Functional Medicine Psychiatry – Getting to the Root Cause of Mental Illness

Coming up on this episode of the Doctor's Pharmacy.

Between the environmental toxins, between the malnutrition, the sugar, I believe the genetic vulnerability catching up with us. It's just a kind of perfect storm that has resulted in this mental health crisis. Although, you know, I always stress that I'm tired of hearing the term mental health crisis.

Yeah.

'Cause I think the better term, at least for us, it's a crisis of care. It's the model. Yeah. Because it is treatable. It's not just numbers going up.

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I think we all know that we have a mental health crisis, but we also know that our current approaches don't work. Things are getting bad and even worse than bad for many people. And we had an amazing conversation on the Doctor's Pharmacy podcast with Dr. James Greenblatt who's been studying functional psychiatry for four decades plus. And even in college, he was studying vitamin B3 and mental health issues. And he's an expert in this. And we go deep into how our current understanding of mental health is completely wrong. And that we are not looking at the root causes, which include nutrition, toxins, our gut microbiome, and nutritional deficiencies and all sorts of other factors which aren't often looked at in traditional psychiatric care. So we deeply about issues like ADD and depression, anxiety, bipolar disease, schizophrenia, even things like Alzheimer's and even eating disorders. So we get in a really beautiful conversation about what will be the future of psychiatry for everybody, but you're not hearing about it from your psychiatrist. So check out the podcast, learn more about Dr. Greenblatt's work. It's quite amazing. And that was a very profound conversation for me. So I hope you like it too, and I hope you enjoy it. We're gonna dive deep into the work you've been doing for the last decades, what it means for us today, and why it's so critical to rethink psychiatry.

Great. Thank you. I have hundreds of hours of content that I've been teaching, but I've really kind of boiled it down to one sentence to help psychiatrists, just what you alluded to. We have a neck, you know, what connects our brain and our body. And if our mental health professionals understood that, then we could kind of make inroads into understanding what's going on. Yeah, that's such an important point because.

Years ago, like maybe almost 30 years ago, I started treating patients with functional medicine and I was treating their gut or their autoimmune disease or their allergies or some nutritional deficiency or their blood sugar, the list goes on. Whatever I found, I would correct, which is what we do. We take out the bad stuff, put in the good stuff. That's functional medicine essentially in a nutshell. But then I noticed all these other things were happening. The side effects were depression would go away, panic attacks would go away, Bipolar disease would improve or go away. People's autism would get better. Sometimes even go away. Kids with ADD would normalize. I was like, Alzheimer's would reverse. I'm like, what the heck is going on here? So I might jokingly call myself the accidental psychiatrist. And I wrote a book about it called the UltraMind Solution, which essentially is about how we need to fix our broken brains by fixing our body first. That's essentially what we do. So how did you kind of first kind of get the aha? We were talking about back in college, you were studying with the leading thinkers in psychiatry at the time, Dr. Abraham Hoffer, orthomolecular psychiatry. In fact, Linus Pauling, who won two Nobel prizes, one for discovering the structure of protein, the other for the Nobel Peace Prize for the nuclear test ban treaty, he basically wrote this paper that started the whole field called orthomolecular psychiatry, published in one of the leading science journals called Science. And it was called Orthomolecular Psychiatry about.

Correcting ortho means to straighten and molecular means molecules to straighten molecules to fix your your psychiatric issues, right?

So how did you kind of come into that?

Really, by accident in college, I just wrote a paper on vitamin B3 and brain function, and that's how I found orthomolecular medicine and Abraham Hoffer. So that was B. I mean, I know I wanted to go to medical school. I had no concept of thinking about psychiatry, but always interested in nutrition and brain function. Yeah. Kind of carried that through. I got diverted for about seven years where I went through psychiatry and child psychiatry and came out as a psychopharmacologist, but quickly realized why I went into medicine and got back into- you- joined the cult for a minute.

You joined the cult and then you got out? Is that what happened?

Well, as soon as I got in practice, you know, most of what I was seeing with kids with ADHD and I just realized the stimulants weren't the answer and got back to why I went to medical school.

Yeah, it's the same thing happened to me. I was like a family doctor. I sort of came in as a yoga teacher, studying nutrition, and really focused on fundamental lifestyle issues and diet and health. I mean, there were all these books. And nutrition against disease that I read in college by Roger Williams and changed my thinking about everything. And I got into medicine and definitely got sucked into the black hole and realized that she's, after four or five years of doing this, I wasn't helping people and I need to go back to the way I was thinking before and it was powerful. And in this view that you shifted your thinking, what were the sort of fundamental root causes that you're finding that account for the magnitude of the mental health crisis we're seeing now? And I include mental health crisis. I include ADD and autism and all these things, eating disorders, all of it.

Yeah, I mean the challenge 30 years ago and the challenge today he's that it's complex. So everything you mentioned that you look at as a functional medicine doctor plays a role in mental health. And then we throw in strong genetic vulnerability. We throw in stress and trauma. And each patient, even though they have the same diagnosis, 10 kids with ADHD, we're looking at 10 different causes. So the only path to really finding a personalized treatment plan is the objective testing that is just doesn't happen in traditional psychiatry. It's just symptomatic based medicine. And you just, you know, throw the dice. Maybe it'll work.

Maybe it won't.

Yeah.

I mean, that's such an important point because traditional psychiatric diagnosis is just based on describing symptoms. If you have these symptoms, it means you have this diagnosis. If you're have low energy, if you're sad and hopeless and helpless and you cry all the time and you don't want to eat and you can't sleep and you have no interest in sex. oh, you're depressed. That's what's wrong with you. That's the cause of your symptoms. No, it's not the cause. It's just the name of those symptoms, not the cause. And so how do you navigate to the cause? Take us through the thinking that you have when someone comes in with depression, let's say. How do you unpack that for them? Like you said, there's 10 people with depression or 100 people. They're all different. How do you begin to sort through the things that are root causes for these patients?

