Food & Your Mood Nutritional Psychology The Interplay between Nutrition, Mood, Brain, and Behavior

Goals for Today’s Talk Learn to use food to your advantage Create a positive influence on your own brain chemistry Live an energized lifestyle

Mental Health Statistics Depression: 6.7% of Americans have major depression and 1 in 10 Americans take antidepressants Anxiety: 18.1% of Americans have anxiety disorders

Standard American Diet (SAD) Image courtesy of digitalart / FreeDigitalPhotos.net

S.A.D. & Processed Foods 320,000 processed foods in market with 10,000 “new” processed foods per year introduced Technology made possible to manipulate foods’ sensory properties (e.g., sweeter, saltier, richer) “There appears to be no set point for the amount of fat or sugar people will eat” (Contento, 2007) Results 1 in 10 Americans meet basic food group recommendations By age 9, only 12% have good diets (same as adults) People now eat predominantly for pleasure, not nutritive value

Dietary Intake/Nutrient Depletion Can Imitate Mental Health Disorders Fatigue Anxiety Depression Irritability Poor mood Stress Intolerance Overeating, cravings Inability to sleep Neurotransmitter Depletion Nutrient Depletion: Fatigue Anxiety Depression Irritability Poor mood Stress Intolerance Overeating, cravings Inability to sleep Neurotransmitter Depletion

Western Diets vs. Traditional Diets Dietary Pattern and Depressive Symptoms During Middle Age (Akbaraly et al, 2009) Findings: Processed food dietary pattern risk factor for depression; Whole food diet is protective Association of Western & Traditional Diets with Depression & Anxiety in Women (Jacka et al. 2010) Findings: Traditional dietary patterns associated with lower risk for disorder; Western dietary patterns associated with higher odds for disorder

Western Diets vs. Traditional Diets Fast-Food and Commercial Baked Goods Consumption and the Risk of Depression (Sánchez-Villegas 2011) Findings: 1) Fast food and processed pastries were associated with a higher risk of depression; 2) Increased consumption led to 48% increase in risk of depression; 3)Trans fats implicated as a relevant risk factor for developing depression Association Between Dietary Patterns and Depressive Symptoms Over Time: A 10-Year Follow-Up Study of the GAZEL Cohort (Le Port et al. 2012) Western style - higher likelihood of depressive symptoms; Traditional style - lower likelihood of depressive symptoms

Nutrition, Inflammation, & Depression Processed foods are linked to higher rates of depression. Diets with foods that trigger inflammation (refined, processed foods) result in 29-41% greater risk for depression. Inflammation itself may mediate depressive symptoms As we already discussed, western dietary patterns, especially processed food diets, have been linked to higher rates of depression. Recent research coming out of Harvard School of Public Health (HSPH) has suggested that diets that include more foods that trigger inflammation—like sugar-sweetened or diet soft drinks, refined grains, red meat, and margarine—and fewer foods that prevent inflammation—like wine, coffee, olive oil, and green leafy and yellow vegetables—have a 29 to 41% greater risk of being diagnosed with depression than those who eat mostly the less inflammatory diet. The researchers concluded that chronic inflammation may underlie the association between diet and depression. In other words, western diets lead to increased inflammation and this increased inflammation leads to depression. Thus, inflammation may be the mediator of the depressive symptoms – the link between western diets and depression may not be as simple as the fact that these diets are void of many important nutrients. Instead, inflammation itself may lead to depression. Additionally, inflammation may be leading to the nutritional deficiencies as well – the inflamed gut cannot absorb nutrients needed for neurotransmitter production. Of course, if you are not consuming key nutrients, this is also going to be problematic and contribute to depression – but the inflammation may have a central role. The idea that depression is a disease of inflammation is novel, but one that is gaining interest in the field. The idea is – depression is definitely not a prozac deficiency, and may be not even a serotonin, dopamine, and norepinephrine deficiency, perhaps instead it is an inflammation issue at heart – inflammation causing deregulation in neurotransmitter production and brain function; inflammation causing issues with gut health and absorption of nutrients. In this way, inflammation may in fact be the root cause of depression. More research needs to be completed in this area – but if this premise continues to be supported by the research, new treatment approaches for depression that target inflammation can be developed.

