Metabolic Health and the Mental Health Crisis

Do you think there is a mental health crisis in the United States? If you answered in the affirmative, you have considerable company: Surveys of representative adult samples in the United States, for instance, suggest that upward of 90 percent believe that the country is facing a crisis of mental health problems.¹

Numerous statistical and scientific data sources support these survey conclusions:

• Rates of mental health treatment climbed significantly over the past five years.²
• Annual deaths from drug overdoses in the United States now exceed 100,000 per year for the first time in history (Centers for Disease Control and Prevention statistics).
• Substance abuse disorder rates continue to rise among both adults and adolescents and now exceed 15 percent among adults in the United States.³
• Mental health conditions such as depression are increasingly affecting our youth, with approximately one in six U.S. teens reporting a depression episode in the past year.³
• The World Health Organization reported that the COVID-19 pandemic alone triggered a 25 percent increase in anxiety and depression.⁴

Despite the argument for the existence of a mental health crisis seeming strong, however, even experts struggle to identify a definitive cause. The pandemic, for example, was clearly an exacerbating agent for mental health problems, but the trends of increasing mental illness were apparent before and have continued since.

Factors such as politics, social media, treatment access, racism, and financial struggles are also commonly cited as potential crisis causes. Yet, while the negative influences of social media remain relatively new, the above-cited social and political factors are not only longstanding but also have often even been much worse in the past. The past century in the United States reads like a series of apocalyptic disasters—World Wars I and II; the Spanish flu of 1918–19; the Great Depression; multiple stock market crashes; the Vietnam, Korean, and Cold Wars; years-long periods of double-digit inflation; loss of pension plans; and massive job changes driven by technology, to name only some of the most prominent existential difficulties endured by previous generations without evidence of a mental health crisis. Looking back just at these major 20th-century events (the 19th century was even more filled with calamity), it is difficult to conclude that the current mental health crisis is the result of new political or socioeconomic factors (see figure below).

Source: Thomas Rutledge

What if instead of the mental health crisis resulting from changes going on outside of us, it is really resulting from changes going on inside of us?

Metabolic Health

Consider the dramatic ways in which our metabolic health has declined in the recent decades corresponding with the emergence of the mental health crisis:

• Obesity rates have tripled among adults, with large increases also present among adolescents and even children under age 5.⁵
• Diabetes rates have quintupled (a five-fold increase), with more than 40 percent of the adult population meeting criteria for diabetes or prediabetes (and 20 percent of teens).
• More than one-third of adults now have fatty liver disease, a condition that was virtually nonexistent outside of chronic alcohol abuse in the past.
• Nearly 9 in 10 adults—and approaching half of adolescents—have one or more metabolic diseases defined as excess blood glucose, abdominal obesity, hypertension, elevated fasting triglycerides, or low HDL cholesterol.⁶

Metabolic health is critical to mental health because it directly affects brain, hormone, and neurotransmitter function. In a state of metabolic dysfunction, our bodies and brains become less resilient to internal and external stressors and more vulnerable to physical and mental diseases.⁷ Thankfully, the reverse pattern is equally true—more robust metabolic health improves mental health—as is recently demonstrated in studies showing the benefits, for example, of exercise for mental health and dementia⁸ and nutrition styles such as the Mediterranean Diet for depression.⁹

How do purely physical health treatments such as exercise, nutrition, improved sleep, and fat loss reliably improve markers of anxiety, depression, and other mental health conditions? By increasing metabolic function, the process by which your body creates, distributes, and utilizes energy. Metaphorically speaking, metabolic health turns our body into the equivalent of a four-wheel-drive vehicle for navigating the difficult roads of life. Metabolic dysfunction, meanwhile, gives us a flat tire.

Source: Thomas Rutledge

Summary

The metabolic model of the mental health crisis (figure above) offers a novel way of understanding its root causes. As importantly, this model offers practical solutions—taking individual steps to improve our metabolic health—that can make us less dependent on external agents or unrealistic changes in our culture. If patterns from the past century hold steady, life in the United States will remain stressful and impose frequent demands on us for change and adaptation. Investing in our metabolic health is among the best strategies at our disposal for helping ourselves meet the challenges of the present and future.