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Archive of ‘children/ adolescents’ category

Flaxseeds: single most important food for mental health?

flax-seeds

by R. Aiken MD PhD @rcaiken

Flaxseed helps lower cholesterol, lowers blood pressure, is anti-inflammatory, has good anti-oxidants, and fiber.  It is the single most neuroprotective food; oh yes, then there is the omega-3 content.

There is no doubt that this food is an excellent source of essential omega-3 fats in the form of alpha-linolenic acid, the basic building block to other omega-3s – eicosapentaenoic acid and docosahexaenoic acid. Omega-3, and a proper omega-3 to omega-6 ratio, is important in mental wellness and recovery from psychiatric disorders.

But flaxseed offers more than just the ideal omega-3 source; it contains many polyphenolic compounds such as phenolic acids[1], flavonoids and lignans along with vitamins C and E[2].  One study found that flaxseed significantly decreased chronic stress (cortisol) levels, indicating a possible synergistic effect between omega-3 fatty acid and polyphenols[3].  Other components such as a flaxseed lignan (a phytoestrogen compound called secoisolariciresinol) has been shown to have possible applications in post-menopausal depression[4].

Studies of flaxseed oil supplementation have indicated a good tolerance even in the pediatric population where one study indicated its effectiveness in child bipolar disorder[5].

I recommend a daily intake of one to three tablespoons of ground flax, each tablespoon of which contains about 30 calories, 2.5 grams fat, 2 grams fiber, and 1.5 grams protein[6]. Be sure to grind the flaxseeds as the fine seeds with their hard shell will likely just pass on through the gut otherwise. Flaxseeds can be ground in a coffee bean grinder and the ground powder added to grains, salads, beans – practically any dish for a little texture.

Note that the shelf life of the oily seeds is limited unless kept in an airtight container in the fridge or freezer.  Ground flaxseeds or flax meal should be kept in the freezer; at room temperature and exposed to air, use the ground seeds within one week. Smell the flax – if it has a strong odor such as fishy smell, it may be rancid.  A taste test should reveal a mild nutty flavor – if bitter or sour that also may be a signal that it is rancid.

For these reasons, chia seeds, rich in antioxidants and omega-3 PUFAs may be preferable to some.

References

[1] Oomah, B. D., Kenaschuk, E. O., & Mazza, G. (1995). Phenolic Acids in Flaxseed. J. Agric. Food Chem. Journal of Agricultural and Food Chemistry, 43(8), 2016-2019. doi:10.1021/jf00056a011.

[2] Bidlack, W. W. (1999). Functional Foods: Biochemical and Processing Aspects, G. Mazza, ed. Lancaster, PA: Technomic Publishing Co., Inc., 437 pp, 1998. Journal of the American College of Nutrition, 18(6), 640-641. doi:10.1080/07315724.1999.10718899.

[3] Naveen, S., Siddalingaswamy, M., Singsit, D., & Khanum, F. (2013). Anti-depressive effect of polyphenols and omega-3 fatty acid from pomegranate peel and flax seed in mice exposed to chronic mild stress. Psychiatry Clin Neurosci Psychiatry and Clinical Neurosciences, 67(7), 501-508. doi:10.1111/pcn.12100.

[4] Wang, Y., Xu, Z., Yang, D., Yao, H., Ku, B., Ma, X., . . . Cai, S. (2012). The antidepressant effect of secoisolariciresinol, a lignan-type phytoestrogen constituent of flaxseed, on ovariectomized mice. Journal of Natural Medicines,67(1), 222-227. doi:10.1007/s11418-012-0655-x.

[5] Gracious, B. L., Chirieac, M. C., Costescu, S., Finucane, T. L., Youngstrom, E. A., & Hibbeln, J. R. (2010). Randomized, placebo-controlled trial of flax oil in pediatric bipolar disorder. Bipolar Disorders, 12(2), 142-154. doi:10.1111/j.1399-5618.2010.00799.x.

[6] A very convenient way to have ground flax ready to serve is provided by Carrington Farms Organic Ground Milled Flax Seeds, two tablespoon packets sealed and lasting without refrigeration about one year.

Pediatric depression/ behavior and diet

depressedChild_header

Adequate nutrition for younger children is a well-known critical factor for growth and development, not only in physiological terms, but also for optimal brain and cognitive function development[1]. Inadequate nutrition has a detrimental effect on children’s health and predispose to childhood obesity, dental caries, poor academic performance, emotional and behavioral difficulties.

A cross-sectional analysis of the dietary patterns of Spanish school children ages 6 – 9 was compared with the Center for Epidemiologic Studies Depression Scale for Children Questionnaire to measure depressive symptoms[2]. Their conclusion was that for children:

“Nutritional inadequacy plays an important role in mental health and poor nutrition may contribute to the pathogenesis of depression.”

The mechanisms behind these effects in children and adolescents are not well described.

Beyond the obvious neurologic development in utero, we know that neurologic development continues after birth and extends throughout childhood and adolescence into young adulthood[3].  It therefore seems logical that a highly nutrient dense diet could result in an advantage in brain development with cognitive, emotional, and behavioral implications.

