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Jodi Bjurman, RD, CDE Outpatient Dietitian El Camino Hospital

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2 Jodi Bjurman, RD, CDE Outpatient Dietitian El Camino Hospital
Can Food Affect My Mood? Jodi Bjurman, RD, CDE Outpatient Dietitian El Camino Hospital Thank you, ________ for inviting me to speak to you today. It’s great that you were able to use El Camino Hospital’s speakers bureau. We are a community hospital, and want to do what we can to work with others to keep the community healthy. One of the ways we do this is by sharing our knowledge and expertise with groups such as yourselves. Our goal is to be a hospital that provides not only the best possible health care, but resources to keep you at your best. So, on behalf on El Camino Hospital, I welcome each of you and thank you for coming. To begin, I have a story to tell you…

3 There once was a speaker who was asked to give a presentation on a healthcare-related topic. She chose to illustrate her overall message by putting in front of the audience 4 jars – one filled with alcohol, one with cigarette smoke, one with chocolate, and one with rich top soil. She then proceeded to drop an earthworm into each jar. At the end of her talk, she closed by saying: “The worm in the alcohol is dead. The one in the smoke-filled jar is dead, and the one in the chocolate is dead. The worm in the rich top soil is very much alive and well. So, what do you think this means?”, she asked her audience. A person in the back row raised their hand and said, “Your message is very clear! IF WE DRINK, SMOKE, AND EAT CHOCOLATE……WE WON’T HAVE ANY WORMS.” So, at the risk of my communications bouncing off of each of you in a very different way, let’s get started. Back to the questions at hand…Can Food Affect My Mood?

4 The answer is… Yes! Ground rules Every BODY is different
Chronic disease complicates the issue Not an endorsement for supplements Body chemistry is very complicated YES! As you can see, this guy probably washed down his Fruit Loops with a cup of strong coffee! Ground rules – 1. Differences: certain foods that send one person into a state of euphoria may do absolutely nothing for another person. One person may be very sensitive to even slight changes in body chemistry, while another appears to remain rock steady, unaffected by changing situations. 2. Chronic disease: examples – diabetes, auto-immune conditions, GI troubles, any medical condition requiring long-term medication. 3. Supplements: certain nutrients play a role in maintaining emotional and mental health. But, this seminar is not intended to be an endorsement for popping doses of individual nutrients. There may be situations where certain types of supplements are appropriate, but individual situations must be carefully reviewed to avoid upsetting delicate balances within the body. 4. This is a complicated topic – what I share with you today is just the tip of the iceberg. Researchers are continuing to find links between food and mood. Your nervous system is an orchestration of a vast number of the cells and chemicals that determine memory, emotions, your ability to solve problems, your personality, and even your food preferences.

5 Next Key Questions HOW does food influence mood?
What does this mean to me personally? Can I learn dietary strategies to break bad cycles?

6 Can Food Affect My Mood? INSTRUCTIONAL GOAL:
The participant will be able to enjoy a sustained sense of health and well-being by purposefully selecting appropriate foods and eating patterns.

7 Can Food Affect My Mood? Objectives: At the end of this seminar, you will be able to… 1. Describe at least 2 ways that food can change brain chemistry. 2. Name the most important factors in maintaining brain power and energy. 3. Design an eating strategy for subduing food cravings.

8 Digestion Food goes in Food is stored, mixed, emptied
Food is digested and absorbed The whole digestions process starts even before a bite of food passes the lips. Your body already knows that food is coming, just from smells, sight, and thoughts about it. If I had you think about chewing on a slice of tart lemon, your mouth would probably begin to salivate. The brain tell the glands in your mouth to respond, and they start secreting enzymes to break down your food. Your stomach even begins to pump out stomach acid to prepare for eating. The vagus nerve is the major communication nerve between the brain and the stomach. [Science: Cephalic phase - This phase occurs before food enters the stomach and involves preparation of the body for eating and digestion. Sight and thought stimulate the cerebral cortex. Taste and smell stimulus is sent to the hypothalamus and medulla oblongata. After this it is routed through the vagus nerve.] Food is excreted

