This quarterly health bulletin focuses on the topic of mental wellness and steps coaches can take to identify and address issues you or a loved one may be facing. The NBCA is very proud to collaborate with NBA Cares, The Jed Foundation (“JED”), and Stacy Goldberg with the goal of educating Coaches on mental health and wellness. The mental health content is provided by JED*, and the nutritional content is being provided by **Stacy Goldberg, MPH, RN, BSN, & the Savorfull Team.
*According to the National Institute of Mental Health, one in five Americans had a diagnosable mental illness in the past year and about one in 25 individuals lives with a serious mental illness. Nearly half of adolescents could be diagnosed with a mental illness at some point (NIH). While these rates of mental health problems may appear alarmingly high, they should not be very surprising when we put them in perspective.
Let’s consider an analogy – knee pain. Anyone who engages in vigorous physical activity might experience knee pain from time to time. Maybe it occurred from overuse or maybe the person injured their knee. This pain is usually not severe or clinically significant, nor will it interfere with most activities, and will usually resolve with rest and some minimal care (icing). But at times the pain might be worse, a person may experience swelling, and it does not go away. Maybe this came from too much activity, or twisting the knee or an awkward turn or fall. There are probably some soft tissue findings on an MRI. We would call this a sprain or strain – a “diagnosable” condition. And now there is a need for more care. This is a very common occurrence, but still considered a treatable and relatively minor illness. And along this continuum could be an ACL tear. Clearly an injury/illness requiring more intensive intervention and recovery – a serious problem or “illness” by orthopedic standards.
The point is that we all have emotions: anxiety, sadness, joy, anger, love. Like the experience of knee pain, our emotions are signals. Emotions are essential in helping us understand our world, our experiences and our relationships. Like people who cannot sense pain, we are in danger if we can’t feel and identify (and know how to manage) our emotions. Lots of times, we feel things that are unpleasant or painful, but like the runner who overdid it, we need to figure out how to soften or alleviate the unpleasant feeling – having a conversation with a friend, getting some sleep, examining our interactions and how the emotion may have come up. If the emotion or thoughts connected with it are causing us to lose sleep or to lose our appetite, be unable to concentrate or to enjoy things, are coming up too frequently and getting in the way of functioning or relationships, we may have a diagnosable condition (like the sprain). There is a problem or disorder and there are steps, like certain therapies or sometimes medications to ease the “painful” feelings of anxiety or depression, or that might help improve the difficulty or the behavior patterns causing the problems. These kinds of things are, again, quite common and often very manageable. People who experience these kinds of problems are part of the 1 in 5 who may have a diagnosable condition in a year.
Smaller groups of people may experience problems with emotions, thoughts or behaviors that are more analogous to the torn ACL or to heart disease and cancer. These problems; bipolar disorder, schizophrenia, and severe substance use problems can often be chronic and for many can cause severe impairment. But for those who experience these problems, the right combination of talk and supportive therapies, medication, positive relationships and supportive life circumstances can be very helpful and support many people in living productive and rewarding lives.
The issue of mental health awareness came to the forefront of the NBA this past 2017- 2018 season, when Cleveland Cavaliers Kevin Love and Toronto Raptors DeMar DeRozan came forward and spoke publicly about the topic of mental health awareness.
“Mental health is an invisible thing, but it touches all of us at some point or another. It’s part of life. You never know what that person is going through. Everyone is going through something that we can’t see.” (Kevin Love, The Players’ Tribune)
In an effort to de-stigmatize mental health struggles, NBA All-Stars Kevin Love (Cleveland Cavaliers), and DeMar DeRozan (Toronto Raptors) openly broke their silence and spoke out about their own battles with depression and anxiety.
“Mental health isn’t just an athlete thing. What you do for a living doesn’t have to define who you are. This is an-everyone thing. No matter what our circumstances, we’re all carrying around things that hurt — and they can hurt us if we keep them buried inside.” (DeMar DeRozan, The Star)
Often enough, being strong is entangled or confused with invulnerability. Therefore, discussing topics relating to mental health that might still be viewed as a “taboo” in today’s society, especially in athletics, encourages people to be willing and open to reaching out for help without feeling any shame or guilt.
