Nutrition as a Factor inNutrition as a Factor in Mental HealthMental Health The evidence is steadily increasing !The evidence is steadily increasing !

Mona Moorhouse B.Sc., B.Ed., RDMona Moorhouse B.Sc., B.Ed., RDRegistered Dietitian, Royal Ottawa Mental Health CenterRegistered Dietitian, Royal Ottawa Mental Health Center

OutlineOutline

1.Discuss studies on nutrition and:1.Discuss studies on nutrition and: MoodMood Drug DependenceDrug Dependence Alzheimer’s DiseaseAlzheimer’s Disease

2.Review some diet recommendations.2.Review some diet recommendations.

3.Questions3.Questions

Waist Circumference & Insulin ResistanceWaist Circumference & Insulin Resistance

Insulin ResistanceInsulin Resistance

Mood & Insulin ResistanceMood & Insulin Resistance

MethodMethod 491 subjects491 subjects Beck Depression Inventory measured Beck Depression Inventory measured

severity of depressionseverity of depression Severity of insulin resistance measured. Severity of insulin resistance measured.

ResultsResults Insulin resistance and severity of Insulin resistance and severity of

depression were positively correlated.depression were positively correlated.

BMJ 2005, 330 (7481)BMJ 2005, 330 (7481)J Affect Disord. 2008: 109(1-2): 75-82J Affect Disord. 2008: 109(1-2): 75-82

It shows up in your It shows up in your bloodworkbloodwork

Metabolic SyndromeMetabolic Syndrome

Abdominal Obesity (waist > 35 inches for Abdominal Obesity (waist > 35 inches for women, > 40 inches for men).women, > 40 inches for men).

Insulin resistance & high blood sugar.Insulin resistance & high blood sugar.

High blood pressure.High blood pressure.

High cholesterol and triglycerides.High cholesterol and triglycerides.

Mood & Metabolic SyndromeMood & Metabolic Syndrome

MethodMethod 1598 subjects at risk for cardiovascular 1598 subjects at risk for cardiovascular

disease screened for metabolic syndrome disease screened for metabolic syndrome and depression.and depression.

ResultsResults Metabolic Syndrome strongly Metabolic Syndrome strongly

associated with depression associated with depression (independent of age, smoking, (independent of age, smoking, socioeconomic factors & lifestyle).socioeconomic factors & lifestyle).

Biological Psychiatry, 2007(62):1251-1257Biological Psychiatry, 2007(62):1251-1257

Depression/Schizophrenia & Depression/Schizophrenia & DiabetesDiabetes

Depression twice as common in diabetics VS general population.

At least 15% of diabetics have major depression.

Schizophrenia Schizophrenia is now listed as a risk factor is now listed as a risk factor for diabetes (Clinical Practice Guidelines for diabetes (Clinical Practice Guidelines 2003, Canadian Diabetes Association).2003, Canadian Diabetes Association).

(Diabetes Care 2001;24:1069-1078, 2002;25:464-470, 1993:16:1167-1178)

Glycemic IndexGlycemic Index

Glycemic Load and MoodGlycemic Load and Mood

Method 42 healthy overweight subjects42 healthy overweight subjects Assigned to either a high or low glycemic load diet Assigned to either a high or low glycemic load diet

for 6 months.for 6 months.

Results Subjects on the high glycemic load diet experienced

worsening mood over 6 months compared to subjects on the low glycemic load diet.

Physiology & Behavior 98 (2009) 374-379Physiology & Behavior 98 (2009) 374-379

Carbohydrate Craving in Alcohol Dependence:Carbohydrate Craving in Alcohol Dependence:

SubjectsSubjects3 groups; a high carbohydrate craving (3 groups; a high carbohydrate craving (nn= 10), a = 10), a low carbohydrate craving group (low carbohydrate craving group (nn= 11), and a = 11), and a non-addicted control group (non-addicted control group (nn= 12). = 12).

ResultsResultsThe carbohydrate-craving alcohol-dependent The carbohydrate-craving alcohol-dependent subjects were uniquely sensitive to the adverse subjects were uniquely sensitive to the adverse effects of a diet high in refined carbohydrate (ie effects of a diet high in refined carbohydrate (ie high glycemic load). high glycemic load).

Moorhouse et al. Moorhouse et al. May 2000May 2000 Alcoholism: Clinical and Experimental Alcoholism: Clinical and Experimental Research Research Volume 24, Issue 5, Volume 24, Issue 5, pages 635–643, pages 635–643,

Low Glycemic Index (GI) FoodsLow Glycemic Index (GI) Foods

Eating low Glycemic Index foods helps: Control your blood sugar levels. Control your cholesterol level. Control your appetite. Lower your risk of getting heart disease. Lower your risk of getting type 2 diabetes.

