May 28, 2024

By Francesco Zangari

Eating is a fundamental aspect of the human experience, transcending nutrition to encompass social, cultural, and psychological dimensions. Emerging at the intersection of nutrition and psychology, the emerging field of nutritional psychiatry delves into the relationship between diet and mental health, offering a new toolkit for psychological care. In this realm, the gut microbiome has emerged as a pivotal player. The microbiome, comprising trillions of microorganisms residing within the gut, significantly influences mental health through the intricate network known as the gut-brain axis.

Despite strides in various areas of medicine, treatments for adolescent depression have seen minimal innovation over the past two decades, leaving a notable gap in mental health support for young individuals.

The notion that dietary choices and the microbes in our gut could be pivotal in mental wellbeing, particularly among youth, is intriguing. Tailoring diets to optimize mental health via the gut microbiome presents a unique opportunity for intervention because eating is universal.

With May being Mental Health Awareness Month, we wanted to delve deeper into this evolving field, and we spoke to Susan C. Campisi, a researcher in the nutritional psychiatry space. Campisi is a research associate with the Korczak Lab in the neurosciences and mental health program at the Hospital for Sick Children and an adjunct lecturer in the nutrition and dietetics program at the University of Toronto.

Can you give readers an overview of the emerging field of nutritional psychiatry and the current consensus regarding gut and mental health?

Nutritional psychiatry examines dietary approaches to prevent and treat mental disorders and their comorbidities. Our focus is on how food choices influence mental health and what interventions can potentially improve mental health.

The field emerged informally in 2010 when the American Journal of Psychiatry commented on it by saying it is both compelling and daunting to consider that a dietary intervention at an individual or population level could reduce rates of psychiatric disorders.

After that point in 2010, if we just look at PubMed publications, we see an explosion of research happening in this area, predominantly in the adult literature with links between nutrition and depression, and nutrition and general mental health. 

Can you describe your team’s research efforts in nutritional psychiatry, addressing the field’s gaps, and your motivations?

Based on the published adult literature, it is possible that nutrition can be used to benefit mental health alongside medications and other approaches such as behavioural therapies.

An unfortunate aspect of nutritional psychiatry is the same abundance of literature on nutrition and mental health examination has not been conducted among adolescents or kids. Initial efforts were almost exclusively focused on adults, and the research for younger age groups remains understudied, which is what motivated my interest in this area.

Our focus is on adapting adult interventions to benefit adolescents and children, as we know acting at a younger age increases the likelihood of successful intervention, but not everything that works for adults will necessarily work for teens.

When speaking specifically about depression, we know that adolescents with depression are more susceptible to cardiovascular risks and worse outcomes later on in life, but we still do not know the cause.

By promoting healthy dietary habits early in life, we aim to establish lifelong patterns that can positively impact both cardiovascular health and mental wellbeing, including reducing the risk of depression. This approach offers the potential for long-term benefits throughout a person’s life.

What does the evidence suggest for any over-the-counter therapies, like pre- or probiotics, and dietary supplements when combined with nutritional approaches?

That’s an excellent question. While research into specific probiotics directly impacting mental health is still in its early stages, there’s compelling evidence for the gut-brain axis. This suggests that changes in diet can significantly impact gut health, which in turn has the potential to positively influence mental wellbeing. So, while we can’t definitively say probiotics alone will improve mental health, prioritizing healthy eating habits could offer long-term benefits for both physical and mental health.

I have some reservations about relying solely on supplements, especially considering the emerging nature of research on the gut microbiome. While the gut microbiome and its potential connection to mental health are exciting areas of research, both are still in their early stages. Focusing on well-established dietary interventions that promote gut health, like incorporating fermented foods such as kefir and kimchi, seems like a more prudent approach at this point. This way, we can leverage the existing scientific evidence to potentially improve both physical and mental wellbeing.

