Nutrition and Mental Health Samantha Garrels, R.D., L.D. - - PowerPoint PPT Presentation

Nutrition and Mental Health

Samantha Garrels, R.D., L.D.

Objectives

• Explore barriers to good nutrition
• Identify nutrition and lifestyle changes to promote optimal mental and

physical health

Making the Connection: Nutrition and Mental Health

• Are we spending as much time thinking

about the connection between nutrition and mental health as we are thinking about nutrition and physical health?

• Food intake affects our mood due to

nutrients influencing the production and release of hormones and neurotransmitters

• Treatment approaches that incorporate a

nutrition component may have better outcomes in treatment of mental illness

Statistics

• Mental illness is associated with increased occurrence of chronic diseases
• “Individuals living with serious mental illness face an increased risk of having chronic medical
• conditions. Adults in the US living with serious mental illness die on average 25 years earlier

than others, largely due to treatable medical conditions.” –NAMI

• “Research suggests that people who have depression and another medical illness tend to have

more severe symptoms of both illnesses.” –NIH

• “In people with Depression, scientists have found changes in the way several different systems in

the body function, all of which can have an impact on physical health: signs of increased inflammation, changes in control of heart rate, abnormalities in stress hormones, metabolic changes typical of those seen in people at risk for diabetes” -NIH

• Prevalence of mental health disorders has increased in developed countries in

correlation with deterioration of the Western Diet

• There are some common nutritional deficiencies that correlate with mental disorders

Neurotransmitters

Serotonin | GABA | Dopamine

Healthy Levels

• Emotional Stability
• Stable Sleep Cycle
• Appetite Control
• Relaxation
• Pleasure and Reward

Deficient/Imbalanced

• Sleep issues
• Carb cravings
• Low mood, irritability
• Difficulty relaxing
• More prone to addiction
• Trouble focusing

Neurotransmitters and Food

• Tryptophan (EAA)
• Glutamine (CEAA)
• Tyrosine (CEAA)
• Stress
• Sugar
• Processed grains
• Caffeine
• Drugs and alcohol

Nutrient Deficiencies

Magnesium

• Role:
• Cofactor in >300 enzyme systems (protein synthesis, muscle and nerve function, blood

glucose control, blood pressure regulation)

• Required for energy production
• Contributes to structural development of bone
• Required for synthesis of DNA, RNA
• Role in active transport of calcium and potassium ions across cell membranes (nerve

impulse conduction, muscle contraction, normal heart rhythm)

• “Relaxation mineral”body and mind

Body contains ~25g mg, 50-60% present in bones, 38-39% in cells, <1% in blood serum

Causes of Mg Deficiency

• Low intake
• Chronic stress
• Excess alcohol, salt, coffee, sugar, cola

consumption

• Alcohol: poor intake, vomiting, diarrhea,

steatorrhea, pancreatitis, renal dysfx

• Excessive sweating, diarrhea,

menstruation

• GI diseases: diarrhea and malabsorption
• Crohn’s, Celiac
• Resection or bypass of SI (ileum)
• Use of diuretics, antibiotics, PPIs
• PPIs taken for >1yrcan cause

hypomagnesemia

• FDA reviewed cases, supplements did not

raise mg levels and pts had to discontinue the PPIrecommended to measure mg levels prior to initiating and check periodically

• Type 2 Diabetes
• Increased urinary mg loss

• Anxiety, depression, insomnia, irritability, panic

attacks

• Muscle cramps and twitches
• Prolonged QT interval
• Associated with:
• Insulin resistance
• Metabolic syndrome
• HTN
• Migraine headaches
• Tetany:
• Muscle spasms and cramps, seizures, involuntary

movements

• Loss of appetite
• Nausea
• Vomiting
• Fatigue
• Weakness
• Numbness, tingling
• Personality changes
• Abnormal heart rhythms
• Hypocalcemia or hypokalemia
• Migraines, headaches

