The Food-and-Mood Connection

Providence Cancer Center Integrative Medicine Program

Loch Chandler ND, MSOM, LAc

November 15, 2011

Our Discussion Today

Causes of Mood Alterations Mind-Body Relationships Neurotransmitters Diet and Nutrition Lifestyle Influences Supplements Summary

Causes of Mood Alterations

Stress (acute or chronic, positive or negative) Food Poor health, low immune function Pain Medications Mental-Emotion-Spiritual Health Social influences…job, family,

financial Limited approach produces

limited results!

Mind-Body Relationships

Your body responds to how you think, act and feel

Extensively connected Central and Peripheral Nervous

Systems Visceral-somatic, somatic-

visceral connections Vast communication networks Effects of Stress on Mind-Body

Effects of Stress on the Mind & Body

Effects of Stress on the Body

• Physical signs that your emotional health is out of balance can include:– Back pain, and general aches and pains

– Change in appetite, dry mouth

– Chest pain

– Digestive issues, constipation or diarrhea

– Extreme tiredness

– Headaches

– High blood pressure

– Insomnia

– Palpitations, shortness of breath

How Do Our Cells Communicate?

Via Neurotransmitters Are molecules that carry

messages between cells in the body and brain

Nutrients in foods are the precursors to neurotransmitters.

How Do Our Cells Communicate?

Neurotransmitters

Excitatory: Epinephrine (Adrenaline): Motivation, energy,

mental focus Norepinephrine: Mental focus, emotional stability Dopamine: Feelings of pleasure and satisfaction,

motivation, muscle control and function Glutamate: Primary excitatory neurotransmitter,

learning and memory

Calming: Serotonin: Elevates mood, reduces pain, decreases

appetite, optimism, inducing sleep, impulse control, and produces feelings of calm

GABA: Primary inhibitory neurotransmitter, anti-anxiety, promotes calm and relaxation

Glycine: Helps with calm and relaxation

Dopamine

-Mediates the experience of pleasure -Synchronizes memory and reward-

incentive-related learning

-REWARDS:-eating highly ‘palatable’ foods (i.e. fatty, rich), smoking-sexual behavior-gambling, risk taking-arousing music-exercise

-Dopamine networks are affected by ingested nutrients…allows for behavioral control over this system

Dopamine-How does this work?

-Repeated intake of ‘palatable’ food can instead amplify brain stress circuitry and down-regulate brain reward pathways-So…. Continued intake becomes

necessary to prevent negative emotional states via negative reinforcement

-Stress, anxiety and depressed moods have shown the high potential to trigger bouts of addiction-like eating in humans

-WHY??

It All Starts With Fat!

-Fat = 9 calories per gram

-Carbohydrates = 4 calories per gram

-Protein = 4 calories per gram

-Alcohol = 7 calories per gram

-PLUS, the brain is mostly fat (60%)!!

Dopamine

-When the rewards of eating healthy foods, intimacy and exercise aren’t

enough, unhealthy options are selected-We get dopamine (and epinephrine and

norepinephrine) from the amino acid tyrosine…which we get from protein…fish, poultry, eggs, meat

-Also under dietary regulation/effect:-serotonin-norepinephrine (noradrenaline)-epinephrine (adrenaline)-acetylcholine

Serotonin

Serotonin

-Can regulate signal intensity in a nerve-Most of the body’s serotonin (>95%) is

stored in intestinal cells…Enterochromaffin cells

Low levels stimulate hunger and the quest for food…to hunt and gather

-It’s presence in the gut is prehistoric and was and is utilized for the preservation of life…bad food

-High levels signal satiety and fullness-To treat mood disorders and

depression treat the gut!

Acetylcholine

-Is a NT in both the PNS and CNS

-One of the many NT in the ANS, and the somatic NS

-Is also the principle NT in all autonomic ganglia

-Ach can slow heart rate when functioning as an inhibitory NT

-Acts as an excitatory NT at the neuromuscular junction

-Is released by pre- and post-ganglionic parasympathetic neurons

Neurotransmitters

Are built from Amino acids (protein!)

Include: Taurine, tyrosine, tryptophan, phenylalanine

Brain is composed of mostly fat (60%)

Nutrient cofactors for optimal cell functioning B vitamins, Vitamin C, zinc, folic

acid, selenium, SAM-e, calcium, magnesium

Use foods to get these nutrients!

