We have long been told that “low levels” of serotonin in the brain equal bad and sad, and we have been educated by the Pharmaceutical industry about the opportunity we have, through the use of antidepressants, to retrain our wayward neurons: by making the proverbial holes in the strainer that much smaller. But even if you accept the conventional wisdom regarding the role of serotonin in the narrative of mind, merriness, and misery, from where do we think that this magical neurochemical arises?
The amount of man-power, mind-power, money, and potentially some well-intentioned vision that goes into the development of a pharmaceutical is truly humbling, and largely compensated for during the life of a given drug’s patent. At this point in my career, though, their creation often strikes me as akin to constructing an elaborate, high-tech mechanical arm to hold up a drooping, dying flower, rather than first attempting to provide it the water and sunlight we know it needs. How is it that we strayed so far from a basic understanding of our fundamental human needs – nourishment, sun, water, air, companionship and community – that we endeavor to work around them and to repair associated damages with technically complex interferences?
Science and the expansion of knowledge are what inspire me and get me going, every day of my life. I also appreciate that with science comes dogma, the influence of its own interpretation, and a zealot sentiment that can undermine its more objective nature. Our science is only as complex as our reason can support, and I appreciate that we may each be feeling the legs of an elephant, in the dark, describing monolithic towers until someone turns on the lights and we see the animal in its full embodiment. We have been wrong countless times in our history.
Our knowledge has awaited quantum leaps in comprehension that render previously espoused beliefs almost childishly silly. In our haste to master information, we often devote ourselves to half-truths and obscure the vacuous gaps in our understanding. We have had doctors recommend cigarettes for asthma, and knowingly withholding treatment from syphilitic African Americans, not to mention other atrocities such as forced sterilization and eugenics. Because of the industrial medical complex, Americans are often late to acknowledgements of these government-sanctioned mistakes.
For these reasons and more, I have developed a passionate allegiance to the precautionary principal, to first, doing no harm. The only ethically sound posture to assume is one that questions interventionist standards and relies on truly informed and active consent. As Bruce Lipton discusses in the Biology of Belief, if there are “exceptions to a theory”, it means that the theory is incorrect, or at least incomplete. These exceptions cannot be ignored. Quantum physics as a model for the non-linear reactions that drive the complexity of our being, begins to expose the A causes B, reductionist viewpoint as woefully inadequate. What happens when entire medical paradigms are based on A causes B? How can we say, “oops, we had it wrong” when scientific truths continue to emerge?
Considering the reality that iatrogenic illness is now one of the leading cause of death, accounting for hundreds of thousands per year, it’s time we find a way to swallow our pride when outcomes dictate. But should we wait for outcomes? What about prevention? What about supporting the system before it breaks down?
To many of my physician colleagues, “prevention” means statins, mammograms, and a low fat diet. The concept of prevention, as represented to budding doctors, is easily dismissed in a curriculum buckling under the weight of anatomy, physiology, and pharmacologic mechanisms. Yeah, yeah, yeah, “watch your diet and exercise more”. What if we were able to better identify early markers of dysfunction in the body (not just the brain) and work to correct those imbalances through support of the parasympathetic nervous system, diet, and targeted nutraceuticals?
Those abreast of trends in the medical literature will know that the monoamine model of depression is now being quietly ushered out the back door as stress and its influence on the hypothalamic pituitary axis and inflammatory markers are being given their moment in the spotlight. Studies are currently aiming to better elucidate psychiatric manifestations of derailed hormonal and metabolic processes.
When the redox balance of the system is overwhelmed, mitochondrial function is impaired, cell membrane structure and stability compromised, and associated messages communicated between cells become disordered. Tryptophan catabolism is induced by inflammatory cytokines leading to the formation of quinolinic acid. Quinolinic acid is the bridge between the brain and the immune system – a bridge we used to think didn’t exist. This enzymatic step (IDO) is stimulated by glucocorticoids and even vaccine-induced viral exposure and pthalate exposure.
Abberant immune responses may even be responsible for criteria-meeting cases of schizophrenia. This is how essential looking outside the brain is. Our immune systems are failing and taking our brains down with them.
