There is a wonderful whakatauki that reminds me that recovery is a journey of learning, self discovery, observation, and patience, and requires listening to the wisdom of others alongside a lot of trial and error! “Mā te rongo, ka mōhio, Mā te mōhio, ka mārama, Mā te mārama, ka mātau, Mā te mātau, ka ora.” From listening comes knowledge, from knowledge comes understanding, from understanding comes wisdom, and from wisdom comes well-being.”
I was raised in a home that relied heavily on western medicine, and as such I came to understand the importance of healing holistically late in my mental health journey. In the early days I misunderstood proponents of alternative and complementary medicine as science-denying snake-oil buyers. So much so that when my father bought me a copy of Patrick Holford’s “Optimum Nutrition for the Mind” in the midst of my most unwell period, it sat on the shelf for ten years before I read it out of desperation and had an epiphany that the mind and the body were inextricably entwined.
The joy at discovering that Holford and others underpinned their advice with sound evidence led me to become a voracious reader of anything that described the science behind holistic therapies. Fast forward nearly 20 years and thousands of pages since, when people interested in nutrition and mental health ask me what I would suggest as “must-reads” I recommend just two books; “The Better Brain” and “The Inflamed Mind” as not only chocked full of digestible science, but safe and practical advice of where to start.
I am a fan of Julia Rucklidge’s research because of my own recovery journey and my whānau’s experience of the protocols she talks at length about in this book. The book she co-authored, ‘The Better Brain’ is so significant to me that my copy is riddled with underlining, asterisks, and notes so I can return again and again to the evidence. What impressed me about this book is how the authors explain in plain language the rationale behind consuming broad-spectrum micronutrients as a mental health intervention. It is a combination of all the vitamins and minerals your brain and body need, in a carefully balanced preparation that ensures you don’t get too much or too little of one particular thing. They explain how the widespread dismissal of this approach as a funded choice has mostly been based on inconclusive research that concentrated on a single vitamin and mineral, rather than all of them in a balanced combination.
Through the success stories shared in the book, you can hear the frustration of both the authors and patients that this is not embraced more widely as a therapeutic intervention. Julia and Bonnie speak openly about supporting people through traumatic events in our recent memory, such as natural disasters and shootings; and how, in a state of fight or flight or chronic stress, our natural stores of micronutrients are depleted as we fight for our survival. It is important to note that while they are explicit that micronutrients can’t resolve trauma, they can ensure your body’s executive functions like mood, concentration and memory are supported as you navigate recovery.
When asking my clinical friends why micronutrients are not more often suggested before resorting to psychiatric medication, given the research, I get responses ranging from a lack of awareness of the research or lack of confidence in the sample sizes (many of the study cohorts are small compared to the random control trials run by pharmaceutical companies), to not having professional confidence in how to control the pace and range of positive effects, particularly in combination with other prescriptions. One friend summed it up as:
“From what I’ve seen, they enhance the effects of the drugs I’ve prescribed – which makes it more difficult to control dosage and tapering. I prefer to get people out of the acute phase before supporting their transition to micronutrients if they have come to me with that wish.”
As an advocate for holistic approaches to mental health and wellbeing, I am frustrated by the sentiment “If they have come to me with that wish’. It reminds me of how far we still have to go in our public conversation around risk and safety in clinical practice. What all eight of the prescribers I spoke to had in common was not that they weren’t aware of micronutrients, or lacked confidence in their effectiveness, but that they never offered them as a choice to their patients. Instead, they waited for their patients to bring them the idea first, putting the onus on the consumer to know enough about them in order to ask for them.
Way before this book came out, our family (who live with the strengths and occasional challenges of stress, anxiety, depression, ADHD and bipolar) have found the supplementation of broad-spectrum micronutrients, fish oils and NAC (N-Acetyl Cysteine) an essential part of our normal routine to stay strong and resilient. In our own personal experiences, these micronutrients have helped us taper off from stronger pharmaceutical interventions, which we now only need to briefly turn to in a crisis, rather than staying on long term. Our ‘responsible clinicians’ have seen the positive impact of them on our mood, stability, and ability to cope. As parents, we certainly notice a marked difference in our child’s mood and ability to focus when the container has run dry and we’re awaiting the next delivery. I once asked our child’s doctor why these supplements are not more widely recommended to children with similar presentations and they responded that they believed it to be hit-or-miss, with spectacular results for some and no difference for others.
I believe this points to a research gap that needs to be explored, in order for this intervention to make it to our regular menu of mental health treatment offerings. The book covers overwhelming examples of efficacy and success, which are all wonderful arguments for funding this approach so that equity and cost are not barriers for consumers to see if this is right for them. But to do this, we need to understand why they do not work (or work as well) for some people. I believe we will only get this information from studies on larger cohorts, which will only be possible if we are funding and offering information on micronutrient therapy as an option to all of our tāngata whai iti ora.
Edward Bullmore's "The Inflamed Mind" was another game changer book for me, not because there was anything I hadn't already heard in parts over the years or suspected through my own journey, but because it presented all the clinical evidence for links between inflammation, depression and mental health in one place. I wish this was a textbook mandatory for every medical student and granted double professional development credits to current practicing clinicians. It explains clearly the flawed Cartesian divide we see in health between what is physical and what is emotional, which prevents us from looking to firstly find, treat and rule out any physical root causes for distress.
It isn't a coincidence that people become depressed after major surgery or physical trauma. The body’s natural immune system inflames the whole body to promote healing and does not discriminate between the brain and the site of trauma. It makes complete sense that if you experience immune system dysfunction, systemic inflammation does not bypass the brain and symptoms of an inflamed brain will affect your mental state.
I have often mused aloud to, my endocrinologist, my ophthalmologist, my gynaecologist, my rheumatologist and my psychiatrist that all my autoimmune diseases and symptoms may be linked to the same root cause but our health-system is still divided neatly into specialties. There is (yet) no auto-immunologist or “inflammologist” who can look at all these things together as a complete system and treat the cause – but I hope one day soon there will be.
Taimi Allan, Tumu Whakarae/ Director of Ember Innovations, a company supporting innovators and entrepreneurs to implement mental wellbeing initiatives that will contribute to better choice and access for everyone in Aotearoa. She is also an appointed director to the Mental Health and Wellbeing Commission of Aorearoa and Deputy Chair of the National Suicide Mortality Committee.
Kaplan, B. J., Ericksen, S., & Rucklidge, J. J. (2021). The better brain: Overcome anxiety, combat depression, and reduce ADHD and stress with nutrition. Vermilion.
Bullmore, E. T. (2019). The inflamed mind: A radical new approach to depression. Picador.