How Does Food Affect Our Brain? The foods you eat can effect the chemical composition of your brain because the nutrients in foods are precursors to neurotransmitters. Neurotransmitters are chemical messengers that tell our body what to do and how to feel. Dopamine Serotonin Endorphins Choline (precursor to acetylcholine)

Serotonin A mood regulator SSRI’s increase amount of serotonin that is available Found in digestive tract, blood platelets, central nervous system. Helps produce a sense of calmness Helps decrease pain and appetite Low levels can increase aggression/irritability.

Amino Acids ->Neurotransmitters Catecholamine Dopamine, Norepinephrine, Epinephrine Tyrosene Tryptophan Serotonin

Serotonin Released or produced by carbohydrates Carbs stimulate insulin -> decreased blood levels of amino acids except tryptophan (usually competes with other amino acids) ->tryptophan has more bioavailability -> increased serotonin. If sad/stressed we crave carbs (comfort foods). (We don’t crave broccoli). There are a lot of serotonin receptors in the digestive tract as well (as much as 80% of serotonin is in the gut). This is why some people of SSRI’s initially have an upset stomach.

Note: this is NOT a good method to use to stabilize mood Serotonin and Diet TRP Result = Serotonin Note: this is NOT a good method to use to stabilize mood A Virtually all tryptophan that crosses the blood brain barrier is converted to serotonin. Serotonin concentration in the brain is very sensitive to the effects of diet. when someone eats a meal high in carbohydrates, insulin secretion is increased. Insulin facilitates the transport of the branch-chained amino acids into the cells of the body, which in turn reduces tryptophan’s competition (aka other amino acids) for the transporter that takes it across the blood-brain barrier. This is why there are ‘comfort foods’ – foods high in carbs, like ice cream and cookies – they help tryptophan get a straight shot into the brain and increase serotonin, giving you the effect of momentary happiness or ‘comfort’. However, these comfort foods only temporarily improve mood with a crash after. Additionally, abnormal insulin surges from constant blood sugar fluctuations alters the blood-brain barrier transporter and disrupts the ability to maintain ideal serotonin levels.

Serotonin Synthesis Fe2+, O2, + Vit C & B12

Serotonin & Vitamin D Serotonin is often lower in winter months Seasonal Affective Disorder (S.A.D.) Part of reason may be that Vitamin D increases Serotonin levels Sunlight helps body synthesize Vitamin D. In winter we go out less, wear more clothes, and therefore, get less sunlight.

Dopamine High levels improve mood, alertness and ability to cope with stress. Can improve overall mental health functioning. Low levels associated with higher levels of depression and other mental health disorders. Helps reduce pain awareness Drugs like cocaine and methamphetamine increase dopamine – have impact on the pleasure centers of the brain. Parkinson’s disease is a low level of dopamine. Parkinson’s is often associated with depression – not completely sure the role of dopamine in depression. Also plays a role in other mental disorders such as schizophrenia.

Dopamine Precursors to dopamine are found in things that have protein in them: Meat Milk Eggs Fish Beans Tofu

Choline A precursor to the neurotransmitter Acetylcholine. Acetylcholine is very important in memory. Alzheimer’s Disease: enzyme acetylcholinesterase breaks down acetylcholine. Aricept = acetylcholinesterase inhibitor Acetylcholine very important in memory and concentration.

Choline Part of the B vitamin complex Found in: Eggs Soy Wheat germ Broccoli Cabbage Cauliflower Chicken Beef Veal Liver

Blood Sugar Fluctuations in Blood Sugar can lead to fluctuations in Mood.

