April 2023

April 2023
University of North Florida
Nutri News
COLLABRATES
WITH
Shahid Sadought University of Medical Science
Zeytoon

TABLE OF CONTENT
06.
YOUR ESSENTIAL GUIDE TO VITAMINS
AND MINERALS
B-12 and Folate
NUTRITION HISTORY RESEARCH
10. Nutriton Psychiatry and Mental
Health
14.
18.
22.
24.
25.
MONTHLY HACKS
Tips on eating well for mental health
NUTRITION SCIENCE
The Link between Nutrition and Psychology
MYTHBUSTING
Are eating disorders prevalent in women?
THE LUNCH BOX
Chocolate Chips Cookies with a twist
RESEARCH ROUND UP
Food Insecurity and mental health
INTERNATIONAL COLLABRATION
29. Medical Nutrition Therapy for Anxiety
Disorders
34.
Chicken Tahchin Recipe

TABLE OF CONTENT
35.
38.
40.
42.
44.
48.
49.
Medical Nutrition Therapy for
Fibromyalgia
Sleep, Nutrition and Mental Health
Frequent Question about Nutrition
and Psychology
A New Approach to Prevent Depression
Medical Nutrition Therapy in Mood
Disorders
THANK YOU TO SHAHID SADOUGHI
UNIVERSITY OF MEDICAL SCIENCES
NUTRINEWS STAFF
Follow us @unfnutrinews

N U T R I N E W S
M A G A Z I N E
P O S I T I O N S A V A I L A B L E
E d i t o r s
W e b s i t e M a n a g e r
P u b l i s h e r s
W r i t e r s
L e a d e r s h i p P o s i t i o n s :
E d i t o r i n C h i e f
C o - e d i t o r
T r e a s u r e r
H e a d P u b l i s h e r
C O N T A C T S A I L Y M E D E R O
N 0 1 4 4 0 5 5 6 @ U N F . E D U

Y O U R E S S E N T I A L G U I D E T O
V I T A M I N S A N D M I N E R A L S
B 1 2 & F o l a t e
Written By:
Ashley Valle
What is vitamin B12? What is folate (vitamin
B9)?
Vitamin B12 is an essential water-soluble
vitamin responsible for various functions in the
body, including, but not limited to, red blood
cell formation, DNA production, and nerve
function.1 This vitamin is known as an essential
vitamin because our bodies do not produce it
on their own.2 It is produced by anaerobic
bacteria, and many animals have these in their
gut, so they get their B12 by absorbing the B12
the bacteria make. Animals also consume feces,
eat other animals, and drink and eat from
contaminated (or supplemented) sources to get
enough B12.3
Folate, or vitamin B9, is another water-soluble
vitamin responsible for DNA production, much
like vitamin B12, as well as RNA production and
red blood cell formation.4 Folate also functions
in amino acid metabolism, in the breakdown of
homocysteine, and during pregnancy and fetal
development.4
How do they work together?
(suspected) prevention of heart disease. As
mentioned previously, folate and vitamin B12
both play a vital role in the breakdown of
homocysteine: an amino acid that
contributes to artery damage and blood clot
formation.4 Both work in the conversion of
homocysteine to methionine, which, in turn,
helps the body synthesize proteins.4 When
our body does not have enough B12 and
folate, homocysteine levels rise. Although the
relationship between folate, B12,
homocysteine, and heart health is currently
being researched, it is still an important
relationship to consider and a valid reason to
ensure adequate consumption of both
vitamin B12 and folate.
Another way vitamin B12 and folate work
together is in the production of S-
adenosylmethionine (SAMe).5 SAMe is a
chemical found in the body that is suspected
to be helpful for symptoms of depression,
osteoarthritis, liver diseases, and other
conditions.6 However, research on its
effectiveness in the treatment of these
conditions is limited and must be studied
further.
Vitamin B12 and folate work together closely.
One of the ways they work together is in the
6

What happens if we are deficient in B12?
What about folate?
Vitamin B12 deficiency can result in several
conditions and symptoms, including fatigue,
weakness, depression, seizures,
megaloblastic anemia, pernicious anemia,
and even dementia.7 Some factors that may
contribute to a higher risk of vitamin B12
deficiency are the avoidance of animal
products, a lack of intrinsic factor (intrinsic
factor is required for the absorption of B12),
inadequate stomach acid (for example, from
taking too many TUMs), and intestinal
surgeries that cause malabsorption.7
Folate deficiency can cause megaloblastic
anemia, hair loss, fatigue, reduced
production of red blood cells, mouth sores,
and more.4 Factors that may contribute to a
higher risk of folate deficiency are pregnancy,
alcoholism, intestinal surgeries that cause
malabsorption, and the genetic variant
MTHFR, which prevents individuals from
being able to convert folate to its active form
used in the body.4
What are some dietary sources of B12 and
folate?
Dietary sources of B12 are predominantly animal
products, such as:
-Fish
-Shellfish
-Liver
-Red meat
-Eggs
-Poultry
However, there are also plant-based sources of
vitamin B12, such as:
-Fortified nutritional yeast
-Fortified breakfast cereals
-Fortified plant milks
-Edible algae (purple laver and green laver).7,8
Dietary sources of folate:
-Liver
-Eggs
-Beans
-Sunflower Seeds
-Peanuts
-Dark Leafy Vegetables
7

RDAs:
The recommended dietary allowance for
vitamin B12 is 2.4 mcg daily for males and
females 14 years old and older. The RDA
increases during pregnancy and lactation to
2.6 mcg and 2.8 mcg per day, respectively.7
The recommended dietary allowance for
folate is 400 mcg of dietary folate equivalents
(DFE) for males and females 19 years old and
older. As with B12, the RDA increases during
pregnancy and lactation to 600 mcg DFE and
500 mcg DFE per day, respectively. It is also
important to note that those who drink
alcohol regularly should consume more folate
(about 600 mcg DFE daily). This is because
alcohol consumption can impair the
absorption of folate in the body!4
Fun Facts:
-Excess folate can mask a vitamin B12
deficiency.4
-Nutritional yeast does not naturally have
vitamin B12; it is fortified, so be sure to
purchase fortified nutritional yeast if
following a plant-based diet!7
-Vitamin B12 supports the maintenance of
healthy hair, skin, and nails!2
-Vitamin B12 may aid in the prevention of
memory loss, but more research is still
needed.2
-The FDA requires that many foods be
fortified with folic acid to prevent neural tube
defects.4 Folic acid is now added to pasta,
rice, flour, and many other enriched grain
products!
8
References:
1.Mayo Clinic Staff. Vitamin B-12. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements-vitamin-b12/art-20363663. Published July 17, 2021. Accessed March 1, 2023.
2.Berkheiser K. 9 Health Benefits of Vitamin B12, Based on Science. Healthline. https://www.healthline.com/nutrition/vitamin-b12-benefits. Published June 14, 2018. Accessed March 1, 2023.
3.Campbell T. 12 Questions Answered Regarding Vitamin B12. T. Colin Campbell Center for Nutrition Studies. https://nutritionstudies.org/12-questions-answered-regarding-vitamin-b12/. Published
February 6, 2015. Accessed March 1, 2023.
4.Folate (Folic Acid) – Vitamin B9. Harvard T.H. Chan School of Public Health. https://www.hsph.harvard.edu/nutritionsource/folic-acid/. Updated 2023. Accessed March 1, 2023.
5.Vitamin B12 (Cobalamin). Mount Sinai Health System. https://www.mountsinai.org/health-library/supplement/vitamin-b12-cobalamin. Accessed March 1, 2023.
6.S-Adenosyl-L-Methionine (SAMe): In Depth. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/sadenosyllmethionine-same-in-depth. Updated January
2017. Accessed March 1, 2023.
7.Vitamin B12. Harvard T.H. Chan School of Public Health. https://www.hsph.harvard.edu/nutritionsource/vitamin-b12/. Updated 2023. Accessed March 1, 2023.
8.Watanabe F, Yabuta Y, Bito T, Teng F. Vitamin B12-containing plant food sources for vegetarians. Nutrients. 2014;6(5):1861-1873. doi:10.3390/nu6051861

A U T I S M S P E A K S
World Autism
Awareness Day
A P R I L 2 , 2 0 2 3
S U N D A Y
Together we stand for a world of
difference.

