While health care professionals are busy caring for and treating COVID-19 patients, researchers are currently not allowed in the research institutes. Especially hospitals (where many research institutes are located) are being extra careful not to create risks for personnel and patients. The researchers working in the Eat2BeNICE consortium normally work in these environments. They have been working from home for a couple of weeks, and probably will continue to do so for another couple more weeks to come.

Like all people working from home, researchers have to be creative and find adaptive ways to proceed with their work. Many ongoing studies are therefore on hold as participants cannot visit the facilities to report on their symptoms, deliver blood, or perform any of the measurements that are usually done for their visits. However, in some cases measurements can proceed; online questionnaires on e.g. mental health can replace the physical visits where possible. Also, stool measurements can still be done, as no physical contact is needed between researcher and participant, and any pathogenic particles are de-activated by the conserving buffer. The collection kits can be sent by post and returned in the same way with the specimen. This is good news especially for studies that have started now rather than paused. These are studies assessing the psychological effects of the corona-crisis, see for example the Dynamore study.

The change in daily routines affects everybody in a different way, some easily adapt and others are dysregulated by it. For example, ADHD symptoms can surge by a lack of or sudden change in structure. Social isolation can trigger melancholic feelings. Also, the insecurity about when society will function as before is a stressor for a lot of people. This is ‘good’ news for those researchers that investigate the effects of stress. Normally they mimic stress-inducing circumstances in the laboratory [2]. For instance by asking participants to give a presentation in front of an unsympathetic audience, or by letting participants learn a game with wrong or misleading instructions. The corona crisis is in this way a ‘natural stressor’, which has consequences on mental health. Similar research has been done previously for other real-life traumatic events e.g. looking at the development of post-traumatic stress disorder after the events on 09-11-2001 [3]. We can learn from the current and previous natural disasters; realizing that crises were overcome before can motivate us to do our part in the containment of the COVID-19 virus and remain mentally healthy in the process. An international team of researchers has recently summarized insights from natural disasters and social and behavioural psychology experiments [1]. They highlight the importance of communicating measures to prevent chaos, how we can combat fake news, and how we can increase cooperation and better manage stress.

As one of the goals of our Eat2BeNICE consortium is to understand the interplay between gut health and mental health, our German colleagues have started extra measurements to look into the effect of the corona crisis. They ask participants to report on their feeling and also donate a stool sample. These measurements allow us to determine whether responding well to stressors due to the corona crisis is associated with, for example, lower diversity in types of gut bacteria or a specific combination of gut bacteria that promote optimal immune functioning. Setting up the logistics of this study requires the creativity of the supporting researchers, as all these preparations should be done from home. Our lab technician found a good solution for this, keeping her kids busy by having them assist in the preparation of stool sample collection kits. With solutions like this, we will reach the end of this crisis in a mentally sane condition.

Read more about the ongoing studies:

Dynamore: https://www.research.net/r/DynaCORE

Lora study (in German): https://lora-studie.de/

REFERENCES:

  1. Bavel, J.J.V., Baicker, K., Boggio, P.S. et al. Using social and behavioural science to support COVID-19 pandemic response. Nat Hum Behav (2020). https://doi.org/10.1038/s41562-020-0884-z
  2. Ferreira, S.A. Emotional activation in human beings: procedures for experimental stress induction. Psicologia USP, 30, e180176. Epub July 22, 2019. https://dx.doi.org/10.1590/0103-6564e20180176
  3. Lowell A, Suarez-Jimenez B, Helpman L, et al. 9/11-related PTSD among highly exposed populations: a systematic review 15 years after the attack. Psychol Med. 2018;48(4):537‐553. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805615/
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Although you might be under lockdown, you are still allowed to go to the supermarket to buy food. The following information might help in terms of making healthier choices on what foods to buy.

When we are under high stress, we can often reach for foods that are “comforting” (like cookies, donuts, cake, pastries, and chocolate bars), but these foods may not be the best choice for feeding your brain under stressful and demanding circumstances. Comfort foods are often calorie-rich but nutrient-poor.

Further, under high stress (and it doesn’t actually matter what has caused the high stress, whether it be a natural disaster like an earthquake or fire, or witnessing something really traumatic or being stressed because of financial and health uncertainty), the reactions our body goes through can be quite similar. We release adrenaline. This is part of our natural alarm response system.

