in brain development and function.

Writing in the article, Dr. Grant states, "To date, the evidence includes observational studies supporting a beneficial role of vitamin D in reducing the risk of diseases linked to dementia such as vascular and metabolic diseases, as well as an understanding of the role of vitamin D in reducing the risk of several mechanisms that lead to dementia." “However, until RCTs are performed, the hypothesis cannot be considered a fact”

A recent analysis(2) found that there is a global widespread insufficiency of vitamin D and there is evidence from the National Diet and Nutrition Surveys (NDNS) which suggests that in the UK deficiency of this vital nutrient is a real problem (3,4,5,6).  The problem is made worse in the older generations, as we age our bodies find it increasingly difficult to manufacture vitamin D.  In the UK many of us do not get enough sunlight exposure to generate decent levels of vitamin D in our bodies, especially in the autumn and winter months when we cover our bodies up and don’t get out during the daylight hours very often. 

Only small amounts of vitamin D are found in food sources such as oily fish (mackerel, salmon and sardines) and egg yolks.  As many of us in the UK are falling short of recommended vitamin D levels, if you rarely get out into the sun, you may wish to consider a vitamin D supplement which provides around 12mcg/day (around 500iu a day).  Such a supplement may be particularly useful during the autumn and winter months.

For more interesting information about the benefits of vitamin D and sunlight for health please visit the SUNARC website, the information there is well presented and backed up by significant amounts of good evidence.

(1)Grant, WB.  2009. Does Vitamin D Reduce the Risk of Dementia?  Journal of Alzheimer's Disease 17:151-159.
(2)Hagenau T et al.  2008.  Global vitamin D levels in relation to age, gender, skin pigmentation and latitude: an ecologic meta-regression analysis.  Osteoporosis International May [E publication ahead of print]
(3) Finch S et at.  1998.  National Diet and Nutrition Survey of People aged 65 Years and Over.  London: H. M. Sationery Office.
(4) Gregory L et al.  2000.  National Diet and Nutrition Survey of People aged 4-18 years. Vol 1.  Report of the Diet and Nutrition Survey.  London:  The Stationery Office
(5) Henderson L et al.  2002.  National Diet and Nutrition Survey: Adults Aged 19-64 years.  Vol 1: Types and Quantities of Foods Consumed.  London: The Stationery Office
(6) Hypponen E & Power C.  2007.  Hypovitaminosis D in British adults age 45y: nationwide cohort study of dietary and lifestyle predictors.  Am J Clin Nutr.  85:860-888.

Written by Ani Kowal

What we eat can certainly have an impact on the way our brains function.  Previously I have written about the importance of a healthy diet for brain function and also the links between the Mediterranean style diet and the brain. 

In both of these posts I write about how important oily fish seem to be for the efficient functioning of the brain (mental function is often referred to as cognition).  Previously I have concentrated on the fact that oily fish provide omega 3 fatty acids which are vital for the structure and function of the brain.  However, oily fish also provides a dietary source of Vitamin D.  This is important, since food sources of vitamin D are limited.  Oily fish such as mackerel, salmon, sardines and trout are the primary food source.  Egg yolks contain some vitamin D and some foods are fortified with this ‘sunshine’ vitamin.  Our main source of vitamin D is the manufacture in the body via the exposure of our skin to sunlight.  Recently, however, there has been a lot of concern that UV exposure in the UK may be insufficient to keep vitamin D levels high enough for optimal for health with many individuals in the UK are falling short of recommended levels.  More can be read on the importance of vitamin D in previous blog posts.

A very recently published study (1) has found a link between vitamin D levels in the body and brain function (cognitive performance).  Previous studies have found that an inadequacy in vitamin D could be linked to problems with brain function but so far results have been inconsistent.  This study (1), which was conducted by University of Manchester scientists, was set up in order to examine the association between blood serum vitamin D levels and cognitive performance in middle-aged and older men.  3,133 Eurpoean men aged 40-79 years were included in the research.  Cognitive (brain) function was tested via a number of different validated tests.  Blood serum vitamin D levels were measured as was physical activity, functional performance and mood/depression.

Higher levels of vitamin D were significantly associated with better cognitive function as measured by one of the tests, the Digit Symbol Substitution test (DSST).  This test is an internationally-recognised test that assesses an individual's memory, recognition capabilities and speed of information processing.  Reduced cognitive function was most pronounced in individuals with the lowest vitamin D levels.  This research provides valuable information, however further research is warranted to determine whether health vitamin D levels, or vitamin D supplementation, can play a role in preserving cognitive function in older adults (1).

Although the study is only an association study it has some key strengths: it was based on a large population sample and took into account potential confounding influences, such as depression and levels of physical activity.   Interestingly the association between increased vitamin D and faster information processing was more significant in men aged over 60 years, although the biological reasons for this remain unclear and requires further investigation.