While there’s a tremendous amount of exciting research happening in the gut microbiome field, we haven’t yet reached the point where we can offer widely applicable interventions based on individual microbiomes. However, I’m incredibly hopeful about the future. One potential direction I’m particularly interested in is the development of personalized interventions based on a comprehensive gut microbiome assessment. Imagine being able to identify specific bacterial species that might be contributing to health concerns, and then tailoring interventions to promote a more balanced gut environment. This could be a game-changer in the way we approach health and wellbeing

How can this lead to personalized medicine approaches for mental health disorders?

The emerging field of nutrigenomics offers exciting possibilities for personalized medicine approaches to mental health. By analyzing an individual’s unique genetic makeup and dietary habits, we can potentially identify specific dietary interventions that could positively influence their gut microbiome and, consequently, their mental wellbeing. However, it’s crucial to acknowledge the complexity of this approach. 

Connecting the dots between individual diet, microbiome composition and mental health requires careful consideration of all these interconnected factors. Furthermore, the dynamic nature of the gut microbiome necessitates ongoing monitoring and adjustments to ensure progress. While personalized medicine approaches might initially be intensive and potentially costly, the potential for tailoring interventions to individual needs could lead to significant improvements in mental health outcomes. It’s important to remember that the gut microbiome and diet are not a one-size-fits-all solution, but rather a promising avenue for complementary and potentially preventative approaches in conjunction with established mental health treatments.

As we move forward, what is the immediate focus of researchers in the field of pediatric nutritional psychiatry, and how is your group involved?

In the field of pediatric nutritional psychiatry, our immediate research efforts are directed toward two crucial areas. First, we need to unravel the gut microbiome’s role in pediatric mental health by early assessment. Understanding the gut microbiome early in childhood is paramount, as it becomes increasingly stable and less susceptible to change during adolescence. This early assessment allows us to delve into the potential role the microbiome plays in shaping mental health development. And two, identifying differences – we’re actively investigating how the gut microbiome of children and adolescents with mental health disorders differs from those without. Identifying these variations could lead to uncovering potential causes and pave the way for targeted interventions.

Next, we need to explore the power of diet and food by assessing what nutrients are the precursors to hormones and other compounds that impact our mental health and our general wellbeing. These nutrients act as building blocks for hormones and other compounds that directly impact our brain and mood. There is still a lot to discover in this area, but a lot of research is taking place. Our research group, for example, is currently conducting a dietary intervention study with children. We’re testing the hypothesis that increasing their intake of fruits, vegetables and whole grains while reducing processed foods can positively impact their mental health.

While this research is still in its early stages, it holds immense potential for developing preventative and complementary approaches to improve mental health in children and adolescents. By unravelling the intricate interplay between the gut microbiome, diet and mental health, we can pave the way for a healthier and happier future for our younger generation..

Is there anything the government can do from a policy perspective to improve on its recommendations to promote better gut health and overall mental wellbeing of children and adolescents?

Yes, there are several ways the government can contribute from a policy perspective to improve the gut health and overall mental wellbeing of children and adolescents:

Expanding access to healthy food: The recent announcement of a national school food program is a positive step in the right direction. Expanding access to fresh, nutritious foods in schools and communities can significantly improve dietary choices and positively impact gut health.

Promoting nutrition education: Integrating comprehensive nutrition education into school curriculums can empower children and adolescents with the knowledge and skills to make informed dietary choices. This education should go beyond basic food groups and delve into the connection between diet, gut health and mental wellbeing.

Supporting mental health services: Increasing access to affordable and culturally competent mental health services for children and adolescents is crucial. This includes early intervention programs, school-based mental health professionals and community-based support systems.

Encouraging family engagement: Promoting family-based interventions that encourage healthy eating habits and open communication about mental health can significantly impact children’s wellbeing. This could involve parent education programs, family-friendly cooking workshops and resources for fostering healthy communication within families.

Additionally, our experience engaging youth highlights the importance of providing information through trusted sources and channels they frequent. Incorporating this insight into policy initiatives, such as training teachers, coaches and even parents on basic nutrition and mental health awareness, could be highly impactful.

Overall, a multipronged approach that addresses both food access, nutrition education, mental health support and family engagement holds the potential to create a healthier and more supportive environment for children and adolescents, ultimately contributing to their long-term wellbeing.