“I didn’t want people to perceive me as somehow less reliable as a teammate, and it all went back to the playbook I’d learned growing up: Be strong. Don’t talk about your feelings. Get through it on your own.” (Kevin Love, The Players’ Tribune)
What about Stigma?
Illness (and especially serious illness) makes us anxious. Think for a moment what is conjured by thinking of the terms “heart attack,” “stroke” or “cancer.” While we’ve made great strides in the medical treatment and management of these problems, these words still make most of us uneasy or anxious. Unfortunately, much of what we see or read about mental illness are similarly disturbing images of severe and chronic illness. We see news reports of mass shootings associated with serious mental illness (even though most mass shooting are not done by people with serious mental illness), observe seriously disturbed people living on the streets in many major cities, and frequently read reports of overdose deaths and suicides. Much news reporting of mental illness focuses on the most chronic and serious of conditions. Our image of mental illness is based on these disturbing but lopsided reports and observations.
This stigmatized view of mental illness makes sense when we consider how mental illness is portrayed and spoken about. When we consider the discussion above about the range of severity of mental illnesses, we may come to a different view. We often hear from experts that mental illnesses are like diabetes-but this image is again of a chronic illness that needs to be controlled with long term medical intervention and frequently leads to other serious medical consequences. Actually, the more accurate analogy is to adult onset diabetes. People who develop this form of diabetes typically have a genetic predisposition to developing diabetes, but, this illness can be prevented for many vulnerable people by properly managing weight and getting regular exercise. And even for people who develop the illness, managing those factors can do a lot to ameliorate the severity of the illness. This is similar to what we see with many psychiatric illnesses. They are typically a result of combinations of genetic and environmental/life stress factors, and much can be done to prevent or ease the severity of problems, including therapy and medication treatment.
So, when we think clearly about mental health problems, we can understand how common and treatable they can be, and how similar mental illnesses are to any other illnesses we all experience quite regularly.
When to get help
When should someone consider getting help or recommending help for someone else for a mental health problem? Mental health problems can impact feelings/emotions (like panic disorder or depression), thinking (like attention deficit disorder, obsessive-compulsive disorder or psychotic illnesses) or behaviors (substance misuse, self-harm, eating disorders). Note if problems in any of these areas are:
3) Typical ways of handling similar problems that are not working (you’ve taken a walk or a vacation, talked to a friend or loved one and you are still experiencing the problem)
4) Interfere with life functions and activities like sleep, eating, job performance or relationships
5) Keep occurring or repeating themselves in similar patterns
6) Result in danger to self or others
What kinds of things help?
Just like with our physical health, there are a range of things we can do to support our mental health before a problem has emerged, and there are a variety of different things we can do when we have a problem or an illness.
Many of the good habits that support our physical health also support our emotional health and resilience. These include good nutrition, adequate sleep and rest and regular exercise. Additionally, a good handle on life skills, having life goals and personal values and most importantly strong supportive relationships all help us maintain emotional health and lower our risk of substance misuse.
When these are not sufficient to maintain optimal health and functioning, various forms of talk therapy can be very helpful in managing mild to moderate anxiety, depression, and relationship and life problems, and are an important ingredient in helping manage more serious problems. Medications are helpful with managing moderate and more severe anxiety or depression, and more serious problems like bipolar disorder or schizophrenia.
**Impact of Foods on Mood/Mental Wellness
In addition to talk therapy and medication, mental health, mood and wellbeing can be impacted by proper nutrition. The human brain is constantly switched “on” – processing thoughts, emotions, movements, and endless physiological processes 24/7, which showcases the importance of properly nourishing and fueling the brain through one’s diet. Nutrition directly alters brain function; thus affecting mood, energy and mental health. For instance, consuming highly-nutritious foods packed with vitamins, minerals, fibers and antioxidants protects the brain against oxidative damage and procures it with good quality fuel to properly carry out its functions. On the contrary, feeding on nutrient-poor foods will only tamper with brain and bodily processes, eventually worsening symptoms of mood disorders.
