September 6, 2011

The Triage Theory

There are many theories of developmental psychopathology and much has been written on the meaning of mental illness, spanning religion, science, philosophy, economics- essentially almost all disciplines have looked into this.  Where there is any type of philosophy, there is also psychology; the same goes for great literature.  For a particularly thorough- and disturbing- history of psychiatry and mental illness, one should delve into Madness and Civilization by Michel Foucault, or his Birth of the Clinic, which traces a more general development of hospital systems and health-care.

But rather than lose myself in the debate on the question of “Is there mental illness?”- I want to talk about a triage theory of aging and illness that might be particularly apropos in our graying society, as indeed, aging, mental decline, and mental illness are in fact all related. Certainly in the case of dementia, they are practically inseparable. Given enough time, we will all lose are minds.

The triage theory is proposed by Dr. Bruce Ames, a biochemist/nutritionist researching in the Oakland area.  A good overview of his theory is presented in the article, “Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage” (PNAS, Nov 21, 2006, vol 103, no 47, p 17589-17594).

In this paper, Dr Ames proposes a theory attributing DNA damage and late disease onset, like cancer, to an evolutionary triage allocation mechanism, whereby essential nutrient resources are allocated for short-term survival at the expense of long-term health as a means to cope with episodic shortages.   DNA damage from nutrient deficiencies thus leads to altered gene expression and subsequent disease emergence. Dr. Ames isn’t referring to states of extreme deprivation or starvation, just shortages; and unfortunately, as he points out, we are almost all malnourished in these subtle ways.

The link between nutrient deficiencies and illness is not groundbreaking, but the method whereby the body controls this is; the fact that these slight variations in resources can lead to DNA damage and altered gene expression is profound.

In the case of mental illness, the stress-diathesis model of psychopathology postulates that one inherits certain genetic risk factors for an illness, like bipolar disorder, and that subsequent environmental stressors lead to the genetic expression of the disorder.   Stress is obviously a very general term, but certainly could include malnutrition. We are, after all, biochemical machines that run on micro- and macronutrients. Your bioindividuality is how you use your nutrients, from absorption through allocation, at least in part.   In some cases, like beriberi (thiamin or vitamin B1 deficiency)- the connection between the deficiency and the subsequent psychosis are obvious.  It might just be that other illnesses, like bipolar, could be the result of similar deficient state.  It would be unlikely that it is a single deficient vitamin or mineral, but could be multiple deficiencies in concert leading towards altered gene expression..

To further complicate things, micronutirent intake recommendations tend to be based on a model of disease, not health.  Below this line, you will get ill.  Unfortunately, we don’t know the optimum intake level for maximum health yet, but it might just be much higher than current RDAs.  Furthermore, requirements might vary in particular populations, like pregnant women requiring more iron and folic acid.  Having any illness would likely also increase nutritional needs.   Those predisposed to mental illness might just need to increase particular vitamins to compensate for their inheritance; those suffering from it might just benefit from nutritional interventions.

At any rate, the theory hinges on ones ability to get proper nourishment from our environment.  And unfortunately, we as a society are malnourished. Ironic really- as we are becoming more obese, we are also becoming more malnourished- the two are practically inseparable.  According to the CDC, 1/3 of U.S adults and 17% of children aged 2-19years are obese.  We fill up on empty calories from processed foods at the cost of the 40 or so essentially vitamins, minerals, and fatty acids.   Evidence in the nutritional literature also points to soil depletion causing nutrient deficiencies in our food.  So even if one strives to meet their daily needs, the fruits and vegetables themselves might not have enough of the calcium, iron, or zinc that we evolved to require.

My hunch is that with a lot of mental illness, not all of it mind you, changes in diet and nutrition might just be the missing link.

As Dr. Ames’s main passion focuses on disease prevention, he advocates that everyone should be taking a daily multivitamin as insurance for better health down the road.

Wouldn’t it be fantastic if we could prevent mental illness with a simple preventative strategy like a vitamin?