9 Nutrition Basics: The Breakdown of Nutrients
Simple sugars are quickly absorbed Glucose is sent to the liver, used for energy or transformed into fat Complex carbohydrate digest more slowly Gradually become glucose Protein is broken down into amino acids Sent to the liver, then on to support muscles, or changed into glucose for energy, and then to fat for storage Fat is absorbed slowly as fatty acids Absorption requires very little digestive energy A quick review – 1.) Simple sugars enter the bloodstream within minutes as glucose… 2.) Complex carbohydrate becomes glucose in a more gradual manner, entering the bloodstream within 15 to 30 minutes of ingestion, and delivering energy for about 2 hours. 3.) Energy delivery from protein is a even more gradual. The amino acids are first sent to the liver to be available for repair and maintenance of body tissues. If there is not enough carbohydrate available for energy, or if the amino acids are not needed for maintenance, then the liver converts the amino acids into glucose and then into fat. Digestion, absorption and processing of protein requires a lot of work, and up to about 30% of its potential energy is burned along the way. 4.) Fat on the other hand is absorbed without hardly any effort. That’s why high-fat diets tend to promote a greater increase in body fat. Fat is slowly absorbed and therefore adds to meal satisfaction, allowing you to feel comfortably full after eating for 4-5 hours or longer.

10 From the gut to the brain
Blood brain barrier Nutrients absorbed into blood stream Carried to brain Cross blood brain barrier Used to activate or create neurotransmitters Neurotransmitters affect brain function Brain function affects mood (Review slide) Neurotransmitters –chemicals that relay messages to other nerve cells. So, what you eat directly affects these neurotransmitters, which in turn influences your moods, energy level, food cravings, stress levels, and sleep habits.

11 Neuron Here is a schematic of a nerve cell, called a neuron. The neurotransmitter chemicals are stored in tiny sacs at the end of nerve cells. They are released from one neuron and enter the terminal of another, where they are then are broken down and reabsorbed. “Every dip or rise in mood, every hunger pang, every thought, every response is orchestrated by these nerve cells and their neurotransmitters.” We are all born with a genetically-determined “neurotransmitter profile”. Some people love fat, some starches, some sweets. We can’t change the preferences that our genes dictate, but we can coax our bodies, through some simple dietary and lifestyle changes, to find healthful foods appealing and to maintain moderation when it comes to eating.

12 Chemicals that influence eating – to name a few
Where? Influence? Cholecystokinin GI tract  food intake Neuropeptide Y Hypothalamus  carb intake Insulin Pancreas Glucagon Cortisol Adrenal glands  fat intake Progesterone + Estrogen Ovaries  food intake Serotonin Brain Low -  carb intake; High -  carb intake Dopamine Inhibits appetite Norepinephrine  intake of sweets Brain chemicals, the ones highlighted in yellow, are not the only ones that influence eating. A host of other chemicals are secreted from the GI tract, the brain, the pancreas, the adrenal glands, fat tissue, ovaries, and testes. Here are just a few examples. The quality of your dietary intake affects activity levels of neurotransmitters: Eat too much or not enough protein, fats or carbs, results in neurotransmitter imbalance that can contribute to cravings, irritability, mood swings, thinking problems. Certain vitamins and minerals play key roles in body processes as well, so deficiencies can also impact your moods. serotonin, dopamine, norepinephrine (and one other, not listed here, acetylcholine) are diet-made chemicals. Lets take a look at specifically how your diet changed your mood by influencing these. Adapted from Food and Mood by Elizabeth Somer, 2nd Edition

