Metabolic Health has Strong Links to Mental Health Issues
By Dr. Ron Hunninghake, MD
Mental health is a significant challenge for many Americans. According to the National Institute of Mental Health, as many as 20 percent of adults in the United States experience a mental illness. Mental disorders can include anxiety and depression or more severe conditions such as schizophrenia and bipolar disorder.
Mental and Metabolic Health
Studies have consistently shown that patients with mental health disorders have a higher risk of metabolic syndrome than the general population. As we have previously described in this newsletter, metabolic syndrome is defined by having three or more of the following conditions:
- Obesity or excess abdominal fat: Usually a waist circumference of 40 inches for men and 35 inches for women
- Elevated blood pressure: Equal to or higher than 130/85 mmHg
- High blood sugar: Fasting blood glucose of 100 mg/dL
- Dyslipidemia: Abnormal lipid levels in the blood, especially high triglycerides (150 mg/dL or higher) and low levels of HDL cholesterol (lower than 40 mg/dL in men and 50 mg/dL in women).
- Insulin resistance: A key factor in metabolic syndrome
The journal JAMA Psychiatry found metabolic syndrome in nearly 33% of patients with schizophrenia after analyzing 61 studies in an article published in 2017. Metabolic syndrome is also associated with bipolar disorder. A review published in 2019 in the Journal of Affective Disorders found that nearly 38% of bipolar patients also had metabolic syndrome.
These articles represent two specific conditions, but there is reason to be concerned about the overall relationship between mental and metabolic health. Metabolic syndrome can add to the overall burden of mental illness and increase the risk of heart disease and other health complications. Managing metabolic risk in psychiatric patients can include lifestyle changes, regular screenings, and medical management when necessary.
Metabolic Syndrome and Recovery
Unmanaged metabolic syndrome can clearly impact a mental health patient’s ability to recover. First, the medications often used to treat mental health conditions can contribute to metabolic issues, such as weight gain, abnormal blood lipid levels, and insulin resistance.
It can also put any patient at increased risk of heart attacks and strokes, which psychiatric patients may be more vulnerable to because of their underlying mental health condition. Additionally, metabolic syndrome symptoms, especially insulin resistance and inflammation, have been linked to cognitive impairments. This can affect a patient’s ability to engage in therapy and treatment plans to effectively manage their symptoms and daily life.
Metabolic syndrome can contribute to a lower quality of life and have a psychological impact in itself. The physical discomfort, chronic health conditions, and lifestyle changes and restrictions associated with metabolic problems can impact day-to-day functions, social interactions, and overall well-being, which can in turn worsen mental health problems.
At the Riordan Clinic, we work to find the root causes of all our co-learners’ conditions, including addressing the underlying cause of metabolic syndrome as it relates to mental health. Surprisingly, the modern medical approach to treating mental health issues typically fails to factor in metabolic dysfunction as a major contributing root cause of chronic mental illness. Psychological and/or emotional factors are all too often the tip of the “mental illness iceberg.”
Addressing metabolic syndrome in psychiatric patients requires an integrative approach with both mental and physical aspects. Effective treatments can include a combination of medication management along with lifestyle changes such as a healthy diet and regular exercise, monitoring the metabolic parameters, and collaboration with mental health and primary care providers.
A metabolic approach to treating mental health issues does not eliminate the need for medication, but it can broaden the treatment to identify deficiencies and imbalances of key nutrients, including vitamins, minerals, and amino acids.
These imbalances can disrupt the proper functioning of the hormones and neurotransmitters, such as adrenaline, dopamine, and serotonin, that are typically associated with mental health disorders, including depression, anxiety, and ADHD.
Nutrient-depleted and toxin-altered biochemical pathways in both the brain and in the gut are now scientifically demonstrated as underlying causes of disrupted brain functioning.
Managing metabolic syndrome more effectively can give patients better outcomes and a better chance at achieving well-being in their psychiatric recovery journey.
A Case Study
In his book “Brain Energy” Dr. Christopher Palmer, MD, a Harvard University psychiatrist, wrote about Tom, a 33-year-old man with schizoaffective disorder — a cross between schizophrenia and bipolar disorder. He had suffered from hallucinations, delusions, and mental anguish daily for 13 years.
