The Food-and-Mood
Connection
Providence Cancer Center
Integrative Medicine Program
Loch Chandler ND, MSOM, LAc
November 15, 2011
Our Discussion Today
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Causes of Mood Alterations
Mind-Body Relationships
Neurotransmitters
Diet and Nutrition
Lifestyle Influences
Supplements
Summary
Causes of Mood Alterations
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Stress (acute or chronic, positive or
negative)
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Food
Poor health, low immune function
Pain
Medications
Mental-Emotion-Spiritual Health
Social influences…job, family, financial
Limited approach produces limited
results!
Mind-Body Relationships
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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
Effects of Stress on the
Mind & Body
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
How Do Our Cells
Communicate?
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Via Neurotransmitters
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Are molecules that carry messages
between cells in the body and brain
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Nutrients in foods are the precursors to
neurotransmitters.
How Do Our Cells
Communicate?
Neurotransmitters
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Excitatory:
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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:
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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
Dopamine
-Mediates the experience of pleasure
-Synchronizes memory and reward-incentiverelated 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
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??
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%)!!
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
Serotonin
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!
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 postganglionic parasympathetic
neurons
Neurotransmitters
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Are built from Amino acids
(protein!)
 Include:Taurine, tyrosine,
tryptophan, phenylalanine
Brain is composed of mostly fat
(60%)
Nutrient cofactors for optimal cell
functioning
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B vitamins,Vitamin C, zinc, folic acid,
selenium, SAM-e, calcium, magnesium
Use foods to get these
nutrients!
Cortisol
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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
Cortisol
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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)
Diet and Nutrition
Diet
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You are what you eat!
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Jimmy Buffet
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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).
Diet
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Mood Disrupters:
Low blood sugar
 High blood sugar
 Caffeine
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Increases heart rate, increases blood pressure,
stimulating effect on the CNS
Meal frequency
 Nutrient value
 Low fat diets
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Low Blood Sugar
Symptoms
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Nervousness
Fatigue, exhaustion, insomnia
Tremor, dizziness
Palpitations, muscle cramps
Sweating
Anxiety/arousal, irritability
Hunger, craving sweets
Numbness
Cognitive impairment
Behavioral changes
Headaches
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Goal: Protein at EVERY meal!
Glycemic Index (GI)
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The Glycemic Index scale ranks carbohydrate-rich
foods by how much they affect blood glucose
levels compared to glucose or white bread
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The speed at which food increases blood sugars is
the Glycemic Response (GR)
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High GI ratings (>70) raise blood sugars quickly =
BAD!
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Low GI ratings (<55) raise blood sugars slowly
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Low ratings are better for many reasons!
Glycemic Index
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Low Glycemic Index Foods:
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Medium GI Foods:
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Skim milk, plain yogurt, apple, sweet potato, oatmeal, hummus, nuts,
cherries, broccoli, lettuce, yams, green peas, lentils, pinto beans
Banana, raisins, popcorn, brown/wild rice,
rye bread
HIGH GI Foods:
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(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
Vicious Cycle
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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
High Fructose Corn Syrup
(HFCS)
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In many foods: soda, processed/
packaged foods, canned fruits/jellies,
dairy products
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Try to avoid due to metabolic effects
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Relationship with increase in U.S. obesity
Reduces the normal glycemic
response
Does NOT stimulate insulin secretion
No “full” feeling generated (44)
Glycemic Control
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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)
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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
Glycemic Index
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Base your food choices on overall nutrition
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Choose a variety of foods from all food groups
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Watch portion sizes (larger meals increase
blood sugars greater)
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Check blood glucose levels before a meal and 2
hours after
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Eat at regular times
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Limit sugars, sweets, refined/processed foods
Mediterranean Diet
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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.
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Lyon Heart: Randomized prospective controlled
study, 4-year followup.
deLorgeril, Arch Int Med, 1998;158:1181-87.
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Greek EPIC: Observational, (n=22,043 people, 44
months) Trichopoulou, NEJM, 2003;348;2599- 608.
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Both: 60-70% reduction in all cancers, cardiac
events and diabetes...preventative!
