Interview with Annett Oehlschläger, author of the book “You can eat stability?!“

After listening to a talk given by Miss Oehlschläger at a conference on bipolar disorder in 2019, and learning how she, as an affected person herself, manages her disorder, I decided to conduct this interview with her to stress the importance of a solid knowledge about one’s disorder, but also about body processes and nutrition. This interview had been conducted in German and translated to English.

Miss Oehlschläger, after living with the diagnosis of a bipolar disorder for many years, you wrote a book named “Stabilität kann man essen?!“ (“You can eat stability?!“) What made you write this book?

Simply speaking: There hasn’t been a book yet which investigated what effect nutrition, exercise, biological rhythm, sleep, and light have on mood and energy fluctuations. During my literature research I was surprised at first that there were so many connections, and I grew angry because I had never heard about this during my psychiatric treatment. It was my wish that other affected people learn about these connections. This was the reason to write this book.

Who is the book written for and what could be reasons to read it?

So first and foremost, it is written for those who are affected by a bipolar disorder, that’s why it is called “Steps for Self-Management”. But it could also be worth reading for people who don’t get along with psychotropic drugs and for people with other psychiatric disorders than those of the bipolar spectrum.

What does “bipolar pilot” exactly mean?

When I created my website, I was looking for a catchy term and while doing this I actually found the term “pilot.” Even though it has nothing to do with the disorder at all at first sight, it is very suitable. A pilot is someone who is helping a non-local to find the right way and that is how I understand my offer. Everybody has to take the journey on his or her own, I can only accompany a part of it. I make an offer and show how to live self-determined and as autonomously as possible with the disorder. With me as an example, I show how to become an expert of my own disorder. I am there for upcoming questions and I offer my experience and my advice.

Would you say that the book is also worth reading for people without a bipolar disorder or for relatives of people with a bipolar disorder or for people with another mental or psychiatric disorder?

Yes, I’d say so. I have been told several times that my explanations are focused on bipolar disorder, but that many connections are shown that basically affect everyone. Everybody has to eat and everybody wants to stay healthy. The things I’m describing don´t only have to do with the bipolar disorder, but also with how to keep the body healthy, and how close body and mind are connected.

In your experience, how do nutrition and psyche relate to each other?

It has always bothered me that the psyche and the body were perceived as something independent and separate from each other. All materials that our body needs, except oxygen, come into our body via food and drinks, and then the body builds it‘s substances from it and produces the necessary energy. Conversely, what I do not ingest and what the body cannot produce itself, or what it cannot process, cannot be built into the cells. My conviction is that the way people eat plays an important role in all chronic diseases, including bipolar disorder. For people with mental disorders the following relation is important: Emotions and thoughts don’t just materialize out of nowhere. They are built in the brain using amino acids and are controlled by messenger substances. This is quite a complex procedure, but it just doesn’t work right without the necessary raw material. Everybody might have already experienced the feeling of well-being after having eaten something sweet, like chocolate. Here, the connection is obvious. To rephrase a saying by Feuerbach: You are not only what you eat, you also feel according to what you have eaten.

Why is the realization that psyche and nutrition are so strongly connected not widespread and an integral part of every therapy or medical consultation?

I often asked myself the same question while I was reading the books. I asked two doctors who helped me with the diet change. One of them is an internist and environmental physician from Rostock, Germany, and he told me that medical students do not learn this. The focus is rather on the treatment of symptoms, mainly using medication. And I have experienced nothing different in psychiatry, symptoms are treated with medication. The vast potential of biochemistry and orthomolecular medicine remains unused. I find this quite regrettable. Additionally, there are guidelines that are set up by professional societies, and each doctor has to treat according to these guidelines. And then, there is also the healthcare system which is growing more and more specialized. This brings certain advantages, no doubt. But especially when it comes to the psyche, in my opinion, you need a holistic approach to sustainably help an affected person.

In your experience, what do exercise and sleep have to do with the psyche in addition to diet?

This has something to do with a human beings’ system, which has evolved over thousands of years. We are adapted to our environment and living conditions that have evolved only very slowly over the thousands of years. The so-called modern progress over the last 200 years brought so many fundamental changes in our living conditions we are not adapted to – yet. Sensitive people react with disturbances in their system. Bipolar disorder is one of them. A basic element of our living condition was regular exercise. The human being is made for walking and not for sitting. The saying “sitting is the new smoking” states that a lack of exercise is similarly unhealthy as smoking is. When we walk, we release endorphins. These are happiness hormones and pain killers, which made it possible for mankind to run long distances. If you move, you brighten up. I find this a very easy way to lift your mood, you just have to get up and do it.

