low carb / paleo eating and serotonin

According to doctors Olfson and Marcus of Columbia University’s College of Physicians and Surgeons (Department of Psychiatry), “Antidepressants have recently become the most commonly prescribed class of medication in the United States” (August 2009 issue of Archives of General Psychiatry).   By far, the most popular of this class of drugs are the SSRI’s (Selective Serotonin Reuptake Inhibitors).    To see how these drugs work, go HERE.  

Not too long ago, I wrote a post about the relationship between OBESITY, DEPRESSION, AND LOSS OF LIBIDO.  As typical, I suggested a LOW CARB OR PALEO DIET as part of the solution to this problem.  Not surprisingly, I had a few people email me links to the research by Dr. Richard Wurtman of MIT who has produced forty years worth of studies on sleep, mood, nutrition, and their relationship to neurotransmitters.   He has studies showing that Serotonin (the ‘feel-good‘ neurotransmitter whose lack is thought to be a huge factor in developing Depression), is released due to the ingestion of dietary carbohydrates.  His wife is Dr. Judith Wurtman (also of MIT) who has published a book on the topic called The Serotonin Power Diet.  As you might imagine, she advocates a higher carb / low fat, lower protein approach to eating in order to boost mood.   There are many similar books on the market.   We have Potatoes Not Prozac and Natural Prozac by Dr. Joel C. Robertson (he advocates a higher carb approach).  But there are also books advocating a low carb approach such as Dr. Michael J. Norden’s (Psychiatrist) Beyond Prozac.  What is the truth?  Our goal today is to sift the evidence and see what we find.

One of the big reasons that I am such an advocate of Paleo-type eating is that it is a highly non-reactive diet (HERE).  This is critical for those dealing with things like LEAKY GUT SYNDROME, AUTOIMMUNITY, HASHIMOTO’S THYROID DISEASE, FIBROMYALGIA, and a host of others.  I am personally very carb-sensitive — particularly when it comes to grains.  In my clinic, I see lots of others who struggle with the same problem.  In fact, it is my opinion that grain sensitivity has become the new norm.   Just be aware that Paleo does not mean “Carb Free”.   However, also be aware that a KETOGENIC DIET (virtually no carbohydrates) can often be a lifesaver for people struggling with seizure disorders or other Neurological / Psychiatric problems, including Depression.

WHAT CAUSES DEPRESSION?

Although there a lot of different theories floating around as to the cause(s) of DEPRESSION, the truth is that no one really knows.  My guess is that there are lots of potential causes of Depression.   There are a few things that we know for sure about Depression.  One is that it is considered to be an Inflammatory Disease.  If you are struggling with Depression but do not really understand INFLAMMATION, you need to read the link.  It will help you understand that you will be hard-pressed to control any of the Inflammatory Diseases (including Depression) with drugs alone.  In that same vein, I will soon show you why drugs are rarely if ever a long-term solution to Depression.  Another factor in Depression is lack of sunlight.  There are numerous studies on this topic, and helping yourself is not as difficult as you might suspect — even if you live in the Arctic Circle (they make special lamps for this).  Probably the biggest factor in Depression, although it is not as well understood as many would have you believe, is the relationship / interplay between your body’s various neurotransmitters. Neurotransmitters are chemicals that carry nerve impulses across nerve synapses.  Interestingly enough, nerves (for instance, the SCIATIC NERVE) do not transmit impulses over their entire length in one long shot.  The impulses go from nerve cell to nerve cell, neuron to neuron via neurotransmitters.   There are tiny gaps between each nerve cell, which the neurotransmitter must cross.  These are called “synapses”.  When discussing this topic, you will see the terms pre-synaptic (before the synapse) and post-synaptic (on the opposite side of the synapse, or after the synapse).   As the nerve impulse reaches the area of the synapse, the pre-synaptic vesicle releases its neurotransmitter across the synapse, where the proper receptor for that specific chemical senses it.  If the threshold is met, the nerve impulse continues on its way to the next synapse.  Think of these synapses as taking a plane ride, which, instead of being a direct flight, is made by taking tens of thousands of different connecting flights.

Although there are many others, a few of the more common neurotransmitters include things like…..

