Nutrition and Mental Health: A Review of the Science The ... · PDF fileNutrition and Mental Health: A Review of the Science The Physiology of Mental Health ... September November

1

Nutrition and Mental Health:

A Review of the Science

The Physiology of Mental Health

Kathleen S. Matt, PhDD C ll f H lth S i

1

Dean, College of Health Sciences Executive Director,

Delaware Health Sciences Alliance [email protected]

Sponsored by The University of Arizona

College of MedicineAt the Arizona Health Sciences Center

2

Disclosures

Kathleen Matt, PhDhas nothing to disclose.

The relationshipbetween mood andfood and health.food and health.

3

Study published in Journal of the American Dietetic Association, ( 2010)indicated poor diet quality was significantly correlated withincreased symptoms of depression

Relationship between Diet and Depression

increased symptoms of depression(p< .0001)

Study published in the BritishJournal of Psychiatry (2009)indicated that participants withhighest intake of whole foods(fruit, vegetables,fish) were less( , g , )likely to report depression. Those with highest intake ofprocessed food (processed meat, sweet desserts, fried food, refinedcereals, high fat milk-products)

showed higher risk of depression.

Mood is affected by the foods you choose:

Carbohydrates and sugaryfoods make you depressed,sleepy and impair memorysleepy, and impair memory.

Fish, chicken and eggs increaseneurotransmitters and enhance mood, memory, and energy.

Blueberries, avocados, oranges, andBlueberries, avocados, oranges, and

spinach inprove memory and concentration.

Why? It’s in your biochemistry!

4

Stress and Nutrition – the foods you choose are affected by your mood.

5

A research study in Britain reported that workers with high levels of stress were

STRESS

g68% more likely to develop heart conditions. Workers with stress had higher stress hormones,heart rates and more heart disease. This was seen in both male and female workers and this effect wasseen most strongly in workers under age 50.

“What is it that makes us unable to think, unable tosleep, increases our cravingsfor salty snacks and sweet foods? “

STRESS

6

STRESS

“What is it that enablesan individual to demonstrateunbelievable speed, concentration,focus, mental abilities and creativity”

Effects of SES on Stress Responsesand Disease Risk,

antioxidant studies

Nervous/ Endocrine/ Immune

Environment

Behavior

Social

Diet

obesity

Rheumatoid Arthritis PTSD

Pre-term labor

Nanotechnology / ‘sensors

Yoga, swimming,qigong, aerobicsand weight training

Cytokines

Exercise

Cancer and autoimmune disease HR, BP, cholesterol, CRP

Endocrine

Nervous System

Immune System

7

Body WeightsBody Weightsgramsgrams45.045.0

40.040.0

35.035.0

SeparatedPairedSeparatedSeparated

Weeks from SeparationWeeks from Separation

30.030.0

--33 --22 --11 00 11 22 33 44

NeuroendocrineNeuroendocrine Lab ASULab ASU

Baseline Baseline CortisolCortisol

8080

100100SeparatedPaired

*Paired

Separated

Baseline Baseline CatecholaminesCatecholamines

2000

2500Paired

Separated

*

00

2020

4040

6060

8080

Plasma Plasma CortisolCortisol ((ngng/ml)/ml)0

500

1000

1500

NorepinephrineNorepinephrine EpinephrineEpinephrine

Plasma Plasma CatecholaminesCatecholamines (pg/ml)(pg/ml)

*

8

Complimentary and AlternativeMedicine

Health

**Acupuncture**Biofeedback

YogaExercise

Mechanismsof Integration

Acute Stress(+)

Chronic Stress Disease

Performance(-)

( )

Functional Stress Score - Pre and Post Assessments effects on mental and physical performance

CORTISOL22

Cognition Score

Cortisol AUC (ug/dl * min)

400 600 800 1000 1200 1400

Co

gn

itio

n s

core

(p

erce

nt)

20

30

40

50

60

70

80

90

100DIASTOLIC BLOOD PRESSURE

B S M A C I R

Dia

stol

ic B

lood

Pre

ssur

e (m

m H

g)

70

75

80

85

90

95

100

105

110

MALESFEMALES

B S M A C I R

Cor

tisol

(ug

/dl)

8

10

12

14

16

18

20

MALESFEMALES

9

“Neuroendocrine Responses to Stress: Linkages to Disease”Kathleen S. Matt, [email protected]

B1 B2 E1 E2 E3 R1 R2 R3-30

0

30

60

.

