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Sunday, November 24, 2019

Nurtitional psychiatry?

Watching CBS Sunday morning. Saw this segment.

Globe-trotting photographer Dave Krugman feels at home no matter where he is in the world. But he hasn't always felt comfortable inside his own head.
He's had issues with depression, even as he was building an Instagram following of about 300,000. "It wasn't matching up with the way I was feeling about life, which was, like, that I wasn't enjoying my day-to-day life, really," he said. "I wasn't."
He tried therapy, then anti-depressants, and finally ended up with an unconventional psychiatrist who posed an unconventional question: What did he eat for breakfast, lunch and dinner? 
And thinking about what he put in his mouth really opened his eyes: "It made me realize I would just eat whatever popped into my head at that moment. Like, 'Oh, I'll go get some ramen. That sounds great.'" 
"Chocolate cake?" asked correspondent Susan Spencer. 
"Yeah! Yeah, chocolate cake!" 
Psychiatrist Drew Ramsey, who is Krugman's doctor, said, "Food is medicine. Food is brain medicine. In your everyday life, the number one factor that you have control over in terms of your mental health is at the end of your fork."
His specialty is the daily special, and how it affects your mind. Dr. Ramsey calls this growing new field "nutritional psychiatry."...

From the National Library of Medicine:
Nutritional Psychiatry: Where to Next?
The nascent field of ‘Nutritional Psychiatry’ offers much promise for addressing the large disease burden associated with mental disorders. A consistent evidence base from the observational literature confirms that the quality of individuals' diets is related to their risk for common mental disorders, such as depression. This is the case across countries and age groups. Moreover, new intervention studies implementing dietary changes suggest promise for the prevention and treatment of depression. Concurrently, data point to the utility of selected nutraceuticals as adjunctive treatments for mental disorders and as monotherapies for conditions such as ADHD. Finally, new studies focused on understanding the biological pathways that mediate the observed relationships between diet, nutrition and mental health are pointing to the immune system, oxidative biology, brain plasticity and the microbiome-gut-brain axis as key targets for nutritional interventions. On the other hand, the field is currently limited by a lack of data and methodological issues such as heterogeneity, residual confounding, measurement error, and challenges in measuring and ensuring dietary adherence in intervention studies. Key challenges for the field are to now: replicate, refine and scale up promising clinical and population level dietary strategies; identify a clear set of biological pathways and targets that mediate the identified associations; conduct scientifically rigorous nutraceutical and ‘psychobiotic’ interventions that also examine predictors of treatment response; conduct observational and experimental studies in psychosis focused on dietary and related risk factors and treatments; and continue to advocate for policy change to improve the food environment at the population level.
Keywords: Diet, Nutrition, Depression, Psychosis, Mental disorder, Neurodevelopment, Neurodegenerative, Nutraceutical, Prevention, Treatment
Interesting. On the subject of food and health more broadly, I wrote this 21 years ago in my "One in Three" essay about my late elder daughter.
A Healing Burger
Or, the "healing pizza/chocolate shake/friesĂ®? One day not long ago, after we'd visited with a pleasant, seemingly intelligent woman of recent acquaintance who had also endured a long struggle with cancer and was committed to a "holistic healing" regimen, I ribbed Sissy that we ought cruise down Sunset for lunch, specifically to order some "healing burgers," -- my facetious reaction to having been cut off mid-sentence the prior evening after uttering the phrase "fruit juice" in the course of responding to a query concerning Sissy's daily diet. "Oh, no! No fruit juice!" "No sugar!" "No fat!" "No meat!"

The magical quality that "holistic" evangelists impute to various vitamins, herbs, and certain foods (the latter for both good and ill), frequently shouts down the more circumspect and common-sense notion of an adequate and balanced diet. In my mind I parry their personal anecdotes with the equally anecdotal evidence of the long and mostly healthy lives of the large extended family comprising my in-laws. Most of these rural northern Alabama farmers manage somehow to live into their 90's despite life-long daily breakfast doses of sausage and eggs with biscuits and gravy-- along the rest of the typical meat-laden, putatively carcinogenic and arteriosclerotic farm fare that would make a brown rice zealot shrink in horror.

Most of these dietary-herbal and related recuperative obsessions ring resonant with the "bargaining" stage of Elizabeth Kubler-Ross's dying process model. Please, Lord, I'll change my indulgent, unhealthy ways, please-- just spare my life! See, I'm doing my herbal/ carrot juice/ seaweed/ colonic/ aromatic/ crystalite/ meditative/ mega-vitamin/ macrobiotic/ psycho-spritual penance; please, please spare my life!
Yeah. But nutrition science has come a long way (though it has yet to find its way into EMRs). My only reflexive concern is that we're likely to be inundated with all manner of money-grubbing quackery around "nutritional pyschiatry."
"Food is medicine. Food is brain medicine. In your everyday life, the number one factor that you have control over in terms of your mental health is at the end of your fork."
The assertion has intuitive appeal. Rigorous clinical establishment of broad efficacy, though, is as yet a work in progress.

