Sunday, May 31, 2015

Cocoa Love

I'm not a huge fan of so-called superfoods...diversity is probably the key to a truly healthy human diet in an ancestral and mictobiome sense, but hey, chocolate may be an exception to the rule. I can rain on the parade with the sustainability issues...anyway, here's my new post:

Your Brain on Chocolate

Already an "Essential Read" at Psychology Today. People love positive news about coffee and chocolate.

Also the second in my three part series at Whole9:

Advanced Tips for a Good Night's Sleep

Part 3 should come out at the end of next month and has to do with teenagers and sleep. I'm probably going to add part 4 at Psychology Today to talk about melatonin. I've always been suspicious of using a hormone as a nightly sleep aid and the science behind it is interesting and scary, considering the widespread popular usage. Itsthewoo was ranting about it on twitter...she uses 1mg in the summer for shift work sleep support, but feels (as I do) that supplementing large supra physiologic doses of a wide-acting hormone is an apocalyptically bad idea on a regular basis. Physiologic doses are somewhere around 0.5mg. You can buy pills with as high a dosage as 10mg! I usually recommend people take small doses for circadian support (jet lag, shift work) for brief periods, when they ask. But it is one of those supplements like creatine that so many people take and don't bother to tell you (even if you ask directly).

More later!

I had a great time in Toronto for the American Psychiatric Association annual meeting. Our Food and Mood workshop was a hot ticket as always, with many people turned away, and so many interested folks. We are still perfecting a couple of the broken slides so if you emailed for a copy, hang in's always so great to see the interest in food and psychiatry at these professional meetings.

It's been a while since I linked a song. Here's an oldie but a goodie: I'll Be You by The Replacements

Sunday, May 3, 2015

Five Years of Evolutionary Psychiatry

Next month will mark the 5th year anniversary of this blog. Hard to believe I would still be at it after all this time. Back in the beginning, an interest in ancestral health felt like a very lonely endeavor. Since then I've met many online friends, physicians and otherwise, who share my interest, and that communication and support has made all the difference. I probably would have never met these people if not for the blog, and for that and the knowledge I've gained, all the thousands of hours and dollars spent have been worth it. Later this year I'll even be going to New Zealand for the Ancestral Health Symposium there, which looks to be absolutely amazing. If your bucket list includes going to New Zealand, the conference is reasonably priced and is the perfect excuse to go.

Have my opinions changed over the years? Yes, I would say so. I'm more cognizant of the differences between people when it comes to diet and genetics instead of thinking of our species as a more homogenous whole. Just one specific example (not really psychiatry but...) I went from being taught about LDL cholesterol by Brown and Goldstein (who won the Nobel Prize for discovering the LDL receptor and basically ushered in the age of statin therapy) to being a cholesterol skeptic to landing somewhere on the skeptical side of the middle ground. I think statins can and do cause wide-ranging side effects, both physical and mental that for many, even most, people outweigh their benefits, but for folks with a personal history of heart disease or familial hypercholesterolemia, or a rotten cholesterol profile and a strong family history of relatives dropping dead from heart attacks at young ages, using a statin to up regulate the LDL receptor will help improve cholesterol particle recycling and might be worth taking. Since the awesome folks over that theNNTblog agree with me, I think I'm on pretty solid ground.

I'm also more friendly to beans and rice than I was at the beginning, but I'm still not a fan of peanuts or processed food. I have more reason to be suspicious of emulsifiers and artificial sweeteners. Due to my blog I've personally seen some very dramatic cases of serious mental illness that are under much better control via gluten-free diets...yes, beware the tyranny of the anecdote, but just keep an open mind about undiagnosed celiac disease that may not present with gastrointestinal symptoms.

I've also spoken with some folks with eating disorders who got a ton better and have remained in remission by restricting food to whole, real, minimally processed diets (which is not standard advice for eating disorders by any means, as restriction is a bad word), but I've also met anxious folks who had no eating disorders begin to worry about every mouthful and obsess about food all the time once they switched to a paleo-style diet. It's so important to know yourself...95% of people in the develop world have to restrict diets somehow. We can't just eat willy nilly whatever and whenever we want, or we will get sick and fat. Some people do much better and are perfectly happy counting calories and having three cadbury creme eggs every Friday night and go on a creme egg binge if they are trying to eat 100% "clean", while other people find strict food quality rules and not thinking so much about calories makes life much easier and lessens eating obsessions. For health reasons I think we should push food quality over quantity rules in general, and far prefer Brazil's food guidelines to the American nutty calculation crazy official rules.  

