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DIET AND NUTRITION

"Always remember that aged men should eat often,


But little at a time for fareth by them,
As it doth by a lamp the light whereof is
Almost extinct, which by pouring in of oil
Little and Little, is long kept burning;
And with much oil poured in at once,
It is clean putout."
Nutrition is essential consideration when working with a patient who has a mental illness.
Because psychiatric illnesses affect the whole person, it is not surprisingly that patients
with mental illnesses frequently have inadequate diets. Often, either their diets are
deficient in the proper nutrients, or they eat too much or too little. Research demonstrates
the intimate connection between nutrition and behavioral issues. For instance, anemia,
which is the most common deficiency disease, often cause depression. Scientists at the
University of California, Davis, reported that omitting breakfast can interfere with
cognition and learning in the classroom.

The value of nutrition in the healing process has long been underrated. Lutz and
Przyulski (1994) state:
Today many diseases are linked to lifestyle behaviors such as smoking, lack of adequate
physical activity and poor nutritional habits. Health care providers, in their role as
educators, emphasize the relationship between lifestyle and risk contracting diseases.
People are increasingly managing their health problems and making personal
commitments to lead healthier lives.
Individuals select the foods they eat based on a number of factors, not the least of which
is enjoyment. Eating must serve social and cultural as well as nutritional needs.

• EAT A VARIETY OF FOODS


No single food can supply all nutrients in the amounts needed for good health. A variety
of foods should be selected from the USDA’s food pyramid. Most of the daily serving
should be selected from the food groups that are closest to the base of the pyramid. A
range of servings is suggested for each group of foods. Smaller, sedentary persons should
select the lower number of servings. The higher numbers of servings are meant for larger,
more active individuals.

• BALANCE THE FOOD YOU EAT WITH PHYSICAL ACTIVITY


Many individuals gain weight with age, which increases their chance of developing a
number of health problems associated with excess weight. These problems include high
blood pressure, heart disease, stroke, diabetes, certain types of cancer, arthritis, breathing
problems and other illnesses. Thirty minutes or more of moderate physical activity, such
as walking, 3-5 days each week can help to increase calorie expenditure and assist in
maintaining a healthy weight.

• CHOOSE A DIET WITH PLENTY OF GRAIN PRODUCTS,


VEGETABLES AND FRUITS
Consumptions of grains, vegetables and fruit is associated with a substantial lower
risk for many chronic diseases, including certain types of cancer. These foods are
emphasized in this guideline because they are an excellent source of vitamins,
minerals, complex carbohydrates(starch and dietary fiber); they are also low in fat,
depending on how they are prepared.

• CHOOSE A DIET LOW IN FAT, SATURATED FAT, AND


CHOLESTEROL
Heart disease and some types of cancer (e.g. breast and colon) have been linked to high
fat diets. Some dietary fat is required for good health. Fats supply energy and essential
fatty acids, and they promote absorption of the fat soluble vitamins A, D, E and K.
However, fats should comprise no more than 30 percent of the total daily calorie intake.
Individuals should choose foods with monounsaturated and polyunsaturated fat sources
and should keep daily cholesterol intake below 300mg.

• CHOOSE A DIET MODERATE IN SUGARS


Many foods that contain sugars supply unnecessary calories and few nutrients. Tooth
decay is a significant health problem from eating too much sugar. Scientific evidence
indicates that diets high in sugar do not cause hyperactivity or diabetes. A recent study by
dr.W.B. Grant of the Atmospheric Sciences division of NASA’s Langley Research center
reports that sugar may be the highest dietary risk factor for heart disease in women ages
35 and older. He states,”Fructose metabolizes into triglycerides, then is incorporated into
very low density lipoprotein cholesterol.
• CHOOSE A DIET MODERATE IN SALT AND SODIUM
Sodium and sodium chloride occur naturally in foods, usually in small amounts. Most
foods are prepared with some salts, and some has already been added during processing.
Studies with many diverse populations have established that a high intake of salt is
associated with high blood pressure. It is therefore important for individuals at risk for
high blood pressure to consume less salt in their diets.

Nutritional Therapy:

Many nutritional deficiencies may produce symptoms of psychiatric disorders. Fatigue,


apathy and depression are caused by deficiencies in iron, folic acid, magnesium, vitamin
C, or biotin. Logically treating these deficiencies with nutrition supplements should
improve the psychiatric symptoms.

In 1967, Linus Pauling espoused the theory that ascorbic acid deficiency produced many
psychiatric disorders. He implemented a treatment for schizophrenia that included large
doses of ascorbic acid and other vitamins. This treatment was referred to as megavitamin
therapy or orthomolecular therapy. Many psychiatric shows interest in Pauling’s proposal
but his research could never be substantiated and most researchers and clinicians became
highly skeptical of this hypothesis.

