Food and Behaviour Research

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Good Food is Vital for Brain Health So We Must Change the Food Industry

Eyre H, Berk M, Ayadi R, Dunlop S, Dickson S, Storch E, Lane M, Brown L, O’Brien K, Salama M, Smith E, Le H, Ibáñez A, Kolappa K, Occhipinti J, Jacka FRoger R (2023) Centre for Health and Biosciences  doi.org/10.25613/1XYC-TM97  

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Abstract:

The world is increasingly relying on “brain capital,” where a premium is put on brain skills and brain health. Building brain capital is fundamental for meeting modern societal challenges and driving innovation. It also provides a framing to understand the negative impacts of the corporate-industrial food industry on our communities and offers insights as to how to mitigate them. In this paper, we argue that today’s food environments and food systems around the world are dominated by the corporate-industrial food industry, and that this is undermining brain capital and therefore sustainable human development and public health on a global scale. Respecting the intertwined relationships between brain capital, health, and sustainable environments is essential for the future of humanity.
 
This paper outlines a range of policy recommendations to reform the corporate-industrial food industry in the interest of protecting brain capital. Recommendations span from transforming the food system through public policy and reforming clinical care, to defending against misinformation driven by the food industry, engaging the brain health field in a “Global Plastics Treaty,” and converging planetary and brain health. The most impactful solutions to build brain capital at scale do not lie at the level of the individual or health services, but in public policy. These solutions have the capacity to directly address a major driver of the many non-communicable conditions — both physical and mental — that are major health burdens globally. In addition, tackling the corporate-industrial food industry will also optimize planetary health, which is essential to human longevity and well-being.
 

Introduction

Brain health was recently defined by the World Health Organization (WHO) as:
 
“the state of brain functioning across cognitive, sensory, social-emotional, behavioral and motor domains, allowing a person to realize their full potential over their life course, irrespective of the presence or absence of disorders. Many determinants are known to impact brain health and continuous interactions between these determinants plus an individual’s context lead to lifelong adaptation of brain structure and functioning.”[1]
 
Improving brain health and developing sustainable environments are crucial goals for the future of humankind. These goals are tightly interlinked. Brain health is influenced by numerous, overlapping determinants including physical health, environmental health, safety and security, learning and social connection, and access to quality services.[2] A wide array of environmental factors can impact brain health across the life course, such as nutrition (including breastfeeding in early life), exposures to toxins or pollutants in food, medications, or through the built and natural environment — including in water and ambient or household air. The relatively new term “planetary health” encapsulates these factors: It has been defined as “the health of human civilization and the natural systems on which it depends.”[3]
 
The global corporate-industrial food industry has enabled the supply and affordability of diverse and nutritious foods, allowing food production to keep pace with rapid population growth and reducing famines.[4] However, it is also responsible for up to one-third of global greenhouse gas emissions, 70% of all freshwater withdrawals, major single-use plastic production and pollution, agricultural chemical toxins, and is the main driver of global deforestation and biodiversity loss.[5] Recent modeling estimates the costs of the current global food system at US$20 trillion per year, with 11 trillion arising from the downstream impacts on human health, and 7 trillion from the environmental impacts.[6] Indeed, because these “substantial hidden costs in food systems”[7] are currently externalized, food is one third less expensive than it would be if these costs were adequately accounted for.
 
Global population growth, environmental externalities,[8] and climate change threaten the sustainability of the current system.[9] Resulting food insecurity will have devastating effects on communities, increasing vulnerability to disease and mental health issues while decreasing their ability to engage in education, build their livelihoods, and take care of vulnerable community members.[10]
 

The Concept of Brain Capital

Brain capital is a novel concept that recognizes brain health and brain skills are indispensable drivers of the modern knowledge economy, economic productivity, and sustainable human development.[11] It is an economic policy innovation that aims to reform global economics to factor in key and otherwise unconsidered elements (brain health and brain skills).[12] This understanding provides a unified framework to define elements of brain health, disorder, and skills; quantify them; and track them in order to develop new ways to enhance them. The Brain Capital Grand Strategy, published in 2021, articulated the need for a Brain Capital Dashboard, Brain Capital In-All-Policies, and a Brain Capital Investment Plan.[13] The Organization of Economic Co-Operation and Development (OECD) also launched the Neuroscience-inspired Policy Initiative to promote and refine the concept of brain capital.[14] Following the success of that initiative, the Brain Capital Alliance has now been formed as its multi-organizational extension.[15] Brain capital is affected by the corporate-industrial food industry but also provides a platform to consider ways to lessen the negative effects that the industry has on communities.
 