13 Serotonin Carb rich snack
Serotonin levels rise and mood improves, carb cravings subside Insulin secreted Blood levels of amino acids (except tryptophan) drop Tryptophan converts to serotonin Serotonin – neurotransmitter made from AA tryptophan Of all the neurotransmitters, serotonin is the one most strongly linked to diet High levels boost mood with a calming and relaxing effect, curb appetite, increase pain tolerance, help sleep Low levels = insomnia, depression, cravings, aggressiveness, poor temperature regulation, increased sensitivity to pain Important nutrients in this process are Vit B6, B12, and folic acid. As your vitamin intake fluctuates between optimal and deficient, serotonin levels follow. Here’s how is works: After carbohydrate is eaten and absorbed into the blood as glucose, insulin is secreted. This is the hormone that facilitates getting glucose out of the blood and into the cells. Insulin also lowers blood levels of almost all AA, with the exception of tryptophan. Tryptophan happens to be a rather large amino acid that shares an entry gate into the brain with several other amino acids, so the action of insulin eliminates this competition. The brain converts tryptophan into serotonin. Moods change with the rise and fall of tryptophan in the blood. Raising blood levels of tryptophan always increases the manufacture of serotonin in the brain. Remember that if much protein is present, tryptophan can’t get into the brain as easily. Dieters, obese people, carb cravers often have low serotonin levels than lean people or people who prefer protein-rich snacks Tryptophan high in blood, readily enters brain Adapted from Food and Mood by Elizabeth Somer, 2nd Edition

14 Serotonin Eat protein-rich meal/snack
Blood levels of amino acids rise (including tryptophan) Person feels depressed, irritable, craves carbs Amino acids compete for entry to brain Very little serotonin is made Eat a protein-rich snack or meal Blood levels of all AA rise (including tryptophan) AAs compete for entry Very little tryptophan gets in Only moderate amounts of serotonin are made and stored Person feels depressed, irritable, and/or craves a carb-rich snack Very little tryptophan gets in Adapted from Food and Mood by Elizabeth Somer, 2nd Edition

15 Dopamine/Norepinephrine
Protein-rich snack A person feels more energetic and clear-headed Levels of tyrosine in blood increases Dopamine converted to norepinephrine via Vit C Levels of tyrosine in brain increase Dopamine and norepinephrine are made from tyrosine with the help of folic acid, magnesium, and Vit B12. Levels drop = depression, irritable, moody. These neurotransmitters help you to feel alert, cope with stress, and enjoy better mental functioning. Tyrosine levels rise in blood when a person consumes pure tyrosine, or to a lesser degree, a protein-rich food. Brain levels will rise only if more tyrosine is needed by nerve cells. In other words, if you are already thinking clearly, eating even more protein doesn’t benefit you. The same process that lowers tryptophan levels (as seen with serotonin) – high levels of competing AAs and no insulin – are the very processes that favor tyrosine. Consequently, tyrosine and tryptophan compete for entrance into the brain. Seesaw relationship has affect on appetite. If you eat carbs at breakfast, will tend to crave protein at lunch. Tyrosine increases conversion of Dopa to Dopamine Adapted from Food and Mood by Elizabeth Somer, 2nd Edition

16 Acetylcholine Choline from diet or supplement
Thinking and memory improve The brain makes acetylcholine Blood choline levels rise The link between food and mood is simple with acetylcholine. Choline is a fat-like substance that is a water-soluble member of the B-complex family. It has no competitors, so the more you consume, the more it enters the brain. Benefits: memory, general mental functioning. People flunk memory tests when they are given a drug that blocks acetylcholine levels. Sources of choline: wheat germ, whole eggs, beef, navy beans, tofu, peanut butter, lecithin or choline supplements Brain choline levels rise Adapted from Food and Mood by Elizabeth Somer, 2nd Edition

17 Hypothalamus The hypothalamus produces a fighting force of nerve chemicals that are important for survival. This is the appetite-control center of your brain. These include NPY (neuropeptide Y), galanin, and endorphins.

