New £4M hub for metabolic psychiatry | Hacker News Reader

New £4M hub for metabolic psychiatry

lister-institute.org.uk

21 pointsbreck19 comments

I am pro anything that breaks away from the idea that prescribing strong medication is the only intervention for mental ill health and other human ailments.

Over prescribing continues despite the fact that the outcome for patients with psychiatric illness having only marginally improved in the past decades.

I have been on a ketogenic diet for the last 20 years, long before it became fashionable.

There is promising ongoing research into the effects of the ketogenic diet on mental ill health as well as other areas of ill health such as diabetes and obesity.

I always ask myself this question:

What has changed in then human race over the past 100 years that has led to such a huge increases in mental illness and developmental problems. For me there is only one answer.

Our diet!

Can you talk more about how you have managed to stay on the ketogenic diet for decades? It seems so crazily restrictive in the context of our society’s current relationship with food.

Countless people maintain diets that others would characterize as crazily restrictive.

Ultimately, you don't embody "society's relationship with food" -- you embody your own relationship with food. For some people, the crazy restrictive diet is a cultural inheritence, for others it's just an adopted practice that becomes easier with time. Once you know how to adhere to a diet in all of circumstances your life involves, which is particular to yourself, it never feels restrictive at all. It's just what you eat, the same as whatever you eat now.

> Ultimately, you don't embody "society's relationship with food" -- you embody your own relationship with food

I should’ve been more pointed with my question. For a few years I was a strict vegan and I found it very challenging to stay vegan when travelling, with visiting others, and when at restaurants or cafes. This wasn’t an issue of “my relationship to food” but more the context of “society’s relationship to food” and my role in that society.

Having tried keto (a half assed attempt that I’d like to build upon in the future with another, real attempt), I think keto is a more difficult than vegan in the examples I gave above as there is a steeper learning curve for the general population given that most people have no idea what “net carbs” means or even pay attention to the carb content of food but everyone knows “did this come from an animal or is it an animal”.

There's nothing more restrictive than being chronically mentally ill. The modern diet is so horribly misaligned with our biology, when you've been to the extreme of its consequences, there is no urge to rejoin with the crowd. Just look at the insane obesity rates, and other chronic diseases.

In passing, check out the popular YouTube channel "living well with schizophrenia", she has recently switched to a ketogenic diet and it's successfully treating her condition and is on the path of going off her medication https://youtu.be/kU1ORt6ZnVE

For me it’s extremely easy to cut things out wholesale from my diet if I’ve recognized a cause-effect relationship. Which can be hard to do, since food problems are often a chronic rather than acute issue, taking months to come into effect or subside.

In my case my primary restriction is removal or reduction of omega-6 sources. This wipes out much of what is found in a grocery store, like most condiments and salad dressings, frozen foods, baked goods and deserts, chips, no fatty pork or chicken (which is high in omega-6 due to bioaccumulating it from their feed), etc. And absolutely no French fries or other commercially fried food.

For me excess Omega-6’s appear to result directly and repeatedly in severe depression, dry(er) skin, eczema outbreaks, and weight gain even when undereating. This turns items containing omega-6 mentally into poison, which makes it easy to avoid. Just think of what happens when you get food poisoning from something you like even once, it changes the way you look at it for a long time. When I look at French fries, I don’t think “oh man I wish…”, I flashback to the times where for months I’d spend hours every single day sucked involuntarily into negative mental spirals, where the only comfort I had was my fantasies about finally dying. While Omega-6s certainly isn’t my sole cause of depression, it does seem to repeatedly amplify it far beyond what I can deal with.

What’s left is things which do require a bit more home preparation, but I’ve worked out a variety of low effort/time options. Beef, non-fatty seafood, some eggs, butter/coconut oil, vegetables, rarely fruits, “pure” carb sources like dry pasta, beans or potatoes. I’ll even make cornbread, brownies, or muffins sometimes, I just make them with an equivalent volume of melted butter instead of oil. Still need to keep an eye on calories for those… but way better tasting and they don’t seem to cause that slightly upset/acidy stomach feeling that I realized store bought versions give me.

