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The Impact of Nutrition: On Substance Abuse, Mental Illness

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Title: The Impact of Nutrition: On Substance Abuse, Mental Illness


1
The Impact of Nutrition On Substance Abuse,
Mental Illness Eating Disorders
  • Sherri Rule, R.D.
  • MGHS Outpatient Dietitian
  • Heidi Schneiderhan, LMSW
  • Marquette Family Medicine Residency
  • Director of Behavioral Science

2
Goals and Objectives
  • Identify behaviors people engage in when stressed
  • Learn about nutritional consequences of these
    behaviors
  • Learn how food choices can affect the recovery
    process
  • Learn about omega-3 fat and vitamin D and
    depression
  • Learn about potential physical side effects of
    medications used in treating mental illness
  • Learn about 3 nutritional interventions for
    physical side effects of medications used in
    treating mental illness

3
(No Transcript)
4
Scores between 90 and 100 - Excellent! Your
answers show that you are aware of healthy food
choices and are making those choices in your
daily eating habits. As long as you continue to
practice these healthy food habits, this area
should not pose a serious health risk. It's also
likely that you are setting an example for your
friends and family to follow. Keep up the good
work. Scores of 55 to 89 - Your food choices for
a healthier you are good, but there is room for
improvement. Look again at the items you
answered with a "sometimes" or "almost never".
What changes can you make to improve your score?
Even a few small changes can often help you
achieve better health through better food
choices. Don't try to change them all at once,
or you may defeat your goal.
5
  • Scores of 20 to 54 -
  • Your health risks associated with healthy food
    choices are showing! Would you like more
    information about the risks you are facing and
    why it is important for you to make changes in
    these behaviors? Perhaps you need help in
    deciding how to successfully make the changes you
    desire.
  • Scores of 0 to 19 -
  • Obviously, you were concerned enough about your
    health to take the test, but your answers show
    that you may be taking serious risks with your
    health. Perhaps you are not aware of the risks
    that your daily food choices have on your health.
    Information is available to help you improve
    your health risks through healthy food choices.
    The next step is yours by contacting a registered
    dietitian.

6
To Calculate Your BMI
  • Weight in pounds ? Height in inches ? Height in
    inches x 703
  • OR
  • Weight in pounds ? 2.2 Weight in kilograms
  • Height in inches x .0254 Height in meters
  • Weight in kilograms ? Height in meters ? Height
    in meters

7
Diet and Stress
Uncontrolled Eating, Poor Food Choices
Fatigue, Mood Swings
STRESS
8
Behaviors that Increase During Stress
  • Excessive eating / Restrictive Eating
  • Meal skipping
  • Caffeine use
  • Alcohol use
  • Smoking
  • Decreased water intake

9
Excessive Eating / Restrictive Eating
  • Excessive
  • Salty foods water retention irritability
    high blood pressure
  • Fat may also be in salty foods weight gain
  • Sugar temporary boost in energy then crash
    (headache, irritable, dizzy, fatigue, cravings)
  • Insomnia
  • Reflux
  • Restrictive
  • Decreased brain power
  • fatigue
  • concentration
  • focus
  • irritability
  • Insomnia

10
Reflux
  • When you have reflux . . .

11
Potential IrritantsReference Tufts Health and
Nutrition Letter, March, 2007, Volume 25, Number 1
  • Food
  • Fatty foods
  • Alcohol
  • Peppermint
  • Chocolate
  • Coffee and tea
  • Possibly carbonated drinks
  • Cranberry juice
  • Citrus
  • Hot spices
  • Spicy foods like onions and garlic
  • Other
  • Smoking
  • Eating right up to bedtime avoid eating at
    least 4 hours before bed AND maintain an upright
    position for 3 hours after eating
  • Irregular eating habits eat 5-6 small meals
    daily
  • Tight fitting clothes
  • Cold liquids (sometimes) try liquids at room
    temperature and limit at meal times, if needed

12
Meal Skipping
  • Blood sugar drops, which increases stress
    hormones and can lead to fatigue, irritability,
    and decreased coping
  • Decreased concentration, inability to focus,
    weight gain
  • Skipping breakfast decreases energy mid-morning
  • Skipping snacks when really hungry can be as
    destructive as skipping meals snacks help to
    prevent overeating at the next meal