++

+

Cor

tiso

l (ug

dl-1

)

H-Women N-Women H-Men N-Men

%

Cor

tiso

l

15

30

45

60

75

*

*

CORTISOL

sol (

ug/

dl)

20

25

OARA

HEART RATE

Ra

te (

bp

m)

72

74

76

78

80

82

OARA

Stress Reactivity and Cognition

Cortisol AUC (ug/dl * min)

400 600 800 1000 1200 1400

Co

gn

itio

n s

core

(p

erce

nt)

20

30

40

50

60

70

80

90

100

B S M A C I R

Cor

ti

15

Both groups responded similarly to the laboratory stressors withsignificant increases in cortisol (p=.01)

B S M A C I R

He

art

R

64

66

68

70

72

HR was significantly increased in response to stress (p<.0001)RA's had a significantly greater response, compared to OA's (p<.05)

The Challenge:To develop new moresensitive,and non-invasive methods to measure nano-quantities of biomarkers such as: steroids, catecholamines, and peptides in saliva, sweat, etc. in real time analysis.

Canyon Ranch: Stress ReactivityCanyon Ranch: Stress ReactivityNorepinephrine (pg/ml)Norepinephrine (pg/ml)

0

250

500

750

1000

0

250

500

750

1000 BeforeAfter

Low DiseaseLow DiseaseHigh DiseaseHigh Disease

RestRest PsychPsych CPCP RecoveryRecovery RestRest PsychPsych CPCP RecoveryRecovery

Canyon RanchCanyon RanchStress Reactivity: Cortisol Stress Reactivity: Cortisol (ug/dl)(ug/dl)

RestRest Psychological Psychological StressStress

Cold Cold PressorPressor

RecoveryRecovery88

1010

1212

1414

1616

1818

2020BeforeAfter

PlasmaPlasma

HormoneHormone

LevelLevel

Neuroendocrine Lab ASUNeuroendocrine Lab ASU

n=21r = -.47, p<.05

A neuroendocrine model of stress

Sympathetic Nervous SystemHypothalamic-

Pituitary Adrenaly p y

CatecholaminesNorepinephrineEpinephrine

Pituitary-AdrenalAxis

Cortisol

Heart racing, rapid breathing,nervousness, lack of appetite,loss of weight, difficulty sleeping , etc.

Increased appetite,weight gain, increasedabdominal obesity,muscle wasting,confusion, etc.

10

Psychological Stress –Its not just in your head! Its in your physiology!It affects your food choices, and your food choices affect your stress!

Eating behavior - Intake of salty and sugary foods

(positive feedback loop on cortisol)Stress – increase in cortisol – increase in NPY

– increase in food intake

Unable to sleep - Caffeine intake

( positive feedback loop it mimics the( positive feedback loop, it mimics thesympathetic nervous system (fight or flight)Increase HR, BP, respiration, anxiety, inability to concentrate

Prolong the stress response

Sometimes we try to alleviate the

Stress reduction:

stress response by :Drinking alcoholSmoking

(mimic the parasympathetic nervous system)

11

Negative consequences of elevated cortisol

• visceral obesity• insulin resistance

N i li id fil• Negative lipid profile• muscle mass• bone mineral density• Impaired cognitive function• immune function• Increased risk for disease:

– Diabetes– CVD – Osteoporosis – Cancer – Alzheimer’s disease

Neuropeptides: CRH, NPY, vasopressin (AVP), Galanin, Oxytocin (OT), CCK, leptin

NPY Galanin

AVP OT

Decreased EatingWeight Loss

Increased Eating Weight Gain

AVP OT

OpiodsCRH

CCK

Choice of Food Amount of FoodQuality of Food

12

Physical Stress

Psychological Stress X

HPA SNSCRH

ACTH

NE E- -

Products of metabolism, pH, 02 saturation, etc.