18 Neuropeptide Y (NPY) Glycogen stores are low NPY levels drop
Desire for carbs increases and carbohydrate is eaten Blood-sugar levels drop NPY ensures that we will not stop fueling our brain with glucose. (Review slide) When glucose stores even in the liver start to be depleted, such as after an over-night fast, the body knows that it will not be able to maintain glucose levels in the normal range much longer… Quick weight-loss diet works against you – sends NPY levels soaring Stress also triggers NPY production – stress hormone corticosterone from adrenal gland triggers it Brain register low blood sugar and sends message to hypothalamus Hypothalamus releases NPY Adapted from Food and Mood by Elizabeth Somer, 2nd Edition

19 A person desires and consumes fatty foods
Galanin Person follows restrictive diet or woman’s estrogen levels rise during menstruation or pregnancy Galanin levels drop Galanin is released from the hypothalamus Galanin increases a desire for fat. Galanin levels naturally rise as the day progresses; lowest in the morning and highest from afternoon to bedtime. Released by the breakdown of body fat (occurs during dieting or when several hours have passed between meals) free fatty acids released into the blood travel to the hypothalamus trigger release of galanin Rises when estrogen levels are high, during strict diets or quick weight loss, during stress because of cortisol (stress hormone), and when insulin levels are elevated. It is also possible that endorphins also turn on galanin - Late night cravings are most common when you skip meals or eat too many sugary foods throughout the day. Dopamine (remember the effect of protein) turns it off A person desires and consumes fatty foods Adapted from Food and Mood by Elizabeth Somer, 2nd Edition

20 Mood Foods from YOU: On a Diet (Roizen/Oz, 2006)
If Your Reach For… You May Be Feeling… Hard or crunchy foods Sugars Sweet and creamy foods Salty foods Bulky, fill-you-up foods Anything and everything Angry Depressed Anxious Stressed Lonely, sexually frustrated Jealous Researchers studied the diets of people to show how personality and foods come together. They looked at how the characteristics of certain foods become more appealing, depending on the direction of our mood. The theory of these studies was that moods send specific signals. This is MOOD affecting FOOD. For example, stressed adrenal glands could be sending salt-craving signals.

21 Carbohydrates and Mood
Increase serotonin levels People feel “happier”, “calm”, and “satisfied” Turn on endorphins Sugar touches your tongue, endorphins are released Basic instinct to crave sweets Warning: impact on blood sugars Let’s review carbohydrate digestion: Carbs broken down into sugar Sugar absorbed into blood stream Insulin levels rise (in healthy individuals) – food intake decreases 97% of women, 68% of men occasionally find it hard to say no to carb-rich snack A desire for sweets is hard-wired into the brain. Neurotransmitters are housed in central region of brain that also regulates reproduction and communicate closely with other brain centers that control emotions. Our food preferences, desires, cravings, are literally hardwired into our basic-instincts for survival, safety, and love.

22 Protein and Mood Essential for normal development of nerve system
Many neurotransmitters are composed of amino acids or choline (fat-like substance) Consume too little Body limits neurotransmitter production Person experiences changes in mood, appetite, and thinking Amino acids supply the building blocks for cells, including neurotransmitters Tryptophan – serotonin Tyrosine - dopamine, norepinephrine Histadine – histamine (allergy meds) Threonine is building block for nerve chemical glycine (processes motor and senory function that allows us to move, see)

23 Fat and Mood Increases transit time through the GI tract
Helps initiate feelings of fullness Cholecystokinin secreted when bowel senses fat, closes pylorus, stomach fills, hunger suppressed Enhances flavors, aromas, textures Craving sweets or salt? Probably craving fat too… Omega-3 fatty acids linked to mood enhancement Survival instincts drive desire for fat (Review slide points 1 and 2) Fat enhances food: Fat can confuse your cravings. You may think you just want sugar or salt. Sugar masks the fat in food. As the sugar content increases, the perception of fat decreases. Commercial cake frosting is too sweet for most adults (70% sugar, 15-20% fat), until increase fat content to 25% or more. Sweet-and-creamy is the desired combo: fat makes the food desirable, and sugar makes is invisible. Take chocolate for example! About 50% of the brain is fat, and much of this fat is a type of highly unsaturated fat such as omega-3 fatty acids. One omega-3, DHA (docosa-hexanoic acid) is an important component of cell membranes. It works to help brain cells easily transport nutrients into the cell and quickly remove debris and waste products. The catch is that DHA is only obtained through the diet, and our diets are typically lacking in this fat. Deficits in omega-3 fa, have been linked to mood disorders. Fat is the long-term storage fuel. Severe dieting lowers body fat stores too rapidly, turns on fat cravings via falling leptin levels. Both sweets and fats are suspected to release endorphins and produce a natural euphoric feeling. Some people become addicted to sweetened fats because of this.