Nutrition Research
Nutrition Psychiatry and Mental Health
For most of us, we typically associate eating a
healthful diet with supporting our physical
health; however, we are also supporting our
mental health when we eat healthy. When it
comes to combating mental illness specifically,
eating a balanced and healthful diet isn’t
usually the first thing that’s considered, but it
can make a huge impact! The connection
between what we eat and how we
feel/function is unmistakable, and it is
something that deserves a lot of attention.
By Isabelle
Brazelton
Nutrition Psychiatry
The use of food as a treatment for mental
health disorders is known as Nutrition
Psychiatry, and it is with this practice that we
can begin to understand and utilize food to
enhance our mood and brain functionality.1
What we eat directly affects the structure and
function of our brain and consequently our
mood, which makes it a huge area of interest
when treating mental ailments. Research in
this area has been expanding exponentially
and has found numerous correlations between
food, feeling, behavior, and gut composition.²
For example, links have been shown between
diet and the development of psychiatric
disorders such as depression, anxiety, and
schizophrenia.¹,² Notably, there are two main
ways that food can impact our mental health,
the gut microbiome and nutrient deficiencies,
which are discussed below.
10

Gut Microbiome
Our gut is filled with a vast array of bacteria
and microorganisms that play a huge role in
balancing our overall health.¹,²,³ Research has
shown that gut microbiome composition can
differ depending on the disease state of
individuals. Some studies have shown that
individuals with schizophrenia and psychosis
have different gut microbial compositions
when compared to individuals who do not.¹ At
the root of this all is the gut-brain connection,
which connects the intestines with the central
nervous system through the vagus nerve.
Disruptions with this connection that are
caused by the composition of the gut
microbiome can be directly related to mental
disorders such as schizophrenia, depression,
and anxiety.
Additionally, the mood-regulating
neurotransmitter serotonin is produced
primarily in the gastrointestinal tract, which
has millions of nerve cells and is heavily
influenced by the beneficial bacteria that exist
in the gut. These bacteria are essential to our
health as they protect the intestinal lining,
provide a barrier against toxins and harmful
bacteria, limit inflammation, improve nutrient
absorption, and activate neural pathways
between the gut and the brain.²Research has
shown that diets high in plant-based foods
and healthy fats and low in processed foods
feed more of the beneficial bacteria in the gut
and thus support overall healthy mental
function.
Nutritional Deficiencies
Nutritional deficiencies can occur when not
enough food is consumed, or if there is a very
limited variety of food that is consumed, or
furthermore if an individual has problems
absorbing nutrients.¹ Nutrient deficiencies
have been shown to be a risk factor for
developing mental disorders, and thus ensuring
adequate nutrient consumption is a way of
preserving mental health. Specifically,
deficiencies in nutrients such as B9(folate), B6,
and B12 can cause problems with DNA and
protein synthesis in the body, which in turn
compromises brain development and
cognition. Once again,
some studies have shown that individuals with
schizophrenia have lower serum B6 and B9
levels than others, as well as a higher
prevalence of vitamin D deficiency.
11

Nutrition as a Treatment
The International Society for Nutritional
Psychiatry Research (ISNPR) provides guidance
to healthcare workers so that patients with
mental health issues can be given nutritional
treatments.¹
The ISNPR has issued many nutritional
recommendations that are aimed to promote
an optimal gut microbiome composition and
suggest that certain dietary changes can
improve gut composition. Some general
recommendations include practicing
traditional diets such as Mediterranean,
Scandinavian, or Japanese diets which consist
of large quantities of fresh fruit, vegetables,
whole grains, and limited quantities of
processed foods. In addition to recommending
the consumption of a diet that supports a
healthy gut composition, the ISNPR
recommends the use of the nutrient
supplements B9, B6, B12, and vitamin D due to
their proven effectiveness in shortening the
duration of illness in those with psychosis and
schizophrenia.
Bottom Line
Ultimately, it is undeniable that food intake
plays a huge role in mental health, and diet
should be a major topic of discussion when
treating individuals that are battling with
mental health disorders. Because nutritional
psychiatry is easily accessible, non-invasive,
and has little to no side effects, it can be the
perfect treatment for those with mild
symptoms or in unison with the medical
treatment of those with more severe
symptoms.¹ In addition, nutritional psychiatry
supports the overall health of people with
severe mental health issues and combats the
development of further complications and
decreased life expectancy. When using regular
medical treatment alone, symptoms,
medication side effects, and declined physical
health can significantly decrease a patient’s
quality of life, but nutritional psychiatry helps
reverse these negative effects.¹³ In the end, it
is important to remember just how powerful of
an impact food can have on life.
References
1. Hanson-Baiden J. What is nutritional psychiatry? News. https://www.news-medical.net/health/What-is-
Nutritional-
Psychiatry.aspx#:~:text=Nutritional%20psychiatry%20is%20the%20practice,treatments%20for%20mental%20he
alth%20disorders. Published February 10, 2022. Accessed February 28, 2023.
2. Selhub E. Nutritional psychiatry: Your brain on food. Harvard Health.
https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626. Published
September 18, 2022. Accessed March 1, 2023.
3. Naidoo U. Nutritional psychiatry: The gut-brain connection. Psychiatric Times.
https://www.psychiatrictimes.com/view/nutritional-psychiatry-gut-brain-connection. Accessed March 1, 2023.
12

M O N T H L Y H A C K S
T I P S F O R E A T I N G W E L L F O R
M E N T A L H E A L T H
Written By:
Sophia Harris
Did you know that the brain has a connection to
your stomach? Your neurons are the link that
connect seemingly unrelated organs.1 The
connection between the nervous system and
your stomach is known as the gut-brain axis.1
The gut-brain axis sends signals to the brain
whenever you ingest anything.1 While there is
nothing wrong with enjoying the not-so-healthy
foods every once in a while, too much of
anything is not always a good idea. The morenutrients
dense foods contain vital elements
the brain needs to get rid of any oxidative stress
as the free radicals can damage the braincells.2
What makes it even worse is that a diet that
consists of too much processed or refined
foods can lead to the production of a stress
hormone that can cause inflammation to the
brain.1 The inflammation to the brain causes
one to become distracted, disorganized,
forgetful, and even depressed.1 As you can see,
adding healthier food products to your diet can
be very beneficial to not only your physical
health but your mental health as well. One food
group that contributes to your mental wellbeing
is complex carbohydrates. Complex
carbohydrates provide the beneficial bacteria
that the GI tract needs to maintain a healthy
digestive system.3 Through the gut-brain axis, a
healthy microbiome is also linked to healthy
well-being because important
neurotransmitters are produced in the gut
such as serotonin, which is the mood
stabilizer hormone.2 Some examples of
complex carbohydrates are: brown rice,
millet, quinoa, and beets.4 Another food
group that also contributes to good mental
health would be lean proteins.4 Lean
proteins are broken down into their amino
acids and then used to produce certain
neurotransmitters.5 For example, the protein
in chicken breaks down and creates
dopamine (the rewarding chemical) while the
protein in fish, dairy, and nuts break down
and creates serotonin, which both
14