The Progression of U.S. Sugar Consumption Americans consume over 130 lbs of sugar per year Infographic from: http://www.mindbodygreen.com/0-5906/MindBlowing-Sugar-Consumption-Infographic.html

Sugar, Mental Health, & Cognition Sugar = a cascade of biochemical reactions that result in chronic inflammation in the body Inflammation = leads to system-wide disruption in biochemical processes, which results in many problems including cognitive problems and mental health disorders Robert Lustig, MD: fructose/sugar research Sugar: The Bitter Truth

Sugar, Mental Health, & Cognition Sugar associated with Schizophrenia and Depression (Peet ,2004) Results showed a higher national dietary intake of refined sugar predicted a worse 2-year outcome of schizophrenia and greater prevalence of depression .

Sugar Isn’t Just Empty Calories… Increased blood pressure Increased depression and anxiety Increased obesity < Memory/hippocampal structure Increased cholesterol Increased triglycerides Reduced learning ability Increased cardiovascular disease Metabolic syndrome in the brain Increased insulin resistance Increased inflammation Dental disease Cancer tumor growth Liver disease

Eat to Stabilize the Blood Sugar-Adrenal Axis: High Blood Sugar Range Stable Blood Sugar Range Low Blood Sugar Range

Omega 3 Fatty Acids Can not be manufactured by the body. Brain is more than 60% fat. Found in oily fish, nut oils, avocados, flax seeds, walnuts May help to reduce depression (protects against it) Helps to reduce inflammation Helps reduce heart disease

Omega-3 Fatty Acids The preponderance of epidemiologic and tissue compositional studies supports a protective effect of omega-3 EFA intake, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in mood disorders As I just reviewed- many researchers have found a strong association between western dietary patterns and rates of mental health disorders. Specifically, diets consisting of mainly processed food lead to increased risk of mental health disorders across the lifespan. Processed foods often are low in nutrient value and so nutrient deficiencies are likely contributing to the link between western processed food diets and mental health. Researchers have outlined a number of nutritional deficiencies that is highly associated with depression. These include but are not limited to B Vitamins, Omega-3 Fatty Acids, Magnesium, Vitamin D, Zinc, chromium, iron, selenium, and iodine. We don’t have time to review each of these micronutrient – and this list is not all-inclusive –but deficiencies in these along with a number of other micronutrients have been shown in research to be linked to mental health disorders. See the reference section for more information on this topic. Another very important topic when it comes to mental health and nutriton is gut health. There is so much we are finding out about the importance of our gut in our physical and mental health. The gut is implicated in immune function, neurotransmitter synthesis and function, inflammation, pain syndromes, and general brain health. We are also learning more and more about the connection of the microbiome (or the bacteria in our gut) and the brain. Notably, gut bacteria produce hundreds of neurochemicals that the brain uses to regulate basic physiological processes as well as mental processes such as learning, memory and mood. Additionally, our microbiome is essential for digestion, absorption, vitamin production, controlling growth of harmful microogranisms, and keeping the integrity of our intestinal cells. Suffice to say there is so much research coming out about this connection that in recent years the gut was named ‘the second brain.’ When the gut’s microbiome is disturbed, which happens due to a plethora of reasons, our brain suffers and often results in mood disturbance. Freeman, et al (2006), J Clinical Psychiatry 67:12.

Endorphins Endo = Endogenous (made in the body) Orphins = Morphine Produce a positive mood state Lower sensitivity to pain Help relieve stress & depression

Endorphins Exercise Body produces Endorphins with exercise. Is as good as medication for mood and mild pain for many people. Have to exercise daily because endorphins break down in the body in about 24 hours. 30 to 45 minutes per day. Exercise is also good for brain cell regeneration and increasing brain cell connections (cognitive functions). (As is socialization, so exercise with others for even more impact!).

