How FUNCTIONAL MEDICINE Can Treat OCD | Mark Hyman & Dr. George Papanicolaou

We know in functional medicine, we know the strong connection between the gut and the brain.

We often think these are psychological problems, but they're not. They're biological problems.

It affects about 2.2 million adults, 500,000 children, which is about 1% of our population. The average onset of OCD is 19 years old, and 25% of people with OCD experience it before the age of 14. So that's about one in 200 children will have it. And so in an average size elementary school, two to four kids will have OCD. And in a large high school, about 20 kids will have OCD.

It's rough.

Yeah.

Tell us about how common is this, what are the symptoms, what do we know about it? What's the general sort of approach? And then let's get into sort of a functional medicine perspective.

It's OCD, it's obsessive compulsive disorder. So as Mark, as you said, it is very uncomfortable for people because they have intrusive thoughts that they don't want. They have thoughts and images, impulses that occur over and over and it's out of their control. And that's that obsessive thing. One person described it as, being on the side of a raging river, falling in and not being able to get out for hours.

Wow.

And not having any control while you're in that river. So then you have the compulsions. So that's the second part. The compulsions are those behaviors that a person engages in to try to neutralize or counteract those obsessions and the feelings of anxiety and anger and agitation and frustration that they have. Because when this happens, when they have those images, when they have those compulsions, it keeps them from being able to be productive in relationships and at work. And it's very difficult to conduct a life. That's obsessive compulsive disorder. That's what it will look like.

And the compulsions, what are the most common compulsions that people have that we know about?

Yeah, so common compulsions are going to be repetitive behaviors. repetitive thoughts. They'll be thinking like excessive cleaning, washing, bathing. They're afraid of contamination. They're afraid of dirt. They're afraid of chemicals. They're afraid of those types of things. And they're afraid that they're going to cause a disaster, like something they do, if they drop a piece of paper or if they leave something in the driveway, they're afraid that they're going to cause a car accident or somebody's going to slip and fall, it's going to be their fault. Now, we all have those thoughts, but these just occur and occur and occur over and over and over again and they can't get it out of their mind. So that will lead into checking and they'll go in and out of doors because the door didn't close right, they'll do repeating things, they'll count, I had one patient who would, when their movie credits were rolling, she would focus in on the letters, on the letter Z and count how many times it would show up in movie credits.

Wow. Yeah, I know. It's pretty bad. I mean, I've had a number of patients that just really horrible. It's controlled. One, one woman, just in particular, was so striking. She, she never cleaned her house because she didn't want to move anything off the and she had some compulsion or obsession about it being able to not deal with that. And her house was a scary place. And she thinks she was a crazy person. When you talk to her, she seems reasonable and nice, but you go in her home and it's like a nightmare. And it was really unexpected what we found worked for her because she tried lots of things and nothing worked. So let's talk a little bit about the approach you would take from a functional medicine perspective. How do we think about this differently? what are the kinds of things we want to look at? Because it is something that really affects people's quality of life. They have trouble with social engagement. They really struggle to kids who haven't struggled to leave home and live by themselves. It's hard to have relationships and these kids often remain financially dependent. And so from a traditional medicine perspective, we don't really have a kind of a clue about why this is happening, right? But what do we know about the causes?

Well, so I want to remind, and you've said it already, it starts when you're young, it peaks around 19, and it continues chronically through life. It doesn't go away. And that's an important point to make because when we talk about the treatments that are the conventional treatments, I'm going to make some points about their effectiveness. And it's important that they be effective long-term. Just as an aside to this, because I think it's important to understand as we start talking about the differences, is that the, and we might as well just jump right in, the common understanding of OCD is that it's, there are many potential causes, by the way, but in conventional medicine, it's more seen as a chemical issue, and it's treated with serotonin reuptake inhibitors because it's considered the primary issue is low serotonin. Now, there are multiple other possibilities that I want to mention, but in conventional medicine, it's really practically treated as a simply chemical problem that has behavioral characteristics. So we use another technique that's been proven. It's the only intervention that's a counseling type therapy that's been proven effective and that's cognitive behavioral therapy. So those are the two main therapies that you're going to be offered when you walk into a conventional doctor's office.

And.

We know that there are other causes that are being studied and these are One of the, so genetically, so there are some genetic factors. So some recent research that was done through John Hopkins and other networks of schools that got together, and they did a study using throughput genetic analysis, where they're able to look at multiple series of genes so they can look at multiple genomes at once. and they can really hone in on genes that are producing abnormal proteins and they can determine which ones are related to OCD. And just, it was, I think, just published this June in Jama Psychiatry, and they looked at about 1300 patients with OCD and age, you know, and then similarly matched controls, and they looked at the DNA in both groups and they identified a gene, it's called the SKRT, no it's SLITKR5 gene. And it has been looked at before for OCD, but they found that it was very prominent in all of the people with OCD and not in the people without OCD. So they're really excited about this gene because then they can do this targeted therapy to turn that gene off. So there's genetics. There's an area that I think is really important and there's more and more research being done is the idea of inflammation in the brain and the role of the gut microbiome. And so, studies go back to 2017 when they did a research study at McMaster's University and they looked at 20 OCD patients and they, again, with matched controls. they did DNA analysis of their stools, and they found that people with OCD had a very low abundance and variety of the key bacteria in the microbiome versus their control group. So that was one study that started to have people start to think, well, the gut microbiome, we know in functional medicine, we know the strong connection between the gut and the brain. And now there's more and more research trying to connect the gut to mental health and psychiatric disorders, particularly OCD. And other studies are being done, and one focused in more on trying to find species of bacteria that might be involved in OCD, whether they're inflammatory or whether they send other signaling to the brain, we don't know yet. But people who have OCD tend to be really low in Lactobacillus rhamnosus and Lactobacillus casei. And so, and some of the, and there's another bifidobacteria species. And so now we're, research is getting us to the point where we're even starting to be able to investigate species of bacteria in the gut that play a role in OCD. We're not sure what that role is, but there seems to be a connection. And, yeah, there's, and there, they did a really Another really cool study that looked at inflammation and dysbiosis. And this was in 2020, actually, at McMaster's University. And they used PET scanning to look at different areas of the brain. And they looked at blood and they looked at stool. And what they were able to find was that people with OCD, again, building that previous study, had really low abundance of particular colonies in their gut, and they had limited diversity. Again, no abundance, no diversity. With those same people, they had a matched group, and the other group had a lot of diversity, a lot of abundance, and they also then compared inflammatory markers. CRP is an inflammatory marker. IL-6 is an inflammatory marker. TNF alpha. And they look at those inflammatory markers and the OCD patients with that low abundance and low variety had high inflammatory markers as well versus the control group. So there's this building data and research. It's early yet, but starting to connect the gut microbiome to inflammation in the brain. And that's a really important thing. And so, inflammation is, I think, one of the areas that holds a lot of promise. Understanding the connection between the gut and the brain is really important. So, the genetic piece, there is a biochemical piece. There are blood flow issues that have been identified. And so, those are some of the important possibilities for what might be at the root cause. It may not be one thing, it may be all of those above, but it certainly isn't one thing and that's how it gets treated in primary care. It gets treated as one thing, low serotonin. And we know that they're only about 50% effective and they have lots of bad side effects.