The positive effects vitamin D appears to have on the brain need to be explored further but certainly raise questions about its potential benefit for those with or susceptible to dementia.  Dr Susanna Sorensen, Head of Research at The Alzheimer’s Society made a comment (2) on the research via the charity website:

“One in three people over 65 will die with dementia making research into this area vital. This study, including over 3,000 men from a number of European locations, shows that maintaining vitamin D levels could play a role in reducing the decline of brain function. 

However, further research is needed to determine whether or not vitamin D can help preserve brain function in older people or reduce risk of dementia. As vitamin D is readily available to most people, through exposure to sunshine or eating oily fish, it will be interesting to see the results of future studies.

In the meantime, current evidence tells us that a healthy lifestyle, including a balanced diet and exercise, is the best way of reducing your risk of dementia.”

Alzheimer's Society is the UK's leading care and research charity for people with dementia and those who care for them.  There are 700,000 people with dementia in the UK with numbers set to rise to one million by 2025.  Alzheimer's Society is a membership organisation, which works to improve the quality of life of people affected by dementia in England, Wales and Northern Ireland.  Please visit their website for more information.  You may also like to read the two posts I mentioned at the start of this piece which are about brain function.

If you rarely get out into the sunlight you may wish to consider taking a vitamin D supplement which provides around 12mcg of the nutrient per day (around 500iu).  Vitamin D supplements may be particularly useful during the autumn and winter months and for individuals who have darker skins or who don’t go outside regularly.

(1) Lee DM et al.  2009.  Association between 25-hydroxyvitamin D levels and cognitive performance in middle-aged and older European men.  J Neurol Neurosurg Psychiatry. Published Online First: 21 May 2009. doi:10.1136/jnnp.2008.165720
(2)Alzheimer's Society comment on research into impact of vitamin D on brain performance
Published Wednesday 20th May 2009 in Research news http://www.alzheimers.org.uk/site/scripts/news_article.php?newsID=469

Written by Ani Kowal

My grandmother always used to say that fish was good for the brain.  A lot of research is now available now to back up these old folk tales.  Our brains are very fatty organs  and we require essential fats for their efficient functioning.  Fish intake in pregnant women has been positively linked to cognitive performance (mental functioning) in infants.  In November last year I wrote about how the food we eat can affect brain function and mentioned that essential omega 3 fats seem particularly important. 

Research has suggested that the long chain omega 3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), found in oily fish such as salmon, mackerel, sardines and trout provide many benefits to the brain, including improving learning and memory and helping to fight against mental disorders such as depression, mood disorders, schizophrenia, and dementia.

A recent report (1) has suggested that teenage boys who regularly eat fish may be doing their brains some good.  The researchers collected food intake data from almost 5000 teenage boys aged 15 in Sweden.  The participants also completed intelligence tests.  The scientists then looked to see if there was any association between fish intake and cognitive performance (mental functioning).  There was a positive association between how much fish was eaten per week at age 15 and cognitive performance measured 3 years later.  Eating fish more than once per week was associated with a significantly higher intelligence test score, verbal performance and visuospatial performance (visual perception of the spatial relationships of objects) when compared to eating fish less than once per week.

This association between fish consumption and intelligence score was the same in lower and higher educated groups of boys, in other words the education level of the boys did not seem to influence the relationship between frequency of fish consumption and cognitive performance (1)

It is not known exactly why fish consumption is linked to improved cognitive performance but the most widely held theory is that the essential fats found in oily fish have positive effects on mental functioning.  Essential fats accumulate in the brain when the foetus is developing (for more info read my blog post on postnatal depression) and essential fats are necessary for the continued efficient functioning of our brains.  Omega 3 fatty acids also have anti inflammatory properties and may be working to positively affect the immune system.

The teenage years are important since the brain is ‘plastic’, it can reorganise the connections between cells and this affects intelligence, emotional and social behaviour.  Brain plasticity is important for learning new skills or recovering from injury.  Diet may well be playing a role here.  Even in older adults there have been some links between fish and omega 3 intake and cognitive functioning so getting enough omega 3 fats throught our lifetimes seems very important.

There are many different nutrients that are essential for the efficient functioning of the brain but omega 3 fatty acids certainly seem to be gaining validity as one of the more important factors.  Eating a healthy balanced diet that includes omega 3 fats is important for many aspects of health.  If you do not regularly eat oily fish you may wish to consider a supplement that provides 250-350mg EPA and 250-350mg DHA daily.  Vegetarians and vegans can get omega 3 fats (the shorter chain variety) from flaxseeds and walnuts or a supplement providing 500-1000mg alpha-linolenic acid daily could be considered.  Some vegetarian algal and phytoplankton supplements are now becoming available these contain the longer chain omega 3 fats (EPA and DHA).