Mediterranean Diet and
Depression
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Diet will: reduce BP, improve lipid profile
and glucose metabolism and
endothelial function and reduced
markers for vascular inflammation
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Depression: reduced in people eating
Mediterranean style diet (Duke Med
Health News, 2009 Dec;15(12):1-2, SanchezVillegas, A., et al, Arch Gen Psychiatry, 2009
Oct;66(10):1090-8)
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Also lowers risk of Alzheimer’s Disease
and improves vascular function and
overall physical health
Mediterranean Diet and
Inflammation
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Decreases inflammation by:
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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
Pro-Inflammation
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Arachidonic Acid:
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Increases: Leukotriene-4 series (LTB-4)
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Increases: Thromboxane-A2 (TXA-2)
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Promotes inflammation
Constricts airways
Prolongs duration of inflammation
Constricts blood vessels
Constricts airways
Increases blood clotting
Reduces circulation
Increases: Prostaglandins-E2 (PGE-2)
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Increases sensitivity to pain
Increases swelling
Induces fever
Constricts blood vessels
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
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
Anti-Inflammatory
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EPA:
 Increases: Leukotriene-5 series (LTB-5)
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Relaxes blood vessels
Increases circulation
Relaxes airways
Promotes anti-inflammatory response
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Improves circulation
Decreases sensitivity to pain
Relaxes blood vessels
Promotes anti-inflammatory response
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Relaxes muscle spasms
Reduces blood clotting
Increases protective stomach secretions
Improves circulation
Increases: Prostaglandin-E3 (PGE-3)
GLA:
 Increases: Prostaglandin-E1 (PGE-1)
Whole Grains
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Includes: Whole wheat, corn, oats,
rye, hulled (not pearled) barley,
brown rice, millet, quinoa, amaranth,
spelt, kamut…
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More minerals, vitamins,
antioxidants, fiber
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Triggers release of
insulin…tryptophan
Legumes
Dried beans (pinto, kidney, white, lima, black,
red), lentils, split peas, black-eye peas…)
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Inexpensive and easy to cook
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Higher levels of folate!
Legumes
How might legumes work?
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High in antioxidants, vitamins
and minerals
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High in fiber (14)
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‘Healthy’ weight loss, while
maintaining lean muscle
mass
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Promote lower insulin levels
Serotonin Foods
Include:
-Recommendation: include in your 5-9 per day
Tryptophan Foods
Include:
-Recommendation: 200 mg per day
You Want to Balance Intake
High Serotonin States:
(less receptors)
Low Serotonin States:
(more receptors)
Choline Foods
Include:
-Recommendation: 400-500 mg per day
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)
Chocolate and Fatigue
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Higher depression scores associated
greater chocolate consumption
(observational, Rose, N.,
Med, 2010;170(8):699-703)
with
et al, Arch Intern
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A daily dose of dark chocolate can
decrease fatigue (74)
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Rich in flavonoids—has antiinflammatory properties (75)
 Lowers CRP, blood pressure
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Also, has caffeine-like Theobromine,
magnesium and Tryptophan
and
Basic Diet
Recommendations
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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
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Basic Diet Recommendations
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Avoid (continued):
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Processed, preserved or cured meats (e.g.
lunchmeats, bacon, ham)
Dietary Fats
Recommendations
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Extra virgin olive oil is the best all purpose
& soy are reasonable
second choices
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Minimize use of other vegetable oils
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Butter is fine in moderation
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Enjoy raw nuts in moderate
amounts (walnuts)
oil, canola
Basic Diet
Recommendations
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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
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Choose whole grains over refined grains
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Regularly enjoy cooked dried beans, peas
and lentils
Eat To Improve Your Mood
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Eat breakfast and eat regular meals
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Eat protein at every meal! (& bedtime snack)
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Eat fish at least 3 times a week
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People who eat fish < 1x/wk have almost a third higher risk of
depression
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Get enough folic acid (dark green leafy vegetables, lentils,
asparagus, peas)
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Limit your alcohol intake
Other Recommendations
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You may want to check for food allergies, or for
(iron deficiency), low iodine
Journal: keep track of what you eat and drink
moods
Anticipate your stress and have healthy food
(fruit, veggies, yogurt)
Are you drinking too much caffeine?
Frequent cravings? Mis-direct the brain.
