www.nutritionhealthreview.com March–April 2021 • Volume 133
Nutrition
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Health Review
T h e Co n s u m e r ’s M e d i ca l J o u r n a l
Inside the Issue FITNESS FOR THE MIND: Using Exercise to Improve Mood and Calm Anxiety
MATCHA MADNESS: Does this Green Tea Measure Up to All Its Health Hype?
PANIC ATTACKS: What Are They? How Are They Managed?
KNOW YOUR NUTRIENT: Potassium
WHAT’S NEW IN NUTRITION RESEARCH? Nutrition as Metabolic Treatment for Anxiety
RECIPES • Wild Rice, Edamame, and Broccoli Salad • Green Monster Smoothie • Peach Oat Smoothie • Cocoa Matcha Bars
SUPERFOOD SPOTLIGHT: Spinach
egetus Foundation
©
EDITORIAL MESSAGE
March-April 2021 • Volume 133
Dear Readers: For this issue’s editorial message, I decided to focus on something even more important than the content of this latest issue of Nutrition Health Review (NHR). I know, right? Hard to believe there’s actually something more important than NHR, but there is...the COVID-19 vaccination. As I write this editorial message, the most current data from the US Centers for Disease Control and Prevention (CDC) indicate that around 45 percent of the American population has received at least one dose of the three available COVID-19 vaccines, and nearly 32 percent of Americans are fully vaccinated.1 That’s great news...but researchers estimate that 70 to 85 percent of the population needs to be immune to the virus before what’s called “herd immunity” kicks in and we can safely return to a relatively normal way of life. Herd immunity is when enough of the population is resistant to a disease, either due to previous infection or vaccination, that the disease wanes because it has nowhere to go (no bodies to infect).2 Despite a few “hiccups” (so to speak) in the vaccination roll-out, all 50 states have now opened vaccination eligibility to all people 18 years of age or older, and in most states, anyone 16 years of age or older can receive the vaccine.3 The vaccine is free to all people living in the United States, regardless of their immigration or health insurance status. We still have a long way to go in this country before we achieve herd immunity, but if we work together, we can beat this virus. Everyone is strongly encouraged to get vaccinated, even those who previously had the virus. The vaccines are safe, free, and accessible. To find a vaccination center near you, visit https:// www.cdc.gov/vaccines/covid-19/reporting/vaccinefinder/about. html, the CDC’s Vaccine Location Finder. If you have questions or concerns about the vaccines, consult with your physician or a qualified healthcare professional. And with that being said, I hope you all enjoy the latest edition of NHR. As always, we love hearing from you, so feel free to email us at info@matrixmedcom.com with any comments or questions. With warm regards, Elizabeth A. Klumpp Executive Editor SOURCES 1.
United States Centers for Disease Control and Prevention site. COVID-19 vaccinations in the United States. Updated daily. https://covid.cdc.gov/coviddata-tracker/#vaccinations. Accessed April 15, 2021.
2.
Harris R. A rocky road on the way to herd immunity for COVID-19. 3 Feb 2021. https://www.npr.org/sections/health-shots/2021/02/03/963373971/a-rockyroad-on-the-way-to-herd-immunity-for-covid-19. NPR site. Accessed 15 Apr 2021.
3.
Hubbard K. COVID-19 vaccine eligibility by state. 19 Apr 2021. https://www. usnews.com/news/best-states/articles/covid-19-vaccine-eligibility-bystate. Accessed 20 Apr 2021.
NHR
egutus Foundation
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Nutrition Health Review • March–April 2021 • Volume 133
NHR EDITORIAL STAFF Elizabeth A. Klumpp Executive Editor Julia E. Eckert Associate Editor Austin K. Vitelli Associate Editor Samantha Fiorenza Contributing Editor Sarabeth Henne Assistant Editor BUSINESS STAFF Robert L. Dougherty President/Group Publisher Giselle J. Geddes, MD Chief Medical Officer Christine C. Franey Vice President, Finance Joseph J. Morris Vice Presidenenough t, Business Development Ali Kinnie Publisher, Director of Media Relations Christopher Moccia Associate Director of Business Development Emily Scullin Social Media and Grants Coordinator Nutrition Health Review: The Consumer’s Medical Journal© ISSN 0164-7202 is published 6 times a year by Matrix Medical Communications © 2021 all rights reserved. Opinions expressed by authors, contributors, and advertisers are their own and not necessarily those of Matrix Medical Communications, the Vegetus Foundation, the editorial staff, or any member of the editorial advisory board. Matrix Medical Communications and the Vegetus Foundation are not responsible for accuracy of dosages given in the articles printed herein. The appearance of advertisements in this journal is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality, or safety. Matrix Medical Communications and the Vegetus Foundation disclaim responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements. Subscriptions and address changes: Subscriptions are $18.00 annually. International print subscriptions are not available. To subscribe, please visit https://tinyurl.com/ y8q72dw5 and complete the online subscription form, or complete and return the subscription form found in the magazine by faxing (when paying with credit card) or mailing (when paying by check made payable to Vegetus Foundation) to Matrix Medical Communications, 1595 Paoli Pike, Suite 201, West Chester, PA 19380; Toll-free 866.325.9907; Phone 484.266.0702; Fax 484.266.0726. Address changes should be mailed to above or emailed to info@matrixmedcom.com Editorial queries: Elizabeth Klumpp, Vice President/ Editorial Director, Matrix Medical Communications, 1595 Paoli Pike, Suite 201, West Chester, PA 19380; Phone: (484) 266-0702; E-mail: eklumpp@matrixmedcom. com Please visit the new online version of NHR at: www.nutritionhealthreview.com. We welcome reader feedback! Email comments, questions, or suggestions to: info@matrixmedcom.com
VETERANS CORNER
News, Updates, and Resources for Veterans
TABLE OF CONTENTS March–April 2021 Volume 133 FITNESS FOR THE MIND: Using Exercise to Improve Mood and Calm Anxiety .................................... 4 PANIC ATTACKS: What Are They? How Are They Managed? ............ 7 WHAT’S NEW IN NUTRITION RESEARCH: Nutrition as Metabolic Treatment for Anxiety..11 SUPERFOOD SPOTLIGHT: Spinach .............................................. 14 MATCHA MADNESS: Does this Green Tea Measure Up to All Its Health Hype? ................................... 18 KNOW YOUR NUTRIENT: Potassium.......................................... 22 RECIPES • Wild Rice, Edamame, and Broccoli Salad ......................... 5 • Green Monster Smoothie ........... 15 • Peach Oat Smoothie ................... 17 • Cocoa Matcha Bar ...................... 21
VA provides free support to help Veterans heal from military sexual trauma The month of April is known as Sexual Assault Awareness Month. To show and offer support, the Department of Veterans Affairs is providing Veterans with information on the available free counseling and treatment for mental and physical health conditions pertaining to military sexual trauma. Access full story: https://www.va.gov/ opa/pressrel/pressrelease.cfm?id=5653 VA partners with National Archives to vaccinate NARA staff By providing the National Archives and Records Administration (NARA) with medical staff and enrolled specialist to administer vaccines, the Department of Veterans Affairs is offering COVID-19 vaccination assistance to NARA staff members who are currently supporting Veteran Affair claims processing. The secretary for Benefits, Thomas Murphy, claims that this will help with processing backlogged claims, which started in March 2020. Access full story: https://www.va.gov/ opa/pressrel/pressrelease.cfm?id=5652 VA strengthens PTSD claims process training In an effort to enhance posttraumatic stress disorder (PTSD) claims processing, the Department of Veteran Affairs is offering additional training, guidance, resources, and updates to claim processors over the next six months. The aim is to make sure the processing employees better comprehend the evidence gathering and stressor verification requirements for PTSD claims. Access full story: https://www.va.gov/ opa/pressrel/pressrelease.cfm?id=5650 NHR
Nutrition Health Review • March–April 2021 • Volume 133
3
Fitness
for the
Mind
Using Exercise to Improve Mood and Calm Anxiety
I
ntegrating physical activity regularly (150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity per week)1 into a daily routine can enhance your mood and calm anxiety.2–4 Indeed, research indicates that consistent physical activity can improve symptoms of depression and anxiety, as well as enhance overall mood, drive, and self-image and improve sleep, in individuals with diagnoses of anxiety and/or mild-to-moderate depression.1–4 Though the benefits of physical activity are within everyone’s reach, there are many factors involved in how these benefits are best achieved. For example, responses to physical activity and developing a consistent exercise routine can vary dramatically person to person, especially in the presence of depression or anxiety/panic disorders. ANXIETY/PANIC
in some people with pre-existing
the National Institute of Mental
anxiety and/or panic disorder.