This could be an effect additional to the now apparent influence diet has on the mental health of adults through inflammation and the immune system, oxidative stress and neurotropic factors. Focus on psychiatric disorders in childhood and adolescence is particularly important given the fact that three quarters of lifetime psychiatric disorders will first emerge by late adolescence or early adulthood[4].

There is a multitude of reasons why judicious choice of dietary patterns is particularly important to establish early.

Therefore, in all practices of medicine, regardless of specialization, it is important to include nutritional habits in assessments of children, adolescents, and adults. Dietary advice and education enhances both physical and mental heath.

References

[1] Gómez-Pinilla, F. (2008). Brain foods: The effects of nutrients on brain function. Nature Reviews Neuroscience Nat Rev Neurosci, 9(7), 568-578. doi:10.1038/nrn2421.

[2] Rubio-López, N., Morales-Suárez-Varela, M., Pico, Y., Livianos-Aldana, L., & Llopis-González, A. (2016). Nutrient Intake and Depression Symptoms in Spanish Children: The ANIVA Study. International Journal of Environmental Research and Public Health IJERPH, 13(3), 352. doi:10.3390/ijerph13030352.

[3] Giedd, JN (2010) Structural MRI of pediatric brain development: what have we learned and where are we going? Neuron 67 (5), 728-34.

[4] Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593. doi:10.1001/archpsyc.62.6.593.

Junk Food = Junk Mood

TeenAnger

 

Teen consumption of “junk foods” and other unhealthy dietary choices may be contributing significantly to the burgeoning mental health crisis in that age group.

Significant increases in the prevalence of adolescent emotional distress and behavioral problems have occurred over the past several generations.1 Paralleling this mental health pathology among young people is a reduction in the quality of adolescents’ diets over recent generations with decreasing consumption of raw fruits, high-nutrient vegetables and associated increases in fast food, snacks and sweetened beverages2 with resulting obesity3.

While data are still relatively scarce from randomized, controlled trials to demonstrate the efficacy of healthful eating on psychiatric disorders, there is considerable epidemiologic evidence. Most of that literature is based on studies of adults; however very recently there is emerging evidence to suggest similar correlations with adolescent diets.

Cross sectional studies on the effect of diet quality on adolescents indicate an association between dietary patterns and mental health in adolescence. Poorer emotional states and behavior were seen in adolescents with a typical Western dietary pattern high in red and processed meats, takeaway foods, confectionary and refined foods compared to those who consumed more fresh fruit and vegetables4,5.

The first prospective cohort study on the effect of diet quality on mental health of adolescents was published in 2011, based on over 3000 adolescents ages 11- 18 years old6. Participants with poor diet quality at baseline had more emotional and behavioral problems; these worsened with time passage if a poor diet continued but improved if their diets improved. Those with good baseline diet quality had fewer psychiatric problems but if that diet deteriorated, so did their mental health. A healthy diet was defined as one that included fruit and vegetables as “core food groups” and included both two or more servings of fruit per day and four or more servings of vegetables, as well as general avoidance of junk food such as processed foods including chips, fried foods, chocolate, sweets, and ice cream.

In October 2013, results from a very large prospective cohort study of 20,000 women and their young children indicated early poor nutritional exposures in utero were related to risk for behavioral and emotional problems in their children7. These difficulties were more severe if the child’s dietary pattern after birth was also poor.

The mechanisms behind these effects in children and adolescents are not well described. Beyond the obvious neurologic development in utero, we know that neurologic development continues after birth and extends throughout childhood and adolescence into young adulthood8. It therefore appears logical that a highly nutrient dense diet could result in an advantage in brain development with cognitive, emotional, and behavioral implications.

This could be an effect additional to the now apparent influence diet has on the mental health of adults through inflammation and the immune system, oxidative stress and neurotrophic factors. Focus on psychiatric disorders in childhood and adolescence is particularly important given the fact that three quarters of lifetime psychiatric disorders will first emerge by late adolescence or early adulthood9. There appear to be a multitude of reasons why judicious choice of dietary patterns are particularly important to establish early.

1 Twenge JM, Gentile B, DeWall CN, Lacefield K, et al. (2010) Birth cohort increases in psychopathology among young Americans, 1938–2007: A cross-temporal meta-analysis of the MMPI.Clin Psychol Rev 30: 145–154. 21.
2 Cavadini C, Siega-Riz AM, Popkin BM (2000) US adolescent food intake trends from 1965 to 1996. West J Med 173: 378–383.
3 Ogden CL, Flegal KM, Carroll MD, Johnson CL (2002) Prevalence and trends in overweight among US children and adolescents, 1999–2000. Jama 288: 1728–1732.
4 Oddy WH, Robinson M, Ambrosini GL, de Klerk NH, et al. (2009) The association between dietary patterns and mental health in early adolescence. Prev Med 49: 39–44.
5 Jacka FN, Kremer PJ, Leslie E, Berk M, Patton G, et al. (2010) Associations between diet quality and depressed mood in adolescents: results from the Healthy Neighbourhoods study. Aust N Z J Psychiatry 44: 435–442. 10.
6 Jacka FN, Kremer PJ, Berk M, de Silva-Sanigorski AM, Moodie M, et al. (2011) A prospective study of diet quality and mental health in adolescents. PLoS ONE 6(9)