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How can motivation be increased by improving brain chemistry with nutrition and activities?

How can motivation be increased by improving brain chemistry with nutrition and activities?


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I'm reading some material about motivation and brain chemistry. One of the interesting articles is "7 Ways to Increase Motivation by Improving your Brain Chemistry". I'm interested in a more scientific treatment of the topic. Thus,

  • How can motivation be increased by improving brain chemistry with nutrition or various activities (sport, exercise, relationships etc.)?
  • What scientific articles exist on this topic?

It would be great if there was some article targeting this exact topic with references.


The best thing you can do is avoid nutritional deficiencies and exercise. In general, it's the same as for the rest of the body. Many people have subtle nutritional deficiencies that they may never know about their whole life just based on eating habits. As Chuck Sherrington said, neurotransmitter-based treatments are subject to homeostatic compensation, but if you have a deficiency, it may be more complicated.

Nutrition

Particularly, the same things that increase pulmonary/circulatory health are going to increase brain health[1,2]. A large contribution to health in the developing fetal brain comes from the mother's diet. There are lots of diseases associated with maternal nutrtional defecits[3,4].

Exercise

Running and other physical activities increases neurogenesis [5,6]. But does it do it "intelligently"? I don't know. More neurons isn't automatically more motivation or intelligence. But it is a stress-relief technique, and too much stress can certainly kill motivation.

Behavior

You didn't ask, but behavioral practice is probably another strong factor. For example, breaking jobs into smaller tasks: getting the first small task done can give a motivational boost towards getting the second done (and so on). They've actually found a correlation between paying smaller loans off first (even though not mathematically more efficient in terms of costs) is more likely to lead to loans being paid off all the way because of the human element[9]


Low / loss of motivation is associated with several Disorders of Diminished Motivation (DDM) (eg, akinetic mutism, abulia, apathy) that occur frequently in individuals with traumatic brain injury or other underlying neurological disorder, as well as avolition, and is a prominent symptom of dysthymia, motivational anhedonia, schizophrenia, and others.

There is not much research on treatment of motivation in these disorders with nutrition, possibly because of the underlying neurological causes, the complexity of studying nutrition, and low incidence rates. For a reasonably useful answer, I will instead review the effect of nutrition on motivation in depression, where much more research is available, and this would hopefully extend to low motivation in general.

Personalized Nutrition:

There are several reasons why it may be impossible to find clear answers on nutritional treatments for motivation. For one, known nutrient deficiencies rarely manifest in isolated cognitive symptoms such as low motivation - but rather with acute physical disease symptoms.

Another important factor is that nutrient deficiencies may have as much to do with individual characteristics as general dietary ones - that is, a dietary prescription may not work the same for everyone. Unfortunately, nutritional genomics as a field is currently in its infancy - see Ordovas et al (2018) for a recent review.

There are also many unknowns remaining regarding the role of the gut microbiome in depression, and the placebo effect of treatment - ie, seeing a nutritionist may well be as important as the prescription they provide. And ironically, some research suggests that fasting may be effective with depression - implying the opposite of a nutrient deficiency!

Healthy Diet:

Rigidly set dietary prescriptions can have advantages even when not personalized. For example, they take the onus off patients to make healthy diet choices, and may be more likely to be followed.

However, research on a variety of diets demonstrate that healthy diets have positive effects on depression (Molendijk et al, 2018; Opie et al, 2015; Firth et al, 2019). The general recommendation therefore is well known: Reduce sugar and processed foods, increase fruits and vegetables. This has the added bonus of not just improving motivation, but also improving overall physical and mental health!

So, the below recommendations are fine to follow, but just note that any healthy diet is fine too.

Dietary Prescriptions:

Several recent reviews of current findings containing specific dietary prescriptions are listed below, with relevant extracts. I encourage reading the papers for specific tests of nutritional interventions and their results, as recommendations may or may not be applicable.

Sathyanarayana et al (2008): Understanding nutrition, depression and mental illnesses

The dietary intake… are often deficient in many nutrients, especially essential vitamins, minerals, and omega-3 fatty acids.

Khanna, Chattu, & Aeri (2019): Nutritional Aspects of Depression in Adolescents - A Systemic Review

… several healthy foods such as olive oil, fish, nuts, legumes, dairy products, fruits, and vegetables have been inversely associated with the risk of depression and might also improve symptoms.

WebMD: Depression and Diet

… while certain eating plans or foods may not ease your symptoms or put you instantly in a better mood, a healthy diet may help as part of your overall treatment.

Brown (2012): Nutritional Brain Energy Enhancement for Reducing Mental Fatigue and Improving Mood and Cognition

The enhancement of brain energy metabolism with nutritional factors such as creatine, acetyl-l-carnitine, multivitamins and polyphenol rich diets may be a novel strategy for reducing mental fatigue and improving mood and cognition…


7 Ways Meditation Can Actually Change The Brain

The meditation-and-the-brain research has been rolling in steadily for a number of years now, with new studies coming out just about every week to illustrate some new benefit of meditation. Or, rather, some ancient benefit that is just now being confirmed with fMRI or EEG. The practice appears to have an amazing variety of neurological benefits – from changes in grey matter volume to reduced activity in the “me” centers of the brain to enhanced connectivity between brain regions. Below are some of the most exciting studies to come out in the last few years and show that meditation really does produce measurable changes in our most important organ. Skeptics, of course, may ask what good are a few brain changes if the psychological effects aren’t simultaneously being illustrated? Luckily, there’s good evidence for those as well, with studies reporting that meditation helps relieve our subjective levels of anxiety and depression, and improve attention, concentration, and overall psychological well-being.

Meditation Helps Preserve the Aging Brain

Last week, a study from UCLA found that long-term meditators had better-preserved brains than non-meditators as they aged. Participants who’d been meditating for an average of 20 years had more grey matter volume throughout the brain — although older meditators still had some volume loss compared to younger meditators, it wasn’t as pronounced as the non-meditators. "We expected rather small and distinct effects located in some of the regions that had previously been associated with meditating," said study author Florian Kurth. "Instead, what we actually observed was a widespread effect of meditation that encompassed regions throughout the entire brain."

Meditation Reduces Activity in the Brain’s “Me Center"

One of the most interesting studies in the last few years, carried out at Yale University, found that mindfulness meditation decreases activity in the default mode network (DMN), the brain network responsible for mind-wandering and self-referential thoughts – a.k.a., “monkey mind.” The DMN is “on” or active when we’re not thinking about anything in particular, when our minds are just wandering from thought to thought. Since mind-wandering is typically associated with being less happy, ruminating, and worrying about the past and future, it’s the goal for many people to dial it down. Several studies have shown that meditation, through its quieting effect on the DMN, appears to do just this. And even when the mind does start to wander, because of the new connections that form, meditators are better at snapping back out of it.

Its Effects Rival Antidepressants for Depression, Anxiety

A review study last year at Johns Hopkins looked at the relationship between mindfulness meditation and its ability to reduce symptoms of depression, anxiety, and pain. Researcher Madhav Goyal and his team found that the effect size of meditation was moderate, at 0.3. If this sounds low, keep in mind that the effect size for antidepressants is also 0.3, which makes the effect of meditation sound pretty good. Meditation is, after all an active form of brain training. “A lot of people have this idea that meditation means sitting down and doing nothing,” says Goyal. “But that’s not true. Meditation is an active training of the mind to increase awareness, and different meditation programs approach this in different ways.” Meditation isn’t a magic bullet for depression, as no treatment is, but it’s one of the tools that may help manage symptoms.

