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This podcast episode is based on Journey to Recovery: A Comprehensive Guide to Recovery from Mental Health and Addiction Issues by Dr. Dawn-Elise SnipesĀ  Read it for free on Amazon Kindle Unlimited.

Journey to Recovery Series
Complimentary Interventions
Nutrition
Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs

CEUs are available at https://allceus.com/member/cart/index/product/id/924/c/

Objectives
~ Review the nutritional building blocks for health and wellness
~ Examine how these nutrients (or lack thereof) contribute to neurotransmitter balance
~ Identify several nutrient dense foods that you can include in your diet
~ Note: Nutritional changes should always be made under the supervision of a registered dietician or your primary physician. This presentation is for general informational purposes only.
Why I Care/How It Impacts Recovery
~ In early recovery, nearly every personā€™s neurotransmitters are out of balance.
~ This causes feelings of depression, apathy, anxiety, and/or exhaustion.
~ Understanding why you feel the way you do is the first step
~ Figuring out how to help yourself feel better is the next
What are Neurotransmitters
~ The human brain is composed of roughly 86 billion neurons.
~ These cells communicate with each other via chemical messengers called neurotransmitters.
~ Neurotransmitters regulate
~ Mood
~ Cravings, addictions
~ Energy
~ Libido
~ Sleep
~ Attention and concentration
~ Memory
~ Pain Sensitivity

Neurotransmitters Contā€¦
~ About 86% of Americans have suboptimal neurotransmitter levels ā€” our unhealthy modern lifestyle being largely to blame.
~ Chronic stress, poor diet, environmental toxins, drugs (prescription and recreational), alcohol, nicotine, and caffeine can cause neurotransmitter imbalances.

Think about it
~ How do you feel when you are not getting enough oxygen? (Hint: You yawn)
~ What effect might a low carb diet have on mood?
~ What effect might a low protein diet have on mood? (Most non-vegan Americans get plenty of protein)
~ Why do doctors test for vitamin-D levels in patients with depressive symptoms?

Amino Acids (Protein Building Blocks)
Essential Amino Acids
~ Must be acquired from diet:
~ Valine
~ Isoleucine
~ Leucine
~ Lysine
~ Methionine
~ Phenylalanine
~ Threonine
~ Tryptophan
Complete vs. Incomplete Proteins
~ Complete proteins are those that contain all essential amino acids:
~ Meat
~ Fish
~ Dairy products (milk, yogurt, whey)
~ Eggs
~ Quinoa*
~ Buckwheat*
~ Chia seed*
~ Spirulina*
Complete vs. Incomplete Proteins
~ Incomplete proteins are those that donā€™t contain all 9 essential aminos
~ Nuts & seeds
~ Legumes
~ Grains
~ Vegetables
Amino Acids (Proteins)
~ Protein Digestibility-Corrected Amino Acid Score, PDCAAS

Tryptophan
~ Food Sources: Egg whites, chia seeds, sesame seeds, wheat germ, turkey
~ Needs Iron, magnesium, B6 and Vitamin C to convert tryptophan to serotonin
~ More readily absorbed when eaten with high carbohydrate meal.
~ Insulin causes competing amino acids to be absorbed into the tissues
~ Only precursor to serotonin

~ Focus on Tryptophan by John W. Crayton, MD, Professor of Psychiatry at Loyola University Medical School, Maywood, Illinois. NOHA* NEWS, Winter 2001
~ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908021/ L-Tryptophan: Basic Metabolic Functions, Behavioral Research and Therapeutic Indications Int J Tryptophan Res. 2009; 2: 45ā€“60.

Important Non-Essential Amino Acids
~ Arginine helps with insomnia
~ Glutamine ļƒ Glutamateļƒ GABA
~ Theanine: Increases GABA and serotonin levels (Green Tea)
~ Tyrosine: Used to make dopamine and norepinepherine and thyroid hormones.
~ Parmesan, mozzarella, swiss cheeses, lean beef, pork or salmon, tuna or mackerel, chicken breast, pumpkin seeds, peanuts, sunflower seeds, dairy, beans

