- IS IT A 'CURE-ALL' FOR MENTAL ILLNESS?
Plesman, BA(Psych), Post Grad Dip Clin Nutr
The Hypoglycemic Diet has often been dismissed as a
¡®one-fit-fits-all¡¯, remedy for depression. This appears to please the
pundits who wants to emphasize the complexity of depression. Such labels
have seldom been used to describe therapy by single or even multiple
drugs, such as the mantra that ¡°it is all in the mind¡±.
Thus we need to consider how a hypoglycemic diet compares with other
more conventional therapies.
If depression is caused by any of the multitude of medical conditions
that has depression as a comorbid condition, then the hypoglycemic diet
cannot be considered a ¡®cure-all¡¯ for these conditions, but could
perhaps improve symptoms. Such diseases as hypothyroidism,
hyperthyroidism, fibromyalgia, coeliac disease, ulcerative colitis,
peptic ulcers, Crohn¡¯s disease, food sensitivities and allergies, heavy
metal intoxication, arthritis, rheumatoid arthritis, bipolar disorder
and schizophrenia to name just a few, need medical attention. There are
many other medical diseases associated with depression. See:
Psychiatric Presentations of Medical Illness by
Ronald Diamoind MD
Thus in certain forms of depression, as occurs in Bipolar Disorder and
Schizophrenia, the administration of drugs may be inevitable, although
it could be combined with the hypoglycemic diet to improve symptoms.
Neither would it apply to ¡®environmental¡¯ depression, brought about by
grieving, divorce, rejection by loved-one or any other type of trauma
resulting in depressive symptoms. Here environmental stressors cause
stress hormone to interfere with the synthesis of neurotransmitters -
our ¡®feel-good¡¯ hormones. This could cause ¡®environmental¡¯
Strickland PL et als. (2002)
When the environmental stress has been removed or a person recovers from
grieving, the body soon starts to produce the ¡®happy¡¯ neurotransmitters
again, and life seems to go back to normal.
It is when a person does not recover from depression - let us say in six
months after the trauma - that we have to consider a diagnosis
depression. Most of the time a depressed person in the absence of
environmental stressors doesn¡¯t understand fully why he/she is
depressed, which is one of the criteria that brings him to a therapist.
Most depressed people, when they attend their first interview with a
therapist, are offered a choice of only either drug therapy and/or
It is logical that if depression has a physiological basis that drug
therapy is a reasonable option, especially, if the depression is very
acute. But it is also generally accepted that drug therapy does not seem
to address the underlying biochemical disorder, seen as being
responsible for depression. In some quarters serious questions are being
raised as to the effectiveness of drugs. Many switch from one drug to
another in an attempt to find a better solution to their problems. This
could well be because biochemical imbalances are not necessarily the
cause, but should rather be seen as symptoms of mental illness.
As an alternative or in addition patients are offered a course in
psychotherapy, on the assumption that depression is really due to a
person being engaged in negative thoughts and attitudes, that can be
altered by a series of psychological counselling sessions. It is assumed
that the causes of depression can be removed by changing a person¡¯s
attitudes and beliefs and confronting irrational thoughts and negative
thinking styles by for instance Rational Cognitive Behaviour Therapy (RCBT).
It is believed the patient can then safely withdraw from drugs and lead
a more normal life. One important question remains unanswered; how can
talk therapy ¡®cure¡¯, what is basically a physical disease?
No doubt there will be ample evidence in support of this approach. But
the reality is that for many if not most depressed patients either drug
therapy and/or psychotherapy simply does not work.
We need to find a solution for this sub-category of patients.
One alternative is to use ¡®natural¡¯ remedies, such as St John¡¯s wort,
tryptophan, 5-HTP, DHEA,, and many nutritional supplements such as
L-tyrosine, vitamin C, B-complex vitamins, Ginkgo biloba, kava and many
others that have by some studies proven to be beneficial to depressed
Natural remedies used as drugs, like their pharmaceutical counterparts,
have about the same success rate (or perhaps less) as drug therapy,
except that ¡®natural remedies¡¯ are milder and have fewer side-effects.
There seems to be very good biochemical reasons why these remedies have
shown to be so unsuccessful in treating endogenous depression.
These treatments are what I call ¡°one single bullet¡¯ remedies. Drugs try
to target certain biochemical imbalances in serotonin and norepinephrine
production, by inhibiting the reuptake of these neuro chemicals. This
causes an increase in these chemicals in the brain. St John¡¯s wort works
in the same manner and thus operates as herbal SSRI. Thus they aim at
specific faulty biochemical mechanisms.
A very well-documented natural antidepressant remedy is SAM-e (S-adenosylmethionine).
This chemical, that can be bought as a supplement, is naturally produced
in the body from
methionine - an essential amino
acid - if combined with a molecule of energy -
ATP (Adenosine triphosphate).
Its antidepressant activity is due to the fact that it contains a methyl
group (CH3), which when donated to another chemical, alters its shape
Methylation is important in the
synthesis of neurotransmitters such as serotonin and norepinephrine,
well-known mood regulators. Yet, apart from the fact that it is very
expensive, many people do not benefit from SAM-e, again because it is
one of those ¡®single bullet¡¯ remedies, that may miss the
biochemical target, responsible for depression.
