Breaking the Paywall: Why Open Access Matters

Imagine you’re a student finishing a dissertation, or a public health professional updating local guidelines. You find the exact article you need, click the link, and hit a wall: Pay £33 to read this article (in the US, that’s roughly $42). And nope, the authors won’t see a single penny, even if their work is downloaded thousands of times, and the peer reviewers (who act as fact checkers) aren’t paid either. That money goes to the publisher, the private company that posts the pdf on the internet.

How did we end up here? For most of its history, scientific communication was not-for-profit, shared directly by researchers and learned societies for the public advancement of knowledge. In the mid-20th century, commercial publishers professionalised and scaled the system, and access to knowledge became a revenue model. And a highly lucrative one: individual subscriptions can cost hundreds to thousands per year and university packages run into their millions.

But we all have to make money, right? Why should you care? Well, firstly, access to knowledge shouldn’t be a privileged luxury. Secondly, it’s both a public health issue and an equity one: researchers in low- and middle-income countries (who arguably are most in need of new discoveries to serve their communities), or students at less well-resourced institutions, are routinely locked out of work that could inform local care and policy. And thirdly (and this is the one that makes my eye twitch), because in many cases WE’VE ALREADY PAID FOR IT! Much health research is publicly or charitably funded. In other words: taxpayers pay for the science, then are asked to pay again to read it. That’s like me coming to your house, locking you out and then forcing you to pay me to open the door. The sheer audacity!

Enter Open Access (OA): the principle that research should be free to read and reuse. In practice; however, OA has often meant shifting the paywall from reader to author via Article Processing Charges, fees that can reach $12,000 per paper. I’m sorry, what? Tell me what researcher can easily afford this? $12,000 to put my own work on the internet? I could literally do that on Instagram (for example) for free. So, yes, technically, OA expands readership but, in reality, it creates a new barrier to publishing, particularly for underfunded labs and researchers in the Global South.

So, what’s the alternative? Well, one option is preprints. Preprints are essentially final draft copies of research articles, shared publicly and for free. They allow researchers to share their findings rapidly and receive feedback before journal publication. The Gates Foundation’s refreshed OA policy leans into this, pushing for immediate open availability of funded research and encouraging preprints to speed up dissemination.

And if you work in research, education, or clinical practice, this isn’t an abstract issue. Paywalls shape who gets to learn, whose ideas spread, and which problems get solved first.

The goal isn’t to vilify every publisher (although it is tempting – these companies have profit margins that rival some multi-national corporations!). The goal is to recalibrate the focus – from enormous industry profits back to the public good. If knowledge saves lives, it shouldn’t be a luxury product.

This week’s podcast is supported by the Gates Foundation, and digs into the history, the economics, and the practical steps we can take.

Tune in here.

And check out The Gates Foundation's Open Access Policy - Gates Open Access Policy

How to Recover from Chronic Stress

Most of us have been there: a long period of pressure, uncertainty, or emotional strain finally lifts and we expect to bounce back. But instead of relief, we feel…flat. Exhausted. Anxious. Even unwell.

This is a completely normal response to chronic stress.

Now, you might think, or at least hope, that after the period of prolonged stress is over that you would just breathe a sigh of relief, have a good night’s sleep and be back to your normal self. Unfortunately, the biology and psychology of chronic stress don’t work like that. The truth is, we don’t just ‘bounce back’ from chronic stress. Because stress isn’t ‘all in your head’, it’s a physiological state that creates real, measurable changes in the brain and body.

 Stress Changes the Brain

Chronic stress causes physical changes in the brain, including shrinking of the prefrontal cortex, the part responsible for decision-making and emotional regulation. These changes mirror those seen in long-term depression, which helps explain the overlap between these two conditions.

 It also affects immune function, hormone regulation, sleep quality, and even gut health.

This wear-and-tear is called allostatic load, and healing from it takes time. We can’t simply ‘snap out of it’ once the pressure lifts; we need to recover intentionally.

In this week’s podcast I share eight effective strategies that support recovery from chronic stress and burnout, including the restorative functions of sleep, and nutrients to improve neurogenesis. If this resonates with you, you can listen to the full podcast episode below, where I go into detail on each step.

6 Causes of Fatigue That Have Nothing to Do With Sleep (And What to Do About Them)

We’ve all had those days where no amount of sleep seems to scratch the surface of our exhaustion. But what if your tiredness isn’t actually about sleep?

in this week’s podcast I explore six lesser-known but clinically significant causes of fatigue, none of which have to do with how many hours you’re clocking in bed. These factors , such as key nutritional deficiences, chronic inflammation, and insulin resistance, may hold the key to understanding your energy slump and reclaiming your vitality.