13
Caffeine
  • Causes release of adrenaline increasing stress
    level
  • Consuming too much caffeine has the same effect
    as prolonged stress can cause irritability,
    restlessness, mood changes, and fatigue
  • Found in coffee, tea, pop, chocolate, and some
    OTC medications
  • Can take up to 12 hours to leave the system
  • Limit caffeinated drinks to 1-2 drinks daily

14
Alcohol
  • Many take alcohol to combat stress but stress is
    worsened by alcohol
  • Stimulates secretion of adrenaline, resulting in
    problems such as nervous tension, irritability,
    and insomnia
  • Excess alcohol increases fat deposits in the
    heart and decreases immune function
  • Limits ability of liver to remove toxins from the
    body
  • Contributes to excess calories
  • Limit 1-2 drinks daily

15
Smoking1. www.stop-smoking-tips.com2.
European Journal of Clinical Nutrition. 1999 Dec
53 (12), 920-6.3. Nutrition Journal 2004,
318.4. www.dummies.com/how-to/content/assessing-
the-consequences-of-smoking.html
  • Short-term stress reliever
  • Long-term health consequences
  • Chemicals in cigarette smoke destroy vitamin C -
    1 cigarette destroys 90 mg. Vitamin C the
    amount found in an orange1
  • Chemicals in cigarette smoke attacks and destroys
    vitamin A puts smokers at higher risk for lung
    infections and cancer1
  • Increases need for vitamin D and calcium2
  • Decreases serum concentration of selenium, zinc
    and vitamin E3
  • Increases likelihood of heart disease, lung
    disease, stroke, cancer4
  • Associated with development of osteoporosis4

16
Decreased Water Intake
  • Water is needed for all chemical reactions in the
    body
  • Once thirst is felt, the bodys cells have
    already started to dehydrate
  • Average healthy adult excretes 80 oz. of water
    daily through normal bodily functions like
    perspiration and elimination
  • Increased water is needed to accommodate excess
    fluid loss through strenuous exercise, exposure
    to extreme cold and hot temperatures, illness
    (fever, diarrhea, vomiting), and pregnancy/nursing

17
Healthy Eating is Important for those in Recovery
or with Mental Illness Because . . . WHY?
18
Good / Bad vs. Safe / Risky
19
Food Choices are Affected By
  • Senses
  • Sight
  • Smell
  • Taste
  • Mouth Feel
  • Sound

20
Food Choices Can Affect
Mood
Recovery
Energy
COPING
21
Food
CHO Pro Fat
Simple
Pop, fruit juice Cookies, cakes,
pies Doughnuts Candy
Cells
GLC GLC GLC GLC GLC GLC GLC GLC
GLC GLC GLC GLC GLC GLC GLC GLC GLC
GLC GLC GLC GLC
Complex
High fiber cereal Whole grain breads,
crackers Fresh fruit Vegetables
Glc
Insulin
Pancreas
Lunch
Supper
Breakfast
22
Is Sugar Addicting?
  • Professor Bart Hoebel, Princeton University
  • Rats fed high sugar diet, then denied sugar for a
    long period of time
  • Rats worked harder to get sugar when sugar was
    re-introduced to them consumed more sugar than
    ever before (suggesting craving and relapse
    behavior)
  • Rats drank more alcohol than normal when sugar
    supply was eliminated

23
Is Sugar Addicting?
  • Rats eating large amounts of sugar when hungry
    (sugar-bingeing) neurochemical changes in brain
  • Neurochemical changes mimic those produced by
    substances of abuse (cocaine, morphine, nicotine)
  • After a month of sugar bingeing, the rats brain
    structure changed adapted to increased dopamine
    levels

24
Is Sugar Addicting?
  • Researchers theorize that sweet taste releases
    endorphines and dopamine impresses this
    experience in the memory
  • Researches induced signs of withdrawal by taking
    sugar away dopamine levels dropped and rats
    exhibited anxiety (a sign of withdrawal)
  • Powerful response the sight and smell of the
    food, at a later time, releases dopamine and
    cravings intensify for another taste

