Demons No More – Mental Illness as a Metabolic Disorder
The Mitochondria Made Me Do It!
Swinging As a Way of Life
As someone who has lived with bipolar disorder and bipolar depression since I was a teenager, I am always on the lookout for new approaches to understanding mental illness. I was not diagnosed until I was in my mid 40s when I had a severe manic reaction to Paxil, which had been prescribed by my internist for what was thought to be situational depression. Three decades later, I am grateful to have had a reasonably productive and satisfying life. I am grateful that I received medications that worked for me and limited my disability. When I was first diagnosed, bipolar disorder was emerging from what was called manic depression – a term which I find more dramatic.
Sometimes I amuse myself and others by calling it polar bear syndrome, since I find it mysterious and unpredictably powerful. This condition is quite prevalent in my mother’s family. Growing up in a large extended Mexican family, in hindsight, I can see that it was something of a background condition. By the same token, the older generation had PTSD from immigration, the Great Depression, and World War II, Korea, and the general stress of being Mexican in the United States. Vietnam sent some of my cousins back with horrendous problems. The 60s did not help. More of my cousins were diagnosed with it as we grew older. Although nicotine and alcohol proved to work for some, for others self-medication led to disaster.
Before my diagnosis in the mid-90s, there was only lithium for the treatment of manic depression. It “kindles” according to psychiatrists, meaning it gets worse as you get older if left untreated. Sometimes, it just gets worse anyway. However, there are ways in which you can use the swings to your advantage if you know that you are having them. I have periods of great productivity and creativity and other periods when everything powers down. There can be crash landings as well if you don’t remember to pull the ejection lever.
Clearly, there is still a lot of stigma about mental illness, which prevents people from getting treatment. I am careful about sharing my condition because it frightens many people. They are concerned that I might go “postal” and start destroying things. No. I am not kidding. It is somewhat analogous to when people find out that I am Mexican American and not Italian or Greek. In anthropology, stigma is a damaged identity. So, how comes it that some people see me as a refugee from a horror movie?
Demons R Us
For millennia, mental health conditions were treated as a visitation from the gods or an infestation of demons. The Christian Scriptures are filled with stories of Jesus and his followers expelling demons and giving relief to those suffering conditions we now call schizophrenia, bipolar disorder, and epilepsy, along with other conditions. Depression has long eluded any attempts at curing it. In previous centuries it was called “melancholy.” It was one of the four temperaments from ancient humeral theory. In the late 20th century, whole new classes of psycho-therapeutic medications were developed. Sometimes they work wonders and sometimes they don’t. Many people suffer side effects that can discourage them from continuing their medications. Nicotine, alcohol, and other drugs, legal and illegal, are widely used as forms of self-medication.
To a great extent, the demons are still with us. Shamans, Catholic priests, and Evangelical pastors still invoke spiritual rituals and prayers to bring people relief. Literature and movies such as The Exorcist provide sensational battles waged by Catholic priests against the forces of evil. However, these designated exorcists often work with mental health professionals and find that the vast majority of cases are mental health issues. In a very few, evil forces are deemed to be present. In the Catholic Church, the Last Rites, which had been reserved for people at the point of death, have been returned to their original purpose of praying for the sick and are now called Anointing of the Sick. Catholic Charismatics, who share evangelical forms of prayer with their Anabaptist counterparts, speak in tongues, prophesy, and hold healing Masses for physical and mental maladies. Mental health ministries are now becoming very common. Suicide is not a fatal sin. It is the fateful end of disease process that can be prevented in many cases.
Even contemporary neurology and psychiatry are often at a loss, since mental health providers can only rely on statements that patients make about the condition of their innermost being. Overlays of drug and alcohol abuse, poverty, moral injury – guilt about wartime or bad actions – along with PTSD make it difficult to sort things out.
Cultural definitions and societal acceptance also play a major role. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a type of mental health almanac that attempts to define various conditions. A September 8, 2022 article in the American Society of Psychiatry traces the changing definition of homosexuality. In 1952 the first edition of the DSM called DSM-I homosexuality was defined as a “sociopathic personality disturbance” which is a view that is still prevalent in many religious communities. DSM-II in 1968 included homosexuality under “personal disorders.” Homosexuality was no longer defined as a psychiatric disorder in DSM-5 in 2013. This article confirmed that these definitions are shaped by culture and that the gay rights movement had shifted society’s definition of mental illness.
It's All in my Head
What if clearly neurological mental health conditions like bipolar depression, epilepsy, and schizophrenia could be diagnosed and treated like metabolic diseases such as type 2 (“adult”) diabetes, obesity, and Inflammatory bowel diseases? Mental health conditions could be defined, measured objectively, and treated specifically. A new field is now emerging to do just that.
On January 27, 2024, NPR’s All Things Considered Program aired a segment “Patients say keto helps with their mental illness. Science is racing to understand why.”
According to NPR, Metabolic Psychiatry was the center piece of the Metabolic Health Summit in Clearwater, Florida on January 25, 2024. A researcher from Scotland, Iain Campbell, has found significant relief from his own bipolar symptoms by changing to a ketogenic diet. This approach to nutrition gets rid of carbohydrates completely and vegetables that grow below ground. It is high in fats such as meat, cheeses, oils, and nuts. No bread. No potatoes, No cakes or cookies. All the meat, cheese, and avocadoes that you want.
In simple terms, the liver produces glucose to power all the power houses in each cell, which are called mitochondria. If things start to get out of balance, the liver sends ketones, which are an alternative “fuel” that boosts the mitochondria. The emerging theory is that the mitochondria in certain parts of the brain are not functioning at an optimal level and therefore depriving the cells of the amount of energy that they need to function properly. This causes mental health problems such as bipolar depression. Stimulating the formation of ketones is called ketogenic. The bio-chemical makeup of glucose and ketones is very different. Diets that promote ketones are called ketogenic.
Ketogenic diets can be severe or more moderate. As a result, dieticians are expressing some concerns.
“There's some research on the potential benefits of the ketogenic diet for many conditions, but it is very challenging for most people to keep it up for the long haul. Plus, the long-term effects on overall health are poorly understood and need more research. Not to mention, we at EatingWell don't believe in being so restrictive and avoiding nutritious foods like whole grains, legumes, fruits and vegetables. If you decide to go keto, work with a registered dietitian nutritionist (RDN) to help you create a plan.”
- Eating Well, August 15, 2023, Keto Diet Food List, What to Eat and What to Limit if You Go Keto
Researchers featured in the NPR segment also stressed that the research is still in its infancy. There have been many anecdotes about the good effects of ketogenic nutrition on various mental health issues. Right now, it seems that the mitochondria theory has a good following. There are known benefits of low carbohydrate diets and avoiding sugar. The keto diet, however, is far from balanced, and most people have trouble staying on it. Interestingly, the keto diet was discovered 150 years ago to help children with epilepsy, and it is now coming back into vogue.
I don’t know if I am ready to give up carbs. I find that a well-balanced diet, moderate exercise, helping others, and being deeply loved keep me functioning and in good health. My faith tells me that good can come out of our response to suffering. There is no darkness that cannot be conquered by the spark of hope. I tell people that I am in very good shape from the shoulders down. However, I am hopeful that science is continuing to advance and that someday in the not-too-distant future, people who have it so much worse than I do, can be relieved of their demons.
Thanks for all your help and support.
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