Nutritional Psychiatry & Addiction

Nutritional Psychiatry, Nutraceuticals, Gut Microitomes and Staying Sober.G

Nutritional Psychiatry is an emerging science led by a small number of neuroscientists and researchers from all around the world.  Just this past week, the International Society for Nutritional Psychiatry Research (“ISNPR”) convened in London.   The ISNPR was formed in 2013 and held its first conference in Washington D.C. in 2017.    It was founded by Dr. Felice Jacka, of Deakin University in Australia.  Dr. Jacka also founded the FoodMood Center at Deakin.  FoodMood is among the leading research institutions in the world studying the relationship between nutrient’s in food, the role of these nutrients to our overall physical and mental health and how nutrients can be utilized as a component of mental health treatment.  Dr. Jacka describes the field of nutritional psychiatry as in its “infancy”.   Many of the presenters noted that knowledge of nutrition itself generally still in its infancy. 

Tom with Dr. Jacka, founder of the FoodMood Center at Deakin University.

Given many of these terms may be new to you, I’ll define them, so we are all on the same page.

Nutritional Psychiatry:  A growing scientific discipline that focuses on the use of food and supplements as a component of traditional psychiatric treatment for mental health disorder.  NP is not intended to replace individual or group therapy or use of prescribed pharmaceutics but rather as a component of an overall treatment plan.   

Nutraceuticals: Nutraceuticals are a broad umbrella term that is used to describe any product derived from food sources, with extra health benefits in addition to the basic nutritional value found in foods. They can be considered non-specific biological therapies used to promote general well-being, control symptoms and prevent disease.

Gut Microbiota: The gut microbiota is comprised of all the bacteria residing in the gastric system including the large intestine. In the past decade the gut microbiota has been explored for potential effects on metabolism, immune, and neuroendocrine responses. The gut microbiota plays an important role in nutrient and mineral absorption, synthesis of enzymes, vitamins and amino acids, and production of short-chain fatty acids. The fermentation byproducts are important for gut health and provide energy, protect against pathogens and disease and strengthen the immune system. 

Physicians Are Often Not Trained in Nutrition

If you feel like you know very little about nutrition, you’re not alone.  Even doctors admit a lack of reliable data and knowledge about the role of diet in the health of their patients.  A 2017 survey of MD’s in the United States found that 75% of MD’s surveyed felt their training, in regard to nutrition, to be inadequate.  An even smaller percentage believe they understand the complex structure of the gut microbiota, fungi and other living organisms contained in your digestive system and how these organisms and brain function (I refer to these organisms collectively as gut microbiota in this article).  Lastly, 85% of the doctors who responded to the survey felt additional nutrition training should be provided as part of a medical school curriculum.  

Spiritual Adrenaline: A Self-Care Lifestyle

The underlying foundation of the Spiritual Adrenaline lifestyle is self-care, in the context of what you eat and your exercise regimen, can play an important role in achieving happiness in sobriety, while dramatically lowering relapse rates.  My book, Spiritual Adrenaline: A Lifestyle Plan to Strengthen & Nourish Your Recovery, contains extensive chapter notes to support my recommendations.  This is important because there’s so much misinformation on social media and a tendency for well-meaning, but misguided advocates, to parrot back things they hear or read online, rather than conduct their own independent due diligence.  Writing Spiritual Adrenaline took five years because of the time it took to locate reliable, peer-reviewed studies, that addressed the science underlying nutrition and exercise, in the specific context of substance abuse treatment.

Valerie L. Darcey, National Institutes of Health

That’s what made attending the ISNPR 2019 conference so interesting!   Having so many of the leading researchers in the world in one place, at one time, was remarkable.  I felt like the proverbial kid in the candy store, trying to attend as many of the sessions as possible.   I have lots of “homework” to do in the weeks and months to come.   I’ll be reading many of the more than forty studies released at the conference!  Many were presented at the conference for the first time publicly and are yet to be published. I’ll also use the data for my Spiritual Adrenaline 2020 Update which will come out in January 2020!  I want to make sure Spiritual Adrenaline is an up-to-date resource you can count on for reliable information.  I’ve omitted study citations in this article but will include them in the January 2020 Spiritual Adrenaline 2020 Update. To learn more about the science behind the benefits of integrating exercise and nutrition into your recovery, visit our YouTube Channel, Facebook page, Instagram feed or website at www.spiritualadrenaline.com.  