(1)Aberg MA et al.  2009.  Fish intake of Swedish male adolescents is a predictor of cognitive performance.  Acta Paediatr. 98(3):555-60

Written by Ani Kowal

There are many hundreds of studies relating brain function to nutrition and I am never sure where to begin trying to relay these to you via this blog – the volume of available evidence always seems so daunting!  Last week I wrote about just one nutrient, vitamin B12 and cognition/mental function.  Fortunately for me one group of scientists, headed by Dr Fernando Gomez-Pinilla, have now published an extensive review paper (1) which analyzed more than 160 studies investigating various different foods and nutrients and how they affect the brain.  A concise press release was published on the UCLA newsroom website (2) and I am going to pick out some of the major findings in my post today.

Dr Fernando Gómez-Pinilla is a member of California’s largest university, UCLA, and works within the Brain Research Institute and Brain Injury Research Centre.  Together with his colleagues he decided to look into how a balanced diet and regular exercise can protect the brain and ward off mental disorders.  Dr Gomez-Pinilla looked at over 160 published studies and believes that food acts like a pharmaceutical agent in the way it can affect the brain.  He also believes that diet, exercise and sleep can, potentially, alter brain health and mental function.
 

It has long been suspected that different nutrients can affect cognitive (mental) processes and emotions.  The paper reviews new evidence exploring the nutrients and the mechanisms by which they may be responsible for the action of diet on brain health and mental function.  So many key nutrients came up as being important.  Omega 3 fatty acids, flavonoids, curcumin, B vitamins, Vitamin D, Vitamin E, Vitamin C, Calcium, zinc, selenium and carotenoids, to name but a few!  The mechanisms by which they positively affect our brain function and cognition are complex and intricate.

Omega 3 fatty acids, found most abundantly in oily fish (such as salmon, mackerel and trout), flaxseeds and walnuts came up trumps, yet again!  These fats are essential for normal brain function and the research suggests that they provide many benefits, including improving learning and memory and helping to fight against mental disorders such as depression, mood disorders, schizophrenia, and dementia.  In contrast to the healthy effects of diets that are rich in omega-3 fatty acids, the studies seem to indicate that diets high in trans fats (often found in processed foods) and saturated fats adversely affect cognition. 

The brain is highly susceptible to oxidative damage (by free radicals).  Antioxidants provided by the diet (such as vitamins A, C and E and flavonoids), found most abundantly in fruits and vegetables, seem very important in protection (many of my previous posts have discussed the importance of antioxidant nutrients).
 
 
Surprisingly what you eat may also affect future generations.  Dr Gomez-Pinilla found that recent research also supports the hypothesis that health can be passed down through generations, and a number of innovative studies point to the possibility that the effects of diet on mental health can also be transmitted across generations  "Evidence indicates that what you eat can affect your grandchildren's brain molecules".

Another interesting reference to brain structure and health was made by a group of scientists (also from UCLA) in a recently published paper (3) which was highlighted in The Times newspaper (4) this month.  The shocking headline reported that our peak age for mental health is 39 years old!!

The study was small, involving 72 men between the ages of 23-83, and the researchers evaluated brain function by testing speed of movement via finger tapping – how many times participants could tap their finger in 10 seconds.  Usually the speed of response slows as we age probably because the fatty ‘myelin’ sheath surrounding our nerves starts to deteriorate which causes responses to slow.   The researchers found that myelination of the brain neurones (nerves) was significantly correlated to finger tapping speed and reached a peak at 39 years of age, declining thereafter.  Keeping our brain myelin 'healthy' seems to be very important for this specific form of brain function (called maximum motor speed).  Although the study only involved men it is likely to be the same in women.

 In The Times newspaper the authors reveal how myelin can be damaged via excess alcohol:  “The brain is made of fat, so when you get drunk you’re basically dissolving your brain.  A glass of wine may have a beneficial effect, but if you get drunk it’s malfunctioning.  As the alcohol leaves the brain tries to repair itself but if you keep doing it, it won’t repair itself fully” (4)

The researchers also suggest that the decline in brain myelination can be diminished (GREAT NEWS!), even halted, by regular exercise, good sleep and a healthy diet including at least one gram of fish oil a day, to provide omega 3 fatty acids, and plenty of colourful vegetables and fruits which are rich in antioxidants that help to prevent free radical damage, which may damage myelin.

The newspaper article also ends on a more positive note.  Although the area of the brain tested seems to declines after the age of 39 there are other areas where the circuitry still repairs itself: wisdom, for instance, is apparently strengthened with age “ most older people have better impulse control than when they were younger because as they age, this circuit continues to myelinate and brings all their knowledge online so that they can make a decision better and faster, even though their movements may be slower”.  The researchers give the following example “It’s the Michael Jordan effect.  He retired as a basket-ball player because those neurons controlling his speed and athleticism had started breaking down, but he went on to run a multi-million-dollar empire, which he probably couldn’t have done at 25”

The take home message from these published papers is to try and live a healthy lifestyle, to exercise, get good sleep and eat an unprocessed diet rich in nutrients and omega 3 fatty acids.  Future research is bound to throw up more dietary wisdom.  As Dr Gomez-Pinilla says:  “Understanding the molecular basis of the effects of food on cognition will help us to determine how best to manipulate diet in order to increase the resistance of neurons to insults and promote mental fitness”(1).