contribute to feelings of happiness and wellbeing.5
Two very important food groups that
also lead towards a healthy mental state are
prebiotics and probiotics.6 Prebiotics are the
food that probiotics need to work.7 The
fermentation process of the probiotics eating
away at the prebiotics aids in the development
of serotonin which helps decrease depression.7
Beans, bananas, berries, and dandelion greens
are a few
examples of prebiotics.6 Some probiotic
food examples include: kimchi, kombucha,
sauerkraut, yogurt with active cultures, and
mozzarella cheese.6 Folate is another type of
nutrient that is an essential ingredient to
achieve good mental health and helps to
reduce the risk of developing depression.8
Foods that contain folate are dark leafy green
vegetables like spinach and kale, fruits, nuts
and whole grains.8 Vitamin D is also very vital
to fighting against depression and Seasonal
Affective Disorder.8 Some foods that
naturally have high amounts of Vitamin D are
salmon and tuna but there are other foods
that are fortified with Vitamin D like milk,
orange juice, and breakfast cereals. One last
indispensable element are foods that contain
omega-3 fatty acids. Omega-3 fatty acids help
support your emotions and can be helpful in
increasing the effectiveness of
antidepressants.8 You can find this nutrient
in oily fish like mackerel, anchovies, and
sardines. You can also find omega-3 fatty
acids in flaxseed oil, olive oil, fresh basil, and
walnuts.8 While this list may seem to be a bit
overwhelming, I am not implying that you
need to eat all of these foods in your diet to
have good mental health. However, trying to
incorporate some of these foods into each
meal you consume can help you achieve an
improved state of mind. You can use this mini
guide to create a variety of meals that will
allow you to obtain nutrients that will
enhance your health both physically and
most importantly mentally.
References
1.Ahmad F, Hasan H, Abdelhady S, Fakih W, Osman N, Shaito A, Kobeissy F. Healthy Meal, Happy Brain: How Diet Affects Brain Functioning. Frontiers for Young Minds website. Published August 3, 2021.
Accessed February 7, 2023. https://kids.frontiersin.org/articles/10.3389/frym.2021.578214#:~:text=Amazingly%2C%20the%20food%20you%20eat,to%20brain%20disorders%20like%20depression
2.Selhub E. Nutritional psychiatry: Your brain on food. Harvard Health Blog website. Published September 18, 2022. Accessed February 7, 2023. https://www.health.harvard.edu/blog/nutritionalpsychiatry-your-brain-on-food-201511168626
3.Haverland SC, Jones E. Carbs & Anxiety: How Carbs Affect Mental Health. Hopeway website. Published August 31, 2022. Accessed March 1, 2023. https://hopeway.org/blog/carbs-and-mood
4.Sutter Health writers. Eating Well for Mental Health. Sutter Health website. Accessed February 8, 2023. https://www.sutterhealth.org/health/nutrition/eating-well-for-mentalhealth#:~:text=To%20boost%20your%20mental%20health,are%20also%20excellent%20brain%20foods
5.Sandwood J. The Connection Between Protein and Your Mental Health. Mental Health Connecticut website. Published July 9, 2019. Accessed March 1, 2023.
https://www.mhconn.org/nutrition/protein-and-mental-health/
6.Naidoo U. What to Eat for Optimal Mental Health. Mindful website. Published February 18, 2021. Accessed February 8, 2023. https://www.mindful.org/what-to-eat-for-optimal-mental-health/
7.Landau K. Why prebiotics are the most important nutrient to boost your mood and prevent anxiety and depression. True Health Initiative website. Published July 30, 2019. Accessed March 1, 2023.
https://www.truehealthinitiative.org/news/why-prebiotics-are-the-most-important-nutrient-to-boost-your-mood-and-prevent-anxiety-anddepression/#:~:text=Prebiotics%20and%20Probiotics%20to%20Boost%20Mood%3A&text=We%20also%20know%20that%20prebiotics,quite%20directly%20effect%20your%20mood
8.Mental Health America writers. Healthy Diet: Eating with Mental Health in Mind. Mental Health America website. Accessed February 8, 2023. https://mhanational.org/healthy-diet-eating-mentalhealth-mind
15

World ArtDay
S A T U R D A Y
A P R I L 1 5 , 2 0 2 3
Art generates a love for
learning and creativity.

Wolrd Health
Day
S A T U R D A Y
A P R I L 7 , 2 0 2 3
Health for all envisions that all
people have good health for a
fulfilling life in a peaceful,
prosperous, and sustainable
world.

Nutrition History Research
The Link Between Nutrition and Psychology
Written by: Sofie Van
Moorleghem
Over time, the topic of mental health has
become less taboo, and more people have
started sharing their emotions. Research has
moved forward in analyzing these emotions,
learning how they can happen, and, most
importantly, how they can make the lives of
people better. Consequently, the idea of
researching how food can affect our mental
state has been investigated more and more.
Mental illness has been shown to be a risk
factor for other health issues like obesity
and heart disease. Meanwhile, dietary
interventions have been successfully used in
the treatment of mental illness and other
psychological disorders.¹ Therefore, the
right foods, in addition to nourishing our
bodies, may help us nourish our minds as
well.
In the Winter Meeting of the 2016 Nutrition
Society, topics under “Diet, nutrition and
mental health and wellbeing” were
requested for research. Out of the research
studies presented, there was strong
evidence that diet quality was a modifiable
risk factor in certain mental illness cases.
These cases showed that interventions
involving nutrition and “food- and nutrientbased
approaches” can significantly ease
the burden of mental and psychological
illnesses.¹
18

Since then, more research has come out
about the correlation between diet and
depression. In a 2017 study, 67 adults with
depression participated in a randomized
controlled trial where they were assigned to
either seven consulting sessions with a
dietitian or seven social support sessions. ²
Over the 12-week trial period, half of the
participants made diet adjustments,
including eating more nutrient-dense foods
and having less processed foods. Among
the depressed patients who went to the
dietitian, almost 33% achieved remission
compared to the control group’s 8%.
In another study of almost 120 children,
researchers found that there was a larger
prevalence of ADHD (attentiondeficit/hyperactivity
disorder) diagnoses
among the children whose diets mainly
consisted of sugar, soft drinks, and fast
food. ² This was coupled with the fact that
the study showed that children who had
fewer healthy fruits, vegetables, and other
foods were “more likely to have ADHD
symptoms, even after accounting for
potential confounders.” ² While this doesn’t
prove causation, it could mean that the
development of ADHD can be influenced by
diet.
The premise of nutritional psychology (NP) is
a study area in the nutrition field where
professionals practice at the intersection
between behavioral, psychological, and
nutritional sciences. There are many topics
included in this field of study, but nutritional
psychologists primarily focus on what is
called a “diet-mental health relationship
(DMHR)”. The DMHR seeks to explain how
food and nutrition can impact how humans
feel, behave, sense, experience, and think.
As a psychology subfield, it focuses on the
internalized feelings, motivations,
functionality, and values of people so they
can function better in the world around
them.³
This is a very complex discipline. However, it
is important that we further investigate how
to help people live stronger, healthier, and
more fulfilling lives. Knowing how a dietmental
health relationship functions require
experience and knowledge about the
intersection between psychological and
nutritional sciences. While there hasn’t been
much research done in the nutritional
psychology field itself, there are tons of
evidence from various other study areas
demonstrating
the
behavioral/psychological effects that
nutrition-based care can have on patients.3
There is still much to learn about nutritional
psychology, but the field is steadily
developing and continues to garner more
interest as it expands.
19

The research that has been conducted in
this developing field of nutritional and
psychological study has led to many
advancements that will no doubt help
people in the long run. The topic of mental
illness and diet still has much to be
explored, and it will undoubtably keep
dietitians, psychologists, and nutritional
psychologists very interested and busy for
years to come. In the meantime, however,
the evidence shows that eating a nutritious
diet and living a healthy lifestyle positively
impacts both our mental and physical health
by diet.
References:
1. Owen L, Corfe B. The role of diet and
nutrition on mental health and
wellbeing. Proc Nutr Soc.
2017;76(4):425-426.
doi:10.1017/s0029665117001057
2. Clay RA. The link between food and
mental health. Monitor on Psychology.
https://www.apa.org/monitor/2017/0
9/food-mental-health. Published
September 2017. Accessed February 15,
2023.
3. Diet and Mental Health. Nutritional
Psychology. https://www.nutritionalpsychology.org/what-is-nutritionalpsychology/#:~:text=In%20relation%20t
o%20psychology%2C%20nutrition%20h
elps%20us%20to,and%20behavioral%2
0components%20leading%20to%20pos
itive%20mental%20health. Published
October 14, 2022. Accessed February
15, 2023.
20

$ Paid $ leadership positions available as well as volunteers needed
Give back to your community by preparing nutritious meals for
seniors at the UNF Center for Nutrition and Food Security. Interested?
Send your N# @ cnfs@unf.edu

M Y T H B U S T I N G
Are Eating Disorders more
prevalent in women?
Eating disorders do not just affect women,
and it is important to recognize that they
can affect anyone, regardless of their
gender, race, ethnicity, or socioeconomic
background. Eating disorders are serious
mental health disorders characterized by
abnormal or disturbed eating habits,
including restricting food intake, binge
eating, and purging behaviors. These
disorders can have serious consequences
on an individual's physical and mental
health, as well as their social and emotional
well-being.4
Written By:
Dahnine McCune-
Moyer
While it is true that eating disorders have
historically been associated with white,
middle-to-upper-class women, research has
shown that people from diverse
backgrounds are also impacted by eating
disorders. Studies have found that
individuals from minority racial and ethnic
groups may be at a higher risk of developing
eating disorders due to cultural factors,
discrimination, and other socioenvironmental
stressors.3 Additionally,
there may be unique cultural factors that
contribute to the development of eating
disorders in certain populations.
22