Source: Canadian Diabetes Association 2008Source: Canadian Diabetes Association 2008

Mood & Omega 3 FatsMood & Omega 3 Fats

Three main omega-3 fats:Three main omega-3 fats:

EPA (fish fats)EPA (fish fats)

DHA (fish fats) DHA (fish fats)

ALA (vegetable oils, flax, nuts, leafy ALA (vegetable oils, flax, nuts, leafy vegetables) vegetables)

Brain Cell Membranes are 2/3 Omega -Brain Cell Membranes are 2/3 Omega -3 Fatty Acids3 Fatty Acids

EPA & DHAEPA & DHA

Brain cell membranes rich in Brain cell membranes rich in DHADHA are are more fluid. more fluid.

EPAEPA improves immune function and improves immune function and has a protective effect in the brain.has a protective effect in the brain.

Neuro-Signals (Neurosignals) 2009, 17(2):144-52Neuro-Signals (Neurosignals) 2009, 17(2):144-52

Mood & Omega-3 FatsMood & Omega-3 Fats

MethodMethodMeta-analysis of 29 studies up to 2009Meta-analysis of 29 studies up to 2009

ResultsResults Evidence provides support for a benefit of Evidence provides support for a benefit of

Omega-3 fats in people with depressive illness. Omega-3 fats in people with depressive illness. Greatest benefits of Omega-3 fats were in Greatest benefits of Omega-3 fats were in

individuals with more severe depression. individuals with more severe depression.

American Journal of Clinical Nutrition, 2010, 91(3): 757-770American Journal of Clinical Nutrition, 2010, 91(3): 757-770

Mood, the Immune System & Mood, the Immune System & Celiac DiseaseCeliac Disease

Celiac Disease (an autoimmune Celiac Disease (an autoimmune disease) is positively associated with disease) is positively associated with Depression.Depression.

Ludvigsson et al. 2007, Celiac disease and risk of mood disorders. Ludvigsson et al. 2007, Celiac disease and risk of mood disorders. Journal of Affective Disorders Journal of Affective Disorders

Mood & Celiac DiseaseMood & Celiac Disease

Treatment of Celiac Disease with a gluten-Treatment of Celiac Disease with a gluten-free diet is associated with improved free diet is associated with improved mood.mood.

Neurological Science 2003, 24: 311-317.Neurological Science 2003, 24: 311-317.

The Journal of Postgraduate Medicine 2002 The Journal of Postgraduate Medicine 2002

Celiac Disease (Autoimmune Celiac Disease (Autoimmune Disease)Disease)

WWhat is Celiac Diseasehat is Celiac DiseaseGluten ( wheat, rye ,triticale and barley) triggers the body’s own Gluten ( wheat, rye ,triticale and barley) triggers the body’s own immune system to release antibodies which attack the small immune system to release antibodies which attack the small intestine and many other systems in the bodyintestine and many other systems in the body

Intestinal damage leads to poor absorption of nutrients. Intestinal damage leads to poor absorption of nutrients. PrevalencePrevalence

Estimated that 1 in 133 people in Canada have celiac disease. Estimated that 1 in 133 people in Canada have celiac disease.

SymptomsSymptoms Iron deficiency anemia, B12 deficiency, chronic diarrhea or Iron deficiency anemia, B12 deficiency, chronic diarrhea or

constipation, extreme fatigue, cramps, bloating, bone pain, constipation, extreme fatigue, cramps, bloating, bone pain, irritability, skin rashes, hair loss.irritability, skin rashes, hair loss.

Celiac DiseaseCeliac Disease

National Institutes of Health, Consensus Development National Institutes of Health, Consensus Development Conference Statement, Celiac Disease, August 2004.Conference Statement, Celiac Disease, August 2004.

“ “Define the relationship between Define the relationship between celiac disease, autoimmune celiac disease, autoimmune disorders & neuropsychiatric disorders & neuropsychiatric disorders”.disorders”.

Drug AddictionDrug Addiction

Food Intake & Drug AbuseFood Intake & Drug Abuse

National Institute of Drug Abuse (USA) National Institute of Drug Abuse (USA)

Omega–3 Fats & Relapse in Omega–3 Fats & Relapse in Cocaine DependenceCocaine Dependence

Method:Study of 32 Cocaine Dependent Patients.Study of 32 Cocaine Dependent Patients.Omega – 3 fat status assessed upon hospital admission Omega – 3 fat status assessed upon hospital admission (baseline).(baseline).Relapse assessed 3 months, 6 months and 1 year after Relapse assessed 3 months, 6 months and 1 year after discharge.discharge.

ResultsLow Omega-3 fat status at baseline was a better predictor of relapse than cocaine use, sociodemographic or clinical parameters.

