File - Gillian Reid

Nutrition & Mental Health: The Body-­‐Mind Connection Considerations for Social Work Practice Gillian Reid, RSW, RHN
gillianreid.ca Social Work Rounds: Feb. 9, 2015 GOALS Expand traditional thoughts about factors in4luencing mental health Increase knowledge about current research in the area of nutrition and mental health Explore ways of integrating nutrition into therapeutic work with clients Identify & problem-­‐solve barriers Fun & interesting food discussion OUTLINE 1.  Making an argument for incorporating nutrition into mental health practice by looking at in4luencing factors 2.  Literature in support of nutrition for mental health and the body-­‐mind connection 3.  Speci4ic Foods to support mental health 4.  Discussion PART 1: FACTORS INFLUENCING MENTAL HEALTH Internal / Intrinsic / Biological / Organic: Genetics, temperament, chemical imbalances External/ Environmental/ Situational: •  Abuse & Trauma •  High con4lict / domestic violence •  Poverty •  Stress •  Bullying •  Other •  Exercise •  Diet FACTORS INFLUENCING MENTAL HEALTH Internal vs. External Factors Traditionally, we understand and accept Mental Health diagnoses as a combination of both. But we treat Mental Health from our “areas of expertise” Physicians treat MH with medication. Social Workers, psychologists treat MH with talk therapy. Psychiatrists use medication and talk therapy. How are we incorporating the other scienti4ically proven external in4luences of Mental Health? OUR PRACTICE IS EXPANDING AND EVOLVING We now accept some integrated body-­‐mind approaches – Mindfulness MEDICAL PSYCHIATRY Psychosomatic patients receiving therapy for physical symptoms of illness (seizure-­‐like episodes, gastrointestinal problems, body pain, headaches and migraines…) with no origin. The physical symptoms are real and present in the patient’s body. So is there really no origin? How is the external environment directly impacting the body? Therapy = addresses external factors like stress, social, sleep…
that seek to connect the mind with the body to reduce symptoms ARE WE STILL MISSING SOME KEY ELEMENTS? Diet Exercise SEASONAL AFFECTIVE DISORDER (SAD) (Depressive Disorder with Seasonal Pattern – DSM-­‐V) One commonly accepted explanation for depression where the 4irst line of treatment includes: Going outside Exposure to light (natural if possible) Movement (exercise) Taking a Vitamin D supplement Therefore, SAD is a great example of mental health where primary interventions are vitamins, exercise and light PART 2: NUTRITION RESEARCH 3 Areas of Focus: 1.  The Gut-­‐Brain Connection 2.  In4lammation & Immunity 3.  Speci4ic Nutrient De4iciencies 1. THE GUT: OUR SECOND BRAIN A strong relationship •  Consultation-­‐Liaison psychiatry has been aware of the connection between gasteroenterology and mental health since the 1800’s High overlap between complaints of abdominal pain, IBS, GERD and psychological stress; •  Celiac Disease – chronic autoimmune enteropathy often includes depression •  51.5% of children with anxiety/depression reported GI pain -­‐ Ediger & Hill (2014) “Celiac Disease” Peds in Rev, 35:409 Ghanizadeh et. al. (2008). “Psychiatric disorders and family functioning in children and adolescents with functional abdominal pain syndrome.” J. Gastro Hepatol, 23:1132 Yacob et. al. (2013). “Prevalence of pain-­‐predominant functional gastrointestinal disorders and somatic symptoms in patients with anxiety and depressive disorders.” J. Pediatr. 