Mental Health Protocol
Mental Health can be impacted by blood sugar, nutritional deficiency, genetic SNP, and even gut infections but before I unpack, its important to note that chronic stress or trauma can be the spike that activates the process or keeps the individual from a regulated state.
The hypothalamus-pituitary-adrenal axis (HPA-axis) when in overdrive from chronic stress demand or constant state of worry can keep the body in “reactive” sympathetic nervous system response with the body’s function focusing on survival mode. This fight or flight reactivity in the body often throws off the balance of the parasympathetic system which regulates the “regulatory” function of the body often known as rest and digest mode.
However, the parasympathetic state has many functions beyond sleep and digestion, it is in this mode that the body has optimal metabolic function for healthy weight loss or maintenance and reproductive function including sexual hormone balance for fertility, regulation of menstrual cycle, and libido.
Running on adrenaline as most people are, can lead to chronic illness and metabolic imbalance driving stubborn body fat and chronic fatigue as well as a feeling of generally buzzing or even feeling like you want to tear out of your skin at times. As I say in the Anti-Anxiety Diet, mismanaged stress or anxiety can be the Achilles heel to your wellness. Getting the body into a parasympathetic regulatory mode is key for mental health. You can dig into my book, the Anti-Anxiety Diet to get more into root causes of anxiety and lifestyle and supplement support for management.
Address your stress with 2-3 of these daily tools:
Breath work to bring down heart rate and support vagus nerve, such as 4-7-8 breath
Gratitude practice, write down 3 things you are grateful for daily. This can reduce cortisol signaling and increase expression of serotonin and dopamine.
Get outside in nature for at least 2 hours daily! This aids in parasympathetic regulation and the body gets regulated by bird sounds, red light from sunset/sunrise, and vibrations in nature.
Bring in Calm and Clear 1-2 at rise, midday, bed as a game changing blend of herbs, vitamins, and amino acids to help you ride the waves of your rocking life without losing sleep or feeling anxious while being productive and feeling grounded
Butterfly arms, cross your arms at your chest with your palms on your clavicle and your fingers pointing up. Tap right, left, right, left with your fingertips tapping on your bone starting with a more rapid intense tap and about one minute in you will notice your heart rate and the rate and intensity of the tapping has eased. Be sure to focus on exhale through this process.
Try GABACalm my ultimate chill pill to aid with agitation, anxiety, and impulsivity serving as a bioidentical inhibitory compound for the brain without acting as a sedative.
My goal always is to pair my functional medicine approach with food-as-medicine solutions. With mental illness I see a strong need to set the foundation of a ketogenic diet with at minimum a higher protein low-glycemic diet. Check out the Naturally Nourished Podcast episode 492 to learn more!
How the Keto Diet Can Support Mood Balance
The ketogenic diet was first brought into the medical realm as a treatment option for epilepsy due to its ability to reduce over-excitability and inflammation in the brain.
Studies have demonstrated clinical overlap in mechanisms of epilepsy and bipolar disorder and now we are seeing common anticonvulsant meds being prescribed for mental health conditions including Lamictal (Lamotrigine), Depoakote, Tegretol, and Trileptal.
Ketones are able to serve as a tool in managing mania, bipolar, and major depressive disorder while further serving to enhance cognitive clarity and mood. When in the blood stream, ketones have favorable influence on the brain with a reduction in excitatory neurotransmitters via ion shifts which create stabilized mood and reduction of anxiety. Ketones are also a lower oxidizing fuel thus reducing inflammation and oxidative stress in the brain to facilitate healthy brain function. Studies show a ketogenic diet for three weeks can enhance brain-derived neurotrophic factor (BDNF) levels by 47%. BDNF is crucial for synaptic plasticity, learning, memory, and hippocampal function. Reduced levels of BDNF are linked to Alzheimer’s, depression, and neurodegenerative diseases.
A 3-Week Ketogenic Diet Increases Global Cerebral Blood Flow and Brain-Derived Neurotrophic Factor - PubMed This study also demonstrated 22% enhanced cerebral blood flow with the keto diet to further enhance brain health and function.