Meet the metabolic demand of exercise

cortisolNE, E

Glucose and Fuel Production

X

13

Matt Stress Reactivity Protocol – a technique developed in the

Neuroendocrine Lab to assess the dynamic function of the Neuroendocrine Axis

-45-----0------3------6-------9--------12------------30---------50

catheter insertion

Baseline

StroopMath

Cold Pressor

InterpersonalRecovery

Anagram

BLUE

18 12x6 x9

oudpn

Measurements:

Heart Rate Plasma ACTH Cytokines

Blood Pressure Plasma Cortisol CRP

14

HEART RATE

75

80

85

MALESFEMALES

He

art

Ra

te (

bp

m)

50

55

60

65

70

•Heart rate increased significantly in response to the stressreactivity protocol (p<.001).

•There was no effect of gender.

B S M A C I R

DIASTOLIC BLOOD PRESSURE

ure

(m

m H

g)

95

100

105

110

MALESFEMALES

Dia

stol

ic B

lood

Pre

ssu

70

75

80

85

90

95

B S M A C I R

70

•DBP changed significantly in response to the protocol (p<.001). •Males had a significantly greater DBP response to the stress (p<.05)suggesting greater sympathetic activation.

15

CORTISOL

dl)

18

20

22

MALESFEMALES

Cor

tisol

(ug

/d

10

12

14

16

B S M A C I R

8

Low cortisol and High HR response to stress

Risk forAutoimmune Diseases

Eating disorders

High cortisol and High HR response to stress

Synchronized

Eating disorders, Anxiety attacks

(greater % females)

High cortisol and Low HR response to stress

Risk for Diabetes,Abdominal Obesity,

Cardiovascular Disease,

Low cortisol and Low HR response to stress

Synchronized

Low Risk for Disease,Stress Resilient

SNSHR response

DepressionCancer

(greater % males)

Active LifestyleGood Nutrition

High SES

Cortisol response

16

Linkages between Stress and Disease

17

Canyon RanchStress Reactivity: Heartrate

100100 100

Before

After

7070

8080

9090

7070

8080

9090After

Heartrate

(beats/min)

RestRest PsychPsych CPCP6060

7070

RestRest PsychPsych CPCP6060

7070

Low DiseaseLow DiseaseHigh DiseaseHigh DiseaseNeuroendocrine Lab ASUNeuroendocrine Lab ASU

Canyon Ranch: Stress ReactivityNorepinephrine (pg/ml)

1000 1000 BeforeAfter

250

500

750

250

500

750

0

250

0

250

Low DiseaseLow DiseaseHigh DiseaseHigh Disease

RestRest PsychPsych CPCP RecoveryRecovery RestRest PsychPsych CPCP RecoveryRecovery

18

DepressionDiurnal Salivary Cortisol in Healthy and Depressed Patients

12

Healthy Patients

4

6

8

10

Healthy Patients Moderate Depression/ no meds Depression / meds

Time

0 2 4 6 8 10

0

2

PTSD DIURNAL SALIVARY CORTISOL LEVEL

3

4

5

6

SUBJ 451

DIURNAL SALIVARY CORTISOL LEVEL

4

5

6

SUBJ 404

0

1

2

WAKE 15 MINS 30 MINS 45 MINS 3 HRS 6 HRS 9 HRS 12 HRS BEDTIME0

1

2

3

WAKE 15 MINS 30 MINS 45 MINS 3 HRS 6 HRS 9 HRS 12 HRS BEDTIME

DIURNAL SALIVARY CORTISOL LEVEL

5

6DIURNAL SALIVARY CORTISOL LEVEL

6

0

1

2

3

4

5


SUBJ 324

0

1

2

3

4

5


SUBJ 406

19

SALIVARY CORT

“Building Reliance: A Neurobiologically Based AffectiveIntervention for PTSD”, Dr.Martha Kent,,Neuropsychologist, VA