25
Is Sugar Addicting?Somer, Elizabeth, MA, RD.
Food and Mood. Presented at the 6th Annual
Nutrition and Health State of the Science
Clinical Applications, May 10-13, 2009 Chicago,
IL.
  • When sugar was re-introduced, the animals binged
    (classic symptom of substance abuse)
  • Changes resembled changes in morphine / heroin
    addiction
  • Researchers theorize that sweet taste releases
    endorphines and dopamine impresses this
    experience in the memory
  • Powerful response the sight and smell of the
    food, at a later time, releases dopamine and
    cravings intensify for another taste

26
Brain Food Recommendations
  • Maintain blood sugar by 6 small
  • meals daily, evenly spaced about
  • every 2-3 hours (NOT longer than
  • every 4-5 hours apart)
  • If including sweets, limit to twice a
  • day and include with meals
  • Limit caffeine to 2 servings daily
  • Increase complex carbohydrates,
  • protein and fiber

27
Omega-3 Fat and DepressionHibbeln, Joseph, M.D.
Healthy intakes of n-3 and n-6 fatty acids
estimations considering worldwide diversity.
American Journal of Clinical Nutrition, 2006 83
(suppl) 1483s 93s
  • 12 risk models
  • CHD for male and female
  • Stroke for male and female
  • CVD for male and female
  • Total mortality for male and female
  • Homicide mortality
  • Postpartum depression
  • Major depression
  • Bipolar depression
  • Greater omega-3 availability decreased disease
    rates in all 12 models

28
Omega-3 Fat and DepressionSublette, M.
Elizabeth, M.D., Ph.D. Omega-3 Polyunsaturated
Essential Fatty Acid Status as a Predictor of
Future Suicide Risk. Am J Psychiatry, June,
2006, 1636.
  • Findings reflected that low DHA (docosahexaenoic
    acid) percentages and high omega-6 / omega-3
    ratio predict suicidal behavior in major
    depression
  • Low omega-3 may result in increased vulnerability
    to suicide
  • The results of this study are preliminary and
    further investigation is needed in a
    placebo-controlled study

29
Vitamin D Deficiency and DepressionHolick,
Michael F., M.D., Ph.D. Vitamin D Deficiency.
N Engl J Med, July 19, 2007 3573.
  • Linked with increased incidence of schizophrenia
    and depression
  • Adequate vitamin D during pregnancy and early
    life may be important for brain development and
    maintenance of mental function later in life

30
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31
Brain Food Recommendations
  • Provide vitamin and mineral supplements as needed
    but dont overtake them
  • Increase variety of diet nutrients are better
    absorbed and utilized through food than through a
    pill

32
Peanuts and Jelly Beans
  • How many were eaten?
  • How is your focus concentration?
  • How do you physically feel?
  • How hungry are you now? (Scale of 0-10)

33
Potential Side Effects of Medications for
Mental Illness
  • Risk of decreased compliance of taking meds
  • Weight changes
  • Blood pressure changes
  • Cholesterol and/or triglyceride changes
  • Constipation

34
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35
Nutritional Remedies for Potential Medication
Side Effects Weight Changes
  • Improve quality of diet nutrient dense vs.
    calorie dense
  • Increase awareness of portion size
  • Increase awareness of hunger cues
  • Increase awareness of fullness cues

36
Nutritional Remedies for Potential Medication
Side Effects Blood Pressure and/or Retaining
More Water
  • Increase awareness of how much salt is eaten
    salt acts like a sponge and holds fluid in
  • Improve the quality of diet nutrient dense vs.
    calorie dense

37
Nutritional Remedies for Potential Medication
Side Effects Cholesterol and / or Triglyceride
Increase
  • Include monounsaturated fats in diet (olive oil,
    nuts, peanut butter, olives, avocados)
  • Include omega-3 fat in diet (fatty fish
    vegetable oils like canola, soybean and flaxseed
    flaxseeds nuts and seeds
  • Include fruits and vegetables, oats, legumes
    (beans, peas and lentils)

