What is Brain Energy?
I want to introduce you to the concept of brain energy and how it plays a very important role in your mental health. By the end of this blog I hope you will understand why there is a lot of excitement and hope surrounding the new field of ‘metabolic mental health’ otherwise also known as ‘metabolic psychiatry’ based on the science of brain energy. Severe and enduring mental health conditions such as depression, bipolar disorder, and schizophrenia are being redefined as energy dysregulation disorders and new therapeutic treatments incorporating powerful lifestyle medicine are being tested with very positive signs.
Let’s consider why metabolic and mental health are connected. You might be familiar with chronic diseases like Type2 Diabetes and Obesity being considered metabolic problems. Simply put one of the basic aspects of metabolic health is how our cells make energy in the brain and the body. Energy is made in our mitochondria, tiny little organelles in our cells, traditionally referred to as the ‘powerhouses’. In relation to brain health, the focus is on the energy produced in the neurons, which are nerve cells that send messages all over your body to allow you to do everything from breathing to talking, eating, walking, and thinking. When metabolic health goes wrong your mitochondria are implicated and when they dysfunction in the brain it can lead to mood disorders, cognitive issues and eventually mental health conditions like depression, anxiety, and bipolar disorder.
Mitochondria: The Master Controllers
You don’t even notice that they exist, but your mitochondria are crucial to your health. They are not just a powerhouse but a ‘command and control centre’ orchestrating a complex cascade of chemical signals and just like a conductor enables an orchestra to play a magnificent concerto, your mitochondria allow life to flourish at the cellular level and support health. Mitochondria generate energy but they also have other roles including regulating oxidative stress which in turn influences inflammation. They also have a role in modulating the production of our steroid hormones and our neurotransmitters too. In addition to this mitochondria are also stress sensors listening our for and communicating with the brain and nervous system in relation to both physiological and psychological stressors.
By physiological stressors I mean physical or environmental impacts like heat and cold, high or low blood glucose, environmental toxins, hormone levels, drug or alcohol misuse, too much or too little body fat, too much or too little physical activity, surgery, illness, too much blue light in the evening or too little natural light during the day or nutrient deficiencies. Psychological stressors can include mental and emotional problems like fear, anxiety, isolation, anger, sadness, grief, overwork, financial problems, relationship problems, having your values compromised, being short on time, having uncertainty to cope with, being frustrated or having no control over your life. Your mitochondria listen out for your body’s response to these stressors, and they actively communicate with your brain and change your metabolism to adapt to your current life situation.
So we have two key concepts so far, the first that metabolic health is regulated by our mitochondria which makes your energy, and second, that the mitochondria regulate our response to all types of stressors. Let’s take a look next at what can go wrong with this process leading to mitochondrial dysfunction and in turn to mental health problems.
Metabolic Health and Mental Illness
Poor mitochondrial function is implicated in many metabolic diseases, such as Type2 Diabetes and Obesity as mentioned above, but also many others including Parkinson’s Disease, Multiple Sclerosis, Alzheimer’s Disease and Cardiovascular Disease. We also know from recent research that there is a massive overlap of these conditions with mental health conditions. We know that people with Bipolar Disorder are 1.6 times more likely to develop T2D and twice as likely to develop obesity than the general population. People with schizophrenia are 50% more likely to develop obesity and 24% more likely to have T2D. But the reverse is true too that, people with T2D are 50-100% more likely to have depression, are at substantially increased risk of anxiety and are twice as likely to have schizophrenia. Researchers have found several factors that might explain why we should perhaps consider mental health conditions to be metabolic disorders too. The first and perhaps most important is insulin resistance but there are others including oxidative stress and inflammation.
Insulin is a hormone that signals to the cells to take up glucose from the blood stream. Insulin resistance occurs when the message insulin is conveying is no longer being heard. More and more insulin is needed to get the message through and for the cells to respond. Your body can produce higher and higher levels of insulin for quite a long time before it starts to struggle to keep up with the demand. It is only when this happens that blood glucose levels start to rise which is the tell-tale sign of pre-diabetes or diabetes. But insulin can be high, a state known as hyperinsulinemia, for up to 20 years before blood glucose starts to rise. This state of hyperinsulinemia is a state of insulin resistance. Eventually the insulin is just not sufficient to keep blood glucose in check and it rises and eventually you become diabetic.
There are other classic signs of insulin resistance aside from insulin and a fasted plasma glucose ≥110 mg/dL (6.1 mmol/L) . This includes high blood pressure over 130/85, abdominal obesity with a waist circumference men ≥102 cm and women ≥88 cm, blood triglyceride levels >150 mg/dL (1·7 mmol/L) and blood HDL or high-density lipoprotein levels <40 mg/dL (1·03 mmol/L) in men and <50 mg/dL (1·29 mmol/L) in women. These are all things your doctor may check for you in relation to metabolic health. Any one of these are signs of metabolic syndrome and suggests that you may have insulin resistance. Studies from the US suggest that 70% of people have poor metabolic health and the UK is not far behind this. In fact metabolic syndrome used to be called the Insulin Resistance Syndrome.