The next sections outline the rise of ultra-processed foods driven by the corporate-industrial food industry and the effects of diet and nutrition on the gut, as well as the brain and gut-brain axis. We also challenge the corporate prioritization of commercial milk formula over breastfeeding and give an overview of brain-harming toxins used for food production and packaging. Finally, we make a range of policy recommendations to reform the industrialized food industry in the interest of protecting brain capital.
 

The Rise of Ultra-Processed Foods

Globally, people are consuming an ever-increasing proportion of their diets in the form of inexpensive, convenient, heavily marketed and easily available ultra-processed foods.[16] Recent systematic reviews and meta-analyses[17] indicate that ultra-processed foods account for between 17% to 56% of total daily energy intake across 28 countries.[18] Ultra-processed food and Western dietary patterns are associated with an increased risk for a large number of non-communicable diseases, including heart disease, diabetes, and common mental health conditions like anxiety and depression, as well as their intermediate risk factors.[19] Although ultra-processed foods are classified according to their intensive level of food processing, while Western dietary patterns are largely based on the nutrient profiles of foods, both typically comprise foods high in salt, sugar, and saturated fat. Below we will outline research on the harmful effects of ultra-processed foods on the gut, brain, and gut-brain axis.
 

The Effects of Diet and Nutrition on the Gut-Brain Axis

Non-communicable diseases and common mental health conditions together form the bulk of the current disease burden, with the World Health Organization (WHO) estimating that chronic diseases account for more than 70% of premature deaths globally. Mental health conditions are one of the top 10 leading causes of disease burden worldwide.[20] The links between nutrition and brain health are becoming increasingly clear.
 
In recent years, the “gut-brain axis”[21] has been an emerging area of research, given the early involvement of the gastrointestinal tract (GIT) in neurodegenerative diseases: There is evidence that gastro-intestinal manifestations can even precede the common symptoms and signs of such disease.[22] Gut dysbiosis[23] may play a role in the process of neurodegeneration — in particular, bacteria, viruses, fungi, protozoa, and bacteriophages[24] have been implicated in several brain diseases (e.g., Parkinson’s disease, Alzheimer’s disease, and multiple sclerosis).[25] Multiple factors, including the types of diets, the ratios of different dietary constituents, and the levels of industrialized components could affect the structure of gut microbiota, resulting in long-term impacts on brain health.
 
Effects of Different Diets. One type of diet may preserve brain health while another may contribute to the development of brain disorders.[26] Western dietary patterns and their components are consistently related to greater dementia risk,[27] as well as negative emotional and neurocognitive outcomes in children,[28] whereas Mediterranean diets have been shown to preserve brain health.[29] One study evaluated the macrolevel effect of dietary changes and food production sustainability across the world over 70 years and found correlations with microbiome changes and an increase in neurological and mental disorders.[30]
 
Recent studies help clarify how Western dietary patterns may have negative structural effects on the human brain, particularly in relation to the hippocampus. The hippocampus is a key brain region that is closely involved in learning and memory as well as brain health[31] and is where structural changes are observed in early stages of Alzheimer’s disease and other cognitive dementias.[32] This brain region is recently understood to be highly “plastic”[33] in response to environmental exposures including diet.[34] In observational studies, healthier diets are related to larger hippocampi and other brain volumes,[35] while unhealthy diets are closely associated with smaller hippocampi.[36] Indeed, emerging human experimental evidence suggests that Western dietary patterns can have negative effects on hippocampal-dependent learning and memory, as well as appetite control, within a very short time frame, even in healthy young adults.[37]
 
Additionally, ultra-processed and Western dietary patterns play a role in the prevalence, development, and symptom severity of mental disorders through various pathways, including inflammation, oxidative stress, reduction in neurogenesis and brain plasticity, and a disrupted microbiota-gut brain axis.[38] That is why the gut microbiome is increasingly recognized as a key factor unifying environmental and human health. There are extensive reciprocal associations between the gut microbiome and major homeostatic body systems including the nervous, endocrine, metabolic, and immune systems. Loss of diversity in the human gut microbiome owing to dietary intake is associated with worse health outcomes in cancer,[39] immune,[40] and metabolic diseases,[41] as well as emotional health in children[42] and depression and cognitive ability in aging.[43] Dysbiosis triggered by the environment can alter bacterial metabolites including metabolites that mimic human molecules.[44] As one example, the metabolite spermidine triggered by the state of gut dysbiosis is linked to cognitive dysfunction and autism spectrum disorder.[45]
 
In brief, the gut-brain axis, influenced by diet, plays an important role in brain health and disease. Western dietary patterns, which are associated with negative brain health outcomes, can impact the gut microbiome, disrupt homeostatic body systems, and impact brain structures, contributing to the prevalence and severity of these disorders.
 
