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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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Vegans abstain from all animal products, for example, meat, fish, milk and dairy products, honey and other substances from animal origin, like milk powder. Nevertheless, countless foods remain that are “vegan” by nature: vegetables, fruits, cereals, legumes, rice, nuts, pasta (if made without eggs, of course), and so on. By contrast, vegetarians eat products made of meat but don’t eat meat and fish itself.

Positive results on (mental) health:

  • A raw vegan diet brought a positive change in quality of life, and a decrease of anxiety and stress (3)
  • A low-fat vegan diet for people with diabetes or BMI >=25 over 22 weeks showed that general health, physical functioning, mental health, and vitality improved in the vegan group (4)
  • In the vegan group, lower stress and anxiety were observed. In men, lower anxiety was related to vegan diet; in females, lower stress was related to vegan diet, and a lower daily intake of sweets (5)
  • Vegans tend to be thinner, have lower serum cholesterol, and lower blood pressure, which is reducing their risk of heart disease (6)
  • Vegetarian diet is associated with many health benefits because of its higher content of fiber, folic acid, vitamins C and E, potassium, magnesium, and many phytochemicals and a fat content that is more unsaturated (6)

But is the only difference the food intake? (7)

Vegans/ Vegetarians…

  • smoke or drink less than average
  • exercise more
  • care more about the ethics and quality of their food
  • are less likely to eat fast food

And there are also negative results:

On the contrary there are studies stating that a strictly vegan/vegetarian diet may be a risk factor for mental health; e.g. higher anxiety and depression levels compared to people who also ate meat and other animal products (8, 9).

But this might be explained by a key bias, because the majority of vegan / vegetarian eaters are female, unmarried, younger, and highly educated. These are all characteristics which are associated with a higher prevalence of mental disorders (10).

So, more research is needed until we can state whether a vegetarian or vegan lifestyle might be beneficial for our mental health or not. Generally speaking, enhancing the fruit, vegetable, and legume content of our everyday food will lead to increased uptake of vitamins, minerals, trace elements, and fibers. These are necessary for a physically healthy lifestyle – and most likely for your mental health status, too.

REFERENCES:

  • Healthy food is key to a healthy mind (2017, October 9) retrieved 3 February 2020 from https://medicalxpress.com/news/2017-10-healthy-food-key-mind.html
  • Skopos (2016): 1,3 Millionen Deutsche leben vegan.
    Online unter: https://www.skopos-group.de/news/13-millionen-deutsche-leben-vegan.html [11.06.2019]
  • Link, L. B., & Jacobson, J. S. (2008). Factors affecting adherence to a raw vegan diet. Complementary therapies in clinical practice14(1), 53–59. doi:10.1016/j.ctcp.2006.12.005
  • Katcher, H. I., Ferdowsian, H. R., Hoover, V. J., Cohen, J. L., & Barnard, N. D. (2010). A worksite vegan nutrition program is well-accepted and improves health-related quality of life and work productivity. Annals of Nutrition and Metabolism56(4), 245-252.
  • Beezhold, B., Radnitz, C., Rinne, A., & DiMatteo, J. (2015). Vegans report less stress and anxiety than omnivores. Nutritional neuroscience18(7), 289-296.
  • Winston J Craig, Health effects of vegan diets, The American Journal of Clinical Nutrition, Volume 89, Issue 5, May 2009, Pages 1627S–1633S, https://doi.org/10.3945/ajcn.2009.26736N
  • Veganism and Vegetarian Effects on Mental Health, retrieved 3 February 2020 from (https://www.serenitymaliburehab.com/veganism-vegetarian-effects-mental-health/
  • Lavallee, K., Zhang, X. C., Michalak, J., Schneider, S., & Margraf, J. (2019). Vegetarian diet and mental health: Cross-sectional and longitudinal analyses in culturally diverse samples. Journal of affective disorders248, 147-154.
  • Hibbeln, J. R., Northstone, K., Evans, J., & Golding, J. (2018). Vegetarian diets and depressive symptoms among men. Journal of affective disorders225, 13-17.
  • Sind Veganer eigentlich Veganerinnen?, retrieved 3 February 2020 from

https://vegawatt.de/vegan-leben/sind-veganer-eigentlich-veganerinnen

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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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Rates of obesity and metabolic diseases are rapidly growing, and much attention is paid to study the effects of consumed foods on human health. We know already that dietary preferences can be a serious factor of diseases and even a cause of them, in a man. However, we do not know molecular and cellular mechanisms behind these effects. Thus, we do not know how these negative processes can be neutralized or diminished by preventive or curative interventions. As such mechanistic studies are needed.

