Content uploaded by Jorge R Miranda-Massari
Author content
All content in this area was uploaded by Jorge R Miranda-Massari on Mar 29, 2018
Content may be subject to copyright.
Diet and Stress
Michael J. Gonzalez, DSc, NMD, PhD
a,
*,
Jorge R. Miranda-Massari, BS, BSPharm, RPh, PharmD
b
“Let food be your medicine and let medicine be your food.”
—Hippocrates
INTRODUCTION
Stress in biological terms refers to the reaction of the body to the disturbance of the
equilibrium given particular stimuli. A stressor can vary in intensity, and people have
different levels of coping ability to respond well or fail to respond properly to an event
that has occurred in their life, whether physical or emotional. Physiologic systems
work in a complex and integrated manner. There are many factors of one’s daily life-
style that bring stress upon the body. Stress is a common problem in most modern
societies, in which there are economic pressures; political, religious, and other social
conflicts; overpopulation; contamination; and a food industry that provides main sta-
ple foods that are additional stressors (refined carbohydrates, excessive animal fats,
artificial colors, preservatives, and sweeteners). Unhealthy eating patterns will only
result in an increased level in stress, followed by further health problems in the near
future if the issues are not resolved. With a healthy eating plan accompanied with sci-
entific supplementation and a proper stress management program, one can overcome
stress, prolong one’s life span, and reduce the likelihood of stress-related illnesses.
The authors have nothing to disclose.
a
Nutrition Program, Department of Human Development, School of Public Health, University
of Puerto Rico, Medical Sciences Campus, GPO Box 365067, San Juan, PR 00936-5067, USA;
b
Department of Pharmacy Practice, School of Pharmacy, University of Puerto Rico, Medical
Sciences Campus, GPO Box 365067, San Juan, PR 00936-5067, USA
* Corresponding author.
E-mail address: michael.gonzalez5@upr.edu
KEYWORDS
Diet Stress Nutrition Supplementation Vitamins Minerals
KEY POINTS
Nutrition, diet and stress.
Stress and nutritional insufficiency.
Nutrition for stress.
Psychiatr Clin N Am 37 (2014) 579–589
http://dx.doi.org/10.1016/j.psc.2014.08.004 psych.theclinics.com
0193-953X/14/$ – see front matter Ó2014 Elsevier Inc. All rights reserved.
The US population in general as a whole is overstressed. It is well understood that
stress and perceived stress in adults contribute to a wide range of disorders including
hypertension and elevated plasma cortisol,
1
cardiac and cardiovascular disease,
2
in-
flammatory bowel syndrome,
3
type 2 diabetes mellitus,
4
and a reduced quality of life
among those suffering with cancer.
5–7
Stress happens in 3 stages. The first is an initial state of alarm (fight or flight
response), which produces an increase of adrenaline. Living organisms can withstand
occasional extreme stress and still survive. The second stage is a short-term resis-
tance mechanism that the body sets up to cope with the problem. The final stage is
a state of exhaustion. The exhaustion stage occurs when the body has used up all
its available resources. If the situation is not taken care of, stress can produce long-
term damage to the body, including heart problems, high blood pressure, the immune
system problems (susceptibility to infections and allergies), skin problems (acne, itchy
rashes, psoriasis, and eczema), pain (neck, shoulder and back), diabetes, and
infertility.
8
Stress affects the whole body is the following sections provide a brief description of
how stress affects different body systems.
Musculoskeletal System
When muscles are tense for prolonged periods of time, other reactions of the body
promote stress-related disorders. Tension headache and migraine headache have
been associated with chronic muscle tension in the area of the shoulders, neck,
and head.
Respiratory System
Stress can make breathing more difficult. For those with asthma or a chronic obstruc-
tive disease, getting enough oxygen can become difficult.
Cardiovascular
Repeated acute stress and persistent chronic stress can induce inflammation in the
vasculature, especially of the coronary arteries. This is one of the proposed mecha-
nisms associating stress to myocardial infarcts. It addition, it has been shown that
the way a person responds to stress can alter cholesterol levels.
