THE MICROBIOME SUMMIT : The New Path to Health
Future of Nutritional Psychiatry Research
Dr. Felice Jacka, PhD
Dr. Felice Jacka works in the field of nutritional psychiatry. Mental health issues are one of the largest drivers of global disability. Until we clean up the current food system – including marketing junk food to children – we will forever struggle with health and mental health issues. In this interview, Dr. Felice Jacka looks at the big picture of global health and what we need to do to have an impact.
- Tracey:
- We’re here at the University of Toronto with Doctor Felice Jacka. She has her PhD in Psychiatric Epidemiology, she is an associate professor at Deacon University in Australia, and she’s joining us here today. Welcome.
- Felice:
- Thank you, thanks for having me.
- Tracey:
- You have just explained so much to us in terms of the global health epidemic we are facing. What motivates you to keep going? Some of it just seems like we have insurmountable things ahead of us. What is motivating you?
- Felice:
- What gets me out of bed in the morning I guess that really passionate desire to make a change. It makes me angry, there is no other way of saying it. It makes me angry that around the world, populations from Brazil to China to Australia etc are being allowed to consume stuff that is making them so unhealthy and that there are no restrictions on industry in terms of their marketing, their making the food products available, the cheap pricing etc etc and we are really destroying the health of the whole globe. There doesn’t seem to be any restrictions on industry doing that. The other thing that motivates me is intellectual curiosity. I really want to understand how things work. I want to design interventions that are going to actually have a beneficial impact for individuals and for the population.
- Tracey:
- We hear so much about moderation. So I’m raising kids and everyone is like “Let them have some cookies. Let them have some cake”. Where do you think the research is going? What is it going to be able to tell us? We hear this 80/20 rule.
- Felice:
- I think that is kind of plucked out of the air and of course industry likes to be able to think that we should be able to have moderate intake of processed foods. I don’t think the research supports that and of course our idea of what is moderate has changed enormously. From once a month at a child’s party to once a day. There’s a whole shift in what we think is normal. Now it is normal to have soft drinks or chips and biscuits and things everyday. That is not normal.
- Tracey:
- You are incredibly knowledgeable, and I want to know where you think the research should be going.
- Felice:
- Look, I just feel that there’s so much to do. This is why I have such a lot of energy here, because there are so many things that we don’t know. We’ve really just started to uncover the tip of the iceberg. We certainly need to do more research, in our interventions, to find out what works, to change mental health, to change gut microbiota, to change all of those things.We’re just about to start a new study in Australia, where we’re looking at pregnant women. We’re going to recruit them coming into their third trimester of pregnancy. We’re going to help them to understand a bit more about diet and food, and the importance of fibre, maybe fermented foods. We know that, in Australia, only about ten percent of women eat according to the dietary guidelines. Then we’re going to have a look at the impact of any dietary change or dietary improvement on their health.But also the health outcomes of their infants. We’re going to look at their microbiome, to see if it’s a healthier one. We’re going to look at measures of inflammation, those sorts of things, to see, “Okay, well, can we actually modify diet, and if we do, does that have an impact on these outcomes that we know are related to physical and mental health across the lifespan?”Where we have funding applications in for large scale population studies of the microbiome, diet, and mental health, and of course, all the other things that go around that, so that we can start to characterize what sort of gut profiles are associated with what sorts of diets, and how is that related to mental health, and to weight, and those sorts of things. We want to run a randomized control trial testing probiotics as a treatment for major depressive disorder. So there’s many studies there that are underway.In 2013 I helped to setup the International Society for Nutritional Psychiatry Research of which I am the President. My hope is that we can start to get a lot of other researchers and younger researchers and students coming in and starting to address some of the questions that are still outstanding in the area. And of course they are many. One of the things that I am really interested in is the more serious end of the spectrum – in psychosis and psychotic illnesses. We get anecdotal evidence that for some people there may be a role of food allergy in some of those symptoms that people have. There may be dietary strategies that we can take that might help some people with psychotic illnesses. There has already been one very important study. Colleagues of mine in Australia where they looked at young people who were at high risk for developing a psychotic illness and they randomized them to receive either fish oil or a placebo and then they followed them over 12 months to see who made the transition to a full psychotic disorder. They saw that those who had the fish oil were much less likely to make that transition.
- Tracey:
- Just something as simple as fish oil.
- Felice:
- Fish oil seems to have anti-inflammatory properties so it reduces the inflammation probably reduces the inflammation in the brain. It might have been that timing was very good at that critical juncture where they could go one way or another. It might have tipped them towards the less unhealthy pathway. So there is much work to be done there. We really need to understand much more fine-grain detail about what sorts of diets are useful for what people. There may also be a role for supplements for some people. So we need to understand what supplements, at what dose are useful for whom under what circumstances and which ones might be noxious because we know that sometimes supplements can actually be noxious. Just because they are natural doesn’t mean that they are always completely safe. So we need to do more research around that because of course people are self-dosing with antioxidants, vitamins and minerals etc and we need to understand really thoroughly what it is that they may or may not do. There is an enormous amount still to be done and it is a really exciting time because we, I think, have now a whole new string to our bow if we are thinking about how we might prevent and treat common mental disorder.