Signs of Mg Def

Evaluation

• Only 1% found in blood serum
• Look for clinical risk factors
• Chronic diarrhea
• PPI therapy
• Alcoholism
• Diuretic use
• Clinical Manifestations
• Previous slide

Prevalence

• Dietary surveys show intakes of Mg are lower than recommended amounts
• NHANES 2005-2006: majority of Americans of all ages ingest less Mg

than needed

• Low levels found in ~12% of hospitalized patients
• 60-65% of intensive care patients
• One study of alcoholic pts admitted to hospital-30% prevalence
• Reversible within 4 weeks of abstinence

RDA

• Age

Male Female Pregnancy Lactation Birth-6mo 30mg 30mg 7-12mo 75mg 75mg 1-3yrs 80mg 80mg 4-8yrs 130mg 130mg 9-13yrs 240mg 240mg 14-18yrs 410mg 360mg 400mg 360mg 19-30yrs 400mg 310mg 350mg 310mg 31-50yrs 420mg 320mg 360mg 320mg 51+yrs 420mg 320mg

Food Sources

Food Mg/serving Percent DV 1oz almonds 80 20 1/2c boiled spinach 78 20 1oz cashews 74 19 1/4c peanuts 63 16 1c soymilk 61 15 1/2c black beans 60 15 1/2c cooked edamame 50 13 2T Peanut Butter 49 12 2slc WW Bread 46 12 1c Avocado 44 11 1 baked potato, with skin 43 11 8oz plain yogurt 42 11 1packet instant oatmeal 36 9

“Suggested that 5-30 minutes of sun exposure between 10am-3pm 2x/week to face, arms, legs, or back without sunscreen usually lead to sufficient vitamin D synthesis”

• NIH

Vitamin D (D3-Cholecalciferol)

Role:

• Fat-soluble vitamin
• Produced when UV rays from sun hit the skin
• Promotes calcium absorption in gut
• Maintains bone density
• Cell growth
• Neuromuscular and immune function
• Reduction of inflammation

• Limited sun exposure
• Season, time of day, length of day, cloud

cover, smog, skin melanin content, sunscreen

• Complete cloud cover reduces UV energy by

50%, shade by 60%

• UVB radiation does not penetrate glass
• Sunscreens with SPF of 8+ appear to block

vitamin D-producing UV rays

• Impaired absorption/use
• Kidneys cannot convert to active form
• Absorption in digestive tract inadequate-fat-

soluble vitamin (liver disease, cystic fibrosis, celiac disease, Crohn’s disease, ulcerative colitis with inflammation)

• Age: older adults’ skin cannot synthesize

vitamin D as efficiently, likely to spend more time indoors

• Dark skin: greater amounts of melanin

reduce skin’s ability to produce vitamin D from sunlight

• Obesity: BMI >/= 30 associated with

lower levels

• Greater amounts of subcutaneous fat alter

release into circulation

Causes of Deficiency

Signs of Deficiency

• Rickets (children)
• Osteomalacia (adults)
• Chronic low back pain
• Fatigue
• Fibromyalgia
• Depression

Evaluation

• 2011 Endocrine Society: desirable serum concentration of 25(OH)D is

>75nmol/L

• Serum 25-Hydroxyvitamin D Concentrations and Health (NIH)

Nmol/L Ng/mL Health Status <30 <12 Associated with deficiency, leading to rickets in infants and children and

• steomalacia in adults

30 to <50 12 to <20 Generally considered inadequate for bone and overall health in healthy individuals >/= 50 >/=20 Generally considered adequate for bone and overall health in healthy individuals >125 >50 Emerging evidence links potential adverse effects to such high levels, particularly >150nmol/L (>60ng/mL)

RDA

Age Male Female Pregnancy Lactaion 0-12mo 400IU 400IU 1-13yrs 600IU 600IU 14-18yrs 600IU 600IU 600IU 600IU 19-50yrs 600IU 600IU 600IU 600IU 51-70yrs 600IU 600IU >70yrs 800IU 800IU