Tiredness is a signal, not a failing.⁣⁣

So if you’re covering all your bases: eating well, sleeping well, and still feel drained, it’s worth digging deeper.⁣⁣

⁣⁣Want a breakdown of how to do this? I covered it in this week’s podcast episode. Check it out below.

Fatigue is your body talking. If you start listening, you might be surprised how much better you can feel.

The Conversation You’re Avoiding Might Be the One That Sets You Free

We all have one.
A conversation we keep dodging.
Something that feels so heavy, so high-stakes, that even thinking about it ties our stomach in knots.

Maybe it’s talking to your partner about money, intimacy, or whether you really want kids.
Maybe it’s telling a friend that their actions have hurt you.
Maybe it’s finally saying out loud to a parent, “You made me feel unloved.”

This week on the podcast, I’m tackling the skillset we all need but rarely get taught: how to have difficult conversations without blowing up, shutting down, or walking away feeling worse.

Because the fact is: so many of life’s most important problems are only solved by having the conversation we’re most afraid to have.

Why Do We Avoid These Conversations?

Because they’re hard. They involve risk. They make us feel vulnerable. They might change relationships.
But here’s what I’ve learned from years of supporting people through these moments:

  • Avoidance costs you more than you realise. It chips away at your integrity and wellbeing every single day.

  • Delaying it makes it harder. Time adds fear, shame and resentment.

  • You don’t need the other person to change to benefit. Simply standing up for yourself, kindly and clearly, is empowering.

  • The pressure of avoidance drains you. Imagine what your mind could do with that emotional bandwidth back.

  • Every tough conversation makes the next one easier. This is how emotional maturity is built.

  • It rarely goes as badly as you fear. Truly. And even when it’s messy, it’s progress.

A 10-Step Plan to Help You Do It Well

In this week’s episode, I’m sharing my tried-and-tested 10-step plan for navigating hard conversations with clarity, composure, and self-respect. These are the same steps I’ve walked through with CEOs, parents, partners, and people just like you, each of whom made it through stronger and more grounded.

You’ll also find a downloadable Big Conversations Toolkit that you can use to prepare for your own Big Conversation.

Listen to the episode below and click here to get the guide

Whether or not the other person understands you, agrees with you, or changes because of the conversation—this is about you. It’s about honouring your voice. Validating your feelings. And reclaiming your peace.

What Nutrition Has to Do With Sleep (It’s More Than You Think)

If you’ve been struggling to fall asleep, waking up in the night, or starting your day in a fog, your sleep hygiene might not be the problem, your nutrition might be.

The Melatonin Cascade

Melatonin, the hormone that regulates your sleep–wake cycle, isn’t made out of thin air. It’s synthesizsd from serotonin, which is itself derived from the amino acid tryptophan. But to make that conversion, your body needs nutritional co-factors, including:

  • Magnesium

  • Vitamin B6

  • Folate

  • Zinc

If you’re low in these nutrients, melatonin production can stall, imparing sleep onset

There’s also a transport issue: tryptophan competes with other amino acids to cross the blood-brain barrier. A small serving of complex carbohydrates at dinner (like lentils, quinoa, or sweet potatoes) helps tryptophan make the journey.

There are also associations between vitamin D status and sleep disorders in both adults and children, as well as blood glucose and sleep fragmentation.

To learn more about the links between nutrition and sleep tune in to this week’s podcast.

Can Nutrition Reduce Violence in Prisons? The Overlooked Solution to a Global Crisis

Prison violence is a global crisis—not just a justice issue but a profound public health and societal challenge. In the latest episode of the Stronger Minds Podcast, I ask a bold, evidence-based question:
Can improving nutrition reduce violence in prisons? And if so, why aren’t we doing it already?

The Scale of the Problem

In the UK alone, violence in prisons is escalating rapidly. According to government data, the 12 months to March 2024 saw:

  • A 24% increase in self-harm incidents

  • A 27% rise in assaults

  • Increased assaults on staff and deaths in custody

Meanwhile, the U.S. incarcerates nearly 2 million people, spending an estimated $182 billion annually across its sprawling detention system.

Overcrowding, underfunding, drug use, and untreated mental illness have created a pressure-cooker environment where violence is both predictable and devastating. Yet hidden beneath these familiar narratives is a less obvious, but deeply powerful factor: brain health and nutrition.

The Hidden Cost: Nutritional Deficiencies Behind Bars

The brain, particularly the regions responsible for impulse control, emotional regulation, and empathy, is the body's most nutrient-hungry organ. Unfortunately, prison diets are typically high in refined carbohydrates and low in fresh fruits, vegetables, and critical micronutrients, leading to deficits that directly impair mood, decision-making, and behaviour.

