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A Look at the Roots of Bipolar Disorder
By Tom Monte
Modified from the original article printed in the July 2008 issue of The Tom Monte Monthly

Bipolar disorder, also referred to as manic depression, arises in people with a genetic vulnerability to the illness. Only recently have scientists begun to unearth clues as to its origin, which very likely arises from a combination of insulin resistance and inflammation of the brain.

Insulin resistance, which is the basis for type II diabetes, is a condition in which cells are fed too much glucose, or blood sugar, well after they have reached full capacity for fuel. Glucose is being forced into the cell because the blood is simply too loaded with sugar. Eventually, the cells say, "No more!" They block their own doors and windows—the insulin receptors on the exterior of the cell—and become "resistant" to insulin. Without insulin, cells die. Also, insulin signaling within the cell becomes disrupted and cells begin to malfunction. That includes the cells in the brain.

Insulin resistance is the basis for metabolic syndrome, a condition in which a person suffers from increased weight, as well as high blood pressure, cholesterol, triglycerides, glucose, and insulin. Metabolic syndrome predisposes a person to diabetes, heart disease, and several forms of cancer. It is also directly linked to Alzheimer's disease and other brain disorders. Now scientists are finding that insulin resistance, and in some cases, metabolic syndrome, is linked to bipolar disorder.

In the October 2006 issue of the Journal of the American Medical Association, M.J. Friedrich noted the following: "Known best for its role in the body as a regulator of blood glucose levels and fatty acid storage, insulin also acts in the brain to aid memory and thinking. Thus, when insulin regulation is disrupted, as it is in many common medical conditions, including obesity and diabetes, the risk for cognitive impairment rises."

The July 2006 Journal of Clinical Nutrition reported, Bipolar disorder and metabolic syndrome share features of hormonal, immunologic, and autonomic nervous system dysregulation." Insulin resistance can spread from body cells to the nervous system and the brain. Once it affects the brain, it alters the way cells function.

The brain is constantly passing whole bundles of information from neuron to neuron. Among the carriers of these packets of information are substances known as neurotransmitters. One of these is glutamate, a chemical neurotransmitter that causes states of arousal, excitement, and even mania.

Within the brain's cells, neurotransmitter production is regulated by sets of chemical enzymes known as kinases. One of these kinases, specifically GSK3, regulates production of a couple of different neurotransmitters, including glutamate. GSK3 is regulated itself by insulin. As insulin function becomes impaired in the brain, GSK3 becomes elevated, which in turn produces more glutamate, which triggers states of excitement and mania. As mania increases, the brain races, neurotransmission increases dramatically, making the person think and speak rapidly. Brilliant ideas appear to flash across the rippled cortexes of the brain. The person feels empowered beyond imagination. Everything is beautiful. Everything makes sense. The world can finally be grasped. Many believe that if they tried hard enough, they could fly. But brain chemistry cannot stay in overdrive forever. Eventually, it must crash. And when it does, glutamate production finally falls and the person plummets into depression.

Other neurotransmitters play a role as well. In manic depression, levels of serotonin—the neurotransmitter that is responsible for our sense of well being, optimism, ability to concentrate, and deep sleep—also fall. Dopamine, the chemical neurotransmitter responsible for rapid action, can become relatively elevated, causing anxiety to increase. The net effect is depression and anxiety, which sometimes lead to even more intense states of fear.

All of this disruption within the brain is triggered by insulin resistance, which itself creates a cascade of cellular changes, all of which make the brain function abnormally.

Insulin resistance is essentially an acidic condition. Lithium, the drug often prescribed for bipolar, is a salt and highly alkaline, which balances the effects of the insulin resistance in the brain. In fact, it is very similar in chemical composition to sodium, also highly alkaline. It is well known that lithium can interfere with sodium regulation in the kidneys, which is one reason those on lithium must be monitored closely with regular blood tests.

For decades, lithium was used without anyone knowing why it worked to the extent that it does. Scientists recently learned, however, that lithium deactivates GSK3, which reduces glutamate levels in the brain. When glutamate levels are reduced, the person no longer has the chemical imbalance needed to create mania (the highs) associated with bipolar disorder. However, this will not treat the person's depression. Serotonin will still be low, which will sustain the depression.

Here are some recommendations on how to balance blood sugar and, ultimately, brain chemistry:

Eat three servings of whole grains, such as brown rice, millet, barley, and quinoa, daily. These grains are all slowly absorbed in the bloodstream and will gradually elevate brain levels of serotonin. Sugar and alcohol create dramatic highs and lows in blood sugar and brain levels of serotonin. Whole grains, on the other hand, keep serotonin elevated over many hours. Eventually, the brain will recognize the high levels of serotonin as normal and will form a new baseline. At that point, the brain itself will sustain higher levels of serotonin as its normal baseline, and thus sustain higher mood.

Also, eat seven to 12 servings of vegetables every day. Green and leafy vegetables, like broccoli and kale (at least four servings), round and sweet vegetables, like onions and cabbage (at least two servings), and roots, like carrots and sweet potatoes (at least two servings), should be eaten daily. Also, add miso soup, pickles, and sauerkraut regularly throughout the week. The vegetables, miso, and pickles will further alkalize the blood and help control insulin levels.

Many with bipolar use sugar, chocolate, processed foods, alcohol, and marijuana to self-medicate. All of these substances increase acidity in the blood and form the basis for insulin resistance. Consuming less of these foods will reduce acidity, and can be replaced with eating small servings of cooked fruit and other healthy desserts three or four times per week.

Another element of balancing blood sugar is physical exercise. Walking, some form of sports activity, dancing, chi gong, tai chi chuan, or some other martial art every day. Exercise is essential, because it balances insulin levels and increases insulin sensitivity in cells.

Finally, be sure to stay on medication. Keep your doctor informed of the changes in diet and lifestyle for they will need to monitor your blood for any changes that may be needed in medication.

Bear in mind rebalancing brain chemistry can take time. While you can feel better in as soon as two weeks, it will take a year of consistent mindfulness to improving diet and lifestyle to make more permanent shifts in brain chemistry. The good news is this attention will level off insulin, and the brain will start to function in a more balanced and peaceful manner.

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