SALIVARY CORT 518

04500

0.5000

SALIVARY CORT 512

0.6000

0.8000

1.0000

1.2000

1.4000

UN

ITS

PRE

POST

00000

0.0500

0.1000

0.1500

0.2000

0.2500

0.3000

0.3500

0.4000

0.4500

UN

ITS

PRE

POST

0.0000

0.2000

0.4000

BSL COG 1 COG 2 COG 3 COG 4

0.0000

BSL COG 1 COG 2 COG 3 COG 4

Stressed EmployeesSALIVARY CORTISOL

HM115

0.25

0.3

0.35

0.4

0.45

G/D

L

HM115PRE

ALPHA-AMYLASEHMS115

80100

120140160

180200

pre

post

0

0.05

0.1

0.15

0.2

1 2 3 4 5 6 7

SESSION

MG HM115 PRE

HM115 POST

020

4060

Baseline Math C.P. Rec

Test Phase

SALIVARY CORTISOLHM117

0 5

0.6

ALPHA-AMYLASEHMS117

C

0

0.1

0.2

0.3

0.4

0.5

BSL

STROOP

MATH

ANAGRM

COLD P

INTE

RP

RECOV

SESSION

MG

/DL

HM117 PRE

HM117 POST

0

200

400

600

800

1000

1200

1400

Baseline Math C.P. Rec

Test Phase

pre

post

20

Stress and Optimum Performance

Biosignatures in athletes with training …

21

GH

GHRH

Immune

22

ACTH - Emerson Ward

100

150

200

250

300

Ho

rmo

nal

va

lue

s

September November March

Increases in hormones in responsein response to exercise both mornand afternoon bout –some changes through the seasonsuggesting adaptation

Cortisol - Emerson Ward

35

40

45


Testosterone - Emerson Ward

6

7

8


0

50

Timepoint 1 AM Timepoint 2 AM Timepoint 3 PM Timepoint 4 PM Timepoint 5 AM

Blood draw timepoints

suggesting adaptation.

Burnout 2.8

0

5

10

15

20

25

30



Ho

rmo

nal

val

ues

0

1

2

3

4

5



Ho

rmo

nal

val

ues

ACTH - Ace Tate

40

60

80

100

120

Ho

rmo

nal

val

ues


Increase in hormones in responseto exercise in morn bout but dampened response through the season

Cortisol - Ace Tate

30

35

40


Testosterone - Ace Tate

7

8

9


0

20



season

Burnout 4.07

0

5

10

15

20

25



Ho

rmo

nal

val

ues

0

1

2

3

4

5

6



Ho

rmo

nal

val

ues

23

VO2max testingaerobic power

Wingate testinganaerobic power

15.00

20.00

25.00

30.00

NG

/ML

SERUM BDNF WINGATE

BDNF

0.00

5.00

10.00

PRE MID POSTTIME

20.00

25.00

30.00

35.00

/ML

SERUM BDNF MSRP

5

7

9

1011131418

0.00

5.00

10.00

15.00

BL STRP MATH ANAG CP IP REC

NG

/

TIME

20222325262834353841

24

300

400

500

600

L

NPY WINGATE

5

6

7

NPY

0

100

200

300

PRE MID POST

PG

/M

TIME

7

9

600

700

NPY Stress Protocol

5

6

0

100

200

300

400

500

BL STR MATH ANAG CP IP REC

PG

/ML

TIME

7

9

1011

Change the inputs to the system

Neural level -Perception to stressReaction to stressR iliResilience to stress

Systemic levelPhysiological adaptations

Exercise and Movement Food choices

25

Heart Rate Response to an Acute Bout of Yoga

Ra

te, b

eats

per

min

ute

70

80

90

100

110

Baseline End

Hea

rt R

40

50

60

26

Positive Interpersonal Event

80

90

Pla

sma

cort

isol

(ug

/dl)

40

50

60

70

Stressors over time

B S M A CP I R

20

30

27

Protective Hormones –

Prolactin

Oxytocin

NPY

Differences in responses to stress –

Fight or Flight –

Tend and Befriend –

What do you see?