B Vitamins
~ Low levels of B vitamins may be linked to depression.
~ Vitamin B3 (Niacin)
~ Food sources: Poultry, fish, meat, whole grains, and fortified cereals
~ What it does:
~ Helps with digestion and changing food into energy
~ Helps body conserve tryptophan and convert it into serotonin
B Vitamins
~ Vitamin B 5 Pantothenic Acid
~ Food sources include: beef, mushrooms, eggs, vegetables, legumes, nuts, pork, saltwater fish, whole rye flour, whole wheat
~ What it does
~ Help control the secretion of cortisol
~ Help with migraines and chronic fatigue syndrome
~ Supplementation in very high doses can increase in panic attacks
B Vitamins
~ Vitamin B6
~ Food sources include: Fortified cereals, fortified soy-based meat substitutes, baked potatoes with skin, bananas, light-meat poultry, eggs, peas, spinach
~ What it does: Supports your nervous system by helping the body break down proteins.
~ Vitamin B9- Folate
~ What it does: May reduce depression when taken in conjunction with vitamin B12.
~ Food sources include: Spinach, kale, lentils, asparagus, black eyed peas, broccoli, avocado, French bread

B Vitamins
~ Vitamin B12
~ Food sources include: Beef, eggs, shellfish, salmon, poultry, soybeans, yogurt, tuna and fortified foods
~ What it does:
~ Helps with cell division and helps make red blood cells.
~ Deficiency can lead to mood problems, including depression, anxiety, poor memory, difficulty concentrating

http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/vitamin-b12-and-depression/faq-20058077
http://www.calmclinic.com/blog/calm-clinic-review-b-vitamins
Fava M, Borus JS, Alpert JE, Nierenberg AA, Rosenbaum JF, Bottiglieri T. Folate, vitamin B12, and homocysteine in major depressive disorder. Am J Psychiatry. 1997;154:426-428.
Alpert JE, Mischoulon D, Nierenberg AA, Fava M. Nutrition and depression: focus on folate. Nutrition. 2000;16:544-546

Vitamin C
~ Food sources include: Citrus, berries, tomatoes, potatoes, broccoli, cauliflower, brussels sprouts, bell peppers, cabbage, spinach
~ What it does:
~ Promotes a healthy immune system
~ Helps make collagen.
~ It's also needed to regulate norepinepherine, dopamine and serotonin
~ Associated with significant reductions in anxiety.

Pak J Biol Sci. 2015 Jan;18(1):11-8. Effects of Oral Vitamin C Supplementation on Anxiety in Students: A Double-Blind, Randomized, Placebo-Controlled Trial
Wang Y, Liu XJ, Robitaille L, Eintracht S, MacNamara E, Hoffer LJ. Effects of vitamin C and vitamin D administration on mood and distress in acutely hospitalized patients. Am J Clin Nutr. 2013 Sep;98(3):705-11.
Mazloom Z, Ekramzadeh M, Hejazi N. Efficacy of supplementary vitamins C and E on anxiety, depression and stress in type 2 diabetic patients: a randomized, single-blind, placebo-controlled trial. Pak J Biol Sci. 2013 Nov 15;16(22):1597-600.
http://www.livestrong.com/article/525632-link-between-vitamin-c-deficiency-anxiety/
J Neurochem. 2013 Feb;124(3):363-75. Behavioral and monoamine changes following severe vitamin C deficiency.
Vitamin D-3 (Sunlight Vitamin)
~ Food sources include: Fortified milk, cheese, and cereals; egg yolks; salmon, cod liver oil
~ What it does:
~ Maintains bone health and helps the body process calcium;
~ Important for immune system function
~ Related to a reduction in depression as it affects the amount of chemicals called monoamines, such as serotonin, and how they work in the brain

J Intern Med. 2008 Dec;264(6):599-609. Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial.
J Chem Neuroanat. 2005 Jan;29(1):21-30. Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain.
Am J Geriatric Psychiatry 2006Dec; 14(12): 1032-1040 Vitamin D Deficiency Is Associated With Low Mood and Worse Cognitive Performance in Older Adults

Calcium
~ Food sources include: Dairy products, broccoli, dark leafy greens, and fortified dairy, grains and juices
~ What it does:
~ Helps build and maintain strong bones and teeth.
~ Helps muscles work.
~ Supports cell communication.
~ Deficiency causes nerve sensitivity, palpitations, irritability, anxiety, depression and insomnia
~ Excess can cause depression and difficulty concentrating

A Beneficial Effect of Calcium Intake on Mood Kamyar Arasteh, Ph.D. Journal of Orthomolecular Medicine
Chromium
~ Food sources include: Some cereals, beef, turkey, fish, broccoli, and grape juice
~ What it does:
~ Helps maintain normal blood sugar (glucose) levels
~ Influences the release of norepinepherine and serotonin
~ Researchers at Duke University have found that a daily dose of 600 mcg of chromium led to a significant decrease in symptoms among those with atypical depression especially their tendency to overeat

