Mental health conditions, particularly depression and anxiety, are extremely common today and yet complex to treat because they’re often caused by a combination of psychological, biological and social factors. An estimated one in seven people in Singapore have experienced a mental health disorder. In the US, approximately one in four women are prescribed at least one psychiatric medication to treat anxiety, depression, ADHD and other mental health disorders. This is truly the global public health crisis of our generation. Yet, a significant number of people in treatment are unresponsive to medication-based solutions.
I was one of those individuals, cycling through countless psychiatric drug interventions in my teens and twenties before finally discovering that if I changed the way I ate and moved, my thought processes and energy levels radically shifted. What I did not know at the time was that I had two common health conditions, endometriosis and non-diabetic reactive hypoglycemia, both of which I’d probably been living with for decades. Looking back on my days of bulimia, I’d binge on tubs of Betty Crocker frosting to chase away feelings of anxiety and dread, dousing my fears with sugar until my body could hold no more. In my twenties, I’d nurse on a bottle of wine most nights to keep the heart palpitations, sadness and physical pain from driving me mad. What I did not know was that I was dealing, in a sense, with a physiological Sisyphus, one that medication or psychotherapy was not meant to fix.
Since getting to the bottom of these health issues, I’ve had to reconsider not only my personal history, but also the entire narrative that currently defines mental illness, one that I had long suspected was off the mark. Yes, millions struggle with psychological conditions which respond well to medication, particularly in tandem with talk therapy. However, there are countless others who would be better served by lifestyle and nutrition interventions rather than by prescriptions for psychiatric drugs.
At a time when suicide rates are rising and increasing numbers of people are incapacitated by symptoms resembling psychiatric illness, it’s critical that mental health professionals, physicians, dietitians, physiologists, personal trainers, and health coaches begin working together as a team rather than approaching behavioral health from opposing and competing camps.
Numerous physical health issues are often misdiagnosed as psychiatric illness — hypothyroidism, diabetes, Ehlers-Danlos Syndrome, endometriosis, PCOS and arthritis are just a few. People waste years and even decades trying to fix the wrong problem, bouncing from one specialist to the next as they collect misdiagnoses. Compellingly, many nutrition-related conditions can also cause symptoms resembling bipolar disorder, major depression, anxiety, schizophrenia and even psychosis. Here are four of the most common:
Iron-deficiency anemia (IDA) impacts an estimated six percent of the population, with higher numbers in women who are menstruating, pregnant or nursing, and in people following a vegan, vegetarian or raw food diet. Worldwide, an estimated two billion people are anemic; iron deficiency is a top ten risk factor for chronic disease. Numerous studies show that iron deficiency anemia increases the risk of psychiatric disorders in both children and adults, and researchers have urged the medical community to consider iron intake in assessing the underlying causes and treatments for mental illness. Symptoms of IDA include fatigue, decreased stamina, insomnia, rapid heartbeat and depression. In other words, they are nearly the same as the symptoms listed on some popular pharmaceutical commercials for depression and anxiety.
So, what can you do if you suspect you may have iron-deficiency anemia?
First, get a complete blood test (CBC) from your doctor and ask to see your results for your red cell count, haemoglobin, hemocrit volumes and mean corpuscular volume (MCV). Compare these numbers to the “normal” range that the blood test includes, and keep in mind that a result which is borderline low but not abnormal may still result in symptoms. Every body is different, and results must be put into context. A subclinical or borderline normal result can still make you feel awful!
Treatment for iron-deficiency anemia is pretty straightforward. An oral iron supplement or IV iron treatment can do wonders, but for long-term relief, changing one’s diet is crucial. Adding foods like red meat and poultry, dark leafy greens, beans, nuts and seeds, seafood and organ meats like liver to your daily diet will boost iron levels over time. Vitamin C and beta-carotene rich foods will also help your body absorb non-heme iron, while substances like caffeine and soy protein can inhibit it. Many people are often shocked by how dramatically their mood and energy levels improve after increasing iron intake over two to three months. One big reason new mothers experience postnatal depression and crippling fatigue during baby’s first year? Iron deficiency!