Endocrine
Stress affects how the hypothalamus signals the pituitary gland and the autonomic
nervous system to secrete the stress hormones epinephrine and cortisol. The hypo-
thalamus stimulates the adrenal glands cortex to produce cortisol and the adrenal me-
dulla to produce epinephrine. This gives the body the energy to run from danger.
The Nervous System
Chronic stress can result in a long-term drain on the body. As the sympathetic nervous
system continues to trigger physical reactions, it causes a wear and tear on the body.
Abbreviations
ANS Autonomic nervous system
DHA Docosahexaenoic acid
EPA Eicosapentaenoic acid
PMS Premenstrual syndrome
Gonzalez & Miranda-Massari
580
Excessive activation depletes the system of neurotransmitters, peptides, cofactors,
and other mediators and also alters receptor response.
9
NUTRITION, DIET AND STRESS: THE LINK BETWEEN STRESS AND NUTRITIONAL
INSUFFICIENCY
Stress creates greater physiologic demands. More energy, oxygen, circulation, and
therefore more metabolic cofactors are needed (eg, vitamins and minerals). The irony
of stress is that people suffering stress need a more nutritionally dense diet but often
opt for comfort foods lacking in the necessary nutrients, consequently inducing a
situation of nutrient depletion that further compromises the metabolic systems. This
situation can be further complicated by the use of medications that often contribute
to nutrient depletion.
Stress can cause unhealthy eating habits. People who often endure stress have no
time to fit a balanced nutrition around their busy schedule. Moreover, stress makes the
body crave foods that are high in fats and sugars. This eating problem in time will inflict
a greater stress on the body, plus a nutritional insufficiency state that poses a threat to
one’s physical and mental health. Stress can have the effect of making people skip or
forget to eat their meals. Also people under stress use coffee or other stimulants to
assist them and help them cope. The problem with coffee is that it contains caffeine,
which, if taken in large quantities, can have negative adverse effects on the body. One
problem is that the person is using coffee to stay awake when rest is obviously
needed. Caffeine also has an impact on the hormones in the body. Adrenaline and
cortisol are increased under the influence of caffeine. The neurotransmitter dopamine
is also increased, all with possible negative adverse effects. The increased amount of
cortisol produced by stress gives the person a strong urge to eat foods that are high in
carbohydrates, sugars, and fats. This eating pattern will result in excess fat being
stored. When someone is stressed and does not eat the right amount of food or the
correct amount of nutrients, he or she will start to encounter inconsistencies in their
blood sugar and other metabolic reactions. These inconsistencies lead to problems
such as tiredness, lapses of concentration, and mood swings. If stress is not dealt
with properly, the body will suffer in the long run problems that are much more serious,
such as diabetes.
DIET AND STRESS
The High-Fat Diet and the Stress Response
Kitraki and colleagues
10
published a study in 2004 using Wister rats, investigating the
effects of a diet high in polyunsaturated fat (corn oil) corresponding with a deceased
consumption of carbohydrates and reduced intake of protein over 7 days on both en-
ergy consumption and a subsequent stress reaction to a short stressor (swimming).
Comparing levels of stress hormones in the high-fat/low-protein/low-carbohydrate
diet rats and normally fed rats, they found that the levels of corticosterone in both
sets of rats were not different during the application of the stressor. Additionally, corti-
costerone concentrations appeared to not be affected by the different diets. However,
further analysis of the blood showed elevated levels of glucocorticoid receptors within
the hypothalamic area of the rats fed a normal diet, while lower glucocorticoid recep-
tors levels were found in the rats fed the high-fat/low protein/low-carbohydrate diet.
The results highlight how quickly an improper diet with high fat intake and lacking in
other nutrients can adversely impact the balance of stress hormones as evidenced
by lower glucocorticoid receptors in the hypothalamus known to mediate the effects
of cortisol.
11
Diet and Stress 581
Omega-3 and Perceived Stress
Bradbury, Myers, and Oliver (2004) did a study to determine if perceived levels of
stress can be lowered through consumption of the omega-3 fatty acid docosahexae-
noic acid (DHA).
