Using the Paleo Diet in the Treatment of Mental Illness
(Photo of a Paleo version of chicken and waffles from Mission Heirloom, one of our favorite restaurants in Berkeley, CA.)
Chronic illness is one of the main reasons many people have turned to a Paleo diet and lifestyle. The Paleo diet has been effective in treating everything from eczema to multiple sclerosis and, due to such great results, people who live with mental illness are now also using it as part of their treatment plan.
Mental illness affects about 61.5% of American adults in a given year, according to the National Alliance on Mental Illness; about 13.6 million people live with a serious mental illness such as bipolar disorder or schizophrenia.[i] While treatment is often successful, what many people do not realize is that relapse rates are also high -- up to 70% for people with bipolar disorder.[ii]
The current medical model says that mental illness, particularly the more acute forms, can only be managed through a combination of medication and therapy. While medication and therapy work for some people, for many others they do not.
Emily Deans, MD is a Board Certified Psychiatrist in Massachusetts and Clinical Instructor in Psychiatry at Harvard Medical School. Dr. Deans also runs the blog Evolutionary Psychiatry, where she shares her knowledge of how evolution has an impact on our modern mental health disorders.[iii] “There is a lot of unmet need for people with mental illness, that medication alone does not help,” said Dr. Deans, “and many people cannot tolerate medication.” Dr. Deans went on to summarize that research shows medication is around 65% effective in reducing symptoms, and only 35% effective in getting rid of symptoms. This is not very encouraging when studies show that a placebo is 30-50% effective in symptom reduction.
For many people like Laura Smart, who has bipolar disorder, medication does not help enough, and sometimes it becomes too much of a risk to take. Smart wanted to limit her use of medications in order to conceive because most psychiatric medications are not deemed safe for women to take while pregnant. Smart turned to functional medicine to look for a doctor who could help her manage her illness more holistically.
After a lot of testing and work with supplements and other interventions, Smart was able to decrease her medications, but she was still struggling a bit, so her doctor told her to try a Whole30.[iv] The Whole30 is a strict Paleo diet plan created by Dallas and Melissa Hartwig and is one way to jumpstart a Paleo lifestyle. Smart says, “I was super skeptical. I'd been mostly vegan for health reasons for a very long time. I'm a librarian so I do look for the peer reviewed, hard science research. And the science about the strict no sugar, no fat, no salt protocol of Drs. Esselstyn, Fuhrman, and McDougall had me convinced. I managed my weight and high blood pressure this way and was happy. In fact, I almost finished raw vegan chef school! I was so convinced this was the way I wanted to make a career change and help others eat healthy and exercise. So eating Paleo is a radical change for me!”
Smart took the leap after visiting Dr. Deans’ blog and reading about other people who use the Paleo diet and lifestyle to manage their mental illness. Smart started to feel better within three days and has continued to get better ever since. This does not mean that there are not difficult days, but a Paleo diet has been an important tool in the management of her bipolar disorder.
Integrative psychologists feel that there is a good body of research that shows that mental illness is created, in part, by inflammation. For many people, this will be a new realization, but it is probably not surprising to people who follow a Paleo diet and know about the brain/gut connection. Dr. Deans says, “Our understanding of mental illness is that a lot of it is regulated by inflammation. What you see is different inflammatory cytokines in different areas of the brain. The immune system is activated or irritated. Over time it can cause brain damage, like in Alzheimer’s.” Depending on which part of the brain is inflamed, long-term inflammation will result in different symptoms in different people, helping to explain why there are so many different forms of mental illness. The modern western diet is very inflammatory with lots of sugar, processed carbs, and food dyes.
There are also food sensitivities, which may be a contributing factor to mental illness in some people. Kelly Brogan, MD ABIHM, Holistic Women's Health Psychiatrist[v] says, “In schizophrenia and bipolar, in particular, there are papers discussing the role of casein (found in milk) antibodies in clinical presentations. In a paper by Severance et al, they found that new onset and long-term schizophrenics were 8 times more likely to have circulating antibodies to casein than controls. In a separate study, they found similar results in the setting of Bipolar I diagnosis, and found that medication treatment did not mitigate this immune response. I don’t think that dairy is an issue for every person or every person with mental health symptoms, but I believe it is a compelling variable to control for."[vi]
Finally, some of the information about the brain/gut connection is reaching mainstream media. National Public Radio recently did a piece on how gut bacteria can affect the mind, citing a study by Stephen Collins of McMaster University in Hamilton, Ontario, which looked at how unbalanced gut bacteria changed the moods of mice. In the study, they found that if they put gut bacteria of non-anxious mice into mice with anxiety, the anxiety in the anxious mice decreased. Conversely, when they gave non-anxious mice the gut bacteria of anxious mice, the mice developed anxiety.[vii]
Not only does diet play an important role in management of mental illness, but so do the other components of a Paleo lifestyle. Both Drs. Deans and Brogan suggest monitoring one’s sleep cycle and adding in daily exercise once sleep is regulated. Dr. Deans suggests, “To do two things: Decrease processed carbs and get your sleep in order. Sleep is right up there with diet with being very important.” Inadequate sleep causes stress, which leads to inflammation.
There is no quick fix for mental illness. It is suggested to try the Paleo diet for at least three months. Dr. Deans says you will see the most improvement in the second and third month. Some people do well starting with a plan that is a drastic change from their previous diet, such as a Whole30, while other people might fare better with slower changes. Dr. Brogan suggests, “at a minimum prioritize gluten and dairy” and remove them from your diet.
It is always recommended to work with a doctor on a treatment plan, and it is never recommended to decrease or eliminate medications on your own. Some people may find great success with the addition of the Paleo diet to their current medications. Each person needs to work with their doctor to find what mix of components work for their treatment plan. Many doctors are open to reading research a patient brings to them and discussing how to implement a Paleo lifestyle and track whether it is helping regulate mental illness.
If you are looking for a doctor who specifically practices integrative medicine, familiarize yourself with Primal Docs, Paleo Physicians Networks, and all physicians and naturopaths trained by the American Board of Integrative Holistic Medicine or Institute for Functional Medicine. They take a whole-life approach to care and work with people who want to add Paleo into their treatment plan.[viii]
[i] National Alliance on Mental Illness http://www.nami.org/factsheets/mentalillness_factsheet.pdf
[ii] Simhandl C, Konig B, Amann BL. (March 2014).“A prospective 4-year naturalistic follow-up of treatment and outcome of 300 bipolar I and II patients.” Journal of Clinical Psychiatry. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24717379
[iii] Emily Deans, MD http://www.psychologytoday.com/blog/evolutionary-psychiatry
[v] Kelly Brogan, MD http://kellybroganmd.com/
[vi] “A Functional Medicine Approach to Perinatal Mental Health- Part 2” http://www.scienceandsensibility.org/?p=7944
[vii] “Gut Bacteria Might Guide The Workings of Our Minds” http://www.npr.org/blogs/health/2013/11/18/244526773/gut-bacteria-might-guide-the-workings-of-our-minds