Everything You Wanted to Know About Mental Health Nutrition and Have the guts to ask

Transcription

1 Everything You Wanted to Know About Mental Health Nutrition and Have the guts to ask Nutritional Therapy Association Dr. Leslie E. Korn March 3rd 2017 Vancouver WA drlesliekorn.com Copyright,Leslie E. Korn,

2 Question diagnosis and diagnostic categories Copyright,Leslie E. Korn,

3 Essential Principles of Mental Health Nutrition Biochemical individuality: Spectrum : Carnivore to Vegetarian Take a Complete history: understand the whole person puzzle Combine: Food, Supplementation, Coaching, Exercise and Detoxification Vitamins, Minerals, Amino Acids, Glandulars,special nutrients Identify strengths and challenges Set doable goals Nourish the relationship and understand how personality and Hx affect the connection Engage the whole family in change Copyright,Leslie E. Korn,

4 Narrative, Meaning and Mindful Eating Explore the meaning of Food Food gathering and preparation History of family and diet, mealtimes In utero experience/breastfeeding etc. Chewing, putting the fork/spoon down Copyright,Leslie E. Korn,

5 Emotional Distress Digestive Distress Where there is mental illness there is digestive dis-ease Anywhere along the way there is a bi directional link to stress.. Digestion occurs in a parasympathetic state. Chewing and swallowing Esophagus Liver Stomach Intestines: Small and Large Elimination Chronic stress inflammation depression self medication behaviors Copyright,Leslie E. Korn,

6 Stress, Trauma and Circadian Rhythm Stress underlies mental illness symptoms Stress and trauma disrupt circadian rhythm Disrupted cortisol rhythm insomnia, depression, blood glucose handling issues, mood disorders, BiPolar ADHD, bulimia, PMS Copyright,Leslie E. Korn,

7 Stress, Trauma and Circadian Rhythm Disrupted circadian rhythm Dysregulated cortisol rhythm insomnia, depression, glycemic dysregulation, mood disorders, BiPolar ADHD, bulimia, PMS, dementia Test: 24 hr. diurnal cortisol to confirm current story and history Copyright,Leslie E. Korn,

8 Emotional Distress and Health 70% of people with addictions have a Hx of Adverse Childhood Events (ACE Score) People with Posttraumatic stress have higher rates of GERD, IBS, tobacco/substances, elective surgeries, chronic pain, autoimmune, GB surgery Chronic stress exacerbates every life stage change PMS peri and menopausal depression, anxiety, insomnia Progesterone is anxiolytic High cortisol Andropause: Low T and depression in men Copyright,Leslie E. Korn,

9 Emotional Stress, Discrimination and Health People of color sleep less than white people- stress of vigilance Higher rates of Gallbladder surgeries among Native peoples, Latino/as Higher rates of diabetes: diabetes begins with chronic stress Stress of Poverty and allostatic load, historical trauma. Migration stress Copyright,Leslie E. Korn,

10 Nutrients to Help Reset Circadian Rhythm Three supplements reset the rhythm- Melatonin.0.5 Methylcobalamin, (vitamin B12) enhances light sensitivity of the clock and regulates cortisol peak Lithium orotate: li-zyme (Lithium rich mineral springs) Bright am light (before 10 am) (reduce sunglass use) Blue light blocking glasses at night Copyright,Leslie E. Korn,

11 Principles of Effective Treatment Isomorphic to the individual Address Cause & Alleviate symptoms Identify preferences and obstacles to ingesting nutrients and supplements Traditional/Ancestral foods Do what will effect change first Identify adherence strategies Address habituation when change occurs Review the protocols/plan every 3 months Balance blood sugar: mood lability due to functional hypoglycemia may be mistaken for bi polar, ADHD, conduct disorder etc. Copyright,Leslie E. Korn,

12 3 Common Mental Health Diagnostic Categories Balance Circadian Rhythm and create lasting change Posttraumatic stress Anxiety Depression Copyright,Leslie E. Korn,

