Sunday, July 24, 2011

Bipolar Case Study on the Web and Whole30 on Vacation

Greetings!  I'm back in town.  The tomatoes, flowers, cats, and fish survived thanks to our very able house sitter, and we're all in good spirits despite air travel with small children (and no, we were not fondled or irradiated extra times in security).

Here's a new song I rather like - Whirring by The Joy Formidable (right click in new tab).

We went to Santa Fe, a lovely New Mexico mountain town and as far as I know, at 7200 feet or thereabouts, the highest state capital in the United States.  Though it is not Disney World or anything, we were able to keep the kids well occupied with the Santa Fe Children's Museum, Grandparents, daily walks through old town to the plaza (they have live music there every day), and a couple of cool parks around town.  These parks had lots of spiced up natural spaces to make it fun for the kids - large sandboxes housed next to tree trunk amphitheaters, stacks of rocks for climbing, slides built into a hillside, tunnels, etc.

The Whole30 did not survive intact, however, I was mostly very compliant with the rules.  But the Whole30 is not about mostly, it is about a strict 30 days of no cheating for a couple of good reasons - 1) it's meant to be an elimination diet to help establish any issues with dairy or gluten or whatnot, and it is important to be quite strict on an elimination diet  2) it's about establishing your supremacy as a human with a will over cravings and food issues.

So what happened?  Well, it turns out that in my normal environment is is relatively easy for me to say no to temptation  Who cares if I sip mineral water instead of wine at this backyard gathering or that one, or skip ice cream at the kid's birthday party?  There will be another backyard gathering next month, and it's not as if the ice cream and cake and pizza at birthday parties are particularly good anyway.  Even when I'm not doing a Whole30, I tend to skip that stuff.

But in Santa Fe, a couple of circumstances came up - food I'm not able to get well made where I live or within a 1000 miles of where I live, and eating at very good restaurants with the chef sort of standing over me.  So a couple of banned foods slipped through - a Whole20 + a Whole10 do not make a Whole30, but I think I'll try to put together 30 days in September instead, when no vacations are planned.  For the most part I stuck to the rules, however (2 meals in 24 over vacation had small infractions, not counting the vegetable oil the fajitas were probably cooked in) - though it was difficult finding safe starches when eating out so much (around here most restaurants have sweet potato as an option - not so popular in the Mexican food arena, I'm seeing).  I ended up eating quite a few bananas over the week.  And when I was out of my normal environment for such a long period of time, it became more clear just how different strict paleo is from what most people eat all the time.

Now onto something perhaps more interesting - an article online by Michael Ellsberg - How I Overcame Bipolar II and Saved My Own Life.  This article was emailed to me and pointed out to me on twitter, and it is a detailed, heartfelt, and well-written account of how some dietary changes (mostly eliminating sugar, refined carbohydrates, coffee, and alcohol, and originally by adding a complete multivitamin/multimineral) dramatically reduced symptoms of bipolar disorder (you'll notice that when he added together bunches of serotonin-boosting supplements he ended up with similar side effects to being on an SSRI).  It is a case study, of course, but I find case studies very intriguing and useful when they involve simple interventions that are unlikely to cause harm (such as eliminating sugar).  Even I don't think even very strict dietary and lifestyle interventions will cure everyone of everything.  I've always felt the major possibilities of nutritional interventions for something as complex as mental illness would be to possibly ameliorate some symptoms and in prevention of a lot of chronic Western disease in general.  And when they are dietary and lifestyle interventions that would lead to better health overall, it seems to fit that "do no harm" bill very nicely indeed.

A huge pile of research papers and common sense tell us that maximizing "real food," minimizing food toxins, and eliminating micronutrient deficiencies are vital for the body to work well, including the brain.  It does not surprise me that some people will have huge mental health benefits from following that sort of plan - and it shouldn't surprise doctors or neuroscientists either.  To me the most striking thing about the article are the number of critical comments (despite his disclaimer) telling Mr. Ellsberg he is being irresponsible for telling his own story.

There are some things, it is fair to say, that we don't want to believe.


