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‘What is this?’
It sounds like I have spoiled children, but I don’t. They’re just used to a different kind of food. It’s said that Chinese children don’t like cinnamon buns. Why? Because they never eat cinnamon buns. You like what you are used to. This way of eating is the opposite of how we used to eat, and the change takes time. But I don’t really care; I have patience. I feel happy in some way. It’s not just the spring light. It’s something more – that’s hard to put into words.
Then I find the explanation. Again, by chance.
I’m working on a book that I’ve been thinking about for a long time.
I once had a brother who died. My handsome, mischievous, idolised brother got sick in his twenties and was diagnosed with schizophrenia, a grim psychiatric diagnosis. In 1986, I lost him in a fire in a Stockholm apartment. Through a contractor project I’ve done for Karolinska Institutet, I’ve begun to think a lot about the stigmatisation of mental illness.
Now I’ve decided to write a book that illuminates and looks into the taboo around mental health problems. This also involves dealing with the taboo within myself, the shame that I’ve felt – because mental health problems are looked at differently than physical disease. Aside from the sorrow, there’s this damned feeling of shame that rests over both the afflicted and their loved ones. And that makes us doubly ashamed. We’re ashamed because people we love have a shameful illness, and then we’re ashamed because we’re ashamed.
I root around eagerly in everything that’s connected to this issue. I talk to researchers, read and interview lots of people with different illnesses, as well as doctors and nurses.
While I’m looking through the latest research, a new branch emerges. It has a very long name: psychoneuroimmunology. It’s the study of how mental illness can arise in the brain, and how it’s linked to– here it is again – inflammation. Hmm . . .
In other words, on the one hand there’s a connection between immune defence and inflammation, and on the other hand, a connection to brain health? Fascinated, I look more closely into this connection.
We’ve already mentioned all the foot soldiers that are sent out by the immune system. Among them are the cytokines, triggered by inflammation to show up in huge numbers – something called a cytokine storm. This storm, like a swarm of bees, starts up the body’s defence system in the form of the so-called B and T lymphocytes. But the cytokines also talk directly to the brain.
Let’s say that again. The immune system and the brain talk to each other.
This is a new piece of knowledge, a new puzzle piece. I investigate further.
The American researcher Robert Dantzer did the pioneering work that showed that the cytokines triggered by inflammation also affect the brain’s signalling substances: dopamine, serotonin and noradrenaline. Since these substances directly affect how we feel, physically and mentally, cytokines can change how we feel in emotional terms.
When you have a high inflammation level, the cytokines decrease the levels of dopamine, noradrenaline and serotonin. You get a feeling of illness, like when you’re coming down with something. You feel low, tired, withdrawn. And when the inflammation decreases, the number of cytokines also decreases, and the signalling substances can flow again at a normal level in the synapses of the brain.
I add this to what we now know about signalling substances, highly simplified. Balanced dopamine levels provide more energy and self-confidence. Balanced serotonin levels lead to more calm and less anxiety. Balanced noradrenaline levels lead to increased alertness.
That’s exactly the change that I’ve felt in myself. This is interesting . . .
Not only does this train of thought offer new possibilities for understanding how mental illness begins, but perhaps it might also account for my new, brighter mood. A signal sent directly from my decreased inflammation level up to my brain might actually be affecting my mood. Has the new diet rearranged my brain chemistry?
I have to keep digging.
Researchers can demonstrate a connection between the degree of inflammation and depression, as well as between the degree of inflammation and the risk of suicide.
Suicide is today the most common cause of death among young men. One of the explanations is that there are too few resources available in the scandalously downsized psychiatric acute care centres. The doctors are forced to make a brutal selection among all the people who are seeking help, asking themselves terrible questions like ‘Who is actively likely to commit suicide? Who can we consider to be managing adequately at home, in spite of their depression?’ They are forced to look for those patients who have the highest risk for suicide and send home the rest even if they are feeling unwell.
Since the price of making the wrong judgement call is so incredibly high, people have looked for more objective markers, something that can be measured, instead of simply asking the patient questions. As most people who have known someone who committed suicide realise, a person who really wants to commit suicide will hide it.