The first is, is working with the individual utilizing, you mentioned Roger Williams, a concept of biochemical individuality. Everyone's different. So I think when patients hear that, they're hopeful and that we're gonna look objectively at what's going on. And so it's that functional medicine workup. It's looking at hormones and minerals and it's understanding the gut. Um, so it's, it's a big objective laboratory workup. to, for step one. And I think what's missed in the functional medicine community a lot is step two and three.

Oh.

Because, yeah, you might get B12 deficiency and you might get hypothyroidism. Yeah. And they'll feel better. But guess what? They have three generations of depression and there's something else going on biochemically. So there we need then add, you know, the second and third layers. And sometimes it's medicine, number three. but there are also lifestyle changes or kind of nutraceuticals, nutrients that we can use at higher doses to affect behavior. So it's not just a pure functional medicine work. Yeah, it's functional plus. Yeah, totally.

I mean, I just think functional medicine is just a way of thinking and it includes all of it, includes pharmacology, it includes anything that works, whether it's trauma therapy or solstice, man, whatever. Right. It's finding the right treatment for the right person. And if someone's had a deep trauma, you know, it's not, it doesn't just register in their psychology, registers also in their biology. We know this from the childhood events score, the adverse childhood events score, the ACE score, that is highly correlated with not just psychiatric issues, but also autoimmune disease, cancer, heart disease, diabetes, obesity, you name it. So the functional medicine perspective is really different because, like you said, we unpack like there were causes, diet, you know, exercise, toxins, allergens, gut microbiome, nutritional, biomarkers, and even looking at nutritional factors in very different ways, looking at urinary metabolites, looking at various kinds of biochemistry that can tell us, for example, if there's inflammation in the brain. But we also look at genetics. You mentioned this sort of family history that people have of three generations. And now there's a whole field of nutritional and metabolic psychiatric genetics. so we can see what risk factors you have that predispose you, but that are modifiable.

Right.

So you're not doomed if everybody in your family is depressed. There's stuff you can do about it.

Absolutely, yeah. I mean, there's some clear genetic variants we know, like maybe an MTHFR gene, but as we get more detailed family history, oftentimes we don't know the genes, but we know there are three generations of depression or anger other mental illness. And it just kind of puts a perspective as to what the treatment model could be and where medications might or might not fit in.

So take us through sort of a depression patient and what would be the things that you're gonna sort of start with? What are the things you're gonna look for? What are the common things that you're gonna find? 'Cause you say it could be anything. There's a great cartoon I often would use in my lectures. It shows a family doctor looking in somebody's ear and goes, It could be anything. And then the caption is a way too general practitioner. But there are things that we know that play a big role. So maybe we can start to share what are the common things you're seeing in patients who have depression that are modifiable.

Sure. I mean, some of the nutritional deficiencies that are pretty common that any family doc could do would be vitamin B12 and D. and vitamin B12 is a pet peeve of mine because our normal range, the lab slips might say 220 to 1100, and nobody feels well with a level of 220. So there are times we've treated people with severe depression that we're told by their PCP, they have normal B12 and a B12 shot and they're on a different path. So some simple nutritional deficiencies and then we get into gut dysbiosis, so we look at organic acids, we look at trace minerals, hormones, and try to understand what's going on for that individual. One of the more common things that it's not commonly looked at, particularly for women, I've found, is low levels of amino acids. Serum amino acids being low, even though they're eating their perfect, you know, protein-rich organic foods. Why is that? The lack of hydrochloric acid. Oh, they're not absorbing it. And they're not digesting or absorbing any of the protein. particularly women that have been through stress or trauma. So somehow their digestive system just kind of stopped at some point years before the depression, not producing acid, not absorbing amino acids. We do testing and they're just deficient in every amino acid. And that's been common, particularly in women. So you give them then what? One, digestive enzymes with acid and just free form amino acids. They feel better in a week.

They due to specific ones like tyrosine or phenylalanine.

All the essential amino acids.

Five HTP or.

So initially it would be all the essential amino acids, so as a blend, and then sometimes we would increase with 5-HTP and phenylalanine. So this is like a powder pre-digested.

Amino acids that then just gets absorbed easily without having to go through all.

That process of breakdown.

Absolutely, yeah. Simple. So you see sort of malnutrition and.

Low nutrient levels, right, which play a role. Again, regardless of diet, people are spending a lot of money eating these perfect healthy foods and you look at their tests and they're malnourished. Yeah.

And there's a lot of things that play a role in mental health, magnesium, zinc, omega-3 fats, right? Copper. Can you talk about some of those.

And how they play a role? Sure. I mean, I think omega-3 is probably the most well researched and dramatic. I mean, it was research from when we were in college looking at omega-3 and depression, anxiety and suicide risk. The military has actually fortified rations. The US military, fortified rations with Omega-3s to decrease suicide. But it's still not standard practice. So we have more research on Omega-3s and brain health than any pharmaceutical.

Yeah.

But it's not standard practice.

It's not just doesn't, doesn't kind of hit the radar when you walk in the psychiatry office.

It's kind of part of that. Tell me about your mother. Alternative medicine, right? It's still alternative, even though it's research. So you mentioned the Omega-3s, the trace minerals, Magnesium is probably the most common deficiency, you know, and certainly anxiety, depression, ADHD, insomnia, cuts across all major psychiatric illnesses. And the zinc-copper ratio, most of the time, we see elevated copper in kids with hyperactivity, but in depression sometimes we see very low copper. So it's testing and then treating the objective tests.

Yeah, I heard a story from a patient once about their brother. I didn't treat them, but I. And they were living in Europe, and the brother had schizophrenia. It was pretty bad. And somehow he heard about or she heard about or somebody told him about using zinc, and he took high dose zinc, and his schizophrenia went away.

