Lifestyle Medicine is the science of how human choices, society and environment impacts on our health. For clinicians it is how we can assist our patients to make better choices around diet, physical activity, smoking, alcohol consumption, stress and connection with others to reverse and prevent chronic disease and promote wellbeing. So where does supplementation fit into this?
As a practising GP, I am sure I like many of you prescribe medications and supplements. From paroxetine to colchicine, and from folate to caltrate, this is part of established clinical practice. In fact the prescribing of nutritional supplements is at the very foundation of what we now call evidence-based medicine.
I am referring to the world’s first randomised clinical trial on the prevention of scurvy. As you will appreciate, in the 18th century scurvy was observed when food was limited, such as on ocean voyages or during military sieges. James Lind, a Scottish physician in the Royal Navy, did his study by dividing twelve sailors into six groups of two. One was given a quart of cider daily, another an elixir of sulfuric acid, the third vinegar, the forth half a pint of seawater, the fifth two oranges and a lemon, and the last group a spicy paste plus some barley water. Interestingly, the study ended for group five after just six days when he ran out of lemons and oranges, but by that time one sailor was fit for duty while the other had almost recovered. In 1753 he published A treatise of the scurvy, which was virtually ignored at the time but was to prove to be a significant landmark in nutritional science and, in fact, medical science in general.
Fast forward to last year’s Lifestyle Medicine conference where we exciting research presented on diet, nutrition and mental health. For example we know that people with depression are more likely to be vitamin D deficient. However we also know that people with depression tend not to respond to vitamin D as a treatment for depression. Dr Julia Rucklidge from Christchurch presented her research on the use of broad spectrum micronutrients (includes vitamins, minerals and amino acids) or a “shot gun approach” at high dose (that is getting close to the UL or Upper Limit) that showed benefits in a number of mental health disorders including ADHD, PTSD and depression. The research doesn’t provide an answer as to why this effect was observed, but we do know micronutrients play a key role in the syntheses of serotonin and other neurotransmitters, and that the food we buy in our supermarkets is significantly depleted in micronutrients compared to 50 years ago.
My personal view is the treatment of disease and the promotion of health with supplements (and pharmaceuticals for that matter) is necessary. However, I also believe that the safest and most sensible path is not in the search for the one supplement, one pharmaceutical or one special bioactive molecule.
So where does ASLM stand on the use of supplements?
ASLM’s ideological position would be that in an ideal world supplementation should be unnecessary; that we should be able to get our nutritional needs from whole, largely unprocessed and mostly plant based foods. This should always remain our aim. After all, the human body is designed to process whole food, not individual nutrients in tables or capsules.
However we also accept that we don’t live in an ideal world and despite the wide range of foods available to us in western society, poor nutrition choices and nutritional deficiencies are rife, both contributing to, and exacerbated by illness. Similarly, our bodies are often under an inflammatory load from sleep debt, stress, toxins and other exposures impacting on metabolism, nutritional needs and balances. Better public nutrition education is needed along with clinical (professionally guided) nutrition to correct problems.
Personal supplementation is also often necessary to address the reality of dietary inadequacies and other lifestyle impacts. But this is where people can fall into the trap of thinking that supplementation will make up for poor dietary or lifestyle choices on an ongoing basis (remember that our aim is to get our nutritional needs from whole food as much as possible), or be misled into buying inadequate or worthless supplements as a result of less than honest marketing. It’s a great idea to get professional advice in deciding what could be beneficial and where possible to buy the highest quality supplements.
ASLM, like other medical and allied health colleges, is concerned about unsubstantiated claims of health benefits from supplements, and that the ingredients are safe, appropriate for the purpose, and formulated to do what they say. There is much work still to be done to ensure that supplements are evidence-based and to improve transparency in the marketing and promotion of supplements. We would like to see as much energy going into public nutrition education as seems to be going into promoting supplements!
While we are on the subject of sensible eating, the first ever randomised control trial to look at diet as a treatment intervention for depression has just been published this January by Felice Jacka and colleagues from Deakin University. Their study showed a 30% reduction in depression symptoms by changing to a Mediterranean diet; or if you prefer the actual numbers, at 12 weeks 32% of patients had a remission of depression in the dietary support group versus an 8% remission in the controls.
The Mediterranean diet is not a replacement or a substitute for traditional depression treatments but you may want to consider (and I appreciate you may be doing this already) adding dietary advice or a dietitian referral to your treatment plan for your next patient presenting with depression.
There are two clear messages from this trial. Firstly that a patient’s nutritional status cannot be ignored in clinical practice, and secondly that a Mediterranean style diet is likely to be protective against depression, amongst all the other things it is good for.
Additional resources
Co-author of the SMILES trial, Dr Catherine Itsiopoulos, wrote “10 commandments for a Mediterranean diet” which was the basis for the diet used in this study.
- You can find this at http://www.abc.net.au/health/thepulse/stories/2013/04/15/3737114.htm
- For the full article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y
- And a news report: http://www.abc.net.au/news/2017-01-31/mediterranean-diet-can-help-in-fight-against-depression-study/8224522
You can also watch the lectures given by Profs Michael Berk, Catherine Itsiopoulos, Julia Rucklige and Dr Adrienne O”Neil at Lifestyle Medicine 2016. These are available FREE to those that attended the Saturday of the conference or can be purchased as part of the conference online.