Over the last two decades, several theories and diets have been developed based on the
belief that food controls behavior. High sugar intake was once thought to produce
hyperactivity in children and Benjamin Feingold developed a diet to eliminate food
additives that he believed increased hyperactivity. Neither claim was substantiated but
further research has determined that tartrazine, sodium benzoate, milk, chocolate, eggs,
wheat, corn, oats and fish may produce behavioral problems for some children (Podell,
1985). An elimination diet was implemented for some children but was difficult and
tendious to follow.

More recently advances in technology have led research to new investigations regarding
dietary precursors for the bioamines. E.g. tryptophan, the dietary precursor for serotonin
has been most extensively investigated as it relates to low serotonin levels and increased
aggression. Individuals given tryptophan-deficient amino acid mixtures have shown
lower levels of serotonin in the brain, resulting in depressed mood and aggressive
behavior (Young, 1990)

Medications also influence the development of nutritional deficiencies, which may


worsen psychiatric symptoms. E.g. drugs with strong anticholinergic activity often
produce impaired or enhanced gastric motility which may lead to generalized
malabsorption of vitamins and minerals.

Nutrition Chart, Guide : Nutrition Requirement / Needs

Nutrition Men over 24 Year Women 25-50 Year Women over 50 Year
Calories 2900 2200 1900 maximum
Fat 96g maximum 73g maximum 63g maximum
Saturated Fat 32g maximum 24g maximum 21g maximum
Cholesterol 300mg maximum 300mg maximum 300mg maximum
Protein 63g 50g 50g maximum
Carbohydrates 446g 335g 283g
Fiber 20 - 30g 20 - 30g 20 - 30g

Sodium 2400mg maximum 2400mg maximum 2400mg maximum

Medication and food:


One important area of nutrition to consider is the interaction of foods and medications.
For instance some medications such as antidepressants classified as monoamine oxidase
inhibitors involve dietary restrictions. Patients taking MAOIs are instructed to avoid
eating foods that contain a substance called tyramine. These foods taken with MAOI,
could cause a hypertensive crisis, in which the patient’s BP soars to dangerous levels.

Caffeine and other Stimulants:


Another important area of nutrition to consider is the ingestion of foods or substances that
produce or exacerbate psychiatric symptoms. For instance, patients with anxiety disorders
should avoid stimulants such as those found in over-the counter diet and cold
preparations as well as caffeine. These substances can intensify anxiety in patients
already struggling with anxiety disorders.
For instance, caffeine triggers increased activity of the sympathetic nervous system,
which causes the fight-or-flight physiological responses typical of an anxiety attack.
Alcohol:
People with moderate to severe anxiety and mood swings should avoid alcohol entirely or
limit its use to occasional amounts. Alcohol is a simple sugar, which is rapidly absorbed
by the body. Like other simple sugars alcohol worsens the symptoms of hypoglycemia,
causing an increase in anxiety and mood swings.

Wheat and other Gluten containing Grains:


In anxious and depressed people who are sensitive to some foods, the ingestion of wheat
may worsen the anxiety and depression. The causative component of wheat appears to be
gluten, a protein derivative that gives dough its tough, elastic character. People suffering
from severe anxiety should eliminate wheat from their diets for at least 1-3 months. Oats,
barley, and rye which also contain gluten should be initially eliminated.
Bluckwheat on the other hand is easily digested by most people who are sensitive to
gluten. It comes from a different plant family than wheat & other gluten rich grains.

Vegetables and fruits:


Swiss cheesed, chard, broccoli, beet greens, mustard greens, kale, raisins, blackberries
and bananas are rich in calcium, magnesium and potassium, which are important minerals
that help improve endurance, stamina, and vitality. Brussels sprouts, parsley, peas,
tomatoes, potatoes, berries, and melons supply a good dose of vitamin C which is
essential for the production of adrenal hormones(Lark,1994)

Seeds and Nuts:


Raw flax seeds and pumpkin seeds are excellent sources of two essential fatty acids-
linoleic acid and linolenic acid. Adequate levels of essential fatty acids are important in
preventing both the emotional and physical symptoms of premenstrual syndrome,
menopause, emotional upsets, and allergies.

Vitamins, Minerals and Amino acids:


Certain vitamins are essential to good mental health. For instance vit B1 is used by the
brain to change glucose into fuel. A lack of thiamine can lead to depression, anxiety and
memory loss. Vitamin B6 also seems connected to depression. The body needs Vitamin
B6 to manufacture serotonin, one of the substances implicated in mood regulation. Folic
acid helps in the production of neurotransmitters and a deficiency of folic acid is
implicated to depression.
The use of specific vitamins, minerals and amino acids in tablet, capsule, powder form to
balance a
Person’s nutritional needs are called orthomolecular therapy. It is not synonymous with
megavitamin therapy. Megavitamin therapy, a person consumes massive quantities of
vitamins, far exceeding recommended daily allowances, in an attempt to achieve overall
health. In orthomolecular therapy, the person consumes specific vitamins, minerals and
amino acids to correct a specific imbalance thought to underlie a specific problem.

