Post-Traumatic Stress and Food - yes, there's a connection
by Rachel Miller, RD
Rachel is a Registered Dietitian at Our Clinic, where she provides patient-centered nutrition care to clients by encouraging balanced and healthy eating patterns.
Rachel completed her practical training at London Health Sciences Centre and had rotations in a variety of areas including the Eating Disorders Clinic and Clinical Neurosciences in-patient unit. From these experiences, Rachel has gained knowledge in the gut-brain axis and the direct impact that nutrition can have on mental health and the brain.
Mental health conditions are associated with long-lasting disability and increased mortality. In fact, by 2030 mental health issues are expected to be the leading cause of disability in Canada1. As patients and practitioners alike look for additional options to traditional pharmaceuticals, the role of nutrition care in properly managing mental health conditions is clear. Registered Dietitians (RDs) are licensed health professionals who have special training in assessing clinical, biochemical, and anthropometric measures, as well as addressing dietary concerns in those with mental health concerns1.
It's well-established that those with post-traumatic stress disorder (PTSD) experience thought and behaviour pattern changes2. PTSD can impact a patient’s appetite in many ways, both increasing and/or reducing appetite leading to erratic eating patterns, associating feelings with particular foods and then subsequently making poor nutrition decisions. Decreasing these damaging nutrition practices and supporting positive nutritional inventions can help maintain the structure and function of neurons1.
With such erratic eating patterns, patients may find it difficult to be able to maintain an adequate oral intake. Insufficient macronutrient consumption affects the brain in several ways. First, carbohydrates are the body's main source of energy, and with insufficient intake blood glucose can become difficult to manage. Unstable blood glucose levels can lead to elevated feelings of frustration and anxiety. Inadequate carbohydrate intake also hinders the production of serotonin, and this puts individuals at higher risk for insomnia, irritability, and depression3. Next, dietary protein (amino acids) is the foundation of neurotransmitters. Dopamine is made from the amino acid tyrosine, and serotonin is made from tryptophan. If an individual lacks either of these amino acids, synthesis of the respective neurotransmitter is disrupted, which affects mood and aggression levels3. The effects of trauma such as sensory issues, hyperarousal, and feelings of numbness can affect appetite and eating. Mealtimes may especially be associated with stress if there's been a history of force-feeding. The RD can incorporate a variety of therapeutic interventions, including elements of trauma-informed care, that can help normalize eating patterns1.
Equally as important, is ensuring excessive oral intake doesn't occur in patients with PTSD. The association between PTSD and increased risk of metabolic comorbidities is well established with studies reporting higher rates of obesity, dyslipidemia, hypertension, diabetes, and cardiovascular disease in this patient population4. This association may be partly explained by poor health behaviors including increased caloric intake as a potential coping mechanism2. In fact, studies found women with PTSD were up to four times more likely to be obese than women without PTSD, even after adjusting for demographics, alcohol/drug use, smoking, psychotropic medication use, depression and binge eating2. Through exploring each patient's individual food habits, the RD can help identify poor nutritional patterns and establish realistic and attainable weight-management goals.
It's clear that with either inadequate or excessive oral intake, there are detriments to mental health. While these adverse behaviors clearly play a critical role in disease risk, it's also important to recognize that optimal health is achieved by promoting healthy behaviors4. Studies suggest many foods may help reduce stress, ease anxiety and fight depression. Nutritional guidelines that include a focus on foods rich in antioxidants such as vegetables, fruit, whole grains, beans, lentils, nuts, seeds, vegetable oils, garlic, and green tea may help counteract the effects of stress1. Omega-3 fatty acid consumption may also help by assisting in the uptake of neurotransmitters and decreasing inflammation. Having a proper balance of omega-6 and omega-3 fatty acids helps neurotransmitter receptors function, which in turn helps increase the number of neurotransmitters that can be active in the brain3. There are even some studies demonstrating a positive association between probiotic consumption and improved mental health4. Proper dietary intervention emphasizing these healthier choices will ultimately aid not only in the management of PTSD, but also its resulting co-morbidities.
In conclusion, diet therapy should be recognized as a vital part of interventions in clinical practice guidelines and standards of care for those with PTSD. Whether there's inadequate or excessive oral intake, an RD can help establish normalized eating patterns which helps prevent the negative outcomes associated with poor nutritional habits. Additionally, providing positive nutritional interventions such as encouraging a diet rich in antioxidants and omega-3 fatty acids, can help lower inflammation and ultimately may improve mental health. Finally, interdisciplinary care that addresses the unique needs of those with a mental health condition and concurrent chronic diseases will ensure equity in care1.
Nutrition and gut health is an important part of the MAPS program - Moving Ahead of Post-Traumatic Stress. This area of health is often overlooking in treatment and care plans so make sure you're choosing whole person care.
1. Davison KM, Cairns J, Selly C, Ng E, Chandrasekera U, Sengmueller E, Jaques M, et al. The Role of Nutrition Care for Mental Health Conditions [Internet]. Toronto (ON):Dietitians of Canada; 2012 Dec [cited 2019 Nov 27]. 111 p. Available from: www.dietitians.ca/mentalhealth.
2. van den Berk-Clark C, Secrest S, Walls J, Hallberg E, Lustman PJ, Schneider FD, et al. Association between Posttraumatic Stress Disorder and lack of exercise, poor diet, obesity and co-occuring smoking: A Systematic Review and Meta-analysis. Health Psychol. 2018;37(5):407–16. https://doi.org/10.1037/hea0000593.
3. Salz A. Substance Abuse and Nutrition. Today’s Dietitian [Internet].2014 Dec [cited 2019 Nov 27];16(12):44. Available from: https://www.todaysdietitian.com/newarchives/120914p44.shtml.
4. Hall KS, Hoerster KD, Yancy WS. Post-Traumatic Stress Disorder, Physical Activity, and Eating Behaviors. Epidemiol Rev. 2015;37(1):103–15. https://doi.org/10.1093/epirev/mxu011.