Mental Illness - Part 2
In the last edition of Vitalité Québec, I addressed the role nutritional deficiencies play in the development or worsening of “mental” illnesses. In this article, I would like to tackle the roles of hypoglycemia and food intolerances and, briefly, that of heavy metal toxicity.
I would like to repeat the point I made in the first part of this article, that not all mental problems - be they psychological or psychiatric - are due to poor nutrition. What’s more, even when, in certain cases, it can be determined that nutrition is a factor - it does not mean that it is the only one. Indeed, while nutrition may be a precipitating or aggravating factor in some cases, it may not be the primary source of the problem. Finally, even among patients who have problems that are basically nutritional, it is often useful - even necessary – for them to work with their health professional in order to ensure optimal results and fewer symptoms. Thus, psychological or psychiatric treatments may be of great value.
“Functional hypoglycemia often masks itself as mental illness because many of its symptoms - especially in extreme cases - mimic psychiatric disorders. The result is that its victims often find themselves on the psychiatrist's couch, with only a limited hope of recovery.”1
This quote taken from the French edition of a book by American psychiatrist Carl Pfeiffer gives an idea of the problem brought up by certain hypoglycemic symptoms. Throughout this article, I will return to the sometimes surprising conclusions of this pioneer in orthomolecular nutrition – a man who was way ahead of his time.
So, what is hypoglycemia and what role does it play at the level of psychological and mental problems? The word hypoglycemia is composed of two words, “hypo” and “glycemia”. The first, a Greek word, means “low” while the second, “glycemia”, comes from Latin and means “sugar”. Thus, the word “hypoglycemia” means a level of blood sugar that is low - lower than it should be.
There are two types of hypoglycemia - clinical hypoglycemia and sub-clinical hypoglycemia.
Clinical hypoglycemia can be diagnosed with a simple lab test that can be performed in a clinic or hospital. A sample of blood is drawn while the patient is fasting. After the first draw, the patient drinks a beverage containing 75 grams of glucose. This large amount of sugar is meant to “provoke” a reaction in the body. After two hours, another sample of blood is drawn to determine the level of sugar in the blood. In some hypoglycemic patients, the level of sugar (glycemia) in the blood falls drastically. This is one way we can determine whether or not the patient is suffering from clinical hypoglycemia.
Note that most medical doctors only prescribe the two-hour test. Unfortunately, this test is not enough to diagnose most cases of hypoglycemia. Most patients will only react three, four, or five hours after consuming the sugary beverage. These individuals - having shown no reaction after two hours - will be told, erroneously, that they are not hypoglycemic.
The second type of hypoglycemia, sub-clinical hypoglycemia, is more difficult to diagnose with blood tests. The reason for this is simple. Optimal health is determined by more than just the sugar that circulates in our blood. It is also, and above all, determined by how efficiently it is used by the cells that need it. In sub-clinical hypoglycemia, blood sugar levels are normal, but the cells of the body don’t make proper use of it. Let me return to my analogy with the automobile used in the first part of this article to illustrate the phenomenon.
The level of glucose in the blood could be considered like the level of gasoline in a car. To produce the energy that makes the motor turn, the car needs fuel, a system that will ignite the fuel, such as spark plugs, and some type of transport system that brings the fuel to the spark plugs. If the car doesn’t have enough fuel, there will no longer be combustion and the motor will not run. This situation is analogous to clinical hypoglycemia.
But it may be possible that the motor doesn’t run even though there is plenty of fuel in the tank. The line that transports the fuel to the spark plugs could be blocked or the spark plugs don’t produce the spark that causes the fuel to ignite.
In the human body, we can think of the different enzyme systems associated with glucose metabolism as the spark plugs and the receptivity of individual cells as the line of transport. Thus, I can have enough sugar in the blood and not be hypoglycemic. But, if the sugar cannot get to the cells that need it, or if the cellular systems that use or “burn” the sugar are not working in an optimal manner, it is as if we did not have enough.
Why is this a problem?