If you are not a lover of oily fish then you may wish to take an omega 3 supplement providing around 250mg EPA and 250mg DHA per day.  For vegans and vegetarians a flaxseed oil supplement providing around 500mg alpha-linolenic acid per day may be useful.  Antioxidants are best provided by vegetables and fruits, if you worry that you are not getting at least 5 portions a day you may consider taking a low dose multi-vitamin and mineral supplement.  I personally prefer 'food-state' nutrients as they are easily absorbed by the body and not made with isolated chemicals.

(1)Gómez-Pinilla F et al. Brain foods: the effects of nutrients on brain function. Nature Reviews Neuroscience, 2008; 9 (7):568-578
(2) UCLA newsroom 09/07/08  Scientists learn how what you eat affects your brain byStuart Wolpert
(3) Bartzokis G et al.  2008.  Lifespan trajectory of myelin integrity and maximum motor speed. Neurobiol Aging. 2008 Oct 14. [Epub ahead of print]
(4)Alexandra Blair.  Thursday November 6th 2008.  If 39 is our mental peak then my brain is in big trouble. The Times 2. Page 6-7

Written by Ani Kowal

On 15th October I wrote about the connection between B vitamins and healthy bones and I also mentioned how elevated homocysteine levels may be implicated in bone deterioration and heart disease.  Today I want to look at the link between elevated homocysteine levels, low vitamin B12 levels and cognitive (mental) decline.

To recap: Homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of many disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.

A new study (1) was recently published which showed that older adults who have vitamin B12 levels that are low, but still within the normal range, may exhibit a quicker rate of brain shrinkage (brain volume loss) as they age compared to those who have good levels.  The authors wanted to investigate the association between vitamin B12 status and brain volume loss in a population of adults aged 61-87 over a 5 year period.  The participants were free of cognitive impairment (they were free of dementia) at the start of the study.  Those with lower vitamin B12 levels at the start of the study experienced the greatest decrease in brain volume over the 5 year period.  This was only a small preliminary study involving 107 individuals, the authors suggest that low vitamin B12 status should be further investigated and that trials with vitamin B supplements would be useful.

A loss in brain volume has been linked to a faster rate of mental decline and progression to diseases such as Alzheimer’s disease and dementia.  Vitamin B12 is extremely important in order to keep nerve cells healthy.  The study mentioned above (1) suggests, but does not prove, that modifying vitamin B12 status could be important in protecting the brain and preventing cognitive decline.  The results of the study do suggest that it is important to keep our vitamin B12 levels higher than just the minimum.

A study last year (2) looked at the association between cognitive decline and vitamin B12.  The study included 1684 individuals who were followed for 10 years.  Mental state (cognition) was examined a minimum of 3 times over the 10 years as were serum vitamin B12 concentrations.  Analysis of the results found that reduced vitamin B12 status was associated to cognitive decline.  The investigators also found that a high homocysteine level was associated with a greater rate of cognitive decline.  Again the authors indicate the need for further studies and supplementation trials for the prevention of dementia.

A review (3) paper published this year discussed the importance of vitamin B12 for brain health throughout life from infancy to adulthood.  In childhood low vitamin B12 levels may be related to behavioural problems and in adults it seems to be related to social development, depression and cognitive problems.  It seems as though this nutrient really is vital throughout our lifespan. 

Many older adults in the UK have lowered vitamin B12 levels.  In the diet, B12 comes from meat, fish, dairy, other animal products, and fortified breakfast cereals. Strict vegetarians, who avoid meat, and vegans, who avoid all animal products, are also at risk of B12 deficiency.  Studies seem to suggest that anything in the stomach that affects the normal acidity and digestive processes, ranging from infections to acid reflux medications to aging, may also interfere with the absorption of vitamin B12. 

The vitamin B group work very well as a team and interact in many processess, if you decide to take a supplement it may well be worth considering a multi-B vitamin supplement rather than single B vitamin supplement, or a broad spectrum multi-nutrient supplement (I prefer food state supplements which appear to be more easily absorbed by the body).

(1) Vogiatzoglou A et al.  2008.  Vitamin B12 status and rate of brain volume loss in community-dwelling elderly.  Neurology.  71:826-832
(2)Clarke R et al.  2007.  Low vitamin B-12 status and risk of cognitive decline in older adults.  Am J Clin Nutr.  86:1384-1391
(3)Black MM.  2008.  Effects of vitamin B12 and folate deficiency on brain development in children.  Food Nutr Bull.  29:S126-131

Written by Ani Kowal

On the 22 October I mentioned the potential use of Vitamin D supplements for helping individuals suffering from the mood disorder SAD (seasonal affective disorder).  This year a number of papers have been published (1,2,3,4) which suggest that vitamin D could potentially be useful for the treatment of other mood disturbances and depressive episodes.