163:767 THE GUT: OUR SECOND BRAIN Central Nervous System IBD Psychological Distress FGID Poorer Health Status Frequency Chronic Pain Other? Multiple pathways to and from our nervous system – Could nutrition work to improve the gut and the brain, thereby supporting this relationship? -­‐ Drossman, D. (2011) “Abuse Trauma and GI Illness: Is there a link?” Am. J. Gastroenterol, 106: 114 THE MICROBIOME & BACTERIA 70-­‐80% of the body’s immune cells are located in the gut Development and maintenance of the intestinal immune system is dependent on microorganisms Stress alters the microbiome by stimulating growth of unhelpful bacteria, reduces resistance to challenge pathogens, decreases helpful bacteria Gut bacteria secretes neurochemicals (acetylcholine, histamine, melatonin, serotonin) Gut bacteria reduces anxiety like behaviour, decrease serum cortisol levels, normalize pro-­‐inblammatory cytokines -­‐ Forsythe et. al. (2010)“Mood and Gut Feelings” Brain Behaviour Immunology, 24:9 -­‐ Dinan et. al. (2013) “Psychobiotics: A novel class of psychotropic.” Biol Psychiatry, 74:720 THE GUT: OUR SECOND BRAIN Takeaway Message Our gut sends signals to our brain Both biological AND psychological factors can in4luence how our gut is feeling and what it is telling our brain Keeping the gut healthy will send good signals to our brain thereby in4luencing mental wellness PART 2. INFLAMMATION & THE IMMUNE SYSTEM “The body’s response to injury, which may be acute or chronic. It involves pain, heat, redness, swelling and loss of function. White blood cells enter the tissue and begin to engulf bacteria and other foreign particles. In certain circumstances, healing does not occur, and chronic in4lammation ensues” Depression is associated with biomarkers of in4lammation (IL-­‐6, TNF, C-­‐reactive protein) Many external factors cause in4lammation in the body including sleep, stress, food allergies, The good bacteria connection to in4lammation (normalizing in4lammatory markers) Oxford Medical Dictionary. Fifth Edition. 2010. Oxford University Press, New York. INFLAMMATION & THE IMMUNE SYSTEM •  A Westernized diet high in fat and sugar has been shown to cause a more porous intestinal lining •  Consequences include systemic access to food antigens, environmental toxins = immune system response -­‐Selhub et al. (2014) “Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry. J Physiol. Anthro. 33:2 INFLAMMATION & THE IMMUNE SYSTEM •  Depression and psychological stress have also been shown to cause intestinal permeability -­‐Selhub et al. (2014) “Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry.” J Physiol. Anthro. 33:2 INFLAMMATION & IMMUNITY Takeaway Message: In4lammation is the body’s way of healing an infection or injury. The immune system does this. When the “injured area” goes unhealed, it becomes chronic, low-­‐
grade in4lammation Chronic in4lammation can kill gut bacteria, lead to intestinal permeability, poor nutrient absorption Food can make in4lammation better or worse PART 3: NUTRIENTS NEEDED FOR MENTAL HEALTH NUTRIENTS NEEDED FOR MENTAL HEALTH • 
Depression, low mood, increased sadness and anxiety has been associated with de4iciencies in neurotransmitters. Amino acids {found in complete proteins} including tryptophan, tyrosine, phenylalanine, methionine have been found effective in increasing neurotransmission of serotonin, dopamine and GABA • 
Since the consumption of omega-­‐3 fatty acids from 4ish and other sources has declined in most populations, the incidence of MDD has increased. 1.5-­‐2g of EPA has been shown to stimulate mood elevation • 
Bipolar disorder, mania and hypomania have been correlated with excess vanadium. One 3g dose of vitamin C decreases manic symptoms. Mood disorders also correlated to vitamin B de4iciencies, taurine de4iciency and anemia • 
Vitamin B12 De4iciency is metabolically signi4icant with a twofold risk of severe depression as a result of its role in production of neurotransmitters, phospholipids and nucleotides in the brain and central nervous system • 
