By Rob Verkerk PhD, scientific and executive director

Each year while attending the Institute for Functional Medicine’s annual conference, my friend and colleague Mike Ash, founder of Nutri-Link, organises a dinner with a small group of UK and US attendees. This year, we ate at an Asian fusion restaurant in San Diego. I’ve come to find that my annual dinner discussions with Barb Schilz, an acclaimed US health coach, nutrition educator and consultant with over 45 years of experience, help to identify notable trends—good or bad—either side of the Atlantic.

This year, our conversation revolved around adolescents and young adults, both of us agreeing that the rising trend in mental health problems we were both witnessing in our professional and personal lives was of deep concern. We found the similarity of pattern we’d been witnessing, regardless of our respective geographies, to be startling, as well as deeply disturbing.

What’s your problem, kiddo?

We’re clearly not alone witnessing this. It appears that teenagers and young people are in crisis — at least in the Western countries with which we were most familiar. Mainstream medicine has few answers and more and more doctors, nurses and health workers are aware of their failure in delivering adequate support. Prescribed psychotropic drugs may also make matters worse for some young patients, and have especially been linked to increased risk of suicide.

Something similar was of course said about the youth of the ‘60s and ‘70s at the time—but today’s crisis is different in several important ways. The flower-power, hippy, illicit drug-fuelled era that anyone now in their mid-fifties or beyond either experienced or witnessed, was all about liberation, experimentation and reaching out to others. For many it was a brief phase in their lives. For a few, it spawned drug addiction, alcoholism or teenage pregnancy all of which have lifelong consequences.

Today’s youth haven’t dispensed of alcohol or drugs, but contemporary street drug use has brought with it a new range of problems as the drugs include more and newer active principles, with unpredictable effects (including death) and hugely variable quality. Mental health issues and street drug use are two issues that are increasingly entwined.

Emphasising the scale of the problem, UK data reveal that the death rate among teenagers taking illicit drugs is the highest since records begun in 1993.

Despite a great showing at this year’s Olympics, the UK tends to be less proud of its highest ranking teenage pregnancy rate. Research shows that sex education, rather than resolving the problem, may actually contribute to it. Other factors are undoubtedly involved, such as the increasing breakdown of familial structures, and in the UK at least, possible enticement through state benefits for single parent families.

But as Barb and I agreed, it’s really what’s going on inside the heads of today’s teenagers and young people that is of greatest concern. Geraldine Bedell, writing in the Independent (27 Feb, 2016), deduced “…rather than acting out, young people are turning in on themselves”. That process, based on emerging evidence, appears often to be associated with unprecedented levels of mental health problems, including depression and anxiety, self-harm, suicidal tendencies and an inability to cope with ‘normal’ daily challenges and activities.

Tentative teenage triggers

There is no scientific consensus as to what might be the triggers for the apparent changes in behaviour. So let’s hypothesise and consider some of the more plausible contributory factors. Here, I’m capturing some of the key ideas that Barb and I through across the dinner table last May.

• Impact of the digital era. Unlike any before it, the youth of today has grown up entirely in the digital era. Social lives are increasingly enacted through social media rather than face to face. Research by the Office of National Statistics in the UK shows that children who spend more than 3 hours a day on social media are more likely to suffer mental health problems. A new study has found that girls in particular are becoming increasingly unhappy in themselves and with their appearance which can readily be contrasted with digital images and depictions of others. Despite an 13-year-old age limit imposed by Facebook, increasing numbers of under-13s are engaging regularly with social media.

• Income inequalities contribute to mental health problems. In richer countries, those who have less have more mental health issues – these inequalities being made more apparent in the digital era

• It’s unsurprising that two people with a profound interest in nutrition would consider nutrition a key factor in mental health. But the level of processed foods, ultra-processed simple carbohydrates and unbalanced fats being consumed today is unparalleled in human history. Nutrition survey data from the UK show that young children consume especially small amounts of vegetables, oily fish and fibre. US science writer Gary Taubes in his 2011 book Why We Get Fat provides one of the most accessible accounts of what has gone wrong with the modern diet.

• Gut microbiome. It’s no secret that the 2 to 100 trillion bugs in our guts are increasingly unhappy and contributing to our expanding waistlines and unsettled guts. A new study led by scientists at the University of Minnesota now reveals that when monkeys are moved from the wild into captivity, their gut microbiome becomes less diverse and very much like our own, being accompanied with the same range of gastro-intestinal complications. What if our kids ate more veg and other plant foods and spent more time outdoors?

• Physical activity. Screen addiction promotes sedentary behaviours. While there aren’t enough studies to show categorically that increased physical activity improves cognitive and mental health in adolescents, it has certainly been shown to improve physical self-perception and esteem, itself a contributor to mental health issues.

• Sleep duration and quality. Young people have often found things to do at night time other than sleep. It’s estimated that the average teenager benefits from 8-9 hours of sleep a night but a 2006 US survey showed less than 20% achieve this, the problem being aggravated by the profusion of electronic devices.

Potential remedies

Given the above are hypotheses, there is no guaranteeing that addressing the above factors will make for perfectly balanced, rational, happy, dynamic and outward-looking youngsters. On the other hand, there is good evidence that each of these issues has some impact on mental health, and it makes sense then apply as many factors as practicable to maximise the chances of success. Dealing with six issues is also in reach for most people, and most families; a list of 20 factors might be less so for many.

• Reduce screen time. Joshua Becker, a writer who aims to inspire others to live more by owning less, suggests 12 invaluable tips to help parents.

• Encourage more real-time, face-to-face socialisation among children. The kids playground shouldn’t be the bedroom with accompanying gadgetry. We are social creatures and we benefit hugely from direct interactions with other humans. As parents, we need to encourage this process rather than treating technology as an acceptable child-management system

• Avoid nature-deficit disorder. It’s official – it has a name – and millions of our kids are suffering as a result of not spending enough time in nature. As Danielle Cohen of the Child Mind Institute explains, being in nature fosters imagination and creativity, teaches responsibility and helps kids be active. Most kids are dependent on adults to make this happen.

• Help kids be active, every day! Helping kids to be active every day is imperative. This won’t always be able to be in a natural setting. As schools have diminished the amount of time devoted to sport, it’s increasingly important that parents sign their kids up for after-school clubs that encourage physical activity.

• Feed your body and your gut microbiome. Government guidelines in the UK are pointing parents of young children towards 4 key food groups for their children, yet we know many of the problems kids suffer from develop through a lack of diversity of their diets. That’s why our own Food4Kids guidelines propose 8 food groups to be consumed every day. Print out our kids’ guidelines, as well as our adult Food4Health plate, and put them in a prominent position in your kitchen. We hope they serve as reminders of how to eat healthier and provide not only for the human cells of our bodies, but also those of our microbial counterparts.

• Sweet dreams. Avoiding TVs in bedrooms and ensuring screens are not accessed before (and after!) lights out to maintain good sleep hygiene practices is key. For kids who have difficulty sleeping, a herbal tea made with ashwagandha, fennel seed and valerian can be very helpful. Some will also benefit from taking an easily digestible vegetable (e.g. pea) protein shake (2g per kg body weight) along with 200 mg supplementary L-tryptophan shortly before bed.

We remain to be informed by scientific research exactly what is contributing to the apparent upsurge of mental health issues among so many young people, but don’t expect definitive answers any time soon given that the causes—as is so often the case—are likely to be multi-factorial. In the meantime, we sincerely hope that the above, inspired by a dinner conversation a few months back, might serve as a useful reminder of some of the things to prioritise as a means of helping to reduce the likelihood of mental health problems in older adolescents and young adults.

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