Nutritional Supplements and Mental Health: Here’s What We Know

We’ve all heard that ‘food is good for your mood’. Now, a new study into mental health and nutrient supplementation has taken a leap forward by establishing the gold standard for which nutrients are proven to assist in the management of a range of mental health disorders.

As well as an established relationship between poor diet and mental illness, there is now a vast body of research examining the benefit of nutrient supplementation in people with mental disorders.

To unpack this research, an international team of scientists led by researchers at the University of Manchester and NICM Health Research Institute, Western Sydney University examined the ‘best of the best’ available evidence. The aim was to provide a clear overview of the benefit of specific nutrient supplements – including dosage, target symptoms, safety and tolerability – across different mental disorders. 

The world’s largest review of top-tier evidence, published online yesterday (10th September 2019) in World Psychiatry, examined 33 meta-analyses of randomised control trials (RCTs) and data from 10,951 people with mental health disorders including depression, stress and anxiety disorders, bipolar disorder, personality disorders, schizophrenia and attention-deficit/hyperactivity disorder (ADHD).

Although the majority of nutritional supplements assessed did not significantly improve mental health, the researchers found strong evidence that certain supplements are an effective additional treatment for some mental disorders, supportive of conventional treatment.

All nutrient supplements were found to be safe when recommended dosages and prescriptive instructions were adhered to and there was no evidence of serious adverse effects or contraindications with psychiatric medications.

Summary of results:

  • The strongest evidence was found for omega-3 supplements (a polyunsaturated fatty acid) as an add-on treatment for major depression – reducing symptoms of depression beyond the effects of antidepressants alone.
  • There was some evidence to suggest that omega-3 supplements may also have small benefits for ADHD.
  • There was emerging evidence for the amino acid N-acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia.
  • Special types of folate supplements may be effective as add-on treatments for major depression and schizophrenia, however folic acid was ineffective.
  • There was no strong evidence for omega-3 for schizophrenia or other mental health conditions.
  • There is currently a lack of compelling evidence supporting the use of vitamins (such as E, C, or D) and minerals (zinc and magnesium) for any mental disorder.

Lead author of the study, Dr Joseph Firth, Honorary Research Fellow at The University of Manchester and Senior Research Fellow at NICM Health Research Institute, said the findings should be used to produce more evidence-based guidance on the usage of nutrient-based treatments for various mental health conditions.

“While there has been a longstanding interest in the use of nutrient supplements in the treatment of mental illness, the topic is often quite polarising, and surrounded by either over-hyped claims or undue cynicism,” Dr Firth said.

“In this most recent research, we have brought together the data from dozens and dozens of clinical trials conducted all over the world, in over 10,000 individuals treated for mental illness. This mass of data has allowed us to investigate the benefits and safety of various different nutrients for mental health conditions – on a larger scale than what has ever been possible before.” Dr Joseph Firth

​Senior author on the study, NICM Health Research Institute’s Professor Jerome Sarris said as the role of nutrition in mental health is becoming increasingly acknowledged, it was vital that an evidence-based approach be adopted.

“Future research should aim to determine which individuals might benefit most from evidence-based supplements and to better understand the underlying mechanisms so we can adopt a targeted approach to supplement use in mental health treatment.” Professor Sarris said. “The role of the gut microbiome in mental health is a rapidly emerging field of research, however more research is needed into the role of ‘psychobiotics’ in mental health treatment.” 

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About The study and Source material:

The review involved researchers from Western Sydney University, King’s College London, The University of Manchester, The University of Queensland, ORYGEN National Centre of Excellence in Youth Mental Health, The University of Melbourne, University of Toronto and KU Leuven.

The research paper on which this article is based can be accessed in the October issue of World Psychiatry and online at http://doi.org/10.1002/wps.20672

This article is based on material provided to us by the University of Manchester newsroom and appears here with permission.

Surgery like Jagger: Here’s the Low-Down on Heart Valve Problems

Rolling Stones fans were concerned by the recent news that Mick Jagger needs a new heart valve. Good news is that, these days, most patients in his situation can get what they need — and often without intensive surgery.

While Jagger has not discussed his condition, Rolling Stone magazine confirmed reports that Jagger, 75, needs heart valve surgery.  Jagger is expected to make a complete recovery, the band said in a statement.