Have you ever seen anything like that? Fortunately, I've had one foot in traditional Psychiatry. I've always been in inpatient. So I've seen the sickest, you know, with those mental illness and. And we've seen psychosis reverse. Gluten is actually really common aggravant for psychosis, vitamin B3 and high copper as well. So there are a number of variables that if we just tested and looked for, we could reverse major issues. I think that's important. I mean, I've had a bunch of.

Schizophrenic patients, probably not as much as you, but I was like, listen, I don't know if I can help you, but let's look and see what we can correct and let's see how you do. And it's amazing to see how people improve. I mean, in the data literature, I looked at the literature about this because I was curious, but about 17% of people with schizophrenia have celiac disease. Absolutely. And it's undiagnosed. So in other words, you get rid of the gluten and they kind of.

Wake up from their psychosis. Yeah, no, I wrote a chapter in Hoffra's book just on gluten and psychosis. Besides the celiac disease, there's other mechanisms, the non-celiac. Yeah. And now with all the, kind of fuss on metabolic psychiatry and the ketogenic diets. Now we have other tools to treat psychosis. So there's information available. It's just not being applied. Yeah, I'm sure, you know, Christopher Palmer's.

Work, he's been on the podcast and talked about his work with psychosis and how he accidentally cured a schizophrenic patient by putting him on a ketogenic diet for weight loss and his psychosis went away.

Right?

And he wrote a book about it called Brain Energy, and he's been out there, which is fantastic. And it was funny because I had him on the podcast. I said, you know, this sounds a lot like what I wrote my book like 15 years ago. He was like, and I said, you might want to check it out. And he emailed me back a few weeks later. He's like, listen, I'm so sorry. I promise I didn't plagiarize anything. I'm like, no, it's okay.

This is just how the body works. Everybody's gonna figure it out eventually. Like it's not rocket science, but it's definitely not medical practice. And the good news, is that the information that you and I have been talking about for 30 plus years is now seeping into academic medicine. Yeah. So there are metabolic clinics at Stanford for psychosis. McLean is starting one now. So, yeah, it's, it's getting there. This is, I'm optimistic. This is amazing.

But again, I would, I would kind of worry that, that they're going to get short-sighted again because they go, oh, it's just a ketogenic diet, and that's the solution. No, it's not. It's all these other things because you can do a ketogenic diet. And if they have high levels of heavy metals or their guts a mess or they're having massive nutritional deficiencies.

That's been, you know, my pet peeve from, you know, psilocybin to ketogenic diets. These are tools, they help, but if you're not looking at the big picture.

You'Re gonna miss something. Yeah, I think that's important. And I think, you know, the whole theory now, I sort of start off with this concept of the madness of civilization and the different epochs in history where we had a different view of mental illness. And now it's shifting to another view. I think this is closer to reality. I think it's a much closer view of actually what's happening because historically our tools have been just really bad for mental health, right? We have therapy, we have some drugs which work a little but not that great. Yep, you're schizophrenic, it'll help put you in a zombie state, but the chemical straight jacket we call it, but it's not really solving the problem.

The problem over the years for me in teaching this material, It's not simple. You know, I make jokes, you know, I should have been a hand surgeon, you know, to learn six inches of the body.

Yeah.

Versus we don't know much about the brain.

The complexity of the human body is infinite and it's impossible for any one person, physician to understand, even if you're Einstein or, you know, the smartest doctor on the planet who's won 55 Nobel Prizes, you're still never going to be able to figure out the infinite complexity of the human body. There's 37 billion trillion chemical reactions every second. You've got 100,000 petabytes of data in your microbiome. You've got thousands and thousands of metabolites. You've got tens of thousands of peptides. I mean, there's just so much going on all the time that it's almost impossible to really understand it. But I would say using principles, theories, laws of nature, which I think is what functional medicine attempts to do is really describe the laws of nature when it comes to human biology. we can start to do things that work even if we don't completely understand them. We can help people improve their microbiome by changing their diet, by giving them prebiotics, probiotics, we can get rid of bad stuff, maybe give them antibiotics for SIBO or any fungal treatments, and it improves our overall brain health and mental health and wellbeing. So we may not actually understand everything about it, but we can still do it and it still works, which is kind of exciting. It's not like we have to, oh my God, I have to understand everything and then we can start to apply this. We can apply it right now and.

End suffering for so many people.

What I'm really seeing now, and this is worrisome to me, is this explosion of psychiatric issues and illnesses, of attention issues, of autism, of violence, aggression, behavior, suicide, the whole spectrum. And it just seems like it's more and more and more than it was 50 years ago. And I wonder if you have any insight, because you've been in this for about that long, what's changed? And is this really true that it's all increasing? Is it better detection or is it actually that more people are messed up?

I think it's clearly increasing. The good news is people now talking about it, but I think absolutely rates of childhood major mental illness from eating disorders to ADHD It's increasing. And I think the factors are broad. I mean, our diets are the, you know, ultra processed foods that are now catching up with us for the last 30 years has profound implications for child mental health. Social media, you know, I don't see it as the cause. I use the term the gasoline on the fire.

Yeah.

So I don't think it's causing it, but it's kind of, you know, the gasoline on the fire. And then, you know, all the environmental things that bind nutrients. A lot of my interest has been with the trace mineral lithium. Thousands of hair tests of kids with lithium. When I started, you know, I'd get like 25-30% undetectable lithium in the hair. Now I'm seeing 75%.

Wow.

So I don't know if it's the bottled water. We're not getting lithium from our natural tap water sources or other environmental things binding it. But I believe that's a factor. So between the environmental toxins, between the malnutrition, the sugar, the kind of, I believe the genetic vulnerability catching up with us, it's just a kind of perfect storm that has resulted in kind of this mental health crisis. Although, you know, I always stress that I'm tired of hearing the term mental health crisis. because I think the better term, at least for us, it's a crisis of care. It's the model.

Yeah.

Because it is treatable. It's not just numbers going up.