For example, some research has suggested that
among African American women, there may be a
cultural ideal of having a curvy body, which may
make it more difficult for individuals to recognize
and seek help for an eating disorder.2 Similarly,
in some Asian cultures, there may be a cultural
emphasis on maintaining a slim body shape,
which can contribute to the development of
disordered eating behaviors.
Moreover, LGBTQ+ individuals may also be at a
higher risk of developing eating disorders due to
the stressors related to stigma, discrimination,
and rejection. These stressors can impact an
individual's self-esteem, body image, and overall
mental health, which may contribute to the
development of disordered eating behaviors.1
It is also important to recognize that individuals
from low socioeconomic backgrounds may be at a
higher risk of developing eating disorders due to
limited access to healthcare, financial stress, and
food insecurity. Food insecurity, in particular, can
lead to disordered eating behaviors as individuals
may restrict their food intake or engage in binge
eating behaviors when food is available.
In conclusion, eating disorders are not only for
white women, and individuals from diverse
backgrounds are impacted by these disorders. It
is crucial to recognize that eating disorders are a
serious mental health issue that can impact
anyone. Seeking help and support from a
qualified healthcare professional is crucial for
those struggling with an eating disorder, and we
all need to work towards creating more inclusive
and accessible healthcare resources for all
individuals who are impacted by these disorders.
Resources
1.Milano W, Ambrosio P, Carizzone F, De Biasio V, Foggia G, Capasso A. Gender Dysphoria, Eating Disorders and Body Image: An Overview. Endocr Metab Immune Disord Drug Targets.
2020;20(4):518-524. doi:10.2174/1871530319666191015193120
2.Rodgers RF, Watts AW, Austin SB, Haines J, Neumark-Sztainer D. Disordered eating in ethnic minority adolescents with overweight. Int J Eat Disord. 2017;50(6):665-671. doi:10.1002/eat.22652
3.Gonzales M 4th, Blashill AJ. Ethnic/racial and gender differences in body image disorders among a diverse sample of sexual minority U.S. adults. Body Image. 2021;36:64-73.
doi:10.1016/j.bodyim.2020.10.007
4.https://www.healthline.com/nutrition/common-eating-disorders#what-they-are
23

The Lunch Box
Chocolate Chip Cookies...
With A Twist
Written By:
Kate Overby
I don’t know about you, but any sweet food is
guaranteed to boost my mood. The problem with
sweets is that it’s easy to overdo them, which can
have a negative impact on mood when they give
me a stomachache. The solution? A cookie with a
twist. This recipe was inspired by none other than,
@earthyandy. They taste amazing and are healthy
enough to enjoy for breakfast! These are vegan,
gluten free, and you can eat the dough!!!
Ingredients:
-1 can drained and rinsed chickpeas
-½ cup peanut butter (try one with only
peanuts and sea salt as the ingredients.
Teddie and CB’s Nuts are a couple of my
favorite brands)
-1/3 cup maple syrup
-2 teaspoons vanilla extract
-½ teaspoon baking soda
-A sprinkle of sea salt
-Vegan dark chocolate chips (Enjoy Life or
Lily’s are a couple of my favorite brands)
Instructions:
1.Preheat the oven to 350 degrees and line a
baking sheet with aluminum foil
2.In a blender or food processor add all
ingredients except for the chocolate chips
3.Blend for at least a minute or until the
mixture is smooth. It should look like cookie
dough!
4.Stir in chocolate chips (1/2 cup to a full cup
depending on personal preference)
5.Spoon dough onto baking sheet. Should
make 12-15 cookies
6.Bake for 20 minutes
7.Store in the refrigerator!
24
Reference:
https://www.instagram.com/p/B785Xa6gxGI/?hl=en

FOOD
R e s e a r c h R o u n d u p
INSECURITY AND
MENTAL HEALTH
WRITTEN BY:
ALICIA SCOTT
The center for Disease Control and
Prevention states that mental health
can include emotional, psychological,
and social well-being.³ How we think,
act, and feel can be affected by
mental status as well as it can
determine how we handle stress,
make choices that are healthy, and
how we interact with each other.³
Often mental health issues are only
highlighted in older individuals, but it
is growing in the younger population.
The correlation between food
insecurity and mental health issues
may not be direct but indirect. One
example of this is that food
insecurity can cause the parental
figures to be distressed and then in
turn affects the child.⁴
When we think of nutrition, one topic that is often forgotten
in the conversation is food insecurity. Food insecurity can be
defined as a household-level economic and social condition
of limited or uncertain access to adequate food.¹ It can
consist of disrupted eating patterns, reduced food intake,
reduced quality, or desirability of diet. In recent reports, in
2020 over 13.8 million households reported some level of
food insecurity.¹ In research, there have been links made
between an increased risk of varied health outcomes and
health disparities such as obesity, diabetes, and
hypertension.² One thing that is often forgotten to be
studied is the mental health effects that can happen when
one is food insecure.
The long-term effects of food
insecurity that happens during
childhood have not been fully
studied but one hypothesis that
appears in the literature is that food
insecurity can affect mental health
status through nutrient metabolism.⁴
The diet of someone that is food
insecure often includes foods that
are calorie-rich but have low
nutrients, low fruits and vegetables,
and an inadequate source of iron.4
Dietary patterns such as this can
negatively affect mental health
status through inflammation,
oxidative stress, brain plasticity, and
through the gut-brain axis.⁴
25

A cluster randomized controlled trial was conducted in a
rural area of Lesotho a country encircled by South Africa.
This trail included 34 villages and included caregivers and
children between ages 1 and 5 in the communities.⁵ The age
for caregivers had to be over 18 years old and they had to
live in the same household as the child and provided consent
for both them and the child or children. With a study such as
this, the protocol had to be approved by the research and
ethics committee. The committee comprised of the Health
Research Ethics Committee located at Stellenbosch
University and the Lesotho Ministry of Health and the study
was approved.⁵
The caregivers were interviewed using questionnaires that
were structured. The questions were focused on the
household, the caregivers, and the child or children. The
question regarding the children consisted of the
demographics, care arrangement, health, behavior,
development, and overall parental practices.⁵ The keep up
with the overall ethics of the study, the interviewers were
trained on informed consent, data management, and
referrals.⁵ A small package of groceries was given to the
participants as an incentive. If there were any reports of
suicidal ideation, the participants were referred to a health
worker in the village or the nearest clinic, and social workers
in the research team assisted in high-risk cases.
In a setting such as this, a common theme among the
caregivers whether older, younger, men, or women, was
that one of the factors that affected their mental health
was food insecurity, poverty, and limited access.⁵ With the
rural areas of Lesotho having scarce arable land, the
drought has caused chronic food insecurity and famine.⁵
Increasing mental health care alone cannot solve the
problem in Lesotho because there is still the issue of
limited food availability. Improving access to food would
be beneficial in this situation because it can relieve some
of the stress on the caregivers.⁵
26

A systematic review looked at the research that was
conducted on the mental health effects of parents and
children as it relates to food security and most of the
results described the outcomes in the parents but not the
children. Some studies were able to correlate food
insecurity and depression in children between the ages of
2 to 17 years old.² When it came to suicide ideation, food
insecurity was associated with a higher risk in teens
Hispanic teens and the 15 years old group.² Depression
was greatly impacted in children and the research pointed
out that it could be due to nutrient metabolic factors. With
a lack of nutrient diversity both macro and micronutrients,
neurotransmitters that are needed for regulating mood
can be affected.² A lack of iron in the diet can alter brain
development and have a lasting effect on neuropsychiatric
regulation.²,⁶ Several factors can lead to these mental
health challenges but being food insecure adds an extra
layer. With the growth in research, there is room for
improvement when it comes to studying the lasting mental
health effects on children as it relates to food insecurity
References
1. Food insecurity. Food Insecurity - Healthy People 2030.https://health.gov/healthypeople/priorityareas/social-determinants-health/literature-summaries/food-insecurity.
Accessed March 1, 2023.
2. Cain KS, Meyer SC, Cummer E, et al. Association of Food Insecurity with Mental Health Outcomes in
Parents and Children. Acad Pediatr. 2022;22(7):1105-1114. doi:10.1016/j.acap.2022.04.010
3. About mental health. Centers for Disease Control and Prevention.
https://www.cdc.gov/mentalhealth/learn/index.htm. Published June 28, 2021. Accessed March 1, 2023.
4. Pryor L, Melchior M, Avendano M, Surkan PJ. Childhood food insecurity, mental distress in young
adulthood and the supplemental nutrition assistance program. Prev Med. 2023;168:107409.
doi:10.1016/j.ypmed.2022.107409
5. Marlow M, Skeen S, Hunt X, et al. Depression, anxiety, and psychological distress among caregivers
of young children in rural Lesotho: Associations with food insecurity, household death and parenting
stress. SSM - Mental Health. 2022;2:100167-. doi:10.1016/j.ssmmh.2022.100167
6. Lozoff B, Jimenez E, Hagen J, Mollen E, Wolf AW. Poorer behavioral and developmental outcome
more than 10 years after treatment for iron deficiency in infancy. Pediatrics. 2000;105(4):E51.
doi:10.1542/peds.105.4.e51
27

