NUTRITION ROLE IN BRAIN

AND MENTAL HEALTH

Learning Objectives
To understand and able to describe the
nutritional role on brain and mental
development
To describe the nutrient role on the brain
and mental function
To understand the way to prevent and
overcome neuropsychiaric problems from
nutritional point of view
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Basic Principles
I. Undernutrition is the primary cause of the
high rates of infant morbidity and mortality
in developing countries
II. The combination of inadequate food
intake and deprived family environment
has a devastating effect on the growth
and development of a child, especially on
his intellectual development
III. Recent evidence indicates a causal
relationship between undernutrition and
deficient mental function
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The Effects of Undernutrition to

Brain Growth
In most regions of the brain, the total number of
cells present in adults is largely determined by
the end of the first year of life
When undernutrition is imposed during the
proliferative phase of growth, the rate of cell
division is slowed, the ultimate number of cells
reduced. This change is permanent.
The brain cell number can be reduced by 15% to
20% when it occurs during the entire period of
lactation.
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The Effects of Undernutrition to

Brain Growth
Deficiencies in nutrients such as vit A, B6,
folic acid, zinc, and magnesium may also
affect development of the nervous system
If it persists beyond 8 months of age, the
size of cells will also be reduced. Total
cholesterol or phospholipid content is
reduced, hence, the number or length of
myelin sheaths is reduced. This leads to a
retarded dendritic branching
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Undernutrition and Mental

Development
In studies, the specific effects of
undernutrition on brain development in
humans are inseparable from effects of
the environment.
Adequate nutrition generally is part of a
good environment and undernutrition
occurs primarily in poor and limited
environments
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Undernutrition and Mental

Development
Early undernutrition in a deprived
environment interferes with subsequent
learning ability
Among the poor, a better nourished, taller
ones generally score higher in IQ tests.
The lowest IQs are usually associated
with the poorest prior nutritional status

Undernutrition and Mental

Development
Performance on psychological tests was
found to be related to dietary practice and
not to differences in personal hygiene,
housing, cash income, crop income,
proportion of income spent on food,
parental education, or other social or
economic indicators.

Undernutrition and Mental

Development
Performance of both preschool and school
children on the Terman and Goodenough
draw-a-man tests was positively correlated
with body weights and heights
The most important variable reflected by
the short stature was poor nutrition during
early life and that this also led to the lag in
development of sensory integrative
competence
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Undernutrition and Mental

Development
The exact time span when undernutrition
has the most serious effect on the brain is
not yet known
In a study done in Jamaica, all of the
chilren from a low-income group
undernourished at any time during the first
2 years of life had significant behavioral
abnormalities at school age
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Rehabilitation from Undernutrition

There are indications that the deleterious effects
on development of early undernutrition can be
reversed
When malnourished children before their 2 nd
birthday have better prognosis when they are
placed in a good nutrition and stimulating
environment
The well-nourished and stimulated children have
the highest learning capacity
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Rehabilitation from Undernutrition

Preliminary results show that the test
levels of the stimulated undernourished
children are higher than those of the
children from the higher socio-economic
group who were not stimulated
Results show that the well-nourished and
stimulated children have the highest
learning capacity
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The Relationship between

Brain Chemicals and Nutrients

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Introduction
Nearly 50 compounds have been
discovered to act as neurotransmitter (NT)
The ability NT synthesis depends upon the
availability of precursor compounds in diet
Synthesis and release of NT can be
altered to some extent by certain foods
Amino acids are the precursors of NT
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Amino Acids and Neurotransmitter

Tryptophan Serotonin
Lecithin & Choline Acetylcholine
Tyrosine the Catecholamines