Research shows that nutritional deficiencies can:

  • Increase irritability and aggression

  • Lower impulse control

  • Raise systemic inflammation linked to mental health disorders

In short: poor nutrition isn't just a health risk. It's a violence risk.

The Evidence

Several gold-standard trials (randomised, placebo-controlled, and even triple-blind) have demonstrated consistent results:

  • Schoenthaler et al. (1997): 28% reduction in violent infractions with nutrient supplementation.

  • Gesch et al. (2002): 37% reduction in violentincidents in a UK prison.

  • Zaalberg et al. (2010): 34% drop in aggression in the Netherlands; aggression rose in the placebo group.

  • Raine et al. (2002): Improved impulse control and reduced reactive aggression with omega-3 and antioxidant supplementation.

  • Schoenthaler et al. (2023): 39% fewer rule violations among supplemented young offenders.

These are not trivial shifts in mood; these are measurable behavioural changes with serious implications for safety and rehabilitation.

The Fiscal Case

Violence in prisons costs billions globally in healthcare, insurance, staffing, compensation and legal payouts, and lost human potential. For example, injury claims from assaulted UK prison staff alone have cost taxpayers nearly £50 million since 2019.

In contrast, providing essential nutritional support to prisoners costs mere pennies per day per person.
The return on investment, both human and financial, could be enormous.

The Opportunity - Nutrition as Criminal Justice Reform

We already know that brain function is influenced by food quality. It’s time for a new conversation:

What would happen if we fed the brain inside our justice systems?

To learn more, listen to the full episode of the Stronger Minds Podcast here. Discover why it's time for justice, healthcare, and public health systems to embrace nutrition as a key pillar of reform.

Support charities like Think Through Nutrition, share this research, and challenge outdated assumptions.

Better nutrition could mean safer prisons, stronger rehabilitation, and healthier societies.

How Gestational Diabetes Impacts Baby Brain Development: What Every Expectant Parent Should Know

Can a mother’s blood sugar shape her baby’s brain? Growing research says yes.

In the latest episode of the Stronger Minds podcast, we explore how this increasingly common condition can influence infant brain development, IQ, and the risk of ADHD and autism.

Listen to the full episode here.

What Is Gestational Diabetes?

Gestational Diabetes Mellitus (GDM) is a temporary condition in which blood sugar levels rise during pregnancy. Affecting 4–9% of pregnancies in the U.S., 1 in 20 pregnancies in the UK, and rising globally, GDM often resolves after childbirth but its effects may last longer than expected.

GDM and Baby Brain Development

A growing body of research links GDM with subtle—but significant—changes in neurodevelopment:

  • A large study in The Journal of Pediatrics found differences in cognitive development among children born to mothers with GDM.
    Study link

  • A study of over 200,000 mother child pairs concluded that children born to mothers with GDM had a greater likelihood of developing externalising problems and ADHD symptoms.
    Study link

Links to ADHD and Autism

A major meta-analysis reviewing over 56 million pregnancies revealed that maternal diabetes significantly increases the likelihood of neurodevelopmental disorders:

  • ADHD risk increased by 30%

  • Autism risk up by 25%

  • Intellectual disability by 32%

Why Does This Happen?

Researchers believe several mechanisms may be at play:

  • Foetal hyperinsulinemia (high insulin levels in the baby) caused by maternal high blood sugar

  • Oxidative stress and inflammation impacting foetal brain development

  • Epigenetic changes that may alter brain wiring

What Can Expectant Mothers Do?

The good news? Proactive care can make a big difference. Here are practical, evidence-backed steps:

  • Attend all prenatal visits to monitor glucose

  • Eat a nutrient-rich, balanced diet

  • Exercise moderately with medical guidance

  • Monitor blood sugar regularly

  • Learn the signs of GDM and act early

  • Follow up post-pregnancy, as GDM raises long-term type 2 diabetes risk

Final Thoughts: Brain Health Starts in the Womb

Gestational diabetes may pose hidden risks, but with the right strategies, many of these can be managed. This is a critical opportunity to support brain health from the very beginning.

Want to learn more? Listen to the full episode here.

If this episode resonates with you, share it with a parent, a healthcare provider, or anyone interested in better beginnings.

Magnesium and Mental Health: What the Evidence Really Says

Magnesium has quietly built a strong case for its importance in mental health and brain function. From mood regulation and stress resilience to cognitive ageing and sleep, magnesium appears to play a pivotal role. But how strong is the evidence, and should you be considering supplementation?

Let’s explore what the research says about magnesium’s impact on depression, stress, sleep, brain ageing, and more—and why it might deserve a place in your brain health toolkit.

Prefer to listen? Catch the full breakdown in the latest podcast episode: Magnesium & the Brain.

Magnesium and Depression

Depression is a complex, multifactorial condition—but emerging research suggests magnesium deficiency may be a contributing factor for some.