One’s good mood results from specific chemicals influencing neural responses in the brain. Factors such as fibers, probiotics, healthy carbohydrates, amino acids, vitamins, minerals and antioxidants have been reported to possess mood enhancing properties. Below is a series of “good mood foods” that have been scientifically proven to ameliorate mood by relieving stress, anxiety, promoting productivity and releasing mood-boosting neurotransmitters (dopamine, oxytocin, serotonin, endorphins, catecholamine) in the brain.
|FOOD||WHY?||Stacy’s Health Swaps|
PROBIOTICS AND FERMENTED FOODS
· Yogurt (probioticenriched)
Think of fermentation as a magic wand that can turn regular foods into superfoods. Fermentation magnifies the bioavailability of B vitamins, zinc, magnesium, healthy fats, vitamins C and D. They also increase dopamine, serotonin, GABA levels and antioxidant capacity. All of these components reduce anxiety, depression and enhance mood and mental outlook.
-Instead of the typical chips & salsa, dip some cut-up veggies or pickle spears into a nonfat probiotic yogurt dip.
-Spread cottage cheese or add marinated tempeh to your sourdough bread instead of white bread.
-Add probiotic-enriched yogurt to your granola or oatmeal.
-Add kimchi to your scrambled eggs or morning omelet.
-Replace meat on your sandwich for BBQ tempeh when available.
-If eating a hot dog at a summer BBQ, top with sauerkraut in place of ketchup and mustard.
· Whole grains (amaranth, buckwheat, barley, oats, rye, bulgur)
· Legumes (beans, chickpeas, peanuts, lentils)
· Dark green leafy vegetables (turnip greens, spinach, Swiss chard)
· Cruciferous vegetables (cabbage, broccoli, Brussel sprouts, cauliflower)
· Nuts and seeds (almond, walnuts, cashews, pumpkin seeds, sesame seeds, flaxseed, chia)
|Once again, we find fiber at the forefront of wellbeing. Fiber is fermented in the body and leads to the production of short chain fatty acids that increase cognitive control (focus, working memory,
multitasking) and reduce negative thoughts associated with sad mood.
|-Avoid the juicing trend and consume the whole fruit or veggie instead of the juice.
-Swap out nutrient void breakfast cereals for a bowl of high fiber, low sugar granola topped with fresh berries.
-Thicken soups and stews with whole chia seeds.
-Toss cooked or roasted lentils into a tasty green salad for extra protein and fiber.
-Spread your sandwiches with hummus instead of mayonnaise or cream cheese.
-Ditch the greasy potato crisps for crunchy baked kale or spinach chips.
-Elevate your pizza by opting for a fiber-rich cauliflower crust.
-Choose to order roasted Brussel sprouts as a side dish when dining out.
-Use nuts and seeds like flax, almonds and pecans as a crunchy topping over soups, salads or desserts.
-Mix and match dried fruits like cranberries or blueberries with almonds, walnuts and pumpkin seeds for a nutritious trail mix.
· Olive oil or canola oil
· Herbs and spices
· Fatty fish and seafood
· Plant-based foods (fruits, vegetables, wholegrains, nuts)
· Low-fat or or full fat dairy in moderation
|Adherence to a traditional
Mediterranean diet lowers the risk of anxiety or depression by 25-30%. This diet reduces tension, anxiety, hostility, fatigue, confusion and total mood disturbances. Adopting this diet for just 10 days, is enough to induce positive mood effects such as increased alertness, content, and activity.
|-Dip your veggies or high fiber chips in hummus rather than ranch dressing.
-Trade in the butter for heart-healthy olive oil.
-Swap bacon and ribs for healthy seafood like shrimp, salmon, sardines and anchovies.
-Think about going meatfree once or twice per week. Meatless Monday is a great way to start the week!
-Try baked falafel wraps in place of chicken salad or deli-meat wraps as a light lunch.
-Season your meals with herbs and spices (oregano, dried mint, pepper) in place of salt.
-Reserve red meat for special occasions. Opt for leaner options such as turkey or chicken breasts for frequent consumption.
-Keep walnuts, pistachios and almonds on hand for a quick snack.