The brain needs a continuous supply of glucose. Every time the amount of glucose in the brain drops - whether it is due to low levels of glucose in the blood or to inefficient use by the cells - the energy supply, and thus the function of the central nervous system, is inevitably reduced. This discovery was made back in 1943 when Doctor Wilder suggested that the symptoms of hypoglycemia, whether they are spontaneous or induced, are essentially neuropsychiatric in nature.2 In the mid sixties, Dr. Salzer came to the same conclusion.3
“Mental” symptoms associated with hypoglycemia may include depression, anxiety, phobias, schizophrenia and bipolar-type symptoms.4 Other symptoms include tremors, excessive sweating, excessive fatigue, sleepiness, difficulty concentrating, dizziness and headaches.5 American psychiatrist Emily Deans suggested that hypoglycemia may be the source of negative mood changes and even violent behavior in some individuals.6
It is clear that other factors may cause states or symptoms similar to those listed above. But with hypoglycemia, symptoms can occur late at night or as you wake up when blood sugar levels are abnormally low. Or, they could be connected with the frequency and/or nature of meals or snacks.
As I mentioned earlier, a two-hour glucose tolerance test is not precise enough to detect subclinical hypoglycemia. However, there are certain tell-tale signs that can help determine whether a "mental" problem is linked with hypoglycemia.
The Association des Hypoglycémiques du Québec (Quebec Hypoglycemic Association) offers its members the opportunity to take a five-hour glucose tolerance test.7 Unfortunately, this test is not covered by health insurance and it does not detect sub-clinical hypoglycemia. The Hypoglycemia Support Foundation also offers an online screening questionnaire8 that gives an idea as to whether hypoglycemia may play a role in the symptoms. It goes without saying that this type of questionnaire has its limits.
Ideally, the best solution is to consult a health care professional who is aware of the problem and is able to offer customized solutions. Some complementary practitioners such as naturopathic doctors and licensed naturopaths have been trained to work with these types of problems as are some holistic doctors, chiropractors and nutritionists.
Although the word hypoglycemia itself describes a situation of low glucose (sugar), the solution is not to consume more sugar, but less. Here is a short list of points that can help.
- Do not skip meals. Make sure your breakfast is high in protein.
- At each meal, make sure you have a sufficient amount of concentrated protein from animal or vegetable sources.
- Reduce simple sugars such as white sugar, glucose, fructose, brown sugar, honey and alcohol substantially. Indeed, remember that alcohol is a sugar. Read labels, sugars are hidden everywhere.
- Finally, certain supplements can help regularize the way the body uses sugars and thus can help improve hypoglycemia. The best supplements for this purpose are chromium, the B vitamins and magnesium. However, supplementation does not eliminate the need to follow a healthy diet.
To conclude this section, I leave the last word to Dr. Pfeiffer...
"Although it is often difficult to find the cause, not all common emotional difficulties can be traced back to the hypoglycemic syndrome. Nevertheless, functional hypoglycemia is one of the most important causes of chronic nervous disorder, and it destroys the lives of many individuals ... By following the recommendations above, the hypoglycemic individual can expect a total recovery."9
We now turn to food allergies, or, to be more precise, food sensitivities. As we move from hypoglycemia to food allergies, it is interesting to note that, according to allergist, J.C. Brennan, hard-to-detect food allergies can aggravate nearly 75% of cases of hypoglycemia.10
Cerebral Allergies / Food Intolerances or sensitivities
Drs T.-G. Randolph and Dohan described, several years ago, a cerebral allergy syndrome whose psychopathology could be considered severe enough to merit the label of schizophrenia.11
Many doctors, including psychiatrists such as Drs. Hoffer12, Pfeiffer13, Dohan14 and Philpott15, have emphasized the role of food allergies in various psychological as well as mental disorders. Hoffer stressed their role in depression, as did Pfeiffer and Philpott. Long before gluten intolerance became a popular theme, Pfeiffer wrote: "A hidden hypersensitivity to gluten cereals may well be the cause of compulsive or ritualistic behaviors, a lack of speech development or even just intermittent mood alterations."16 Jean-Pierre Willem, co-founder of Doctors without Borders, noted the role of food intolerance in anxiety and insomnia as well as in depression.17 In a study published in the British Journal of Psychiatry, American psychiatrist F.C. Dohan showed that patients with schizophrenia improved faster by following a diet free of cereal grains and dairy.18
Food intolerance, therefore, may play a role in "mental" illness. But how can this be? We do not know all the reasons, but there are several possible explanations. We know that food hypersensitivity may cause an increase in a substance, TNF-alpha.19 And we know that one of the effects of an increase of TNF-alpha is to increase insulin resistance which can, in turn, cause many problems including non-insulin dependent diabetes or hypoglycemia of the cells.
