Doing something while depression is on

On Sunday I woke up not very late and made pancakes, brewed a thermos with green tea and drove on a highway to a park to build a snow woman. Yes, it was specifically a very shapy lady, not a snowman. Today after I got home from work I felt that I couldn’t move. I couldn’t move because of overwhelming emotional pain – it was a sense of grief, a feeling that my personal world has collapsed, that there is nothing to look forward to. I am not going to say that on Sunday I was extremely happy, but it was clearly a more normal and stable day. What has occurred to make today different? I’m sure the answer lies in biochemistry, but at this point we don’t have the tools or knowledge to know what exactly should be measured and when. My last period started on February 15th. (I suggest to record start dates in order to understand whether the cycle affects your mood – at least in the case that you usually feel worse in the first few days before/during your period – you can remind yourself that this is not permanent and it will pass as it did before).

Today it is March 14th, could my serotonin levels be dropping? WebMD suggests that “as many as 90% of women experience unpleasant symptoms before their periods“, it has now been almost a month since my period, therefore today is supposed to be close to the “before period” time.

Estrogen and Women’s Emotions

My thyroid antibodies also continue to be high, Anti-TPO at 250 and Anti-Tg at > 4000. TSH is abnormally high as well. My CT scan also indicated “partially imaged polypoid mucosal thickening in the right maxillary sinus”. What does that mean, does that have anything to do with depression? It seems to mean chronic sinusitis. I don’t know whether this ever has any effect on your mood.

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The information above leads to some guesses about why I started to feel more severe emotions, but I can’t say that I actually know. I believe I have already made the changes to my lifestyle that I could – cutting out gluten and cow dairy because of celiac disease, avoiding processed foods, eating a lot of whole grains, fruits, and vegetables. I drink a lot of green and black tea, never drink or smoke, I go to sleep a bit before 12am and sleep for 8 hours. I walk to the subway instead of taking the streetcar, on a grey day I use my daylight lamp in the morning. I got an unlimited pass to a yoga studio and go there during lunch. No caffeine after 6pm. I call my mom and my grandmother. I try to avoid scrolling through Facebook. Therefore I would say – I’ve really done it all, what I could.

So what if you feel you’ve been as healthy as you can, you see your psychiatrist regularly, but the depression still sets in? Currently I am waiting for the IVIG procedure which is supposed to be done in April. You might be waiting for your next appointment to talk about switching medications, or you just started an antidepressant and the psychiatrist said that the positive results may take effect only after four to six weeks. I think the only strategy in such a situation is to think of activities to pass the time. Doing something even though feeling depressed. Even if your brain is dissuading you from it, it’s telling you to sit still, to not move, that any action you take will make it worse.

In DBT therapy there is an idea of opposite action and I believe this is a useful technique. “In DBT, the opposite action skill is a deliberate attempt to act OPPOSITE of your emotion urge. If your emotions are doing more harm than good, try acting opposite.” My thoughts are telling me that I am in too much emotional pain to do anything, but doing nothing will prolong the sense of time and I will just suffer more while waiting. For example last Thursday while sitting at work, I felt that I feel too depressed and lethargic to do anything expect stay seated during lunch and that trying to do any activity would make me feel worse. In this case my emotions and thoughts were only harming me because continuing sitting, after already three hours of sitting, would definitely not make me better off. I would be wrapped in my thoughts, prolonged sitting is not good for blood flow and chronic pain, time would also go very slowly. I had to use opposite action and I forced myself to go downstairs, change, and attend a yoga class. The 45 minute class passed quicker than 45 minutes of sitting would be and because the classroom was hot and I had to keep focusing on switching poses, my negative thoughts were less persistent. I am not saying that I went to yoga and felt delighted and blissful for the 45 minutes, I am saying that I was better off by going there instead of following my emotions and doing nothing.

Another example where following my emotions would make me worse off is often when I start feeling lonely I get wrapped in thoughts that I don’t have any close people and not many people to spend time with. Next, I start to think that I am the only one with no plans for the evening/weekend, and therefore it is pointless to ask anyone whether they want to meet. Clearly in this case acting as my thoughts and emotions tell me to would only harm me as I would end up not reaching out to anyone and of course then I will have no plans with certainty. Here opposite action would be texting/calling someone and proposing to make plans. Preferably be specific with an activity, place, and time. Refer to Sheldon’s friendship algorithm for instructions.

