1. Nutrition as a Factor inNutrition as a Factor in Mental HealthMental Health
 The evidence is steadily increasing !The evidence is steadily increasing !
Mona Moorhouse B.Sc., B.Ed., RDMona Moorhouse B.Sc., B.Ed., RD
Registered Dietitian, Royal Ottawa Mental Health CenterRegistered Dietitian, Royal Ottawa Mental Health Center

2. OutlineOutline
1.Discuss studies on nutrition and:1.Discuss studies on nutrition and:
 MoodMood
 Drug DependenceDrug Dependence
 Alzheimer’s DiseaseAlzheimer’s Disease
2.Review some diet recommendations.2.Review some diet recommendations.
3.Questions3.Questions

3. Waist Circumference & Insulin ResistanceWaist Circumference & Insulin Resistance

4. Insulin ResistanceInsulin Resistance

5. Mood & Insulin ResistanceMood & Insulin Resistance
MethodMethod
 491 subjects491 subjects
 Beck Depression Inventory measured severityBeck Depression Inventory measured severity
of depressionof depression
 Severity of insulin resistance measured.Severity of insulin resistance measured.
ResultsResults
 Insulin resistance and severity of depressionInsulin resistance and severity of depression
were positively correlated.were positively correlated.
BMJ 2005, 330 (7481)BMJ 2005, 330 (7481)
J Affect Disord. 2008: 109(1-2): 75-82J Affect Disord. 2008: 109(1-2): 75-82

6. It shows up in your bloodworkIt shows up in your bloodwork

7. Metabolic SyndromeMetabolic Syndrome
 Abdominal Obesity (waist > 35 inches forAbdominal Obesity (waist > 35 inches for
women, > 40 inches for men).women, > 40 inches for men).
 Insulin resistance & high blood sugar.Insulin resistance & high blood sugar.
 High blood pressure.High blood pressure.
 High cholesterol and triglycerides.High cholesterol and triglycerides.

8. Mood & Metabolic SyndromeMood & Metabolic Syndrome
MethodMethod
 1598 subjects at risk for cardiovascular1598 subjects at risk for cardiovascular
disease screened for metabolic syndrome anddisease screened for metabolic syndrome and
depression.depression.
ResultsResults
 Metabolic Syndrome strongly associatedMetabolic Syndrome strongly associated
with depression (independent of age,with depression (independent of age,
smoking, socioeconomic factors & lifestyle).smoking, socioeconomic factors & lifestyle).
Biological Psychiatry, 2007(62):1251-1257Biological Psychiatry, 2007(62):1251-1257

9. Depression/Schizophrenia &Depression/Schizophrenia &
DiabetesDiabetes
 Depression twice as common in diabetics VS
general population.
 At least 15% of diabetics have major
depression.
 SchizophreniaSchizophrenia is now listed as a risk factoris now listed as a risk factor
for diabetes (Clinical Practice Guidelinesfor diabetes (Clinical Practice Guidelines
2003, Canadian Diabetes Association).2003, Canadian Diabetes Association).
(Diabetes Care 2001;24:1069-1078, 2002;25:464-470, 1993:16:1167-1178)

10. Glycemic IndexGlycemic Index

11. Glycemic Load and MoodGlycemic Load and Mood
Method
 42 healthy overweight subjects42 healthy overweight subjects
 Assigned to either a high or low glycemic load dietAssigned to either a high or low glycemic load diet
for 6 months.for 6 months.
Results
 Subjects on the high glycemic load diet experienced
worsening mood over 6 months compared to subjects
on the low glycemic load diet.
Physiology & Behavior 98 (2009) 374-379Physiology & Behavior 98 (2009) 374-379

