Insight from the U.K.: An Interview with Patrick Holford

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Patrick Holford is a nutritionist, author and founder and director of the Institute for Optimum Nutrition in London.  He is the CEO of Food for the Brain Foundation, a registered charity which promotes mental health through nutrition.  He is also director of the Brain Bio Centre, which specializes in a nutrition-based approach to mental health problems.  He appears regularly on television and radio in the UK and has written more than thirty-five books including The Optimum Nutrition Bible which has sold more than 500,000 copies worldwide.


How significant are the findings of The Associate Parliamentary Food and Health Forum report on the links between diet, mental health and behaviour?


This is an excellent report that really shows just how far the scientific evidence has developed linking the effects of food and nutrition to behaviour. I think that there is no doubt that the sort of general increase in mental health issues, ranging from depression to increased aggression, are definitely contributed to in part by a lack of specific nutrients – not just essential fats but also key vitamins and minerals. The report is excellent. The one area it didn’t focus on in enough depth is the new research relating to B vitamins. 


There is a vital process called methylation, which happens at the rate of a billion reactions a second which helps to control all our neurotransmitters and is absolutely vital for nerve function. And it’s exquisitely dependent on a family of B vitamins. If you are not doing methylation properly then you get an increase in blood levels of something called homocysteine.


There is a lot of evidence that increased homocysteine and a lack of certain B vitamins increases risks for Alzheimer’s, depression and also schizophrenia.  We’re hosting probably the biggest and best ever conference on the food and brain function and mental health in October.  We have a number of internationally renowned speakers on essential fats and also on methylation. 


In terms of putting it into the sort of political context for the nation, the health condition that is most likely to bankrupt the National Health Service is actually Alzheimer’s. It already costs as much as all cancer and heart disease combined. We have Professor David Smith from Oxford University talking on his excellent research and asking the question “Is Alzheimer’s a preventable disease?”  And the evidence to date certainly suggests that it is preventable by insuring low homocysteine which not only predicts risk for Alzheimer’s but there is also evidence that the homocysteine molecule itself can damage the brain in the way that is seen in Alzheimer’s and is easily lowered by increasing intake of B vitamins. 

Of course, everyone gets a bit hung up on the notion that you can get all the nutrients you need from a well balanced diet. But in the case of some B vitamins, this just is not the case.  For example, something like three in ten people over 70 are functionally deficient in B12.  I mean functional.  If you actually test their blood properly, you find that they are deficient.  The amount of B12 that you need to correct deficiency in an elderly person is literally hundreds of times above what you can eat. 


The reason for this apparent disparity is that absorption gets worse as you get  older. Vitamin B12 lowers homocysteine and hence lowers risk for Alzheimer’s.  So there is a very hot area in and around homocysteine, brain function, Alzheimer’s and other areas as well, including depression.


Do you think that the report will help the nutritional approach to good health become more mainstream?


I think the real difficulty, which was highlighted in the report, was that doctors get virtually no training in the link between nutrition and mental health.  Ultimately, for any of the research and recommendations to get through and make a difference, doctors are going to need to be on side – and that means education. In order for this to have an impact, I think that one of the first steps is to start to properly educate health practitioners who interface with patients. That’s not just doctors; it’s also social workers and psychiatric nurses and so on.  The first step is awareness at each stage along the process of influencing clinical policy.  The reason we put on a conference like this is to attract more and more people who are working in the field to actually get informed and get up to date.


Some of the attacks on you and other high profile nutritionists by mainstream health practitioners are extraordinarily hostile.  Do you think this is going to be lessened by the parliamentary report and by other projects that you have taken on with schools in south London or is that resistance still there?


I think that there is such a big gap between people applying what the research is showing right now in mental health.  For example we have a Brain Bio Centre where we apply all the latest research on the treatment of schizophrenia.  So that’s one end of the spectrum.  At the other end of the spectrum there are practitioners who are very ill informed.  I’ve been involved in many debates on schizophrenia where I’ve literally been laughed at for the idea that you could even make an improvement in this condition.  The accepted belief among many is that this is an incurable condition and all you can do effectively is to tranquilise someone so they’re safer to themselves and their family. 

So we’ve really got a massive gulf to bridge.  I think that what’s needed to gradually reduce the sort of knee jerk resistance that some people have is education and evidence.

