Interview with Annett Oehlschläger, author of the book “You can eat stability?!“

After listening to a talk given by Miss Oehlschläger at a conference on bipolar disorder in 2019, and learning how she, as an affected person herself, manages her disorder, I decided to conduct this interview with her to stress the importance of a solid knowledge about one’s disorder, but also about body processes and nutrition. This interview had been conducted in German and translated to English.

Miss Oehlschläger, after living with the diagnosis of a bipolar disorder for many years, you wrote a book named “Stabilität kann man essen?!“ (“You can eat stability?!“) What made you write this book?

Simply speaking: There hasn’t been a book yet which investigated what effect nutrition, exercise, biological rhythm, sleep, and light have on mood and energy fluctuations. During my literature research I was surprised at first that there were so many connections, and I grew angry because I had never heard about this during my psychiatric treatment. It was my wish that other affected people learn about these connections. This was the reason to write this book.

Who is the book written for and what could be reasons to read it?

So first and foremost, it is written for those who are affected by a bipolar disorder, that’s why it is called “Steps for Self-Management”. But it could also be worth reading for people who don’t get along with psychotropic drugs and for people with other psychiatric disorders than those of the bipolar spectrum.

What does “bipolar pilot” exactly mean?

When I created my website, I was looking for a catchy term and while doing this I actually found the term “pilot.” Even though it has nothing to do with the disorder at all at first sight, it is very suitable. A pilot is someone who is helping a non-local to find the right way and that is how I understand my offer. Everybody has to take the journey on his or her own, I can only accompany a part of it. I make an offer and show how to live self-determined and as autonomously as possible with the disorder. With me as an example, I show how to become an expert of my own disorder. I am there for upcoming questions and I offer my experience and my advice.

Would you say that the book is also worth reading for people without a bipolar disorder or for relatives of people with a bipolar disorder or for people with another mental or psychiatric disorder?

Yes, I’d say so. I have been told several times that my explanations are focused on bipolar disorder, but that many connections are shown that basically affect everyone. Everybody has to eat and everybody wants to stay healthy. The things I’m describing don´t only have to do with the bipolar disorder, but also with how to keep the body healthy, and how close body and mind are connected.

In your experience, how do nutrition and psyche relate to each other?

It has always bothered me that the psyche and the body were perceived as something independent and separate from each other. All materials that our body needs, except oxygen, come into our body via food and drinks, and then the body builds it‘s substances from it and produces the necessary energy. Conversely, what I do not ingest and what the body cannot produce itself, or what it cannot process, cannot be built into the cells. My conviction is that the way people eat plays an important role in all chronic diseases, including bipolar disorder. For people with mental disorders the following relation is important: Emotions and thoughts don’t just materialize out of nowhere. They are built in the brain using amino acids and are controlled by messenger substances. This is quite a complex procedure, but it just doesn’t work right without the necessary raw material. Everybody might have already experienced the feeling of well-being after having eaten something sweet, like chocolate. Here, the connection is obvious. To rephrase a saying by Feuerbach: You are not only what you eat, you also feel according to what you have eaten.

Why is the realization that psyche and nutrition are so strongly connected not widespread and an integral part of every therapy or medical consultation?

I often asked myself the same question while I was reading the books. I asked two doctors who helped me with the diet change. One of them is an internist and environmental physician from Rostock, Germany, and he told me that medical students do not learn this. The focus is rather on the treatment of symptoms, mainly using medication. And I have experienced nothing different in psychiatry, symptoms are treated with medication. The vast potential of biochemistry and orthomolecular medicine remains unused. I find this quite regrettable. Additionally, there are guidelines that are set up by professional societies, and each doctor has to treat according to these guidelines. And then, there is also the healthcare system which is growing more and more specialized. This brings certain advantages, no doubt. But especially when it comes to the psyche, in my opinion, you need a holistic approach to sustainably help an affected person.

In your experience, what do exercise and sleep have to do with the psyche in addition to diet?

This has something to do with a human beings’ system, which has evolved over thousands of years. We are adapted to our environment and living conditions that have evolved only very slowly over the thousands of years. The so-called modern progress over the last 200 years brought so many fundamental changes in our living conditions we are not adapted to – yet. Sensitive people react with disturbances in their system. Bipolar disorder is one of them. A basic element of our living condition was regular exercise. The human being is made for walking and not for sitting. The saying “sitting is the new smoking” states that a lack of exercise is similarly unhealthy as smoking is. When we walk, we release endorphins. These are happiness hormones and pain killers, which made it possible for mankind to run long distances. If you move, you brighten up. I find this a very easy way to lift your mood, you just have to get up and do it.

Further, chronobiology has found out that it is important for our well-being to stick to biological rhythms. If you act against these rhythms you risk affecting your health, i.e., sleeping disorders. This is a common symptom of bipolar disorder and other mental conditions. The sleep-wake-cycle is an important pacemaker, such as sunlight. It is not irrelevant when you eat or sleep when you work or regenerate. Regularity stabilizes. Mental stability can be achieved by living according to these rhythms. I do live according to these principles.

And if we are going to be more practically now, what would you say, which food should one eat?

Of course, all of the food I need for a good mood. These foods have to provide all the 47 substances that each body necessarily needs in order to stay healthy: 10 amino acids, omega-3 and omega-6 fatty acids, 13 vitamins and 22 minerals and trace elements.

However, we don’t eat single substances but complex food. So by selecting my food, this is what I do: If I am aware that drive and mood are dependent on amino acids, then the logical conclusion is that I eat food that contains these. Proteins are built from amino acids. Enhancing your protein intake doesn’t necessarily mean eating more meat. Fish, eggs, and legumes contain protein as well.