Sheldon’s Friendship Algorithm

Suggestions for passing time with depression are listed below. What works for me are simple activities, not trying to follow some life changing goals or saving the world. Depression is a real illness, and if all I was able to do during a bad day is coming out to convenience store to buy plantains, I will say – good for me.

  • See an old friend, talk about your feelings, or talk about nothing in particular – remember a dumb high-school story, laugh about it
  • Talk on the phone to someone you think is a good person, call them even if your brain is telling you that you are better off not speaking to anyone
  • Cook/bake something that you know how to make and enjoy eating, I make crepes because the recipe is simple and this activity passes time as I have to fry each crepe separately
  • Walk to a store nearby to buy something small – tea, eggs, apples, etc.
  • Jump with a skipping rope at home, or on a porch, or outside. Aerobic exercise is healthy
  • Get the lyrics to a song that you know and sign the full song, even if initially you really don’t feel like it. It will help pass the time and singing will not hurt you
  • Walk around the block while listening to a podcast
  • Watch CollegeHumor or Big Bang Theory

 

Planks, gut health, and mental health

I’ve had many conflicts with my father, but one thing I’ve always agreed with him on is that there is no mental health without physical exercise. Especially for those with emotional instability like me, I find that exercise is a necessity. It’s definitely not easy to do it with an autoimmune disease since sometimes after I get home from work – I feel lethargic, or I feel arm pain, or I feel isolated and a need to go on Facebook and see that people are alive. Well this is where logical thinking comes in – in the end choosing to exercise has the best payoff even though it’s not immediate. Lying down on the sofa and turning on Netflix has an immediate pay off, but if this is what I will do daily after work, after a while I will be worse off.

Currently I am trying to exercise two to three times a day. I do about 10-12 minutes before leaving for work in the morning, I include stretching, planks, downward dog, inversion poses, etc. Recently there have been some articles about positive impact of even very short intervals of exercise. I would like to believe that these statements are true as I am not able to force myself to wake up another twenty minutes earlier and engage in a 30 minute work out before work or breakfast. I do believe that some exercise is better than no exercise. I work in a boring office, so my hours are pretty standard. During lunch I walk around listening to a podcast and currently I signed up at a yoga studio located in the office building downstairs, which offers lunch classes. In the evening I try to do another 20-30 minutes of exercise. Is this exercise plan difficult? Yes, but once you do it several days in a row, I feel that there is some kind of adjustment and you get used to the schedule. Also I find it easier when I know that my exercise interval is only 12 or 20 minutes, I am not trying to push myself into an hour jog. In fact I don’t jog at all. I mentioned this before – one psychiatrist with whom I had a consultation stated that the best way to combat inflammation is exercise and that I should only do the type of exercise that I like, otherwise I will not stick with the routine for long. Therefore no jogging for me, I am doing planks and yoga poses.

The latest research shows that a single 10-minute bout of very light (30% of VO2 Max) physical activity can increase the connectivity between brain regions linked to memory formation and storage.

This potentially groundbreaking study on the cognitive benefits of short periods of mild exertion activity (such as gentle yoga, tai chi, slow dancing, or playing bocce) was conducted by researchers at the University of California, Irvine (UCI) and the University of Tsukuba in Japan.

Ten minutes of mild exercise may improve brain connectivity and enhance memory

From the abstract of the actual paper: ” A single 10-min bout of very light-intensity exercise (30%V˙O2peak) results in rapid enhancement in pattern separation and an increase in functional connectivity between hippocampal DG/CA3 and cortical regions (i.e., parahippocampal, angular, and fusiform gyri). Importantly, the magnitude of the enhanced functional connectivity predicted the extent of memory improvement at an individual subject level. These results suggest that brief, very light exercise rapidly enhances hippocampal memory function, possibly by increasing DG/CA3−neocortical functional connectivity.

Rapid stimulation of human dentate gyrus function with acute mild exercise

I now have some evidence to support my belief that my 10 minute work-outs are useful. Sometimes at work I do yoga poses in the staircase, or run up ten flights of stairs. There are many ways to exercise for free, it’s not necessary to purchase a monthly gym membership or pay $20 for a yoga class.

Some studies also indicate that exercise positively modifies gut bacteria. This change in turn can reduce inflammation and depression.

Recent studies suggest that exercise can enhance the number of beneficial microbial species, enrich the microflora diversity, and improve the development of commensal bacteria.