Further, chronobiology has found out that it is important for our well-being to stick to biological rhythms. If you act against these rhythms you risk affecting your health, i.e., sleeping disorders. This is a common symptom of bipolar disorder and other mental conditions. The sleep-wake-cycle is an important pacemaker, such as sunlight. It is not irrelevant when you eat or sleep when you work or regenerate. Regularity stabilizes. Mental stability can be achieved by living according to these rhythms. I do live according to these principles.

And if we are going to be more practically now, what would you say, which food should one eat?

Of course, all of the food I need for a good mood. These foods have to provide all the 47 substances that each body necessarily needs in order to stay healthy: 10 amino acids, omega-3 and omega-6 fatty acids, 13 vitamins and 22 minerals and trace elements.

However, we don’t eat single substances but complex food. So by selecting my food, this is what I do: If I am aware that drive and mood are dependent on amino acids, then the logical conclusion is that I eat food that contains these. Proteins are built from amino acids. Enhancing your protein intake doesn’t necessarily mean eating more meat. Fish, eggs, and legumes contain protein as well.

Further, many processes in my body require enzymes, co-enzymes and co-factors: This is where vitamins, minerals and trace elements come into play. They are needed so that the substances eaten can be absorbed by the body, and also by the brain. If I know that, then I am aware that I have to eat food that provides these substances – these are mainly vegetables, nuts, seeds, and fruit.

Going shopping at the supermarket, I often get the impression that these foods only account for a small proportion of the vast offer. More dominant are sugar-sweetened beverages, alcohol, packed and conserved foods, bread, bakery products, and candy. We are constantly exposed to these temptations. If you want to eat according to what your brain needs, you can stick to these easy advices:

Don’t consume sweetened beverages, which also include fruit juice and smoothies, because they contain large amounts of sugars. These simple sugars are mood killers.

Don’t buy processed food. You will recognize processed food mainly because it is packaged and contains a lot of food additives. If there are many different ingredients on the list, chances are quite high that there are additives in it that nobody really needs. Their true serving is to make the product either more tasty – using salt, sugar, flavor enhancers, emulsifiers, and the like, or to enhance shelf life by preservative agents or antioxidants, or to make the product more appealing by adding colorants.

The issue with these unnecessary additives is that they harm the gut – in some people more, in some people less. This can lead to a reduced ability to absorb the substances needed, on the one hand, and on the other hand it can happen that the gut gets leaky and unwanted substances can enter the body. This can also lead to sickness. Both affects drive and mood.

Simply speaking, for a good mood and drive I need foods that are as natural as possible, regionally produced, seasonally, and preferably organic. A large part of my nutrition comes from these foods. If I stick to these principles, I take care of a good basis for mental stability.

And what about fat?

Fat is an essential substance, too. We could not survive without fat. If you consider that 60% of our brain’s dry matter is composed of fat, that each cell in our body is coated by a double lipid layer, then one can hardly comprehend this fat phobia which has been going on for many years.

However, there is fat that is beneficial for mood and drive, and there is fat that is unfavorable for the psyche. For thinking, we need a properly functioning of signal conduction in the brain. Our feelings are influenced by our thoughts and the other way round, both are a product of our brain. Both affect our behavior – all of which are very complex processes of the brain.

The cells build those fats into their cell walls that the person ingests. For the membranes to be fluid enough they need a certain composition of fatty acids. Here, the synergy between vitamin D and the omega-3 fatty acids EPA and DHA play a crucial role. Vitamin D is needed when neurotransmitters are built, and EPA makes sure that the cell membrane is fluid enough so that the neurotransmitter can be spilled into the synaptic cleft. DHA takes care that the receptor at the post synapse can pick up the signal to be transmitted. This is why I take specific care to take up at least 2 grams of fish oil every day.

Would you say that nutrition ultimately plays a greater role than psychotropic drugs in improving the disease?

From my point of view, in an acute crisis, psychotropic drugs are a blessing. I am convinced that I would not be alive anymore today if I hadn’t received medication.

But what’s bugging me is constant medication. I, too, have been told that I have to take psychotropic medication all my life. I have a different point of view today. To stay stable permanently, I only need medication as long until my body is strong enough to stabilize my psyche.

This is a long-lasting, exhausting, and also pricy process. Not everybody manages that. This is why it might be that somebody still needs to take psychotropic medication.

A diet that provides all the substances my body needs adds considerately to strengthen the overall health and also the immune system. That way, one improves one’s overall quality of life, not only the mental stability. In this sense, nutrition plays a bigger role.