Earth Day
”Invest in Our Planet”
22 APRIL 2023
SATURDAY

INTERNATIONAL COLLABRATION
M E D I C A L N U T R I T I O N T H E R A P Y F O R
A N X I E T Y D I S O R D E R S
Written by:
Hooman Yekrang Safakar
Anxiety is a widespread phenomenon.
Anxiety disorders are one of the most
common types of psychiatric conditions
worldwide. One-third of Americans will
experience some form of Anxiety at some
point in their lives, making anxiety
disorders the most common psychiatric
condition in the United States. About half
of the patients are successfully treated
with standard-of-care medications and
psychotherapy, and only one-quarter
achieve complete symptomatic
resolution. In 2019, 301 million people,
including 58 million children and
adolescents, had an anxiety disorder.
The WHO defines anxiety disorders as characterized by excessive fear, worry, and related
behavioral disturbances. Symptoms are severe enough to result in significant distress or
significant impairment in functioning. American psychological association has mentioned
that people with anxiety disorders usually have recurring intrusive thoughts or concerns.
They may avoid certain situations out of worry. They may also have physical symptoms such
as sweating, trembling, dizziness, or a rapid heartbeat. Anxiety is not the same as fear but is
often used interchangeably. Anxiety is a future-oriented, long-acting response broadly
focused on a diffuse threat. In contrast, fear is an appropriate, present-oriented, short-lived
response to a clearly identifiable and specific threat.
The use of nutritional interventions in preventing and treating mental health disorders is
the subject of an emerging field of study known as nutritional psychiatry. In clinical
practice, nutritional recommendations for psychiatric patients are rarely given, despite
growing evidence of their benefits. Nutritional interventions have recently been shown to
have an antidepressant effect in high-quality intervention studies. Anxiety disorders, on
the other hand, have received less research than mood disorders. There is a lack of studies
that provide individuals with diagnosed anxiety disorders with diet counseling, education,
or food as an intervention.
29

Due to nutrients' crucial role in the neuroendocrine system, suboptimal nutrition has been
linked to the underlying pathology of behavioral health disorders. Nutrition plays a role in
preventing and treating behavioral health disorders. For the production of
neurotransmitters like serotonin, dopamine, and norepinephrine, which are involved in the
regulation of mood, appetite, and cognition, nutrients like tryptophan, vitamin B6, vitamin
B12, folic acid (folate), phenylalanine, tyrosine, histidine, choline, and glutamic acid are
required
B vitamins, vitamin C, magnesium, and zinc are all involved in converting a-linolenic acid
into longer-chain n-3 fatty acids, and nutrients also impact neuronal membranes' structure
and neurotransmitters' release. n-3 fatty acids are linked to a lower risk of anxiety.
Compared to social support, the SMILES RCT demonstrated that individuals with moderate
to severe depression who received individual nutrition counseling to adhere to a modified
Mediterranean dietary pattern experienced less Anxiety. However, a recent meta-analysis
and systematic review of 11 RCTs (n=2270) demonstrated that dietary interventions did not
affect Anxiety.
IIn a prospective analysis from a large clinical trial conducted in Spain, the PREDIMED
study showed that increased anxiety symptoms were associated with a lower
Mediterranean diet score. Traditional dietary patterns in Australia (characterized by
vegetables, fruit, meat, fish, and whole grains), China (characterized by "a typically healthy
and recommended diet," and including foods such as gruel, oatmeal, whole grains, fresh
yellow or red vegetables, fruit, and soy milk), and the Mediterranean have been associated
with a lower risk for anxiety disorders. In Norway, Anxiety was inversely correlated with a
healthy diet score. Additionally, there is evidence that people who eat more Lactovegetarian
foods are less likely to experience Anxiety. Men who reported eating a vegan
diet and consuming fruit and vegetables daily also had lower anxiety scores. As a result,
epidemiological studies suggest that eating a high-quality diet with enough nutrients
associated with Anxiety may lower the risk of Anxiety.
A cross-sectional study in Iran found that women who followed a fast-food diet were more
likely to experience psychological stress than those who followed a Western diet.
According to another Iranian cross-sectional study, Anxiety was linked to increased
processed food consumption.
According to epidemiological studies conducted in numerous nations, a diet high in fruits
and vegetables, whole grains, lean protein, nuts, and legumes, and low in added sugars
may lower the risk of anxiety disorders. Interestingly, a Western-style dietary example that
does not meet food-based dietary proposals is related to a more severe gamble of
nervousness.
30

A correlation between higher levels of Anxiety and a diet with a higher glycemic index—
also known as sugar intake—and a higher intake of simple or refined carbohydrates was
one trend that emerged from the studies on carbohydrates. In human experimental
studies, there was a correlation between higher anxiety symptoms and tryptophan
depletion. In experimental and animal studies, tryptophan supplementation reduced
anxiety symptoms. The effects of caffeine on anxiety symptoms have been the subject of
many studies. Higher caffeine intake was associated with worsening anxiety symptoms in
both human experimental and observational studies.
Anxiety has been shown to increase when artificial sweeteners are given to animals.
Sweeteners' harmful effects on inflammation and the microbiome may play a role in their
anxiolytic effects. In both human and animal models, it has been demonstrated that certain
sweeteners harm systemic metabolism; however, the precise pathways are unknown. There
are a variety of ways that omega-3s help address the metabolic foundations of Anxiety, but
the most likely ones include maintaining a healthy microbiome, reducing inflammation, and
rebalancing neurochemistry.
As a metabolic treatment for a wide range of neurodegenerative conditions, ketogenic diets,
or high-fat, low-carbohydrate diets that cause the body to produce ketones, a fuel source for
the brain, are gaining popularity. Anxiety was significantly reduced in rats when exogenous
ketone supplements were administered orally to achieve ketone levels comparable to those
experienced by ketogenic diet patients. In addition, there is evidence that intermittent
fasting, an intervention that causes ketosis, causes neurological adaptations over time (such
as an increase in mitochondrial sirtuin, SIRT3, and GABAergic activity) that are
neuroprotective and less stressful.
As the collective scientific evidence suggests, fatty fish and marine-derived n-3 fatty acids
may have advantages for foods, nutrients, and Anxiety. In terms of micronutrients, there is
some evidence that taking a multivitamin and mineral supplement, magnesium, zinc, some
vitamins (like B vitamins, vitamin C, and vitamin E), the amino acids lysine and arginine, and
some vitamins (like B vitamins, vitamin E, and vitamin C) may help prevent and treat anxiety
disorders. As a result, adopting a healthy eating plan that adheres to nutrient and foodbased
recommendations may assist in reducing Anxiety. Micronutrients like magnesium,
zinc, and some vitamins like B vitamins, vitamin C, and vitamin E, as well as n-3 fatty acids
that can reduce Anxiety, can be found in a healthy diet.(1)(2-5)
References
1. Aucoin M, LaChance L, Naidoo U, Remy D, Shekdar T, Sayar N, et al. Diet and Anxiety: A Scoping Review. Nutrients. 2021;13(12).
2. Kris-Etherton PM, Petersen KS, Hibbeln JR, Hurley D, Kolick V, Peoples S, et al. Nutrition and behavioral health disorders:
depression and Anxiety. Nutr Rev. 2021;79(3):247-60.
3. Bakhtiyari M, Ehrampoush E, Enayati N, Joodi G, Sadr S, Delpisheh A, et al. Anxiety as a consequence of modern dietary pattern
in adults in Tehran--Iran. Eat Behav. 2013;14(2):107-12.
4. Hosseinzadeh M, Vafa M, Esmaillzadeh A, Feizi A, Majdzadeh R, Afshar H, et al. Empirically derived dietary patterns in relation to
psychological disorders. Public health nutrition. 2016;19(2):204-17.
5. Norwitz NG, Naidoo U. Nutrition as Metabolic Treatment for Anxiety. Front Psychiatry. 2021;12:598119.
31