In the next section, we will explore the toxins used in the production and packaging of ultra-processed foods.
 

Toxins in Food Production and Packaging Harm the Brain

Industrial farming practices, with intensive cropping and use of pesticides and artificial fertilizers, result in a substantial loss of microbial diversity in the soil and a loss of nutrients in both plant and animal foods.[46] These practices also result in the increase of endocrine disruptors — they are present in containers, foods, and farming materials and cause microbiome disruption and neurotoxicity.[47]
 
All of these have been implicated[48] in deleterious effects on gut microbiota and microbiome-host interactions:
 
  • Micro- and nanoplastics arising from packaging.
  • Insufficient micronutrients in foods arising from industrialized soil.
  • Antibiotics used in intensive livestock production.
  • Agricultural pesticides and persistent organic pollutants.
  • Advanced glycation end products,[49] artificial sugars, and emulsifiers in industrial foods.
The extensive evidence linking the health of the gut microbiome,[50] as well as industrialized foods, to mental and brain health across the life course points to the critical need to consider the health and biodiversity of the environment and humans as one — and to urgently improve global food systems.
 
Microplastics are released from food and drink packaging,[51] and there are multiple plastic packaging-associated chemicals that, because they are not covalently bonded to the polymer, leach from packaging.[52] Perinatal exposure to compounds used in the production of plastic food and drink containers and packages (e.g., BisphenolA), may disrupt stress-sensitive and endocrine systems that translate to anxious and depressive states along the life course.[53] Of 906 chemicals likely associated with plastic packaging, 63 have high hazard rankings,[54] although publicly available safety data often lacks transparency and completeness. Indeed, many chemicals that have been detected in food-contact materials have not been listed for this use.[55]
 
In addition, human exposure to air pollutants like nitrogen oxide and particulate matter alter the microbiome. Exposure during pregnancy to air pollutants and pesticides that cause microbiome disruption has been associated with higher risks of autism spectrum disorder in children.[56]
 
The next section outlines how the corporate-industrial food industry is undermining early childhood brain capital formation via the commercial milk formula industry and associated predatory marketing to pregnant women and mothers.
 

The Need to Re-Prioritize Breastfeeding Over Commercial Milk Formula

Formula is a type of ultra-processed food. Breastfeeding has clear advantages over commercial milk formulas and is critical and advantageous for healthy brain development.[57] Unfortunately, fewer than 50% of babies worldwide are breastfed as recommended by WHO, and a recent Lancet series suggests this in part is due to “underhand marketing strategies, designed to prey on parents’ fears and concerns, to turn the feeding of infants and young children into a multibillion-dollar business.”[58] Likewise, more work is needed to address the structural and social factors that shape societal preferences in favor of commercial milk formulas, despite many women and families wanting to continue to breastfeed (for example, non-existent or insufficient parental leave).[59] To this end, Smith et al. recently published the Mothers’ Milk Tool, a method to quantify the economic value of women’s milk production: It can and should be measured to ensure this contribution is visible and properly valued.[60]
 

Recommendations

Below we provide key recommendations to reduce the harmful effects of the corporate-industrial food industry on global brain capital.
 

Food System Public Policy Transformation

Current food policy frameworks and regulatory approaches typically reform or adjust isolated components of food systems (as well as sustaining the perceived benefits of competitive markets and other capitalist values and practices).[61] This means that existing approaches are likely insufficiently equipped to tackle the transformative food system changes needed to promote brain health and planetary health.[62] Instead, we need an ecological approach to regulation — one that calls for the reorientation of policymakers so they can consider the economic, environmental, and political dimensions within and between complex food systems and better deal with these important challenges.[63]
 
