MICRONUTRIENTS FOR THE BRAIN

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1 MICRONUTRIENTS FOR THE BRAIN Bonnie J. Kaplan, PhD Professor Emerita Cumming School of Medicine University of Calgary Calgary Neuropathy Association January 17, 2018

2 Disclosure No commercial interest in any company or sale of any product Disclaimer The relevance of this research to neuropathy is not at all clear to me!

3 NUTRITION: THERE ARE 2 SIDES TO THIS WHAT WE EAT THAT MAYBE WE SHOULD NOT EAT Gluten Casein/ dairy Artificial additives

4 WHAT WE SHOULD EAT BUT MAY NOT BE GETTING ENOUGH OF Minerals Vitamins Omega-3 fatty acids

5 OVERVIEW 1. Why pay attention to mental health in general? (because it is not this group s focus) 2. Why pay attention to nutrition in relation to brain/mental health? 3. What types of data confirm the importance of nutrition to mental health? 4. Societal issues

6 1. WHY PAY ATTENTION TO MENTAL HEALTH IN GENERAL? Because we have a problem of epidemic proportions

7 THE INVISIBLE PLAGUE: THE RISE OF MENTAL ILLNESS FROM 1750 TO THE PRESENT (2001) E. FULLER TORREY & JUDY MILLER Ø Excellent data from England and Wales, Ireland, Canadian Atlantic provinces, and the USA Ø Very concerned because amount of insanity seemed to be increasing, to 0.03% in 1960

8 Prevalence of diagnosed mental illness in % Prior to 1750 Prevalence Irish famine

9 Prevalence of diagnosed mental illness in % Prior to 1750 Prevalence Over 20% Irish famine Now

10 TAKE HOME MESSAGE We have a problem of epidemic proportions Conventional treatments are not helping much

11 2. WHY PAY ATTENTION TO NUTRITION IN RELATION TO MENTAL HEALTH? Brain health is probably more dependent on optimal nutrition than any other organ

12 Our brain accounts for 2% of our body weight but, it represents 20-50% of our metabolic demands *

13 Each of us has ~6 liters of blood inside us Ø ~1 liter passes through our brain every minute Ø

14 WHAT IS THAT BLOOD DOING? Nutrients Oxygen Other immunulogic factors your brain needs Remove waste products

15 Why so many nutrients every minute? BRAIN METABOLISM

5-Hydroxyindoleacetyaldehyde Iron 5-Hydroxy-Ltryptophan

16 ONE SMALL PORTION OF SEROTONIN PATHWAY Vit. B 6 Molybdenum 6-Hydroxykynurenate 5-Hydroxy-Nformylkyunrenine 5-Hydroxyindoleacetyaldehyde Iron 5-Hydroxy-Ltryptophan 5-Hydroxyindolepyruvate Vit. B 6 Vit. B 6 Serotonin 3-Formylaminobenzaldehyde Copper Indole Copper Vit. B 6 Iron Tryptophan 3-Indole-glycolaldehyde

17 25% of calories from junk food

18 Flax, Soybean, Canola Oils, Walnuts Hemp & Modified Veg. Oils OMEGA-3 OMEGA-6 -Linolenic Acid (ALA) Linoleic Acid (LA) < Δ6-desaturase > (Cofactors: Vit C, B3, B6, Mg, Zn) Stearidonic Acid y-linoleic Acid (GLA) < Elongase > (Cofactor: B6) Corn, Soybean, Sunflower, Safflower Oils Evening Primrose, Borage Oil Eicosatetraenoic Acid Dihomo y-linoleic Acid (DGLA) Fish, Fish/Krill Oil, Seaweed Eicosapentaenoic Acid (EPA) < Δ5-desaturase > (Cofactors: Vit C, B3, Zn) Arachidonic Acid (AA) Meat, Eggs, Dairy 24:5n-3 Elongase (Cofactor: B6) Elongase (Cofactor: B6) Δ6-desaturase (Cofactors: Vit C, B3, B6, Mg, Zn) Docosapentaenoic Acid (DPA) 24:6n-3 β-oxidation Docosahexaenoic Acid (DHA) Fish, Fish/Krill Oil, Algae

