Nutrition and Dietetics for Psychiatric conditions

1. Chapter 40
MNT for Psychiatric Conditions

2. The Brain (1 of 2)
 Weighs approximately 3 lb
 Neurons are the nerve cells that gather
and transmit electrochemical signals via
axons and dendrites.
 Neurons are the gray matter
 Dendrites and axons are the white matter
 Figure 40-1

4.  Cerebrum is the largest part of the brain,
which is divided into two halves that are
divided into four lobes
1. Frontal lobes: Speech, thought, learning,
movement, emotion
2. Parietal lobes: Sensory information
3. Occipital lobes: Vision
4. Temporal lobes: Hearing and memory
The Brain (2 of 2)

5. The Brain and Fatty Acids
 Brain is 80% fat
 Composition of neuronal cell membranes
phospholipid reflects dietary intake
 Ratio of omega-6 to omega-3 fatty acids
influence transmission
 Essential fatty acids involved in synthesis
and functions of neurotransmitters

6. Neurotransmitters
 Serotonin
 Acetylcholine
 Dopamine
 Norepinephrine
 Epinephrine
 Glutamate
 Refer to Table 40-1

7. The Enteric Nervous System
 Gut functions autonomously
 Contains 100 million neurons
 Major neurotransmitters: Acetylcholine,
serotonin, norepinephrine
 Bidirectional signaling
 Gut bacteria and their by-products
influence brain activity and behavior
 Leaky gut

8. Blood Glucose Regulation
 Emotional “sugar roller coaster”
 CHO-rich foods raise serotonin in brain
causing soothing effect
 Adequate diet with 45% to 65% total kcal
from whole grains, fiber-rich vegetables
and fruit help maintain healthy glucose
levels and protect against mood
disturbances.
 Balanced diet improves state of well-being

9. Brain and Nervous System Structure
and Function: Nutritional Aspects
 Nutrition maintains structure and function of
neurons and brain centers
 Omega-3 fatty acids appear to be the type of fat
preferred by the brain and nervous system
 Each omega-3 fatty acid has unique, important
functions
 Research links EPA and DHA to various
psychiatric conditions

10. Fatty Acids in the Brain and
Nervous System
 Omega-3 fatty acids
 Alpha linolenic acid (C18:3 n-3)
• Found in flax and flaxseed oil, canola oil, soybeans, perilla, nuts,
and nut oils
• Inhibits inflammatory process
• functions as precursor for EPA and DHA
 Eicosapentaenoic acid (EPA, C20:5 n-3) and
docosahexaenoic acid (DHA, C22:6 n-3)
• Primarily found in fish
 Arachidonic Acid
 Precursor for inflammatory mediators

11. Omega-3 Fatty Acids and
Brain Function
 EPA
 Important for general health
 Adjunctive therapy for depression
 Works better when ingested with DHA
 DHA is the brain’s preferred structural fatty acid
 Required for normal brain growth, development, and
maturation
 EPA and DHA found in oily fish

12. EPA and DHA in Lifecyle
 Pregnancy
 Recommended for fetal brain development
 Treat depression
 Childhood
 Possible treatment for depression, ADHD,
ADD
 Adulthood
 Treatment for depression, bipolar,
schizophrenia
 Maintain cognitive function

13. Omega-3 Fatty Acids
 1000 mg fish oil
 180 mg EPA
 120 mg DHA
 Therapeutic effects around 400 mg each
 ISSFAL recommends 500 mg combined
daily
 Supplements: Read label for dosage and
potential contaminants

14. Vitamins and the Brain
 Thiamin—Wernicke encephalopathy
 Riboflavin—deficiency reduces metabolism of
other B vitamins
 Niacin—Pellagra; therapeutic effect with
Alzheimer’s
 B12—Deficiency associated with mental
symptoms; drug-nutrient interactions
 Folate—deficiency associated with depression,
cognitive decline, and dementia
 Vitamin D—deficiency associated with mood
disorders

15. Minerals and the Brain
 Iron—deficiency causes poor brain myelination;
defects in memory and learning capacity
 Selenium—deficiency linked to adverse mood
and depression
 Zinc—status impacts Alzheimer’s and ADHD;
adequate zinc can reduce depression symptoms

16. Nutrients and the Brain
 Amino acids—building blocks of
neurotransmitters and antioxidants
 Phytochemicals
 3 subclasses flavonoids: Flavanols,
anthocyanins, flavanones protect and
preserve brain cell structure and metabolism;
antioxidants
 Antioxidant and nutrigenomic effects: Onion,
ginger, turmeric, oregano, sage, rosemary,
garlic

17. Addiction and Substance Abuse
 Addiction—persistent, compulsive use of a
substance known to be physically,
psychologically or socially harmful
 Dopamine, serotonin, glutamate
 Nutritional issues associated with alcohol:
Deficiencies of thiamin and magnesium,
malnutrition, GI symptoms, liver disease,
cardiomyopathy, neuropathy
 Medical management: Supplementation of
magnesium and thiamin
 MNT: B vitamins, minerals, amino acids, omega-3
fatty acids; support digestive function

