AHS Slides_Emily Deans and Jamie Scott

ResiliencyAn Evolutionary Pathway to Optimal Mental and Physical Health

Emily Deans, M.D.
Clinical Instructor in Psychiatry at Harvard Medical School
evolutionarypsychiatry.blogspot.com
Featured blogger on Psychology Today at Evolutionary Psychiatry
Disclosures: None
Participated in research funded by NIH

Jamie Scott
PGDipNutMed PGDipSportExMed BSc BPhEd
Workplace Health Educator
Nutritionist/Trainer
thatpaleoguy.blogspot.com
Disclosures: None

Why Evolutionary Medicine for Mental Health?
Existing treatments, therapy and medication, are only partially effective.
They take a long time, are expensive, or have side effects.
No truly novel treatments in 20 years, despite an explosion in neuroscience knowledge since 1990.
We need a new approach

Diseases of Civilization (DOC)
Related to differences in our current lifestyle compared to our hunter gatherer past.
Ultimate pathology of disease is inflammation – true of obesity, autoimmune disease, heart disease, acne… and mental illness.
A clue we are dealing with DOC – the recent appearance and/or acceleration of change in illness in recent industrial history.

Mental Health
Schizophrenia
Wither hebephrenia?
MDD and Anxiety
Increasing in prevalence and changing in morphology
(Stanley Jackson Melancholia and Depression)
Bipolar Disorder
In last 40 years age of onset decreased from 30s to late teens, now more resistant to lithium, more rapid cycling (Fred Goodwin)

Mental Health
Eating Disorders
Now more common in women and men; striking younger cohorts
(NIH National Comorbidity Study)
Autism
Increasing?
Yale SK study, teachers
Dementia
Definitely increasing, but is it just due to aging population?

What Causes Mental Illness?
Genes
+ Stress
+ Diet
Changes to our modern, industrial, nutrient-poor diets have reduced our resiliency to stress

What really causes mental illness?
Genes
Typically two, three, or more in a single signaling pathway (NRG-erbB in schizophrenia)
One gene - no increased risk
Two genes - 8-fold increased risk
Three genes - 27-fold increased risk
The suspect genes (for schizophrenia, autism, anxiety, depression, etc.) oftenreside in the stress response pathway

Recipe for a brittle brain
Suboptimal genes, plus…
Stress;
Inflammation and poor immunity (includes gut);
Micronutrient deficiency;
Deranged sleep (cause or effect?);
Lack of recovery and repair

Recipe for a resilient brain
Eat a diet with reduced food toxins and one likely to promote a happy gut
Avoid the Neolithic Agents of Disease
Fermented foods to avoid inflammation
Avoid autoimmune reactions
Keep the immune system strong to suppress or avoid infection…
Viruses and intracellular pathogens associated with worse cognitive functioning or greater severity of symptoms in schizophrenia, dementia, and mood disorders
NOT FDA APPROVED

Recipe for a resilient brain
Eat a nutrient rich diet
Magnesium is typically low in modern diets and plays a role modulating and reducing every part of the stress response.
Zinc needs higher during stress.
Phospholipids also seem to modulate stress response, choline can be especially low in modern diets
Periods of fasting to promote ketosis, mitochondrial decommission, nerve plasticity and repair
Sleep, play, love, exercise
NOT FDA APPROVED

Research Evidence
Randomized Controlled Trials (RCT) of EvoMed lifestyle and diet for treatment of mental illness…
THERE. ARE. NONE.
The research has not been done.
I blog in an effort to raise awareness.

Evidence – a few shining jewels
RCT of children with ADHD and food elimination diet
Small trials of ketogenic diets in autism and dementia
Diet and Violence studies
Geschfound the prisoners were eating the RDA- topped them off with additional micronutrients violence decreased, study was replicated, mechanism remains mysterious
Australian dietary pattern studies
Depression and Bipolar disorder
“Traditional” beats out “Modern” and “Western” patterns
Many more in the constellation of studies I mention on my blog

The Future
A holistic, evolutionary medicine approach could not only revolutionize mental health treatment, but be preventative for the population.