Yeah, I think this is so important and it's hard for people to understand the power of this approach. Oh, okay, take a little vitamin here, change your diet there, maybe to do this or that and it'll help. But we're talking about radical shifts in people's biology. that affects their depression. I mean, I remember one patient I had who had really severe depression. She also had really severe weight issues and gut issues and a million other things going on. And it turned out she'd really have those of mercury. And we treated her and her, all her symptoms went away. Her depression went away. Now, most psychiatrists are not checking for mercury. They're not checking your poop test. They're not checking your vitamin levels. They're not looking at you know, your hormones probably, maybe they'll look a little bit of thyroid if you're thyroid slow, they'll give you a T3. But this, it's kind of not even on the radar. I'm just so blown away by the degree of improvement in some of these patients. And I'm sure you've seen the same thing. I wonder if you maybe share a few stories of some of your cases over the last years and what you found to be so kind of mind blowing. if you're a longtime listener, you know.

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These are particularly children who were put on a trajectory of major mental illness, you know, inpatient hospitalizations, multiple medications. And once you're on that path, it's hard to get off that train.

Yeah.

You know, I have a bunch of cases with just celiac disease. So chronic malnutrition from age six to age 12 is gonna, for some individuals, result in major mental illness. Anxiety, depression, and just treating the celiac disease, those symptoms get better. So my favorite stories are kind of these irritable, aggressive kids kicked out of private schools.

Yeah.

You know, schools that are getting a lot of money from a parent. and low dose nutritional lithium kind of was the answer. They have a family history of major mental illness. They're aggressive, they're irritable, and just small amounts of nutritional lithium was enough to kind of keep them behaving.

So it was like behavior issues, ADHD.

And these were kind of more severe, but they were ADHD. But the impulse control was such where they would hit other kids.

They were violent. Kids, yeah. and they're many sociopaths.

Well, no, they. They felt bad. The sociopath wouldn't feel bad. These kids would hit, and then they'd feel terrible. They just couldn't control their impulses. But these tiny amounts of nutritional lithium, they were able to kind of inhibit that aggressive impulse and. And be able to actually get back in school.

It reminds me of a case I had who had severe behavior problems. He was 12 years old and. been kicked out of kindergarten for being disruptive and was on Ritalin for years and diet fully junk food, processed food, just struggling, very, very sick. And also had other issues. He had gut issues and neural bowel and allergies and headaches and insomnia and anxiety. So he had a whole list of problems, right? Anal itching and things that most psychiatrists wouldn't pay attention to or care about. but they were all bits of data that were highly important. So things that most psychiatrists would discard as, oh, that's not my domain are actually the answer. Right? Right. And they're not looking in the right place. And, and this kid was just such a striking case because we, we basically put him on elimination diet, got him on Whole Foods, replenished the nutrients that he was missing. It was missing everything. Zinc, magnesium, Omega-3s he had high trans fats. He had low B6. I mean, just the whole bucket basically was empty. We got rid of a little lead that was in his system and we fixed his gut. He had a lot of grow overgrowth of yeast because of all the sugar and everything ate and we kind of cleaned up his gut. And two months later, the mother comes back and she's like, well, my little kid's better. And I'm like, really? She said, yeah, here's his homework from before and after. Here's his handwriting before and after. And I'm going to put in the show notes. I wrote an article about this in a medical journal and I published it because it was just so compelling. and you couldn't read his handwriting. He had severe, we call dysgraphia, which is really bad handwriting. I got mine after medical school, so I don't think I was sorry. It was an early onset condition. But his handwriting in two months went from illegible to perfect penmanship. There was no occupational therapy or handwriting lessons or any of that. It's just his brain went from being completely asynchronous, chaotic and dysfunctional, to functional and coherent. and he was able to actually not only have better handwriting, but not have ADD anymore, not have behavior issues, not have any of his other health issues, like his gut issues and his headaches and his skin issues and his allergies all went away. And I was like, wow, this is amazing stuff. And that's kind of what got me to write this book, the Accident of the Ulcer Mind Solution, and talked to this kid, years later, and he graduated from aerospace engineering or something, you know, so we really have a whole generation of kids that are being neglected, in my view. they're being maltreated because they're not actually taking advantage of the current evidence of science. Because what we're talking about is not stuff we made up, you know, in our garage. It's stuff that's in the literature, right? It's just not being applied. Right. So maybe take us through the lithium story because I think most people might not have heard about this. Lithium sounds like it's something you treat bipolar patients with. It's something that's we learned in medical school is toxic. You have to measure blood levels and you don't want to take too much of it and you can get thyroid suppression and It's like a little bit of a hairy thing when you use it as a doctor. So can you take us through the difference between therapeutic medication, pharmacologic doses, and nutritional therapy? Sure. Sure. What we mentioned some of the causes, filtering water that's in our soil, it's in our water, but we're not getting those now as you're seeing this increase in sort of nutritional lithium deficiency. And we don't think of it as a vitamin or mineral. We need calcium, we need magnesium, we need zinc, but Nobody says, oh, you need lithium, right?

So in my world, and my work is, I'm quite convinced there's such a thing as a lithium deficiency disorder. So lithium, the story, it goes back, you know, 13.8 billion years, the big bang. No. So there are only three elements, hydrogen, helium, and lithium. Really? And the big bang. So lithium goes way back and the earth's crust is filled with lithium. So lithium is a natural element. and it's essential for human health in small amounts. And the early studies in lithium in the seventies demonstrated the amount of lithium in the tap water, in our drinking water, varied geographically. If you, first studies were in Texas, one part of Texas high lithium, guess what? They had low rates of suicide and mental illness. Another part of Texas had low lithium, they had high rates. Interesting. and we've done these studies all around the globe. And the amount of lithium in the tap water predicts exactly rates of suicide, high lithium low rates. And we can 15 different countries, millions of data points.

So it's a pretty strong correlation. It's not causation, but it's a pretty strong correlation, right?