· Nuts and nut butters
· Chia seeds and Flaxseed
|Fats aren’t your arch enemy. Healthy fats provide omega-3s
which are building blocks for the brain, as they protect against
learning impairments and depression. They are also rich in vitamin E and antioxidants which slow mental decline, improve memory and protect against depression and anxiety.
|-Almond, peanut or cashew nut butters are fantastic on-the-go snacks. Pack single serving nut butters that you can add to fruits such as apples or bananas.
-When craving dessert, turn your nut butter into a fudge by simply freezing it for a couple of minutes.
-Elect salmon as your goto fish, as it is extremely rich in brain-healthy omega-3 fatty acids.
-Avoid cheesy dips, butterbased sauces and creamy pastas in restaurants as they lack healthy fats.
-Fill your burrito with avocado slices or chunky guacamole instead of filling it with cheddar cheese.
-Blend avocado in your protein shake or smoothie for a creamy texture and top that off with chia seeds or flaxseed.
|This brain food, especially Matcha tea, contains L-theanine and
phytochemicals. Consumption of 2- 3 cups/d increases the secretion of GABA, serotonin and dopamine. This then reduces caffeine-induced tension and anxiety, promotes happiness, increases relaxation and enhances sleep quality.
|-When you head to Starbucks in the morning for a quick fix of caffeine, order a cup of green tea in place of your espresso.
-Combine 1 frozen banana and 1 cup of milk or nondairy beverage with a drizzle of honey and matcha for the perfect green smoothie.
-Mix matcha with coconut yogurt for a perfect snack.
-Aside from cinnamon, matcha is a great addition to coffee. Give it a try.
-Sprinkle matcha over your popcorn for a delicious earthy flavor.
-Top your coconut milk ice cream or frozen yogurt with matcha instead of sprinkles or chocolate chips.
|TURMERIC||The “golden goddess” of spice is both an anti-oxidant and an antiinflammatory agent. It boosts serotonin and dopamine which enhance mood and alleviate depression. In fact, one study found that over six weeks, turmeric was able to improve depression
symptoms just as much as an
|-Curries are filled with turmeric. Add black pepper to your curry dish because it boosts curcumin’s absorption in your body.
-Keep an eye out for turmeric tea when you stop by your favorite coffee shop next time.
-If you’re looking for a superfood to add to your smoothie, turmeric should be your #1 choice.
-Another way to spice up your popcorn is to season it with turmeric.
-For a warm and peppery flavor, toss your favorite roasted veggies in turmeric and olive oil.
-Intensify the color and taste of your morning scrambled eggs with 1 teaspoon of turmeric.
|BERRIES||Berries might be small in size, but they sure are mighty when it comes to health benefits. They are packed with anti-inflammatory color pigments and antioxidants that improve memory and act against aging and inflammation which could worsen mood and depressive symptoms.||-Jumpstart the day by adding antioxidant-packed berries to your breakfast oats or protein bars.
-Berries are a tasty add on to probiotic-enriched yogurt, oatmeal, wholewheat waffles, banana pancakes and even salads.
-Add fresh frozen organic berries to your protein smoothie for enhanced taste, consistency and health benefits.
-Infuse your favorite sparkling water with blackberries and lemon slices instead of opting for soda.
-Add fresh berries and nut butter spread to your whole-grain toast for an upgraded version of PB&J.
|DARK CHOCOLATE +
|Think of fermentation as a magic wand that can turn regular foods into superfoods. Fermentation magnifies the bioavailability of B vitamins, zinc, magnesium, healthy fats, vitamins C and D. They also increase dopamine, serotonin, GABA levels and antioxidant capacity. All of these components reduce anxiety, depression and enhance mood and mental outlook.||-Eat it straight. Just a bite of 70% dark chocolate is enough to provide a quick boost
-70% dark chocolate chips are another fun ingredient to incorporate into shakes or a trail mix
-Skip the cake. If you’re craving dessert, dip fresh fruits into 70% dark chocolate.