13 The Principle of Substitutions Clinical Intervention Ask: What is the behavior trying to self medicate? Find the food or nutrient that is a substitute for the harmful substance or behavior. Teach: Conscious self medication with foods Psychobiological efforts at self regulation/self-medication gone awry Copyright,Leslie E. Korn,

14 The Bodhisattva Eating figs, rich in tryptophan Copyright,Leslie E. Korn,

15 Arugula Fig Peach Salad From: The Good Mood Kitchen, Norton 2017 Leslie Korn The Buddha gained enlightenment while sitting under a fig tree, perhaps because he was eating the figs that were dropping all around him. Figs are rich in antioxidants, minerals and mood boosting amino acids like tryptophan. The combination of these sweet fruits and bitter greens in this end of summer salad, awaken the senses and stimulate joy. Add some nuts, thinly sliced hard cheese or crisped serrano ham to make a whole meal. 6 ripe Figs 3 ripe Peaches Arugula (Half a bunch) Fresh parsley sprigs Sea salt Wash and dry the greens and then drizzle virgin olive oil very lightly over the greens, salt, toss and set aside. Cutting the peaches into slices and halve the figs. Heat some olive oil in a pan and when hot, place the fig cut side down in the plan and sear for 10 seconds only. Remove and cool. Top the greens with the fruit, and lightly drizzle balsamic vinegar, toss and serve. Copyright,Leslie E. Korn,

16 NT s Amino Acids/ Nutrients Botanicals Foods Entheogens GABA Glutamine, taurine milk derived neuropeptides. lithium orotate, phenibut Valerian, hops, skullcap, green tea, kava Walnuts, oats, spinach, beans liver, mackerel Serotonin Tryptophan, 5 HTP, B-vitamins, esp B-12, B-6, niacicinimide, folic acid St. John s wort Salmon, beef, lamb, figs bananas, root vegetables, brown rice LSD, Psilocybin, DMT, Ibogaine, Ayahuasca Dopamine Tyrosine, DL- Phenylalanine, B-12, B-6 Ginseng, Fenugreek Coffee, tea, eggs, pork, dark chocolate, ricotta cheese MDMA/MDE Mescaline Norepinephrine Tyrosine St John s wort, Holy basil,licorice Acetylcholine GPC choline phosphatidylserine, acetyl-l-carnitine, huperzine Sage, Bacopa, Melissa, Ginkgo, Ashwaganda Glutamate Glutamic Acid Gotu Kola, Kava, Passionflower Meats, fishes cheese Eggs, liver, salmon shrimp, nut butters, coffee Caffeine, fermented foods, chicken, eggs, dairy MDMA/ MDE Mescaline Scopolamine (contraindicated) Ketamine Ibogaine Endogenous opioids Milk biopeptides Papaver somniferum Casein (milk), gluten (grains), spinach, fat, fasting Ibogaine, Salvia divinorum Cannabinoids Fish oil, lactobacilli Cannabis Copyright,Leslie E. Korn, 2017 Hemp seeds/hemp oil Cannabis 16

17 Traditional Foods of Pacific Northwest Copyright,Leslie E. Korn,

18 Glandulars- Foods and Supplements Brain Hypothalamus Pituitary Adrenal Thymus Liver Heart Thyroid Lung Traditional Foods Tripe Lung/ Chanfaina Sweetbreads Heart Liver Tongue Testicles Kidneys Blood Copyright,Leslie E. Korn,

19 Traumatic Stress, Relationship & Program Adherence PTSD/complex trauma Experiences that overwhelm the psycho-bio physio self chronic HPA axis disruption; chronic digestion, pain, addictions Clinical Relationship challenges: trust, hopelessness, shame, self blame, dependency and need Adherence : Learned Helplessness Seligman s research Copyright,Leslie E. Korn,

20 Anxiety, Relationship and Program Adherence A feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome. Microbiome rich in GABA receptors Bidirectional effect (relaxed, integrative states of consciousness) Crohn s, Colitis, IBS and Anxiety Copyright,Leslie E. Korn,