12
Participants scoring high on a scale of perceived stress were
randomly assigned to either a group taking fish oil supplements containing DHA or
a group (placebo group) taking supplements of olive oil for 6-weeks. For the analysis,
both the fish oil group and the olive oil placebo group were compared with each other
as well as against a larger control population. Following the 6-week trial, results
showed that perceived stress levels were significantly lower among both the fish oil
and olive oil groups. When comparing perceived stress levels between the fish oil
group and the larger population, the fish oil group had significantly lower perceived
stress. Further analysis showed that there were no significant differences in perceived
stress levels between the fish oil and olive oil groups, and no significant difference in
perceived stress levels between the olive oil and the control groups. At the end, only
the fish oil group showed significant reductions in perceived stress compared with the
control sample, consistent with the conclusion that omega-3 attenuates perceived
stress.
Diet, Stress, and Inflammation
Inflammation is a biomarker of stress. Ha
¨nsel, Hong, Ca
´mara, and von Ka
¨nel
13
demonstrated that situations such as work-related stress, stress associated with living
in poor socioeconomic conditions, stressful events suffered in childhood, and stress
associated with caring for another all contribute to chronic stress and influence the
function of the immune system. Furthermore, Ha
¨nsel and colleagues
13
described
how chronic stress impacts the HPA axis and the autonomic nervous system (ANS),
resulting in increased levels of inflammation. Galland
14
did research exploring the
impact of nutrition and patterns of food consumption on immunologic indicators of
inflammation (eg, interleukin-6, tumor necrosis factor alpha, and C-reactive protein).
Galland
14
showed healthier, anti-inflammatory influences with food consumption pat-
terns that result in a greater monounsaturated fat to saturated fat ratio, a greater
omega-3 to omega-6 ratio, and greater levels of vegetable, fruit, whole grain, and
legume consumption.
Bakker and colleagues
15
did research to see if dietary changes could reduce mod-
erate levels of chronic inflammation in individuals identified as being overweight. They
provided men who were overweight with a mix of nutrients known to deliver anti-
inflammatory effects (vitamin C, omega-3, and extracts derived from green tea and
tomatoes) for 5 weeks. Measures were taken of blood plasma, fat tissue, and meta-
bolic enzymes. At the end of the 5 weeks, there were no changes in measures of
inflammation (C-reactive protein). Yet, there were small changes indicating some
attenuation of inflammation in fatty tissues as indicated by improved performance of
endothelial tissue and oxidation of fatty acids in the liver. The outcome indicates
that adopting a diet high in anti-inflammatory and antioxidant properties may have
beneficial impacts on inflammation and oxidative stress. It is possible that the nutri-
ents provided were not given in enough quantities to have a more profound effect
on inflammatory parameters.
Vitamins and Stress
As mentioned earlier, supplementation with vitamins may reduce stress and improve
overall mood. The benefit of vitamin supplementation in reducing stress and improving
mood and mental performance was shown by Kennedy and colleagues
16
in a sample
Gonzalez & Miranda-Massari
582
of working men between the ages of 30 and 55. These men were required to fill out
questionnaires measuring their mood state and perceived stress, and assessing their
overall health. Cognitive functioning, mood change, and fatigue were also assessed
during a battery of cognitive tests. The men where then randomly assigned to an
experimental or control group. For 30 days, the men in the experimental group
received dietary supplements of vitamins and minerals. During the last day of the trial,
all men were asked to walk on a treadmill as they were engaged in a test of cognitive
function. Analysis showed that the men who received supplements of vitamins and
minerals exhibited improved cognitive performance, lower rated stress, and improved
mental functioning.
Another study conducted by Mishra and colleagues
17
further demonstrates how
insufficient amounts of vitamins, specifically B vitamins, can contribute to distressed
mood. They assessed the impact of vitamin levels (vitamins B6, B12, niacin, and
folate) taken as a child and taken as an adult on women’s psychological state during
adulthood. Using a standardized questionnaire to assess levels of psychological
distress and a memory recall session to assess patterns of food consumption and
vitamin intake during childhood, they collected food intake information from a sample
of women. They found that only deficient levels of vitamin B12 taken at their current
adult age had an association with higher reporting of psychological distress. With
respect to diet, improper nutritional balance, insufficient vitamin intake, and excess
consumption of fat have been shown to exacerbate the stress response and create
unhealthy balances of stress hormones. The dietary patterns shown to create posi-
tive protective effects against stress and inflammation are consistent with the Med-
iterranean diet, consisting of increased levels of vegetables, fruit, whole grain, nuts,
seeds, beans, eggs, and higher levels of fiber along with lower levels of red meats.