Health, aerobic exercise can
relax the sensory nervous system,
However, maintaining a consistent
help manage symptoms of
release endorphins (“feel-good”
exercise regimen over the long
anxiety; however, researchers
hormones), and lower resting
term has been shown to lower
caution that exercise should
heart rate, other hormonal
overall cortisol levels, reducing the
not replace standard care by
and bodily reactions (shallow
risk of exercise-induced nervous
a qualified physician or mental
breathing, racing heart rate,
system arousal and improving
health therapist; rather, it
and sweating) that typically
symptoms of anxiety. Here are
should be used in conjunction
accompany moderately or
tips on how to get the most out of
with standard treatments for
vigorously intense workouts can
physical activity when faced with
anxiety and/or panic disorders
elicit symptoms of anxiety and
symptoms of anxiety and/or panic.
(e.g., cognitive behavioral
Though physical activity can
3–6
panic responses in susceptible individuals.
3–6
When cortisol,
a stress hormone, is activated
4
therapy, antidepressant and/ Tips
or anti-anxiety medications).7
✔ Opt for aerobic (cardio)
Other research has shown that
during exercise or subsequent
exercises, if possible (e.g., brisk
regular aerobic exercise can
exhaustion, it can potentially
walking, jogging, swimming,
enhance the activity of calming
induce a fight-or-flight response
dancing, cycling). According to
neurotransmitters, such as
Nutrition Health Review • March–April 2021 • Volume 133
gamma-aminobutyric acid (GABA), in the brain.4–6
✔ If aerobic workouts aren’t for you, try Pilates or yoga. Both incorporate monitoring heart rate and breathing and encourage mindful relaxation.6
✔ If you experience a panic attack during a workout, stop the activity and practice breathing and other relaxation exercises, wet your face or take a shower, talk to a friend, or do some stretches instead.6 When your heart rate slows and anxiety/ panic dissipates, resume the workout or do some stretching and breathing exercises. aware of bodily responses, you’ll be able to gauge your limits and prevent the occurrence or exacerbation of anxiety and panic attacks during exercise or other triggering events.
MILD-TO-MODERATE DEPRESSION According to researchers, physical activity and exercise can be the optimal treatment for suggest that regular physical activity and exercise is as effective as anti-depressants in patients with mild-to-moderate depression.8–10 Unfortunately, the actual symptoms of depression that are improved by physical activity are also the ones that weaken the drive to engage in physical activity in the first place.8–10 Depression typically hinders adaptation to novel circumstances and experiences by interrupting the communication of important neurotransmitters, such as dopamine, serotonin and norepinephrine, throughout the brain.9,10 This can result in feeling “stuck” and a lack of interest and/or motivation to engage in any physical activity, let alone a workout. Exercise, however, can amplify the production of brain-developed neurotrophic factor (BDNF), which enhances the ability of dopamine, serotonin,
motivated to exercise and helping you overcome that “stuck-in-a-rut” feeling.
8–10
Not your run-of-the-mill salad! Delicious and loaded with nutrients, it can help reeplenish your body after a tough workout. PREP TIME: 10 minutes; COOK TIME: 55 minutes; SERVES: 4
2 cups of wild rice 1 bell pepper, chopped ½ cup of raisins or dried cranberries 2 cups of edamame, shelled 4 cups of broccoli, chopped 1 pinch of salt and pepper Optional: Spinach, other chopped veggies of your choice DRESSING INGREDIENTS
depression. Further, data from clinical studies
jobs, increasing your ability to feel interested and
and Broccoli Salad
SALAD INGREDIENTS
✔ Learn your symptoms and triggers. By becoming
and norepinephrine neurotransmitters to do their
Wild Rice, Edamame,
1 tsp of sea salt 1 tsp of garlic powder 2 tbsp of lemon juice 4 tbsp of tahini 2 tbsp of maple syrup Water DIRECTIONS
1. Cook wild rice according to instructions. Set aside. 2. Mix all of the salad ingredients in a large bowl. Set aside. 3. For the dressing, mix all of the ingredients together in another large bowl as well, slowly adding some water until reaching favorable consistency. 4. Pour the dressing into the salad bowl and mix everything together. NUTRITION INFORMATION
Serving Size: 1; Calories: 426; Protein: 22g; Carbohydrates: 63g; Total Fat: 12g; Sodium: 171mg NHR Nutrition Health Review • March–April 2021 • Volume 133
5
Tips
the days you do not feel like
✔ Though the exact amount
moving.11,12 Take a brisk walk
of time and level of intensity
around the block, practice a few
of physical activity required
yoga poses or a group of dance
to improve symptoms of
moves, or weed a small patch of
depression has yet to be nailed
garden.
down, experts from Harvard Health Publishing agree that individuals with depression who begin exercising should start to “feel better within a few weeks.”10
✔ Sustainability of physical activity for the long-term is integral to experiencing and maintaining improvement in one’s mood.10 Set short-term goals that are achievable (and not overwhelming), start small, and increase gradually.11 For example, start off doing five minutes of exercise a day for a week. Then, next week, increase it to 10 minutes of exercise a day, and then 15 minutes a day the following week, and so on.
✔ Try a variety of activities and do ones you enjoy, rather than focusing on building a routine doing specific exercises you don’t enjoy. Note: Any level of physical activity can elevate mood and energy levels; it does not have to leave you breathless and sweating—even a leisurely stroll around the block can provide physical and mental benefits. The important thing is to get your body moving in one capacity or another11,12
✔ Push yourself to move, even on 6
SOURCES 1. Laskowski ER. How much should the average adult exercise every day? 27 Apr 2019. https://www.mayoclinic. org/healthy-lifestyle/fitness/expertanswers/exercise/faq-20057916. Accessed 4 Apr 2021. 2. Sharma A, Madaan V, Petty FD. Exercise for mental health. Prim Care Companion J Clin Psychiatry. 2006;8(2):106. 3. Anderson E, Shivakumar G. Effects of exercise and physical activity on anxiety. Front Psychiatry. 2013;4:27. 4 Maddock RJ, Casazza GA, Fernandez DH, Maddock MI. Acute modulation of cortical glutamate and gaba content by physical activity. J Neurosci. 24 Feb 2016;36(8):2449-2457. 5. Nonaka S, Arai C, Takayama M, et al. Efficient increase of gammaaminobutyric acid (GABA) content in tomato fruits by targeted mutagenesis. Sci Rep. 2017;7:7057. 6. Leiva C. Yes, workout-induced panic attacks are a real thing. 25 OCT 2019. https://www.shape.com/lifestyle/ mind-and-body/workout-panic-attacksanxiety. Accessed 4 APR 2021. 7. National Institute of Mental Health. Anxiety diorders. Last revised Jul 2018. https://www.nimh.nih.gov/health/ topics/anxiety-disorders/index. shtml#part_145338. Accessed 11 Apr 2021. 8. Craft LL, Perna FM. The benefits of exercise for the clinically depressed. Prim Care Companion J Clin Psychiatry. 2004;6(3):104–111. 9. McMillen M. Exercise for depression: how it helps. Updated 16 FEB 2012. https://www.webmd.com/depression/ features/does-exercise-help-depression. Accessed 4 APR 2021. 10. Harvard Health Publishing site. Exercise is an all-natural treatment to fight depression. Updated 2 FEB 2021. https://www.health.harvard.edu/mindand-mood/exercise-is-an-all-naturaltreatment-to-fight-depression. Accessed 4 APR 2021. 11. Greenlaw E. Getting started: exercise for depression. Updated 22 JUL 2010. https://www.webmd.com/depression/ features/exercise. Accessed 4 Apr 2021. 12. Mayo Clinic site. Depression and anxiety: exercise eases symptoms. 27 SEPT 2017. https://www.mayoclinic. org/diseases-conditions/depression/ in-depth/depression-and-exercise/art20046495. Accessed 4 Apr 2021. NHR
Nutrition Health Review • March–April 2021 • Volume 133
KNOWLEDGE NUGGET
Green Space is Good For Your Brain! According to the U.S. Environmental Protection Agency (EPA), green space is land that is partly or completely covered with grass, trees, shrubs, or other vegetation.1 Many studies have shown that access to green spaces can produce many health benefits, including improved mental health, such as stress reduction and lower risk of depression.2–8 For example, a study of nearly 900,000 Danish citizens found that children who grew up with the lowest levels of green space had up to 55 percent higher risk of developing a psychiatric disorder independent from effects of other known risk factors.6 Even just the color green is associated with positivity, health, and empowerment.7 However, it is worth noting that the degree of restorative feelings stemming from green space seem to be correlated
to the amount of greenery (i.e., more green=greater mental health benefit.8 Sources 1.