Folate levels not only are critical to brain metabolic pathways but have recently been linked to poorer antidepressant response -­‐ Alpert, J. and Fava, M. (1997). “Nutrition and Depression: The Role of Folate”. Nutrition Reviews. Vol. 55: 5 Department of Psychiatry, Harvard Medical School Penninx, B. et. al. (2000). Vitamin B12 De4iciency and Depression in Physically Disabled Older Women: Epidemiologic Evidence from the Women’s Health and Aging Study”. American Journal of Psychiatry. Vol. 157: 715 Vieira, K., Lakhan, S. (2008). “Nutritional Therapies for Mental Disorders” Nutrition Journal NUTRIENTS NEEDED FOR MENTAL HEALTH Curcumin -­‐ has shown potential anti-­‐depressant-­‐like activity in patients with MDD Fatty Fish – Numerous studies have shown that omega-­‐3 fatty acids are present at very low levels in most Americans and bipolar sufferers. The brain requires omega-­‐3 oils in order to transpit signals that enable proper thinking, moods and emotions Sugar – increased consumption of re4ined sugar results in an overall decreased state of mind for schizophrenic patients as measured by increased # of days in hospital and decreased social functioning St. John’s Wort -­‐ “A commercially available supplement called Amoryn has recently been proven to help patients suffering from depression, anxiety and OCS. The main ingredient, St. John’s Wort (herb), was found with 2 double-­‐blind placebo-­‐controlled studies that in comparison to patients taking Paxil, the Amoryn showed a 57% decrease in OCD symptoms and were 47% less likely to experience side-­‐effects” -­‐Sanmukhani, J et. al. (2013) “Ef4icacy and Safety of Curcumin in Major Depressive Disorder: A Randomized Controlled Trial” Journal of Phytotherapy Research. Vol. 28 pp. 57 – Vieira, K., Lakhan, S. (2008). “Nutritional Therapies for Mental Disorders” Nutrition Journal. Vol. 7, pp. 585 NUTRIENTS NEEDED FOR MENTAL HEALTH Takeaway Message: Neurons are built from proteins, fats and vitamins Neurons degenerate with age, stress, toxins and without proper nourishment The gut then is less able to communicate effectively with the brain The gut becomes in4lamed Nutrients are more dif4icult to absorb The brain needs basic nutrients to regenerate and function properly FOOD FOR MENTAL
WELLNESS - THE GUT
•  Naturally fermented foods •  Raw food •  High 4ibre foods •  Water •  Yogurt* •  Cabbage •  Aloe Vera Although research has proven good bacteria is benebicial to gut health, it is still lacking in studies related to specibic foods FOOD FOR MENTAL WELLNESS INFLAMMATORY & ANTIINFLAMMATORY FOODS
In4lammation-­‐ inducing Foods • 
Sugar • 
“Non-­‐foods” • 
Dairy (there I said it) • 
Alcohol (sorry) • 
Foods that people are allergic to or have an intolerance to (immune-­‐marked reaction) • 
Common allergenic foods include gluten, wheat, soy, dairy, eggs, shell4ish, nuts… Anti-­‐In4lammatory Foods • 
Greens • 
Lemons • 
Vegetables • 
Fermented Foods FOOD FOR MENTAL
WELLNESS - NUTRIENTDENSE FOODS
Nutrient-­‐Dense Foods: Leafy Greens (kale, swiss chard, spinach) Fish Ginger, garlic Chia Seeds Lemon Coconut Oil Herbs – cilantro, parsley Spices – cinnamon, turmeric, cayenne pepper SOCIAL WORK PRACTICE Barriers to incorporating nutrition into therapeutic work with clients: SOCIAL WORK PRACTICE Solutions to Barriers: NUTRITIONAL PSYCHIATRY: AN EMERGING DISCIPLINE “In 21st-­‐century public health, rapid urbanization and mental health disorders are a growing global concern. The relationship between diet, brain function and the risk of mental disorders has been the subject of intense research in recent years. In this review, we examine some of the potential socioeconomic and environmental challenges detracting from the traditional dietary patterns that might otherwise support mental health…. Changes to dietary load, ultraprocessing of food and microbiota may be of relevance to depression, anxiety and other mental disorders”. Logan, A. and Jacka, F. (2014). “Nutritional psychiatry research: an emerging discipline and its intersection with