Stress reduction is also aided by supplementation with vitamins and minerals
including magnesium, calcium, manganese, B vitamins, and vitamins C and E. Addi-
tional stress protection was shown with the intake of omega-3 fatty acids, particularly
DHA from fish oil, and increasing the ratio of monounsaturated fats (omega-9) to
saturated fats.
NUTRITION FOR STRESS
“Don’t be foolish enough to dig your own grave with a fork and spoon.”
—Anonymous
It cannot be overstated that emotional stress affects all aspects of nutrition. A wide
variety of foods needs to be consumed in order to remain healthy. This is because
there is not 1 food available that contains all the necessary nutrients that are required
for optimal health. Therefore a selection of healthy foods is needed. Nutrients needed
include minerals, vitamins, proteins, and fatty acids. Consuming the required nutrients
(typically between 40 and 60 nutrients) per day is essential to a healthy, well-protected
body. Sadly, most physicians have no background in nutrition. Sugar is one of the
foods we should eliminate. Sugar itself contains no required vital nutrients. Sugar
may produce a burst of energy for a short period of time only. When this high runs
out, the person will suffer a crash.
One of the main problems with on-going stress is the depletion of nutrients. The
stress response is fight or flight; either action requires lots of energy. Stress utilizes
many nutrients for energy production, even if one sits in front of a computer screen
all day.
B vitamins are essential for coping with stress, as they are used in most metabolic
enzymes. Substances like sugar, alcohol, and caffeine will drain these resources and
Diet and Stress 583
affect the functionality of the body and the brain. When under stress, the body uses
reserve B vitamins.
Foods can help relieve stress in several ways. Comfort foods, like a bowl of warm
oatmeal can boost levels of serotonin, a calming brain chemical. Other foods can
cut levels of cortisol and adrenaline, stress hormones that take a toll on the body
over time. And a healthy diet can counter the impact of stress, by revving up the im-
mune system and lowering blood pressure. One of the best ways to reduce high blood
pressure is to get enough potassium, and half an avocado has more potassium than a
medium-sized banana. Guacamole, made from avocado, just might be a healthy alter-
native when stress has one craving a high-fat food.
Carbohydrates prompt the brain to make more serotonin. For a steady supply of this
feel-good chemical, it is best to eat complex carbohydrates, which are digested more
slowly and have a lower glycemic index. Good choices include whole grain breakfast
cereals, breads, and pastas, as well as old-fashioned oatmeal. Complex carbohy-
drates can also help one feel balanced by stabilizing blood sugar levels. Carbohy-
drates at bedtime can speed the release of serotonin and help one sleep better.
Because heavy meals before bed can trigger heartburn, stick to something light,
such as fruit and low-fat yogurt. Another bedtime stress buster is a glass of warm
milk. Research shows that calcium eases anxiety and mood swings linked to premen-
strual syndrome (PMS). The authors recommend organic, skim, or low-fat milk.
Oranges provide vitamin C. Studies have demonstrated that this vitamin can curb
levels of stress hormones while strengthening the immune system. In a study of people
with high blood pressure, high cortisol levels (a stress hormone) returned to normal
quicker when people took vitamin C.
Crunchy raw vegetables can help ease stress in a purely mechanical way. Munching
celery or carrot sticks helps release a clenched jaw and may ward off tension. Spinach
and all green leafy vegetables are a good source of magnesium. Insufficient magne-
sium may trigger headaches and fatigue, compounding the effects of stress. Cooked
organic soybeans or a filet of salmon can also provide magnesium.
Omega-3 fatty acids, found in fish such as salmon and tuna, can prevent increases
in stress hormones and may help protect against heart disease, mood disorders like
depression, and PMS. For a steady supply of feel-good omega-3s, aim to eat 3 oun-
ces of fatty fish at least twice a week.
Pistachios, as well as other nuts and seeds, are good sources of healthy fats. Eating
a handful of pistachios, walnuts, or almonds may help lower cholesterol, ease inflam-
mation, reduce the risk of diabetes, and help protect against the effects of stress.
