Dr. Kate, Micronutrient Interventions for Mental Health

Transcript

1. Micronutrient Treatment of Mental Health Disorders Improving Outcomes in Depression and Anxiety using a Food-as-Medicine Approach
2. What We'll Cover Micronutrient treatment of mental health disorders is powerful root-cause medicine that can lead to miraculous recoveries when done appropriately. During this talk, Dr. Kate will cover recent and important landmark studies that have changed the way we conceptualize the biochemical underpinnings of mental health disorders. Then, they will review the most important micronutrients for treating mental health conditions as well as how to help clients get them through food and other sources.
3. How we'll cover it 01 New Paradigm How to treat in this new paradigm Case Studies Clinical applications The brain is the organ of behavior. Oxidative stress, inflammation, infection, and malnutrition all drive dysfunction. Which micronutrients can we use to make an impact in common mental health disorders? Which nutrients are required to make neurotransmitters? Using the conditions you'll see most often in your practice (depression and anxiety today). How to teach clients to optimize their dietary intake of these nutrients. 02 03 04
4. Why are we covering this today
6. How common are mental illnesses? Mental illnesses are among the most common health conditions in the United States. More than 50% will be diagnosed with a mental illness or disorder at some point in their lifetime.3 1 in 5 Americans will experience a mental illness in a given year.4 1 in 5 children, either currently or at some point during their life, have had a seriously debilitating mental illness.5 1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.6 https://www.cdc.gov/mentalhealth/learn/index.htm#:-:text-Mental%20illnesses%20are%20among%20the some%20point%20in%20their%20lifetime &text=1%20in%205%20Americans%20will, illness%20in%20a%20given%20 1 in 5
7. The United States The World 66,645,878 people in our country this year
8. How we'll cover it The brain is the organ of behavior. Oxidative stress, inflammation, infection, and malnutrition all drive dysfunction. Which micronutrients can we use to make an impact in common mental health disorders? Using the conditions you'll see most often in your practice (depression and anxiety today). How to teach clients to optimize their dietary intake of these nutrients. 01 02 03 04 New Paradigm How to treat in this new paradigm A focused trail guide Clinical applications
9. New Paradigm The brain is the organ of behavior. Oxidative stress, inflammation, infection, and malnutrition all drive dysfunction. https://pubmed.ncbi.nlm.nih.gov/25462 890/ published in 2015
10. New Paradigm The brain is the organ of behavior. Oxidative stress, inflammation, infection, and malnutrition (HDL, Zinc, Vitamin C) all drive dysfunction. PMID: 26445247
11. New Paradigm The brain is the organ of behavior. Oxidative stress, inflammation, infection, and malnutrition all drive dysfunction.
12. New Paradigm The brain is the organ of behavior. Oxidative stress, inflammation, infection, and malnutrition all drive dysfunction. PMID: 25365455
13. TAC The comparisons of effect sizes for serum TAC (A), serum non-enzymatic antioxidants (B), red blood cell enzymatic antioxidants (C), serum enzymatic antioxidants (D), serum free radicals (E) and serum oxidative damage products (F) in acute episodes between depressed patients and controls (red bar) and in comparison before and after treatment of depressed patients (yellow bar).
14. What is TAC?
15. There are two types of TAC Serum Dietary 01 02
16. Nutrients can protect against oxidative damage to mitochondria and lipids in the neuronal circuits associated with cognitive and affective behaviors. These nutrients include • Omega 3 fatty acids • Antioxidants (vitamin C and zinc) • Members of the vitamin B family (Vitamin B12 and folic acid) and • Magnesium." PMID: 25365455 Dietary TAC
17. How would you test for these biomarkers?
18. Lipids Total immunoglobulins, allergies, sensitivities Iron panel with ferritin RBC Zinc and Copper hsCRP, ESR 01 02 03 04 05 06 07 08 HbA1c - blood sugar TSH, T3, T4 - thyroid Vitamin D CBC CMP 09 10 11 12 13 14 15 16 Homocysteine (B12, folate) Infections (viral, bacterial, etc.) ANA RBC Magnesium Heavy metals ASCA, ANCA, Calprotectin if gut issues High-Yield Tests for Mental Health Clients *can reduce the need for some of these with a nutrient analysis or good history
19. Are Americans really DEFICIENT in micronutrients?
20. Risk of Deficiency in Multiple Concurrent Micronutrients in Children and Adults in the United States
21. Americans are not at risk for over-nutrification. In fact, even with fortification and supplements, there are nutrient shortfalls. Source on EARS: Institute of Medicine Dietary Reference intakes/ Age range 19 years unless otherwise stated Data derived from: Foods, fortificants and supplement: Where do Americans get their nutrients? journal of Nutrition 2011. 141:1847-1864.
