What If It's NOT Depression? A Functional Medicine Approach to Mental Health with Dr. Achina Stein

Welcome back. Once again, I am so excited to be here with my friend and colleague at Sheena Stein. She is an amazing practitioner psychiatrist in the functional medicine world, which we'll talk about that as well. So after a brief introduction, I want to kind of get into talking about mental health depression, what if it's not Depression? Which is actually her name of her book, which is an intriguing title in and of itself. So after a brief introduction, we'll just hop into things. So, uh, Dr. Tina Stein is an Amazon International best selling author. Author of what if It's Not Depression? Your guide to finding answers and solutions. She's bor a board certified psychiatrist and has been in practice for 30 years. So she has a lot, a lot of clinical experience. Propelled by her son's mental health crisis in 2010, she found functional medicine which resolved all of his mental health problems as well as her own. So her son's story and her story kind of got her down this pathway. She has a busy private practice called Functional Mind Limit LLC in Providence, Rhode island where she sees patients for functional medicine and psychotherapy. She's also the clinical director for a new initiative called Healing Depression Project which launches in September 2024. So I guess it's already launched. She's a certified practitioner of the Institute for Functional Medicine, a distinguished fellow of the American Psychiatric association and azarist energy healer, and was awarded the Exemplary Psychiatrist award by the NAMI in Rhode island in 2008. She is a former clinical assistant professor of psychiatry and human behavior at in Alpert Medical School of Brown University. And as a companion to her book, she offers programs to find and reverse all of the root causes to your depression like symptoms. It's a perfect alternative to medicine for people with chronic mild to moderate depression like symptoms that does not respond to antidepressant therapies. So with that, I'm so excited to be with you today and talk about what if it's not depression.

Thank you for that wonderful introduction. I'm really pleased to be here and excited to talk to you about it all.

So before we kind of go into this, I mean, you're 30 years of clinical experience or psychiatrist, but you have a story with your son and yourself. So before we kind of go into some of that stuff, could you talk about what got you? How did you go from what in my mind, typical psychiatry is, you know, diagnosis and medications. I mean, I was taught basically traditional psychiatry could be wrong, but it's basically medication management. Like what is your story to get you from that to what you're doing now?

Yeah, it's a pretty long story, but I'll try to keep it short. My son was having, you know, some. Playing some games with his, his brother and we were actually in France. We took a trip to France with the family, took them out of school and he. We were in France and we homeschooled them during these two months. And it was after a trip of being in India for two months, where my family of origin is. And so he was missing his friends and he wasn't getting along with his brother. And, you know, just typical adolescent kind of tiff. Suddenly he was gone from the room. And we were in this two bedroom studio kind of studio apartment, very small apartment, and suddenly he was gone. I look out the window and he's standing on a ledge on the fifth floor of a fifth floor building ready to jump. And that kind of shocked me, first of all, like, oh my gosh, what are you doing? And basically blindsided me in terms of how did I miss this? How, how did it go from having a little fight with your brother to suddenly being on, on a ledge ready to jump? And you know, after bringing him in and talking to him, there was a sudden overnight change in, in. And there were other symptoms. He had double vision, he had extreme anxiety, and just, just not himself at all. When we got home from this trip, this long trip, uh, I had him see a psychiatrist. I saw. Had him see a therapist, which is the traditional way of addressing these issues. I was still a traditional psychiatrist. And he was ultimately, in a matter of weeks to a month, put on four medications. And he was given like three diagnoses, major depressive disorder, generalized anxiety disorder, attention deficit disorder. And, and nobody was able to tell me, like, why did this happen? Like, what about this double vision? What's. I feel like there's something going on in his brain because that's the only conclusion I could draw. Sure, yeah, we have a family history of depression on both sides. But that wasn't enough for me to say, okay, you know, now we've been struck by our family history. It wasn't good enough for me. And he was not himself. He was literally a zombie. He couldn't read, he couldn't function, even though he was taking these medications. And so I. That was just not acceptable to me. And so I had to find other routes of finding help for him. And I serendipitously came across functional medicine. I was looking into alternative ways of healing at around the same time for my patients, and I came across a functional medicine doctor, you might know him, E.B. lavatan and his wife Wendy Trubo. They have a practice called Five Journeys now, but at the time they had a practice called Visions Healthcare. I brought my son there and the. He was found to have severe celiac disease, severe nutritional deficiencies. It became, you know, pretty clear that there was a lot going on in his body, um, that was ultimately affecting his brain. Within two months of being gluten and dairy free, and also, you know, we also realized he also needed to be soy free. He became significantly better in other areas of his body. The lifelong constipation, the lifelong severe eczema that he had had gotten significantly better almost disappeared. And his depression and also anxiety and sleep got better, wasn't gone, but a lot better than these medications were doing. And, but ultimately it took about a good year of doing, you know, the five Rs of gut restoration and getting him sleeping better, you know, addressing all of the issues, all the root causes that he was able to come off of, all the medications and, and, and functioning and thriving quite well. So it took some time, but it, it worked and he was able to get well. And so as a psychiatrist, once you see that, especially to the degree of how sick he really got, how much medication he had to take, and then coming off of it through this process, I couldn't unsee that. And I, I wanted to know more. And I was literally hired. I said, can you hire me? Because they, you know, it's funny how things come together. You know, they, they were looking for an integrative psychiatrist. And I said, can you hire me? You know, and I learned how to be a functional medicine doctor at that point. I did all the training and, and that's all I do now.