Ketone levels enhance GABA production and reduce the breakdown of GABA which supports a higher GABA/Glutamate ratio to reduce neuronal hyperexcitability. Enhanced GABA activity helps manage neuroinflammation and aids in a calm balanced mood.
The use of the ketogenic diet is powerful and substantial in the treatment of psychiatric disorders, here are some highlighted studies:
We report the unexpected resolution of longstanding schizophrenic symptoms after starting a low-carbohydrate, ketogenic diet. After a review of the literature, possible reasons for this include the metabolic consequences from the elimination of gluten from the diet, and the modulation of the disease of schizophrenia at the cellular level.
The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients
31 adults with severe, persistent mental illness (major depressive disorder, bipolar disorder, and schizoaffective disorder) whose symptoms were poorly controlled despite intensive psychiatric management were admitted to a psychiatric hospital and placed on a ketogenic diet restricted to a maximum of 20 grams of carbohydrate per day as an adjunct to conventional inpatient care 248 days.
Means and standard deviations (SDs) improved for the Hamilton Depression Rating Scale scores from 25.4 (6.3) to 7.7 (4.2), P < 0.001 and the Montgomery-Åsberg Depression Rating Scale from 29.6 (7.8) to 10.1 (6.5), P < 0.001. Among the 10 patients with schizoaffective illness, mean (SD) of the Positive and Negative Syndrome Scale (PANSS) scores improved from 91.4 (15.3) to 49.3 (6.9), P < 0.001. Significant improvements were also observed in metabolic health measures including weight, blood pressure, blood glucose, and triglycerides.
Ketogenic Diet: A Dietary Modification as an Anxiolytic Approach? - PMC
This study from 2020, is like an outline of my book The Anti-Anxiety Diet (2018) as a lovely summary. See this image from the study which highlights many of the 6Rs of The Anti-Anxiety Diet.
To learn more about my Naturally Nourished approach to a ketogenic diet, check out my virtual archived class here or consider joining my bi-annual Live group program. As you are learning more about getting keto adapted, start with a low-glycemic diet while focusing on ample protein. Blood sugar balance is key for mental health as researchers have found individuals with elevated blood sugar levels are more than two-fold more likely to develop depressive illness.
Getting started with food-as-medicine:
Carb Control: Bring total carbohydrates down by eliminating gluten and all flour based foods (no gluten-free substitutes other than almond flour). Select carbs from whole fruits and starchy vegetables in moderation with a goal of bringing carbs to less than 60g daily.
Ample Protein: Start to focus on ample protein to support amino acid needs for neurotransmitter production and prefrontal cortex function. Aim for 1g of protein per pound of ideal body weight daily.
Quality Fats: Consume healthy whole food fats from coconut, avocado, olives/olive oil, tallow, lard, and fats in animal products. Your brain is the fattiest organ of the body containing around 60% of its mass in fat, for optimal mental health you need to ensure your brain is bathed in healthy fats.
Focus on whole real foods and eliminate processed products! Whole foods will have more vitamins, minerals, and antioxidants while providing lower calorie density and less inflammatory ingredients. Processed products often have additives or stabilizers that can further drive inflammation and gut stress while driving elevated blood sugars.
Ample protein and animal based products are key!
The human brain is incredibly cholesterol rich holding 20% or greater of the body’s total cholesterol in the brain and heavily concentrated in the myelin sheath serving to protect nerve circuits. Consuming high quality animal products aids in providing brain boosting nutrients while supporting neurological function.
Pregnenolone is a neurosteroid made from cholesterol with mental health benefits. Some studies show that pregnenolone can improve depression, anxiety, schizophrenia, and biopolar disorder while reducing cravings for substances. This randomized clinical trial used 50mg twice daily working up to 250mg twice daily pregnenolone compared to placebo and demonstrated 61% remission of depression. Note: I advise testing blood pregnenolone and cholesterol levels prior to intervening with pregnenolone and ruling out any hormone dominance concerns. A Randomized, Double-Blind, Placebo-Controlled Trial of Pregnenolone for Bipolar Depression - PMC
Protein could be an entire article within this protocol, but I’ll keep it at protein is key for neurotransmitter production, blood sugar balance, immune function, and to support the prefrontal cortex in executive functioning and socialization. Aim for 1g per pound of ideal body weight. If this is difficult in the beginning, bring in Whey Protect and add this to yogurt or make a smoothie or protein shake as insurance. Generally get at least 30g protein per meal.
