M19. Melhorando sua libido depois da Bari - AULA 4. ANSIEDADE E INSÔNIA DEPOIS DA BARI

Introduction to the Session

Opening Remarks

• The session begins with a warm welcome and an invitation for participants to engage in the chat.

• The host mentions that the class will be recorded for later viewing, encouraging participation from attendees.

Guest Introduction

• Renan, a nutritionist specializing in mental health and nutrition, is introduced as the guest speaker.

• The host emphasizes that this session will focus on sleep and anxiety, inviting questions throughout the discussion.

Renan's Background and Expertise

Professional Journey

• Renan shares his academic background, including scientific initiation, master's degree, and doctorate in nutrition.

• He discusses his shift towards focusing on mood disorders such as depression and anxiety after working with Dr. Ítalo Marcili.

Clinical Focus

• Renan highlights his clinical work with patients experiencing anxiety, panic attacks, insomnia, fatigue, and irritability.

• He notes a significant concern regarding bariatric patients who often face these issues without proper nutritional assessment.

Nutritional Deficiencies in Bariatric Patients

Common Issues

• Many bariatric patients report symptoms of anxiety and depression but may not receive adequate evaluation from psychiatrists regarding their nutritional status.

• Renan points out that deficiencies in vitamins and minerals can exacerbate mental health issues among these patients.

Focus on Magnesium

• The discussion shifts to magnesium deficiency; bariatric surgery often leads to reduced intake of magnesium-rich foods.

• Unlike vitamin D levels which are easily measured through blood tests, magnesium levels do not accurately reflect overall nutritional status due to its cellular presence.

Symptoms of Magnesium Deficiency

Impact on Mental Health

• Symptoms associated with magnesium deficiency include hyperexcitability of the central nervous system leading to agitation and increased anxiety levels.

Understanding Magnesium in Nutrition

The Importance of Food Composition

• The nutritional value of food is assumed to be consistent with what is listed in nutritional tables, which is a foundational principle in nutrition science.

• Variability exists in the magnesium content of foods based on factors like soil quality and growing conditions, making it difficult to rely solely on standard nutritional data.

Challenges with Magnesium Deficiency

• There is uncertainty regarding whether patients are truly deficient in magnesium based on blood tests; newer tests like erythrocyte magnesium levels are being explored for better accuracy.

• Symptoms such as insomnia, anxiety, and depression can be linked to magnesium deficiency, highlighting its significant impact on mental health.

Supplementation vs. Dietary Intake

• Increasing dietary intake of magnesium can be challenging; often supplementation is necessary to address deficiencies effectively. Simply increasing food intake may not suffice due to potential imbalances created by altering nutrient levels.

• A proactive approach involves prescribing magnesium supplements universally since they generally have no adverse effects when taken at appropriate doses.

Safe Supplementation Practices

• Proper dosing is crucial; excessive amounts can lead to serious side effects such as diarrhea or even heart issues, emphasizing the need for careful management of supplementation practices.

• It’s important to clarify that "supplementation" does not mean providing large quantities but rather ensuring minimum daily intake (around 300 mg) through supplements when dietary sources may fall short.

Understanding Elemental Magnesium

• When selecting supplements, it's essential to focus on elemental magnesium content rather than total weight, as different forms contain varying amounts of actual magnesium. This ensures accurate dosing and avoids manipulation errors by manufacturers.

Discussion on Magnesium and Zinc Supplementation

Magnesium Types and Their Efficacy

• The speaker discusses bisglycinate magnesium, noting its chelated form and mentions a specific product with 350 mg of magnesium.

• Emphasizes that magnesium malate is readily available in pre-made forms, suggesting it’s effective without needing to spend excessively on supplements.

• Mentions the use of magnesium chloride for those with financial constraints; while not the best absorption method, it can still be beneficial for sleep issues.

• Highlights rapid improvements in sleep quality when supplementing with magnesium chloride, particularly for elderly patients who find it easy to incorporate into their routine.

• Clarifies that milk of magnesia is different from other forms of magnesium; expresses preference for dimalate and chelated forms.

