Saturday, August 20, 2011

Do Carbs Keep You Sane? Midmorning Post-Bagel Slump and the Wurtmans

We are going to rely more on this most excellent review paper by Dr. David Benton of Swansea, UK, Carbohydrate ingestion, blood glucose, and mood to continue our exploration of the question of how ingestion of carbohydrates affects mental state.

First off, some of the short-term studies.  We all can guess the results, but a dozen or so studies have shown comparisons between a meal of say, turkey breast versus starch-based meals, or placebo versus a sucrose or glucose containing drink.  Not surprisingly, mood/energy measurements at 14-30 minutes after the sugar drinks shows an increase in energy levels, followed by a slump at two hours.  In the protein meals versus starchy meals, subjects report a decrease in subjective sense of energy two hours after eating the starchy meal compared to protein.  All of these studies were done while subjects were resting quietly.

In studies done of subjects asked to do demanding cognitive tasks (presumably slurping up all available glucose as the noggin is burning nitro), falling levels of reported energy directly correlated with falling blood sugar levels.  Subjects with low blood glucose at 30 minutes and 2 hours doing demanding cognitive tests had higher tension ratings than those with high blood glucose.   In diabetics, blood glucose levels  (measured continuously) have been associated with immediate mood changes, with low corresponding to a more negative mood state than high levels.  (There are some interesting perturbations of this phenomena over measurements of days and weeks, however, which I will address in detail in the next post).

Now on to that theory I've actually already discussed at some length in previous posts - via insulin and albumin effects, ingestion of carbohydrate leads to the preferential shuttling of the rare amino acid, tryptophan, into the brain.  Since tryptophan is the precursor to serotonin, eating carbohydrates will presumably make one more serene, sleepier, and more sated than someone whose brain is starving for serotonin (low cerebrospinal fluid (CSF) serotonin levels are associated with violence, insomnia, hunger, and suicide, partly because serotonin and its metabolite melatonin play a major role in the mood, appetite, and sleep centers).

Richard and Judith Wurtman of MIT are the ones who originally proposed the theory, and they suggested that humans (particularly premenstrual women and those afflicted with seasonal affective disorder) crave carbs for the serotonin-boosting pharmacologic effect (1)(3).  I've seen this theory in textbooks and in research papers many, many times, and I rather took it as fact.  Judith Wurtman is a big carb proponent and is likely to give rather strongly-worded quotes to the media damning low-carb diets for causing depression.  In the comments, Zooko pointed me to this, er, interesting article by Dr. J. Wurtman for the Huffington Post.  Also to her twitter feed, which advises the dubious practice of snacking on pure carbs in between meals for a "serotonin surge" - with specific recommendations for pretzels, rice cakes, and marshmallows.  Long term I would say that anyone wanting to lose fat who also has mental health problems should really pretty much avoid adding any processed, micronutrient-poor calories to the mix.  What is interesting about the good Dr. Benton's review paper is that he leaves the Wurtmans' tenuous theory crumbled into dust when we look at the context of carbohydrate ingestion in the real world.

It is absolutely true that a carbohydrate only meal after a fast will increase the entry of tryptophan into the brain in rodents, humans, and other primates.  The problem is, the moment you eat a bit of food protein, this effect no longer takes place.  Dr. Garner was able to increase serotonin in mice brains via a mixed diet, but he fed the little critters extra tryptophan supplements to do the trick (which resulted in increased mouse brain serotonin and a deadly increase in scratching and subsequent skin infections).  Without the extra tryptophan boost, as little as 4% of protein in the meal will eliminate the carbohydrate tryptophan-boosting effect.  To put that amount of protein into perspective, potatoes, rice, chocolate, and flour all have too much protein for them to increase tryptophan entry into the brain.  Bascially, one has to eat pure starch (or a sugary drink) to achieve the pharmacologic carb-serotonin effect, long enough after a previous meal that no protein remains in the gut.  That also means that pretzels and rice cakes wouldn't work for a "serotonin surge," and one must stick to marshmallows and jelly beans, which doesn't have much of an evolutionary precedent. This teensy amount of protein killing any "serotonin surge" is true in studies of rats, other primates, and humans (2).