Given my aversion to most pork and chicken, keto wouldn’t be the most sustainable for me personally, since I’d be left with basically only beef and vegetables. That would end up monotonous even for me and I don’t have further identifiable problems with carbs I’m trying to solve. Which might be for the best, I’d likely be happy to eat nothing but brats and chicken wings until I die.

> For me excess Omega-6’s appear to result directly and repeatedly

Have you looked into what the biomechanisms might be? What is Omega-6? What happens to Omega-6 once it goes down your esophagus? Where in the body does it go? Does it cross the blood brain barrier? Does it enter cells? How is it excreted?

> What has changed in then human race over the past 100 years that has led to such a huge increases in mental illness and developmental problems. For me there is only one answer. > Our diet!

Well, that... and decreased infant/youth mortality, and increased population density, and increased pollution, and novel models of what qualifies "illness and problems", and social fragmentation, and cultural erosion, and de-institutionalization, and expansive communication, and sedentary lifestyles, and... well, and about a quite a lot other potentially contributing things.

That said, I actually think the large variety of possible contributors better makes the point about how pharmaceutical approaches are shallow and inadequate anyway.

I’m a psychotherapist. I think there’s many possible factors in the past 100 years which could contribute to our poor mental health. For example: hormonal birth control, exceptionally high THC cannabis, single parent families (nothing creates personality disorders that mimic psychosis like insecure attachment and high stress households), and widespread glyphosate. But I agree with your theory that omega-6 fatty acids and super high carb foods are deleterious to our mental health. I was a vegan in my teens and 20s and now eat almost exclusively meat (beef, like yourself), eggs, cheeses, and whole plant foods. This is the largest modifiable risk factor by far.

I routinely recommend a ketogenic diet to my clients, and many of them are interested, but at the same time have to encourage them to consult with a physician or prescriber for support. This is where the possibilities end for most clients because few mental health prescribers buy into this model and even fewer want to risk their licensure or credentialing by going against the dogma.

> here’s many possible factors in the past 100 years which could contribute to our poor mental health

Some more examples: breaking down of social contracts especially around family structures and religion, greater mobility meaning people lose contact with family and friends, greater isolation due to increased internet and tv usage, increased loneliness in many age groups, social media, greater access to depressing news (reddit in particular is a massive fountain of depression), a focus in modern western media on violence and violent heros, increased over sexualization which leads to fewer genuinely supportive sexual relationships for many people, and on and on.

I do think diet may play a role for some people. But I've personally been struggling with a deep depression over the past year (I think I'm over the worst now but it's been rough) and my diet is very healthy, low carb. I get plenty of exercise - could improve a bit but I'm probably top 5% for my age and gender. I don't sleep well when depressed, that's a big slippery slope. But I don't think fixing diets will be a magic bullet (although a society wide shift to healthier diets would have massive benefits in many areas).

The things that have genuinely helped me:

* CBT therapy (self taught). So called bibliotherapy I guess. Books by Beck and Seligman were especially helpful

* The book on male depression by Terence Real, especially the idea of covert depression that can hide for years behind addictions, or workaholism, or chasing status, etc. until that is lost for some reason and "real" depression appears. So many of the examples in that book resonated with me.

* Taking time off work

* Journaling daily

* Meditation and relaxation practice

* Deep and often painful conversations with my partner

* Socializing as much as possible but being careful to "fake it" and stay positive while doing so. After a few attempts I decided not to tell nearly anyone about my struggles

Things that didn't help me, or at least were ambivalent

* Keto diet for a few weeks. I feel it might have helped a bit but not hugely, and it was too hard for me to keep up. Going from a very unhealthy diet to a healthy diet would probably have a big benefit though

* Reaching out to friends and family - it's a sad truism that as a man, reaching out to people rarely works and is more likely to result in further isolation. If you do reach out, choose the people with great care. Accept when they don't respond well with feeling hard done by. Society has conditioned all of us to be hard on men who share. You might be more lucky than I was - it really depends on your friends I guess. Pre-covid I lived on the other side of the world and might have had better luck with my friends there. In any case, as per CBT therapy, it may even be more effective to go out and ignore your depression for a while and have a good time anyway

* Xanax - it did help me through a few rough nights but each time I paid back by feeling super anxious a day later so I don't take it much. I don't drink much but alcohol similarly

Didn't try but would if going through this again:

* Therapy, but only with a CBT (or similar) trained therapist

* Antidepressants, but only one of the non-anticholinergic ones, preferably something fast acting, and only with the clear intension to use it for a short time (3-6 months)

Have you tried a hobby(s) building things in the real world (ie cooking, pottery, camping, auto work, carpentry, et cetera)?