Collectively, the available data strongly support that, in addition to other well-known internal and external factors, exercise appears to be an environmental factor that can determine changes in the qualitative and quantitative gut microbial composition with possible benefits for the host. In fact, stable and enriched microflora diversity is indispensable to the homeostasis and normal gut physiology contributing also to suitable signaling along the brain-gut axis and to the healthy status of the individual. Exercise is able to enrich the microflora diversity; to improve the Bacteroidetes-Firmicutes ratio which could potentially contribute to reducing weight, obesity-associated pathologies, and gastrointestinal disorders; to stimulate the proliferation of bacteria which can modulate mucosal immunity and improve barrier functions, resulting in reduction in the incidence of obesity and metabolic diseases; and to stimulate bacteria capable of producing substances that protect against gastrointestinal disorders and colon cancer (such as, SCFAs).

Exercise Modifies the Gut Microbiota with Positive Health Effects

From ScienceDaily – “Two studies — one in mice and the other in human subjects — offer the first definitive evidence that exercise alone can change the composition of microbes in the gut. The studies were designed to isolate exercise-induced changes from other factors — such as diet or antibiotic use — that might alter the intestinal microbiota.”

Exercise changes gut microbial composition independent of diet, team reports

I think it’s very crucial to our mental health to exercise daily in any way – on a yoga mat at house, running up the stairs at work, going out for a jog, dancing, playing ping-pong, jogging with your dog, anything really that replaces sitting.

CAMH ER Waiting Room

The room is in the building at College and Spadina. The room doesn’t have any windows,  but it does have a clock, so you can know what time of day it is. What you can’t know is when you will be let out (but to be fair, involuntarily hospitalization can be a maximum of 72 hours). There are armchairs along the perimeter of the area and in the middle. There are about six of us at the moment. Some will be released soon and new ones will arrive. None of us want to be waiting here, twisting on the pale green chairs. Also most don’t agree that they should be here. A young black woman is banging on the locked door of the staff room, a nurse comes out. The woman is nearly dressed with a designer purse and fur boots. She starts pacing back and forth. “If I knew what this place is like, – she yells at the nurse, – I would have never come here. Look at me, I don’t need to be here. I don’t cut myself and shit.” The nurse talks to her calmly, she tells her what she tells everyone – you have to wait to speak with the psychiatrist. The woman continues to yell that she is not like the rest of us. She complained to her family doctor about stress at work and the doctor referred her to this address,  told her that she could get a note for stress leave. She just wants a note,  she assures that she doesn’t cut herself.

As of that is what we all do. If only it was that simple – you either cut yourself and are insane, or you don’t,  and are not. I’ve never cut myself and yet I voluntarily checked myself into the CAMH ER. I also didn’t think that I needed to be in there, but there was no other way. I wanted to be set free from my inflamed brain, from the malfunctioning neuronal synapses. I wanted to be free to get lost in writings of other people’s ideas, to play Bach’s Gavotte, to be attracted and be attractive. I wanted to be released from the dark well inside my own mind. I wanted to suppress the hell, to get the intravenous immunoglobulin treatment. But how to convince them, how to make them understand that is what I needed?

After sometime the black woman was released. I was still waiting. There was renewed yelling,  coming from a different patient. Similar to the woman who just left,  she was yelling at the nurse that she didn’t need to be here. She was also getting extremely agitated,  I think if she had something to throw,  she would. The whole room now was aware that she was old enough to have ten children and that she didn’t want this visit on her record. Her sister couldn’t take care of her own kids and who would then be doing it if not her? But with a CAMH visit on the papers, maybe she wouldn’t be allowed to take the children in. The nurse tried to explain that visiting CAMH was not same as police record, but the woman already went into rage, reasoning does not work at that point.

So why do we all scream in fear – I shouldn’t be here, I am not like the rest of them? We must have evolved to have this fear of being declared insane. Insane means being banned from the tribe, starving alone in the savannah. It’s hard to let go of that basic fear of being abandoned by our tribe. Even in the isolated room at CAMH, where only the doctors and about five other strangers could hear you, we still don’t want to admit that something could be wrong. We could admit cancer, meningitis, infertility, but not that we are not mentally well. Most diseases are just affecting our body, but it is our mind that makes us who we are. And if there is something wrong with that, then what are we? Of course this is not what I think, this is an assumption of what goes on through people’s minds in this state of fear. There is no separation from mind and body, both are a combination of cells, proteins, amino acids. Signalling to each other, reproducing. And any part of the whole mechanism can malfunction.