12. Carbohydrate Craving in Alcohol Dependence:Carbohydrate Craving in Alcohol Dependence:
SubjectsSubjects
3 groups; a high carbohydrate craving (3 groups; a high carbohydrate craving (nn= 10), a low= 10), a low
carbohydrate craving group (carbohydrate craving group (nn= 11), and a non-= 11), and a non-
addicted control group (addicted control group (nn= 12).= 12).
ResultsResults
The carbohydrate-craving alcohol-dependentThe carbohydrate-craving alcohol-dependent
subjects were uniquely sensitive to the adversesubjects were uniquely sensitive to the adverse
effects of a diet high in refined carbohydrate (ieeffects of a diet high in refined carbohydrate (ie
high glycemic load).high glycemic load).
Moorhouse et al.Moorhouse et al. May 2000May 2000 Alcoholism: Clinical and Experimental ResearchAlcoholism: Clinical and Experimental Research
Volume 24, Issue 5,Volume 24, Issue 5, pages 635–643,pages 635–643,

13. Low Glycemic Index (GI) FoodsLow Glycemic Index (GI) Foods
Eating low Glycemic Index foods helps:
 Control your blood sugar levels.
 Control your cholesterol level.
 Control your appetite.
 Lower your risk of getting heart disease.
 Lower your risk of getting type 2 diabetes.
Source: Canadian Diabetes Association 2008Source: Canadian Diabetes Association 2008

14. Mood & Omega 3 FatsMood & Omega 3 Fats
Three main omega-3 fats:Three main omega-3 fats:
 EPA (fish fats)EPA (fish fats)
 DHA (fish fats)DHA (fish fats)
 ALA (vegetable oils, flax, nuts, leafyALA (vegetable oils, flax, nuts, leafy
vegetables)vegetables)

15. Brain Cell Membranes are 2/3 Omega -3Brain Cell Membranes are 2/3 Omega -3
Fatty AcidsFatty Acids

16. EPA & DHAEPA & DHA
 Brain cell membranes rich inBrain cell membranes rich in DHADHA areare
more fluid.more fluid.
 EPAEPA improves immune function and has aimproves immune function and has a
protective effect in the brain.protective effect in the brain.
Neuro-Signals (Neurosignals) 2009, 17(2):144-52Neuro-Signals (Neurosignals) 2009, 17(2):144-52

17. Mood & Omega-3 FatsMood & Omega-3 Fats
MethodMethod
Meta-analysis of 29 studies up to 2009Meta-analysis of 29 studies up to 2009
ResultsResults
 Evidence provides support for a benefit of Omega-3Evidence provides support for a benefit of Omega-3
fats in people with depressive illness.fats in people with depressive illness.
 Greatest benefits of Omega-3 fats were inGreatest benefits of Omega-3 fats were in
individuals with more severe depression.individuals with more severe depression.
American Journal of Clinical Nutrition, 2010, 91(3): 757-770American Journal of Clinical Nutrition, 2010, 91(3): 757-770

18. Mood, the Immune System &Mood, the Immune System &
Celiac DiseaseCeliac Disease
Celiac Disease (an autoimmune disease)Celiac Disease (an autoimmune disease)
is positively associated with Depression.is positively associated with Depression.
Ludvigsson et al. 2007, Celiac disease and risk of mood disorders.Ludvigsson et al. 2007, Celiac disease and risk of mood disorders.
Journal of Affective DisordersJournal of Affective Disorders

19. Mood & Celiac DiseaseMood & Celiac Disease
Treatment of Celiac Disease with a gluten-Treatment of Celiac Disease with a gluten-
free diet is associated with improved mood.free diet is associated with improved mood.
Neurological Science 2003, 24: 311-317.Neurological Science 2003, 24: 311-317.
The Journal of Postgraduate Medicine 2002The Journal of Postgraduate Medicine 2002