Cortisol

Glucocorticoid secreted by the adrenal glands when under stress (‘fight or flight’ response)

Affects every cell of the body If elevated for long periods of

time affects immune function Suppresses an immune cell’s

ability to activate telomerase, which when active preserves telomere length and keeps immune cells young

Cortisol

Glucocorticoids: Accelerate breakdown of proteins into amino

acidsbloodliverglucose (via gluconeogenesis) Accelerate mobilization of lipids from adipose cells

and lipid catabolism in nearly every cell in the body

Cause a shift from carbohydrate metabolism to fat metabolism

Are essential for maintaining a normal blood pressure (helps adrenaline and

noradrenaline exert their effects). High levels decreases levels of white blood

cells and atrophy of lymphatic tissues, and a reduction of lymphocytes and antibody-processing cells (including the Thymus)

(Thibodeau, et al, 1996, p. 564)

Diet and Nutrition

Diet

You are what you eat!

Jimmy Buffet

What you put in, you get out

“Nutrition should be the missing link in modern medicine. It should be rightfully placed as the foundation of your health”

Melvyn R. Werbach, M.D., Author, Nutritional Influences on Mental Illness: A sourcebook of clinical research (1991).

Diet

Mood Disrupters: Low blood sugar High blood sugar Caffeine

Increases heart rate, increases blood pressure, stimulating effect on the CNS

Meal frequency Nutrient value Low fat diets

Low Blood Sugar Symptoms

Nervousness Fatigue, exhaustion, insomnia Tremor, dizziness Palpitations, muscle cramps Sweating Anxiety/arousal, irritability Hunger, craving sweets Numbness Cognitive impairment Behavioral changes Headaches

Goal: Protein at EVERY meal!

Glycemic Index (GI)

The Glycemic Index scale ranks carbohydrate-rich foods by how much they affect blood glucose levels compared to glucose or white bread

The speed at which food increases blood sugars is the Glycemic Response (GR)

High GI ratings (>70) raise blood sugars quickly = BAD!

Low GI ratings (<55) raise blood sugars slowly

Low ratings are better for many reasons!

Glycemic Index Low Glycemic Index Foods:

Skim milk, plain yogurt, apple, sweet potato, oatmeal, hummus, nuts, cherries, broccoli, lettuce, yams, green peas, lentils, pinto beans

Medium GI Foods: Banana, raisins, popcorn, brown/wild rice, rye bread

HIGH GI Foods: (HFCS), Watermelon, white bread, dried dates,

cheerios, baked white potato, parsnips, corn flakes, bagels, french fries, ice cream, potato chips, beets, scones,

gatorade

RESOURCE: www.glycemicindex.com, www.nutritiondata.com

Vicious Cycle

Intake of high GI foodsHigh blood sugar

High insulin levelsLow blood sugar and increased

fat storageIncreased hunger

Increased cravings for high GI foods

High Fructose Corn Syrup (HFCS)

In many foods: soda, processed/ packaged foods, canned

fruits/jellies, dairy products

Try to avoid due to metabolic effects Relationship with increase in U.S. obesity Reduces the normal glycemic response Does NOT stimulate insulin secretion No “full” feeling generated (44)

Glycemic Control

The goal is BALANCE! One study found balancing blood

sugars normalized mitochondrial function. Vanhorebeek, Mech of Dis,

2005;365:53-59 (n=1548). (see ALA) Cell functions require energy or ATP If mitochondria don’t work…affects all

organs and tissues Preventing hyperglycemia helps

mitochondria, which helps the liver and all cells

Glycemic Index Base your food choices on overall nutrition

Choose a variety of foods from all food groups

Watch portion sizes (larger meals increase blood sugars greater)

Check blood glucose levels before a meal and 2 hours after

Eat at regular times

Limit sugars, sweets, refined/processed foods

Mediterranean Diet

More: vegetables, carrots, tomatoes, fruit, legumes, grains, fish, olive oil,

canola oil, less red meat (particularly preserved meats), more white meat, dairy (cheese, yogurt), butter, moderate alcohol OK, sage

Fortes, C., Nutr Cancer, 2003, 46(1):30-37.

Lyon Heart: Randomized prospective controlled study, 4-year followup.

deLorgeril, Arch Int Med, 1998;158:1181-87. Greek EPIC: Observational, (n=22,043

people, 44 months) Trichopoulou, NEJM, 2003;348;2599- 608.

Both: 60-70% reduction in all cancers, cardiac events and diabetes...preventative!

Mediterranean Diet and Depression

Diet will: reduce BP, improve lipid profile and glucose metabolism and endothelial function and reduced markers for vascular inflammation

Depression: reduced in people eating Mediterranean style diet (Duke Med Health News, 2009 Dec;15(12):1-2, Sanchez-Villegas, A., et al, Arch Gen Psychiatry, 2009 Oct;66(10):1090-8)

Also lowers risk of Alzheimer’s Disease and improves vascular function and overall physical health

Mediterranean Diet and Inflammation

Decreases inflammation by: Lowers Arachidonic Acid (AA) Decreases Prostaglandins E2 (PGE2),

Thromboxane-A2 (TXA-2), & Leukotrienes-4 series (LTB-4)

