When an almost unspeakable tragedy occurs like the recent murder of 20 innocent children and seven adults in Newtown, Connecticut, our first task is to absorb the event and then mourn for those lost and for their families and friends. Because of the nature of this crime, this process will take some time. Before the tears begin to dry, it’s also important to start asking the Who, How, Why and What questions in the important effort to try to prevent similar events in the future.

• Who was involved? We need to know very quickly who was involved in the event.
• How did the event take place? We need to understand the time course and details of the event.
• Why did the individuals involved in the event do what they did?
• What can we do to prevent future similar events?

These questions must also be answered in this order. We immediately need to know who was involved to make sure there are no individuals still on the loose who can threaten society. In this case there was some initial confusion because Adam Lanza was apparently carrying the driver’s license of his older brother Ryan, but the “who” question was answered within 24 hours of the event.

The “how” question usually takes weeks or months because law enforcement agencies must do a thorough forensic investigation of the crime scene and events leading to it, and this always takes time to complete. The investigators in this case have released little information to date and they won’t do so until their investigation is complete. Knowing how an event took place gives us valuable information about how to prevent similar tragic events in the future.

The next important question involves finding out why the person or persons involved in the event acted in such a heinous manner. We need to understand the motives involved. This question is sometimes difficult to completely answer, especially as in this case where the perpetrators are no longer with us. Even with Adam Lanza dead, a careful forensic investigation will likely give us some sense of his motives.

Preventing Future Tragedies
Once these first three questions are answered, it’s important to move on to the most important question: What can we do to prevent future similar events? There is nothing we can do to bring back those who were brutally murdered. The best we can do is to protect our citizens from similar future events. Barely hours after the tragedy occurred, some pundits and talking heads in the news media started to speculate about the “what” question before we had answers to the first three questions. I understand why this occurs. Our first instinct after mourning is to protect those left behind.

Speculation about this “what” question has mainly centered on two areas: guns and mental illness. Every time that we have gone through one of these tragic mass murders where firearms are involved, it’s natural to have a national conversation about our citizen’s access to guns. Although I think this is an important conversation to have, in this case the guns used were legally registered to Adam’s mother. Even the most restrictive gun laws would likely have not prevented this event from occurring.

As a physician with an interest in neuroscience, I am very interested in the mental health discussion. Seung-Hui Cho, James Eagan Homes, Jacob Rogers, Eric Harris and Dylan Klebold—some of the most notorious mass killers in recent years, all seemed to have some form of mental disorder. Adam Lanza apparently had a form of autism called Asperger’s syndrome and perhaps a personality disorder. Within hours of the tragic shooting the pundits and talking heads were already proposing beefing up our creaky national mental health system, suggesting that if we put a Psychiatrist or Psychologist on every street corner in America, such events could somehow be prevented. I strongly disagree with this sentiment.

An Epidemic of Autism
Before we beef up our mental health system, we need to answer a few important questions. The most important question has to do with the prevalence of common mental or brain disorders, which seems to be increasing at an epidemic rate. The prevalence of a disorder is the number of people in a given population with the disorder at a given time. For example, let’s look at the prevalence of autism. The CDC now estimates that 1 in 88 children in the United States now has some form of autism spectrum disorder and this is a 23% increase from 2009.

Autism is now the fastest growing serious developmental disability in the U.S. The same is true for other common brain disorders like depression, anxiety disorders, ADHD, eating disorders, oppositional defiant disorder, PSTD and similar conditions. Although most individuals with these disorders don’t commit violent crimes, those who do so usually seem to have one or more of these conditions.

Although genetics certainly plays an important role in autism and other common brain disorders, the genes haven’t changed, so we must look to environmental influences for an answer to this important question. Yesterday I was discussing autism with a physician from West Africa. He made the comment that in his home country, he has never seen a case of autism, yet in this country his five children all have friends and classmates with this disorder. He concluded that there must be something about our lifestyle in this and other developed countries that is driving the increase in autism and similar conditions. I agree with him and I believe I know what that factor is–our food.

Last year a study was published linking autism to maternal diabetes, an increasingly common condition:

http://www.frontiersin.org/Cellular_Endocrinology/10.3389/fendo.2011.00054/full

Although we don’t know exactly how diabetes might trigger autism in a fetus, they proposed that insulin signaling plays a key role. It’s also interesting to note that diabetes and obesity have been associated with other common brain disorders, including depression, ADHD, PTSD, eating disorders, anxiety disorders and similar conditions. This would suggest that diabetes and obesity somehow adversely affect brain function. It is now established that adults with diabetes are prone to a form of reversible brain dysfunction. The incidence of type II diabetes and obesity are increasing at an alarming rate, so to understand why brain disorders are increasing in incidence, we need to take a careful look at diabetes and obesity.

For years we have known that there is a connection between obesity and diabetes and for a long time we assumed that this was a linear relationship—when people eat too much calorie-dense food they become obese, leading to something called insulin resistance, and eventually their pancreas burns out and they become diabetic. Recent research has shown that this simple linear time line is probably not correct. The same factor that causes excessive fat storage (obesity) also causes insulin resistance. That critical factor appears to be excessive fructose, mainly from sugar and HFCS. Wait a minute—how could a simple sugar found in fruit be related to a mass killing? Let me walk you through it.