Psychiatry Research 120 (2003) 29-35Psychiatry Research 120 (2003) 29-35

Triggers for Drug CravingTriggers for Drug Craving

Alcoholics Anonymous & the HALT Alcoholics Anonymous & the HALT acronymacronym

H H ungerunger

A A ngernger

L L onelyonely

T T iredired

Digestive Tract & Digestive Tract & Pleasure/Survival Center in the Pleasure/Survival Center in the

BrainBrain

Food Restriction & Drug Food Restriction & Drug CravingCraving

Alcoholics have elevated GHRELIN levels.Alcoholics have elevated GHRELIN levels.

Elevated GHRELIN is positively correlated Elevated GHRELIN is positively correlated with intensity of alcohol craving in with intensity of alcohol craving in alcoholism.alcoholism.

Food restriction increases ghrelin levels, drug Food restriction increases ghrelin levels, drug craving & the rewarding effects of drugs. craving & the rewarding effects of drugs.

Cabeza de Vaca et al. Food Restriction Enhances the Central Cabeza de Vaca et al. Food Restriction Enhances the Central Rewarding Effect of Abused Drugs. The Journal of Neuroscience Rewarding Effect of Abused Drugs. The Journal of Neuroscience 1998,18(18):7502-7510.1998,18(18):7502-7510.

Alzheimer’s DiseaseAlzheimer’s Disease

Alzheimer’s Disease (AD)Alzheimer’s Disease (AD)

Method:Method:194 patients with AD 194 patients with AD COMPARED TOCOMPARED TO 1790 1790

subjects without AD subjects without AD

Results:Results: Greater adherence to Mediterranean Diet Greater adherence to Mediterranean Diet

associated with significantly reduced risk for AD. associated with significantly reduced risk for AD.

Even moderate compliance to the Mediterranean Even moderate compliance to the Mediterranean diet was shown to have a protective effect.diet was shown to have a protective effect.

Arch Neurol.Arch Neurol. 2006;63:1709-1717.  2006;63:1709-1717.

Alzheimer’s Disease & Alzheimer’s Disease & AntioxidantsAntioxidants

Introduction. The most abundant dietary anti-oxidants are the polyphenols (in

the skins & peels of fruits/vegetables). Polyphenols are strongly neuroprotective.

Method. 1836 subjects, dementia-free in 1992-1994 were followed for 9

years. Data determined if drinking fruit/ vegetable juices (apple, grape,

citrus) high in polyphenols, decreased risk for Alzheimer’s..

Results. Drinking juice at least 3 times per week was associated with

significantly less risk for developing Alzheimer’s compared to drinking juice less than once a week.

American Journal of Medicine, 2006 (119):751-759.

Vitamins & MineralsVitamins & Minerals

Folic AcidFolic Acid B12B12 Vitamin DVitamin D MagnesiumMagnesium ZincZinc

Recommendations to Recommendations to Promote Mental HealthPromote Mental Health

Consider eating more like the Consider eating more like the Mediterraneans do.Mediterraneans do.

The Mediterranean DietThe Mediterranean Diet

Other Nutrition RecommendationsOther Nutrition Recommendations

Choose Low Glycemic Index FoodsChoose Low Glycemic Index Foods Gi Diet Books by Rick GallopGi Diet Books by Rick Gallop

Eat a 3-4 oz serving of fatty fish twice per weekEat a 3-4 oz serving of fatty fish twice per week Rich in omega-3 fats(albacore tuna, mackeral,halibut,herring, salmon, sardines, trout)Rich in omega-3 fats(albacore tuna, mackeral,halibut,herring, salmon, sardines, trout)

Eat plenty of fruits and vegetables every day for the protective effects of Eat plenty of fruits and vegetables every day for the protective effects of polyphenols. polyphenols.

Concentrated sources of polyphenols are Concentrated sources of polyphenols are Orange juiceOrange juice, apple juice, grape juice., apple juice, grape juice.

Eat at least 3 servings whole grains per day.Eat at least 3 servings whole grains per day. Reduces insulin resistance, source of magnesiumReduces insulin resistance, source of magnesium

Eat at regular intervals throughout the day.Eat at regular intervals throughout the day. Brain functions best with a continuous supply of nutrients.Brain functions best with a continuous supply of nutrients.

Stay well hydratedStay well hydrated Drink water dailyDrink water daily

Other RecommendationsOther Recommendations

Aim for a healthy weight & a healthy waist Aim for a healthy weight & a healthy waist circumference circumference (40” for men, 35” for women)(40” for men, 35” for women)

Talk to your family doctor if you have Talk to your family doctor if you have persistent gastrointestinal problems.persistent gastrointestinal problems.

ExerciseExercise Improves mood, increases length of sobriety, improves Improves mood, increases length of sobriety, improves

insulin resistance, improves sleep and much more.insulin resistance, improves sleep and much more.