That's so interesting.

Medicine. Yes.

Yeah. It's really that you're so. But obviously, as you're saying this story, I mean, I've heard the story over and over again. I've talked with people and the thought hit me like, this is such a common thing where, you know, you're a medical doctor. I'm a medical doctor. We have friends, we have family members, we have people who have health crises. People try strange things, they get better, like. But yet most people don't actually have it impact their practice. It doesn't actually change most people's practice. They keep on going down the same pathway. Like, what is, what was it about you or your experience that made you say, I can't unsee this? And what do you think's different from you and other physicians, medical doctors who See stuff like this and kind of like eh, kind of blow it off as a one off and don't actually take a dive into that.

Well, I mean I being a do a doctor of osteopathy, we have a more holistic training. And so it was within the realm of trying, trying different things, trying more natural things. You know, I learned how to do osteopathic manipulation, manual therapy and how, you know, I've seen how other things, you know, that I've learned have helped my patients. And so to me it wasn't a huge leap. To me it was expanding my toolbox and it, it's not like this, it's this way or that way. To me it wasn't abandoning conventional medicine or traditional medicine. It was expanding my two bots to include other ways of treatment. And you know there's, there's plenty of people who do fine on medication. It's just, you know, there's, it's just that some people don't respond, some people have massive side effects or they all respond and then they'll get worse again. So I think the, the treatment needs to be tailored to what the patient wants and how they respond to what you provide and then thinking out of the box sometimes and, and provide what, what else you might know. And if they're willing to try it and work on it, it's, it's work. Some people aren't willing to do the functional medicine approach because it's a lot of work. But there's other patients who's like, who say to me, why did my doctor do, why did they talk about diet and exercise and why didn't they tell me all of these things? And you know, so you're going to get a gambit of, of different situations. And I think it's important for all doctors to expand their toolkit and, and tailor it to what the patient needs. Now, you know, the other thing is courage. It takes courage to make changes, especially when the mainstream is not, you know, banging that drum. Right. So I was really fortunate to be able to be part of Visions Healthcare, which at the time was 18 practitioners, functional medicine practitioners. It was, it was the largest functional medicine practice in the country at the time. And I was just so, you know, grateful to be able to be part of that and have a tribe. So I felt safe in making the changes because I had the support around learning and had other people who were learning with me and we helped each other learn together. So there aren't those opportunities available to everybody. And so I do encourage people to, to Find a functional medicine practice that's willing to train you.

Yeah, it's really also kind of interesting mentioning Ed and Wendy, because I don't actually know Wendy, but I actually met Ed at a ILAS conference several years ago. I've kept in contact with him. Great, great guy.

But.

But it's kind of interesting how small the world is, right?

Yes. Yes.

So what if it's not depression? Now that. That's intriguing because, you know, brain inflammation, nutritional issues. What can you just break down for us? Because depression. I think many people don't realize depression's a symptom of something else just because it has a diagnosis code, because we can bill for it. It's got an ICD10 code for it, which is how we quantify stuff in medicine for billing purposes. It's literally just a symptom. Could you kind of break down for what are some of the things that. That can look like depression or masquerade as depression and are often diagnosed as depression when they're actually something else? It's just a symptom of what they are.