  • Several observational studies have found lower serum magnesium levels in people with depression.

  • A 2023 meta-analysis reported a significant positive effect of magnesium supplementation compared to placebo. However, the total sample size across studies was just 325 people, highlighting the need for larger clinical trials to strengthen these findings.

Bottom line: Early evidence suggests that magnesium may help alleviate depressive symptoms, particularly in those who are deficient—but more data is needed.

Stress, Cortisol & Sleep

Magnesium plays a crucial role in regulating the hypothalamic-pituitary-adrenal (HPA) axis, which governs our physiological stress response.

  • Supplementation has been shown to reduce serum cortisol levels, the primary stress hormone.

  • It also enhances levels of GABA, a calming neurotransmitter, helping to promote relaxation and improve sleep.

  • While observational studies suggest a strong link between magnesium status and sleep quality, randomised controlled trials (RCTs) have been more mixed.

Key takeaway: Magnesium appears to influence both stress regulation and sleep quality, though evidence for supplementation is stronger in stress-related contexts.

To get the lowdown on magnesium and brain aging, migraine and metabolic health tune into the podcast episode Magnesium & the Brain. I’ll explore the research in more depth and unpack how to apply this knowledge in your day-to-day life. Listen now →

Like this content? Join our mental health newsletter and get brain-supportive strategies straight to your inbox each week. Subscribe here

How Just 5 Days of Ultra-Processed Foods Can Impact Your Brain Health

We often think of diet in terms of weight or physical health—but what if what you eat can change your brain function in just five days?

A recent study uncovered something both fascinating and a little alarming: even a short-term diet high in ultra-processed snack foods—think cookies, chips/crisps, sugary treats—can significantly affect how your brain responds to insulin, and these effects may linger long after you return to your regular eating habits.

What they Did

In this study, researchers split healthy young men into two groups:

  • One group continued eating their usual diet.

  • The other group added 1,200–1,500 extra daily calories of ultra-processed snacks for just five days.

What the Study Found

Despite no changes in weight, cravings, or body composition, the snack-heavy group showed:

  • Decreased brain insulin sensitivity

  • Lower activity in cognitive-related brain regions

  • Signs of reduced brain integrity, even after resuming their normal diet

The researchers concluded:

“A short-term diet rich in sugar and saturated fat has prolonged effects on the brain that outlast the time-frame of its consumption.”

Why This Matters for Mental Health

Your brain needs glucose for fuel—and insulin is the hormone that helps brain cells access that glucose. When the brain becomes insulin resistant, it’s like locking the fuel out of the engine. This can lead to:

  • Mental fatigue

  • Brain fog

  • Increased inflammation

  • And possibly even long-term cognitive decline

In other words, your highly processed snacking may be doing more than just messing with your blood sugar—it could be affecting your mood, memory, focus, and overall brain health.

What You Can Do

  • Limit ultra-processed snacks where possible

  • Focus on whole, unprocessed foods like fruits, vegetables, legumes, and whole grains

  • Stay informed - knowldge is power

Want to learn more about ultra-processed foods? Tune into the Ultra-Processed Foods - Part 1: A Beginner's Guide podcast episode, or download my free guide Understanding Ultra-Processed Foods. And if you want to deep dive into what our modern diets are doing to our brain and mental health, check out my book, Unprocessed*.

Love content like this? Join my weekly newsletter where I break down important brain and mental health ideas into practical, doable insights. Sign up here.

*Affiliate link

Mastering Distress Tolerance: A Powerful Skill for Mental and Emotional Resilience

Distress tolerance is one of the most important yet overlooked skills when it comes to improving mental health, brain health, and emotional resilience. Whether you're trying to break a bad habit, navigate intense emotions, or manage stress more effectively, learning how to tolerate discomfort can make all the difference.

If you'd rather listen than read, this article is based on my latest podcast episode - tune in here for the full discussion!

What is Distress Tolerance?

Distress tolerance refers to your ability to sit with emotional discomfort without reacting impulsively or trying to escape it. It’s a core component of Dialectical Behavior Therapy (DBT), originally developed by Dr. Marsha Linehan to help people with Borderline Personality Disorder (BPD)—a condition marked by emotional intensity and impulsivity.

But distress tolerance isn’t just a problem for those with a diagnosis of BPD. People with anxiety, depression, eating disorders, and substance use issues often struggle with low distress tolerance, and building this skill is a key part of recovery.

But, beyond this, let’s be honest — most of us aren’t great at feeling uncomfortable. When sadness, anger, loneliness, or frustration shows up, many of us reach for food, alcohol, social media, shopping, sex, or other distractions to escape. Perhaps that sounds familiar?

Putting it into practice

So what does distress tolerance look like? Here’s an example skill called STOP:

  • S – Stop: Freeze. Do not act.