Can an improvement of the disorder solely occur through nutrition?

Bipolar disorder is a serious mental disorder with many causes. Stress plays a pivotal role, my reaction towards it just as well, just as my core beliefs. A sole change in diet can’t change anything about that, it takes psychotherapy and psychoeducation. However, I can influence my vulnerability towards stressors through my diet. For example, a certain level of magnesium is important for being able to relax and to stand above things. Magnesium is also called “salt of inner peace”, and for a reason.

Further, the effect of my diet on my mood is influenced by the origin of my food, and what it contains or doesn’t contain anymore. Take selenium for example. This is very important for the thyroid gland and, by the way, enhances your mood. Through the last ice age, it has been washed out of the ground here in Germany. So if I eat local products, they contain less selenium than food from the US, for example.

If I measure my blood composition and see that I lack a certain substance that I can’t properly ingest via my food, I go for food supplements. I don’t manage to get all the nutrients I need through the food I eat.

But an improvement of the mental disorder depends on many more factors. Nutrition is the most important part, in my opinion, because only through nutrition I get the raw material for the production of neurotransmitters. No drug can achieve that.

To clarify which components are important for a good mood and drive, I like to use the metaphor of a jigsaw puzzle, just as in my book. Only when all the pieces are in place, I get a coherent image – that of mental stability. Which pieces I need are quite specific. But it’s worth it to find that out. My puzzle pieces were psychotropic drugs, psychotherapy and psychoeducation at first. Today I don’t need these components anymore. But other factors play a role now: nutrition, exercise, sleep, stress management, self-care, and a meaningful occupation. And also, regular measurements of blood levels to identify imbalances or low levels of substances at an early stage and being able to react promptly. These are my puzzle pieces for stability, so it’s not nutrition alone.

You have already mentioned the keyword “dietary supplements.” Which dietary supplements should one take, or should you take any at all?

Sometimes I get the impression that when it comes to the topic of food supplements, it is often about opinions and factoids rather than scientific facts. Often it is stated that supplements are unnecessary if you eat healthily because then you get everything you need. Or that supplements have a beneficial effect only for the producers. I have believed such statements for a long time before I started having my blood levels measured. My level of vitamin D had been so low I basically didn’t have any of it in my blood. The level of magnesium had been below the reference value, B vitamins had been at the lower level, not to talk about zinc and selenium, and the overall level of protein had been way too low. And at that stage I had been eating healthily, or I had assumed that my nutrition is healthy and contains everything I need. So there had to be something wrong here, or what was the reason for these results?

Today I know that certain essential substances are not available in our food in adequate amounts – or not anymore. Take selenium for example. It is even more dramatically regarding vitamin D. This can be built by the skin, so technically it is not really a vitamin. Experts, such as Prof. Holick from the US, call it a prohormone, because it is associated with more than a thousand of metabolic processes, and more than 2000 of our 23000 genes depend on vitamin D directly or indirectly. Because of the degree of latitude we live in regarding Germany, between October and April the sun is so low we can’t build vitamin D at all. The angle of the sunbeams is below 45 degrees, and so the UVB part of the sunlight doesn’t reach our skin. However, vitamin D reservoirs are depleted after 4 months, so even after I have built up enough vitamin D during the summer it won’t help me get through the winter. Vitamin D is very important for the mood. Once you experience what a difference it makes if you refill such a lack of a substance you stop believing those depreciative statements, even if they come from a doctor.

My recovery started with heightening my vitamin D level. It was at 7ng/ml and today I make sure it stays around 60-70ng/ml. Since I don’t build it appropriately through sun exposure or food I take supplements. So I supplement what I don’t get otherwise if I see that I’m lacking it.

On the other hand, it’s no use just to take anything just because somebody told me it’s good for me. Everybody has his or her individual metabolism. If two persons eat the same food, blood levels can differ. So supplements are very helpful if they are taken specifically and for a purpose.

People with mood fluctuations or mental issues should know their level of vitamin D, especially if they take psychotropic drugs because these drugs deplete the body’s vitamin D reservoirs. B vitamins are vital because they enable the building of serotonin, the happiness hormone, from tryptophane. B vitamins act as co-factors here; this is why I recommend eating a handful of nuts every day because they are full of B vitamins.

It also needs omega-3 fatty acids, magnesium, iron, zinc, but describing this here would go too far. But I am describing this in my book in detail.

