In the first part of this brain wellness series, we reviewed brain structure and function, including the key elements required to maintain brain wellness. These elements include adequate sleep, nutrition, exercise, positive social interaction, exposure to sunlight and avoidance of toxins‒all aspects of a healthy lifestyle.
But what happens when the brain is deprived of these key elements or is exposed to toxic elements on a regular basis? Our second installment of the series this month is dedicated to the pathophysiology of the mistreated brain, and how to diagnose and treat common clinical manifestations caused by unbalanced or unhealthy lifestyles.
Pathophysiology of Mental Illness
Mental illness is extremely common in the United States; nearly 50 percent of all Americans experience a mental disorder at least once in their lifetime. Risk factors include a family history of mental issues and adverse conditions, including environmental toxins, socioeconomic adversities, trauma, other illnesses and abuse. Drug and alcohol use can be a risk factor for, or a symptom of, mental illness. For a detailed discussion on risk and protective factors, visit https://bit.ly/2HOYL0w.
The pathophysiology of mental illness involves derangements in the complex neurobiological structures and networks discussed in Part 1 of this series. This process involves malfunctions in brain tissue, electrochemical signaling and silencing along with neural circuit functioning. Recent advances in cognitive neuroscience, brain imaging and epigenetics (turning genes on and off) are changing the way researchers approach the diagnosis and management of mental illnesses. But these disorders can manifest on every level, from molecules to consciousness. So, despite our complex and detailed knowledge of neurobiology, we cannot directly translate this information into concrete clinical psychiatric practices. Consciousness is too subjective, and the nature of human experience is too broad.
When mental illness does manifest, there are specific emotional symptoms, behavioral indicators and physical signs of lifestyle imbalance that steer the skilled clinician to the correct diagnosis(es). Symptom severity can be quantified using measurement-based care (MBC) to aid in assessment, modifying treatment and measuring outcomes. The standardized questionnaires used to this end are based on diagnostic criteria found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. (We’ll discuss MBC in more detail later in this series.)
Clinical Manifestations of Mental Illnesses
The most common clinical manifestations of the mistreated brain are anxiety and depression. The key moderating factors that determine whether mental illness will reach a clinical threshold are stress (perceptions of severity) and coping (behavioral responses). For example, a person with a balanced lifestyle who gets laid off may experience moderate stress, but copes by increasing exercise and positive social interactions while maintaining other key elements of brain wellness. Another person in the same situation, however, may cope by isolating herself, staying up all night worrying, or turning to drugs or alcohol for relief. This individual is far more likely to develop mental illnesses and/or other problems linked to substance use. (See the following illustration of where the stress response occurs in the brain).
The Profound Effect of Lifestyle on the Brain
The way individuals cope with stress is directly related to their lifestyle habits. Habits and coping strategies largely determine whether a person will be resilient to or vulnerable to stress. Maladaptive stress responses, such as drinking too much or avoiding friends, increase anxiety and depression, which in turn may trigger maladaptive behavior. The result is a vicious cycle that increases the risk of behavioral health disorders, as shown in the flowchart below:
After depression and anxiety, the most common forms of mental illness are trauma-related disorders, obsessive-compulsive disorders, phobias, bipolar illness, personality disorders and psychosis. Behavioral disorders, such as eating disorders and addiction, go hand-in-hand with mental disorders and can occur as a direct result of behavioral problems or because of them (such as self-medicating with drugs and alcohol). However, maladaptive behaviors are not set in stone and can be prevented, managed or even cured by attending to the brain’s needs daily, allowing it to function properly.
Getting sufficient sleep is essential for brain wellness. Each phase of sleep serves a function for information processing, rest and healing. Chronic sleep deprivation has detrimental effects on the brain and other organs (see the figure below).
Common causes of insomnia and sleep deprivation include poor “sleep hygiene,” anxiety, substance use, environment and mental illness. Good sleep hygiene consists of healthy habits that are conducive to quality sleep and regular sleep times. For example, avoiding caffeine and electronic devices prior to getting into a clean, comfortable bed before turning out the light is good sleep hygiene. Avoiding long-term use of sleep medication is essential because such medications disrupt sleep quality by preventing normal phases of sleep. Also, even over-the-counter sleep medication can be habit-forming and lead to memory loss and dementia.