Other Nutritional Factors & Mental Health Gut Health Implicated in: immune function, neurotransmitter synthesis and function, inflammation, pain syndromes, mental health, and general brain health Microbiome (gut bacteria) As I just reviewed- many researchers have found a strong association between western dietary patterns and rates of mental health disorders. Specifically, diets consisting of mainly processed food lead to increased risk of mental health disorders across the lifespan. Processed foods often are low in nutrient value and so nutrient deficiencies are likely contributing to the link between western processed food diets and mental health. Researchers have outlined a number of nutritional deficiencies that is highly associated with depression. These include but are not limited to B Vitamins, Omega-3 Fatty Acids, Magnesium, Vitamin D, Zinc, chromium, iron, selenium, and iodine. We don’t have time to review each of these micronutrient – and this list is not all-inclusive –but deficiencies in these along with a number of other micronutrients have been shown in research to be linked to mental health disorders. See the reference section for more information on this topic. Another very important topic when it comes to mental health and nutriton is gut health. There is so much we are finding out about the importance of our gut in our physical and mental health. The gut is implicated in immune function, neurotransmitter synthesis and function, inflammation, pain syndromes, and general brain health. We are also learning more and more about the connection of the microbiome (or the bacteria in our gut) and the brain. Notably, gut bacteria produce hundreds of neurochemicals that the brain uses to regulate basic physiological processes as well as mental processes such as learning, memory and mood. Additionally, our microbiome is essential for digestion, absorption, vitamin production, controlling growth of harmful microogranisms, and keeping the integrity of our intestinal cells. Suffice to say there is so much research coming out about this connection that in recent years the gut was named ‘the second brain.’ When the gut’s microbiome is disturbed, which happens due to a plethora of reasons, our brain suffers and often results in mood disturbance.

Other Nutritional Factors & Mental Health Gut Health (cont.) The 100 trillion microbes that make the GI tract their playground are critical to health. Gut bacteria regulate digestion and metabolism. They extract and make vitamins and other nutrients from food that you eat. They program the body's immune system. Gut bacteria also produce hundreds of neurochemicals that the brain uses to regulate basic physiological processes as well as mental processes such as learning, memory and mood. For example, gut bacteria manufacture 80 to 95 percent of the body's supply of serotonin, which influences both mood and GI activity. As I just reviewed- many researchers have found a strong association between western dietary patterns and rates of mental health disorders. Specifically, diets consisting of mainly processed food lead to increased risk of mental health disorders across the lifespan. Processed foods often are low in nutrient value and so nutrient deficiencies are likely contributing to the link between western processed food diets and mental health. Researchers have outlined a number of nutritional deficiencies that is highly associated with depression. These include but are not limited to B Vitamins, Omega-3 Fatty Acids, Magnesium, Vitamin D, Zinc, chromium, iron, selenium, and iodine. We don’t have time to review each of these micronutrient – and this list is not all-inclusive –but deficiencies in these along with a number of other micronutrients have been shown in research to be linked to mental health disorders. See the reference section for more information on this topic. Another very important topic when it comes to mental health and nutriton is gut health. There is so much we are finding out about the importance of our gut in our physical and mental health. The gut is implicated in immune function, neurotransmitter synthesis and function, inflammation, pain syndromes, and general brain health. We are also learning more and more about the connection of the microbiome (or the bacteria in our gut) and the brain. Notably, gut bacteria produce hundreds of neurochemicals that the brain uses to regulate basic physiological processes as well as mental processes such as learning, memory and mood. Additionally, our microbiome is essential for digestion, absorption, vitamin production, controlling growth of harmful microogranisms, and keeping the integrity of our intestinal cells. Suffice to say there is so much research coming out about this connection that in recent years the gut was named ‘the second brain.’ When the gut’s microbiome is disturbed, which happens due to a plethora of reasons, our brain suffers and often results in mood disturbance. Freeman, et al (2006), J Clinical Psychiatry 67:12.

