Emotional regulation (or self-regulation) refers to our ability to exert control over our own emotional state. It may involve cognitive-behavioural, attention-training or imagery-based methods for example, self-hypnosis, self-to-self dialogue, rethinking a challenging situation to reduce anger or anxiety, hiding visible signs of shame, sadness or fear, or focusing on images and reasons in order to feel happy or calm. Daniel Mirea has developed and introduced TED, a self-regulation tool more than ten years ago; this is a guide consisting of a mental checklist and a series of specific actions which may be summarised as ‘Tired – Exercise – (and) Diet your way out of trouble!’
“T” or ‘being tired‘ is the character symbol for basic sleep hygiene training. It is well evidenced by now that sleep deprivation is the number one risk factor for a range of mental health problems. Basic sleep training ought to be within the repertoire of every clinician but unfortunately this is not the case. The basic rule of thumb is 8 hours of sleep during the night – and I mean during the night ! This is the time when metabolism switches off, parts of your brain is processing data and rebooting, the digestive system slows down, etc. As such, it is important to sleep during the dark hours, and this is easier said than done during the shorter summer nights. No training and definitely no food three to four hours (even longer in some cases) before falling asleep would help improve the quality of the sleep and your blood works test results. Please consider following Dr Huberman’s research in this particular area, a Stanford University professor of neuroscience, who delivers excellent free presentations on a range of sleep relating topics.
‘E‘ or ‘exercise‘ is a symbol for physical strengthening and the need to exercise on a daily basis. Again, it has been shown time and time again that a daily regular routine does not only boosts the immunity but helps with hormonal regulation, protein synthesis (much like sleep does) and can help with a range if not all menta health conditions. Of course, one has to remember that the notion of physical exercise varies with age and sex as well as current physical condition.
‘D‘ or ‘diet‘ refers to eating and drinking – the secret has been out for some time, indeed what we eat and drink throughout the day makes a difference to our mental health. This is an area of increasing interest, and the internet is simply being overwhelmed with interviews, podcasts and papers on this topic. With the risk of sounding like a broken record, I would attempt to recount some fun facts from recent research studies that correlate well-being with nutrition.
In addition to considering the impact that a daily diet has on mental health, research has also started to focus on the role of specific vitamins and minerals. Vitamin C is one such micronutrient that has drawn significant attention in the diet and well-being landscape. Vitamin C is in fact one of the few hormones that humans do not naturally produce, hence our predisposition to fruits and vegetables. In fact, if one considers the human anatomy, we could easily notice that we are a particular type of mammal lacking in the department of adequate equipment for the consumption of tough or raw animal meat. Most of us, do not possess strong fangs or tough long nails, therefore historically, it has always been much easier to rely on a vegetarian or even vegan diet, evidently rich in vitamin C. Not only that, but this simple water-soluble micronutrient that humans, along with only several other species, are unable to synthesize themselves, remains an absolute requirement for a range of important biological functions. This contradiction between an absolute requirement for vitamin C and our species’ loss of ability to synthesise it, has been explained earlier, as such our early ancestors relied on diets rich in vitamin C which led to the eventual pruning of genes involved in endogenous vitamin C synthesis. Therefore, vitamin C must be obtained exclusively from diet, principally through the consumption of fruits, vegetables or more recently supplements. Vitamin C acts as an antioxidant and free radical scavenger and is an essential cofactor in numerous enzymatic reactions including that of dopamine β-hydroxylase, an enzyme that is central to the synthesis of adrenaline from dopamine. Vitamin C also acts as an essential cofactor in the metabolism of tryptophan, a necessary requirement for the synthesis of serotonin. Altered dopamine β-hydroxylase activity has been described in a range of psychiatric conditions including mood and anxiety disorders and disorders of the digestive tract and acute tryptophan depletion has been associated with reduced serotonin levels and lowered mood states. Emerging work in the field of epigenetics indicates that vitamin C contributes to epigenetic modifications in early development which in turn may influence key psychological and physiological outcomes across the lifespan. Reinforcing its role in neurocognitive functioning, the highest concentrations of vitamin C in humans are found in the brain and cerebrospinal fluid and vitamin C is preferentially retained in these areas even when plasma and other organs in the body are depleted of vitamin C.