2.
3.
4.
5.
6.
7.
8.
The United States Environmental Protection Agency site. What is open space/green space? Updated 10 Apr 2017. https:// www3.epa.gov/region1/eco/uep/ openspace.html. Accessed 9 Mar 2021. Kruize H, van der Vliet N, Staatsen B, et al. Urban green space: creating a triple win for environmental sutainability, health, and health equity through behavior change. Int J Environ Res Public Health. 2019;16(22):4403. Slater SJ, Christiana RW, Gustat J. Recommendations for keeping parks and green space accessible for mental and physical health during COVID-19 and other pandemics. Prev Chronic Dis. 2020;17:200204 Cohen-Cline H, Turkheimer E,uncan GE. Access to green space, physical activity and mental health: a twin study. J Epidemiol Community Health. 2015;69:523-529. Roe JJ, Thompson CW, Aspinall PA, et al. Green space and stress: evidence from cortisol measures in deprived urban communities. Int J Environ Res Public Health. 2013; 10(9):4086-4103. Engemann K, Pedersen CP, Arge L, et al. Residential green space in childhood is associated with lower risk of psychiatric disorders from adolescence into adulthood. PNAS. 2019;116 (11):5188-5193. Jonauskaite D, Parraga CA, Quiblier M, Mohr C. Feeling blue or seeing red? similar patterns of emotion associations with colour patches and colour terms. Iperception. 2020;11(1):2041669520902484. Brink P, Mutafoglu R, Schweitzer, et al. The health and social benefits of nature and biodiversity protection. 28 Apr 2016. Institute for European Environmental Policy website. https://ec.europa.eu/ environment/nature/biodiversity/ intro/docs/Health%20and%20 Social%20Benefits%20of%20 Nature%20-%20Final%20 Report%20Main%20sent.pdf. Accessed 10 Mar 2021. NHR
PANIC ATTACKS Fight OR Flight
What Are They? How Are They Managed?
A
panic attack is a sudden feeling of intense fear that triggers severe physical reactions, such as rapid heart rate and shortness of breath, when there is no real danger or apparent cause.1,2 Panic disorder is an anxiety disorder in which a person experiences recurrent and often unexpected panic attacks that are often followed by periods of time in which the individual is so fearful of experiencing another attack that they will change their behavior to avoid situations that might trigger an attack (e.g., won’t leave their house).3 Staff at the Mayo Clinic report that most individuals will experience at least one panic attack in their lifetime, usually induced by circumstantial stress.3 It is estimated that 11 percent of the general United States population experience panic attacks, and 2 to 3 percent of those individuals go on to develop panic disorder.2
SYMPTOMS Though not life-threatening, panic attacks can negatively impact quality of life and overall mental well-being. In addition to an overwhelming feeling of fear, rapid heartbeat, and shortness of breath, symptoms of a panic attack may include:1,2 • feelings of impending doom or danger • worry about loss of control or death • sweating Nutrition Health Review • March–April 2021 • Volume 133
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PANIC DISORDER vs. GENERALIZED ANXIETY DISORDER Panic disorder—Frequent, sudden, short bouts of intense feelings of fear combined with acute physical symptoms (e.g., racing heart, quickened breathing, sweating), followed by periods of pervasive worry over experiencing future panic attacks that result in disruptive behavioral changes (e.g., won’t leave the house). Generalized anxiety disorder—Excessive, unrealistic, disruptive worry lasting at least six months, with symptoms of restlessness, fatigue, difficulty concentrating, irritability or explosive anger, muscle tension, sleep problems, and/or personality changes (e.g., becoming less social). SOURCE: American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Press Inc.; 2013. NHR
• hot flashes • trembling • shaking • chills • abdominal cramping • numbness • tingling sensations • chest pains/pressure • headaches • throat tightness • dizziness • lightheadedness • nausea • uncertainty • feelings of detachment from reality.
CAUSES AND RISK FACTORS While the causes of panic attacks are not yet well understood, the Mayo Clinic suggests that family history of panic attacks (genetics), exposure to major stress, changes in brain function, and a sensitive temperament (i.e., being prone to stress 8
and negative emotions) are factors commonly associated with panic attacks.1,2 Having a family history of panic attacks or panic disorder; personal history of sexual or physical abuse, trauma, or major life change(s); and even smoking and excessive intake of caffeine have been shown to increase the risk of experiencing panic attack.1,2
NERVOUS SYSTEM INFLUENCE It has been hypothesized that panic attacks are connected to the “fightor-flight” response in mammals.4,5 The fight-orflight response is a survival mechanism prompted by the sympathetic nervous system that enables mammals to react quickly to danger.6–8 Basically, when a threat is perceived, the autonomic nervous system, which controls
Nutrition Health Review • March–April 2021 • Volume 133
unconscious bodily functions (e.g., breathing, heart rate, digestion, etc), triggers a number of physiological changes in the body to prepare it to flee from or fight the threat. The hormone epinephrine—aka adrenaline— is released, which causes a number of reactions in the body: the heart beats faster and breathing quickens, increasing blood flow and oxygen to the muscles and brain. The increased oxygen to the brain sharpens the senses and makes us more alert. Epinephrine also triggers the release of sugars and fats into the bloodstream, which supply the body with the energy needed for an intense burst of physical activity.4–8 When the fight-or-flight response is triggered, other functions of the body, like digestion, are turned off.6–9 As the threat and, subsequently, the release of adrenaline subsides, the parasympathetic nervous system kicks in, returning heart and breathing rates and blood pressure to normal and channeling blood back to the digestive system and other systems in the body.7,9 Overall, the parasympathetic nervous system counteracts the alarmed sympathetic nervous system effects, preserves energy, mends the body,
and helps create a sense of calmness and safety.4–9
HOW TO STOP A PANIC ATTACK If you feel a panic attack coming on, there are things you can do to stop the triggered sympathetic nervous system response and alleviate or prevent a panic attack within minutes: The purpose of these simple actions is to send calming signals to the brain and remind it that you are not in danger. 1,2,10–17 • Acknowledge the panic attack—Acknowledging that you are experiencing a panic attack can give you a sense of control over your fears.10 • Chew gum—Research has shown that chewing suppresses stress-induced activation of the autonomic nervous system.11 • Splash cold water on your face—Research has shown that cold-water face immersion stimulates the parasympathetic system, which counteracts the stress-induced effects of the sympathetic nervous system.12 • Practice deep breathing— Research suggests that breathing triggers the brain to activate GABA neurotransmitters, which calm behavioral responses
to stress.13 Slowly inhale for five seconds, hold for two seconds, and exhale for five seconds. Repeat until calm. The number of seconds can be adjusted for your personal comfort. • Soften your eyes—The release of adrenaline during a panic attack might cause you to experience tunnel vision (a part of the fight-orflight response that allows you to hyperfocus on the threat). To counteract this, try to “soften” your gaze. Gently massage the skin around your eyes while keeping them closed. After a minute or two, open your eyes and encourage the use of your peripheral vision, making note everything around you without looking directly at it.14 • Practice grounding techniques—”Grounding” refers to the practice of distracting a person from distressful feelings by focusing on the five senses. -- Take note of your surroundings. Name five things you can see, five things you can hear, five things you can touch, five things you can taste, and five things you can smell. This can help calm and distract you from intrusive stressful thoughts. -- Take off your socks and/ or shoes and plant your
feet on the ground. This especially helps if it is cold outside. Research has shown that physical contact with the earth can relax the mind and improve mood.15,16 -- Consciously relax one muscle at a time. Start with a muscle or muscle group in which you feel the most tension or pressure, such as your chest/diaphragm, and concentrate on relaxing that muscle, then work your way through surrounding muscles.17 -- Massage tense muscles. Give yourself a forearm massage—Cross your arms, grabbing the opposite elbows, and slowly pull your hands toward your wrists. Repeat for a few minutes while practicing deep breathing.17 • Engage in light physical activity—Take a walk, go for a swim, or go on a bike ride.17 • Repeat a personal mantra—For example, repeat the words, “This too shall pass,” or “All is well. I am OK.” • Contact someone you trust and makes you feel safe—Call or text a friend or family member and just have a conversation about something...anything.
