Eating poorly for a day or two isn’t going to have much effect on overall health. It has been estimated that eating well 80% of the time will cover your nutritional needs. Usual habits of eating poorly are a different story. The effect of marginal intake over time has a predictable effect on what happens in the cells and to health. This sequence of gradual depletion of nutrients in the body has been called the Stages of Nutritional Injury. Gradual accumulation of excess (excess calories, vitamins, minerals, etc.) may also result in nutritional injury.

The early stage could be called Predisposition. No nutritional depletion has occurred, but genetic inheritance leaves an individual disposed to perhaps needing more of a nutrient than the average person. The “average” healthy person is used in determining the RDA (Recommended Dietary Allowances). An example of medical problems which have inherited qualities include pernicious anemia, or metabolic and mental changes found in untreated phenylketonuria. Bipolar disorder, depression, eating disorders, alcoholism and schizophrenia have also been reported to have genetic factors.

There is a state of mind, known to religious men, but to no others, in which the … time of tension in our soul is over, and that of happy relaxation, of calm, deep breathing, of an eternal present, with no discordant future to be anxious about, has arrived.

William James, The Varieties of Religious Experience, 1902

James describes exactly a condition that I’ve been enjoying since the middle of January. However, he must be mistaken when he concludes that this state of mind is available only to religious men, because I am by no means religious. Setting that important discrepancy aside, the psychologist’s numerous case studies prove that a profoundly wise and peaceful state of human existence awaits us; our task is to find ways to achieve and retain this higher mode.

The faded childhood scars on my knees hold memories of me learning how to ride a bike minus the training wheels. If I look hard enough, I can still see embedded gravel under the skin. When I used to fall, it never occurred to me to wash off my cuts. I would just hop back on my bike, let the blood run down my leg until the cuts stopped bleeding and keep on going. It wasn’t until after the ride that I actually felt the stinging pain of the cut, when my mom would apply a concoction of hydrogen peroxide, alcohol and the antiseptic mercurochrome.

Whether it was riding my bike, roller skating or skiing, I always felt a comfort in falling down sooner rather than later. The men in my family (my dad and his seven brothers) taught me the art of how to fall down with minimal impact to the body. They taught me that falling down was just a part of the process in learning anything new and it was how one landed that was important. The intensity and quality of the landing could make it easier or more difficult to get back up.

Medications and nutrients often interact with one another. This interaction may involve absorption in the intestines, competition for binding sites in the cells, or inhibition or stimulation of an enzyme or neurotransmitter. If a nutrient changes the level of circulation or activity of a medication, it may change the effectiveness or the dose needed. Be sure to understand the directions from the physician, pharmacist, or dietitian for best results.

One example is lithium. Lithium and sodium compete with each other. Since salt is a major source of sodium, a person’s salt intake can influence the blood level of lithium. (A high intake of sodium causes lower blood level of lithium; a lower intake of sodium causes a higher level of lithium in the blood.) Since lithium levels that are either too high or too low (ineffective or toxic), it important to keep a consistent sodium intake to help keep lithium in the desired range. “Consistent” doesn’t mean an exceptionally low sodium intake, but means a moderate intake over each day. Moderate (or average intake) is often defined as around 1800 to 2300 milligrams of sodium per day. This is a little less than one teaspoon of salt, although sodium is found in many processed foods, not just in the salt shaker.

You Have More Power Than You Can Imagine.

I remember being a big fan of the TV show The Incredible Hulk when I was a kid, and the The Hulk, Spider-Man, Fantastic Four, and the X-Men series as movies when they came out. I always thought they portrayed mental illness in a quirky way, but I never realized the significance they had for me until recently. It was in watching the latest episode in the X-men series, X-Men: The Last Stand, that it all came together for me: We are the X-Men.

Stan Lee and the creators of all of those characters have shown uncanny insight into the nature of our condition and our struggles. All of their characters have special powers. They also have weird quirks and idiosyncrasies. Most of all, they struggle with their powers and their inability to handle them.

Fortunately, generalized nutrition advice such as “don’t eat fat” is being replaced by “eat the good fats.” For years, Americans have focused on eating polyunsaturated fats, which ended up being mostly Omega-6 fats. The proportion of Omega-3 (O-3) to Omega-6 (O-6) became out of balance, with O-3 fatty acids becoming in short supply in many people’s diets. Scientific studies often show that this lack of balance between O-3 and O-6 fats occurs in individuals with mental illness. Research regarding schizophrenia has shown many interesting, but inconclusive, results. Alteration in metabolism as well as dietary and supplement intake are being studied. Both O-3 and O-6 fatty acids are Essential Fatty Acids (EFA).