At Lund University, the researcher Lena Brundin found that in people with depression, the will to commit suicide was directly linked to the degree of inflammatory markers in the blood. Not only that, but the degree of violence used in the suicide could also be correlated with the degree of inflammation.
In autumn 2017, new research was presented in London, where scientists from the University of Cambridge argued that there is a ‘very robust link between inflammation and depressive symptoms.’ Professor Ed Bullmore, chief of psychiatric staff, pointed to the fact that people who have just received vaccinations and people who take inflammatory medicines get depressed more often. The teams are now thinking of depression as a physical illness that might be treatable with anti-inflammatory measures.
It turns out that 30 per cent of people who suffer from inflammatory diseases like rheumatism are also depressed, making that group four times more likely to develop depression than the general population.
Schizophrenia has also turned out to have connections to inflammation, in research carried out at the Karolinska University Hospital by the psychoneuroimmunologist Sophie Erhardt, a pioneering scientist I had the privilege of meeting when we both became involved in the Swedish Psychiatry Foundation’s work. The same goes for bipolar illness.
It’s clear that cytokines are linked to poorer mental health for people, and cytokines are produced when there is inflammation.
I’m now hearing more and more researchers say that there’s a real connection between immune defence and the mind. Might these mental illnesses actually be immunological diseases? Which one is the chicken and which is the egg?
More and more doctors are coming to radical conclusions.
‘Our old model of care, where we make a distinction between body and mind, is completely outdated, where psychiatric care is provided by psychiatric specialists and physical care by doctors and nurses who specialise in the body. We have to begin to educate people within healthcare who can bridge this gap – between immune defence and the nervous system,’ thunders Professor Robert Lechler, chairman of the British Academy of Medical Sciences, in an interview in the Daily Telegraph.
Everything is connected, and the link is inflammation.
This is the very front line of research. I’m standing right at this front line and probing it as I’m writing this book, and I see the inflammation trail grow red hot again. I have to dig deeper, even though it’s sometimes tough going – very tough.
I have the twenty-five-year-old grief of a big sister simmering away inside. It’s been shut up in a closet with the door bolted shut and marked with a sign saying ‘Open at your own risk!’ In that closet lives the grief I feel for not being able to save my brother. It sometimes feels like I’ve gone straight down into a black hole while I’m working on this book. I also encounter the sorrow and anxiety of the people I interview, people who have been stricken with serious illnesses and sometimes met with little understanding from the outside world; who feel alone and vulnerable even though they’re fighting with such courage. It touches me at my very core, since I understand them all too well.
But then I notice something. The afflicted and their families say almost exactly the same thing: when they eat junk food, or bad food, their symptoms get worse. When they choose better food, the symptoms decrease.
The new lifestyle that I’m learning about shines so brightly in the midst of all this darkness, and it’s signalling from all directions. It turns into a kind of lift that leads me up towards joy, out of my grey mine shaft.
Up in the daylight again, a journey to completely ordinary things – things that might be trivial but that absolutely need to work, things that used to be self-evident before, in my old life, but that I now have to relearn.
Like how to shop for food, for example.
I used to wander around fairly randomly and pick out things that looked interesting when I wasn’t shopping for a recipe or based on sale prices. I bought things mainly based on what my family likes to eat every day. Crisps, bread, jam, cereal, milk, chicken, pasta, muffins and vegetables. Nothing strange. That’s what a regular shopping list might look like.
Now I’m starting to see the supermarket in a whole new way. It has its agenda, I have mine. That’s why it’s important to examine the supermarket’s setup. You are often met by freshly baked bread that’s meant to tempt you with its warm aroma, and then you’re supposed to walk all the way inside the shop to find the milk, a product that almost everyone buys. The vegetables are often hidden far inside, along some wall.
I decide to outsmart the shop’s selling agenda and my own old reflexes. I’ll get a maximum amount of good and nutritious foods while minimising gluten, lactose and sugar, and I’ll shop economically.