20. Celiac Disease (AutoimmuneCeliac Disease (Autoimmune
Disease)Disease)
WWhat is Celiac Diseasehat is Celiac Disease
Gluten ( wheat, rye ,triticale and barley) triggers the body’s ownGluten ( wheat, rye ,triticale and barley) triggers the body’s own
immune system to release antibodies which attack the small intestineimmune system to release antibodies which attack the small intestine
and many other systems in the bodyand many other systems in the body
Intestinal damage leads to poor absorption of nutrients.Intestinal damage leads to poor absorption of nutrients.
PrevalencePrevalence
Estimated that 1 in 133 people in Canada have celiac disease.Estimated that 1 in 133 people in Canada have celiac disease.
SymptomsSymptoms
Iron deficiency anemia, B12 deficiency, chronic diarrhea orIron deficiency anemia, B12 deficiency, chronic diarrhea or
constipation, extreme fatigue, cramps, bloating, bone pain, irritability,constipation, extreme fatigue, cramps, bloating, bone pain, irritability,
skin rashes, hair loss.skin rashes, hair loss.

21. Celiac DiseaseCeliac Disease

22. National Institutes of Health, Consensus DevelopmentNational Institutes of Health, Consensus Development
Conference Statement, Celiac Disease, August 2004.Conference Statement, Celiac Disease, August 2004.
““Define the relationship between celiacDefine the relationship between celiac
disease, autoimmune disorders &disease, autoimmune disorders &
neuropsychiatric disorders”.neuropsychiatric disorders”.

23. Drug AddictionDrug Addiction

24. Food Intake & Drug AbuseFood Intake & Drug Abuse
National Institute of Drug Abuse (USA)National Institute of Drug Abuse (USA)

25. Omega–3 Fats & Relapse inOmega–3 Fats & Relapse in
Cocaine DependenceCocaine Dependence
Method:
Study of 32 Cocaine Dependent Patients.Study of 32 Cocaine Dependent Patients.
Omega – 3 fat status assessed upon hospital admissionOmega – 3 fat status assessed upon hospital admission
(baseline).(baseline).
Relapse assessed 3 months, 6 months and 1 year after discharge.Relapse assessed 3 months, 6 months and 1 year after discharge.
Results
Low Omega-3 fat status at baseline was a better predictor of
relapse than cocaine use, sociodemographic or clinical
parameters.
Psychiatry Research 120 (2003) 29-35Psychiatry Research 120 (2003) 29-35

26. Triggers for Drug CravingTriggers for Drug Craving
Alcoholics Anonymous & the HALT acronymAlcoholics Anonymous & the HALT acronym
HH ungerunger
AA ngernger
LL onelyonely
TT iredired

27. Digestive Tract & Pleasure/SurvivalDigestive Tract & Pleasure/Survival
Center in the BrainCenter in the Brain

28. Food Restriction & Drug CravingFood Restriction & Drug Craving
 Alcoholics have elevated GHRELIN levels.Alcoholics have elevated GHRELIN levels.
 Elevated GHRELIN is positively correlatedElevated GHRELIN is positively correlated
with intensity of alcohol craving in alcoholism.with intensity of alcohol craving in alcoholism.
 Food restriction increases ghrelin levels, drugFood restriction increases ghrelin levels, drug
craving & the rewarding effects of drugs.craving & the rewarding effects of drugs.
Cabeza de Vaca et al. Food Restriction Enhances the CentralCabeza de Vaca et al. Food Restriction Enhances the Central
Rewarding Effect of Abused Drugs. The Journal ofRewarding Effect of Abused Drugs. The Journal of
Neuroscience 1998,18(18):7502-7510.Neuroscience 1998,18(18):7502-7510.

29. Alzheimer’s DiseaseAlzheimer’s Disease

30. Alzheimer’s Disease (AD)Alzheimer’s Disease (AD)
Method:Method:
194 patients with AD194 patients with AD COMPARED TOCOMPARED TO 1790 subjects1790 subjects
without ADwithout AD
Results:Results:
 Greater adherence to Mediterranean Diet associatedGreater adherence to Mediterranean Diet associated
with significantly reduced risk for AD.with significantly reduced risk for AD.
 Even moderate compliance to the Mediterranean dietEven moderate compliance to the Mediterranean diet
was shown to have a protective effect.was shown to have a protective effect.
Arch Neurol.Arch Neurol. 2006;63:1709-1717. 2006;63:1709-1717.

