Three Books to Change the Way We Think About Mental Illness & Disorder.
Three Books to Change the Way We Think About Mental Illness & Disorder.
A Clarion Call for Re-Writing Mental Health Policy.
Do these three books provide the foundation for re-writing government policy for mental illness and disorder? You be the judge!
The Better Brain (2021) sheds light on how nutrition improves resilience, supporting traumatic life events, and the role of micronutrients in underpinning nutritional resilience, with a particular focus on anxiety, depression, and ADHD. Change Your Life, Change Your Mind (2024) is a deep dive into the intertwined relationship of mental illness with dietary insufficiency, insulin resistance and inflammation, and the surprising role of dietary meat as a game changer for people with mental challenges and all too often, intolerances and allergies. The Better Brain and Change Your Life come with dietary recommendations for change.
Brain Energy (2022) is a fascinating and comprehensive treatise which is intended to overturn the narrative that mental illness is an exclusively brain-centred and neurotransmitter-centric phenomenon, asking that we look deep into metabolic and mitochondrial function for answers to the mental health crisis in front of us.
The books offer different perspectives yet neatly dovetail.
All the authors condemn the:
‘severe deficiency of nutritional education at all levels of medical training.’
The Better Brain
All the authors have observed patients and research subjects experiencing fundamental changes in levels of mental illness and disorder as a consequence of eliminating ultraprocessed food consumption and replacing deficient diets with nutrient dense wholefoods.
Their case studies provide exciting examples on remission and reduction in symptoms, and these case studies do not appear to be isolated incidents.
All of these books emphasise the speed of growth of mental disorder diagnoses over recent decades. As Harvard psychiatrist Chris Palmer states: ‘what we’re doing isn’t working.’ In the US one in five people have been diagnosed with mental illness, while in the UK one in four people have been diagnosed. Mental illness rates in younger groups under twenty-five have surged – and
‘Rates of very different mental disorders – autism, bipolar disorder, depression and ADHD, to name a few – are all increasing at the same time.’
The evidence in these three books, whether zooming in on case studies all the way out to meta-analyses in the published and peer reviewed scientific literature, firmly contradicts existing government policies which depend exclusively pharmaceutical drugs for the treatment of mental disorders.
Meanwhile, in New Zealand, the 2018 He Ara Oranga Report of the Government Inquiry into mental health and addiction noted that:
The authors of these three books are unanimous – mental health and metabolic health are intricately interwoven. All the authors maintain that poor dietary nutrition is the key driving force of the maelstrom of mental suffering that presents in front of doctors and clinicians on a daily basis.
As Professors Julia Rucklidge and Bonnie Kaplan state
‘the direction of causality was probably going the wrong way.’
For Georgia Ede as with Palmer, Rucklidge and Kaplan the question is
‘What causes neurotransmitters to become unbalanced in the first place?’
The books provide a cohesive argument that the health of the immune system and the digestive system, whether viewed at the system level or when zeroing into the cellular and mitochondrial level, is intricately connected to lifetime exposure to safe and nutritious food. Safe food doesn’t promote toxicity, inflammation and oxidative stress; and nourishing food provides the optimum level of nutrients to synthesise all metabolic processes.
All the authors emphasise that many people may have genetic traits – defective enzymes – that increase risk for illnesses or disorders. However, the capacity to alter diet and nutritional support to appears to overwhelmingly compensate for such risk factors not in the minority, but the majority of cases.
PSGR suspects that the production and release of these books has lagged behind the extent of evidence in the peer reviewed literature because the contents are, well, controversial.
These books are heavily referenced. The authors have had to arm themselves with defensive armaments. They’ve had to fortify their arguments with a weight of evidence to ensure that any political backlash would not result in the loss of their careers. There’s a lot of money to be made in medication and in the sale of food-like substances.
The role of medical treatment and drug delivery is expertly and sensitively articulated by all authors. These experts in psychiatry and psychology, and are not naïve. They acknowledge that some conditions cannot be healed. But for those that can alter their diets and/or increase multinutrient exposures, the authors maintain that most patients will experience a reduction in symptoms, including improvements in other concomitant health conditions from dietary changes.
It appears that for many – for many – significant dietary change can result in far less prescription drugs and a healthier, happier, more content (or as Ede puts it) a ‘quieter’ life.
But these authors are adamant that conventional treatments by and large, do not solve the problems of their patients. The authors provide repeatable, demonstrable evidence that diets high in highly refined ‘ultraprocessed’ food (UPF diets) promote metabolic conditions that set the stage for a large range of mental illness.
