Those of you who have spent some time learning about the new disease Carbohydrate Associated Reversible Brain syndrome or CARB syndrome already know that I believe many common brain disorders are connected through a shared pathology. As a clinician, this is what I see in my patients. Many patients with depression also have symptoms overlapping with ADHD or bipolar disorder. This overlapping of symptoms is also common with other brain disorders, and I believe that many of these conditions are often triggered by three dietary elements:
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- Excessive fructose, mainly from sugar and HFCS.
- High glycemic (rapidly absorbed) carbohydrates, mainly from grains.
- Omega 6 fatty acids, mainly from vegetable oils.
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Many of these disorders also seem to run in families, suggesting a strong genetic component. The CARB syndrome disease model is based on the concept that if people with a genetic predisposition to these disorders are exposed to the above three dietary elements, they are likely to end up with the phenotypic expression of a disease state. You start accumulating metabolic and brain disorder labels.
Genetic Link Between Common Brain Disorders
Today an article was published in the journal The Lancet showing genetic links between five common brain disorders: major depression, autism, bipolar disorder, ADHD and schizophrenia. The investigators performed a genome-wide associative study (GWAS). They looked at single nucleotide polymorphisms (SNP), a variation in a single site in DNA. Individuals tend to have literally millions of these genetic variations and they looked at the entire genetic makeup of thousands of individuals to see if any of these variations were associated with the above five conditions. Their study identified five risk genetic locations that overlap with all five of these clinical disorders. In other words people with these genetic variations seem to be at increased risk for all five of these brain disorders. You might be asking yourself, as I did when I read the article, what does this mean for patients? The answer is not so straightforward.
This study has several important implications. First of all, it suggests that these clinical disorders are not the distinct clinical entities that we once believed. For example, people with bipolar disorder often have symptoms overlapping with the other five conditions. This is hardly news to me because I have already been proposing that a group of common brain disorders has a shared pathology and environmental triggers. This is the basis of the CARB syndrome disease model.
The authors of the paper also suggest that their findings might lead to new treatments. One of their high-risk locations was CACNA1C, a gene that helps regulate voltage-dependent calcium channels. Among other things these calcium channels help to regulate the release of neurotransmitters. Thus people with these genetic variants have brains that function a little bit differently than those with normal genes. Perhaps targeting treatments at these calcium channels will result in new treatment methods, but at this point in time it’s too early to speculate.
The World Around You Shapes Your Genetic Expression
The other import point that was not discussed in the paper is the role of the environment in phenotypic disease expression. Each of us enters this world with a unique genetic makeup and each of us has our own unique genetic variations. Some of these variations might make us more prone to a given disease or diseases. That is the focus of this paper. Whether or not we actually develop a given disease often depends on environmental influences—our diet, our level of stress, our exposure to toxins, our level of physical activity—the list goes on and on. The environment can affect genes through the process of epigenetics, where genetic expression (phenotype) is changed without changes to the underlying genetic structure. This often occurs through the process of DNA methylation or histone modification. These changes in genetic expression can last for the life of a cell and can even be passed on to the next generation. In other words, what you eat or do today may potentially affect your offspring in either a positive or negative way.
We Already Have Highly Effective Treatments That Don’t Come in a Bottle
I think we’ve spent enough time wading through the complicated field of genetics. It likely will be years or decades before this type of research has any direct clinical application to patient care. It is much more productive to focus on what we do know—eating a healthy diet reduces the incidence of all five of these brain disorders and others not mentioned in the article. For reasons we don’t fully understand, eating a diet loaded with sugar, HFCS, grain-based, high glycemic carbohydrates and excessive omega 6 fatty acids seems to dramatically increase your risk of developing many common brains disorders like depression, ADHD, bipolar II, anxiety disorders, PTSD, eating disorders, autism, OCD, fibromyalgia and similar conditions. Certainly genetic predisposition plays a role, but people who don’t consume these dietary elements seem to have a very low incidence of all these disorders. Certainly genes are important, but in my opinion lifestyle trumps genes every time.