Yeah, I mean, it. Do. What you're asking is everything that I've talked about in my book, and I'll. So I'll try to. Because it's complicated. It's very complicated. So depression is a symptom, and sometimes people say they're depressed, but they're actually not necessarily depressed. They could be irritated, they could be disappointed, they might be grieving. So, you know, it's kind of a word that's thrown out around a lot for. For a variety of types of feelings that. That probably would best serve people to be more accurate about what they're actually experiencing. That being said, you know, the diagnosis of depression, it's still a symptom that occurs with other symptoms. And the most common diagnosis is major depressive disorder. And if you have five of nine symptoms and, you know, five of those symptoms are actually physical symptoms, you know, so. So you could feel. You can feel depressed or have a feeling of emptiness or lack of pleasure, I should say loss of interest. And also what needs to happen in order to get this diagnosis is have a sleep disturbance or energy loss, concentration difficulties, appetite problems, restlessness, or what we call psychomotor retardation. All of those things are physical symptoms. The sleep, energy, concentration, appetite issues and. And motor apathy or restlessness are physical symptoms. And. And the rest is either guilt feelings or feelings of worthlessness or hopelessness and to the extreme of suicidal ideations. So, you know, when you look at the whole diagnosis Some people have all of these physical symptoms and. And they have to have them every day, most the day, for at least two weeks in order for you to even have this diagnosis. And you could have it mild, moderate, severe. And sometimes it could be so severe that it could cause you to have problems with your thinking, like having auditory visual hallucinations or fixed false beliefs, which is what we call delusions. So sometimes your mind can play tricks on you. Um, that's how bad it can get. But if you look at the mild and moderate types of symptoms, sometimes people meet the criteria. And it's not to the point that you would. You wouldn't necessarily immediately give them an antidepressant, an SSRI or an snri, and they wouldn't necessarily see a psychiatrist. But if you meet that criteria and you present to somebody like a mental health provider, they might say, oh, you meet the criteria and you. Of major depressive disorder. And they match a pill, an ssri, which is a selective serotonin reuptake inhibitor, or an snra, which is a selective serotonin norepinephrine reuptake inhibitor. That's a mouthful. You know, one of those categories of medications in general, that would be the first choice in order to resolve those symptoms. What, what people don't realize is, or. And actually what's not even investigated is what is causing those symptoms. And it's investigated to some degree. They look at psychosocial issues. You know, they look at possibly the biology. The one. The kinds of issues that are in the forefront would be hypothyroidism, and they might do some blood work for maybe B12 or folate deficiency, for example. But it's very, very narrowed amount of testing. And. And the rest, the psychosocial issues are really dealt with more with psychotherapy or supportive. You know, then there's different kinds of psychotherapy or supportive therapy, but it's not integrated. It's kind of all siloed. You know, it's siloed in different. With different providers, and nobody really puts it together. Instead, from a functional medicine standpoint, we might look at digestion, right? So if you think about how neurotransmitters are made and where they're made, neurotransmitters are made in the gut. 80% of your neurotransmitters that your brain needs are made in the gut. And where are. Where does that come from? It comes from protein, amino acids. So if you're not digesting, you know, let's say you are eating the right foods first. Of all you want to make sure you're eating the right foods and that. But if you're not digesting those foods, it's not going to be broken down into the components that are needed and absorbed through the gut lining for your gut microbiome to actually make the neurotransmitters. Right? So that's just, just one puzzle piece or two puzzle pieces that need to be addressed. And then, you know, so then there's, if you're not, why are you not digesting? Suppose you are eating the right foods, why are you not making the digestive enzymes? Or, you know, why is your, your, your pancreas not releasing digestive enzymes? Or why are you not making enough hydrochloric acid in your gut? Could be because you're in fight flight. You know, you're not releasing the, the acid to break down the proteins that you're, that you're to, to supply to your gut microbiome. So there's different pieces that need to come together in order for your body to function and do the job that it knows how to do. And so if you connect all those pieces together, maybe you need to eat more, more regularly and, and honor the rhythms of your gut to release those, those digestive juices. Maybe you need to eat the right foods and, and also not necessarily eat, you know, all day long. You want to clear, have some times when you're clearing those meals so that your body can calm down and reset, so to speak. And you want to make sure that you're not accumulating all of this inflammation from removing toxins. You want to be able to remove the toxins so that your liver doesn't get backed up. So all of these are connected. It's finding all the pieces that might be affecting you. People don't realize that just being, you know, go, go, go, go, go, and is kind of a modern fight flight, you know, not being able to rest, not resting in order to digest those proteins that you're eating. So doing breath work, taking time for yourself, connecting to your body, all of these things matter. And that's, these are just small pieces of the puzzle. So we look at foods, infections, looking for chronic infections that might be interfering in your ability to digest. For example, H. Pylori, we look at the, the types of infections that might be causing an imbalance in your microbiome. And, and that's why your microbiome is not making the neurotra, you know, manufacturing these neurotransmitters. So it's not, you're not supplying the food to the microbiome that it needs. So, you know, foods, infections, toxins can be interfering in your body's ability to remove those toxins. And hormones are part of it that can be disrupted from stress as well. So I like to use the acronym SHIFT, you know, to remember those five categories. So stress, hormones, infections, foods and toxins.