Importance of Zinc in Mental Health

• Introduces zinc as another crucial mineral related to anxiety, especially relevant for bariatric patients who may have deficiencies due to low protein intake.

• Discusses the relationship between zinc and neurotransmitters like glutamate (excitatory) and GABA (inhibitory), emphasizing the need for balance in mental health.

• Explains how insufficient zinc affects neurotransmitter function, leading to potential issues with mood regulation and anxiety levels.

• Notes that zinc deficiency can lead to depression by impairing glutamate's ability to activate its receptors effectively.

• Stresses the importance of maintaining equilibrium between excitatory and inhibitory neurotransmitters for overall mental well-being.

Addressing Zinc Supplementation Challenges

• Discusses common issues faced by patients taking zinc supplements, such as gastrointestinal discomfort or nausea from high doses.

• Suggests two solutions: reducing the dose or using enteric-coated capsules that dissolve in the intestines rather than the stomach.

Discussion on Magnesium and Zinc Supplementation

Magnesium Absorption Timing

• The speaker mentions a preference for taking magnesium supplements post-meal, suggesting that this timing may enhance absorption compared to taking it on an empty stomach.

Zinc Levels and Testing

• The conversation shifts to zinc levels in the body, noting that blood tests are not the best indicators of overall zinc status. A target level of around 90-100 is recommended for optimal health.

Zinc and Copper Interaction

• An important point is made about zinc competing with copper in the body; excessive zinc can hinder copper's effectiveness, which is crucial for neurotransmitter production.

Recommended Dosage Guidelines

• For zinc supplementation, a guideline of no more than 30 mg per day is suggested. If exceeding this amount, copper should be supplemented alongside it to prevent imbalances.

Effects of High Zinc Intake

• The speaker warns against high doses of zinc (e.g., 50 mg), especially during COVID-related treatments, as they can lead to toxicity and require careful monitoring through blood tests.

Mental Health: Anxiety and Depression

Impact of Zinc on Mood Disorders

• It’s noted that zinc plays a significant role in mood regulation, influencing symptoms related to depression and premenstrual syndrome (PMS).

Introduction to Phytotherapy

• The discussion introduces phytotherapy as a treatment option for anxiety, explaining that these are plant-derived compounds used therapeutically.

Benzodiazepines Overview

• Benzodiazepines like Rivotril and Diazepam are discussed as common pharmacological treatments for anxiety. They work by enhancing GABA receptor activity to promote calmness.

Personal Experiences with Anxiety Medication

• A personal anecdote highlights the sedative effects of benzodiazepines during panic attacks but emphasizes their use should be temporary rather than long-term solutions.

Treatment Approach Post-Crisis

Understanding Anxiety Treatment and Alternatives

The Limitations of Conventional Medications

• Traditional anxiety medications, such as Rivotril, often lead to tolerance, requiring higher doses over time for the same effect.

• Discontinuing these medications necessitates a tapering process due to dependency issues; abrupt cessation can lead to withdrawal symptoms.

• Users may experience poor quality sleep, cognitive impairment, and memory loss as side effects of long-term use of these medications.

Exploring Herbal Alternatives

Passiflora (Maracujina)

• Passiflora is highlighted as a herbal alternative that acts similarly to benzodiazepines but with fewer side effects.

• A study comparing Passiflora with benzodiazepines showed both groups had similar improvements in generalized anxiety disorder (GAD), but the herbal group experienced less impact on work performance.

Efficacy and Side Effects

• While benzodiazepine users improved more quickly, they faced significant side effects like sedation and cognitive decline compared to those using Passiflora.

• The conclusion drawn is that while traditional medication may offer faster relief, herbal alternatives like Passiflora provide comparable benefits with reduced adverse effects.

Dosage Considerations

Individual Tolerance

• Dosage adjustments are crucial; some individuals may require higher amounts of Passiflora for effective results without excessive sedation.

Other Herbal Options

• Melissa officinalis (lemon balm) is introduced as another effective sedative herb used for sleep improvement.

• The speaker emphasizes the importance of understanding individual responses to different herbs when treating anxiety or sleep disorders.