Nutrition Health Review • March–April 2021 • Volume 133
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SEEKING TREATMENT FOR PANIC ATTACKS IS IMPORTANT Individuals who experience panic attacks should not hesitate to seek professional help. Without treatment, frequent panic attacks, along with the constant feeling of uncertainty and worry over when the next attack will occur, can prompt avoidance behaviors (e.g., reluctance to leave the house, drive, and/or socialize with people), increase one’s risk of developing other debilitating mental health issues (e.g., depression, suicidal ideation), and/or increase one’s risk of abusing drugs or alcohol—all of which can substantially interfere with school, work, personal relationships, physical health, and overall quality of life.18 Evidencebased, effective treatment methods for frequent panic attacks are available. A qualified healthcare professional can work with the individual to develop a comprehensive treatment plan based on that individual’s specific needs. This treatment plan would likely include psychotherapy (e.g., cognitive behavioral therapy) with a qualified mental health therapist, medication(s) (e.g., anti-anxiety, antidepressant), and/or other evidence10
based therapies that have been shown to ease symptoms of anxiety (e.g., physical activity, good nutrition).18 SOURCES 1. Mayo Clinic site. Panic attacks and panic disorder. 4 MAY 2018. https:// www.mayoclinic.org/diseasesconditions/panic-attacks/symptomscauses/syc-20376021. Accessed 4 Apr 2021. 2. Cleveland Clinic site. Panic disorder. Updated 12 Aug 2020. https:// my.clevelandclinic.org/health/ diseases/4451-panic-disorder. Accessed 4 Apr 2021. 3. American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Press, Inc.;2013. 4. Goddard AW. The neurobiology of panic: a chronic stress disorder. Chronic Stress (Thousand Oaks). epub 10 Nov 2017;1. 5. Kim JE, Dager SR, Lyoo IK. The role of the amygdala in the pathophysiology of panic disorder: evidence from neuroimaging studies. Biol Mood Anxiety Disord. 2012;2:20. 6. Alshak MN, M Das J. Neuroanatomy, sympathetic nervous system. In: StatPearls [internet]. Treasure Island (Florida): StatPearls Publishing;2021. 7. McCorry LK. Physiology of the autonomic nervous system. Am J Pharm Educ. 2007;71(4):78. 8. Harvard Health Publishing site. Harvard Medical School. Understanding the stress response. Updated 6 Jul 2020. https://www. health.harvard.edu/staying-healthy/ understanding-the-stress-response. Accessed 14 Apr 2020. 9. British Broadcasting Corperation site. Nervous system - peripheral nervous
10.
11.
12.
13.
14.
15.
16.
17.
18.
system. https://www.bbc.co.uk/ science/humanbody/body/factfiles/ peripheralnervoussystem/peripheral_ nervous_system.shtml. Accessed 4 Apr 2021. Smith A. How can you stop a panic attack? Medical News Today site. Updated 29 Sep 2020. https:// www.medicalnewstoday.com/ articles/321510. Accessed 15 Apr 2021. Kubo KY, Iinuma M, Chen H. Mastication as a stress-coping behavior. Biomed Res Int. 2015;2015:876409. Jungmann M, Vencatachellum S, Van Ryckeghem D, Vögele C. Effects of cold stimulation on cardiac-vagal activation in healthy participants: randomized controlled trial. JMIR Form Res. 2018;2(2):e10257. Jerath R, Crawford MW, Barnes VA, Harden K. Self-regulation of breathing as a primary treatment for anxiety. Appl Psychophysiol Biofeedback. 2015;40:107–115. McAdam E. Turn off anxiety in your nervous system: four ways to turn on the parasympathetic response. [Video] 19 NOV 2020. https://www. youtube.com/watch?v=FPH5CFSmYEU. Accessed 4 Apr 2021. Chevalier G. The effect of grounding the human body on mood. Psychol Rep. 2015;116(2):534-42. Epub 2015 Mar 6. The Doctors TV site. Three ways to stop a panic attack in its tracks. 24 DEC 2018. https://www.thedoctorstv. com/articles/3-ways-to-stop-panicattack-its-tracks. Accessed 4 Apr 2021. Cutler N. Bodywork can help panic disorder. 11 Sep 2006. https://www. integrativehealthcare.org/mt/ massage-for-panic-attacks/. Accessed 4 Apr 2021. WebMD site. What are the treatments for panic attacks? Updated 20 Jun 2020. https://www.webmd.com/ anxiety-panic/guide/understandingpanic-attack-treatment. Accessed 4 Apr 2021. NHR
FAST FACT EXERCISE vs. PHYSICAL ACTIVITY According to researchers at the Cardiovascular Institute, “Physical activity is any activity that works your muscles and requires energy and can include work, household, or leisure activities. Exercise [on the other hand] is a planned, structured, and repetitive body movement done to improve or maintain physical fitness.” SOURCE: Cardiovascular Institute site. What’s the difference between physical activity and exercise. 16 APR 2020. https://www.cardio.com/blog/whatis-the-difference-between-physical-activityand-exercise. Accessed 4 APR 2021. NHR
Nutrition Health Review • March–April 2021 • Volume 133
What’s New in Nutrition Research?
NUTRITION as metabolic treatment for
A N XI E TY
I
n a “Perspectives” article by Norwitz and Naidoo, published this past February (2021) in the peerreviewed journal, Frontiers in Psychiatry,1 researchers explored published research supporting nutrition as a means to address underlying metabolic pathologies associated with mental illness—in particular, anxiety. We have summarized the article for our readers and present here what we feel are the key points of the article. Role of the gut microbiome in managing anxiety. In their article, “Nutrition as Metabolic Treatment for Anxiety,” the authors first emphasized the importance of the gut microbiome in our overall health. The gut microbiome comprises trillions of microorganisms that live in
the gastrointestinal tract forming little ecosystems that affect various bodily functions. For example, according to these researchers, gut peptides, which are chemical messengers that regulate gastrointestinal functioning, are thought to modulate anxiety by signaling the amygdala—the part of the brain that activates the fear response—to suppress the threat response once the perceived danger has passed. The release of these gut peptides is regulated by short chain fatty acids, which are produced by certain gut bacteria, and it has been shown that people with anxiety have less of this type of gut bacteria. Nutritional interventions for anxiety. In this article, the authors suggest specific
nutritional interventions that might improve symptoms of anxiety by supporting gut microbiome health. These proposed interventions are 1) avoiding artificial sweeteners, 2) avoiding gluten, 3) including omega-3 fatty acids, 4) including turmeric, 5) supplementing with vitamin D, and 6) following a ketogenic diet. The authors discuss research in support of their proposed interventions, and are careful to note any limitations the cited studies might have. Here we’ve summarized the authors’ discussion and review of these proposed interventions. 1. Avoiding artificial sweeteners. The authors describe research that has shown an association between artificial sweeteners, metabolic dysfunction, and the development of
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neuropsychiatric problems, such as anxiety; however, the authors note that research is limited to the study of aspartame alone, not other types of artificial sweeteners. The authors suggest that, based on the limited data available, stevia, a natural sugar alternative, may be less likely to cause metabolic dysfunction, but that this is not yet firmly supported by clinical studies. 2. Avoiding gluten. The authors briefly describe gluten’s potential to cause a condition known as “leaky gut,” in which the intestinal lining becomes more permeable, allowing immune-stimulating compounds from the intestine to leak into the bloodstream. This can trigger systemic inflammation and increase the risk for inflammationinduced anxiety. The authors suggest that a gluten-free diet may reduce inflammation-induced anxiety by decreasing risk of leaky gut and its associated systemic inflammation, though research supporting this theory has only been done in individuals with celiac’s disease. 12
3. Including omega-3 fatty acids in the diet. The authors reviewed beneficial properties of omega-3 fatty acids (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]), describing them as “potent anti-inflammatory signaling molecules that support the microbiome and are important in cognition
and mental health,” according to animal and human studies. Human studies have shown that omega-3 supplementation can effectively reduce anxiety, though the benefits are doseand omega-3 type-dependent. In other words, supplements containing less than 2 grams a
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day or with lower proportions of DHA were less effective in reducing anxiety, while supplements containing more than 60% EPA had no significant effect on anxiety. 4. Including turmeric in the diet. The authors note the large number of studies that have been conducted regarding the benefits of curcumin (the active component of the spice turmeric). These benefits include improving the gut microbial ecosystem, decreasing systemic inflammation, and moderating levels of dopamine, serotonin, and cortisol, to name a few. Animal and human studies have also suggested that curcumin supplementation can reduce anxiety. However, the authors are careful to point out the limitations of curcumin research, which include the wide variability in supplement purity and formulations from study to study, which make results difficult to reproduce. The chemical instability of curcumin and its ability to interfere with results of lab testing also limit the results of clinical research. Some positive studies incorporated
