The Mental Injury

A physical or chemical injury can easily trigger a mental or emotional impairment of some type. When we think of mental problems, visions of psychological tension and emotional instability come to mind. But we should distinguish the mental state from the psychological and realize that many athletes struggle with mental and emotional distress but are psychologically stable. Stress affecting the brain, from the chemical or physical aspects of the body, can easily cause a mental injury. The problem is not uncommon in the athletic community.

Unlike a physical injury such as an aching Achilles tendon or sore knee, a mental injury is often invisible. Moreover, athletes will talk freely about their aches and pains, but when it comes to discussing their true mental or emotional state, they tend to stay mute. It’s like some kind of unwritten law within the athletic community. The social stigma is that athletes are tough, and immune to mental and emotional harm. (This is especially true of the word “stress,” which, according to some, implies mental weakness. I’ve been asked by professional athletes, and sometimes even by team management honchos, to not use the word “stress,” especially with the media, because it imparts an image of lack of self-control on the part of the athlete.)

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All these ideas of mental and emotional stress being a sign of weakness, of course, are myths. In fact, athletes are as vulnerable to stress and to mental and emotional injury as anyone else. What makes an athlete tough and able to endure is optimal balance of fitness and health.

Let’s consider the case of a former patient of mine whom I will call Robert. A talented twenty-nine-year-old triathlete, he was in his third year of great racing. His training never felt better, and in a triathlon he was nearly unbeatable. Always full of energy, and without injury, Robert was climbing the ladder to national success.

But then Robert became increasingly anxious about competition. He dreaded showing up on race morning. He had not only lost his desire to train or race, but his personal life was being affected as well.

What was happening to Robert in the absence of disease? He was experiencing a functional imbalance in the brain’s chemistry—a subtle yet noticeable change in certain neurotransmitters that can chemically modify the way one thinks, feels, and acts. Fortunately for Robert and others, with few exceptions, these problems are reversible and, more importantly, preventable. Normally, when you think a thought or perceive a sensation from the outside world, it’s the result of major chemical reactions in the brain. Billions of messages are sent throughout the brain and body on a regular basis by chemicals called neurotransmitters. Different neurotransmitters in the brain make you feel certain ways: high, low, sleepy, awake, happy, or sad. Sometimes the brain may have too many of one type of chemical or not enough of another. As a result, you may feel too high or too low, agitated or depressed.

There are dozens of types of neurotransmitters in our brains and elsewhere in our bodies, especially the intestines. These neurotransmitters are vital for relaying messages throughout the brain and body. Some of our important neurotransmitters are made in the body from amino acids derived from dietary protein, and once produced, they are often influenced by the amount of dietary carbohydrates we consume via the hormone insulin.

Two important examples of neurotransmitters that can significantly influence our mental and emotional state are serotonin and norepinephrine. Serotonin is produced with the help of the amino acid tryptophan and functions with the help of insulin. This neurotransmitter has a calming, sedating, or depressing effect in the brain. A high-carbohydrate meal, such as pasta or oatmeal, or eating sweets, results in more serotonin production. An individual who is overactive may benefit from a natural high-carbohydrate meal, but the same meal in those who are a bit mentally low may get worse, even to the point of depression. Sweets are traditionally thought of as providing energy, but for the brain they are sedating. Go to a nice hotel and you’ll find some type of sweet treat on your pillow—that’s because sugar usually helps you sleep. (Sometimes, sweets may give the feeling of a pick-up but that is very short-lived.)

In Robert’s case, the overproduction of serotonin—a common problem even in athletes—may have helped establish his mental injury. This would have corresponded to his high intake of refined carbohydrates, and as he progressed into his mental injury, his craving for more sugar further worsened his problem.

Norepinephrine is another neurotransmitter produced with the help of the amino acid tyrosine—but only in the presence of normal levels of insulin. A high-protein meal with little or no high- or moderate-glycemic carbohydrates will provide the brain with increased norepinephrine levels. This neurotransmitter has a stimulating effect on the brain. The person who needs a mental pick-up or is depressed could often benefit from more of this brain chemical. If you’re taking a class, have an important meeting, or are driving your car, you want more of this neurotransmitter and less serotonin so your attention is high and you don’t doze off. A protein meal or snack without refined carbohydrates can be key. But the relationship between food and neurotransmitters is very sensitive—even eating a single meal of high carbohydrates can quickly change your brain chemistry in the wrong way, resulting in dozing off after lunch or getting sleepy during a long drive.

An imbalance in serotonin and norepinephrine—with a shift toward the former—may produce more feelings of depression. Perhaps Robert was eating too many sweets and other carbohydrates, which increased serotonin and made him more depressed. Upon careful questioning, he noted that he became very sleepy after lunch and couldn’t concentrate on his work very well.

Fortunately, most people do not need medication, and Robert succeeded without it. His first step toward eliminating his mental injury was the Two-Week Test. In fact, after the first few days, he reported an 80 percent improvement in his mental state.

In addition to the way he ate, Robert’s training, may also have contributed to his mental injury. Especially if he was over-trained, which can result in undue stress on his brain and emotional instability.