  • T – Take a step back: Physically or mentally pause. Take a breath.

  • O – Observe: Notice your thoughts, emotions, and urges. What triggered them?

  • P – Proceed mindfully: What choice aligns with your long-term goals? What would future-you be proud of?

Tip: Reinforce small wins by writing them down, telling someone you trust, or giving yourself a healthy reward.

Want more on this topic? Listen to the full podcast episode here for insights, practical tips, and encouragement.

Like what you read? Subscribe to my free weekly newsletter where I explore the science and psychology of mental and brain health with real-world tips to help you thrive. Sign up here.

The Relationship Between Dietary Inflammation Index® and Depressive Symptoms

Inflammation is the body’s response to illness or injury; the swelling around a cut or a bruise is part of this process. The inflammatory model of depression suggests that, for some people, depression may be caused or exacerbated by inflammation.

Supporting this theory is the finding that people with depression tend to have higher levels of markers of inflammation in their blood. In addition, inducing an inflammatory immune response (by injecting participants with particles of bacteria) promotes the development of depressive symptoms in placebo-controlled trials.

Though inflammation is most obviously the response to a pathogen, it also occurs in response to other non-injury factors such as prolonged stress, an imbalance of bacteria in the gut, or poor diet.

The Dietary Inflammatory Index® (DII®) is a scale that measures the inflammatory potential of dietary patterns. On this scale diets high in saturated fatty acids, trans fats and cholesterol are ranked as pro-inflammatory. In contrast, diets higher in vegetables, fruits, fibre/wholegrains, herbs and spices such as ginger, garlic and turmeric, green and black tea, and dietary patterns such as the Mediterranean diet are associated with lower biomarkers of inflammation. It should be noted that the DII® scores overall dietary intake rather than highlighting specific nutrients.

Landmark studies such as the ‘SMILES Trial’ and ‘HELFIMED’ have demonstrated that dietary modification may be a useful depression intervention for many patients. A new study, using the DII®, seems to add to these results, indicating a role for nutrition in depressive illness. This study followed people for eight years, tracking their diet and their risk of developing depressive symptoms.

3,648 participants (1,577 males, 2,071 females; mean age: 60.6 years) with/at risk of knee osteoarthritis took part. Participants filled out a food frequency questionnaire, indicating how often they ate certain foods from ‘never’ to ‘every day’. This data was used to give each participant a ranking on the DII®. They were also assessed for depression.

At the start of the study (baseline), those with the most pro-inflammatory (higher scores on the DII®) diets also had higher depression scores. Over the course of the eight-year follow-up period 837 people developed depressive symptoms, and the incidence of depression was significantly higher in people with the most pro-inflammatory diets at baseline, potentially indication a cumulative effect of inflammation on depression. In further analysis, being female and having a higher BMI were also associated with increased incidence of depressive symptoms during follow-up. The authors report that participants with the highest DII score had a 24% increased risk of developing depressive symptoms over the course of the study.

More research is required to clarify and confirm these results and, since depression is one of the leading global causes of disability, I look forward to more research in this important area of mental health.

 

References

Shivappa, N., Hébert, J. R., Veronese, N., Caruso, M. G., Notarnicola, M., Maggi, S., ... Solmi, M. (2018). The Relationship Between the Dietary Inflammatory Index (DII®) and Incident Depressive Symptoms: A Longitudinal Cohort Study. Journal of Affective Disorders. DOI: 10.1016/j.jad.2018.04.014

Shivappa, N., Steck, S. E., Hurley, T. G., Hussey, J. R., & Hébert, J. R. (2014). Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutrition, 17(8), 1689–1696. http://doi.org/10.1017/S1368980013002115

A Mediterranean-style Dietary Intervention Improves Mental Health in People with Depression: A Randomized Controlled Trial

The year in Nutritional Psychiatry started with the publication of the first RCT into the positive effect of a healthy diet on depression (the SMILES Trial). A new study bookended the year with similar promising results. 

In this study people with self-reported depression were randomly assigned to one of two groups. The first group received nutritional education, a fortnightly food box containing ingredients that adhered to the Mediterranean diet for three months, and six months of fish oil supplements. The control group were assigned to receive regular social support for the same amount of time. 

At the end of the trial the MedDiet group saw a significant reduction in their depression scores and overall Quality of Life with 60% fewer persons experiencing extremely severe levels of depression, 72% of anxiety and 69% of stress in the MedDiet group compared to the social support group. 

This was a small trial and replications of the SMILES are already underway which will give use a deeper understanding of the role of diet on mental health and clarify the most effective interventions for different treatment groups. 