So 1. So lots of things revolving around mental health, depression. Gut health is a center of that. I want to talk a little bit about, like some nutritional things because, you know, I remember early on my career finding about a medication called metfolin, which is basically just super high doses of folic acid. And I thought that was kind of weird. Like, why, why would you use this. This thing for some people with bipolar and really bad depression? And then autistic kids started learning about folate receptor issues and folate receptor antibodies. And then all of a sudden things started clicking in my head. Wait a second. Maybe this high dose of folic acid basically is overpowering this thing. So could you talk about some, like, nutritional things that you've seen? Whether it's folic acid or B12 or other things you've seen have a significant impact on people's depression and mood disorders that act like a drug and you've seen them and could you explain that to us a little bit?

Sure, yeah. I mean, some people, we. There is lots of research that shows that people with B12 and folate and. Or a folate deficiency can result in depression. Um, so it is important to get those levels. That's actually part. I was trained as a traditional psychiatrist to get those levels. Um, the thing is though, even if those levels are normal, sometimes there are certain people with certain genetic SNPs, including MTHFR. And it's not just MTHFR. There's a lot of emphasis on just that one gene. I think it's important to do, to look at a variety of genes in the methylation cycle. But MTHFR is known for its utilization of folate and it's. And specifically methylfolate. So some people who have genetic SNPs in the C6, C677T MTHFR, there's also the 1298. That's the. You can be heterozygous or compound heterozygous in those genes. There's more research for the C677T side of the MTHFR gene in. In terms of utilization of folate. But the depression P. That's. That's more cardiovascular. But the depression piece is. Is heavier on the 1298 piece. So we do. It's important to know. And again, this is just one piece of the puzzle. I get a little worried when people think, oh, I have the MTHFR disease. You know, they look at it as a disease. It's just a snp, a single nucleotide polymorphism. And you know, so if you have the snp, it's important to take methylated folate as opposed to regular folate or folic acid. Those people with this particular SNP aren't able to use folic acid. So you want to get your folate, which is not synthetic from your food, you know, but or from, from methylfolate, which is a supplement that you can get. Uh, the other thing is though, it's important to get a test called the homocysteine test. Um, that's how you know whether or not your body is utilizing. It's part of the methylation cycle, um, utilizing folate. Because if you're, if your homocysteine is normal, which is like 7, 6 or 7, then you may not need to supplement. Sometimes people, people over take. Just because they have the gene doesn't mean that you are not. Doesn't mean that you need methylfolate. You know, you want you. Because some people can over get over methylated and cause more problems. I've had patients who have taken too much methylfolate and they become suicidal sometimes. There, you know, there is a form of. There was a time where many psychiatrists were providing patients deplin, which is a high dose folate methylfolate and that has, has actually caused worse problems for some people. This is really important to know when a person needs folate. And so the testing is really important. Don't just take folate or methylfolate because you have the genetic snp.

Yeah, I had a patient who had some homocysteine levels. She actually has cancer she's dealing with and I put her on some methylfolate and she just took it for a couple of years and forgot about it and then started developing chronic diarrhea and GI tract issues and took like a couple months to realize that waist signals related to her overdose of her methylfolate stopped it and these symptoms went away. It took unfortunately three or four months to figure that out because he kind of forgot. Oops. She'd been taking this for a while. And it's easy to add things on, but sometimes people forget that we don't always need to. Should always, you know, test, don't guess, but should also retest because you can't overdose on some of these things, you know, B6 vitamins, you can potentially get peripheral neuropathy. So there are some, some concerns with these supplements. They're not all 100, you know, take all you want, no side effects kind of thing.

Right, right.

So, so one of the things I learned early on in my, my training was your, you know, depression, anxiety, mood changes can be a symptom of brain on fire. And early on, you know, started seeing some interesting literature with kids with ADD and ADHD using actually oral DHA prescription for their brain, brain imbalances for adhd. Could you talk about inflammation and some things you found to be helpful with brain inflammation in patients with mood disorders?

