OCD has been classified by the World Health Organisation (WHO) as one of the top ten mental health disorders negatively affecting quality of life1. It involves persistent, unwanted thoughts and compulsions that disrupt daily life and create challenges in relationships.OCD can present as either obsessions or compulsions and sometimes both2. Obsessions are the persistent, repetitive, intrusive, and unwanted thoughts while compulsions are the repetitive behaviours and rituals performed to make the individual feel better. Compulsions are, however, not helpful as they only provide short term relief before the anxious thoughts begin again, thereby keeping affected individuals in a vicious cycle.
OCD, once thought to be rare, is now more prevalent. It is currently estimated that 1% to 2% of the UK population have OCD2 and it can occur in any age group regardless of the gender, ethnicity, social and economic circumstances3. The risk of OCD is, however, higher in women than in men4.
Though the cause of OCD remains uncertain, there are factors that have been attributed to its incidence. There is an increased risk for individuals with a family history of OCD due to genetic factors5,6. Environmental, behavioural, and cognitive factors also contribute to the cause of OCD. These include past trauma, neglect, emotional and sexual abuse, parental influence7,8. Substance abuse, history of phobia and loss of employment can also contribute to the occurrence of OCD in some people9.
Persistent, unwanted thoughts that cause distress and the compulsive behaviours used to reduce anxiety sit at the core of OCD. There are many forms of OCD, each triggered by fears or concerns about things or people that matter deeply to the individual. For example, excessive washing and cleaning can stem from a fear of contamination. Table below shows OCD themes as well as related obsessions, and compulsions.
Theme | Obsession | Compulsion |
Contamination | Fear of germs and dirt | Excessive showering, washing, and cleaning |
Harm | Harm-related fears and concerns | Constant checking |
Symmetry | Concerns about disorder | Straightening, ordering, counting |
Intrusive thoughts | Fears concerning religion, relationships, sexuality | Ruminations |
Cognitive Behaviour Therapy (CBT) is the recommended treatment option for people with OCD, in conjunction with selective serotonin reuptake inhibitors (SSRIs) in severe cases2. However, nutrition has been observed to play a significant role in OCD outcomes.
The Western diet, high in sugar and processed foods, does not contain adequate nutrition required to manage OCD and support individuals experiencing symptoms. Research has shown that nutritional deficiencies are present in patients with mental disorders such as OCD10. It has also been observed that specific nutrients have reduced patients’ symptoms effectively11. It is important however, to consult your GP if you are experiencing OCD to discuss further, before taking any supplements.
Patients with OCD have been observed to have low levels of Vitamin B1212. Vitamin B12 is essential for brain health because it helps metabolise homocysteine, a compound that can increase the risk of certain mental health conditions when elevated, including those linked to serotonin and dopamine13. These neurotransmitters are important to prevent anxiety, depression and stress which are all indicators of OCD. There is an inverse relationship between homocysteine and Vitamin B12 in that homocysteine levels rise as the Vitamin B12 levels drop. Studies have shown that patients with OCD have high levels of homocysteine and low levels of Vitamin B12 in comparison to healthy individuals14. It is also possible that OCD is an early manifestation of Vitamin B12 deficiency13.
Individuals following a vegan diet are most at the risk of Vitamin B12 deficiency as the richest sources of Vitamin B12 are of animal origin15. However, foods fortified with Vitamin B12 should meet requirements where there have been no previous deficiencies.
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Prebiotics and probiotics have been found to be beneficial to gut health by increasing the “good” bacteria in the gut16. These bacteria are also involved in the production of Vitamin B12. Healthy gut flora will increase the production and absorption of Vitamin B12. The disruption in the gut microbiome is shown to have an impact of the mental health due to the gut-brain axis. This refers to the connection between the gut and the brain through a network of nerves and neuron pathways17. Studies undertaken record an improvement in OCD symptoms with the introduction of prebiotics and probiotics17.
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Omega-3 fatty acids are a type of essential fatty acids which can only be obtained from the diet because our bodies cannot produce it18. There are three types of omega-3 fatty acids namely, Alpha-linolenic acid (ALA), Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA). EPA and DHA especially, have been seen to be beneficial to mental health19.
Fatty acids are present in the brain and are useful to regulate communication between the brain and neurons especially with brain processes that control mood20. Studies have shown that the combination of polyphenols and omega-3 fatty acids increase the availability of omega-3 due to anti-oxidative properties of polyphenols21. Polyphenols are found in red wine, tea, dark chocolate, fruits and vegetables.
Though there is insufficient evidence to support the recommendation of omega-3 fatty acid supplementation20, some research has shown an association between omega-3 intake with the alleviation of symptoms22.
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Researched by: Enitan Femi-Obasan, BSc Dietetics London Metropolitan University