19 TAKE HOME MESSAGE We eat for our brains Optimal brain function requires a broad spectrum of minerals and vitamins for metabolism

20 3. WHAT TYPES OF DATA CONFIRM THE IMPORTANCE OF NUTRITION TO MENTAL HEALTH? correlational prospective treatment

21 ~15 POPULATION HEALTH STUDIES: MEDITERRANEAN VS WESTERN DIET Mediterranean, whole foods diet associated with lower rates of mood and anxiety symptoms Western, processed foods diet associated with higher rates of mood and anxiety symptoms Jacka et al., PLoS ONE, 2011 Sanchez-Villegas et al., Public Health and Nutrition, 2012 Liu et al., Am J Clin Nutr, 2002 Jacka et al, Am J Psychiatry, 2010 Chrysohoou et al. J Am Coll Cardiol, 2004.

24 THE PROBLEM WITH CORRELATIONAL DATA MOOD, ANXIETY SYMPTOMS DIET HIGH IN PROCESSED FOOD

25 TO PROVE CAUSALITY 1. Prospective, longitudinal studies (to prove poor dietary patterns precede mental health problems) 4-5 now 2. Treatment studies (to prove that improving nutrition removes mental health problems) At least 45

Spain, >16,000 former students and professors from Univ of Navarra, begun in

26 FAST FOOD AND COMMERCIAL BAKED FOODS INCREASE THE RISK OF DEPRESSION, IRRITABILITY, ANXIETY Sequimiento Universidad de Navarra (SUN) Project in Spain, >16,000 former students and professors from Univ of Navarra, begun in 1999; ongoing. Semi-quantitative FFQ Sanchez-Villegas et al., Public Health and Nutrition, 2012.

27 LONGITUDINAL STUDY OF DIET QUALITY AND MOOD Dietary intake at baseline for Ø Muffins, doughnuts, croissants: summed to be commercial baked goods Ø Hamburgers, sausage, pizza: summed to be fast foods Added: 1 score indicating unhealthy diet and people were divided into thirds

28 RISK OF DEPRESSION AVERAGE OF 6.2 YEARS LATER, IN ~9,000 PEOPLE 1.8$ Risk of depression 1.6$ 1.4$ 1.2$ 1$ 0.8$ 0.6$ 0.4$ P for trend = $ 1.02$ 1.49$ 0.2$ 0$ LOWEST$Q1$ Q2$ Q3$ Lowest third Middle third Highest third Consumption

29 AM I SAYING MUFFINS CAUSE DEPRESSION? With every bite, we are making a choice

30 TO PROVE CAUSALITY 1. Prospective, longitudinal studies (to prove poor dietary patterns precede mental health problems) 2. Treatment studies (to prove that improving nutrition removes mental health problems)

31 SMILES TRIAL IF I IMPROVE MY DIET, WILL MY MENTAL HEALTH IMPROVE? Øn = 67, diagnosed with major depression ØRandomized to diet counseling or social support: 7 sessions over 12 weeks Jacka et al. (2017). BMC medicine, 15(1), 23.

32 SMILES TRIAL RESULTS 1. Even with depression, diet modification is possible and therapeutic 2. 32% remission (diet) vs 8% (social support) 3. Number needed to treat (NNT) = 4 4. Cost $112 AUS/week Jacka, et al. (2017). BMC medicine, 15(1), 23.