Gluten Sensitivity and Celiac Disease are two different yet related issues that present with similar symptoms. Celiac Disease is an autoimmune reaction to gluten and can be easily tested and confirmed by a doctor. Non-celiac gluten sensitivity is more nebulous and therefore, there are no specific biomarkers to diagnose it. Celiac disease is rare — an estimated one percent of the population has it. Gluten intolerance appears to be more common, and may affect up to thirteen percent of people, although estimates widely differ. Symptoms of both include bloating, gas, fatigue, depression, constipation, iron-deficiency anemia (see above!), delusional thinking, and even psychosis. Some fascinating research on the connection between schizophrenia and gluten has been published recently, although results are not yet consistent enough to conclude a causal relationship.
Researchers at John’s Hopkins University’s School of Public Health found that people with celiac disease are three times more likely to develop schizophrenia than those without it. A literature review of studies published between 1900 and 2014 found that anxiety, depression and fatigue are all common complaints in patients with celiac disease that has been untreated.
So, what can you do? Simple serology tests, the Tissue Transglutaminase IgA antibody and the IgA antibody, will look for antibodies in the blood to determine whether or not you have a negative reaction to gluten. If this test is negative but you still suspect you have celiac disease, you may want to ask your doctor for an IgA Endomysial antibody test, although this is more expensive and less accurate. Genetic testing can be helpful in determining if you might be a candidate for celiac or gluten sensitivity, but only about five percent of people who carry the genes will actually develop Celiac Disease. You may also want to rule out a straightforward wheat allergy, which often presents differently, by taking an allergy panel like RAST or skin prick testing.
Celiac disease and gluten sensitivity are treated through dietary shifts— but that doesn’t mean that the process is easy! Many foods in restaurants contain hidden gluten (one-third of gluten free dishes in US restaurants have been found to contain gluten) and package labels in the grocery store are not always accurate. Cross-contamination in manufacturing plants is common, so it’s rarely safe to rely on an ingredient list unless the packaged food is certified “gluten-free.” And, many people who are aware that gluten trashes their health still cannot resist the siren song of pizza and freshly baked bread, which is where enlisting the help of a health coach may be extremely helpful. Going gluten free is definitely a lifestyle shift, but if you have celiac disease or gluten sensitivity, it’s the only way to heal. Give your body and mind three months to adjust to the change, and be patient with yourself as you navigate living in a gluten-free world. It’s not easy, but the boost to your wellbeing may be considerable!
Reactive Hypoglycemia, also known as the great mimicker of depression and anxiety, is a little known yet increasingly common condition where blood glucose levels become dangerously low three to four hours after eating a meal. There are a few different types of hypoglycemia and while some are associated with pre-diabetes, non-diabetic reactive hypoglycemia is simply caused by low blood sugar without the highs. Symptoms include weakness, shakiness, dizziness, headache, sweating, anxiety, irritability, heart palpitations, insomnia, a sense of doom, hallucinations, extreme fatigue and loss of consciousness. Studies conducted on the prison population found that reactive hypoglycemia was linked to violence among inmates, and it is often misdiagnosed as chronic fatigue, subclinical hypothyroidism, depression, bipolar disorder, alcoholism, anxiety, and others.
Hypoglycemia can also drive alcohol use disorders and eating disorders because temporary relief from symptoms is usually dependent on the ingestion of sugar, creating a vicious cycle. This may be why Alcoholics Anonymous often pushes donuts and juice on the newly sober to counteract the terrible effects of decreased glucose in the body!
Testing for reactive hypoglycemia is straightforward, although few doctors look for it. If you suspect you may have reactive hypoglycemia, you will need to ask an experienced endocrinologist for a Mixed Meal Tolerance Test, which involves swallowing a sweet drink containing fat, protein and sugar. This will raise your blood glucose and force your body to pump out more insulin. Then, you’ll be given several blood tests over the five hours following ingestion to see how your body reacts.
