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The Role of Nutrition in Open Sky Treatment: Connections between Nutrition and Mood

Joanna Bettmann Schaefer, PhD, LCSW

Open Sky Wilderness Therapy

Why is Nutrition Important?

• “Let thy food by thy medicine and thy medicine be thy food.” - Hippocrates, 400 BC

• Basic foundational piece

• Simple intervention that is often overlooked

• Can apply to any setting or environment

Agenda• Overview of research on nutrition and behavior• The role of a balanced diet• Why a balanced diet is critical for mental health• Open Sky nutritional interventions• Data from the field• Recommendations for home nutrition

Research Links Nutritional Factors to Mental Health

• People with nutrient deficiencies often manifest psychological symptoms first, rather than physical symptoms (Benton, 1992)

• Nutrition is the simplest single intervention for treatment of behavioral issues

“Dietary improvement and supplementation may offer an inexpensive and acceptable adjunct to standard treatment [of depression]; yet this has, to date, been largely overlooked, owing to lack of evidence and knowledge.” (Bamber, Stokes & Stephen, 2007)

Research Links Nutritional Factors to

Mental Health

• Unhealthy eating has been associated with suicide attempts, delinquency, substance abuse and other behavioral issues in adolescents (Neumark-Sztainer, Story, Toporoff, et al., 1997)

• Dietary intervention alone has been shown to improve hyperactive and disruptive behavior in children (Schmidt et al., 1997)

• A healthy diet can have a protective effect against depression in adolescent girls (Brooks et al., 2002)

Research Links Nutritional Factors to Mental Health

• Specific nutrient levels are commonly low in some mental health clients

• Supplementation leads to symptom improvement (Bamber, Stokes & Stephen, 2007)

• Vitamin B1 intake has been linked to behavioral improvements, even in patients with adequate Vit. B1 levels (Benton et al, 1997)

• Participants reported feeling more clearheaded, composed, and energetic. Low folic acid levels are associated with a lack of clinical response to treatment in depression (Papakostas et al, 2004)

• Folic acid has been shown to enhance effectiveness of Prozac in treatment of depression (Coppen & Bailey, 2000)

Components of a Balanced Diet

Complex carbohydrates:• Major source of fuel• Brain function and physical activity

Fiber:• Important for aiding elimination

and pushing waste out of our

bodies

Examples:• Brown rice, quinoa,

fresh fruits, and veggies

Components of a Balanced Diet

Simple carbohydrates should be avoided:

• Nutritional value removed during processing

• Can cause unhealthy weight gain

• Can spike blood sugar

• Examples: white sugar, white flour, white rice, candy, soda

Components of a Balanced Diet

Proteins: • Basic structural components of

all body parts (e.g. bones, muscle, organ tissue)

• Critical for neurotransmitter function, healthy cell metabolism, and energy

• Examples: red meat, eggs, quinoa, nuts, beans, chicken, fish

Components of a Balanced Diet

Proteins also play an important role in serotonin production

• Proteins are made of amino acids

• Amino acids help to create neurotransmitters (i.e. dopamine

and serotonin)

• Some suicidal individuals demonstrate altered serotonin activity (Mann, 2003)

• Without adequate protein, we do not have the raw materials needed to maintain mood and regulate behavior

Components of a Balanced Diet

Vitamins and Minerals:

• Drive healthy body systems

• Are crucial co-factors for every cellular function in the body

• Without essential nutrients, we become susceptible to physical and mental imbalance or disease (Papakostas et al, 2004)

Components of a Balanced Diet

Essential Fatty Acids (EFAs)

• We all need good fats for optimal central nervous functioning

• Many American are afraid of the word “fat”, but a significant portion of our brains is made up of fat

• Adequate amounts of EFAs are necessary throughout life to maintain normal central nervous system and proper sleep function (Richardson and Puri, 2000)

• EFAs aid in balanced hormone production

• Examples: fish, raw nuts, raw seeds, whole grains• At Open Sky, we support this by offering students fish oil and

primrose oil in the field

EFAs and Mental Health • Deficits in EFAs have been linked to many commonly seen

behavioral and psychological issues like ADHD, depression and anxiety (Colquhoun and Bunday, 1981; Peet, Murphy, Shay and Horrobin, 1998)

• Increased EFAs create a more fluid cell membrane which increases serotonin transport (Block and Edwards, 1987)

• The fats in cell membranes affect neurotransmitter functioning. For example, Valium efficacy can be doubled by altering the fatty acid environment. (Richardson and Puri, 2000)

The Role of Essential Fatty Acids (EFAs)