Exactly. And those are the antidepressants like Paxil and other things they'll use for for OCD. You know, you brought up a couple of things which reminded me of a patient I had. And this was really at the beginning. I wrote a book called the UltraMind Solution 2008, I think. And in that, you know, in that book, I talked about these stories of patients who had just remarkable, surprising findings. And, you know, I didn't really figure this out by doing the research, but by treating patients and seeing what happened in observing. And then, and then I began to sort of dig into the research, and now the research sort of is picking up a little bit of what the clinical observations were, which was in this patient I told you who had really bad OCD, she could never clean her house, it was stuff on the floor all over, it was just like a disaster mess. Turned out when I did her testing, she had massive amounts of bacterial and fungal overgrowth in her gut. And on your urine test, she had one of the highest levels of something called DHPPA, which is a Claustidial Metabolite, some particular bacteria. And it's known to have psychoactive effects. And it can be present in autism and other cases. And so I treated her with an antibiotic to get rid of that particular bacteria and also any fungal. And after like 15 years of never being able to like touch anything in her house and clean up, she was able to clean up her whole house, which was amazing to me. Like that you can give someone an antibiotic and any fungal and their psychiatric problems will go away because you're changing the messaging from their gut Flora. Pretty remarkable.

I don't know, Mark. It sounds like you may have just changed your obsession.

Yeah, it was. Yeah, it was amazing.

Yeah, you changed your compulsion. Now she's a pain freak. But no, that's amazing. One of the things that you just said, and I think that's when we talk about how functional medicine is different, and you've just been doing this for so long, for 20 years, is that It's observation, observation and curiosity and digging deep and then say, Hey, you know what? Look what I found. And now 20 years later, people are starting to look at the government. Now we're applying research. Now we're getting data. But that all started with people making observations and then, you know, and then talking about the results. And in your case, publishing your results in the books that you write. I think that's what we do in functional medicine and that's awesome. That's a great case.

Exactly, and it reminds me of some other causes you wouldn't expect, because we think this is a psychiatric problem, but it may not be really. It may be, like some people get arthritis, some people get OCD. And one of the things we mentioned was an infectious cause, which is strep and pandas. And pandas is a pediatric autoimmune sort of neurologic condition. that is related to strep. And the strep toxins, even if you get it when you're a kid, it may continue your whole life. You don't even know. And I'll just share a quick story. I want to hear sort of a little bit about, you know, what your thoughts about functional medicine approach and how we dig in. But, you know, this kid had an interesting story of OCD, and we did a particular test called pandas screen, which looks at the antibodies against certain neurologic markers. yes, the Cunningham panel, which is something, by the way, you wouldn't get in your regular doctor. And he had a positive Cunningham panel, meaning he did have the pandas syndrome. And, you know, he'd been on antibiotics, but it doesn't seem to really work that well. So I treated him with intravenous ozone, recommended you go get ozone. And he went and did that and completely went from, like, almost non-functional kid to totally normal. and I was like, holy cow. Like, it's that simple. If we do things that, you know, kills the infections and the inflammation, it's actually the thing that works rather than taking an antidepressant.

Yeah.

Yeah. You know, and, and ozone is, you know, it's antibacterial, antiviral, it has antioxidant capacity. It, it, it levels out your inflammatory response. So if there's an inflammatory response with the pandas now known as pans, because there are other things besides strep that can cause it. Bartonella can cause it, Lyme can cause it. There are other viruses that haven't been identified yet. And so, and it's an autoimmune process. That's why it can last. That's why you, you can get it, you know, have strep once and then have constant recurrences because now you've triggered your immune system and you're making antibodies against self tissue. So, yeah, very fascinating case.

It's really powerful. And, and, and tell us about your case. You had a 14 year old kid who had bad OCD and ticks, because ticks often go along with it, right?

Yeah, yeah. So, yeah, and I'll talk about some of the things we think about differently as I do the case, so that would be good. So, it's a 14-year-old kid. It was actually a gal. She had OCD and a tick. Her parents divorced. It was a fairly ugly divorce when she was five. Prior to the divorce, it was just a chaotic household. And so, she had a fair amount of trauma as a youngster. And when she came to see me, She was now in high school, she was starting to struggle socially.

And.

She had this tic and she had obsessive thoughts about bad things happening, about car accidents, and always fearful about being in a car, driving on highways, driving over bridges. It made it very difficult for her to have a social life. She came in, and of course, as part of the workup, we do stool analysis, we do nutritional analysis. I look for toxins like heavy metals, chemical toxins that could cause a disruption of the gut microbiome like glyphosate. We can measure that. Then we look for stealth infections. There are markers that we can use to determine if somebody has been infected with strep, even though they might not have current symptoms. I do stealth self-infection workup, looking for Lyme, Bartonella, strep, and then I assess gut permeability.