It isn’t that O-6 fats are “bad,” it is just that they are out of balance. The head of The National Institute of Mental Health, Joseph Hibbeln, MD, and colleagues, estimate that a healthy dietary allowance for O-3 fatty acids for current U.S. diets was estimated at 3.5 g/d for a 2000-kcal diet. This allowance for O-3 fatty acids can likely be reduced to one-tenth of that amount by consuming fewer O-6 fats. A healthy ratio of O-3:O-6 is said to be 1:2 or 1:1-this is the estimated ratio in the human diet in Paleolithic times. When reading labels, remember O-3 fatty acids include ALA, EPA, and DHA. O-6 fatty acids include GLA and AA.

What would you notice if you didn’t eat enough essential fatty acids? You may notice dry hair and skin, brittle nails, eczema, and asthma among other things, as well as abnormal lab findings, especially in red cells.

Like many others, I’ve suffered through years of severe depression. Fortunately, in recent months the quality of my life has greatly improved. In part this is because depression doesn’t distress me as much as it used to. One of the key points made by Tom Wootton of Bipolar Advantage (the host of this blog) is that depression carries a bit of beauty and majesty. It adds texture to life. Once I abandoned my relentless struggle against the darkness, the low moods became more tolerable. Coincidentally, once I quit despising my dark periods, they lessened in severity. (By the way, Acceptance and Commitment Therapy has also helped me appreciate rather than hate depression.)

But many other factors have been involved, and I have begun to address some of them here. So far I’ve touched on the benefits of humility, ego-suppression, and mental discipline. Another useful item in my tool chest has been a deepening understanding of what it means to be a human being. The many layers to this clarity include growing respect for my biological nature; it helped remove a major obstruction in my path toward mental wellness.

To get to a point where lasting growth could take hold, I had to overcome very low self-esteem. Having suffered severe trauma during my upbringing, my opinion of myself has long been rather abysmal. It’s been hard to believe that I deserve love, or success, or happiness. Recently, a therapist helped me appreciate an aspect of my being that I had long overlooked. In the course of a visit during which I felt quite down, he instructed me to hold out my hand. “Can you love your hand?” he asked.

James Turrell is one of the most remarkable artists alive. He has an amazing understanding of light and perception. By using darkness and almost imperceptible light, his artwork totally changes the way we see the world. I think his work with light and darkness is a perfect metaphor for trying to see depression in a new light.

When you enter one of Jim’s installations, it is so dark that you cannot see anything, or at least not much. The amount of available light is simply too little for our eyes to use. His artwork is not a picture on the wall; it is the entire environment, in which both the perception of the audience and time act as critical components.

If you stay long enough, your eyes begin to adjust to the lack of light. You start to see things that were there all along, but your eyes were not yet ready to perceive.

When you go back out into the “real” world, you bring an entirely new perspective; you begin to see everything in a whole new light (pun intended). Jim’s work can truly be described as a discovery of the act of seeing.

My own art is similar to Jim’s in many ways. Like Jim, instead of using a brush to paint a picture, I choose to build an environment that blocks out light and helps me to perceive. Unlike Jim, my art is not in the physical world; it is in my interior world.

People may say “I feel low in energy,” or “I feel energetic today,” but may mean different things by that. Depression may be experienced as “not having any energy.” The manic phase of bipolar disorder may be described as “having very high energy.”

“Energy” is defined in science as the ability to do work. For example, “Person A is able to lift 50 ft./lbs. over a one-minute period.”

In the field of nutrition “energy” refers to calories or kilocalories. For example, “Fat provides 9 calories/gram, while carbohydrate provides 4 calories/gram.” A person burns energy/calories as a part of sustaining life, maintaining body temperature, and during activities.

These two definitions do not seem to totally describe mental or emotional energy as experienced by individuals.

The Mediterranean Diet May Reduce Depression.

In one study, researchers analyzed the effect of the Mediterranean Diet Plan (MDP) on depression in 10,094 healthy Spanish individuals during a mean follow-up of 4.4 years (Arch Gen Psychiatry 66:1090). After adjustment for confounders, MDP adherence (especially for fruits and nuts, fatty-acid ratio, and legumes) was associated negatively with new incidence of depression and positively with improved glucose metabolism. Similarly, researchers prospectively assessed the relation between self-reported depression and dietary pattern (either “whole food” [highlighting vegetables, fruit s, and fish] or “processed food” [emphasizing sweetened desserts, fried food, processed meat, refined grains, and high-fat dairy products]).

Of 3468 London-based office workers, those with high whole-food intake were less likely, and those with high processed-food intake were more likely, to report depression (Br J Psychiatry 95:408). This finding held even after adjustment for multiple variables, including exercise; a secondary analysis showed that diet affected depression and not the reverse.

This diet is also associated with significant improvements in cardiac risk factors. It also reduces the risk of elevated blood glucose, which is more common in people with depression, and may worsen depression.