About Kelly Brogan

KELLY BROGAN, MD, is a holistic psychiatrist, author of the New York Times Bestselling book, A Mind of Your Own, Own Your Self, the children’s book, A Time For Rain, and co-editor of the landmark textbook Integrative Therapies for Depression.

I’m a very visual person. When I meet a patient who presents with complaints of irritability, anxiety, foggy thinking, fatigue, and insomnia, I visualize something that looks like a concert of rising and falling graph lines, and I plot her day to day symptoms on this image. What I find is that the sugar rollercoaster accounts for the vast majority of symptoms troubling patients.

We know that sugar influences behavior; we see it in our kids and know not to give them a lollipop if we want them to read a book quietly at their desks. Somehow, though, we are not convinced of the powerful effects of this toxic substance on our adult bodies and brains.

Sugar disturbs mental health in at least three ways:

1. Starving the Brain

Here’s a typical scenario. You wake up, have a glass of orange juice and a bagel (or a bowl of “healthy” cereal, or a Special K Bar), and your pancreas is confronted with a wave of sugar that it does not react kindly to. It puts out a counterwave of insulin, charged with sweeping that sugar into cells for energy production. The resultant dip in blood sugar can alarm the body and the adrenal glands, making them work over time.  These glands are charged with producing cortisol (which ultimately promotes insulin resistance or the lack of cellular response to insulin) and fight or flight chemicals that can get your heart racing, and rachet up anxiety.  The solution to this agitated slump is often a follow up serving of refined carbohydrate and/or caffeine and sugar – midmorning cookie with coffee.

The more days of your life you engage in this pattern of sugar and refined carb consumption, the more your brain suffers, potentially even putting you at risk for Alzheimer's dementia, down the line[1][2].

2. Fueling the Flames

Sugar has direct inflammatory effects on the body[3][4] that may be related to its influence on gut flora, its associated insulin spike, or glycation effects of circulating sugar on proteins.[5] Inflammation is understood to be the major driver of chronic disease including mental illness, and is promoted by sugar, stress, food, and environmental toxins.

3. Derailing Hormones

When cortisol is in demand for its blood-sugar balancing effects, or because of other psychological or bodily stressors, the body “shunts” the production of progesterone to support further cortisol output. This makes evolutionary sense, because if we are under stressful circumstances, preserving progesterone, our “pro-gestational” reproductive hormone, becomes secondary. Insulin can also stimulate production of DHEA and sex hormones including testosterone, which can drive the pathology we see with polycystic ovarian syndrome[6]. As if that weren’t enough, sugars have been demonstrated to reduce liver production of sex hormone binding globulin, freeing up testosterone and estrogen in ways that may promote symptoms of estrogen dominance including premenstrual moodiness and irritability.

So, how do you kick the habit? For my patients I recommend a 2-4 week sugar fast, following some basic guidelines. Everyone knows that sugar in the form of candy, cake, and ice cream is the first to go on the chopping block.

Here are 3 less intuitive sugar balancing changes:

1. Up the Fats

The hallmark of a Paleo diet, high natural fat intake, including and notably featuring saturated fat, is the antidote to much that ails the Standard American Dietary victim. Accumulating data supports the role of this diet in improvement of hunger[7], blood pressure, HDL cholesterol, body mass index, and HgA1C (a measure of sugar's damage to protein in the body)[8]. As Nora Gedgaudas has said: sugar-based metabolism is like crumpling papers and throwing them into the fire all day long whereas fat-based metabolism is like putting a log on the fire and walking away.

I recommend that my patients use liberal amounts of grassfed ghee, coconut oil, and cook with animal fats from pastured sources in addition to frequent consumption of bone broths.

2. Ditch the Grains

Thanks to Dr. Perlmutter’s bestselling book, Grain Brain, the public now has an awareness of the insidious role of grains, including whole grains, in blood sugar destablization and brain health. I am concerned, primarily, about grain-based toxins such as inflammatory lectins in wheat, genetically modified corn, and changes to the prolamine content of grains since hybridization techniques have taken hold. These grains are rarely traditionally prepared (sourdough, sprouted) in ways that would aid in their less inflammatory digestion, and are almost always featured in processed foods. I recommend a one month elimination of all grains.