techniques to improve the bioavailability of curcumin and its absorption in study participants. The authors note that more research on bioavailable forms of curcumin, as well as the impact of curcumin on gut bacteria, are needed. 5. Vitamin D supplementation. The authors review the role Vitamin D plays in many neurological functions, including regulating levels of certain neurotransmitters, such as dopamine and serotonin. The authors describe research linking vitamin D deficiency to decreased production of vitamin B by gut bacteria, which can trigger an immune response in the body. Systemic inflammation is linked to anxiety, and vitamin D supplementation has been shown to reduce symptoms of anxiety. The authors note, however, that research has yet to clarify if vitamin D supplementation for anxiety is only effective in the presence of a vitamin D deficiency. 6. Ketogenic diet. Finally, the authors review available data regarding the effects of ketogenic diets (high-fat, lowcarbohydrate diets that induce the body to produce ketones) on neurological diseases and mental illness. The authors mention well-established
BREAKING IT DOWN 1. Chronic stress appears to negatively impact the immune response, resulting in systemic inflammation. 2. Systemic inflammation has been linked to anxiety. 3. The gut microbiome appears to strongly influence how we adapt to stress and how our immune system functions. 5. Diet can affect the type and number of healthy bacteria in an individual’s gut microbiome. 6. Certain nutritional interventions may enhance the gut microbiome’s ability to counteract the negative effects of the stress response in the body. evidence supporting the use of ketogenic diets to manage treatment-resistant epilepsy in children. The authors also mention more recent research touting positive effects of ketogenic diets in patients with neurological conditions, such as Parkinson’s and Alzheimer’s diseases, and in individuals with certain mental health conditions, such as ADHD, schizophrenia, or depression. The authors discuss how ketones produced by the liver can “shift the gut microbiome and improve the gut barrier function.” The authors suggest that induced ketosis may have anti-anxiety effects; however, data supporting this hypothesis are from animal studies only—no human studies examining the effects of ketogenic diets on anxiety have been done. Thus, no solid conclusion regarding
the benefits of a ketogenic diet on symptoms of anxiety can be made at this time. Editor’s notes: The authors hypothesize that specific nutrition interventions can enhance gut microbiome functioning, which in turn may improve or prevent symptoms of anxiety. Additional research is needed to confirm their hypothesis. Consult with a qualified nutritionist or healthcare professional before making sudden or big changes to your diet. Seek help from a qualified mental health professional if you suffer from anxiety. Source: Norwitz NG, Naidoo U. Nutrition for metabolic treatment for anxiety. Front Psychiatry. 2021;12:598119. Published online 2021 Feb 12. Full access to this article is available here: https:// www.ncbi.nlm.nih.gov/pmc/articles/ PMC7907178/ NHR
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Superfood Spotlight
Spinach O
riginating in central and southwestern Asia, spinach (Spinacia oleracea) is a leafy green flowering plant that grows annually and is of the Amaranthaceae family, just like beetroot and chard.1–3 Similar to its relatives, spinach has a mild, bitter, and somewhat salty taste. There are three types of spinach: savoy, semi-savoy, and smooth leaf. A spinach plant can grow up to 30 centimeters in height,3 and its leaves can be anywhere from 2 to 30 centimeters in length and 1 to 15 centimeters in width.3 Spinach was introduced to the United States by people from Spain during the eighth century.2 HIGH FIBER CONTENT
Spinach contains high amounts of insoluble fiber. Increased intake of fiber has 14
been correlated to lowered recurrence of colon polyps and an overall reduced incidence of colon cancer.4–7 Fiber stimulates butyrogenic activity in the gut microbiome, which has antineoplastic properties, protecting the colon from tumor development.4–7 The insoluble fiber found in spinach provides the gut microbiome with an energy source while helping to keep things moving along efficiently in the gastrointestinal track. Fiber is particularly beneficial to those who suffer from constipation; irregular bowel movements allow prolonged contact between carcinogens in the stools and the gut wall.6,7 Fiber helps regulate blood sugar, aids in digestion, and has anti-inflammatory properties.4–7 Lower levels of tumor necrosis factor-alpha (TNF-a) and interleukin-6
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(IL-6), pro-inflammatory immunity cells (cytokines) that signal immune/ inflammatory responses, have been reported in those who maintain a higher intake of fiber.5–8 LOADED WITH ANTIOXIDANTS
The abundance of vitamin C, kaempferol, and quercetin in spinach combats oxidative stress that can occur throughout the body in reaction to lifestyle factors such as poor diet or smoking, metabolic diseases such as obesity, and/or environmental factors such as air or water pollutants.8,9 Oxidative stress can damage cells and tissue and trigger chronic systemic inflammation in the body, which in turn can promote the development of other chronic conditions, such as lung disease, diabetes, and cancer.10–12 The antioxidants
in spinach can counteract the effects of oxidative stress.12 Vitamin C also plays a significant role in optimizing tissue and cell construction and iron absorption, destroying harmful pathogens, and boosting overall immune health.12
The monogalactosyl diacylglycerol and sulfoquinovosyl diacylglycerol components found in spinach can prevent cancer/ tumor growth or slow its progression, according to data from clinical trials.13,14 Researchers have identified a positive association between increased spinach intake and reduced occurrence of prostate and breast cancers.13,14
can boost their functions, including protection from sun damage and prevention of macular degeneration and cataracts.16,17 Moreover, higher intakes of spinach have even been reported to reverse pre-existing sun damage.15 Making a habit of integrating spinach into your meals can enhance overall heart health.3 Spinach is a good source of nitrates, which moderate blood pressure and can decrease heart disease risk.1–4 Spinach is also a good source of calcium, which influences the muscle walls of the heart (vascular contraction and vasodilation).18 Calcium is also responsible for the transmission of nerves, cellular signaling, and hormone secretion.18
IMPROVES AND MAINTAINS
BENEFITS COGNITIVE AND
EYE AND HEART HEALTH
MUSCULAR FUNCTIONING
The plant pigments lutein and zeaxanthin, which provide many vegetables with their red, orange, or yellow color, have been linked to better eye health.15 Leafy green vegetables, such as spinach, are good sources of these pigments. These pigments are already located in human eyes, and consuming more spinach
Spinach contains Vitamin K1 and folate, which are important nutrients for brain health. Vitamin K1 ensures the brain has enough calcium, exhibits anti-inflammatory effects, and improves cognitive performance. Folate is vital for fetal brain development and continues to play an important role in cognitive
CONTAINS CANCERPREVENTING COMPOUNDS
Green Monster Smoothie Don’t be scared of the Green Monster! The mild, sweet taste of the banana cancels out the taste of the spinach. This creamy, delicious smoothie is cholesterol free, low in calories and fat, and is loaded with protein, fiber, vitamin A, vitamin C, potassium, iron, and folate. See? Not scary at all! PREP TIME: 10 minutes; SERVES: 1 INGREDIENTS
• 1 cup of unsweetened almond milk • 2 larges handfuls of spinach • 1 tbsp of flax seeds, ground • 3 ice cubes • 1 banana, chopped TIP: Use frozen bananas for a smoother, creamier consistency. DIRECTIONS
1. Toss everything into a blender or food processor. 2.Blend until desired consistency. 3.Enjoy! NUTRITION INFORMATION Serving: 1; Calories: 136; Protein: 6g; Carbohydrates: 23g; Fiber: 5g; Fat: 1.4g; Potassium: 400mg; Vitamin A: 9150IU; Vitamin C: 155.6mg; Calcium: 30mg; Iron: 2.8mg; Folate: 58 micrograms NHR
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functioning throughout life.19,20 Folate deficiency can lead to cognitive dysfunction and has been linked to Alzheimer’s disease, depression, and even epilepsy.20 Spinach is also an excellent source of iron. Iron is an essential mineral due to its role in the oxygen delivery process and regulation of many biochemical reactions throughout the body.21 Iron deficiency can lead to anemia, muscular problems, fatigue, high blood pressure, mental disorders, and osteoporosis.21 SPINACH AND WORKOUTS26
Did you know the nitrates in spinach can help increase the effectiveness of your muscles during physical activity? Findings from a study published in Cell Press indicated that participants who were given a small dose of inorganic nitrate (the amount found in a few handfuls of spinach) over the course of three days required less oxygen while working out on an exercise bike. Consuming less oxygen while working out improves overall workout performance, researchers surmised. And, with the assistance of
16
“good” oral bacteria, dietary nitrites create nitric oxide in our bodies, a molecule that opens up blood vessels, which can lower blood pressure, allow more blood to be sent to muscles and tissue, and combat inflammation.27 EASILY PREPARED AND ADAPTABLE
Spinach is commonly purchased fresh (raw) or cooked (e.g., canned, frozen). Typically, fresh spinach is sold loosely or bunched in bags or containers and has a shelf life of approximately eight days. However, purchasing frozen or canned spinach can increase its shelf life and preserve its folate and carotenoid content.22 There are numerous preparation methods for this hearty vegetable, including chopped (raw), steamed, sautéed, or blanched. Spinach can be added to soups, dips, burritos, and pasta dishes, or just function as a side dish. Often, fresh spinach serves as the foundation for a variety of salad and smoothie combinations. Plus, given its mild flavor, spinach effortlessly harmonizes with other reagents.
