Introduction:

“It is our brain’s job to allow us to cope with stress effectively, but to do that, it need to be fed optimally!” 

As we all know, prevention itself is a powerful long-term strategy in our fight against addiction. It takes many shapes and forms, but the key is to build resilience in vulnerable populations. In this position paper, you will learn powerful strategies which use targeted nutrition and education to directly support brain health in these populations, thus laying the foundation for more robust engagement in all other prevention strategies. 

Prevention as a 3-legged Stool:

Just like we think of addiction itself as a bio-psycho/social and spiritual process, driven by imbalances in the brain, so do we think about prevention and treatment as following the same structure. See https://www.youtube.com/watch?v=sQRXau3hwfo. So how do we apply this approach to Prevention itself?

To address the biochemistry of addiction before addiction occurs, several questions must be asked:

  1. What do we even mean by “the biochemistry of addiction”?
  2.  Does the target population understand the necessity of proper nutrition to robust mental health and stress resilience? 
  3. Are they actually able to consistently feed themselves what is needed?
  4. Do local prevention staff and treatment providers understand this necessity and are they able provide support to the target population in developing and maintaining these particular self-care skills?
  5. Are the local medical providers educated in how to identify and address common underlying physiological issues that can drive mental health symptoms such as depression, anxiety, violence, insomnia, etc., before the need for relief which drives self-medication becomes overwhelming?
  6. What are the requisite programs that local treatment providers can put into place, and what type of funding is needed and might be available? 

The Biochemistry of Addiction:  This refers to all of the genetic and physiological issues which interfere with stress resilience, and create or contribute to the distressing symptoms of depression, anxiety, insomnia, acute emotional pain, etc, which drive some people to seek relief by using mood altering chemicals and behaviors, or which grab ahold of them when they are introduced to such substances and behaviors (such as gambling or gaming). 

While typically psychotropic medication is the only resource offered to provide biochemical support, in reality we have found that feeding the brain the nutrients it needs to function optimally, goes a long way towards alleviating these symptoms. Feeding the brain what it needs to function optimally, also goes a long way towards giving youth and adults much better stress resilience, as well as supporting the ability to learn and use effective coping skills. (See references below)

Advanced approaches (to be addressed after healthy eating is in place) to addressing the underlying biochemical which can predispose someone to addictive behavior, or drive the painful mental health issues which lead people to seek relief through addictive behaviors include the following: 

  • Genetic polymorphisms such as MTHFR and COMT, along with the snps throughout the neurotransmitter pathways which characterize Reward Deficiency Syndrome. 
    • These can be addressed using nutrient supplements.
  • Imbalanced or depleted neurotransmitter systems due to such snps, nutrient deficiencies, illness, chronic stress, PTSD. 
    • These can be addressed using high protein food and targeted amino acid supplements, available over-the-counter.
  • Essential Fatty Acid deficiencies due to lack in the diet or difficulty with digestion. (Difficulty digesting protein may also be an issue).
    • This can be addressed through diet, fish or flaxseed oil supplements, and digestive aids. 
  • Food Allergies and Intolerances to foods such as gluten and casein.
    • It takes 4 days to get an allergen out of the body. Eliminating the food for 7-10 days will give you a clear answer most of the time, or blood tests are also available. 
  • Hormone Imbalances: PMS and Menopause are high risk times for emotional dysregulation and starting or relapsing into addictive behaviors. 
    • Dietary and nutrient support helps here as well.
  • Chronic infection such as Lyme disease, heavy metal or mold toxicity and pain conditions.
    • The key here is accurate diagnosis, and patient, supportive treatment.
    • There are many psycho-social tools for chronic pain management, which are often ignored by pain management doctors.

Incomplete Nutrition Understanding and Commitment: Most teenagers and many adults don’t care about what they eat. They’ve never been taught that it actually matters to their emotional well-being, stress resilience, school and job success, and/or addiction recovery. As a result, nutrient intake typically falls very short of what is recommended for a healthy body and optimal brain function. 