Meditation May Lead to Volume Changes in Key Areas of the Brain

In 2011, Sara Lazar and her team at Harvard found that mindfulness meditation can actually change the structure of the brain: Eight weeks of Mindfulness-Based Stress Reduction (MBSR) was found to increase cortical thickness in the hippocampus, which governs learning and memory, and in certain areas of the brain that play roles in emotion regulation and self-referential processing. There were also decreases in brain cell volume in the amygdala, which is responsible for fear, anxiety, and stress – and these changes matched the participants’ self-reports of their stress levels, indicating that meditation not only changes the brain, but it changes our subjective perception and feelings as well. In fact, a follow-up study by Lazar’s team found that after meditation training, changes in brain areas linked to mood and arousal were also linked to improvements in how participants said they felt — i.e., their psychological well-being. So for anyone who says that activated blobs in the brain don’t necessarily mean anything, our subjective experience – improved mood and well-being – does indeed seem to be shifted through meditation as well.

Just a Few Days of Training Improves Concentration and Attention

Having problems concentrating isn’t just a kid thing – it affects millions of grown-ups as well, with an ADD diagnosis or not. Interestingly but not surprisingly, one of the central benefits of meditation is that it improves attention and concentration: One recent study found that just a couple of weeks of meditation training helped people’s focus and memory during the verbal reasoning section of the GRE. In fact, the increase in score was equivalent to 16 percentile points, which is nothing to sneeze at. Since the strong focus of attention (on an object, idea, or activity) is one of the central aims of meditation, it’s not so surprising that meditation should help people’s cognitive skills on the job, too – but it’s nice to have science confirm it. And everyone can use a little extra assistance on standardized tests.

Meditation Reduces Anxiety — and Social Anxiety

A lot of people start meditating for its benefits in stress reduction, and there’s lots of good evidence to support this rationale. There’s a whole newer sub-genre of meditation, mentioned earlier, called Mindfulness-Based Stress Reduction (MBSR), developed by Jon Kabat-Zinn at the University of Massachusetts’ Center for Mindfulness (now available all over the country), that aims to reduce a person’s stress level, physically and mentally. Studies have shown its benefits in reducing anxiety, even years after the initial 8-week course. Research has also shown that mindfulness meditation, in contrast to attending to the breath only, can reduce anxiety – and that these changes seem to be mediated through the brain regions associated with those self-referential (“me-centered”) thoughts. Mindfulness meditation has also been shown to help people with social anxiety disorder: a Stanford University team found that MBSR brought about changes in brain regions involved in attention, as well as relief from symptoms of social anxiety.

Meditation Can Help with Addiction

A growing number of studies has shown that, given its effects on the self-control regions of the brain, meditation can be very effective in helping people recover from various types of addiction. One study, for example, pitted mindfulness training against the American Lung Association's freedom from smoking (FFS) program, and found that people who learned mindfulness were many times more likely to have quit smoking by the end of the training, and at 17 weeks follow-up, than those in the conventional treatment. This may be because meditation helps people “decouple” the state of craving from the act of smoking, so the one doesn’t always have to lead to the other, but rather you fully experience and ride out the “wave” of craving, until it passes. Other research has found that mindfulness training, mindfulness-based cognitive therapy (MBCT), and mindfulness-based relapse prevention (MBRP) can be helpful in treating other forms of addiction.

Short Meditation Breaks Can Help Kids in School

For developing brains, meditation has as much as or perhaps even more promise than it has for adults. There’s been increasing interest from educators and researchers in bringing meditation and yoga to school kids, who are dealing with the usual stressors inside school, and oftentimes additional stress and trauma outside school. Some schools have starting implementing meditation into their daily schedules, and with good effect: One district in San Francisco started a twice daily meditation program in some of its high-risk schools – and saw suspensions decrease, and GPAs and attendance increase. Studies have confirmed the cognitive and emotional benefits of meditation for schoolchildren, but more work will probably need to be done before it gains more widespread acceptance.

Worth a Try?

Meditation is not a panacea, but there’s certainly a lot of evidence that it may do some good for those who practice it regularly. Everyone from Anderson Cooper and congressman Tim Ryan to companies like Google and Apple and Target are integrating meditation into their schedules. And its benefits seem to be felt after a relatively short amount of practice. Some researchers have cautioned that meditation can lead to ill effects under certain circumstances (known as the “dark night” phenomenon), but for most people – especially if you have a good teacher – meditation is beneficial, rather than harmful. It’s certainly worth a shot: If you have a few minutes in the morning or evening (or both), rather than turning on your phone or going online, see what happens if you try quieting down your mind, or at least paying attention to your thoughts and letting them go without reacting to them. If the research is right, just a few minutes of meditation may make a big difference.

WATCH: Some Of The Most Exciting Discoveries To Come Out Of Brain Research


Improving your relationship with food and your body

When you have a poor relationship with food and your body, it can have a big impact on daily life. When it consumes your thoughts it can make you feel low and, at its worst, even contribute to depression and eating disorders.

Building a healthy and nurturing relationship with yourself is key. This can take time, work and a whole lot of compassion, but the results are worth it. Learning more about body neutrality may be a helpful first step for you. Many people find it both helpful and necessary to work with professionals.

You may want to look into counselling to see if a therapist can help you understand why your relationship with food and your body is the way it is and how to take those first steps to self-acceptance. To complement this work, a nutritionist can help you honour your hunger, eat more intuitively and reach any health goals you set.

Trying new foods and building confidence in the kitchen can also help to rekindle a love for food. The aim here is for you to see eating as a joyful thing, not something that triggers stress and anxiety. Understanding how different foods affect your body and mind will help hugely with this.

I take joy in food and note how the foods I eat make me feel. If I feel bloated, in pain or lethargic after a meal, I remember to avoid (or reduce my portions) next time. If a particular snack boosts my energy &ndash I&rsquoll keep it in mind for the future. This way of eating, with its distinct lack of restrictions, rules or calorie counting, is called intuitive eating.


Brains Do It: Lust, Attraction, and Attachment

Did you ever experience the unsettling sense that your sexual desires, romantic longings,and feelings of long-term emotional union were racing down different tracks? And perhaps ask yourself: Which of these is love?

The three tracks may be different brain circuits, says Helen Fisher, an anthropologist at Rutgers University conducting research on the brain chemistry of the emotions associated with mating, reproduction,and parenting. With classic understatement,she suggests that the three emotional systems—lust, attraction, and attachment—“are somewhat disconnected in human beings…” But the situation is not hopeless, Fisher arguesthe role of the prefrontal cortex in humans is to control and direct these emotions—if we so choose.

“ W hat t’is to love?” Shakespeare asked. Thousands of answers have been offered—but surprisingly few by biologists, including brain scientists. Perhaps at some level scientists share the poet’s conceit that love is ineffable, a human fifth dimension beyond reason’s ken. While scientists regard other complex emotional states such as depression, anxiety, or fear as complex, but not unfathomable, love is relegated to the poets and songsters.

Neglecting the biology of the emotions that direct mating and reproduction, emotions that in our species are sometimes called “love,” has had tragic consequences. Certainly such love can be a joyous state, but it is also capable of producing deeply disturbing, even dangerous results. At least 25 percent of homicides in the United States involve spouses, sexual partners, or sexual rivals. Each year, some one million American women are followed and harassed by rejected lovers 370,000 men are stalked by former partners and approximately 1.8 million wives in the United States are beaten by their husbands. In fact, male sexual jealousy is the foremost cause of wife battering in cultures worldwide. Husbands, although to a lesser degree, are physically abused by wives. Men and women in societies everywhere can experience clinical depression when a love relationship fails and psychologists say that a significant percentage of those who commit suicide do so because they have been rejected by a beloved.

Love is a powerful force the vast majority of Americans marry. But the divorce rate in the United States is expected to reach 67 percent in the next decade. Currently, some 80 percent of divorced men and 72 percent of divorced women remarry but 54 percent and 61 percent, respectively, divorce again. High divorce and remarriage rates are seen in many other cultures, as well. It is time to investigate the biology of this bittersweet experience we call love.


Four Important Brain Chemicals

Serotonin

You probably already know that serotonin plays a role in sleep and in depression, but this inhibitory chemical also plays a major role in many of your body’s essential functions, including appetite, arousal, and mood. Many antidepressants target serotonin receptors to improve your mood and lessen depressive symptoms.