In 2007 a review paper was published (5) which suggested that vitamin D deficiency may play a role in depression and other mood and mental health disturbances, especially in the elderly where low vitamin D levels are commonly found.  The paper highlighted a number of trials that which showed that vitamin D supplementation appeared to be useful in the treatment of depression but expressed a need for further studies.

Vitamin D seems to be a hot topic this year and I have written about it a number of times in my blog posts.  Low vitamin D levels seem to be linked to cancer, heart disease, SAD, chronic fatigue syndrome, migraine headaches and various other diseases, not only bone conditions such as osteoporosis and osteoarthritis.  It is becoming glaringly obvious that this ‘sunshine vitamin’ is more important than we once thought. 

Two studies this year have linked low vitamin D status, as measured by low circulating blood levels of vitamin D, with depressive symptoms.  One study (1) was carried out in overweight and obese individuals and the other (3) in older adults (aged 65 – 95 years).  Both studies found that there was an association between depression status and severity with decreased serum (blood) vitamin D levels.  In the study with overweight/obese participants high-dose vitamin D supplementation led to significant improvements in depressive symptoms, compared to placebo, during the study.  The studies so not prove a causal relationship between low vitamin D and depression but they do add to the mounting evidence which suggests a very real link.  Further, larger studies will be needed to verify the information and investigate this exciting association further.

It is not currently known why vitamin D may be useful in treating mood disorders or why low levels may have a part to play in causing mood problems.  It may be that vitamin D has an effect on hormones linked to mood.  Studies are bound to unravel the mystery over the next few years!

A recent analysis(6) found that there is a global widespread insufficiency of vitamin D and there is evidence from the National Diet and Nutrition Surveys (NDNS) which suggests that in the UK deficiency of this vital nutrient is a real problem (7,8,9,10).  The problem is made worse in the older generations, as we age our bodies find it increasingly difficult to manufacture vitamin D.  In the UK many of us do not get enough sunlight exposure to generate decent levels of vitamin D in our bodies, especially in the autumn and winter months when we cover our bodies up and don’t get out during the daylight hours very often. 

Walking and exercise have also been linked to improved mood, so a lunchtime walk, in daylight, may bring added mood lifting benefits.  Only small amounts of vitamin D are found in food sources such as oily fish (mackerel, salmon and sardines) and eggs.  As many of us in the UK are falling short of recommended vitamin D levels, if you rarely get out into the sun, you may wish to consider a vitamin D supplement which provides around 12mcg/day (around 500iu a day).  Such a supplement may be particularly useful during the autumn and winter months.

You may also want to think about getting a daylight lamp for your work desk to help improve mood.  Some of these lamps produce light that the body can use for vitamin D production (check with the manufacturer of the lamp).

For more interesting information about the benefits of vitamin D and sunlight for health please visit the Sunlight Nutrition And Health Research Centre, the information there is well presented and backed up by significant amounts of good evidence.

(1)Jorde R et al.  2008.  Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial.  J Intern Med. Sep 10. [Epub ahead of print]
(2)Murphy PK & Wagner CL.  2008.  Vitamin D and mood disorders among women: an integrative review.  J Midwifery Womens Health.  53:440-446
(3)Hoogendijk WJ et al.  2008.  Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry. 65(5):508-12.
(4)Johnson MA et al.  2008.  Vitamin D deficiency and insufficiency in the Georgia Older Americans Nutrition Program.  J Nutr Elder.  27:29-46
(5)Berk M et al.  2007.  Vitamin D deficiency may play a role in depression.  Med Hypotheses.  69:1316-1319
(6)Hagenau T et al.  2008.  Global vitamin D levels in relation to age, gender, skin pigmentation and latitude: an ecologic meta-regression analysis.  Osteoporosis International May [E publication ahead of print]
(7) Finch S et at.  1998.  National Diet and Nutrition Survey of People aged 65 Years and Over.  London: H. M. Sationery Office.
(8) Gregory L et al.  2000.  National Diet and Nutrition Survey of People aged 4-18 years. Vol 1.  Report of the Diet and Nutrition Survey.  London:  The Stationery Office
(9) Henderson L et al.  2002.  National Diet and Nutrition Survey: Adults Aged 19-64 years.  Vol 1: Types and Quantities of Foods Consumed.  London: The Stationery Office
(10) Hypponen E & Power C.  2007.  Hypovitaminosis D in British adults age 45y: nationwide cohort study of dietary and lifestyle predictors.  Am J Clin Nutr.  85:860-888.

