This is a joint post with myself and my very good friend Dr. Emily Deans
I recently had a nutrition client who, during her initial consult, was super nervous to tell me that she had recently been diagnosed with cyclothymia, a mild version of bipolar disorder. She had an appointment coming up with a psychiatrist and was concerned that I might tell her that she would be just fine with diet alone.
My answer to her was this, “I think that there are meds out there that can be really helpful in situations like this. Why live your life in pain when there are tools out there to help you? If you had a heart condition, would you try to just ‘stick it out’ with diet alone? No! So, if you have a mental illness, why do you feel like a failure if you try medication?”
I think people sometimes have a false perception that the paleo diet is magic. Like mythical unicorns and rainbows, people sometimes think eating real food can solve everything, and make you live forever. I do believe that getting optimal sleep, a paleo-type diet, time outdoors, and having a supportive social network are key to good health. However, I also believe that there are times when all of these things are simply not enough. Modern medicine, with all its criticisms, can also be a true blessing. Many people would not be here today without it. Me included. If it wasn’t for antibiotics, I may have died as a child from infection. There are tons of people today who owe their lives to advances in the medical world like vaccines, emergency surgeries, medical testing and prescription drugs.
Long ago, it was quite common for women and infants to die during childbirth. Longevity for men in Paleolithic times exceeded women for this reason. The countries (worldwide) with lowest infant mortality in the world have a C-section rate of about 20%. Although almost no one “chooses” a C-section, having the option of a C-section improves infant outcomes, and along with antibiotics to treat the formerly deadly pupuerial fever, modern medicine has led to the lengthening of the average woman’s life to exceed that of men.
Some folks feel that if one has a maximized immune system for their children via respecting the gut flora and breastfeeding, vaccines aren’t necessary. Well, Native Americans on the East Coast of the US and Canada had been fighting off incursions by the Vikings and everyone else for hundreds of years. Then, in 1620, a very few Pilgrims followed by a few more Puritans managed to successfully permanently settle a hostile coastline. There is no way Pilgrims were more militaristic or aggressive than the Vikings…but the Pilgrims landed right after infectious disease decimated the native population (with estimates of up to 95% of the population perishing), leaving the land nearly empty. These peoples didn’t have c-sections, or antibiotics, or formula. They ate plenty of mineral rich organ meats and collagen for their guts and bones…and they died, as most humans in history have, from infectious disease. Hygiene, antibiotics, and vaccines have been some of the most important advances for modern humans when it comes to fighting off this ancient scourge.
Now before you get all cranky with me about the vaccine debate, I want to make it clear that I think that the science is still out on the efficacy of certain ones, and a healthy debate to question the research is necessary. However, chances are you don’t know anyone who has died from measles, smallpox, polio, syphilis, diphtheria, or scarlet fever, and antibiotics and vaccines are the reason why.
Let’s also look at pain. I personally had a natural childbirth with baby #1. I did it. Nobody gave me a medal. It hurt. A lot. With #2, I had an epidural, then watched “Goonies”, had a baby, then ate a cheeseburger (gluten free bun). I have to say that my experience with #2 was much more pleasant. I’m NOT saying that it’s crazy to want to have a natural childbirth, or that I discount the “cascade of events” that can happen when women are forced into medical situations that end up in unnecessary C-sections. However, I do think that it’s TOTALLY OK to accept an epidural if you want one. I also think that if men actually had to give birth, the rate of epidurals would be much higher. I felt tons of pressure to have a “natural” childbirth, and felt guilty having the epidural. Guess what? That’s silly! I pass no judgment on any woman who chooses to relieve the pain of childbirth with an epidural.
Now let’s look at mental illness. According to the CDC, suicide is the #10 leading cause of death. The most common underlying disorder is depression, 30% to 70% of suicide victims suffer from major depression or bipolar (manic-depressive) disorder, which is often undiagnosed. Approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year.