Interestingly, most of your serotonin is stored in the intestine, and this chemical may play a role in digestive functioning as well.

Dopamine

Dopamine controls many functions, including behavior, emotion, and cognition. This chemical also communicates with the front part of your brain, which is associated with pleasure and reward. On the positive side, it helps motivate you to work toward achieving a reward. However, many illegal drugs also target dopamine receptors, contributing to drug and alcohol addiction. Because dopamine is related to movement, low levels have also been linked to Parkinson’s disease.

Glutamate

This is the most common excitatory neurotransmitter, found throughout your brain and spinal cord. Glutamate has many essential functions, including early brain development, cognition, learning, and memory.

Norepinephrine

This chemical, also called noradrenaline, can sometimes act as a hormone as well. Its primary role is part of your body’s stress response. It works with the hormone adrenaline to create the “fight-or-flight” feeling. Norephinephrine may also be used as a drug to raise or maintain blood pressure in certain illnesses.


Enhancing motivation in sport

With Torino Olympic Games underway, the sports world will be in the spotlight for much of this month. Psychologists have been supporting the U.S. Olympic mission formally since the 1980s and a team of sport psychologists will be on-hand in Italy this month to continue the work they have been doing for the past 4 years with some of the country’s finest athletes. As important as performance enhancement can be for elite athletes, it is only a small piece of how psychologists are contributing to the world of sport. Millions of youth participate in organized sports annually in the United States (Ewing & Seefeldt, 2002) and another interesting line of inquiry in sport psychology focuses on how organized sport experiences can be used to foster optimal motivation. Enhancing motivation can lead to the sustained, high-quality engagement in sport that is required for the development of Olympic-level expertise (Ericsson, Krampe, Tesch-Römer, 1993) and it may also contribute to healthy youth development which will be the focus of this essay.

The Value of Youth Sport Participation

One of the most powerful rationales for promoting youth sport participation draws from the documented benefits of physical activity. The United States Surgeon General (USDHHS, 1996) and the American College of Sports Medicine (2000) endorse regular physical activity to reduce long-term risk for disease (e.g., diabetes, cardiovascular disease, some forms of cancer). Strikingly, the prevalence of diseases such as type-II diabetes recently increased dramatically in children and youth (Ludwig & Ebbeling, 2001). This increase is widely attributed to concurrent increases in childhood obesity (Ebbeling, Pawlak, & Ludwig, 2002). Overweight status among children and adolescents in the United States has more than tripled in the past 25 years (Baskin, Ard, Franklin, & Allison, 2005 Flegal, 2005).

Given the nature of energy balance (i.e., caloric intake vs. energy expenditure), increasing youth physical activity will surely be one part of the solution to the current childhood obesity crisis. Unfortunately, daily physical activity is being cut out of school curricula across the country (Jago & Baranowski, 2004). The greatest single source of organized youth sport participation appears to be recreational sport programs, such as those sponsored by community recreation departments (Ewing & Seefeldt, 2002) but it is well-established that youth sport participation rates experience a steady decline starting between ages 10-13 years (Brustad, Babkes, & Smith, 2001). Getting and keeping youth involved in organized sport programs outside of school is a motivation problem of great importance for public health. Of course, physical activity and its benefits for physical health represent only one class of youth sport outcomes.

Sport is also a powerful context for youth psychosocial development. Youths’ subjective experience during organized sports and other structured voluntary activities is unique because they report greater concentration than they do when playing with friends in unstructured settings, and greater enjoyment than they do in structured activities such as school (Cziksentmihalyi & Larson, 1984 Kirshnit, Ham, & Richards, 1989). These conditions are ideally-suited for social learning and internalizing environmental characteristics.

Notwithstanding a few undesirable correlates (e.g., reported alcohol use, getting drunk, perceiving aggressive behavior to be more legitimate Barber, Eccles, & Stone, 2001 Conroy, Silva, Newcomer, Walker, & Johnson, 2001 Eccles & Barber, 1999), the available evidence suggests a generally positive profile of correlates associated with youth sport participation. Compared to non-athletes, high school athletes report greater liking of school, are less likely to dropout, have higher grade point averages, are more likely to attend college, are less socially-isolated, attain greater occupational success, and have greater increases in self-esteem through high school (Barber, Eccles, & Stone, 2001 Eccles & Barber, 1999 Mahoney & Cairns, 1997 Marsh & Kleitman, 2003).

On balance, youth sport participation seems to be a positive developmental experience however, it seems apparent that not all youth sport programs are equal with respect to their developmental yield for youth. Many factors are likely to play a role in determining the quality of a youth sport experience (cf., National Research Council and Institute of Medicine, 2002). My colleagues and I are among a group of scientists who focus on the role that coaches play in determining the developmental yield of youth sport participation (for a broader model of youth development in sport, see Petitpas, Cornelius, Van Raalte, & Jones, 2005).

The Importance of Youth Sport Coaches

Behavior observation research has provided compelling evidence that coaching behaviors influence the quality of youth sport experiences. In one study, youth reported greater liking for basketball when their coaches exhibited high levels of mistake-contingent technical instruction, and low levels of keeping control and general encouragement (Smith, Zane, Smoll, & Coppel, 1983). Similarly, youth evaluated their coaches more positively when the coaches exhibited high levels of instructive (e.g., general and mistake-contingent technical instruction) and supportive (e.g., reinforcement, mistake-contingent encouragement) behaviors, and low levels of punishment (Smith et al., 1983 Smith & Smoll, 1990). Interestingly, Smith and Smoll (1990) also found that youth self-esteem at the beginning of the season moderated the effects of coach behavior on youth evaluations – low self-esteem athletes’ evaluations of coaches seem to be especially influenced by the coaches use of the desirable coaching behaviors described above. Clearly, what coaches do impacts how youth evaluate those coaches and the activities that are organized by those coaches.

Beyond a specific behavioral repertoire, coaches are able to create motivational climates by the way they choose to structure the setting. To illustrate the role of coaching climates on young athletes’ sport experience, consider a recent study of female and male recreational swim league participants aged 8 – 18 years (Conroy, Kaye, & Coatsworth, in press). In this study, we were interested in whether and how the perceived coaching climate predicted changes in youths’ reasons for swimming. Youth completed measures of their situational motivation (i.e., their reasons for swimming) at the beginning, middle, and end of the season. At the beginning and end of season, youth also rated their achievement goals. Achievement goals represent the purpose or aim of their achievement behavior. We employed Elliot’s (1999) 2×2 model of achievement goals that distinguishes four goals based on their definition of competence (i.e., task- or self-referenced criteria vs. normatively-referenced criteria) and the valence of the goal (i.e., approaching competence vs. avoiding incompetence). At the end of the swim season, youth rated their perceptions of the coaching climate – that is, the degree to which youth perceived the coaches as emphasizing each of the four achievement goals when evaluating the youths’ competence.

Results indicated that youth perceptions of avoidance coaching climates positively predicted approximately 40% of the change in youths’ corresponding avoidance achievement goals during the season. Additionally, to the extent that youth increased their focus on avoiding self-referenced incompetence (e.g., not performing worse than they previously performed), they described their reasons for swimming as being more externally regulated (i.e., done to satisfy external demands, such as parents’ directives) and more amotivated (i.e., done without a clear purpose in mind). Thus, avoidance coaching climates in swimming appear to be linked with deterioration in the self-determination of young swimmers’ motivation.

The studies described above illustrate the emerging conclusion from this literature – coaches may influence youth motivation both through their observed behaviors and the motivational climate they create. Similar to the literature on developmental correlates of youth sport participation, evidence for coaching effects on youth sport motivation is based largely on non-experimental research that does not permit strong causal inferences. For this reason, a number of researchers in this area have turned to experimental designs to test their hypotheses about the critical factors for optimizing youth sport experiences.