When you consume more than 25 grams of fructose per day, much of it is converted to triglycerides and stored as fat or converted to uric acid, a waste product that promotes fat storage on a cellular level. Richard Johnson describes this process in his new book “The Fat Switch”. One of the first organs to accumulate this fat is the liver, the first step in the process of insulin resistance, where it takes more insulin to move glucose inside of cells. Insulin resistance leads to high levels of insulin and unstable glucose levels, both of which are bad for the brain. This process is accelerated with you add high glycemic (rapidly absorbed) carbohydrates to the mix, especially grain-based carbohydrates. This further pushes up insulin levels and results in magnified glucose spikes. Even though the brain relies mostly on glucose for its energy needs, too much glucose is bad for brain cells because neurons don’t require insulin for glucose to enter into the cells. Too much glucose inside of neurons results in the release of too many free radicals, eventually damaging the cells.

A New Disease Model
Even though it is clear that diabetes seems to be associated with a long list of brain disorders, it also makes sense that the brain takes a hit long before someone develops full-blown diabetes. We now believe that long-term exposure to excessive fructose and high glycemic carbohydrates can eventually trigger a form of food-induced brain dysfunction called Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. People with CARB syndrome can develop up to 22 brain dysfunction symptoms that interfere with their ability to function. Some of these symptoms include poor impulse control, mood swings, anxiety, depression, inability to empathize with others, difficulty concentrating and focusing, poor cognitive functioning and disrupted sleep. Because the symptoms of CARB syndrome overlap with many common hereditary disorders like classic major depression, individuals with food-induced brain dysfunction start to accumulate labels, often more than one. Adam seemed to be one such individual.

Hereditary factors also come into play. Let’s use Adam Lanza as an example. Let’s assume that his genetic makeup made him prone to the adverse metabolic effects of excessive fructose and grain based carbohydrates, two mainstays of our modern diet. Let’s assume that his mother ate some of this food during her pregnancy and perhaps developed some degree of insulin resistance, a common occurrence in modern pregnancies. Let’s assume that after Adam was born, he was once again exposed to these dietary elements as an infant, child and young adult. We now have a perfect storm for brain dysfunction.

CARB syndrome can develop at any age from the fetus to adulthood. When it develops during a period of rapid brain development, it often presents in children as autism spectrum disorder, ADHD or oppositional defiant disorder. Although in adults CARB syndrome seems to be completely reversible with proper treatment, this is probably not the case when it develops in a fetus or young child.

If you subject children or young people with CARB syndrome to excessive amounts of stress, especially social isolation or teasing from peers, and then give them access to lethal weapons, sooner or later something terrible is going to happen. Very few will resort to mass murder, but many will suffer in silence and live a life where their true potential is never met. Remember, it only takes one disturbed individual like Adam to create a terrible tragedy.

You Can Be Thin and Obese
Although virtually every individual with CARB syndrome tends to inappropriately store excessive body fat, many are not visually big and some are quite thin. Adam Lanza appears to be almost too thin, but this doesn’t exclude CARB syndrome. Anorexics have excessive body fat and they are always thin. You need to measure their body composition to see this excessive fat. Although all individuals with CARB syndrome have excessive body fat, there is no correlation between the amount of extra fat in their bodies and the degree of their brain dysfunction. A thin person with CARB syndrome like Adam can have severe brain dysfunction, whereas some very large people with a lot of extra body fat may have only minimal brain dysfunction.

Shoring up our mental health system will have absolutely no impact on preventing tragedies like Newtown until the mental health profession realizes that it has completely missed the most common brain disorder in modern societies—CARB syndrome. Drugs and counseling will have no effect on CARB syndrome as long as a person continues to consume toxic food loaded with sugar, HFCS and high glycemic carbohydrates. In some cases commonly prescribed psychotropic drugs can even make the condition worse.

Sugar and Violence
When somebody already has CARB syndrome, is it possible that the consumption of certain dietary elements might directly affect their behavior? Recent research has tied the consumption of sugary beverages to violent behavior:

http://www.nutrociencia.com.br/upload_files/artigos_download/Solnick%20e%20Hemenway,%202011.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586153/

Instead of just focusing on guns and mental illness, I suggest that it’s time to focus on how these dietary elements might not only be adversely effecting our health, but also our brain function and behavior.

In a way I wish I were wrong about this. Things would be much simpler if the Newtown story was only about one disturbed young man with access to guns. We could have our gun control discussion, beef up our mental health system and then be done with it. But unfortunately, this does not seem to be an isolated case. With each passing year we see more similar cases where disturbed young males use guns to create mass murder. The incidence of obesity and diabetes is increasing, the incidence of common brain disorders is increasing and the presence of food loaded with sugar, HFCS and high glycemic carbohydrates is increasing. I suggest that it’s time to start connecting the dots.

My thoughts and prayers are with the families and friends of those who lost their lives in this tragic event.