fake smile depression
Over the summer, whilst I sipped a coffee, a friend of mine told me he'd attempted to kill himself, twice. I was in town talking to companies about the importance of good nutrition for balanced mental health, so depression was an obvious subject for us. When he told me, I was surprised and I'm ashamed to say, embarrassed. I wasn't sure how to react and so skipped neatly over his comment. Two weeks later, he was successful in his third attempt and my awkwardness in the coffee shop was forever burned into my memory as a regret.
"Suicide is the single biggest killer of British men under the age of 45"
Worldwide, at least 322 million people are depressed and 264 million are pathologically anxious. In Britain, suicide is the single biggest killer of men under the age of 45. In both the UK and US mental health illness has increased 'significantly' between 2005 and 2015, affecting the young most often. It's likely this upward trend has accelerated since then.
"In the United States those with mental health issues are sixteen times more likely to be killed during a police encounter"
The NHS has been caught off guard by the increase. Mental health patients have endured days and nights in police cells, when hospitals could not accept them due to overcrowding. In the United States, those with mental health issues are sixteen times more likely to be killed during a police encounter, versus those without cognitive dysfunction in the same situation. Unfortunately, police lack sufficient training for these scenarios and things can spiral out of their control.
"The neurotransmitters we require for appropriate cognitive function are built from the raw materials (nutrients) we get from a good diet."
depression infographic
© The National Alliance on Mental Health
Keeping It Simple

I base this article on the following facts:
  • The neurotransmitters (NTs) we require for appropriate mental health are built from the raw materials (nutrients) we get from a good diet.
  • Cheap, junk foods and fad diets replace real foods all too often and are causing nutrient deficiencies in the richest of countries.
Below is a short list of potential causes and triggers of mental health issues that web together in a million different ways, making the aetiology elusive. Your diet and lifestyle plays a pivotal role in each of those things listed below. For example, the expression of our genes are, in part, controlled by our diet and lifestyle choices. Those choices impact our gut health, including our microbiota and systemic levels of inflammation; all have been shown in studies to play a role in mental health. I will not be discussing those in detail here. Neurotransmitters for brain health

The predominant school of thought for treating mental health illness, of many shades, has been the monoamine hypothesis (chemical imbalance) which took hold in the mid 1960s. This proposes that mental health patients have depleted levels of the neurotransmitters (NTs) serotonin, dopamine and noradrenaline (norepinephrine). The behaviours associated with a lack of these NTs are:
  • Anxiety, obsessions and compulsions — serotonin.
  • Motivation, pleasure and reward — dopamine.
  • Decreased alertness, attention, cognition and energy — noradrenaline (norepinephrine).
Increasing the availability of these NTs with drugs has dominated the treatments and research until very recently. Lately, two neurotransmitters, GABA and glutamate, have also shown themselves to be important for mental health but my focus is on those three NTs I have mentioned, the drugs for which are successful in about 60% of cases.
"A deficiency of those nutrients, both amino acids and micronutrients, will mean a reduction of those NTs that are absolutely essential for brain health".
Nutrient raw materials required for NT synthesis

The slide below, taken from my presentation Food For Thought, shows two pathways separated by the central purple line. Each pathway shows the steps towards synthesizing all three of the NTs discussed, highlighted in red. Inside the grey boxes are the micronutrients (vitamins and minerals) required to build them.

neurotransmitter raw material
© Slide from my Food For Thought presentation
Below those boxes, signified with a small fish, are broken down proteins (amino acids) that are also required, initially, as raw materials to complete the steps. As you move along the pathway we see more raw materials added and new functional molecules being built until we get to serotonin in the top pathway, and dopamine and noradrenaline in the pathway beneath it.

A deficiency of those nutrients, both amino acids and micronutrients, will mean a reduction of those NTs that are absolutely essential for mental health and that have been almost the sole focus of drugs from the 1960's until the present day. Things cannot be built within the body from thin air, just as a wall cannot be built without materials.
"..one billion people are protein deficient and two billion are micronutrient deficient."
Notice also that melatonin, a key sleep hormone, is just two steps down from serotonin. This means if you're not synthesizing enough serotonin you cannot build enough melatonin and so, you won't be surprised to hear, "three quarters of depressed patients have insomnia."