The seminal coach training efficacy trials involved Coach Effectiveness Training (CET Smith, Smoll, & Curtis, 1979). This program focused on teaching coaches a behavioral repertoire and philosophy of winning based on some of the behavioral research reviewed above (for additional details, see Smoll & Smith, 2002). This behavioral repertoire is designed to enhance youth perceptions and recall of coaches, and ultimately youth evaluative reactions in the sport setting (Smoll & Smith, 2002). To accommodate recent theoretical developments and emerging research findings, my collaborator and I have posited that coach training programs may influence youth motivation (and ultimately some important indicators of youth development) via a sequence of cascading changes in (a) coaches observed behaviors and activity structures, (b) youth perceptions of coaches behaviors and the coaching climate, and (c) youth self-perceptions (Conroy & Coatsworth, 2006). This model provides a framework for evaluating the experimental coach training literature (unless otherwise specified, this brief review includes studies employing various psychosocially-based coach training programs).

First, it appears that some coach behaviors may be modified by brief training programs. Specifically, coaches’ use of reinforcement following desirable behaviors appears to be the behavior most amenable to change following training (Conroy & Coatsworth, 2004 Rushall & Smith, 1979 Smith et al., 1979). Other theoretically-important behaviors may be sufficiently well-engrained that they are resistant to modification or infrequent enough to escape detection of modest changes in their base rates. Second, athletes evaluate CET-trained coaches more positively than non-CET-trained coaches (Smith et al., 1979 Smith et al., 1995 Smoll et al., 1993). These findings are based on post-training differences in youth perceptions of coach behaviors it will be important to determine whether randomly-assigned coach training programs can account for changes in youth perceptions of coaches.

One of the most consistent findings from this literature concerns the effects of coach training on youth self-perceptions. Psychosocial coach training programs have led to increases in self-esteem for low self-esteem youth (Coatsworth & Conroy, in press Smoll et al., 1993). It is worth noting that these self-esteem enhancement effects for low self-esteem youth are significantly larger when coaches and youth are homogeneous as opposed to heterogeneous with respect to biological sex. Finally, experimental investigations of the effects of coach training on youth motivation are scarce in the literature. The most compelling evidence for the motivational benefits of coach training was provided by Barnett, Smoll, & Smith (1992) who found that 95% of youth who played for CET-trained coaches returned the following year whereas only 74% of youth who played for non-CET-trained coaches returned the following year.

Conclusions

Scientific understanding of the factors that make youth sport a motivationally-rich and developmentally-productive experience is in its infancy. The available evidence suggests more developmental benefits than costs to youth sport participation however, rigorous experimental studies that manipulate characteristics of the youth sport context and isolate change in causal mechanisms are needed to strengthen conclusions from this literature. In light of the public health crisis and persisting social problems confronting youth in the United States, psychologists will make a positive impact on society by enhancing understanding of the factors that motivate youth to participate in organized sport. This knowledge also may help to explain why some individuals persist in their deliberate practice and reach the most elite levels of athletic competition whereas others drop out of sport altogether.

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Rushall, B. S., & Smith, K. C. (1979). The modification of the quality and quantity of behavior categories in a swimming coach. Journal of Sport Psychology, 1, 138-150.

Smith, R. E., & Smoll, F. L. (1990). Self-esteem and children’s reactions to youth sport coaching: A field study of self-enhancement processes. Developmental Psychology, 26, 987-993.

Smith, R. E., Smoll, F. L., & Curtis, B. (1979). Coach effectiveness training: A cognitive-behavioral approach to enhancing relationship skills in youth sport coaches. Journal of Sport Psychology, 1, 59-75.

Smith, R. E., Zane, N. W. S., Smoll, F. L., & Coppel, D. B. (1983). Behavioral assessment in youth sports: Coaching behaviors and children’s attitudes. Medicine and Science in Sports and Exercise, 15, 208-214.

Smoll, F. L., & Smith, R. E. (2002). Coaching behavior research and intervention in youth sports. In F. L. Smoll, & R. E. Smith (Eds.), Children and youth in sport: A biopsychosocial perspective (pp. 211-233). Dubuque, IA: Kendall-Hunt.

United States Department of Health and Human Services (1996). Physical activity and health: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.

Acknowledgement

I am extremely grateful to my research collaborators for their contributions to our work, especially Doug Coatsworth (Penn State), Andy Elliot (University of Rochester), Aaron Pincus (Penn State), and all of the graduate and undergraduate students in my lab. I also wish to express my appreciation to Chris Janelle (University of Florida) for his thoughtful feedback on an earlier draft of this essay.

Based on the Torino experience, a group of USOC sport psychologists will be presenting a symposium entitled, “Olympic Sport Psychology Service Provision: Perspectives on Preparation for the 2006 Games” at the 2006 APA Convention in New Orleans.

For the purpose of this essay, optimizing motivation is assumed to be a central mechanism involved in the physical health and psychosocial benefits of youth sport participation because it can promote physical activity and foster developmental competence and initiative among participants.


Brown Rice

Brown rice is a good source of the amino acid tryptophan, which is converted to serotonin when the body has adequate vitamins B1, B3, B6 and folic acid. Serotonin, a calming neurotransmitter, plays an important role in brain activities such as learning and memory. Serotonin promotes contentment and normal sleep. When serotonin levels in the brain are low, you may experience depression, insomnia or aggressive behavior. Other foods rich in tryptophan that will help increase serotonin levels include peanuts, cottage cheese, meat and sesame seeds.

The yolks of eggs specifically contain choline, a building block for the neurotransmitter acetylcholine. Other foods that are good sources of choline include soybeans, wheat germ, whole wheat products and organ meats. Essential for thought and memory, acetycholine helps the brain store and recall memories, concentrate and maintain focus. It is also important for muscle coordination. Insufficient acetylcholine results in reduced cognitive capacity and memory decline.


Tips for Finding Motivation When You're Depressed

Telling a depressed person to get motivated is like telling a rock to dance. You&rsquoll get the same result.

It&rsquos not because depressed people don&rsquot want to get motivated. It&rsquos because getting motivated is an overwhelming task when you&rsquore depressed. Is motivation impossible? Definitely not. You just have to find a process that works for you.

There is a saying: &ldquoThe journey of a thousand miles begins with a single step.&rdquo But many depressed people can&rsquot get out of bed, much less take a thousand-mile journey. For many sufferers, medication is the first step.

There are those who scoff at the idea of medication as an answer. But for those in a major clinical depression, life is a dark place full of pain, hopelessness and insecurity.

Sometimes the blame can be placed on brain chemistry. Neurotransmitters don&rsquot work right, and brain chemicals such as serotonin, norepinephrine, and dopamine &mdash your feel-good chemicals &mdash often don&rsquot go where they&rsquore supposed to go. Medications deal with chemical imbalances. Find the right one, and you may feel more like your old self again. Because you feel better, getting motivated becomes a little easier.

A good therapist goes hand in hand with medication. One without the other is kind of a half-solution. By talking to a trained professional, you&rsquoll feel better because you&rsquore talking to someone who knows how to listen.

Good friends listen, sure, but don&rsquot forego a therapist for a friend. Well-meaning friends may tell you to just get over it or to pull yourself up by your bootstraps. This results in a vicious cycle. You may feel worthless and stupid because you&rsquore finding it hard to brush your teeth, much less pull yourself up by your bootstraps. This leads to a deepening depression, which leads to more &ldquohelpful&rdquo remarks, which leads to even more depression. Unfortunately, the thick, ugly scars of depression aren&rsquot outwardly visible, and when your wounds aren&rsquot visible, sympathy from your friends is hard to come by.

There&rsquos a method used in Alcoholics Anonymous that works for some, and that&rsquos acting as if something were already true. For example, every morning when you wake up, pop up with as much vigor as you can muster. Don&rsquot give yourself time to dwell. Get dressed immediately. It can be for the gym or dog-walking or some other form of exercise. Or, get dressed to go to the mall, the bookstore, or the theater.