Further, many processes in my body require enzymes, co-enzymes and co-factors: This is where vitamins, minerals and trace elements come into play. They are needed so that the substances eaten can be absorbed by the body, and also by the brain. If I know that, then I am aware that I have to eat food that provides these substances – these are mainly vegetables, nuts, seeds, and fruit.

Going shopping at the supermarket, I often get the impression that these foods only account for a small proportion of the vast offer. More dominant are sugar-sweetened beverages, alcohol, packed and conserved foods, bread, bakery products, and candy. We are constantly exposed to these temptations. If you want to eat according to what your brain needs, you can stick to these easy advices:

Don’t consume sweetened beverages, which also include fruit juice and smoothies, because they contain large amounts of sugars. These simple sugars are mood killers.

Don’t buy processed food. You will recognize processed food mainly because it is packaged and contains a lot of food additives. If there are many different ingredients on the list, chances are quite high that there are additives in it that nobody really needs. Their true serving is to make the product either more tasty – using salt, sugar, flavor enhancers, emulsifiers, and the like, or to enhance shelf life by preservative agents or antioxidants, or to make the product more appealing by adding colorants.

The issue with these unnecessary additives is that they harm the gut – in some people more, in some people less. This can lead to a reduced ability to absorb the substances needed, on the one hand, and on the other hand it can happen that the gut gets leaky and unwanted substances can enter the body. This can also lead to sickness. Both affects drive and mood.

Simply speaking, for a good mood and drive I need foods that are as natural as possible, regionally produced, seasonally, and preferably organic. A large part of my nutrition comes from these foods. If I stick to these principles, I take care of a good basis for mental stability.

And what about fat?

Fat is an essential substance, too. We could not survive without fat. If you consider that 60% of our brain’s dry matter is composed of fat, that each cell in our body is coated by a double lipid layer, then one can hardly comprehend this fat phobia which has been going on for many years.

However, there is fat that is beneficial for mood and drive, and there is fat that is unfavorable for the psyche. For thinking, we need a properly functioning of signal conduction in the brain. Our feelings are influenced by our thoughts and the other way round, both are a product of our brain. Both affect our behavior – all of which are very complex processes of the brain.

The cells build those fats into their cell walls that the person ingests. For the membranes to be fluid enough they need a certain composition of fatty acids. Here, the synergy between vitamin D and the omega-3 fatty acids EPA and DHA play a crucial role. Vitamin D is needed when neurotransmitters are built, and EPA makes sure that the cell membrane is fluid enough so that the neurotransmitter can be spilled into the synaptic cleft. DHA takes care that the receptor at the post synapse can pick up the signal to be transmitted. This is why I take specific care to take up at least 2 grams of fish oil every day.

Would you say that nutrition ultimately plays a greater role than psychotropic drugs in improving the disease?

From my point of view, in an acute crisis, psychotropic drugs are a blessing. I am convinced that I would not be alive anymore today if I hadn’t received medication.

But what’s bugging me is constant medication. I, too, have been told that I have to take psychotropic medication all my life. I have a different point of view today. To stay stable permanently, I only need medication as long until my body is strong enough to stabilize my psyche.

This is a long-lasting, exhausting, and also pricy process. Not everybody manages that. This is why it might be that somebody still needs to take psychotropic medication.

A diet that provides all the substances my body needs adds considerately to strengthen the overall health and also the immune system. That way, one improves one’s overall quality of life, not only the mental stability. In this sense, nutrition plays a bigger role.

Can an improvement of the disorder solely occur through nutrition?

Bipolar disorder is a serious mental disorder with many causes. Stress plays a pivotal role, my reaction towards it just as well, just as my core beliefs. A sole change in diet can’t change anything about that, it takes psychotherapy and psychoeducation. However, I can influence my vulnerability towards stressors through my diet. For example, a certain level of magnesium is important for being able to relax and to stand above things. Magnesium is also called “salt of inner peace”, and for a reason.

Further, the effect of my diet on my mood is influenced by the origin of my food, and what it contains or doesn’t contain anymore. Take selenium for example. This is very important for the thyroid gland and, by the way, enhances your mood. Through the last ice age, it has been washed out of the ground here in Germany. So if I eat local products, they contain less selenium than food from the US, for example.

If I measure my blood composition and see that I lack a certain substance that I can’t properly ingest via my food, I go for food supplements. I don’t manage to get all the nutrients I need through the food I eat.

But an improvement of the mental disorder depends on many more factors. Nutrition is the most important part, in my opinion, because only through nutrition I get the raw material for the production of neurotransmitters. No drug can achieve that.

To clarify which components are important for a good mood and drive, I like to use the metaphor of a jigsaw puzzle, just as in my book. Only when all the pieces are in place, I get a coherent image – that of mental stability. Which pieces I need are quite specific. But it’s worth it to find that out. My puzzle pieces were psychotropic drugs, psychotherapy and psychoeducation at first. Today I don’t need these components anymore. But other factors play a role now: nutrition, exercise, sleep, stress management, self-care, and a meaningful occupation. And also, regular measurements of blood levels to identify imbalances or low levels of substances at an early stage and being able to react promptly. These are my puzzle pieces for stability, so it’s not nutrition alone.

You have already mentioned the keyword “dietary supplements.” Which dietary supplements should one take, or should you take any at all?

