Food for Body and MindFood for Body and Mind

Carolyn Denton, MA, LNCarolyn Denton, MA, LN

Perspectives in NutritionPerspectives in Nutrition“Nutrients are the nourishing substances in food that

are essential for the growth, development and

maintenance of body functions. Essential meaning

that if a nutrient is not present, aspects of function

and therefore human health decline. When nutrient When nutrient

intake does not regularly meet the nutrient needs intake does not regularly meet the nutrient needs

dictated by the cell activity, the metabolic dictated by the cell activity, the metabolic

processes slow down or even stop” processes slow down or even stop”

Wardlaw and Insel

NutrientsNutrients

• Nourishing substances substances

• Each nutrient has a specific job or function in Each nutrient has a specific job or function in the body.the body.

• Nutrients act as cofactors, coenzymes, triggers Nutrients act as cofactors, coenzymes, triggers of other processes.of other processes.

• Without nutrients metabolic processes slow Without nutrients metabolic processes slow down or even stop.down or even stop.

Nutrient SupportNutrient Support

• Immune System FunctionImmune System Function: : vitamin A, vitamin E, zinc, vitamin A, vitamin E, zinc,

folic acid, vitamin B-6, riboflavin, magnesium, selenium, folic acid, vitamin B-6, riboflavin, magnesium, selenium,

vitamin Cvitamin C

• Nerve Impulses:Nerve Impulses: sodium, potassium, magnesium, sodium, potassium, magnesium,

calcium, vitamin B6, folic acid, B-12, copper, vitamin Ccalcium, vitamin B6, folic acid, B-12, copper, vitamin C

• Tissue Repair and Formation:Tissue Repair and Formation: vitamin A, vitamin E, vitamin A, vitamin E,

copper, riboflavin, magnesium, vitamin B6, vitamin Ccopper, riboflavin, magnesium, vitamin B6, vitamin C

• MetabolismMetabolism: : potassium, thiamin, niacin, vitamin B6, potassium, thiamin, niacin, vitamin B6,

magnesium, riboflavin, folic acid and vitamin Cmagnesium, riboflavin, folic acid and vitamin C

MagnesiumMagnesium

FunctionFunction

Needed for healthy bonesNeeded for healthy bones Initiates muscle releaseInitiates muscle release Promotes healthy blood Promotes healthy blood

vesselsvessels May lower blood pressureMay lower blood pressure Involved in temperature Involved in temperature

regulationregulation Needed for serotonin Needed for serotonin

productionproduction

Involved in nerve Involved in nerve transmissiontransmission

Activates energy synthesisActivates energy synthesis Inhibits platelet Inhibits platelet

aggregationaggregation Increases HDL cholesterolIncreases HDL cholesterol Helps control blood sugarHelps control blood sugar Enhances immune functionEnhances immune function

Food is InformationFood is Information

Shift in FocusShift in Focus

• Food contains messages or directions to Food contains messages or directions to the systems of the body about function.the systems of the body about function.

• Function as single systems as well as Function as single systems as well as interconnected/interdependent systems.interconnected/interdependent systems.

• Focus should be on foods to include Focus should be on foods to include rather than foods to exclude.rather than foods to exclude.

Functional NutritionFunctional Nutrition

• If a nutrient is not present over a period If a nutrient is not present over a period of time, aspects of dysfunction then of time, aspects of dysfunction then give rise to symptoms, decline and the give rise to symptoms, decline and the development of disease.development of disease.

• Dysfunction is a pre-disease state for Dysfunction is a pre-disease state for which intervention with nutrients or which intervention with nutrients or “information” is needed to restore “information” is needed to restore function and thereby reduce risk of function and thereby reduce risk of chronic disease.chronic disease.

Functional NutritionFunctional Nutrition

• Looks for core underlying imbalances.Looks for core underlying imbalances.• Faulty digestion, impaired Faulty digestion, impaired

detoxification, oxidative stress, detoxification, oxidative stress, hormonal imbalances, altered immunity hormonal imbalances, altered immunity and inflammation.and inflammation.