Nutrition and Mental health

All psychiatric drugs work to rebalance out-of-kilter brain chemistry. But the success
rates achieved by providing the brain with the same molecules it uses to build brain cells
and neurotransmitters are eye-opening - hence the well-publicised success of the essential
fatty acid omega 3.
Twenty per cent of the brain is made up of essential fats. These fats are missing from the
modern diet, and the body can't manufacture them itself. Each of our 100 billion brain
cells links up to 20,000 others, and when essential fats are in short supply, the link-ups
become difficult. The potential consequences are manifold: our mood, concentration,
memory and intelligence can all suffer. So it is unsurprising that essential fats have been
proven to help with numerous brain-based afflictions.

While 40% of patients who walk into doctor's surgeries are suffering from a mental
health problem, an astonishing two-thirds of GPs have had no mental health training. As
a result, most GPs do not even consider their patients' nutritional status. Professor André
Tylee is chairman of the National Institute for Mental Health and is responsible for
educating all British GPs in the treatment of mental health. He is passionate about the
benefits of nutritional therapy and describes it as "the breakthrough we've been waiting
for". He is hoping to ensure that nutritional approaches will become the first step that
doctors use to defeat mental illness.

Tylee is working with Patrick Holford, founder of the Institute of Optimum Nutrition and
author of the bestseller Optimum Nutrition for the Mind. Holford's latest enterprise is The
Brain Bio Centre, which is dedicated to helping patients recover from all forms of brain-
centred illness, from depression to Alzheimer's, using nutritional therapy. Tylee is
anxious to introduce the clinic's approaches to the NHS and to conduct a clinical study
that confirms their anecdotal success rate of 80%. The clinic defines success as freedom
from symptoms, the ability to socialise with friends and family, and the paying of income
tax.

According to Holford, a nutritionist and psychologist, nine out 10 people eat less than the
recommended daily amounts of our 39 essential nutrients. "They're not called essential
for nothing," he says. When this is combined with other factors such as high
homocysteine levels, which leave one twice as likely to succumb to depression, blood-
sugar and neurotransmitter imbalances, it is hardly startling that people's brain chemistry
goes awry.

James Maclean, 21, is a typical Brain Bio Centre success story. James developed manic
depression in his second year at university. He was given antipsychotics and
antidepressants and received guidance from an NHS psychiatric nurse who "normally just
spoke about his own family".

"I had to leave university," says James. "I hated taking so much medication - it made me
put on five stone." When he started to believe that the radio was speaking to him, he
knew he needed further help. "Within a space of 10 days I was sectioned, then released,
then detained again three times." He was eventually hospitalised for two months. He calls
the mental hospital the most soulless place on earth.

On his release, his sister-in-law suggested he see a nutritionist. After an internet search
which yielded only a quack who wanted $10,000 for the first consultation, James
eventually tracked down the Brain Bio Centre. After tests he was found to be very low in
minerals and to be yeast- and gluten-intolerant; he was also suffering from blood-sugar
problems. He changed his diet and took a comprehensive range of supplements, including
high doses of niacin and essential fats. "The difference was startling," he says. "I feel
sharper than before and I'm now supermotivated. I have lost three stone in the last two
months and I feel whole again." James has reapplied to read sports science at university
and hopes to play rugby professionally.

Holford may be regarded as being outside the mainstream, but increasingly his approach
is being fostered in conventional medicine. Many respected scientists and physicians are
reporting unprecedented success with the orthomolecular approach, so named by the
American chemist Linus Pauling, who died in 1994. In the UK, Malcolm Peet, an NHS
psychiatric consultant, recently led separate studies with schizophrenics and depressives
who were failing to respond to drugs. Both studies concluded that the essential fat, EPA,
is effective. Earlier this year, Dr Basant Puri, a consultant psychiatrist at Imperial College
School of Medicine, published an entire book dedicated to explaining why EPA is so
good at treating depression.

In the US, Dr Mary Megson, a fellow of the American Academy of Paediatrics, has
treated over 2,000 children for autism and uses under a teaspoon of cod liver oil every
day. The majority of subjects come out of the autistic spectrum within six months - some
within weeks, she says. She has seen children making eye contact for the first time in
their lives after just three days of treatment.

Similarly, Dr Alex Richardson, a senior research fellow at Oxford University, recently


published a study showing remarkable turnarounds in concentration, attention and
disruptive behaviour after combining the fish oil EPA with omega 6 to treat dyslexics and
ADHD sufferers.

"We're not talking about easily labeled disease entities," says Richardson. "We are simply
saying there is a frightening epidemic of children falling into categories where extra help
and special education is needed. One in four children is now affected by underlying
problems that stop them achieving their potential." Richardson, director of a new charity,
Food and Behaviour Research, is anxious to emphasise that a single nutrient cannot work
in isolation. "You can't carry a single nutritional supplement around as a talisman for
superhealth, because usually specific vitamins, minerals or enzymes are necessary to
ensure the key nutrient is absorbed.