You will even find studies like this one, attempting to use, once again, pharmaceuticals to resolve this “problem”. The answer to resolving systemic imbalance is not in a pill, and there is not a blanket intervention for all people. It’s more complex than even just improving inflammatory markers such as cytokines, CRP, and homocysteine, and that’s why I tend to default to allowing our bodies to re-equilibrate through diet and stress management. Perhaps the best living example of this is Dr. Terry Wahl’s TED talk, an inspiration and reminder that we don’t know all that much about human physiology and what we think we know can sometimes lead us down a path of harm.
Perhaps the greatest reveal of the limitations of our scientific dogma was the grand anticlimax of the Human Genome Project. With the successful sequencing of a mere 25,000 genes (10,000 more than a fruit fly!), scientists were forced to recon with the inadequacy of the gene-to-disease model and to accept that genes alone cannot possibly account for the complexity of human health. Enter epigenetics.
Here we have the opportunity to explore a second chance. Our best insights into the factors that influence modification of DNA expression come from the study of methylation, histone and chromatin modification. The integrity of gene-expression is just one process that is susceptible to nutrient availability and toxin disruption. Activity of essential fatty acids and maintenance of the gut microbiome also have “top-down” effects on expression of health and disease.
These effects have turned out to be transgenerational. That caught my attention. In my work with pregnant patients as a perinatal psychiatrist, my conventional training is in attempting to glean evidence of safety or harm from imperfect studies of gestational and lactational exposure to psychotropics. It became clear to me that studies that demonstrated high rates of relapse might reflect a phenomenon of pulling the rug out without checking the floorboards beneath.
This discontinuation risk is eloquently addressed in Anatomy of an Epidemic, but often providers and patients alike believe that the post-med distress is a sign of symptoms breaking through, rather than a complex reflection of décor that came to rely on that particular carpet. The practice of treating these women became rather reductionist – to medicate, or not – but an elaborate informed consent of several hours was, nonetheless, undertaken.
I felt that I needed to be able to offer a third path, a different perspective. I also felt frustrated by the lack of safety data, or even gestures toward the accumulation of safety data in the industrial chemical world, and in other arenas of medicine including infectious disease and the bold recommendation of flu shots to my patients. I sought to apply a functional medicine approach, and to support the body’s innate wisdom while minimizing interference within the framework of the patient’s preferences.
So, how do we support that innate wisdom? First and foremost, through a nutrient-dense diet, preferably, one that provides a plethora of essential nutrients. As Cate Shanahan discusses in Deep Nutrition, and Weston Price observed in his global efforts to quantify the most health-promoting diet, an omnivorous diet is one that best supports the information our genes are expecting to receive. Fat soluble vitamins, minerals, probiotics were all available to our ancestors well before the industrial revolution. Organ meats were sought out, and the explosion of nutritional sustenance was evidenced by the apparent ability to fast in ways that our snack-driven culture can’t even fathom. A high vegetable, whole food starch, natural fat and protein diet provides the amino acid and fatty acid precursors we require to sustain brain and gut function.
The relationship between the two is quite essential, as detailed by Natasha Campbell McBride in Gut and Psychology Syndrome. In addition to housing some 70% of our immune system, the gut is host to an ecosystem responsible for the breakdown of nutrients, absorption, production of vitamins, elimination of hormones and toxins, and cellular signaling. Intestinal permeability, growth of disruptive bacteria, and poor nourishment of epithelial cells all compromise the essential functions of this highly active “lining”. McBride theorizes that this abnormal flora is passed from mother to child, and perpetuated by poor diet and toxic exposures such as antibiotics.
The Modern Dish
What is a poor diet? Well, it starts with the soil and its disordered microbiome. The soil matrix, teaming with all manner of microorganisms also serves to support its vegetative inhabitants in a symbiotic manner. When the soil is compromised, as is the case in modern farming methods, the food grown in that soil is compromised. The animals we eat no longer have a natural relationship to the plants grown in that soil and have tissue toxified with medications. Those plants and animals are then processed, cooked at high temperatures in rancid, oxidized vegetable oils and served with other refined, highly preserved foods as accompaniment.