31. Alzheimer’s Disease &Alzheimer’s Disease &
AntioxidantsAntioxidants
Introduction.
The most abundant dietary anti-oxidants are the polyphenols (in the
skins & peels of fruits/vegetables). Polyphenols are strongly
neuroprotective.
Method.
 1836 subjects, dementia-free in 1992-1994 were followed for 9 years.
 Data determined if drinking fruit/ vegetable juices (apple, grape,
citrus) high in polyphenols, decreased risk for Alzheimer’s..
Results.
 Drinking juice at least 3 times per week was associated with
significantly less risk for developing Alzheimer’s compared to drinking
juice less than once a week.
 American Journal of Medicine, 2006 (119):751-759.

32. Vitamins & MineralsVitamins & Minerals
 Folic AcidFolic Acid
 B12B12
 Vitamin DVitamin D
 MagnesiumMagnesium
 ZincZinc

33. Recommendations toRecommendations to
Promote Mental HealthPromote Mental Health

34. Consider eating more like theConsider eating more like the
Mediterraneans do.Mediterraneans do.

35. The Mediterranean DietThe Mediterranean Diet

36. Other Nutrition RecommendationsOther Nutrition Recommendations
 Choose Low Glycemic Index FoodsChoose Low Glycemic Index Foods
Gi Diet Books by Rick GallopGi Diet Books by Rick Gallop
 Eat a 3-4 oz serving of fatty fish twice per weekEat a 3-4 oz serving of fatty fish twice per week
Rich in omega-3 fats(albacore tuna, mackeral,halibut,herring, salmon, sardines, trout)Rich in omega-3 fats(albacore tuna, mackeral,halibut,herring, salmon, sardines, trout)
 Eat plenty of fruits and vegetables every day for the protective effects ofEat plenty of fruits and vegetables every day for the protective effects of
polyphenols.polyphenols.
Concentrated sources of polyphenols areConcentrated sources of polyphenols are Orange juiceOrange juice, apple juice, grape juice., apple juice, grape juice.
 Eat at least 3 servings whole grains per day.Eat at least 3 servings whole grains per day.
Reduces insulin resistance, source of magnesiumReduces insulin resistance, source of magnesium
 Eat at regular intervals throughout the day.Eat at regular intervals throughout the day.
Brain functions best with a continuous supply of nutrients.Brain functions best with a continuous supply of nutrients.
 Stay well hydratedStay well hydrated
Drink water dailyDrink water daily

37. Other RecommendationsOther Recommendations
 Aim for a healthy weight & a healthy waistAim for a healthy weight & a healthy waist
circumferencecircumference (40” for men, 35” for women)(40” for men, 35” for women)
 Talk to your family doctor if you haveTalk to your family doctor if you have
persistent gastrointestinal problems.persistent gastrointestinal problems.
 ExerciseExercise
Improves mood, increases length of sobriety, improves insulinImproves mood, increases length of sobriety, improves insulin
resistance, improves sleep and much more.resistance, improves sleep and much more.

38. QuestionsQuestions

40. Prevent Diabetes & Weight GainPrevent Diabetes & Weight Gain
Start with “Big Volume, Small Calorie”Start with “Big Volume, Small Calorie”
Foods.Foods.
• Reduces appetite stimulating hormonesReduces appetite stimulating hormones
produced in an empty stomach.produced in an empty stomach.
• Eg. vegetable soups, salad, rawEg. vegetable soups, salad, raw
vegetables, fruit.vegetables, fruit.