Just get dressed. Do your hair. Groom yourself attractively, and do it quickly. Don&rsquot give yourself time to talk yourself out of it. In other words, act as if you feel great already and you know for a fact that you&rsquore leaving the house and will have a good time. At the very least, getting dressed and looking decent can go a long way toward giving you a mental boost. It may even give you enough motivation actually to go to the gym and exercise, which is great for alleviating depression.

If you&rsquore not at the gym phase yet, however, walk the dog, or go into the yard and pull weeds for 20 minutes a day (assuming it&rsquos spring or summer). This gives you the added benefit of sunshine. According to research, 20 minutes of sun a day will lift your mood. If it&rsquos winter and you live in a cold climate, invest in a light box, which simulates full-spectrum sunlight.

Even if you can&rsquot find the motivation to do anything, don&rsquot berate yourself for it. You&rsquore up and ready for the day, aren&rsquot you? Do only what you can do, and let go of major expectations. If you brushed your teeth, that&rsquos positive. Don&rsquot be hard on yourself, or getting motivated to do anything becomes another chore to be avoided.

Depression whispers bad things in your ear about your capabilities. We hear, &ldquoYou can&rsquot do anything right. Look at the mess you&rsquove made of your life. Why aren&rsquot you further along in your career? Why don&rsquot you have a career at your age?&rdquo By consciously replacing the words on these soundtracks with positive words, we&rsquoll be able to change our way of thinking. The brain is able to create new neural pathways. Change your way of thinking over a period of time, and a new neural pathway is created.

Use positive thoughts about yourself to create new neural pathways. Over time, the old, bad, unused pathways wither, die and fall off, much like the branches on an old tree. With some determination to stay on the positive path, you create a new soundtrack, which is filled with hope, giving you more motivation to keep stepping forward.

The same premise applies to self-talk in the mirror. Whenever you see yourself in the mirror, say something positive about yourself. Some people carry flashcards to remind themselves of their good traits when they&rsquore feeling particularly down. This is a behavioral psychology method to get you to replace bad thoughts with good ones. Before long you are reminded of all the wonderful things that you have to offer, and you are motivated enough to take another step in the healing process toward rejoining the world.

Socialization is important. Make a standing appointment to have a friend or family member pick you up to go out. This way you&rsquore held accountable to someone else. If there are no friends or family members available, don&rsquot use that as an excuse. Going to the bookstore and people-watching in the coffeeshop is preferable to sitting home alone. Who knows? You may make a new friend. That is certainly motivating.

Give yourself credit for progress made, even if it seems tiny. Set small goals. Do what you can handle and nothing more. Are there seven loads of laundry to fold? Tell yourself you&rsquoll fold laundry for five minutes, then do it. You&rsquoll be surprised by how accomplishing one thing you said you were going to do can boost your spirits and motivate you.

By the same token, don&rsquot set yourself up to fail by telling yourself you&rsquore going to do something you know you can&rsquot do. Because, when you do fail, your motivation to move forward stops. Try doing only one thing at a time, a little bit at a time. Five minutes here, 10 minutes there &mdash each success makes it easier to stay motivated for the next step in your journey to feeling good about yourself.

Many people struggle with depression you&rsquore not alone. Take that first step. Find what works for you, and the motivation to continue forward will come. It&rsquos not easy, but it&rsquos not impossible.


#7: The "Sleep Molecule" &mdash How Meditation Boosts Melatonin

Since the beginning of time, our biological clocks have been dictated by Earth’s natural cycles of light and dark. In recent decades, in an effort to become a 24 hour per day, super-productive society, modern man has been experimenting with ever shorter nights and longer and longer days.

This unbalancing, combined with our newfound love of morning to night screen staring, is taking a heavy biological toll on us all. With excessive light being the number "1" enemy of melatonin, perhaps the most important casualty of this epidemic is that we are shutting down our body’s production of this critical chemical.

A key to good mood and restful sleep, melatonin is a hormone manufactured by the pineal gland, with levels in the blood peaking just before bedtime. A chemical "Superhero", melatonin is known to prevent cancer, strengthen the immune system, slow down aging, and has been linked to helping prevent over 100 different diseases.

Luckily there is a very effective, all natural solution. Rutgers University researchers discovered that melatonin levels for meditation practitioners were boosted by an average of 98%, with many participants having increases of more than an incredible 300%! Incorporating meditation into your life can be your much needed biological re-balancing tool.


How can motivation be increased by improving brain chemistry with nutrition and activities? - Psychology

December 2014 Issue

CPE Monthly: Substance Abuse and Nutrition
By Alyssa Salz, MS, RD, LD
Today's Dietitian
Vol. 16 No. 12 P. 44

Suggested CDR Learning Codes: 5000, 5350 Level 2

The dietitian's role in treating substance abuse is an important but often lacking part of patients' long-term recovery process. Nutrition therapy for substance abuse is complex, as the nutritional risks vary depending on the substance of choice and negative conditions for successful treatment are common, including poor support, co-occurring mental health disorders, or poverty.

Addiction is defined as a chronic brain disorder characterized by compulsive and relapsing behavior.1 Predisposing factors for an addiction include psychological vulnerability, biochemical abnormalities, genetics, and environmental conditioning.1 Social isolation, depression, and anxiety are common among substance abusers, and drugs and/or alcohol often are used to relieve these negative feelings because they increase dopamine activity, which boosts mood.

Proper nutrition and hydration are key to the substance abuse healing process because they help restore physical and mental health and improve the chance of recovery. Macro- and micronutrient deficiencies can lead to symptoms of depression, anxiety, and low energy, all of which can lead someone to start using drugs or alcohol or trigger a relapse.

Substance abuse generally leads to a lack of proper nutrition, either as a result of not eating enough throughout the day or eating foods that are low in necessary nutrients.2 Certain substances, such as stimulants, may suppress appetite and disrupt metabolic and neuroendocrine regulation, leading to improper calorie consumption and impaired nutrient processing.1 Other substances may lead to an increase in appetite, causing weight gain.

Many programs that target substance abuse prevention address nutrition because a healthful lifestyle can promote mental health. And for those who are battling substance abuse, nutrition plays the same key role in maintaining recovery while also improving the resulting health conditions and deficiencies.

Individualized nutrition counseling and comprehensive nutrition education programs provided to the substance abuse population have been found to significantly improve three-month sobriety success rates.3 Just as patients with diabetes or heart disease receive nutrition education to manage their diseases, patients dealing with substance abuse should have nutrition education that addresses their specific risk factors and increases their chances of recovery.3

Medical nutrition therapy (MNT) and nutrition education for this population should target the following goals:

• heal and nourish the body damaged by alcohol or substance abuse

• stabilize mood and reduce stress

• reduce cravings for drugs and alcohol

• address medical conditions that are co-occurring or have resulted from substance abuse and

• encourage self-care and a healthful lifestyle.

This continuing education course reviews the effects of substance abuse as they relate to nutrition and health, and addresses the role RDs play during treatment to correct nutrition-related deficiencies, address resulting health disparities, and improve the lives of addicts by providing tools for lasting recovery.

Heal and Nourish
Substance abuse is known to lead to vitamin and mineral deficiencies that threaten physical and mental health, damage vital organs and the nervous system, and decrease immunity.4 Harmful lifestyles often are associated with addiction, such as poor eating patterns, lack of exercise, and changes in sleep patterns. These compounding factors result in an increased risk of long-term health problems, including metabolic syndrome, diabetes, hypertension, weight problems, and eating disorders.

To help an individual recover from the effects of substance abuse, it's important to supply them with balanced, calorically appropriate meals. This may be difficult during the initial detox period but should be a targeted goal as soon as the patient is deemed stable for oral intake.1 Calculating adequate calories for each patient will help them manage hypoglycemia, improve deficiencies, and achieve or maintain an appropriate weight. Encouraging them to consume regularly scheduled meals and snacks and to increase their level and amount of physical activity will help address these issues as well as contribute to stress management and improved sleep.2

It's vital to correct any nutritional deficiencies and address any medical conditions, as continued malnutrition and instability increase disease risk and will produce cravings for drugs or alcohol. Increased consumption of nutrient-dense foods (eg, fruits, vegetables, whole grains, fish) and antioxidants is important these foods help decrease inflammation, reduce cell oxidation, and provide the basics of a healthful diet.4

Psychotherapy also is an important part of the healing process for substance abuse patients. They should be encouraged to seek regular help from counselors and/or support groups since psychological and social problems are common.