So it can be not just strep, it can be all these other things like tick infections.

Yeah, absolutely. And then I look at inflammatory markers, the ones I mentioned earlier, IL-6, TNF-alpha, CRP, and then we also do, we look for single nucleotide polymorphisms or genetic workup. We look for genes that have variations so that when they make their proteins or those proteins or enzymes, which, you know, and we can look at ones that are specifically involved in the neural networks in the brain and neurotransmitter metabolism and activation. We can look at those genes and we can find it. If that variation is making that gene work too slow, work too fast, maybe not even work at all. And if we can find those, they might be having an impact as well. So this is a test that I did, and what I found with her, was that she did have dysbiosis or that imbalance of good and bad bacteria in her gut. She did not have a lot of abundance and she did not have a lot of diversity.

She was kind of messed up down in her gut.

Yeah, the gut was messed up. I did a gut permeability test and that test is looking at that very important permeable membrane filter that is the gateway to your immune system through the gut. and it has these gates that open and close in a very precise manner to allow all the good nutrients and compounds that bacteria make for us into our system and at the same time able to keep out the bad guys, viruses, bacteria, and toxins. And so if those gates have been disrupted by a microbiome that has too many unfavorable bacteria, or if you have food sensitivities, gluten, egg, dairy, those things can break down the mucosa, break down that membrane, and now those gates are wide open, and you can have bacteria and viruses and toxins freely flowing through, and that creates systemic inflammation, and that's how the brain gets inflamed. You can also trigger autoimmunity, and now you can start making antibodies against self antigen, and that can include the the brain. Dysbiosis, leaky gut, did the nutritional analysis, and she was low in B6 and zinc. We know B6 and zinc are really important for brain function, particularly neurotransmitters. The last thing I found is in that genetic analysis, she had a blueprint for an enzyme that breaks down dopamine and norepinephrine in the brain. and that enzyme worked really, really slow. So she had a build up of dopamine and norepinephrine at baseline. So that type of genetic, the phenotype of that, what it looks like for a person when they have that gene variants is that they'll have less stress resilience because they have so much norepinephrine in the frontal lobe at baseline that any type of stress pops them right into flight or flight right away. And they get anxious and they can get panicky and agitated and irritated very quickly. If you combine that with the OCD, it makes it very difficult. So those are the things I addressed.

So the gut gets inflamed and that inflames the brain and that causes all the crazy behavior. So we often think these are psychological problems, but they're not. They're biological problems.

So now you, everything you just said, person has OCD and they're getting anxious. So what happens when you get anxious? You are in constant fight or flight and now you have cortisol that, you know, you have the, you have the hypothalamus pituitary adrenal axis that gets triggered. Cortisol rises in fight or flight and cortisol, we're finding through data and research, disrupts the gut microbiome, can cause shifts that are not favorable in the microbiome, and it also can trigger those gates, a breakdown in those gates so that it can trigger leaky gut. So now you have this terrible cycle, bad gut, bad brain. Now you're anxious, now you have bad gut, bad brain, and just goes around in a terrible cycle.

So.

I treated her with probiotics. I gave her a probiotic that had Lactobacillus, Bifidobacterium, Ruminococcus, and KCI, and then multiple groups of Bifidobacteria species. For her leaky gut, I use glutamine, and Albuterol. Albuterol, you know, there are different things that you can use to heal leaky gut. I use Albuterol because there's two reasons. One is, is that Albuterol is a huge source of energy for the cells of the colon and it helps heal those tight junctions in those gates. So it's really good for healing the colon, It also in the brain modulates inflammation by regulating glial cells. It has a twofold purpose. In her case, I chose to try to treat her gut with the butyrate and the glutamine and increased her foods that had B6 and zinc. I treated her genetic variants that predisposed her to poor stress resilience. I used some targeted supplements allow her brain to account for that slow acting gene. And having done all those things.

She.

Also did some cognitive behavioral therapy. And she had a complete turnaround. By the middle of her year, she was feeling really comfortable. She could get in cars, she could drive, she'd go out to movie theaters with her friends. And it was really remarkable.

Amazing. You want to know my secret for living a long and happy and healthy life? Well, all I have to do is check out my weekly newsletter, Mark's Picks, where I share my favorite tips for health, longevity, well-being, and lots more. Check it out and link below. And that speaks to the fact that we really have not addressed psychiatric problems effectively in this country, whether it's depression, anxiety, OCD, bipolar and other brain issues like autism or ADD, we really have a very backwards approach that's based on old ideas about mental health and are all psychologically focused. And I'm not saying that psychological issues aren't real. They are and trauma is real and we have to deal with that. And, there's a lot of wonderful approaches to that, including the new approaches using medically assisted psychedelic therapy, which is called MAPS. And I think we're looking at other kinds of innovations, but for kinds of problems that just seem bizarre, like the OCD or even schizophrenia, you know, is not exactly a psychiatric condition. It's really biological autism. And you can start to really change people's brain function by fixing their brain, by fixing their gut, by looking for ticks, by looking for strep, by looking for imbalances in the floor, by heavy metals. All kinds of stuff will cause this. And I think the difference in functional medicine is we dig down into looking at your gut, looking at nutritional status, looking at toxins, looking at hidden infections, looking at inflammation markers and all sorts of things, and genetics. And then we customize and personalize the approach to really help these people kind of recover. And it's pretty amazing. So what happened to her?

Well, as I said, she did really well. She continued to make it through her year. She did great. She was still struggling a little bit. And so, near the middle, three-quarters of the way through school, I think in general, kids at that point, I talked about it with her mom, start to get school fatigue anyhow. And I think she was wearing down. So, I did give her something called 5-HTP, which is a precursor to serotonin. And I gave it to her in a fairly higher dose than most people would use it to go to sleep at night because it can be used for that. And that turned that that calmed everything down. She started to struggle near the end of the year. We put her in five HTP and she made a complete turnaround. So she did great. She's going back to school. I think she's going back to school this year and I haven't heard yet how she's doing at this point.

