People with serious mental illness, on average, die 25 years earlier than the general population.1 This startling fact is largely ignored by both health and mental health providers. And yet, according to the Diagnostic and Statistical Manual of Mental Disorders, one in four Americans has been diagnosed with a mental disorder. Major depression, bipolar disorder, schizophrenia and obsessive-compulsive disorders are the most common diagnosis. With these disorders comes an increased risk of death associated with a myriad of physical illnesses. Cardiovascular disease, gastrointestinal, metabolic, neurologic and pulmonary diseases are the top five causes of death. However, most people with a mental disorder have more than one major illness. A prevalence study indicated that of the clients who participated, thirty percent were treated for three or more conditions, a fifth were treated with four or more conditions and some were treated with eight of more conditions.2
Few psychiatrists or mental health providers understand the nutritional needs of the brain. Rather than address physical conditions, antipsychotic medications are prescribed as the first line of treatment. The underlying physical causes are often ignored. Although the psychiatric symptoms may be ameliorated with the antipsychotic drugs, severe side effects can contribute to or exacerbate existing illnesses. The medications can induce weight gain and worsen other metabolic and cardiovascular disease risk factors. With weight gain and poor diets, for example, the prevalence of diabetes in persons diagnosed with mental illness increased from three percent at onset to 16.5 percent as patients’ age. People who were prescribed antipsychotic medication were also at greater risk for coronary heart disease and stroke. A comprehensive study found a 1.99 – 2.26 fold increase in sudden death in current users of antipsychotic medications.3
Mental disorders are increasingly being connected to malnutrition. Common deficiencies occur in omega-3 fatty acids, B vitamins, amino acids and minerals. Omega-3s are vitally important for brain health. As our food choices have moved from natural, whole foods to processed foods, our diet is dominated by omega-6 fatty acids. The ideal balance of omega-3 fatty acids to omega-6 fatty acids is a range from 1:1 to 1:4. The balance today, because of the abundance of omega-6s in processed foods, is 1:20. Excessive omega-6s cause cardiovascular disease, cancer, and inflammatory and autoimmune diseases.
The B vitamins support many brains functions. Deficiencies can cause low energy and problems in activities of daily living. Eighty percent of people with bipolar disorder have some B vitamins deficiencies. The B vitamins also affect cognitive impairment.
Proteins are the source of amino acids and form the foundation for cell formation and the production of neurotransmitters in the brain. The neurotransmitters function as behavior and mood regulators. They affect serotonin and dopamine the “feel good” hormones. People with schizophrenia often exhibit disturbances in the synthesis of amino acids.
Minerals are often overlooked as necessary for brain health. Chromium, magnesium, selenium and zinc affect our moods and low levels are correlated with depression. 4,5
A new paradigm is slowly emerging. New research indicates that nutritional supplements are often effective in reducing psychiatric symptoms. Nutrient dense diets combined with targeted omega-3 fatty acids, amino acids, and vitamins and minerals have been shown to be effective for controlling and to some extent, preventing depression, bipolar disease, schizophrenia, among many others. 5,6
In the early 1960’s Abram Hoffer, a Canadian biochemist and medical doctor, pioneered an approach that was mindful of the role of nutrition in schizophrenia and other diseases. Called orthomolecular therapy, he defined it as the provision of the optimum environment of the mind. He treated patients with prescribed B vitamins, vitamin C, vitamin E and the minerals selenium, zinc and chromium. He also had his patients eliminate all foods containing sugar along with foods that might cause an allergic reaction.7
Nutritional studies in the 1970s and 1980s continued to explore the role of nutrients in mental health but were discontinued because of lack of funding.9 The money was invested instead in the pharmaceutical industry where the emphasis was on investigating and producing synthetic drugs. Most nutritional therapies could not be patented and owned and therefore were not profitable. However, nutritional therapy is experiencing a comeback as more evidence indicates that good nutrition is directly connected with brain health and cognitive functioning.8
As a result, more psychiatrists and other providers are beginning to advocate for and practice nutritional therapy, addressing diet and lifestyle along with prescribing vitamins, minerals and other supplements.9,10 Placing more emphasis on the whole person is necessary to prevent or treat the co-occurring physical disorders that accompany a mental disorder. Persons with a diagnosis of a mental disorder are entitled to a life expectancy that is comparable to that of the general population. As we continue to expand our understanding of what the brain needs and the role of nutrition to improving and maintaining mental health, hopefully their life expectancy will improve over time.
- Parks, J., Svendsen, D., Singer, P., & Tate, M.E. (2006, October). Morbidity and Mortality in People with Mental Illness. National Association of State Mental Health Program Directors (NASMHPD). Medical Director Council. Retrieved from www.nasmhpd.org.
- Jones, D.R., Macias, C., Barreira, P.J. et al. (2204). Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatric Services 55:1250 – 57. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15534013.
- De Hert, M., Dekker, J.M., Wood, D. et al. (2009, August 13). Cardiovascular disease and diabetes in people with severe mental illness position statement paper for the European Psychiatric Association (EPA). European Psychiatry, 24, 412–24. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19682863.
- Sathyanarayana Rao, T.S., Asha, M.R., Ramesh, B.N. & Jagannatha Rao, K.S. (2008, April–June). Understanding nutrition, depression and mental illness. Indian Journal of Psychiatry. 50(2): 77–82). doi: 10.4103/0019-5545.42391.
- Goldstein, M. (2013, April 22). Nutritional approaches and diets safely cure mental illness. Natural News. Retrieved from http://www.naturalnews. com/nutrition.html.
- Logan, A.C. (2007). The Brain Diet. Nashville, TN: Cumberland House Publishing.
- Abram Hoffer. Retrieved from http://en.wikipedia.org/wiki/Abram_Hoffer.
- Lakhan, S.E. & Vieira, K. (2008, January,21). Nutritional therapies for mental disorders. Nutrition Journal, 7:2 doi:10.1186/1475-2891-7-2.
- Robert J. Hedaya. Retrieved from https://www.psychologytoday.com/experts/robert-j-hedaya-md-dfapa.
- Campbell-McBride, Natasha. (2010). Gut and psychology syndrome: natural treatment for autism, dyspraxia, A.D.D., dyslexia, A.D.H.D., depression, schizophrenia. Cambridge, U.K.: Medinform Publishing.
Karen V. Unger
Karen V. Unger is the author of the new book “Brain Health for Life, Beyond Pills Politics and Popular Diets.” Dr. Unger has a Master’s Degree in Social Work from Arizona State University, a Master’s Degree in Psychology from Chapman College and a Doctorate in Education from Boston University. She has written a previous book, book chapters, peer-reviewed articles, federal policy papers and an evidence-based practice kit for the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services. At Boston University she was a senior staff person at the Center for Psychiatric Rehabilitation and an adjunct professor at Sargent College of Allied Health Professions. She has also been a research associate professor at the Community Rehabilitation Division, Arizona State University in Tucson and is currently a research associate professor at the Graduate School of Education at Portland State University. Dr. Unger is president of Rehabilitation Through Education.