The Impact of Nutrition: On Substance Abuse, Mental Illness

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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

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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

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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.
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• 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.

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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

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Diet and Stress
Uncontrolled Eating, Poor Food Choices
Fatigue, Mood Swings
STRESS
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Behaviors that Increase During Stress

• Excessive eating / Restrictive Eating
• Meal skipping
• Caffeine use
• Alcohol use
• Smoking
• Decreased water intake

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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

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Reflux

• When you have reflux . . .

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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

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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

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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

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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

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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

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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

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Healthy Eating is Important for those in Recovery
or with Mental Illness Because . . . WHY?
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Good / Bad vs. Safe / Risky
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Food Choices are Affected By

• Senses
• Sight
• Smell
• Taste
• Mouth Feel
• Sound

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Food Choices Can Affect
Mood
Recovery
Energy
COPING
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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
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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

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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

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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)

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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)

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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)
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Questions
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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.

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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.

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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