They provide an information-rich policy basis outside the common toolbox promoted by governments, the mainstream media, and the pharmaceutical and medical complex of medical treatment and therapy.
What they all do – is turn medical orthodoxy on its head. Instead of a ‘treat with drugs first’ their focus is on nutrition as a primary tool in alleviating a syndrome. (Obviously all are aware that if a condition is life threatening then short-term pharmaceutical treatment may be desirable and all emphasise that drugs must only be discontinued with medical supervision).
Another thing they do – is emphasise the relative safety of taking a nutritional approach to reversing a given mental condition. Dietary changes, and nutritional supplements do not carry the same risks (as side effects) as psychiatric drugs.
Could dietary changes be a game changer for metabolic and mental illness?
CHANGE YOUR DIET, CHANGE YOUR MIND (2024)
Change your diet, change your mind contains an exceptionally rigorous and elegantly articulated description of brain and nutrition function.
Harvard trained psychiatrist Georgia Ede’s book is structured in two parts. The first outlines the relationship between metabolic, mental health and the nutritional quality of the diet. The second part delves into the dietary ingredients and recommends graduated meal plans that reflect different personal requirements and dietary stages.
Ede spent ten years as a conventional psychiatric clinician, followed by fifteen years as a nutritional psychiatrist. Her basis rests on the evidence (case studies and extensive research in the scientific literature) that the mental illnesses she has clinically observed are predominantly accompanied by dietary insufficiency and accompanying inflammation and digestive issues, and that her observation is balanced by scientific data.
Therefore, dietary changes must necessarily take into account concomitant problems with digestion and food intolerances. For many, it is not enough to remove ultraprocessed food, dietary changes need to remove exposures that promote inflammation and impede nutritional absorption.
Ede brilliantly articulates how for nearly seventy-five years the long search for the biological causes of mental illness has been preoccupied with neurotransmitters – yet now it is evident that
‘inflammation, oxidative stress and insulin resistance have emerged as an unholy trinity of destructive forces that help to explain why neurotransmitter imbalances occur.’
Ede, sheds light on the two pillars of treatment and therapy – the biological or neurotransmitter theory of mental illness, and the psychotherapeutic approach. Ede states early on, that in two decades of work she is yet to see psychotherapy alone ‘put any case of serious mental illness into remission’.
The chapter on brain and nutrition function and the pathway foods can promote metabolic harm (through system inflammation, for example) is accessible for non-experts and experts alike, however experts will be impressed by the clarity of her writing, and the depth of scientific understanding.
Ede’s chapter on insulin is exceptional, she demands that we pivot to viewing Type 2 diabetes as primarily an insulin problem, rather than a glucose problem, and lays out her basis, with a particular focus on Alzheimer’s disease.
But it’s more than just inflammation and oxidative stress – diets provide the ‘construction materials’ to build healthy resilient brain cells, without an optimum diet, cells cannot develop nor function properly influencing
‘brain development, neurotransmitters, stress hormones, inflammation, antioxidant capacity, brain energy production, brain ageing and brain healing.’
While Ede acknowledges that the neurotransmitter theory
‘pulled psychiatry out of the dark ages and into the modern medical age.’
Ede zeroes in on a dilemma that is rarely acknowledged – the 1000-plus page reference book used for formal psychiatric diagnosis, the Diagnostic and Statistical Manual of Mental Disorders, gives names to the symptoms, but contains no guidance about to treat symptoms, and no ‘biological clarity about what might be causing them.’
She outlines how conventional treatment works. Doctors make an ‘educated guess’ about what might be causing a patients’ symptoms. A treatment plan (of medication to address chemical imbalances) and some form of counselling is recommended, such as ‘psychotherapy (to process stressful life experiences) or cognitive-behavioural therapy (to change negative thought and behaviour patterns).’
Doctors are taught that genetic and transmitter function increases susceptibility to mental illness and disorder – yet emphasises a surprising gap. There are still no tests doctors can rely on to measure this activity. As Ede acknowledges, the ‘guesswork’ involved in treatment often leaves ‘too many without meaningful relief.’
Ede highlights the surprising contradiction, that as medical doctor, psychiatrists ‘are uniquely qualified to assess and treat… the biology behind your symptoms – yet this is the piece we understand the least.’
For Ede, the wider story is derived from drivers that promote ill-health in all of the body and the extensive evidence that industrially ultraprocessed diets powerfully promote oxidative stress and excessive inflammation and insulin resistance, the key conditions that reverberate across all metabolic and mental illnesses.