There are several other important supplements which impact on our mental health, that are currently being investigated including magnesium, zinc, also proteins, and of course links have been established between depressive states and our gut bacteria. Results are conclusive enough for general medicine to at least start paying more attention.
For example, physical and emotional stress, a constant reality in our multi-tasking society, drain the body of magnesium. In fact, studies show inverse relationships between serum cortisol and magnesium, the higher the magnesium, the lower the cortisol. Stress robs the body of magnesium, but the body must have magnesium to respond effectively to stress. Magnesium deficiency afflicts 90% of all people with ADHD and triggers symptoms like restlessness, poor focus, irritability, sleep problems, and anxiety. These symptoms can lessen or vanish one month after supplementation starts. And further more, magnesium can also prevent or reverse ADHD drug side effects.
Clinicians found that 125 to 300 mg of magnesium glycinate at meals and a bedtime (four times daily) produces clinically significant benefits in mood. This form of magnesium is gentle on the digestive tract. 200 to 300 mg of magnesium glycinate or citrate before bed supports sleep onset and duration through the night. Magnesium in powder or liquid form could be effective alternatives to capsules, particularly for children with ADHD. Ways to increase the bioavailability of magnesium include supplementing with vitamin D3, which increases cellular uptake of the mineral. Vitamin B6 also helps magnesium accumulate in cells. Taking the mineral in divided doses instead of a single daily dose. Taking it with carbohydrates, with improves absorption from the intestine. And taking an organic form, such as glycinate or citrate, which improves absorption by protecting the mineral from antagonists in the digestive tract. It may be best to avoid giving magnesium in enteric-coated capsules, which decreases absorption in the intestine. Magnesium oxide is poorly absorbed and tends to cause loose stools. Magnesium-l-threonate has been shown to readily cross the blood-brain barrier, and animal studies show that it supports learning ability, short and long-term memory and brain function, I don’t typically prescribe it, however, because of its higher cost, and the clinical effectiveness of other forms. The therapeutic response to magnesium i reported to take several weeks, as levels gradually increase in the body.
Although a lot less research on this topic is carried out in the UK, a cross-sectional, population-based data set, the National Health and Nutrition Examination Survey, was used to explore the relationship of magnesium intake and depression in nearly 9,000 US adults. Researchers found significant association between very low magnesium intake and depression, especially in younger adults. And in a recent meta-analysis of 11 studies on magnesium and depression, people with the lowest intake of magnesium were 81% more likely to be depressed than those with the highest intake
For now, it remains important to understand that these articles do not aim to substitute real professionals or live clinical assessments. It remains crucial to see your local GP, or a qualified a nutritionist or even have an assessment with your NeuroAffective-CBT therapist, who will no doubt look at your blood works and try to understand how your lifestyle and choices that you make on a daily basis impact on your mental health. Supplements in general cannot and should not, replace psychatric medication they operate differently and at a completely different level. But the above mentioned supplements would very likely improve your prospects and perhaps bring you closer to your behavioural goals.
In regard to, what this article and video brings to attention, it is clearly important to change one’s lifestyle and redirect the focus on all three ‘TED’ domains – sleeping patterns, physical exercise and daily diet. Let’s not waste anymore time and get close to T E D ! The sooner he becomes your best friend the better !
* As a side note, although this is not a weight loss program, sometimes it delivers this added benefit. I used TED to loose 35 kg – a dramatic 8-10 months weight loss from almost 130kg to 95kg (my usual weight class), weight I started to gain just before and during the long pandemic episode, largely as a result of a static job, less exercise and glucose snacking. This could well be the subject of a new article, but for now I shall leave you with this video.
NeuroAffective-CBT 