Nutrition and Mental Health Samantha Garrels, R.D., L.D. - PowerPoint PPT Presentation

Nutrition and Mental Health Samantha Garrels, R.D., L.D.

Objectives • Explore barriers to good nutrition • Identify nutrition and lifestyle changes to promote optimal mental and physical health

Making the Connection: Nutrition and Mental Health • Are we spending as much time thinking about the connection between nutrition and mental health as we are thinking about nutrition and physical health? • Food intake affects our mood due to nutrients influencing the production and release of hormones and neurotransmitters • Treatment approaches that incorporate a nutrition component may have better outcomes in treatment of mental illness

Statistics • Mental illness is associated with increased occurrence of chronic diseases • “Individuals living with serious mental illness face an increased risk of having chronic medical conditions. Adults in the US living with serious mental illness die on average 25 years earlier than others, largely due to treatable medical conditions.” – NAMI • “Research suggests that people who have depression and another medical illness tend to have more severe symptoms of both illnesses.” – NIH • “In people with Depression, scientists have found changes in the way several different systems in the body function, all of which can have an impact on physical health: signs of increased inflammation, changes in control of heart rate, abnormalities in stress hormones, metabolic changes typical of those seen in people at risk for diabetes” -NIH • Prevalence of mental health disorders has increased in developed countries in correlation with deterioration of the Western Diet • There are some common nutritional deficiencies that correlate with mental disorders

Neurotransmitters Serotonin | GABA | Dopamine Healthy Levels Deficient/Imbalanced • Emotional Stability • Sleep issues • Stable Sleep Cycle • Carb cravings • Low mood, irritability • Appetite Control • Difficulty relaxing • Relaxation • More prone to addiction • Pleasure and Reward • Trouble focusing

Neurotransmitters and Food • Tryptophan (EAA) • Stress • Glutamine (CEAA) • Sugar • Tyrosine (CEAA) • Processed grains • Caffeine • Drugs and alcohol

Nutrient Deficiencies

Magnesium • Role: • Cofactor in >300 enzyme systems (protein synthesis, muscle and nerve function, blood glucose control, blood pressure regulation) • Required for energy production • Contributes to structural development of bone • Required for synthesis of DNA, RNA • Role in active transport of calcium and potassium ions across cell membranes (nerve impulse conduction, muscle contraction, normal heart rhythm) • “Relaxation mineral”  body and mind Body contains ~25g mg, 50-60% present in bones, 38-39% in cells, <1% in blood serum

Causes of Mg Deficiency • Use of diuretics, antibiotics, PPIs • Low intake • Chronic stress • PPIs taken for >1yr  can cause hypomagnesemia • Excess alcohol, salt, coffee, sugar, cola consumption • FDA reviewed cases, supplements did not raise mg levels and pts had to discontinue • Alcohol: poor intake, vomiting, diarrhea, the PPI  recommended to measure mg steatorrhea, pancreatitis, renal dysfx levels prior to initiating and check • Excessive sweating, diarrhea, periodically menstruation • Type 2 Diabetes • GI diseases: diarrhea and malabsorption • Increased urinary mg loss • Crohn’s, Celiac • Resection or bypass of SI (ileum)

Signs of Mg Def • Loss of appetite • Anxiety, depression, insomnia, irritability, panic attacks • Nausea • Muscle cramps and twitches • Vomiting • Prolonged QT interval • Fatigue • Associated with: • Weakness • Insulin resistance • Numbness, tingling • Metabolic syndrome • Personality changes • HTN • Abnormal heart rhythms • Migraine headaches • Hypocalcemia or hypokalemia • Tetany: • Migraines, headaches • Muscle spasms and cramps, seizures, involuntary movements

Evaluation • Only 1% found in blood serum • Look for clinical risk factors • Chronic diarrhea • PPI therapy • Alcoholism • Diuretic use • Clinical Manifestations • Previous slide

Prevalence • Dietary surveys show intakes of Mg are lower than recommended amounts • NHANES 2005-2006: majority of Americans of all ages ingest less Mg than needed • Low levels found in ~12% of hospitalized patients • 60-65% of intensive care patients • One study of alcoholic pts admitted to hospital-30% prevalence • Reversible within 4 weeks of abstinence

RDA Age Male Female Pregnancy Lactation Birth-6mo 30mg 30mg • 7-12mo 75mg 75mg 1-3yrs 80mg 80mg 4-8yrs 130mg 130mg 9-13yrs 240mg 240mg 14-18yrs 410mg 360mg 400mg 360mg 19-30yrs 400mg 310mg 350mg 310mg 31-50yrs 420mg 320mg 360mg 320mg 51+yrs 420mg 320mg