Clarifying Herbal Names

Common Confusions

• There’s confusion regarding names like "capim limão" and "erva cidreira," which refer to different plants in various regions.

• It’s suggested that searching for "Melissa" might simplify finding the correct herbal remedy.

Practical Applications in Treatment

Usage Recommendations

Herbal Remedies for Anxiety and Sleep

Overview of Herbal Options

• Discussion begins with lower doses of herbal remedies, noting that some may have less sedative effects. The speaker mentions a specific herb called "cava-cava" as the least sedative among three options.

Cava-Cava: Historical and Cultural Context

• Cava-cava is introduced as an herb from the South Pacific, historically used by indigenous tribes for relaxation, akin to alcohol consumption in modern contexts.

Mechanism of Action

• The speaker explains that cava-cava acts on GABA neurotransmitters and also appears to modulate dopamine and serotonin levels, indicating its multifaceted impact on mood.

Research Insights on Cognitive Effects

• Comparison of cava-cava's effects with other herbal remedies shows it may enhance cognitive performance while others like melissa can impair it during cognitive tests.

Practical Applications in Treatment

• Studies indicate that cava-cava can assist individuals tapering off benzodiazepines, providing a smoother transition without significant sedation or cognitive impairment.

Alternative Herbal Remedies

Other Herbal Options Discussed

• The speaker lists additional herbs such as valeriana and mulungu but emphasizes their personal preference for the previously mentioned remedies due to familiarity and effectiveness.

Mulungu: Usage Guidelines

• Mulungu is described as highly sedative; recommendations suggest avoiding use before 6 PM due to its strong effects on motor relaxation.

Preparation Methods for Mulungu

• Instructions are provided for preparing mulungu tea, emphasizing proper steeping time to extract beneficial compounds effectively.

The Role of Melatonin in Sleep Regulation

Importance of Melatonin

• Transitioning into sleep discussions, melatonin is highlighted as a crucial hormone for inducing sleep, produced primarily in darkness by the pineal gland from serotonin.

Factors Affecting Melatonin Production

Understanding Sleep Hygiene and Nutritional Deficiencies

Importance of Sleep Hygiene

• Emphasizes the significance of sleep hygiene for those suffering from insomnia, advising against screen time before bed to improve sleep quality.

• Highlights the need for a conducive environment for sleep, stressing that many people fail to disconnect from screens even right before sleeping.

Role of Serotonin in Sleep

• Discusses how serotonin production is crucial for good sleep and mentions nutritional deficiencies that can hinder its production.

• Identifies magnesium and vitamin B6 as essential nutrients for serotonin synthesis, particularly after bariatric surgery.

Vitamin B6 and Its Effects

• Questions the reliability of blood tests for measuring vitamin B6 levels, suggesting a focus on homocysteine levels instead.

• Explains the link between low serotonin levels during PMS (premenstrual syndrome) and cravings for carbohydrates due to a need for serotonin.

Hormonal Influences on Nutrient Needs

• Connects hormonal imbalances, such as excess estrogen during PMS, with decreased effectiveness of vitamin B6 in producing serotonin.

• Discusses postpartum depression's connection to vitamin B6 deficiency due to high progesterone levels degrading this nutrient.

Managing Nausea During Pregnancy

• Relates high progesterone levels in early pregnancy to nausea and suggests small doses of vitamin B6 throughout the day as a remedy.

• Notes that nausea may also indicate deficiencies in both vitamin B6 and thiamine (B1), prompting further investigation into these nutrients.

Nutritional Strategies for Enhancing Serotonin Production

Carbohydrates' Role in Serotonin Levels

• Explains how consuming carbohydrates increases insulin levels, which facilitates the entry of tryptophan into the central nervous system where it converts into serotonin.

Timing Carbohydrate Intake

• Suggesting that eating carbohydrates before bedtime can enhance sleep by increasing serotonin production, especially when done in a dark environment where serotonin converts to melatonin.

Impact on Cortisol Levels

• Describes how adequate carbohydrate intake at night can help regulate cortisol levels by preventing hypoglycemia-induced stress responses.