Amazing, yeah. Well, I think people can have lasting change and I think people aren't having to feel like they're stuck in these this horrible mental conditions that, and it's worth digging in. And I, you know, even though it's a little bit dated, I think the ultramind solution is really a great map of how to address the brain. And then we updated protocols and stuff. But essentially, the framework is the same.

And Mark, it's absolutely the same because every time I get on here to talk about a neurologic issue, I pick.

It up and I do it. Is it good? Is it good?

I haven't looked at it in years.

That was. That was like a download from God. That. That. I literally sat in my office in my house, and I sat for three weeks at 12 hours a day, and I just. I just unloaded everything in my brain that was there after doing this for so many years and all the patients and their stories.

Yeah.

That.

That was. That was Visionary work.

You know, I don't know. I'm just paying attention to what's in front of me and just doing the best. Hey, YouTube, if you like this video, you're gonna. love the next one. When I was treating my patients for their physical problems, their digestive issues, their hormonal imbalances, their food sensitivities, whatever it was, nutritional deficiencies, that they would report back to me, God, my anxiety is gone. My depression is gone. My ADD is so much better. My OCD is better. My bipolar symptoms are better. My memory is better. And I'm like, well, what's going on here? And I began to really think about it and realize that we talk about the mind-body effect, which is sort of a incorrect way of thinking about it. We maybe talk about the body-mind effect, which is how the body affects the brain. But neither of those really explain what's going on. It's really a system. Your body is a system. The body affects the brain. The brain affects the body. And it's this, complete synergistic system. And if you don't think about it holistically, you're actually going to treat people by dealing with the downstream symptoms and not the upstream causes. So I began to really learn about how these physical issues can explain psychological symptoms and how we often attribute psychological or emotional problems to symptoms that are really physical. physical. And then when you treat the physical cause, all these problems go away. That doesn't mean we all don't have psychological issues, but it's a lot easier to deal with them once you've cleared up all the garbage that's actually causing these symptoms. So if you're just an example everybody knows, if you are tired and you haven't slept, you can't focus as well, you feel depressed, you're more irritable, has sex. I mean, is that because you're depressed? Yeah. Or you have dementia? No, it's because you didn't sleep. Right. And it's an easy example, but there's so much more that we know about actually how the body affects the brain. And we're going to dig into that today with Dr. George, particularly about anxiety. And so traditionally in medicine, when you have anxiety, what's, what's the general approach that we, that we have?

General approach is you've five minutes to see your patient, they tell you anxiety and great, you're on an SSRI or some other anxiolytic. What's that? An SSRI is a serotonin specific reuptake inhibitor. And all it does- It's an antidepressant. Prozac. It's Prozac, it's Lexapro, it's Citalopram. It's all those things that everybody out there is taking. All the AMS. Yep, it's the AMS. And they basically all they do is they allow the serotonin that's in your brain, to do its work longer, but it doesn't account for why isn't there enough serotonin in the brain to begin with? Great question.

That's the difference between regular medicine and functional medicine. Instead of going, oh, the cause is not of serotonin, let's get the serotonin up. No, the cause isn't there's not enough serotonin. The cause is something else that's causing.

The serotonin not to be okay. So what's causing the low serotonin?

Right.

So that can be any number of things, but the first thing you need to do is ask the question. you know, why? Why isn't the serotonin elevated? So, you know, we do know that the bacteria in our gut make serotonin for us. So one of the things we want to think of when we're looking at people with anxiety is let's look at their gut. And we always talk about the gut-brain connection.

Yeah.

And that's a very tight connection. So the difference between, you know, functional medicine and the conventional approach to anxiety is that we are going to say, and I know I do this and have been doing this for years, anxiety is just a symptom of other problems. And the cases that we're going to go over, anxiety was a part of the presentation, but it allowed me to get into the history and figure out what was causing it. And in both these next cases, we're going to see that there are multiple things causing it. It's never one thing.

So that's the- But it's not just a Prozac deficiency.

It's not a Prozac deficiency, Mark. It is not. It's usually a deficiency or it is an addition of a toxin into the system that can either be a relationship or it can be a xenoestrogen or it can be lead or mercury or it can be bacteria, but it's never just anxiety. And it's never just one thing.

Right, right. So, that's the other thing is we often sort of are reductious in our approach in traditional medicine. We go, well, you have anxiety, that's what's causing you to feel anxious. No, that's just the name of what your symptoms are. The causes are multiple, right? I mean, maybe it's one thing, maybe it's just you've got too much lead in your system, but it's often many, many different things that are all reflecting imbalance in your system. And that's the difference. Functional medicine and traditional care is functional medicine says, how do we restore balance in the system? How do we take out the things that are causing imbalance? And how do we add the things that are going to restore balance? And that's the difference. And we use a very in-depth set of tools both through a detailed history and ask a lot of questions that normally don't get asked, like, were you breastfed? Right. You know, were you- I used to.

Time too much tuna fish.

Right. It's a timeline. And these are the questions we ask that are different. And then we do diagnostic tests in functional medicine that are helping us to reveal causes, not just sort of, do you have some terrible disease? But we want to know, like most of the tests, you know, you go to your doctor, they go, oh, your tests are fine, you must be fine. Well, your tests that your doctor does typically are only abnormal if you're really sick. like for hospitalized patients, you'll see an abnormal electrolyte or a normal kidney function or normal liver. Unless you're really sick, these tests are pretty normal. So we look at a different set, pull the bail back. I mean, there are thousands and thousands of metabolites in your blood. And to think that you know what's going on by looking at 30 or.

40 on a typical blood test is a joke. And in fact, Mark, most doctors won't even get a blood test for anxiety. you know, they, they don't see it as anything other than a psychological event.