Food Sources

• Very few foods have vitamin D, flesh of fatty fish (salmon, tuna, mackerel) and fish liver
• ils are best sources
• Milk is fortified with 100IU/cup (began in 1930’s to combat rickets)

Food IUs/serving Percent DV 1T cod liver oil 1360 340 3oz cooked swordfish 566 142 3oz cooked sockeye salmon 447 112 3oz canned tuna 154 39 2 canned sardines 46 12 1 large egg 41 10

Supplementation

• American Academy of Pediatrics:
• Exclusively and partially breastfed infants receive supplements of 400IU/day of

vitamin D after birth until weaned and consume >/= 32oz/day of vitamin D-fortified formula or whole milk

• Older children and adolescents who do not get 600IU/day through fortified milk and

foods: 600IU supplement daily

• D3: 1500-2000IU/day of supplemental vitamin D in adults
• D3 in active form (cholecalciferol), more potent than D2
• Deficiencies may require moremedical supervision of 5000-10,000IU or 50,000IU
• Monitor status
• Give time to “fill your tank” (can take up to 6-10 months to optimize)

Omega-3’s

Role

• Components of cell

membrane structure

• Anti-inflammatory
• Development and function of

the brain, CNS Deficiency

• Imbalance of O6:O3
• Inadequate intake

Types of Omega-3

• DHA (Docosahexaenoic acid)
• EPA (Eicosapentaenoic acid)
• Found in cold-water fish

(salmon, mackerel, halibut, sardines, tuna, herring)

• ALA (Alpha-linolenic acid)
• Flax, walnuts, chia seeds
• What’s the problem?
• Optimal ratio of Omega 6:

Omega3 is 1:1-4:1

• SAD is 10:1-25:1

Good Fats equal Good Mood?

• EPA plus DHA may improve depression
• Epidemiological studies indicate an association between depression and

low dietary intake of O3

• Biochemical studies have shown reduced levels of O3 in red blood cell

membranes in both depressive and schizophrenic patients

• Review of 15 trials involving 916 participants
• Supplements with at least 60% EPA improved depression symptoms

Good Fats equal Good Mood?

• Low omega-3 levels associated with suicide and self-harm
• NIH found low blood levels of Omega-3s raised suicide risk

by as much as 62%

• Placebo-controlled trial showed 2g of O-3 per day reduced

suicidal thinking by 45% as well as depression and anxiety scores amongst individuals with recurrent self-harm

Good Fats equal Good Mood?

• May improve depression during and after pregnancy
• 16 new mothers with postpartum depression took 0.5-2.8g of EPA/DHA

daily for 8 weeks

• Depression scores dropped 50% in all groups
• May improve menopausal depression
• 20 menopausal women with moderate depression took 2g EPA/DHA

daily for 8 weeks

• 70% found mood improved
• 45% found depression went into remission
• Mean scores on Montgomery-Asberg Depression Rating Scale: 24.2 to 10.7

Supplementation

• AHA recommends eating fatty fish 2x/week
• On average would give you 500mg of DHA and EPA daily
• Most adults and kids get closer to 100mg or less/day
• Blood levels of these fats are low, and even lower in ppl with

depression and anxiety

• Those with mood disorders may benefit from 1000mg of

EPA/DHA daily

• Careful if pregnant, nursing, blood thinners, bleeding disorder,

may reduce blood clotting

Food Sources (grams/serving)

Food ALA DHA EPA 1T flaxseed oil 7.26 1oz chia seeds 5.06 1T flaxseed 2.35 3oz Atlantic wild salmon 1.22 0.35 3oz Atlantic Herring 0.94 0.77 3oz Atlantic Mackerel 0.59 0.43 3oz canned pink salmon 0.04 0.63 0.28 1oz black walnuts 0.76 3oz light canned tuna 0.17 0.02

We want to make sure we get the best use out

• f the foods we are

putting into our body!

