Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health.
This week I’m going to talk about a fascinating book that I’ve been dissecting for the last month called Brain Energy by Christopher M. Palmer, MD. It’s about getting to the root cause of mental illness.
What causes mental illness? This was the question that Dr. Palmer could not answer. As a Harvard professor of psychiatry, 25+ years a practicing psychiatrist, he felt like a fraud. His frustration sent him on a quest for answers, which led him to write the book, Brain Energy.
When you look at the root cause of mental illness, is it a chemical imbalance? Is it genetics? Is it caused by childhood trauma? Dr. Palmer says, NO. It’s the energy available for your brain, and I agree with him.
Note: “Mental illnesses are among the most common health conditions in the United States. More than 50% will be diagnosed with a mental illness or disorder at some point in their lifetime. 1 in 5 Americans will experience a mental illness in a given year.” www.cdc.gov
What Really Causes Mental Illness?
Throughout the centuries there have been many theories about what really causes mental illness. Demonic possession has been traced through the medieval and early modern periods. Hippocrates thought that it was an imbalance of the body’s four “humors”, which are your four body fluids. He thought that the “black bile” was the one that caused depression.
Freud thought that mental illness was due to unconscious desires and conflicts. He talked about three things: Id, Ego, and Superego. Remember those? These are interesting theories, but not so relevant today. More recently, chemical imbalances have been thought to cause mental illness, which has led to the creation of a lot of medicines to treat those chemical imbalances.
Today, most psychiatrists and most doctors go by this thing called the biopsychosocial model, which does seem reasonable. There’s biologic reasons. There’s psychology to it. There’s social reasons for mental illness. Certainly, if you were abused as a kid or had a very traumatic childhood, you would be more prone to mental illness. However, this is not the whole story, because some people who were abused as children don’t become mentally ill.
A Story About A Patient
Dr. Palmer changed his whole viewpoint on this when he started helping a patient lose weight. This patient had a schizoaffective disorder (a blend between schizophrenia and bipolar). He had hallucinations and paranoia, had been on 17 different medications, and was diabled. Not only did the meds not work, but as a side effect he gained over 100 pounds. Note: weight gain is a common side effect of psych meds.
Dr. Palmer asked him to lose weight, but the patient didn’t know how, and neither did he! To further complicate the problem, the patient wouldn’t go out of the house for any other doctor, so Dr. Palmer took it upon himself to put him on a ketogenic diet (knowing it worked for epilepsy). What happened? The patient lost 150 pounds and his psychosis disappeared!
Note: This book is not about the ketogenic diet. It’s about all the factors that cause mental illness. He calls it brain energy. A problem with metabolism.
Mental illness is a metabolic problem and it starts with your mitochondria. The study of mitochondria (the little parts of each cell that produce energy in the cell / converts ATP into ADP) is the key to this book. All your energy comes from ATP through the function of these little cells and the little parts of the cells (billions) called mitochondria.
BUT, they do so much more than produce energy. They can act on your genome. They can change your DNA, switching on and off certain signaling pathways. This is called epigenetics. It’s not just the genetics you’re born with, it’s how your genetics are modeled. These pathways can be turned on and off by your mitochondria.
Note: We study this a lot in functional medicine. Mitochondrial medicine is functional medicine.
The Use Of Medications For Mental Health
It’s a fact that what we’re doing in mental health right now is not working. The lifetime prevalence of mental illness is 50%. That’s one out of every two of us! Anxiety is number one and depression is number two. Depression is the leading cause of disability worldwide.
We have lots of medicines that work in different ways, and some help part of the time. I’ve seen this a lot in my 36 years of practice. I’ve used them, and still sometimes use them. But 90% of people are not cured by these medications (plus they have a lot of side effects).
Psych meds usually target neurotransmitters like serotonin, dopamine, and norepinephrine. Anxiety medicines, mood stabilizers, antipsychotics, stimulants, and antiepileptic medicines, all work in different ways.
The field of mental health is difficult due to the lack of routine outcome measurement. There’s no brain scan or objective tests to tell you what mental illness you have. It’s all subjective. All about the symptoms. Nothing concrete.
A Common Pathway?
There’s a common pathway to all mental and physical illnesses – your metabolism (the process by which the body changes food and drink into energy). It’s not simple. It involves many factors other than diet.
- Gut Microbiome
This is what Dr. Palmer is talking about in the book. Metabolism is a big deal! When you go to a psychiatrist, most of the time they will just prescribe you a pill and then let you talk to a psychologist. Sometimes cognitive behavioral therapy, in combination with medications, will work, but wouldn’t you rather get to the root cause of the problem (like we do in functional medicine)?