Jacques Duff PhD, from the Behavioural Neurotherapy Clinic of Victoria University in Melbourne Australia, tells us how a deficiency of nutrients will prevent those critical NTs from being synthesized to the proper degree.
"The role of omega-3 essential fatty acids, zinc, magnesium, B vitamins...are necessary for serotonin, dopamine and norepinephrine [noradrenaline] metabolism.."
We know that the body cannot create functional molecules without the nutrients needed to build them, but why is that a problem in the developed world, when we live with such abundance?
"..a young boy in the UK lost his eyesight permanently. Multiple micronutrient deficiencies were discovered too late by his doctors."
Nutrient deficiency in the developed world

It is estimated that one billion people are protein deficient and two billion are micronutrient deficient worldwide. We know those in the developing world face shortages often and nutrient deficiency diseases are common and obvious in many cases. However, what about in the developed world where so many of us are fortunate enough to consume more than we need if we choose?
"..31% of the population risk single, or multiple, nutritional deficiencies concurrently."
We're overfed but undernourished in the richest of countries. We're surrounded by foods, many of us eat every few hours, selecting high energy, low nutrient snacks that feed addiction more than real appetite and rarely, if ever, to true hunger. They turn us away from proper meals and demotivate us to prepare and cook our foods. Instant gratification is the name of the game, calories in calories out, move more and you're golden. This is a disaster.

In 2019, a young boy in the UK, lost his eyesight permanently. Multiple micronutrient deficiencies were discovered too late by his doctors. Fortunately, a 61 year old's dementia was reversed after a B12 deficiency was discovered to be the only cause of her serious cognitive decline. The simple blood test was finally carried out after a five year period in which she hallucinated dead relatives and thought her family were out to kill her.

Old nutrient deficiency diseases, thought to be all but extinct in developed countries, have started appearing in our society again. An article in the Independent newspaper (2019) entitled, 'Huge increase in 'Victorian diseases' including rickets, scurvy and scarlet fever, NHS data reveals', gives us some surprising stats, including over 100,000 people being admitted to hospital for vitamin D deficiency in 2018. What does the scientific research say about all of this?

The Research

Epidemiological research, in the US, indicates 31% of the population risk single, or multiple, nutritional deficiencies concurrently.
Based on representative data from the National Health and Nutrition Examination Survey (NHANES), the US Office of Disease Prevention and Health Promotion classified vitamins A, C, D, E, and folate, calcium, and magnesium as "nutrients of concern" that may pose a substantial public health concern in the general US population.
More robust evidence shows the following subgroups of people, within the developed world, are at risk of nutrient deficiencies; pregnant and lactating women, women in their 20's, infants and toddlers, children, adolescents, older adults and obese individuals. Some remaining groups tend not to be tested for nutrient deficiencies and so specific data doesn't exist.

These deficiencies are often overlooked by health care professionals because of the vast array of variables, potential symptoms and a lack of nutrition training.
It is absolutely critical that you provide your body with the nutrient, raw materials it needs to to function well, both physically and mentally.
Which nutrients, shown to be deficient in populations, are critical for our mental health?

(Not an exhaustive list)

"A recent randomized clinical trial in a population of adults diagnosed with mild-to-moderate depression found that the consumption of 248 mg of magnesium per day for 6 weeks resulted in a clinically-significant 6 point decrease (p < 0.001) in depressive symptoms."
"Collectively, empirical evidence most strongly supports a positive association between zinc deficiency and the risk of depression and an inverse association between zinc supplementation and depressive symptoms."
Folate & B12
"Both low folate and low vitamin B12 status have been found in studies of depressive patients, and an association between depression and low levels of the two vitamins is found in studies of the general population."
"Vitamin B12 supplementation with antidepressants significantly improved depressive symptoms in our cohort."
"In this study, by analyzing the relation of calcium intake and depression level of middle-aged women, higher total calcium and animal calcium intake were shown to significantly lower depression scores."
"The mean ferritin level in students with depression was significantly lower than the healthy ones."
Omega 3 Fats
"The meta-analysis showed an overall beneficial effect of omega-3 polyunsaturated fatty acids on depression symptoms."
How can you protect yourself from this epidemic?

