Autoimmune disease and Mental Health Issues
An article appeared yesterday in the Sunday USA Today concerning mental health concerns and inflammation caused by the auto immune system (Weintraub, 2013). The article is interesting of course for type 1 diabetics who suffer from an autoimmune disorder which is the root cause of the disease. The article does not speak directly to diabetes, but it does offer some interesting information about the connection between mental health and autoimmune disorders. Here is one quote that really stood out to me;
"We just didn't understand how much of a role the immune system plays in how we think and feel and act," says Andrew Miller, a professor of psychiatry at Emory University. "An overactive immune system or when there's something going on in the immune system, it can have consequences on the brain." (Weintraub, 2013).
It is fascinating that an overactive immune system (what is the cause of type 1) can have consequences on the brain.
So what are those consequences? The article points out that this may explain a connection between inflammation and multiple sclerosis, Parkinson's and Alzheimer's disease among others (Weintraub, 2013). The most interesting quote for me is as follows:
“People with higher rates of inflammation are more likely to show signs of depression than those with healthy immune function” (Weintraub, 2013).
So this raises a bigger issue which I have been interested in for years and that is the incidence of depression among diabetics. But before we take off on this issue lets explore the issue of inflammation for a bit. Inflammation has been defined as “the body's attempt at self-protection; the aim being to remove harmful stimuli, including damaged cells, irritants, or pathogens - and begin the healing process”(Nordqvist, 2012). Such a wide ranging definition can be said to include both type 1 diabetes, but also Type 2 diabetes. It is true that Type 2 is not an autoimmune disease, but it certainly does cause inflammation especially in uncontrolled diabetes. In fact one statement, albeit about type 1, relates to all diabetes. That statement is “inflammation in various parts of the body are likely if the diabetes is not well controlled” (Nordqvist, 2012). Frankly that seems to make an awful lot of sense to me.
Now what I am going to say, I say with some trepidation. Remember high blood sugar is connected to significant complications of diabetes. I say that because I do not want someone to stop using a drug because of the following quote. You should only change medication only under a doctor’s supervision and I certainly would never say that based on my writings you should change anything. So with that said here goes.
There is some research evidence that the use of Metformin has been associated with impaired cognitive ability. Here is a finding from a large scale study:
“Metformin use was associated with impaired cognitive performance. Vitamin B12 and calcium supplements may alleviate metformin-induced vitamin B12 deficiency and were associated with better cognitive outcomes. Prospective trials are warranted to assess the beneficial effects of vitamin B12and calcium use on cognition in older people with diabetes who are taking metformin” (Moore et al., 2013).
Note these complications may be muted with the use of a B12 agent. However the jury is still out on the wide scale use of any supplement to stem the tide of mental issues. In fact some researchers have noted, but not studied, a wide spectrum of supplements with various outcomes to stem any increase in inflammation. These might include Harpagophytum procumbens, Hyssop Hyssopus, Ginger, Turmeric (Curcuma longa), Fish oil (Omega-3), and Green tea (Nordqvist, 2012).
So are there other studies that seem to point to inflammation and mental impairment? In fact there is a large scale, yet dated, study that examined a large population of diabetics and non-diabetics and issued the following conclusion:
“The odds of depression are higher in individuals with diabetes than in those without diabetes. Depression in individuals with diabetes is associated with increased health care use and expenditures, even after adjusting for differences in age, sex, race/ethnicity, health insurance, and comorbidity” (Egede, Zheng, & Simpson, 2002).
Given all of this and much more, I believe the case is being made that diabetes does affect brain related issues, including depression, and more significant mental health issues. The take away? When we talk about diabetes we should also discuss mental health. I know personally I have suggested this in the past. Yet a growing body of research is supporting a notion of the diabetic / brain connection.
We may or may not like it or even believe it, but it looks like one outcome of high blood sugar and some prescribed drug used might be mental health issues. It is an issue that bears more examination, a lot more.
References
Egede, Leonard E., Zheng, Deyi, & Simpson, Kit. (2002). Comorbid Depression is Associated With Increased Health Care Use and Expenditures in Individuals With Diabetes. Diabetes Care, 25(3), 464-470. doi: 10.2337/diacare.25.3.464
Moore, Eileen M., Mander, Alastair G., Ames, David, Kotowicz, Mark A., Carne, Ross P., Brodaty, Henry, . . . Investigators, the AIBL. (2013). Increased Risk of Cognitive Impairment in Patients With Diabetes Is Associated With Metformin. Diabetes Care, 36(10), 2981-2987. doi: 10.2337/dc13-0229
Nordqvist, Christian. (2012, July 30). What Is Inflammation? What Causes Inflammation?, Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/248423.php
Weintraub, Karen. (2013, December 1). Immune system may play crucial role in mental health, USA today, p. 1. Retrieved from http://www.usatoday.com/story/news/nation/2013/12/01/immune-inflammation-mental-health/3712121/