Check out this YouTube video if you would like to know more about this. https://youtu.be/kYxPWZpE0b0?si=WuQQEqu4RrAL3z8E
I think we have now established that having poor metabolic health puts you at risk of poor mental health, mental health problems are metabolic health problems. In fact, all chronic diseases are metabolic health problems but they result in different symptoms in different people. Whereas one person might end up with diabetes another might end up with depression or dipolar disorder. The good news is that because there is a common root cause improving metabolic health can improve all these conditions.
How Do We Make Our Energy?
I am fascinated by the process of energy production, my family call me the Mitochondria Queen because I just love to learn as much as I possibly can about them, I find them fascinating and I hope you will too! Mitochondria as tiny little organelles in your cells and they are responsible for producing most of your energy. Cells that require a lot of energy like neurons in the brain, heart muscle or liver cells and neurons have a lot of mitochondria in fact neurons (nerve cells in the brain) have been found to contain over 2 million mitochondria in just one cell!
Your mitochondria take the nutrients from the food you eat and the oxygen you breathe in and convert them into a chemical form of energy known as ATP or adenosine triphosphate. Although mitochondria are often depicted as sausage shapes their structural form is very varied and they are also in a constant state of change, dividing and reorganising all the time in response to various signals. Each mitochondrion has an outer and inner membrane and it produces energy through what is known as the electron transport chain which is a series of proteins (collectively known as a super complex) embedded in the inner membrane. The mitochondria strip electrons off hydrogen molecules, leaving positively charged particles known as protons. The protons are pumped into the gap between the inner and outer membranes and as more flow into this space it builds up an electrical gradient. The inner membrane acts like a dam holding back the electron pool and stops it from spilling back through. At the same time the electrons are passed down the protein chain in a series of redox reactions (reduction and oxidation). There is one final protein complex known as the ATP synthase which allows the protons to flow back into the central space of the mitochondria. It is like a little tap and as the electrons flow through it turns and generates ATP which fuels our bodies and brains.
If you think this sounds amazing, then consider the mind-boggling complexity of it a little more. In a neuron in your brain you can have 2 million mitochondria. Each mitochondrion can have thousands of super complexes embedded in its inner membrane. You might be getting an idea that the amount of ATP and therefore energy produced is quite big. Would it surprise you to know that in 24 hours you produce your own body weight in ATP? You aren’t aware of it and you mostly use it up as fast as it is produced.
Even more fantastical is the fact that the flow of electrons across the membrane which is only a 5-nanometer gap generates a powerful force known as the mitochondrial membrane potential of ∼16,000,000 volts/m, an order of magnitude larger than a bolt of lightning. It is like having a huge battery in every cell that could
power your phone, flashlight, laptop, car or anything that works with electricity!
There is one last thing about energy that I want to touch on, it’s important to understand that food we consume has to contain the building blocks for energy. In fact, all energy comes from the sun! The sun beams energy down to earth as photons in a form of electromagnetic radiation which is absorbed by chloroplasts in plants (you might recall this from high school biology lessons). The chloroplasts condense atmospheric carbon dioxide and break it down into starch and in doing so release oxygen back into the air. The energy from the photons is trapped in the plant, when an animal eats that plant it reunites the carbon in the starch molecules and the oxygen it breaths in inside the mitochondria which gives flow to further energy transformations powering our brains and bodies. Nature never ceases to amaze me!
When Mitochondria Start To Struggle
You might be wondering how all of this links to brain health or mental health problems. Well, when the mitochondria get the message that all is not well from those physiological and psychological stressors they can change their energy production, turn it down and move into more of a defence mode. It is sometimes easiest to think about this in relation to catching a virus, you simply feel exhausted and need to lie down and sleep more than usual. The fatigue is caused by the mitochondria sensing your body needs to rest and turning down energy production. In the case of a viral infection this is a good thing as it gives you a change to recuperate and allow your body to fight the infection.
However, if the situation continues and the mitochondria get stuck in this low energy mode, a more dormant or defensive stance it is known as mitochondrial dysfunction. Most of the time we can cope with a couple of these stressors without any negative symptoms, but in the modern world we often have to deal with many of them often all happening at once, particularly including things like stress, a poor diet, or our body clock being out of alignment. If we don’t take action to improve the situation it can lead to a range of metabolic health problems which all link back to mitochondrial dysfunction. In relation to brain health we have lots of recent research suggesting that this includes mental health conditions like depression, anxiety, bipolar and schizophrenia.
How Inflammation Is Implicated
When your mitochondria start to struggle it can lead not only to impaired energy production but also to increased oxidative stress and inflammation which can contribute to negative affects on your mental wellbeing. While your mitochondria are busy making energy in the form of ATP the process itself also generates highly reactive molecules as a by-product, also known as free radicals or reactive oxygen species. Oxidative stress is a state in which there is an imbalance between the free radicals and the body’s ability to neutralise them with antioxidants. Free radicals are highly reactive which basically means that they can damage cells including the proteins, lipids, and the DNA in them.
