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The Tomato Effect by James Greenblatt, M.D.
Nutritional medicine has long been considered “alternative medicine,” and despite increasing scientific research supporting the link between nutrition and health, the mental health profession continues to regard the link between nutrition and brain function as alternative or “complementary.”
Despite the research that supports use of nutritional approaches in augmenting treatment for depression and mood disorders, these approaches are considered experimental and alternative. The side effect profiles of psychiatric medications are extensive and often irreversible. The side effect profiles of nutritional supplementation are essentially nonexistent. It is mind boggling that there is not more research in this crucial area of mental health treatment.
It was nice to find an impartial study that utilizes nutritional testing to demonstrate measures of mental health published in Neurology (Bowman et al., 2012).
This study examined 104 non-demented adults, average age of 87, participating in the Oregon Brain Aging Study. All patients underwent nutrient blood testing for 30 nutritional biomarkers and a battery of cognitive tests. All study participants aged 85 and older also had MRI scans within one month of the blood test.
Results demonstrated that optimal mental function was found in individuals with high blood levels of specific nutrients evaluated: Vitamins B1, B2, B6, folate, B12, as well as vitamins C, D and E.
Higher levels of these nutrients positively correlated with improved cognitive function, increased attention, and increased executive function.
Equally important was that elevated blood levels of trans fats were strongly associated with repressed cognitive function and decreased performance: impaired memory, cognition, language, mental processing speed, and attention.
Omege-3 fatty acid levels were significantly associated with enhanced cognitive function.
Notably, MRI results of individuals with higher levels of blood vitamins B, C, D and E showed increased brain area compared to their peers with lower vitamin levels. Additionally, individuals with the highest blood levels of omega-3 fatty acids had significantly less small vessel disease in the brain.
One of the most important clinical lessons of integrative psychiatry is that there is a very poor correlation between dietary recall and blood levels of nutrients in the body. There are many reasons for this variation:
First, reliance on subjective reporting, especially around food, is not consistently accurate. And even if reporting is accurate, what a person eats does not necessarily correlate with nutrient levels present in their body.
Reliance on a diet history does not consider the genetic biochemical variability of digestion and absorption.
A phenomenon labeled “the tomato effect” helps explain the reluctance of the medical community to embrace nutritional approaches for medical conditions.
The tomato effect was first described by Dr. James Goodwin in the Journal of the American Medical Association in 1984. He wrote, “The tomato effect in medicine occurs when an efficacious treatment for a certain disease is ignored or rejected because it does not ‘make sense’ in light of the accepted theories of disease mechanism and drug interaction.”
The rejection of potentially effective treatments because “everyone knows it won’t work” is named for Americans’ persistent belief – from the sixteenth to the nineteenth centuries – that tomatoes were poisonous. Although tomatoes were available in America, throughout the 1600s and 1700s they were considered inedible decorative plants. The belief that tomatoes were poisonous stemmed from the suspicion that the tomatoes were a part of the poisonous nightshade family. Americans, however, were aware that Europeans were serving and eating tomatoes at the dinner table.
The fate of the tomato in America changed in 1820, when a New Jersey man publicly consumed a basketful to prove they were safe to eat. When he neither dropped dead nor even suffered any apparent ill effects, witnesses of the experiment slowly began to open their minds. By the end of the decade, American gardeners were growing tomatoes for food.
Dr. Goodwin coined the term “tomato effect” to explain the rejection by American medicine of therapies that did not fit with currently accepted theories of disease and treatment. He believed the tomato effect delayed the acceptance of vitamin and mineral supplementation. This type of intervention is outside the familiar medical paradigm, particularly for mental illness.
Understanding the human tendency to reject a treatment outside one’s frame of reference – even in the presence of contradictory evidence – should help us identify the medical profession’s persistent resistance to recognizing the importance of nutritional deficiencies in brain function.
I frequently speak with patients who, despite being on medication for years, continue to live with the symptoms that the medications were intended to treat. Based on continued reluctance of the medical community to evaluate nutritional status as a factor for health and well-being, many patients are unnecessarily and inappropriately treated because the cause of their condition is never addressed.
Another article describes the role of vitamin D and mental health. This published study correlated low levels of vitamin D to psychosis in adolescents. The results demonstrated that adolescents presenting for acute mental health treatment with a vitamin D deficiency were more likely to have psychotic features.
Vitamin D is one example of the importance of laboratory testing to evaluate nutritional status. How do you know if you’re deficient without testing? You can’t! Ultimately, the only way to fully understand your health is to test, test and retest.
The Great Plains Laboratory’s Organic Acids Test has markers for the following vitamins: B12, B6, B5, B2, C, CoQ10, and Biotin. An additional test offers results for vitamin D.
The history of nutrition and medicine is long. Even before we understood the mechanisms in which dietary components provided health benefits, we understood the inexorable link between nutrition and health. Current options for nutritional testing are extensive and need to be better utilized by mental health professionals.
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