24 Micronutrients Key in the development of the nervous system
Essential for neurotransmitters Assist with manufacture of neurotransmitters Aid in neurotransmitter activity Protect them from damage Over- and under- consumption have negative consequences Can contribute to depression, irritability, food cravings, mood swings, and thinking problems Vitamins and minerals are either part of the manufacturing process for neurotransmitters, or aid in their activity, or protect them from damage…

25 Pit falls to avoid Caffeine Skipping meals or strict dieting Sugar
Processed foods High intake of saturated fat Ignoring the signs Being sedentary 1. Caffeine provides a temporary elevation in energy and mood – especially when combined with sugar. But what comes up must come down (energy crash). Limit to mg per day (2-3 cups of coffee or 4-5 cans of soda). 2. Erratic eating habits such as dieting, starvation, or bingeing send many appetite control chemicals into a tailspin. If you are going to diet your significantly for weight loss, avoid chemical imbalances by making changes gradually, maybe even over a year’s time. This will avoid the yo-yo rebounds that are so common. 3. Sugar – remember that sugar is naturally found in fruits, vegetables, milk and grains. Keep added sugar to 10% of calories, or will crowd out room, calories-wise, for the nutrient-dense foods. Too many sweets leads to too many calories – eat more sugar, want more sugar. Have nutritious foods too, calories are too high. 4. Processed foods - Food additives, like MSG for example, can influence brain activity (block neurotransmitters, change their structure, increase or decrease their output). 5. Diets high in saturated fat lead to less sensitivity to CCK, so you do not feel as full as you should after eating a steak. 6. Ignoring: You know yourself better than anyone else. People often ignore subtle red flags, times when they just feel “under the weather”, but not bad enough to seek medical attention. Since the food-mood connection is immediate, why not pay a little more attention to your eating habits, so that you can feel the best you can?

26 Brain Power Confused? Brain fog? Unfocused? Poor memory?
So now, lets consider a few strategies. Is this a common condition for you?

27 Brain Power Clear thinking Focused Alert Quick problem-solving
Isn’t this the way we would like to be?

28 Fueling the Brain Check your diet before blaming your age.
Eat breakfast. Include protein in your midday meal. Don’t forget Omega-3s. Protect brain tissue with lots of antioxidants. Promote maximum brain function with daily vitamins and minerals. 1. If you feel well, that doesn’t necessarily mean that you are thinking as well as you can. (memory, figuring tips?) Or, you may get irritable or unfocused long before there are actual physical consequences of eating a poor diet (catching a cold, developing a fatty liver, etc.). So, check out your diet first before blaming your age or heredity factors (like the color of your hair!) for mental lapses. 2. The brain contains 100 billion nerve cells and an equal amount of supporting tissue. These cells have a voracious need for energy. 3. In the morning, CHO fuels your thinking. Breakfast eaters have been shown to think better and faster, and remember more than breakfast skippers. But, by midday, if you only eat carbohydrate, like skip lunch for a granola bar, you will start to feel sleepy and less able to concentrate. Time for some protein, so dopamine levels can get back up and increase your brain power! 4. Remember: DHA is brain food. and our diets are typically lacking in this fat. It’s primarily in fish oils, but in the US the main source of omega-3 is canola oil and soybean oils. It’s also in flax seed and walnuts. So eat fish twice a week, look for omega-3 in breakfast cereals containing flax, and cook with the best oils. 5. Antioxidants are important for keeping our memories from fading as we age. The brain consumes 20% of your daily oxygen, which exposes it to lots of oxygen fragments called free radicals. It’s these free radicals that cause damage over time. These fragments are a result of breathing smoggy air, eating fried foods, and are a natural consequence of normal metabolic processes. Our means of protection is antioxidants, like vit C, E, beta carotene and selenium. Many of these compounds are part of the colors of fruits and vegetables. So to keep up your brain defenses, include 4 or more cups of colorful fruits and vegetables every day. Prunes, by the way were found to have the most antioxidant activity of any fruit or vegetable tested at Tufts University. 6. Other vitamins and minerals are really crucial as well, especially B vitamins (see list) and iron. Iron is essential for transporting oxygen to the brain. It’s the most common deficiency in the US and could be affecting attention span, work performance, and motivation.