Addressing Weight Concerns

Carbohydrate Timing and Sleep Improvement

The Impact of Carbohydrates on Weight Loss and Sleep

• Discussion on using carbohydrates to improve sleep without causing weight gain, referencing a study by an Israeli team that explored nutrient timing.

• Two groups were studied: one consumed carbohydrates throughout the day while the other had all their carbs at dinner. The latter group lost more weight and reduced waist size.

• Emphasis on daily caloric intake being crucial; proper carbohydrate consumption does not lead to weight gain if managed correctly.

• A strategy employed in clinical practice involves concentrating carbohydrate intake at night, which reportedly improves sleep quality due to its relaxing effects.

• Carbohydrates stimulate the parasympathetic nervous system, promoting relaxation and aiding in falling asleep.

Nutritional Supplements for Anxiety and Insomnia

Importance of Magnesium and Zinc

• Highlighting magnesium's role in alleviating insomnia and anxiety, with caution advised regarding zinc supplementation.

• Personal anecdotes about patients dependent on high doses of anxiolytics, illustrating the need for alternative treatments like supplementation.

Clinical Observations on B12 Deficiency

• Noting a significant number of patients with anxiety who also have low B12 levels; many are unaware of their deficiencies due to inadequate medical guidance.

• Discussion about patients presenting with low B12 levels despite taking antidepressants, indicating a lack of comprehensive treatment approaches.

B12 Deficiency Linked to Depression

Case Study Insights

• Introduction of a case study linking B12 deficiency with insomnia and depression; highlighting the importance of monitoring vitamin levels in mental health treatment.

• Mentioning a classic case where a woman suffered from refractory depression linked to undiagnosed B12 deficiency over two years before symptoms appeared in blood tests.

Treatment Outcomes

• After starting B12 supplementation, significant improvement was noted within six months for the patient previously resistant to treatment.

Understanding the Role of Supplements in Mental Health

Initial Skepticism about Supplementation

• The speaker initially doubted the effectiveness of supplements for serotonin production, considering claims exaggerated.

• After researching, they found numerous studies supporting the benefits of certain supplements, although large-scale studies are often lacking due to funding issues.

Importance of Addressing Mental Health Issues

• The speaker emphasizes the serious impact of anxiety and depression on individuals, linking these conditions to weight gain and other health problems.

• They stress the importance of identifying and managing mental health issues effectively.

Bipolar Disorder and Supplementation

• While acknowledging that bipolar disorder has significant genetic and organic causes, supplementation can aid in its management.

• Specific supplements like ginseng and CoQ10 may help reduce depressive episodes but require personalized treatment approaches.

Melatonin Dosage Insights

• Discussion around melatonin reveals confusion over appropriate dosages; lower doses (0.3 - 0.5 mg) are suggested as more effective than higher ones.

• The speaker criticizes high-dose melatonin products available on the market, advocating for careful dosage management based on individual needs.

Exercise's Impact on Mental Health

• Questions arise regarding specific exercises that enhance serotonin production; while no definitive answers exist, physical activity is acknowledged as beneficial.

B2 and B12: Understanding Their Impact on Health

Discussion on Vitamin B2 and B12

• The speaker mentions that Vitamin B2 (Riboflavin) is beneficial, while also questioning the effects of a deficiency in Vitamin B12, suggesting it may lead to headaches.

• There is an acknowledgment of mental health issues such as anxiety and depression, with a message of hope for those struggling. The speaker encourages listeners to seek help.

Renan's Course on Nutrition

• Renan's course titled "Practical Nutrition for Anxiety and Overweight" is currently open for enrollment.

• The course covers various topics including dietary techniques, protein goals, carbohydrate management, and supplementation strategies aimed at addressing anxiety and weight loss.

Key Techniques Discussed

• Specific techniques taught include:

• Dietary adjustments related to low-carb diets.

• When to implement these diets based on individual needs.

• Addressing how certain diets can exacerbate anxiety in some cases.

Additional Resources

• Renan provides insights into supplementing for anxiety and insomnia as part of the course content.

• Participants are encouraged to leave comments with questions after viewing the session, indicating ongoing support within the community.