For resilience, we need to start

not with what’s missing,

but with what’s already there.

28

From the Greeks: “Happiness is the exercise of vital powers along the lines of excellence in a life affording them scope”excellence in a life affording them scope .

29

Heartmath

Time for Yourself

Recovery and Rest

30

Hippocrates said,“walking is man’s bestmedicine”

Walking:Strive for 10,000steps/daylower blood pressure,loose weight, increaseinsulin sensitivity, improve your health, p y

Decrease your calorie intact by100 calories a day and you will Loose 10 pounds in one year.

or

Burn 100 extra calories a day, byWalking 1 mile a day and loose10 pounds in a year.

31

Food Choices: A P thA Path

to Better Health”

Protection

Calcium, Magnesium-Mood stabilizers,

Increase in: Abdominal Fat

Salt, Sugar,Caffeine, and Fat

Citrus fruits, broccoli, t t dGlucose Level

Heart RateBlood PressureFree RadicalsOxidative Damage

tomatoes, red peppers

Fiber,Protein, olive oil

Walnuts , seafood

32

• Decrease intake of salty and sugary foods “addictive” because they trigger changes in hormones that increase the “d i ” t t (i

Stress and Nutrition

“drive” to eat (increase cortisol)

Decrease intake of refined and processed sugars and starches, eat more complex carbohydrates (less spikes in insulin)

Increase fiber intake, decrease transit time of food in gut, less absorbed.

The Anti-stress Diet

Protein-endurance

Iron –mental speed

Choose nutritious and healthy chewing

33

Healthy ways to meet those STRESS cravings -

Salmon – omega 3 – moodWhole grain – slow released

energy Almonds and

carrots – crunch and Mg

Fruit -sweet, energy, fiber

Whole grainsprotein, fiber, iron, vitamins

Sweet and creamy – yogurt, calmingProbiotics – help digestive system

“The less legThe better”

Core Performance. Mark Verstegen

34

“Eat a rainbowOften…”

Core Performance. Mark Verstegen

35

Stress and Anxiety

DehydrationH l iL k f Sl

Norepinephrine

Epinephrine Caffeine

Hypoglycemia

Heat

Lack of Sleep

Hormonal changes

36

Learn from the strategies of athletes, capitalize on the stress response.

Use the burst of energy created byadrenaline and noradrenalineto fuel your creativity, and giveyou the endurance and focus that

d t l t th j tyou need to complete the project.

Break up these very concentratedintense periods of work withbreaks, preferably exercise suchAs a walk, a run, lifting weights.

Refuel your body with high quality, y y g q y,Nutrient dense foods and natural sourcesOf anti-oxidants.

Personal bests come from a combinationof a strong stimulus and an appropriate

recovery period. Work + Rest + Refuel = Success

Diabetic Patient

Environment

Genes vs

37

Diabetic Patient Pharmacological Treatment – Insulin

Nutrition

Exercise

Personalized Medicine.

38

Interprofessional Teams in Education and Research

39

Delaware Rehabilitation InstituteOptimum Performance and Health InstituteAging and Chronic Disease CenterM C C t

Interdisciplinary Centers

Memory Care Center

Center for Women and Children’s Health ResearchCenter for Global Health

Faculty Hires in the College of Health Sciences

1 Named Chair in School of Nursing2 Junior Faculty positions in School of Nursing

Chair of Behavioral Health and NutritionChair of Behavioral Health and Nutrition

Chair of Kinesiology and Applied Physiology

Unidel Chair in Physiology

78

40

Enjoy life, live it well,

and live it balanced!

Contact information:

Kathy Matt, [email protected]; 302-831-8370

Nutrition and Mental Health: A Review of the Science The ... · PDF fileNutrition and Mental Health: A Review of the Science The Physiology of Mental Health ... September November

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