1. Nutrition and Mental Health Bernadette deGonzague, M.Sc., RD Southwest Ontario Aboriginal Health Access Centre

2. Is there a Connection?

3. Biological Basis of Depression Deficiency of monoamine neurotransmitters Norepinephrine Serotonin Dopamine Due to ? Impaired neurotransmitter production ? Impaired neurotransmitter transmission ? Impaired receptor sensitivity and function

4. Antidepressants attempt to correct neurotransmission by inhibiting reuptake of neurotransmitters SSRIs (serotonin): Prozac, Zoloft SDRIs (dopamine) SNRIs (serotonin- norepinephrine) SARIs (serotonin antagonist) Non-selective MAOIs

5. Antidepressants and Nutrition SSRIs may cause: –Nausea or vomiting (take with meals) –Diarrhea or bloating –Weight loss/decreased appetite Weight gain with chronic use (Paxil) Mouth sores Constipation Excessive caffeine: can increase agitation, blood levels of antidepressants

6. Antidepressants and Nutrition May need to avoid grapefruit juice with certain meds: increases blood levels of med. Alcohol affects metabolism of antidepressants Irreversible MAOIs: excessive consumption of certain foods (aged cheese, Fava beans, tofu) should be avoided-risk of high blood pressure

7. Weight gain Increased appetite may result in bingeing, poor body image, obesity Medication distribution may be affected by weight gain Weight Loss SNRIs (Zyban) may cause decreased appetite and weight loss with chronic use

8. Can Nutrition Improve Mental Health?? Correct existing nutrient deficiencies through food or supplements Correct metabolic abnormalities that increase nutrient needs Improve efficiency of antidepressants

9. Nutrients and Mood Carbohydrates Omega-3 fatty acids Folate Vitamin B6 and B12

10. Carbohydrate-Serotonin Connection Carbohydrate intake increases insulin production Insulin promotes uptake of other amino acids into muscle Serotonin formed Tryptophan enters brain

11. Sources of Carbohydrate Whole grain breads, pasta, and cereals (fortified), legumes Fruits, vegetables “Other” foods: sweets, beverages

12. Omega 3 Fatty Acids Forms part of cell membrane, maintains flexibility, helps cells communicate Affect receptor function, neurotransmitter uptake and signal transmission Found in fatty fish: tuna, salmon, mackerel, omega3 eggs, ground flaxseed, fish oil supplements, nuts, new foods with O-3 added *Inhibited by trans fats: processed cookies, snack foods, partially hydrogenated margarines, etc.

13. Folate, Vitamin B6 and B12 Involved in formation and conversion of serotonin, SAM-e and noradrenalin SAMe: raises brain levels of serotnin, helps form cartilage Food sources: Folate: green leafy vegetables, wild rice, orange juice, fortified breakfast cereals, B6: Meat, fish and poultry, bananas B12: Meat, fish and poultry, liver, dairy,eggs

14. Nutrition Advice Need order /structured meal plan Nutritional needs for breastfeeding Eat every 2-3 hours (scheduled meals/snacks) Fish 3 times/week Use convenience, frozen foods, etc. Grocery lists, simple recipes Cook large quantities and freeze Adequate fluid intake Limit caffeine and alcohol Exercise

15. Healthy meal Protein (meat or alternative) Fruit/vegetable Starch/grain Dairy Fat (non- hydrogenated marg, oil, nuts)

16. Sample meal plan Breakfast: 1 cup whole grain cereal (folate) w/ground flaxseed (O-3) 3/4 cup milk 1/2 cup berries (folate and B12) Snack: Small container yogurt and 2 trans-fat free cookies Lunch : Sandwich: 1./2 can salmon (O-3) 2 slices whole grain bread (folate) Mayo Vegetable soup (folate) water or juice Snack : Whole grain crackers with cheese Supper : Omega-3 Egg omelet with broccoli (folate and O-3) 1/2 cup baked beans (folate) Whole wheat toast (folate) Orange (folate) 1/2 cup frozen yogurt Snack: Banana (B-12)

17. Supplements Omega 3: Fish oils, flax seed oil: avoid fish “body” oils, can contain excessive vitamin A –1 - 3 g/day B complex: Contains all B vitamins, –B-50 complex; 400 mcg folate SAMe: Relatively safe, need adequate B12, B6, and folate to avoid increasing homocysteine levels (assoc. w/depression, Alzheimer’s and heart disease risk) –200 - 400 mg/day (?safety in breastfeeding not established) Exercise!! 30 - 60 minutes/day

18. Q & A??? Thanks!!