The Application of Evolutionary Biology to Corporate Health & Wellness Programmes
New Zealand Market

The Reality of the Corporate Environment
Constant pressure to do more with less
Absenteeism + Presenteeism
High cost of employee recruitment + replacement
Human biology rarely given a second thought

International Wellness Landscape - What is driving a wellness focus

International Wellness Landscape - Top Wellness Elements

International Wellness Landscape - Fastest growing wellness elements

Dr Emily Deans: What Causes Mental Illness?
Genes
+ Stress
+ Diet
Changes to our modern, industrial, nutrient-poor diets have reduced our resiliency to stress

What Causes Low Resiliency to Work Stress?
Genes?
+ Stress
+ Diet
Plus other lifestyle factors

Over-exposure to neolithic agents of disease
Under-exposure to nutrient-dense foods
Over-exposure to sedentariness and/or ‘chronic cardio’
Under-exposure to evolutionary-appropriate physical activity
Over-exposure to artificial lighting
Under-exposure to natural lighting
Deranged sleep patterns and a disconnect with circadian rhythms
Disconnect with evolutionary-appropriate socialisation
H.R. APPROVED

Our evolution designed us for a world very different from that we have constructed for ourselves. Within a mere instant, in evolutionary terms, we have transformed our environment.
But this widening mismatch between our biology and our environment has its costs. And we cannot evolve our way out of the problem.
Mismatch - why our world no longer fits our bodies (Oxford Press, 2006).
Prof Peter Gluckman and Mark Hanson

Greatest capacity for adaptation?
Soft biological object
Rigid inanimate objects

Our Current Focus
Creating awareness around how our biology impacts on;
health and well-being
stress resiliency
work productivity

Building Resilience

Some of the Challenges Ahead…
Conventional wisdom entrenchment
The perceived authority of those delivering information
Evolutionary model is ‘novel’ compared to conventional wisdom - needs to be proven as an intervention
Status quo is path of least resistance (cost)
Lack of support services… doctors, nutritionists, trainers
Perception of ‘paleo re-enactment’…

Future Hopes and Dreams…
Evolutionary biology becomes the default model, with the onus shifting to those outside of this model to justify their approach with a robust level of evidence…
More focus shifted to how to integrate evolutionary biology rather than why we should…
More adaptation of the physical work environment to the soft squishy objects…
Growth of a support services network(e.g. PPN)

PHOTO CREDITS
Slides 2+3; Emily Deans and Jamie Scott
Slide 6; Wikimedia Commons
All other slides; images licensed from iStock
REFERENCES - Emily Deans, M.D.
Crystal HA, Dickson D, Davies P, Masur D, Grober E, Lipton RB: The relative frequency of “dementia of unknown etiology” increases with age and is nearly 50%in nonagenarians. Arch Neurol 2000, 57:713-719.
Eby, George A, Eby, Karen L. Rapid recovery from major depression using magnesium treatment. Med Hypotheses. 2006;67(2):362-70
Evangeliou, Athanasios MD. Application of a Ketogenic Diet in Children With Autistic Behavior: Pilot Study. J Child Neurol February 2003 vol. 18no. 2 113-118
Eves A, Gesch B, Food provision and the nutritional implications of food choices made by young adult males, in a young offenders' institution. J Hum Nutr Diet. 2003 Jun;16(3):167-79
Gesch, B. et al, Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners: Randomised, placebo-controlled trial The British Journal of Psychiatry 2002 181: 22-28
Goodwin, Frederick K and Jamison, Kay Redfield. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Second Edition. Oxford University Press. Mar 2007.
Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA: Alzheimer disease in the US population. Prevalence estimates using the 2000 census. Arch Neurol 2003, 60:1119–1122.
Hellhammer, J. et al. Effects of Soy Lecithin Phosphatidic Acid and Phosphatidylserine Complex (PAS) on the Endocrine and Psychological Responses to Mental Stress. Stress. 2004, Vol. 7, No. 2 , Pages 119-126
Hudson, James et al. The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry 1 February 2007 (Vol. 61, Issue 3, Pages 348-358)
Jacka, Felice N. et al. Association between magnesium intake and depression and anxiety in community-dwelling adults: the Hordaland Health Study. Australian and New Zealand Journal of Psychiatry 2009 43:1, 45-52
Jacka FN, Pasco JA, Mykletun A, Williams LJ, Hodge AM, O'Reilly SL, Nicholson GC, Kotowicz MA, Berk M, Association of Western and traditional diets with depression and anxiety in women. Am J Psychiatry. 2010 Mar;167(3):305-11
Jacka FN, Pasco JA, Mykletun A, Williams LJ, Nicholson GC, Kotowicz MA, Berk M. Diet quality in bipolar disorder in a population-based sample of women. J Affect Disord. 2011 Mar;129(1-3):332-7
Jackson, Stanley W. Melancholia and Depression: From Hippocratic Times to Modern Times. Yale University Press. 1990