Nutrition and Psychology Are linked Conclusion Nutrition and Psychology Are linked A healthy diet is associated with better mood and less depressive symptoms. A diet high in refined/processed foods is associated with increased risk of depressive symptoms and lower mood. Nutritional deficiencies lead to mental health disorders and cognitive impairment Sugar consumption has deleterious effects on mental, physical, and cognitive health

Without consuming right amount of nutrients – the cell cannot function Macro- and micronutrients are essential for cellular function, including brain cell function Without consuming right amount of nutrients – the cell cannot function Results in signs and symptoms of physical disease and mental health disorders The production of neurotransmitters does not happen in a vacuum We want to eat a balanced array of foods with an awareness of the balance of neurotransmitters we are trying to activate in our system. Diet, Exercise and Stress management are key to good physical and mental health

What Diet is optimal for brain health and mental health?

Out with the Bad; In with the Good Macronutrient Mood Therapy Out with the Bad; In with the Good Removal of dietary factors associated with mental health symptoms Sugar and simple carbohydrates Processed foods Trans fats Caffeine Replace with increased intake of: Protein Healthy fat Vegetables Complex/high nutrient carbs

This Presentation was adapted from presentations by: Amanda Hull, PhD Integrative Health and Wellness (IHW) Program Director, War Related Illness and Injury Study Center (WRIISC) Acting Patient Centered Care (PCC) Director, Washington DC VA Medical Center Nancy Hoffman, PsyD Kaiser Permanente Medical Center

References Carson, R. (2012). The Brain Fix. Deerfield Beach, FL: Health Communications, Inc. Ross, J. (2002). The Mood Cure. New York, NY: Penguin Books. Hedaya, R. (2008). Depression: Advancing the Treatment Paradigm. Gig Harbor, WA: The Institute for Functional Medicine. Kharrazian, D. (2013). Why Isn't My Brain Working? Carlsbad, CA: Elephant Press. Perlmuitter, D. (2013). Grain Brain. New York, NY: Little, Brown and Company. Gershon, M. (1998). The Second Brain. New York, NY: Harper. Carpenter, S. (2012). That Gut Feeling. The Monitor on Psychology, 43(8), 50- 58. Zell & Grundmann (2012). An Orthomolecular Approach to the Prevention and Treatment of Psychiatric Disorders. Advances, 26 (2), 14-25. Lakhan & Vieira (2008). Nutritional therapies for mental disorders. Nutrition Journal, 7 (2), 1-8.

Akbaraly et al. (2009). Dietary “pattern and depressive symptoms in middle age. Br J Psychiatry, 195(5), 408-413 Jack et al. (2010). Association of Western and traditional diets with depression and anxiety in women. Am J Psychatiry, 167(3), 305-311. Sánchez-Villegas et al. (2011) Fast-Food and Commercial Baked Goods Consumption and the Risk of Depression. Public Health Nutrition, 15(3), 424–432. Le Port et al. (2012). Association Between Dietary Patterns and Depressive Symptoms Over Time: A 10-Year Follow-Up Study of the GAZEL Cohort. Plos One. Popa T. & Ladea M. (2012). Nutritiona and depression at the forefront of progress. J Med Life. 5(4):,414–419. Peet, M. (2004). Sugar associated with Schizophrenia and Depression British Journal of Psychiatry, 184, 484-495

Pandya, C. , Howell, K. , Pillai, A. (2012) Pandya, C., Howell, K., Pillai, A.(2012). Antioxidants as potential therapeutics for neuropsychiatric disorders. Prog Neuro-Psychopharmacol Biol Psychiatry. Parletta, N., Milte, C. M., Meyer, B. J., (2013). Nutritional modulation of cognitive function and mental health. Journal of Nutritional Biochemistry. 24, 725-743. Peet, M. (2003). Eicosapentaenoic acid in the treatment of schizophrenia and depression: rationale and preliminary double blind clinical trial results. Prostaglandins Leukot Essent Fatty Acids. 69, 477-485 Peet, M. (2004). International variations in the outcome of schizophrenia and the prevalence of depression in relation to national dietary practices: an ecological analysis. British Journal of Psychiatry. 184, 404-408. van der Heijden, D., Tuinier, S., Sijben, A., Kahn, R., Verhoeven, W. (2005). Amino acids in schizophrenia: evidence for lower tryptophan availability during treatment with atypical antipsychotics? Journal of Neural Transmission. 112, 577-585. Young SN, Folate and depression--a neglected problem. (2007). J Psychiatry Neurosci. 32:80-82. Zell, M., Grundmann, O. (2012). An Orthomolecular Approach to the Prevention and Treatment of Psychiatric Disorders. ADVANCES. 26, 14-28.