• Dysfunction and disease arise from diet, Dysfunction and disease arise from diet, nutrient balance, environment, trauma, nutrient balance, environment, trauma, stress, attitude, beliefs, mind and spirit.stress, attitude, beliefs, mind and spirit.

DopamineDopamine Functionally creates a state of heightened arousal Functionally creates a state of heightened arousal

and alertness. Dopamine is excitatory.and alertness. Dopamine is excitatory.Rapid movementRapid movementLearningLearningMental focusMental focusCognitionCognitionEmotional significance Emotional significance Relevance of an eventRelevance of an event““Reward” neurotransmitterReward” neurotransmitter

Dopamine ImbalanceDopamine Imbalance

ADD and ADHDADD and ADHDParkinson’sParkinson’sRestlessness, restless leg syndromeRestlessness, restless leg syndromeDifficulty concentratingDifficulty concentratingImpulsivityImpulsivityAnxietyAnxietyAddictive behaviors (cigarettes, alcohol, drugs)Addictive behaviors (cigarettes, alcohol, drugs)Impatience and explosiveness Impatience and explosiveness Unable to relaxUnable to relax

Nutritional InfluenceNutritional Influence

Normal insulin signaling in the brain stimulates Normal insulin signaling in the brain stimulates the release of dopamine.the release of dopamine.

Insulin resistance leads to the impairment of Insulin resistance leads to the impairment of dopamine release.dopamine release.

Zinc increase brain dopamine, thought that there Zinc increase brain dopamine, thought that there is a zinc deficiency in ADHD.is a zinc deficiency in ADHD.

Tyrosine is a precursor to dopamine.Tyrosine is a precursor to dopamine.Theanine and alpha lipoic acid also increase Theanine and alpha lipoic acid also increase

dopamine.dopamine.Vitamin B6, folic acid and B12 are necessary for Vitamin B6, folic acid and B12 are necessary for

synthesis of dopamine.synthesis of dopamine.

Recipe for DopamineRecipe for Dopamine TyrosineTyrosine found in black beans, pumpkin seeds, sesame found in black beans, pumpkin seeds, sesame

seeds, avocadoseeds, avocado

ZincZinc found in oysters, wheat germ, cashews, cocoa powder found in oysters, wheat germ, cashews, cocoa powder

   Vitamin B6 Vitamin B6 found in bananas, spinach and white potatoes found in bananas, spinach and white potatoes

   Folic acid Folic acid found in orange juice, lentils, chickpeas and found in orange juice, lentils, chickpeas and

asparagusasparagus

   TheanineTheanine found in green tea, black tea, plants found in green tea, black tea, plants

  

 

Serotonin Serotonin

Functionally, serotonin creates a sense of Functionally, serotonin creates a sense of wellbeing. Serotonin is inhibitory.wellbeing. Serotonin is inhibitory.

Regulates comfort ‘rest and digest”Regulates comfort ‘rest and digest”Regulates sleepRegulates sleepInfluences moodInfluences moodPromotes concentration and focusPromotes concentration and focusAllows for social engagementAllows for social engagement‘‘Let’s you feel good inside yourself”Let’s you feel good inside yourself”

Serotonin ImbalanceSerotonin Imbalance

Reduced appetiteReduced appetitePain sensitivityPain sensitivityNegative thoughts, low self esteemNegative thoughts, low self esteemSleep disordersSleep disordersHyper-vigilance Hyper-vigilance Depression, anxietyDepression, anxietyPTSD (post-traumatic stress syndrome)PTSD (post-traumatic stress syndrome)SAD (seasonal affective disorder)SAD (seasonal affective disorder)OCD (obsessive compulsive disorder)OCD (obsessive compulsive disorder)

Nutritional InfluenceNutritional Influence

Ample dietary protein, specifically tryptophan.Ample dietary protein, specifically tryptophan.Vitamin C, vitamin B6, and folic acid are cofactors Vitamin C, vitamin B6, and folic acid are cofactors

in the conversion of tryptophan to serotonin.in the conversion of tryptophan to serotonin.Magnesium is a cofactor for serotonin synthesis.Magnesium is a cofactor for serotonin synthesis.Vitamin B12 cofactor in neurotransmitter Vitamin B12 cofactor in neurotransmitter

methyalation.methyalation.Vitamin D influences the metabolism of serotonin.Vitamin D influences the metabolism of serotonin.Food that contains slowly absorbed carbohydrates Food that contains slowly absorbed carbohydrates

from whole grain provides from whole grain provides long-lasting serotonin.