I would say – learn to accept. You didn’t choose this body, you just sort of woke up in it. I would have chosen another model, if I could, but no choices were given. Well here I am, at CAMH ER, because some signals are malfunctioning, and it’s not my fault. This is the situation though, and I have to accept.

List of medications and supplements for depression and obsessive thoughts

Here I will list different medications, supplements, and  procedures that are used to treat depression, anxiety, and obsessive/suicidal thoughts. I am not suggesting that you go out and buy a bunch of antidepressants and try them one by one, I just want you to be aware of what exists out there so that you can discuss this with your doctor. Some things, such as a daylight lamp, or omega 3s, don’t require prescription. Since I have been dealing with autoimmune encephalitis for more than three years already,  I have tried most of these treatments in attempts to reduce my depressive symptoms, psychosis, and intrusive thoughts.

Many people do get better with antidepressants. I have to note though, that in my case, the most useful treatment was high-dose intravenous steroids (IV Solu-Medrol) for five days. I did have severe psychotic depression with suicidal tendencies, my neurologist and psychiatrist propose that this was due to autoimmune encephalitis (Hashimoto’s encephalitis) – brain inflammation. Many people have milder depression and do well after antidepressant treatment. My state has improved but it is not without moments of intrusive thoughts and for this reason I continue trying different methods.

Medication

Antidepressants

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How does your psychiatrist determine which antidepressant to try? It seems that in general this is not based on any specific medical tests, but is based on the discussion with you about your symptoms. I did get a genetic test done on my saliva. This was part of CAMH Impact Study in Toronto, the provided report is called GeneSight Psychotropic Test. The company states that their test “analyzes how your genes affect your response to psychotropic medications commonly prescribed to treat depression, anxiety, bipolar disorder, posttraumatic stress disorder (PTSD), obsessive compulsive disorder, schizophrenia and other behavioral health conditions. There are dozens of medications used to treat depression and other mental illnesses and selecting the right antidepressant medication or other medication can be a challenging and frustrating process. GeneSight Psychotropic’s genetic testing enables your clinician to identify and avoid depression, anxiety and/or other medications that are unlikely to work or may cause side effects.” This test was provided to me for free by CAMH in Toronto.

GeneSight Psychotropic Test link

New antidepressants: 

There are three new antidepressants that have become recently available in US and Canada – vortioxetine, levomilnacipran extended-release (ER), and vilazodone. Vortioxetine – may enhance serotogenic activity via reuptake inhibition of serotonin receptors. Levomilnacipran is a a serotonin norepinephrine reuptake inhibitor. Vilazodone is a serotonin reuptake inhibitor and partial serotonergic 5-HT1A receptor agonist.

The role of new antidepressants in clinical practice in Canada: a brief review of vortioxetine, levomilnacipran ER, and vilazodone

Antipsychotics

Sometimes antipsychotics are added to antidepressants during treatment. Usually antipsychotics are used to treat schizophrenia, why are they given to depressed patients? I think the reason is that many patients don’t achieve remission with antidepressants, so other medications/methods must be tried. In the large National Institute of Mental Health Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, only about 30% of patients achieved remission (virtual absence of depressive symptoms) after up to 12 weeks of first-line treatment with citalopram. Evidence of the usefulness of atypical antipsychotics in treating MDD goes back more than 7 years (statement from 2009). A controlled trial found that the combination of olanzapine and fluoxetine was more helpful in treating patients with MDD (without psychosis) than fluoxetine or olanzapine alone.2 The group that received combination therapy did significantly better than the others. In November 2007, the FDA approved aripiprazole as the first atypical antipsychotic to treat MDD. It is specifically for adjunctive treatment, along with an antidepressant, for the treatment of refractory MDD.

Atypical Antipsychotics for Treating Major Depression

Aripiprazole (Abilify) – was approved by FDA for major depressive disorder in 2007, for patients who had inadequate response to antidepressants. Aripiprazole is a partial agonist at dopamine D(2) and D(3) and serotonin 5-HT1A receptors, and is an antagonist at 5-HT(2A) receptors.

Ripseridone – risperidone has actions at several 5-HT (serotonin) receptor subtypes. A study showed that depression symptoms improved modestly but significantly more in the risperidone group compared with the placebo group, as measured by clinician-rated symptom response and patient-rated self-assessment. The 17-item Hamilton Rating Scale for Depression score improved more in the risperidone group versus the placebo group.