These studies can be in principle carried out in vitro or in vivo. Food consumption and consumed nutrients affects both the brain and a periphery. Another words, these processes are systemic and involve a lot of interplay mechanisms. Consequently, in vitro approach has very limited potential to achieve research goal with studies on diets. For example, the use of a tissue from peripheral organs or brain, cell cultures or even mini-organs would not help to understand systemic mechanism.

With in vivo approach, human studies cannot help to understand the mechanisms and they exclude any interventions. The remaining solution then is the use of animal models – of course, in compliance with the three R’s principle1 (reduction, refinement, replacement). “Replacement” defines the choice of the object: to use the lowest phylogenetic ordered animal possible, when it’s impossible to use in vitro methodology or a non-animal model, to address a given scientific question.

The most commonly used animal in nutritional research is a mouse. Are mice perfect organisms to model dietary-induced disorders?

Like us, humans, mice are omnivore mammals, and almost all the genes in mice share functions with the genes in humans. In comparison to other mammals, mice have small size of the body (3000 times smaller than a human), and genetically identical mice (like human monozygotic twins) are available for experimental use. Basal metabolic rate per gram of body weight is 7 times greater in mice than in humans which speeds up the development of diet-induced disease. Because of the rapid generation and short life cycle (about 2 years) mice are used to study the effects of maternal diet in the offspring and model diet role in aging processes. Mice display complex behaviours, including social interactions, cognitive functions and emotionality, that are similar to human features.

The use of mice in nutritional research offers a unique tool: possibility to study the role of a given gene using genetic modification. Generation of mutant mice is well established in comparison with other mammalian species. Many genetically modified mouse models were developed over the years, including knockout mice in which genetic material is deleted, mice carrying additional genetic material or “humanized” models expressing human genes.

Numerous mouse models were generated to use in nutrition research. Probably the most popular model in diet research is diet-induced obesity model (DIO model)2 in which animal is fed high-fat or high-density diets – to mimic the most common cause of obesity in humans. Changes seen in DIO mice are remarkably consistent with those seen in obese patients. DIO mice are used to investigate mechanisms of obesity development and novel medication screening.

Another prominent example of a model in nutrition research is the ob/ob mouse3. Due to a mutation in hormone leptin these mice display severe obesity, insulin resistance and dyslipidemia. Studies performed on this model revealed new aspects of hypothalamus role in human energy metabolism.

Mouse model plays its role in development of anti-obesity and anti-diabetic medication. Information about the receptors and hormones that regulate food intake and energy balance can be used to choose a target for a new drug. For example, mice lacking serotonin 5-HT2C receptor were found to exhibit mild obesity and type 2 diabetes4, suggesting the role of this receptor in regulation of food intake. Recently appetite reducing drug (lorcaserin), 5-HT2C receptor agonist, was developed.

However, there are certain limitations in translating discoveries from mouse models to humans in nutrition research. There are clear differences in feeding patterns, nutrient metabolism and hormone control between humans and mice. In case those aspects are key features of the study, another available model could be used.

No model is perfectly mimicking all aspects of human disease. It is likely that better new models will be developed in the nearest future to study the human conditions not adequately replicated in mouse models. But for now, mouse model is a useful tool in studying dietary-induced diseases and it plays an important role in translational research and advancement of human health.

REFERENCES

  1. Tannenbaum, J. & Bennett, B. T. Russell and Burch’s 3Rs then and now: the need for clarity in definition and purpose. J. Am. Assoc. Lab. Anim. Sci. 54, 120–32 (2015).
  2. Hariri, N. & Thibault, L. High-fat diet-induced obesity in animal models. Nutr. Res. Rev. 23, 270–299 (2010).
  3. Ingalls, A. M., Dickie, M. M. & Snell, G. D. Obese, a new mutation in the house mouse. J. Hered. 41, 317–318 (1950).
  4. Tecott, L. H. et al. Eating disorder and epilepsy in mice lacking 5-HT2C serotonin receptors. Nature 374, 542–546 (1995).
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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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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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Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopment disorder characterized by inattention or hyperactivity–impulsivity, or both. It might seem paradoxical, but many studies indicate that individuals with a diagnosis of ADHD suffer from overweight and obesity. Therefore, it is important to understand the underlying mechanism that put individuals with ADHD at risk for obesity.

