I am a secondary caregiver to someone with bipolar disorder. Caregivers know about the textbook formula for dealing with this condition. It involves medication prescribed by a psychiatrist, therapy from a certified psychologist and monitoring of moods, to put it simplistically. Truth is, the formula works only when accompanied by deep patience, and a deeper understanding not just of the illness, but also the person.
My journey as a caregiver started in 2014 . We were advised to set a daily routine because it is key to healing. Each day is carefully divided into time slots to include exercise, work, downtime, meals, sleep and errands. During every appointment, doctors would advise regular exercise and a healthy diet.
What is the right exercise? In our case, by trial and error, we found yoga didn’t help but football and volleyball did. For us, sports proved to be more interesting and easier to stick to. And what about diet? Does it mean starting the day with warm water with honey and lemon juice? Does it mean a balance of essential carbohydrates, protein and vitamins? Does it involve controlling the intake of junk food? There’s no one answer for all these questions.
Last year, I stumbled upon a book, Beyond The Label: 10 Steps To Improve Your Mental Health With Naturopathic Medicine by Dr Christina Bjorndal. Dr Bjorndal has bipolar disorder. In the book, she talks about the relationship between the gut and brain. Eating foods to fortify the gut, she writes, improves brain health and overall mental well-being. The book gave me hope.
It was my first brush with nutritional psychiatry—a subject that deals with diet as one of the tools for mental well-being. The book focuses on specifics such as neurotransmitters and hormones and the interdependency of the brain and gut. The two organs are connected by the vagus nerve. This implies that the foods you eat feed the brain.
“Strong evidence suggests that gut microbiota has an important role in bidirectional interactions between the gut and the nervous system. It interacts with the central nervous system by regulating brain chemistry and influencing neuroendocrine systems associated with stress response, anxiety and memory function,” reads a report, The Gut-brain Axis: Interactions Between Enteric Microbiota, Central And Enteric Nervous Systems, published in the US-based The National Center for Biotechnology Information journal in 2015. Simply put, any inflammation in the gut will impact the brain, thereby affecting moods.
Popular culture would have one believe coffee kick-starts Monday mornings, a tub of ice cream soothes heartbreaks and weekends call for alcohol. These foods spell disaster for those with bipolar disorder. Dr Bjorndal writes that alcohol depresses the central nervous system, artificial sugar blocks the production of the happy hormone serotonin and caffeine can play a strong role in triggering depression or anxiety in some cases by affecting sleep patterns.
A handful of books establishes this link between gut and mental health. A few weeks ago, Hachette India released The Food Mood Connection. It is written by the nutrition specialist, psychiatrist and professionally trained chef Uma Naidoo. Apart from diet recommendations for severe psychiatric disorders like bipolar and schizophrenia, the book touches upon conditions that can do without medication or do not require lifelong treatment, like depression and anxiety. “The central nervous system produces chemicals such as dopamine, serotonin and acetykchlonine critical for regulating mood and processing thought and emotion. Serotonin, a key chemical deficient in the brains of depressed and anxious people, plays a major role in regulating the gut brain axis. Serotonin is one of the most buzzed about brain chemicals because of its role in mood and emotion, but did you know that about 90% of serotonin receptors are found in the gut?” Dr Naidoo writes.
Some aspects run like a thread through the book. For instance, the standard American junk food menu high in artificially sweetened soft drinks, red meat and fries is best avoided. Dr Naidoo cites findings that connect these foods to anxiety. At the end of each chapter, she suggests a list of foods. One such item, recommended in the chapters on depression and anxiety, is turmeric. She refers to studies which found curcumin, the compound in turmeric, adjusting “brain chemistry” and safeguarding “brain cells against toxic damage that leads to depression”.
Turmeric’s anti-inflammatory properties contribute to a healthy gut. Indian meals contain enough turmeric to meet everyday dietary requirements. But an inflamed gut may not allow for absorption of turmeric. “If you come to me with conditions of an inflamed gut, I would recommend kacche haldi ka achaar (raw turmeric pickle). The pickle is fermented and it will be easier for your gut to absorb it,” says macrobiotic nutritionist Shonali Sabherwal. She adds: “If you are a healthy and happy person overall, then you reap the benefits of turmeric from your diet anyway. The daily requirement of curcumin, the compound in turmeric, is about 400-600mg.” Piperine, a compound in black pepper, helps the liver to retain turmeric in the body. Usually, it is advised to mix the two for optimal retention of curcumin by the bo.
Sabherwal does not suggest buying over-the-counter curcumin tablets—“Any excess curcumin will be eliminated by the body and popping these tablets, unless advised by a doctor, will put extra load on the liver.”
Both the books lay emphasis on a diet rich in certain vitamins and food groups for better mental health. These include bananas, chickpeas, chicken and sunflower seeds for B6, flaxseed oil, seafood and walnuts for essential fatty acids, bitter foods, beetroot and lemons for cleansing the liver, curd and buttermilk for probiotics, fermented foods like pickles and kimchi to improve gut health and water to stay hydrated and help the body eliminate toxins.
Even though these books have informed our family meals, I have learnt that diet cannot be considered in isolation. There’s therapy, change in medication—and life takes unexpected turns. There were and will be countless slip-ups. The anxiety triggered by caregiving will lead to sugar or caffeine binges. Those undergoing treatment for mental illness will give in to their moods swings and obsessively eat several packets of chips in one sitting.
There is no such thing as the perfect recipe to treat chronic mental disorders. But most caregivers doggedly hold on to the belief that there is. And belief is the star ingredient.