Simone Biles; my 'coming out' anniversary
Plus: toddler nutrition; how inflammation underlies mental illness
Dear community,
Today is the day when two years ago, I first shared my own mental health journey publicly, while I was serving as California’s acting Surgeon General. I wrote about it in my friend Emi Nietfeld’s Post-Mortem newsletter today.
If you followed this year’s Olympics, you know just how many inspiring stories there are among this slate of athletes — and how prominent the focus on mental health was.
For anyone who hasn’t yet, I highly recommend checking out the Netflix mini-series, Simone Biles Rising — for an inside look at what it took for her to step aside in Tokyo, and her challenge-ridden path through to today. It also really uplifts the power of post-traumatic growth and wisdom.
Here’s what Simone Biles’ public decision not to compete in Tokyo and triumphant return this year shows:
When needed, our brains and bodies will claim their rest and healing — even at a highly inconvenient, costly moment.
It takes strength to honor this, and there can be deep feelings of shame, blame, guilt, and regret when our health gets in the way of expectations of our performance. The documentary shows how tortured Simone was in the wake of her decision not to compete in Tokyo, even when she knew it was absolutely the right decision for her then. (Anyone who has needed time away from work or other important obligations for mental health reasons knows just how this feels — myself included.)
Focusing on recouping our health is the most important investment we can make. The hardest part about this is that it’s never clear how long it’ll take… and it takes immense patience to persist.
When it finally comes, finding that strength and clarity post-breakdown brings us to a place where we're not just “back to baseline” — we’re actually stronger and better than we were before. We know ourselves better, including our vulnerabilities, our boundaries, and what it’ll take to protect our health in the future.
Walking through adversity and reclaiming a sense of equilibrium on the other side allows us to rise like a phoenix from the ashes — more brilliant, secure, wiser, and ever more resilient.
Inflammation and the brain
Last week, two large prospective studies (where an exposure or risk factor precedes an outcome of interest) added to our knowledge about how inflammation and metabolic dysfunction underlie mental illness — with signals measurable decades prior to symptoms or a diagnosis. If we systematically assessed low-grade inflammation, we could risk-stratify, predict who might go on to develop symptoms, and even intervene to *prevent* sequelae like mental illness and metabolic syndrome in the first place.
Persistent inflammation in childhood (as measured by C-reactive protein, CRP, peaking at age 9 years), was associated with the following outcomes at age 24:
psychosis
severe depression
insulin resistance
Among 585,279 individuals tracked over 30 years, those with a higher than median white blood cells (leukocytes: hazard ratio [HR], 1.11; 95% CI, 1.09-1.14)], haptoglobin (HR, 1.13; 95% CI, 1.12-1.14), or CRP (HR, 1.02; 95% CI, 1.00-1.04) or lower IgG level (HR, 0.92; 95% CI, 0.89-0.94) had a greater risk of experiencing any psychiatric disorder. These inflammatory and immune markers were in place up to 30 years prior to a mental illness diagnosis.
Inflammation and the brain:
“Inflammation may contribute to the development of psychiatric disorders through several pathways. Increasing evidence suggests that inflammatory cytokines could cross the blood-brain barrier and contribute to neuropathology through affecting neurotransmitter metabolism, neuroendocrine function, and neural plasticity, which might induce cognition dysfunction and emotional dysregulation. For example, inflammatory cytokines and their metabolites can decrease the synthesis and release (but increase the reuptake) of serotonin, norepinephrine, and dopamine, leading to reduced activities in reward-related regions in the brain.” — Zeng et al, 2024
Toddler nutrition update
A recent study found that the majority of baby and toddler foods sold in the US failed to meet the World Health Organization’s nutritional standards: over 70% did not have sufficient protein; 44% exceeded total sugar recommendations and 20% exceeded recommended sodium limits. Nutritional and taste preferences are established early, and what kids ingest in the early years can determine their health trajectories later in life. The study concludes that “urgent work is needed to improve the nutritional quality of commercially produced infant and toddler foods in the United States.” For now, if you live in the US, consider creating easy meals and snacks from whole foods, rather than ultra-processed pre-packaged items. Some go-to ideas:
Sliced fruits or vegetables with nut butters or alone — some faves in our house include watermelon, papaya, apples, carrots, cucumbers, and broccoli
Mix rolled oats + banana + egg in equal parts for yummy, healthy pancakes or baked “cookies” (big hit with toddlers — and no added sugar!) that will also keep constipation at bay
Pasta with meatballs
PS: This year’s COVID booster is now available for anyone 6 months and older — check out this QnA for more. If you’ve never received a COVID shot before, all you need is one other shot to be considered ‘up-to-date.’ And it’s considered safe to get multiple shots (say RSV, flu, and COVID) at the same time. If you’re based in the US, Walgreen’s and CVS are great options.
Wishing you light,
Dr Devika Bhushan
If you enjoyed this post, explore these others:
Revisit all prior posts here. Submit any feedback or questions to explore in future posts by replying to this email. Thank you for being here!
This is great Devika--I didn't see the 'coming out' piece when it first was published. And Emi is amazing!