Food Sources Food Mg/serving Percent DV 1oz almonds 80 20 1/2c boiled spinach 78 20 1oz cashews 74 19 1/4c peanuts 63 16 1c soymilk 61 15 1/2c black beans 60 15 1/2c cooked edamame 50 13 2T Peanut Butter 49 12 2slc WW Bread 46 12 1c Avocado 44 11 1 baked potato, with skin 43 11 8oz plain yogurt 42 11 1packet instant oatmeal 36 9

Vitamin D (D3-Cholecalciferol) Role: • Fat-soluble vitamin • Produced when UV rays from sun hit the skin • Promotes calcium absorption in gut “Suggested that 5 -30 minutes of sun exposure • Maintains bone density between 10am-3pm 2x/week to face, arms, • Cell growth legs, or back without sunscreen usually lead to sufficient vitamin D synthesis” • Neuromuscular and immune function -NIH • Reduction of inflammation

Causes of Deficiency • Limited sun exposure • Age: older adults’ skin cannot synthesize vitamin D as efficiently, likely to spend • Season, time of day, length of day, cloud more time indoors cover, smog, skin melanin content, sunscreen • Dark skin: greater amounts of melanin • Complete cloud cover reduces UV energy by 50%, shade by 60% reduce skin’s ability to produce vitamin D • UVB radiation does not penetrate glass from sunlight • Sunscreens with SPF of 8+ appear to block • Obesity: BMI >/= 30 associated with vitamin D-producing UV rays lower levels • Impaired absorption/use • Greater amounts of subcutaneous fat alter • Kidneys cannot convert to active form release into circulation • Absorption in digestive tract inadequate-fat- soluble vitamin (liver disease, cystic fibrosis, celiac disease, Crohn’s disease, ulcerative colitis with inflammation)

Signs of Deficiency • Rickets (children) • Fibromyalgia • Osteomalacia (adults) • Depression • Chronic low back pain • Fatigue

Evaluation • 2011 Endocrine Society: desirable serum concentration of 25(OH)D is >75nmol/L • Serum 25-Hydroxyvitamin D Concentrations and Health (NIH) Nmol/L Ng/mL Health Status <30 <12 Associated with deficiency, leading to rickets in infants and children and osteomalacia in adults 30 to <50 12 to <20 Generally considered inadequate for bone and overall health in healthy individuals >/= 50 >/=20 Generally considered adequate for bone and overall health in healthy individuals >125 >50 Emerging evidence links potential adverse effects to such high levels, particularly >150nmol/L (>60ng/mL)

RDA Age Male Female Pregnancy Lactaion 0-12mo 400IU 400IU 1-13yrs 600IU 600IU 14-18yrs 600IU 600IU 600IU 600IU 19-50yrs 600IU 600IU 600IU 600IU 51-70yrs 600IU 600IU >70yrs 800IU 800IU

Food Sources • Very few foods have vitamin D, flesh of fatty fish (salmon, tuna, mackerel) and fish liver oils are best sources • Milk is fortified with 100IU/cup (began in 1930’s to combat rickets) Food IUs/serving Percent DV 1T cod liver oil 1360 340 3oz cooked swordfish 566 142 3oz cooked sockeye salmon 447 112 3oz canned tuna 154 39 2 canned sardines 46 12 1 large egg 41 10

Supplementation • American Academy of Pediatrics: • Exclusively and partially breastfed infants receive supplements of 400IU/day of vitamin D after birth until weaned and consume >/= 32oz/day of vitamin D-fortified formula or whole milk • Older children and adolescents who do not get 600IU/day through fortified milk and foods: 600IU supplement daily • D3: 1500-2000IU/day of supplemental vitamin D in adults • D3 in active form (cholecalciferol), more potent than D2 • Deficiencies may require more  medical supervision of 5000-10,000IU or 50,000IU • Monitor status • Give time to “fill your tank” (can take up to 6 -10 months to optimize)

Omega- 3’s Role Deficiency • Components of cell • Imbalance of O6:O3 membrane structure • Inadequate intake • Anti-inflammatory • Development and function of the brain, CNS

Types of Omega-3 • DHA (Docosahexaenoic acid) • What’s the problem? • EPA (Eicosapentaenoic acid) • Optimal ratio of Omega 6: • Found in cold-water fish Omega3 is 1:1-4:1 (salmon, mackerel, halibut, • SAD is 10:1-25:1 sardines, tuna, herring) • ALA (Alpha-linolenic acid) • Flax, walnuts, chia seeds

Good Fats equal Good Mood? • EPA plus DHA may improve depression • Epidemiological studies indicate an association between depression and low dietary intake of O3 • Biochemical studies have shown reduced levels of O3 in red blood cell membranes in both depressive and schizophrenic patients • Review of 15 trials involving 916 participants • Supplements with at least 60% EPA improved depression symptoms