  1. That article was eye opening. I photocopied it and gave it to my PCPs and psychiatrists at our facility. Dr. K

  2. Ah, my home state of NM. I was never a big fan of Santa Fe, but given the chance, you might want to check out the Gila. A unique blend of high desert fauna, ghost towns, mountains, trees and rivers. If you want to camp out in an isolated spot, the Gila is a good place to start.

  3. Interesting article, I was especially interested in the backfiring of oversupplementation--everyone forgets that there's an economy at work with micronutrients.

    This has been the source of my hesitance with EMPowerPlus--how would it interact with a low carb diet?

    I think it's also important to keep considering nutrition as only one piece of the puzzle--an important one, but one that can't be the only path. Even after turning to better nutrition, it didn't hit me for a long time that my ultimate responsibility was to keep practicing at focus, to robustly build it up.

  4. 1) If you admit you have bipolar, and 2) if you also admit that non-drug interventions have helped your bipolar, and 3) if you do so on the interweb...

    ... you will be inundated by critical responses from other bipolar people who call you a quack/a crazy person who is still crazy/you don't really have bipolar/ you will crash hard one day/etc.

    Bipolar people are conditioned to believe that only lamictal, depakote, risperdal, and maybe MAYBE zoloft can help bipolar. Don't try anything else.

  5. I really loved that article. Good writer and I can relate to much of it. Particularly the part about billions of supplements. When you're manic all supplements just seem like such a great idea. Some can definitely help but when you run out of space on your desk to store them that's when it's time to call it quits! Down to 5 now :)

  6. I was a bipolar person, I no longer consider I am.

    Just like Michael in the article my 'cure' was achieved through dietary change which then allowed me mental space to work at other lifestyle changes.

    Yes, I too have been pillaried as not really bipolar to start with, or falling for quackery - all I can say is I am well now and I was not before.

    I didn't even bother to read the comments that were made knowing the range that was likely to be there, but I forwarded his article to a number of people I know who would benefit from understanding better the power of taking your mental health into your own hands.

    No dairy, no alcohol, no added sugars, no grains for me = mental health. Period!

  7. I have decided that "bipolar" generally contains two types of people.

    First type of person is someone who has clear cut manic depression. This person is not likely to be helped by interventions such as cutting out coffee or sugar or wheat. Manic depression is primarily genetic and it is not caused by what you are eating or drinking. It is believed to relate to genes regulating circadian clock, but either way, sugar and coffee is not going to affect real manic depression.

    The second type of "bipolar" person is a person who does not have manic depression but rather what they have are extreme energy swings which are usually relatively short lived. They may be called bipolar by some doctors, but the fundamental difference is that this person can respond quite well to interventions like don't drink a lot of caffeine, and don't eat a lot of sugar, as these can play havoc with your energy levels. (and other interventions as well).

    It sounds like the person who wrote this article is more the second type.

    REal manic depression involves distinct episodes of mania or depression which last weeks or months, where the person consistently has a high (or low) mood and energy. There are periods of wellness between where he or she is "normal".

    This gentleman does not fit that profile. Rather, like so many other given a "bipolar" label, he really doesn't meet the criteria. Staying all night on a pot of coffee loaded with sugar with your mind alive and wired due to that coffee/sugar... and then crashing at 8 am and sleeping until 2pm waking up feeling dreadful is not mania leading into depression. That's called having a really crappy irresponsible lifestyle.

    I'm not blaming this dude for doing it, odds are he is genetically predisposed to respond to coffee and sugar with these extreme reactions... however it isn't appropriate for him to say "I am no longer bipolar because I stopped using coffee and sugar". What he has is not related enough to what a manic depressive has for him to make that statement.

  8. I didn't have a crappy irresponsible lifestyle, I was following a conventional wisdom diet of lots of whole-grain carbs, low fat and for two long periods (vegetarian), I exercised regularly, was married with two children.

    My family history includes a paternal grandmother who was diagnosed manic depressive and in and out of hospital during my father's childhood and finally died aged 56 from complications of uncontrolled diabetes.

    There is more and more evidence to support a dietary link - there is a high proportion of diabetics with mental illness - this is not a coincidence in my opinion.

