Dietary Stress Theory – How malnutrition & toxicity stole happiness and joy.

I had fun writing this paper in 2019 as part of a Sociology of Mental Health 300 level paper to gain entrance to a masters degree. To be published in 3 parts (with a couple of edits).

Part 1.

Depression is the single biggest contributor to global disability, whilst anxiety disorders are ranked sixth. Women are more likely to be impacted, and many people experience both depression and anxiety concurrently. (WHO, 2017) I contest that by a significant order, the current symptoms of depression and anxiety when parsed, and deconstructed, resemble diet related deficiency, chemical toxicity and gastrointestinal disorder.

This does not diminish the fact that sustained stress or trauma are also pathways to depression and anxiety.

I propose that modern malnutrition and toxicity, standard in urban-industrial Western diets, is playing the most substantial role in accelerating non-communicable disease, and leaving otherwise affluent Western populations without the resilience to cope with daily stresses.

Microbiome and gastrointestinal health are key to mental health. Physicians have recognised this for two thousand years and the pharmaceutical industry now actively exploits this fact. Twenty-first century science has clarified that micronutrients, as well as bacteria in a healthy microbiome and gastrointestinal tract play a role in synthesising the neurotransmitters and neuromodulators serotonin, GABA, acetylcholine, dopamine, and noradrenalin, the very chemicals the pharmaceutical and psychiatric industries infer lie exclusively in the brain.

Alongside dietary collapse sits modern market-driven ‘efficiencies’ fostering an allopathic culture to privilege synthetic neurotransmitter drugs in response to symptomology. Reorientation to whole food diets that are protective of human biological systems would directly challenge and impact corporate profitability.

As such, public health mental illness management is enfolded in socio-political cultures that privilege the chemical industry; big agribusiness; the food processing industries; while downplaying and ignoring the polluting and chronic disease production externalities of their activities and shaping media and knowledge. Effectively, neoliberal culture and policy, privileges and promotes processed food, shaping economic and political environments to engender the current socially produced ‘manufactured epidemic’ (Stuckler, McKee, Ebrahim, & Basu, 2012).

The fact that industrial processed food would directly result in a pandemic of mental illness, was first proposed in 1972 (Crawford & Crawford, 1972). Western neoliberal climate that has shaped health and education to manifest the cultural ‘not-knowingness’ that surrounds personal descent into depression and anxiety. The system that I propose might be described as ‘dietary stress theory.’

In order to validate these claims, I will draw from the social and physical sciences to explain how ancient wisdom complements new physiological understanding of the gut brain axis, how this impacts psychiatry and mental health, while vested interests profit from continued non-knowledge. I will also suggest why sociology may have been slow to respond to this knowledge, despite the opportunities for sociological critique this provides.

Brief history of depression and anxiety - Hippocrates, black bile, and the spleen.

Physicians and researchers have recognised the complex interplay of psychological health with physiological health for over two thousand years. The twentieth century preoccupation of limiting brain chemicals to the brain appears to have been preempted by multiple factors, including;- Christian restrictions in dissection research; the fading out of humoral theory; the lack of data to substantiate hormone-based theory as a replacement theory; the rise of Freudian psychoanalytical theory; and the opportunity of wartime psychiatry to deftly construct mental illness categories that would become the foundation of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Somatic, physical symptoms in mental illness is long recognised. Greek physician Hippocrates described depression as an

‘aversion to food, despondency, sleeplessness, irritability and restlessness.’

(Davison, 2006). Hippocrates focussed on diet and the gastrointestinal system and was one of the first physicians to consider that disease originated in the body rather than the Gods (Jones, 1868) (Adams,1891).

A ‘healthy mind in a healthy body’ was a core component of Hippocratic philosophy (Kleisiaris, Sfakianakis, & Papathanasiou, 2014). Hippocrates was credited with connecting the brain to mental illness (Kleisiaris, Sfakianakis, & Papathanasiou, 2014).

Much of his work attributes melancholia to the ‘black bile’ of humoral theory. Hippocrates placed emphasis on the spleen, thought to filter black bile from the blood (Wilkins, 2002). Science now recognises that the spleen and brain engage in cross-talk (Hurn, 2014). A swollen spleen can indicate illness including gastrointestinal disease for which a common comorbidity is mental illness (William & Corazza, 2013). There may be a social element also, as the spleen can directly react to stress (McKim, et al., 2016).

Hippocrates was adamant each individual would respond differently to diet changes and advocated for individualised treatment (Jones, 1868).