21 Cholesterol Low cholesterol is a biological marker of suicidality Low cholesterol is a risk factor for anxiety Women with total cholesterol over 200 lived longer than those with lower cholesterol Study in Norway of 50,000 women Copyright,Leslie E. Korn,

22 Anxiety and Blood ph Vegetarian (Vegan) diet can lead to over-alkaline state in non biological vegetarians Bidirectional effect Anxiety, hyperventilation, (& asthma) leads to blood alkalosis Over alkalinity exacerbates anxiety and hyperventilation Sigh, holding breath, can t finish sentence in breath, be anxious to please, or about to be doing it correctly Somatic symptoms also include hyperventilation headaches, neck pain, jaw pain, leg and body cramps and tension in the shoulder muscles Tx: Diet Acidify animal proteins Bone broths; rich in glycine; (also for psychotic disorders), celery, oatmeal Reduce dietary stressors; caffeine, sugar Copyright,Leslie E. Korn,

23 Anxiety, Food and Supplementation Supplements to Balance Superphosphozyme (30 drops a day for 1 month) B complex/glucose balance Probiotics & prebiotics (foods and supplements) Magnesium Lithium Supplements/Herbs To Alleviate Symptoms Glycine strips: antagonizes norepinephrine- sublingual: dose: 2-10 grams* 2 gms under the tongue every few minutes in case of anxiety attack/ acute panic Lactium (De-Stress) Theanine VHP Kava Prousky, J. E. Orthomolecular treatment of anxiety disorders. Copyright,Leslie Townsend Letter for Doctors E. Korn, and 2017 Patients. February-March 23

24 Anxiety Yoga specific exercises for anxiety and the respiratory matrix Skin brushing lympathic dissociation/out of body 2005 Copyright,Leslie E. Korn,

25 Hydrotherapy for Anxiety Ice packs to mid thoracic spine Vinegar baths (am) Magnesium sulfate(epsom salt baths)(pm) Copyright,Leslie E. Korn,

26 Case: Sally- 20 yr. old college student Vegan for 2 years, increasing anxiety and fatigue Conducted a 3 days Food/Mood diary* ADHD medication since 11 years old Anxious, depressed, fitful sleep, unfocused, fatigued, allergies High refined carbs, sugary low protein low fat diet Behavioral: belief systems, didn t cook or do much food prep Begin with broths and vinegar baths, vinegar /hemp oil salad dressings Good quality B Vitamin extra B-6 Sorted vitamins with her as we talked Begin food prep and smoothie recipes Slow cooker recipes, Adrenal glandular, probiotics, glutamine, curcumin, black pepper Support & exercise Nutrition Essentials for Mental Health: The complete guide to the food - mood connection Copyright,Leslie E. Korn,

27 The Nutritional Change Process Asking people to change their diet is like asking them to change their religion! Change first what is easiest; obtain early success Change oils, find substitutes for poor quality oils Eliminate the negative while adding in the positive Work where people are: substitute a commercial hotdog and store sauerkraut for an organic hot dog and fresh sauerkraut Identify the best methods and times for ingestion for nutrients Explore Cost Management: probiotic supplements, probiotic food (or both) Copyright,Leslie E. Korn,

28 Depression Inflammation is the model of depression Behaviorally: Learned Helplessness Principle of low doses of a variety of interventions Proteolytic enzymes for inflammation 5-HTP Herbal medicines, (St John s Wort, SSRI rhodiola and coffee dopamine Foods: green papaya salad, chocolate, raw butter, raw soaked almonds, fermented foods spinach ( lutein), figs Glandulars hypothalamus, brain, adrenal, liver Detoxification: liver flushes, coffee enemas Bodywork therapies (abdominal, rocking, 10 th cranial nerve) Copyright,Leslie E. Korn,