I've grown in my appreciation of the microbiome over the years, which is reflected in my most recent blog posts at Psychology Today. Modern chronic disease is all about chronic inflammation, and the microbiome is a huge part of our immune system. I think the first truly successful "diet pill" will be a modified probiotic of some kind (and if I'm being cynical will probably be terribly expensive and bankrupt the health care system). I also think the next breakthrough in pharmacology for mental health, particularly for depressive disorders and anxiety disorders (and maybe autistic spectrum disorders and other serious mental illness), will come from a better understanding and manipulation of the microbiome and the "old friends."

I recently closed comments at this blog. Though a few thoughtful comments were being posted, some were at long ago posts I had no time to address, and the vast majority of comments coming through were spam or witch doctors advertising pregnancy and AIDS spells. It's been nice not to have to deal with all that irritating spam email. I do keep comments open on my Psychology Today posts for a few weeks to a month or two.

I do have some new posts up elsewhere:

Improve Your Mental Health With Sleep Part 1
Improve Your Mental Health With Sleep Part II (will be live soon at the 9blog)

And at Psychology Today:
Junk Food, Gut, and Brain

Five Year Synthesis: Start Here Post

Still plugging away and finding *some* new things to write about from time to time. I appreciate all of you who have taken the time to come by, read my blog, and then think about psychiatry and human health maybe a little differently than before. I've even had researchers tell me that my articles helped them out. It's exciting to think my little blog could do something to change the treatment of mental illness for the better.

Here's to the next five years.

Thursday, March 19, 2015


We've been struck by a harder than usual winter here in the Boston suburbs, and the spring bounceback, where increased light meets slow-clogged sidewalks and freezing temperatures, has been worse than in times past. Insomnia is a major problem along with irritability and reversed sleep wake cycle.

In the coming month a couple of blog posts on sleep hygiene and solutions for more serious insomnia will be published on the 9blog.

I've just now posted a blog about major mental illness and the genetics of seasonality at Psychology Today.

In the mean time, I've been wanting to expound on genetics and psychiatry for quite a bit. In the past few years, companies have been courting the psychiatrist, enticing us to get some genetic information about our patients. The jury is out scientifically as to whether that information is useful in the general population. However, I have begun to do genetic profiles on patients, and have found it to be quite clinically useful.  Beware the tyranny of the anecdote...but I must say I'm a proponent of genetic testing for various reasons, but not always a proponent of the slick genetic testing companies.

The genetic profiles offered now will give you, first and foremost, information about the metabolism of psychiatric medications. How important is this issue? Well, the large STARD trial used the antidepressant citalopram, which is metabolized through the 2D6 pathway. Poor metabolizers (who might experience increased side effects) in this pathway are up to 10% of whites and less so in other races. Ultrarapid metabolizers exist as well ( The numbers are enough to be important when it comes to establishing how effective the medication might be in a popualtion wide study.

There are genetic polymorphisms in how we metabolize all psychiatric medications, and a genetic clue as to what to expect can be helpful in most people. However, these first level genetics are only one part of the metabolism of medications. We have pharmacogenetics, pharmicodynamics, and pharmicokinetics, and just because you metabolize a medicine as expected does not mean it will work, and it doesn't mean you don't have side effects.

In my use of these genetic tests, I've found some other findings to be more useful than the cytochrome p450 profile. One is if certain medicines are more likely to work (the serotonin reuptake receptor promoter region gene, discussed here) and the methylation profile. In the test I've used the methylation data is limited to the C677t data, but I've been able to turn around some serious longstanding resistant depressions with the addition of methylfolate.

I've been interested in methylfolate in a while, but nothing convinces a person to actually buy and take methylfolate like a genetic profile that says they don't metabolize folate well. Patients who've tried many antidepressants suddenly find they work with the addition of the right folate support in extraordinary ways.

The latest psychiatric magazines and journals are laden with genetic studies. It is the future of medicine. I'm concerned that a company charges $4000 for a pretty report on meds and genome of a few genetic polymorphisms when you can get all your raw genetic data for $99 at 23andme, and the methylation profile for free at Hopefully in the future we can get this vital data for a reasonable price, and use caution to interpret the results.