Quetiapine (Seroquel) – quetiapine is a dopamine, serotonin, and adrenergic antagonist, and a potent antihistamine with some anticholinergic properties. Quetiapine binds strongly to serotonin receptors; the drug acts as partial agonist at 5-HT1A receptors. One study involved more than 700 people who had suffered from depression for at least one month but less than one year. Patients were randomly assigned to take one of three doses of Seroquel or a placebo once a day for six weeks. Those taking Seroquel showed greater improvement in depression symptoms than those on placebo.

Supplements

St. John’s Wort  – hypericum perforatum, it is a flowering plant. Sold in health stores/drug stores/online. A 2008 review of 29 international studies suggested that St. John’s wort may be better than a placebo and as effective as different standard prescription antidepressants for major depression of mild to moderate severity. A 2015 meta-analysis review concluded that it has superior efficacy to placebo in treating depression, is as effective as standard antidepressant pharmaceuticals for treating depression, and has fewer adverse effects than other antidepressants.[23] The authors concluded that it is difficult to assign a place for St. John’s wort in the treatment of depression owing to limitations in the available evidence base, including large variations in efficacy seen in trials performed in German-speaking relative to other countries. In Germany, St. John’s wort may be prescribed for mild to moderate depression, especially in children and adolescents.

Omega – 3 – omega-3 fatty acids are found in oily fish such as salmon. You can also purchase fish oil supplements in health stores/online. In general eating oily fish is considered to be a healthy choice. There is some evidence that omega-3s might help with depression, but this evidence is not very strong. From Cochrane review: “At present, we do not have enough high quality evidence to determine the effects of n-3PUFAs as a treatment for MDD. We found a small-to-modest positive effect of n-3PUFAs compared to placebo, but the size of this effect is unlikely to be meaningful to people with depression, and we considered the evidence to be of low or very low quality, with many differences between studies.

SAMe – S-adenosyl-L-methionine (SAMe) is a compound found naturally in the body. SAMe helps produce and regulate hormones and maintain cell membranes. A synthetic version of SAMe is available as a dietary supplement in the U.S. In Europe, SAMe is a prescription drug.  From Cochrane review: “We included eight studies involving 934 people in this review. There was no strong evidence of a difference in effectiveness between SAMe and imipramine or escitalopram when used alone. It was superior to placebo when used in combination with selective serotonin reuptake inhibitor antidepressants, but this evidence was of low quality. There was no significant difference in terms of effectiveness between SAMe and placebo alone, but again this evidence was of very low quality.

Folic acid – also known as vitamin B9. Foods that are naturally high in folate include leafy vegetables (such as spinach, broccoli, and lettuce), okra, asparagus, fruits (such as bananas, melons, and lemons) beans, yeast, mushrooms, meat (such as beef liver and kidney), orange juice, and tomato juice.

“The evidence for a link between depression and folate levels comes from various sources. Along with vitamins B6 and B12, folate helps break down the amino acid homocysteine. High blood levels of homocysteine are associated with Alzheimer’s disease and depression, although a cause-and-effect relationship hasn’t been proven. The breakdown of homocysteine generates SAMe, a major constituent of brain cells and, some think, a possible treatment for depression. Low levels of SAMe might explain any connection between folate and depression.”

Folate for depression

Probiotics – there is one combination of two bacterial strains that has shown some promise in treating mental health issues. Bifdobacterium longum R0175 and L. helveticus R0052 have been found to reduce symptoms of stress and anxiety. In Canada there are two brands with these strains – CalmBiotic and Jamieson Probiotic Sticks.

Clinical Guide to Probiotic Products Available in Canada

Other things to consider

  • Getting tested for hypo/hyperthyroidism – potential need for thyroid hormones

Treating an underactive thyroid gland may improve mood

  • Getting tested for anemia

Sometimes the first symptoms of iron deficiency are neurologic

  • Getting tested for coeliac disease – possible benefit from excluding gluten from diet

The Link between Celiac Disease and Depression

  • Autoimmune disease testing – includes coeliac disease, hashimoto’s thyroiditis, autoimmune encephalitis, lupus, type 1 diabetes, etc.