Because your health is so important to me, here are some key scientific updates that I want to share with you now!!!

Diet, Addiction & Disease

            Medical knowledge regarding the role substances play in disease common in individuals with a history of substance abuse is changing. For example, it was long thought that the ethanol in alcohol was the direct cause of damage to the liver, resulting in disease of liver, including alcoholic fatty liver.  Research has now confirmed that rather than the alcohol (ethanol) causing the damage, it’s how the alcohol impacts gut microbiota, that is the actual cause of liver damage.  In other words, the conditions caused by excessive alcohol intake in relation to gut microbiota is what ultimately causes damage to the liver, not the ethanol itself.  Given this ground-breaking change in our understanding of how liver damage is actually caused, it’s possible that new treatments, including modification of diet to impact gut microbiota, can be developed. 

Fermented Fiber & Addiction Recovery

            In Spiritual Adrenaline, the import of fiber is explained at length, i.e., stabilization of blood glucose as well as colon health.   See Spiritual Adrenaline, Chapter 3, pages 21-36.  Recent research confirms fiber contained in fermented foods enables your body to create a wider range of healthy metabolites, which enhances the biodiversity of your gut microbiota.   Although science has recognized the import of fermented foods and fiber for years, the research is among the first to fermented foods to diversification of gut microbiota. 

Substance Abuse Treatment & Diet

To date, there is no clinical trial research that confirms the relationship between modification of gut microbiota and more favorable substance abuse treatment outcomes in humans.  1990 was the last time nutritional guidelines for treatment of substance abuse disorder were updated.  The consensus among researchers is that as a discipline, we are not “there yet” with the science to the extent of promulgating dietary guidelines.   Given the dearth of updated recommendations, presenters at the ISPNR conference focused on two separate areas of nutrition:  during early treatment and in long-term recovery.   Presenters also recognized that the line distinguishing “early” and “long-term” recovery will be different for each individual and a subjective, rather than objective, standard.  Also, that recommendations in whatever guidelines are ultimately adopted should distinguish between short and long-term recovery.

Drug Use and Microbiota

 Studies have already confirmed that cocaine, meth, Opioids and alcohol all have major impact on the composition of gut microbiota.  Moreover, Opioids dramatically impact the function of the gastric system by substantially delaying the digestive process.  For example, some Opioid addicts will not have a bowel movement for up to two weeks.  Combine this with the well-established fact that when Opioid addicts eat, they favor sugary foods and drinks.  The gut microbiota of Opioid addicts in active addiction and how this can impact their brain function, cravings and other associated behaviors, needs further study. A second major issue ripe for research is the impact of commonly prescribed medications in early and long-term recovery, on gut microbiota.  In Spiritual Adrenaline, I looked at how medications often prescribed in addiction recovery can impact nutrient retention.  See Spiritual Adrenaline, Chapter 7, page 76.  Science is now broadening that understanding to include how medications can impact gut microbiota and they in turn other biological function including brain function. This area will continue to develop in the years to come. 

Gut Health, Hormones and Cravings

When a person enters treatment, the cessation of the usage of their drug of choice can impact the production of hormones and other substances in the body relating to behavior.    An example is the hormone Ghrelin which can have a direct impact on impulsivity, anxiety and depression.  Alcohol cessation is known to increase Ghrelin production. This is thought to play a major role in cravings and anxiety experience by people in early recovery.  In the long-term, managing gut microbiota may empower treatment providers to better help those seeking treatment to have more direct control over Ghrelin levels.   For example, science has proven that unprocessed foods suppress Ghrelin levels.  The challenge will be to come up with dietary guidelines that promote the creation of positive gut microbiota while creating a diet acceptable to the palate of someone in early recovery.

Studies Nearing Publication

Publication of two studies of great interest to this community are expected in the near future.   One is a study of the impact, if any, of a ketogenic diet on cravings in the first six months of recovery.  A second study followed people in recovery who ate a plant-based diet for a period of one year to determine if their diet had any measurable impact on relapse rates. 