 

Reference

Parletta, N., Zarnowiecki, D., Cho, J., Wilson, A., Bogomolova, S., Villani, A. Itsiopoulos, C., Niyongsenga, T., Blunden, S., Meyer, B., Segal, L., Baune, B. T. & O’Dea, K. (2017). A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED).Nutritional Neuroscience, 1-14. https://doi.org/10.1080/1028415X.2017.1411320

Vitamin D and Sleep

Vitamin D modulates hundreds of genes and plays an essential role in many biological systems, including those linked to brain function and sleep.


Consistently poor sleep is a serious health concern and is linked to increased risk of weight-gain, type 2 diabetes, heart disease and increased susceptibility to illness. Psychologically, poor sleep and sleep disorders are a common feature of many mental health concerns such as anxiety, bipolar disorder, post-traumatic stress disorder, Alzheimer’s Disease and other forms of dementia. So an accessible intervention that improves sleep is valuable. A recent clinical trial tested the effect of vitamin D supplementation on sleep quality.


The researchers took a group of 89 people all of whom had sleep disorders characterised by long sleep latency (taking a long time to fall asleep), low sleep quality, duration and/or efficiency (spending a lot of time in bed but not much of it asleep). The participants were randomly assigned to two groups, one received a very high dose vitamin D supplement every fortnight for a total of eight weeks, the other received an identical looking placebo. :
At the start all the participants had insufficient vitamin D. As expected, at the end, the supplement group had sufficient levels and the placebo group had not changed. In addition, supplement group reported better overall sleep quality, with longer duration and reduced latency, suggesting that adequate vitamin D levels can help support healthy sleep.


It is important to note that the supplement in this trial was a very high, clinical dose. For example, the NHS recommends UK adults supplement with 10mcg of vitamin per day (equivalent to 140mcg per fortnight). The dose in this trial is equivalent to 1250mcg per fortnight. Very high dose supplements may be available on prescription and a blood test would need to be taken first to establish that there was definitely a deficiency.

Reference
Majid, M. S. et al (2017). The effect of vitamin D supplement on the score and quality of sleep in 20–50 year-old people with sleep disorders compared with control group. Nutr Neuro. DOI: 10.1080/1028415X.2017.1317395

B Vitamins Reduce Symptom Severity in Schizophrenia

Schizophrenia is a serious, long-term mental health disorder characterised by experiences of distorted reality (such as visual and auditory hallucinations) and cognitive impairments such as false beliefs, paranoia, and language deficits. Though many people are able to live full lives following a diagnosis of schizophrenia, for a large proportion of patients the illness destroys their quality of life and is associated with increased mortality.

Medication saves lives but the side-effects can be distressing and debilitating, so it is essential that research continues to look for safe and effective treatments for patients. A systematic review and meta-analysis published this year by an international team of researchers found that high-dose B vitamin supplementation alongside prescribed medication reduced the severity of symptoms, particularly in those with low baseline levels, high homocysteine, and when given earlier on in the illness progression. The authors conclude that further research is warranted to understand the underlying biological mechanisms and work out which combination and dosages of nutrients would have the most benefit. -


Reference
The effects of vitamin and mineral supplementation on symptoms of schizophrenia: a systematic review and meta-analysis. 10.1017/S0033291717000022

One Hour of Exercise Per Week Reduces Depression Risk by 44%

A new study published yesterday suggests that even modest amounts of exercise could prevent some cases of depression. The prospective study monitored over 22,000 healthy people, seeing how many of them went on to develop depression over 11 years.

At follow-up and accounting for factors such as smoking, alcohol consumption, BMI, other illness and social support, people who, at the start of the study, said they didn't do any exercise had a 44% increased risk of developing depression compared to people doing just 1-2 hours of exercise per week. This outcome was the same for males and females, and younger and older people. On top of this it didn't seem to matter whether it was intense exercise. People didn't need to break a sweat to get the protection. Just moving was enough to reduce the likelihood of developing depression.

Why is this so important? Rates of depression and treatment-resistant depression (that don't respond to medication) are on the rise. If there is a causal relationship between exercise and depression (and no other confounding factors) this research suggests that 1 in 8 cases of depression could be *prevented* with just one hour a week of exercise (or that severity could be reduced). This research also helps shift the thinking from treatment to *prevention*. While many of the causes of depression such as genetics and traumatic life events are out of our control, physical activity is a 'modifiable risk factor' i.e. we can do something about it. And if we can save some people the distress of depression that is something everyone should get behind.