41. Prevent Diabetes & Weight GainPrevent Diabetes & Weight Gain
Eat breakfast. Do not skip meals.Eat breakfast. Do not skip meals.
• Increases metabolic rateIncreases metabolic rate
• Prevents overeating laterPrevents overeating later
• Protein VS CarbohydrateProtein VS Carbohydrate

42. Food Intake & Drug DependenceFood Intake & Drug Dependence
Binge eating, food hoarding , excessive weight gain.Binge eating, food hoarding , excessive weight gain.
Food described as a drug substitute; a response toFood described as a drug substitute; a response to
intense food cravings (i.e. sweets).intense food cravings (i.e. sweets).
High rates of eating disorders (Bulimia, Binge eatingHigh rates of eating disorders (Bulimia, Binge eating
disorder).disorder).
Janowski et al. 2003. Preference for higher sucrose concentrations in cocaineJanowski et al. 2003. Preference for higher sucrose concentrations in cocaine
dependent patients. Journal of Psychiatric Research.dependent patients. Journal of Psychiatric Research.
Lenoir et al. 2007. Intense sweetness surpasses cocaine reward. PLos ONE.Lenoir et al. 2007. Intense sweetness surpasses cocaine reward. PLos ONE.

58. Nutrition & SobrietyNutrition & Sobriety
Positive association between nutritionPositive association between nutrition
education & drug abuse treatmenteducation & drug abuse treatment
outcomes (Addiction Severity Index).outcomes (Addiction Severity Index).
ROMHC Meadow Creek AddictionROMHC Meadow Creek Addiction
Treatment Program includes NutritionTreatment Program includes Nutrition
Education.Education.
Grant LP et al. Nutrition Education is Positively Associated withGrant LP et al. Nutrition Education is Positively Associated with
Substance Abuse Treatment Program Outcomes. Journal of theSubstance Abuse Treatment Program Outcomes. Journal of the
American Dietetic Association 2004, 104: 604-610.American Dietetic Association 2004, 104: 604-610.

60. Liquids VS SolidsLiquids VS Solids
• Liquids have little satiety value and canLiquids have little satiety value and can
contain many calories.contain many calories.
• Avoid fruit juices and eat the wholeAvoid fruit juices and eat the whole
fresh fruit.fresh fruit.
• Avoid soft drinksAvoid soft drinks

61. Try an Afternoon SnackTry an Afternoon Snack
• Appetite usually starts to increase byAppetite usually starts to increase by
late afternoon.late afternoon.
• A mid afternoon snack containingA mid afternoon snack containing
protein (eg yogurt, low fat cheese &protein (eg yogurt, low fat cheese &
whole grain crackers etc.) can helpwhole grain crackers etc.) can help
prevent hunger buildup.prevent hunger buildup.

62. ExerciseExercise

63. Emphasize FiberEmphasize Fiber
• eg. whole fruits, whole vegetables,eg. whole fruits, whole vegetables,
whole grains, legumes.whole grains, legumes.
• Aim for 25 – 35 grams fiber per day.Aim for 25 – 35 grams fiber per day.
• Creates a feeling of fullness.Creates a feeling of fullness.

65. Mood & GI ComplaintsMood & GI Complaints
 Majority of treatment-resistant depressivesMajority of treatment-resistant depressives
have somatic complaints ( nauseated, sickhave somatic complaints ( nauseated, sick
stomach, upset bowels, cramps, muscle pains).stomach, upset bowels, cramps, muscle pains).
 Greater somatic complaints predicts greaterGreater somatic complaints predicts greater
treatment–resistance.treatment–resistance.
Psychiatry Research 2003: 118 (1): 39-45Psychiatry Research 2003: 118 (1): 39-45..

66. Mood & Immune SystemMood & Immune System
Altered immune function may play a role inAltered immune function may play a role in
the development of major depressionthe development of major depression..
Miller et al. Inflammation and Its Discontents; The Role ofMiller et al. Inflammation and Its Discontents; The Role of
Cytokines in the Pathophysiology of Major Depression. BiologicalCytokines in the Pathophysiology of Major Depression. Biological
Psychiatry 2009Psychiatry 2009

67. AcknowledgementsAcknowledgements
Thank you to:Thank you to:
Susannah Juteau M.Sc. (Nutrition)Susannah Juteau M.Sc. (Nutrition)
 Dietetic Intern McGill UniversityDietetic Intern McGill University
For assisting in the research for thisFor assisting in the research for this
presentation.presentation.