The Gut: Our Lifeline

• First line of defense
• 70% of protective immune system cells and antibodies live in GI tract
• 500 different species of bacteria
• 5-8# of “flora”
• Sugar, low fiber, antibiotics, minimal exercise
• Set stage for microbial terrain of gut to shift in unhealthy ways

Brain-Gut Connection

• ENS: the 2nd brain
• Half of nerve cells in your body are in your gut (more in bowel than spine)
• As many neurotransmitters are found in your gut as in your brain
• 80-90% of serotonin manufactured in gut
• Brain and gut in constant communication via vagus nerve
• Bidirectional
• Stress Response

Stress and Digestion

• Biochemicals released to put body in crisis/response mode
• Adrenaline, noradrenaline, cortisol, etc.
• Intention to help body react to life-threatening emergency
• Sympathetic Nervous System
• Moves resources to lifesaving functions, inhibits biological processes not

immediately necessary

• GI motility may freeze, and food may be evacuated
• Stress may cause upper digestive sphincters to remain open

Small Intestine

(on average 22 feet long)

• Duties:
• Break food down into molecules we can absorb
• Differentiates things we can absorb from non-digestible food

particles and pathogens

• House Immune System
• Absorb nutrients, fats, proteins

Large Intestine

Microbiome

We are mostly bacteria

• Outnumber our own cells by 10:1
• Average gut contains 5# of bacteria
• Healthy gut: most should reside in large intestine
• Purpose
• Regulate digestion and absorption of nutrients
• Extract and make nutrients from food
• Maintain and protect gut barrier
• Outside invaders, harmful microbes, energy for gut wall

Source: autismspeaks.org

What the Research Says

• Evidence from rodents that gut microbiome can

influence:

• Neural development
• Brain chemistry
• Wide range of behavioral phenomena: emotional behavior,

pain perception, how the stress system responds

What the Research Says

• Tweaking the balance between beneficial and disease-

causing bacteria in an animal’s gut can alter its brain chemistry and lead it to become either more bold or more anxious

• Mild stress can tip microbial balance, making the host more

vulnerable to infectious disease and triggering molecular reactions that feed back to CNS

What the Research Says

• Microbiome-gut-brain axis (Gastroenterology 2011)
• Gave mice (typically timid and shy) cocktail of antibiotics to

change the composition of their gut bacteria

• Behavior changed completely, became bold and adventurous
• When antibiotic regimen stopped animals soon reverted to

usual, cautious selves, brain biochemistry returned to normal

What the Research Says

• Follow-up study: 2 strains of mice (timid, NIH

Swiss mice-courageous, exploratory)

• Colonized each group of “germ-free” mice with bacteria

from mice of opposite strain

• Normal anxiety prone mice became fearless explorers
• Daring mice grew hesitant and shy

What the Research Says

• Gastroenterology 2010: infected mice with parasite

to induce chronic, low-grade gut inflammation

• Found suppressed levels of BDNF in hippocampus,

caused mice to behave more anxiously

• Treated 10-day course of Bifodobacterium

longumbehavior normalized, as did BDNF levels

What the Research Says

• Brain, Behavior, and Immunity 2011: psychological stress

suppresses beneficial bacteria

• Sharing a cage with more aggressive mice, a “social

disruption” stressor, reduced beneficial bacteria, decreased

• verall diversity of gut microbiome, and promoted
• vergrowth of harmful bacteria, making animals more

susceptible to infection and causing inflammation in the gut

Gut Health

• WHO definition of Health: the absence of diseases
• Modified for gut health: state of physical and mental well-being

in the absence of GI complaints that require the consultation

• f a doctor, in the absence of indications of or risks for bowel

disease and in the absence of confirmed bowel disease

• Intestinal microbiota, or gut flora and gut barrier determine gut

health

Gut Health

• “Any impairment of the GI barrier can increase the risk of developing

infectious, inflammatory and functional GI diseases, as well as extra- intestinal diseases such as immune-mediated and metabolic disorders”

• “It’s the predominance of the beneficial bacteria referred to as the

probiotic bacteria, such as bifidobacteria and lactic acid bacteria, that ensure good health and prevent diseases of the gut and other organs in the body.”

