As I mentioned in part I of this blog, there is a strong association between insulin resistance, diabetes and mental health.

Caught and treated early, insulin resistance is reversible in >90% of patients, and there is a clear improvement in well-being associated with this reversal.  To get to the foundation of the problem, you must do a diagnostic work-up, to identify and deal with the layered factors which promote insulin resistance and diabetes. Factors to be assessed include:

a)     Cortisol-levels which are too high, (as might be the case in anxiety disorders, mood disorders, and psychotic disorders) cause insulin to be elevated, and increase appetite. Cortisol can be reduced easily enough by either supplements or medications, as well as psychotherapeutic methods (e.g., biofeedback, certain therapies, body work etc)

b)     Female and male hormones-low levels of testosterone result in lowered lean body mass (therefore lower metabolic rate), lower energy and vitality. High levels of estrogens (e.g. with potent birth control pills) can also cause weigh gain, albeit in a different pattern of distribution.

c)      Stress-many people over eat when tired, angry, frustrated, bored, lonely; Becoming mindful of your sense of hunger before eating, can, over time, reduce unconscious habitual stress eating. Identifying the situations which make you stressed and problem solving them when possible can help reduce stress eating. Keeping a daily log  (what you ate, when you ate it, and situations in which you over-ate) will definitely raise consciousness

d)     Lifestyle-getting adequate sleep (7-9 hours for most people), moderate exercise 4-5 times per week will reduce the tendency to eat highly processed foods in an out of control manner when you are tired.

e)     Inflammation and toxins: inflammation due to infection, or toxins in your environment can cause weight gain, as a hormone called Leptin can rise to unusual levels. Irvingia Gabonensis has been shown to help reverse leptin elevation and therefore help with appetite reduction and weight loss.

f)       Nutritional deficiencies (e.g., chromium, vanadium, thiamine) can lead to trouble handling carbohydrates in the body.

g)     Caloric restriction-the hardest part of the program is to reduce calories, but with the above measures, perhaps a support group (e.g. weight watchers, over-eaters anonymous, food addicts anonymous), you can do it.

Yours in Health,

Dr. Hedaya

Insulin resistance is a fully reversible condition in which the cells of the body become insensitive to the insulin signal, which itself is designed to take glucose (sugar) out of the blood and into the cells (for energy). If insulin resistance becomes severe enough, it progresses into type II diabetes. Diabetes is more difficult to reverse, and is associated with frequent urination, increased weight, increased thirst, and a host of other problems.

The connection between obesity, insulin resistance, diabetes and mental health problems is no longer questioned. There are number of reasons for the association, including the use of psychotropic medications which cause weight gain, and promote the metabolic syndrome; the social stigma associated with obesity and the lifestyle changes associated with diabetes; and inflammatory activation due to poor diet, high insulin and glucose levels, which in turn changes brain neurochemistry.

A recent study (McIntyre et al.  brain volume abnormalities and neurocognitive deficits in diabetes mellitus: points of pathophysiological commonality with mood disorders?: Adv. Ther. 2010 Feb;27(2):63-80. ) reviewed the literature on brain changes in type one and two diabetes, and concluded that the brain areas which are affected in mood disorders and DM diabetes mellitus, significantly overlap. The association is so compelling that one article in 2007 (Ann. Clin. Psychiatry; 2007 Oct-Dec;1994):257-64) was titled: “Should Depressive Syndromes Be Reclassified as “Metabolic Syndrome Type II”. The association with diabetes (and obesity and insulin resistance) extends beyond just mood disorders, to anxiety disorders, and major psychiatric syndromes such as bipolar disorder and schizophrenia.

Women have twice the frequency of depression as men, and are more vulnerable to many psychiatric disorders between puberty and menopause. Menopause and the post partum are time of high vulnerability for women. Women are more likely to be hospitalized or jailed in the days just before menstruation begins. Transdermal estrogen has been proven in three studies to have antidepressant effects (as opposed to oral estradiol). These facts, and others, beg for our attention to the role of female hormones in mental health. When one adds the concerns raised by the woman’s health initiative study of over 160,000 women on synthetic estrogens, one can easily be left in a state of confusion.
What to do?

First, write down a complete history of your mental health and hormonal events. This means looking at mental health symptoms just before and during puberty, in the days before your period, in response to pregnancy and birth control pills, after any female surgeries, and around menopause. What were your symptoms, did they get better or did some get worse? Include your family history of female (ovarian, uterine, breast) cancers, male cancers (prostate), and cardiovascular disease.

Next if you are still menstruating, track your symptoms and your cycle for three months. Some studies suggest that 50% of women who think they have PMS, do not. Whether that statistic is correct or not, you need to make an accurate correlation.

Finally, work with your doctor to check your FSH, LH, estradiol and progesterone in both the follicular (first 10-12 days) and luteal (days 18-24) parts of your cycle. If you can arrange for continuous salivary monitoring of estradiol and progesterone (less reliable) during that same cycle, you will get a very nice picture of what your hormones are doing in relation to your symptoms. In a simplistic way–estrogen tends to be activating, and progesterone is like the drug Valium—calming in small doses, sedating and depressing in large doses. If you want to be really comprehensive, you can test your genetics (CYP450 1B1 and COMT) and estrogen metabolism to determine whether you can improve your protection against female cancers by eating crucifers, or whether these veggies might increase your risk for making ‘bad’ estrogens.

In addition, look at other hormones (adrenal and thyroid) that influence the female hormone cycle to round out the picture.

All this and more will be discussed in my upcoming complimentary Lunch and Learn teleconference May 5th, at 12:00.

A recent study known as the Colorado Thyroid Disease Prevalence Study, found that 13 million Americans may have undiagnosed thyroid conditions, and suggested that more widespread thyroid testing is needed. Among their findings are the fact that 9.9 percent of the population had a thyroid abnormality that had gone unrecognized. An underactive thyroid -- hypothyroidism -- affects more women than men, and the risk increases with age for both men and women. Clearly, there is a need for more widespread thyroid stimulating hormone (TSH) testing and more aggressive treatment, especially for subclinical patients. Additionally, another study, called the NHANES study, showed that the reference ranges (for TSH) in most laboratories are too wide. Furthermore, relying on the TSH (being in the normal range) as the only way to define hypothyroidism may mean that still more millions are hypothyroid, but undiagnosed and overlooked.

A thorough workup of the thyroid axis should include an assessment of the adrenal axis as well. Of course a history (dry skin, hair loss, constipation, weight gain, brittle nails, irregular menses, muscle weakness, sensitivity to cold, recurrent upper respiratory tract infections, depression, low energy, hoarseness, elevated cholesterol), physical exam, body temperatures, and lab testing (TSH, free T4 , Free T3, reverse T3) are part of a complete evaluation.

Finally, another new study (of 17, 684 people) showed that when one is on thyroid hormone, an optimal dose is one that keeps the TSH very low, but not completely suppressed. This reduces risks of cardiovascular complications and fractures. These results are surprising, but the study was quite strong in design. (J. Clin Endocrinology Metab, Jan 2010, 951(1):185-193).

We will be hosting a workshop webinar on the effects of thyroid function and mental health on April 7th at 12:00 noon EST - 12:30pm. Registration is free, sign up today.