Serotonin is one of the most important substances in balancing the mood. A decrease of serotonin can cause anxiety, depression and insomnia, among others. Many antidepressant drugs work by altering serotonin metabolism. And, we now know that about 95% of serotonin is produced in the gut.20 Furthermore, studies show that any inflammatory intestinal processes, including those caused by allergies or food intolerance, can reduce serotonin production.21 The decrease in serotonin will then increase the risk of anxiety, depression and insomnia.
Finally, we know that food allergies can cause nutritional deficiencies. We know, for example, that individuals with celiac disease typically have deficiencies in iron, folic acid, vitamins B12 and D as well as magnesium and zinc.22 As we saw in the first part of this article, these deficiencies may trigger changes in personality, behavior or simply cause mental fatigue.
Therefore, food intolerance must be considered in all natural approaches whose goal is to treat "mental" or "behavioral" disorders.
An explanatory note
Food intolerance and food hypersensitivity, which some authors have called a "cerebral allergy", is different from the classic allergy. First, unlike a classic allergy, the reaction is not immediate. In fact, the individual may feel better after eating the food and react up to 72 hours later. The individual may become addicted to the food so eliminating it from the diet may cause withdrawal symptoms.23 Obviously, this has the effect of clouding the issue.
Various tests are available to detect the presence of food sensitivities but the most certain way is by following an elimination diet. In this diet program, the patient eliminates foods that are potential threats for 3-4 weeks and then challenges the body by reintroducing them, one at a time, over a period of several days. If one of the eliminated foods provoked the symptoms, its elimination should improve them and, conversely, its reintroduction would aggravate them or cause them to reappear. To prevent nutritional deficiency, it is preferable, when possible, to undertake this type of approach under the supervision of a health care professional.
The last word goes back to Dr. Pfeiffer, "The final evolution of an allergic patient with cerebral symptoms may be excellent once the diagnosis and treatment have been properly conducted."24
Heavy Metal Toxicity
Some studies associate certain forms of depression with the presence of toxic metals in the body. Although this is less well documented than the previous two factors, it has been recognized that heavy metal poisoning damages the central nervous system.25 Unfortunately, there are no reliable studies which determine the levels of metals needed to cause these symptoms. However, in cases where individuals with neurological disorders or psychological symptoms have been in contact with high concentrations of these metals, the possibility that these metals could be a factor should be evaluated. My list is not exhaustive, but it includes people working with metal-based paints, metalworkers, people living near areas where high concentrations of pesticides are used and people with many dental amalgams (fillings).26 27
The presence of these metals can be determined by a simple hair analysis.28 While a hair analysis is far from perfect, in the hands of an experienced health professional, it is an excellent screening tool.
Thousands of people suffer from "mental" problems whether they be anxiety, depression, phobias or obsessions. The use of a nutritional approach should be considered in all individuals suffering from the most depersonalizing disorder, one which affects their personality. This approach can do no harm if it is well done, and its use is well-justified in a large number of cases. If adopting a nutritional approach has had effects as convincing as those described by Drs. Pfeiffer or Dohan on such extreme conditions as bipolar disorder or schizophrenia, its effects on milder diseases should not be easily dismissed.