Recipe for SerotoninRecipe for Serotonin TryptophanTryptophan found in protein such as turkey, soybeans or found in protein such as turkey, soybeans or

milkmilk

Vitamin C Vitamin C found in citrus fruits, tomatoes, kiwi, broccoli and found in citrus fruits, tomatoes, kiwi, broccoli and parsleyparsley

Vitamin B6 Vitamin B6 found in bananas, spinach and white potatoes found in bananas, spinach and white potatoes

Folic acid Folic acid found in orange juice, lentils, chickpeas and found in orange juice, lentils, chickpeas and asparagusasparagus

MagnesiumMagnesium found in brown rice, hazelnuts and Swiss chard found in brown rice, hazelnuts and Swiss chard

CarbohydrateCarbohydrate found in whole grain such as wheat, oats and found in whole grain such as wheat, oats and quinoaquinoa

 

GlutamateGlutamate

Functionally, glutamate is the neurotransmitter of Functionally, glutamate is the neurotransmitter of excitability.excitability.

The most abundant free amino acid in the central The most abundant free amino acid in the central nervous system.nervous system.

Balances with GABA, interaction of excitation and Balances with GABA, interaction of excitation and inhibition.inhibition.

Controls pain perception Controls pain perception Plays a role in cellular memoryPlays a role in cellular memoryInfluences learning processesInfluences learning processesExcess glutamate causes cell death and Excess glutamate causes cell death and

neurodegeneration.neurodegeneration.

Glutamate ImbalanceGlutamate Imbalance

SeizuresSeizuresMigraine headachesMigraine headachesParkinson’sParkinson’sALS (amyotrophic lateral sclerosis)ALS (amyotrophic lateral sclerosis)PTSD (post traumatic stress disorder)PTSD (post traumatic stress disorder)Bipolar disorder SchizophreniaBipolar disorder SchizophreniaAlzheimer'sAlzheimer'sMultiple SclerosisMultiple SclerosisAutism Autism

Nutritional InfluencesNutritional Influences

Mercury and other heavy metals increase Mercury and other heavy metals increase glutamate.glutamate.

Homocysteine, aracadonic acid and inflammatory Homocysteine, aracadonic acid and inflammatory cytokines all increase glutamate.cytokines all increase glutamate.

Excessive sympathetic nervous system activation Excessive sympathetic nervous system activation (cortisol) increases glutamate.(cortisol) increases glutamate.

Vitamin D blocks glutamate.Vitamin D blocks glutamate.Taurine and Vitamin B6 convert glutamate to Taurine and Vitamin B6 convert glutamate to

GABA.GABA.

GABAGABA

Functionally, GABA (gamma aminobutyric acid) Functionally, GABA (gamma aminobutyric acid) calms the brain. It is the primary inhibitory calms the brain. It is the primary inhibitory neurotransmitter.neurotransmitter.

GABA plays a critical role in cell to cell GABA plays a critical role in cell to cell communication.communication.

GABA plays a role in sedation and anticonvulsant GABA plays a role in sedation and anticonvulsant activity.activity.

GABA ImbalanceGABA Imbalance

AnxietyAnxietyDepressionDepressionExcessive worryingExcessive worryingInsomnia and other sleep disturbancesInsomnia and other sleep disturbancesPanic attacks and restlessnessPanic attacks and restlessnessSeizuresSeizuresBipolar disorderBipolar disorderPTSD (post traumatic stress disorder)PTSD (post traumatic stress disorder)

Nutritional InfluencesNutritional Influences

Taurine and vitamin B6 boost the production of Taurine and vitamin B6 boost the production of GABA.GABA.