• GABA
• Acetylcholine
• Epinephrine (Adrenaline)
• Nor-epinephrine (Nor-adrenaline)
• Serotonin
• Dopamine

When any of these neurotransmitters get depleted or out of balance in relationship to each other, bad things start to happen.  It can affect your mood, your sleep habits, your ability to think logically, your sex drive, your ambition, as well as a host of others.  Today we will spend some time touching on the relationship between the amount of carbohydrates one chooses to eat or not eat, neurotransmitters, and Depression.

DOES A SIMPLE LACK OF SEROTONIN CAUSE DEPRESSION?
WILL EATING LOTS OF CARBOHYDRATES BOOST SEROTONIN PRODUCTION AND MOOD?

A large number of serotonin subtypes are associated with anxiety and other negative emotions. A quick look on Wikipedia about these subsystems will quickly dispel any notion that they are all positive uplifting systems.  I would guess, having researched it a fair damn bit, that far more negative emotion comes from the serotonin system than positive – largely around negative social and self perceptions.   Paleo Hacks website   Serotonin research is relatively new, but it rivals estrogen research for the level of incompetence and apparent fraudulent intent that can be found in professional publications….  Extremely serious mistakes about the nature of the solar system didn’t matter too much until interplanetary travel became a possibility. Extremely serious mistakes about brain “transmitters” and “receptors” didn’t matter too much until the drug industry got involved.  From Dr. Ray Peat’s “Serotonin, Depression, and Aggression: The Problem of Brain Energy“

I’ll admit it.  Sometimes I get wrapped up in “scientific facts” and miss the forest for the trees.  I did this with LOW FAT / FAT FREE eating back in the late 80’s and early 90’s.  I have been recently guilty of following the pack and referring to Serotonin as a “feel good” neurotransmitter.  While this is probably true on some level, when it comes to the human body, nothing is ever quite as simple as it seems.  It is all about achieving a natural balance.  Even though the current hype tells us that in order to defeat Depression, we need to increase Serotonin production (or inhibit its reuptake) in one way or another, is this really the case?

There is a growing body of evidence that seems to show that Dopamine is probably more associated with well being and feeling good than is Serotonin.  While there are a whole host of drugs that modulate specific areas of the brain or neurotransmitter function, it can be done naturally as well via DIET / EXERCISE, SLEEP, touch, SEX, certain emotions, and even sunlight.  It is important to remember that Serotonin (particularly ‘excess’ Serotonin) should probably not be thought of as a ‘feel good‘ hormone.  In fact, there are many who believe that the nature of Serotonin might actually be 180 degrees opposite of what we have learned.  Part of the problem is that Serotonin is known to upregulate the steroid hormones — including the glucocorticoids; namely CORTISOL — your body’s primary stress hormone (think adrenal glands here).

From the early 1980’s (Fuller in 1981, Petraglia in 1984, Stark in 1985, Potter in 1985, Lesieur in 1985, Frances in 1987; Manier in 1987, etc), we have known that SSRI-like medications can stimulate the body’s adenergenic system (adrenaline or nor-adrenaline) to the point that Cortisol levels are doubled.  If you have even a cursory understanding of what Cortisol does to the body, this should at least make you apprehensive about SSRI’s.  Yes, they may very well make you feel “good”.  I have never told patients that Cortisone will not make them feel better — at least for the short-term.  However, I do tell them that the side-effects of this medication are numerous, brutal, and frequently permanent (HERE).  It all begs the question as to what happens to endogenous Cortisol production in a person who is taking daily doses of Serotonin-boosting substances?  It’s simple.  Among other things, they kick in the adrenal glands, potentially moving patients towards a state of SYMPATHETIC DOMINANCE.  While this certainly gives them a seeming ‘boost’ of energy, it is frying their system and dumping in Cortisol.

Thus, Serotonin — particularly increased levels —- is not necessarily the mood panacea that it has been made out to be.  As you are beginning to see, Serotonin is actually a component of the body’s response to stress.  Take it to the next logical step.  Since higher levels of Serotonin increase Cortisol levels, and high Cortisol levels are associated with weight gain — particularly BELLY FAT, is it any wonder that SSRI’s are themselves associated with weight gain (as are most Psych Drugs).  So much so that Dr. Judith Wurtman, author of The Serotonin Power Diet, wrote an article for the Huffington Post almost exactly three years ago called, “10 Tips to Prevent Weight Gain on Antidepressants“. 