D E L I C I O U S T I M E
Written by:
Hanieh Dehghan niri
Tahchin is one of the loveliest and most famous foods in Persian cuisine. It contains
rice, yogurt, saffron, eggs, and barberries (zereshk) sprinkled on top. Some versions of
the dish are more elaborate, folding in chicken fillets, vegetables, fish, or red meat.
Tahchin can also be made with other ingredients, such as walnuts and pomegranate.
The crust's texture depends on the type of rice used.
32

Tahchin can be cooked in various ways, such
as: Chicken Tahchin, Meat Tahchin, Meat and
eggplant Tahchin, Spinach Tahchina, and
Bani Tahchin.
Cooking chicken Tahchin has two steps. The
first one is cooking the chicken, and the
second step is preparing golden rice.
The ingredients for the first
step:
Olive oil 3 tablespoons
1 large onion
Garlic 5 cloves
2 chicken thighs
Half a teaspoon of salt
Half a teaspoon of pepper
3 tablespoons of brewed
saffron
2 cinnamon sticks
5 Cardamom
3 glasses of boiling water
First, pour olive oil into the pan and add
onion and garlic; after they change color
a little, add chicken. Add salt and pepper
as needed. Then add saffron, cinnamon,
and cardamom seeds and boil it with
three glasses of water for 1 hour. After
cooking, take the chicken out of the pan
and divide it into smaller pieces.
The ingredients for the second step:
3 cups of dry rice
2 eggs
1 cup of yogurt
3 tablespoons of saffron
Rose water 1 tablespoon
Barberry 1 cup
33

C H I C K E N
T A H C H I N
Put 6 cups of water on the stove to boil.
Add 1 tablespoon of salt to the boiling
water, add the washed rice, and let it sit
for 8 to 10 minutes until the rice
becomes soft. Drain the rice and set
aside. After washing the barberry with
water, put it in a pan, fry it with a small
amount of oil, and keep it aside. Mix
eggs, yogurt, saffron, and rose water in a
large bowl, and then add drained rice to
the desired mixture.
Please choose a suitable saucepan and
grease its bottom with a few spoons of
oil. Pour half of the rice mixture into the
pan and spread and press it with a
spoon. First, put a layer of sliced ​chicken
on the rice and pour roasted barberry.
Then pour the remaining rice on the
chickens and squeeze again.
Cook, uncovered, for 10 minutes, then decrease the heat to low and cook for 1 hour or
until, when raised slightly, a golden crust has formed on the bottom. Invert onto a serving
plate and sprinkle with pistachios, fried onion, and extra barberries (Zereshk). Cut Tahchin
into the slices and serve it. Hope you enjoy it :)
34

NUTRITION THERAPY
FOR FIBROMYALGIA
written By: Hadis Varaee
What is fibromyalgia?
Fibromyalgia is a chronic (long-lasting) nondegenerative
condition that causes people to
feel widespread pain in the muscles and soft
tissues throughout the body. People with
fibromyalgia also have a lot of places on their
bodies that hurt a lot when touched. It is not
known what causes fibromyalgia.
Sometimes, fibromyalgia seems to get better. However, in
most people, it cannot be cured. It does not get worse over
time, and it is not life-threatening. People can learn to deal
with the condition and lead pretty ordinary lives.
People with fibromyalgia often feel tired, and that sleep
does not help them feel rested. They can also have trouble
thinking, flu-like symptoms, headaches, depression and
anxiety, stomach pain, diarrhea or constipation, pain in the
bladder or the need to urinate in a hurry, or often, problems
with the jaw.
35

Everybody can get fibromyalgia, but more women get it than men. Fibromyalgia can affect
people of any age, even children, but it usually starts in middle age, and the chance of having it
grows as you age. It occurs in a population of all racial and ethnic backgrounds. There is no test
for fibromyalgia.
To diagnose it, doctors review the symptoms. First, they look for other causes of the
symptoms, such as arthritis or a hormone problem. Doctors might distinguish fibromyalgia if
there is a pain in several body parts and they cannot find another cause.
Brain imaging studies and other researchers have discovered evidence of altered signaling in
neural pathways that transmit and receive pain in people with fibromyalgia. These changes can
also contribute to the fatigue, sleep disturbances, and cognitive problems that many people
with the disorder experience.
Genetic factors probably contribute to the disorder, but little about the specific genes
involved are known. Researchers believe that environmental (nongenetic) agents influence a
person's risk of developing the disorder. These environmental factors can include having a
disease that causes pain, such as rheumatoid arthritis, or mental health problems, such as
anxiety or depression.
There are medicines and strategies to help with the symptoms of fibromyalgia. Treatment
usually involves a combination of exercise or other movement therapies, psychological and
behavioral therapy, and medications.
It is essential to stay active. Walking, swimming or biking can all help ease muscle pain.
Outlook has a significant effect on feeling pain, and it is essential to be positive.
36

It is recommended that B12, iron, total iron-binding capacity (TIBC), and ferritin levels be
evaluated. Measuring erythrocyte magnesium and zinc may be beneficial; however,
laboratory tests are unreliable indicators of nutritional status. Due to a low-nutrient density
diet and possible increased nutrient needs, other possible nutrient deficiencies are possible.
A multivitamin can be warranted if nutritional needs are not met through diet lonely. Patients
with fibromyalgia often need to increase salt and water intake, especially with low blood
pressure or orthostatic dizziness. Salt restriction is generally ill-advised in patients with
fibromyalgia because of adrenal dysfunction and orthostatic intolerance. Gluten avoidance
may be beneficial in a subset as well.
Aim for a wholesome diet. Having the right mix of nutrients is particularly important to
people with fibromyalgia. Diets that are rich in antioxidants and provide adequate nutrients,
such as vitamin B12, can help reduce symptoms.
According to a systematic review of the original articles, significant improvements in
biochemical parameters, quality of life, sleep quality, pain at rest, and general health status
were demonstrated when following mainly plant-based dietary patterns. Although these
findings are promising, the interpretation of the findings is limited due to the methodological
quality of the studies. More well-designed clinical trials are needed to establish these
dietary recommendations in people with fibromyalgia.
SHINE Protocol for Treating Fibromyalgia indicates 1-Sleep support 2-Hormonal support 3-
Infection treatment 4-Nutritional support 5-Exercise as able.
References
1. Nadal-Nicolás Y, Miralles-Amorós L, Martínez-Olcina M, Sánchez-Ortega M, Mora J, Martínez-Rodríguez A. Vegetarian and Vegan Diet in
Fibromyalgia: A Systematic Review. International journal of environmental research and public health. 2021;18(9).
2. Fibromyalgia Diet: Eating to Ease Symptoms 2021 [Available from: https://www.healthline.com/health/fibromyalgia-diet-to-easesymptoms.
3. Fibromyalgia 2020 [Available from: https://www.cdc.gov/arthritis/basics/fibromyalgia.htm
4. Janice L. Raymond KM, Krause and mahan's food and the nutrition care process. 15 ed2022.
5. Don L Goldenberg. Patient education: Fibromyalgia (Beyond the Basics) 2022 [Available from:
https://www.uptodate.com/contents/fibromyalgia-beyond-the-basics.
6. UpToDate. Patient education: Fibromyalgia (The Basics) 2023 [Available from: UpToDate.com.
37

