December 03, 2021 We Know So Much More Now…

From the Clinician AND From the Lived Experience

Last spring we posted about mind-body insights and tools for stress regulation that we learned from Dr. Kathleen Mackenzie at the Active Minds conference, and recently we had a chance to catch up with her directly.  Dr. Mackenzie's insights are especially powerful since they stem from a broad academic and clinical career, as well as personal life experiences with racial concerns and mental and physical health issues. Dr. Mackenzie's background motivated her to develop a scientific understanding of the factors that contribute to our overall functioning and wellbeing.  As outlined in her bio, Dr. Mackenzie has a background in clinical social work across various settings, academic contributions at Northeastern University, and certification in mental health integrative medicine. As she personally addressed her health 'through the help of alternative medicine and a lot of research, she realized that individual, social, and group dysfunction has a lot to do with a lack of knowledge about how what we do to our bodies and brains not only impacts our health and our lives, but it also impacts the people around us, including family, co-workers, community members, and future generations.' Much of what we are learning from Dr. Mackenzie is also included in this interview with the New Bedford Guide, where Dr. Mackenzie highlights her views on mental health, regulation, and mind-body concerns. She promotes a need for understanding ourselves and our lives in context, and highlights that help seeking is a good thing.  We invite you to listen as she talks mind-body connections: sleep as 'the number one thing,' the importance of setting body clocks and the dangers of electronics, and benefits of good nutrition, sunlight and fresh air, exercise, and other habits for mental health and wellbeing. Dr. Mackenzie also advocates for screening and awareness, and highlights that the average person experiences a delay of 8-10 years from symptom onset to mental health diagnosis, even as 50% of symptoms appear by age 14 and 75% by age 24. That is a lot of lost time and opportunity, especially when interventions can help change a life's course and rates of suicide in young people are increasing by 70 to 150%.  As a provider in a local school system she focuses on supporting regulation in her students, much of which can occur through schedules and healthy approaches to physical needs of sleep, exercise, diet, etc. Dr. Mackenzie hopes that telling her personal story and journey helps to make these considerations more approachable to parents and individuals who need support and information to overcome their fears and get needed help.  As she highlighted in this video from September 2020, we were already in a mental health crisis and Covid is only making things worse.

July 21, 2021 My Journey With My Mental Health and How I Deal, Part Two: Diet

In her second piece for From the Lived Experience our contributing writer discusses the impact of diet, which affects our brain and mental health just as it does our physical health--as JKBF has outlined here

By Guest Contributor, Christine Bushrow
I grew up eating predominantly healthy, comforting, home-cooked meals with my family. My mom's Italian heritage influenced most of the meals she cooked; there was plenty of lasagna, ravioli, spaghetti, and "stuffed shells." She'd also make delicious, creamy casseroles and frittatas. Despite being a vegetarian for most of her life, she cooked all kinds of meat for us and let us decide whether we wanted to partake or not. She never tried to influence our decision based on her preference. My dad is also an excellent cook, but most of my memories growing up of his cooking revolved around the grill. He's the reigning "grill master" and is rightfully proud. Not a single summer weekend passed without grilling cheeseburgers, steaks, and hotdogs on the back deck, with a side of watermelon, chips, and salad. Another fun tradition I remember fondly is ordering pizza every Friday night and eating in the living room - it was a huge deal to eat away from the kitchen table! - while watching a movie as a family. When I went away to college, I pretty much ate whatever I pleased, whenever I pleased. I had a lot of fun destroying my health with dorm cafeteria food, 7-11 burritos, frozen Bagel Bites, Hostess cupcakes, and soda.  It didn't get much better when I returned from college and moved into my first "adult" apartment. I had a roommate, but we lived parallel lives and didn't interact much, so I focused on myself at mealtimes. For example, I didn't see the point in grocery shopping since I didn't know how to cook for one, so I'd stop by any fast food drive-thru on my lunch breaks and after work each day.  After a few years of living that way, I was feeling pretty horrible mentally and physically. I had brain fog, daily stomach pain, headaches, and absolutely no energy. Plus, my skin started breaking out badly. All of this, on top of my existing anxiety and depression, felt unbearable. I knew I needed to make a change but had no clue how. One day while scrolling online, I came across the term "veganism" and was immediately intrigued. A parade of healthy, happy, glowing people flooded my screen as they excitedly explained how veganism had positively changed their lives and their health. I wanted to feel like that, too.  The changes I made started small. First, I cut out red meat, then all meat, and noticed a massive difference in how I felt. After that, I ate many processed vegetarian foods and slowly learned how to adjust my vegetable portion sizes to be more substantial rather than small side dishes.  About a year later, I made the ethical connection to animals, cut out eggs and dairy, and began eating more whole foods than processed foods. Not only did my self-esteem improve as my actions matched my morals, but this was also when the most significant shift in my health occurred. My skin cleared up, I felt light on my feet, I had more energy, my seasonal allergies disappeared, and my brain fog slowly cleared. I engaged in more physical activity with this newfound energy, not because I had to, but because it felt great to move my body! My yoga practice intensified, I hiked and kayaked often, and I discovered a new passion: walking. Christine Bushrow is a passionate freelance mental health writer and mental health advocate. When she's not writing, you can find her reading, spending time with loved ones, practicing yoga, and exploring the outdoors in a constant state of wonder.  