REFERENCES - Emily Deans, M.D
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62: 593–602
Kim, Young Shin, Leventhal, Bennett L., Koh, Yun-Joo, Fombonne, Eric, Laska, Eugene, Lim, Eun-Chung, Cheon, Keun-Ah, Kim, Soo-Jeong, Kim, Young-Key, Lee, HyunKyung, Song, Dong-Ho, Grinker, Roy Richard. Prevalence of Autism Spectrum Disorders in a Total Population Sample. Am J Psychiatry 2011 0: appi.ajp.2011.10101532
Le-Niculescu, H. et al. Convergent functional genomics of anxiety disorders: translational identification of genes, biomarkers, pathways and mechanisms. Translational Psychiatry (2011) 1, e9; doi:10.1038/tp.2011.9
Mulvhill, B. et al. Prevalence of Autism Spectrum Disorders - Autism and Developmental Disabilities Monitoring Network, United States, 2006. MMMR Suveillance Summaries December 18, 2009 / 58(SS10);1-20
Okusaga O, Yolken RH, Langenberg P, Lapidus M, Arling TA, Dickerson FB, Scrandis DA, Severance E, Cabassa JA, Balis T, Postolache TT. Association of seropositivity for influenza and coronaviruses with history of mood disorders and suicide attempts. J Affect Disord. 2011 Apr;130(1-2):220-5
Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Dubois AE, Pereira RR, Haagen TA, Rommelse NN, Buitelaar JK. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. Lancet. 2011 Feb 5;377(9764):494-503
Schiff M, Bénit P, Coulibaly A, Loublier S, El-Khoury R, Rustin P. Mitochondrial response to controlled nutrition in health and disease. Nutr Rev. 2011 Feb;69(2):65-7
Szewczyk B, Kubera M, Nowak G. The role of zinc in neurodegenerative inflammatory pathways in depression. ProgNeuropsychopharmacolBiol Psychiatry. 2011 Apr 29;35(3):693-701
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Yaffe, Kristine Yaffe et al. Mild Cognitive Impairment, Dementia, and Their Subtypes in Oldest Old Women. Arch Neurol. 2011;68(5):631-636.
Yolken RH, Torrey EF, Lieberman JA, Yang S, Dickerson FB. Serological evidence of exposure to Herpes Simplex Virus type 1 is associated with cognitive deficits in the CATIE schizophrenia sample. Schizophr Res. 2011 May;128(1-3):61-5.
Zaalberg, A., Nijman, H., Bulten, E., Stroosma, L. and van der Staak, C. (2010), Effects of nutritional supplements on aggression, rule-breaking, and psychopathology among young adult prisoners. Aggressive Behavior, 36: 117–126. doi: 10.1002/ab.20335
Zeisel, Steven H, and da Costa, Kerry-Ann. Choline: An Essential Nutrient for Public Health. Nutr Rev. 2009 November; 67(11): 615–623.

ResiliencyAn Evolutionary Pathway to Optimal Mental and Physical Health

AHS Slides_Emily Deans and Jamie Scott

by Ancestry on Aug 08, 2011

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