Right.

And so, or, and, and a biochemical event, you know, it's reductionistic.

Right.

It's, it's, it's no serotonin in the brain. Serotonin reuptake inhibitor works for you.

Great.

And it does, you know, and that's it. And we do know by now that they don't work, that they're very ineffective, and you really don't get to the root cause of the problem. I mean, people suffer with their anxiety. They go from one anti-depressant or anti-axiolytic to another, never getting to the root cause.

And sometimes they do help with symptoms. They do, and they can be life-saving, but you got to go deeper. Absolutely. At the Ultra Wellness Center here in Lenox, we go deeper. And now we're doing all virtual consults, which is great. So if you're a new patient, you want to come and see us, you don't have to schlep all the way to Lenox. We can do it all virtually. And you can get get the tests you need and we work with a great team.

We've done this for years. It's actually been really, it's really been interesting and amazing. It's almost like you have more focus and more of the attention of the patient. There's a whole different dynamic that occurs that has its own benefit when you do it, but when you do it, you know, by Zoom. Yeah, we do Zoom, right?

Yeah.

And I've asked my patients afterwards, so how was this for you? And not one person has complained. They've always said, I felt connected to you, Dr. Papandrea.

I got what I was looking for.

So it's been really a positive experience. It's true.

I did my first, you know, five patients last week doing Zoom, and it was like, wow, this is awesome.

Yeah.

You know, it's great. And I think it was, it's not, it's not the same as being in person, but it was really quite good. So I feel like we really have the ability to take care of patients, and particularly now more than ever. And people are feeling anxiety, people are feeling worried, and, and there are real things, right? You lose your job, you, your economic you know, resilience is threatened by what's happening in the economy, your fear of getting sick and your health issues. I mean, so these are real psychologically hard times. But you can become more psychologically resilient by making yourself more physically resilient. So you become less victim to the waves of emotional stress that we're having and learn how to sort of manage it. I think I'm feeling it, you're feeling we're all feeling it. I have to work every day to regulate that. And I do it by taking care of the physical things. If I don't work out, if I don't get outside, if I don't sleep enough, if I don't eat okay, like, I don't feel as good. And I'm not, I'm actually more susceptible to the emotional imbalances that occur because of the reality of what's happening in the world right now. And I think, I think this is a perfect time for people to start to focus in on their own health because not only will it make it less likely they get COVID-19, but they actually can can really deal with issues that have been going on for a long time and they have their time and you can actually deal with the lifestyle issues much easier. Not traveling. I mean, for me, I don't travel anymore. It's like, I agree.

It's been a renewal for me and a lot of my friends. We've talked about it. It's the opportunity. I think a lot of people deep down are sort of happy that the world has slowed down a little bit.

Yeah.

It's so fast before. Yeah.

And you're like, wow, I don't have to wake up on Saturday and do a soccer tournament for the whole weekend. you know, and I, I don't have to be rushing off to, you know, all these practices at night or to this class or to. And I've noticed a difference in my own kids. They are more relaxed. All right. I'm home and you'd think there'd be more tension, but we're actually getting along more. We're playing board games, we're playing chess again. I have my, my 24 year old is home, and it's been very enjoyable. What has been really important, though, and that's why I chose these anxiety cases.

Yeah.

Number one. I love being a sleuth. I love being a medical detective.

That's why I love functional medicine.

That's what functional medicine is. You nailed it, right?

Right.

And so, I get to tell you these, I have disease mysteries this morning, right? So, it starts out with anxiety, but then anxiety really, is that really the culprit or is there, you know, is there a secret hidden person or character.

In this plot that's causing the problem?

You're like the Sherlock Holmes of medicine. I love you.

So, so that's, that's, so tell us about this patient. He was 32.

So we're gonna jump to the case. We're gonna forget about, I was gonna tell you about COVID and getting ritual and routine. We'll go right to the case. So, yeah, so he's a 32 year old and he came in with his partner, his wife, and they, his major complaint was, I have panic attacks, particularly at night. And when I'm having panic, I'm also feeling bloated and distended.

Oh, interesting.

And that was his main reason for coming in. He had these panic attacks and then during the day, I'm finding I'm having a harder time getting my work done. I've become a really intricate part of the business of our that we do and a lot of responsibility has been placed on me and I'm finding it harder to get work done. I can't concentrate, I can't focus and I'm getting anxious.

Wow.

Okay. that's the fundamental story. I want to know where it all started. So we do the timeline. We go backwards. It turns out with this young man who's 32, that his problems started a long time ago. He had a really bad diet growing up, sugar tooth, sad, you know, standard American diet, ate a lot of sugar, was having problems in school early on, developed school phobia, and then anxiety that was so debilitating he had to stop his first year of high school. I mean, no, his senior year of high school. So then he went to college where he had a little bit more control. Oh, and he found some friends who had Adderall and he tried Adderall. Oh, and Bingo.

Oh, well.

And Bingo. He was a forest.

To call it speed.

Yeah.

In college, he, he actually did well through, through college. But after college, he had successful years until one year they went traveling and he developed a really bad gastrointestinal infection. and shortly after that, he started gaining lots of weight. And that's when the anxiety and the panic and everything started to multiply until they came to the office. So, as a traditional psychiatrist, you go.

There, you have anxiety, you have panic attacks. They're not like, well, did you have traveler's diarrhea? Did you get bloating? And was it connected to your gut? Let's look at your poop. But maybe that's where the answer is. Right.

So, there's this thing that I call pattern recognition. so when I hear, the reason why I go back to get all these clues is because all of those clues together start to create a puzzle or almost a war shock. And I have to then, you know, have a pattern recognition and say, oh, this is starting because of the experiences I have with people.

Yeah.

I begin to see these patterns and I can start to see that, you know what? Yeah, there's something going on this guy's gut.

Oh, yeah.