Sleep, Nutrition and
Mental Health
Written By: Kimia Rostampour
A healthy lifestyle with high-quality sleep, eating well, and being physically active is
related to mental and physical health. Sleep and health disorders have a substantial social
and economic burden and cost governments trillions of dollars annually. Short sleep
duration and sleep disorders are common issues in society. Only about a third of adults
sleep the recommended 7 to 9 hours for good health. Modern lifestyles with social, work,
and family activities, working at night, and the further use of technology at night (such as
smartphones, computers, and televisions) can disrupt the circadian rhythm and thus be
associated with poor sleep quality.
Sleep problems may play a role in mental disorders, and improving sleep benefits mental
well-being. Short sleep duration has been related to medical and mental health
problems. Also, it can be identified as a significant predictor of mood deficits in all mood
states, such as depression, anxiety, and anger. Additionally, previous studies have shown
the association between poor sleep habits and worse mental health outcomes such as
depression, anxiety, and aggression. Sleep and mental health could affect each other bidirectionally.
For example, sleep problems have been seen in anxious persons. Nutritional
psychiatry is a new field of research that investigates the effect of dietary patterns, diet
quality, and dietary components on mental and sleep health.
38

Recent research has shown the effect of various
nutrients, dietary components, and diet quality on
sleep and mental health. Dietary intake is one of the
factors that can affect sleep outcomes, so the intake
of micronutrients such as vitamin D and B,
magnesium, zinc, Foods with carbohydrate content,
and consumption of berries and fish is associated
with improvements in sleep parameters (e.g., sleep
latency, duration, quality) in contrast, Drinking
caffeinated and sweetened beverages as well as
intake of saturated fats and processed foods have
adverse effects on the quality and quantity of sleep
on the other hand, Studies have shown that
following the Mediterranean diet, a diet with daily
consumption of olive oil and plenty of vegetables
and fruits, whole grains, seafood, and nuts, along
with moderate consumption of low-fat dairy
products and also limited consumption of red meat,
Saturated and trans fats, processed foods and
sodium can be effective in improving the sleep
quality. Sleep parameters (e.g., increased sleep
duration and quality and decreased sleep latency)
have been influenced by consuming food containing
tryptophan, such as milk, and food source of
melatonin and serotonin, such as cherries.
References:
1. Chin M-K, Anderson E, de Ridder JH, Uvinha RR, Durstine JL. BRICS to BRICSCESS—A perspective for practical action in the promotion of healthy lifestyles to improve public health in five
countries. Journal of Sport and Health Science. 2019;8(6):520.
2. RAND. Why sleep matters — the economic costs of insufficient sleep
[Available from: https://www.rand.org/randeurope/research/projects/the-value-of-the-sleep-economy.html.
3. Zuraikat FM, St-Onge M-P. The influence of diet on sleep. Neurological Modulation of Sleep: Elsevier; 2020. p. 205-15.
4. Zomers ML, Hulsegge G, van Oostrom SH, Proper KI, Verschuren WMM, Picavet HSJ. Characterizing Adult Sleep Behavior Over 20 Years-The Population-Based Doetinchem Cohort Study.
Sleep. 2017;40(7).
5. Freeman D, Sheaves B, Goodwin GM, Yu L-M, Nickless A, Harrison PJ, et al. The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis.
The Lancet Psychiatry. 2017;4(10):749-58.
6. Luxton DD, Greenburg D, Ryan J, Niven A, Wheeler G, Mysliwiec V. Prevalence and impact of short sleep duration in redeployed OIF soldiers. Sleep. 2011;34(9):1189-95.
7. Short MA, Booth SA, Omar O, Ostlundh L, Arora T. The relationship between sleep duration and mood in adolescents: A systematic review and meta-analysis. Sleep medicine reviews.
2020;52:101311.
8. Al-Khani AM, Sarhandi MI, Zaghloul MS, Ewid M, Saquib N. A cross-sectional survey on sleep quality, mental health, and academic performance among medical students in Saudi Arabia.
BMC research notes. 2019;12(1):1-5.
9. Soehner AM, Harvey AG. Prevalence and functional consequences of severe insomnia symptoms in mood and anxiety disorders: results from a nationally representative sample. Sleep.
2012;35(10):1367-75.
10. Hosker DK, Elkins RM, Potter MP. Promoting mental health and wellness in youth through physical activity, nutrition, and sleep. Child and Adolescent Psychiatric Clinics. 2019;28(2):171-93.
11. St-Onge M-P, Mikic A, Pietrolungo CE. Effects of diet on sleep quality. Advances in nutrition. 2016;7(5):938-49.
12. Sutanto CN, Wang MX, Tan D, Kim JE. Association of sleep quality and macronutrient distribution: a systematic review and meta-regression. Nutrients. 2020;12(1):126.
13. Godos J, Ferri R, Caraci F, Cosentino FII, Castellano S, Galvano F, et al. Adherence to the Mediterranean Diet is Associated with Better Sleep Quality in Italian Adults. Nutrients. 2019;11(5).
14. González-Gómez D, Lozano M, Fernández-León M, Ayuso M, Bernalte M, Rodríguez A. Detection and quantification of melatonin and serotonin in eight sweet cherry cultivars (Prunus
avium L.). European Food Research and Technology. 2009;229:223-9.
15. Bravo R, Matito S, Cubero J, Paredes S, Franco L, Rivero M, et al. Tryptophan-enriched cereal intake improves nocturnal sleep, melatonin, serotonin, and total antioxidant capacity levels
and mood in elderly humans. Age. 2013;35:1277-85.
39

QUESTION &
ANSWERS
WRITTEN BY:BITA FOROOTANI
Can food insecurity affect children's mental health?
It has been found that 12- to 17-year-olds had lower
psychosocial function if they lived in food-insecure households.
What is the best nutritional course of action to manage
anxiety
Evaluation of B and D vitamins is suggested. Also, if there is a
lack of magnesium in the body, mineral food sources can be
helpful. Reducing caffeine intake can help to manage anxiety
as well.
Can any nutritional exposure worsen bipolar disorder?
Excessive iron intake can cause bipolar disorder to emerge. So,
iron status is recommended to be checked.
Can vitamin E supplementation help to improve Alzheimer's
disease?
Vitamin E can help improve Alzheimer's disease if obtained
from food sources such as almonds, peanuts, or vegetable oils.
Which kind of diet can be protective against depression?
Diets rich in fruits, vegetables, fish, olive oil, whole grains, and low-fat dairy can
be protective against this mental disorder. One of the diets with these
characteristics is the Mediterranean diet.
40

Does turmeric play a role in depression treatment?
There is a substance called curcumin in turmeric, which according to studies,
has been proven to be effective in treating depression due to its antiinflammatory
effects.
Can the Nordic diet help in stress management?
A nordic diet that is high in vegetables can cause a decrease in stress and
anxiety.
Is the ketogenic diet a treatment for
depression?
While diet modifications are considered a tool
that may improve mental health, a ketogenic
diet is also suggested because it changes
nutritional behaviors. However, further
research is required to investigate the
mechanisms of action of nutritional ketosis in
the brain.
41

A NEW APPROACH TO
PREVENT DEPRESSION
WRITTEN BY: BEHNAZ JAFARI
Depression is a common mental disorder;
Around 350 million people worldwide
suffer from depression. Depression
manifests differently in each person; the
primary symptoms include anhedonia, a
gloomy mood, fatigue, sleep disturbance,
and self-destructive behavior.
It influences thoughts, feelings, and
behavior and may cause several
emotional and physical issues.
there is no specific cause or trigger for
depression; it can happen for many
reasons. Factors such as genetics,
personality, and environment may
affect depression. Additionally, lifestyle
factors such as diet have also been
proposed as risk modifiers for
depression.
Selective serotonin reuptake inhibitors are
one type of antidepressant drug
commonly used to treat major depressive
disorder. Nevertheless, nearly 30% of
depressed patients fail to adequately
respond to antidepressant medications,
which also have some adverse effects.
According to research, diets high in
plant foods such as vegetables, fruits,
legumes, whole grains, and lean
proteins such as fish are associated
with a lower risk of depression.
In contrast, diets high in processed
foods and sugary products are
associated with an increased risk of
depression.
The Mediterranean diet is a healthy
dietary pattern with the most
substantial evidence for alleviating
depression symptoms. This dietary
pattern refers to a food profile with
high intakes of fruits, vegetables, nuts,
legumes, and complex carbohydrates
(combined with low intakes of
saturated fat), moderately high intakes
of fish, low intakes of dairy and meat
products, and regular but low-tomoderate
alcohol use.
42