During my nutrition consult, I did a quick google search of “Wellbutrin and Cyclothymia”, and guess what? Wellbutrin (bupropion) seems to be quite effective in treating the depression associated with bipolar disorder and contrary to other antidepressants, does not cause weight gain. In fact, weight loss is quite common with patients taking Wellbutrin. I showed her my computer screen. She told me that the fact that I “approved” of her taking an antidepressant was a huge relief.
Life is short. Everyone’s goal is to have a happy life. Why go through it in pain when there are some very effective tools out there that could help you be happier?
My client has significant weight to lose. She is 100% willing to do whatever it takes, via food and lifestyle changes, to lose the weight. I believe she will be quite successful. However, I also think that removing the stigma of mental illness, accepting help, and trying a pharmaceutical intervention will give her that extra edge she needs in order to have live a happier life.
Let’s look to diet and lifestyle as a starting point to a better life. When these things aren’t enough, let’s consider what modern medicine has to offer, weigh the benefits and consequences, and make a good decision.
As the “evolutionary psychiatrist” I get a lot of consults from people who want to minimize or come off of medications. Sometimes optimizing lifestyle interventions can really help…getting the nutrition, sleep, exercise, and microbiome dialed in can be miraculous for many chronic modern health conditions. However, I’ve also seen people come to me obsessed with health, with lab values, with clean diets, whose obsessions have significantly impaired their quality of life. I’ve also seen folks who have done their best with therapy and lifestyle interventions whose symptoms and functioning improve immeasurably by adding a few medications. Intervention with medications can be enormously helpful with mental illness, despite some known limitations. I know many cases where folks have literally been given their lives back from devastating suicidal depression or incapacitating psychosis with medications…and sometimes people are in no condition to take on rigorous food and lifestyle change until they are feeling better.
In the more general paleo community, I feel there is sometimes an unstated wish for immortality, that if you just eat the right omega 3 supplement and use the best blue-blockers and combine hiking and HIIT and organ meats, you will live happily and healthy forever more.
In my medical training, I’ve had many occasions to sit with the dying of all ages. In the emergency room, in the cancer ward, in the pediatric trauma wing, after 2 futile months in the ICU after a stroke, even a sudden and devastating heart attack induced by the deadly heart attack of a spouse. In fact the majority of our medical dollars in the US are spent during the last 6 months of life.
I can tell you that the dying regret working too much. They regret worrying too much. They do regret those many years of cigarettes. They wish they had learned a musical instrument, spent more time with family, and read more books, and visited more places. They don’t think about how much omega 3 they consumed…they think about taking in that last sunrise and getting out of the hospital and into some place more comfortable with their loved ones. Even the young ones whose losses are the most heartbreaking want to have lived well if they don’t have the choice to live for very long.
I’m all for spending a judicious amount of time and money maximizing lifestyle interventions and providing societal incentives to promote breastfeeding, home cooking of whole foods, reduce unnecessary C-sections, reduce antibiotics (particularly as a regular component of animal feeds) and for appropriate nuanced study of vaccine safety. But I also think we should accept our mortality and be well-informed of the realities of heroic interventions to keep life extended unnaturally, with resultant suffering. We should also understand that in many cultures in written human history, young children weren’t even named before the age of two because we were so likely to lose them as infants or to infectious disease. Let’s not throw out the baby with the bathwater of modern hygiene and medicine and instead use our science to maximize evolutionary science and modern medicine to create the happiest, healthiest human bodies we can, and accept our limitations and eventual deaths with dignity. We have the technology…and sometimes that includes modern medicine (even statins! sometimes!).
The good news is there’s almost no chronic health condition a healthy whole foods diet, appropriate sleep, and proper physical activity won’t improve. And for those of you with chronic kidney disease who need to avoid potassium or too much protein (so your standard paleo diet would be horrible), or unusual fat metabolism genetic disorders who need to eat super high carb…well, you have medical science to help guide the way.
For those of you who are suffering from depression, please know that there are diet and lifestyle changes you can make to improve your life, but that taking a prescription drug doesn’t mean you’ve failed. There’s no shame in reaching out for help.
And in closing, I’ll leave you with the song below, recommended during a twitter exchange with “Doc Parsley” and written by one of my favorite childhood authors, Shel Silverstein.