Death Knell of the Low Fat Craze
Another important study published this week in the NEJM highlights this important fact. In this large Spanish study they compared three groups of high-risk individuals. The first group was instructed to eat their usual diet, but they were also told to reduce their fat intake. The second group was instructed to eat a typical Mediterranean diet and they were given free olive oil every week to incorporate into their diet. The third group was instructed to also eat a Mediterranean diet and every week they were given free nuts to include in their diet. The control group was unable to reduce their fat intake by very much, so this study was really comparing a Mediterranean diet with added healthy fats to a standard, somewhat low fat diet.
The study was stopped early after 4.8 years when they noticed that the group on a standard diet had over a 30% increased risk of developing heart attacks and strokes compared to the groups following a high-fat Mediterranean diet. Now that’s a really big deal. Change your diet and lower your risk of heart attacks and strokes by over 30% in a few years. That’s something you can take home to momma. All patients in the study were considered to be high risk because they smoked cigarettes, had hypertension or had metabolic problems like obesity or type II diabetes. We also know that the common brain disorders discussed above have been shown to be co-morbid with these common metabolic disorders.
If you connect the dots, I suspect that the groups eating a Mediterranean diet also had a lower incidence of these brain disorders. Interestingly, an article published at the end of last year in the European Journal of Clinical Nutrition showed that women who followed a Mediterranean diet did indeed have a lower incidence of depression. Other studies have shown a similar association between the modern western diet and other common brain disorders.
Let’s Spend a Little Dough on Diet
The Lancet article made headlines in newspapers around the world, giving people with these disorders new hope that this type of research will quickly bring about new treatments. President Obama recently announced that he would be supporting an effort costing billions of dollars to map the human brain. We are already spending billions of dollars studying the human genome. While I am a strong supporter of basic science, it seems to me that sometimes these efforts overwhelm less sexy areas of research like the well-established role that diet plays in health and disease.
It’s important to remember that we are in the middle of a catastrophic epidemic of obesity, type II diabetes and common brain disorders. We already know that what we eat has a great influence on these conditions. I suggest that we move some of this money away from basic research to performing more studies like the one outlined the NEJM article. It isn’t very sexy, but this information is much more likely to have an impact on your health and the health of your children than studying obscure calcium ion channels or mapping the human brain.
We desperately need more nutritional studies that are not supported by the agricultural and food industries. To date our government seems to be focused on basic research rather than nutritional science. That is why I am supporting Gary Taubes in his NuSi project, an effort to provide more direct funding of meaningful nutritional research. One small study has already been published suggesting that a Paleo style diet is even more effective than a Mediterranean diet at improving glucose tolerance, an important marker for metabolic health. In my experience people who follow a Paleo style diet are much less likely to suffer from both metabolic disorders and the brain disorders discussed in this article.
For more information about a Paleo diet, I suggest reading Loren Cordain’s book “The Paleo Answer” or Robb Wolf’s book “The Paleo Solution”. For information about the adverse effects of excessive fructose, I suggest reading Richard Johnson’s books “The Sugar Fix” and “The Fat Switch”. To learn more about the benefits of omega 3 fatty acids and the dangers of consuming too much omega 6 fatty acids, I recommend reading Barry Spears book “Toxic Fat”. I just finished this book and it is excellent.
Start Today—There’s No Need to Wait
We certainly do need more studies to further document the benefits of a healthy diet on all areas of our health, but exactly who will fund such studies? It seems like the human genome studies, brain mapping efforts and similar esoteric endeavors are siphoning off all the research dough. I don’t know about you, but I don’t want to wait decades to learn how to stay healthy.
The good news is that you don’t need to wait for any new basic science studies. We already have the basic constructs to tell us how we should eat to stay healthy. Even though you can’t change your genes, you can change the genetic expression of those genes by eating a healthy diet and following a healthy lifestyle. Changing your diet today is easy to do with minimal risks. What are you waiting for? Your body and brain will thank you for your efforts.