Infection, autoimmune disease linked to depression

  • Don’t forget to exercise and eat healthy! I really mean it, you just really need to do it, there is no other way…

Depression and anxiety: Exercise eases symptoms

Mediterranean diet tied to lower risk of depression

Following the MIND diet for autoimmune encephalitis and depression

So there has been the MIND diet going around. Some research indicates that it can reduce the risk of developing Alzheimer’s/dementia. The MIND diet is very similar to the Mediterranean diet. As most people know, that means eating a lot of oily fish, whole grains, vegetables, nuts, and beans/legumes. The MIND diet is a bit more specific – it recommends green leafy vegetables every day, berries (especially blueberries), whole grains three! times a day, nuts every day. You can see the list below:

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Dietitians provide some information on how this diet might work: “A diet that supports vascular health is certainly protective against vascular dementia, but certain foods and food components have been directly linked to improved neurological function or reduced AD biomarkers in the brain.1,8 “MIND diet foods reflect nutrients shown to slow cognitive decline, lower risk of AD, decrease amyloid in the brain or neuron loss in animal studies, or decrease oxidative stress and inflammation”.

Food for Thought: The MIND Diet — Fighting Dementia With Food

Well since my brain seems to be screwed up, anything that might fight inflammation while improving neurological function sounds good to me! It’s also a lot less restrictive than the AIP diet or ketogenic diet. Definitely much easier than intermittent fasting. I see myself being able to follow this diet long-term. I want to eat my grains, I also haven’t found much evidence that excluding grains helps with depression or inflammation. I like to eat my quail eggs and goat yougurt, so I don’t want to be excluding eggs or dairy (AIP excludes these foods). I don’t think the strict AIP diet should be followed for a long time, neither the ketogenic diet. I am not even sure whether keto diet can help with inflammation and depression, it includes tons of saturated fat. The MIND diet researchers actually recommend limiting saturated fat.

So how do you follow the MIND diet list in practice? Green leafy vegetables every day, berries, olive oil, nuts… how do you fit all of that into one day? And what if you don’t like looking or don’t have time? What if you are not one of those people who post on their vlog about avocado toast? I came up with some quick recipes, here I will post my breakfast idea. The breakfast consists of onions (vegetable √ ), kale (green leafy vegetable √ ), cooked with olive oil √, yougurt with blueberries (berries √), also you can add some toast (I don’t eat gluten, but I make gluten-free sourdough buns  – whole grain flour √), or you can easily make a lot of brown rice pudding – also whole grain √.

I want to make this simple. This is for actual practical eating, now a decorative meal. I prepare several items in the evening so that in the morning I can cook my breakfast in several minutes. I start work at 9 am and I try to wake up as late as possible, I don’t want to be cooking for even fifteen minutes in the morning.

Ingredients to buy:

  • Buy some frozen chopped onions, chopped kale, olive oil, eggs. Yougurt, frozen blueberries, nuts/seeds. Bread/sourdough bread. I don’t consume cow milk, so I buy goat/sheep yougurt, I also make soy yougurt. I also eat gluten-free, so I make sourdough buns at home. I make a lot of buns and a liter yougurt at once, so I don’t have to do this every day.
  • Why frozen vegetables? Because they are chopped and I don’t like chopping. Also they don’t go rotting in my fridge if I forget about them. Also you don’t need to wash frozen vegetables. So many benefits!

Evening preparation:

  • Get a frying pan. I hope you have one in your house. You do need at least one frying pan for this MIND diet project. If you don’t have one – go to the Dollar Store and get one please. Place the pan on your your counter. 20 seconds
  • Take out frozen kale and frozen onions out of the freezer. 10 seconds20181101_213108           20181101_213148 
  • Place some kale and onions into the frying pan. Add salt, pepper, and olive oil. 30 seconds

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  • Place the pan in the fridge. The vegetables will defrost overnight. 10 seconds

Morning cooking:

  • Take out some eggs from the fridge, take out the pan

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  • Turn on the burner, place frying pan on the burner, leave it on medium-high for about five minutes. And don’t just stand there those five minutes, go brush your teeth, or something!
  • After five minutes crack the eggs onto the pan, mix everything together with a spatula
  • Fry for another three- four minutes
  • Place in a container and take to work, if you work in an office using a computer – you can easily enjoy eating while pretending to work
  • Take a jar of yougurt with you, add frozen blueberries – another item checked off from the MIND list

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  • Don’t forget toast/sourdough bread – because they say whole grains three times a day. Can be gluten-free. Eating toast should be easy, not like eating a bunch of kale. Toast is good!