July 21, 2020 Diet Matters: The Food-Mood Connection

by Alison Brown, MSc

“Let thy food be thy medicine and thy medicine be thy food” - Hippocrates, 400 BC

We are generally aware that our diets affect our physical health—after all, “you are what you eat” is a fairly common idiom. However, it’s interesting that 2000+ years passed before the mental health field focused on one of Hippocrates’ great insights: food is medicine for our entire bodies, including the ever-important human brain.
Increasing evidence suggests that what you eat affects your mental health—in more ways than one. While more research needs to be done, several studies have found that eating a diet of whole, unprocessed foods may decrease your risk of depression and suicide, and a diet made up of refined carbohydrates, simple sugars, and processed meats can increase that risk. Diet may offer an additional modifiable tool in an integrative approach to mental health. Scientists and clinicians have launched the relatively new field of nutritional psychiatry, where research builds a case that focusing on nutrients for the brain and a strategic diet can help to avoid, and even substantially improve, symptoms of depression, anxiety, and other conditions. Reinforcing the concept of mind-body connections, diet affects how your brain and body function to keep your mind healthy. In fact, researchers from the International Society for Nutritional Psychiatry Research claimed in an opinion piece in Lancet Psychiatry that, “the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology.” Can your diet protect you from depression and suicide? Mediterranean-style diets, popular in addressing many physical health conditions, have received increasing attention in the nutritional psychiatry field. As mentioned in the Harvard Health Blog, one study that surveyed dietary patterns suggested that the risk of depression is lower in those who follow ‘healthy’ dietary patterns rich in fruits, vegetables and fish, as compared to those consuming a diet rich in processed meat, chocolates, sweetened desserts, fried food, refined cereals and high-fat dairy products.
Furthermore, a meta-analysis of observational research surveying dietary patterns showed that consumption of whole, unprocessed foods was associated with less depression and that Western-style diets increased depression risks. The authors called for further studies and clinical trials to confirm and build upon these findings. Crucial evidence that changing your diet can support your mental health comes from the SMILES trial, the first intervention study to test the therapeutic effect of food on the development of major depressive episodes. In this controlled study, adults with major depressive disorder reported significant improvements to their mood after following a Mediterranean-style diet for 12 weeks. Participants were asked to add 12 key food groups to their diets: whole grains, vegetables, fruit, legumes, low-fat and unsweetened dairy foods, raw and unsalted nuts, fish, lean red meats, chicken, eggs, and olive oil. In addition, they were asked to reduce their consumption of sweets, refined cereals, fried food, fast food, processed meats, and sugary drinks. In comparison with the control group, improvements were also shown in secondary measures of anxiety. The researchers pointed out that weight loss did not occur, and surmised that diet-induced changes in inflammation, oxidative stress, brain plasticity, or the microbiome might be influential factors. Another trial recently found that young adults who followed a Mediterranean-style diet for only three weeks reported significant improvement in depressive symptoms and lower levels of anxiety and stress. Those who had a greater intake in fruits and vegetables showed the greatest improvement in depressive symptoms. These authors refer to diet as a modifiable risk factor for depression, meaning that it is something you can changethat reduces risk. In meta-analysis of clinical trials published just last year, researchers reviewed 16 studies of dietary interventions and their effects on symptoms of depression and anxiety. They found that improving diet by increasing vegetable and fiber intake and decreasing consumption of fast food and sugar shows promise in providing a measurable benefit on depression and, to a lesser extent and more so in women, anxiety, and suggested a need for more research into mechanisms and approaches for dietary interventions. As for diet’s relationship to suicide (beyond the overlaps with depression), there is some evidence that deficiencies of certain nutrients can influence suicidal behavior, but as of yet, there are no controlled studies assessing dietary interventions. This paper highlights nutritional features associated with depression and suicide and suggests that there are certain nutrients (fatty acids, vitamin C, zinc, magnesium, vitamin B12 and folic acid) that support key cellular functions and may have therapeutic benefits for depression and suicidal behaviors. Researchers have made a case that a deficiency of Vitamin D can affect suicide risk. One study found that low Vitamin D levels in the blood samples of US service members were associated with an increased risk for suicide. In an investigation of patients with a recent suicide attempt, researchers found that as many as 90% of the patients who had made a suicide attempt had low levels of Vitamin D, and 60% had a clear deficiency as well as elevated markers of inflammation. A recent study of adolescents who had made suicide attempts revealed Vitamin D deficiency, and the authors suggested that those treating adolescents test for Vitamin D levels, as there is some support that treatment may reduce risk.