29 Energy Burned out? Lethargic? Slow to react? Sleepy?

30 Energy Fully awake Energetic Invigorated

31 Energizing Strategies
Meals: low in fat, contain protein, low sugar Frequent small meals Plenty of fluids Avoid alcohol Avoid caffeine Pay attention to diet quality Whole foods, wide variety of colorful produce Follow the concept of including protein and complex carbs, not sugar. Provide a steady supply of fuel to your body. Don’t forget breakfast. Half of us eat breakfast “only occasionally”. If you aren’t hungry in the morning, just start your day with something small at first, like one piece of toast. It will take about 2-3 weeks to reset your appetite clock. Water is the most important nutrient when it comes to general health and emotional well-being, because it’s essential for all body processes. Dehydration from drinking a little, but not enough water is one of the most common causes of fatigue. Drink a minimum of 6-8 cups of hydrating fluid a day; the color of urine should be very pale or clear. Alcohol is a depressant, dehydrates you, and uses up lots of B vitamins while it’s being detoxified by the liver. Caffeine: studies at the Univ of South Alabama revealed that when people suffering from depression eliminate coffee and sugar, 50% report improvements in energy levels within one week. They first became more energetic, then their moods improved. Quality counts! Whole foods, like oatmeal, brown rice and beans, even out your energy levels

32 Conquering Cravings Be aware of how food affects YOU
Keep a food and mood journal Make the connection with brain chemicals Craving for sweets: serotonin Craving for fat: galanin Avoid deprivation Find healthier substitutes Maintain moderation Work with an expert (Registered Dietitian) Learn to eat mindfully – keep a journal of food, moods, appetite Consider how you are affecting your body chemistry… Do not consider any food forbidden. Work with your natural cravings to calm them with healthy versions of what you need. Moderation: savor the taste, eat slowly Dietitians can be a big help if you want a professional to help sort things out.

33 The web site of the American Dietetiic Assoc can help you locate a dietitian close to home. Click on Find a Nutrition Professional and follow the prompts. You can request a dietitian with a particular specialty as well.

34 References Somer E. (1999) Food and Mood: The complete guide to eating well and feeling your best, 2nd edition. New York, NY: Henry Holt and Company, LLC. Null G. (2000) The food-mood-body connection: nutrition-based and environmental approaches to mental health and physical well-being. New York, NY: Seven Stories Press. Roizen, M and Oz, M. (2006) YOU: On A Diet. The Owner’s Manual for Waist Management. New York, NY: Free Press, Simon & Schuster, Inc. Questions? Again, thanks to ________ for inviting me to speak today. If you would like more information, here are the references that formed the foundation for this presentation. You might also enjoy Eating Mindfully by Susan Albers_____. I would also like to invite you to drop by or call El Camino Hospital’s Health Library and Resource Center. You can sign up for a free library card that gives you access to sophisticated databases of medical information. Brochures are available on the table about the library and my services at the hospital.

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