What affects our GI Barrier?

• Unbalanced diet
• High fructose diets
• Shown to increase

circulating LPS by 40%

• HFCS represents 42%

caloric sweeteners

• Excess carbohydrate intake
• High blood

sugarinflammation

• AGEs develop
• Insulin Resistance
• Lack of fiber
• “starving” our microbes
• <3% of Americans meet

recommended intakes

What affects our GI Barrier?

• External stressors (psychological stress) may compromise the intestinal

barrier

• Internal stressors (infections, AI disorders, IBD) may damage gut

lining/increase gut barrier permeability

• Environmental chemicals, food ingredients, antibiotics
• Lack of nutrients to support bacteria growth

Inflammation Defined

• “To kindle” or “to set on fire”
• May include redness, heat, swellingsprained ankle
• Far beyond this
• When persists or serves no purposeillness
• Obesity, diabetes, CA, depression, arthritis, MS, Parkinson’s, Alzheimer’s, etc.
• Inflammatory markers are increased
• Cytokines, C-reactive protein, IL-6, etc

Metaflammation

• Metabolic inflammatory state
• Product of oxidative stress, cytokines, and intestinal

permeability (leaky gut) “If your gut leaks, your blood-brain-barrier leaks”

Leaky Gut

• Loss of the

protective barrier fxenlarged spaces between the cells of the gut wallleaky gut

Leaky Gut

• Tight-Junctions
• Gatekeepers
• Compromisedsusceptible

to health issuesincreased inflammation

• RA, food allergies, asthma,

eczema, Celiac, IBD, Cystic Fibrosis, DM, Autism, Alzheimer’s, etc.

• Movement of LPS across

gut barrier

• Increase in LPS cause systemic

inflammation

• Threaten blood-brain

barrier

LPS: Lipopolysaccharide

• Structural fragments of the external membrane of gram-

negative bacteria

• Protects bacteria from being digested by bile salts from gallbladder
• Normally abundant in gut
• Endotoxinviolent inflammatory response if finds way to

bloodstream

• Blocked by tight junctions (ideally)

Lipopolysaccharide (LPS) translocation

• In healthy adults, only small amount of LPS are found in the blood,

indicating intact intestinal barrier function

• LPS administration at low levels causes acute anxiety, depressed mood,

cognitive blunting, increased visceral pain sensitivity

• Higher levels associated with abdominal obesity, metabolic syndrome, DM
• Higher levels in ALS patientslevel directly correlates to severity of illness
• Causes and perpetuates increased permeability of the intestinal and blood-

brain barriers

Maintaining Gut Health

“Diet and nutrition therapy should be the first route (to obtaining gut health), not the alternative.”

Maintaining Gut Health

• A systematic review, including results from 13 observational

studies, concluded that a healthy diet is significantly associated with a reduced odds for depression

• Meta-analysis of 22 studies investigating the protective effects of

adherence to a Mediterranean-style diet on brain diseases demonstrated that higher adherence was associated with a reduced risk for depression as well as cognitive decline

Treatment

• “Sealing and Healing” the gut, reducing

inflammation, supporting neurotransmitters and hormones, eliminating toxins, managing stress

What seems to be the problem?

• Only 1/3 of Americans eat enough fruits, ¼ eat enough vegetables
• Average fiber intake ~15g, should be 20-35g/day
• White grains vs. whole grains
• 50% of food dollars spent away from home
• Sugar accounts for ¼ of total caloric intake (~22tsp/day)
• Limit to 36g/day (9tsp) for men, 24g/day (6tsp) for women

Carbohydrates

• Contains Three Parts
• Bran
• Provides the most fiber
• Provides the most B

vitamins and minerals

• Germ
• Variety of nutrients, protein,

fat

• Endosperm
• Contains the starch

Refined Sugar

• Consuming large amounts may lead to addictive

eating:

• Insulin release
• Reactive hypoglycemia
• Endogenous opioid system
• Response to a high sugar diet in the body can be similar to

those using cocaine, morphine, etc.