Sometimes I get the impression that when it comes to the topic of food supplements, it is often about opinions and factoids rather than scientific facts. Often it is stated that supplements are unnecessary if you eat healthily because then you get everything you need. Or that supplements have a beneficial effect only for the producers. I have believed such statements for a long time before I started having my blood levels measured. My level of vitamin D had been so low I basically didn’t have any of it in my blood. The level of magnesium had been below the reference value, B vitamins had been at the lower level, not to talk about zinc and selenium, and the overall level of protein had been way too low. And at that stage I had been eating healthily, or I had assumed that my nutrition is healthy and contains everything I need. So there had to be something wrong here, or what was the reason for these results?

Today I know that certain essential substances are not available in our food in adequate amounts – or not anymore. Take selenium for example. It is even more dramatically regarding vitamin D. This can be built by the skin, so technically it is not really a vitamin. Experts, such as Prof. Holick from the US, call it a prohormone, because it is associated with more than a thousand of metabolic processes, and more than 2000 of our 23000 genes depend on vitamin D directly or indirectly. Because of the degree of latitude we live in regarding Germany, between October and April the sun is so low we can’t build vitamin D at all. The angle of the sunbeams is below 45 degrees, and so the UVB part of the sunlight doesn’t reach our skin. However, vitamin D reservoirs are depleted after 4 months, so even after I have built up enough vitamin D during the summer it won’t help me get through the winter. Vitamin D is very important for the mood. Once you experience what a difference it makes if you refill such a lack of a substance you stop believing those depreciative statements, even if they come from a doctor.

My recovery started with heightening my vitamin D level. It was at 7ng/ml and today I make sure it stays around 60-70ng/ml. Since I don’t build it appropriately through sun exposure or food I take supplements. So I supplement what I don’t get otherwise if I see that I’m lacking it.

On the other hand, it’s no use just to take anything just because somebody told me it’s good for me. Everybody has his or her individual metabolism. If two persons eat the same food, blood levels can differ. So supplements are very helpful if they are taken specifically and for a purpose.

People with mood fluctuations or mental issues should know their level of vitamin D, especially if they take psychotropic drugs because these drugs deplete the body’s vitamin D reservoirs. B vitamins are vital because they enable the building of serotonin, the happiness hormone, from tryptophane. B vitamins act as co-factors here; this is why I recommend eating a handful of nuts every day because they are full of B vitamins.

It also needs omega-3 fatty acids, magnesium, iron, zinc, but describing this here would go too far. But I am describing this in my book in detail.

As a last question, which message do you definitely want to transmit to the readers with this interview? Everybody should be worth it him- or herself to stabilize oneself by following a healthy diet. For me, measuring my blood levels is part of it, so really going to the lab to have your status determined and when you add supplements to your diet, to see what happens. And I am convinced that if you fill up such deficiencies, then everyone will experience his or her own miracle, just as I have experienced it. Because nobody believed that one can become psychologically stable by just a change in diet. Even “only” an improvement of the quality of life is an achievement in my opinion. I know enough sufferers who take psychotropic drugs, but still take dietary supplements such as omega-3 fatty acids and vitamin D because they improve their life situation. And that is actually what we want, isn’t it?

Miss Oehlschläger, we that you very much for this interview!

About the author: Annett Oehlschläger has been diagnosed with Bipolar Disorder when she was 47 years old. She has been solely occupied with this disorder for eight years and has been to psychiatric hospitals 24 times during these years. Through psychotropic medication and many hours of psychotherapy, the bipolar phases got shorter and the dose of medication could be reduced – however, Miss Oehlschläger still didn’t really become mentally stable. She set out to search for alternatives. Through a diet and lifestyle change and by tackling her vitamin and mineral deficiencies she has been managing to become stable for six years now. This made her write a book called „Stabilität kann man essen?!“ (“You can eat stability?!” – available in German) which has been sold more than 3000 times so far.

About the interviewer: Anne Siegl, PhD is a psychologist and neuroscientist at Klinik für Psychiatrie, Psychosomatik und Psychotherapie Universitätsklinikum, Frankfurt am Main, Germany. She is researching effects of nutrition on psychological well-being.

This interview has been conducted and translated together with Laura Müller, B.Sc. Laura Friederike Müller, B.Sc., is a Student of Psychology at the Fresenius University of applied Sciences in Frankfurt am Main. At the time of the interview she has been doing an internship in the Eat2beNice project group at the Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, studying the effects of nutrition and lifestyle on mental health.

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Have you ever done your weekly grocery shopping and ended up with more than actually written on your grocery list?
Everybody has at least once experienced how it is to buy food in a supermarket with hunger and buy much more than planned. The widely known recommendation: Never go grocery shopping when you are hungry!!!

But is it only a myth or is there a grain of truth in that advice?
What exactly is the issue with going grocery shopping when you are hungry? If you do you probably buy more food than you need and planned to buy. Additionally, unhealthy food might be much more attractive for you than healthy food. The consequence: you have more food at home, so you might eat more and unhealthier. Imagine you are hungry and are coming home from work after a stressful day and now you get to choose between a frozen pizza and a healthy meal that has not been prepared yet – What would you choose? In that situation, I think I would definitely choose the frozen pizza.

High-calorie food and unhealthy food are associated with obesity. Obesity research found a moderate relationship between obesity and emotional disorders like depressive disorder and anxiety disorder (1). Thus, having fast food frequently might not only affect your physical, but also your mental well-being.