QuestionsQuestions

Prevent Diabetes & Weight GainPrevent Diabetes & Weight Gain

Start with “Big Volume, Small Calorie” Start with “Big Volume, Small Calorie” Foods.Foods.

• Reduces appetite stimulating hormones Reduces appetite stimulating hormones produced in an empty stomach.produced in an empty stomach.

• Eg. vegetable soups, salad, raw Eg. vegetable soups, salad, raw vegetables, fruit.vegetables, fruit.

Prevent Diabetes & Weight Prevent Diabetes & Weight GainGain

Eat breakfast. Do not skip meals.Eat breakfast. Do not skip meals.

• Increases metabolic rateIncreases metabolic rate

• Prevents overeating laterPrevents overeating later

• Protein VS Carbohydrate Protein VS Carbohydrate

Food Intake & Drug Food Intake & Drug DependenceDependence

Binge eating, food hoarding , excessive weight Binge eating, food hoarding , excessive weight gain. Food described as a drug substitute; a gain. Food described as a drug substitute; a response to intense food cravings (i.e. sweets).response to intense food cravings (i.e. sweets).

High rates of eating disorders (Bulimia, Binge High rates of eating disorders (Bulimia, Binge eating disorder). eating disorder).

Janowski et al. 2003. Preference for higher sucrose concentrations in Janowski et al. 2003. Preference for higher sucrose concentrations in cocaine dependent patients. Journal of Psychiatric Research. cocaine dependent patients. Journal of Psychiatric Research. Lenoir et al. 2007. Intense sweetness surpasses cocaine reward. PLos ONE.Lenoir et al. 2007. Intense sweetness surpasses cocaine reward. PLos ONE.

Nutrition & SobrietyNutrition & Sobriety

Positive association between nutrition Positive association between nutrition education & drug abuse treatment education & drug abuse treatment outcomes (Addiction Severity Index). outcomes (Addiction Severity Index).

ROMHC Meadow Creek Addiction ROMHC Meadow Creek Addiction Treatment Program includes Nutrition Treatment Program includes Nutrition Education.Education.Grant LP et al. Nutrition Education is Positively Associated Grant LP et al. Nutrition Education is Positively Associated with Substance Abuse Treatment Program Outcomes. Journal with Substance Abuse Treatment Program Outcomes. Journal of the American Dietetic Association 2004, 104: 604-610.of the American Dietetic Association 2004, 104: 604-610.

Liquids VS SolidsLiquids VS Solids

• Liquids have little satiety value and Liquids have little satiety value and can contain many calories.can contain many calories.

• Avoid fruit juices and eat the whole Avoid fruit juices and eat the whole fresh fruit.fresh fruit.

• Avoid soft drinksAvoid soft drinks

Try an Afternoon SnackTry an Afternoon Snack

• Appetite usually starts to increase by Appetite usually starts to increase by late afternoon.late afternoon.

• A mid afternoon snack containing A mid afternoon snack containing protein (eg yogurt, low fat cheese & protein (eg yogurt, low fat cheese & whole grain crackers etc.) can help whole grain crackers etc.) can help prevent hunger buildup.prevent hunger buildup.

ExerciseExercise

Emphasize FiberEmphasize Fiber

• eg. whole fruits, whole vegetables, eg. whole fruits, whole vegetables, whole grains, legumes.whole grains, legumes.

• Aim for 25 – 35 grams fiber per day.Aim for 25 – 35 grams fiber per day.• Creates a feeling of fullness.Creates a feeling of fullness.

Mood & GI ComplaintsMood & GI Complaints

Majority of treatment-resistant depressives Majority of treatment-resistant depressives have somatic complaints ( nauseated, sick have somatic complaints ( nauseated, sick stomach, upset bowels, cramps, muscle stomach, upset bowels, cramps, muscle pains).pains).

Greater somatic complaints predicts greater Greater somatic complaints predicts greater treatment–resistance.treatment–resistance.

Psychiatry Research 2003: 118 (1): 39-45Psychiatry Research 2003: 118 (1): 39-45..

Mood & Immune SystemMood & Immune System

Altered immune function may play a role Altered immune function may play a role in the development of major depressionin the development of major depression..

Miller et al. Inflammation and Its Discontents; The Role of Miller et al. Inflammation and Its Discontents; The Role of Cytokines in the Pathophysiology of Major Depression. Cytokines in the Pathophysiology of Major Depression. Biological Psychiatry 2009Biological Psychiatry 2009

AcknowledgementsAcknowledgements

Thank you to:Thank you to:

Susannah Juteau M.Sc. (Nutrition)Susannah Juteau M.Sc. (Nutrition) Dietetic Intern McGill UniversityDietetic Intern McGill University

For assisting in the research for this For assisting in the research for this presentation.presentation.