- Tracey:
- Why do you think it took us so long to get here?
- Felice:
- I think that cartesian mind-body dichotomy has really informed psychiatry and so people would think of the mind and body as being separate which we now know that they are not. And of course somebody had to do the research to actually say and it needs to be scientifically rigorous. It can’t be poor quality research. We do not want to see anymore open-label trials, trials that have insufficient sample size, interventions where they haven’t properly considered the methodological processes and done the very best they can to make it as water-tight as possible. We really need to improve the science in this area. Having that causal data, having the results of the randomized control trial we’ve just run, I think is probably going to make a big difference. Because it really is saying if you improve people’s diet it seems to have an impact on their symptoms. And of course other people need to take up that challenge and do that again, they need to replicate it. We need to look at how we might scale that up so we can reach more people – it maybe that we use telephone, skype, online those sorts of things. We need to really understand what diet is best for whom because it is unlikely that it is going to be one size fits all. And we really need to teach people how to shop and to cook again and how to enjoy whole foods.
- Tracey:
- The practicality part of it. I mean you said 10% of people are following the current guidelines.
- Felice:
- In Australia, it is only 10% of women, 5% of men.
- Tracey:
- We have a lot of work to do.
- Felice:
- We have a lot of work to do.
- Tracey:
- So the practicality of it is something that, no one wants to have a bad diet. But I think that we need some sort of support systems or our doctors need to learn how to cook themselves and explain.
- Felice:
- There are some moves towards that now with some medical schools where they are learning how to cook and learning about whole foods. I think people really get hung up on the details. It’s like the woods and the trees issues. They get completely hung up on what sort of dietary fats I should have, should I have only organic, do I need to have superfoods. All of these questions that are actually red herrings. I think the easiest thing to say would be to eat what your grandparents ate. Eat whole foods, eat the foods that you like but that are not processed. Just go to the farmer’s market if you can. Go to the grocery store if you can. I mean we did a great study last year. One of my students is a clinical dietitian and as part of the randomized control trial what she did was she did a very very detailed costing analysis of how much it cost to eat the unhealthy diet that the people in the trial were currently eating and then she costed against the diet we were recommending. And found it was actually cheaper to eat the healthy diet. Now as long as you didn’t got out and do silly things like buy all your spinach from the organic market on the first day it was on the shelf but actually bought it at the end of the day on the Sunday for example when they are having the end of day sales. Those sorts of strategies. You can get a big box of fruit and vegetables, you can get lentils and legumes so cheaply and you just soak them and put them in the slow cooker. You can get tinned fish very cheaply. There are so many things you can do to make food, really good whole food affordable.
- Tracey:
- And to get back into cooking again. With our children we focus so much on the maths and sciences, reading and writing, but not so much on how to cook. And take care of their bodies that way.
- Felice:
- Grow food. Right from the start so that they understand that connection with the soil. I mean cooking is just a wonderfully pleasurable thing. So some of our traditional foods like fermented foods. I make my own kombucha at home. It is practically free, it is so cheap to make it. Same with kefir – fermented milk products. Many people make their own fermented vegetables now. These are things you can do at home for very little money. So those are sorts of strategies you can employ as well. I particularly like very moldy cheese. That’s another great way of getting bacteria back into your body.
- Tracey:
- That’s true. More of the traditional foods that we have gotten away from. Or a lot of people watching us may not even know what kombucha is. Right?
- Felice:
- It is fermented tea. Basically you make tea, a big pot of tea. You put some sugar in it because that is what the bacteria eat and what you need is a scoby or a mother. You can often get one from a friend or some networks. And then you put the scoby in the tea and the sugar together and then you just leave it. Then you get this fantastic fermented product that is actually very low in calories because the bacteria eat the sugar. But it is full of the microbiota that we think are really useful.
- Tracey:
- Really important.
- Felice:
- If you think of traditional diets in Japan you have things such as tempeh which is fermented soybeans, you have miso soup, you have soy sauce. These are all fermented products. In Korea you have kimchi, in Europe you have sauerkraut. There’s traditional foods where we’d use fermentation when we didn’t have refrigeration and again it’s likely our bacteria are kind of used to those foods and need them for optimal health.
- Tracey:
- Yeah, I think that understanding that the bugs in our guts must be fed, and must be fed well, is something that we need to be thinking about as well. And I think that your research is going to start giving us that type of information that we need.
- Felice:
- Yeah, I hope so, and it doesn’t need to be complicated.
- Tracey:
- No.
- Felice:
- You know, just eat real foods. Not too much, mostly plants.
- Tracey:
- Thank you for sharing all your great information with us.
- Felice:
- Such a pleasure. Yeah.
- Tracey:
- And hopefully, we’ll have you visit us again in Toronto, and we’ll be able to see where you’re up to in the future.
- Felice:
- Yeah, that would be great. We’re setting up a food and mood centre online, so that people can come and get the information and get the latest research, and know that it comes from a credible source, get links to places where you might be able to go and improve your diet with some online information. So, we’re setting that up in the next few months, so look out for that. And of course, we’re running meetings for health professionals and researchers in the U.S.A. next year, as well.
- Tracey:
- Thank you so much.
- Felice:
- It’s a pleasure.
