What’s Causing the Problem and What Can We Do?
It’s time to fully revisit the known risk factors and theories for what causes mental illness through the new lens of brain energy, or metabolism and mitochondria. If all mental disorders are metabolic disorders and if mitochondria are really the common pathway, then all known risk factors for mental illness must tie directly to metabolism and mitochondria, fitting together somehow. We must see evidence of cause and effect. Most of what I’m about to run through are well-established and irrefutable risk factors. Until now, though, no one has been able to connect them. In the following chapters, I will connect each one of them to metabolism and mitochondria, proving the link that has long been missing in the mental health field.
The term risk factor is appropriate when cause-and-effect relationships are unknown. The brain energy theory changes this. Therefore, I will start using the term contributing causes instead of risk factors. For most people, there are several contributing causes that come together to result in illness; it’s not usually just one single root cause.
A quick note on terminology: In this section, I’ll sometimes refer to metabolism and other times talk about mitochondria. They are closely related, but they are not the same thing. Going back to our traffic analogy, it might help to think of the difference this way: Metabolism is the flow of traffic, and mitochondria are the drivers and workers inside the cars. As discussed earlier, while the drivers are primarily responsible for the flow of traffic, they aren’t the only factor. Traffic is also affected by environment, weather, and unforeseen obstacles, including things like daylight or nighttime driving; rain, snow, or hailstorms; road construction; and other factors that are beyond the control of the drivers but require drivers to respond as well. So, mitochondria are always involved in metabolism, but metabolic problems or challenges are not always due to mitochondrial “dysfunction.” Sometimes the mitochondria are doing what they are supposed to be doing under the circumstances, but the environment poses metabolic challenges. To give an easy example, a woman could be metabolically healthy, but if she takes a hallucinogen, she might begin to hallucinate right away. The drug dysregulates her metabolism and mitochondria, causing symptoms, but it’s unfair to mitochondria to say they are “dysfunctional.” They are simply doing their best under the circumstances, just like drivers in cars might be doing their best in a hailstorm.
Many of the contributing causes I will discuss simply slow down mitochondria and their function. Some of them, however, are outright assaults. Some can destroy the mitochondria in cells. Some can impair their ability to produce energy. Some can impair their ability to perform other functions, such as fusing with each other or sending signals to the DNA. While some of these causes may be minor and go unnoticed initially, together with the occurrence of additional assaults they can result in enough mitochondrial impairment to produce mental symptoms. Others can be decisive and catastrophic assaults on mitochondria that result in severe mental symptoms immediately—such as mitochondrial poisons. These serious assaults often affect more than just the brain (all the cells in the body can be affected, for instance), and life-threatening situations can sometimes result.
Some of the contributing causes stimulate mitochondria and increase their production of energy, at least in the short run. This can sometimes be beneficial. It can improve symptoms of reduced cell function, such as fatigue. At other times, however, it can result in problems of too much energy. This can be as simple as the inability to sleep at night after drinking coffee. Caffeine stimulates mitochondria. But remember hyperexcitable cells? If they get too much energy, it can mean trouble—anxiety, psychosis, or seizures. As different as these symptoms are, you’ll be surprised to see that sometimes one factor can trigger all of them. Prescription stimulants, such as Ritalin or Adderall, stimulate mitochondria. They can provide appropriate symptom relief in some people. However, they can also cause anxiety, psychosis, or seizures in other people.
There are three important themes to note when reviewing the different contributing causes:
1.All directly impact metabolism and mitochondria.
2.All are associated with a wide variety of symptoms of mental disorders. Not one of them is specific to any one disorder or symptom. This is consistent with the observation that all mental disorders have one common pathway: mitochondria.
3.All are also associated with metabolic and neurological disorders—obesity, diabetes, cardiovascular disease, Alzheimer’s disease, and epilepsy. They are also associated with many other medical diagnoses, but I will focus on these five. The factors that I will be discussing can trigger exacerbations of these “physical” disorders as well. This supports the observation that mental disorders share a common pathway with these medical and neurological disorders.
I am not going to present an exhaustive scientific review of each factor. There is a tremendous amount of science to support each one. My goal here is to provide a broad overview for how all these contributing causes relate to metabolism, mitochondria, and mental health.
I will begin with the biological factors and end with psychological and social factors. This is not to imply that biological factors are more important. In many cases, they aren’t. However, reviewing the biological factors first will set the stage for how psychological and social ones affect metabolism and mitochondria.
Why Different People Have Different Symptoms and Disorders—And Why Connections Persist Across Them
I began to address this issue in Part Two, but it’s worth revisiting two questions as we move into looking at specific contributing causes and treatments. First:
If all mental disorders are due to mitochondrial dysfunction or dysregulation, why is there so much variability in symptoms? How do malfunctioning mitochondria and metabolic toll cause one person to end up with depression, and another with OCD, for instance?