Yes, I've been teaching myself guitar for the last six months. I think I would put that in the ambivalent category. It's more often frustrating than exulting and probably will be for another year at least.

But I also took up old hobbies of going out dancing and hiking and those are in the definitely helpful category. I never gave them up fully but had stopped doing them as often as I used to.

I think I'd summarize as: pick up an old hobby that you already know, if possible, or if choosing a new one, make it easy and even better if it involves meeting other people, being in nature, physical movement, or all three. I.e. go out to a pottery making workshop rather than learning it by yourself at home if you can handle it.

Physical activity, and social activity, and interacting with the world (guitar) are all critical too.

But have you "tried a hobby(s) building things in the real world"? Movement is great, but in addition to that I'm specifically wondering about building.

I can tell you are a great writer, which makes me think your mind likes to build things, and I wonder if you've been restricting yourself to only building 2 dimensional things (on paper/screens), and not building things in the 3d/4d world (plumbing, gardening, electronics, etc). Maybe the depression is your body telling you it needs to be building in the real world too.

(Just an idea; could be wrong; feel free to totally disregard)

It's a good idea and one I've considered myself - and it is true that over the last few years for several reasons (running a business, living in the tropics where it's pushing 40C much of the year) I don't build real things as much as I used to. I do miss that, and I do identify it as a contributing factor.

However, one thing I'm sure of is that there are many contributing factors, and any reductive attempt to fix depression (just do a keto diet, just build things, just get more exercise) is not gonna be a solution. Besides, in a deep depression, these are likely to be close to impossible.

The best initial solution, as per modern scientific research, is CBT therapy and/or antidepressants. Next step is to bring joy and health back into your life - exercise, socialize, healthy diet, build things etc.

The third step is to figure out what went wrong and what's needed to fix it. You can and should do all of these concurrently - although it's probably a good idea to hold off on the last one until you've retrained yourself, or used drugs, to have a positive mindset - but the first step is the one that's needed to kick things off.

> The third step is to figure out what went wrong and what's needed to fix it.

Very much agree.

Lately I've been wondering if depression is nature's way of forcing us to leave behind our current ways of thinking and grow a new neural shell: https://breckyunits.com/doHumanBrainsMolt.html

Lobsters act depressed during molting. It's a painful process. Even if they are comfortable in their current shell, nature does not give them a choice. Proteins escalate, and they must molt. This goes on for their entire lives. I wonder if we will discover a similar mechanism in human brains.

> It's a sad truism that as a man, reaching out to people rarely works and is more likely to result in further isolation.

In my experience, the only men I've gotten any kind of positive support from are men with daughters. Not all men with daughters, of course. The rest just minimize my feelings, give bad advice that doesn't work for my situation, blame me for having stupid feelings, or just shut down and change the subject. So I tend to only reach out to other women for support. And when a man reaches out to me for support, I'm gonna try to help him, but if he hasn't been there for me when I tried to lean on him? That's free lunch, and I have a limited budget.

It's a chicken-and-egg problem. You guys need to learn how to listen. Do that, and there will be more support available when you need it.

So I'll add one to your try-next-time list: go out and help people. Volunteer in a soup kitchen or something. I do tend to wallow a bit when I'm depressed, and doing something selfless breaks me out of that mindset for at least the duration of the act.

> I have been on a ketogenic diet for the last 20 years, long before it became fashionable.

Wow! Have you written anything about your experience? Would love to read it.

I find this exciting because after reading Brain Energy [1] by Christopher Palmer I was convinced that his thesis that "Mental disorders are metabolic disorders of the brain" is certainly worthy of research.

[1] https://benbellabooks.com/shop/brain-energy/

This is a very small amount of money...

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