The ideal approach, of course, would be for the naturopath or other dietary specialist to work in conjunction with the psychologist or psychiatrist. But, with or without their cooperation, the nutritional approach can help improve patient outcomes and thereby improve their quality of life.
1 Pfeiffer, Carl and Pierre Gonthier Équilibre psycho-biologique et oligo-aliments, Equilibres aujourd'hui (1988)
2 Wilder, Joseph Psychological problems in hypoglycemia The American Journal of Digestive Diseases Volume 10, Issue 11, pp 428-435 (1943)
3 Harry M. Salzer Relative Hypoglycemia as a Cause of Neuropsychiatric Illness, Journal of the National Medical Association January (1966)
4 Maria J. Harp, B.S. and Lawrence W. Fox Correlations of the Physical Symptoms of Hypoglycemia with the Psychological Symptoms of Anxiety and Depression Journal of Orthomolecular Medicine Vol. 5, No. 1 (1990)
5 Alvarez-Guisasola et al. Association of hypoglycemic symptoms with patients’ rating of their health-related quality of life state: a cross sectional study, Health and Quality of Life Outcomes 8:86 (2010)
6 Deans, Emily Do Carbs Make You Crazy? Evidence that blood glucose and dietary carbohydrate affect mood. Psychology Today March 01 (2012)
7http://hypoglycemie.qc.ca/diagnostique/inscription/ or 450 325-1163
9 Pfeiffer, Carl and Pierre Gonthier Équilibre psycho-biologique et oligo-aliments, Equilibres aujourd'hui (1988)
10 Brennan, James C. Basics of Food Allergies, Thomas (1978)
11 Pfeiffer, Carl and Pierre Gonthier Mental and Elemental Nutrients, Keats Publ. (1975)
12 Hoffer, Abram “How Orthomolecular Medicine Can Help” in Finding Care for Depression SEAR Publications (2001)
13 Pfeiffer, Carl Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry Healing Arts Press (1988)
14 Dohan, F.C. “Schizophrenia: are some food-derived polypeptides pathogenic? Coeliac disease as a model” in The Biological Basis of Schizophrenia MP Press(1978)
15 Philpot, William Brain Allergies: The Psychonutrient and Magnetic Connections Keats Publishing (2000)
16 Pfeiffer, Carl and Pierre Gonthier Équilibre psycho-biologique et oligo-aliments, Equilibres aujourd'hui (1988)
17 Willem, Jean-Pierre Intolérances alimentaire Éditions La Maisnie-Tredaniel (2012)
18 F. C. Dohan et al., ‘Relapsed schizophrenics: more rapid improvement on a milk and cereal-free diet’, Brit J Psychiat, Vol 115, pp. 595-6 (1969)
19 Rueff, Dominique Immunonutrition François-Xavier de Guibert (2007)
20 Hadhazy, Adam Think Twice: How the Gut's "Second Brain" Influences Mood and Well-Being Scientific America February 12 (2010)
21 Brummer, R.J.M. Serotonin and Integrated brain-gut function Presses de l’Université de Maastricht (2007)
22 Caruso R, Pallone F, Stasi E, Romeo S, Monteleone G. Appropriate nutrient supplementation in celiac disease. Ann Med. 2013 Dec;45(8):522-31.
23 Theron G. Randolph An Alternative Approach to Allergies Avon (1990)
24 Pfeiffer, Carl and Pierre Gonthier Équilibre psycho-biologique et oligo-aliments, Equilibres aujourd'hui (1988)
25 Adefris Adal, Chi and Asim Tarabar, Heavy Metal Toxicity MedScape 2015-09-18-03:17
26 Queen, Sam Chronic Mercury Toxicity: New Hope Against an Endemic Disease, Queen and Company Health Communications, Inc (1988)
27 Huggins, Hal It's All in Your Head: The Link Between Mercury Amalgams and Illness Avery Publishing; 1 edition (1993)
28 Passwater, Richard and Elmer Cranton Trace Elements, Hair Analysis, and Nutrition, Keatsb Publ. (1983)