Lowers CRP levels Decreases inflammatory cytokines (IL-6) Decreases glycemic load Decreases insulin resistance Decreases oxidative stress markers Increases serum antioxidant capacity

Pro-Inflammation Arachidonic Acid:

Increases: Leukotriene-4 series (LTB-4) Promotes inflammation Constricts airways Prolongs duration of inflammation

Increases: Thromboxane-A2 (TXA-2) Constricts blood vessels Constricts airways Increases blood clotting Reduces circulation

Increases: Prostaglandins-E2 (PGE-2) Increases sensitivity to pain Increases swelling Induces fever Constricts blood vessels

High Fat Diets

-Lead to increased food (and alcohol) consumption…10-15% increase calories

-Stimulates the synthesis and release of galanin (a neuropeptide)

-Galanin = orexigenic peptide

-Orexigenic peptides = stimulate appetite

-Result = more fat…more appetite…more fat…

-Biological purpose: feast vs. famine

High Carb Diets

-Lead to increased Neuropeptide Y (NPY)-NPY is associated with carbohydrate

intake-Levels increase with negative energy or

low energy diets-Cravings for carbohydrates typically

meands your blood sugar is dropping…need to increase serotonin

-Levels of NPY increase with increase in cortisol, which is released with low energy stores or when a stress response requires additional energy

Anti-Inflammatory EPA:

Increases: Leukotriene-5 series (LTB-5) Relaxes blood vessels Increases circulation Relaxes airways Promotes anti-inflammatory response

Increases: Prostaglandin-E3 (PGE-3) Improves circulation Decreases sensitivity to pain Relaxes blood vessels Promotes anti-inflammatory response

GLA: Increases: Prostaglandin-E1 (PGE-1)

Relaxes muscle spasms Reduces blood clotting Increases protective stomach secretions Improves circulation

Whole Grains

Includes: Whole wheat, corn, oats, rye, hulled (not pearled) barley, brown rice, millet, quinoa, amaranth, spelt, kamut…

More minerals, vitamins, antioxidants, fiber

Triggers release of insulin…tryptophan

Legumes

Dried beans (pinto, kidney, white, lima, black, red), lentils, split peas, black-eye peas…)

Inexpensive and easy to cook

Higher levels of folate!

Legumes

How might legumes work?How might legumes work?

High in antioxidants, vitamins High in antioxidants, vitamins and mineralsand minerals

High in fiberHigh in fiber (14)(14)

‘‘Healthy’ weight loss, while Healthy’ weight loss, while maintaining lean muscle maintaining lean muscle massmass

Promote lower insulin levelsPromote lower insulin levels

Serotonin Foods

Include:Include:

-Recommendation: include in your 5-9 per day-Recommendation: include in your 5-9 per day

Tryptophan Foods

Include:Include:

-Recommendation: 200 mg per day-Recommendation: 200 mg per day

You Want to Balance Intake

HighHigh Serotonin States: Serotonin States:(less receptors)(less receptors)

LowLow Serotonin States: Serotonin States:(more receptors)(more receptors)

Choline Foods

Include:Include:

-Recommendation: 400-500 mg per day-Recommendation: 400-500 mg per day

Acetic Acid

-Main component of vinegar-Main component of vinegar-Acetyl group, derived from acetic -Acetyl group, derived from acetic acid is fundamental to all forms of acid is fundamental to all forms of lifelife--AcetylcholineAcetylcholine is an is an esterester of acetic of acetic acid and cholineacid and choline--IncludesIncludes::

-Recommendation-Recommendation: 1-3 tsp 1-3 times per : 1-3 tsp 1-3 times per day (with meals)day (with meals)

Chocolate and Fatigue Higher depression scores associated

with greater chocolate consumption (observational, Rose, N.,

et al, Arch Intern Med, 2010;170(8):699- 703)

A daily dose of dark chocolate can decrease fatigue (74)

Rich in flavonoids—has anti-inflammatory properties (75) Lowers CRP, blood pressure

Also, has caffeine-like Theobromine, and magnesium and Tryptophan

Basic Diet Recommendations

Avoid: Refined flours Refined sugars and juices Artificial sweeteners:

especially high fructose corn syrup (HFCS)!!!