Written by Ani Kowal

Last week I wrote about light box therapy, and other ideas, for improving mood in SAD (seasonal affective disorder).  A more conventional approach to SAD is pharmaceutical antidepressant therapy with, for example, SSRI (selective serotonin reuptake inhibitors) type antidepressants which include fluoxetine (Prozac) and paroxetine (Paxil, Seroxat).  However, these drugs come with certain side effects (including an increased risk of suicide attempts) and their effectiveness has also been questioned.  For these reasons, many individuals seek alternative ways of dealing with low mood.  One well recognised natural agent is the herb St John’s wort (Hypericum perforatum).  Historically this plant has been used as a remedy for the treatment of depression and there is now quite a bank of medical and scientific evidence(1) confirming the effectiveness of this herb for aiding various mood disturbances.

St John’s wort is a shrubby perennial plant with bright yellow flowers, named after St John the Baptist.  Ancient Greeks and Romans believed that the herb could deter evil spirits but today it is mainly used as a natural, alternative to antidepressants.  The herbal supplements are made from the dried flowers of the plant.  The herb has been routinely used in Germany for many years where doctors and health practitioners frequently prescribe supplements for depression.

Very recently a paper was published (1) reviewing the available evidence for the use of St John’s wort in the treatment of depression.  The review included 29 high quality studies (randomised and double-blind) from a variety of countries, the studies included a total of 5489 patients and ranged from 4 weeks to 12 weeks in length.  The researchers found that, for people suffering from mild to moderate depression, St John’s wort can provide effective relief, similar to that of standard antidepressants but with fewer side effects. 

The authors note, and it is important to state, that people suffering from depressive symptoms (including a low mood, loss of interest or pleasure in life and activities) who wish to use a St John’s wort product should ALWAYS consult a doctor.  The quality of products available on the market varies widely and the herb can interact with other medications so it is always best to check with a medical practitioner before embarking on a treatment plan.

The antidepressant properties of St John’s wort are thought to be ascribed to the compounds hypericin and hyperforin that are contained within the herb.  It is not entirely known how the herb works to lift the mood but it seems to act on certain ‘feel-good’ brain chemicals (known as neurotransmitters) such as dopamine, serotonin and noradrenaline.

The typical recommended dose is 300mg of St John’s wort extract three times a day for supplements standardised to contain 0.3% hypericin.  One a day supplements containing 900mcg hypericin are also available.  ALWAYS check with a doctor before taking the herb.  It may take 4 weeks before you see any benefit.  Side effects are uncommon, however in people with fair skin it is advisable to avoid prolonged exposure to sunlight whilst taking the herb.

The herbal supplement also seems useful for the treatment of other mood disturbances such as anxiety, apathy, insomnia, stress and SAD, if you think you could benefit from taking St Johns wort I would suggest chatting with a health professional prior to undertaking a supplementation regimen.
 

(1)Linde K et al.  2008.  St John’s wort for major depression.  Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3

Written by Ani Kowal

Iron deficiency anaemia is the most common nutritional deficiency worldwide, affecting around 2 billion people.  Here in the UK the National Diet and Nutrition Surveys have revealed that most children under the age of 18 have dietary iron intakes below the RNI (reference nutrient intakes).  This is very worrying as iron is important for normal neurodevelopment (development of the brain and nervous system) and deficiency, with or without anaemia, in infants and children appears to adversely affect social and emotional development, intellectual performance and concentration span and has been linked to ADHD (Attention Deficit Hyperactivity Disorder), hyperactivity, aggressiveness, poor mood and fatigue.

The most recent study was published in an American journal in May(1).  The study leader, Dr Betsy Lozoff, is a leading researcher in the field of iron deficiency in childhood.  The researchers looked at the social and emotional behaviour in a group of infants who were 9 months old at the start of the study.  Tests confirmed that around a third of the children had iron deficiency anaemia, a third had iron deficiency without anaemia and a third had sufficient iron levels.  All infants then received a 3 months course of liquid iron supplement.  The supplement was given to all infants, even those with sufficient iron levels in order to prevent deficiency during their transition to being fed cows milk (which is very low in iron). 

At 12 months the infants were assessed.  Those with poorer iron status were more shy, harder to sooth, less likely to be engaged in their surroundings and less likely to orientate themselves in their surroundings.  The associations were present in iron deficient infants regardless of anaemia status.  Dr Lozoff concludes that the results need to be confirmed in larger trials but her findings do add to the ever growing body of evidence that links iron deficiency in children and developmental problems.

Iron is essential in the diet as it is used by the body in the manufacture of the blood protein haemoglobin, which is responsible for the transport of oxygen from the lungs to all cells in the body so that they can generate energy.  If iron levels are very low it can cause a condition in the body called iron deficiency anaemia.  This can be checked via tests which screen for haemoglobin in the blood.  However, individuals can become deficient in iron without becoming anaemic.  Iron deficiency without anaemia is widespread and not detected by the most commonly used screening procedures.  Both deficiencies are related to low mood, fatigue and mental ‘slowness’ in adults(2,3) and a host of behavioural and mental developmental issues in children(4).  It is not entirely understood why iron deficiency is linked to childhood behavioural issues, such as ADHD, but it may be related to the fact that iron is essential for the normal development of the brain and the functioning of dopamine, a brain chemical.  The most accurate way to check for overall iron status is to screen for ‘serum ferritin’ levels, this will pick up on iron deficiency (with or without anaemia).