3. Make Room for Starch - Safe Starches

Rigid interpretation of low-carb Paleo diets may leave some women feeling strung out after an initial boost. The role of thyroid hormone in the transition to a low carb diet suggests that a thyroid hormone called reverse T3 may be produced as a way to signal the body to slow down, and insulin resistance may actually result as a means for the body to hold on to that suddenly dwindled supply of glucose.  For these reasons, and because of the extensive research performed by Drs. Shou-Ching and Paul Jaminet, I recommend incorporation of non-grain “safe starches” into my patient’s diets. It may come as a surprise to learn that certain carbohydrates may actually help to balance blood sugar.

An interest in food-based nutrient synergy will make clear the distinction between a sweet potato and its caloric equivalent – 4 teaspoons of table sugar. The former comes packaged with the B vitamins, phosphorous, magnesium, iron, copper, manganese, zinc, and chromium needed to metabolize the carbohydrate content, in addition to vitamin E, beta carotene, c, calcium, potassium, zinc, and selenium. This tuber improves blood-sugar stabilizing adiponectin and reduces inflammation[9].  But isn’t it high glycemic?

Herein lies the limitation of the glycemic index. Investigation into the “high carb” traditional Kitava diet reveals:

Yam sweet potato, taro, and fruit were staple foods while grains, dairy, refined fats, and sugar were absent. The study adds to the notion that some of our most common diseases are preventable and that a high-carbohydrate intake is not a problem in itself.

Resistant Starch

Starch comes in two varieties, one of which is not enzymatically broken down and serves as a source of fermentable fiber in the intestines, producing anti-inflammatory saturated fats such as butyrate. Butyrate has been demonstrated to be an anti-inflammatory bridge between the gut and the brain. In this way, it supports healthy gut flora as a “prebiotic,” mineral absorption, gut blood flow, and minimization of inflammatory response. Data supporting the role of this starch in weight loss, gut health, and sugar balance[10] has been primarily focused on grain sources, beans, potatoes[11], and green bananas[12][13].  Therapeutic use of resistant starches such as green banana and potato are being pioneered by patients who are enjoying the health benefits of glycemic stability through gut flora rehab. I typically recommend one month detox with non-starchy vegetables, fermented vegetables, liberal fats, and pastured meat with broths. After the month, we introduce non-grain carbs (tubers, beets, carrots, and sometimes even white rice) and supplemental resistant starches if needed (often as 2-4 tablespoons of potato starch daily). Of course, customization of these interventions is key, given fundamental differences in what gut microbiome imbalances we all come to the table with.

It takes about one week to reset one’s sweet tooth, and there is a profound liberation that comes with elimination of addictive foods such as dairy, sugar, and grains. From this experiment emerges the “real you,” free from the influence of industrial food toxins. Only then can you know what your mind-body “issues” really are.

Originally published on MindBodyGreen.com

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/

[2] http://www.ncbi.nlm.nih.gov/pubmed/16216936

[3] http://ajcn.nutrition.org/content/26/11/1180.abstract

[4] http://www.ncbi.nlm.nih.gov/pubmed/16087988

[5] http://ajcn.nutrition.org/content/87/5/1188.full

[6] http://www.ncbi.nlm.nih.gov/pubmed/18803938

[7] http://www.nutritionj.com/content/12/1/105

[8] http://www.ncbi.nlm.nih.gov/pubmed/19604407

[9] http://www.ncbi.nlm.nih.gov/pubmed/21861722

[10] http://ajcn.nutrition.org/content/82/3/559.abstract

[11] http://www.hindawi.com/journals/jnme/2012/478043/

[12] http://www.ncbi.nlm.nih.gov/pubmed/15287677

[13] http://www.ncbi.nlm.nih.gov/pubmed/11427691