And so it's an essential mineral, and I'm convinced that genetics, some people need more. and also nobody's drinking tap water anymore. We don't get a lot from our food. Most of it was from the water. So that small amount of lithium, two micrograms, milligrams a day might be what we need as some people estimate. Many people aren't getting it.

Yeah, there was a day when tap water was safe to drink.

Not anymore.

We never had a bottle of water.

I was like, you just drank the tap water. Those individuals with family histories of addiction, aggression, bipolar, I believe those families have just a higher need for lithium. And if they're in the wrong, you know, geographic area, they're gonna have symptoms. So small amounts of what we call nutritional lithium, one, two milligrams can have major implications for mental health.

One or two milligrams?

I start at one or two, maybe go up to 10 or 20 milligrams.

In medicine, when we use it for bipolar disease, it's like 300 or 600 milligrams.

Or 1800. Right. Yeah.

Yeah.

So six to 1800. It is, it is toxic, does have side effects, affects thyroid and kidney. So as psychiatrists, we shy away from prescription lithium. But as functional docs, we should be thinking about low dose nutritional lithium.

And how do you measure it? Cause it's not on blood tests that you can do or you have to.

Do a hair analysis. Hair analysis is, I find the most helpful. There should be no blood level of lithium for any of us. So blood tests aren't gonna help. so a hair test, we all should have a little lithium in our hair, and you'll see many individuals have undetectable lithium.

So normally when you have something in your diet, a mineral, it gets excreted in the hair, whether it's heavy metals like mercury or minerals. So a hair test can check for minerals, it can check for metals.

So it's a very useful tool. We don't use it much in medicine, a little bit. 30 years ago, I wouldn't get up in front of my colleagues and talk about a hair test, but now it's so essential to my practice as a child psychiatrist, I'm very comfortable. talking about looking both at heavy metals, lithium, magnesium, copper thing.

Yeah, I mean, there was a Gemma article published years ago about President Andrew Jackson, and the article was basically talking about how crazy he was and how they found a bunch of his hair, and they analyzed his hair, and in his hair they found high levels of mercury and lead, which makes you crazy. Sure. And the mercury came from a remedy that was used for almost everything back in the 1800s. called Calomel, which was a remedy for infections and for pretty much everything. So Lewis and Clark took it across the country. And also he was a bit of a hothead and he would get in all these duels and get all this lead buckshot in him. So the lead, the gunshots and the mercury made him a little nuts. So that was Andrew Jackson. But that was a hair test that they published in JAMA. So it's not that medicine doesn't understand that these things are in hair. what is the sort of level of evidence around lithium use and the issues around mental health? Are there any clinical trials? Is it all sort of population-based data? What do you know about the data on this?

We have a lot of literature on the psychiatric doses being helpful for dementia as well as aggression, irritability. And we have a lot of epidemiological data extensive on these trace amounts in the water supply. So we know again, suicide risk, dementia risk, aggression based on how much is in the water. There has not been a lot of studies on low dose nutritional supplementation. There's a few based on research looking at dementia and Alzheimer's, so low dose preventing cognitive decline and a few looking at addiction treatment.

You know, in medicine, we have kind of a snotty view of anecdotes. We call them anecdotes. But, you know, they're also anecdotal. And they're also what we call N of 1 studies, where if you have a person and you do something and they're their own control. And now, of course, placebo plays a role and a lot of other factors. But, you know, tell us some of the stories about cases where you found significant deficiencies, like you mentioned ADD. what has been the clinical outcomes from using these low doses of 1 to 5 milligrams?

I think the term that cuts across all major psychiatric illnesses and many of us would be the concept of irritability. So to me, that is the symptom that lithium helps. So I've seen, you know, a woman came to see me for depression. She couldn't get off her antidepressant. She was an alcoholic, family history of alcoholism. While we were waiting for the testing, because of her family history, I just gave her five milligrams of lithium. When she comes back in the office to go over the testing, she just started crying.

Really?

Why? 'Cause she, one, felt so good. The five milligrams of lithium, she said she didn't realize how angry and nasty she was to her adolescent daughter and her husband.

Wow.

But just that five milligrams of lithium completely took that away. And again, wouldn't be for everybody, but we have found, actually I learned this from Jonathan Wright, 40 years ago, those with family histories of addiction, particularly responsive to this low dose lithium.

Really, it's such a benign treatment and it's so inexpensive, like literally pennies a day, right?

Right.

No blood level, no side effects.

How does it work? Do we know how it works? It's fascinating actually. There are hundreds of mechanisms, you know, both affecting genes, second messengers, Affecting neurotransmitters. I mean, really, the list of 20 or 30 mechanisms that we've identified over the years and which mechanism, you know, is the answer? It's hard to tell. I mean, lithium increases BDNF, brain-derived neurotrophic factor, both the genetic synthesis as well as rates in the serum. And so we have literature supporting it.

That's amazing. and you also talk about lithium as a treatment in the Alzheimer's area.

The prevention, yeah. And again, we've known prescription lithium. Those with bipolar taking it less dementia rates. We started looking at low dose lithium. We have one, two, there's some four year studies. It prevents cognitive decline.

Wow.

There are biotech companies looking at drugs that are called GSK-3 inhibitors, right? and lithium is a GSK3 inhibitor, so it kind of prevents some of the buildup of these tau proteins and things.

It seems like a hair nose, which is pretty expensive and easy to do and non-invasive should be part of every new psychiatric practice.

I would think so. It's certainly my recommendation. I mean, we have so many tests as functional medicine doctors, but I do think there are a core set of four or five tests that should be done on every psychiatric patient to be able to kind of start.

I have tried. What are yours?

Mine for psych patient would be cryptopyrrol, amino acid, fatty acid, organic acid and hair test. Besides the routine, you know, lab core, B12 and D and all that stuff. Yeah.

Omega-3 fats and celiac gluten.

Absolutely.