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Editor’s Note: Due to
high levels of calcium and oxalates, increased spinach intake could lead to the development of kidney stones, especially in those who are prone to the condition.23,24 The vitamin K1 in spinach might also impede blood-thinning medication.25 Consult with your healthcare provider prior to adding more spinach to your diet. SOURCES 1. Lewin J. Top 5 health benefits of spinach. Updated 17 FEB 2021. https://www.bbcgoodfood.com/ howto/guide/ingredient-focusspinach. Accessed 4 APR 2021. 2. New World Encyclopedia site. Spinach. https://www. newworldencyclopedia.org/ entry/Spinach. Accessed 4 APR 2021. 3. Encyclopedia Britannica site. Spinach. Updated 6 NOV 2020. https://www.britannica.com/ plant/spinach. Accessed 4 APR 2021. 4. Pahwa R, Singh A, Jialal I. Chronic inflammation. In: StatPearls [Internet]. Treasure Island (Florida): StatPearls Publishing; 2020. 5. Mayo Clinic site. Nutrition and healthy eating. https://www. mayoclinic.org/healthy-lifestyle/ nutrition-and-healthy-eating/ in-depth/high-fiber-foods/art20050948. Accessed 4 APR 2021. 6. Kojima M, Wakai K, Tokudome S, et al. Bowel movement frequency and risk of colorectal cancer in a large cohort study of Japanese men and women. Br J Cancer. 2004;90(7):1397–1401. 7. Harvard Health Publishing site. Surprising sources of dietary fiber. DEC 2020. https://www. health.harvard.edu/stayinghealthy/surprising-sources-ofdietary-fiber. Accessed 4 APR 2021. 8. Ocvirk S, Wilson AS, Appolonia
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CN, et al. Fiber, fat, and colorectal cancer: new insight into modifiable dietary risk factors. Curr Gastroenterol Rep. 2019 Dec 2;21(11):62. Valko M, Leibfritz D, Moncol J, et al. Free radicals and antioxidants in normal physiological functions and human disease. Int J Biochem Cell Biol. 2007;39(1):44–84. Aruoma OI. Free radicals, oxidative stress, and antioxidants in human health and disease. JAOCS. 1998(75):1–14. Maeda N, Hada T, Yoshida H, Mizushina Y. Inhibitory effect on replicative DNA polymerases, human cancer cell proliferation, and in vivo anti-tumor activity by glycolipids from spinach. Curr Med Chem. 2007;14(9):955–967. Kirsh VA, Peters U, Mayne ST,et al. Prostate, lung, colorectal and ovarian cancer screening trial. Prospective study of fruit and vegetable intake and risk of prostate cancer. J Natl Cancer Inst. 2007 Aug 1;99(15):1200–1209. Longnecker MP, Newcomb PA, Mittendorf R, et al. Intake of carrots, spinach, and supplements containing vitamin A in relation to risk of breast cancer. Cancer Epidemiol Biomarkers Prev. 1997 Nov;6(11):887–892. Maeda N, Yoshida H, Mizushina Y. Spinach and health: anticancer effect. In: Watson RR, Preedy VR (eds.) Bioactive Foods in Promoting Health. Cambridge Massachusetts): Academic Press; 2010:393–405. Roberts RL, Green J, Lewis B. Lutein and zeaxanthin in eye and skin health. Clin Dermatol. 2009 MarApr;27(2):195–201. Liu R, Wang T, Zhang B, et al. Lutein and zeaxanthin supplementation and association with visual function in age-related macular degeneration. Invest Ophthalmol Vis Sci. 2014 Dec 16;56(1):252–258. Vu HT, Robman L, Hodge A, et al. Lutein and zeaxanthin and the risk of cataract: the Melbourne Visual Impairment Project. Invest Ophthalmol Vis Sci. 2006 Sep;47(9):3783–3786. National Institutes of Health site. Calcium. https://ods. od.nih.gov/factsheets/CalciumHealthProfessional/. Accessed 4 APR 2021.
Peachy Oat Smoothie
PREP TIME: 10 minutes; COOK TIME: 20 minutes; SERVES: 2
INGREDIENTS
2 pitted peaches 1 tbsp of chia seeds ¼ cup of rolled oats ½ frozen banana, peeled ¼ cup of orange juice ½ cup of almond milk (or a plant-based milk of your choice) 1 tbsp of agave or maple syrup DIRECTIONS
1. Place all the ingredients in a blender and let sit for 10 to 15 minutes (to let chia seeds and oats oak). 2. Blend everything until reaching a smoothie consistency. Add more banana for a thicker result; add more milk or water for a thinner result. 3. Taste and adjust accordingly. NUTRITION INFORMATION
Serving Size: 1; Calories: 142; Protein: 4g; Carbohydrates: 28g; Fiber: 5g; Total Fat: 3g; Sodium: 46mg; Sugar: 14g NHR 19. Alisi L, Cao R, De Angelis C, et
20. 21.
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al. The relationships between vitamin K and cognition: a review of current evidence. Front Neurol. 2019;10:239. Reynolds EH. Folic acid, ageing, depression, and dementia. BMJ. 2002;324(7352):1512–1515. National Institutes of Health site. Iron. https://ods.od.nih. gov/factsheets/Iron-Consumer/. Accessed 4 Apr 2021. Science Daily site. Storage time and temperature affects nutrients in spinach. 23 MAR 2005. https://www.sciencedaily.com/ releases/2005/03/050323124809. htm. Accessed 4 APR 2021. Marsh BM, Sathianathen N, Tejpaul R, et al. Public perceptions on the Influence of diet and kidney stone formation. J Endourol. 2019 May;33(5):423–429. Nutrition Facts site. Kidney stones.
https://nutritionfacts.org/topics/ kidney-stones/. Accessed 4 APR 2021. 25. Chang CH, Wang YW, Yeh Liu PY, Kao Yang YH. A practical approach to minimize the interaction of dietary vitamin K with warfarin. J Clin Pharm Ther. 2014 Feb;39(1):56–60. 26. Eurekalert! Site. Want more efficient muscles? eat your spinach. 11 FEB 2011. https:// www.eurekalert.org/pub_ releases/2011-02/cp-wme012611. php. Accessed 4 APR 2021. 27. Whitworth G. Is vasodilation good? 2 NOV 2018. https:// www.healthline.com/health/ vasodilation. Accessed 4 APR 2021. NHR
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Matcha Madness Does this special green tea measure up to all its health hype?