There are two primary answers:
1.Differences in preexisting vulnerabilities. All people are different. This includes identical twins. Even when the genetic code is the same for two people, they are still different. At the end of the day, we are all products of our biological blueprints (genetics) and our past experiences and environmental exposures. Nature and nurture. Experiences and exposures include the psychological and social experiences we’ve had, but they also include metabolic environmental exposures. These begin at conception. Our bodies are constantly responding to the environment and its access to nutrients and oxygen, hormones, temperature, light, and so many other factors. These all affect our metabolism and mitochondria, but specific factors affect some cells and not others. Over time, we develop parts of our brains and bodies that are strong and resilient, but also ones that are weaker and more vulnerable to failure. Metabolic failure of specific cells or brain networks is what causes mental symptoms,so these areas of vulnerability influence which symptoms develop first. In essence, our metabolism is only as strong as its weakest link.
Think of it like the muscles of your body. Some of your muscles are stronger than others. If you have to lift something very heavy—a major stressor—the weakest muscles will likely fail first. This can be different in different people. If three people lift the same heavy object, one might sprain a wrist, another might pull a muscle in his leg, and a third might throw out her back. Same stressor—different symptoms—that will require different treatments due to different vulnerabilities.
2.Differences in inputs. Cells and the mitochondria within them are affected by many inputs, ones that impact different parts of the body and brain at different times. In the following chapters, I will discuss contributing causes that affect mitochondria in one way or another. Most of these are well-known risk factors for mental illness. Some of them will impact all the cells in the body and brain. However, most won’t. Many of these factors affect only some cells but not others. When faced with different situations or tasks, different body parts or brain regions need different amounts of energy. If energy were equally distributed throughout the body and brain, not only would it be a waste of energy for the cells that don’t need it, but it would divert precious energy from the cells that do need it. This means that some of these contributing causes will impact some brain regions but not others. This can lead to different symptoms.
The answers here lead directly to a second question:
If there are clear differences in individual vulnerabilities and other factors that lead to differences in dysfunction, how are all mental and metabolic disorders related? Why should having metabolic problems in one type of cell have anything to do with the function of other types of cells?
To answer this, let’s go back to our analogy of metabolism: traffic in a city. There are many factors that determine whether city traffic flows smoothly or not. The same is true with metabolism. And at the same time, it’s all interconnected.
A traffic problem can start in one small section of the city—a single car accident blocking a busy street. Likewise, a metabolic problem can start in one group of cells that cause symptoms related to what those cells do. The problem can start off contained to only those cells due to preexisting vulnerabilities and/or different inputs as I just outlined.
If the problems persist, however, the symptoms can spread. When it comes to city traffic, if the car accident isn’t quickly removed, the traffic jam will become more widespread, affecting traffic in other parts of the city. If traffic problems are caused by poor road maintenance, then it can result in long-term problems. Metabolism is the same. A problem in one area of the body will often spread over time. Why? Because metabolism is highly interconnected. It relies on feedback loops all over the body. So, if one area is not doing well, the rest of the body can be affected. If the problem isn’t corrected, it will gradually take a toll and spread—sometimes over years or decades.
Treatments and Success Stories
For each of the contributing causes of mental illness, I will outline some strategies that can be used to address problems when possible. Some of them are standard, existing treatments. (Again, a new theory doesn’t replace what we already know to work.) Some of them will be new treatments that you likely haven’t considered before. As a rule of thumb, they fall into the following broad categories:
1.Treatments that remove or reduce things that are dysregulating mitochondria or metabolism, such as poor diet, sleep disturbances, alcohol or drug use, some medications, or psychological/social stressors.
2.Treatments that correct for metabolic imbalances, such as neurotransmitter or hormonal imbalances.
3.Treatments that improve metabolism. I break these strategies into three categories:
•Mitochondrial biogenesis—There are ways to increase the number of mitochondria in your cells. Increasing the workforce improves metabolic capacity.
•Mitophagy—Getting rid of old, defective mitochondria and replacing them with new, healthy ones can also play a role. Rejuvenating the workforce improves metabolism.
•Autophagy—Repairing structural damage that has occurred to your cells because of longstanding metabolic problems can be essential to long-term healing.
In Chapter Twenty, I’ll give you an overarching approach and basic strategies to use in developing a comprehensive treatment plan. Please hold off on implementing any of the treatments that I discuss until you get to the very end of the book. You’ll need to understand all the different contributing causes and treatment approaches before deciding which ones will be appropriate for you.
Along the way, I will also share stories of real people who have improved their mental health using metabolic interventions. Their names have been changed to protect their privacy, but their stories are true.