Fatty acid levels have also received some attention. A study of young Chinese males found that low levels of the omega 3 fatty acid EPA represented a risk factor for suicide attempts. Another study of US service members who died by suicide found that low levels of the omega 3 fatty acid DHA were a strong predictor of suicide, and service men with the lowest levels of DHA were 62% more likely to die by suicide. Dr. Arthur Ryan (who received the first James Kirk Bernard Foundation Award for Excellence in the Biological Exploration of Suicide) presented evidence to a conference from his study which found that individuals who later died by suicide were more likely to have particular combinations of fatty acid profiles. It’s important to note that these studies cannot confirm that these nutrient deficiencies were caused by diet alone, as metabolism, genetics, and lifestyle may affect any individual’s results. However, sometimes nutritional imbalances can be supplemented or improved with diet, especially critical nutrients such as DHA and EPA that cannot be made by our bodies. How does your diet regulate mental health? There appear to be three mechanisms by which diet affects mental wellness. First, your diet provides your brain with nutrients, such as fatty acids and B vitamins, that it needs to grow, function, and generate new connections. Dozens of neurotransmitters affect brain function and mood, and many of the nutrients needed to make them come from your diet. Of note, serotonin is a major regulator of mood, appetite, pain, circadian cycles, and digestion and is so important in mental health that boosting it is the target of anti-depressant medications such as SSRIs. Dopamine regulates pleasure, energy, mood, focus, and sleep and norepinephrine is involved in learning, mood, and forming new brain cells. One lesser-known nutrient for brain growth is brain-derived neurotropic factor, or BDNF, which increases plasticity and primes your brain for learning, good moods, and clear thinking. In fact, increased BDNF levels are associated with effective treatment of clinical depression. Another means by which diet may affect mental health is by regulating inflammation, a factor of interest in many chronic health conditions, both physical and mental. Inflammation can lead to distress signals in the brain that influence anxiety and depression. Studies have shown that people with major depression have higher levels of some inflammatory markers, including C-reactive protein. Inflammation is also associated with symptoms of suicidal behavior like aggression, hopelessness, and hostility, and of increasing interest in the suicide research field. While the exact mechanisms that link inflammation, and especially neuroinflammation, to suicide are not yet firmly established, there are multiple theories currently being researched. The third mechanism by which diet may affect mental health is through your gut health. The gastrointestinal tract contains millions of nerve cells that send signals back and forth to the brain, so if your gut is feeling unwell, your cognition and mood can be affected too. Key to gut health and gaining increasing attention in both physical and mental health conditions, the microbiome is important for the production of neurotransmitters such as GABA and serotonin. While we think of serotonin as elemental to thought and emotions, and it’s important (and interesting!) to consider that 90% of serotonin is produced in the gut. Microbiome biodiversity is essential to gut health, and one study found that bacterial richness and diversity (influenced by what you eat!) was associated with decreased severity of depression and anxiety. What should we be eating? While consuming a diet including more whole, unprocessed food will likely also benefit your physical health, mental wellness is the target of these suggestions. That said, many chronic diseases raise the risk of suicide and psychological conditions, so what’s good for the body can be good for the mind. Of course, always consult your doctor before deciding which diet is right for you. Additionally, there’s a large body of research and an increasing number of experts on the food-mood connection, so we’ll just be highlighting a few recommendations here. The message is that what you eat can affect how you feel, so you may want to consider diet when thinking about mental health. Seafood is especially important—according to the CDC, the majority of Americans fall short of the recommended amount of fish in their diet (the USDA recommends two servings of seafood per week). Meat from seafood, including fish, shellfish, and mollusks, is the most concentrated source of the important omega 3s DHA and EPA, and diets high in these omega 3s are associated with reduced  depression, obesity, cancer, and heart disease. This study showed that men with low seafood consumption were much more likely to be severely depressed. Along with the omega 3s, fish is full of other great mood-boosting nutrients like iodine, magnesium, vitamin D, and zinc.