Let’s rewind to grocery shopping, but now consider you are not hungry. You probably would only buy the things that are on your grocery list, and also rather healthy food than an unhealthy one. So now you come home hungry from a stressful day at work and you don’t have the choice between healthy and unhealthy food, and the temptation of the frozen pizza isn’t there. So you would start to prepare your healthy food and thus automatically eat healthier.

Coming back to the question if these scenarios are devised or true, and thus representative for weekly grocery shopping.
Research has shown that impulsivity, obesity, and food buying behavior are related. People with obesity are more impulsive than slim people. Also, impulsive people eat more than less impulsive people. Hunger influences food buying behavior and food consumption, especially of high caloric food. The relationship between impulsivity and buying food might be state dependent: researchers have found that impulsive people bought more calories, especially from snack food, but only when they were feeling hungry. This means that impulsivity and hunger interact in their influence on consumption. Obese people are found to show a preference for energy-dense, high-fat food and eat more of these foods, compared to slim people (2).

So what’s the conclusion?
Yes, hunger influences your grocery shopping, especially in interaction with impulsivity. If you consider yourself an impulsive person, you might be more prone to buying more than intended when you go shopping hungry.

So if you have the chance: only go shopping for groceries when you are full and focused. If you accidentally get into a hungry grocery shopping situation, keep this blog in mind and try to focus on your grocery list.

REFERENCES:
Scott, K. M., Bruffaerts, R., Simon, G. E., Alonso, J., Angermeyer, M., de Girolamo, G., … & Kessler, R. C. (2008). Obesity and mental disorders in the general population: results from the world mental health surveys. International journal of obesity32(1), 192.

Nederkoorn, C., Guerrieri, R., Havermans, R. C., Roefs, A., & Jansen, A. (2009). The interactive effect of hunger and impulsivity on food intake and purchase in a virtual supermarket. International journal of obesity33(8), 905.

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Probably the best known example on how the brain and mental health are linked to nutrition and our gut, and the one that we can all identify ourselves with, is stress. We all know it: studying 24/7 for an important exam, pressure in the job or even a house full of work. We have no time to think and – no – we definitely don’t have time to cook. But at the same time we are constantly hungry, craving for a snack. The fastest solution? The next best, nicest looking, edible piece of food we can find. But why do we change our dietary habits during stress and what happens in our body? What are the consequences and what can we do to avoid this impulsive eating behavior? A study from Yau and Potenza in 2013 states that about 20% of the population do not change their eating behavior during stress (good for them), while about 40% decrease and another 40% increase their caloric intake. But besides simply increasing the amount of food we consume, we also tend to choose more pleasurable and palatable food when we’re stressed. This usually leads to the consumption of unhealthy and calorie-dense foods, which unfortunately results in gaining weight (at least for most of us). Stress can have many different causes, ranging from physical stressors like severe illnesses to emotional stressors such as the loss of a loved one. So far, it is known that acute and severe stressors tend to suppress appetite, which results from our evolutionary conserved ‘fight-or-flight’ reaction (Adams und Epel, 2007). On the other hand, lighter – but therefore often chronic – stressors (occurring on a daily basis) seem to increase our appetite, especially towards energy-dense foods. These two roughly categorized types of stress activate two different systems in our body, causing different stress responses:

  • Acute stressors activate the sympathetic adrenal medullary system
  • Chronic stressors activate the hypothalamic-pituitary-adrenal [HPA] axis (Torres & Nowson, 2007)

The sympathetic adrenal medullary system induces the release of adrenaline and noradrenaline. These are the ones increasing our heart rate right before we have to give a talk in front of a huge audience, while they, at the same time, reduce our drive to eat or even make us want to throw up… On the opposite side, the HPA-axis, activated by daily stressors, leads to the release of cortisol. And, cortisol can have some unwanted effects. This hormone is known to stimulate our appetite by affecting our reward system, in a very similar way as alcohol and drugs affect this system. In the case of chronic stress, chocolate or chips can have the same effects as drugs: they make us feel better for a short amount of time. This “positive” feeling, that might reduce our stress level for a few moments, reinforces the consumption of sweets later on, thereby resulting in some kind of dependence. But as in all cases of addictions, this repeated stimulation of the reward system can lead to an adaptation, eventually increasing this compulsive behavior. Knowing now that in some strange ways it is our body that makes us crave burgers and pizza in times of stress, what can we do to avoid gaining weight? Well, the first thing is: listen to your body and try to understand what is going on. Ask yourself why you are stressed and if there is anything you can do to reduce it, like taking more breaks during the day. If this is not possible, try to find other ways to compensate: take walks, do more exercise, find something else that makes you feel better at the end of the day, besides that tasty chocolate donut and popcorn. Before snacking, hesitate and ask yourself if you are really hungry or just eating because you feel like it. And if you absolutely can’t resist, try to substitute the chocolate bar with healthier snacks, like dried fruits or nuts. But finally, keeping all that in mind, don’t forget that food is not always your enemy and there is no problem with eating what you desire as long as it is in moderation. REFERENCES: Yau, Yvonne H. C.; Potenza, Marc N. (2013). Stress and Eating Behaviors. Minerva Endocrinol, 38(3): 255–267. Link: https://www.ncbi.nlm.nih.gov/pubmed/24126546 Adam, Tanja C.; Epel, Elissa S. (2007). Stress, eating and the reward system. Physiology & Behavior 91, 449–458. DOI: 10.1016/j.physbeh.2007.04.011 Torres, Susan J.; Nowson, Caryl A. (2007). Relationship between stress, eating behavior, and obesity. Nutrition Volume 23, Issues 11–12, Pages 887-894. DOI: 10.1016/j.nut.2007.08.008

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Feeling more happy after a run? Or feeling a bit blue during the dark winter days? Regular exercising and regular daylight exposure can influence your mood, behaviour and sleep-wake cycle 1,2,3. But can this also be used in a therapeutical setting, for instance in addition to or instead of the usual treatment with medication?