Impact of Diet on Depression

Given the prevalence of anxiety and depression in the addiction recovery community, I prioritized attending presentations relating to research studies on these topics.  What I learned was fascinating.   Ten years of extensive studies have shown a strong link of increased risk of depression in adults who consume a highly processed diet.  In fact, a yet unpublished study confirmed a 30% reduced risk of depression in people who eat a healthier diet, irrespective of bodyweight.  The study also found that diet quality has a direct correlation with increased rates of depression as people age.  Those who consumed a Mediterranean or Japanese diet, had substantially lower rates of depression, than those who consumed highly processed foods common in a western diet. 

Impact of Gut microbiota on Depression

Researchers fed laboratory rats a highly processed “western type” diet along with sugary water, to mimic soda consumption.   The rats were fed this diet for a period of six weeks.   Over those six weeks, the rats manifested behaviors consistent with depression, i.e., lack of activity and reduced socialization (rats are very social animals).  Researchers then removed gut microbiota from these rats and injected the microbiota into a second group.  The second group were not fed the highly processed and sugary diet and had not manifested depressive symptoms at the time of injection.   After being injected with gut microbiota taken from the depressed rats, this group also developed depressive behaviors.  The study confirmed the direct correlation between diet, gut microbiota and brain function. The study’s conclusion is consistent with findings of other studies that gut microbiota are able to penetrate the blood/brain barrier and impact brain function.   

Impact of Diet on the Brain

David Wiss presenting. David is an internationally recognized expert on diet and addiction.

Researchers sought to understand the Impact on the hypothalamus, the part of the brain responsible for a number of critical functions, including prompting production of hormones, of foods common in a western pro-inflammatory diet, over a short period of time.  In the study, one group of rats were placed on this diet for a period of eight weeks while another control group were fed a healthier diet (consistent with Mediterranean diet).   The heavy sugar intake resulted in hippocampal inflammation in the brain, in only five days.  Eight weeks on western pro-inflammatory diet resulted in the rats developing hypertension.    

Impact of Omega-3 Fatty Acids on Depression

            Research confirms that an increase in daily intake of Omega-3 fatty acids relieves symptoms of major depressive disorder (“MDD”).  Researchers measured markers of inflammation, including C Reactive Protein (“CRP”), in overweight individuals who were also diagnosed with MDD.  One group of study participants was given 4 grams of Omega-3 each day while following a Mediterranean diet. The other followed a similar diet but did not receive supplemental Omega-3.  Dosages of 1 to 2 grams of Omega-3 per day were recommended as a supplement for this group.  However, those participants who received 4 grams a day, had the greatest reduction in CRP markers.  The correlation between a reduction in CRP changes and group that received 4 grams a day.   Researchers also noted substantial potential for use of Omega-3 as a preventative treatment for those with a higher risk of MDD.

Impact of Omega-3 for PTSD and Anxiety

Researches in Japan sought to ascertain the impact, if any, of Omega-3 intake on people diagnosed with Post-Traumatic Stress Disorder (“PTSD”) and/or anxiety.   The study was comprised of residents of Japan who were diagnosed with PTSD and/or anxiety immediately after a major earthquake.  Researchers integrated daily Omega-3 supplementation into the treatment plan for one group while a second group were given a placebo over a period of several weeks.  The results of study found Omega-3 supplementation, even up to 4 grams per day, had no impact in relation to reducing symptoms of those suffering from PTSD.  However, the study confirmed that for those diagnosed with anxiety, symptoms were relieved in those taking between 2 to 4 grams of Omega-3 daily.   Therefore, the study recommended Omega-3 fatty acids in the range of 2-4 grams to alleviate anxiety.  Current treatment protocols recommend up to 2 grams.  

A final study of interest to the addiction recovery community involved non-nutrition interventions to address anxiety.  The researchers made the following statement at the ISPRN Conference: “Regulation of lifestyle is step zero.  Not step one, it’s step zero.   Lifestyle medicine for people with anxiety and depressive disorder includes…drug and alcohol cessation, diet and nutrition optimization, physical activity regulation and smoking cessation.”