15

Vitamins and Trace Minerals

Serious deficiencies of thiamin, vitamin B6, B12,
vitamin C, and folic acid can also provoke
psychiatric symptoms
Mild vitamin deficiencies might cause some
impairment of brain function
The known minerals which deficiency may result
on brain and nerve function damage are: Iodine,
Iron, Zinc, Copper, Calcium, Manganese,
Magnesium
While high lead and mercury levels result in
central nervous system abnormalities
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Hyperactivity in Children
The use of diet therapy to treat hyperactive
children has always been questionable
The Feingold Diet proposed that salicylates,
artificial food colors, and artificial flavors caused
hyperactivity
In autistic children, gluten and casein cannot be
digested completely leaving peptides that can
function as opoid or endomorphin, hence gluten
free and casein free diet is recommended for
autistic children.
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Hyperactivity in Children
Caffeine has been claimed to cause
hyperactivity The truth is caffeine
causes increased motor activity and
fidgetiness in pre-adolescent boys
Sugar consuming directly enhances
serotonin production, predicting that sugar
may have calming effect on children,
rather than being more hyperactive
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Malnutrition and Behavior

While most links between diet and behavior are
weak, there is no question that severe
malnutrition can have a significant impact on
behavior, particularly in children
Malnourished children tend to have difficulties in
learning to speak, in adaptive and motivational
behavior, interpersonal relationships, and
development of motor skills

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Breakfast and School Performance

Far more subtle are the learning difficulties that
may or may not relate to fasting in schoolchildren
In general, it was found that children who ate
breakfast performed better throught the morning
on different measures of cognitive performance
than those who skipped it
The optimal breakfast was one that was
balanced in protein, carbohydrates, and fats
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Medical Nutrition Therapy

for Psychiatric Conditions

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Nutritional Aspects of Brain and Nervous

System Structure and Function
One of the most important contributions of
nutrition to mental health is the
maintenance of the structure and function
of the neurons and brain centers
coordinating communication within the
body and between the body and the
environment

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Nutritional Aspects of Brain and Nervous

System Structure and Function
Sixty percent of the brains dry weight is fat, and
under optimal conditions 25% of this fat is
docosahexaenoic acid (DHA), an omega-3 (n-3)
fatty acid
n-3 fatty acids appear to be the type of fat
preferred by the brain and nervous system
Each of the three n-3 has been found to have
unique, important, and noninterchangeable
contributions to overall brain and nervous
system functioning
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Eicosapentaenoic Acid (EPA) &

Docosahexaenoic Acid (DHA)
EPA (20:5 n-3) is primarily found in fish
Under conditions of tissue DHA saturation,
DHA can retroconvert into EPA
DHA (22:6 n-3) is also primarily found in
fish, which obtain it by eating marine algae
DHA is stored in the fishs muscle tissue
and can also be obtained from marine
algae as supplements
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Omega-3 Fatty Acids

and Brain Function
DHA is the brains building block, providing
structure to neurons and is an anchor
point for neurotransmitter receptor
DHA also has an antioxidant effect
Adequate DHA is important for maintaining
healthy neurotransmitter function,
including for dopamine and serotonin
DHA has the ability to raise the seizure
threshold of the nervous system
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Obtaining Adequate DHA and EPA

Obtaining and retaining DHA and EPA depend
on adequate intake, as well as important lifestyle
and macro nutritional choices
It is often what is eaten in addition to DHA and
EPA that determines whether overall essential
fatty acid levels are adequate
The daily needs of omega-3 fatty acids
recommended by ISSFAL is 220 mg each of
both DHA and EPA.
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Source of DHA and EPA

Currently DHA and EPA are appearing in
foods in four different forms: Menhaden,
Microencapsulated Fish Oil Powder, DHA
and EPA Produced by Other Livestock and
Marine Algae
It is important to note that eggs and
marine algae-based products contain DHA
only
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During Infancy
One of the most important sources of DHA
and EPA is mothers milk
Reduced time spend between mother and
babies has reduced the availability of
omega-3 fatty acids to babies.
Important Note : Some baby formulas
contain only DHA as their source is marine
algae
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During Adulthood
Long-chain fatty acid (LCFA) supplements will
often improve depression and its related
pathology
They should be used with vitamin E
supplementation to make sure that they are not
oxidized and are thus effective
Patients with bipolar disorder, postpartum
depression, schizophrenia, dementia,
alcoholism, tardive dyskinesia and other
psychiatric conditions may also improve with
LCFA supplementation
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Nutrition Recommendations
Goal 1 : Consumption of Dietary DHA and
EPA
Goal 2 : Maintenance of a Diet With a Low
Total Daily Omega-6 to Omega-3 Ratio
Goal 3 : Avoidance of Restrictive Diets that
Encourage Rapid Weight Loss
Goal 4 : Increased Antioxidant Intake
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Nutrition in Eating Disorders