That's up there. So you just mentioned a bunch of stuff. that probably most people have never heard about, amino acid testing, organic acid testing, pyrrole testing. These are things that are pretty common in the functional medicine world, but that are not part of standard medical practice. If you go to your doctor after you listen to this podcast and ask for, can I always have a pyrrole test or organic acid test? They'll look at you like you're, you know, from another planet. How a psychiatrist or someone in the.

Mental health field can start to learn about this. It's challenging and that's why we started Psychiatry Redefined. So it's really set up for professionals to, it's kind of a two year training program because it does take time to help them understand some of these tests and to interpret them and then how to treat patients. Because, you know, our psych patients are sometimes challenging for lots of reasons. So we can't just throw 20 supplements at them. So there is a, an art and a science to it. So, you know, many of the lab companies offer trainings. but it's not focused on mental health. So, you know, wasn't on my plan to be teaching this years ago, but there just wasn't enough out there.

Nutritional functional medicine psychiatry is something that's, it's such a gap in the, in the field of medicine. And there are just a few people doing it now. I I'm just stunned at how effective it is, you know? It's one of those things in medicine where you're like, wow, this is just short of a miracle. I hate to be hyperbolic about it, but if you kind of check out Dr. Greenblatt's books and read my book, Cultural Mind Solution, it's just this case after case of miracle stories. I mean, like I had a girl who was this violent little girl, she was nine years old, super aggressive, kicked out of class 10 times a day, couldn't make it home on the bus without the bus having to stop 10 times, basically, almost suspended from school. And she was this beautiful little nine year old girl and she was beating up on her sister and tearing pictures of her family apart. It's like kind of a terror. And she didn't have any gut symptoms, but I did check her organic acids and I found this is a urine test, non invasive, easy to do on kids. And she had extremely high levels of bacterial overgrowth and yeast overgrowth. And by the way, for people listening, you know, it's kind of shocking to think about it. But, but there's a lot of things that happen in your gut and those things get translated across your intestinal membrane and get absorbed in the blood and they come out of the urine or you can check them in the blood. So we're gonna be able to soon look at your microbiome by doing a blood test. So that's crazy to think about, but I was talking to Leroy Hood, who's the father of systems biology yesterday, and he was going through this and I was like, this is amazing.

So, so this little girl had really high levels.

So what did I do for her? I didn't give her, you know, a psychiatric drug to calm her down or some anti-psychotic or some, you know, thing to kind of suppress her symptoms. I just gave her an antibiotic and any fungal, and I gave her a little gut repair. And the mother came back, you know, a few weeks later, and she's like, she's perfect. I'm like, really? You gotta be kidding me. Like, that couldn't have worked. But it did. And it doesn't mean that every kid like that has that problem. Like we said at the beginning, just because you know the name of the diagnosis doesn't mean you know what's wrong with you. You gotta dig and you gotta find out because it's different for everybody. So you just mentioned a word that probably no one's ever heard about, Cryptopyloridaria, which is a big gobbledygook mouthful of scientific term that is basically something that has been linked to psychiatric disorders. behavior issues, aggression, autism, ADD. It's something we don't learn about in medical school. It's something I learned about afterwards. And it's something that we can actually test and treat. So what is this compound? What is Cryptopygaria? Why does it occur? And what is a cause? And how do we begin to think about treating it and testing for it?

As you said, it is a simple urine test that I believe has profound implications for mental health. the problem for me, it's one of the few things that I teach now, I don't have a lot of research, but I have thousands of clinicians and my 30 years with clinical experience that if we can detect this chemical in the urine, we know that these individuals are gonna be functionally deficient in two nutrients, B6 and zinc. So this some kind of pyrrole molecule most people don't have high amounts. If you do, it binds B6 and zinc, and both are critical for mental health. B6 for neurotransmitter synthesis is zinc for hundreds of enzymes. So over time, the depletion of B6 and zinc, we see symptoms from anxiety. I've seen depression. I've seen paranoia. I've seen actually every psychiatric symptom. It doesn't always is the answer, but until we treat it, we can't treat anything else.

Yeah.

So again, it's an inexpensive test. Implications are profound. We give B6 and zinc, and some of these kids have tremendous deficiencies. Normal doses are just, the zinc is pretty normal, 30, 60 milligrams. The B6, we can actually push up. So much higher than I might normally. So it could be 50, 100. I've been up to 400 milligrams. Again, it's such a simple test. We just make sure it goes down. and under stress, we can see individuals will produce more cryptopyrrole so they can kind of modulate stress by taking more B6 and zinc.

So what causes it? Is it a genetic thing? Is it acquired somehow by what you're doing or eating or.

We don't know. I mean, the kind of word, you know, in the communities, it's likely genetic in terms of how we produce it and. the, and then under stress, it just gets higher. But it is a screening test on every individual. Is the treatment?

I mean, does it, does it really work when you give these? Oh, it's traumatic.

B6 and zinc. Now, it might be, might have an ADHD keto. Might have elevated cryptopyrrole, high copper and low magnesium. So you can't just do the B6 and zinc.

You're gonna give all these. You can't do one thing. You gotta do everything.

Right.

You gotta kind of, it's not the kitchen sink, but it's, it's a very. selected group of interventions based on that particular person's findings. And this is really precision psychiatry. It's really where we're all headed. Absolutely. And precision medicine in general, it's not one size fits all. Okay, you're depressed, take Prozac.

But depression is not a Prozac deficiency. ADD is not a Ritalin deficiency, right? And we're moving along pretty quickly in oncology and other medical specialties. Psychiatry and mental illness is just really lagged behind that concept of precision medicine.