Sure. So you know, what we can do is address these symptoms by looking at these symptoms downstream and how they're manifested and how much discomfort it causes. So I have a tendency to try to address issues acutely by looking downstream and making, having people become more comfortable so that they're at least sleeping and not in so much distress so that they can then do the work of functional medicine which is looking at root causes upstream. So the goal would be to reduce sort, you know, sources of inflammation. It's finding those sources and then addressing them in the way that we discussed food, looking at diet, exercise, foods, looking for, doing testing to look for chronic infections, toxins, stress and hormones and then seeing how all the pieces, you know, how, how the cards fall. I like to use the multiple symptom questionnaire, test the MSQ to, and follow those symptoms to see how much improves and what's left over after doing the msq. And that way you can see, you know, and be able to fine tune your treatment. So depending on what's left is what is then what I would target. So, so as an example, if they're still having, let's say ruminations that are, that are causing them, they're sleeping better, but they're having trouble still falling asleep and it was triggered by an event that happened that day and they're starting to ruminate about it. I like to use supplements like Al Theanine as, you know, as an as needed basis. Gaba. Those are really, really helpful for, for addressing acute symptoms of anxiety if, if, and those are fine to use. You know, even with certain medications, I think it's important to make sure that people are evaluated and make sure that these are right for them. So as a disclaimer, you know, please don't just start taking these things, you know, just willy nilly make sure you're working with someone that you know, evaluates you and make sure that this is right for you in terms of, you know, a ADD or adhd. Again, it's looking for root causes. Why, why are they having distractibility? Is it because of trauma? You know, so is it because of worry? So it's fine looking under the hood to see what might be driving it. And they may not necessarily be aware of the emotions that might be driving and causing them to be distractible, but let's say they have True, true add. I like to use things like phosphatidylserine, phosphatidylcholine, and there are, there are herbs like ashwagandha, magnolia, you know, Siberian ginseng. There's, there's a number of herbs that might address adrenal issues. There. Some. There are adrenal dysfunction, HPA axis dysfunction that might, that might be a root cause for some of these types of symptoms. So it's, it's, it's kind of zooming out and looking at how it's all connected and what might be driving the symptom that that's resulting. Some people have adrenal dysfunction and it, and it shows up as anxiety. Some people, it shows up as depression. So it's, it's kind of zooming out and seeing what are the patterns that are showing up and, and looking for those roots. So the diagnosis aren't necessarily helpful to me. Those diagnoses, when people come and say, I have been given this diagnosis, that diagnosis, they're really helpful just to match a pill to an ill. They're not, they don't help you to decide what the root is. And so it's getting, it's gathering that history and looking for patterns that will help me to know in which direction to move.

Yeah, and maybe, maybe I'm reading into things a little bit here, but what I'm kind of hearing is a pushback a little bit maybe against what I call green allopathy, which is you have a symptom, you're depressed. So instead of an ssri, let's take some methylfolate and fish oil. Because you keep on, actually, you keep on going back to finding the root cause, which can be a myriad of things. And so I think this is a point that happens a lot in, in our world where people learn a lot of things and you kind of get stuck in this green allopathy, where it's like, cool, you've got depression, anxiety. So I'm going to give you phospholipids, you know, phospholethanolamine, phosphorine. And it's like, it's, it's. Instead of a drug, we do a supplement. But it's the same kind of thing where you're treating symptoms with something versus, like, why are you depressed, why are you anxious, why, why are you bloated, why do you sleep poorly, why are you ruminating all these kind of things? And so I think that's something I'm hearing. I'm. You're not saying that, but I feel like I'm hearing that.

Not exactly what I'm saying. Yes. Yeah. I mean, so that's what I mean by, you know, focusing on downstream. Certainly you don't want to do. The thing about functional medicine is it's work. It takes time. It takes time to figure it out. It takes time to establish habits and make changes. You need a lot of support around that. It's very hard to make those changes when you're suffering. So I think that green, what you're calling green allopathy is focusing on helping people to feel comfortable or get to a comfortable space enough that then they can do the work of finding the root causes and really address, address the root issues so that you don't even have to take those, you know, downstream interventions in the long run. So I think ultimately we want, at least my goal for people is to get people to, you know, really making lifestyle and dietary changes and getting all of their medicine through food and, and habits and lifestyle. But there's always going to be situations where not everyone can either do that work or, or there are, you know, genetic SNPs that they do have to, to, you know, supplement on a daily basis. So in the case of a patient, a few patients that I have with autism where they have, you know, really, really are thriving now, they, they do have to take a combination of vitamins and minerals that are provided to them through compounding, through compounding vitamins on a daily basis. And they'll probably be on them for years because they're just not going to be able to get as much as they need. Some people have a higher need for genetic reasons of, let's say vitamin B6, you know, than, than the average person and, or a higher need of zinc. So you're never going to be able to get certain nutrients just through food. So it's in those situations where I might have them take certain supplements long term and keep track of that. But yeah, I think ultimately, yeah, that's what I'm saying that you, you want to get to the root cause and that Medications are, are, are really downstream interventions as well as what you're calling Green. Green Alpap. Yeah, I like that term.