  • Among other things, protein provides the amino acids building blocks for our all-important mood-mediating neurotransmitters in the brain. Low neurotransmitter levels cause mental health symptoms and cravings for addictive substances. The FDA recommends a minimum of around 50 grams of protein/day for older teenagers and adults. For example, 2 eggs=14 grams.
  • There is a reason why the FDA recommends a minimum of 6 servings of fruits and vegetables/day. Fruits and vegetables provide fiber to create a healthy microbiome, and keep us regular. They also provide the vitamins and minerals necessary for optimal brain health. For instance, low levels of Vitamin D and zinc, as well as the B vitamins and other nutrients actually cause depression and anxiety. 
  • Healthy fats such as the omega 3’s, phospholipids from beans, egg yolks and seeds, and even cholesterol are also required for neurotransmitters to function properly, so not eating enough healthy fats also contribute to depression and anxiety. For instance, very low cholesterol levels correlate with increased suicidal ideation and behavior. If we don’t eat the raw materials our brains require, they can’t do their job, and we suffer. Or, if we eat too many trans fats from processed and deep-fried foods, our healthy fats can’t effectively do their mood-regulating job.
  • Furthermore, stable blood sugar through eating regularly throughout the day, also prevents yo-yo mood and energy from the adrenaline spike that follows a drop in blood sugar. Many kids and adults regularly skip one or two meals, or snack on sugary and starchy treats which are very low in crucial nutrients and create mood and behavioral disruption. 

Research increasingly indicates that a better diet translates into improved mental and behavioral health. And we know that improved mental health is part of prevention. Thus, educating people in these concepts is crucial to prevention.

Possible Solutions & Action StepsMany kids, as well as their parents have never been taught how to cook simple, healthy meals. Knowing how to stretch food dollars may also be an issue. (Btw, a large bag of potato chips costs about the same as a bag of organic apples.) Thus, fun education and encouragement in these areas can truly make a difference. 

Most Prevention Initiatives, along with most treatment programs do not make it a point to teach their clients how to feed their brains optimally or that it even matters. Some programs provide healthy food and even some basic nutrition education, but don’t help their clients connect the dots between what they eat, how they feel emotionally, behaviors such as violence, ditching school, poor grades, and self-harm, along with their cravings for addictive substances and behaviors. I believe that helping our clients (along with our children) connect these dots, and learn how to shop, cook and eat brain food should be a crucial piece of prevention planning.

Programming could include:

  • Providing healthy protein rich snacks and meals.
  • Teaching basic cooking classes and holding fun cooking competitions.
  • Teaching budgeting, shopping and pantry stocking skills. This could include grocery store tours.
  • Holding discussions around the following topics:
    • What is your relationship to food and feeding yourself?
    • Do you think that some of your anxiety, anger, trouble in school, etc. might be related to missing one or more meals?
    • What are your favorite sources of protein?
    • What are your favorite fruits and veggies?
    • Did you learn how to shop and cook as you were growing up?
    • What is your relationship to sugar?
    • At each individual session or group ask about healthy eating:  
      • Clients need frequent reinforcement  
      • Problem-solve compliance issue
    • Each time a client reports a distressing symptom, craving, or a slip, ask them: 
      • When was the last time you ate protein prior to…..?
  • Using a tool such as the attached Food/Mood/Craving 24-hour diary to help people connect the dots.
References:

Dipnall, Joanna F., Julie A. Pasco, Denny Meyer, Michael Berk, Lana J. Williams, Seetal Dodd, and Felice N. Jacka. 2015. “The Association Between Dietary Patterns, Diabetes, and Depression.” Journal of Affective Disorders 174 (March): 215–224.

Firth, Joseph, Wolfgang Marx, Sarah Dash, Rebekah Carney, Scott B. Teasdale, Marco Solmi, et al. 2019. “The Effects of Dietary Improvement on Symptoms of Depression and Anxiety.” Psychosomatic Medicine 81 (3): 265–280.

Higher Sugar Intake Linked to Depression in Men. http://www.medscape.com/viewarticle/883604. Accessed July 31, 2017

Hunter P. Your decisions are what you eat. Metabolic state can have a serious impact on risk-taking and decision-making in humans and animals. EMBO Rep. 2013;14(6):505-508. doi:10.1038/embor.2013.69.

Jacka, Felice N., Adrienne O’Neil, Catherine Itsiopoulos, Rachelle Opie, Sue Cotton, Mohammadreza Mohebbi, et al. 2018. “The SMILES Trial: An Important First Step.” BMC Medicine 16 (1). 

Jacka, Felice N., Adrienne O’Neil, Rachelle Opie, Catherine Itsiopoulos, Sue Cotton, Mohammedreza Mohebbi, et al. 2017. “A Randomised Controlled Trial of Dietary Improvement for Adults with Major Depression (the ‘SMILES’ Trial).” BMC Medicine 15 (1): 23.