In monkeys, Grimes et al. contrasted protein and carbohydrate breakfasts and found no impact on the levels of cerebrospinal fluid (CSF) tryptophan or serotonin turnover from individual carbohydrate-heavy meals.  He went from protein being 25% to 6% of calories, and as protein declined, so did plasma and CSF levels of tryptophan due to lower amounts of raw material protein consumed.  There was no immediate change in serotonin turnover or CSF tryptophan levels to individual meals.  In the case of the monkeys, higher protein chronically is associated with higher serotonin, not higher carbohydrate, and blood changes of the ratio of tryptophan to other amino acids did not predict CSF tryptophan levels as it does in rats (which are what the Wurtmans studied).  I must say the Wurtmans' studies are cited a good deal more often than Benton or Teff or Grimes.

So the carbohydrate = serotonin-increasing theory is likely bogus for humans, especially in the real world (yes, even on Thanksgiving), unless you happen to have a glass of lemonade for breakfast every morning, excluding all other food.  BUT, that doesn't mean that carbs don't affect mood.  What do studies without such ridiculous attention to actual mechanisms show?

In one study, a drink with 48 grams of carbohydrate and no protein decreased depression, anger, and confusion in women suffering PMS.  Judith Wurtman also found that women increased their intake of carbohydrate and fat in the premenstrual stage, and experimental meals with only 4% of the energy as protein did improve the mood of women with PMS.  (She did find these women had no higher ratios of tryptophan in their blood than women given control meals, and that women who had improved mood also had no increase in blood levels of tryptophan, suggesting that is not the mechanism for the improved mood) (4).

What do other researchers find?  In several reviews, it was found that women generally report an increased craving for sweets and increased appetite in the pre-menstrual period.  In humans and animals, there are also changes in basal metabolic rate in the different parts of the cycle, corresponding to the appetite changes, which makes sense.  However, a review of studies of what women actually eat showed no difference in the total amount of carbohydrate consumed in any part of the menstrual cycle.  Some studies have shown an increase in sweets, chocolate, and cake consumption before and during menses compared to ovulation (which occurs mid-cycle).  So there is definite evidence that appetite increases just before and a bit during menstruation, but this corresponds to a higher metabolic rate, and it is foods generally containing a combination of carbohydrate and fat that are craved, not strictly carbohydrates.

In other studies, carbohydrate ingestion has been associated with better mood.  De Castro had subjects keep food diaries and mood journals for 9 days, and found that on the days when more carbohydrates were consumed, mood was better (5), and people felt more energetic.  He also found a cumulative effect - the more carbohydrate consumed over the week, the happier the person tended to be.  In a study of 686 folks who reported their mood at mid-day and what they ate that morning, the more absolute carbohydrate the male subjects consumed that morning, the happier their morning mood.  Absolute and relative amounts of protein and fat had no impact on mood in this unpublished study by Benton.

Finally, studies of experimental low carb vs. high carb diets of one week (6), three weeks (7), six weeks (8), and one year (9) show a better comparative mood and increased serenity in the high-carb dieters.  The one year study was complicated by the fact that twice as many people in the low-carb group were on antidepressants, and the other studies may have been of too short a duration to bypass the "low carb flu" - and all of those low carb diets may have been high in omega 6.  I don't have the energy to chase down all the full texts of all these studies right now (I've seen the year-long one, however), and the one-week one was done in cyclists, who might be cranky in the first week of a low-carb diet while training!

So what have we learned?  Well, the Wurtmans and the carbohydrate-tryptophan-serotonin boost theory are scuttled, for now*.  But carbohydrates don't seem to cause craziness, and for some people, they seem to help.  Is the story any different for folks who have insulin resistance?  We'll find out next time (though there might be a quick intervening review of a related topic in between that post and this one).

Please see the later post, Carbs and Serotonin, A Connection After All

23 comments:

  1. Interesting stuff. I always found it to be implausible that humans are dependent upon carbohydrate to make sufficient serotonin. There have to be other mechanisms.