The thing that is critical to grasp is that SSRI’s cover the effects of Depression by providing a prolonged boost of stimulation via the adenergic system.  And when you want to get off of that SSRI, it’s going to be tough because the Serotonin System has been down-regulated —- part of the reason that the statistics for SSRI use are so shockingly high.  Creating an artificial imbalance in your neurotransmitters may for a short time make you feel better, but in the long run it will cause problems and create a dependence.  Anytime you have what the body believes to be ‘enough’ of a certain substance in the body, it will down-regulate it.  Let me give you an example of down-regulation from the world of hardcore Strength Training / Bodybuilding.

In the pursuit of bigger, stronger muscles, many individuals have taken Anabolic Steroids (synthetic forms of Testosterone or GH).  How does the body respond to this surge in male androgenic hormones?  Men (and women) get cranky (‘roid rage’), aggressive, and horny (that is what testosterone does for both men and women —- but it also causes PCOS, in which case it actually diminishes sex drive).  As you might have already guessed, this can be a potentially dangerous combination.   But there is obvious evidence that the system, while being artificially pumped up, is actually being down-regulated and suppressed.  One of the common male side effects of taking steroids is testicular atrophy (shrinkage).  Think about why this might be true.  Oversimplified; since there is an over-abundance of testosterone in the body,  it says to itself, “hey; I don’t need any more of this stuff“.  Thus, it down-regulates testosterone production in the testicles.   In the case of Anabolic Steroids, this can be so dramatic that the testicles dramatically atrophy / shrink / shrivel.   Since shriveled testes don’t make much testosterone, the bodybuilder will either go back on the steroids, or try and take a substance (a popular one is human chorionic gonadotropin — does anyone remember the hCG diet?) to ‘re-start’ their own endogenous production.

Now imagine that this downregulation is going on with the Serotonin System.  As the SSRI’s inhibit the post-synaptic reuptake of Serotonin (see the first link in this post), the body sees this as an abundance (or over-abundance as the case may be) of the neurotransmitter.  What do you think this does?  Of course, the body begins to down-regulate the production of Serotonin —– of which about 95% occurs in the Gut.  The actual medical term for this is Selective Serotonin Reuptake Inhibitor Discontinuation Syndrome.  The symptoms include things described as electric shock-like sensations (“brain zaps,” “brain shocks,” “brain shivers,” “brain pulse-waves,” “head shocks,” “pulses,” “flickers,” or “cranial zings” are a few of the names for these), as well as dizziness, sweating, nausea, insomnia, tremors, confusion, nightmares, and vertigo.  Many people also get symptoms which look suspiciously like Depression.

HOW TO SOLVE MANY CASES OF
DEPRESSION WITHOUT DRUGS

First off, everyone is different.  What works for me might not work for you.  Secondly, I am simply providing information.  The contents of this post are not meant to diagnose or treat diseases of any kind.  If you feel you have an actual disease, please seek medical attention immediately. 

How do we balance neurotransmitters?  How do we prevent receptor desensitization on the post-synaptic membrane?  And how do we prevent Selective Serotonin Reuptake Inhibitor Discontinuation Syndrome?  The first thing to understand that taking SSRI’s is highly likely to down-regulate innate Serotonin production via receptor desensitization.  The key is to get the system rebooted and working again after going off these drugs (or making it work more effectively even if you have never taken SSRI’s).  If, in fact, your body is not making enough Serotonin, the first question you must ask is why.  I believe that there are two chief reasons……

• INFLAMMATION:  Interestingly enough, numerous “psychiatric” (brain) issues have INFLAMMATION at their root.  If you do not understand Inflammation, it is imperative that you click on the link and take just a couple of minutes to learn. Knowing how to address Inflammation will help you with almost any disease process you can imagine — including Depression.

• POOR GUT HEALTH:  As I just told you, the vast majority of the Serotonin in your body is manufactured in your Gut (about 95%).  POOR GUT HEALTH, DYSBIOSIS, ANTIBIOTICS, DRUGS OF ALL SORTS (both prescription and non-prescription), food sensitivities such as GLUTEN, as well as a host of others, can upset the body’s balance and cause a wide variety of problems, including LEAKY GUT SYNDROME (which almost always ends up as some sort of AUTOIMMUNE ISSUE).  Although your doctor will not talk to you about Leaky Gut, it is very real, backed by over 10,000 peer-reviewed medical studies, and is a full-blown epidemic here in America.  Be aware that the medical community usually calls it Increased Intestinal Permeability.