N-acetylcysteine (NAC) influences GABA.N-acetylcysteine (NAC) influences GABA.

Calming herbs such as passionflower and valerian Calming herbs such as passionflower and valerian promote GABA production.promote GABA production.

L-theonine found in green tea and oolong tea L-theonine found in green tea and oolong tea increases GABA. increases GABA.

InflammationInflammationDuring the past decade inflammation has been During the past decade inflammation has been

revisited as an important etiological factor of revisited as an important etiological factor of mood disorders.mood disorders.

Review looked at the evidence for an association Review looked at the evidence for an association between inflammation and mood disorders.between inflammation and mood disorders.

Discussed the induction of a proinflammatory Discussed the induction of a proinflammatory state in healthy or medically ill subject induces state in healthy or medically ill subject induces “sickness behavior” resembling depressive “sickness behavior” resembling depressive symptomology.symptomology.

InflammationInflammationPotential mechanisms include effects of pro-Potential mechanisms include effects of pro-

inflammatory cytokines on monoamine levels, inflammatory cytokines on monoamine levels, dysregulation of the HPA axis, impaired dysregulation of the HPA axis, impaired neuroplasticity, and structural and functional brain neuroplasticity, and structural and functional brain changes.changes.

Agents include anti-inflammatory agents such as Agents include anti-inflammatory agents such as acetylsalicylic acid (ASA), celecoxib, anti-TNF-a acetylsalicylic acid (ASA), celecoxib, anti-TNF-a agents, minocycline, curcumin and omega-3 fatty agents, minocycline, curcumin and omega-3 fatty acids.acids.

Progress in Neuro-Psychopharmacology & Biological Psychiatry, 2014Progress in Neuro-Psychopharmacology & Biological Psychiatry, 2014

InflammationInflammationChronic exposure to elevated inflammatory Chronic exposure to elevated inflammatory

cytokines and persistent alterations in cytokines and persistent alterations in neurotransmitter systems can lead to neuro- neurotransmitter systems can lead to neuro- psychiatric disorders and depression. psychiatric disorders and depression.

Mechanisms of cytokine behavioral effects involve Mechanisms of cytokine behavioral effects involve activation of inflammatory signaling pathways in activation of inflammatory signaling pathways in the brain that results in changes in monoamine, the brain that results in changes in monoamine, glutamate, and neuropeptide systems, and glutamate, and neuropeptide systems, and decreases in growth factors, such as brain-derived decreases in growth factors, such as brain-derived neurotrophic factor. neurotrophic factor.

InflammationInflammationMedically healthy depressed patients who are Medically healthy depressed patients who are

resistant to antidepressant therapy demonstrate resistant to antidepressant therapy demonstrate higher concentrations of circulating inflammatory higher concentrations of circulating inflammatory cytokines and CRP than patients who respond to cytokines and CRP than patients who respond to antidepressants.antidepressants.

Baseline concentrations of circulating cytokines, Baseline concentrations of circulating cytokines, such as IL-6, and markers of inflammation, like CRP, such as IL-6, and markers of inflammation, like CRP, may be useful for indentifying subjects that will fail may be useful for indentifying subjects that will fail to respond to current antidepressant therapies and to respond to current antidepressant therapies and for determining potential novel treatment strategies.for determining potential novel treatment strategies.

Neuroscience, 2013Neuroscience, 2013

InflammationInflammation So depression is an inflammatory disease, but where does it So depression is an inflammatory disease, but where does it

come from?come from? A range of factors appear to increase the risk for the A range of factors appear to increase the risk for the

development of depression and seem to be associated with development of depression and seem to be associated with inflammation including psychosocial stressors, poor diet, inflammation including psychosocial stressors, poor diet, physical inactivity, obesity, smoking, altered gut permeability, physical inactivity, obesity, smoking, altered gut permeability, atopy, dental caries, sleep and vitamin D deficiency.atopy, dental caries, sleep and vitamin D deficiency.