Policy Actions to Reduce Cardiometabolic Diseases. Comprehensive and multilevel policy actions have recently been put forward in the context of the ultra-processed food problem and cardiometabolic diseases.[64] These proposed policy actions may mutually benefit mental health conditions and neurological disorders that often co-occur with cardiometabolic diseases and may be plausibly transferred to diet-related chronic diseases in general. Proposed policy actions include:
 
  1. Targeting ultra-processed foods in dietary guidelines and policies.[65]
  2. Limiting the impact on policy development of the food industry with vested interests by instituting strong conflict of interest policies.[66]
  3. Developing food assistance programs to promote diets rich in unprocessed or minimally processed whole foods.[67]
  4. Requiring front-of-package labeling that warns against the health implications of ultra-processed foods, and implementing food labeling regulations that restrict claims on packaging that imbue products with “health halos.”[68]
  5. Setting public procurement criteria that limit the abundance and types of ultra-processed foods that are made available in public institutions.[69]
  6. Implementing fiscal policies like monetary support/subsidization for unprocessed or minimally processed whole foods, as well as taxation of industrial formulations that have little to no nutritional value and where better alternatives exist (e.g., sugar-sweetened beverages).[70]
  7. Implementing “zoning,” which refers to limiting the number of fast-food outlets near medical and educational institutions.[71]
Food Prescription Initiatives. A recent assessment[72] of over 6,000 public health food prescription initiatives suggests they improve fruit and vegetable consumption and reduce food insecurity. However, they typically lack the funding needed to foster long-term, sustainable change, and they often fail to track data that shows the relationship between increased produce consumption and improved health. Initiatives like the Montana Product Prescription Collaborative (MTPRx) are working to track the impact of such programs on blood sugar, lipids, and cholesterol.[73] Broadscale public policy engagement will be essential to increase the reach of these programs.
 
Need for Ongoing Evaluation of Food Policy. To respond to the rise of ultra-processed foods and related harms to brain health and planetary health, ongoing evaluation of food policy actions on ultra-processed food markets and ultra-processed and Western dietary patterns is required.[74] Examples of evaluations include assessments of synergies of food availability, choices, and consumption compared with the cost of agricultural crops, coupled with investigations into the effects of sugar-sweetened beverage taxes on consumption and sale trends.[75]
 
How to Focus Health Messaging and Conversations. Focusing health messages about food on brain health — using the gut as a concrete and accessible mechanism for understanding the myriad impacts of food — results in changes to dietary behaviors even in challenging populations, including young men and pregnant women.[76] Focusing public and clinical conversations on the concept of increasing diet quality to improve mental, brain, and gut health, rather than on weight loss, may yield improvements to dietary habits and choices — particularly when the potential for cost savings is emphasized.[77]
 
White House Strategy on Hunger, Nutrition, and Health. The new White House National Strategy on Hunger, Nutrition, and Health[78] will pursue action across five pillars:
 
  1. improving food access and affordability,
  2. integrating nutrition and health,
  3. empowering all consumers to make and have access to healthy choices,
  4. supporting physical activity for all, and
  5. enhancing nutrition and food security research.
Further research is required to reinforce the importance of brain capital development within this strategy.
 
Importance of School-Based Programs. It is important to continue to advance school-based nutrition, farming, and cooking programs. These programs are critical to educate the citizens of tomorrow and will likely prevent or mitigate the consumption of excessive amounts of ultra-processed foods later in life. A recent systematic review by Collado-Soler et al.[79] (reviewing 16 programs in kindergarten and primary education) found these programs had positive effects on improving knowledge and behaviors about healthy habits and, consequently, reducing body mass index. However, they noted major variability in results based on geography and the socio-economic status of families.
 
Commercial Determinants of Health. Studying the commercial determinants of health[80] is a new area of study in relation to the corporate-industrial food industry and its effects on the brain.[81] In this context, a recent Lancet paper noted the need to protect the diversified food systems of Brazil against corporate oligopolies.[82] Complex systems modelling and simulation also has an important role to play in understanding which combination of policies and initiatives would deliver the greatest improvements in the corporate-industrial food industry to better support brain capital.[83]
 

Promote Nutritional Brain Health Science, Clinical Care Innovation, and Public Health Policy

Evidence of Dietary Link to Depression. The field of nutritional psychiatry[84] is relatively young. The first studies linking diet quality to clinical psychiatric disorders were published in 2010,[85] and the first clinical trial to show that dietary improvement can reduce even severe major depressive disorder was published in 2017.[86] The field has grown rapidly since then with multiple meta-analyses linking diet quality to depression risk[87] and dietary treatments to reductions in depressive symptoms.[88] In addition, several more clinical trials confirming the utility of diet as a treatment strategy for clinical depression (e.g., the “AMMEND: A Mediterranean Diet in MEN with Depression” study [89]) have now been published.
 