 Evidence from within-individual study
A systematic review and meta-analysis (1) based on 728,136 individuals from 42 studies, suggested a significant association between ADHD and obesity both in children/adolescents and adults. The pooled prevalence of obesity was increased by about 70% in adults with ADHD and 40% in children with ADHD compared with individuals without ADHD. However, due to the lack of longitudinal and genetically-informative studies, the meta-analysis was unable to explain the exact direction of association and the underlying etiologic mechanisms. There are several potential explanations:

  • ADHD causing obesity: The impulsivity and inattention components of ADHD might lead to disordered eating patterns and poor planning lifestyles, and further caused weight gain.
  • Obesity causing ADHD: Factors associated with obesity, for example dietary intake, might lead to ADHD-like symptoms through the microbiota-gut-brain axis.
  • ADHD and obesity may share etiological factors: ADHD and obesity may share dopaminergic dysfunctions underpinning reward deficiency processing. So the same biological mechanism may lead to both ADHD and obesity. This is difficult to investigate within individuals, but family studies can help to test this hypothesis.

We will further investigate these possibilities in the Eat2beNICE research project by using both perspective cohort study and twin studies.

Evidence from a recent within-family study
Recently, a population-based familial co-aggregation study in Sweden (2) was conducted to explore the role of shared familial risk factors (e.g. genetic variants, family disease history) in the association between ADHD and obesity. They identified 523,237 full siblings born during 1973–2002 for the 472,735 index males in Sweden, and followed them until December 3, 2009. The results suggest that having a sibling with overweight/obesity is a risk factor for ADHD. This makes it likely that biological factors (that are shared between family members) increase the risk for both ADHD and obesity.

Evidence from across-generation study
Given that both ADHD and obesity are highly heritable complex conditions, across-generation studies may also advance the understanding of the link between ADHD and obesity.

A population-based cohort study (3) based on a Swedish nationwide sample of 673,632individuals born during 1992-2004, was performed to explore the association between maternal pre-pregnancy obesity and risk of ADHD in offspring. The sibling-comparison study design was used to test the role of shared familial factors for the potential association. The results suggest that the association between maternal pre-pregnancy obesity and risk of ADHD in offspring might be largely explained by shared familial factors, for example, genetic factors transmitted from mother to child that contribute to both maternal pre-pregnancy obesity and ADHD.

Together, based on previous evidence from various study designs, there is evidence to suggest that the association between ADHD and obesity mainly is caused by shared etiological factors. However, future studies on different population are still needed to further test these findings.

REFERENCES:
1. 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. The American journal of psychiatry. 2016;173(1):34-43.

2. Chen Q, Kuja-Halkola R, Sjolander A, Serlachius E, Cortese S, Faraone SV, et al. Shared familial risk factors between attention-deficit/hyperactivity disorder and overweight/obesity – a population-based familial coaggregation study in Sweden. J Child Psychol Psychiatry. 2017;58(6):711-8.

3. Chen Q, Sjolander A, Langstrom N, Rodriguez A, Serlachius E, D’Onofrio BM, et al. Maternal pre-pregnancy body mass index and offspring attention deficit hyperactivity disorder: a population-based cohort study using a sibling-comparison design. Int J Epidemiol. 2014;43(1):83-90.

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Why 12 genetic markers for ADHD are exciting news for New Brain Nutrition

We are finally here: for the first time, genome-wide significant markers are identified that increase the risk for Attention Deficit / Hyperactivity Disorder (ADHD). This research was conducted by an international consortium of more than 200 experts on genetics and ADHD, and includes several researchers that are also involved in our Eat2beNICE project (the scientific basis of this New Brain Nutrition website). The findings were recently published in the prestigious journal “Nature Genetics” and will greatly advance the field of ADHD genetics research.