Jagger has plenty of company. In America alone, more than 5 million people live with heart valve disease. In 2013, the most recent year for which numbers are available, over than 100,000 people had heart valve surgery, according to the US National Center for Health Statistics.

Dr. Catherine Otto, a professor of medicine at the University of Washington in Seattle, offered this primer on the heart’s four valves – and how they can malfunction.

The two valves on the right side, which pump blood into the lungs, are rarely a problem, said Otto, co-chair of the committee that wrote the latest American Heart Association guidelines on heart valve disease. The valves on the left, which pump blood into the body, are typically the issue when something goes wrong, she said.

Heart valve illustration (Courtesy of the American Heart Association)

If one of these valve narrows, blood can’t go forward without the heart working extremely hard to push it; and if a valve leaks, the heart has to pump extra blood to make up for it.

“It’s a very delicate structure that with time can become a little bit thicker and get a little bit of scar tissue,” said Dr. Robert Bonow, professor of cardiology at Northwestern University Feinberg School of Medicine in Chicago and co-author of those AHA guidelines.

A small percentage of people are born with malformed valves; many live for decades without problems. But even an anatomically normal valve is opening and closing with every heartbeat. Bonow did the maths: For someone with an average heart rate, the valve opens about 3 billion times over 80 years.

“It’s just one of those things that if you live long enough, these valves will begin to wear out at some point,” said Bonow, a past AHA president.

Risk factors include the same ones that lead to heart attacks: Namely, high cholesterol, smoking, high blood pressure and diabetes, Bonow said.

“But even people who have no risk factors, including athletes, can develop problems,” he said.

Symptoms can include chest pain or palpitations; shortness of breath; fatigue; lightheadedness or swelling in the ankles, feet or abdomen. But the warning signs can be “very subtle,” Otto said. (Jagger, in fact, was spotted frolicking with his girlfriend and toddler son in Miami Beach just after the band canceled upcoming tour dates because of his health.)

Otto said the most common symptoms she sees include reduced ability to exercise. Patients get out of breath, fatigued or just don’t feel like doing it.

“If they get to the point of actually having chest pain with exertion or shortness of breath or dizziness or passing out – those are really more severe symptoms of the disease,” she said.

“For someone with an average heart rate, the valve opens about 3 billion times over 80 years.”

Worn-out valves can be replaced with new ones made from metal or from animal tissue. And treatment has undergone a “transformative” change in recent years, Bonow said, with the growth of a procedure called transcatheter aortic valve replacement, or TAVR. The aortic valve is on the left side of the heart and releases blood to the body’s main artery, the aorta.

Until recently, complicated open-heart surgery was standard. But with TAVR, a replacement valve can be inserted without surgery by puncturing a leg artery, inserting a new valve, threading it up to the heart “and just popping it in place,” Otto said.

“It’s a very short procedure – it takes an hour or two at the most,” she said. The patient is usually in hospital overnight or maybe a couple of days, followed by a week or two of recovery at home. That compares with six weeks to three months of recovery for the hitherto traditional surgical procedure.

TAVR is currently approved in people for whom open-heart surgery would be considered risky, although both doctors were excited about a recent study indicating TAVR can produce results comparable to traditional surgery in even low-risk patients.

Also, Otto noted, if the problem is related to the mitral valve – that’s less likely in someone Jagger’s age – a transcatheter approach is possible, but a patient is more likely to need open-heart surgery.

The good news is that barring complications, heart valve problems are usually “pretty much alleviated completely” by treatment, she said. “There is some risk up front, but the outcomes are excellent.”

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Source Material:

The material for this article was provided to us by the American Heart Association on 3rd April 2019 and is reproduced here under CCL copyright permissions, with minor editorial changes to account for our predominantly UK & European readership. If you’d lke to visit the American Heart Association website it’s here

Time-Restricted Eating: Good or Fad?

Time-restircted diets are currently all the rage, but some are more effective than others. This report, from The American Heart Association, takes a closer look.

Tipping the scales at 233 pounds, Charles Joy realised he needed to make some changes.

The 28-year-old Louisville, Kentucky, native already had tried many diet plans to varying degrees of success. In 2013, he lost more than 100 pounds through exercise and diet. But afterwards, his weight slowly began to creep back up.

In 2017, Joy decided to try time-restricted eating, consuming all his meals within an eight-to 10-hour window each day. The pounds melted away. Today, he weighs 183 pounds.