As the Mediterranean-style diet has been the most extensively researched, many nutritional psychiatrists recommend following this or a similar meal plan, as popular press is starting to report. Dr. Lisa Masconi, the director of the Women’s Brain Initiative at the Weill Cornell Medical Center, said in a New York Times article, “imaging studies show that the brains of people who follow a Mediterranean-style diet typically look younger, have larger volumes, and are more metabolically active than people who eat a more typical Western diet.” While following a traditional diet is a worthy goal, many experts agree that there’s no one food or one diet that is optimal for mental wellness. Instead, focusing on upping your intake of whole, unprocessed fruits, vegetables, fish, and meats and cutting out refined carbohydrates and sugar can make a difference. Dr. Drew Ramsey, an assistant clinical professor of psychiatry at Columbia University and a leading expert in the nutritional psychiatry field, champions these top mood-boosting foods: wild salmon and shrimp, cherry tomatoes and watermelon, chile peppers, beets, and garlic. Dr. Ramsey has helpful tips and tricks to eating your way towards a healthy and happy brain in his book, The Happiness Diet, and in his TEDx talks, linked here and hereWhat shouldn’t we be eating? First and foremost, one of the most important dietary changes to improve your mental health is to significantly reduce sugar consumption. In the past 200 years, we’ve increased our sugar intake by 3,000 percent, resulting in various metabolic changes. Alarmingly, one investigation shows that countries with the highest intake of sugar per capita are the countries with the highest rates of depression. Sugar is one of the primary driving forces behind the obesity epidemic, and obesity-related diseases, such as diabetes, heart disease, and cancer, have much higher rates of depression. Not surprisingly, studies show that excessive consumption of energy drinks and sugary beverages increases the risk of depression and suicide ideation. Diets high in sugar decrease the amount of circulating BDNF, which is important for your brain to grow and make new connections. High blood sugar can also shrink the hippocampus and amygdala, affecting brain areas essential to regulating mood, memory, anxiety, and cognition. Modern processed foods also wreak havoc on our mental health. Many nutrients that contribute to a happy brain have been stripped from our food supply, and in some cases, replaced with chemicals that may impair brain functioning. For example, to increase the shelf-life of flour, the naturally-occurring fiber is removed and replaced with chemical bleach. Vegetable oils (corn, soybean, sunflower) are particularly damaging, since they have high levels of pro-inflammatory omega 6 fats, in contrast to anti-inflammatory omega 3 fats found in fish. High levels of omega 6 fats and trans fats have been linked to an increased risk of depression. Preliminary evidence shows that meat intake may have an association with depression, while one review suggests that grass-fed and grass-finished meats have a healthier nutritional profile of fats and antioxidants. Factory farmed cows, chickens, and even fish are usually fed diets of corn and soybeans which reduces the amount of mood-boosting omega 3s in their meat. The less-than-ideal conditions that the animals live in also increase their stress hormones, which lowers their concentration of B vitamins, zinc, and vitamins A, E and C. Furthermore, higher consumption of meats cured with added nitrates, such as hot dogs and beef jerky, has been associated with episodes of mania. You Feel What You Eat Experts in nutritional psychiatry, as well as medical doctors, are increasingly aware that what you eat truly affects how you feel. As Dr. Felice Jacka, president of the International Society for Nutritional Psychiatry Research, said in a twitter video, “we now have a very large and consistent evidence base… to say that the quality of your diet is linked to your risk of depression in particular.” The growing field of nutritional psychiatry reinforces the idea that mental health isn’t all in your head, but rather a part of a complex biological and psychological system that does not function in isolation.  And while experts agree that there is consistent and compelling evidence that diet affects mental wellbeing, diet is not a silver bullet for treating mental health concerns or preventing suicide.  That said, healthy whole food coupled with professional support, as well as physical activity, carefully delivered  medication (when needed), adequate sleep, exposure to nature, social connectedness and a commitment to a balanced lifestyle can combine to help you feel your best each and every day. Alison Brown, MSc., is a freelance writer with a background in cognitive science and evolutionary and comparative psychology.      Reviewed 7/20 by Jian Zhang, MD, DrPH, MSc, Professor in the Department of Biostatistics, Epidemiology, and Environmental Health Sciences of Jiann-Ping Hsu College of Public Health at Georgia Southern University 