Adrenaline is an essential neurotransmitter that is released as part of the fight-flight response. It enables our body to get us to safety, shut down non-essential functions, and make sure the muscles needed for flight or flight get activated. Cortisol, a hormone, is also essential for the alarm system to function optimally.

Unfortunately, over extended periods of time, the alarm system can go into over-drive, and this is one factor that can lead to re-experiencing memories, flashbacks, hypervigilance, being on edge all the time, feeling anxious and panicky when reminded of the traumatic event, struggling with sleeping and having nightmares.

Making neurotransmitters (like dopamine or serotonin) and hormones (like cortisol) requires micronutrients, which are numerous kinds of vitamins and minerals. This is a well-established scientific fact. Micronutrients like zinc, calcium, magnesium, iron, and niacin are all essential for making neurotransmitter chemicals for the brain and the body. If your body is depleted of these nutrients, then either it won’t have sufficient nutrients to make these essential chemicals, or it will redirect all resources to the fight-flight response (as it is so vital for survival) and there won’t be much left for ensuring optimal brain function to do things like concentrate, regulate moods and sleep.

Consequently, as micronutrients get depleted at a high rate during times of stress, we need to replenish them in greater quantity from our food (and perhaps other sources).

Where can we get these micronutrients from?

Answer: Nutrient-dense foods; real food, not ultra-processed foods.

Compare a banana to a cookie; one obtains far more of these micronutrients (like potassium, magnesium, folate) that are required for brain function from a banana. Eating kale chips over potato chips would also provide more nutrients. Reaching for a carrot stick and dipping it in hummus would be better for your brain than gorging down a commercial meat pie (although meat pies can be healthy if they contain lots of vegetables too). Choosing nuts and seeds over pretzels would also give you better brain food.

Overall, to cope well with stress your goal should be to increase intake of plant food and food high in nutrient density while still getting adequate protein, fats and carbs. Fish is a great source of protein and of essential fatty acids, which are also vital for brain function. In eating these types of foods, you would be shifting your diet from a Western type of diet (ultra-processed, high in sugar) to a Mediterranean-style diet (high in fruits and veggies, fish, nuts, healthy fats and low in processed foods).

Therefore, stop counting calories and start focussing on nutrients, especially nutrients that are good for your brain!

Would this be sufficient to sooth the over activated alarm system in a situation of high and chronic stress? Possibly, although some people might need more nutrients than what they can get out of their diet, even if it is a healthy one. There are many reasons for this, some of which reflect reduced nutrient density in modern foods, some of which are due to our own specific genetic make-up, and some have to do with the health of our microbiome (the millions of helpful bacteria that live inside us, especially in our gut).

If you do need to consume more nutrients than what you can source from your diet, or you are struggling with cooking due to your particular circumstances and the stresses you are experiencing, or you are time poor because of family or work demands, what do you take in terms of a supplement? Research from the Mental Health and Nutrition Lab in Christchurch, NZ found that following the Christchurch earthquakes as well as other research on stressed communities shows that B vitamins in particular can be helpful. A recently published meta-analysis confirmed the positive effect of B vitamins on reducing stress. In addition, some may find reduction of intrusive thoughts require additional minerals as well.

Basic tips

  1. Start with whole foods diet approach including good fats, nuts, seeds, fish, modest amount of meat, vegetables, fruit, whole grains
  2. Shifting towards eating “real” as opposed to processed foods naturally eliminates unnecessary food additives such as artificial colors, flavors, sweeteners and preservatives that do not add nutritional value and may contribute to psychiatric symptoms in some people
  3. Limit sugar intake (sugar is everywhere in processed foods, energy/fizzy drinks – look at labels to spot the hidden sugar)
  4. Watch caffeine and alcohol intake doesn’t creep up
  5. Eat a good solid nutrient-dense breakfast: e.g., omelette with vegetables, muesli (oats, nuts, raisins) with milk, yogurt, fresh fruit
  6. Aim for 80:20. That is mostly real food but still enjoy treats! And when you do, savour them!

Being in lockdown for some might mean having a lot of extra time on your hands. Maybe take the opportunity to try new recipes, learn what to do with chick peas or how to cook beans, make bread, yogurt or cheese, But overall focus on what you can control. And when it all gets a bit too much, focus on your breath. It is amazing what a few deep breaths, slowly inhaling, holding and exhaling, can do to calm the mind.

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 728018

New Brain Nutrition is a project and brand of Eat2BeNice, a consortium of 18 European University Hospitals throughout the continent.

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