The following excerpt is from the ANMF’s Post-Traumatic Stress disorder (PTSD) and diet tutorial on the Continuing Professional Education (CPE) website.
This tutorial is a new addition to the courses on the CPE website and was written by Peta Adams, an accredited practising dietician for over 10 years.
Post-Traumatic Stress disorder (PTSD) is defined as ‘the lingering, persistent psychological reactions to traumatic events or experiences’ (Sareen & Mason 2018).
It is characterised by revisiting, avoidance/numbing and arousal symptoms. Also, hypersensitivity, hypervigilance, changes in mood and behaviours and aggression.
PTSD is considered to be the most debilitating mental illness with higher rates of suicide. People commonly suffer from depression, anxiety and mood disorders.
They are likely to have deficiencies in Neurotransmitters (NT) such as serotonin, dopamine, noradrenaline and GABA. It is a manifestation of traumatic experiences.
It causes the sympathetic nervous system to go into overdrive and release the stress hormones, cortisol and adrenaline over long periods of time.
Patients commonly suffer altered neural and cognitive behaviours, particularly related to food-brain areas of consumption (Sathyanarayana Rao et al. 2008).
They tend to struggle with the cognitive inhibitions of food and also alcohol and therefore often over eat and drink alcohol to excess (Farr et al. 2014).
WHO IS AT RISK?
- Ex veterans – it is the most common condition plaguing this population
- Witnessing death or severe injury (nurses)
- Involved in a life-threatening event such as natural disasters, robbery, car accident
- Sexual abuse (adults and children) The risk is increased in repeated stressful life-events.
There is often delayed symptom development ~25% >6 months after the trauma (Sareen 2014).
Signs and symptoms of PTSD normally develop in a 3-6 month period after a traumatic event. However, sometimes it can take years for the symptoms to develop.
Symptoms include:
- Intrusive thoughts
- Nightmares
- Flashbacks
- Detachment
- Irritability and outbursts
- Headaches
- Disrupted sleep or insomnia
- Feelings of guilt
Also:
- Hypersensitivity including at least two of the following:
- Sleep issues
- Anger
- Poor concentration
- Startling easily
- Physical reactions (racing heart or increased blood pressure).
(Sareen 2014).
Epidemiological studies show >90% of sufferers have at least one comorbid mental condition (Sareen 2014).
The burden of physical illnesses in Australians of those suffering from depression and anxiety, is around 43% (Clarke & Currie 2009).
Studies have showed a distinct and significant association between PTSD, diabetes, psoriasis, thyroid conditions, cardiovascular disease and stomach ulcers (Britvić et al. 2015).
PTSD can lead to central obesity and metabolic dysfunction
Increase in Leptin and Adiponectin (the hunger and storage hormones respectively).
Stress hormones such as cortisol and catecholamines further worsen this profile and contribute to metabolic dysfunction (Sagud et al. 2017).
Medications for PTSD can also have an effect on nutrition.
Selective Serotonin Reuptake Inhibitors (SSRI’s) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRI’s) are the medications of choice to treat and manage this condition, however they increase gastrointestinal symptoms. People are likely to experience irritable bowel syndrome (IBS) symptoms temporarily or long-term.
They reduces GI tolerance to high fibre, high fat meals and snacks.
They may increase appetite, but their effect on weight is person dependent (some gain, others may lose weight). PTSD is generally considered to be a biochemical or emotional dysfunction in response to trauma but nutrition can play a key role in the onset as well as the intensity and duration.
COMMONALITIES IN FOOD PATTERNS OF THOSE WITH PTSD INCLUDE:
- Skipping meals
- Poor appetite and desire for foods
- Desire for sweet foods (Sathyanarayana Rao et al. 2008).
Often their diets can contain a lower intake of crucial nutrients such as omega 3 fatty acids, essential vitamins and minerals due to convenience meals, limited fruit and vegetables and inadequate meat/dairy protein.
Common deficiencies are from amino acids and minerals that are precursors to neurotransmitters.
Those with PTSD are more likely to consume a higher energy (kJ) intake, with more frequent consumptions of fast foods, soft drinks and snacks.
Patterns of eating are likened to food addiction or bingeing, which is why there is a direct correlation of PTSD and obesity.
Food intake is often associated with mood and the consumption patterns relate to the dysfunction of the hypothalamic-pituitaryadrenal axis and low serotonin (Sathyanarayana Rao et al. 2008) as the reward circuitry of food and mood appears to be dysfunctional (Farr et al. 2014).
The cycle of over eating, in particular high energy foods, leads to a dampening of the appetite suppressing effect of foods, increasing the neural reward system of consumption (Sareen 2014).
The main core macronutrients that are important to mood are carbohydrates and proteins and micronutrients (Sareen 2014).
This is an excerpt from the tutorial and if you choose to access the complete tutorial, you will find detailed information on foods that improve the symptoms of PTSD including macronutrients, the role of carbohydrates, the preferred glucose index, proteins and amino acids, Omega-3 fatty acids and vitamins and minerals.
An optimal diet for people with PTSD is offered including daily and weekly food inclusions and those that require limitation or exclusion.
If you are interested in nutritional advice for your clients or yourself, Peta has written three other tutorials for the CPE website:
- Diabetes and diet
- Health eating for adults
- Metabolic syndrome and obesity, nutritional and medical management
The following excerpt is from the ANMF’s Nutrition and PTSD course on the (CPE) website. The complete tutorial is allocated one hour of CPD, the reading of this excerpt will give you 20 minutes of CPD towards ongoing registration requirements.
Be sure to add it to your portfolio on the CPE website To access the complete tutorial, go to anmf.cliniciansmatrix.com
For further information, contact the education team at education@anmf.org.au
anmf.org.au/cpe
QNMU and NT members have access to all learning on the CPE
Great facts on nutrition with PTSD patients observed regularly in job ,( mental Health)