33 None of these results are surprising if you know the HISTORY of research relating diet to mental health 1/18/18

34 WHAT DO THESE CHARACTERISTICS RESEMBLE? ü Depression ü Hysteria ü Irritability ü Self-mutilation ü Apathy, lethargy ü Social withdrawal ü Inability to concentrate

35 SUBOPTIMAL NUTRITION! UNIV MINNESOTA STARVATION EXPERIMENTS, wks of nutrient deprivation in normal healthy students: ü Depression ü Hysteria ü Irritability ü Self-mutilation ü Apathy, lethargy ü Social withdrawal ü Inability to concentrate

36 Treatment studies with nutrients in pill form

37 Terminology Micronutrient definition varies Multinutrient formulas (e.g., B complex) Broad-spectrum formulas (25 or more nutrients)

38 WHICH COMMERCIAL MULTINUTRIENT FORMULAS HAVE ANY EVIDENCE OF BENEFIT FOR MENTAL SYMPTOMS?

39 Alberta Broad-Spectrum Formulas Ø EMPowerplus ( Ø Daily Essential Minerals [DEN] ( Ø For information and clinician guidance, please go to their websites. Ø Both companies provide education and support to clinicians, as well as families

40 Ø Studied by independent scientists: from Canada, New Zealand, USA, and now Europe Ø Companies never fund any scientist or any study Ø Because of ethics committee requirements, the formulas have been reviewed by FDA and granted IND certificates Ø They have also been scrutinized and approved by Health Canada

41 EVIDENCE FOR BROAD-SPECTRUM MICRONUTRIENTS IN: 1. Depression/bipolar disorder 2. Stress (e.g., after Natural Disasters) 3. ADHD 4. Anxiety 5. Psychosis 6. Explosive rage, sleep disturbance, recovery from head injury

43 7.1 EARTHQUAKE IN CHRISTCHURCH,NZ OCCURRED DURING ACTIVE TRIALS OF MULTINUTRIENT TREATMENT Ø September 4 th :35am Dr. Julia Rucklidge and her research team were evaluating broad spectrum mineral/vitamin formulas in the treatment of ADHD symptoms in a group of adults

45 185 people died, 7000 injured

46 RCT WITH GENERAL POPULATION Ø B complex, EMP low dose, EMP higher dose Ø All 3 treatment groups showed improvements from baseline, more than controls (taking no nutrients) Ø Groups taking broad spectrum formula improved more than B complex on some measures ØFor symptoms of probable PTSD

47 % meeting criteria for PTSD 80% 70% 60% 50% 40% 30% 20% 10% 0% Control (n=25) Berocca (n=30) EMP4 (n=31) EMP8 (n=30) Baseline 4 weeks Rucklidge et al., 2012, Human Psychopharmacology

48 Alberta, June 2013

49 ALBERTA NEW ZEALAND COLLABORATION Ø Sample: 56 adults aged Ø Med-free, evidence of moderate depression and/or anxiety on the Depression, Anxiety and Stress Scale (DASS) Ø Placebo: unethical Ø Randomized to 3 groups 6 week blinded RCT: Ø Single nutrient (vitamin D 1000 IU): n=17 Ø Few nutrients (B complex): n=21 Ø Broad spectrum (~30 minerals and vitamins): n=18 Kaplan et al. (2015), Psychiatry Res

51 FLOOD STUDY RESULTS F(2,52)=3.81, p<.05; ES= DASS Stress Vitamin D B Complex Broad Spectrum Formula 5 0 Baseline Week 2 Week 4 Week 6 Kaplan et al., Psychiatry Research, 2015

52 ØSometimes studies show that B complex alone is just as effective. ØAt least 8 RCTs in nonclinical samples ØGeneral population post-earthquake and post-flood benefited significantly from B complex

53 3 STUDIES NOW SHOW THE SAME THING Ø HUMANS are more resilient to stress when they are better nourished Ø As a supplement, providing even just B complex results in major benefit for acute stress* *but not for a significant mood or anxiety disorder, or for explosive rage, etc Why not the Fort Mac fires??