The PROUD trial aims to investigate the potential of bright light therapy and physical exercise to improve and prevent depression and obesity in adolescents and young adults with ADHD. This clinical trial is part of the CoCA research project, in which comorbid conditions of ADHD are investigated [insert hyperlink: https://coca-project.eu/coca-phase-iia-trial/study/]. In addition, we collect the stool samples of all participants in order to investigate the effects of physical exercise on the gut microbiome and how this is linked to behaviour. That part of the study is part of the Eat2beNICE research project.

Most people with Attention Deficit Hyperactivity Disorder (ADHD) receive medication to reduce their symptoms4. While this medication works well for many people, there is a lot of interest in other types of treatment. One reason for this is that people with ADHD suffer from additional conditions, such as depression5 and obesity6. The risk for developing these comorbid conditions is especially high during adolescence and young adulthood4.

Adolescents and young adults (age 14-45) with ADHD that want to participate are randomly assigned to one of three groups: 10-weeks of daily light therapy (30 minutes), 10-weeks of daily physical exercise (3x per day) or 10-week care as usual (for instance, the normal medication). The random assignment is very important here in order to compare the different interventions. We don’t want to have all people that like sports in the physical exercise group, because then we don’t know if the effects of the physical exercise are due to the intervention, or due to the fact that these people just like sports better.

Another nice feature of the study is that it uses a phone app (called m-Health). This app is used to remind the participants to do their exercise or light therapy, but it also gives feedback and summaries of how the participant is doing. The app is linked to a wrist sensor that measures activity and light.

The clinical trial is currently ongoing in London (England), Nijmegen (Netherlands), Frankfurt (Germany) and Barcelona (Spain). We can’t look at the results until the end of the trial, so for those we will need to wait until 2021. But in the mean time the PROUD-researchers have interviewed four participants. You can read these interviews here:

This blog is based on the blog “10 weeks of physical exercise or light therapy: what’s it like to participate in our clinical trial?” by Jutta Mayer and Adam Pawley, 9 Oct. 2018 on MiND the Gap – https://mind-the-gap.live/2018/10/09/10-weeks-of-physical-exercise-or-light-therapy/

REFERENCES

  1. Terman, M. Evolving applications of light therapy. Sleep Medicine Reviews. 2007; 11(6): 497-507.
  2. Stanton, R. & Reaburn, P. Exercise and the treatment of depression: A review of the exercise program variables. Journal of Science and Medicine in Sport. 2014; 17(2):177-182
  3. Youngstedt, S.D. Effects of exercise on sleep. Clinical Sports Medicine. 2005; 24(2):355-365.
  4. Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018;5(9):727-738.
  5. Jacob CP, Romanos J, Dempfle A, Heine M, Windemuth-Kieselbach C, Kruse A, et al. Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center. Eur Arch Psychiatry Clin Neurosci. 2007;257:309–17.
  6. Cortese S, Moreira-Maia CR, St Fleur D, Morcillo-Penalver C, Rohde LA, Faraone SV. Association between ADHD and obesity: a systematic review and meta-analysis. Am J Psychiatry. 2016;173:34–43.
  7. Meinzer MC, Lewinsohn PM, Pettit JW, Seeley JR, Gau JM, Chronis-Tuscano A, et al. Attention-deficit/hyperactivity disorder in adolescence predicts onset of major depressive disorder through early adulthood. Depress Anxiety. 2013;30:546–53
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Yoga practice has become very popular in the last two centuries. In most western countries, yoga studios are booming. For example, Dutch practitioners are said to spent 325 million euros per year on yoga classes, clothes and events.

In scientific research, yoga and its beneficial effects on physical and mental health, have also become a serious topic of interest. In a previous post, Hannah Kurts had already outlined the positive effects of yoga for several psychiatric disorders (https://newbrainnutrition.com/how-to-help-mental-health-with-yoga/)

Recently, the effects of yoga on cognitive performance and behavioral problems in 5-year old children have been examined. A group of Tunisian researchers offered 5-year old children in kindergarten a 12-week yoga program, regular physical education, or no kind of physical activities.

They found that this kind of kindergarten-based yoga practice, had significant positive effects on visual attention, visuo-motor precision and symptoms of hyperactivity and impulsivity, in comparison to regular physical activities or no physical activities [1].

One might wonder: Quiet and peaceful yoga exercises with a bunch of energetic 5-year olds? How would that even work?

The yoga they offered in this project was a 30-minute routine, instead of a more regular 90-min session: 5 minutes of warming up, doing jogging, jumping, stretching. Next, 15 minutes of the well-known yoga postures, standing, sitting, flexing. Next, 5 minutes of breathing techniques and lastly, 5 minutes of yogic games, to train memory, awareness and creativity. And they practiced only twice a week.

It seems very promising that such a curtailed version of yoga practice can have positive effects on attention, executive functions, and behavioral control, which are all skills that are vital to good academic performance [2][3].

In some European and North-American countries, the idea of school-based yoga practice isn’t so revolutionary anymore. France, Italy, Brazil, and Canada have recognized yoga practice in its school curriculum. Italy seems to be the school-yoga champion: Classroom-based yoga is performed in all Italian schools since 2000 [4].

