New research suggests that military veterans living with trauma and post-traumatic stress disorder who suppress their emotions may spark a pattern of unhealthy eating, indicating that close attention to diet quality could potentially provide a framework for more effective therapies.

860 U.S. military veterans were assessed in the study, published April 13 in the European Journal of Psychotraumatology. Three years later, 503 participants completed a follow-up survey. The authors found that severity of PTSD symptoms and exposure to trauma were both associated with the veterans' diet quality. Fruits, vegetables, grains and dairy were some food categories from the better-quality diets, while the lower-quality diets included fried foods, soft drinks and alcohol. The research team added fast-food consumption to this standard questionnaire based on dietary guidelines from the U.S. Department of Agriculture. 

Corresponding author Erika J. Wolf has long been fascinated by research that deals with the brain and behavior. "Some of my earliest memories of science go back to when I was a little kid, and my parents would bring me to the Museum of Science in Boston," she told The Academic Times. As an undergraduate at Harvard University, Wolf had the opportunity to volunteer at the VA Hospital. "I am honored to hear the stories the veterans told about their life and their medical and mental health," she said. 

"We know that the biology is only part of the story, and we've always thought there are behavior[al] pathways related to exercise and nutrition," Wolf explained. "What are the health implications of having these psychiatric conditions?" The team's findings suggest that PTSD could be one of the culprits behind accelerated aging – a condition wherein a person's body ages faster than it normally might, in this case because of distressing emotions and inflammation.  

The study also builds on previous research showing that diet is more than just a small factor to consider when looking at aging and trauma. Take dementia, for example. This neurological disease is more likely to occur in people who consume drinks high in sugar and is one of many illnesses that are co-morbid with PTSD. On the other hand, eating foods rich in vitamins E and B12 has been shown to lower the risk of dementia. "Diet quality is a common denominator among multiple physical and neurological health outcomes commonly co-morbid with PTSD," the authors reported in the study.

The association between trauma and physical health may have a third key component: emotion regulation. Past studies showed that severe PTSD is linked to both poor diet and low emotional awareness. The authors predicted that being able to regulate emotions in a balanced way could influence all three of these factors: PTSD symptoms, exercise and diet quality.

The severity of the trauma the participants experienced also played into nutrition. People who lived through more traumatic events over the course of their lives were found to eat lower-quality foods, and the researchers point to the comforting nature of food as a possible reason. These individuals "may eat poorer quality foods as a way to reduce their emotional burden," the authors stated, which could help to explain the much broader relationship between PTSD and health. Surprisingly to the researchers, neither PTSD nor trauma were directly related to exercise.

Wolf hopes that the study will lead to better counseling for veterans. "Emotions are biological, so it's really hard to say you're going to shut off your emotions because you're fighting basic biology," she explained. Yet veterans and people living with PTSD often chronically suppress their emotions, which has long-term effects on cardiac health. The authors urge therapists and nutritionists to take emotion regulation skills into account when dealing with patients who experienced trauma. Otherwise, poor eating habits and the quality of their diet may not improve.

Wolf noted that the sample size was skewed to older males, with 91.5% of the participants male and the mean age 63 years. There is a higher proportion of males in the U.S. military, she said, but further study is needed with younger and female participants.

One question that came up for the authors after reviewing their results was whether treatments that focus on emotion regulation can lead to better physical health. For example, could the results benefit new mothers who experience PTSD after birth? Further psychiatric and genetic research could help explore this connection, Wolf said.

Wolf notes that her co-authors send out research summaries to all veterans who participate in studies, keeping them updated about new findings. "I really have a special place in my heart for veterans," she said. "They have made major sacrifices in their lives for the betterment of our society, and continue to inspire by contributing to research that helps other veterans with PTSD."

The study, "Emotion regulation and the association between PTSD, diet, and exercise: a longitudinal evaluation among US military veterans," published April 13 in the European Journal of Psychotraumatology, was authored by Shaline Escarfulleri, Stephanie Ellickson-Larew and Dana Fein-Schaffer, National Center for PTSD; and Karen S. Mitchell and Erika J. Wolf, National Center for PTSD and Boston University School of Medicine.