If the nervous system could use words:

it would tell us that its neurons plus the cells and tissues of all the systems of our body [the head and brain is included as part of our body] work together in order to create the proper conditions for our chemical reactions to take place. I imagine that the nervous system would tell us that nervous tissue uses energy , whether it services mind or the spinal cord or continually maintaining proper chemical conditions in the body.

The nervous system requires energy just like the other systems of the body.. The mind is simply a by-product of the many chemical reactions of the body. We need need food [fuel] and oxidizer-air- [contains oxygen] to burn the food and release its energy.
“An oxidizer is a type of chemical which a fuel requires to burn. Most types of burning on Earth use oxygen, which is prevalent in the atmosphere” What is an oxidizer? https://www.qrg.northwestern.edu/projects/vss/docs/propulsion/2-what-is-an-oxidizer.html

The brain, and the mind require a lot of energy in the form of glucose and oxygen to work properly.……..It is well established that the brain uses more energy than any other human organ, accounting for up to 20 percent of the body’s total haul. Until now, most scientists believed that it used the bulk of that energy to fuel electrical impulses that neurons employ to communicate with one another. Turns out, though, that is only part of the story.……..A new study in Proceedings of the National Academy of Sciences USA indicates that two thirds of the brain’s energy budget is used to help neurons or nerve cells “fire” or send signals. The remaining third, however, is used for what study co-author Wei Chen, a radiologist at the University of Minnesota Medical School, refers to as “housekeeping,” or cell-health maintenance.MIND & BRAIN Why Does the Brain Need So Much Power? https://www.scientificamerican.com/article/why-does-the-brain-need-s/

In cases of serious depression with cognitive and memory impairment, it would seem logical to check not just the brain, but the overall physical state of health, in particular… appetite, feeding, changes to weight and glucose readings and also breathing, both lung function and ventilation. ……………….

…………..The nervous system would urge us to check the function of the autonomic nervous system via the measurements of the vital signs [RR.,HR, BP., Body temperature, blood sugar, and circulation] in order to check on homeostasis; it is is useless asking the patient what is wrong because they have no access to the details of their internal energy status, any more than it is helpful to ask a car engine why it can’t start . These systems do not speak in the same way. They cannot say that they are having energy problems, their energy system needs checking.

In humans, the easiest way to check whether the mind and brain’s energy is to check glucose levels of the body and to check if air [and oxygen] is circulating properly in and out of the body. [we cannot directly check only the brain] Hence the minute ventilation is a key measurement if one wishes a non invasive tool or one can do an arterial blood gas to determine oxygen/carbon dioxide levels and pH- if one wishes to immediately use a more accurate but invasive tool.

So checking and monitoring weight and appetite would be important as would checking a monitoring the vital signs. Vital signs involve movement of some type of muscle system; cardiac, smooth or skeletal. It is important to know if the function of these different muscles are working properly. Muscles [skeletal muscles] are necessary for us to breath and exchange oxygen for carbon dioxide. The heart is all muscle [cardiac muscle] and the muscles [smooth muscle] of the arteries and veins of the circulation must vasoconstriction or vasodilator in order to circulate blood and maintain proper body temperature.

Dr Emile Kraepelin described signs of poor health in unmedicated bipolar depressed patients:

to be continued……..

” The attacks of manic-depressive insanity are invariably accompanied by all kinds of bodily changes. By far the most striking are the disorders of sleep and general nourishment…….Depressed patients have as a rule little inclination to eat, and usually take nourishment only with reluctance and with much persuasion. Their tongue is coated and they suffer from constipation…………..In states of depression, the skin becomes pale, wrinkled, withered, dry, rough, the eye becomes dull, the growth of nails stops and becomes irregular, the menses become scanty or intermittent, the secretion of tears dries up; the whole being appears prematurely old. “ Chapter Three, Bodily Symptoms, Manic Depressive Insanity. Emile Kraepelin, 1926

The patient with bipolar depression appears sick and malnourished and dehydrated.

Physical evaluation by Kraepelin and colleagues shows that the vital signs are abnormal. Kraepelin checks the vital signs because he is suspicious that bipolar depression is a metabolic dysfunction.

He checks the heart and discovers, ” fairly frequently there are found murmurs at the heart, extension of cardiac dullness, increased excitability of the heart, tendency to congestion, erythemata, great perspiration, dermography, .

In states of depression the complexion is usually pale and grey; the lips often appear slightly cyanotic, the hands and feet cold, pale or livid. Not very infrequently, one observes indications of Basedow’s phenomena, a soft swelling of the thyroid gland with acceleration of the pulse, tremor, and abundant preparation, now and then also occasional exophthalmos. Not at all infrequently and in comparative youth, arteriosclerosis is present.”

Blood pressure is erratic, but the investigations of Weber carried out with newer and more perfect instruments confirm the rise of blood pressure in states of depression; it was greatest in depressive excitement. On the other hand it was shown that also in mania, especially in more severe excitement and in manic stupor, it is frequently raised.

Respiration is accelerated in states of excitement, retarded in simple depression and in stupor.

Temperature is occasionally high normal in violent excitement and often lowered in severe states of depression.

The vital signs are part of the autonomic nervous system and they are signalling that something is wrong.

What did Kraepelin find? What is “retarded” respiration ? How did Kraepelin define this? Do the blood pressure and heart signs and the vasoconstriction and lowered body temperature explain the link between depression and heart disease? Should’t we examine the physical health of these patients more closely? Perhaps the physical signs could provide clues to the abnormal mood and cognitive impairment and problems with the brain.

Kraepelin’s findings about the possibility of heart disease and early arteriosclerosis have been confirmed in modern times: ” Bipolar disorder is one of several mental and physical health conditions associated with an increased risk of developing atherosclerosis (hardening of the arteries) and cardiovascular heart disease. And according to the American Heart Association, that increased risk may be evident early in life.” https://www.psycom.net/bipolar-disorder-and-heart-disease/

Could the * sad or anxious moodiness and also the sluggishness of thought and action in bipolar depression and the disturbed vital signs and circulation be related? * Chapter One Definition, Manic Depressive Insanity, Emile Kraepelin, 1926

What if the effects found in the brain and the rest of the body are due to energy problems? Problems involving oxygen or with other substrates necessary to change food into energy.

Paula has “retarded” breathing and has had bipolar depression.

We only checked this out because of Kraepelin’s observations.

Is this a coincidence or is this an important clue?

We think, Paula and I, that it is an important clue and that by mentioning metabolic dysfunction as a factor in bipolar illness, Kraepelin was suggesting that temperature, acid base status, and ratio’s of oxygen/carbon dioxide in the blood and other tissues affecting brain function could be important clues that future researchers should explore further, when tools become available to do so.

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