None of the 17 medications he had tried worked. Some sedated him enough to reduce his anxiety and agitation, but they didn’t stop his hallucinations or delusions and had been a factor leading him to gain more than 100 pounds. This contributed to low self-esteem, and he had become a virtual hermit, with therapy sessions with Dr. Palmer becoming some of his only excursions outside the home.
Dr. Palmer agreed to help him lose weight. In the book, he writes, “I was the doctor he saw most often, and he wasn’t in the market for a referral to a specialist he’d never met. More to the point, it was highly unusual for him to take action to improve his health. Maybe losing weight could help him gain a sense of control over his life.”
They experimented with several approaches and settled on a ketogenic diet low in carbohydrates, moderate in protein, and high in fat. Dr. Palmer writes that within weeks Tom had not only lost weight, but he was less depressed and less sedated. After two months, Tom reported having fewer hallucinations and was rethinking his many paranoid conspiracy theories.
Dr. Palmer concluded by saying that Tom eventually lost 150 pounds, moved out of his father’s house, completed a certificate program, and even performed improv in front of a live audience.
As I mentioned in the April issue of Health Hunters, mitochondrial function also profoundly affects your mental health. The brain has, by far, one of the highest concentrations of mitochondria, which are considered the “powerhouse” of our cells. Mitochondria are very tiny organelles within cells that generate the ATP energy that powers our cellular metabolism and signaling pathways. Mitochondrial functioning is closely related to mental health.
One way that mitochondrial dysfunction can affect mental health is through the generation of reactive oxygen species (ROS), which are harmful byproducts of cellular metabolism. If not properly neutralized by the body’s antioxidant systems, ROS can damage cellular structures, including those in the brain, and contribute to oxidative stress, inflammation, and neurodegeneration. These results are significant factors in a range of mental health conditions, including depression, anxiety, bipolar disorder, and schizophrenia. It can also impair cognitive function and contribute to neurological conditions such as Alzheimer’s and Parkinson’s diseases.
Finally, mitochondrial dysfunction can also impair cellular signaling pathways – including those related to serotonin, dopamine, and glutamate – which play crucial roles in regulating mood, emotion, and cognition.
Restore Mitochondrial Functioning
Many of the recommendations for restoring mitochondrial function will also improve metabolic issues.
Exercise has been shown to stimulate the growth of new mitochondria and improve cellular energy production. A diet rich in nutrients such as vitamins, antioxidants, and minerals can help support mitochondrial health. A Mediterranean-style diet is a good place to start, but it is always best to talk with your healthcare provider.
Avoid environmental toxins when you can, including plastic containers, and buying organic whenever possible.
If you are taking supplements, I always advise you to test, don’t guess. The most important supplement is the one you are most deficient in. However, there are supplements that can possibly improve your mitochondrial health, including Coenzyme Q10, Nicotinamide adenine dinucleotide, and alpha-lipoic acid.
Make sleep and stress reduction a priority! Sleep is crucial for your mental and physical health. Chronic stress can cause inflammation and a variety of health issues that can specifically affect the metabolic system, which impacts the mitochondria – and potentially mental health. Yoga, meditation, and deep breathing exercises can help reduce stress and support mitochondrial health.
Orthomolecular psychiatry is a part of the Riordan Clinic’s heritage and founding. It is a branch of psychiatry that focuses on the use of nutrients, such as vitamins and minerals, to maintain and restore mental health. It was popularized in the 1960s by Dr. Linus Pauling, a two-time Nobel laureate.
Dr. Hugh Riordan, co-founder of the Riordan Clinic and my extraordinary mentor, pioneered 15 International Conferences on Human Functioning, thus laying a solid and scientifically diverse foundation for a truly metabolic approach to mental illness.
Adverse factors contribute to metabolic and mitochondrial functioning such as poor diet, chronic stress, a sedentary lifestyle, lack of sleep, and chronic exposure to toxins.
If you are plagued with mental illness and haven’t changed your lifestyle for the better, medications alone may not solve your psychiatric problems. You need to live better in order to feel better.