Hippocratic knowledge benefitted from the practice of cadaveric dissection in the third century BC. The practice was prohibited by the Christian religion. For 1,700 years doctors largely relied on earlier writings and guesswork (Ghosh, 2015). Thus, the Hippocratic custom of making a prognosis of patients, presenting them with an outcome of treatment became tenuous once a chronically ill person could not be scientifically examined after death (Jones, 1868; Adams, 1891). Without cadavers to scrutinise, neither, the irritable bowel, nor inflamed spleen of the depressed person might be detected.

In conjunction this religion-dominated Judeo-Christian period was underpinned by the expulsion and repression of female centred herbal knowledge and the infamous witch-hunts, shaping a normative patriarchal medical culture. This may have created the vacuum for Western symptom-based suppression medicine to arise, and alongside this, the convenient myth of brain centred mental illness.

After the middle ages, key figures in Europe and the United States played instrumental roles in the development of knowledge and classification, and mental illness was frequently related to diet. The connection of melancholia to the spleen persisted into the seventeenth century. Robert Burton (1577-1640) recognised a swollen spleen presented in melancholic patients, considering that a radical diet was the critical treatment for ‘the most grievous and frequent’ form of melancholy (Mueller, 1949).

Mental illness was directly related to the health of the body until the eighteenth century where the concept of ‘humors’ lost favour, yet there appeared no substantive explanation to replace a now considered outdated notion (Crocq, 2015).

Thomas Willis (1621-1675) is recognised as the father of neurology for his work on cerebral anatomy and categorisation (Suris, Holliday, & North, 2016). However, like earlier researchers, Willis remained certain that the spleen played a role in mental illness (Wright, 1980).

Brief history of depression and anxiety – biological connections

Thomas Sydenham (1624-1689) differed, insisting ‘mind-body’ imbalances included a potential role of iron deficiency in mental illness. Modern science demonstrates that iron related deficiency relates to three significant symptoms of depression or anxiety;- fatigue, an irregular heartbeat and dyspnea (Hegde, Rich, & Gayomali, 2006) (Neuman, et al., 2006).

Anxiety and depression occur more frequently in women, and lower socio-economic groups consume less protein. (It remains surprising that all pre-menopausal women presenting with anxiety or depression are not automatically tested for anaemia.)

Similarly, Philippe Pinel (1745 –1826) considered the stomach and digestion critical as ‘psycho-gastric’ in mental illness (Williams, 2010). Pinel was credited with displacing humoral treatments with a psychological approach (Balmuth, 2017).

American Benjamin Rush (1745-1813) considered mental illnesses were physiological in origin and would recommend a ‘low diet’ of vegetables to patients (Mills, 1886). French psychiatrist Joseph Lévy-Valensi (1879-1943), also noted many somatic (physiological) symptoms of the disorder (Crocq, 2015).

The notion of ‘chemical imbalances’ in the brain has early genesis in nosology or ‘disease entities’ first described by Emile Kraepelin (Hoff, 2015). Kraepelin constructed an endogenous, empirical classification system which recognised that particular symptoms of mental illness could coexist across categories, and that symptom combinations would result in a particular disorder (Ebert & Bär, 2010).

Kraepelin’s thoughtful glandular and metabolic theory that underlined his research on dementia praecox (premature dementia) included a suspicion that environmental rather than genetic or hereditary aetiology was instrumental in development of mental illness. In order to protect health, the mechanisms of the ‘self-poisoning process could be discovered’ (Noll, 2007, p. 303).

Kraepelin appears intrigued by interplay of the immune and endocrine system (and the thyroid) as players in ‘autointoxication’ which, in his opinion, lay ‘somewhere in the body’ (Noll, 2007, p. 307). Finally, Kraepelin is notable for documenting sleep and circadian rhythm disruption in mental illness (Kraepelin, 1919). Sleep is, of course mediated by the hormones melatonin, cortisol, leptin, ghrelin and the growth hormone which are mediated by diet (Kim, Jeong, & Hong, 2015).

Brief history of depression and anxiety – all in the head

In the early twentieth century, diagnostic criteria emerged as the most efficient way to describe mental illness. Development of criteria to describe mental illness was shaped by the psychiatry profession (rather than the pharmaceutical industry)(Cohen, 2016, p. 62; Horwitz & Wakefield, 2007).

Adolf Meyer (1866 –1950) was considered the most prominent and influential American psychiatrist of the first half of the twentieth century. Meyer played an instrumental role in standardisation of psychiatry and appears to be the defining actor in the United States that shifted mental illness exclusively into the brain. Meyer had earlier dismissed Kraepelin’s metabolic autointoxication (endocrine) theory (Noll, 2007).

The DSM originated as a military paper, the Medical 203. This was created in a male-dominated arena that sought to describe psychiatric problems that precluded military aged men from active duty; but also the symptoms of traumatised soldiers returning home from war (Gomory & Dunleavy, 2018, p. 121).