So there, in one breakfast – kale – green leafy vegetable √ , onion – a vegetable , good enough! √, olive oil √, toast/sourdough – whole grains √

What else did they say… nuts? just add them to yougurt √ add blueberries √ don’t add oily fish to your yougurt… Χ

Wine? Well I think you can have that any time 😉

Sourdough for mood and hyperglycemia

Not all carbs are equal. Several months ago I made a discovery of gluten-free sourdough recipes and now I eat it almost daily. I obtained a sourdough starter, and now that I have one, it can live on forever, as long as it gets fed. It can definitely outlive me! Feeding the starter is very simple and requires only two ingredients – brown rice flour and warm water. After being on a strict AIP diet for almost a year (a lot of food group exclusions, including grains), it was very exciting to once again eat bread, burritos, and blueberry muffins. I no longer follow the strict AIP diet since it did not turn out to be a magical cure for me. I did improve a bit, but that does not mean that every food group exclusion contributed to my improvement. One person (me) trying the AIP diet is not a clinical trial with test and control groups.

I do see strong correlation between my psychotic episodes and consumption of gluten/cow’s dairy/corn/chocolate/nightshades (bell peppers are fine, small amounts of tomatoes are also OK)/ high-glycemic foods. I haven’t found issues with eating gluten-free whole grains and also found no evidence that grains are inflammatory. I don’t consider any blog post evidence. If a blog post refers to a research paper, then I will consider their claim. I do agree that anecdotal evidence is also useful, it was other people’s stories that helped me to obtain the right diagnosis after being misdiagnosed with schizophrenia by my psychiatrist. Only we can’t know from anecdotes what actually helped, if someone did the AIP diet and they got better – was it because they eliminated all the foods the diet suggests to exclude, or they could have improved just as well if they only avoided refined carbohydrates?

The evidence that I found so far indicated that whole grains are actually anti-inflammatory. For example, whole grain intake was found to be inversely related with inflammatory protein concentrations, while refined grain intake was positively related with the inflammatory markers. “In summary, whole grain intake was inversely related to PAI-1 and CRP plasma concentrations, but these relationships were attenuated by the addition of metabolic variables to the model. Refined grain intake was positively independently related to plasma PAI-1 concentrations.

Whole and Refined Grain Intakes Are Related to Inflammatory Protein Concentrations in Human Plasma

I introduced whole grains after a year of strict AIP diet with no problem. I find that consumption of whole grains puts me in a more relaxed state of mind, I actually consume half a cup of rolled oats with green banana flour in the evening for better sleep. Sourdough is great because the baked goods end up with a low glycemic index after the fermentation process. I have a glucometer that I use to determine my blood glucose response to different food products. The standard test is a two-hour glucose test. Two slices of gluten-free bread increased my blood sugar to over 11 mmol/L two hours after consumption, which is a sign of high blood sugar. I did the same test with sourdough bread and sourdough muffins and my blood sugar was back to under 6 mmol/L two hours after consumption, which is a big difference. Short grain brown rice is also a high glycemic index food, while long grain brown rice was found to have lower glycemic index.

Sourdough allows me to eat the foods that I missed out on for so long, at the same time it does not cause a blood glucose spike for me. I have used sourdough to make pizza crust, tortillas, bread, and muffins. Currently I am learning to use fermented batter to cook dosas, an Indian dish. Controlling blood sugar for me means also stabilizing my mood. A glucose spike and then crash turns me lethargic and weepy, it takes away my energy, I definitely want to avoid that. Sourdough allows me to have blueberry muffins for breakfast, goat cheese toast, burritos – all without the consequences of an emotional roller coaster. High glycemic foods may also promote inflammation and given my diagnosis of autoimmune encephalitis, that is something that I definitely want to avoid as well.

Hyperglycemia can cause inflammation through varying mechanisms that result in the production of free radicals and pro-inflammatory cytokines (19, 24). Thus, high glycemic index and glycemic load diets may stimulate inflammation. Glycemic index is the blood glucose-raising potential of the carbohydrates in different foods. A more accurate indicator of the relative glycemic response to dietary carbohydrates, however, is glycemic load. Glycemic load incorporates the relative quality of carbohydrates characterized by the glycemic index. Consumption of high-glycemic index foods results in higher and more rapid increases in blood glucose levels than the consumption of low-glycemic index foods. Rapid increases in blood glucose are potent signals to the β-cells of the pancreas to increase insulin secretion, which can cause a sharp decrease in glucose levels and lead to hypoglycemia (25). In contrast, the consumption of low-glycemic index foods results in lower but more sustained increases in blood glucose and lower insulin demands on pancreatic β-cells (26).