    If we agree with Robert Lustig and common sense, increased energy expenditure improves mood, and most people are dependent upon carbohydrate for optimal energy levels. Those who are used to burning fat will probably rely less on a high-carb breakfast.

    I have been following the method of having a low carb breakfast because people are more insulin resistant in the morning, and it has been great. But then again I only average about a quarter of my calories as carbs so I'm not so dependent upon them.

    Definitely looking forward to seeing how insulin resistance changes things.

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  2. While I find that I lose weight much faster on a low-carb diet, I get anxiety attacks to the point where I can hardly function. I am definitely one of those happy, high carb people. For me, it's a matter of finding balance.

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  3. I had a comment related to this last week: http://perfecthealthdiet.com/?p=4315#comment-27865. Wish I'd seen this post first. Thanks, Emily.

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  4. Interesting discussion. I wonder what you think of the argument of Diana Schwarzbein, The Scharzbein Principle, that every meal should have a modest level of carbs to go with eating fat and protein to appetite to ensure hormonal balance. Overall, she advocates lowish carb but at least 15-30 grams per meal and three meals a day. I ask because I lost weight on low carb and then start having fatigue and stress issues as I returned to more carbs during the holiday season. It could either be because I burned out on the low carb or because I didn't stay with it. The problem with n=1 experiments...

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  5. According to my n=1 observation, ketosis is great for my mental balance(I didn't have much of mental issues before getting into premenopausal age), but LC was the first step for me being keto-adapted. Second step was the IF adaptation. In order to get there I had to suffer migraine each time when I prolonged eating intervals. Now my blood sugar curve is much flatter, BS readings never get below 98 when I am in ketosis for a long time. After reaching my weight goal,I started experimenting again and added some carbs into my diet. I still have LC breakfast but add some amount of buckwheat or starchy veggies and a fruit to the dinner. Attempts to have something carb-containing early in the day caused return of extreme irritation and agitation, especially before menstrual period.

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  6. Dear Dr. Emily Deans:

    Thank you for writing this! I hope some people read this and are thus disabused of the Wurtman theory. Your link to "damning low carb diets for causing depression" doesn't go to the most egregious of Dr. J. Wurtman's writings on the subject. I would have to vote for this one (http://www.huffingtonpost.com/judith-j-wurtman-phd/carbohydrates-mood-_b_833431.html ) in which she states that carbohydrate intake is as necessary to daily life as water and that without eating carbohydrates your brain cannot function.

    See also her twitter stream: https://twitter.com/#!/stopmed_wt_gain

    A small editing suggestion: you started using the acronym "CSF" without defining it. I had to look it up. :-)

    I think we should be careful not to generalize from studies of eating "really high carb vs. really-really high carb" to infer what happens on a low carb diet. That is, if people were happier on days that they ate 400 grams of carbohydrate than on days when they ate 300 grams, that doesn't mean that going on a real low carb diet (let's say, less than 30 grams per day) is going to make them unhappy! Nor, of course, if 300 made them happier than 400. The effect could well be different across such a large range.

    The one-year long trial by Dr. Brinkworth et al. is a much better piece of evidence for this question that I'm interested in -- the question of whether a low-carb diet is good for mood. I am not persuaded by that one study to reject my hypothesis that a (very) low-carb diet is good for mood, because the low-carb arm was on a calorie-restricted diet (which is against the recommendations by low-carb experts) and because the results were so different from McClernon et al. 2007.

    Also, see the "Comments" section at the end of Brinkworth's paper, which discusses the limitations of their results in great detail. I really appreciated that they had the caution and humility to spell out the limitations so carefully! The world would be a better place if all scientists did that.