We do need a certain amount of free radicals because they play important roles as signalling molecules, helping cells communicate and regulating various physiological processes, including cell growth, the response of our immune system, and apoptosis (or programmed cell death to allow for renewal). Indeed, low levels of these free radicals can actually help us adapt to stress, fight off infections and repair damage. We also acquire free radicals from external environmental sources such as pollution, UV radiation and toxins. UV radiation is perhaps the easiest example because you clearly know when you spent too much time in the sun and the highly reactive free radicals damaged your skin causing sun burn.
Your body has a good defence system against free radicals, antioxidants, both from your diet like vitamin C, vitamin E and vitamin A, but also and most importantly very powerful antioxidants that we make ourselves such as glutathione, superoxide dismutase, catalase, melatonin and alpha-lipoic acid. These act to neutralize the free radicals, preventing them from causing cellular damage.
The problem occurs when the free radical production overwhelms the antioxidant defences in part due to factors like stress, poor diet, or high energy demands and then oxidative stress occurs. When cells are damaged by oxidative stress it results in an inflammatory response to try and clear up the damage. Just like when you cut yourself your skin may get red and swell, a similar process goes on at the site of any cellular damage and this includes the brain.
Unfortunately, when the mitochondria are not working optimally there start to be problems in the energy production process that result in excessive free radical production and this coupled with external sources increases free radical production to extent that there is imbalance which if left to continue will result in chronic inflammation.
Mitochondria & Neurons
The scientific literature can tell us that the activity of our neurons regulates mitochondria and vice versa. The neurons in your brain depend on oxidative metabolism (making energy with oxygen) in the mitochondria to meet their high-energy needs. Every time a neuron fires in your brain it requires a large amount of ATP hence why neurons need a lot of mitochondria. The mitochondria are also involved in regulating calcium, which is essential for neurotransmitter release and signalling at the synapse, the place where neurons connect and communicate with each other. When a neuron fires, calcium ions flood into the neuron and are partially taken up by nearby mitochondria, helping to regulate calcium levels and protect against excitotoxicity.
The neurons transport mitochondria along their axons (the long bit of the neuron) and dendrites (the tree like structure that connects to other neurons) to areas of high energy demand. Firing the neuron increases the need for mitochondria to be positioned at the synapses, and the mitochondria are transported about to ensure adequate ATP and calcium buffering right where neurotransmission is occurring. Therefore, mitochondria are constantly moving and being redistributed as needed.
If mitochondria become dysfunctional there is less ATP available to fuel the energy-intensive processes like maintaining calcium balance, sending signals at the synapses and transporting mitochondria to the right place in the cell. This can impair lead to a lack of communication between neurons, damage to the cells, and ultimately contribute to neuronal death. An increased production of free radicals by dysfunctional mitochondria contributes to further cell damage and inflammation. Elevated calcium levels in the cell fluid can trigger excitotoxicity, which in turn leads to the activation of harmful enzymes, ultimately causing cell death.
As these processes continue over time, we start to see the results with neurological or mental health symptoms becoming noticeable.
This is the end of Part One of this blog, please continue to read more in Part Two where I look at the link with the biopsychosocial model of mental health and solutions that fit with the concept of metabolic psychiatry and how we can bring all of this together with practical suggestions for lifestyle change.
There are some more suggested reading links below.
FREE - Brain Energy E-book
I have a new e-book that explains the key concepts that are important for you to grasp if you want to optimise your brain energy. It explains how brain energy works, what can go wrong with it and how you can improve it.
You get 26-pages packed full of information which simplify the science of metabolic health and how it is linked to mental health.
If you would like to book a call with me to discuss how best to start using nutrition to help you improve, and perhaps even reverse, your symptoms then please use the link below to book a free 30 minute chat. I can help you work out the best place to begin based on your own individual circumstances.
Book A Call To Start Your Health Journey With Me
References are provided at the end of Part Two of this blog.
If you would like to know more about some of the studies looking at metabolic mental health and trials of ketogenic diets, please read this blog: https://www.moiranewiss.co.uk/post/metabolic-mental-health-the-link-between-brain-energy-ketogenic-diets
If you would like to understand more about insulin resistance, please read this blog: https://www.moiranewiss.co.uk/post/unpacking-insulin-resistance-fatigue-sugar-crashes-to-chronic-diseases
If you would like to know more about ketones then read this blog. https://www.moiranewiss.co.uk/post/how-to-get-30-more-energy-understanding-how-ketones-work
To understand more about how mitochondria make your energy then this is the one to read. https://www.moiranewiss.co.uk/post/fatigue-the-miracle-of-making-energy
Disclaimer: Before changing your diet or lifestyle and taking any supplements always seek the advice of your doctor or another suitably qualified professional such as a nutritional therapist. The content of this blog is for informational purposes only and is not a substitute for professional medical advice. Always seek the advice of your doctor with regards to any questions you have about a medical condition.
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