K
nown for being high in antioxidants, green tea has long been considered part of a healthy diet. Recently, however, a form of green tea—matcha—has surged in popularity among tea drinkers and healthy lifestyle enthusiasts, though it has been around for hundreds of years.1 Matcha is a versatile powdered form of green tea that can be prepared as a hot beverage on its own or mixed into other hot drinks, such as lattes. It can also be added to iced drinks and smoothies or even sprinkled on top of granola or cereal. As for health benefits, let’s take a closer look. WHAT IS MATCHA?
First, what exactly IS matcha? The practice of preparing and drinking 18
powdered green tea was first formed into a ritual by Chan Zen Buddhist monks in China nearly 1,000 years ago. After studying with monks in China, a Japanese Buddhist monk named Eisai returned to Japan in the year 1191, bringing Zen Buddhism and the matcha tea ritual with him. From that point, matcha became a traditional part of the Japanese tea ceremony.2 Like other green teas, matcha is derived from the unfermented leaves of the Camellia sinensis plant; however, it is grown and harvested a bit differently.3 Several weeks before harvest, matcha farmers begin covering their tea plants to limit exposure to direct sunlight. This increases chlorophyll production, boosts the amino acid content, and
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gives the leaves their dark green hue.4 The young tea leaves are then picked, laid out to dry, deveined and destemmed, and ground into a bright green powder called matcha.1 BENEFITS OF MATCHA
While there is an abundance of literature supporting the health benefits of green tea, peer-reviewed, clinical research specifically on the health benefits of matcha is relatively scarce. However, because matcha is a type of green tea, it potentially offers similiar health benefits. Let’s review the benefits of green tea. Antioxidants. Green teas are high in antioxidants, which have been shown to counteract the negative effects of free radicals,
unstable moleciules in our bodies that result from exposure to environmental or lifestyle stressors (e.g., smoking, consuming a highly processed diet, pollution).6 Antioxidants help protect the cells under attack by free radicals. Oxidative stress. Free radicals are unstable oxygencontaining molecules with an uneven number of electrons. Antioxidants are molecules that can donate electrons to free radical molecules to neutralize them. When there is an imbalance between free radicals and antioxidants in your body, oxidative stress can occur.5,6 Prolonged oxidative stress damages cells, which can lead to negative health outcomes, such as heart disease, certain types of cancer, and neurodegenerative diseases. Antioxidants, which are abundant in green tea, can prevent oxidative stress. Matcha also contains antioxidants, and thus may be similarly effective in fighting the damage caused by oxidative stress.1 Liver health. The liver does many things, such as regulate blood sugar, filter toxins from the blood, and break down and store fat. The liver also produces HDL cholesterol (the “good” kind) and helps our
bodies clear LDL cholesterol (the “bad” kind). Green tea contains catechin, a chemical that has been shown to help reduce LDL cholesterol. Catechin is thought to assist the liver in clearing LDL cholesterol from the blood by inhibiting cholesterol synthesis and absorption.5 A metaanalysis of 15 studies showed a significant protective effect of green tea on the liver, indicating that regular consumption lowered the risk of liver cancer, fatty liver disease, hepatitis, and liver cirrhosis.7,8 Obesity and diabetes. Various studies have shown beneficial effects of green tea on cardiovascular diseases, obesity, and Type 2 diabetes. One randomized clinical trial reported that participants who drank four cups of green tea daily experienced a reduction in several risk factors for diabetes, including high body mass index (BMI) and systolic blood pressure.9 Some research suggests that the catechins in green tea, especially when combined with caffeine, are beneficial in managing weight (by speeding up the metabolism and regulating the endocrine system), food intake, and lipid and carbohydrate
metabolism.5,10,11 Green tea, and matcha especially, packs a heavy punch in terms of caffeine. In fact, just one gram (or roughly half a teaspoon) of matcha has 35mg caffeine.4 Cognitive function. Multiple studies have linked caffeine consumption to improved mood, reaction times, and memory. In a recent, very small intervention study, researchers assessed the effects of matcha consumption on mood and cognitive performance. Participants who consumed matcha in beverage or nutrition bar form showed “...significant improvements in tasks measuring basic attention abilities and psychomotor speed in response to stimuli over a defined period of time,” compared to participants who consumed placebo products.
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However, no effects on mood were observed.12 THE BOTTOM LINE Research supports a variety of health benefits associated with green tea consumption, ranging from reducing risks for metabolic disorders, such as Type 2 diabetes and obesity, to certain chronic diseases, such as cardiovascular and liver diseases. However, many of these studies specifically assessed green tea, not matcha. Though matcha is made from the same green tea leaves and contains the same compounds as green tea in dried leaf form, there are differences in how the tea used to make matcha is grown, harvested, and processed, which may or may not affect how our bodies react to matcha vs. green tea. Additional research is needed to confirm whether matcha
confers the same benefits as green tea. Editor’s note. While matcha is considered to be generally safe, it is more concentrated than regular green tea and contains a lot of caffeine, so moderation is key. The caffeine in matcha may cause unpleasant side effects, such as headache, insomnia, irratability, stomach upset, and/or diarrhea/constipation in sensitive individuals. Consult with your physician or a qualified nutritionist to see if matcha consumption is right for you or your family, especially for those who are sensitive to caffeine, are pregnant, or are very young. SOURCES 1. MarketWatch website. At 7.5% CAGR, North America Matcha Market to be worth more than $1 Billion by 2026. 21 Mar 2021. https://www.marketwatch.com/ press-release/at-75-cagr-northamerica-matcha-market-tobe-worth-more-than-1-billion-
2.
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by-2026-2021-03-22. Accessed 24 Mar 2021. Sifferlin A. Should you drink matcha tea? 8 Mar 2018. TIME Magazine website. https://time.com/5188377/ matcha-tea-benefits/. Accessed 24 Mar 2021. Pure Leaf website. Matcha 101: introduction to matcha. https:// www.pureleaf.com/us/matcha-101introduction-to-matcha. Accessed 25 Mar 2021. Link R. 7 proven ways matcha tea improves your health. 24 Feb 2020. Healthline website. https:// www.healthline.com/nutrition/7benefits-of-matcha-tea. Accessed 25 Mar 2021. Chacko SM, Thambi PT, Kuttan R, Nishigaki I. Beneficial effects of green tea: a literature review. Chin Med. 2010;5:13. EatRight site. Antioxidants— protecting healthy cells. 25 Mar 2021. https://www.eatright.org/ food/vitamins-and-supplements/ types-of-vitamins-and-nutrients/ antioxidants-protecting-healthycells. Accessed 25 Mar 2021. Yin X, Yang J, Li T, et al. The effect of green tea intake on risk of liver disease: a meta analysis. Int J Clin Exp Med. 2015;8(6):8339-8346. Sakata R, Nakamura T, et al. Green tea with high-density catechins improves liver function and fat infiltration in non-alcoholic fatty liver disease (NAFLD) patients: a double-blind placebocontrolled study. Int J Mol Med. 2013;32(5):989-994. Mousavi A, Vafa M, et al. The effects of green tea consumption on metabolic and anthropometric indices in patients with Type 2 diabetes. J Res Med Sci. 2013;18(12):1080-1086. Ahmad, RS Butt MS, Sultan MT, et al. Preventive role of green tea catechins from obesity and related disorders especially hypercholesterolemia and hyperglycemia. J Translation Med. Hursel R, Viechtbauer W, Westerterp-Plantenga MS. The effects of green tea on weight loss and weight maintenance: a meta-analysis. Int J Obes (Lond). 2009;33(9):956-961 Dietz C, Dekker M, PiquerasFiszman B. An intervention study on the effect of matcha tea, in drink and snack bar formats, on mood and cognitive performance. Int Food Res J. 2017;99(1)72-83. NHR
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Nutrition Health Review • March–April 2021 • Volume 133
Cocoa Matcha Bars
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With 11 grams of protein and 6 grams of fiber, this delicious matcha tea sports bar is an easy and delicious way to replenish your body after a workout.
