An unexpected horror involving mangled limbs, death and life-threatening injuries for hundreds of people places an almost unmanageable strain on any healthcare system. On April 15th after the bombs exploded on Boylston Street at the Boston Marathon, our city showed the world that this could be accomplished with dignity, valor and grace. Within 30 minutes of the duel blasts, every seriously injured patient had been triaged and transferred to one of our world-renowned medical centers, a truly remarkable feat.
It’s Not Over Until It’s Over
Once the dust has settled—when the international media have headed home and the acute injuries have been treated, patients injured in this tragic event face one more major hurdle—the prospect of developing post-traumatic stress disorder (PTSD). This disease can turn an acute stressful event into a lifetime of anxiety, stress, disability and dysfunction. PSTD can result from any type of physical or emotional trauma and is characterized by flashbacks, nightmares, heightened arousal, mood swings, anxiety, disrupted sleep patterns and avoidance of triggers. The symptoms are usually chronic and often disabling.
As with most brain disorders, PTSD is a clinical diagnosis and there are no tests available to confirm the diagnosis. Because we are only beginning to understand how the brain functions on a cellular level, the exact pathology of the condition has yet to be illuminated. It likely has something to do with the concept of neuroplasticity, the idea that the brain undergoes actual physical changes in response to external events and internal thoughts. Norman Doidge outlines this very well in his book “The Brain That Changes Itself”. Genetic makeup also likely plays a role in triggering this disease. When a person is exposed to a traumatic event, new synapses are formed that can be strengthened if a person continues to ruminate on the traumatic experience. Such memories also become tagged with the painful emotions experienced at the time of the trauma, resulting in a “broken record” experience of repeated thoughts and emotional reactions to the traumatic event.
An Epidemic of PTSD
Although we don’t yet understand why one person develops PTSD and others don’t when exposed to the same traumatic event, recent research has made one thing clear—the incidence of PTSD seems to be increasing at an epidemic rate. Our genes obviously haven’t changed, so it makes sense to look at environmental factors that might be in play.
When it comes to preventing PTSD in those exposed to trauma, we have few high-quality studies to guide us, but we do know what doesn’t work. Debriefing or reliving the traumatic experience has been shown to be ineffective at preventing the disorder and it may cause more harm than good. Even though we lack controlled trials to guide us, that doesn’t mean we should throw up our hands and give up. Empirical science can often be useful in this setting. This involves making observations in a real world clinical setting.
Because I have over three decades of clinical experience and a strong interest in brain disorders, I have noticed certain trends in my patients that seem to be supported by some basic research. Over the years I have noticed that patients who are very healthy at the time of the traumatic event tend to have a very low incidence of PTSD. The opposite is true for patients with common metabolic disorders like insulin resistance, obesity and type II diabetes. Many studies have documented the co-morbidity of these metabolic conditions with many common brain disorders such as PTSD, but at the present time we don’t fully understand why this is so. We now call this form of food-induced brain dysfunction Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. Many cases of PTSD seem to fit nicely under the CARB syndrome umbrella.
Although the medical profession tends to focus on treating these metabolic disorders, I have always focused on preventing or reversing them. I have found the most effective way to do so is by making simple lifestyle changes. The most important consideration is our standard American diet (SAD). There is mounting evidence that certain dietary elements are a least partially responsible for the epidemic increase in these common metabolic conditions. At the present time the most likely suspects are excessive fructose mainly from sugar and HFCS, high glycemic carbohydrates mainly from grains and excessive omega 6 fatty acids mainly from vegetable oils. Of course this describes typical modern processed food. One of the easiest ways to eliminate these dietary elements is to follow a Paleo style diet as outlined by Loren Cordain in his book “The Paleo Answer”.
Eat a Healthy Diet to Trauma Proof Your Brain
Over the years I have found that if I can convince my patients to reduce or eliminate this toxic triad, their metabolic conditions seem to slowly melt away. I have also noticed a simultaneous improvement in any brain disorders that they might have, including PTSD. When my patients are exposed to traumatic events, I advise them to avoid thinking about the event and instead focus on their health and their future. I push them to eat a healthy diet and to start exercising on a regular basis and I recommend that they make these changes today, not tomorrow. In my experience when they do so, they almost never develop PTSD.
I recently watched a television segment describing the remarkable story of Heather Abbott, a 38-year-old female from Newport, R.I. Heather was near the finish line of the Boston Marathon when the bombs went off. After the blast she realized that she couldn’t stand and she had severe pain in her left foot. After multiple operations she was given a choice—they could save the foot but it would leave her with an appendage that was barely functional or they could amputate the foot and fit her with a prosthesis. Because Abbott was interested in her future ability to function, she chose to amputate.
She also mentioned that she really didn’t think about the individuals who caused her harm and she wasn’t following the events unfolding on television—she was simply too busy planning her new future. When I saw a picture of her it was obvious to me that she is a very healthy young lady who knows how to take care of herself. I have a prediction to make—Heather doesn’t need to worry about developing PTSD.
Yesterday a colleague was telling me about one of her patients—let’s call her Jane Doe, who was in one of the buildings near the explosions. Jane has many chronic metabolic conditions and is not known to follow a particularly healthy lifestyle. Shortly after the event she developed tremors, extreme anxiety, nightmares and insomnia despite the fact that she suffered no physical injuries. Jane likely already has early stage PTSD and unless she quickly changes her lifestyle, her future won’t be nearly as bright as Heather’s.
My advice to you if you are exposed to a traumatic event is to quickly move on and if possible don’t even think about the event. If your diet and exercise habits are a little lax, now is the time to focus on making some real changes. In other words, follow the example of a remarkable young woman named Heather Abbott.