Breaking the Sugar Habit

• Americans consume 355 calories, or 22t of added sugar a day

from soda and packaged foods

• Limit added sugar consumption
• Women: no more than 100calories or 6t of sugar/day (24g added sugar)
• Men: no more than 150cal or 9t of sugar/day (36g added sugar)

Treatment: Satiety

Treatment: Fiber

• Carb consumption, particularly fiber, is an important factor in

microbial composition promotes a shift towards growth of ‘beneficial’ bacteria and prevents an increase of ‘bad’ bacteria

<age 50 >age 50 Men 38g 30g Women 25g 21g

Treatment: Prebiotics

“Food” for good bacteria

• “Non-digestible food ingredients that

beneficially affect the host by selectively stimulating the growth and/or activity of one

• r a limited number of bacteria in the colon,

thus improving host health”

Food Sources of Prebiotics

All prebiotics are fiber, but not all fiber is prebiotic

• Raw leeks
• Asparagus
• Raw chicory root
• Jerusalem artichokes
• Raw garlic
• Raw onions
• Wheat (bran, flour)
• Oats
• Soybeans
• Acacia gum (or gum arabic)
• Raw dandelion greens
• Bananas
• Psyllium

Treatment: Prebiotics

• Oxford University study:
• 45 healthy adults between ages of 18-45
• Prebiotic or placebo daily for 3 weeks
• Findings:
• Prebiotic group paid more attention to positive information, less to

negative

• Prebiotic group had lower levels of cortisol

Probiotics

Role

• Inhibit growth of pathogenic bacteria
• Reduce pH environment
• Compete for binding sites
• Enhance production and secretion of

mucus forming agents

• Enhance integrity of epithelial lining

Picture: http://dailyhealthpost.com/6-natural-ways-to-improve-your-digestion/

Treatment: Probiotic Supplements

• British Journal of Nutrition 2011: 30 day course of probiotic

bacteria (lactobacillus helveticus and bifidobacteria longum) led to decreased anxiety and depression in healthy human volunteers

• Another study linked intake of multi-strain probiotic with

significantly reduced overall cognitive reactivity and negative thoughts associated with sad mood

• Preliminary PC human studies have shown that oral probiotic

microbes can decrease anxiety, diminish perceptions of stress, and improve mental outlook

Probiotic Rich Foods

• Live-cultured yogurt
• Kefir
• Kombucha tea
• Tempeh
• Fermented meat/fish/eggs
• Kimchi
• Sauerkraut
• Pickled fruits and vegetables
• Miso soup

Taking Probiotics

• May be beneficial to start with small dose then slowly increase dose and/or

fermented foods (5-10 billion CFU)

• Die-off reaction
• Choose one with a variety of strains (3+)
• 5-30 billion bacteria per capsule or teaspoon
• Protected from light, heat, moisture
• Expiration date

Stay Hydrated

Hydration

• Proper transport system
• Waste elimination
• Biochemical reactions
• Lubricant

Dehydration

• Thirst
• Flushed Skin
• Dizziness
• Increased Weakness
• Muscle Cramping
• Fatigue

How Much?

• Men ~13c/day
• Women: ~9c/day
• Or ½ body weight

in ounces

Mindful of Caffeine Intake

Caffeine

• #1 source of antioxidants in the

American Diet

• May lower risk of Type II DM

May want to limit if:

• Prone to stress, anxiety, sleep

problems

• Acid reflux or stomach ulcers
• Irregular or fast hear rhythms

American Medical Association: moderate tea or coffee drinking is not likely to be harmful to your health as long as you have OTHER GOOD HEALTH HABITS

Food Options

• Whole grain toast with peanut

butter

• Scrambled/hard boiled eggs
• Celery or apple and peanut butter
• Yogurt
• Can add nuts or ground flax or chia
• Whole wheat pasta tossed with

frozen veggies

• Tacos
• Meat mixed with black beans
• Can put over tossed greens
• Stir-fry
• Frozen rice or quinoa, frozen veggies
• Sandwich and baby carrots
• Fruit/cheese/nuts/seeds
• Cottage cheese

Food Options

• Vegetable soups
• Meats prepared in crockpot
• Can add veggies/beans
• Chicken topped with salsa
• Bean/Cheese quesadilla
• Oatmeal
• 1 flavored/1 plain (or flavor with fruit)
• Add nuts or chia or flax
• String/sliced cheese paired with fruit
• Nature-Valley protein bars
• Aldi brand
• Microwaved baked potato with melted

cheese/veggies/beans

• Crock-pot taco soup
• 1-2 cans of beans, can of corn, diced

tomatoes, salsa, taco seasoning

Food Options

• Rice/Beans/Salsa (burrito bowl)
• Bagged salad, rotisserie chicken
• Tuna or egg Salad on Wheat
• Bean and cheese burrito
• Hummus with crackers and veggies
• Frozen/dry roasted edamame
• Increasing water
• Herbal teas
• Splash of juice
• Infused water
• Carbonated water

Resources

• Fareforall.org
• Hungersolutions.org/find-help
• Loavesandfishesmn.org
• Foodpantries.org/ci/mn-north_branch

References

• Carpenter, S. (2012). That Gut Feeling. Monitor on Psychology, 149 (8). Retrieved from

http://www.apa.org/monitor/2012/09/gut-feeling.aspx.

• Gunnars, K. How to Optimize Your Omega-6 to Omega-3 Ratio. Retrieved from the Authority Nutrition

Website http://authoritynutrition.com/optimize-omega-6-omega-3-ratio/.

• Harrar, S. (2012 January). Omega-3 Fatty Acids and Mood Disorders. Today’s Dietitian, 14(1), 22.
• International Foundation for Functional Gastrointestinal Disorders. (2014, Oct. 14). Functional GI
• Disorders. Retrieved from http://www.iffgd.org/site/gi-disorders/functional-gi-disorders/.
• Mental Health: Research Findings. Retrieved from

http://www.ahrq.gov/research/findings/factsheets/mental/mentalhth/index.html

• Mullin, G.E., & Swift, K.M. (2011). The Inside Tract. New York, NY: Rodale Inc.
• Peet, M., & Stokes, C. (2005). Omega-3 fatty acids in the treatment of psychiatric disorders. Drugs,

8, 1051-9.

• Data on behavioral health in the United states. Retrieved from the American Psychiatric Association

website http://www.apa.org/helpcenter/data-behavioral-health.aspx.

References

• Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry, Eva M

Shelhub, alan C Logan, and Alison C Bested, Journal of Physiological Anthropology

• Gut Bacteria by Megan D Baumler, PhD, RD, CD, Today’s dietitian Vol 15 No. 6 P. 46 (june 2013 issue)
• Gut health’: a new objective in medicine? Bischoff BMC Medicine, 2011, 9:24, Stephan C Bischoff

http://www.biomedcentral.com/1741-7015/9/24

• Gut Health and Immunity—It’s All About the Good Bacteria that can help figh disease, by Lori Zanteson,

Today’s Dietitian, Vol. 14, No. 6, P. 59, June 2012

• Harrar, S. (2012, January). Omega-3 Fatty Acids and Mood Disorders. Today’s Dietitian, Vol. 14(1), 22.
• Microbes for Mental health by M. Mihalovic and Lauren LeBano, Psych Congress Nework (official

publication of US Psychiatric and Mental Health congress), fall/winter 201, vol1. No.2, pg 34

• Peet, M., & Stokes, C. (2005). Omega-3 faty acids in the treatment of psychiatric disorders. Drugs, 8, 1051-

1059.

• The Gut Microbiome and Diet in Psychiatry: Focus on Depression. Sarah Dash, Gerard Clarke, Michael

Berk, Felice N. Jacka, curr opin psychiatry 2015/ 28 (1): 1-6