Normalize Neurotransmitters and Mood
Psychoactive substances may lead to psychiatric problems, as the substances can have toxic effects on brain chemistry. Before detoxification, neurotransmitters are decreased due to poor nutrition and altered amino acid absorption and utilization.2 This leaves addicts feeling depressed, agitated, and unregulated early in recovery. It's thought that these imbalances disappear over a period of weeks but may last as long as one year after an addict becomes sober.2

For some, mood and behavior abnormalities may have been present before the substance abuse. With proper diagnosis of any possible underlying mental health disorders, a healthful diet and education on how nutrition influences mood and brain chemistry, recovery can be enhanced.

An understanding of how food affects mood and the risk of substance abuse begins with macronutrients. Carbohydrates are the body's main source of energy without this macronutrient, the brain can't properly function, blood sugar becomes unstable, and neurotransmitters become disrupted. Unstable blood sugar can lead to feelings of frustration, anxiety, and cravings.

Carbohydrates aid in the production of serotonin, which facilitates a happy, stable mood aids in sleep and helps curb food cravings. Low serotonin levels can result in sleep problems, irritability, and depression.

Insulin release following carbohydrate intake helps glucose enter cells, where it's used for energy and triggers tryptophan's entry into the brain.5 Then folic acid and vitamins B6 and B12 help the synthesis of tryptophan to serotonin. Ensuring that clients receive adequate carbohydrates and tryptophan-rich foods, such as dairy and meats, helps stabilize these reactions.

Amino acids, the building blocks of protein, also are the foundation of neurotransmitters. Low levels of neurotransmitters, particularly dopamine, can trigger an individual to turn to substances to feel better, as most substances markedly impact the body's dopamine levels. Dopamine is made from the amino acid tyrosine, and serotonin is made from tryptophan.5 If an individual lacks either of these amino acids, synthesis of the respective neurotransmitter is disrupted, which affects mood, aggression, and the desire for drugs or alcohol.5

Dietary fat also plays a role in maintaining mental health. Because it affects inflammation and cell membrane integrity, limiting dietary fat directly influences mood. Research has shown that increased inflammation or proinflammatory cytokines result in more depressive symptoms.6

Omega-3 fatty acid consumption may help with depression 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 amount of neurotransmitters that can be active in the brain.4 Supplements containing polyunsaturated fatty acids have been recommended to help reduce anxiety in people with substance abuse.4

Other vitamins important for mental health include iron, folate, and vitamins B6 and B12. Deficiencies of any of these nutrients can mimic mental health problems such as depression, fatigue, poor attention, and altered sleep.2

Encouraging patients to drink adequate amounts of hydrating fluids also will help them manage mood while ensuring adequate absorption of any medications they take to prevent side effects from withdrawal or underlying psychiatric disorders. Common symptoms of dehydration include irritability, trouble concentrating, and disorientation. Dehydration also commonly results from detoxification, so monitoring daily intake and output values will help determine appropriate fluid intake recommendations.1

Caffeine intake should be monitored, as it triggers the same reward centers of the brain as do substances and can markedly impact anxiety and sleep. Low caffeine intake and smoking cessation have been shown to improve long-term sobriety for all addictions.1

Reduce Cravings
Anxiety, irritability, and low mood or energy levels are triggers for cravings. All of these symptoms can result from low blood sugar, dehydration, high levels of caffeine, and an unbalanced diet. Increased relapse occurs when an individual has poor eating habits, mainly because of the impact on cravings. Encouraging balanced meals and regular eating times helps patients decrease these events. Generally, a diet relatively high in complex carbohydrates, moderate in protein, and low in fat and sugar is recommended to help sustain recovery.7 It isn't wise to advise clients to follow a high-protein diet, as excess protein will strain the already damaged liver.7

Often in early recovery, patients struggle with differentiating hunger from cravings for drugs or alcohol and emotions. Addicts commonly forget what normal hunger feels like and may perceive a craving for substances when actually they're just hungry. Similarly, many addicts will switch to sweets to replace their drug dependency some of this is a result of seeking pleasurable foods that trigger a physiological response (such as increasing dopamine), emotional eating, or experiencing irregular blood sugar levels. Monitoring sweets intake may be important with some clients because approximately 50% of substance abusers also have co-occurring eating disorders, so monitoring signs of binge behavior may help in properly identifying possible binge-eating disorder or bulimia.1

RDs can help educate patients on identifying physical hunger cues and encourage more frequent, balanced eating to help them maintain a normal level of hunger and satiety rather than getting overly hungry.

MNT for Substance Abuse
Depending on the substances different individuals abuse, their nutritional status, weight problems, and disease may differ, leading to a need for a full assessment to determine their individual requirements. This course first examines the common needs for MNT in substance abuse and then discusses the specific nutritional threats each substance poses as well as the recommendations for addressing those threats.

Malnutrition
Malnutrition related to addiction is categorized as primary or secondary. Primary malnutrition occurs when the substance replaces other dietary nutrients.8 Secondary malnutrition results from improper nutrient metabolism, absorption, utilization, or excretion even though the diet may be adequate. Both types of malnutrition can result from any substance use.

Patients struggling with multiple addictions show increased deficiencies due to malnutrition. One study revealed that 70% of addicts suffered vitamin D deficiency and low levels of vitamin C, and another showed that 50% were deficient either in iron or vitamins (vitamins A, C, and E being most common) during detox.9,10
MNT for malnutrition includes correcting any deficiencies, providing an adequate diet, and addressing any alterations that need to be made to the diet due to oral, digestive, or metabolic issues. A once-a-day, low-potency multivitamin/mineral supplement may be useful for those unable to consume a calorically adequate diet and those with dietary limitations or severe gastrointestinal damage.7

Metabolic Syndrome
Substance abuse, especially alcohol abuse, is associated with an increased risk of metabolic syndrome, which consists of increased abdominal obesity, hyperglycemia, abnormal cholesterol, and hypertension. The mechanisms through which substance abuse contributes to this condition includes increased cell damage, reduced energy production, cells' reduced antioxidant potential, and enhanced excitotoxicity.11 Some substances, including alcohol and marijuana, lead to higher calorie intakes, increased weight circumference, and poorer nutritional profiles, all of which will lead to an increased metabolic syndrome risk.

The prevalence of metabolic syndrome in substance abusers is reported to be 5% to 31%, with a higher risk for those who abuse alcohol and opioids.11 Higher risk is thought to be associated with an increased period of dependence on a substance.12

Counseling patients on lifestyle changes to decrease their risk of cardiovascular disease and diabetes is important. This includes encouraging exercise, weight loss, dietary changes to reduce blood pressure and cholesterol, and quitting smoking.

Weight Management and Eating Disorders
Weight management is a common nutritional concern related to substance abuse. Detoxification programs commonly lead to weight gain, as addicts turn to food instead of their drugs of choice. Biochemical changes result in increased appetite and a preference for highly palatable foods, and confusion in hunger/fullness cues arise. However, for some, weight gain is important due to significant protein-energy malnutrition and low BMI as a result of substance use.13 Increased calorie intake and weight can lead to obesity, diabetes, hypertension, and cardiovascular disease, so RDs should monitor and counsel patients on healthful eating and weight management.

