Food, micronutrients, and psychiatry.

Nutritional biochemistry is not a subject with which most psychiatrists, psychologists, and psychopharmacologists are familiar. A stream of recent epidemiological studies and clinical trials, however, indicates that understanding of nutritional biochemistry is soon going to be essential for anyone working with mentally ill patients. Those who are tempted to dismiss this statement as airy-fairy holistic nonsense will benefit from reading some recent issues of the American Jo urn a1 o f Psychiatry, British Journal o f Psychiatry, Archives of General Psychiatry, Schizophrenia Research, Journal of Affective Disorders, and New England Journal o f Medicine. Nutrition is important in psychiatry at two levels. First, all essential nutrients are required if the brain is to function normally. Second, certain specific nutrients, particularly folic acid and essential fatty acids, are emerging as specific treatments for particular psychiatric disorders. At the first level, the brain is the most metabolically active organ of the body, utilizing around 20% of total energy while being only 2% of body weight. Metabolic activity requires the essential nutrients, vitamins, minerals, and essential fatty acids as cofactors. Without an adequate intake of d l the required essential nutrients, the brain simply cannot function normally. Trying to apply any treatment modality, whether psychological, pharmacological, or social, to a brain that cannot function normally because of lack of an essential nutrient is like trying to run a 220-volt electrical appliance on a 120volt system. Yet anyone who works with mentally ill patients, particularly the severely depressed, those with schizophrenia, or the elderly, knows that diets are often appalling and micronutrient deficits are common and serious. However, rarely is anything done about it. Occasionally there might be a half-hearted referral to a dietician, as though patients are going to be any better than the rest of us in changing our diet. But much more usually, nothing at all is done. This is bizarre, when the remedy is simple and cheap. Prescribe any of the excellent one-a-day multivitamin/multimineral supplements that are readily available. Most patients are happy to take these. Moreover, these supplements will correct all the micronutrient deficits quickly and much more effectively than any attempt a t dietary change. Many professionals may then