Almonds are full of helpful vitamins: vitamin E to increase the immune system, plus
B vitamins, which may make one more resilient during bouts of stress such as depres-
sion. Snack on a quarter of a cup every day.
Drinking black or green tea may help one recover from stressful events more quickly.
One study compared people who drank 4 cups of tea daily for 6 weeks with people who
drank another beverage. The tea drinkers reported feeling calmer and had lower levels
of the stress hormone cortisol after stressful situations. When it comes to stress, the
caffeine (in coffee) can boost stress hormones and raise blood pressure.
Caffeine can be responsible for inducing the first stage of stress (alarm stage).
Caffeine is also responsible for making people hyperactive and nervous. Because of
this, the person’s sleeping pattern can be affected significantly by caffeine. If one
has trouble controlling stress and always feels tired, one should look at his or her
diet to see if there are any nutrient deficiencies or insufficiency. When the body is under
stress, it has been proven that the body uses up its resources until they are finished.
Following a diet plan will strengthen the body against stress and other illnesses.
Gonzalez & Miranda-Massari
584
The following are the main nutrients that the body will use up
1. B vitamins. These help the body cope with stress (build metabolism) and control the
whole nervous system
2. Proteins. Assist in growth and tissue repair
3. Vitamin A. Essential for normal vision
4. Vitamin C. Protection of the immune system (eg, antioxidants and diabetes protec-
tion), lowers the amount of cortisol in the body
5. Magnesium. Needed for a variety of tasks such as muscle relaxation, fatty acid for-
mation, making new cells, and heartbeat regulation
There are many herbal supplements that claim to fight stress. One of the best stud-
ied is St. John’s Wort, which has shown benefits for people with mild-to-moderate
depression. This herb also appears to reduce symptoms of anxiety and PMS. Valerian
root is another herb that has a calming effect. Health care providers should be told
about any supplements a patient is taking, especially herbs, so they can check on
any possible interactions with any medication.
DIETARY TIPS TO IMPROVE DIET TO HELP COPE WITH STRESS
Tip # 1 Eat a Variety of Different Color Foods
The colors and their intensity are a guide to the variety of phytochemical (pigments)
and their concentrations.
The color blue/purple on fruits and vegetables reveals the presence of natural plant
phytochemicals called anthocyanins, which act as powerful antioxidants, protecting
cells from damage. In general terms, the darker the color means the higher the phyto-
chemical concentration. Anthocyanins have been shown to have a role in the support
of healthy blood pressure, the prevention of blood clot formations, the improvement of
memory function, and in lowering the risk of cancer.
18–20
Blue/purple on fruits and vegetables also shows that they contain flavonoids that
support blood vessels, help prevent short term memory loss, and even prevent urinary
infections by precluding bacteria from sticking in the epithelium of the urinary tract.
Green fruits and vegetables reveal chlorophyll content. Another phytochemical
found in green colored food is lutein, which is important for eye health.Lutein works
with zeaxanthin (found in corn, red peppers, and grapes) to reduce the risk of cata-
racts and macular degeneration.
21
Other nutrients present in green food include the indoles in broccoli, cabbage, and
other cruciferous vegetables, which may help protect against some types of cancer.
22
Many green plant foods are also rich in isothiocyanates, which stimulate enzymes in
the liver that assist the body in removing potentially carcinogenic compounds. Greens
(especially dark leaves) are also rich sources of folate, vitamin K, potassium, some
carotenoids, and omega-3 fatty acids.
Red fruits and vegetables reveal lycopene and anthocyanins. Lycopene is a power-
ful antioxidant that is found in plants such as tomatoes, watermelon, and pink grape-
fruit. Anthocyanin is found in fruits such as strawberries, raspberries, and red grapes
and has powerful antioxidant activity. Lycopene is believed to reduce risk of myocar-
dial infarcts and certain types of cancer, especially prostate.
23,24
Yellow/orange
Orange/yellow fruits and vegetables reveal carotenoids. Beta-cryptoxanthin, beta-
carotene, and alpha-carotene are all orange-friendly carotenoids that can be con-
verted in the body to vitamin A. Vitamin A is important for vision and immune function,
Diet and Stress 585
as well as skin health. There are scientific reports on carotenoid-rich foods helping to
reduce the risk of cardiovascular disease and some cancer.