And there's there's some sleep issue going on here. It's not just anxiety, it's not just I can't sleep, there's something else going on. So in his particular case, I understood the pattern of ADHD and I saw that as an early issue for him. And there's gonna, and that also clues me into where am I gonna look? Where does that come from?

So we do now- Again, ADD is a symptom.

Yeah, it's a symptom. So it's coming from, you know, and there are a lot of culprits, there are a lot of things and facets to ADHD that come into play. And one of the things I thought about with him is what is his DNA going to tell me? What is his DNA going to tell me about his brain that predisposes him to ADHD, panic, and anxiety? So, I knew that, okay, I'm going to do some testing. Wait, wait, wait, wait.

So, you're saying that your DNA controls your mood, anxiety, and your...

It can.

Hey, everybody, it's Dr. Hyman. Thanks for tuning in to the Doctor's Pharmacy. I hope you're loving this podcast. it's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only to you once a week on Fridays, nothing else, I promise. And all you have to do is go to DrHyman.com/picks to sign up. That's DrHyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode.

Your DNA predisposes you to different conditions and states of being. So, we actually at the Ultra Wellness.

Center do a swab, a cheek swab, where you just take a little basically Q-tip and rub it against your cheek, stick it in a vial, send it in the lab, and it's called DNA Mind.

Right. So, tell us about what is this DNA Mind and what does it show? So, the DNA Mind is going to actually look at genes, the blueprints that your body uses to make amino acids and proteins that are going to be the basis for your communication in your brain. They can determine mood, they can determine cognition, they can determine memory.

And so you can tell if you're more likely to be anxious or more likely to be depressed or more likely to be an addict or.

Yeah, exactly. So DNA mind will look at the area to look at the genes in multiple different areas that can impact neurodegeneration, your mood, and your addictive qualities.

Yeah.

And so we look at very specific genes. that are well researched and we understand that if they do have variations, what those variations will mean and then-- what.

We can do about it.

And then informs me what I can do about it. Those genes are actionable. You get a 23andMe, you get 5,000 genes. You don't know what 4,999 of them do. And so we only test, or DNA Health only tests actionable genes in critical areas.

So this is really an important point because people are talking about DNA and personalized medicine and most of it's noise, right? So we actually have genes that are common in the population that have clinical impact, that we know a lot about and how to modify the expression of those genes and change what's going on so that you have a positive clinical outcome as opposed to just checking your 20,000 genes and not only want half of the mean or 99% of the mean like you said. I mean, there's one in particular that is very common when people have anxiety and what is it? MTHFR. And there's also- and there's also- CMT, catechol-O-methyltransferase. And that's a big mouthful, but essentially that gene- It's really good. That gene is involved in metabolizing the stress hormones, adrenaline. Yeah, the catecholamines. And catecholamines, right? So, the adrenaline, noradrenaline, or epinephrine, right? Dopamine. Dopamine. And if those can't be properly processed by the the body, you get a buildup of these stressors.

This is a great point.

So you feel really anxious and I mean, one of my staff members has this gene and she was giving me an IV the other day and she was like so nervous and I said, you, must have that gene and she's like, I do. And I'm like, but then you can fix it, right? How do you fix it?

Right.

Oh, how do you fix it? Oh, okay.

So it's one thing to know you have it.

So, Let's go back to him because this is just a perfect segue. I'm going to tell you how I fixed it with him. So, what was really interesting is that with that pattern recognition at the first visit, I understood that he's got ADHD. I think he's and in the way described his personality, I thought he had a dopamine deficiency.

So, I put him on- and dopamine is one of the neurotransmitters that helps you focus, pay attention.

And, the CMT gene has impact on that because you can either metabolize your dopamine very quickly and keep it at a low level, or you don't metabolize it at all like the norepinephrine, and you'll have high levels of it. And if you're, so each one of those conditions has a phenotype or, or a way that you're going to appear if you have that. So in his case, he sort of like was distant and didn't feel emotion all the time. and he had a hard time with focus in general. So, I thought that he had dopamine by pattern recognition. So, I put him at the first visit, he left with something called L-Tyrosine. L-Tyrosine is a precursor to dopamine. And I told him- It's like a building block.

A building block for dopamine. L-Tyrosine is an amino acid. It's a building block for these neurotransmitters.

Which comes from protein. Exactly. So, interestingly enough, when he comes back for six week follow up to go over all his labs. One of the things he wrote in his medical update to me was that I'm not depressed, but I'm feeling things I've never felt before and I'm a lot more tearful and a lot more emotional and a lot more engaged emotionally with people. Well, why? Because he's getting dopamine in his brain that he hasn't had for a long time. And now that dopamine is allowing him to experience and feel emotion they didn't have before. and he's able to concentrate better.

And, this is a perfect example of functional medicine because it talks about how we personalize based on genes, based on person's lifestyle, and based on their levels of their labs. And, we really create a customized approach for each person to target in like a medical detective on the things that make the most difference.

Yeah, yeah.

You just gave them a simple amino acid, but it's like, wow, how simple was that? But, it was knowing that you needed to do that that was the key.

Yeah.

And here's the cool thing. When I looked at his DNA to go over those results with him, he had the CMT defect that, you know, that didn't process his, that over processed his amino, his amino acids that made dopamine and norepinephrine. So it matched up.

So his genes matched up with his.

Clinical picture, and he responded appropriately to the dopamine. precursors.

But he also saw other things that were going on that in his gut that you mentioned that were relevant.

So how.

How does his gut play a role in his brain health?

Okay, so this is. This is. This is always a favorite area. So he had what we call small intestinal bacterial overgrowth. That's when bacteria that should not be living in the small intestine is there, and it can cause bloating and distension. That's what he was having. That's what was waking him up in the middle of the night.

You got a food you have a food baby.

He was eating foods that were fermenting in his small intestine and they would cause that gas that would really cause him discomfort and wake him up in the middle of the night.

So, like when you got apple cider and the bugs grow in there and it creates that thing that you open up and it explodes, right?

Yeah.