While in treatment, most patients reduce their levels of exercise either due to lack of time, the program structure, or lack of motivation. Increased abnormal liver tests are common in refeeding among hospitalized drug addicts, which is theorized to be caused by a lack of exercise and increase in weight.14 In a study from the Journal of the American Dietetic Association, daily weight change had a significant positive correlation with changes in serum alanine transaminase or aspartate aminotransferase concentrations from admission to discharge.14 RDs can help monitor weight gain and laboratory results and identify patient goals for achieving or maintaining a healthy weight. RDs also can work with program administrators to develop exercise programs during and after treatment that can help to level patients' liver enzymes and manage their weight.

With the high occurrence of eating disorders in the substance abuse population, care must be taken in making recommendations for weight management to ensure they aren't too restrictive and weight gain or loss is monitored and steady. In women younger than 30 with alcoholism, 72% also have an eating disorder, and other substances such as cocaine are associated with a higher prevalence of eating disorders, so precautions and available resources are helpful when working with these populations.1

Pharmacotherapy
Pharmacotherapy is a common component of addiction treatment. These medications are intended to improve mood stability and recovery success and to assist with any medical or mental health problems resulting from or co-occurring with detoxification. RDs can help manage the nutritional implications of these medications.

Medication-assisted treatment for substance abuse has been effective for alcohol and opioid dependence. It's important for dietitians to be familiar with these common medications, as the side effects may influence patients' nutritional status.
Dietitians need to be cautious when recommending supplementation in this population due to addicts' quick-fix mindset and already-taxed bodies. A damaged liver may not be able to correctly process certain supplements, and the supplements may ultimately have a negative impact on liver health.2 However, a study funded by the National Institutes of Health suggested that a common over-the-counter herbal supplement, N-acetylcysteine, can reduce the cravings of cocaine and heroin addicts and possibly alcoholics during withdrawal.1

Naltrexone (ReVia, Vivitrol, Depade), disulfiram (Antabuse), and acamprosate calcium (Campral) are used to treat alcoholism. Naltrexone, which also has been used with opiate and narcotic dependence, may cause anorexia, weight loss, nausea, and vomiting.15 Disulfiram may cause nausea and vomiting, and if patients ingest alcohol, they will become very ill. Therefore, care must be taken to ensure that all traces of alcohol are eliminated from patients' diets, including any that may be used in recipes.1,15 Acamprosate calcium may cause an increase in appetite, increased weight, and taste changes.15 Dietitians should take note of these side effects and work with patients to identify ways to promote adequate nutritional intake.

Medications used for opioid dependence include methadone, buprenorphine (Suboxone, Subutex), and naltrexone. Methadone treatment may produce extreme constipation, abdominal pain, dry mouth, appetite abnormalities, hypokalemia, hypomagnesemia, and weight gain.15 Encouraging and outlining a diet with adequate fluids and fiber may help with these side effects. Methadone, like disulfiram, can cause patients to become very ill if they ingest alcohol, so abstinence should be advised.1,15 Buprenorphine, like the other medications, can influence digestion and appetite, so dietitians should advise patients to slowly increase fiber and make sure meals are appetizing and aromatic.15 Stool softeners also are commonly used to help manage secondary constipation in opiate and cocaine addicts.

Buproprion (Wellbutrin, Zyban) is commonly used for depression, nicotine dependence, and methamphetamine addiction, and tricyclic antidepressants (imipramine, desipramine) are used to help with depression, insomnia, and pain. Both of these medications can result in dry mouth, constipation, changes in appetite, and nausea.15

Substances' Nutritional Impact

Alcohol
Alcohol is a major cause of nutritional deficiency in the United States.16 Alcohol provides calories but little nutrition to the body. Many alcoholics are malnourished, either due to ingesting a nutritionally inadequate diet or changes in the body's ability to use the nutrients it receives.8

Alcoholism affects every area of the body. It can cause insomnia, anorexia, weight changes, gastrointestinal cramping, decreased digestive enzymes, ulcers, muscle wasting, liver disease, and abnormal glucose levels depending on the amount of alcohol ingested. Those who take in more than 30% of their total calories in alcohol generally have a significant decrease in their intake of all macronutrients and deficiencies in vitamin A, vitamin C, and thiamine.8

Alcohol's impact on digestion and the absorption of essential nutrients is important to understand when treating an alcoholic. Alcohol interferes with protein metabolism, leading to important clinical consequences, including low albumin levels, increased fluid in the abdomen, reduced blood clotting, and decreased urea production (resulting in excessive ammonia levels), which may increase the likelihood of altered brain function (eg, hepatic encephalopathy).8

Liver disease resulting from alcoholism alters the organ's ability to take up beta-carotene and/or convert it to vitamin A, causing disorders such as night blindness.8 Dietitians should be cautious when treating alcoholics with low vitamin A levels because blood levels may be inconsistent with what's stored in tissues and because high doses are toxic. It's recommended that patients with low vitamin A and night blindness be treated with 2 mg of vitamin A per day for several weeks.8 Zinc treatment also may be useful, as it's needed for vitamin A metabolism.8

The body moves through four stages of liver damage as alcoholism progresses: fatty liver, alcoholic hepatitis, cirrhosis, and encephalopathy or coma.1 Protein-calorie malnutrition predicts survival in patients with alcoholic liver disease. Forty-five percent to 70% of alcoholics with liver disease also are glucose intolerant or diabetic.2

Treatment goals for patients with alcoholism are to reverse malnutrition, prevent alcoholic liver disease, and establish a healthful lifestyle and coping skills for avoiding alcohol use. If malnourished, alcoholics benefit from a diet high in carbohydrates and moderate in protein. Low-calorie diets and fasting should be avoided because of the nutritional risks and the possibility that a patient has an existing eating disorder or may cross over to a new addiction with food, dieting, or exercise.4

The diet should include a mix of omega-3 and omega-6 fatty acids since the amount and type of fats impact hepatic steatosis, fibrosis, and cirrhosis.1 If tube feeding or total parenteral nutrition is required, dietitians should avoid glutamine-enriched formulas, as they increase ammonia levels. The amino acid taurine, in addition to patients' prescribed diets, has been used to help maintain recovery after detoxification, as it represses the rewarding effect in the brain associated with alcohol.4

Wernicke-Korsakoff's syndrome (wet brain), which occurs with heavy alcohol use due to a lack of thiamine, may be prevented with thiamine supplementation during intervention. Thiamin deficiency occurs because of decreased absorption as a result of the diuretic effect of alcohol and the utilization of thiamin in detoxifying alcohol.8

Opioids (Narcotics)
Opioids are used to treat pain and include codeine, oxycodone, heroin, methadone, and morphine. These drugs slow body movements and can cause sedation, leading to slower digestion and constipation.

Withdrawal symptoms can occur with opioids, even with a short duration of use. It brings a wide range of symptoms, mainly diarrhea, nausea, and vomiting, which can lead to poor oral intake, dehydration, and electrolyte imbalances.16 Nutrient deficits may be caused by poor nutritional intake or the drug's impact on digestion and absorption. Opioids are water soluble, so they clear the body faster than do fat-soluble drugs but produce painful and uncomfortable detox periods. Heroin use can cause glucose intolerance, but this usually resolves with abstinence. For that reason, patients will require blood sugar monitoring and balanced, frequent meals.1

When newly abstaining from opioids, patients typically have very low pain tolerance, increased heart rate, anxiety, and trouble sleeping. These symptoms commonly cause them to relapse to their drug of choice. Pharmacotherapy, counseling, and lifestyle changes help prevent relapse in this population of addicts.

Stimulants
Stimulants, including crack, cocaine, amphetamines, methamphetamine, nicotine, and caffeine, generally lead to decreased appetite and weight loss. Cocaine has been associated with anorexia and eating disorders and may impact energy intake and requirements.13 Large amounts of stimulants result in insomnia, paranoia, anxiety, malnutrition, and memory problems.1

When individuals first discontinue stimulant use, dehydration and electrolyte imbalances may occur, so careful monitoring is important. Since low weight and eating disorders may be of concern, encouraging and educating patients on proper nutrition and helping them achieve a healthy BMI is important.