Sunday, February 15, 2015

Snowed in

Hello there. We've had a record month of snow around these parts, which paradoxically does not make me more productive, but rather makes me want to sit on the couch wrapped in a blanket, sipping tea and doing nothing.

I have a few new posts up despite all of that...some from last month that I'm just getting around to linking here:

Diet, Depression, and the Microbiome

(I've started to use Grace Liu's fiber protocol just as a little self-experiment, btw).

I've FINALLY written something about how exercise affects the brain (it's very positive except when you hit your head with the bar, which I have done more than once in CrossFit), over at the whole9 blog:

Does Exercise Help the Brain?

And last but not least, there is a brand spanking new post at Psychology Today about lifestyle factors and depression based on that wonderful article from BMC Psychiatry:

Lifestyle Interventions for Depression 

Some are obvious, some not so keep those gums healthy!

Look for a new post at the 9 blog soon and I have some other folks requesting blog posts too...I'll get to them when the snow melts, maybe ;-)

In the mean time, just got the brand new book from Diana Rodgers delivered last night, literally on a pile of snow, and I've very excited to try the recipes and projects. Around my house we would need to stand guard with weaponry to keep the animals from eating our garden, but herbs grow very well in the sun room, and maybe we could keep the back porch safe for some pots of garlic and some's the book trailer for her amazing work full of recipes, home projects, and how to grow your own food at home:

And one final little snippet...I find the following song/music video amazing. It is a dance with a 12 year old girl (the fantastic Maddie Ziegler from Chandelier) and a full grown man (yeah, Shia LaBeouf) in a cage representing two aspects of one person battling mental illness. It's creepy and artistic and powerful, but some may find it too creepy, so fair warning.

Sia: Elastic Heart

Sunday, November 16, 2014

More new blog posts (everywhere but here)

I meant to do even more posts, but I've been down for the count with a horrible cold that felt like a combination of rhinovirus and chikunguna. Finally I'm feeling better, though weak as a kitten. Anyway, prior to the cold I wrote these:

A Gene For Violence (at Psychology Today)

How Food Is Linked to Mood (at Whole9Life)

Earlier today I put out this new post:

Sunshine and Suicide

(Yes, they are linked, but not how you think)

I'm doing a regular monthly column over at Whole9 now, which will be for a more general audience than the biochem-snark ridden curiosities I've been spewing over here since 2010. I think my next one will be about mood and FODMAPS. Let me know if there is anything interesting you want to read about there.

Here's a good song: Kooks Bad Habit.

Oh, I also finished the first draft of another sci fi novel as part of #NoWriNoMo, but the hump of starting book three plus high fever has scuttled my chances of making 50K words this month. C'est la vie. Enjoy your week!

Sunday, October 26, 2014

Magnesium and the Ketamine Connection

Another new post is now live at Psychology Today, discussing how magnesium is a physiologic counterpart to the powerful drug ketamine:  

Folks interested in that may also be interested in the following posts:

The Ketamine Key (this article was Boing Boinged! Hooray)

Have a great week! New Walking Dead tonight...

Friday, October 24, 2014


There's been a bit of upheaval at the house...all will be well, but in the mean time, I'm trying to blog more and get some more clicks over at Psychology Today. Clicks support the writing and research I do and they are much appreciated! There's a new post up about ketamine, the noncompetitive inhibitor of the NMDA receptor that, in one single IV infusion, can alleviate a suicidal depression in about 30 minutes. However, the magic doesn't last, and depression comes back after a week or two. Still, the mechanism and understanding of this phenomenon is important to figuring out the physiology underlying depression.

For right now, ketamine is being used experimentally in hospitals and also in some "salvage" clinics where folks who've responded poorly to other treatments pay for to get a short break from depression.   Other NMDA receptor antagonists might be useful drug targets for experimentation...but to be honest glutamate has been the holy grail neurotransmitter for several psychiatric disorders (schizophrenia, major depressive disorder, and bipolar disorder among them) for the past 20 years, and I've not seen anything come of it, or anything new in the drug pipeline that has panned out.

The supplement NAC utilizes the glutamate pathway via a somewhat convoluted mechanism. I've seen it work for obsessive thoughts, hair pulling (but never for picking behaviors in general) and, interestingly, bipolar depression when every other treatment has already been tried. There's only one study for bipolar depression, but the trichotillomania efficacy is solid and NAC should be part of the clinical arsenal for that symptom.

Here's the post: The Ketamine Key

And here's a new Lorde song I like a lot: Yellow Flicker Beat