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  7. I just wrote about this too Emily. Ironic. Aug 14th.http://jackkruse.com/your-gutneurotransmitters-and-hormones/

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  8. what if it's less about the carbs and more about the micro-nutrients that come with some of the carbs? i've done low-carb before and tend to need to supplement potassium because of my narrowed food choices and that certainly made a huge difference in my energy levels and cramping (carb-flu?).

    in the past couple months i eliminated more foods to determine food intolerances (no grain, soy, dairy, nightshade veggies, etc). i'm eating low-carb, though not as low as in the past. between 50-100 grams per day. about a week into it, i felt absolutely terrible for a couple days 'til i remembered to take some potassium and i also got more serious about magnesium (i had been taking it sporadically). now i'm taking some citrate and slathering on magnesium gel. not only has all my energy come back, but my mood is unbelievable. irritability, anger, anxiety, and depression virtually gone (or at least reasonable to life events). pms crazy/hunger and menstrual pain also gone. but the biggest surprise is my finger nails. i used to have to keep them short because they would always break otherwise, now they are absurdly strong and smooth. i've been dealing with these issues since my youth. 30+ years later i seem to have found at least part of the answer. and the really good news is that i don't have to eliminate all the foods i've been testing.

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  9. If I want to worsen my depression, the best way to do that is to eat a high carb diet. Boom. Done.

    I always, ALWAYS feel worse the more carbs I am eating.

    Today I had a stressful day at work, running around, hardly eating other than a snack of 2 ounces of nuts, half an atkins protein bar, 1 cracker, a ton of cream in my coffee (no sugar)... and the past few days, I was low carb too, so it is sure that right now I am in ketosis. I feel fricking fabulous. I feel energetic, alert, motivated, my mood and confidence is high, I am not hungry (although I just ate fatty pork and a little broccoli drowning in butter and coconut oil, cuz ya know, I logically know that I need foodz and it will help my ketosis). This is my ideal state - not a lot of calories, ketogenic macronutrient ratios, not a lot of protein, not eating that often, doing low level activity often, stress level moderately elevated.
    This, for me, is like drugs. This is how my brain works the best it can work. I feel soooo good and alert right now.

    If I were to eat some "happy calming serotonin raising carbs", I would feel much crappier right now. If I were to eat those "happy calming serotonin raising carbs" three meals per day, I would be depressed slightly if not significantly. I think, at least in my brain, a lot of my depression relates to an abnormal regulation of stress response and I think that glucose suppresses ACTH and dopamine too much.

    The lowest my depression got - before I knew anything about diet - I was like a corpse. My hair was matted and I slept 12 hrs or more a day, I didn't know if it was day or night, and I was PHYSICALLY INCAPABLE of caring about anything. It was like I was a victim of a mad scientist who burned the areas of the brain out which are associated with motivation. My life, thus far, was completely void of the feeling of drive. I was so ruined. It wasn't until I went on a ketogenic diet that my brain began to spark a little bit and I started feeling rudimentary feelings of concern or inspiration about life or anything at all.

    I have never, ever, felt happier after eating a high carbohydrate pig out. "Comfort food" is an oxymoron as far as I am concerned. I observe people eating ice cream and cake and stating how it makes them feel better and I think they are insane. I mean logically I understand that it probably feels different to them... but from my frame of reference that is the last thing I am going to do if I am trying to use food to modify my depression. It makes no sense what so ever. Food does, however, help to numb overstimulation and sometimes I will find myself eating a lot if I feel nervous... but depression? Never.

    To help depression I need stress and I need ketosis. Lack of food, dietary fat, staying up all night, lots of bright light - wake up, get up, get going, and my mood will flip.

    And right now, this is pretty much the best I can get, without being craz-ay (e.g. too high - drug like happy and not fully in control).

    Tonight I will nap for 2 or 3 hrs and then I am back to the grind for 16+ hrs.

    One of the few benefits of being a crazy weirdo is that everything which hurts normal people, actually helps you. I look forward to sleep loss, moderate stress, and lack of carbs/food because WEEEEEE. Normal people hate these things but there is a part of me that is like "oh good, I will sleep 2 hrs, I can expect to be flying, it will be fun".

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  10. Wow tangents... but yea... I don't get this idea that carbs are "good for depression", or "good for atypical depression" or "good for seasonal depression" because I have all of those things and carbs RUIIIN me. Sure I crave them when in the pit, but I know that eating them pushes my head further underground. I KNOW that because I have experienced low carb. I suppose for a depressive who has never felt the difference they might think that food helps their mood, too?