54 TAKE HOME MESSAGE We eat for our brains Optimal brain function requires a broad spectrum of minerals and vitamins for metabolism

55 4. SOCIETAL ISSUES $$$$ THREATS TO OUR FOOD SUPPLY

56 COST OF CONVENTIONAL MENTAL HEALTH TREATMENT Cost in $B Canadian Mental Health Commission report, July 2012

57 ANDREW Ø Middle child of 3; borderline IQ, moderately severe language problems Ø Age 10: stressed and overwhelmed Ø Disturbances in sleep, concentration, behaviour Ø Auditory hallucinations, paranoid ideation Ø Symptoms of Obsessive Compulsive Disorder (OCD)

58 Ø 6 months inpatient at Alberta Children s Hospital, with many medication trials Ø Discharged after 6 months unchanged Ø Returned to outpatient care (Mood & Anxiety Disorders clinic; Dr. Megan Rodway) Ø Parents suggested trying a broad spectrum micronutrient formula (EMPowerplus) Ø Dr. Rodway: This is snake oil, but I don t have anything better to offer.

59 What happened to Andrew? (what happened to Dr. Rodway)

60 Daily psychosis symptom score 10-day moving average Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov-09

61 Self-reported account of hallucinations Visual hallucinations Auditory hallucinations

62 ANDREW BY 2010 (AND STILL IN 2018) Ø No psychotic symptoms ØGraduated high school in 2015 ØNo longer on any psychiatric medication Ø Still struggles with anxiety M Rodway et al, BMJ Case Reports, Nov 9, 2012

63 COST TO HEALTH CARE Micronutrients cost <2% of conventional treatment Cost of conventional inpatient treatment Cost of micronutrient outpatient treatment

64 KAPLAN ET AL. (2017). HOSPITALIZATION COST OF CONVENTIONAL PSYCHIATRIC CARE COMPARED TO BROAD-SPECTRUM MICRONUTRIENT TREATMENT. INTERNATIONAL JOURNAL OF MENTAL HEALTH SYSTEMS, 11:14. Ø diagnoses from 1997 (at age 33): bipolar disorder, depression, and PTSD. Ø Avg annual cost of inpatient hospitalizations was $59,864; Ontario, BC, Alberta Ø Dec 2001: Began cross-titration onto micronutrient formula and off medications Ø From 2002 present, zero medication and zero hospitalizations for mental health; self-funded micronutrients average annual cost of $760.

Costs for provincial disability payments and self-funded micronutrients are patient-reported estimates.

65 Figure 2. Annual costs for hospitalization, disability payments, and micronutrients. Hospitalization costs are based on data from Canadian Institute for Health Information (CIHI). Costs for provincial disability payments and self-funded micronutrients are patient-reported estimates. *Disability payments continued until 2009 as explained in the text. Cost (2015 Canadian dollars) $59,864 $60,000 $50,000 $40,000 $30,000 $24,000 $20,000 $10,000 $0 Hosp Disability Nutrients prior to 2001 $0 $0 $0 $760 Hosp since 2002 Disability since 2009* Nutrients since 2001

66 COST OF SUCCESSFUL TREATMENT WITH BROAD-SPECTRUM MICRONUTRIENTS: < 2% AND < 10% What could our societies do with that kind of cost savings?

67 MY VISION OF THE FUTURE Ø Every clinician will say There is increasing evidence that how we eat affects how we feel. Let s talk about your diet. Ø Every mental health clinic will teach cooking, educate about nutrition and mental health. Ø Every child will have the opportunity of being given broad-spectrum micronutrients for emotional/behavioural challenges.before ever being exposed to medication. 1/18/18

68 ØOffices and workplaces will create a culture of health, including healthy food and exercise ØConsumers will demand nutrient-dense food ØFarmers will be rewarded for nutrient density, not yield 1/18/18

69 How to reach me Ø Request my slides Ø Join my updates list Ø Connect me to potential donors for the 2 charitable funds. Ø But, for questions about the Alberta Formulas, please contact the companies: Ø Daily Essential Nutrients (DEN) hardynutritionals.com Ø EMPowerplus: truehope.com

Bonnie J. Kaplan, PhD Professor, Faculty of Medicine, University of Calgary April 13, 2014

Bonnie J. Kaplan, PhD Professor, Faculty of Medicine, University of Calgary April 13, 2014 Disclosure for all speakers today 1. No commercial interest in any company or sale of any product 2. And this