Jacka, Felice N., Julie A. Pasco, Arnstein Mykletun, Lana J. Williams, Allison M. Hodge, Sharleen Linette O’Reilly, Geoffrey C. Nicholson, Mark A. Kotowicz, and Michael Berk. 2010. “Association of Western and Traditional Diets with Depression and Anxiety in Women.” American Journal of Psychiatry 167 (3): 305–311.

Jacka FN, Kremer PJ, Leslie ER, et al. Associations between diet quality and depressed mood in adolescents: results from the Australian Healthy Neighbourhoods Study. Aust N Z J Psychiatry. 2010;44(5):435-442. doi: 10.3109/00048670903571598

Jacka FN, Maes M, Pasco JA, Williams LJ, Berk M. Nutrient intakes and the common mental disorders in women. J Affect Disord. 2012;141(1):79-85. doi: 10.1016/j.jad.2012.02.018.

Jacka FN, Ystrom E, Brantsaeter AL, et al. Maternal and early postnatal nutrition and mental health of offspring by age 5 years: a prospective cohort study. J Am Acad Child Adolesc Psychiatry. 2013;52(10):1038-1047. doi: 10.1016/j.jaac.2013.07.002.

Hoare E, Millar L, Fuller-Tyszkiewicz M, et al. Associations between obesogenic risk and depressive symptomatology in Australian adolescents: a cross-sectional study. J Epidemiol Community Health. 2014;68(8):767-72. doi: 10.1136/jech-2013-203562.

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Nanri A, Eguchi M, Kuwahara K, et al. Macronutrient intake and depressive symptoms among Japanese male workers: the Furukawa Nutrition and Health Study. Psychiatry Res. 2014;220(1-2):263-268. doi: 10.1016/j.psychres.2014.08.026.

O’Neil A, Quirk SE, Housden S, et al. Relationship between diet and mental health in children and adolescents: a systematic review. Am J Public Health. 2014;104(10):e31-42. doi:10.2105/AJPH.2014.302110.

 ∙ Opie RS, Itsiopoulos C, Parletta N, et al. Dietary recommendations for the prevention of depression. Nutr Neurosci. 2016;20(3):1-11. doi:10.1179/1476830515Y.0000000043

Opie, Rachelle S., Adrienne O’Neil, Catherine Itsiopoulos, and Felice N. Jacka. 2015. “The Impact of Whole-ofDiet Interventions on Depression and Anxiety: A Systematic Review of Randomised Controlled Trials.” Public Health Nutrition 18 (11): 2074–2093.

Parletta N, Zarnowiecki D, Cho J, et al. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutr Neurosci. 2017:1-14. doi:10.1080/1028415X.2017.1411320.

Penckofer S, Quinn L, Byrn M, Ferrans C, Miller M, Strange P. Does glycemic variability impact mood and quality of life? Diabetes Technol Ther. 2012;14(4):303-310. doi:10.1089/dia.2011.0191. 

Sánchez-Villegas A, Henríquez-Sánchez P, Ruiz-Canela M, et al. A longitudinal analysis of diet quality scores and the risk of incident depression in the SUN Project. BMC Med. 2015;13(1):197. doi:10.1186/s12916-015-0428-y. 

Segoviano-Mendoza, Marcela, Manuel Cárdenas-de la Cruz, José Salas-Pacheco, Fernando Vázquez-Alaniz, Osmel La Llave-León, Francisco Castellanos-Juárez, et al. 2018. “Hypocholesterolemia Is an Independent Risk Factor for Depression Disorder and Suicide Attempt in Northern Mexican Population.” BMC Psychiatry 18 (1): 7.

Shih-Hsien Lin, PhD, Yen Kuang Yang, MD, Sheng-Yu Lee, MD, Pei Chun Hsieh, MD,

Po See Chen, MD, PhD, Ru-Band Lu, MD, and Kao Chin Chen, MD. (J Addict Med 2012;6:    287–291). Association Between Cholesterol Plasma Levels and Craving Among Heroin Users.  Also see (Partonen et al., 1999; Buydens-Branchey et al., 2000; Chen et al., 2001; Lehto et al., 2008).

Sprague, Jennifer E., and Ana María Arbeláez. 2011. “Glucose Counterregulatory Responses to Hypoglycemia.” Pediatric Endocrinology Reviews

This article is prepared by:
Christina Veselak, MS, CN, LMFT
Director, Eating Protein Saves Lives, Inc.  501c3
www.eatingproteinsaveslives.org
65 Dana Drive, Wayne WV, 25570
303-888-9617

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