    My depression has atypical symptoms (leaden paralysis - can't move my hands, too heavy to lift... I get hungrier, I get very fatigued and want to stay in bed), my depression clearly has a seasonal pattern where I tend to have flares in the fall/winter (although it can happen any time, it is clear that decreasing light triggers me big time whereas increasing light elevates my mood). Carbs are the worst for my depression and are an independent trigger. I've had depressions that have lasted weeks after eating poorly for a few days.

    Thank you Dr Deans for this info, I hadn't even considered that perhaps the "general truism" that carbs raise serotonin might be false. I just believed the hype. That it actually is NOT true makes a lot of sense. I never experienced anything like a mood boost after carbs. I suspect the damage to brain energy use from shifting to glucose in my glucose - intolerant cells vastly outweighs any change in serotonin from carbs.

    Speaking personally regarding menstrual cycle and appetite changes, I find that progesterone, at least for me, does more than just increase my metabolic rate (therefore appetite) ... progesterone very specifically worsens my glucose tolerance with the end result being that I am incredibly hungry with a shift to get fatter. The difference is this... during the non-progesterone dominant parts of the cycle, if I restrict food (eating less than my hunger) I feel hungry and a desire to eat more, but I can easily resist the hunger and I do not intensely crave food. The hunger is something I can put out of my mind easily and my energy levels are not dramatically lower.

    When progesterone is high, I can not IGNORE the hunger, it's like, on blast in my mind and I want to eat a ton of calories. If I attempt to resist it, I get low blood sugar (presumably this is because progesterone raises insulin/worsens glucose tolerance). Also, progesterone seems to specifically increase appetite independent of any metabolic effect... which is why megace (megastrol acetate) is so useful for cachexia.

    I can tell when progesterone is high because I eat such weird things. I'll eat like, flax seed chips (I get intense cravings for fatty/salty food), and then I'll eat sugar free chocolate, then I'll eat meat, then I'll eat some cheese, then I'll eat low carb cookies. I would not eat this way normally, the idea of eating these foods in combination would be gross or strange. When progesterone is high, I will and can and do eat these foods in combination, it's like I am driven to consume sugar, fat, salt, and protein. Considering what progesterone does, it totally makes sense.

    There is definitely more going on to progesterone and appetite besides raising metabolic rate. In my experience, is absolutely modifies how I desire to eat and how easily I can resist. I suspect people who are at baseline glucose intolerant and prone to hyperinsulinemia are probably much more sensitive to progesterone mediated fattening. It seems that women who get the fattest after pregnancy are women who have a family history of diabetes/obesity and signs of IGT before hand (being chubby, feeling "shaky" after eating and stuff like that). Women with good glucose tolerance usually rebound from pregnancy with no weight gain and no metabolic damage.

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  11. Also, mood wise, I don't really suffer from "PMS" in that I get depressed. Sometimes, rarely, I will have depression a few days premenstrually, but usually my mood is just kinda flattened and stabilized by progesterone. I usually feel very "stable" from progesterone, I am not prone to moods being too low or too high.

    What I do experience is this strange reaction to progesterone where I get a blip of mood elevation and energy elevation upon WITHDRAWAL. I can tell when I am going to menstruate because anywhere from 48hrs to the day of menstruation, I move faster, my mood lifts a lot, I talk faster, I get hyped up. This happens very predictably, but of course it depends on my baseline mood too and other random factors. Sometimes it doesn't happen that much other times it happens very significantly.

    I know this menstrual effect is a progesterone withdrawal reaction, there is evidence to suggest progesterone is mood stabilizing, a depressant that blocks estrogen's normal mood elevating (and manicogenic ) properties, an antiepileptic, so abrupt withdrawal of progesterone can then lead to mental disinhibition and increase in brain activity. This also can cause seizures in seizure patients and there is a phenomenon called catamenial epilepsy which describes seizures following the trend of progesterone highs and lows (highs being seizure remission, lows being breakthrough seizures). There is a mental illness equivalent described called menstrual psychosis - this is insanity which follows the same curve as catamenial epilepsy, with the exception that the symptoms are manic and/or psychotic and not seizures. The women with catamenial epilepsy, and menstrual psychosis, find that their symptoms flare 48hrs before to 24 hrs after their menses.