REFERENCES
[1] Jarraya S, Wagner M, Jarraya M and Engel FA (2019) 12 Weeks of Kindergarten-Based Yoga Practice Increases Visual Attention, Visual-Motor Precision and Decreases Behavior of Inattention and Hyperactivity in 5-Year-Old Children. Front. Psychol. 10:796. doi: 10.3389/fpsyg.2019.00796

[2] Chaya, M. S., Nagendra, H., Selvam, S., Kurpad, A., and Srinivasan, K. (2012). Effect of yoga on cognitive abilities in schoolchildren from a socioeconomically disadvantaged background: a randomized controlled study. J. Altern. Complement. Med. 18, 1161–1167. doi: 10.1089/acm. 2011.0579

[3] Verma, A., Uddhav, S., Ghanshyam Thakur, S., Devarao, D., Ranjit, K., and Bhogal, S. (2014). The effect of yoga practices on cognitive development in rural residential school children in India. Natl. J. Lab. Med. 3, 15–19.

[4] Flak, M. (2003). Recherche Sur Le Yoga Dans L’éducation. 3ème Millénaire: Spiritualité – Connaissance De Soi – Non-Dualité – Méditation, 125. Available at: http://www.rye-yoga.fr/ (accessed July 15, 2018).

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The popularity of yoga practice has risen sharply in recent years. In 2006, already 2.6 million people in Germany practiced yoga regularly (1). The arguments for yoga are widely spread in the population, for example the energy and immune function are increased and back pain, arthritis and stress are relieved (2). For others, the practice of yoga is an important factor in doing something good for themselves, while for others the discipline and control of the body is more in focus.

But, where does yoga come from?
The yoga tradition originates from India, the religion of Buddhism, and has a philosophical background with original roots reaching back over 2000 to 5000 years. The term “yoga” comes from the word “yui”, which has its origin in Sanskrit, a very ancient Indian language, and means “unite”. Accordingly, yoga refers to the union of body, mind and soul (3).

What exactly does a yoga practice involve?
In western countries the focus is especially on the Asana practice, the postures. The postures can be lying, sitting or standing and should be performed as attentively as possible. All Asanas have associated Sanskrit names and also pictorial names such as the Cobra (Bhujangasana) or the down looking dog (Adho Mukha Svanasana). Further essential elements are the breathing techniques (Pranayama), where the breath is consciously directed (e.g. Kapalabathi, alternative breathing) and the meditation (Dhyana), where the mind is consciously directed, by calming down, insight can be attained and a state of deep relaxation can be achieved.

But, can yoga really have a positive effect on mental and physical health?
In view of the study and literature available, YES! A meta-analysis results that yoga is effective as a complementary treatment for psychiatric disorders such as schizophrenia, depression, anxiety, and posttraumatic stress disorder (4).

Yoga can have a positive influence on the reduction of depression symptoms, the reduction of stress and anxiety, and can lead to an increase in self-love, awareness and life satisfaction (5, 6). On the physiological level, the results can also be found in the reduction of the stress hormone cortisol (7).

In the case of anxiety disorders, relaxation is a central component of yoga practice. Clients lack confidence, courage and stability, so that autogenic training, progressive muscle relaxation and deep relaxation can be beneficial.

In the presence of eating disorders, yoga can make an important contribution to increasing body satisfaction, awareness and receptivity as well as reducing self-objectivity and psychological symptoms (8). Prevention programs with concentration on yoga appear promising, as body satisfaction and social self-concept have been increased and bulimic symptoms reduced.

Conclusion: The integration into the health system for prevention and complementary therapy seems to be reasonable and as Mind Body Therapy, integrated into the treatment concept, positive effects on mental health can be achieved. In addition to body awareness, yoga concentrates on personal awareness and self-love and has an effect on the emotional, mental, cognitive and physical body levels. The yoga classes can be specifically adapted to the needs of the participants and can be set up in a disorder-specific way.

Advantages of yoga as a complementary therapy:
– Lower costs

– At the same time positive effect on the body
– No side effects
– Preventive and therapeutic support
– Less time required
– New contacts

What do you need to consider?
1. Choice of Yoga-Studio (atmosphere, costs, course offers)

2. Yoga teacher (e.g. education of teacher, authentic)
3. Yoga style (discover your preference, adapt to your daily state, examples follow)

– Vinyasa = flowing asanas, activating, breath and asanas in harmony
– Hatha = origin, breathing exercises, meditation, gentle asanas
– Ashtanga = powerful, always constant flowing sequences, condition
– Yin = relaxing, longer lasting asanas, calm, passive
– Acro Yoga = combination of acrobatics and yoga
– Kundalini = spiritual, mantras singing, meditation, energies

