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Psychiatry and Society
by Keith Russell Ablow, M.D.
July 1996

Fat Chance

When I was a medical student, one of the first patients I helped treat on the inpatient psychiatry unit was a paranoid man who had to be coaxed into the hospital from a nearby hotel. He refused to admit himself until he could be assured continued access to a fat-laden vegetable oil he had been drinking by the glass. He insisted the oil had quieted his auditory hallucinations and that he could not bear to go without it until the medications we might prescribe for him began to work.

His was the first of many cases over the years in which l have observed a link between fat intake and psychiatric symptoms.

Just a few months ago I began treating a woman who came to my office with a typical story. She needed help with low mood, impaired sleep and difficulty concentrating.

"This all began," she said, "about six weeks ago when I started working out and losing weight."

"Perhaps," I ventured, "you were already feeling low and decided to exercise in hopes of feeling better."

"No," she insisted. "The diet and exercise came first."

Could a high level of circulating triglycerides or cholesterol be necessary to prevent or control certain mental disorders? Could lowering fat intake precipitate mental illness? Might we be able to treat psychiatric conditions with a high-fat diet?

It has occurred to me that most psychiatric medications effective in treating mood instability and psychosis--including lithium, many antidepressants and most antipsychotic medications--also tend to cause weight gain. The correlation seems so strong that I sometimes wonder whether sparking an increase in appetite and fat consumption is the mechanism by which these medications work.

Adding to my suspicion is the fact that patients with anorexia and bulimia, who restrict their fat intake, are more vulnerable to disorders of mood. Likewise, illicit drugs that are appetite suppressants, such as cocaine and amphetamines, carry risks of depression and psychosis.

Serotonin reuptake inhibitors, which cause an increase in anxiety and agitation in some patients, tend to reduce appetite as well.

And some seizure disorders that might otherwise be controlled by medicines like Depakote and Tegretol can be controlled by a diet very high in saturated fat. Might bipolar disorder also be controlled by such a diet?

A link between fat consumption and emotional stability would also be supported by a significant result from worldwide research studies on lowering blood cholesterol conducted during the 1980s. When data from the studies were combined, it became clear that using medications to lower patients' cholesterol reduced their risk of death from heart attack, but increased their risk of dying violently.

Might it be that some of those individuals thought to be moved toward violence while on Prozac were those who experienced a significant loss of appetite, with resulting increased intake of fat?

If fat is a natural mood stabilizer, the tendency of psychologically traumatized individuals to become overweight might be explained in biochemical rather than dynamic terms. Perhaps lipid molecules actually buoy mood, with the deposition of body fat being an unfortunate side effect.

It seems to me that our culture intuited this link between mood and fat long ago. The stereotype of fat people as kind and jolly is deeply rooted. Our most gentle cultural heroes--Santa Claus and Humpty Dumpty, to name two--are almost always portrayed as fat.

The Grinch, on the other hand, is thin, just like most real-life, notorious criminals.

If it is true that fat is necessary for some people to maintain psychiatric stability, the extended use of new appetite suppressants may carry with it the risk of an increase in cases of new-onset depression or psychosis. And a new direction in research might be charted: trials of treatment resistant bipolar, psychotic and violent individuals on high fat diets.

Keith Russell Ablow, M.D., born in Marblehead, Massachusetts in 1961, is a psychiatrist, author and journalist. Dr. Ablow graduated from Brown University, the Johns Hopkins School of Medicine and the Tufts/New England Medical Center with a Residency in Psychiatry.