Becky, actually, I heard her say that term and I've kind of co opted it. So, so, and you're, and so hormones. That's something I think is kind of interesting as part of depression and mood because you know, people tend to think about hormone issues. That's only when you're going through menopause or when you're older. Young, young people don't have hormone issues. It can't be. Could you talk about the impact of, of hormones on mental health and, and maybe your perspective on, you know, as people, as, particularly as women age, how, and obviously men, men's hormones with testosterone and women with estrogen, they do a little different with the brain. But could you talk about like that? Because I feel like hormones is not something that is commonly talked about as a potential root cause for someone's depression and mood stuff.

Oh. And it's at any age. You know, I saw an 18 year old yesterday who's been having terrible problems with her period since the age of 11. And you know, mood changes with every cycle to the point where she's on birth control and has been taking birth control for three years and skipping the placebo, the week of placebo. So continuous birth control. And you know, I, I, I cannot see how that is healthy in the long term, it solves a problem in the short term. But ultimately, well, why is she even having these experiences? And it's becoming more and more common. It's more common now that women in their 30s are starting to early 30s, starting to experience perimenopause symptoms. And, and many women are, you know, going into menopause in their early 40s now. It's just getting earlier and earlier. And the question is, why is that? Well, our toxic lifestyle is part of it. But you know, when you, when you are inflamed, you're, you know, raising those levels of cortisol and that shuts down your hormone production as part of the process. But there's also estrogen, estrogen dominance. That's a term where, you know, when you do go through perimenopause and menopause that the progesterone slowly goes down and then you have that gap of estrogen and progesterone. But then there's the added problem and this is where it happens in the younger population of having high levels of estrogen. And it's not because they're producing it, it's because of the Estrogen disruptors. And estrogen disruptors are chemicals that are absorbed in our body through exposures every single day from plastics and makeup and pesticides and all of the chemicals that we spray cleansers that were around. I mean, we're surrounded by them, the. The air fresheners and the synthetic candles that we burn and breathe all of these fumes of a variety of things that a lot of people don't even realize is part of the problem. And so that just accumulates. It's just one more or a hundred more things that your body has to deal with and attempt to process and eliminate through our organs. But what happens is that they accumulate instead and, and they just pile up in our bodies and that those estrogen disruptors, they. They bind to the estrogen receptors, which are in practically all of our organs, including our brain. And, and when we, you know, so we'll have this inappropriate lock and key mechanism with the wrong. With the wrong substance instead of actual estrogel estrogen that our body makes, it's. It's clogged up by these, these synthetic chemicals, and then it's sending the wrong signal. So, you know, people are getting. Women are getting depressed, men are getting depressed and anxious for, for those reasons, these inappropriate signals. And so when we address these, These issues of not detoxifying and address the other factors that can cause a shutdown of these hormones on some level, then you can bring the body back into balance. By reducing the sources of inflammation, by reducing cortisol, these hormones can get back into a normal level. So. And it's improving detoxification, supporting the liver, detoxing the gut, like just getting all of these processes back into it, back into balance. Well, your hormones will eventually normalize, but some women who are going through perimenopause, it will ultimately reach menopause, and they would benefit from replacement of progesterone. And this is bioidentical progesterone as well as bioidentical estradiol and even bioidentical testosterone. Having the nice. The right combination of these three hormones can actually get your body and brain back into balance in those years.

Yeah, it's really interesting you mentioned the plugging candles, since I, you know, because I control my office and I control my home. Like, I, I'm just not around those. And we're at a stage where our kids are doing things, are going to people's homes, and I feel like every home I walk into, there's scented candles and usually about four or five minutes now. And Becky, my wife, she Starts getting a headache and it's like you just forget how ubiquitous, how common plugins and candles and these, these things that are putting off these volatile organic compounds that are actually, I know, endocrine disruptors, they mess up women's hormones, they mess up men's hormones. So it's things like that that people don't realize. This is kind of ubiquitous. And I'm kind of surprised we've actually made it as long as we have without a lot of issues with stuff. Could you talk a little bit about. You mentioned infections before Lyme disease and potentially mold. You know, one of the things that got me in this, in this field of functional medicine early on was actually mold and learning about. There are certain psychiatrists actually who have been brought into this world by mold inducing psychosis. Could you talk a little bit about, about maybe tick borne illnesses and mold as far as what you, what your experience with those is?