global urbanization, environmental challenges and the evolutionary mismatch. Journal of Physiological Anthropology. Vol. 33: 22 CASE #1 Adrian is a 16 year old female who came to the Emergency Department complaining of severe migraine with vomiting and loss of vision. She was admitted, had a full work-­‐up, no biological origin was determined. She now sees a social worker for ongoing therapy. Her parents live near Avenue Road and send her to private school. What would the normal treatment be? How could we incorporate nutrition into her treatment? THEMES & SUMMARY •  The body is a series of interconnected systems •  Mental Health is impacted by both physiological and psychological factors •  Integrative treatments that look at the system as a whole are being increasingly studied for their impact on mental health and well-­‐being •  Nutrition plays a key role in mental health and can be integrated into traditional talk therapy •  Social Workers can incorporate nutrition as part of therapeutic treatment if remaining within scope of expertise QUESTIONS / COMMENTS? Happy Eating! FOOD RESOURCES http://nourishedkitchen.com/recipe-­‐index/ferments-­‐cultured-­‐
food/ http://ohsheglows.com/ http://www.mindbodygreen.com/0-­‐9444/the-­‐7-­‐best-­‐spices-­‐
for-­‐healing.html http://www.theglobeandmail.com/life/health-­‐and-­‐4itness/
how-­‐to-­‐get-­‐your-­‐friendly-­‐bacteria-­‐4ix-­‐with-­‐probiotics/
article4105504/ http://psychcentral.com/blog/archives/2015/02/05/good-­‐
nutrition-­‐is-­‐important-­‐in-­‐depression-­‐but-­‐often-­‐overlooked/ REFERENCES Alpert, J. and Fava, M. (1997). “Nutrition and Depression: The Role of Folate”. Nutrition Reviews. Vol. 55: 5 Department of Psychiatry, Harvard Medical School Dinan et. al. (2013) “Psychobiotics: A novel class of psychotropic.” Biological Psychiatry, 74:720 Drossman, D. (2011) “Abuse Trauma and GI Illness: Is there a link?” American Journal of Gastroenterology, 106: 114 Ediger & Hill (2014) “Celiac Disease” Pediatrics in Review, 35:409 Forsythe et. al. (2010)“Mood and Gut Feelings” Brain Behaviour Immunology, 24:9 Foods That Fight In4lammation (2015). Harvard Health Publications, Harvard Medical School. Ghanizadeh et. al. (2008). “Psychiatric disorders and family functioning in children and adolescents with functional abdominal pain syndrome.” J. Gastro Hepatol, 23:1132 Kim, J. Good nutrition is important in depression, but often overlooked. Psychology Central. Retrieved Feb. 8, 2015 http://psychcentral.com/blog/archives/2015/02/05/good-­‐
nutrition-­‐is-­‐important-­‐in-­‐depression-­‐but-­‐often-­‐overlooked/ Logan, A. and Jacka, F. (2014). “Nutritional psychiatry research: an emerging discipline and its intersection with global urbanization, environmental challenges and the evolutionary mismatch. Journal of Physiological Anthropology. Vol. 33: 22 Mayer, E. (2011). “Gut feelings: the emerging biology of gut-­‐brain communication” National Review of Neuroscience, 12:453 Oxford Medical Dictionary. Fifth Edition. 2010. Oxford University Press, New York. Penninx, B. et. al. (2000). Vitamin B12 De4iciency and Depression in Physically Disabled Older Women: Epidemiologic Evidence from the Women’s Health and Aging Study”. American Journal of Psychiatry. Vol. 157: 715 Sanmukhani, J et. al. (2013) “Ef4icacy and Safety of Curcumin in Major Depressive Disorder: A Randomized Controlled Trial” Journal of Phytotherapy Research. Vol. 28 pp. 579-­‐585 Selhub et al. (2014) “Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry.” Journal of Physiological Anthropology. 33:2 Vieira, K., Lakhan, S. (2008). “Nutritional Therapies for Mental Disorders” Nutrition Journal. Vol. 7 Yacob et. al. (2013). “Prevalence of pain-­‐predominant functional gastrointestinal disorders and somatic symptoms in patients with anxiety and depressive disorders.” Journal of Pediatrics. 163:767