SAM-e is converted to homocysteine, a substance that in excess, has been
associated with a greater risk of cardiovascular diseases. It needs to
be converted either to cysteine - and form part of an important
antioxidant enzyme - with the help of vitamin B6. Or it can be
reconverted back into methionine, with the help of vitamin B12 and folic
acid or trimethylglycine (betaine contained in choline).
Thus a person using SAM-e has to have a fairly healthy diet to start off
with to benefit from SAM-e.
But there are many other nutritional supplements that could dispel
depression. Serotonin is produced from
tryptophan (found in food) with
the help of
vitamin B6 and
magnesium. Thus a deficiency of
tryptophan due to a low protein diet (high junk food diet) could cause
depression. What happens if we are deficient in B6 and magnesium
required in serotonin synthesis??
The biochemistry of depression is far more complex than can be handled
by ¡®single bullet¡¯ remedies. Vitamin B6, as with all other vitamins and
minerals, plays a major role in biochemical reactions. Nutritional and
biochemical imbalances could cause havoc with our health and mind.
For example, vitamin B6 must be converted to an active form called
pyridoxal-5-phosphate (P5P), before the body can use it in chemical
reactions. The enzyme responsible for this conversion (pyridoxal kinase)
is zinc dependent. And zinc absorption in turn depends on ample supply
of the biological active form of vitamin B6. This is because zinc is
absorbed in combination with picolinic acid, produced in the pancreas
from tryptophan with P5P (vitamin B6) as a coenzyme.
When people use SSRI drugs for depression, the body
stops producing natural neurotransmitters of its own. This is done by
inactivating the very same enzyme that converts vitamin B6 to P5P. Hence
in the absence of active B6 natural synthesis of serotonin is
interrupted. Because serotonin is also involved with appetite
regulation, this could explain why many AD medications have weight gain
as a side effect.
There are other nutrients, deficiency of which are directly responsible
for depression. If vitamin B3 (niacin) is deficient, the body will use
tryptophan to synthesize B3 at the rate of 60 to 1, leaving little for
serotonin production. Niacin supplementation has miraculously cured
depression in some people. Some people just happen to have a high
requirement for niacin.
There are other nutrients and non-nutrients too numerous to mention here
that affect depression and mental illness. See
Werbach Page 123.
And then consider that all these chemical reactions need energy in the
form of ATP. With inadequate amounts of ATP, the body cannot produce
SAM-e, nor can it convert vitamin B6 to its biological active form, all
requiring ATP. (There are several forms of B6)
An active healthy cell uses 2 million molecules of ATP per second to
energize the biochemical machinery of a cell. And ATP is the end-product
of glucose metabolism (glycolysis) ultimately derived from food. Thus
people with insulin resistance (hypoglycemia) are unlikely to produce
adequate amounts of SAM-e or P5P and others, all essential in the
synthesis of neurotransmitters..
The brain, representing only two percent of the body, requires 75 per
cent of all available glucose (ATP) in the body as its only source of
energy AT ALL TIME, whether asleep or awake. (Stryer
Page 438). Thus unstable and wildly fluctuating blood sugar levels to
the brain would have unforeseen ¡®psychological¡¯ consequences. Erratic
supply of biological energy to the brain causes it to send stress
hormones to the adrenal glands in the form of adrenaline and cortisol in
an attempt to rebalance energy supply. These internally driven stress
hormones - produced in excess - are seen as the symptoms for depression,
anxiety attacks and other abnormal psychological experiences.
Having regard to the complexity of the biochemistry of mental illness,
it is obvious that the ¡®single bullet¡¯ remedies in the form of either
single drugs or nutrients is bound to fail in the majority of cases. In
fact, these ¡®single bullets¡¯ may be expected to further disturb the
delicate interplay and equilibrium among biochemicals in the body.
What is needed is NOT ¡®single bullets¡¯ but a
¡®shotgun¡¯ remedy supplying all the bullets that will target
Such a remedy could well be the
Hypoglycemic Diet. This diet can
be defined as a NATURAL diet, supplying all the necessary ingredients
for the body to manufacture the right neurotransmitters. It is specially
adapted to overcome unstable blood sugar levels- common among depressed
people - as well as erratic insulin and stress hormones. This diet does
not conflict with drug therapy and may even overcome some of their side
The human body is a complex and very adaptive system. It will adapt to a
toxic environment given the time, but when it exceeds the boundaries of
tolerance, the body will inevitably break down. The most sensitive organ
- the brain - will be the first to suffer the effects. But
also given the time it will readapt to a healthy nutritional environment
that will restore the balance nature intended for living creatures on
The body appears to be wiser than the brain and will choose and pick
those ingredients from the environment best suited to its needs. A
natural diet will restore both physical and mental health and over time
will make drugs superfluous for our happiness.
One may wonder after all whether the hypoglycemic diet - unlike the
simplistic remedies on the market - could be seen indeed as an
¡®one-fit-fits-all¡¯ remedy for mental illness. Perhaps it may not be a
¡®cure-all¡¯, but ¡®cure-many¡¯ remedy.
At least it is food for thought.