November 04, 2019 JKBF bestows first Biological Research Award

At the 2019 International Summit on Suicide Research in Miami, FL, the International Academy of Suicide Research (IASR) and JKBF presented the first James Kirk Bernard Foundation Award for Excellence in the Biological Exploration of Suicide to Arthur Ryan, Ph.D. Selected by an IASR committee as a finalist in a pool of early career researchers presenting innovative biological studies, Dr. Ryan was chosen by JKBF for his work investigating fatty acid profiles associated with suicide. Dr. Ryan’s research was done in collaboration with co-authors and mentors from several leading research institutions, including the Uniformed Services University of the Health Sciences, The Johns Hopkins Bloomberg School of Public Health, and the Washington D.C. VA hospital. Dr. Ryan is an advanced postdoctoral research fellow studying the biology of suicidal behavior in U.S. Veterans at the Mental Illness Research, Education, and Clinical Center, a research institute located within the Baltimore VA hospital. He received his Ph.D. in clinical psychology from Emory University, where he studied the development of psychotic disorders. Dr. Ryan’s goal is to become a career VA research scientist developing biological treatments to prevent suicide in Veterans and other individuals living with mental illness. JKBF’s interest in the exploration of biological factors involved in suicide plays out in Dr. Ryan’s research, which suggests that fatty acid profiles may be associated with suicide. His work is described in our first From the Scientist piece below. We celebrate the cross-institutional collaborations involved in this work, as we believe that a gathering of various perspectives and expertise promotes discovery. JKBF is pleased that our first award recipient exhibits a dedication to researching the biological factors related to suicide, and we wish Dr. Ryan success and productivity in his career ahead. JKBF appreciates the collaboration with IASR and the efforts of the selection committee members, Gil Zalsman, Maria Oquendo, and Cornelis van Heeringen, in making this award possible. Dr. Ryan received an honorarium as well as an award featuring a piece of Jamie's art, and his research is being submitted for publication in a research journal. UPDATE: Dr. Ryan's paper, Serum Fatty Acid Latent Classes Are Associated With Suicide in a Large Military Personnel Sample was published February 2021 in the The Journal of Clinical Psychiatry.