22. Research shows that Americans who take full spectrum multivitamins are 60% less likely to have nutrient deficiencies than those who don't.
23. Depression and low mood Pathophysiology, Micronutrients Involved, Case Studies, Treatment Interventions
24. Which 2 dietary nutrients are used to make dopamine? Bonus, what is the third nutrient needed to convert dopamine to adrenaline?
25. Phenylalanine tyrosine hydroxylase aromatic amino acid decarboxylase dopamine B-hydroxylase monoamine oxidase phenylethanolamine N-methyltransferase monoamine oxidase aldehyde dehydrogenase phenylalanine hydroxylase aromatic aming acid decarboxylase Vitamin B6 Vitamin B6 Cortisol SAMe Vitamin C L-DOPA Tyrosine Rate Limiting Step L-DOPA Norepinephrine Epinephrine DHPG DOPEGAL Dopamine DOPAL DOPAC alcohol dehydrogenase
26. What is the most common micronutrient deficiency in the U.S.?
27. Top Nutrient Deficiencies in the U.S. https://www.cdc.gov/nutritionreport/pdf/4page_%202nd%20nutrition%20report_508_032912.pdf
28. Signs of b6 deficiency
30. Nutrients that Matter for optimizing Gaba ME Pyruvate Phosphoenol Pyruvate PK PEPCK PC PDH Acetyl-CoA glutamate synthase Aspartate Oxaloacetate Citrate Glutamine glutamine synthetase Glutamate glutamate decarboxylase Vitamin B6 GABA ME * Malate a-KG Glutamine Glutamate GABA glutamate synthase Succinate Semialdehyde Succinate Branched chain amino acids (Leucine, Isoleucine, Valine), Propionate, Triheptamoin and others Methylmelonyl-CoA Propionyl-CoA Carboxylaso Propionyl-CoA Succinyl-CoA Fumarate dehydroenase Citric Acid Cycle Vitamin B6 4-aminabutyrate Succinate semialdehyde
32. How to get more Vitamin D Meals like Salmon, mushrooms and asparagus Trout and broccoli Fortified Soy and broccoli Notice that milk is fortified with vitamin D and some cereals are as well. You can also supplement Just do so with a doctor / nutrition professional's guidance and routine lab work
33. Signs of an iron deficiency
34. SEROTONIN FORMATION Tryptophan TRPH 1 (gut) TRPH 2 (brain) BH4 Fe 5-HTP 5-hydroxytryptophan Serotonin Production 5-HTP AADC TRPH BH4 aromatic L-amino acid decarboxylase tryptophan hydroxylase tetrahydrobiopterine Fe iron AADC Vit B6 Serotonin
35. Top Sources of Folate Beef liver and onions, again! If you can learn to like it, do it Spinach and black eyed peas can put these in a chili overtop of rice Meals Asparagus, brussels sprouts paired with meat or beans. Take a multivitamin each day with a methylated form of folate as good nutritional insurance.
36. Top Sources of B12 Cobalamin Beef liver again! .... sensing a pattern, here? Seafood night a few times a month. clams, tuna, salmon Nutritional Yeast Add to recipes, salads, vegan main courses. Milk and Yogurt Can be an okay source of B12 as long as you are not allergic. If you're taking a supplement, I recommend either methylated B12 in a multivitamin or a sublingual form.