• Chronic omega-3 fat deficiency has been linked to decreased levels of dopamine (Richardson and Puri, 2000)

• This correlates to symptoms of ADHD, anxiety, and depression (Peet, Murphy, Shay and Horrobin, 1998)

• Impulsivity symptoms improved with EFA supplementation (Hallahan and Garland, 2004)

• EFAs have been shown to decrease depressive symptoms while not inducing manic symptoms in the treatment of bipolar disorder

• EFAs are a “naturally occurring and safe psychotropic compound” (Frangou, Lewis and McCrone, 2006)

Essential Fatty Acids and Mental Health

Things that can interfere with the conversion of EFAs to more active constituents (Richardson and Puri, 2000) :

• Saturated or hydrogenated fats

• Vitamin and mineral cofactor deficiencies (especially Zinc)

• Excessive alcohol consumption

• Stress hormones

Why is a Balanced Diet Critical for Mental Health?

• Without the foundation of balanced nutrition, we don’t have the essentials to support neurotransmitter function, strong cognitive function, attention, and focus

• Underlying nutrient deficiencies can be associated with mental health issues (Bamber et al., 2007)

• Providing good nutrition significantly decreases the impact of blood sugar fluctuations and allergic responses on behavior (Benton, 2002; Swanson & Kinsbourne, 1980; Egger, 1985)

• Nutrients have been shown to increase effectiveness of antidepressant medication, especially in treatment-resistant individuals (Bamber et al., 2007; Coppen & Bailey, 2000; Peet & Horrobin, 2002)

How does this relate to the students we work with?

Poor nutrition can combine with other factors to be the straws on the camel’s back:• Eating simple carbs, no

breakfast, energy drinks• Using drugs and alcohol• Health issues like asthma,

eczema, constipation• Not sleeping well

These are things we can change!

Open Sky Nutritional Interventions

Students eat 3 solid meals a day plus snacks

• Ensures consistent blood sugar levels

Students eat a whole foods diet: no refined carbohydrates, no simple sugars, no additives or preservatives

• Maintains blood sugar, minimizes impact of environmental toxins

• Can reduce feelings of distress by limiting simple carbohydrate consumption (Christensen, 2001)

Open Sky Nutritional Interventions

Whenever possible, produce is organic, meat is local, grass-fed and free from hormones and

antibiotics• Minimizes impact of environmental toxins and non-naturally occurring hormones

Diet is limited in common allergens like wheat, soy, and dairy • Certain foods can cause mental and behavioral symptoms via reaction to certain neuropeptides

formed from foods (Rippere, 1984)

• Allergic responses to food have been associated with hyperactive and/or disruptive behavior (Schmidt

et al., 1997)

• Open Sky can meet most dietary needs, ie. Peanut allergies, gluten sensitivity, or tree nut allergies

•

Fresh produce has many more anti-oxidants and nutrients than food that has to travel long

distances

Nutritional supplements offered (e.g. fish oil, multivitamins, B vitamin complex)

Sample Day of Meals

Breakfast: • Oatmeal with dried fruit and nuts• Breakfast burritos with sausage,

spinach, potatoes, onion, and pepper• Granola

Lunch:

Whole-wheat tortillas with:• Tuna and cheese• Peanut butter and fruit • Chicken and cheese

Dinner: • Split pea soup with rice, kale, and carrots• Quinoa Pasta with carrots and onions• Coconut vegetable curry with yams,

tempeh, and spinach• Black bean burritos with onion, peppers,

and cheese.

Snacks: • Raw nuts and seeds, fresh and dried

fruits

Drinks: • Herbal teas

What We Don’t Eat

• Ultra refined sugar or sweeteners (e.g.white sugar)• Processed meats (e.g. spam)• Simple carbohydrates (e.g. ramen, white pasta, white

rice, white sugar)• Gatorade• Caffeine (e.g. chocolate, black tea)• Food dyes or preservatives

Why We Don’t Eat Those Things

• Refined sugars: spikes blood sugar, can cause behavioral problems, can induce fatigue and irritability (Benton, 2002)

• Processed meats: often have compromised nutritional value (from meat byproducts and from animal diet), introduces unnecessary hormones

• Simple carbohydrates: cause blood sugar dysregulation, also most nutritional value is removed during refining process

• Hydrogenated oils and saturated fats: negatively impact the flow of nutrients into every cell in body and interfere with healthy neurotransmitter function (Peet, Murphy, Shay and Horrobin, 1998)

Open Sky Nutritional Intervention: Junk Food DayStudent must be in the west phase (at Open Sky for roughly 3-4 weeks)

Students are given the option to have snacks and drinks that would be available at home

Students eat a regular Open Sky diet, with these snacks in addition to their normal food. They must eat the Junk Food in the morning.