25,26
In conclusion, many phytonutrients are essential in helping the body fight oxidation
and degenerative diseases.
Tip #2 Eat Antioxidant-Containing Foods
Most phytochemicals are known to have antioxidant activity. Free radicals are oxygen
molecules with an aberrant electron. Metabolically speaking, this unbalanced electron
configuration causes damage to the following: cell membranes, DNA, RNA, and mito-
chondria. Free radicals are a hazard to the body’s integrity at the cellular and tissue
level. They have been associated with the development of cancer and heart disease,
and other diseases as well. Antioxidants destroy free radicals. The 4 major antioxi-
dants are: carotenes (precursors to vitamin A) vitamin C, vitamin E, and the mineral,
selenium. Antioxidants are found mostly in fruits and vegetables.
Tip # 3 Choose Organic Foods (Whenever Possible)
In simplest terms, currently available foods are full of chemicals: synthetic fertilizers,
pesticides, herbicides, and fungicides. Organic foods will largely reduce the burden
of contaminants.
Tip #4 Drink Filtered Water
In general, people are usually dehydrated. People do not drink enough water! Many
beverages (eg, coffee, tea, sodas) act as diuretics, meaning they increase the loss
of water through urination, thus promoting dehydration. Various studies show that
the water supply is not as clean as it should be. City drinking water may contain sizable
traces of antibiotics, hormones, and chemicals.
It is in the best interest to install a high-end water filter system to be used for all
drinking water (and cooking). Remember to replace the filter once a year (or as often
as needed). One should also know that there is no federal regulation on bottled water.
Most bottled water is ordinary tap water, sitting in plastic containers on pallets, stored
in warehouses months before store delivery. It might be best to carry one’s own
filtered water in a suitable water bottle.
The importance of being hydrated cannot be overemphasized. Water helps flush out
metabolites, waste products, and toxins for elimination. Dehydration will compromise
this process. How much water is enough per day?
The authors suggest the best indication of being hydrated is producing near-clear
urine (since dark urine may be a sign of dehydration).
Tip # 5 Eat Herbs and Spices
Use fresh spices and herbs to cook and in salads. Prepare a backyard garden with
herb plants that may include rosemary, thyme, sage, cilantro, oregano, garlic, and
many others. These spices and herbs are not only added for taste, they have health
benefits (essential oils of herbs enhance the immune system and may have antimicro-
bial and other beneficial properties). The leaves, stems, and roots of these plants
contain phytochemicals such as bio-flavonoids and antioxidants. There are several
mushrooms (shitake, maitake and reishi) that are known to enhance the immune sys-
tem as well.
27,28
Tip # 6 Consume Free Range Meats and Poultry and Wild Caught Fish
Free range means that the cattle are allowed to eat as they roam around the pasture
for their entire lives. Nonfree range refers to those animals that are raised on factory
Gonzalez & Miranda-Massari
586
farms, live in overcrowded conditions and fed corn and other grains. Once again, corn
is not a food source and is not found in their normal diet. The problem is that it may
contain synthetic fertilizers, herbicides, fungicides, or pesticides. Also, living in such
close quarters gives rise to infections; hence more antibiotics are used even prophy-
lactically. Hormones and steroids are also given to increase yield. As for the consump-
tion of beef, chicken, mutton, pork, and salmon, the best way to go is organic.
Tip # 7 Eat Fiber
Fiber (roughage) is found in fruits, vegetables, grains, and legumes (eg, peas, beans,
and lentils). These are complex carbohydrates that are not digestible. Fiber sweeps
out both the small and large intestine, carrying fat molecules (which is why fiber is
said to lower cholesterol) and toxins. The World Health Organization suggests that
each person consume 30 to 40 g of fiber a day. One should try to consume a good
amount of fruits and vegetables each day.
Tip #8 Consume Omega 3s
Omega 3 and omega 6 oils are essential fatty acids. This means that one’s body
cannot produce them, and hence they must be obtained from the diet.