In infants breast feeding for less than 6 months duration, the use of non iron-fortified infant formula and the introduction of cow’s milk before 1 year of age are risk factors for iron deficiency and in children dietary deficiency is common.  There are two forms of dietary iron: Haem iron (found in meat sources) and non-haem (found in non-meat, vegetarian sources) iron; and the extent to which iron from food is absorbed depends upon the form it is in.  Haem iron is the most easily absorbed form.  However, absorption is greatly affected by other factors. Most importantly vitamin C, found abundantly in fruits and vegetables, is important in promoting the absorption of non-haem iron.  Adding fruits and vegetables high in vitamin C to a meal may triple iron absorption from foods such as wholegrain cereals and pulses.  On the contrary tea and coffee reduce the amount of iron that is absorbed from all foods.  Try avoiding tea and coffee with meals as they can reduce iron absorption by 50%.  Calcium also reduces iron absorption, drinking a glass of milk with a meal can also half iron absorption.  Phytic acid (also known as inositol hexaphosphate) found in peanuts, wholegrains and seeds can greatly reduce the absorption of iron. 

For individuals who are vegetarian or rarely consume meat, wholegrain cereals, eggs, nuts, dried fruit and pulses (beans and peas) will provide adequate iron if consumed as part of a high vitamin C containing meal.  If you are relying on non meat sources of iron you may wish to consider taking a 100-200mg vitamin C supplement with your main meal to ensure good absorption.

Iron is a nutrient that can accumulate in the body and an excess can be damaging so ALWAYS get iron levels checked prior to embarking on a supplementation programme.  When asking the doctor for a test for yourself or your child, be sure to ask for a ‘serum ferritin’ test (rather than a test for anaemia) as this will provide a better indication of bodily iron status. 

Unfortunately, in the UK there is no consensus among doctors as to what a ‘normal’ blood ferritin level should be.  Many doctors who regularly employ complementary medicine would suggest that in children a ferritin level of less than 30ng/ml (30ng ferritin per 1ml blood) or 50mcg/l in adults would indicate a deficiency.  If you have any concerns do talk them through with your GP.

(1)Lozoff B et al.  2008.  Dose-response relationships between iron deficiency with or without anemia and infant social-emotional behaviour.  J Pediatr.  152:696-702
(2)Khedr E et al.  2008.  Iron states and cognitive abilities in young adults: neuropsychological and neurophysiological assessment.  Eur Arch Psychiatry Clin Neurosci. Jun 20. [Epub ahead of print]
(3)Patterson AJ et al.  Dietary and supplement treatment of iron deficiency results in improvements in general health and fatigue in Australian women of childbearing age.  J Am Coll Nutr. 2001 Aug;20(4):337-42
(4)Lozoff B et al.  2006.  Long-lasting neural and behavioral effects of iron deficiency in infancy.  Nutr Rev.  64(5 Pt 2):S34-43; discussion S72-91

Written by Ani Kowal

New research(1) has just emerged from Baycrest which shows that adults with type 2 diabetes who eat unhealthy, high-fat, meals may experience memory declines immediately afterward, but this may be offset by taking antioxidant vitamin supplements together with the meal.

Baycrest is an academic health sciences centre, affiliated with the University of Toronto, which is internationally-renowned for its research on aging and the conditions associated with ageing such as memory loss, depression and stroke.

The study authors make reference to the fact that there is already a growing body of evidence that links diabetes to cognitive (mental) complications in humans.  Adults with type 2 diabetes seem especially vulnerable to acute memory deficits after eating unhealthy foods.  This latest study suggests that taking high doses of antioxidant vitamins C and E with such meals may help minimize those memory slumps.

One of the study authors, Michael Herman Chui, said “Our bottom line is that consuming unhealthy meals for those with diabetes can temporarily further worsen already underlying memory problems associated with the disease”.

The study was a very small preliminary trial that involved only 16 adults (with an average age of 63) with type 2 diabetes who were not regularly taking antioxidant supplements.  They attended three weekly sessions that involved consuming a different test meal on each visit. One meal consisted of high fat foods (a Danish pastry, cheddar cheese and yogurt with added whipped cream); the second meal consisted of only water; and the third test meal was the same high-fat meal plus vitamin C (1000 mg) and E (800 IU) supplements.

After eating the meal, participants completed a series of tests that measured their recall abilities for words they had heard and paragraph information they had read.  It was found that vitamin supplementation consistently improved recall scores.  Compared to those who consumed only water or the meal with antioxidant vitamins, participants who ate the high fat meal showed significantly more forgetfulness (of words and paragraph information) in immediate and time delay recall tests. 