Ede reasons that taken for granted ideologies concerning the alleged health risk posed by unprocessed meat and eggs, fat and cholesterol promoted for fifty years by government guidelines, when scrutinised closely, are less evidence-based than maintained. Ede claims that ‘unscientific research methods drive fickle nutrition headlines and illogical dietary guidelines’ to influence public belief about what food groups are risky or healthy.
Ede zeros in on the narrative formation of guidelines through population level studies in nutritional epidemiology, and questions why a extraordinary body of reliable information across the fields of ‘anthropology, anatomy, biochemistry, physiology, neuroscience, animal husbandry botany and toxicology’ – have been sidelined.
Ede’s section on ‘dietary madness’ lays out the extent to which ultraprocessed foods are embedded in western diets. UPFs promote inflammation, and ‘chronic brain inflammation plays a significant role in many psychiatric disorders.’ Ede states
‘Oxidative stress plays a role in depression, anxiety, bipolar disorder, psychosis, and neurodegenerative conditions such as Alzheimer’s disease’
Ede outlines in fascinating detail how firstly by driving high blood glucose and insulin resistance; and secondly from exposure to chemically refined vegetable oils drive inflammation and oxidative stress, and the remarkable differences in brain biology that can increase risk for mental disorders.
As with Palmer, Rucklidge and Kaplan, Ede draws attention to metabolic pathways, and the complex triggers and feedback loops that promote deficiencies in certain nutrients; while also disrupting hormone production through knock on, or cascading effects.
For example, inflammation and oxidative stress alter the way the brain uses the amino acid tryptophan, which is involved in serotonin and melatonin production. However, tryptophan is also involved in the regulation of the most ‘abundant and widespread neurotransmitters in the brain’ glutamate and GABA.
‘Glutamate imbalances are a feature of many psychiatric disorders, including depression, biopolar disorder, schizophrenia, obsessive-compulsive disorder and Alzheimer’s disease.’
But is there evidence that moving away from high-carbohydrate, ultraprocessed food will help? Ede cites a 2022 review which found that inflammatory markers reduced substantially when diets moved to a low carbohydrate diet.
Another well-argued point is that conventional medicine tracks glucose levels but fails to focus on insulin resistance – because ‘persistently high insulin levels set the stage for most of the diseases we dread’, with insulin resistance going unrecognised in most people.
With insulin levels in mind, Ede extends her focus to explain why many commonly consumed foods included cereals and grains, and various fruit and vegetable types might need a rethink for people who are struggling with their mental and metabolic health. Ede cites a study which demonstrated how instant oatmeal led to adrenaline surges in boys four hours later, but that also over those hours those boys also felt hungrier, and consumed more calories.
But of course, it is not just adrenaline, falling glucose triggers the release of cortisol.
‘Unstable or overactive cortisol is a common feature of many psychiatric conditions including depression, anxiety, insomnia, bipolar disorder, schizophrenia, post-traumatic stress disorder and dementia.’
It’s not just sugar:
‘Bread, potato chips, pizza, pretzels, and polished grains are all high in refined carbohydrate and can be just as addictive as candy.’
Because for Ede meat is the original superfood, and vegetarians can adopt .
THE BETTER BRAIN (2021)
This accessible book has arisen after decades-long research by Professor Julia Rucklidge (University of Canterbury, New Zealand) and Professor Bonnie Kaplan (Professor emeritus, University of Calgary), exploring neuroscience, psychology and the role of broad-spectrum multinutrient supplements in alleviating common disorders including anxiety, depression, ADHD and stress.
The Better Brain is an information-rich tool which can be utilised to shift our social and cultural focus from food as fuel, to food as critical to the metabolic and chemical processes required for optimum brain function.
All too often public conversations tend to conflate fuel and ‘energy’ with generic carbohydrate energy, and downplay or ignore the nutrients that are vital to support metabolic and mental health.
The authors provide ample evidence that nutrition impacts mood - from reducing irritability, aggression and emotional dysregulation all the way to improving cognition and learning and reducing addictive impulses.
An often unarticulated concept is the issue of resilience. Resilient people can often cope with stressful events better. They appear less traumatised over the longer term, recovering more quickly.
Rucklidge and Kaplan provide a unique perspective, which enriches the nutrition and mental health ‘debate’. The scientist-researchers have not merely studied diet and nutrition, but have scientifically researched the impact of broad-spectrum multinutrient supplementation.
Multinutrient formulations can be layered on top of healthy dietary changes; can support dietary changes or can be used by people who struggle to, or are unable to, make substantial dietary change. Common side effects experienced when taking many psychiatric drugs are not experienced by people taking multinutrient formulations.
The Better Brain centres around a oft-neglected fact – the brain is ‘greedy’ or ‘hungry’.