Sort of like that.

Absolutely. And so he was also gluten sensitive. So we do a test to look for gluten sensitivity. So now you have- and that can.

Also cause anxiety and depression.

Exactly. So now you have gluten and you have overgrowth of bacteria. The two of those can disrupt the epithelial barrier membrane in the intestine. Basically, your intestine is a hollow tube and then the first layer is a layer of cells. That's that barrier.

It's only one cell thick. It's one cell between you and a sewer, basically.

Right.

Basically it and it's very tightly controlled. cells can separate and then close, separate and close to let things in and keep things out. So in his particular case, he has two things going against him. He has gluten sensitivity, which is going to lead to leaky gut. He has bacterial overgrowth that's going to lead to leaky gut.

It creates inflammation.

And that you have leaky gut, you have leaky brain. So you have two things possibly going on with him. The leaky brain causes general neuroinflammation. and then the overgrowth.

Wait, wait, wait. What you're saying is that when you had bad bugs growing in your gut and you're getting gluten, it inflames your brain.

Yep, it does.

Wow. Okay.

Yeah, it inflames your brain because what happens is, is that you can have an autoimmune response that can be triggered against neural tissue from the gluten and also from the inflammation you cause in the gut, that inflammatory response. can be generalized and affect the brain.

A lot of people call SIBO Irritable Bowel Syndrome, right? Now we have a better name for, you know, figuring out what it's caused by. And not all Irritable Bowel is SIBO. But what we found was that when I was in training, and I'm sure it was like this for you, George, we were taught that people with Irritable Bowel Syndrome were psychologically impaired, that they were anxious, and that's what was causing their gut issues. I'm embarrassed to say that. And, and we had this sort of pejorative, this term called the Functional Bowel Disease, which wasn't like functional medicine, which is like, meaning it's like we had this sort of secret code word. We called super tentorial, which means it's in your head.

Right.

And, and so it was kind of a medical inside joke. And it was very judgmental and pejorative. And what we found was that actually it's the opposite that, that when you look at, and it was published in the New England Journal years ago, where they looked at people with irritable bowel, and what it does, it triggers inflammation, irritation in the gut. And because there's a gut-brain connection and there's a huge nervous system that connects your gut to your brain, that it feeds back to the brain and creates an irritable brain. So, it's not the irritable brain that's causing your bowel, it's your bowel that's causing your irritable brain. Exactly.

That's a very different frame of thinking about it. And also, that means you can fix it by fixing the gut, which is what you did with this guy. Tell us about that. So, we fixed his gut. And the other connection there too, Mark, is when you have an imbalance of bacteria. Remember, up to 70% of your serotonin can be made in the brain. And serotonin does have a big impact on your mood. So, he had multiple things going against him all stemming from the gut. And so, basically, with the gut, you know, we, and I don't want to get too much into the treatment for what we did for him, but we do.

We're not. Tell us about what you did. So, how do you treat the gut like that that fixed the brain?

So the first thing you do is you alter diet. So you put patients on what we call low FODMAP diet. And these are foods that are easily fermentable. So we take them off these foods and we put them on foods that are gonna be easier for them to digest, not ferment.

So you're not basically feeding the bad bugs.

You're not feeding the bad bugs. Their favorite food, which is starch and sugar and processed foods. And so we do that. And then we also give them some probiotics. And you have to be careful with probiotics because they are bacteria and you are treating a bacterial overgrowth. So, I'm very careful. Except then I'm gonna kill the bad guys first, right? Yeah, you wanna kill the bad guys first. But we do know that sometimes some people with SIBO respond well to probiotics, but you have to be careful which ones you use. I'll tend to use spore-based. Because then they tend to fight.

You gotta get a problem. Yeah, so it's a careful balance.

But basically, change the diet, then we give them some nutrients like glutamine, that will help heal that barrier lining. And then we use antibiotics to get rid of the bacteria. And those antibiotics can be herbal protocols. Sometimes I will use pharmaceutical grade depending on what organisms, what gases are being produced by what organisms.

Yeah. So we actually look at breath testing to see what's growing. Is it hydrogen? Is it methane? And then we can customize our herbal treatments or our even our prescription drugs which can clear out the bad guys. So we gotta do this what we call weeding, feeding and seeding program which is we basically get rid of the bad guys, we seed it with the good guys and we feed the gut to get it healthy. We call it the 5R program and it's something we do really well here at the Ultra Wellness Center and it's amazing how many things it can fix. So in this case, the patient had more psychological issues, ADD and anxiety.

And the bloating, that was definitely the SIBO was driving. The SIBO was driving part of of the anxiety. It was sort of like, again, you have this genetic predisposition, you're under lots of stress, which is one driver, you develop SIBO, and stress can be one of the causes of SIBO. Then he also had the gluten sensitivity cause a leaky gut. And there was another piece to this is that he had sleep apnea. So, before you touch- I'm not gonna.

Give you- It's really interesting. I want to talk about the gut-brain axis because it's a big issue. But the gut issue is so interesting because now in medicine, we are understanding, for example, if people take antibiotics, they get depression. That if your gut floor is off, it can cause psychological symptoms, which we didn't really know before. And, I wrote this book 12 years ago, like it was published in 2009, but I wrote it like 12 years ago. And, I wrote about the discoveries I was making from a clinical perspective. of what happened when I treated people's gut around anxiety, OCD, ADD. It improves. Depression. It's amazing. And it doesn't mean that that's the cause of everybody's anxiety. It was a cause of his anxiety. I just remember another patient who I remember came in and he was like, every day at 3 o'clock, I get terrible panic attacks. I'm so anxious. I feel like I'm gonna die. I'm sweating. I can't breathe. My heart's racing. I'm like, oh, well tell me about like what's going on in your life as well. You know, I work on Wall Street and I'm like, work hard all day and I don't eat much and then like at night I eat a lot and I drink a lot and then I go to bed and I wake up, I'm not hungry so I don't eat again till late and then every day around, I get this pain. I'm like, maybe you're hypoglycemic, right? So why don't you eat breakfast? Don't eat so late, stop drinking. Panic attacks went away. So that was his problem but this guy was different. He's different. Everybody's different. It's because you say you have anxiety. body or panic attacks doesn't necessarily. And somebody else, it may be truly from, like I have a friend who was in war zones and has PTSD and that's what causes panic. So, it's very different for everybody.