I stand before companies and implore them, "do not wait until you are ill to start making positive changes to your diet and lifestyle". I'm emotionally invested in this because I've been hurt very badly by chronic disease. Conventional medicine was unable to help and so, I was left to rebuild my health brick by brick. I can tell you this, it's not easy and I'm not finished. It turns out, an ounce of prevention really is worth a pound of cure, and then some.

Nourish yourself

It is absolutely critical that you provide yourself with the nutrient, raw materials you need to function well, both physically and mentally. This is fundamentally what eating is all about. When you eat nutritious foods, energy will come along with it. When you eat foods high in energy, the nutrients may not be present, and problems far beyond obesity will manifest at some point. Here's my list of basic recommendations.
  • Eat real foods, born and grown.
  • Throw away highly processed foods.
  • Eat 2 or 3 proper meals per day that satisfy you and allow you to concentrate on other tasks.
  • Stop snacking because this is where junk foods live.
  • Invest time to prepare meals, they pay dividends.
  • Think of each meal time as an opportunity to nourish yourself rather than to obtain energy or satisfy a craving.
  • It's OK to be hungry.
Have a read of this article if you want to know more about how, when and what I recommend people eat, as well as what I think you should avoid and why you should stop snacking. Also, what the most nutritious superfood really is.


The rise in the numbers of people experiencing mental health issues may partly be explained by an increase in reporting. As the stigma of mental health illness is slowly eroded people are more willing to talk about it — #ItsOkNotToBeOk. Perhaps, acceptance is improving, because empathy is easier from those who have experienced similar problems and it seems this number of people increases daily.

These two researchers think the monoamine theory, or 'chemical imbalance theory' of depression, is more about sales of antidepressant drugs than it is about robust scientific evidence. There is evidence that lowering NTs deliberately does not cause depression in healthy subjects so it may not be as simple as addressing brain chemical imbalances. This is supported by the fact that the drugs don't work for everyone. There is also no available data as to what 'normal' brain chemical balance actually is:
"In fact, there is no scientifically established ideal "chemical balance" of serotonin, let alone an identifiable pathological imbalance."
The brain is the least well understood organ in the body and scientists are learning more about it all the time. So, how reliable is the other research presented here?

There is a lack of good, causative research regarding nutrient deficiencies in the developed world. Epidemiological evidence, relying on memory recall, is wildly inaccurate and derided by some scientists.
We challenge the field of nutrition to regain lost credibility by acknowledging the empirical and theoretical refutations of their memory-based methods and ensure that rigorous (objective) scientific methods are used to study the role of diet in chronic disease.
I would very much like to see more people tested for nutrient deficiencies upon visiting their health professional. The data could be enlightening, the resolution simple and cheap.

Start today

There is no doubt that nourishing yourself is essential for the synthesis of those NTs required for balanced mental health. Both the epidemiological evidence and more robust evidence from subgroups, of people assessed for micronutrient deficiencies, agree that a large proportion of our society is struggling to obtain sufficient vitamins and minerals. A lack of nutrients specific to NT synthesis will mean a reduction in those brain chemicals which may mean mental health issues arise. Correcting nutrient deficiencies eliminates this potential cause and provides your brain with the raw materials you require to experience the joys of life.

It's exciting to think you can begin to have a positive impact on your mental health today. Eating well is a great place to start and gives you some control and focus. Bear in mind, those under stress and strain will require more nutrients than those gliding through life, so it's important to improve your diet during times of trouble. This is why I beg people to start being proactive and make the changes now because one of the cruel things about mental health issues is the fact that it can rob you of your motivation to help yourself.

I'm not telling you that this is a cure for your depression, however, if your depression is caused by nutrient deficiencies, as has been shown to be a potential cause for some, then you may be able to resolve it by reversing those deficiencies. Even if it's not the cause of your mental health issues, nutrients can help in countless ways.

At the very least, nourish yourself for body and brain, start today.

Tim Rees - Registered nutritionist (BSc mBANT rCNHC) writing about health, nutrition & my own battle with chronic disease. https://www.facebook.com/timreescoaching/