Omega-3s
The American Psychiatric Association guidelines support omega-3 consumption for the mentally ill, through the consumption of at least 1 g of EPA and DHA daily.
DHA plays a role in the brain’s cellular structure construction, because as much as 20% of the brain is composed of it. All omega-3 formulations exhibit anti-inflammatory activity and help to maintain brain cells’ stability, with linkages to neurotransmitters’ (serotonin, dopamine) proper functioning.
EPA-DHA Extra: 2-3 capsules daily to provide 2-3 grams of EPA and DHA in combination.
Liquid EPA-DHA: 1-2 tsp daily to provide 1.5-3g of EPA and DHA in combination
Magnesium
Magnesium is key for mood stability and many studies demonstrate those with mental illness and chronic stress signaling to be magnesium deficient. Magnesium bisglycinate is the most bioavailable form and key for neuromuscular relaxation aiding in regulating neurotransmitters that affect mood, such as glutamate and GABA. Glycine, the other component of magnesium bisglycinate, is an amino acid that also supports neurotransmitter function and can have a calming effect.
In this double-blind, randomized clinical trial, 500 mg/day of magnesium supplementation for 8 weeks improved the Beck test scores and serum magnesium level.
Magnesium also can inhibit NMDA receptors, which are linked to anxiety and panic disorders and excitatory brain activity. The Relax and Regulate powder has magnesium bisglycinate at 250mg and myoinositol at 4g which aids further as an anxiety reducing compound while supporting blood sugar stability.
Relax and Regulate: 1-2 scoops at bed with optional 1/2-1 scoop midday
Methylfolate
This biologically available form of folate, vitamin B9, plays a key role with methylation the building or excreting of compounds in the body. Methylfolate aids in producing serotonin and dopamine with solid research on mood management in conditions such as schizophrenia, bipolar disorder, and manic depressive disorder. There is strong research on the clinical use of methylfolate and many studies use this nutrient in conjunction with medications and see favorable impact. Patients treated with methylfolate have a higher rate of clinical response, defined as a 50% reduction in depression scores.
Lifestyle Support for Mental Wellness
Beyond the stress regulation tools above there are two priorities for mental wellness: Limiting Screen Time + Daily Movement
Screen Time Can Drive Mental Stress and Neurotransmitter Imbalance
The brain is overburdened with bright blue screen lights, rapid visual effects from electronic monitors flickering quicker than the eye can detect, driving dopamine dumping. Checking your social media, email, and scrolling your digital device can release a surge of dopamine in the brain. This is partially the explanation of why we are all so addicted to our smartphones and tablets. The enhanced information processing ability of electronics can tax the brain and neurotransmitters, bombarding the brain with information at a rapid rate and driving a dump of dopamine for reward/bliss action as well as other key players based on the stimulus. Stressful newsfeed, constant comparison, and intense games can drive surges of epinephrine with adrenaline survival needs in some or can drive depletion of GABA in the brain’s attempt to mellow out the racing brain!
It is recommended to limit screen time, including phones, computers, and television to five hours/day. If this is not possible due to your field of work, consider blue blocker glasses, which reduce the impact of artificial bright blue light that can throw off your melatonin and serotonin levels, and drive cortisol stress hormone release.
Movement is Medicine for Mental Health
A meta-analysis in the BMJ analyzed 218 studies involving over 14,000 participants, the results demonstrated that dancing outperformed medications and other physical activities including walking, jogging, yoga, and strength training. What was surprising to the researchers is that dance had a large effect size defined >0.8, coming in at 0.96 score where as the most popular drug for mental health SSRIs were seen with a small effect with a range of 0.2-0.49 at the size of 0.26 with possibly not clinically important, benefits. Many forms of movement scored superior to the SSRI drugs including a simple walk outside. Movement releases feel good endorphins, supports serotonin and dopamine levels and reduces cortisol stress hormone.
Action: Get moving and focus on 1 hour daily which can be set up as a class, a walk, or broken up into 15-min exercise snacks 4x throughout the day.