REFERENCES

  1. Klatte, R., Pabst, S., Beelmann, A. & Rosendahl, J. S. (2016). The efficacy of body-oriented yoga in mental disorders. Deutsches Arzteblatt international, 113 (20), 359. https://doi.org/10.3238/arztebl.2016.0195.
  2. Cramer, H., Ward, L., Steel, A., Lauche, R., Dobos, G. & Zhang, Y. (2016). Prevalence, Patterns, and Predictors of Yoga Use: Results of a U.S. Nationally Representative Survey. American journal of preventive medicine, 50 (2), 230–235.
  3. Jaquemart, P. & Elkefi, S. (1995). Yoga als Therapie. Lehrbuch für die Arzt und Naturheilpraxis. Augsburg: Weltbild Verlag.
  4. Cabral P, Meyer HB, Ames D. (2011). Effectiveness of yoga therapy as a complementary treatment for major psychiatric disorders: A meta-analysis. Prim Care Companion CNS Disord. 2011;13:pii: PCC10r01068.
  5. Ponte, S. B., Lino, C., Tavares, B., Amaral, B., Bettencourt, A. L., Nunes, T. et al. (2019). Yoga in primary health care. A quasi-experimental study to access the effects on quality of life and psychological distress. Complementary therapies in clinical practice, 34, 1–7. https://doi.org/10.1016/j.ctcp.2018.10.012
  6. Snaith, N., Schultz, T., Proeve, M. & Rasmussen, P. (2018). Mindfulness, self-compassion, anxiety and depression measures in South Australian yoga participants: implications for designing a yoga intervention. Complementary therapies in clinical practice, 32, 92–99. https://doi.org/10.1016/j.ctcp.2018.05.009
  7. Bershadsky, S., Trumpfheller, L., Kimble, H. B., Pipaloff, D. & Yim, I. S. (2014). The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms. Complementary therapies in clinical practice, 20 (2), 106–113. https://doi.org/10.1016/j.ctcp.2014.01.002
  8. Neumark-Sztainer, D. (2014). Yoga and eating disorders: is there a place for yoga in the prevention and treatment of eating disorders and disordered eating behaviours? Advances in eating disorders (Abingdon, England ), 2 (2), 136 145. https://doi.org/10.1080/21662630.2013.862369

 

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Why do some people have a higher craving for carbohydrate-rich and junk-food than others? Why are weight-loss programs more effective in some individuals than others? And why are some people more physically active?

The dopamine system in the brain plays an important role in regulating how much you eat and whether or not you gain weight. When this system does not function optimally, people have a higher craving for junk-food, lower physical activity, and unsuccessful body weight control.

There are two mechanisms that determine food-related behaviour.

The more direct, homeostatic, mechanism constantly surveys the body’s energetic needs and holds them actively in balance. That is homeo-stasis.

The second non-homeostatic mechanism determines the way humans, and other animals, react to food: how willingly and often they will consume it again, and whether they feel anticipation or craving for it.

These behaviours are both largely regulated by the neurotransmitter dopamine, a chemical that conveys information in the brain. Once released by one nerve cell it binds to a receptor, a large molecule on the surface of the adjacent nerve cell, thus changing its functioning. A major component in eating-related behaviour is the dopaminergic D2 receptor (DRD2) that is most abundantly localized in striatum, a brain region activated by food anticipation and consumption1.

The function of the dopaminergic system affects eating and weight-related problems in four ways.

First, in some people, the dopamine system reacts more vigorously in response to food.

Second, this response leads to increased eating and possibly obesity.

Third, overeating and obesity lead to less efficient dopaminergic signaling.

Fourth, this lower dopaminergic signal needs to be compensated by more intense behaviour e.g., more eating2.

For example, in people with lower levels of dopamine D2 receptor, cravings for carbohydrate-rich food and junk-food are more prevalent3,4.

Besides eating-related behaviour, dopamine also affects health/obesity via voluntary physical activity, creating a vicious circle: obesity leads to weaker dopaminergic signal, especially lower levels of DRD2 receptor, and this, in turn, leads to decreased exercise and motivation for physical activity5–7.

Furthermore, individuals with lower levels of DRD2 receptors may benefit less from long-term weight loss programs and are less effective in weight maintenance8,9. Thus, dopamine affects body weight via choice of foods, physical activity, and body weight reduction efficacy. Despite the reasons for food-cravings, part of the solution is acknowledging and managing these impulses. Conscious action towards weight-reduction will lead to less pronounced food-cravings, which in turn leads to favourable solution of weight related problems10.

REFERENCES
1. Wise, R.A. Philos Trans R Soc Lond B Biol Sci 361, 1149–1158 (2006).

2. Alonso-Alonso, M. et al. Nutrition reviews 73, 296–307 (2015).
3. Lek, F.-Y., Ong, H.-H. & Say, Y.-H. Asia Pac J Clin Nutr 27, 707–717 (2018).
4. Yeh, J. et al. Asia Pac J Clin Nutr 25, 424–429 (2016).
5. Kravitz, A.V., O’Neal, T.J. & Friend, D.M. Front Hum Neurosci 10, 514–514 (2016).
6. Matikainen-Ankney, B.A. & Kravitz, A.V. Ann N Y Acad Sci 1428, 221–239 (2018).
7. Ruegsegger, G.N. & Booth, F.W. Front Endocrinol 8, 109–109 (2017).
8. Roth, C.L., Hinney, A., Schur, E.A., Elfers, C.T. & Reinehr, T. BMC Pediatr 13, 197–197 (2013).
9. Winkler, J.K. et al. Nutrition 28, 996–1001 (2012).
10. Smithson, E.F. & Hill, A.J. Eur J Clin Nutr 71, 625 (2016).

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Cigarette smoking may give immediate pleasure but is dangerous for your health. Smoking may be seen as a way to deal with feelings like anxiety and stress and may be viewed as a way of coping with everyday life. Smoking a cigarette may also be used as a reward, and as part of a celebration of big and small victories. But what happens to your mental well-being if you quit smoking?

Smoke cessation is one of the best things, if not the best, you can do for your health! Smoking is ranked as the second leading cause of death by a body called “the Global Burden of Disease 2017 Risk Factor Collaborators”.1 Quitting smoking lowers your risk of cardiovascular diseases and your risk of cancer. 2 But does this come at a price concerning your mental health – how is that impacted by quitting smoking?