· Skinless chicken or turkey breast
· >90% lean beef
· Legumes (edamame, beans, chickpeas, peanuts, lentils)
· Low-fat dairy (skim milk, fat-free yogurt, lowfat cheese)
|Our brains love proteins as much as our muscles do. Lean proteins are an excellent source of vitamin B6, B12 and folate which produce “good mood” neurotransmitters such as serotonin, catecholamine, dopamine, norepinephrine and epinephrine.||-Edamame is a great snack to eat alone or added to soups, stews and salads. Try dry roasted edamame as a crunchy alternative to pretzels or chips.
-If you’re opting for a salad for lunch, choose satiating boiled eggs, chickpeas or black beans as a topping.
-Swap out potato chips for roasted lentils, beans or chickpeas.
-Use cottage cheese as a dip with veggies or a spread with fruits. A 4-oz. serving of this cheese contains about 13g of protein.
-For a balanced snack, pair almonds and cashews with cheddar cheese cubes.
-Skip the bologna and salami at the deli counter and swap out lunch meats for a grilled chicken breast or piece of wild salmon.
|COFFEE||Coffee first? There’s a reason why coffee is the highlight of many people’s mornings. The antioxidants and caffeine found in this drink boost physical endurance, cognitive function, vigilance, mood and fatigue perception. However, coffee can be a double-edged sword for health.||-Do not exceed the daily safe amount of caffeine (400 milligrams/day) which is equivalent to 4 cups of brewed coffee/d
-Coffee’s one of the most heavily pesticide-sprayed crops in the world. Opt for organic coffee beans to enhance your drink’s quality.
-Brighten your coffee with a drizzle of cinnamon or vanilla.
-Top off your coffee with unsweetened cocoa powder for a twist on “hot cocoa”.
BAD MOOD FOODS
Just as some foods promote better mental health and improve mood, other foods do the exact opposite. Research has shown that high-sugar, high-fat and highly processed nutrient-poor foods are more commonly consumed by individuals with anxiety, depression, and high levels of chronic stress. These foods possess negative effects on memory, mood, neurotransmitter production and inflammation. For instance, processed foods and baked goods are linked to depression, aggression, anxiety and worsened mental illness symptoms while high-sugar foods often promote irritability and worsened mood. Here is a comprehensive list of “Bad Mood Foods” explaining the rationale behind negative effects these foods have on mental health and wellbeing.
|FOOD||WHY?||Stacy’s Health Swaps|
|COFFEE||Too much of a good thing can become bad. Caffeine overconsumption is associated with poorer sleep quality, daytime sleepiness and increased daytime dysfunction. Unfortunately, caffeine in excess suppresses serotonin and worsens depression symptoms, distress and anxiety.||-Always start your day with water, regardless of whether or not you have a cup of coffee afterwards.
-Alternate between coffee and green tea to avoid the harmful effects of caffeine.
-Opt for organic coffee beans as they are packed with natural nutrients and free of chemicals.
-Avoid highlyprocessed and artificial creamers. Instead use organic milk or honey.
-Sprinkle cinnamon or vanilla extract in your coffee for added sweetness.
|ALCOHOL||When consumed in moderation, alcohol can be very much enjoyable with a nice balanced meal. However, excessive use has harmful effects on the brain and leads to nutrient deficiencies (vitamin B1), sleep disturbances, and changes in emotion recognition in a way that increases sensitivity to angry faces which may be a cause of alcohol-related aggression.||-When selecting from different types of drinks, opt for the antioxidant-rich red wine.
-Space your beverages out and drink water in between to promote moderation.
-Avoid mixers as they are packed with unnecessary sugar and extra calories.
-Alcohol depletes electrolytes (i.e. potassium, calcium, magnesium). Bananas, pomegranate, mangoes, cucumbers and celery are perfect for refueling.
-Stay away from mixed drinks on an empty stomach to avoid hypoglycemia.
|HIGH MERCURY FISH||Mercury is a neurological toxin that can disrupt neurotransmitter synthesis and central nervous system function as it accumulates in tissues for a long time. It also worsens depression symptoms and decreases emotional intelligence.||-Avoid high mercury fish such as king mackerel, shark, swordfish and skipjack tuna.
-Opt for low mercury fish such as salmon, catfish, shrimp, lighttuna and cod.