Identifying sources of inflammation and with quality evidence Identifying sources of inflammation and with quality evidence linking depression to these factors provides mechanistic linking depression to these factors provides mechanistic support. The pivotal element is that most of these factors are support. The pivotal element is that most of these factors are plastic and amenable to intervention both therapeutic and plastic and amenable to intervention both therapeutic and preventive. Prevention being the most pressing.preventive. Prevention being the most pressing.

BMC Medicine, 2013

Fatty AcidsFatty Acids

Fatty acids are of highest concentration in brain Fatty acids are of highest concentration in brain membranesmembranes

Phospholipids are the most critical membrane Phospholipids are the most critical membrane lipid and are composed of polyunsaturated fatty lipid and are composed of polyunsaturated fatty acids including omega 3 and omega 6.acids including omega 3 and omega 6.

Lipid composition is critical to how a message is Lipid composition is critical to how a message is received.received.

Neuronal membranes are either stabilized or Neuronal membranes are either stabilized or destabilized by fatty acids.destabilized by fatty acids.

Fatty acids modulate neurotransmission and Fatty acids modulate neurotransmission and reduce excitability.reduce excitability.

Fatty AcidsFatty Acids

Fatty acid deficiency:Fatty acid deficiency:Learning disabilities and delay in development.Learning disabilities and delay in development.Reduced visual acuity and tracking.Reduced visual acuity and tracking.Increase in aggressive behavior.Increase in aggressive behavior.Risk of other neurological issues.Risk of other neurological issues.Risk of depressive disorders.Risk of depressive disorders.Increases brain inflammation. Cytokines break Increases brain inflammation. Cytokines break

down tryptophan and force it into a pathway down tryptophan and force it into a pathway toward glutamate, away from serotonin synthesis.toward glutamate, away from serotonin synthesis.

Fatty AcidsFatty Acids One of the most promising research fields is the inflammatory One of the most promising research fields is the inflammatory

component of major psychiatric diseases (depression, bipolar component of major psychiatric diseases (depression, bipolar disorders and schizophrenia).disorders and schizophrenia).

Four major classes of anti-inflammatory drugs were identified, Four major classes of anti-inflammatory drugs were identified, namely polyunsaturated fatty acids (PUFAs), cyclooxygenase namely polyunsaturated fatty acids (PUFAs), cyclooxygenase (COX) inhibitors, anti-TNFalpha and minocycline.(COX) inhibitors, anti-TNFalpha and minocycline.

Further studies are warranted to identify more precisely the Further studies are warranted to identify more precisely the biomarkers that could identify potential responders and biomarkers that could identify potential responders and orientate some specific treatment.orientate some specific treatment.

The benefit/risk ratio of add-on-anti-inflammatory drugs should The benefit/risk ratio of add-on-anti-inflammatory drugs should always be discussed Omega-3 may have the better always be discussed Omega-3 may have the better benefit/risk ratio in depressive disorders as no severe side-benefit/risk ratio in depressive disorders as no severe side-effects have been described to date.effects have been described to date.

Acta Psychiatrica Scandinavica, 2013

Fatty AcidsFatty Acids• A number of epidemiological and preclinical studies have A number of epidemiological and preclinical studies have

proven the potential benefit and critical role of omega-3 proven the potential benefit and critical role of omega-3 PUFA in the development and management of major PUFA in the development and management of major depressive disorder (MDD).depressive disorder (MDD).

• Article presents an overview of the evidence to date about Article presents an overview of the evidence to date about the clinical application and biological mechanisms of omega-the clinical application and biological mechanisms of omega-3 PUFA in the treatment of MDD.3 PUFA in the treatment of MDD.

• Given the potential action mechanism, clinical benefits and Given the potential action mechanism, clinical benefits and currently available clinical trial data, omega-3 PUFAs may currently available clinical trial data, omega-3 PUFAs may deserve greater attention and wider application for deserve greater attention and wider application for treatment of MDD.treatment of MDD.