38
Nutritional Remedies for Potential Medication
Side Effects Constipation
  • Include enough water during the day
  • Increase fiber by adding more fruits, vegetables,
    whole grain breads and cereals, and legumes
    (beans, peas, lentils)

39
Hunger Fullness ScaleOffice-Based Intervention
Stomach Hurts, Full up to Chin
Dizzy Shaky
Nauseous
Nauseous
Irritable Lightheaded
Headache, Foggy Brain
Stomach is Very Distended, Foggy Brain
Growling or Burning Stomach
Starting to Feel Bloated
Perfectly Comfortable
Slightly Uncomfortable, Heavy
(2-3 bites too many)
40
Questions
41
References
  • American Dietetic Association Nutrition Care
    Manual 2009 American Dietetic
  • Association.
  • Clark, Nancy, M.S., R.D. Nancy Clarks Sports
    Nutrition Guidebook 3rd edition.
  • United States Human Kinetics, 2003. Pg
    221.
  • Dare C, et al. Psychological therapies for
    adults with anorexia nervosa
  • Randomized controlled trial of
    out-patient treatments. The British Journal of
  • Psychiatry 2001, 178 216-21.
  • Devlin, Michael J., M.D., FAED. Obesity and
    Eating Disorders Finding the
  • Right Fit (Part II). National Eating
    Disorders Association Newsletter, Fall, 2005.
  • European Journal of Clinical Nutrition. 1999
    Dec 53 (12), 920-6.
  • DSM-IV-TR. American Psychiatric Association
    2000.
  • Garner, David M., Ph.D. The effects of
    starvation on behavior implications for dieting
    and eating disorders. Healthy Weight Journal.
    September/October, 1998. Pg. 68-72.

42
References
  • Hibbeln, Joseph, M.D., et al. Healthy Intakes
    of n-3 and n-6 fatty acids estimations
    considering worldwide diversity. American
    Journal of Clinical Nutrition, 2006, Volume 83
    (suppl) 1483s 93s.
  • Hibbeln, Joseph, M.D., et al. Maternal seafood
    consumption in pregnancy and neurodevelopmental
    outcomes in childhood (ALSPAC study) an
    observational cohort study. The Lancet,
    February 17, 2007, volume 369, pages 578 585.
  • Holick, Michael F., M.D., Ph.D. Vitamin D
    Deficiency. New England Journal of Medicine,
    July 19, 2007, Volume 357, Number 3, pages 281.
  • Mehler PS, Andersen AE. Eating Disorders A Guide
    to Medical Care and Complications
  • NIH News in Health. When eating goes to
    extremes. May, 2007. newsinhealth.nih.gov.
  • Nutrition Journal 2004, 318.
  • Position of the American Dietetic Association
    Nutrition Intervention in the Treatment of
    Anorexia Nervosa, Bulimia Nervosa, and Other
    Eating Disorders. Journal of the American
    Dietetic Association, December, 2006, Volume 106,
    Number 12, pgs. 2073 - 2082.

43
References
  • Somer, Elizabeth, M.A., R.D. Food and Mood, How
    What You Eat Affects How You Feel, Think, Sleep,
    and Handle Stress. Presented at the 6th Annual
    Nutrition and Health State of the Science
    Clinical Applications, May 10-13, 2009, Chicago
    Marriot Downtown Magnificent Mile Chicago, IL.
  • Sublette, M. Elizabeth, M.D., Ph.D, Hibblen,
    Joseph, M.D., et al. Omega-3 Polyunsaturated
    Essential Fatty Acid Status as a Predictor of
    Future Suicide Risk. American Journal of
    Psychiatry, June, 2006, Volume 163, Number 6,
    pages 1100 1102.
  • Tufts Health and Nutrition Letter, March, 2007,
    Volume 25, Number 1
  • www.dummies.com/how-to/content/assessing-the-conse
    quences-of-smoking.html
  • www.princeton.edu. Sugar can be addictive,
    Princeton scientist says, by Kitta MacPherson.
    Posted December 10, 2008 0600 a.m.
  • www.stop-smoking-tips.com
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