Reference

Exercise and the Prevention of Depression: Results of the HUNT Cohort Study.American Journal of Psychiatry Online. DOI: 10.1176/appi.ajp.2017.16111223

Probiotic Supplementation in Pregnancy Reduces the Risk of Anxiety and Depression

Though the evidence of the role of diet and the gut in the development of psychological disorders is established and growing, the majority of the research has either been epidemiological (observations of large groups of people – these do not show causality) or animals trials (show the mechanisms but might not completely translate to humans). At the end of all of these papers the authors remark that more high-quality human trials are required to draw firmer conclusions. Earlier in the year we had the publication of the SMILES Trial, a study that showed a cause and effect relationship between poor diet and depression and now a new paper provides more good evidence of the role of probiotics and the gut microbiome on mental health. Even more interesting is that this was not even the main aim of the research.

Researchers in New Zealand set up a trial to see whether giving pregnant women probiotics would affect their children’s risk of developing eczema. Eczema is an inflammatory skin condition and the gut microbiome plays an essential role in regulating inflammation. A baby’s gut microbiome is seeded at birth during its transit through the birth canal, or from skin contact after delivery by caesarean section. In the study 423 pregnant women were randomly assigned to two groups. One group received a daily supplement of a strain of bacteria called Lactobacillus rhamnosus (HN001). The other group received an identical looking/tasting placebo. The women took the supplement/placebo from the moment they enrolled until their child was born, and from birth until 6 months if the mother was breastfeeding. Information about the women’s mental state was taken at baseline (14-16 weeks pregnant), when the child was 6 months and 12 months old. They found a strong effect of the probiotic. The women who had taken the supplement (and none of the women knew whether they were taking the active supplement or the placebo) were much less likely to experience depression and anxiety after the birth of their children.  

The researchers report that between 10%-15% of women experience post-partum (post-natal) depression, which can impair the development of a strong bond between mother and infant, creating psychological and physical health risks for both. Medication options for breastfeeding women are limited because of the risk that the medication would be ingested by the baby in breast milk. In addition, it is practically difficult for women to access psychological or psychosocial interventions on top of the demands of a new baby. Further, some women feel reluctant to ask for help because they feel ashamed or guilty that they should feel so unhappy following the birth of their baby. Clearly then, the development of accessible and effective treatments is essential. There are many questions still to be answered about what a probiotic treatment might look like. This trial looked at only one strain and it might be that others of a combination are important too. We also need to know how long treatment should last and what the dose should be. But this well-designed study adds to the evidence of the role and importance of gut health in mental health and of taking the health of the whole body in to consideration when looking to treat mental health problems.

 

Reference

Effect of Lactobacillus rhamnosus HN001 in Pregnancy on Postpartum Symptoms of Depression and Anxiety: A Randomised Double-blind Placebo-controlled Trial. DOI: 10.1016/j.ebiom.2017.09.013

 

Vitamin D Supplementation Improves Sleep Quality in Sleep Disorders

Vitamin D is a corticosteroid hormone that modulates the activity of hundreds of genes and plays an essential role in many other biological functions, including those linked to brain function and sleep regulation. I have previously reported research showing that serum levels of vitamin D predicted cognitive performance in adults. 

Consistently poor sleep should be considered a serious health concern. Inadequate sleep is linked to an increased risk of weight-gain, type 2 diabetes, heart disease and increased susceptibility to illness. Psychologically, poor sleep and sleep disorders are a common feature of many mental health concerns such as anxiety, bipolar disorder, post-traumatic stress disorder, Alzheimer’s Disease and other forms of dementia. Sleep problems such as insomnia or excessive sleep are diagnostic criteria for depression, the major cause of global disease burden. Rather than being just a symptom, impaired sleep can precede the onset of other symptoms and, conversely, improving sleep quality can help to alleviate symptom severity. So an accessible intervention that improves sleep is a valuable weapon in the mental health armoury. A recent clinical trial tested the effect of vitamin D supplementation on sleep quality.

Published in the journal Nutritional Neuroscience researchers at the Ahvaz Jundishapur University of medical science in Iran took a group of 89 people all of whom had sleep disorders characterised by long sleep latency (taking a long time to fall asleep) low sleep quality, duration and/or efficiency (spending a lot of time in bed but not much of it asleep). The participants were randomly assigned to two groups, one received a very high dose vitamin D supplement every fortnight for a total of eight weeks, the other received an identical looking placebo of edible paraffin.  

What was helpful about this study was that the researchers assessed the participants baseline vitamin D levels at the start of the trial and then again after it. This is important because it help to determine more accurately what blood levels might be most beneficial and helps to identify any individual differences between the participants that might influence the outcomes. At the start all the participants had insufficient levels of vitamin D (less than 29ng/mol of 25 (OH) D). At the end, as you might expect, the supplement group had sufficient levels and the placebo group had not changed significantly. In addition, at the end of the trial, the supplement group reported better overall sleep quality, with longer duration and reduced latency, suggesting that adequate vitamin D levels can help support healthy sleep.