18. Anxiety
 Heightened and poorly controlled
emotional, somatic, and neurologic
symptoms triggered by specific
circumstances
 Clear genetic component
 Medical management
 Pharmacotherapy: Benzodiazepines, SSRIs,
norepinephrine reuptake inhibitors

19. MNT for Anxiety
 Maintain glycemic control
 Potential nutrient deficiencies: Vitamin D,
B vitamins, magnesium
 Fermented foods containing probiotics
 Exercise and diet rich in fruit and
vegetables
 Meditation, mindfulness, yoga

20. Bipolar Disorder
 Experiences episodes of an elevated or
agitated mood (mania) alternating with
episodes of depression
 Symptoms depend on level of severity
 Mania: Excitable and productive to erratic
 Depression: 25% to 50% attempt suicide;
psychosis
 Medical management
 Pharmacotherapy: Lithium, benzodiazepine,
antipsychotics

21. MNT for Bipolar Disorder
 Stable, moderate salt intake
 Lithium and sodium have similar chemical
binding
 Lithium side effects: Weight gain, thirst,
nausea, vomiting, diarrhea
 Adequate omega-3 fatty acid intake
 Iron excess associated with bipolar
 Determine presence of celiac disease or
gluten sensitivity

22. Dementia and Alzheimer’s (AD)
 Mild cognitive impairment (MCI)
 Dementia
 Alzheimer’s disease
• 4 A’s: amnesia, aphasia, apraxia, agnosia
 Vascular disease
 Medical management
 Vascular: Aspirin, cholesterol and BP lowering
 AD: Acetylcholinesterase inhibitors,
memantine
 Manage diabetes and insulin resistance

23. MNT for Dementia and AD
 Mediterranean-DASH diet (MIND)
 Substantially slows cognitive decline with aging
 Key elements investigated for involvement
 folate, vitamins A, E, D, B12, and B6, choline,
iron, potassium, omega-3 fatty acids, flavanols,
polyphenols, coffee/caffeine, curcumin, iron,
saturated fats, cholesterol
 Healthy microbiota
 Advanced glycation end products formed
within body and dry cooking; beef fat

24. Depression
 Major depressive disorder (MDD)
 Contributing factors: Genetics, nutrition,
environmental stressors, hormone
disruption, changes in neurotransmitter
biology and function
 Pathophysiology: Monoamine deficiency,
nutrition and hormonal deficiencies,
omega-3 fatty acids
 Pharmacotherapy—Box 40-11

25. MNT for MDD
 Mediterranean diet
 Curcumin—combined with piperine to
enhance bioavailability
 Zinc reduces depressive symptoms
 Increase serotonin response with St
John’s Wort, 5HTP, tryptophan, vitamin D,
SAMe
 Optimize folate and B12
 Drug-nutrient interactions

26. Fatigue, Chronic Fatigue Syndrome (CFS)
and Fibromyalgia Syndrome (FMS)
 “brain fog” is frequent symptom
 Diagnosis based on combination of
widespread pain and symptom severity
score
 Medical management
 SHINE (Box 40-13)
 Disordered sleep
 Immune dysfunction and infections
 General pain relief

27. MNT for Fatigue, CFS, FMS
 Check B12, iron, TIBC and ferritin levels
 Elevated B12 may be sign of MTHFR mutation
and inadequate B12 utilization
 Increase salt and water intake with
hypotension and orthostatic dizziness
 Gluten avoidance

28. Schizophrenia
 Severe mental disorder that presents as
psychosis, often with paranoia and
delusions
 Medical management
 Pharmacotherapy: Combination of dopamine-
blocking antipsychotics, antidepressants and
tranquilizers
• Antipsychotic side effects: Dry mouth, constipation,
increased appetite
 Psychosocial interventions

29. MNT for Schizophrenia
 More likely to be overweight and smoke
and have hyperglycemia, diabetes, HTN,
dyslipidemia
 Altered metabolism results in high amount
of visceral fat and reduced energy needs
 Weight gain
 Screen for celiac disease and gluten
sensitivity

30. Focal Points (1 of 2)
 The brain is a complex system of neurons,
axons, dendrites, and neurotransmitters,
all of which is dependent upon specific
nutrients for its health
 The brain and gastrointestinal tract are in
constant communication; a healthy gut is
integral to a healthy brain
 Regular inclusion of foods that contain
targeted nutrients is essential for lifelong
mental wellness

31. Focal Points (2 of 2)
 Promotion of appropriate inclusion of
omega-3 fatty acids, antioxidants, and the
phytochemicals in fruits and vegetables is
important in the prevention and
management of psychiatric disorders.
 RDN plays a major role in managing
nutritional recovery of psychiatric and
substance abuse patients, and improving
nutritional status for a return to a state of
well-being.