According to the result of a cohort
study in the year 1992 that was
conducted on 49,261 Swedish women
aged 29-49, after 20 years of followup,
the result demonstrated that
Higher adherence to a Mediterranean
diet in middle age was associated
with a lower risk of depression later in
life among Swedish women.
In addition, a clinical trial in New
Zealand aimed to determine if
a Mediterranean diet can improve
depressive symptoms in young males
with clinical depression. Seventy-two
people completed the study, and after
a 12-week diet intervention, the result
showed that the Mediterranean diet
intervention leads to lower depressive
symptoms.
In conclusion, these results highlight
nutrition's critical role in treating
depression and should inform advice
given by clinicians to this specific
demographic population.
REFERENCES
1. Wu S-X, Li J, Zhou D-D, Xiong R-G, Huang S-Y, Saimaiti A, et al. Possible Effects and Mechanisms of Dietary
Natural Products and Nutrients on Depression and Anxiety: A Narrative Review. Antioxidants [Internet]
2022;11(11):2132. Available from: http://dx.doi.org/10.3390/antiox11112132
2. Bayes J, Schloss J, Sibbritt D. The effect of a Mediterranean diet on the symptoms of depression in young
males (the "AMMEND: A Mediterranean Diet in MEN with Depression" study): a randomized controlled trial. Am J
Clin Nutr. 2022 Aug 4;116(2):572-580. doi: 10.1093/ajcn/nqac106. PMID: 35441666.
3. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
4. Yin W, Löf M, Chen R, Hultman CM, Fang F, Sandin S. Mediterranean diet and depression: a population-based
cohort study. International Journal of Behavioral Nutrition and Physical Activity. 2021;18:1-10.
43

Nutrition Therapy in Mood Disorders
Written By: Arezoo Emrani
What are mood disorders?
Mood disorders disturb a person's emotional state or
general mood and interfere with his ability to
function. This state may cause severe sadness or
depression or may cause periods of depression
alternating with being excessively happy.
What are examples of mood
disorders?
Major depressive disorder, which is
prolonged and persistent periods of sadness
Bipolar disorder also called manic
depression, which is a depression that
includes alternating times of depression and
mania (extreme happiness)
Persistent depressive disorder (dysthymia),
which is a long-term form of depression
Depression is related to medical illness; it is a
persistent depressed mood and a significant
loss of pleasure in most or all activities
directly related to another medical condition's
physical effects.
Depression induced by substance use or
medication; it is depression symptoms that
develop during or soon after exposure to a
medication.
Seasonal affective disorder (SAD); is a form
of depression most often associated with
fewer hours of daylight in the far northern
and southern latitudes from late fall to early
spring
Cyclothymic disorder; is a disorder that
causes emotional ups and downs that are less
extreme than bipolar disorder.
44

Major depressive disorder, which is
Premenstrual depressive disorder (dysthymia);
mood changes and Irritability that occur during
the premenstrual phase of a woman's cycle and
go away with the onset of menses
Disruptive mood dysregulation disorder; is a
disorder of chronic, severe, and persistent
Irritability in children that often includes
frequent temper outbursts inconsistent with the
child's developmental age.
What are the risk factors for mood
disorders?
Sex
Family history
Inadequate social support
Stressful life events
Coexisting medical illness
Medications
Drug intoxication or withdrawal
What are the common symptoms of
mood disorders?
Irritability, aggression, or hostility
An ongoing sad, empty, or anxious mood
Changes in appetite or weight
Changes in sleep patterns
Difficulty concentrating
Nutrition considerations in mood
disorders
Today, many studies have shown the connection
between nutrition and mood disorders. In fact,
nutrition in different ways can effectively improve
mood states. Some of the mechanisms through
which nutrition affects mood disorders are:
inflammation, mitochondrial dysfunction, and the
brain-gut microbiome axis.
45

Dietary patterns
46
A dietary pattern comprises multiple nutrients and
bioactive compounds that can theoretically
modulate pathways associated with mood disorders.
Recent meta-analyses studies reported the
association between a healthy diet, like the
Mediterranean diet, which is characterized by a
high intake of fruits, vegetables, legumes, nuts,
whole grains, and high-quality protein sources, and
decreased risk of mood disorders. More recently, it
was shown that high adherence to another dietary
pattern based on the Mediterranean diet, called
Mediterranean-DASH diet intervention for
neurodegenerative delay (MIND), also decreases
the risk of developing depression. This diet
emphasizes neuro-protective foods such as green
leafy vegetables, nuts, berries, beans, olive oil, and
wine. The ketogenic diet is also one of the dietary
patterns recently considered for treating mood
disorders. The potential metabolic effects of the
ketogenic diet influence different processes
implicated in the pathophysiology of mood
disorders, such as mitochondrial biogenesis,
inflammation, and oxidative stress. However, there
still needs to be more information about the
beneficial effects of this diet on mood disorders.
A healthy body weight
Obesity and mood disorders are often
comorbidities. Excess body weight may reduce the
efficacy of some medications. In addition, weight
loss in obese persons is associated with
improvement in mood. Therefore, maintaining the
ideal weight should be among the priorities of
nutritionists.
Preventing or treating diabetes
People with type 2 diabetes are more likely to
develop depression than the general population.
Poor metabolic control may worsen depression
and diminish the response to antidepressants.
Additionally, persons who are depressed are at
increased risk for diabetes.
Complex carbohydrate consumption
Carbohydrates and proteins influence the rate
neurotransmitter precursors to enter the central
nervous system from the blood. Meals with high
carbohydrates raise blood glucose and insulin
secretion, which results in a drop in plasma
amino acids.This means that fewer amino acids
compete

administered along with standard antidepressants.
These fatty acids have an anti-inflammatory role, so
it is possible that botanical sources of omega-3s,
such as flex oil, might have the same effect.
However, more evidence in this field is needed.
Nevertheless, these fatty acids may be suggested as
an adjuvant treatment for mood disorders.
Inositol
with tryptophan –which is a serotonin precursorfor
transport through the blood-brain barrier.
Also, it has been suggested to reduce the use of
artificial sweeteners. Studies demonstrated that
diets high in artificial sweeteners are associated
with higher levels of depression and anxiety.
Adequate intake of B vitamins
Studies have shown a relationship between lacking
B vitamins, especially folate, and mood disorders.
Folate is linked to these disorders in several ways.
It is essential in producing tetrahydrobiopterin
(BH4), hydroxylation of tryptophan, and synthesis
of dopamine, norepinephrine, and serotonin. It is
also shown that folate status predicts response to
antidepressant treatments in the elderly.
In addition, some limited evidence suggests that
patients with depression and cognitive dysfunction
respond better to an antidepressant medication
when given supplemental vitamins B1, B2, and B6.
Omega-3 fatty acids
Depression is related to lower levels of long-chain
omega-3 fatty acids, especially EPA and DHA.
Some trials indicated improvement in the
depression rating scale when fish oil where
DInositol is a substance found in many foods, such
as whole-grain cereals and legumes. It is a key
intermediate of the phosphatidyl-inositol cycle, a
second messenger system used by several
noradrenergic, serotonergic, and cholinergic
receptors. Limited studies have suggested that
inositol reduces anxiety symptoms at doses of 8-12
g per day.
Botanical treatments
St. John's Wort is effective in 50-70% of
outpatients with mild depression. Passionflower,
chamomile, and lemon balm contain flavonoids that
bind to benzodiazepine receptors. However,
evidence of their anxiolytic effects is modest.
You should be careful when using herbal
treatments.
In general, having a healthy diet, affluent in antiinflammatory
foods and B vitamins, as well as
maintaining an ideal weight under the supervision
of a nutritionist, can be effective in improving
mood disorders.
References:
1. SLais B Martins, Jenneffer Rayane Braga Tibães, Marsal Sanches, Felice Jacka,
Michael Berk & Antônio L Teixeira (2021) Nutrition-based interventions for
mood disorders, Expert Review of Neurotherapeutics, 21:3, 303-315, DOI:
10.1080/14737175.2021.1881482.
2. Mood Disorders: Nutrition Guide for clinicians; [updated November 24, 2020.
47

Thank you Shahid Sadoughi
University of Medical
Sciences
Fatemeh Mirjalili
Editor in Chief
Behnaz Jafari
Writer
Hadis Varaee
Writer
Bita Forootani
Writer
Kimia Rostampour
Writer
48
Arezoo Emrani
Writer
Hanieh Dehghan niri
Writer
Hooman Yekrang Safakar
Writer
Special thanks to Dr. Amin Salehi-Abargouei for initiating and
supporting this collaboration!!!

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