Methamphetamine abusers commonly suffer severe dental problems that interfere with diet quality. One study reported that 41.3% of methamphetamine users had dental disease, and nearly 60% had missing teeth. Dietitians should offer nutrition education to support dental health and recommend foods with an appropriate consistency.17

Marijuana
Marijuana, which impairs memory, attention, judgment, and balance and increases heart rate, is the most commonly used drug in the United States. The main nutritional impact of this drug is increased appetite.16 Long-term users may be overweight and may need a calorically restricted diet and an exercise program to help them achieve a healthy weight.

Since marijuana is a fat-soluble drug, it can take up to six months for a daily user's brain to return to normal functioning after abstaining.

Promoting Self-Care and a Healthful Lifestyle
RDs should help promote a healthful lifestyle to accompany substance abuse patients' recovery. Important aspects of self-care include physical activity, proper sleep, and devoting time for pleasurable activities. These activities may help to keep patients positive, improve health, establish new routines, and reduce idle time that may lead to relapse. Exercise is thought to stimulate some of the same circuits in the brain as do most substances, so promoting healthful activities may be a good way to replace old behaviors. Lack of sleep can lead to a decrease in well-being, reduced cognitive function, and reduced energy, so encouraging patients to practice healthful bedtime routines is beneficial.

Patients must be educated on the importance of nutrition in their recovery process. Grocery shopping, cooking, and preparing foods are important skills that dietitians can promote for patients in recovery. Cooking classes or recipes may be of interest to clients who are unsure about how to cook or are looking for ideas for healthful options. Financial struggles and unstable living situations are common obstacles to recovery that can lead to food insecurity, which significantly contributes to the nutritional status of drug abusers and to relatively unbalanced diets.13 Educating patients on nutrition resources, budget-friendly options, and support may be helpful.

Overall, dietitians play an important part in the process of recovery for patients seeking help for substance abuse. Many patients must be encouraged to understand how nutrition can play an important part in their recovery process, and they need help navigating the struggles that arise so they can achieve a healthful lifestyle.

— Alyssa Salz, MS, RD, LD, is a behavioral health dietitian in St. Louis and a freelance food and nutrition writer.

Learning Objectives
After completing this continuing education course, nutrition professionals should be better able to:

1. Identify and evaluate conditions and deficiencies of concern as a result of substance abuse.

2. Provide appropriate diet and activity recommendations for those seeking recovery.

3. Educate clients on the importance of nutrition in preventing relapse.

Examination
1. Before detoxification, which of the following is decreased due to poor nutrition and altered absorption/utilization of amino acids?
a. Neurotransmitters
b. Blood glucose
c. Digestive enzymes
d. Vitamin D

2. Having a proper balance of which of the following helps neurotransmitter regulation, decreases depression, and controls inflammation?
a. Omega-3 and omega-6 fatty acids
b. Amino acids
c. Antioxidants
d. Carbohydrates

3. Intake of which of the following should be monitored because it triggers the same reward centers in the brain as do substances while also impacting sleep and anxiety?
a. Sodium
b. Sweets
c. Monosodium glutamate
d. Caffeine

4. While detoxing from heroin, a woman experiences diarrhea, nausea, and disorientation. She struggles to eat or drink anything. It's important for a dietitian to monitor her for which of the following conditions and provide treatment if the condition is present?
a. Glucose intolerance
b. Eating disorder
c. Dehydration
d. Digestive disorders

5. A 23-year-old man is about to be discharged after completing alcohol treatment. He has received proper nutrition education, tools for acquiring and preparing healthful foods, and exercise recommendations. What other recommendation would be included in his discharge plan?
a. Adopt a low-calorie diet.
b. Take a multivitamin plus glutamine supplements.
c. Seek psychotherapy and/or a support group.
d. Adopt a high-protein, low-carbohydrate diet.

6. Metabolic syndrome is most common among those who abuse which of the following substances?
a. Opioids
b. Marijuana
c. Stimulants
d. Alcohol

7. A patient has been prescribed disulfiram (Antabuse) while recovering from polysubstance abuse. It's important that a dietitian checks the foods/recipes for this patient to ensure they don't include which of the following?
a. Added sugar
b. Alcohol
c. Caffeine
d. Gluten

8. A patient with dental disease or missing teeth may need an altered-consistency diet and education on nutrition for dental health. Most likely this is as a result of use of which of the following substances?
a. Methamphetamine
b. Heroin
c. Alcohol
d. Marijuana

9. Eating disorders co-occur in what percentage of patients recovering from substance abuse?
a. 10
b. 25
c. 35
d. 50

10. Which substance is known to be a leading cause of nutrition deficiencies?
a. Opiates
b. Marijuana
c. Alcohol
d. Stimulants

References
1. Escott-Stump S. Nutrition and Diagnosis-Related Care. 6th ed. Baltimore, MD: Lippincott Williams & Wilkins 2008.

2. Emerson M, Dubois C, Hatcher A, et al. Psychiatric nutrition therapy: a resource guide for dietetics professionals practicing in behavioral health care. Dietetics in Developmental and Psychiatric Disorders Practice Group of the American Dietetic Association. http://www3.nd.edu/

3. Grant LP, Haughton B, Sachan DS. Nutrition education is positively associated with substance abuse treatment program outcomes. J Am Diet Assoc. 2004104(4):604-610.

4. Carson RE. The Brain Fix: What's the Matter With Your Gray Matter. Deerfield Beach, FL: Health Communications 2012.

5. Sathyanarayana Rao TS, Asha MR, Ramesh BN, Jagannatha Rao KS. Understanding nutrition, depression, and mental illnesses. Indian J Psychiatry. 200850(2):77-82.

6. Harrison NA, Brydon L, Walker C, Gray MA, Steptoe A, Critchley HD. Inflammation causes mood changes through alterations in subgenual cingulate activity and mesolimbic connectivity. Biol Psychiatry. 200966(5):407-414.

7. Althaus CB. The glucose factor: diet and addiction. Foodservice Director. 200114(10):62.

8. Lieber CS. Relationships between nutrition, alcohol use, and liver disease. Alcohol Res Health. 200327(3):220-231.

9. Saeland M, Haugen M, Eriksen FL, et al. High sugar consumption and poor nutrient intake among drug addicts in Oslo, Norway. Br J Nutr. 2011105(4): 618-624.

10. Ross LJ, Wilson M, Banks M, Rezannah F, Daglish M. Prevalence of malnutrition and nutritional risk factors in patients undergoing alcohol and drug treatment. Nutrition. 201228(7-8):738-743.

11. Nebhinani N, Gupta S, Mattoo SK, Basu D. Prevalence of the metabolic syndrome in substance-dependent men. German J Psychiatry. 201316(2):61-67.

12. Mattoo SK, Chakraborty K, Basu D, Ghosh A, Vijaya Kumar KG, Kulhara P. Prevalence and correlates of metabolic syndrome in alcohol and opioid dependent inpatients. Indian J Med Res. 2011134:341-348.

13. Forrester JE. Nutritional alterations in drug abusers with and without HIV. Am J Infect Dis. 20062(3):173-179.

14. Fontaine KR, Cheskin LJ, Carriero NJ, Jefferson L, Finley CJ, Gorelick DA. Body mass index and effects of refeeding on liver tests in drug-dependent adults in a residential research unit. J Am Diet Assoc. 2001101(12):1467-1469.

15. Pronsky ZM, Crowe JP, Young VSL, Elbe D, Epstein S, Roberts W. Food Medication Interactions. 15th ed. Birchrunville PA: Food-Medication Interactions 2008.

16. Diet and substance abuse recovery. MedlinePlus website. http://www.nlm.nih.gov/medlineplus/ency/article/002149.htm. Updated March 22, 2013. Accessed October 7, 2013.

17. Shetty V, Mooney LJ, Zigler CM, Belin TR, Murphy D, Rawson R. The relationship between methamphetamine use and increased dental disease. J Am Dent Assoc. 2010141(3):307-318.



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