People have an imbalance of fatty acids in their diet; it is overloaded with omega 6s
(vegetable oils) and severely lacking in omega 3. The standard American diet, which is
high in omega 6 oils, tends to favor inflammation. Sources of omega 3s include cold-
water fish (eg, salmon, cod, and tuna), flax seed oil, and walnuts. Omega 3 fats act as
anti-inflammatory agents. They are also essential for brain cells and the retina. DHA
comprises about 97% of all the omega-3 fatty acids in the human brain and 93% of
those in the retina. Low concentrations of eicosapentaenoic acid (EPA) and DHA
have been shown to result in an increased risk of death from all causes and accelerate
cognitive decline.
29–32
There is evidence that omega 3 oils may also help to prevent
and combat cancer. If one chooses salmon, the authors recommend buying wild
Alaska salmon or Norwegian salmon, not farm-bred salmon. The latter is known to
have a high polychlorinated biphenyl content (a known carcinogen).
Tip # 9 Take a Multivitamin and Mineral Formula with a High Content of B-Complex
B-complex vitamins are known to act as a stress fighter vitamin, because many of the
B vitamins are used to assist metabolic processes for energy production (fight or flight).
SUMMARY
The impact that stress can have on one’s health is serious and can cause problems to
every major system of the body. With the right nutrition, one can reduce the impact
that stress has on the body and effectively repair any damage that has been done.
Proper nutrition prepares the body for any stress. When the body becomes stressed,
it craves foods that are high in fats and sugars. These are the foods that need to be
avoided, as they only provide someone with a small burst of energy, which will result
in a long period of fatigue. On the other hand, a high-fiber diet rich in fresh fruits, veg-
etables, nuts, and whole grains provides greater appetite satisfaction over a longer
period than processed, high-fat, and high-sugar snacks. But even more important,
when one replaces junk foods with fresh, high-fiber plant foods, one is more likely
to consume greater amounts of vitamins A, B6, and C, and the B vitamins niacin,
thiamin, riboflavin, and folate. One will also have a higher intake of magnesium, iron,
selenium, zinc, phosphorus, and calcium. These nutrients are all vital to a healthy
metabolism and provide significant stress protection.
Diet and Stress 587
REFERENCES
1. Esler M, Eikelis N, Schlaich M, et al. Presence of biological markers of stress. Clin
Exp Pharmacol Physiol 2008;35(4):498–502.
2. Stanley R, Burrows G. Psychogenic heart disease - stress and the heart: a histor-
ical perspective. Stress & Health: J of the Intern Soc for the Investigation of Stress
2008;24(3):181–7.
3. Jordan C. Stress and inflammatory bowel disease: encouraging adaptive coping
in patients. Gastrointest Nurs 2010;8(10):28–33.
4. Heraclides A, Chandola T, Witte D, et al. Psychosocial stress at work doubles the
risk of type 2 diabetes in middle-aged women: evidence from the Whitehall II
study. Diabetes Care 2009;32(12):2230–5.
5. Hansen F, Sawatzky JV. Stress in patients with lung cancer: a human response to
illness. Oncol Nurs Forum 2008;35(2):217–23. http://dx.doi.org/10.1188/08.ONF.
217-223.
6. Kreitler S, Peleg D, Ehrenfeld M. Stress, self-efficacy and quality of life in cancer
patients. Psychooncology 2007;16(4):329–41.
7. van de Wiel H, Geerts E, Hoekstra-Weebers J. Explaining inconsistent results in
cancer quality of life studies: the role of the stress–response system. Psychoon-
cology 2008;17(2):174–81.
8. Carlson NR. Physiology of behavior. 8th edition. New York: Allyn & Bacon; 2004.
9. American Psychological Association. Psychology help center: stress effects on
the body. Available at: http://www.apa.org/helpcenter/stress-body.aspx. Ac-
cessed May 27, 2014.
10. Kitraki E, Soulis G, Gerozissis K. Impaired neuroendocrine response to stress
following a short-term fat-enriched diet. Neuroendocrinology 2004;79(6):
338–45.
11. Manary M, Muglia L, Vogt S, et al. Cortisol and its action on the glucocorticoid
receptor in malnutrition and acute infection. Metabolism 2006;55(4):550–4.
12. Bradbury J, Myers SP, Oliver C. An adaptogenic role for omega-3 fatty acids in
stress; a randomised placebo controlled double blind intervention study (pilot).