A systematic review of 26 studies assessing mental health before and after smoking cessation found that quitting was associated with mental health benefits. 3 Assessment of mental health were made both in the general population and in clinical populations, including persons with physical or psychiatric conditions. In the included studies, the assessment of mental status at least 6 weeks after cessation was compared with the baseline assessment. Smoking cessation was associated with improvements in levels of anxiety, depression, stress and psychological quality of life. The authors point to clinicians to recommend smoking cessation interventions also among smokers with mental health problems.

There are several aides to be used by smoke quitters. These span from brief advice to nicotine replacement therapy. How do you get help for smoking cessation? Talk to your doctor about it! And don’t give up if you fail at a quit attempt! Each attempt will bring you closer to the status “former smoker”.

REFERENCES:

  1. Collaborators GBDRF. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1923-94.
  2. https://www.who.int/tobacco/quitting/benefits/en/
  3. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ 2014;348:g1151. https://www.bmj.com/content/348/bmj.g1151

 

 

 

 

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The food choices we make, how much we exercise and the amount of body fat we have affects our health already at a young age. Although seemingly healthy, our metabolism might tell a different story. This can already be seen at a young age.

The Estonian Children Personality Behaviour and Health Study (ECPBHS) started 20 years ago in 1998 and has since measured the participants’ body composition and assessed their metabolic abnormalities, such as insulin resistance and metabolic syndrome, at ages 15, 18, 25 and 33 years.

Insulin resistance is a state in which the body does not respond to normal levels of insulin efficiently, eventually causing a rise in blood sugar levels. It has been proposed that insulin resistance has a role in the development of several metabolic abnormalities what we know as metabolic syndrome1. These metabolic abnormalities include a large waistline (abdominal obesity), high levels of certain types of fat in the blood called triglycerides, a low level of HDL cholesterol, high blood pressure or usage of blood pressure medication and elevated fasting blood sugar levels or type 2 diabetes diagnosis2.

We have found that already at age 25, individuals who consumed more than 300 milligrams of cholesterol per day and had more than 4 hours of screen time were at higher risk of components of metabolic syndrome3. Insulin resistance was associated with male gender3,4, overweight and obesity, low physical activity levels and the consumption of lipids above the recommended daily energy intake*4. Individuals who consumed carbohydrates below the recommended daily energy intake*, were less likely to be insulin resistant. Already at age 25, insulin resistant individuals had higher serum cholesterol, lower HDL cholesterol, and higher triglyceride levels, fasting blood sugar and insulin levels. People who were overweight also had 4 times higher odds of insulin resistance and being obese increased the odds 12 times if compared to normal weight individuals4. From 15 to 25 years the occurrence of components of metabolic syndrome increased rapidly. At age 15 years 18% of participants had one or more metabolic abnormality and by age 25 years the number had doubled, whereas 5% already had metabolic syndrome.3 Individuals who were insulin resistant were more likely to have metabolic syndrome.4

Insulin resistance and the metabolic syndrome are risk factors for type 2 diabetes and cardiovascular disease later in life1. As we observed, one fifth of the adolescents already have at least one metabolic abnormality and the number of components of metabolic syndrome increases from adolescence to young adulthood. That is why it is important that healthy lifestyle habits should be introduced and encouraged already in early childhood. Although young people may seem to be healthy, the first signs of developing metabolic abnormalities may already be there.

*According to the Estonian nutrition and physical activity recommendations (2015), the recommended consumption of macronutrients from daily energy intake (E%) is as following: proteins 10–20%, lipids 25–35%, carbohydrates 50–60%5.

Written by:
Urmeli Joost, MSc is a PhD student at the Institute of Family Medicine and Public Health, University of Tartu, Estonia. Her main focus of research is the genetic, environmental and behavioural factors in obesity, dyslipidemia and glucose metabolism.

Inga Villa, MD, PhD is a Lecturer in Health Promotion at the Institute of Family Medicine and Public Health, University of Tartu, Estonia. Her main focus of research is nutrition, physical activity and sociocultural factors on health status and body composition.

REFERENCES
1. Xu, H., Li, X., Adams, H., Kubena, K. & Guo, S. Etiology of Metabolic Syndrome and Dietary Intervention. Int J Mol Sci 20, (2018).

2. Alberti, K. G. M. M. et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120, 1640–1645 (2009).

3. Taimur, T. Metaboolse sündroomi komponentide levimus ja seosed toitumisega noorukieast täiskasvanueani. Tartu: Tartu Ülikooli peremeditsiini ja rahvatervishoiu instituut; 2018.

4. Joost U. Insuliinresistentsuse seosed elustiiliharjumustega noortel täiskasvanutel Eestis [masters thesis]. Tartu: Tartu Ülikooli tervishoiu instituut; 2015.

5. Pitsi, et al. Eesti toitumis- ja liikumissoovitused 2015. Tervise Arengu Instituut. Tallinn, 2017.

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Download your FREE REPORT

How do you eat in a healthy fashion?  Anne Siegl, PhD writes that a big part about eating healthy is nutritional diversity.  Not eating the same thing every day, but providing your body with a rich variety of all kinds of foods and nutrients.  Part of our objective is to keep our gut happy, because our gut drives so much of our health.  And we are discovering that the gut is in continual high-speed two-way communication with the brain.  If the bacteria (microbiota) in your gut are happy, you will lead a more healthy physical life, and we are learning, a more healthy mental life as well.  We are one organism, and it’s all connected.  Keep your gut microbiota healthy with a varied diet.

Download this important report today.

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