PREP TIME: 20 minutes; COOK TIME: 4 hours; SERVES: 4 CRUST INGREDIENTS ½ cup of roasted hazelnuts ¾ cup of raisins Pinch of salt FILLING INGREDIENTS 1 tsp of matcha powder ½ cup of almond milk 1 cup of raw cashews 2 tbsp of maple syrup 2 tbsp of lemon juice 1/24 cup of cocoa nibs Optional: dark chocolate chips DIRECTIONS 1. Line a cake pan or container with parchment paper. 2. Add all of the crust ingredients into a blender/food processor and blend until mixture is sticky (and close to dough-like). 3. Spread the crust mixture on the bottom of the pan/ container and place in freezer.
4. Using a blender/food processor, blend all the filling ingredients together, minus the cocoa nibs. 5. When consistency is smooth, slowly mix in the cocoa nibs with a spoon. 6. Remove the pan/ container from the freezer. Pour the filling mixture over the crust. 7. Melt some dark chocolate chips and drizzle over filling (optional). 8. Refrigerate for at least 4 hours (or overnight for best results). 9. Cut into bars and enjoy!
(US only. No international.) $18/1 year; $32/2 years—Mailed 6 times/year Please complete this form and submit, along with payment, via fax (if paying by credit card) or mail (if paying by check) to: Matrix Medical Communications 1595 Paoli Pike, Suite 201, West Chester, PA 19380 Fax 484-266-0726. Checks payable to Vegetus Foundation OR subscribe online! Visit https://tinyurl.com/y8q72dw5 to subscribe via our secure online order form. Questions? Email us at vegetusfoundation@ matrixmedcom.com First Name Last Name Mailing Address City State Phone Email (optional, to receive NHR online) Credit Card # Exp Date
NUTRITION INFORMATION Serving Size: 1 bar;
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1 yr, $18.00
2 yrs, $32.00
Calories: 565; Protein: 11g;
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Carbohydrates: 55g; Fiber: 6g;
OPTIONAL QUESTIONS:
Fat: 39g; Sodium: 44mg
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Nutrition Health Review • March–April 2021 • Volume 133 21
Know Your Nutrient
Potassium P
otassium is an electrolyte, and is one of the body’s seven essential microminerals.1,2 While the body only needs trace amounts of it, a proper potassium balance is crucial to maintaining good health. RECOMMENDED INTAKE The amount of potassium you need each day depends on your age and sex.3 The recently updated guidelines issued by the National Academies of Sciences, Engineering, and Medicine recommend that adult men should consume 3,400mg of potassium daily and women should consume 2,600mg daily.4 BENEFITS Among its many functions in our body, potassium helps maintain normal blood pressure by limiting the effects of sodium, helps muscles contract, and helps maintain
22
our body’s balance of fluids.4 Potassium may also reduce the risk of recurrent kidney stones. Blood pressure. Chronic high blood pressure increases risk of death by cardiovascular disease. High levels of dietary potassium have been linked to decreased risk for stroke and coronary heart disease.5 According to the American Heart Association, potassium helps regulate the amount of sodium in the body. The more potassium you eat, the more sodium you lose through urine.6 Potassium can also help lessen tension in your blood vessel walls, which helps further lower blood pressure.6 Nerve Impulses. As an electroyte, potassium is essential for nerve impulses in the body.7 Like other electrolytes, when potassium is exposed to water, it dissolves into positive ions, which can conduct electricity.
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Sodium is also an electrolyte that dissolves into positive ions, and works synergistically with potassium to create nerve impulses. As potassium ions move out of cells, sodium ions move into cells. This pump-like movement causes an electrical charge in the cells, which activates nerve impulses. These nerve impulses are what regulate muscle contractions in the body, including our heartbeat, as well as a number of other functions.7 Fluid and mineral balance. The water in your body is a combination of intracellular fluid (ICF) (the water inside cells) and extracellular fluid (ECF) (the water outside cells [e.g., blood, spinal fluid]). ICF levels are regulated by potassium, while ECF levels are regulated by sodium. Together these two electrolytes help maintain the proper balance of water throughout the body.7–12 If
the ratio of potassium to sodium is out of whack, the water from the side with fewer electrolytes will be drawn to the side with more electrolytes, which can cause cells to either shrink as water leaves them or to swell and burst as water moves into them. This can cause cell damage, dehydration, and hypo- or hyperglycemia.7–12 Preventing kidney stones. Chronic dehydration is a major risk factor for developing kidney stones.7 Without proper hydration, hardened mineral deposits can form in the kidneys (i.e., kidney stones). Calcium stones are the most common type of kidney stone, and research has shown that higher potassium intake, along with proper hydration, can decrease the amount of calcium released in the urine, thus reducing the risk of calcium stone formatoin in the kidneys.10 It’s important to note, however, that kidney stones can be caused by a number of factors, and increased potassium intake (along with proper hydration) is only one of a number of potential preventative measures. If you suffer from kidney stones, it is important to consult with a urologist to determine the best treatment plan for you.
FOOD SOURCES A variety of foods can help you meet your daily potassium needs, and most people get enough by eating a wellbalanced diet. Here are some of the best sources of potassium: • Vegetables: acorn squash, potatoes, spinach, tomatoes, broccoli, mushrooms1,2,5 • Fruits: bananas, dried apricots, raisins, prunes, citrus, avocadoes, cantaloupe, and honeydew1,5 • Dairy: 1% milk, low fat yogurt5 • Meat: lean beef, chicken, turkey, tuna, halibut, wild salmon1,5 • Other: molasses, bran products, granola, peanut butter, nuts and seeds5,6
SOURCES
1. United States Office of Dietary Supplements (ODS). Potassium: fact sheet for consumers. Updated 11 July 2019. National Institutes of Health website. https://ods.od.nih.gov/ factsheets/Potassium-Consumer/. Accessed 24 Feb 2021.
2. US National Library of Medicine. Potassium. Updated 4 Dec 2020. Medline Plus site. https://medlineplus.gov/potassium. html#summary. Accessed 24 Feb 2021.
3. Cogswell M, Zhang Z, Carriquiry A, et al. Sodium and potassium intakes among US adults: NHANES 2003–2008. Am J Clin Nutr. 2012;96(3):647-657.
4. Klemm S. What Is potassium? Updated 2 March 2021. Academy of Nutrition and Dietetics website. https://www.eatright.org/ food/vitamins-and-supplements/types-ofvitamins-and-nutrients/what-is-potassium. Accessed 4 March 2021.
5. Staruschenko, A. Beneficial effects of high potassium. Hypertension. 2018;71(6): 1015–1022.
6. American Heart Association website. How potassium can help control high blood pressure. Updated 31 Oct 2016. https://www.heart.org/en/health-topics/ high-blood-pressure/changes-you-canmake-to-manage-high-blood-pressure/ how-potassium-can-help-control-highblood-pressure. Accessed 25 Feb 2021.
7. Ramen R. What does potassium do for your body? a detailed review. 9 Sep 2017. https://www.healthline.com/nutrition/whatdoes-potassium-do#TOC_TITLE_HDR_4. Accessed 15 Apr 2021.
BOTTOM LINE Potassium serves critical functions in our bodies. It helps maintain normal blood pressure, regulates muscle contractions, including our heart beat, and helps maintain fluid balance in body. To ensure you are receiving the daily recommended amount of potassium in your diet, eat a wide variety of fruits, vegetables, nuts, and seeds. Lean meat and fish also contain potassium.
8. Daniels MC, Popkin BM. Impact of water intake on energy intake and weight status: a systematic review. Nutr Rev. 2010;68(9):505–521.
9. Roumelioti ME, Glew RH, Khitan ZJ, et al. Fluid balance concepts in medicine: principles and practice. World J Nephrol. 2018;7(1):1–28.
10. Loughlin KR. What causes kidney stones (and what to do). 17 May 2019. Harvard Health Publishing. Harvard Medical School website. https://www.health.harvard.edu/ blog/what-causes-kidney-stones-andwhat-to-do-2019051716656. Accessed 25 Feb 2021.
11. Kowey P. The role of potassium. In: Lobo RA, Crosignani PG, Paoletti R, Bruschi F (eds). Women’s Health and Menopause. Boston, MA: Springer; 2002:151-152.
12. US National Library of Medicine. Fluid and electrolyte balance. Medline Plus site. https://medlineplus.gov/ fluidandelectrolytebalance.html. Accessed 8 Mar 2021.
NHR
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