NUTRITION ROLE IN BRAIN AND MENTAL HEALTHdr. Nazly Hanim, D.A.Nut., MA.

Learning ObjectivesTo understand and able to describe the nutritional role on brain and mental developmentTo describe the nutrient role on the brain and mental functionTo understand the way to prevent and overcome neuropsychiaric problems from nutritional point of view

Basic PrinciplesUndernutrition is the primary cause of the high rates of infant morbidity and mortality in developing countriesThe 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 developmentRecent evidence indicates a causal relationship between undernutrition and deficient mental function

The Effects of Undernutrition to Brain GrowthIn most regions of the brain, the total number of cells present in adults is largely determined by the end of the first year of lifeWhen 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.

The Effects of Undernutrition to Brain GrowthDeficiencies in nutrients such as vit A, B6, folic acid, zinc, and magnesium may also affect development of the nervous systemIf 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

Undernutrition and Mental DevelopmentIn 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

Undernutrition and Mental DevelopmentEarly undernutrition in a deprived environment interferes with subsequent learning abilityAmong 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 DevelopmentPerformance 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 DevelopmentPerformance of both preschool and school children on the Terman and Goodenough draw-a-man tests was positively correlated with body weights and heightsThe 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

Undernutrition and Mental DevelopmentThe exact time span when undernutrition has the most serious effect on the brain is not yet knownIn 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

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

Rehabilitation from UndernutritionPreliminary 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 stimulatedResults show that the well-nourished and stimulated children have the highest learning capacity

The Relationship between Brain Chemicals and Nutrients

IntroductionNearly 50 compounds have been discovered to act as neurotransmitter (NT)The ability NT synthesis depends upon the availability of precursor compounds in dietSynthesis and release of NT can be altered to some extent by certain foodsAmino acids are the precursors of NT

Amino Acids and NeurotransmitterTryptophan SerotoninLecithin & Choline AcetylcholineTyrosine the Catecholamines

Vitamins and Trace MineralsSerious deficiencies of thiamin, vitamin B6, B12, vitamin C, and folic acid can also provoke psychiatric symptomsMild vitamin deficiencies might cause some impairment of brain functionThe known minerals which deficiency may result on brain and nerve function damage are: Iodine, Iron, Zinc, Copper, Calcium, Manganese, MagnesiumWhile high lead and mercury levels result in central nervous system abnormalities

Hyperactivity in ChildrenThe use of diet therapy to treat hyperactive children has always been questionableThe Feingold Diet proposed that salicylates, artificial food colors, and artificial flavors caused hyperactivityIn 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.

Hyperactivity in ChildrenCaffeine has been claimed to cause hyperactivity The truth is caffeine causes increased motor activity and fidgetiness in pre-adolescent boysSugar consuming directly enhances serotonin production, predicting that sugar may have calming effect on children, rather than being more hyperactive

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

Breakfast and School PerformanceFar more subtle are the learning difficulties that may or may not relate to fasting in school-childrenIn general, it was found that children who ate breakfast performed better throught the morning on different measures of cognitive performance than those who skipped itThe optimal breakfast was one that was balanced in protein, carbohydrates, and fats

Medical Nutrition Therapyfor Psychiatric Conditions

Nutritional Aspects of Brain and Nervous System Structure and FunctionOne 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

Nutritional Aspects of Brain and Nervous System Structure and FunctionSixty 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 acidn-3 fatty acids appear to be the type of fat preferred by the brain and nervous systemEach of the three n-3 has been found to have unique, important, and noninterchangeable contributions to overall brain and nervous system functioning

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 EPADHA (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

Omega-3 Fatty Acidsand Brain FunctionDHA is the brains building block, providing structure to neurons and is an anchor point for neurotransmitter receptorDHA also has an antioxidant effectAdequate DHA is important for maintaining healthy neurotransmitter function, including for dopamine and serotoninDHA has the ability to raise the seizure threshold of the nervous system

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

Source of DHA and EPACurrently 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 AlgaeIt is important to note that eggs and marine algae-based products contain DHA only

During InfancyOne of the most important sources of DHA and EPA is mothers milkReduced 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

During AdulthoodLong-chain fatty acid (LCFA) supplements will often improve depression and its related pathologyThey should be used with vitamin E supplementation to make sure that they are not oxidized and are thus effectivePatients with bipolar disorder, postpartum depression, schizophrenia, dementia, alcoholism, tardive dyskinesia and other psychiatric conditions may also improve with LCFA supplementation

Nutrition RecommendationsGoal 1 : Consumption of Dietary DHA and EPAGoal 2 : Maintenance of a Diet With a Low Total Daily Omega-6 to Omega-3 RatioGoal 3 : Avoidance of Restrictive Diets that Encourage Rapid Weight LossGoal 4 : Increased Antioxidant Intake

Nutrition in Eating Disorders

Eating DisordersIncludes :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

Nutrition Rehabilitation and CounselingNutrition rehabilitation includes nutrition assessment, medical nutrition therapy (MNT), nutrition counseling, and nutrition educationNutrition assessment routinely includes a diet history and the assessment of biochemical, metabolic, and anthropometric indices of nutrition status

Diet HistoryGuidelines include assessment of energy intake, macro & micronutrient consumption, eating attitudes & behaviorsBN : Energy intake may be unpredictable Energy elimination by vomiting is below energy consumptionMany AN patients follow vegetarian diets

Diet HistoryInadequate calorie + limited variety + poor food group representation = inadequate vitamin and mineral consumptionMicronutrient 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

Eating BehaviorPatients tend to regard foods as absolutely good or absolutely badDetermine unusual or ritualistic behaviorsDetermine meal spacing and length of time allocated for a meal

Anorexia NervosaGoals of Nutritional RehabilitationCorrection of biologic and psychological sequelae of malnutritionRestoration of body weightsNormalization of eating patterns, eating behaviors, and hunger/satiety cues

Bulimia NervosaGoals of Nutritional RehabilitationInterruption of the binge-and-purge cycleRestoration of normal eating behaviorStabilization of body weightCognitive Behavioural TherapyThe nutritionists role is to help develop a reasonable plan of controlled eating while assessing the patients tolerance for structure

Bulimia NervosaEstimating Initial Caloric PrescriptionsFor 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)Have the patient describe a typical food on a B/P, B/nP, MI, and RI daysEstimate 50% of the caloric intake on the B/P, and 100% on the B/nP, MI, and RI

Bulimia NervosaEstimating Initial Caloric PrescriptionsCalculate the total caloric intake over the 7-day periodCalculate an average daily intake. The RD can than formulate an initial eating and meal plan based on this estimated average daily intake

Guidelines for Medical Nutrition Therapy for AN and BNFat : 25%-30% ; provide source of essential fatty acidsProtein : 15%-20%, minimum : RDA in g/kg ideal body weight ; high biologic vale sourcesCarbohydrate : 50%-55% ; encourage insoluble fiber for treatment of constipationMultivitamin-mineral preparation to ensure adequacy, particularly in the initial phase, especially calcium, iron and vitamin D

Nutrition EducationThough patients tend to have knowledge about food and nutrition, nutrition education is still an essential component of the treatment planThe patients may receive from unreliable sources or have distorted interpretationChoose the information carefully, some source indicate a low-fat low-calorie intake (for preventing chronic disease)

PrognosisRelapse rates after weight restoration in AN is high, Adolescents have better outcomes than adult, and younger adolescents is better than older adolescentsMortality 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 populationBN patients have a short-term success rate of 50%-70%, and a relapse rates of 30%-85%