“It’s working much better, because it’s so flexible,” Joy said. “With calorie restriction, you have to plan out everything, and I was never satisfied. Now I don’t even think about food until the afternoon.”

Time-restricted eating is one variation of a hot diet trend that also includes intermittent fasting. According to Krista Varady, an associate professor of nutrition at the University of Illinois at Chicago, there are several types of intermittent fasting, including one meal per day, the 5/2 method, which involves five feast days and two days with restricted calories, and alternate-day fasting.

Fasting is nothing new. It’s been a part of many religious traditions for centuries, with many traditional Christian communities restricting their dietary intake in the run-up to Easter and Muslims fasting from sunrise to sunset during Ramadan But is it healthy and effective to restrict eating or fast on a regular basis?

Alternate Day Fasting

It can be, said Varady, who said she has run more than a dozen clinical trials on alternate-day fasting and one on time-restricted eating.

In a 2017 JAMA Internal Medicine trial, Varady and her colleagues showed alternate-day fasting was just as effective as daily calorie restriction for losing weight and maintaining the loss.

“With alternate-day fasting, people typically lose 3 to 8 percent of their body weight over three to 12 months,” Varady said. And it can work with both low- and high-fat diets.

Weight loss is not the only benefit. In a 2009 study, most of the study participants also saw reductions in the so-called “bad” LDL cholesterol and in blood pressure. Other studies show decreases in insulin resistance, which is associated with an increased risk of Type 2 diabetes. And diabetes is a risk factor for heart disease.

Alternate-day fasting works, at least in part, because people wind up consuming less food overall.

Time-Restricted Eating

Those who use time-restricted eating can lose weight without restricting caloric intake, said Dr. Satchidananda Panda, a professor and researcher at the Salk Institute for Biological Studies in La Jolla, California. He also wrote a book about time-restricted eating.

“The science and the benefits of time-restricted eating are very different from those of other forms of fasting,” Panda said.

According to Panda, time-restricted eating is based on the science of circadian rhythms, which control every hormone.

In a 2012 study, Panda and his team split mice into two groups. One ate all the sugary, fatty foods they wanted during a 24-hour period. The other group had the same sorts of foods but were only allowed to eat during an eight-hour daily window. Both groups consumed the same number of calories, but the mice that ate round-the-clock became fat and sick while those on a time-restricted diet did not.

Panda also has shown that fruit flies placed on a time-restricted eating plan have hearts that appear to be 20 to 30 percent younger than their age would suggest. Fruit fly hearts and human hearts are similar, so Panda believes it’s reasonable to conclude humans might benefit in the same way.

It’s all in the Circadian Rhythms

“It works by slightly reducing ATP producing proteins of mitochondria in the heart and keeping the mitochondria healthy, which reduces oxidative stress,” Panda said, noting that time-restricted eating gives the body time to repair itself. “Most of our studies are showing that the effect is on multiple organs and on the central nervous system. It’s a positive feedback loop.”

Panda hopes to continue his research, and find out whether the health benefits seen in animal studies hold true for humans. Data collected from his smartphone app, myCircadianClock, could be key. The app helps people track when they eat, sleep, exercise and take supplements and medications.

“We send them push notifications asking them what improvement they are seeing,” Panda said.

In most of Panda’s studies, people eat their first meal between 8 a.m. and 10 a.m. but Charles Joy typically waits until 4 p.m. to break his fast. Joy’s doctor initially was concerned by the diet, but Joy felt vindicated by his low cholesterol and blood pressure readings. He has no plans to change things up anytime soon.

“I’ve been obese and super-unhealthy pretty much my entire life, the biggest guy in school,” Joy said. “This feels great, and I want to keep it going as long as I can.”

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Source Material:

The material for this article was provided to us by the American Heart Association on 22nd March 2019 and is reproduced here under CCL copyright permissions, with minor editorial changes to account for our predominantly UK & European readership. If you’d lke to visit the American Heart Association website it’s here

Fasting Ramps Up Human Metabolism and Helps Reverse Aging

Fasting may help people lose weight, but new research suggests going without food may also boost human metabolic activity, generate antioxidants, and help reverse some effects of aging. Scientists at the Okinawa Institute of Science and Technology Graduate University (OIST) and Kyoto University identified 30 previously-unreported substances whose quantity increases during fasting and indicate a variety of health benefits.