-While dining out, order your seafood grilled, steamed or baked instead of fried.
-Ditch the croutons or bacon bits and top your green salad with grilled baby shrimp.
· Fruit juice
· Energy drinks
· Sports drinks
|Often enough, these sweet and colorful drinks are packed with high fructose corn syrup which is linked to impairments in brain function, memory, learning, appetite control and satiety. In fact, the Whitehall II Study confirmed that sugarsweetened beverages increase the chance of mood disorders in men.||-Replace soda with unsweetened iced tea, kombucha or sparkling water.
-Revamp your tap or sparkling water by adding lemon, berries or mint to it.
-Try electrolyte-rich coconut water instead of sugar packed sports drinks.
-Try vegetable juice (i.e. avocado, cucumber, celery and lime) in place of fruit juice.
|ASPARTAME||Individuals often seek aspartame when trying to avoid sugar. However, studies have shown that this artificial sweetener magnifies irritability, increases depression rates and negatively impacts emotions and learning.||-Ditch the processed sweetener for natural maple syrup, molasses, honey, coconut sugar or date paste.
-Go for cinnamon and vanilla drizzles if you’re avoiding sugar.
-Avoid aspartame containing drinks such as soda.
-Stay away from “diet” or “sugar-free” labeled products as they are often packed with aspartame.
|PROCESSED, PACKAGED AND READY-MADE FOODS
· Deli meats
· Chips and packaged desserts
· Ready-made meals
|Processed foods may be a quick goto; however, they negatively alter brain function and contribute to neurodegeneration, impaired memory and learning. Specifically, a diet high in processed meats causes inflammation and
deterioration in reasoning over 10 years.
|-On food labels, avoid ingredients that sound more like chemicals than foods.
-Buy organic canned and/or frozen veggies + fruits without any other added ingredients or preservatives such as sugar, salt, fat and carbs.
-Choose no salt added or air popped popcorn as replacement for packaged snack foods such as chips and cookies.
-Avoid excessive deli meat consumption. Opt for tempeh, tofu or tuna when available.
-Avoid calorie-dense dressings. Options such as lemon and balsamic vinegar with olive oil are a great swap.
· Cookies and crackers
· Sweets and baked desserts
|Refined carbs cause a spike in blood sugar and insulin levels, followed by a quick drop triggering hunger and cravings. Studies have shown that these foods trigger inflammation to parts of the brain that affect memory, mood and responsiveness to hunger/fullness cues.||-Order lettuce wraps, cauliflower rice/ puree or zucchini noodles when you spot them on menus.
-Get rid of the saltines and go for 100% whole wheat peanut butter crackers for extra protein and fiber.
-Instead of a bagel, choose a thin slice of 100% whole wheat or sprouted grain bread topped with smoked salmon and avocado.
-Avoid buying bags of croutons. Rather, use sunflower seeds as a crispy element in soups and salads.
-In place of a taco or burrito, try a “bowl” option with brown rice, no rice or no burrito/wrap/
Mental disorders do not discriminate. They affect both the young and the old, the rich and the poor, the players and the coaches. Everyone is at risk. The lifestyle of an NBA coach is to be on-the-go constantly with very few days off. Investing all of our energy for the success of our team can be a mentally draining process. For these reasons, it is crucial for coaches to look after themselves and their health so they can be strong support systems for their players, as well as their families.
Mood and mental wellbeing are clearly impacted by food choices and lifestyle habits. A balanced diet rich in whole grains/vegetables/fruits and low in caffeine/alcohol is a useful way to shield coaches against impaired cognitive functioning, lowered energy, and depressed mood. After all, a healthy body equals a healthy mind.
*Mental health content provided by The Jed Foundation and NBA Cares. To learn more about
mental health and specific mental health problems check out The Jed Foundation’s “Mental
Health Resource Center” https://www.jedfoundation.org/mental-health-resource-center
**Nutritional tips written by Stacy Goldberg, and the Savorfull Team. Stacy Goldberg is the
Official Health and Wellness/Nutritional Consultant for the National Basketball Coaches
Association. Sources available upon request.
Stacy Goldberg – MPH, RN, BSN
CEO & Founder