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.
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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)
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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
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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
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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
WAKE 15 MINS 30 MINS 45 MINS 3 HRS 6 HRS 9 HRS 12 HRS BEDTIME
SUBJ 324
0
1
2
3
4
5
WAKE 15 MINS 30 MINS 45 MINS 3 HRS 6 HRS 9 HRS 12 HRS BEDTIME
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 …
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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
September November March
Testosterone - Emerson Ward
6
7
8
September November March
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
Timepoint 1 AM Timepoint 2 AM Timepoint 3 PM Timepoint 4 PM Timepoint 5 AM
Blood draw timepoints
Ho
rmo
nal
val
ues
0
1
2
3
4
5
Timepoint 1 AM Timepoint 2 AM Timepoint 3 PM Timepoint 4 PM Timepoint 5 AM
Blood draw timepoints
Ho
rmo
nal
val
ues
ACTH - Ace Tate
40
60
80
100
120
Ho
rmo
nal
val
ues
September November March
Increase in hormones in responseto exercise in morn bout but dampened response through the season
Cortisol - Ace Tate
30
35
40
September November March
Testosterone - Ace Tate
7
8
9
September November March
0
20
Timepoint 1 AM Timepoint 2 AM Timepoint 3 PM Timepoint 4 PM Timepoint 5 AM
Blood draw timepoints
season
Burnout 4.07
0
5
10
15
20
25
Timepoint 1 AM Timepoint 2 AM Timepoint 3 PM Timepoint 4 PM Timepoint 5 AM
Blood draw timepoints
Ho
rmo
nal
val
ues
0
1
2
3
4
5
6
Timepoint 1 AM Timepoint 2 AM Timepoint 3 PM Timepoint 4 PM Timepoint 5 AM
Blood draw timepoints
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
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Enjoy life, live it well,
and live it balanced!
Contact information:
Kathy Matt, [email protected]; 302-831-8370