The experience we are typically left with, metabolically, is one demanding of hepatic detoxification and neutralization of foreign compounds, minimal micronutrient repletion, and an insulin spike from sugars and refined carbs with its attendant inflammatory cascade and subsequent mood-altering reactive hypoglycemic dip. Sugar accounts for a significant percentage of the symptomatic profiles I see in my office, and for much of the systemic inflammation that accompanies those symptoms.
Advanced glycation end products are responsible for disordered functioning of proteins and tissues in our body as they meld together in crusty crosshairs. Insulin activates phospholipase A2, slicing up our essential cell membranes, freeing pro-inflammatory mediators. Our cell membranes and associated essential fats are either overly rigid, deprived of cholesterol and saturated fat, or overly fluid, lacking essential integrated protein support. Our brains, after all, are 60% fat, and none of that is the yellow fat in the “heart healthy” imitation spread.
When industry seeks to improve upon nature, we must remain skeptical and put the burden of proof on those corporations to assure us of long-term safety before we sign up for that experiment pro bono. Genetically modified foods and the implicit assertion that we know enough about the incorporation of engineered DNA into our cells is a preposterous notion. Not only do we lack the basic understanding of how our cells interact with non-human DNA, the overwhelming likelihood is that this practice would interfere with the highly sophisticated process of cellular transcription. Isn’t that obvious? These efforts and those that have brought us Frankenfoods with long- shelf lives serve to protect the bottom line of food corporations. What is more astounding is when the medical community colludes in endorsing these processed products as representing a healthy diet.
And if you wouldn’t eat it, should you be slathering it on your skin? What about the 85,000 substances registered in the Toxic Substances Inventory, only 200 of which have been even looked at for safety? Data is emerging to support the deleterious effects that these endocrine disruptors and neurotoxins have on fetal and child development, once again, we must participate in a vast experiment for which we were not properly consented. Autoimmune disorders are slated to affect 25% of the American population, and every diagnosis in this poorly understood arena carries with it psychiatric manifestations. The stimulation and bombardment of our self/other detectors with ever escalating levels of molecular mimics can switch on a defense that leads to self-destruction.
The unintended consequences of mass marketing of pharmaceuticals including direct-to-consumer advertising often take decades to unfold, and in some instances tens of thousands of lives (Avandia, Vioxx, etc). These companies represent a for-profit enterprise beholden to shareholders, using the power of their dollars to influence policy makers and pundits. I have concerns about the subtle impact of some medications on long-term functioning and the perpetuation of chronic disease. Examples such as oral contraceptives, proton pump inhibitors, statins, and psychotropics encompass an array of medications best employed sparingly, in a targeted manner, and for strict indications after a patient consent.
- The digestive process and its primary role in rendering the information in our food accessible to our DNA cannot be simplified without secondary offense. The intricacy of B12’s absorption is one instance in which we see the carnival-like pop the weasel effect of suppressing stomach acid.
- It seems that we have collectively forgotten the many essential roles of cholesterol beyond its now dubious role in artery clogging. How can it be in the best interest of healthy individuals to suppress natural production of cholesterol – and sex hormones, bile acids, vitamin D, cell membrane integrity? Why is hypocholesterolemia correlated with affective disorders? Could pharmaceutical companies have missed the forest for the trees?
- OCPs, which many women perceive as a symbol of feminist liberation, may represent quite the opposite. When we better appreciate the micronutrient toll these synthetic hormones take on our physiology, and the question of increased oxidative stress , we may look more kindly upon the old barrier method.
- Can psychotropics have deleterious effects on mitochondrial function?
Who are the canaries in the coal mine? How can we know? In my practice, I screen patients for genetic polymorphisms, inflammatory markers, vitamin levels, autoantibodies, fatty acids, and organic acid markers of mitochondrial dysfunction. This gives me a small glimpse through the keyhole so that I might better tailor some reparative interventions. Heal the body, nourish the body, and the mind will follow.
Before we wait for inventive researchers and enterprising pharmaceutical companies to fix what is broken, perhaps we should start with supporting our native complexity, our body’s innate wisdom, and the examination of barriers to health in physiology and psychology. This requires reworking society’s perception of healing, of symptom tolerance, and of an individual’s agency in her own health and wellness. It implies a mandate to expose evidence-based medicine for the corruptible enterprise it is and resetting checks and balances between science and industry so that patients are not field test subjects.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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