Expert Opinion on Investigational Drugs, 2013

Fatty AcidsFatty Acids Increasing evidence from the fields of neurophysiology and Increasing evidence from the fields of neurophysiology and

neuropathology has uncovered the role of polyunsaturated neuropathology has uncovered the role of polyunsaturated fatty acids (PUFA) in protecting neuronal cells from oxida- fatty acids (PUFA) in protecting neuronal cells from oxida- tive damage, controlling inflammation, regulating tive damage, controlling inflammation, regulating neurogenesis, and preserving neuronal function.neurogenesis, and preserving neuronal function.

This review article outlines the role of PUFA in This review article outlines the role of PUFA in neurodevelopment and the regulatory mechanisms in neurodevelopment and the regulatory mechanisms in neuronal stem cell differentiation and also the possible use neuronal stem cell differentiation and also the possible use of PUFA as a prescription medicine for the prophylaxis or of PUFA as a prescription medicine for the prophylaxis or treatment of neuropsychiatric illnesses such as dementia, treatment of neuropsychiatric illnesses such as dementia, mood disorder, and PTSD.mood disorder, and PTSD.

Journal of Pharmacological Sciences, 2014

TheThe StressStress ResponseResponse

• Fight or flight Fight or flight Sympathetic nervous Sympathetic nervous system stimulatedsystem stimulated

• Parasympathetic nervous Parasympathetic nervous system is over-ridden.system is over-ridden.

• Pupils dilatePupils dilate• Blood pressure risesBlood pressure rises• Digestion suppressedDigestion suppressed• Immunity suppressedImmunity suppressed• Detoxification Detoxification

suppressedsuppressed

• Glucose releasedGlucose released• Cholesterol releasedCholesterol released• Fluid retainedFluid retained• Fat is depositedFat is deposited• Decreased energy Decreased energy • Hormones derangedHormones deranged• Mood fluctuationsMood fluctuations• Inflammatory mediators Inflammatory mediators

stimulatedstimulated• Gradual demineralization Gradual demineralization

of boneof bone

Stress and InflammationStress and Inflammation Stressful life events can bring about symptoms of a Stressful life events can bring about symptoms of a

depressed mood through physically damaging the brain. depressed mood through physically damaging the brain.

This damage triggers a repair response (not unlike any This damage triggers a repair response (not unlike any wound repair) that includes inflammation. The changes wound repair) that includes inflammation. The changes caused by these inflammatory messengers may lead to caused by these inflammatory messengers may lead to physical pain and depression of normal function during the physical pain and depression of normal function during the repair process. repair process.

When these repair processes continue for longer periods, When these repair processes continue for longer periods, due to ongoing stress or an inability to fully repair, then due to ongoing stress or an inability to fully repair, then depressive symptoms can become chronic.depressive symptoms can become chronic.

Neuroscience and Behavioral Reviews. 2011

““There is nothing bad or good but There is nothing bad or good but thinking makes it so” thinking makes it so” ShakespeareShakespeare

• Key mediator of stress response is appraisal.Key mediator of stress response is appraisal.

• The physical stress response varies depending on The physical stress response varies depending on interpretation and perception.interpretation and perception.

• When unconscious attention is tied up in “fight or flight” When unconscious attention is tied up in “fight or flight” the result is mental, emotional and metabolic patterns the result is mental, emotional and metabolic patterns of excess and depletion.of excess and depletion.

• Ability to downshift out of SNS and promote PNS Ability to downshift out of SNS and promote PNS dominance is critical.dominance is critical.

Case PresentationCase Presentation

• 45 year old woman depressed since age 1245 year old woman depressed since age 12• First severe episode in collegeFirst severe episode in college• Recurrent, estimates she is depressed 25% of Recurrent, estimates she is depressed 25% of

timetime• PMDD PatternPMDD Pattern• Seasonal PatternSeasonal Pattern• Strong family history: mother and 3 sisters with Strong family history: mother and 3 sisters with

depressiondepression

Core SymptomsCore Symptoms• Sad, depressed and irritable moodSad, depressed and irritable mood• Loss of interest, pleasure, motivationLoss of interest, pleasure, motivation• Poor concentration, distractiblePoor concentration, distractible• Energy sluggishEnergy sluggish• Sleeps excessive-10 hours, not restoredSleeps excessive-10 hours, not restored• Ruminative thought, negative self-talkRuminative thought, negative self-talk• Shame, low self esteemShame, low self esteem• Isolated, few significant relationshipIsolated, few significant relationship