The first step is to make a plan for the day’s meals every morning. Breakfast, lunch, dinner and snacks. And then shop according to that. Just like an architect, you have to begin with a drawing in order to build a good house.
My plan might look like this:
Breakfast: Smoothie with protein powder, green spirulina powder, chia seeds, raisins, blueberries and spinach.
Snack: Boiled egg, tomato.
Lunch: Chicken, sweet potato, raw grated carrot and cooked broccoli.
Snack: Fruit and nuts.
Dinner: Lentil patties, spinach and tomato salad.
If the kids are eating at home I add things that they like, but only then.
I’m beginning to dig around a lot more in the vegetable bins. I’m starting to pick up onions, tomatoes, carrots, lemons, garlic, broccoli, green beans, cauliflower, Brussels sprouts, squash, aubergine and so on, according to season and price; I inspect them and smell them. I find green cabbage. And white cabbage! This is an unassuming but wonderful, cheap delicacy – especially in the springtime, when the delicate spring cabbage arrives. Here I also find my clumsy, ugly, new best friend – the sweet potato.
I buy blueberries, especially if they’re on sale, since you can freeze them. Strawberries and raspberries according to the season. Lots of frozen berries. Rita doesn’t want me to eat too many bananas since they have a high GI value. Okay, I’ll try.
I’m starting to think about the store in unpoetical terms. Like for example ‘protein shelves’. That’s where there are chicken fillets, meatloaf, pork chops. The egg shelf, and the shelves with canned sardines, mussels and tuna, are also protein shelves. What has good quality and reasonable prices?
I often come home with different kinds of fish, preferably ethically sourced. Chicken thighs have more taste than breast fillets, and you can buy them in bigger packages with six or twelve thighs and then freeze the part you don’t use in smaller bags. I buy according to season, price and quality. Cans of mussels, salmon and sardines, and quick protein solutions with lots of omega-3 fats. And also lots of eggs. They have to be from cage-free, happy chickens. I also buy beans and lentils of all kinds and shapes, since it turns out not everything is a good fit for my stomach.
I buy low-lactose milk, yogurt and sometimes soy yogurt. I often try different kinds of nut milk, like almond, coconut and hazelnut, and soy milk. I use butter once in a while, preferably organic.
The spice shelf expands. New tastes turn up there, and more experiments. At the base are of course salt and pepper of different kinds, and now also turmeric, which I’m beginning to learn is extremely anti-inflammatory. But other spices reduce inflammation as well. I check lists and find cinnamon, oregano, cumin, coriander, thyme, rosemary, basil, different kinds of chilli, garlic, ginger, capers . . .
I buy different kinds of oil and begin flavouring it myself. A sprig of rosemary, some garlic and a few lemon peels quickly add a new taste in a couple of days. I try new kinds of vinegar – there are so many to choose from. I learn more about my trigger points – whipped cream and toasted bread.
ANTI-INFLAMMATORY SPICES
• Basil
• Capers
• Chilli
• Cinnamon
• Cloves
• Coriander
• Cumin
• Garlic
• Ginger
• Lovage
• Oregano
• Rosemary
• Thyme
• Turmeric
• and many more!
I become a seed and nut eater and also buy lots of dried fruit, with favourites like goji berries, dried apricots, dried plums, figs and cranberries. Little delicacies.
I put all these little things in plastic jars in a row at home.
My usually good-natured husband bangs around angrily among all the new jars that are crowding out his tubes of caviar, fig marmalade and cheese, when he’s in his home-economics-teacher mood. We start having new types of arguments. About foods in the cupboards. What goes where? It is not dignified but it is the new reality at home.
I also learn to make more food than I need.
Apparently, this is called ‘food prep’ in bodybuilder language. You’re prepping food when you grill long rows of chicken thighs, for example, and save them in the freezer. Or boil sixteen eggs at once. Or make a big batch of vegetable stew at a time.