    My manias led me into dangerous situations with scant (if any) regard for my own safety and could last weeks running on minimal sleep, and with large gaps in my recall of events. My depressions were suicidal at times.

    I'm one of the lucky ones who was able to 'stumble' on a solution for me and it was as simple as putting a different range of nutrition into my system.

  9. I completed a master's degree in counseling a few years ago and did my internship at a hospital inpatient facility (average patient stay was several days; people were usually admitted after expressing a desire to commit suicide). I had access to patients' entire health records, both mental and physical. Almost all the patients had chronic illnesses in addition to their mental disorders, so the psychiatrists were writing out prescriptions for both mental and physical problems. Most patients were on several medications.

    I had been studying nutrition on my own for awhile before my internship (low carb / paleo / etc), and I was already aware of the connection between some foods and mental disorders. It seemed pretty obvious to me that mental health problems have to be related to physical health problems ... or rather, they were all *symptoms* with some underlying common cause(s). I saw no evidence that any of the psychiatrists, counselors, or nurses felt the same way though. And I couldn't talk about nutrition with patients either; I wasn't a dietitian, I was only an unpaid counseling intern. Anything differing from the food pyramid would have been verboten. It was pretty frustrating and a big part of the reason why I decided against becoming a counselor. I thought about studying to be a dietitian so I could do both, but I would have had to spend a few years learning all the politically correct food pyramid stuff, and I couldn't stomach that thought.

    Oh, and nutrition was NEVER discussed at any time during my 48 credit hours of counseling coursework!

  10. @Cavegirl

    I was speaking of the author of the article. He describes his lifestyle as drinking an entire pot of coffee at night, loaded with sugar, which is enough to cause most creative people to get wild minded. He then "crashed" the next day. That really doesn't sound all that bipolar but rather it sounds like a supersensitivity to sugar and caffiene.

    You don't have to defend yourself. I also was diagnosed with bipolar disorder, and believe diet / supplements have made a tremendous difference in my mood disorder.

    I have an extensive family history of mental illness (my grandmother was locked in a mental institution for schizophrenia and was never released, my father describes her as paranoid and with dangerous plans... my paternal grandfather had bouts of depression as well as psychosis... my paternal uncle killed himself for unknown reasons, his personality is clearly described as depressive although I never met him... my mother has had recurrent depressions, as has her father, etc etc etc).

    My depression started when I was a child, became significant when I was a teenager, reached a point where I was totally completely non-functional. Severely depressed. My mania started when I was 23.

    I, too, feel diet, nutrition supplements have made a tremendous effect in my mood disorder, as well as light therapy.

    Even though I feel this way I still wouldn't necessarily write a long article saying I cured myself of bipolar disorder. First of all I don't think you can cure bipolar disorder, at best you can control it really well. I also simply do not think that diet can make much of an effect for someone with severe classic manic depression. Sure, I've had nights where it was like I was FLYING on drugs, extreme energy and somewhat disordered thinking... I've had a few weeks weeks where I've been more hyped up than usual buying a lot of things and sleeping a few hrs a night (hypomania). But would I necessarily compare what I have to someone who thinks they are god and is locked in a mental ward? Probably not, no.

    I mean we may have a few genes in common or whatever but I don't know if it is appropriate for me to assume that diet can help this person much.

  11. @ItsTheWooo2

    I was merely pointing out that I didn't lead his kind of lifestyle but still suffered the consequences of bipolar symptoms/episodes (and do come from a genetic lineage of such difficulties - I was also gestational diabetic another link in the puzzle for me) and yet I was freed of them through a change of diet! No more, no less.

    And personally I think it's important that we write about our experiences (I blog mine) in order that people are given the broadest chance to consider alternatives.

    Doctors are not omnipotent as much as their patients might like to wish it so. They can also have a huge amount invested in having patients that require treating, just as drug companies require customers etc, etc.

  12. Dear Dr. Deans,

    Great article. It somehow triggered off a thought: can the symptoms of Celiac/Gluten sensitivity/Leaky Gut be masked by anticholinergic medications that usually treat Bipolar/Schizophrenia?




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