McGuire, M. & Beerman, K. A. (2013). Nutritional Sciences, 3rd ed McGuire, M. & Beerman, K.A. (2013). Nutritional Sciences, 3rd ed. Belmont, CA: Wadsworth, Cengage Learning. Stanhope, K. L., Bremer, A.A., Medici, V., Nakajima, K., Ito, Y., Nakano, T., Chen, G., Fong, T. H., Lee, V., Menorca, R. I., Keim, N. L., Havel, P. J. (2011). Consumption of fructose and high fructose corn syrup increase postprandial triglycerides, LDL-cholesterol, and apolipoprotein-B in young men and women. J Clin Endocrinol Metab., 96(10), E1596-605. Cox, C. L., Stanhope, K.L., Schwarz, J. M., Graham, J. L, Hatcher, B., Griffen, S. C., Bremer, A. A., Berglund, L., McGahan, J. P., Havel, P. J., Keim, N. L. (2012). Consumption of fructose- sweetened beverages for 10 weeks reduces net fat oxidation and energy expenditure in overweight/obese men and women. Eur J Clin Nutr. 66(2), 201-8. Ying, H., Kimmelman, A. C., Lyssiotis, C. A., Hua, S., Chu, G. C., Fletcher-Sananikone, E., Locasale, J. W., Son, J., Zhang, H., Coloff, J. L., Yan, H., Wang, W., Chen, S., Viale, A., Zheng, H., Paik, J. H., Lim, C., Guimaraes, A. R., Martin, E. S., Chang, J., Hezel, A. F., Perry, S. R., Hu, J., Gan, B., Xiao, Y., Asara, J. M., Weissleder, R., Wang, Y. A., Chin, L., Cantley, L. C., DePinho, R. Ahmhy, (2012). Oncogenic Kras maintains pancreatic tumors through regulation of anabolic glucose metabolism. Cell. 149(3), 656-70. Burger K. S., Stice, E. (2012). Frequent ice cream consumption is associated with reduced striatal response to receipt of an ice cream-based milkshake. Am J Clin Nutr. 95(4), 810-7.

Johnson, R. K., Appel, L. J., Brands, M., Howard, B. V., Lefevre, M., Lustig, R.H., Sacks, F., Steffen, L. M., and Wylie-Rosett, J. (2009). Dietary Sugars Intake and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation.120, 1011-1020. Lustig, R. H. (2006). The ‘Skinny’ on Childhood Obesity: How Our Western Environment Starves Kids’ Brains. Pediatric Annals, 35(12), 899-907. Lustig, R. H., (2010). Fructose: Metabolic, Hedonic, and Societal Parallels with Ethanol. Journal of the American Dietetic Association, 110(9), 1307-1321. Nguyen, S., Hyon K. Choi, Lustig, R. H., & Hsu, C.Y., (2009). Sugar Sweetened Beverages, Serum Uric Acid, and Blood Pressure in Adolescents. J Pediatr. 154(6): 807–813. Lustig, R. H., Schmidt, L. A., & Brindis, C. D. (2012). The toxic truth about sugar. Nature, 482, 27–29 Chen, M., Su, T., Chen, Y. Hsu, J., Huang, K., Chang, W., Chen, T., Bai, Y. (2013). Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry, 13, 161.