Rita thinks I should cook in bulk twice a week so that there’s always something at home that’s easy to serve. I wonder if I have the time, but I soon discover that it doesn’t take more time to make food in advance. It takes exactly the same amount of time, sometimes even less. But the difference is that you eat better when you’ve planned better.
But what if you’re not eating at home? This will be a big challenge for me. With work in several countries and with children who are studying or working abroad as well, the year includes many days of travel. At such times, I’ll set off early, on crowded morning flights where they serve sandwiches packed in plastic and a cup of coffee, and return late on other planes, where they serve even more sandwiches in plastic and more coffee. Food on the go, food in canteens, meals with clients – always on the road to somewhere.
How will I manage this?
It will be especially hard when I’m headed out on a really long trip to a completely different corner of the world, where I might be able to get a few more leads to how all the remarkable things I’m experiencing actually fit together.
Ayurveda is the holy science of life and serves the whole human being. Both in this life and the next one.
– Charaka, the father of Indian medicine, c. 300 BCE
4. HEAL (#ulink_211cba03-fbc6-552b-9a0d-e8c28cbe46ec)
When you travel to India, the plane flies through the night and over the Indian Ocean.
On this night, there is so much turbulence that the red safety belt sign never turns off. No food or drinks can be served, and the toilets are closed for hours. Luckily, I’ve learned to bring food with me. Little cherry tomatoes, almonds and protein bars become my salvation when the food trolley is chained down all through the shaky trip.
We land in Mumbai early in the morning. I see an older woman in a sari leaning on her son’s arm. She looks pale and worn out from the trip. We all desperately want to use the bathroom. But I’m continuing on and take the bus to the domestic terminal. It’s been a few years since I was last here. The development has been rapid.
What was then like a sea of walking people now consists more and more of people on motor scooters, often carrying two or three people. Young women dressed in saris sit behind the men in their white shirts and black gabardine trousers. The women sit sideways, sidesaddle, with a tight grip on the waist of the person in front; they travel at high speed on the road between terminals. Through the bus window I watch this bustling city pass by.
India has everything, extra everything, of everything.
More colours and more joy, but also more pain and a vaguely menacing feeling. The poverty hits you like a blow to the gut. We pass slum districts where little children play among piles of rubbish and puddles of brown water. But beyond the poverty, there are many other aspects to India.
India has one of the world’s most sophisticated and cohesive systems of integrative medicine. It’s called Ayur-Veda in Sanskrit, the ancient Indic language that was spoken by India’s conquerors around 2000 BCE and is distantly related to all the languages of Europe, even our Nordic ones. Veda is basically the same as our word for wisdom, and ayur means life, youth and health. When I was working in India, people explained this to me as the eternal and genuine knowing.
I’ve been invited to a course especially for women. It’s a leadership course, but Ayurveda treatments are also included. Might I find more knowledge there?
I’m going to head to one of India’s most advanced health spas for Ayurveda, outside Thiruvananthapuram, the capital city of the state of Kerala. The name of this city is almost unpronounceable. I just have to cross my fingers and hope that I’ve booked a flight to the right place.
When I arrive, I get to meet a doctor.
An Ayurvedic doctor is not like a medical school doctor, like the ones we are used to in Europe. She does take my blood pressure and measure my pulse. She is also professional, with a white jacket over an exquisite sari in blood red and gold. She asks me about any apparent diseases and ongoing medication, after having first asked about my medical history and past surgeries.
But that’s where the similarities end.
I get a questionnaire with forty questions. What kind of food do I like the most? What kind of exercise do I do? Which smells and sounds do I react to? Digestive habits are extensively handled, as are sex drive, sleep rhythm and the colour and intensity of my dreams. The doctor looks through the questionnaire and makes some remarks to her assistant.
‘Sweet, sour, salty, and bitter.’ She nods meaningfully.
The doctor creeps closer to me and suddenly peers up my nose at very close quarters. She listens to my voice and my way of talking. She takes my pulse for a long time and gently rotates my hand on my wrist.
Then the last question.
‘You like bitter tastes?’ she asks again.
‘Yes, I do,’ I say, thinking of my favourites: tea, Campari and rocket.