37. Effects of n-3 Polyunsaturated Fatty Acid Supplementation in the Prevention and Treatment of Depressive Disorders-A Systematic Review and Meta-Analysis
38. It's not either or
39. Anxiety & Panic attacks
40. Population burden and features of anxiety. PMID: 32447382 Several anxiety disorders are characterized by persistent, excessive, and unrealistic worry about everyday occurrences, and are based on criteria defined in the Diagnostic and Statistical Manual of Mental Disorders. 10 The spectrum of anxiety disorders is not 1 particular disorder; it clusters around excessive, irrational fear and dread. Approximately 31.1% of the US population has experienced an anxiety disorder in their lifetime; prevalence is 2-fold higher in women compared with men. 90 The prevalence of anxiety disorder is highest from childhood through middle age.10
41. Panic Attacks 2.4 million Americans per year Symptoms of a Panic Attack The National Institutes of Mental Health define panic attacks as "episodes of intense fear accompanied by physical symptoms that may include: Chest pain Heart palpitations Shortness of breath Dizziness Abdominal distress These episodes occur 'out of the blue,' not [always] in conjunction with a known fear or stressor." Additional physical symptoms that people with panic attacks repart feeling during an attack include sweating, trembling, shaking, nausea, numbness, and tingling. The DSM-V includes the psychological symptoms of "depersonalization (feeling detached fram oneself)/derealization, fear of losing control/gaing crazy, or fear of dying" in its definition of panic attacks. When someone has repeated and recurrent episades of panic, this is termed "panic disorder." Panic disorder will affect up to 4.7% of adults at some point in their lives, and 44.8% of people with panic disorder report that it severely impairs their ability to function. Panic disorder can cause people to miss work and school, avoid travel, impact relationships, and much mare.
42. Common Nutrient Deficiencies Linked with Panic Attacks Vitamin C Vitamin E Vitamin B6 Selenium Iron Magnesium Omega 3 fatty acids
43. Panic Attacks, Anxiety and Vitamin C 500 mg BID
44. Table 2: Vitamin C Content of Selected Foods [12] Top Sources of Vitamin C Citrus Orange juice and oranges -- add to smoothies Red peppers stir-fry in with high iron meats like beef. Snacks Citrus fruits, kiwi, broccoli and red peppers with hummus. A note Many nutrition experts think our needs for vitamin C are much higher than 100mg per day and are closer to 1 gram per day. The science is still evolving on this, but esssentially, the more the better. Milligrams (mg) per serving Percent (%) DV* Red pepper, sweet, raw, ½ cup Orange, 1 medium Grapefruit juice, ¼ cup Orange juice, ¼ cup Kiwifruit, 1 medium Green pepper, sweet, raw, 1½ cup Broccoli, cooked, ½ cup Strawberries, fresh, sliced, ½ cup Brussels sprouts, cooked, ½ cup Grapefruit, ½ medium Broccoli, raw, ½ cup Tomato juice, ¼ cup Cantaloupe, ½ cup Cabbage, cooked, ½ cup Cauliflower, raw, ½ cup Potato, baked, 1 medium Tomato, raw, 1 medium Spinach, cooked, ½ cup½ cup Green peas, frozen, cooked, ½ cup 95 93 70 70 64 60 51 49 48 39 39 33 29 28 26 17 17 09 08 106 78 78 71 103 67 53 43 57 54 43 37 31 29 19 32 10 09 19
45. Panic Attack Iron + B6
47. Top Sources of B6 Pyridoxine Hummus, hummus, hummus! Eat it as a snack with veggies :) Beef liver and onions if you can eat it, do it! Salmon, Tuna and Chicken with potatoes as a side. Turkey meatballs and marinara sauce with chickpea pasta OR Turkey and bean chili Combines multiples sources of B6.
49. 8 7 6 5 Placebo (N=11) n-3 PUFAs (N=11) Anxiety and Omega 3's 3 GRAMS Dose matters 4 3 2 1 0 BL Figure 2 Anxiety scores of substance abusers during a 3-month administration of n-3 PUFAs or placebo, Values are means±SEM. A comparison of the scores of the two patient groups by a repeated measures ANCOVA, with baseline values as covariates, revealed a significant difference (p=.023). The effect size was large (f-.567). Anxiety scores 3 MO 2 MO 1 MO
50. 8 7 6 5 Placebo (N=11) n-3 PUFAs (N=11) Anxiety and Omega 3's 3 GRAMS Dose matters 4 3 2 1 0 Figure 2 Anger scores of substance abusers during a 3-month administration of n-3 PUFAs or placebo. Values are means SEM. A comparison of the scores of the two patient groups in a repeated measures ANCOVA, with hassline valnes an covariates, revealed a significant difference (040). The effect size was lange (f=506) Anxiety scores BL 3 MO 2 MO 1 MO
51. How to get more Omega 3's Flax and Chia add them to everything. Oatmeal, smoothies, chia, etc Salmon Eat it often! Walnuts Have them as a snack with a piece of fruit Meals If you can do herring or mackerel or sardines in addition to salmon, do it! Otherwise, think about supplementing. You can keep the pills in the freezer and take right before a meal to avoid weird smells / fish burps.