    I seem super super super sensitive to estrogen mediated mood changes. I have had pretty significant depressions from estrogen withdrawal (e.g. I have observed that I can become quite depressed several days following the end of menses and I can get quite high at ovulation when estrogen is surging - spazing out with crazy energy is very common the days before ovulation, with a crash after it happens). I think that my sensitivity to progesterone withdrawal - energy burst from it - may be an offshoot of my sensitivity to estrogen induced mood elevation (or withdrawal depression).

    Estrogen btw is an important antidepressant, not many women realize that and a lot of altie quack gurus on the interwebz are making a mint convincing women that estrogen is bad for them and they need progesterone cream/pills which is so very very silly if anyone properly educates themselves on the reality of what progesterone does and what estrogen does for mood, metabolism and general function / well being.

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  12. Thanks for the comments!

    Stabby, Zooko - I agree that many of the hi/carb low carb studies were done in people on mostly high carb diets, so the data may not be that useful for folks on higher fat diets. And Zooko, I agree about the Brinkworth paper - he was very fair about the limitations. It was a good paper, though with the retrospectroscope I think I would have designed the low carb arm a little differently myself…and thanks Zooko for the links. I've edited my post quite a bit to add them in. Also fixed the "CSF" (it doesn't even occur to me that is an acronym after so many years in the field). I think it's striking that the same fasted pure sugar jolt that will, actually, result in a "serotonin surge" will cause me, personally, to be absolutely miserable and sugar-crashy within a short period of time.

    Bill, Michelle, Woo - from comments and emails it is very clear to me that some people thrive on low carb or zero carb diets, even eliminating serious mental health issues. Others don't do well and feel much better with moderate carb, and others who prefer high carb. I need to look at the hormones more specifically with respect to the hard core biochem and neurotransmitters - I've seen the clinical literature, but the biochem itself is a big project. There are women's health hormonal psych specialists at MGH I will refer to who is a whiz at that kind of thing.

    Bonita - I think you are spot on with respect to the minerals. Best source of magnesium and several others outside of organ meats, mineral water, shellfish are whole grains (even with the phytic acid) - drop those for just steak and veggies with lowish calories (if you are trying to lose weight) in the already mineral-poor SAD state and you may well end up deficient pretty quickly. I take a mineral supplement, extra magnesium, use celtic salt and dulse flakes, drink mineral water, and usually eat a couple of bananas a day. (Shellfish tends to make me sick). What all these papers and studies can't even address are all these confounders!

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  13. John - you write too fast for me to keep up with all your blogs!

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  14. Emily,
    Do you have any experience with treating bruxism?
    There are many of sufferers out there, but I haven't been able to find any real help for a long suffering friend.
    I'm trying to get her to minimize sugar and eliminate grains. Also supplement with magnesium.
    A topic that I hope you will consider covering in the future.

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  15. Bill - honestly, besides my guess about keeping the nutrients tip-top, the stuff that works best in my patients' experience are mouth guards and certain types of yoga breathing or meditation right before bed. At least the latter wouldn't hurt, and I'd say 50% of people get significant benefit from a few minutes' time.

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  16. I see you'll get to insulin resistance next time, but midmorning-post-bagel-slump sounds like insulin resistance already. For the insulin sensitive, the carb/mood story is about liver glycogen replenishment and how you do need some evil fructose (or possibly galactose) to efficiently accomplish it.

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  17. Another good source of magnesium is bone broth. I haven't found evidence that anyone has ever actually measured or tested the magnesium benefits of drinking bone broth, but it pretty much makes sense, doesn't it?

    And what about eating bone marrow? I was very happy to find out the other day that my dear son, age 10, likes cracking open chicken bones and eating the marrow out. That's gotta be good.

