Exploring Integrative Medicine and Nutrition for PTSD
I am pleased to announce that Psychiatric Times has published my new peer-reviewed article, Exploring Integrative Medicine and Nutrition for PTSD, in its special report on Complementary, Alternative, & Integrative Approaches in Mental Health Care.
Read an excerpt below:
Evidence from a growing number of studies suggests that 38% to 40% of adults living in the United States use complementary and alternative medicine (CAM) therapies, yet only 42% have told their primary physician that they do so. Patients do not disclose their use for numerous reasons. They are not asked about it; they are concerned that their clinician will disapprove; they may not think it is necessary; and/or their clinicians are not interested in or do not know about CAM methods. Moreover, integrative medicine (IM) appeals to groups like veterans who traditionally avoid or experience dissatisfaction with conventional treatment and are prone to posttraumatic stress disorder (PTSD). Hence, clinicians should disclose their interest and training in IM and ask patients about their health practices.
Integrative medicine and nutrition for the treatment of PTSD consists of 18 components, called the BrainBow Blueprint®. To best support patients, clinicians should individualize their approach based on patients’ needs and preferences.
Digestion, Nutrition, and PTSD
Stress and trauma affect all aspects of physical function: blood glucose levels, brain metabolism, energy, and altered brain structures where neurons misfire or fail to communicate. When stress dysregulates digestion, it leads to a cascade of events affecting mood, cognition, sleep, and immune function. Parasympathetic activity governs digestion, which explains why in PTSD and complex trauma, there is at least 1 associated digestive problem. In sympathetic arousal, the head hurts, the stomach aches, and the intestines are too active or immobilized by fear. Irritable bowel syndrome (IBS) often co-occurs with traumatic stress, and chronic gut distress can lead to PTSD. Similarly, there is a causal chain that links childhood abuse, dissociation, and somatization with IBS.
These often-explicable somatic symptoms represent a complex neuroimmunomodulatory communication system between the gut and the brain. Gut bacteria regulate the hypothalamic-pituitary-adrenal (HPA) axis and γ-aminobutyric acid (GABA) via the vagus nerve, which reduces anxiety and depression.
Patients should consider increasing healthy intestinal bacteria by eating fermented foods (eg, yogurt, kefir, kimchee, kombucha, sauerkraut, and stink eggs) or via supplementation with high-dose probiotics. Probiotics have been associated with pain reduction, suggesting an anti-inflammatory effect.
Nutraceuticals and Supplements
Nutritional medicine, diet, and nutraceuticals are increasingly used in psychiatry. Vitamin D, omega-3 fatty acids, antioxidants (eg, vitamin C, vitamin E, and zinc), folate, magnesium, and vitamins B6 , B9 , and B12 can provide core nutritional support for mental health. Phospholipid supplements have been found to reduce circulating cortisol, improve memory, prevent cognitive decline, and improve perceived well-being. Phosphatidylserine (PS) and phosphatidylcholine (PC) are concentrated in brain cell membranes and support cell structure and function. PS aids neurotransmitter activity, especially dopamine and acetylcholine, and supports cognitive function.
Brain neurons have a high demand for adenosine triphosphate (ATP), and their high oxygen consumption rate leads to free radicals and inflammation, which benefit from antioxidants. Mitochondria may be affected by lack of sleep, pesticides, pollutants, antibiotics, and psychotropic drugs, including selective serotonin reuptake inhibitors (SSRIs). Medications that are commonly prescribed to patients with PTSD (eg, statins, beta-blockers, neuroleptics, and corticosteroids) interfere with mitochondrial function, and mitochondria also suffer degradation as part of the aging process. Mitochondrial biogenesis may benefit from CoQ10, pyrroloquinoline quinone, quercetin, and carnitine. High-intensity aerobic exercise and photobiomodulation (PBM) also enhance mitochondrial biogenesis. Exercise enhances cognition and neuroplasticity, balances HPA function, reduces inflammatory markers, and increases brain derived neurotrophic factor (BDNF). Anaerobic exercise builds core muscle strength and lean body mass; increases metabolism, glucose uptake, and energy; and improves sleep and anxiety in individuals with PTSD.
The energetic exercises qigong and tai chi have been used with survivors of torture and have improved well-being and the quality of life in individuals with fibromyalgia. Yoga has been found to increase levels of gamma-aminobutyric acid in the brain. In one study, for example, African American female veterans who practiced 10 weekly classes of trauma-informed yoga experienced significant reductions in PTSD symptoms. Research on PBM in individuals with traumatic brain injury (TBI), PTSD, anxiety, and sleep disorders showed improvements following treatment, with a medium to large effect in major depressive disorder. One animal study found that PBM treatment applied immediately after a traumatic event can prevent the development of PTSD-like fear.