Why is this finding so important?

The genetics of ADHD are very complex. While ADHD is highly heritable, there are likely to be thousands of genes that contribute to the disorder. Each variant individually increases the risk by only a tiny fraction. To discover these variants, you therefore need incredibly large samples. Only then can you determine which variants are linked to ADHD. The now published study by Ditte Demontis and her team combined data from many different databases and studies, together including more than 55,000 individuals of whom over 22,000 had an ADHD diagnosis.

We can now be certain that the twelve genetic markers contribute to the risk of developing ADHD. Their influence is however very small, so these markers by themselves can’t tell if someone will have ADHD. What’s interesting for the researchers is that none of these markers were identified before in much smaller genetic studies of ADHD. So this provides many new research questions to further investigate the biological mechanisms of ADHD. For instance, several of the markers point to genes that are involved in brain development and neuronal communication.

Why are our researchers excited about this?

A second important finding from the study is that the genetic variants were not specific to ADHD, but overlapped with risk of lower education, higher risk of obesity, increased BMI, and type-2 diabetes. If genetic variants increase both your risk for mental health problems such as ADHD, and for nutrition-related problems such as obesity and type-2 diabetes, then there could be a shared biological mechanism that ties this all together.

We think that this mechanism is located in the communication between the gut and the brain. A complex combination of genetic and environmental factors influence this brain-gut communication, which leads to differences in behaviour, metabolism and (mental) health.genetic markers for adhd

The microorganisms in your gut play an important role in the interaction between your genes and outside environmental influences (such as stress, illness or your diet). Now that we know which genes are important in ADHD, we can investigate how their functioning is influenced by environmental factors. For instance, gut microorganisms can produce certain metabolites that interact with these genes.

The publication by Ditte Demontis and her co-workers is therefore not only relevant for the field of ADHD genetics, but brings us one step closer to understanding the biological factors that influence our mental health and wellbeing.

Further Reading

Demontis et al. (2018) Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nature Genetics. https://www.nature.com/articles/s41588-018-0269-7

The first author of the paper, Ditte Demontis, also wrote a blog about the publication. You can read it here: https://mind-the-gap.live/2018/12/10/the-first-risk-genes-for-adhd-has-been-identified/

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What is inflammation?

Inflammation is the response of the body’s immune system against external factors that can put your health in danger. When this system feels it is attacked by something that may harm your health, it activates some molecules that are called cytokines in order to neutralize or avoid any damage so you can be safe.

Why is inflammation bad? What does it do?

Inflammation isn’t bad by itself, since its purpose is to protect our body. In some cases however, when the duration of this response is extended for too long- I’m talking about years- it can cause harmful effects to your health. Especially, it can affect the brain by active transport of cytokines throughout this organ.

Neuro-inflammation may occur if this process continues past early stages. Neuro-inflammation plays an important role in the development of mental diseases such as attention-deficit/hyperactivity disorder (ADHD), autism, schizophrenia, depression, anxiety, bipolar disorder (BD), and obsessive-compulsive disorder (OCD), where elevated levels of inflammation have been found(1).

What causes inflammation? 

Inflammation can occur by different factors. Some of them could be: pathogens, injuries, chronic stress, and diseases like dermatitis, cystitis or bronchitis to mention a few.

Nutritional factors like overweight and poor diet quality can also trigger this process by increasing fat accumulation in our cells and damaging them (2). The exact mechanisms that are involved in these processes are still in research.

What decreases inflammation?

Research has found that adhering to a healthy diet, like the Mediterranean diet, characterized by high intake of fruit, vegetables, whole grains, fish, lean meats and nuts, can decrease inflammation and protect you against depressive symptoms and anxiety (3,4).

There is evidence that prebiotics, probiotics and synbiotics (a combination of prebiotics and probiotics) can also help lowering inflammation. In addition, you should avoid eating pro-inflammatory foods that have been found to increase the risk of inflammation, and with it mental disorders. Some of these are refined carbohydrates, beverages with a lot of sugar added like soda, juice and sports drinks, processed meat and foods high in saturated fats (5).

What are anti-inflammatory foods

Anti-inflammatory foods are the contrast of pro-inflammatory foods. These are foods that have been found to promote or induce low levels of inflammation in our body, which may protect us against neurological disorders. Briefly, these foods include fruits, vegetables, olive oil, fish and spices like curcuma (turmeric).