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  18. I think that I-suddenly-eat-logs-of-carbs is not adequate to judge about value of the carbs because of many reasons - enzyme and receptor downregulation, beta cell adaptation latency to new carb intake, less bioavailability of vitamin C (and with it, more infection sympthoms and accordingly different brain states).

    I am more interested in gradual carb boost up over a period of few weeks.

    Any opinion on that Emily ?

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  19. Interesting studies. I mean it sounds smart, but it probably doesn't work in real life.

    I will one of those anecdotes I guess. Whenever I eat a low-protein vegetarian meal offered by the Hare-Kirshnas, my mood is UP. I still fele hungry and eat more after but again, MOOD IS UP.

    TO prove whether or not I'm releasing more serotonin in my CSF or w/e I guess that would have to be tested. Maybe we should look for studies on vegetarian diets (which are low protein), and serotonin levels?

    And Itsthewoo, as you probably know you are just running on adrenaline. That usually doesn't last forever so who knows what the underlying cause is. Deciding that carbs = bad for you because you feel like shit isn't a good conclusion. SOmetimes feeling like shit is necessary for some time as your body readjusts. I wonder what your insulin/glucose tolerance and stuff like that is

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    1. Pretty rude and unappreciative of another's experiences. Also showing some vegetarian bias. Low carb works for tons of people.

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  20. @avishek
    I don't think I am running on adrenaline.

    The mood boost from stress is definitely from Adrenaline, but ketosis itself does not produce that "high". Typically ketosis involves a mellow feeling of bliss and inexplicable happiness, more similar to taking opiates + benzos.

    No matter what my energy and stress level, running my metabolism on fat will make it better.

    I will never "adjust " to a high carb intake, I am glucose intolerant and was morbidly obese before I was even an adult. My present thinness, health (and fabulous lab work) is a direct result of not eating those "happy serotonin producing calming energy giving carbs". Mah body = broke from birth.

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  21. The faulty logic of using a Ketogenic diet for bipolar disorder.
    Since anti-epileptics (AE's)are used to treat bipolar disorder and the ketogenic diet(KD) has proven to be an effective treatment option in children with treatment resistant epilepsy therefore it might have an application to treating bipolar disorder. KD is NOT effective for adults with epileptic seizures.

    First of all the rational of using AE's like Carbamazipine ,Valproate, Limicatal, Trileptal, Neurontin, Dilantin... for bipolar disorder is questionable as far as successful response rates. Besides Lithium (and Lithium is NOT AE) Carbamazipine the response rate for AE's for bipolar disorder is very poor. Lithium has a "good response rate" of about 50%! The other AE's have a much lower response rate than lithium. That is why Big Pharma push for approval of their damaging Antipsychotics to bipolar disorder- because the AE's have such a poor response rates. AE's are very effective for bringing down mania but do little or nothing for the depressive phases of bipolar disorder.

    Due to the ever changing an cyclical nature of the illness it is possible to get a positive response to a AE during a remission or tampering down of symptoms. How would you know it was the AE's effectivness or the illness naturally changing?

    Despite over 40 years of use no one knows how lithium works nor do we know the physiological/genetic causes of bipolar disorder. Emily Deans provides mechanisms of actions that AE's have on neurons it's effect on sodium and calcium and the similarities of the KT diet but so what. Ask yourself if AE's are SO SUCCESSFUL for bipolar disorder then how is it that you have not seen one Pharmaceutical company dedicate any research or seek approval for a new AE for bipolar disorder? Why cause Big Pharma knows that AE's are NOT effective against bipolar disorder. Pfizer got fined alot of money trying to peddle Neurontin off label for bipolar disorder. Because AE's are not an effective treatment for bipolar disorder. Emily Deans with your logic how did you graduate medical school? Oh I forgot med school is just memorization and regurgitation.

    As it turns out bipolar disorder looks more like a broken clock or a messed up circadian rhythm disorder. That is why one night of sleep deprivation works in some 70% of bipolar patients. The only problem the antidepressant effect last for only a few days.

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    1. Very spiteful. Comes across as pathetic.

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