Yeah. And it's exciting to me to see that it's actually starting to happen. Like you mentioned in major academic institutions or departments of nutritional psychiatry, metabolic psychiatry, looking at the microbiome and mental health. I mean, it's quite amazing to see the changes happen since the last few years. So I'm pretty excited about it. I think it's not fast enough for the amount of people that are suffering, but it's pretty cool. You know, one of the things you work on that I think is really important and is a tough condition to treat, which is eating disorders. You know, most people have a view, and this goes back to the original sort of conversation about Michel Foucault and madness and civilization, that eating disorders are a result of controlling parents, and it's the parents' fault and the kids just trying to control the thing that they can control, and which is why they starve themselves or they have bulimia. And it's not quite as simple as that. Right? So can you kind of unpack what we know from a functional medicine perspective about anorexia? And I, and I had a number of these patients early on, it taught me a lot about, about this condition, but what do we know about how to think differently about taking care of these patients in a way that actually helps them?

Sure. I think one thing I didn't know when I got in the field of eating disorders is it is the most life threatening psychiatric illness. So eating disorder patients have the highest risk of suicide. Highest mortality rate, the same as overdoses. So it's a life-threatening illness. And our traditional model, we have no medications and we have no consistent therapy.

Remember Karen Carpenter? She was like, probably most of you don't know what that is, but she was like, it was a band way back in the 70s.

That's true. She had anorexia, she died from it. Yes. And so our model for years was just feeding calories, and they would gain weight and then go home and relapse. And then give them junk food. Anything to gain weight calories. and so what we're now understanding that I'm still hitting, you know, my head trying to get people to appreciate is it's pretty clear these individuals are malnourished. I believe anorexia nervosa in particular is a zinc deficiency disorder. It's the clash of puberty where you have a high need for zinc and sometimes a diet deficient in zinc.

67% of kids diet is ultra processed food. which essentially has no zinc or anything else except sugar and processed ingredients.

And then we go through puberty. We have a higher need for zinc. And guess what? Genetically vulnerable individuals. So what we do know about eating disorder is highly genetic. And then one of the causes is malnutrition. And then this disorder goes. Now, there's clearly other factors, you know, psycho-social and social media and parents and pediatricians calling these kids fat or they need to lose weight. There are multiple factors. But what happens is a change in diet, restrictive eating, malnutrition.

But is it chicken of the egg, right? If they don't eat, obviously they're gonna be malnourished, but is that what caused them to not eat in the first place?

No. So anything might cause them to not eat. I need to lose two pounds or I want to lose weight for this sport. So any form of dietary restriction starts that process. But again, 10 kids who go on a diet, only one might develop what we call anorexia nervosa, this unrelenting kind of fear of food. So again, it's a genetically vulnerable individual, malnutrition, psychological factors, perfect storm. and it's a life-threatening illness.

Yeah, and it's really resistant to treatment. So how do you treat this? And what's the success rate you're seeing in these patients?

Well, the standard of care is somewhere, you know, 50-60%. I think the programs that I work in at Walden and other programs where we have been able to kind of diversify and look at micronutrients, I think the success is much higher. And patients I see in outpatient, who can really follow a micronutrient repletion plan completely can recover.

That's incredible. I mean, that's a really hopeful story because it's, it's, like you said, it's one of the most serious psychiatric conditions and it's, you know, the whole kind of culture of being afraid of being overweight and, and body dysmorphia, it's a real thing and it's, it's amplified by our culture, but But the underlying kind of place where that lays on top of is a place of all sorts of other factors that are predisposing people like nutritional deficiencies.

Yeah, there's an underlying genetics, clearly biology, brain's different, everything's different. Part of my goal is just stopping the blame game of parents blaming kids and kids blaming parents. They can appreciate it as a serious medical illness. there's a path to treatment.

One category of mental illness, I don't really have been talked about much is personality disorders, narcissism, sociopathic behavior. I talked about this before in the podcast, but I've read a study, a couple of studies about juvenile detention centers and prisons where they swap out the bad food for good food. And there's like 97 drop in violence inside juvenile detention centers or a 56 drop in prisons and 80 of you add a vitamin. Yeah. So what about personality disorders? 'Cause it's kind of a black box in medicine. There's really no good treatments. There's really no good approaches to it. There's no drugs for it. What have you found in your career as a psychiatrist who practices this way that may be helpful for some of these personality disorder patients? 'Cause just to kind of back up a little bit, the way we define personality disorders in medicine is, you know, a neurotic person or neuroses, is someone who thinks everybody else is fine, they drive themselves crazy, and a personality disorder thinks they're fine and drives everybody else crazy. Fact, right? So it's kind of the definition.

So if we just separate some of the personality disorders, if we take one that's common, talked about borderline personality, these are individuals who are impulsive, emotional, irritable, angry, labile. So we call it a personality disorder. We say it's just who you are. We can't treat it. But those are all responsive to nutrient interventions, particularly the low dose lithium I talked about, the Omega-3s I talked about, and magnesium that you brought up. So I've seen these personality disorders, some of the disabling symptoms disappear.

Yeah. So in a way, you know, borderline is kind of borderline psychosis, so it's a little bit more extreme kind of, what about narcissism? Is that also related?

Not probably the personality disorder, but maybe some of the symptoms. What if we again, just took that irritability and quick to anger? So yes, that might be responsive to magnesium and nutritional lithium. But some of the other kind of personality structure is probably who you are.

Well, I'm just so inspired by this conversation because I think that most people have a view, fatalistic view of mental health issues. if you're a depression, it's kind of a terminal illness. If you've anxiety, you just have anxiety. If you have a schizophrenia, well, good luck, you know, if you autism or ADD, and you got to live with it. And what you're proposing is a whole new rethinking of Psychiatry and reimagining of mental health that redefines it based on our current understanding of how the brain and the body are connected and how everything from nutrition to exercise to our gut health, to toxins, to our genetics, to anything that drives inflammation. Because basically most psychiatric issues are really about neuroinflammation in the brain, whether it's autism or Alzheimer's or ADD or depression, we're learning that they're all basically inflammatory.

Disease of the brain. And- Suicide risk. I mean, we know inflammatory markers in.