It is important to note that the supplement administered in this trial was a very high, clinical dose. For example, the NHS recommends that adults in the UK consider supplementing with 10mcg of vitamin per day (equivalent to 140mcg per fortnight). The dose in this trial is equivalent to 1250mcg per fortnight. Very high dose supplements may be available on prescription and a blood test would need to be taken first to establish that there was definitely a nutritional deficiency.

Reference

Majid, M. S., Ahmad, H. S., Bizhan, H., Hosein, H. Z. M. & Mohammad, A. (2017). The effect of vitamin D supplement on the score and quality of sleep in 20–50 year-old people with sleep disorders compared with control group. Nutritional Neuroscience. Epub ahead of print. DOI: 10.1080/1028415X.2017.1317395

Disclaimer

Disclaimer: This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern.

Emotional Awareness and Expression Training Reduces Symptom Severity in Irritable Bowel Syndrome

IBS is a functional gut disorder that disturbs the normal functions of the bowel but with no obvious, single cause. The main signs and symptoms of IBS are abdominal pain or discomfort, that is associated with either diarrhoea or constipation or a combination of both. IBS is suspected to be a disorder that involves the dysfunction of the brain-gut-microbiome axis; for some reason the signalling and feedback to and from the brain and the gut is impaired leading to changes in motility, increased nerve sensitivity and comorbid symptoms of depression and anxiety. For a fuller overview of the disorder tune in to the podcast episode all about understanding the illness. Listen here.

It is well documented that people with a diagnosis of IBS tend to experience high levels of psychological stress and/or have experienced traumatic experiences in the past. They are also more likely to have difficulty in intimate relationships and in expressing their feelings. Building on previous research that psychological therapies are an effective treatment for IBS, a new randomised controlled trial investigated the utility of a type of therapy specifically designed to address emotional awareness and expression in people with IBS.

In this study IBS patients were recruited and were then randomly assigned to one of three groups:

1.      Emotional Awareness and Expression Training (EAET)

2.      Relaxation training, which has been shown to be helpful for IBS patients

3.      Waiting list – this was the control group, to compare whether any changes seen in the other two groups would have happened anyway without any intervention.

Both the EAET and relaxation groups received three 50-minute training session delivered over three consecutive weeks i.e. one session a week. They were then assessed two weeks after the end of the last session and then again 10 weeks after that. Participants in groups one and two received a similar explanation about the link between stress and IBS but the EAET group were provided with specific skills to improve emotional expressions such thinking of someone they have a difficult relationship with and being encouraged to describe those feelings out loud as if the person was present. They were later encouraged to express their emotions directly with that person. The relaxation group were coached in muscle relaxation, deep breathing and mindfulness meditation.

Most of the 106 participants in this study were women (IBS is more common in women than men) and had had IBS for more than 20 years. At the end of the 10-week follow-up period 63% of the people in the EAET group reported significant improvements in their IBS symptoms. People in the relaxation and waiting list groups did not report any significant change in the severity of their IBS. Both relaxation and EAET improved the participants’ quality of life. What is striking about this result is that the intervention was very brief, less than three hours in total, and the participants had been ill for many years. The therapists administering the treatment were clinical psychology graduate students. This could mean that, in practical terms, provision of this kind of treatment might be highly cost-effective.

This was a small study with a short follow-up period. It will be important to replicate and extend the research by looking at larger groups and whether the results are sustained over many months. Nonetheless, this paper supports the theory that psychological stress and emotional suppression lead to overstimulation of the stress response and that this dysregulates the nervous communication between the brain and the gut. On an everyday level we recognise this as, for example, feeling so nervous about something that we feel nauseous or have butterflies in our stomachs. In IBS there is  understood to be a continuous over-activation of this system, and the body struggles to return to equilibrium.

Separately, this study also reinforces the importance of acknowledging and expressing emotions rather than ignoring, avoiding or denying them. Unexpressed emotional states don’t just go away, they exert a physiological effect that can lead to somatic symptoms.

As a side note, the researchers’ description of EAET sounds akin to the Distress Tolerance protocols inherent in a type of therapy called Dialectical Behaviour Therapy (DBT), originally designed to help people with a diagnosis of Borderline Personality Disorder to improve how they manage their emotions and their interpersonal effectiveness. There are many Clinical and Counselling Psychologists trained in DBT so this may prove a more accessible route for clients than trying to find an EAET trained therapist.

 

Reference

Thakur, E. R, Holmes, H. J, Lockhart, N. A., Carty, J. N., Ziadni, M. S., Doherty, H. K., Lackner, J. M., Schubiner, H. & Lumley MA. (2017). Emotional awareness and expression training improves irritable bowel syndrome: A randomized controlled trial. Neurogastroenterology, Epub ahead of print. doi: 10.1111/nmo.13143