Sure, sure. Yeah, it's, it's interesting. I actually diagnosed a 14 year old boy with Lyme's disease just from his history. If you get a really, really good history, you know, he had severe depression, but just the way he talked about it, it just didn't make any sense to me that he had depression from psychosocial reasons or any internal, you know, thought process. It made no sense. And so then we started talking about, you know, what kinds of activities he had and he went hiking, he went camping, was boy scout and you know, have you ever been bitten by a tick? And it's like, oh yeah, several times. Nobody ever asked him those questions. So it really comes down to getting a really, really good history and having an index of suspicion in order for you to determine whether or not somebody might have had. He didn't have the bullseye rash, but he clearly had a strong history. And we're in an endemic area, we're right in Massachusetts, Rhode Island, Connecticut, right in that band where there's tons of exposures to ticks. And you know, we got the testing and sure enough, he had lung disease. So it does require a good index of suspension suspicion. I mean, Babesia, bartonella can cause significant mood symptoms, especially babesia with rage reactions, OCD types of reactions. So there's quite a few infections that can cause depression and anxiety. It's again, having that index of suspicion. I'm sure you're aware of pans and pandas. Right? And so I always have to look what, you know, what the, the letters stand for. You know, it's pandas is, is a, it's a diagnosis and It's a close relationship between the abrupt onset or worsening of OCD tics or like a motor tic disorder and a strep infection. It's pediatric autoimmune neuropsychiatric disorders associated with strep infections. And so it's all a matter of doctors and other providers and even parents learning that this exists. So that when someone has OCD and there's still so many doctors and providers that don't know that this exists, and it's a matter of having that training, learning that it exists and being able to diagnose it, as opposed to having someone be put into a hospital and put on high doses and medications when the treatment is IVIg, you know, immunotherapy. And so there are quite a few infections that can cause all sorts of psychiatric issues. Mold, you mentioned mold. I see mold in so many people. It's a major root cause of not just depression, but also cognitive impairment, insomnia, dementia, and you know, it. I see it common in people who have lived in the same home for 20, 30 years. And it, and they might have had water damage a while ago and they may have cleaned it up superficially, but it's still, still there, like behind the wall. Or it could be a mold in a room where you have a library with lots of books that haven't been moved or touched and accumulates this dust and then it's closed off from ventilation. Aspergillus is, is major in these situations. You don't have to have water damage. It could be just that you have a closed off room with a lot of organic materials, lots of dust for things just sitting for long periods of time. And all you need is a change in the weather and humidity, you know, humidity increasing. If you don't have, if you don't have air conditioning on a really, really hot, humid day, everything in that room without the ventilation becomes moldy just from those three things coming together. And that's Aspergillus. No water damage is necessary, just humidity, organic material and lack of ventilation. So it's important to look at those homes where people have had children moving out, they're now empty nesters, they don't move anything in that room, the doors are shut and it's, it's a haven for mold. Right. Most people think about mold in their basements and water damage and they think, oh, it's in the basement, you know, it's not up here. That's not true. The ventilation pathways bring it all up. And if you are inhaling that you are Colonizing yourself with mold. And that can absolutely affect your brain. Your brain is extremely sensitive to those things because it goes right through the blood brain barrier. They, they go right into the cells because they are fat soluble. These are fat soluble. So they affect the brain more than anything else if you're living in a mold environment.

Now, before, before we started talking, you actually mentioned this concept of metabolic psychiatry, which I think I'd like to talk about briefly, because we're learning now that energy production in the mitochondria is related to pretty much every disease, even cancer. With the electron transport train breaking down, you get genetic instability, and that sets people up for cancer. But now we're just realizing that potentially I'm going to be bold and say every illness is related to energy production. And the phrase you used was metabolic psychiatry. Could you talk a little bit about that? What is this and how can we understand it a little better?