From the Scientist: 

Summary of Presentation “Latent Class Profiles of Serum Fatty Acids are Associated with Risk of Suicide in Military Personnel.”

By Arthur Ryan, Ph.D.
I was interested in how levels of fatty acids in a person’s blood might be associated with risk for suicide, the leading cause of death among active duty members of the U.S. military.Previous research has shown that different types of fatty acids can have various effects on a person’s health.  For example, increased levels of omega-3 fatty acids appear to help reduce the risk of stroke.I wanted to know whether considering levels of several fatty acids at once might help illuminate biological changes that predispose individuals towards suicide. My co-authors and I analyzed data derived from blood samples previously collected from 800 military service members who eventually died of suicide and 800 living military service members. I used a statistical technique that allowed me to identify groups of individuals who have similar “profiles” of fatty acids; by that I mean they had similar patterns of elevations and deficits of multiple individual fatty acids. I then compared these fatty acid groups, known technically as “latent classes,” with one another. [caption id="attachment_764" align="alignleft" width="300"] Photo: Suzy Hazelwood,[/caption] My statistical analysis showed that individuals who later died by suicide were more likely to have certain profiles of fatty acids; for example, they were more likely to have profiles with high levels of certain saturated fatty acids and low levels of certain omega-3 fatty acids. Individuals with the suicide-associated fatty acid profiles were also more likely to have been diagnosed with depression and alcohol use disorder, conditions associated with increased risk for suicide. Fatty acids are essential to many biological systems related to suicide, from the creation and maintenance of neurons to the proper functioning of the immune system.  My co-authors and I speculate that the suicide-associated fatty acid profiles could contribute to changes in the brain, such as increased inflammation, which might further predispose a vulnerable individual towards suicidal behavior. Overall, our research suggests that the levels of fatty acids in a person’s blood might be associated with increased or decreased risk for suicide. It’s important that my co-authors and I note the possibility that the association between fatty acids and suicide is because of some unmeasured third variable related to both fatty acids and suicide; for example, people at risk for suicide might stop eating healthy foods, which would also change their fatty acid levels. However, it is also possible that there is a direct causal connection between fatty acid profiles and suicide.  Measuring fatty acid profiles might never be a way to reliably tell that an individual person is at imminent risk for suicide, but understanding their possible biological connection with suicidal behavior might lead to interventions that help to foster population-level health and resilience, similar to the way that the American Heart Association recommends restricting the amount of saturated fatty acids in your diet as one way to encourage heart health.This research identifying suicide-associated profiles of fatty acids represents one piece in a much larger effort in finding biological factors that might eventually be used to prevent suffering and deaths by suicide.
  1. Armed Forces Health Surveillance Center. Surveillance snapshot: Manner and cause of death, active component, US Armed Forces, 1998-2013. MSMR, 21 (2014).
  2. Yang, B. et al.Circulating long-chain n-3 polyunsaturated fatty acid and incidence of stroke: a meta-analysis of prospective cohort studies. Oncotarget, 83781–83791 (2017).
  3. American Heart Association. Saturated Fat.
Dr. Ryan’s team and their institutional affiliations: Arthur Thomas Ryan, PhD 1,2; Teodor T. Postolache, MD 1,2,3; Daniel Dennis Taub, PhD 4; Holly C. Wilcox, PhD 5,6; Marjan Ghahramanlou-Holloway, PhD 7; John C. Umhau, MD 8,9; Patricia A. Deuster, PhD 10 1- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD 2- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 3- Rocky Mountain MIRECC for Suicide Prevention, Aurora, CO 4- Washington DC VA Medical Center, Washington, DC 5- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 6- Johns Hopkins School of Medicine, Baltimore, MD 7- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 8- Office of New Drugs, Division of Psychiatry Products Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 9- Fort Belvoir Community Hospital, Fort Belvoir, MD 10- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD