Stress, Cortisol and the Food for Mood Diet

June 2014

Stress, Cortisol and the Food for Mood Diet

Written by Millie Lytle ND, MPH, CNS

Mood disorders are among the fastest rising health conditions across the world. It has been estimated that by 2020, depression will rank second in disease burden worldwide, and first in developed countries.¹ Depression and its comorbidities (general anxiety disorder, social phobia, panic disorder, and obsessive-compulsive disorder) have been linked to obesity and other chronic conditions of metabolism involving high glucose, insulin, and cholesterol/triglycerides. Diet is also linked to type-2 diabetes mellitus and heart disease. However, it is plausible that dietary mediation of the metabolic role of nutrition may have the ability to improve mood disorders. As the rate of mental illness increases, it is becoming even more crucial to address the physiological connection between diet and mood disorders, and to explore the metabolic causes as well. Research has shown a predictive correlation between the increasing rates of depressive disorders and those with blood sugar and cholesterol regulation problems.³

Dietary Approaches

Metabolic risk–mediated dietary counseling regimen may be effective in treating depressive disorders by moderating the intake, type, and ratio of carbohydrates, protein, and fats in the diet and the physiological response to these foods. Stress and nutrition both play important roles in depressive conditions because they affect our hormones and neurotransmitters. Wurtman ⁵ found that when under trauma or stress, a malnourished or obese individual was more susceptible to anxiety and depression. Lustig⁶ suggests that a likely cause is the effect on blood glucose and insulin levels after stimulation of the hypothalamic-pituitary-adrenal axis (HPA axis). Another key to nutritional intervention is to improve the health of the satiety signals in the digestive tract. By eating foods that increase the hormone Leptein you can stimulate satiety, or the feeling of fullness. Likewise, you can change your diet in order to decrease Grehlin, the hormone that tells your brain you are still hungry. Changing the gut response to food also helps stimulate Serotonin receptors in the intestines. In response to this promising research, I developed the Food for Mood Diet to attempt a nutritional counseling treatment for patients with depression who are at risk of metabolic disorders.

What is Cortisol?

Cortisol is a stress hormone produced in the adrenal glands. We need this hormone in order to simply wake up in the morning. However, too much stress can stimulate the hypothalamus of the brain, signaling the adrenal glands to product cortisol too often. High cortisol can cause problems affecting mood, weight and sleep. High levels of cortisol secretion can cause sleep issues such as early morning waking, anxiety, agitation and weight gain. Over long periods of time, if unattended, cortisol secretion may actually become a vicious chain of events that leads to some of the most common lifestyle illnesses currently faced by those of us living in the Western world: depression, anxiety, obesity, hypothyroidism, central obesity and diabetes. Fortunately, though, there are nutritional interventions and lifestyle factors to mitigate the one-way relationship between stress, cortisol and chronic illness. In fact, chronic disease may even be reversible.

After identifying that hyperglycemia or hypoglycemia symptoms and panic or anxiety symptoms had much overlap, I began to suspect that my patients might not be able to tell where one group of symptoms ended and the other began. So, before reaching for that Ativan, check here to see if your moods overlap with symptoms of high or low blood sugar:

High Blood Sugar or Hyperglycemia

When fasting blood sugar remains above 100 mg/dL in the majority of people. Diabetes is diagnosed at 126 mg/dL.
Hyperglycemia develops over time.

How do you get it?

• Eating, snacking or drinking sweet beverages too frequently (every 1-2 hours)
• Eating sugar and refined carbohydrates too frequently
• Eating high-calorie diet, especially in the evening
• Insulin stops being as sensitive to presence of sugar in the blood
• The pancreas stops producing as much insulin
• Insulin builds up in the liver

Low Blood Sugar or Hypoglycemia

When fasting blood sugar falls below 70 mg/dL, the majority of people will notice symptoms.

How do you get it?

• Not eating breakfast
• Going long periods of time without eating
• Eating too much sugar and refined carbs
• Your body mistakenly sends too much insulin in to correct these poor habits. This is called “reactive hypoglycemia”. Your belly may be full, but your brain is actually starving!

Source: Mayo Clinic

The Food for Mood Diet

If you are already following Weight Watchers, the Mediterranean Diet, the Paleo Diet or another diet regime you can incorporate the Food for Mood Diet, too! The Food for Mood Diet is a series of eating guidelines based on naturopathic nutrition and clinical nutrition research. Here’s how to follow this effective diet plan:

1. Eat breakfast within an hour of waking. Mitigate stress by eating every 3-4 hours. Food stabilizes blood sugar and prevents hypoglycemia. Eating regularly controls hunger levels, so binging is less likely. Nabb and Benton¹² found that individuals with higher glucose tolerance report better moods. Although the brain functions on glucose, those who eat breakfasts containing greater amounts of simple carbohydrates report more fatigue and memory loss. Those who don’t eat breakfast at all are at risk for panic attacks on the subway¹². Irregular eating causes blood sugar fluctuations and triggers a stress response.

2. Avoid ALL-CARB meals. Trauma, medication, and daily stress play a large role in mediation of the HPA axis, predisposing patients to mood disorders, the metabolic syndrome, and other chronic illnesses. However, research shows that daily nutrient intake can alter the ability of an individual to cope, either by preempting or facilitating a continuation of the HPA-induced glucose and insulin resistance.⁷ In contrast, drinking soda pop and other high-calorie beverages does not increase satiety, but rather increases glucose levels and overall caloric intake.

3. Remember this: fiber is filling; sugar is killing! All carbs are not created equal! Flood¹¹ and team observed that eating low-calorie, high-fiber vegetables in salads or soups prior to a meal increases satiety without increasing blood glucose levels. In a 2002, cross-national epidemiological study of major depression and bipolar disorder, Westover and Marangell⁸ reported a correlation between sugar consumption (calories per capita per day) and national prevalence of major depression. Although the cause was speculative, six countries demonstrated an association of sugar consumption with annual depression rate.

4. Eat vegetables. No matter what else you eat, never skip the veggies. In a clinical trial, Markus⁹ found that eating regular meals that include complex carbohydrates (with fiber) results in better performance, improved mood, and increased tryptophan levels. Stress was found to increase cortisol, blood glucose, and insulin levels, and also to worsen mood and cognitive performance. Wurtman⁵ also found that dietary and pharmacological interventions that increase serotonin activity normalize food intake and diminish depressed mood, suggesting that daily diet can affect future food intake.

5. Make the best choice you can right now. But don’t beat yourself up for making mistakes. What someone eats one day has an effect on their dietary choices, portion sizes, and mood up to 11 days later.¹⁰ If you didn’t do your best today, do your best tomorrow. Research shows what you do today can predict your level of health for the next 20 years.

6. Start a meal with green tea, soup or salad to initiate digestion and increase satiety signals. The fuller you are, the more satiety signals will be stimulated in brain to stop eating. A diet lacking in protein causes fatigue, light-headedness, brain fog, and persistent hunger, which may be concomitant with anxiety and depressive symptoms. Eating complex carbohydrates is beneficial, while consuming simple carbohydrates such as sweetened beverages may increase appetite. Green tea has been shown to increase satiety signals when taken prior to a meal¹⁷.

7. Eat protein at every meal and snack. Yes, organic chicken is good – but remember to eat fish, small amounts of organic red meat, beans, raw nuts and seeds, sprouts, legumes and algae. A diet lacking in protein causes fatigue, light-headedness, brain fog, and persistent hunger, which may be concomitant with anxiety and depressive symptoms. Levels of dopamine and norepinephrine are increased by the consumption of protein-rich foods. Depletion of the body’s stored nutrient is a major cause of hunger.

8. Remember to include fatty fishes and other sources of Omega-3 fatty acids. A study in Finland found that people who eat more fish are 31 percent less likely to suffer from depression¹⁴. Take Fish Oils and Krill Oil to supplement the diet with mood healthy Omega 3 fatty acids that support metabolism.

9. Probiotics take precedent. Strains of probiotic are associated with appetite control and mood regulation. Strains of probiotic are associated with appetite control, mood regulation and weight management. In fact, there are receptors that signal serotonin as well as hunger and satiety signals in the intestines. Those with higher numbers of good bacteria such as lactobacillus and bifidus in their intestines may have better appetite control (higher leptein and lower grehlin levels)¹⁵, which may lead to a better brain chemistry and better mood¹⁶.

Research shows a direct link between high sugar consumption in the daily diet and diabetes and mood disorders due to a negative feedback cascade in the HPA axis. Because diseases like diabetes and mental illness are the result of a process that develops over time, the signs, symptoms, and metabolic damage can go on for years or even decades before transitioning into a medical diagnosis. This is why it’s so important to recognize the early signs and symptoms of a disease process before its diagnosis. This way, nutritional intervention can do its job effectively!

References:

1. Canadian Psychiatric Association. Mental Illness Awareness Week Guidebook. Ottawa, ON: Canadian Psychiatric Association; 2001.
2. Lake J. Integrative mental health care: from theory to practice, part II. Altern Ther Health Med. 2008; 14 (1):36-42.
3. Skilton MR, Moulin P, Terra JL, Bonnet F. Associations between anxiety, depression, and the metabolic syndrome. Biol Psychiatry. 2007; 62 (11):1251-1257.
4. Mozaffarian D, Kamineni A, Prineas RJ. Metabolic syndrome and mortality in older adults: the Cardiovascular Health Study. Arch Intern Med. 2008; 168 (9):969-978.
5. Wurtman JJ. Depression and weight gain: the serotonin connection. J Affect Disord. 1993; 29 (2-3):183-192.
6. Lustig RH. The ‘skinny’ on childhood obesity: how our Western environment starves kids’ brains. Pediatr Ann. 2006; 35 (12):898-902, 905-907.
7. Poulin MJ, Chaput JP, Simard V, et al. Management of antipsychotic-induced weight gain: prospective naturalistic study of the effectiveness of a supervised exercise programme. Aust N Z J Psychiatry. 2007; 41 (12):980-989.
8. Westover AN, Marangell LB. A cross-national relationship between sugar consumption and major depression? Depress Anxiety. 2002; 16 (3):118-120.
9. Markus CR. Effects of carbohydrates on brain tryptophan availability and stress performance. Biol Psychol. 2007; 76 (1-2):83-90.
10. Rolls BJ, Roe LS, Meengs JS. The effect of large portion sizes on energy intake is sustained for 11 days. Obesity (Silver Spring). 2007; 15 (6):1535-1543.
11. Flood JE, Roe LS, Rolls BJ. The effect of increased beverage portion size on energy intake at a meal. J Am Diet Assoc. 2006; 106 (12):1984-1991.
12. Nabb SL, Benton D. The effect of the interaction between glucose tolerance and breakfasts varying in carbohydrate and fiber on mood and cognition. Nutr Neurosci. 2006; 9 (3-4):161-168.
13. Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain, part 2: macronutrients. J Nutr Health Aging. 2006; 10 (5):386-399.
14. Tanskanen A, Hibbeln JR, Tuomilehto J, Uutela A, Haukkala A, et al. . Fish consumption and depressive symptoms in the general population in Finland. Psychiatr Serv. 2001 Apr; 52 (4):529-31.
15. Queipo-Ortuño MI, Seoane LM, Murri M, Pardo M, Gomez-Zumaquero JM, et al. Gut microbiota composition in male rat models under different nutritional status and physical activity and its association with serum leptin and ghrelin levels. PLoS One. 2013 May 28; 8 (5):e65465.
16. Tillisch K. Gut Microbes. The effects of gut microbiota on CNS function in humans. 2014 May 16; 5 (3). [Epub ahead of print]
17. Josic J1, Olsson AT, Wickeberg J, Lindstedt S, Hlebowicz J. Does green tea affect postprandial glucose, insulin and satiety in healthy subjects: a randomized controlled trial. Nutr J. 2010 Nov 30; 9:63.

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