Here’s what YOU can do to minimize inflammation and improve your mental health.

Inflammation and Foods

This was co-authored by Josep Antoni Ramos-Quiroga, MD PhD psychiatrist and Head of Department of Psychiatry at Hospital Universitari Vall d’Hebron in Barcelona, Spain. He is also professor at Universitat Autònoma de Barcelona.

Sources

  1. Mitchell RHB, Goldstein BI. Inflammation in children and adolescents with neuropsychiatric disorders: A systematic review. J Am Acad Child Adolesc Psychiatry [Internet]. Elsevier Inc; 2014;53(3):274–96. Available from: http://dx.doi.org/10.1016/j.jaac.2013.11.013
  2. Ogłodek EA, Just MJ. The Association between Inflammatory Markers (iNOS, HO-1, IL-33, MIP-1β) and Depression with and without Posttraumatic Stress Disorder. Pharmacol Reports [Internet]. 2018;70:1065–72. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1734114017305923
  3. Lassale C, Batty GD, Baghdadli A, Jacka F, Sánchez-Villegas A, Kivimäki M, et al. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Mol Psychiatry [Internet]. Springer US; 2018;1. Available from: http://www.nature.com/articles/s41380-018-0237-8
  4. Phillips CM, Shivappa N, Hébert JR, Perry IJ. Dietary inflammatory index and mental health: A cross-sectional analysis of the relationship with depressive symptoms, anxiety and well-being in adults. Clin Nutr. 2017;37.
  5. Shivappa N, Bonaccio M, Hebert JR, Di Castelnuovo A, Costanzo S, Ruggiero E, et al. Association of proinflammatory diet with low-grade inflammation: results from the Moli-sani study. Nutrition. 2018;54:182–8.

 

 

 

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Have you experienced drowsiness after eating a large meal? Has an important presentation made your stomach turn? Seeing a special someone made you feel butterflies in your stomach? If you have (and you most likely have), then you know how strong the connection between the brain and the gut is.

Scientists have found that many chronic metabolic diseases, type 2 diabetes, mood disorders and even neurological diseases, such as Parkinson’s disease, Alzheimer’s disease, amyotrophic lateral sclerosis (ALS) and multiple sclerosis, are often associated with functional gastrointestinal disorders (1). The importance of the association between the gut and the brain is gaining momentum with each new study. However, the way HOW the signaling between these two integral parts of the body exactly works hasn’t been clear until recently.

It was thought for a long time that the only “communication channel” between the gut and the brain was the passive release of hormones stimulated by the consumed nutrients. Hormones entered the bloodstream and slowly notified the brain that the stomach is full of nutrients and calories. This rather slow and indirect way of passing messages takes from minutes to hours.

But now, a recent study (2) has elegantly proven that the gut can message the brain in seconds! Using a rabies virus enhanced with green fluorescence, the scientists traced a signal as it traveled from the intestines to the brainstem of mice, crossing from cell to cell in under 100 milliseconds – faster than the blink of an eye.

The researchers had also noticed that the sensory cells lining the gut were quite similar to the receptors in the nose and on the tongue (3). The effects, however, differ. In the mouth, the taste of fatty acids triggers signals to increase hunger, whereas in the small intestine, fatty acids trigger signals of satiety. This means that the discovered “gut feeling” might be considered as a sixth sense, a way of how the brain is being signaled when the stomach is full.

This new knowledge will help to understand the mechanism of appetite, develop new and more effective appetite suppressants and help those struggling with weight and problematic eating patterns.

REFERENCES
(1) Pellegrini C et al (2018) Interplay among gut microbiota, intestinal mucosal barrier and enteric neuro-immune system: a common path to neurodegenerative diseases? Acta Neuropathol 136:345. doi:10.1007/s00401-018-1856-5

(2) Kaelberer et al (2018) A gut-brain neural circuit for nutrient sensory transduction. Science 361(6408):eaat5236. doi:10.1126/science.aat5236

(3) Bohórquez and Liddle (2015) The gut connectome: making sense of what you eat. J Clin Invest 125(3):888–890. doi:10.1172/JCI81121

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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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