Using inositol for promoting brain wellness: an interview with Robert Belmaker, MD - Nutritional Medicine Update - Interview

Townsend Letter for Doctors and Patients, July, 2002 by Robert Crayhon

Robert Crayhon: Joining us now to discuss his groundbreaking research on inositol and mental health is psychiatrist and researcher Robert H. Belmaker, MD. Dr. Belmaker, would you please give us your educational background?

Robert Belmaker: I received my Bachelors Degree in 1967 at Harvard University and my MD in 1971 at Duke University. I then started a psychiatric residency at Duke and then went to the National Institutes of Mental Health as a clinical associate from 1972-1974. I then came to Israel in 1974 and completed my psychiatric residency. Eventually, I became director of research at the Jerusalem Mental Health Center in Jerusalem. Later, I became in addition, an associate professor of psychiatry at the Hebrew University School of Medicine in Jerusalem. In 1985 I came to the new medical school in Beersheva at Ben Gurion University to become the Hoffer-Vickar Chair of Psychiatry.

RC: Can you just describe for us briefly, your daily duties?

RB: I am a professor of psychiatry; I am the assistant director of the Beersheva Mental Health Center, so I have administrative duties. Every Monday I have a full clinic day with my own patients. Sometimes with my own 30 patients. Two to three times a week I do rounds on inpatients with the residents as well. So I have clinical, teaching and research duties.

RC: What got you interested in the role of nutrition in brain function as a psychiatrist?

RB: I think it's partly derived from some skepticism about the pharmaceutical companies. It is also derived from the feeling that so much of what we ingest everyday is food, and that chemicals in food must have some effect on our brain, and perhaps some potential therapeutic effects on the brain. But actually the chair of psychiatry that I am incumbent of was endowed by a family that has been famous for their interest in nutrition and psychiatry. I haven't decided to this day whether they found me and endowed the chair, or whether the endowment of the chair influenced my thinking. But, of course, Abram Hoffer, MD, PhD, from Canada has been interested and influential in nutrition and psychiatry for fifty years now. He published in the 1950s about nutrition and psychiatry when it was very unpopular, and he very bravely continued.

RC: Is the connection between nutrition and psychiatry any more popular now in psychiatric circles?

RB: There is an increase in interest in nutrition and psychiatry. However, like the increased interest in nutrition and medicine, it goes with a healthy degree of skepticism. There are a fair number of people who are suspicious -- perhaps sometimes rightly so -- of excessive claims. Often people with severe mental illnesses reject any drug treatment. They do that partly because of their illness in their thinking. Sometimes they use arguments derived from the nutrition literature and don't get proper pharmaceutical treatment. This is a shame, and this makes some psychiatrists in this position skeptical about nutrition. Clearly, however, some patients with heart disease need surgery and sometimes need triple artery by-pass, and other patients with high blood pressure are clearly going to need hypertensive and anti-hypertensive medicine. All cardiologists today know and believe and preach the role of nutrition in preventing heart disease and high blood pressure. So, the two should not be seen as antagonistic. In psychiatry there is no question that the anti-psychotic drugs and the mood stabilizer drugs are effective. But I think perhaps we are a little behind cardiology and some of the papers show that folate supplementation can enhance the ability of lithium to prevent mood disorders and the ability of anti-psychotic drugs to reduce psychosis. These papers are not given as much publicity and as much acceptance as they really deserve. I don't know if it's because they do not have a pharmaceutical company pushing folate -- because it's too cheap -- or whether it's the skepticism that might be a result of excessive claims of the past. Or perhaps it is the skepticism that is coming as an antidote to the fact that some patients refuse pharmaceutical treatment, and only want natural treatment. Often those patients are too sick to be able to make a rational decision.

RC: Dr. Belmaker, do you feel the future of psychiatry is an intelligent integration of pharmaceuticals and nutrients? And, should nutrients be tried first?

RB: I think we have to answer that question empirically. There are going to have to be studies, like the ones we did with inositol. There is no way to know what comes first and what comes second. Certainly in most cases nutrients are milder. If a person finds changing his diet can prevent his headaches, we would like to see him do that before he tries a strong medicine like Valproate to prevent a headache. Ultimately, it has to be an empirical question. We have to do the studies.

RC: What got you interested in inositol?

RB: I had been interested previously in lithium and I am still interested in lithium. As you know, lithium is a very simple compound and a non-patented compound and a cheap compound. Those are some of the things that keep my interest. I have been interested in lithium for 30 years. Lithium has a major effect on inositol and the brain that was discovered by a wonderful man, name of Dr. Berridge from London, a Nobel prize candidate for that work. That work was done on flies, of the salivary gland of the fruit fly. For those people who sometimes make jokes about how animal research is not relevant, here is an example of how something that seems terribly funny, the salivary gland of the fruit fly, has become a major area of scientific research, with many important benefits for humanity. He discovered the whole cycle, the inositol cycle of the cell, and that lithium had an effect on it. So, as a lithium researcher, I read his papers and got interested in inositol. Professor Berridge was very interested in how inos itol can affect cell function. We were really the first to think that one could possibly give inositol as a nutrient in quantities that could get it to the brain.