We get two reactions from doctors.  Some doctors are initially hostile – they think it’s a load of nonsense. Others are open. But any doctor who actually bothers to take the time to look at the evidence and hear it from the people who are working in the field become convinced.  So it’s not really to do with a lack of evidence or effectiveness in clinical practice, it’s just to do with a total disbelief that something as basic as nutrition could have such a big impact upon a serious mental health disorder.


Is this just to do with their training?


It’s partly to do with training.  If a doctor trained ten years ago they will have had between six and twelve hours on nutrition.  And probably none of those hours were to do with mental health and nutrition.  What is more insidious is that the pharmaceutical approach to health funds a lot of education and a lot of continued education. 


What is emerging from science is that simple nutritional factors such as Omega 3 supplements appear to be as powerful as anti-depressants or Ritalin for the treatment of ADHD.  When you have a multi-million pound market with a very evolved structure of marketeers and educators influencing conventional medical practice, then to start to suggest that a supplement might be an alternative or an adjunctive treatment is really quite controversial.  


In other words, money talks. One of the big factors that I think is holding back the adoption of what’s emerging in the nutritional research is that all of the recommendations are non-patentable. You can’t patent vitamin D or B vitamins or eating a low glycaemic diet.  And consequently there isn’t a big profit to be made and consequently there are no well-funded marketing campaigns. 


While doctors will be approached by drug reps there are no food reps.  So it’s quite a hard message to get into the medical profession.  I think that’s certainly part of the resistance. 


A common criticism is that by selling supplements you’re simply replacing the sort of pills that doctors prescribe that are manufactured by the pharmaceuticals with another type of pill which convinces the patient that it’s going to make them better.  What would you say to that criticism?


I think there are a couple of points on that.  Let’s take children as an example.  The first thing you have to do is actually look at the evidence of what works and, theoretically, if we had the evidence that providing children with a well balanced diet could achieve the goal of improved learning, reducing ADHD for instance and so on – if we knew that to be the case, then the question is, can we deliver it?  At the moment we don’t know that that is the case.  So, I’ll give you two examples.  We have 16 studies of giving children multi-vitamins, of which 14 show an increase in what’s called the non-verbal IQ scores.  Now some of these studies have been done on well nourished children. Some people have wrongly assumed that the only reason why giving a child a multi-vitamin would work is because the child is actually eating a bad diet.  But that’s not what the evidence shows.  So if we’ve got the evidence that children function better when given a multi-vitamin even if they’re eating a well balanced diet, they function even better if given a multi-vitamin if their diet was poor to start with. If that’s what the evidence shows, then it would make sense to do both – improve the child’s diet as much as possible and give them a multi- vitamin.

That’s exactly what we’ve been doing in our school project.  We’ve gone into really poorly performing schools and we’ve worked really hard to influence the parents, the school and the children to take on board healthier eating habits.  We are only partially successful.  At the coalface, one would be very naïve to think that it would be possible to influence all parents to feed all children with the kind of food that we wish they would feed them with. So, if it were only possible to partially achieve the goal of giving a child a well balanced diet and if you know that giving them multi-vitamins improves their academic performance and behaviour, then what do you do?


Do you just say “tough” or do you consider that actually giving them the supplement would be good? I think that we had the brilliant post-war intervention of the UK government giving all children cod liver oil.  And it worked! So it’s quite funny that now, when we have the evidence that did not exist then, there is resistance to effectively doing a similar thing.


On the subject of essential fats, again we have an increasing body of evidence that shows that giving children essential fats on a daily basis can make a significant difference.  In this case, we don’t know whether it makes a difference to all children but we do know that it makes a difference to children with learning difficulties.  So the amount of, for example, omega 3 that seems to have an impact could be equivalent to eating oily fish three to five times a week.


For example, the School Food Trust recommends that a child has fish every week and every other week it must be an oily fish.  That amount of omega 3 has not been shown to produce the kind of effect that has been shown in daily supplementation.  So you either say that you base policy on the science and the science shows the kind of levels of nutrients that are most likely to produce a beneficial effect or you have policy that is not based on science.  I think that that’s the logic for supplementation.


And personally, my view has always been both.  What you’re not trying to do with supplementation is allow children to continue to eat lousy food.  You actually want to tackle both fronts. The idea that all you’re doing is replacing drugs with supplements is to some extent brilliant.  We’ve got 250,000 children in Britain taking stimulant drugs for their behavioural problems and the idea that if it were possible to replace them all with fish oil supplements – that has to be a step in the right direction.  There are no side effects that we know from taking fish oil supplements.






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