Treatment HistoryTreatment History• Psychotherapy Psychotherapy

– On and off for yearOn and off for year– Had long-term therapy with benefit but without Had long-term therapy with benefit but without

change in her pattern of depressionchange in her pattern of depression• MedicationMedication

– Several, including SSRI and WellbutrinSeveral, including SSRI and Wellbutrin– Good response to Zoloft, but effects wore offGood response to Zoloft, but effects wore off– Doses increased with temporary improvementDoses increased with temporary improvement– Unpleasant withdrawal, even if missed one doseUnpleasant withdrawal, even if missed one dose

StressStress

• Work StressWork Stress

• Parents’ divorce, fighting during childhood, Parents’ divorce, fighting during childhood, father is estrangedfather is estranged

• Loss of 3 significant relationships (triggering her Loss of 3 significant relationships (triggering her most severe episodes)most severe episodes)

• Feels alone, wearing out her supportsFeels alone, wearing out her supports

Relevant Medical HistoryRelevant Medical History

• Juvenile Rheumatoid ArthritisJuvenile Rheumatoid Arthritis

• Current joint painCurrent joint pain

• PsoriasisPsoriasis

• Severe acne as a teenSevere acne as a teen

• IBS, mild reflux, loose stoolsIBS, mild reflux, loose stools

Relevant Medical HistoryRelevant Medical History

• Eats well. Craves sugar, occasional bingingEats well. Craves sugar, occasional binging

• Weight gainWeight gain

• Sisters and mother are diabeticSisters and mother are diabetic

• Sisters and mother are obeseSisters and mother are obese

• Paternal alcohol dependencePaternal alcohol dependence

Nutritional InterventionNutritional Intervention

• Discussed blood sugar metabolism and the Discussed blood sugar metabolism and the physiology of potential insulin resistance.physiology of potential insulin resistance.

• Reviewed the guidelines for insulin/glucose Reviewed the guidelines for insulin/glucose balance. balance.

• Recommended alpha lipoic acid and chromium. Recommended alpha lipoic acid and chromium.

• Additionally described how stress both internal Additionally described how stress both internal and external can contribute to such an imbalanceand external can contribute to such an imbalance.

Nutritional InterventionNutritional Intervention

• Conducted a modified elimination challenge to Conducted a modified elimination challenge to determine potential food sensitivity or intolerance.determine potential food sensitivity or intolerance.

• After the four week challenge subject was found After the four week challenge subject was found to have sensitivities to wheat and corn.to have sensitivities to wheat and corn.

• Felt terrific without these foods, eczema cleared, Felt terrific without these foods, eczema cleared, joint pain diminished, bowels normalized and she joint pain diminished, bowels normalized and she felt less anxious. felt less anxious.

• Recommended omega-3 fatty acids and turmeric Recommended omega-3 fatty acids and turmeric (curcumin) to help as anti-inflammatory agents. (curcumin) to help as anti-inflammatory agents.

Nutritional InterventionNutritional Intervention

Discussed estrogen metabolism.Discussed estrogen metabolism.

Discussed the sleep cycle.Discussed the sleep cycle.

Discussed the stress response. Participant Discussed the stress response. Participant in program for depression based on the in program for depression based on the work of Dr. Henry Emmons called work of Dr. Henry Emmons called Resilience Training.Resilience Training.

OutcomeOutcome

• ““I feel like the cloud lifted.”I feel like the cloud lifted.”• Mood stable.Mood stable.• Energy improved.Energy improved.• Digestive system normalized.Digestive system normalized.• Sleeps less, feels more rested.Sleeps less, feels more rested.• Achiness in body and “heart” gone.Achiness in body and “heart” gone.• Said, “This is the first winter I have not Said, “This is the first winter I have not

been depressed in my entire life.”been depressed in my entire life.”