The brain predict suicide. We have the research. Ignored. That's incredible. I mean, and, you know, suicide is a third leading cause of death in teenage boys. So this is a big deal. and what causes inflammation, mostly our processed food diet and environmental toxins and our screwed up gut microbiome from eating that way. And it's like a simple fix, really, if you look at actually what's going on and yet we don't really approach it that way. So your whole reimagining of psychiatry, you call it psychiatry redefined, I think it's just an incredible gift to the world. I think your work is so important. And I sort of want to sort of close by talking about what you call the plus minus healing plan in psychiatry. 'Cause I think it's a useful heuristic or kind of rule of thumb to use to think about how we start to approach people with pretty much any disease, but we're talking here about mental health.

Yeah, no, I mean that's how we kind of wrote the Finally Focus, the ADHD book. You know, how to explain functional medicine to a parent.

Yeah.

And so we just came up with this plus minus plan, plus meaning what things do you need to add? And that could be everything from nurturing to magnesium to other phytochemicals. And then what things do you need to minus? And that could be food additives, ultra processed foods, high copper. And so we just listed 10 things plus minus helped them kind of with a guide of how to test and then how to treat. But I just think it was a simple framework to help parents really appreciate that there are things that might be contributing to their kids' symptoms.

Yeah, it's very similar to my mentor, who I'm sure also you've learned from as well, Sidney Baker.

Oh, absolutely.

Who was, you know, one of the, I think one of the unsung heroes of modern medicine has really came up with a lot of the, fundamental, I would say, concepts or heuristics or frameworks to think about complex chronic illness. Yes. And he said, you know, you have to think about what you need to get rid of and what you need to get.

Right.

So you get rid of the bad stuff and you put in the good stuff and the body knows what to do. So you don't actually have to understand it all. You just kind of have to go hunting for what's the bad stuff and get rid of it and have to go hunting for what's the good stuff and add it and, and what's missing, right? The stuff that's missing. and there's basically ingredients for health and impediments to health. And if you remove the impediments, you add the ingredients, the body is pretty smart. And even if we don't know exactly how it all works, it works and people get better. And that's at the end of the day, what we care about is helping our patients and helping people and needless suffering. And that, for me, is really what drives me. It's just the, the, the, and I, I'm just, I'm flooded every day with requests for help because of what we do. And I'm like, God, this is so easy to solve and nobody's helping you and I'm so sorry. And yeah, I'll try. And, you know, they come to my practice, the Ulcer Wellness Center. It goes to you and where you, you practice in, at, at Walden, which is a psychiatric treatment center. People can get this help, but it's far and few between it. It just really needs to be developed at scale. So if you're out there listening and you're a mental health professional, if you're a psychologist, a psychiatrist, a counselor, in any space, this is something you should pay attention to and check out Dr. Greenblatt's work. Go to psychiatrydefined.org, you can take the courses. The reality is this, a lot of this stuff doesn't require any kind of sophisticated treatment other than like diet, lifestyle, and sometimes supplements that can be very helpful. So the basics actually are quite simple to implement. Like you say, take out the bad stuff, put in the good stuff. cross your fingers and see what happens. Now, it's not going to fix everybody, right? You're still gonna have to then go dig in. And that's when you need help from somebody like you or me who can really dive deeper into the story and figure out what the issues are and do deeper diagnostic testing. But I'm curious how you're received now, you know, in terms of your work around the psychiatric community. Are they, are they welcoming now? Are they dismissive?

Are they curious? Are they like, I don't know, I'm busy. Don't bother me. Well, I mean, I've kept my one foot in traditional psychiatry by treating, you know, anorexia for 25 years. 'Cause I could talk about zinc and fatty acids 'cause everyone was malnourished. But I would say the last five years, I've been doing more talks for traditional psychiatrists, big psychofarm conferences, and hundreds of docs. And it's been amazing to me, I've been talking about this, and they're asking questions about themselves and their families. Yeah, of course. They're not realizing that they could utilize this information to treat their patients. Right. But at least the traditional psych world now clearly is ready for the information.

Yeah. So, yeah, it is. It seems like it's a very auspicious time where things are actually starting to shift and change in the paradigm shifting and the convergence of systems biology and diagnostic testing and ability to actually track what's going on. co-founded a company called Function Health, which allows people to get access to their own data and their own lab testing. So a lot of things you're talking about, we measure, right? We measure metabolic Health. We measure nutritional things like B12 and methylic acid and vitamin D and magnesium and zinc, just standard, right? Copper we look at, and we can also look at Omega-3 fats. So a lot of things that you're talking about, we do. And I think it allows people to start to have agency and ownership over their own health and become the CEO of their own health and be guided by simple insights that could be helpful. So it's super exciting. I think, you know, people can check out your book, Functional Medicine for Antidepressant Withdrawal. You have another one called Finally Focused, the Breakthrough Natural Treatment Plan for ADHD that Restores Attention, Minimizes Hyperactivity and Helps Eliminate Drug side Effects. You've got a Psychiatry Redefined Fellowship and ADHD intensive for practitioners. Could have just kind sailed off into the sunset and relaxed playing golf somewhere, but you're working hard to make sure that all the amazing wisdom that you've accumulated through decades, literally almost half a century of practice and learning are accessible to the next generation of practitioners and are gonna help millions of people. So thanks so much for your work and what you've done. Any final thoughts or?

No, I think we hit a lot and I think we've said it a couple times, but I think the most important thing in functional medicine for psychiatry is everyone's different. and we really need to kind of provide the path for hope as we look for what's going on with that individual.

Yeah. So I would say if you're out there listening, hope is really the word I would leave you with, which is despite what you may think and what you've been told by the traditional psychiatric world, there are a tremendous number of things that you can do and learn about and get help for that are outside the box, that are really not outside the box, that are in the scientific literature, but they're not in the practice, they're not in the clinic. You can learn more about it. You can check out my book, UltraMind Solution. We're going to put all this in the show notes. So thank you all for listening today to this conversation with Dr. James Greenblatt. Thank you.

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