Nutr J 2004;3:20.
13. Ha
¨nsel A, Hong S, Ca
´mara RA, et al. Inflammation as a psychophysiological
biomarker in chronic psychosocial stress. Neurosci Biobehav Rev 2010;35(1):
115–21.
14. Galland L. Invited review: diet and inflammation. Nutr Clin Pract 2010;25(6):
634–40.
15. Bakker GC, van Erk MJ, Pellis L, et al. An antiinflammatory dietary mix modulates
inflammation and oxidative and metabolic stress in overweight men: a nutrige-
nomics approach. Am J Clin Nutr 2010;91(4):1044–59.
16. Kennedy DO, Veasey R, Watson A, et al. Effects of high-dose B vitamin complex
with vitamin C and minerals on subjective mood and performance in healthy
males. Psychopharmacology 2010;211(1):55–68.
17. Mishra G, McNaughton S, O’Connell M, et al. Intake of B vitamins in childhood
and adult life in relation to psychological distress among women in a British birth
cohort. Public Health Nutr 2009;12(2):166–74.
18. de Pascual-Teresa S, Moreno DA, Garcı
´a-Viguera C. Flavanols and anthocyanins
in cardiovascular health: a review of current evidence. Int J Mol Sci 2010;11(4):
1679–703.
19. Lilamand M, Kelaiditi E, Guyonnet S, et al. Flavonoids and arterial stiffness: prom-
ising perspectives. Nutr Metab Cardiovasc Dis 2014;24(7):698–704.
Gonzalez & Miranda-Massari
588
20. Spencer JP. The impact of fruit flavonoids on memory and cognition. Br J Nutr
2010;104(Suppl 3):S40–7.
21. Zampatti S, Ricci F, Cusumano A, et al. Review of nutrient actions on age-related
macular degeneration. Nutr Res 2014;34(2):95–105.
22. Ahmad A, Sakr WA, Rahman KM. Anticancer properties of indole compounds:
mechanism of apoptosis induction and role in chemotherapy. Curr Drug Targets
2010;11(6):652–66.
23. Kelkel M, Schumacher M, Dicato M, et al. Antioxidant and anti-proliferative prop-
erties of lycopene. Free Radic Res 2011;45(8):925–40.
24. Holzapfel NP, Holzapfel BM, Champ S, et al. The potential role of lycopene for the
prevention and therapy of prostate cancer: from molecular mechanisms to clin-
ical evidence. Int J Mol Sci 2013;14(7):14620–46.
25. Ciccone MM, Cortese F, Gesualdo M, et al. Dietary intake of carotenoids and their
antioxidant and anti-inflammatory effects in cardiovascular care. Mediators In-
flamm 2013;2013:782137.
26. Tanaka T, Shnimizu M, Moriwaki H. Cancer chemoprevention by carotenoids. Mol-
ecules 2012;17:3202–42.
27. Johnson JJ. Carnosol: a promising anti-cancer and anti-inflammatory agent. Can-
cer Lett 2011;305(1):1–7.
28. Gebreyohannes G, Gebreyohannes M. Medicinal values of garlic: a review. Intern
J of Med and Medical Sci 2013;5(9):401–8.
29. Wennberg M, Bergdahl IA, Hallmans G, et al. Fish consumption and myocardial
infarction: a second prospective biomarker study from northern Sweden. Am J
Clin Nutr 2011;93(1):27–36.
30. Montgomery P, Burton JR, Sewell RP, et al. Low blood long chain omega-3 fatty
acids in UK children are associated with poor cognitive performance and
behavior: a cross-sectional analysis from the DOLAB study. PLoS One 2013;
8(6):e66697.
31. Lee LK, Shahar S, Chin AV, et al. Docosahexaenoic acid-concentrated fish oil
supplementation in subjects with mild cognitive impairment (MCI): a 12-month
randomised, double-blind, placebo-controlled trial. Psychopharmacology (Berl)
2013;225(3):605–12.
32. Stonehouse W, Conlon CA, Podd J, et al. DHA supplementation improved both
memory and reaction time in healthy young adults: a randomized controlled trial.
Am J Clin Nutr 2013;97(5):1134–43.
Diet and Stress 589