The purpose is to invite students to experience for themselves any physical/mental/emotional changes from shifts in diet

Sample Options:• Sun Chips, Fritos, Potato Chips • Oreos, Skittles, Mini Donuts• Mt. Dew, Coke, Monster Energy drink

Measuring the Impact of Junk Food Day

Students are asked to respond to the following questions before snacks, after snacks, and at bedtime:• What is your energy level right now? • What is your emotional state? How are you feeling?• How is your ability to concentrate or focus?• Are there any areas of pain, discomfort, or tension in your

body?• What was it like to do exercise (such as hiking) today?• What was your meditation practice like today?• What was your outlook on life today?• How is your body, mind, heart, and soul?

Junk Food Day: Before Snacks

Sample responses:• “Emotional state is decent, I am feeling optimistic”• “My ability to concentrate and focus is good” • “Mild discomfort in my upper back”• “I feel accomplished and content” • “Some tension but nothing irregular”• “I feel really excited”• “My energy is normal to high”

Junk Food Day: During Sample Responses:

• “I’m feeling good, but guilty about all the junk food I ate”• “Hyper, excited, distracted by junk food, stomach ache”• “I am feeling bloated and hyper”• “I feel a little out of it. My moods have been all over the place. I’ve been

silly, happy, mad, sad, manipulative, and down.”• “I am pretty full, and sort of weak. I am sort of unstable, not thinking

clearly or positively. I am feeling full and fat. I cannot concentrate or focus well.”

• “Weird feeling, hyped up, things speeding up, a high like feeling that’s intense, a lot of things, going on, seems like there are less filters.”

• “I feel like my body is tired. I feel like my mind cant think. I have been talking more aggressively and my ADHD has flared out of control. My impulses are hard if not impossible to control.”

Junk Food Day: BedtimeSample responses:

• “My energy is sapped. I feel hungover.• “My energy level is very low.”• “I feel really tired. Kind of depressed.”• “Depressed and irritable”• “Extremely low energy level. Extremely depressed. Bad focus” • “Out of it, but happy, stressed”• “My energy is returning, but I’m extremely hungry”• “The junk food made my body more energetic, but in the long run, the

healthy food made me feel a lot better.”

Junk Food Day Behavior Patterns

• Addictive behavior emerges: students’ attitudes and behaviors mimic their substance abuse patterns (e.g. overeating)

• There is a link between how we feel about ourselves and how we eat (Fulkerson et al, 2004)

• Relationship to food: self image issues• Known that we go for high carbohydrate, high fat, low protein

foods when we’re stressed (Gibson, 2006)

• Peer pressure issues (e.g. sneaking food to others)

Recommendations for Nutrition at

Home

Evaluate your current home menus, focusing on removing hydrogenated oils (trans-fats), refined sugars and carbohydrates (including corn syrup), food dyes, preservatives

Increase food variety: introduce grains such as quinoa, amaranth, and barley instead of potatoes, white pasta and white rice

Introduce dark leafy greens such as kale,

collard greens, chard, etc.

Buy local where available.

Recommendations for

Nutrition at Home Introduce healthier meat and dairy sources: organic,

antibiotic-free, without hormones, cage-free, grass-fed

Learn more about whole-food nutrition,

supplementation, vitamin deficiencies, digestion, food

allergies, emotional connection to food

Consult with naturopathic physician or holistic

physicians to consult with you on dietary interventions

and educational needs

Contact Information:Joanna Bettmann Schaefer, PhD, LCSW

Open Sky Research Director

joanna@openskywilderness.com

(801) 587-7600

Dr. Jade Wimberly, ND

Consulting Naturopathic Physician, Program Liaison

drjade@openskywilderness.com

(970) 759-9733

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•  

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•  

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•  

• Pitchford, P. (1993). Healing with Whole Foods. Berkeley, CA: North Atlantic Books.

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students. Journal of Adolescent Health, 26, 361-67.•  • Turner, K. (2002). The Self-Healing Cookbook. Vashon Island, WA: Earthtones Press.•  • Weintraub, S. (1995). Minding Your Body. Portland, OR: Complementary Medicine Publishing

Company.•  •  

Suggested Readings

Web Resources• www.naturopathic.org• http://www.organic.org/• http://www.foodreference.com/html/artorganicfoods.html• http://www.yale.edu/sustainability/foodproject.htm• http://www.localharvest.org/