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Eating Disorders
Includes :
Anorexia Nervosa (AN)
Bulimia Nervosa (BN)
Eating Disorders Not Otherwise Specified
(EDNOS)
Binge Eating Disorder (BED)

Treatment requires a multidisciplinary

approach including psychiatric/
psychological, medical, and nutritional
intervention
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Nutrition Rehabilitation and

Counseling
Nutrition rehabilitation includes nutrition
assessment, medical nutrition therapy
(MNT), nutrition counseling, and nutrition
education
Nutrition assessment routinely includes a
diet history and the assessment of
biochemical, metabolic, and
anthropometric indices of nutrition status
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Diet History
Guidelines include assessment of energy
intake, macro & micronutrient
consumption, eating attitudes & behaviors
BN : Energy intake may be unpredictable
Energy elimination by vomiting is below
energy consumption
Many AN patients follow vegetarian diets

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Diet History
Inadequate calorie + limited variety + poor
food group representation = inadequate
vitamin and mineral consumption
Micronutrient intake parallels
macronutrient intake (fat fatty acid & fat
soluble vitamins)
Extreme fluid restriction or consumption
may require monitoring of urine specific
gravity and serum electrolytes
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Eating Behavior
Patients tend to regard foods as
absolutely good or absolutely bad
Determine unusual or ritualistic behaviors
Determine meal spacing and length of
time allocated for a meal

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Anorexia Nervosa
Goals of Nutritional Rehabilitation

Correction of biologic and psychological

sequelae of malnutrition
Restoration of body weights
Normalization of eating patterns, eating
behaviors, and hunger/satiety cues

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Bulimia Nervosa
Goals of Nutritional Rehabilitation

Interruption of the binge-and-purge cycle

Restoration of normal eating behavior
Stabilization of body weight
Cognitive Behavioural Therapy

The nutritionists role is to help develop a

reasonable plan of controlled eating while
assessing the patients tolerance for
structure
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Bulimia Nervosa
Estimating Initial Caloric Prescriptions

1. For a typical week, ask patient to

estimate the number of binge/purge days
(B/P), binge/nonpurge days (B/nP),
moderate-intake days (MI), and
restrained-intake days (RI)
2. Have the patient describe a typical food
on a B/P, B/nP, MI, and RI days
3. Estimate 50% of the caloric intake on the
B/P, and 100% on the B/nP, MI, and RI
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Bulimia Nervosa
Estimating Initial Caloric Prescriptions

4. Calculate the total caloric intake over the

7-day period
5. Calculate an average daily intake. The
RD can than formulate an initial eating
and meal plan based on this estimated
average daily intake

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Guidelines for Medical Nutrition Therapy for AN

and BN
Fat : 25%-30% ; provide source of essential fatty
acids
Protein : 15%-20%, minimum : RDA in g/kg
ideal body weight ; high biologic vale sources
Carbohydrate : 50%-55% ; encourage insoluble
fiber for treatment of constipation
Multivitamin-mineral preparation to ensure
adequacy, particularly in the initial phase,
especially calcium, iron and vitamin D
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Nutrition Education
Though patients tend to have knowledge
about food and nutrition, nutrition
education is still an essential component
of the treatment plan
The patients may receive from unreliable
sources or have distorted interpretation
Choose the information carefully, some
source indicate a low-fat low-calorie intake
(for preventing chronic disease)
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Prognosis
Relapse rates after weight restoration in AN is high,
Adolescents have better outcomes than adult, and
younger adolescents is better than older
adolescents
Mortality rates in AN : among the highest in
psychiatric illness half is caused by emaciation,
half to suicide (Palmer, 1990)
AN women are 12 times more likely to die than
women of similar ages in the general population
BN patients have a short-term success rate of 50%70%, and a relapse rates of 30%-85%
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