As a last question, which message do you definitely want to transmit to the readers with this interview? Everybody should be worth it him- or herself to stabilize oneself by following a healthy diet. For me, measuring my blood levels is part of it, so really going to the lab to have your status determined and when you add supplements to your diet, to see what happens. And I am convinced that if you fill up such deficiencies, then everyone will experience his or her own miracle, just as I have experienced it. Because nobody believed that one can become psychologically stable by just a change in diet. Even “only” an improvement of the quality of life is an achievement in my opinion. I know enough sufferers who take psychotropic drugs, but still take dietary supplements such as omega-3 fatty acids and vitamin D because they improve their life situation. And that is actually what we want, isn’t it?

Miss Oehlschläger, we that you very much for this interview!

About the author: Annett Oehlschläger has been diagnosed with Bipolar Disorder when she was 47 years old. She has been solely occupied with this disorder for eight years and has been to psychiatric hospitals 24 times during these years. Through psychotropic medication and many hours of psychotherapy, the bipolar phases got shorter and the dose of medication could be reduced – however, Miss Oehlschläger still didn’t really become mentally stable. She set out to search for alternatives. Through a diet and lifestyle change and by tackling her vitamin and mineral deficiencies she has been managing to become stable for six years now. This made her write a book called „Stabilität kann man essen?!“ (“You can eat stability?!” – available in German) which has been sold more than 3000 times so far.

About the interviewer: Anne Siegl, PhD is a psychologist and neuroscientist at Klinik für Psychiatrie, Psychosomatik und Psychotherapie Universitätsklinikum, Frankfurt am Main, Germany. She is researching effects of nutrition on psychological well-being.

This interview has been conducted and translated together with Laura Müller, B.Sc. Laura Friederike Müller, B.Sc., is a Student of Psychology at the Fresenius University of applied Sciences in Frankfurt am Main. At the time of the interview she has been doing an internship in the Eat2beNice project group at the Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, studying the effects of nutrition and lifestyle on mental health.

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What makes some of us more likely to drive over the speed limit, participate in extreme sports or make decisions that can impact health over time? Risk-taking behavior has distinct subtypes (for example disinhibition, sensation seeking, calculated risks, impulsivity) that develop due to the complex interplay of different factors: our lifestyle and environment, our personal susceptibility (genetic and biological variants) and a wide range of psychological effects.

In the study of Strawbridge and colleagues (2018) the goal was to identify genetic determinants of this trait. This approach has the potential to improve our understanding of impulsive behavior across different psychiatric disorders. It can also help later on to explore the possible overlap between mental illnesses and physical health.

„Would you consider yourself a risk taker?” This was the question posed to 116,255 participants, aged 40 to 69, from the UK Biobank project, a large population cohort containing a wide range of sociodemographic and medical information. Roughly one-quarter answered yes, they were the ’risk takers’ group.

A subset of participants took part in a prolonged follow-up occasion as well, where the same question was asked enabling an assessment of response consistency. Reproducibility was quite good, 81% of all participants responded consistently, 13% inconsistently, while in 6% the data was missing.

Genetic loci associated with risk-taking behavior were explored using the genome-wide association study approach. The authors identified one potential locus on chromosome 3 (CADM2) consistently, which was previously implicated in cognitive and executive functions.

Considering the entire genome using the polygenic risk score approach, the authors found, that the genetic variants that make us risk-prone also make us more likely to develop mental illnesses, such as bipolar disorder, schizophrenia, attention-deficit hyperactivity disorder, and post-traumatic stress disorder.

This trait has not only significant positive genetic correlations with a range of mental health disorders, but also with smoking, lifetime cannabis use and body mass index (BMI). The latter implies the possibility that this finding could be followed up in a study exploring the nutritional aspects of impulsivity as well.

Overall, using dimensional approach for traits (from “normal” to pathological) rather than discrete diagnostic categories could be helpful for finding the common ground in the neurobiological underpinnings across psychiatric disorders. From this point of view, risk-taking behavior is also a complex and important phenotype for investigations.

You can find the full research article here.

Strawbridge, R. J., Ward, J., Cullen, B., Tunbridge, E. M., Hartz, S., Bierut, L., Horton, A., Bailey, M. E. S., Graham, N., Ferguson, A., Lyall, D. M., Mackay, D., Pidgeon, L. M., Cavanagh, J., Pell, J. P., O’Donovan, M., Escott-Price, V., Harrison, P. J., & Smith, D. J. (2018). Genome-wide analysis of self-reported risk-taking behaviour and cross-disorder genetic correlations in the UK Biobank cohort. Translational Psychiatry, 8. https://doi.org/10.1038/s41398-017-0079-1

This was co-authored by  Tünde Kilencz, a psychologist and research assistant at Semmelweis University, Department of Psychiatry and Psychotherapy in Budapest, Hungary.

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