Changes in Clinical Practice. This evidence base is being integrated into clinical practice, with the Royal Australian and New Zealand College of Psychiatrists’ clinical practice guidelines — for the first time — listing diet along with other lifestyle behaviors as foundational and non-negotiable treatment targets for mood disorders.[90] The first set of international clinical guidelines for lifestyle-focused care in mental health treatment[91] was published in the last two years.
 
More Work is Needed. Unhealthy diets are now recognized as a risk factor for mental health conditions by many global organizations including the World Health Organization.[92] However, the fact that two of the leading causes of global disease burden — Western dietary patterns and mental illness — are linked, and that these associations and effects appear to be independent of body weight, has not yet been widely recognized. Moreover, the potential to leverage public policy and changes to clinical practice to both prevent and treat mental disorders via changes to dietary intake has not, as yet, been fully explored.[93] Lessons may be learned from non-linear and practice-based modeling from actors in the community-based obesity prevention sphere.[94]
 

Defend Against Misinformation Driven by the Food Industry

A vast array of foods are marketed with misleading health claims. Junk food in the form of sugared beverages is routinely paired with sports and recreational activity, and spurious claims are made about the health benefits of ultra-processed foods. Many claims made on the packaging of commercial milk formulas are backed by little, or even no, supporting scientific evidence,[95] essentially making these products a major source of misinformation that affects parental decision-making about feeding infants or young children.[96] Under the Convention of the Rights of the Child, governments have a duty to tackle commercial milk formula-related misinformation — and they also need to fully implement provisions of the World Health Assembly’s International Code of Marketing of Breast-milk Substitutes and subsequent resolutions — to ensure that manufacturers making misleading claims about their products are held accountable.[97]
 

The Brain Health Field Must Engage In and Support a Legally Binding Global Plastics Treaty

We call on trusted professionals to use their privileged position in society to educate government leaders and policymakers about plastic’s clear and present dangers on the human brain and to demand sweeping changes in regulation and control of chemicals and plastics. The Global Plastics Treaty being negotiated in and around the United Nations Environment Assembly may be an ideal pathway for this effort.[98] We note the leading work of the Minderoo-Monaco Commission on Plastics and Human Health.[99]
 

Integration of Brain Health Metrics into Existing Food Monitoring Systems and Dashboard

Data-driven approaches to this topic are critical. We note a number of recent advances in brain health monitoring from the Brain Health Atlas,[100] Countdown Global Mental Health 2030,[101] and the Brain Capital Dashboard.[102]
 
A recent paper from Mozaffarian et al.[103] provides an overview of novel monitoring tools to encompass both food and nutrition security factors. Such a data-driven approach could be integrated with existing food and brain health monitoring approaches.
 
Initiatives to inform the Global Burden of Disease Study modelling, and support the estimation of the proportion of burden of mental disorder risk that could be averted by improving population dietary intakes, are currently underway.[104]
 

Incorporation of Brain Capital and Nutrition Metrics into Environment, Social and Governance (ESG) Assessments

Some observers believe the food and beverage industry, in particular, lags in environmental, social and governance (ESG)[105] rigor.[106] We argue that all ESG frameworks should include evidence-based nutrition and brain health metrics, and that the time is especially ripe for increased objectivity and accountability in the food industry. Lessons can be learned from the movement to insert human capital into ESG.[107]
 

Advance Planetary Health Science and Education Within the Field of Brain Health

Preparing for climate-related health repercussions requires educational institutions to disseminate planetary health knowledge in a systematic way. We support the broad review of Moloo et al. to evaluate the extent to which planetary health is included in undergraduate and postgraduate medical education to guide curricular development.[108] A plan to advance this type of education is prudent.
 

Emphasize the Need for Interdisciplinary Collaboration Between Nutritionists, Psychiatrists, Psychologists, Environmental Health, and Public Health Professionals

Advocacy for the integration of nutritional education in medical and mental health curricula will raise awareness of the connection between diet and mental health among professionals. Also, encouraging large-scale, longitudinal research and dietary intervention studies will help further establish the causal relationship between diet and mental he