The study authors emphasize that their findings obviously require further replication in much larger trials. Future studies will also need to look at how the antioxidant vitamins may be working.  Personally, I would also like to see further trials using antioxidant foods, such as fruits and vegetables, in conjunction with meals to test if the same benefits are seen as with supplementation (I have a feeling results would be very positive)!

Type 2 diabetes is associated with persistent, long term oxidative stress, a known major contributor to cognitive (mental) decline and Alzheimer disease. Consuming unhealthy foods can induce this type of stress which is triggered by elevations of free radicals: unstable molecules that can damage body tissue, including brain tissue. These destructive reactions tend to occur over a 1-3 hour period after the ingestion of food.  Fruits and vegetables contain numerous antioxidant nutrients and can minimise oxidative stress, it is important to include such foods as an integral part of all meals.  This study showed that antioxidants could reduce immediate memory deficits caused by unhealthy eating.

Dr. Carol Greenwood, senior author of the study, cautioned that relying on antioxidant vitamins at meal time is not a quick fix. “While our study looked at the pill form of antioxidants, we would ultimately want individuals to consume healthier foods high in antioxidants, like fruits and vegetables” (well said!).

An overall healthy lifestyle is important in maintaining optimal mental health at all ages.  This includes regular exercise, staying mentally active, being socially engaged in a variety of activities as well as adopting a healthy diet rich in fruits, vegetables and healthy fats found in oily fish, nuts and seeds.

(1) Chui MH & Greenwood CE.  2008.  Antioxidant vitamins reduce acute meal-induced memory deficits in adults with type 2 diabetes.  Nutrition Research.  28 (7): 423-494
(2) Baycrest press release

Written by Ani Kowal

Last weekend (18/05/08) The Sunday Times ran a story entitled “Superfood celery combats brain diseases”.  Quite timely I thought, as I was in the middle of preparing a post on the important role that dietary flavonoids , also known as bioflavonoids  (a group of over 4000 types of polyphenol plant compounds), play in maintaining mental health e.g. memory, learning and general mental performance.  The newspaper article focussed on the flavonoids, luteolin and diosmin, found in celery and how they may be important in slowing the progress of brain diseases such as Alzheimer’s disease.

A recently published medical review paper(1) brought together evidence for the role of dietary derived flavonoids and mental health.  In this paper Dr Jeremy Spencer, a researcher and lecturer at my old University, highlights a number of studies in both humans and animals which have found that flavonoids, from a variety of dietary sources such as grapes, tea, blueberries, cocoa, onions, broccoli and tomatoes (to name but a few), have beneficial effects on cognitive (mental) performance.  He postulates that the benefits come from the ability of the flavonoids to protect brain neurones, reduce neuronal inflammation, enhance neuronal function and even stimulate neuronal regeneration (regrowth). 

The paper is extensive, however I would just like to mention one study that is reviewed(2).  In this study 1640 individuals, all over the age of 65, were followed for ten years and their dietary habits assessed over that time.  All of them were free of dementia at the start of the study.  Cognitive (mental) performance was examined four times over the ten year period.  Flavonoid intake was associated with a significantly better cognitive performance at the start of the study and throughout the study period.  The individuals with the highest flavonoid intakes were found to have better preservation of mental performance with ageing than subjects with the lowest intakes of flavonoids.  After 10 years the individuals with the lowest intakes were found to have lost an average of 2.1 points on a test of mental performance (the Mini-Mental State Examination) compared to those with the highest intakes who had lost on average only 1.2 points.  Such data provides a strong indication that regular dietary flavonoid consumption may have a positive effect on preserving mental performance with ageing.

As Dr Susanne Sorensen of the Alzheimers Society is quoted as saying in the newspaper “we know a healthy balanced diet can reduce dementia risk.  This work reinforces the need to eat a diet rich in fruits and vegetables”.  There are many dietary factors which can contribute to a healthy brain and positive mood and I am sure that I will address these factors in my future writings!

It is clear that a diet rich in a variety of different vegetables and fruits is really very important for all aspects of health.  There is NO substitute for a diet plentiful in a variety of vegetables and fruits.  Choosing produce with a mixture of colours will provide an array of different flavonoids.  Flavonoid supplements do exist and these may be helpful to take in addition to a healthy diet as a means of boosting intakes.  If you do choose to take a supplement look out for one that provides an assortment of many different flavonoids (they may be labelled as bioflavonoids).

(1) Spencer JPE.  2008.  Food for thought: the role of dietary flavonoids in enhancing human memory, learning and neuro-cognitive performance.  Proceedings of the Nutrition Society.  67:238-252
(2) Letenneur L et al.  2007.  Flavonoid intake and cognitive decline over a 10 year period.  Am J Epidemiol.  165:1364-1371

Written by Ani Kowal