The Food-and-Mood Connection

1. The Food-and-Mood Connection Providence Cancer Center Integrative Medicine Program Loch Chandler ND, MSOM, LAc November 15, 2011

2. Our Discussion Today Causes of Mood Alterations Mind-Body Relationships Neurotransmitters Diet and Nutrition Lifestyle Influences Supplements Summary

3. 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!

4. 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

5. Effects of Stress on the Mind & Body

6. 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

7. 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.

8. How Do Our Cells Communicate?

9. 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

10. 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

11. 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??

12. 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%)!!

13. 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

14. Serotonin

15. 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!

16. 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

17. 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!

18. 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

19. Cortisol • Glucocorticoids: • Accelerate breakdown of proteins into amino acidsbloodliverglucose (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)

20. Diet and Nutrition

21. 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).

22. 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

23. 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!

24. 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 GIratings (>70) raise blood sugars quickly = BAD! • Low GIratings (<55) raise blood sugars slowly • Low ratings are better for many reasons!

25. 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

26. Vicious Cycle Intake of high GI foods High blood sugar High insulin levels Low blood sugar and increased fat storage Increased hunger Increased cravings for high GI foods

27. 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)

28. 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

29. 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

30. 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!

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. Legumes Dried beans (pinto, kidney, white, lima, black, red), lentils, split peas, black-eye peas…) • Inexpensive and easy to cook • Higher levels of folate!

39. Legumes How might legumes work? • High in antioxidants, vitamins and minerals • High in fiber(14) • ‘Healthy’ weight loss, while maintaining lean muscle mass • Promote lower insulin levels

40. Serotonin Foods Include: -Recommendation: include in your 5-9 per day

41. Tryptophan Foods Include: -Recommendation: 200 mg per day

42. You Want to Balance Intake High Serotonin States: (less receptors) Low Serotonin States: (more receptors)

43. Choline Foods Include: -Recommendation: 400-500 mg per day

44. Acetic Acid -Main component of vinegar -Acetyl group, derived from acetic acid is fundamental to all forms of life -Acetylcholine is an ester of acetic acid and choline -Includes: -Recommendation: 1-3 tsp 1-3 times per day (with meals)

45. 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

46. 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

47. Basic Diet Recommendations • Avoid (continued): • Processed, preserved or cured meats (e.g. lunchmeats, bacon, ham)

48. 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)

49. 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

50. 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