LCDR Kelly Ratteree of the National Institutes of Health

Conclusions & Dietary Recommendations

Each of us is unique, as is our past health history, current health and long-term goals.  The uniqueness of each person is referred to as biodiversity.   In the context of gut microbiota, our biodiversity is magnified. Each of us has trillions, not billions but trillions, of organisms comprising our gut.   No two human beings have identical gut microbiota.   The science is mind-boggling. Although there is no one-size-fits-all approach, certain overall dietary recommendations are in fact supported by science.

Here are my recommendations to: enhance your overall health; thrive in your recovery; and, diminish your chances of relapse.   All of these recommendations are consistent with the recommendations in Spiritual Adrenaline: A Lifestyle Plan to Strengthen and Nourish Your Recovery.  I cite to the relevant pages of Spiritual Adrenaline so you can utilize my book as a resource to learn more on these topics as well as integrate exercise and spirituality. 

Here are my recommendations:

*Recommended dietary fiber intake per person/per day is 30 grams.  If you’re not currently eating a high fiber diet, increase your intake slowly over time.  For example, 2 grams a week to build up your palate and the tolerance of your body to fiber.  For many, this will be a major dietary change.  See Spiritual Adrenaline, Chapter 9, pages 112-120.

*Not all dietary fibers are the same.   Get the full range but at least half of your daily dietary fiber intake from fermented fiber.  Fermented fiber permits your body to create a wider range of healthy metabolites, which enhanced the biodiversity of your gut microbiota.  Increase intake of fermented foods which have been established to enhance diversity of gut microbiota.  Sources of fermented foods include kefir, yogurt, sauerkraut, Kombucha (non-alcoholic), Miso, Tempeh.

* Increase intake of Inulin, a type of fiber comprised of chains of fructose which has long been known to be beneficial for colon health, has been shown to assist in enriching gut microbiota, reducing inflammation and improvements in mental health.   Think of Inulin as a fertilizer for healthy gut microbiota. Inulin can be found in asparagus, garlic, artichoke, onions and beans.   See Spiritual Adrenaline, Chapter 9, pages 112-120.;

*Omega-3, Omega-6 are critical to the health of your body and brain.  As confirmed by study after study at the ISPNR 209 Conference, not only do these fats enhance your overall health, but they help reduce symptoms of anxiety and depression and can even be used for prevention of these conditions. Recent studies suggest the dosage to maximize benefits is 4 grams of Omega-3 and Omega 6 vitamins daily.   Good sources include olive oil, nuts, eggs, red meat, cold water fish, flax oils.  For food choices and information on Omega-3 and Omega-6 fats, see Spiritual Adrenaline, Chapter 3, pages 34-35, Chapter 9, pages 117-119. 

*Increase intake of Polyphenols:        Polyphenols can be found in dark chocolate, strawberries, blackberries, raspberries, blueberries, pomegranates, black beans, white beans, hazelnuts, almonds, walnuts, pecans, red onions, artichokes, spinach, chicory, soy, black tea and green tea.  See Spiritual Adrenaline, Chapter 9, pages 112-120.*

*Follow traditional dietary patterns, such as the Mediterranean, Norwegian and Japanese diet.

*Increase fruits, vegetables, legumes, wholegrain cereals, nuts and seeds. See Spiritual Adrenaline, Chapter 9, pages. 112-120. 

*Limit the intake of ultra-processed foods.    Remember, eating whole foods, will suppress Ghrelin levels. 

If you or anyone you love will benefit from this information, make sure to purchase a copy of Spiritual Adrenaline: A Lifestyle Plan to Strengthen & Nourish Your Recovery, on Amazon or at Barnes & Noble.   For more information, visit www.spiritualadrenaline.com. Make sure to look for my Spiritual Adrenaline 2020 Update in January 2020 as well.  This guide and all the other free resources provided by Spiritual Adrenaline are funded through sales of my book.  I don’t take money from any corporate entities.  This keep the information I provide honest and unbiased.  By purchasing Spiritual Adrenaline, you enable me to continue to serve as a valuable resource to the addiction recovery community. 

My best,

Tom Shanahan, Author, Spiritual Adrenaline

Meet the Ladies of Rise & Grind Reno: Hear How an Active Sober Lifestyle Enhanced Their Recovery

Meet the fab four, graduates of the Rise & Grind Reno program in Reno, Nevada.  The program was founded by Grant Denton and has helped turn around the lives of its participants.   This interview was taped in Reno on August 24, 2018.