Excerpt link here.

See also "Mosconi's Brain Food Diet." Read through the hundreds of post-article comments, too.


Beyond nutrition, there's exercise, and other stuff going to psych stressors:

Dysfunctional sleep patterns, work-related stress, and the gamut of chronically unresolved psych issues, etc.
I'd add to those factors things such as social isolation and poverty. All of these elements contribute overlappingly to suboptimal psych well-being. Health IT is not capturing it all very well.

Uncovering the Mental Health Crisis of Climate Change

The young man believed he only had five years to live. “Not because he was sick,” said Kate Schapira, “not because anything was wrong with him, but because he believed that life on Earth would be impossible for humans.”…

Over the coming decades, rising temperatures will fuel natural disasters that are more deadly than any seen in human history, destabilizing nations and sending millions to their death. Experts say that we need to prepare for a hotter, less hospitable world by building sea walls, erecting desalination plants and engineering crops that can withstand punishing heat and drought, but few have considered the defenses we need to erect in our minds. Some, like Shapira, have called for more talking, more counseling to process our grief. But will that be enough? Climate change will do untold violence to life on this planet, and we have remarkably few tools to deal with its emotional cost…

Mental health professionals are just beginning to grapple with this fact. Renee Lertzman, a psychologist who studies the mental and emotional dimensions of climate change, believes few people have managed to process their grief about the slow decay of life on Earth. She said that many people are caught in “a state of arrested mourning,” what she calls “environmental melancholia.”

“The reason why, I think, we have a pervasive environmental melancholia is directly related to the fact that we’re not really talking about this,” Lertzman said. While psychologists have developed ways of grappling with the death of family member or the loss of job, experts are still learning how to dislodge anxieties about climate change…
I will soon be 74, a first-wave baby-boomer. The U.S. population has doubled across my lifetime to date. World population has more than tripled.
My country comprises 4% of world population, and consumes 25% of its resources. Notwithstanding its unsustainibility, the reactionary America-Firsters currently in control of my government are bent on rapaciously plowing ahead full-bore with a dirty extractive fuel-driven incumbent status quo economic regime.
When I was a kid the world seemed inexhaustibly immense, and there for the taking.

My, how times have quickly changed. See my "Covering Climate Now" posts. And, again, ponder the bracing import of Frase's "Quadrant IV."

Despite my indelible residual grief over losing both of my daughters, my mental health is fine (and, 15 months out of open heart surgery, I'm--poignantly--back on the basketball court). But, I cannot but fret about the world my kids (and soon-to-arrive new grandson) will inherent absent concerted, effective mitigating climate action.

The Dr. Lertzman cite led me to this:

Two more books.

Click either cover image for the Amazon links. Twitter link to Lesley Head here.

Don't be depressed. Be pissed, and motivated to act.


One of my current reads.

Again, Amazon link embedded in the cover pic. This one goes to my AI tech riffs, to which I will be returning soon. to wit,
The Power of Unintended Consequences

Neither Alfred Nobel nor Mikhail Kalashnikov anticipated how their inventions would be used for disruptive political violence. In the same way, the creators of the Internet, social media, and the many new and emerging technologies today have not foreseen the nefarious uses to which they’re being put. 

Today’s period of innovation is comparable to the explosive era of open technological innovation at the turn of the nineteenth century, and arguably even more potentially disruptive. Current and emerging technologies were not consciously designed to kill, as the AK-47 was; they are just as subject to popular whim, more tailored for attention-getting, and more wide-ranging in their potential applications, both good and bad. Because the current technological revolution is an open one, and because there is again so much money to be made by the diffusion of the new technologies, they have again spread rapidly and will continue to do so. Due to their accessibility and ease of use, clusters of new technologies will be combined in novel ways that are unanticipated. 

In the next part of the book, we will use the insights introduced in the first two sections to examine how today’s new and emerging technologies are already being used to raise the stakes of political violence, by enhancing the mobilization and reach of surprise attacks. We’ll also investigate how emerging breakthroughs in autonomy, robotics, and artificial intelligence may be harnessed for even more potent leverage...

Cronin, Audrey Kurth. Power to the People (pp. 167-168). Oxford University Press. Kindle Edition.
In bleak report, U.N. says drastic action is only way to avoid worst effects of climate change
“We need to catch up on the years in which we procrastinated,” a top official says.
The world has squandered so much time mustering the action necessary to combat climate change that rapid, unprecedented cuts in greenhouse gas emissions offer the only hope of averting an ever-intensifying cascade of consequences, according to new findings from the United Nations…

More to come...

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