The way I recommend that most of my patients deal with these two problems is to eat a LOW CARB / PALEO DIET.  Not only is this diet extremely non-reactive, it provides ample protein —- something which people who follow a VEGAN DIET can be hard–pressed to do.

If Serotonin needs to be boosted, it can be boosted naturally, while essentially remaining on a Low Carb diet.  The goal is to make sure that there is ample Serotonin at the post-synaptic receptor without having so much that the desensitization process and subsequent down-regulation of the system occurs.  Be aware that certain foods have the capability of accomplishing this.  Insulin not only removes sugar from the bloodstream, it removes amino acids (the building blocks of proteins) as well — that is, it removes all but Tryptophan.   Tryptophan is the amino acid that is said to make you “sleepy” (Tryptophan is the precursor to Serotonin, which is the precursor to Melatonin).  This is why a glass of warm milk is said to be beneficial in helping people sleep. 

The secret to using Tryptophan as a booster of Serotonin is to use it purposefully and at the right time.  Simply giving in to a CARB ADDICTION because it temporarily gives you an energy and mood boost via the adrenals, does not fall into this category.  Since we know that a high carb diets have the ability to increase Serotonin levels, using this knowledge strategiclly could help us to boost Serotonin levels at the proper time.  Just make sure that you eat your carbs at the same time you eat Tryptophan.  Another popular Serotonin booster is the supplement 5-HTP — a precursor of Serotonin.

THE LOW CARB / VEGAN DEBATE

This debate over Serotonin is essentially the repackaged debate between the Vegans and the Paleo Adherents.  Suffice it to say that Dr. Wurtman’s is not the final voice on this subject.  Dr. Emily Deans’ Evolutionary Psychiatry website has tons of information (often using Wurtman’s own studies) which shows that everything is not what it always seems as far as high carbs and Serotonin is concerned.  Some of her articles on the subject include Carbs and Serotonin, A Connection After All?;  Do Carbs Keep You Sane?; and More About Sunlight, Food, And Serotonin. 

Dean, however, is not the only voice crying out from the wilderness.  When doing the research for this post, I quickly realized the overwhelming amount of evidence stacking up against the status quo ideas on the subject.  There is tons of information out there saying that high carb is not the best solution to boosting mood and aiding those with Depression.  In fact, if you were paying attention, you realize that many, if not most of these people, are questioning whether you really want to boost Serotonin in the first place.  Regardless, eating Low Carb, does not mean ‘No Carb’ (although KETOGENIC DIETS have been proven to be quite effective for large numbers of people dealing with Neurological and Psychiatric Diseases).

The thing about carbohydrates is that they are not all created equal — far from it (HERE).  What carbohydrates do I recommend while eating a Low Carb Diet (by the way, in the same way that there about a jillion different versions of Vegans, there are about the same numbers of variations on what constitutes a Paleo Diet)? 

• Firstly, remember that if you are eating carbs to boost your mood without eating foods that are high in Tryptophan, you are getting that boost purely from your adrenals.  This is dangerous and will lead to ADRENAL FATIGUE / FIBROMYALGIA.  Proof of this is the way that your heart races after eating a ton of sugar.  This is purely an adrenal response.  Overstimulate your adrenals and you end up with all sorts of problems.  And unfortunately, when you start throwing one area of the ENDOCRINE SYSTEM out of whack, others are sure to follow.

• Secondly, DO NOT eat your carbs in the form of sugary junk.  This should go without saying, but many people will use any excuse to get their hands on some junk carbs — especially those who are seriously ADDICTED. 

• Thirdly, make sure that the carbohydrates you are eating are high in glucose and not fructose.  There are a bundle of studies showing that glucose is not nearly the problem that fructose is —- particularly HIGH FRUCTOSE CORN SYRUP.  This means that you may need to stay away from certain fruits. 

• Fourthly, GRAIN-BASED CARBS are one of the worst ways to boost carbohydrate intake.  My chief source of carbohydrate is Sweet Potato.  There are a few others that are fine.  I also do some rice (a mixture of brown and wild, long grain).

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