Dietary carbohydrates and inflammation

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Sniffing soil for depression and PMS

I have been sniffing soil and I think it did me some good. And by soil I mean regular soil, it’s not some kind of code name for a street drug. I started sniffing soil and eating unwashed parsley this summer, after I came across an article about antidepressant effects of a bacteria mycobacterium vaccae, which lives in the soil. Since none of the standard antidepressants worked for me, I am very open to new research. Also soil from the backyard or pots seems pretty harmless. I am currently renting in a first floor of a house and my landlord is a very nice lady, she let me plant stuff at the back, where she also grows kale and tomatoes. I purchased stems of parsley and leek and usually I eat them right from the ground, unwashed. I have also placed a fork in my slot in the backyard and each morning I try to remember to stop by and inhale some soil that I pick up using the fork.

About m. vaccae  “In 2004, Mary O’Brien, an oncologist at the Royal Marsden Hospital in London, published a paper with unexpected results: She injected lung cancer patients with a common, harmless soil bacteria, Mycobacterium vaccae, to see if it could prolong their life. M. vaccae had some success in earlier trials where it was tested for its abilities to fight drug-resistant pulmonary tuberculosis and boost immune system response. O’Brien thought maybe the bacteria could help her patients’ immune systems beat back the cancer in their lungs. It failed.

Only, it succeeded elsewhere: the bacteria injection “significantly improved patient quality of life,” O’Brien wrote in the paper detailing the findings. Her patients were happier, expressed more vitality, and better cognitive functioning—in short, it reduced the emotional toll of advanced cancer.”

Dirt has a microbiome, and it may double as an antidepressant

I am a one person sample and I cannot construct a test and control group using just myself, but I can still provide some observation. Friday was a day three days before my period. I did not know it then because I am never aware of when my period will start. I do know from multiple observations that days -3, 1, 2, and 3 in regards to period start are when I have more severe mood swings. So it was day -3 and I started to get more depressed already after lunch. Like a crushing feeling coming on, everything becomes more bleak, it becomes painful to speak. It’s a real sense of dysphoria, as if from opiate withdrawal. I held it in, but started to cry on my way home. At the back of my mind I still had a thought of hope that there were still interventions I could try and hopefully not go into a very dark hole.

I had plans to meet with my friend at a noodle place near my house after work and I was starting to be concerned that I wouldn’t be able to do it. You could say – why not? Wouldn’t it be better in any case if you do see your friend? Yes, yes, it would, but a severe depressive episode is not just being sad, it can be such extreme emotional pain that you are just unable to speak. What’s also interesting, is that the closer you are to such a state, the less likely you are to try an intervention. You have to keep reminding yourself about the time you said to yourself that you will try. You could write it down in your phone, put an alarm clock. I had to say to my brain – I don’t care about your opinion at this moment, I don’t care that you say no treatment will work. So I stopped in the backyard and ate a lot of parsley from the garden bed. I lifted up soil crumbles to my nose and I inhaled.

An hour and a half later I made it to the noodle place and I was able to talk and laugh. Maybe it was m. vaccae, or placebo effect, it could have been also just the natural course of my symptoms that day. Therefore I have no concrete proof, but still wanted to share this observation, especially considering that there is research out there indicating antidepressant effects of soil bacteria. From Friday on, I continued sniffing soil each morning and I can definitely say this period was less emotionally eventful. No running out to the staircase during work to sob. Also it has been the first time in many months that I did not take any naproxen or ibuprofen. I believe this is an indication that there is a reduction in inflammation. As I have written previously,  I am on a specific Mediterranean diet with extra exclusions such as gluten. I have also been consuming goat kefir and kombucha daily, and infected myself with therapeutic helminths six weeks ago. Which one of these treatments has reduced my PMS pain I am not sure, but I sure am glad that one of them or all of them are showing some positive results.

I suggest you consider getting dirty and maybe eat some herbs straight from the ground. Just make sure to read about parasites in your area, we don’t have any serious pathogenic parasites in Ontario soil, therefore I am not concerned about eating unwashed herbs/vegetables here. I hope some m. vaccae will provide you with a better day.