Unfortunately, the typical American diet consists largely of foods from boxes, cans, jars and packages, all of which contain many mysterious ingredients that are difficult to pronounce. Many Americans substitute fast foods for home-cooked meals, washing them down with bubbly chemical beverages. While this is unhealthy for anyone, it is particularly dangerous for people with mental health and substance use issues.
Focusing diet on consuming essential nutrients, on the other hand, helps to restore neurotransmitters in the brain, which improves mood and cognitive function. But what is a healthy diet? Nutrition experts at Yale University compared common types of diets – such as low fat, low carbohydrate, etc. – to see which ones were the healthiest. While no single diet was superior, the researchers stated, “…a diet of minimally processed foods close to nature, predominantly plants, is decisively associated with health promotion and disease prevention.”
A healthy diet includes:
- . Mainly vegetables, fruit, legumes, whole grains, seeds, nuts, herbs and spices
- . Variety
- . Multiple colors
- . Lean meat and fish
- . Eggs and dairy
- . Nothing artificial, processed, fried or with added sugar or sugar substitutes
For individuals recovering from addiction, a healthy diet can also help to maintain sobriety by reducing or eliminating cravings for drugs and alcohol. Avoiding sugary foods and beverages prevents stimulation of addiction receptors in the brain. In addition to consuming a nutritious diet, people in recovery benefit from avoiding a few dietary no-no’s:
- . Avoid or minimize caffeine intake, as it mimics the effects of neurotransmitters
- . Avoid fasting, as hunger can trigger cravings
- . Eliminate refined sugar, as it also stimulates addiction receptors
- . Minimize intake of simple carbohydrates such as white bread, pasta, white rice and bakery products; the body converts these foods into sugar, a stimulator of addiction receptors
Remember, patients should consult with a health care provider before starting a new diet, including taking nutritional supplements such as vitamins and mineral products.
The importance of exercise for brain wellness cannot be understated. Daily exercise is a well-established treatment for patients with depression, anxiety, psychosis and mood disorders, and those who are recovering from addiction. A review of the literature suggests exercise also decreases craving and drinking in patients with substance use disorders. Exercise increases oxygen delivery to the brain, liver and heart, which promotes healing and prevents disease. Endorphins released during exercise improve mood and decrease anxiety.
Outdoor exercise is optimal to prevent vitamin D and magnesium deficiency; both nutrients are required for normal brain function. But how much exercise is needed to achieve these effects? See the infographic on page 17 for basic recommendations on a healthy exercise routine.
Positive Social Interaction
Humans cannot thrive in isolation. There is overwhelming evidence that positive supportive social groups are essential for normal growth and development, and contribute to longevity. Socializing helps people process stress and buffer adversity. Add a dash of laughter as it has been shown to improve cognitive function and overall feelings of well-being. Maybe it really is the best medicine.
The importance of having a social life and support groups for people recovering from addiction was illustrated in a 1999 study published in The American Journal of Drug and Alcohol Abuse. The research examined qualities of support groups whose members had the lowest relapse rates over two years. The most successful group members had formed friendships that extended beyond the group and participated in group special events and activities such as outreach, volunteering and fundraising.
While avoiding toxins may sound simple, it is not; they are everywhere, in our air, water and food. There is evidence that invisible radiation from the environment, including electromagnetic radiation from Wi-Fi and electronics, can be harmful. Many of these elements are an unavoidable part of daily life, but patients can be counseled to avoid chemical exposure from smoking, vaping, taking drugs and drinking alcohol. Mind-altering drugs damage the brain and nervous system and permanently affect neural networks. Fortunately, these effects can be overcome with abstinence and evidence-based treatment.
Fortunately, the human brain is just as simple as it is complex. The master organ needs an adequate amount of a few simple things daily to function properly. When the brain is mistreated, it becomes ill. The first line of treatment, therefore, is to restore homoeostasis by increasing the healthy lifestyle habits the brain needs. Doing so not only improves mental health and overall well-being, but it prevents physical illnesses as well. Even under the best circumstance, however, mental illnesses and addiction can develop that require professional treatment. Reminding patients that caring for their bodies will help their brains can improve outcomes and even accelerate recovery.
“We are what we repeatedly do. Excellence is not an act, but a habit.”
—Will Durant (U.S. American writer, historian and philosopher)
About the Author
Dana Connolly, Ph.D., is a senior staff writer for Sovereign Health. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. For more information, inquiries or to comment on this article, contact the author at firstname.lastname@example.org.