While only occupying some 2-3% of bodyweight, the brain demands 20% of average energy intake. The brain is not just greedy for carbohydrate energy, but for essential micronutrients – vitamins and minerals.
Demands on the brain spike in times of stress and trauma, and in times of growth - just when clinicians often observe increases in mental illness and disorder, and struggles with cognition.
When the average standard diet is nutritionally deficient (which it is in Western populations) the brain will be effectively starved and unable to optimally function - then, in peak times of stress, tipping points can arrive faster and harder.
Impaired neurological function is therefore, an inevitable outcome of deficiency. The rapid increase in mental illness over the past four decades parallel the decline of home cooking and the increased consumption of ultraprocessed food.
The Better Brain thoughtfully outlines many of the underlying drivers that have contributed to a failure to recognise ‘the missing key for mental health’. The power of the pharmaceutical industry; nutrient poor foods; the Western industrial diet; and the challenges in recognising that diet predominantly drives poor mental health, rather than the reverse.
Conventional western diets are, all too often, broadly deficient, and our bodies require broad mixtures of nutrients for optimum function.
The Better Brain provides a critical layer of scientific knowledge – for many people dietary changes are all that is needed to reverse mental illness. However, Rucklidge and Kaplan outline why for many people a well-balanced diet can be sufficient to maintain mental health, but emphasise that some people may need higher amounts of multiple nutrients.
They may not absorb nutrients efficiently, they may have, for example, an under-functioning gene that results in underproduction of a critical enzyme which might be central to neurotransmitter function or they may be exposed to unavoidable and persistent stress that requires higher supplementation.
But Rucklidge and Kaplan stress that we can never cherry pick ‘favourites’ in nutrition. Our bodies and brains are complex and so nutrient-dense whole food is critical, as are broad-spectrum multinutrient formulations specifically designed to reflect brain nutrient demands.
Rucklidge and Kaplan’s work provides critical insight into the underpinning drivers of resilience. Their work may also indicate why our children and young people, who by and large are not exposed to trauma or abuse, appear increasingly unable to cope with life’s everyday stressors.
The role of multinutrients and resilience was highlighted by the authors’ research into traumatic life events – earthquakes, flooding, and the 2019 Christchurch (New Zealand) mosque shootings. Research during these events determined that better nutrient levels in people promoted resilience in times of trauma and stress. People’s sleep improved more quickly and they coped better.
This is a key point – as human life has always involved exposure to tragedy and stress. What the researchers found is that those supplementing with a broad-spectrum nutrient formulation had improvements in depression, anxiety and stress.
Earthquake (and aftershock) victims recovered generally more quickly on multinutrient formulations and rates of post-traumatic stress disorder (PTSD) in the treated groups dropped much lower than in the untreated group.
‘Although everyone experienced heightened anxiety and stress just after the event those who were taking the nutrients at the time of the earthquake recovered more quickly than those who weren’t’.
Patients who were taking nutrients before the mosque shootings could be studied alongside others not taking the multinutrient formulations. The researchers observed:
‘the exact same treatment effect that we had seen after the earthquakes and the flood. Not everyone got better, but many people did’.
The researchers were astonished to find that the multinutrient treatment resulted in 70% of people going into remission from PSTD, a finding that is rarely observed with conventional treatment.
Controversially, Rucklidge and Kaplan recommend counselling and family therapy after nutritional changes, including supplementation are undertaken. This is because they have been told by trial study participants that:
‘they were not able to absorb and/or implement strategy taught in therapy until after their thoughts had cleared following better nutrition. … Knowing that ‘pre-treatment with nutrition and supplements helps with resilience and clearing people’s brain fog is why we urge mental health clinics to begin all new referrals by educating about nutrition and mental health, teaching them to shop for wholefoods, and even holding cooking classes.’
The Better Brain can be read by scientists, educators, and laypeople. It lays a policy foundation for bringing evidence-based multinutrient formulations into general practice.
The Better Brain helps laypeople and clinicians alike to ask, why, if the data is sound, the evidence compelling, aren’t these formulations an option for children and young people as a first step when mental illnesses or disorders are first diagnosed by general practitioners?
When the absence of side effects are considered, they appear to be a soundly based, and ethical, first step for our young people.
BRAIN ENERGY (2022)
Harvard psychiatrist, Assistant Professor Chris Palmer’s 2022 book Brain Energy is a densely referenced treatise on how the metabolic conditions in the body set the stage for poor mental health.
His paradigm shifting assertion is that people presenting in front of doctors and clinicians are presenting with a disordered metabolic and mitochondrial system. The brain is the most sensitive to energy deprivation, so it will be most sensitive to impaired mitochondrial and metabolic function.