Hydrogenated and partially hydrogenated oils (“trans fats”) and oils heated to smoking

Basic Diet Recommendations

Avoid (continued): Processed, preserved or cured meats

(e.g. lunchmeats, bacon, ham)

Dietary Fats Recommendations Extra virgin olive oil is the best all purpose

oil, canola & soy are reasonable second choices

Minimize use of other vegetable oils

Butter is fine in moderation

Enjoy raw nuts in moderate

amounts (walnuts)

Basic Diet Recommendations

5-9 servings daily of a variety of fruits and vegetables

Whole foods (not juiced) are preferred A variety of vegetables, berries, cabbage family foods, onions, garlic,

mushrooms Choose whole grains over refined grains Regularly enjoy cooked dried beans, peas and lentils

Eat To Improve Your Mood

Eat breakfast and eat regular meals Eat protein at every meal! (& bedtime

snack) Eat fish at least 3 times a week

People who eat fish < 1x/wk have almost a third higher risk of depression

Get enough folic acid (dark green leafy vegetables, lentils, asparagus, peas)

Limit your alcohol intake

Other Recommendations

You may want to check for food allergies, or for anemia (iron deficiency), low iodine

Journal: keep track of what you eat and drink and your moods

Anticipate your stress and have healthy food ready (fruit, veggies, yogurt)

Are you drinking too much caffeine? Frequent cravings? Mis-direct the brain. Learn to express your feelings in appropriate

ways

Lifestyle Influences

Lifestyle:Proper Hydration-Water

Fatigue can be a symptom of dehydration

Hypo-hydration has been related with: lethargy, irritability and headaches

Found a decrease in visual memory

Checked more symptoms and greater severity when dehydrated (36)

A British food and mood study found 70% of participant’s mood improved by increasing water and produce intakes

Lifestyle:Proper Hydration-Tea

Japanese study involving over 40,000 people

Psychological stress 20% lower in those who drank at least 5 cups of Green tea (Camellia sinensis) per day compared to those who drank less than 1

Protective effects from oxidative stress (anti-oxidant polyphenols)

Green Tea (Camellia sinensis)

Same plant for: Green, Black, & White teas

Also contains 1/3 caffeine as coffee

Numerous health benefits from cancer- protective to blood sugar balancing

Lifestyle:The Benefits of Exercise!

A recent review: Graded exercise therapy reduced symptoms and improved function (37)

Active people are less depressed (38)

Easy way to increase serotonin and the endorphins!

Melatonin

The gut is the most important extra-pineal source of melatonin

It’s presence tells us it’s important to digestive pathology-physiology

Close relationship with serotonin Again, most of the body’s serotonin

is produced and stored in the gut (enterochromaffin cells)

So, important relationship with SLEEP!

Poor sleep de-sensitizes serotonin pathways

GOOD SLEEP = GOOD SEROTONIN!

Moods

Our emotions and moods can alsoaffect serotonin levels

Difficult when we aren’t feeling good Things to try to help:

Meditation Relaxation techniques Guided Imagery Talking with friends, spiritual faith advisor Counseling,…

Supplements

Fish Oil and Depression Recommendation: three 6

ounce servings of salmon, tuna, herring or sardines per week

Reasonable dose: 1 Tbsp fish oil per day

High-dose omega-3 fats have significant anti-depressant value (50)

Helps inflammatory bowel disease, rheumatoid arthritis, asthma, heart disease…

Possible enhanced benefit when omega-6 fats (vegetable oils) are minimized

Probiotics

Balanced microflora has been shown to: 95+% of the body’s serotonin is produced and

stored in the gut! Synthesize a number of water soluble vitamins Reduce intestinal inflammation (decreases antigen

load and pro-inflamm cytokines) Decrease frequency of colds and flu Found to induce the expression of mu-

opioid and cannabinoid receptors in the intestinal epithelial cells (similar to the effects of morphine)

Vitamin D

Deficiency of Vitamin D has been associated with depression

Vitamin D has also been linked withserotonin levels

Supplementation: 2,000 i.u. per day

Goal: 40-60 ng/mL in serum Garland, CF, Ann Epidemiol, 2009;19:468-483.Shinchuk, L, Nut Clin Pract, 2007;22(3):297-304.

Supplements

Choose supplements with care and consideration of evidence, cost and complexity of dosing routine

Best to take an individualized approach

Seek professional advice, as needs vary and may interact with other supplements and/or medications

Some may be contraindicated for certain mental health conditions

Summary

Treating Mood and Depression issues with Integrated Medicine:

Treat the whole person

Improve Overall Mental Health Using: Food…Diet and Nutrition Lifestyle Influences Supplements Chinese Medicine and Acupuncture Massage

Consider Integrative Medicine as a part of the healthy brain and mood health care team

Providence Integrative Medicine Clinics

Westside9135 S.W. Barnes Rd.,Suite 161Portland, OR 97225Phone: 503-216-0246 Located in the East

Pavillion (Medical Office Building) next to St. Vincent Hospital

Eastside4805 N.E. Glisan St., 1st

Floor North TowerPortland, OR 97213Phone: 503-215-

3219 Located on the first

floor of the cancer tower near the elevators and the fountain

Resources

The Mood Cure, by Julia Ross The UltraMind Solution, by Mark Hyman,

MD The Edge Effect, by Richard Braverman,

MD Potatoes Not Prozac, by Kathleen

DesMaisons The Food-Mood Solution, by Jack Challem