Title: The Impact of Nutrition: On Substance Abuse, Mental Illness
1The 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
2Goals 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
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4Scores 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.
6To 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
7Diet and Stress
Uncontrolled Eating, Poor Food Choices
Fatigue, Mood Swings
STRESS
8Behaviors that Increase During Stress
- Excessive eating / Restrictive Eating
- Meal skipping
- Caffeine use
- Alcohol use
- Smoking
- Decreased water intake
9Excessive 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
10Reflux
- When you have reflux . . .
11Potential 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
12Meal 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
13Caffeine
- 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
14Alcohol
- 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
15Smoking1. 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
16Decreased 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
17Healthy Eating is Important for those in Recovery
or with Mental Illness Because . . . WHY?
18Good / Bad vs. Safe / Risky
19Food Choices are Affected By
- Senses
- Sight
- Smell
- Taste
- Mouth Feel
- Sound
20Food Choices Can Affect
Mood
Recovery
Energy
COPING
21Food
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
22Is 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
23Is 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
24Is 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
25Is 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
26Brain 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
27Omega-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
28Omega-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
29Vitamin 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
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31Brain 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
32Peanuts 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)
33Potential 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
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35Nutritional 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
36Nutritional 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
37Nutritional 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)
38Nutritional 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)
39Hunger 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)
40Questions
41References
- 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. -
42References
- 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.
43References
- 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