Learn to express your feelings in appropriate
anemia
and your
ready
ways
Lifestyle Influences
Lifestyle:
Proper Hydration-Water
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Fatigue can be a symptom of
dehydration
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Hypo-hydration has been related with:
lethargy, irritability and
headaches
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Found a decrease in visual memory
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Checked more symptoms and greater
severity when dehydrated (36)
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A British food and mood study found
70% of participant’s mood improved by
increasing water and produce intakes
Lifestyle:
Proper Hydration-Tea
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Japanese study involving over
40,000 people
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Psychological stress 20% lower in
those who drank at least 5 cups
of Green tea (Camellia sinensis)
per day compared to those who
drank less than 1
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Protective effects from oxidative
stress (anti-oxidant polyphenols)
Green Tea (Camellia sinensis)
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Same plant for: Green, Black, & White teas
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Also contains 1/3 caffeine as coffee
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Numerous health benefits from cancerprotective to blood sugar balancing
Lifestyle:
The Benefits of Exercise!
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A recent review: Graded exercise
therapy reduced symptoms and
improved function (37)
Active people are less depressed (38)
Easy way to increase serotonin and the
endorphins!
Melatonin
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The gut is the most important extra-pineal
source of melatonin
It’s presence tells us it’s important to
digestive pathology-physiology
Close relationship with serotonin
Again, most of the body’s serotonin is
produced
and stored in the gut
(enterochromaffin cells)
So, important relationship with SLEEP!
Poor sleep de-sensitizes serotonin
pathways
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GOOD SLEEP = GOOD SEROTONIN!
Moods
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Our emotions and moods can also
affect serotonin levels
Difficult when we aren’t feeling good
Things to try to help:
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Meditation
Relaxation techniques
Guided Imagery
Talking with friends, spiritual faith advisor
Counseling,…
Supplements
Fish Oil and Depression
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Recommendation: three 6 ounce
servings of salmon, tuna, herring
or sardines per week
Reasonable dose: 1 Tbsp fish oil per
day
High-dose omega-3 fats have
significant anti-depressant value
(50)
Helps inflammatory bowel disease,
rheumatoid arthritis, asthma, heart
disease…
Possible enhanced benefit when
omega-6 fats (vegetable oils) are
minimized
Probiotics
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Balanced microflora has been shown to:
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95+% of the body’s serotonin is produced and stored in the
gut!
Synthesize a number of water soluble vitamins
Reduce intestinal inflammation (decreases
antigen load
and pro-inflamm cytokines)
Decrease frequency of colds and flu
Found to induce the expression of muopioid and cannabinoid receptors in the
intestinal
epithelial cells (similar to the effects
of morphine)
Vitamin D
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Deficiency of Vitamin D has been
with depression
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Vitamin D has also been linked with
serotonin levels
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Supplementation: 2,000 i.u. per day
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Goal: 40-60 ng/mL in serum
Garland, CF, Ann Epidemiol, 2009;19:468-483.
Shinchuk, L, Nut Clin Pract, 2007;22(3):297-304.
associated
Supplements
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Choose supplements with care and consideration of
evidence, cost and complexity of dosing routine
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Best to take an individualized approach
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Seek professional advice, as needs vary and may interact
with other supplements and/or medications
Some may be contraindicated for certain mental health
conditions
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Summary
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Treating Mood and Depression issues with
Integrated Medicine:
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Improve Overall Mental Health Using:
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Treat the whole person
Food…Diet and Nutrition
Lifestyle Influences
Supplements
Chinese Medicine and Acupuncture
Massage
Consider Integrative Medicine as a part of the healthy
brain and mood health care team
Providence Integrative
Medicine Clinics
Westside
9135 S.W. Barnes Rd.,
Suite 161
Portland, OR 97225
Phone: 503-216-0246
 Located in the East Pavillion
(Medical Office Building)
next to St.Vincent Hospital
Eastside
4805 N.E. Glisan St., 1st Floor
North Tower
Portland, OR 97213
Phone: 503-215-3219
 Located on the first floor of
the cancer tower near the
elevators and the fountain
Resources
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The Mood Cure, by Julia Ross
The UltraMind Solution, by Mark Hyman, MD
The Edge Effect, by Richard Braverman, MD
Potatoes Not Prozac, by Kathleen DesMaisons
The Food-Mood Solution, by Jack Challem