Davidson JR, Abraham K, Connor KM, McLeod MN. Effectiveness of chromium in atypical depression: a placebo-controlled trial. Biol Psychiatry. 2003;53:261-264. Abstract
Copper
~ Food sources include: Seafood, cashews, sunflower seeds, wheat bran cereals, whole-grain products, avocados, and cocoa products
~ What it does:
~ Helps break down iron
~ Make red blood cells
~ Helps produce energy for cells
~ Helps maintain bones, connective tissue, and blood vessels.
~ High copper and low zinc can contribute to depression

Indian J Physiol Pharmacol. 1991 Oct;35(4):272-4. Levels of copper and zinc in depression.

Iodine
~ Food sources include: Iodized salt, some seafood, kelp, and seaweed
~ What it does: Works to make thyroid hormones.
~ Deficiency: Weight gain, fatigue, difficulty concentrating, depression

Philip NS, et al. “Pharmacologic Approaches to Treatment Resistant Depression: A Re-examination for the Modern Era,” Expert Opinions in Pharmacotherapy (April 2010): Vol. 11, No. 5, pp. 709ā€“22
Iron
~ Food sources include: Leafy green vegetables, beans, shellfish, red meat, eggs, poultry, soy foods, and some fortified foods
~ What it does: Carries oxygen to all parts of the body through red blood cells, synthesis of neurotransmitters. (Helps fight fatigue and brain fog)

~ Indian J Psychiatry. 2008 Apr-Jun; 50(2): 77ā€“82. Understanding nutrition, depression and mental illnesses

Magnesium
~ Food sources include: Whole grains, leafy green vegetables, almonds, Brazil nuts, soybeans, halibut, peanuts, hazelnuts, lima beans, black-eyed peas, avocados, bananas, cocoa
~ What it does:
~ Helps muscles and nerves work
~ Optimizes thyroid function
~ Steadies heart rhythm
~ Maintains bone strength
~ Helps the body create energy

http://kellybroganmd.com/magnesium-most-important-female-supplement/
Pharmacol Rep. 2013;65(3):547-54. Magnesium in depression.
Rapid recovery from major depression using magnesium treatment Eby, George A. et al. Medical Hypotheses , Volume 67 , Issue 2 , 362 – 370

Omega 3 Fatty Acids
~ Food sources include: Walnuts 1/3c., chia seeds 4t., 2/3 cup mackerel, 9 ounces tuna, 1 T salmon fish oil
~ Use canola, olive and flaxseed oil to increase omega-3s
~ Flax Seeds are not nearly as efficient at producing positive effects because the ALA needs to be converted to EPA and DHA to be useful
~ What it does:
~ Helps your body transmit nerve signals
~ Maintain serotonin balance
~ Reduce inflammation
Omega 3s and Omega 6s
~ ā€œThe ideal ratio is one to one or two to one, omega-6 to omega-3.ā€
~ The American diet has been flooded with omega-6 fatty acids, mostly in the form of vegetable oils such as corn oil and safflower oil.ā€

Artemis Simopolous, MD, who directs the Center for Genetics, Nutrition and Health, in Washington, D.C http://www.webmd.com/diet/healthy-kitchen-11/omega-fatty-acids?page=3
J Clin Psychiatry. 2009 Dec; 70(12): 1636ā€“1644. A Double-Blind Randomized Controlled Trial of Ethyl-Eicosapentaenoate (EPA-E) for Major Depressive Disorder
Nemets B, Stahl Z, Belmaker RH. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry. 2002;159:477-479.
Cott JM. Omega-3 essential acids and psychiatric disorders. Program and abstracts of the American Psychiatric Association 2004 Annual Meeting; May 1-6, 2004; New York, NY. Symposium 19B.
http://www.health.harvard.edu/staying-healthy/why-not-flaxseed-oil
http://www.doctoroz.com/article/daily-dose-omega-3

Lycopene
~ What it does: Antioxidant, prevents brain degradation with age
~ Food sources include (Reds): Watermelons, pink grapefruits, apricots, tomatoes (cooked is better)

~ J Affect Disord. 2013 Jan 10;144(1-2):165-70. A tomato-rich diet is related to depressive symptoms among an elderly population aged 70 years and over: a population-based, cross-sectional analysis.
~ https://draxe.com/lycopene/