If you test positive during this test for reactive hypoglycemia, your endocrinologist will likely implant a blood glucose monitor into your arm and ask you to eat a wide variety of foods over a period of a few weeks, taking note of when your blood glucose drops and symptoms appear. He will then analyze this data and work with you to create a nutrition plan of action, as well as discussing medication options. You can usually treat non-diabetic reactive hypoglycemia through dietary changes alone, but patience and persistence is key. While some do well on a nutrition plan that incorporates moderate complex carbohydrates ingested every few hours, others cannot tolerate any carbs and may find relief on a Paleo approach to eating, the “keto diet” or a “zero carb” meal plan, which stabilizes insulin levels and trains the body to turn fat into ketones for energy production, rather than relying on glucose. Regular exercise and daily glucose monitoring are also important! Nutritional changes and lifestyle adjustments can completely reverse this frustrating condition.
Not Eating Enough is a surprisingly common reason for why people experience symptoms of decreased mental wellness.
The dieting industry and weight loss culture that has predominated over the past thirty years taught millions of women that if they wanted to shed pounds, they’d need to eat somewhere between 900 to 1200 calories per day. This ludicrous suggestion has given rise to an increase in eating disorders, slowed metabolism, suboptimal health and self-loathing.
When we do not eat enough to support bodily functioning, we rob our organs of the macro- and micronutrients they require, which can lead to a host of pretty scary symptoms, including severe depression, anxiety, fatigue, and insomnia. In my coaching practice, about thirty to forty percent of the women I work with are not eating enough, and have been living that way for years and even decades. There is so much confusion over how many calories we actually need to perform at our best. A simple way to figure this out is to use something called the Mifflin St. Jeor equation:
For women, the equation is: 10 x weight (kg) + 6.25 x height (cm) – 5 x age (y) – 161.
For men, the equation is: 10 x weight (kg) + 6.25 x height (cm) – 5 x age (y) +5
Your result will give you the amount of calories you a recommended to ingest in order to support your Basal Metabolic Rate (or BMR, your metabolism at complete rest).
From there, you’ll want to multiply that number depending on your daily activity level, which is called your basic activity factor, as follows:
1.2 if you are sedentary (little or no exercise = BMR x 1.2
1.375 if you are lightly active (exercise 1-3 days/week) = BMR x 1.375
1.55 if you are moderately active (exercise 3-5 days week) = BMR x 1.55
1.75 if you are very active (hard exercise 6-7 days week) = BMR x 1.725
1.9 if you do very hard exercise on a daily basis and work a physical job BMR = 1.9
Using this formula will give you a pretty good idea of how many calories you need to consume daily in order to keep your body functioning optimally, assuming that you do not wish to lose weight and that there are no serious underlying health problems. If you are trying to shed some body fat, a certified and experienced health coach can help you figure out how to adjust your caloric intake and still keep your body in a happy place.
Behavioral health issues like depression and anxiety can be tricky to treat, and their underlying causes are not always straightforward. I know that if my nutrition is on point and I’m exercising regularly, I generally do not experience any symptoms of depression and anxiety, but if I consume sugar or carbohydrates, skip my workouts, and surround myself with negative people, I’m in for trouble. For many of us who have faced mental health issues, a cure does not exist in a pill, but rather in the way we eat, move and live. If you’re struggling with a drug resistant mental health condition, consider consulting an endocrinologist and a registered dietitian to investigate potential physical underlying causes. A skilled, experienced health coach or nutritionist can also be helpful in crafting a plan of action while providing support and accountability as you move into a more peaceful and contented frame of mind—and body!
As always, thanks for reading! I have not posted in a long while - between mamahood, health coaching, consulting, school, long-form writing and self-care, my priorities have changed. Social media/blogging doesn’t happen often these days! I do, however, continue to work with a small number of health and behavior change coaching clients, so if you’re curious about how coaching may help to improve your energy levels and overall well-being, email me at firstname.lastname@example.org. Please be aware that I am only taking clients in Singapore at this time.