The architect, William Menninger, drew on Meyerian and Freudian concepts to frame disorders predominantly psychoanalytically. The DSM-1 in 1952, was created to standardise diagnostic systems. The transition from psychoanalytical to psychoneurosis and biological occurred with the DSM-II in 1968.

New biological pharmaceutical antidepressants were under development (Shorter, 2015). The monoamine hypothesis of depression arrived, proposing deficiencies in noradrenergic and/or serotonergic systems (Hirschfeld, 2000), and much of the discovery of drug classes would be structured for the market to compliment psychiatric classification.

While the DSM was developed separately to the pharmaceutical industry, the influence of new knowledge in separate disciplines, as industry influence, can shape decision-making (Kleinman, 2001; Latour, 1987). Categories within the DSM Fifth Edition (DSM-5) includes a large range of non-brain health related symptoms (American Psychiatric Association, 2015; Whitaker & Cosgrove, 2015).

Brief history of depression and anxiety - always somatic symptoms

The depression categories of depression includes major depressive disorder, or ‘dysthmia’, the latter a milder form of persistent, chronic depression. The DSM-5 requires five or more symptoms to indicate a major depression episode. This includes loss of interest or pleasure, a depressed mood (anhedonia), sleeping problems, psychomotor issues fatigue, diminished ability to think and concentrate and suicidality.

The DSM-5 categorisation for generalised anxiety disorder (GAD) includes excessive anxiety for at least six months, and control of worrying thoughts are difficult, along with symptoms of restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance (American Psychiatric Association, 2015)

Somatic symptoms play a significant part in disorder determination, including chronic weakness, easy fatiguability and exhaustion. Brain function relating to mood and behaviour, as carefully framed neurochemical and neurobiological hypotheses, have framed discourse and research concerning the aetiology of depression (Dean & Keshaven, 2017; Menard, Hodes, & Russo, 2016; van Praag, 2004) and anxiety (Gross & Hen, 2004; Kindt, 2014).

Historically clinicians have recognised that a considerable array somatic and physiological symptoms and health related problems lay external to the brain (Tolentino & Schmidt, 2018) ( Simon, Von Korff , Piccinelli, & et al., 1999).

Epistemic interconnections and origins in diet deficiency remain unexamined within American psychiatric diagnostic criteria.

Brief history of depression and anxiety - pharmaceutical funding

A pivotal moment in mental health policy occurred in the mid-fifties by the Joint Commission on Mental Illness and Health of the Action for Mental Health Report. The planning funding for the Commission was supplied by the pharmaceutical company Smith, Kline & French (Gomory & Dunleavy, 2018, p. 122).

This placed the pharmaceutical industry in a powerful and strategic position to frame twenty-first century mental illness. The consequent report did not consider how physiological symptoms might arise (Joint Commission on Mental Illness and Health, 1961, p. v) The report discussed brain nutrition, but did not appear to engage further with the origins of such nutrition.

In Appendix V, the report alludes to ‘a Dr Tiedeman who favors a nutrition like theory of mental health which he says is rudimentary but evolving’ (Joint Commission on Mental Illness and Health, 1961, p. 318)

Lower serotonin levels in the brain were first reported in depressive suicide victims (Hoff, 2015). After this, anti-depressant drugs as ‘biological psychiatry’ appears developed to exploit deficiencies and dysregulation in nutrients, hormones and neurotransmitters and neuroactive substances, and to identify depleted brain chemicals to synthetically reproduce and modulate the chemical in the patient. As Whitaker and Cosgrove have stated,

‘The search for new drug molecules mainly follows the tradition of developing compounds targeting neurotransmitters, such as ‘serotonin, norepinephrine, dopamine, c-aminobutyric acid (GABA), acetylcholine, glutamate, or the enzymes responsible for their metabolism, such as monoamine oxidase, and acetylcholinesterase.’

These drugs frequently did not work, with evidence was kept from the public (Whitaker & Cosgrove, 2015).

Private and public research now recognises complex individual biological modulatory and dietary habits are insufficiently responsive to simplistic, anti-depressant drugs.

New drug development research today is unguardedly focussed on the human gut and the central nervous system as the critical mediator of neurotransmitter and endocrinological function.

Research is being undertaken to graft psychobiotic medication into the suite of medications proffered by pharmaceutical corporations (Sarkar, Lehto, Harty, & Dinan, 2016). Research to unpack glutamate neurotransmitter function (Hillhouse & Porter, 2016) which are synthesised by bacterial strains (Baj, et al., 2019) and understand how microbiota impact the Brain-Derived Neurotrophic Factor (BDNF) protein (Maqsood & Stone, 2016) is underway (Hillhouse & Porter, 2016),

End part 1.