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.

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