“We have been researching aging and metabolism for many years and decided to search for unknown health effects in human fasting,” said Dr. Takayuki Teruya, first author of the paper and a technician in the OIST G0 Cell Unit, led by Prof. Mitsuhiro Yanagida. “Contrary to the original expectation, it turned out that fasting induced metabolic activation rather actively.”

The study, published January 29, 2019 in Scientific Reports, presents an analysis of whole human blood, plasma, and red blood cells drawn from four fasting individuals. The researchers monitored changing levels of metabolites — substances formed during the chemical processes that grant organisms energy and allow them to grow. The results revealed 44 metabolites, including 30 that were previously unrecognized, that increased universally among subjects between 1.5- to 60-fold within just 58 hours of fasting.

In previous research, the G0 Cell Unit identified various metabolites whose quantities decline with age, including three known as leucine, isoleucine, and ophthalmic acid. In fasting individuals, these metabolites increase in level, suggesting a mechanism by which fasting could help increase longevity.

“These are very important metabolites for maintenance of muscle and antioxidant activity, respectively,” said Teruya. “This result suggests the possibility of a rejuvenating effect by fasting, which was not known until now.”

A study by the G0 Cell Unit and Kyoto University researchers suggests that fasting, which puts the body in “starvation mode,” leads to fuel substitution, antioxidation, increased mitochondrial activation and altered signal transduction.

Metabolites Give Clues to Mechanism and Health Effects

The human body tends to utilize carbohydrates for quick energy — when they’re available. When starved of carbs, the body begins looting its alternate energy stores. The act of “energy substitution” leaves a trail of evidence, namely metabolites known as butyrates, carnitines, and branched-chain amino acids. These well-known markers of energy substitution have been shown to accumulate during fasting.

But fasting appears to elicit effects far beyond energy substitution. In their comprehensive analysis of human blood, the researchers noted both established fasting markers and many more. For example, they found a global increase in substances produced by the citric acid cycle, a process by which organisms release energy stored in the chemical bonds of carbohydrates, proteins and lipids. The marked increase suggests that, during fasting, the tiny powerhouses running every cell are thrown into overdrive.

Fasting also appeared to enhance the metabolism of purine and pyrimidine, chemical substances which play key roles in gene expression and protein synthesis. The finding suggests fasting may reprogram which proteins cells build at what time, thus altering their function. The change may promote homeostasis in cells, or serve to edit their gene expression in response to environmental influences.

When metabolized, purine and pyrimidine also boost the body’s production of antioxidants. Several antioxidants, such as ergothioneine and carnosine, were found to increase significantly over the 58-hour study period. Antioxidants serve to protect cells from free radicals produced during metabolism. Products of a metabolic pathway called the “pentose phosphate pathway” also stay the harmful effects of oxidation, and were similarly seen to increase during fasting, but only in plasma.

Newfound Health Benefits of Fasting?

The authors suggest that these antioxidative effects may stand as the body’s principal response to fasting, as starvation can foster a dangerously oxidative internal environment. Their exploratory study provides the first evidence of antioxidants as a fasting marker. In addition, the study introduces the novel notion that fasting might boost production of several age-related metabolites, abundant in young people, but depleted in old.

Prof. Mitsuhiro Yanagida and Dr. Takayuki Teruya of the G0 Cell Unit recently published a paper with Kyoto University on the effects of fasting on the human metabolism. The study suggest novel health benefits of fasting, never-before reported.

“Recent aging studies have shown that caloric restriction and fasting have a prolonging effect on lifespan in model animals…but the detailed mechanism has remained a mystery,” said Teruya. “It might be possible to verify the anti-aging effect from various viewpoints by developing exercise programs or drugs capable of causing the metabolic reaction similar to fasting.”

The findings expand on established ideas of what fasting could do for human health. The next step would be to replicate these results in a larger study, or investigate how the metabolic changes might be triggered by other means.

“People are interested in whether human beings can enjoy the effects of prevention of metabolic diseases and prolonging life span by fasting or caloric restriction, as with model animals,” said Teruya. “Understanding the metabolic changes caused by fasting is expected to give us wisdom for maintaining health.”

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About the source material:

The material for this article was provided to us by the press office of the Okinawa Institute of Science and Technology, 29th January 2019.

References:

The original scientific paper by Takayuki Teruya et al.  “Diverse metabolic reactions activated during 58-hr fasting are revealed by non-targeted metabolomic analysis of human blood, Scientific Reports (2019)” may be viewed here