And it is. And I chose him too because I don't want everybody to think that SIBO is always going to be your anxiety always is going to be just your SIBO. It's never just one thing. This was a contributor to a gentleman who had a genetic predisposition but he also had some metabolic findings as well. He had things that we call cryptopyrroles and he had urine peptides. Wow, what is that?

So, I gotta tell you.

Now, these are not tests you'd get.

At a traditional doctor. No, you do not get these at a traditional doctor. The ways of looking at brain function.

Through the urine that are so helpful, what are the things you're producing? So tell us about them. Yeah, so urine peptides, when you break down your dairy products like milk, you break them down into whey and casein, but you break them down into other proteins and some even things are smaller than proteins called peptides.

That's less than 100 amino acids.

50.

50? Okay, what do I know?

I'm not going to argue.

I don't know. It's been a while since I took biochemistry.

So, you have these peptides. And so, if you break them down into certain peptides, particularly with milk, you break them down into casein morphins. And, these are these peptides that can cross your blood-brain barrier and then they have an opiate-like effect on the brain, which can affect mood, cognition, and memory.

So, it's like you're stoned all the time on heroin. Right.

He had really high peptides in his urine.

He also has... Now, wait, wait, wait. This is not an allergy to dairy. It's a whole different reaction. No, his body just... It's not even a sensitivity. It's his digestion wasn't working and he couldn't digest the dairy proteins. So, they were partially digested. They were getting absorbed across the leaky gut. They went to his brain and had morphine-like effects, which changes cognition behavior, and then you can see them coming out in the urine because they're excreted in the urine. Bingo. So, it's really a different way of.

Looking at this than traditional medicine. Yeah, and you're not going to get this as a conventional doctor. You're just not. And so, then I also checked them for cryptopyrols. So, what are cryptopyrols? Well, your red blood cells break down periodically, and when they break down, they have iron in them, and that iron has to be metabolized. Everybody does it. one of the metabolites is a cryptopyrrole. Well, cryptopyrroles are benign and they're going to go out of your blood, through your bloodstream and into your urine and leave the body. But, if you happen to be a person who breaks down too much of your iron into cryptopyrroles and you have lots of cryptopyrroles, when cryptopyrroles leave the body, they take B6 and zinc with them. B6 and zinc are really critical co-factors to neurotransmitter function in the brain. and you won't get it on a blood test because it's intracellular loss. And, this test is what we call a functional test. And, it tells you what's happening that is due to the defect or the lack of B6 and the lack of zinc.

This is really what we call nutritional psychiatry.

Right.

It is. And, his cryptopyroles were way off the charts. And, so I can't reverse that. but I can supplement him with B6 and zinc. And we find when we do, we take care of urine peptides and we take people off their dairy to avoid those and we give them their zinc and their B6 back, we add to the benefit. We fixed his gut, we take care of his urine peptides, we take care of his cryptopyroles, and now we're putting all these pieces together and he's getting better. It's just never one thing.

And by the way, in order to convert tryptophan, which you get in your diet to serotonin, the enzymes require vitamin B6.

Yes.

So maybe it's not prozac that you need, but B6.

Right. Exactly.

That's really important. So this is such a great case. He had ADD. They got better. You targeted him with supplements like fish oil and another neurotransmitter support. You got his gut fixed. You got his sleep apnea fixed. it's so great. This is such an amazing case. And I think, Mark, I just gotta say one thing.

The sleep apnea piece is, is, is like another critical piece. I just have to say the one thing about sleep apnea is that, you know, what sleep apnea is, it's pauses in your breathing that happen intermittently and frequently when you're sleeping. And when that happens, you have a lack of oxygen to your brain and you have disrupted sleep so that your brain can't do important things. One of the important things that happens with sleep apnea is it impacts REM sleep the most. And in REM sleep is where you're consolidating memory. And if you're not getting REM sleep, it's going to make it harder for you to function the next day. Not only are you going to be fatigued, but that part of your brain responsible for memory isn't going to be working as well. You're going to forget your keys, you're going to forget your tasks, you're going to read something and forget what you just read. and that's sleep apnea. And so, and it's under diagnosed. We think that it's only obstructive sleep apnea, which is one of two forms of sleep apnea, only occur in obese people, but it can occur in thin people because it's not just the weakness of muscles in the throat that cause it, but also the upper airway. Your airway is narrow or something. Yeah. And so, he had sleep apnea and he'd been snoring all his life.

Point being is sleep apnea.

Maybe it's ADD and anxiety was probably.

Related to his sleep.

Steal my thunder, Mark?

No, it's good. Just like read your mind. Yeah, you read my mind.

So it's very possible that his snoring as a kid was driving his ADHD, right? And as you age, we have a lot of adults that are being diagnosed with ADHD. Some of them had it all their life. Some of them are developing it because of their sleep apnea. So we fix his sleep apnea, we fixed his urine peptides, we fixed his cryptopirals, we fixed his gut, we got him off of gluten, we reduced inflammation in his brain and his body. Not only is he feeling better, but we just helped him to create a floor plan for the rest of his life. That's going to keep him from chronic disease and let him perform at his highest level.

Well, that's the other really important point you're making is in functional medicine, we don't just keep people on forever. We give them the roadmap of how their body works on a personalized level, how to take care of it for life, and how to optimize it. If you love that last video, you're going to love the next one. Check it out here. Step number one is you get rid of the term mental illness and you call these things what they really are.

Brain health issues that steal your mind.

Get your brain right and your mind will follow.

So the end of mental illness really.