Potassium
~ Food sources include: Broccoli, potatoes with the skin, prune juice, orange juice, leafy green vegetables, bananas, raisins, and tomatoes
~ What it does: Required to activate neurons; helps maintain a healthy balance of water
~ ā€œWithout the electrical charge sparked by potassium, neurotransmitters like serotonin cannot be utilized to make us feel better.ā€

~ Br J Nutr. 2008 Nov;100(5):1038-45. doi: 10.1017/S0007114508959201. Epub 2008 May 9. Dietary electrolytes are related to mood.
~ Nat Neurosci. 2006 Sep;9(9):1134-41. Epub 2006 Aug 13. Deletion of the background potassium channel TREK-1 results in a depression-resistant phenotype.
~ McCleane, G. J. and Watters, C. H. (1990), Pre-operative anxiety and serum potassium. Anaesthesia, 45: 583ā€“585.

Selenium
~ Food sources include: Brazil nuts, Brown rice, turkey, Chicken, Spinach, sunflower seeds
~ What it does:
~ Antioxidant
~ Regulates thyroid hormone
~ Helps regulate circadian rhythm
~ Caution toxicity is easy. Upper limits are only 55-60mcg for adult females

~ The Importance of Selenium to Human Health. Margaret P. Rayman Centre for Nutrition and Food Safety, School of Biological Sciences, University of Surrey, Guildford GU2 5XH

Zinc
~ Food sources include: Red meat, fortified cereals, oysters, almonds, peanuts, chickpeas, soy foods, and dairy products
~ What it does:
~ Supports immune, reproductive and nervous systems,
~ Balances with copper.
~ Deficiency: Anxiety

~ The Neuropsychotherapist. Kim Uildriks (2016); 4(12): 16-17. Clinical Implications of Zinc Deficiency for Anxiety.
Effect of Nutrition on Brain Function

~ Eating foods with a low glycemic index improves the quality and duration of intellectual performance http://www.glycemicindex.com/
~ Dietary proteins contribute to good brain function
~ Tryptophan is necessary for the creation of serotonin and melatonin
~ Brain cell functioning requires omega-3 fatty acids.
~ Omega-3s have also been found to help prevent and/or treat mood disorders, particularly depression
~ Iron is necessary to ensure oxygenation and for the synthesis of neurotransmitters.
Effect of Nutrition on Brain Function

~ The iodine is necessary for energy metabolism in the brain cells.
~ Vitamin B1 is necessary for the utilization of glucose in the brain.
~ Vitamins B6 and B12, among others, are directly involved in the creation of neurotransmitters.
~ Nerve endings contain the highest concentrations of vitamin C in the human body.
~ Vitamin E is necessary for effective transmission of neurological signals
Helpful Notes
~ When you get nutrients from real foods
~ There is much less danger of toxicity
~ It is more bioavailable in most instances because it is in a useful ratio
~ Nature is all about balanceā€”increases in one may decrease others
~ Buy/grow organic fruits and vegetables to maximize nutrient value
~ Download an app such as Spark People or MyFitnessPal to track your nutrition.
~ Small changes are longer lasting. Try to add more of one type of food that has multiple vitamins.

Summary
~ Deficiencies of nutrients such as calcium, magnesium, zinc, omega-3 fatty acids, and vitamins A, B-complex, C, D3 and E are common, especially if you eat refined foods.
~ There are a variety of different vitamins and minerals involved in addiction and mental health disorders
~ It is not always about increasing a vitamin or mineral. Sometimes you need to decrease it.
~ Human brains try to maintain homeostasis and too much or too little can be bad
~ A balanced diet will provide the brain the necessary nutrients in synergystic combinations
Nutrient Summary
Other Resources
~ An overlooked connection: serotonergic mediation of estrogen-related physiology and pathology Leszek A RybaczykEmail author, Meredith J Bashaw, Dorothy R Pathak, Scott M Moody, Roger M Gilders and Donald L Holzschu. BMC Women's Health BMC series open, inclusive and trusted 2005 5:12
~ Isr Med Assoc J. 2003 Sep;5(9):653-8. Aggression: the testosterone-serotonin link. Birger M1, Swartz M, Cohen D, Alesh Y, Grishpan C, Kotelr M.
~ Phytother Res. 2011 Nov;25(11):1636-9.
~ Nutr Neurosci. 2013 Jul 23.