Palmer’s book is purposely intended to upend the paradigm that mental illnesses are exclusively to do with poor neurotransmitter function. He emphasises the consistency with which people presenting in front of a clinician with psychiatric problems also ordinarily present with metabolic problems, and that multimorbidity is the norm.
Palmer asserts that the relationship between metabolic and mental health is intricately bidirectional. He emphasises this by drawing attention to the relationship of mitochondria, the master regulators of the metabolism and brain health who influence the development, functioning, maintenance and end life stages of all cells – including brain cells.
Most people who are diagnosed with one mental disorder will normally have multiple diagnoses, and they will commensurately have poor metabolic function. Palmer considers that it is metabolism, not neurotransmitter function that should be consider the ‘lowest common denominator in all mental disorders.’
As Palmer states ‘the Human Genome Project’ did not pay off in psychiatry –
‘researchers found a plethora of genes that might be related to psychiatric disorders, but they found almost no genes that confer significant risk to a significant portion of the people with the disorders.’
Palmer maintains that the risk genes which are implicated in psychiatric disorders, are often associated with mitochondrial and metabolic function. Such an example is the mood disorder risk gene CACNA1C which ‘plays a major role in oxidative stress and mitochondrial integrity and function.’
Discussions concerning the extent of comorbidities that are suffered by a patient may be downplayed, but Palmer emphasises that it is critical to acknowledge these strong associations and the evidence they are driven by environmental factors which impair metabolic health. Chronic pain for example is experienced by 50% of people with depression. Half of people diagnosed with any mental disorder will have more than one’ with depression and anxiety common commonly diagnosed together.
Palmer also emphasises the problem of treatment failure. Professionals ‘don’t tend to advertise what isn’t working’. For example, depression, for most people is a long-term, fluctuating illness.
‘Many people go on to suffer for years, despite trying treatment after treatment’… Palmer continues ‘disorders like OCD (obsessive compulsive disorder), autism, bipolar disorder and schizophrenia are all at least as bad as depression in terms of both treatment success and the chronic nature of their afflictions.’
Palmer goes deep into explanations about feedback loops and relationships that are often not recognised. For example, insulin receptors are found throughout the brain, and insulin resistance can occur in the brain. As well as regulating whole body metabolism and a whole lot of other factors including appetite and reproduction,
‘brain insulin modulates neurotransmitter activity and mitochondrial function within brain cells.’
Palmer cites research that suggests a path – insulin resistance might come first, then the mitochondrial dysfunction, and then the psychosis. Palmer then discussing a study of 15,000 children where fasting insulin levels were measured at ages nine, fifteen, eighteen and twenty-four, the final year of the study.
‘Children who had persistently high insulin levels (a sign of insulin resistance) betting at age nine were five times more likely to be at risk for psychosis, meaning they were showing at least some worrying signs, and they were three times more likely to be already diagnosed with bipolar disorder or schizophrenia by the time they turned twenty-four’ (p.205)
Palmer’s book is dense with references. For Palmer, healing and remission of psychiatric illness is unlikely to arrive without a comprehensive treatment plan that includes dietary changes.
Palmer’s recommendations reflect the other authors. Dietary changes, Palmers stresses, involves adaption and then coming to terms with given dietary (metabolic) intervention/s and maintaining it with necessary changes. If interventions are stopped a withdrawal reaction should be expected.
Palmer finishes with this call to action:
‘We need multidisciplinary healthcare teams working together to restore metabolic health in people. These teams with include physicians, nurses, psychotherapists, social workers, physical and occupational therapists, pharmacists, dieticians, personal trainers, health and wellness coaches and many others.
Health insurance will need to cover some of these costs. The biotech and pharmaceutical industries will need to rise to the challenge of developing more effective therapeutics.
Government will need to be involved. We need research funding for all this work and parity for mental health services. We may also have metabolic toxins in our everyday lives that need to be regulated and/or eliminated. And of course, each and every one of us will need to do our part as well. We need self-help groups, support groups, and advocacy initiatives.’
All doctors emphasise that no changes to prescription medicine should ever be made without consultation with the patient’s medical doctor.
Who better to lead a fundamental change to mental health treatment than New Zealand, the test-bed for big tech due to New Zealand’s small population and OECD status.
Could New Zealand be a test-bed for a paradigm restructure on how society frames mental illness and disorder - and how the public and private sector work together to fundamentally change an approach to prevention and treatment?
When it comes to children and young people - is there an ethical imperative that such changes take place?
Is it time to update New Zealand’s mental health policies?