Well, yeah, I mean, the mitochondria, it is, is a part of the cell that creates energy on a cellular, cellular basis. And you're. There are certain organs that have more mitochondria than others. And most people think of it as mostly in your heart and your muscles, but they're also in your brain. And so when you have mitochondrial disorders like metabolic syndrome, which is a combination of high lipids and fatty liver, diabetes, obesity, these are, these are all issues of mitochondrial problems that also affects your brain too. So if you have a situation where you have other mitochondrial issues in your body, it's also going to affect your brain. So if you have depression, see, this is how you figure out what the root cause is. Just looking for patterns, then most likely the depression, especially if it comes after all of these issues, you know, over years, getting worse and worse, the, the brain is going to be affected ultimately as well. And so the best way to address the depression and, or anxiety, even psychosis or bipolar disorder, is to address the metabolic dysfunction. And the best way, the fastest way actually is by utilizing the ketogenic diet. And some people get a little crazy about the ketogenic diets, like, oh, that's the worst diet, because they don't understand what the ketogenic diet is. You know, they think it's, it's the Atkins diet or, or a carnivore diet, but basically it's a low carb diet having, you know, under, you know, 20, 20, at least under 20 grams and having a certain set of pro, Certain amount of protein, you know, 20 to 80 grams of protein. And then depending on, you know, your, your, the Size of the person and the rest being fat. And, but those fats are all healthy fats, healthy proteins and healthy carbs. It's having primarily though a reduction in carbs and, and, and getting that the, the metabolism to change, utilizing fats burning fats burning off the carbs and then moving into fat burning mode essentially. And that's what the brain wants. The brain wants ketones. It, it passes the blood brain barrier and loves to utilize ketones that you can actually treat anxiety, depression, psychosis, bipolar disorder within a matter of a couple weeks to a couple months. And, and, and then, and see those changes very, very quickly. There's a couple centers around the country that use utilizes this approach. One is in Massachusetts, in Boston, Massachusetts. And I'm blanking on the name of it, but it's, it's, it's basically learning how to cook in this way. Matthew Bernstein is the person who's running the program and it's called accord ACC O R D ACC O R D and through an organization called Ellen Horn E L L E N Horn H O R N When I, when we have our program, the healing depression project, that will be our diet, the ketogenic diet. And there's some great books about metabolic disorders of the brain. Christopher Palmer wrote a book called brain energy and Georgia Ede E D E she wrote a book called change your diet, change your mind and all about how the ketogenic diet can really change quite a bit for you.

Yeah, that's interesting. Yeah. So do you, this is just a little side note because you, the concept of ketones, ketogenic diets really kind of interesting, particularly using C8 which actually goes right into mitochondria, bypasses the whole, the glucose process and particularly helpful. Then there's other ones like C12 which actually astrocytes prefer to use to make ketones. So it's interesting how there's different CC6, the AT12. Like do you just use either MCT World or C8 or other things like that with patients to help kind of bypass some of stuff to kind of jumpstart the process.

It's to help them get there initially. But ultimately yeah, we do use MCT oil in a, in a rescue kind of way, but also to help people get there and not, not feel the stress or distress of, of getting there. So it does take some work and learning. It's, it's certainly a huge learning curve and we would want you to measure your ketones and find out where your sweet spot is. It's different for everybody.

Gotcha Gotcha. Well, you know, Ch really, this has been a great conversation. I appreciate your time. I know you have a hard stop coming up here soon and you did mention a program. So I want you to if people want to learn more about metabolic psychiatry or what you're doing or if it's not depression, how can people learn about you or learn more?

Sure. So if they want to learn about me and work with me, I am at Functional Mind LLC. It is www.fxn mind.com that's in Providence, Rhode Island. The healing depression Project, that's the website for that too. It's www.healingdepressionproject.com. the CEO and founder is Silvia Covelli, who resolved her 25 years of depression and has been depression free from doing the methods that we'll be implementing in our program. And that includes the ketogenic diet. And so it's, it's a very exciting program that we're offering and we're actually recruiting members now for, for that program. It's starting in March and scholarships are available. We will be doing research so that we can show people that, you know, the functional medicine approach, a combination of functional medicine, lifestyle medicine and metabolic psychiatry can resolve your chronic. What was thought to be treatment resistant depression is no longer treatment resistant. There's, it's other treatments other than medications that are available to resolve your depression. So I want people to know that there's absolutely hope for them and so to reach out to me or to Silvia Covelli at the website and talk to us more if you're interested.

Sounds great. And the information will include that in the show notes below when this gets posted up. So Chini, want to thank you so much for your time being generous to sharing with us. I know you've got patients you have to talk to after this, so thank you so much for your time and just sharing your wisdom with us. And hopefully this was helpful to everybody out there who's listening to it right now.

Yeah. Thank you.