29 What gets in the way? How do mental health diagnostic categories affect adherence to nutritional change plans Why do our clients not do what we suggest? Learned helplessness= depression and trauma. Seligman s work Self care challenges, trauma: pills powders liquids. The compulsive type person, less organized in their life will need more help with navigating change; ADHD The obsessive type, well organized or over-organized will follow what you say and do what you say; they may also obsess over the details. Copyright,Leslie E. Korn,

30 Nutritional Change and Personality If we have a mismatch between practitioner and client (type) and thus expectations, adherence is reduced. some people respond to more directive information, others gentle suggestions; advanced coaching techniques or paradoxical intention Action: integrate understanding of the personality client: the past informs the present Ask the client : what will be the obstacles to you incorporating nutrition changes. Among my suggestions: what will be easy and which difficult What do you want to tackle first Listen to what the client says, reflect it back and problem solve together Copyright,Leslie E. Korn,

31 Alternatives to Psychotropic Medications Work with the prescriber Prescribers rarely want to help people detoxify from meds because its too labor intensive The role of nutritional therapy in preventing, reducing or eliminating the use of pharma Identify goals and timeline Require basic adherence to a comprehensive prep program for 3 months ( diet, nutrients, exercise self care) Basic rule: Every year on the medication = 1 month to withdraw (this may vary) Work with compounding pharmacies to provide liquid meds to titrate down ml. each week Identify what the brain/mind is craving and substitute Copyright,Leslie E. Korn,

32 Working Successfully with Prescribers Start simply with prescribers Suggest doing coaching for improved well being Simple dietary changes; stabilize mood with reducing Provide a handout of latest research Clients want alternatives for pharma; esp. parents and their children Knowledge of treatment refractory- depression Nutrients Demonstrate knowledge of the scientific research and controversies Provide a service they do not have time to provide Identify a mental wellness focus Copyright,Leslie E. Korn,

33 Laboratory Testing for Mental Health Nutrition Testing in context Client may want it Tests may confirm what we believe or suspect Illuminate nuances Vitamin D depression, pain, immune function Tissue Mineral Analysis (excess minerals heavy metals can contribute to mental illness) 24 hr diurnal cortisol; Hormone panels Food sensitivities Digestive Panels Specialized testing: Walsh protocols, B-12, APOE genetic testing Copyright,Leslie E. Korn,

34 Niche Practice Success Nourish the relationship Rapport, empathy and understanding the needs and obstacles will enhance the relationship and enhance participation returning clients referrals and adherence. Use self disclosure, sparingly Maintain professional boundaries Offer individual and group sessions Offer groups that have a focus, w/another type of clinician Nourish self care Copyright,Leslie E. Korn,

35 Collaborative Opportunities Work in a multi practice setting Deliver Brown Bag lunch presentations Peer supervision groups Professional supervision/ review cases Advanced degrees Identify opportunities to volunteer (it will lead to paid consultations) Collaborate with naturopaths, acupuncturists, Bodyworkers Organize support groups that Prescribers: ND s, ARPN, MD Copyright,Leslie E. Korn,

36 Working in Diverse Settings Ask: who where and how is ready for the change. Where can I have the best effect: Clinical and hospital settings Provide the peer reviewed research Pub Med/ Google Scholar Working across cultures Foods in schools and prison. Recovery programs Volunteer positions-research funding-non profit funding- Maid Marian. Copyright,Leslie E. Korn,

37 Next Steps to Advance your Career in Mental Health Nutrition Developing your niche practice Dr. Leslie Korn s Savvy Food-Mood School Books Nutrition Essentials for Mental Health: The Complete Guide to the Food Mood Connection The Good Mood Kitchen (Fall, 2017) Eat Right Feel Right/50 recipes and tips.. Rhythms of Recovery: Trauma, Nature and the Body Preventing and Treating Diabetes Naturally, The Native Way Multicultural Workbook Medicinal Plants of the Jungle/Plantas Medicinales de la Selva Clinical Coaching Degree Programs/ Career Coaching Copyright,Leslie E. Korn,

38 Questions and Cases Thank you! Dr. Leslie Korn drlesliekorn.com Copyright,Leslie E. Korn,