Remember, many metabolic and and neurologic disorders have strong bidirectional (one or both can cause the other) relationships with mental illness. If you have heart disease, you’re probably going to get depressed. If you have schizophrenia, you’re probably going to get obese. Most of them do.
When we talk about obesity, diabetes, heart disease, Alzheimer’s and epilepsy, all have common pathways, and are associated with mental symptoms like depression, anxiety, insomnia, and even psychosis. People with mental illnesses are more likely to be obese. Look at obesity and autism. People with schizophrenia are three times more likely to develop diabetes. They call Alzheimer’s Type 3 Diabetes for a reason. It’s a metabolic disease.
Most mentally ill patients have shortened lifespans. Men up to 10 years shorter and women seven years shorter. Depression in early life doubles your chances of Alzheimer’s. Ninety-seven percent of Alzheimer’s patients develop psychiatric symptoms (that’s a lot of psychosis).
The Functional Approach
How do you approach a patient with mental illness? When patients are told to change their diet or to exercise, they often say they just don’t have the energy. Doctors are often skeptical, but the patient is right! It’s not a motivational problem. It’s a metabolic problem that involves production of energy inside cells (mitochondria).
Essentially all the risk factors for mental and metabolic disorders are the same. They have a common pathway with many ways to get there:
- Social factors (i.e., diet, exercise, smoking, drug use, alcohol)
- Sleep imbalances
- The On/Off switch of Epigenetics
- Gut microbiome
Note: With all the autoimmune diseases that I see, I always start with the gut microbiome. Then I look at inflammation, hormones, nutritional status, exercise tolerance, vitamin levels, sleep patterns, and insulin resistance. These are all interrelated.
If we can somehow simplify it, we could get better at treating these patients. All the current treatments work by affecting the metabolism. They either speed you up or slow you down, switching ON that energy if you’re depressed, and switching it OFF if you have a mania (bipolar manic episode). The energy is switched ON or OFF by your mitochondria. Your mitochondria has that power! Note: Although the brain is just 2% of your body’s total mass, it takes 20% of your resting energy. That’s incredible!
- Think about diabetics and insulin. From 1927 up until the mid 1960’s, insulin coma therapy was the most used treatment for psychosis and severe depression. They’d give you so much insulin that it would put you into hypoglycemic coma, and sometimes it actually worked! I don’t even want to think about how dangerous that was. Further down the road, all these medicines were invented that took the place of insulin. Note: this should be a clue that glucose metabolism is involved in mental illness!
- Think about estrogen and hormones. Women are twice as likely to suffer depression than men, and four times more likely to get dementia, because of low estrogen.
- Hypothyroidism (more common in women) is linked to bipolar, schizophrenia, and dementia. When I get somebody that has dementia, one of the first things I check is their thyroid (aka a major player in your metabolism). Remember, if you have a very low thyroid, you’re going to have a falsely elevated cholesterol level.
- Inflammation plays a huge role in autoimmune diseases because it causes mitochondrial dysfunction. Sleep problems exacerbate all mental and physical metabolic disorders.
- Vitamin deficiencies can result in mental and neurologic symptoms. Especially Thiamin (B1), Folate, and B12. Any neurologist is going to check those when they see a dementia patient. A lot of times we find that they’re really low. Why? Because they’re required for energy at the mitochondrial level.
- intermittent fasting. Fasting is so good for many mental disorders. It promotes autophagy, which means cellular repair. It improves cognition, improves your mood, and increases BDNF (Brain Derived Neurotrophic Factor) which improves neuroplasticity.
- The gut microbiome is so important to mental health. It’s that gut-brain connection.
You can make new neurons. You can learn new things. You don’t lose neurons permanently. You can regenerate them. That’s a fairly new discovery. Think about the ketogenic diet and epilepsy. The Ketogenic Diet stops seizures in about 85% of people, but all the new drugs have taken over this simple practice.
Brain Energy by Christopher Palmer, MD is such a good book! I hope it gets our mental healthcare providers to look at a more functional medicine approach to treating our ever increasing mental health needs. I’m not against medicines. We use them everyday and sometimes we really need them! BUT a lot of times what I find is they work for a while and then they quit working. Look at antidepressants. They just don’t work that well. They also have many side effects.
We need more functional medicine doctors that will spend the time to look through this stuff. Drug companies want money and patients want a pill. Obviously, this is not working. We’re getting more unhealthy all the time. We need to simplify things.
Let’s hope that more doctors start to see mental illness as a metabolic disease and like Dr. Palmer, use a more functional (getting to the root cause) approach for the cure. Kudos Dr. Palmer, for such a groundbreaking book on mental health.
Till next week.