52. Food Sources of Gaba
53. How to get more Gaba Fermented Vegetables and Soy Tempeh Sauerkraut Kimchi Natto Miso Kombucha Chili and Beans and Tomato Sauce Have some rice on the side
54. Clin Psychopharmacol Neurosci. 2019 Mar, 17(2): 145-154. Published online 2019 Apr 30. doi: 10.9758/cpn.2019.17.2.145 PMCID: PMC6478076 PMID: 30905115 Pharmacological Therapy in Panic Disorder: Current Guidelines and Novel Drugs Discovery for Treatment-resistant Patient Inositol Inositol or myo-inositol is a simple isomer of glucose and an important precursor in the phosphatidylinositol (PI-cycle) second messenger system in the brain.59) In a double-blind randomized study, inositol showed a higher efficiency than placebo with no substantial side effects reported.60) In a further randomized crossover trial comparing inositol with fluvoxamine, symptomatic improvements were similar for both treatments although frequent side effects of nausea and tiredness were reported in patients receiving fluvoxamine.61) The second-messenger strategy as opposed to the transmitter-receptor strategy is a novel therapeutic mechanism for PD and deserves further investigation. Inositol systemic Inositol (12 g) Double-blind randomized, placebo- controlled crossover Inositol> placebo Benjamin et al., 199560) Inositol systemic Inositol (18 g) Fluvoxamine (150) Double-blind randomized controlled, crossover Inositol= fluvoxamine Palatnik et al., 200161)
55. 18 grams per day, no side effects, double the effectiveness of SSRI doi: 10.1097/00004714-200106000-00014 Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder A Palatnik 1, K Frolov, M Fux, J Benjamin. Affiliations + expand PMID: 113-86498 DOI: 10.1097/00004714-200106000-00014 Abstract Only 70% of patients respond to current treatments for panic disorder, and many discontinue drugs because of side effects, myo-Inositol, a natural isomer of glucose and a precursor for the second- messenger phosphatidyl-inositol system, has previously been found superior to placebo in the treatment of depression, panic disorder, and obsessive-compulsive disorder (OCD), but a direct comparison with an established drug has never been performed. A double-blind, controlled, random-order crossover study was undertaken to compare the effect of inositol with that of fluvoxamine in panic disorder. Twenty patients completed 1 month of inositol up to 18 g/day and 1 month of fluvoxamine up to 150 mg/day. Improvements on Hamilton Rating Scale for Anxiety scores, agoraphobia scores, and Clinical Global Impressions Scale scores were similar for both treatments. In the first month, inositol reduced the number of panic attacks per week (mean and SD) by 4.0 (2) compared with a reduction of 2.4 (2) with fluvoxamine (p = 0.049). Nausea and tiredness were more common with fluvoxamine (p=0.02 and p = 0.01, respectively). Because inositol is a natural compound with few known side effects, it is attractive to patients who are ambivalent about taking psychiatric medication. Continuing reports of inositol’s efficacy in the treatment of depression, panic disorder, and OCD should stimulate replication studies. Clinical Trial J Clin Psychopharmacol. 2001 Jun;21(3):335-9.
57. Top Sources of Magnesium Pumpkin seeds as snacks Keep unsalted pumpkin and chia seeds on your counter, sprinkle them in salads and grab them as a snack. Meals like Oatmeal with soy milk and pumpkin seeds and chia seeds Smoothies made with spinach, chia and pumpkin Snacks like Almonds Cashews Peanuts
58. Key takeaways Neuroinflammation and oxidation play a major role in the pathophysiology of mental health conditions The old paradigm of DSMV and talk-therapy + medication only approaches to mental health has been upgraded given the evidence. Nutrition plays a major role in addressing these issues. Today we discussed how we use nutrition in our practice to get improved outcomes for people with mental health conditions. Assessing those nutrients needs to be done right.
59. Lipids Total immunoglobulins, allergies, sensitivities Iron panel with ferritin RBC Zinc and Copper hsCRP, ESR 01 02 03 04 05 06 07 08 HbA1c - blood sugar TSH, T3, T4 - thyroid Vitamin D CBC CMP 09 10 11 12 13 14 15 16 Homocysteine (B12, folate) Infections (viral, bacterial, etc.) ANA RBC Magnesium Heavy metals ASCA, ANCA, Calprotectin if gut issues High-Yield Tests for Mental Health Clients *can reduce the need for some of these with a nutrient analysis or good history