Is Poor Gut Health Or Sleep Issues Driving Your Depression, ADHD, And More?

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

If you're looking at trying a drug that has potential risky side effects, the bar is a lot higher than saying, why don't you stop eating sugar and gluten and eat some vegetables and fiber and fix your gut? Hey everyone, it's Dr. Mark. One of the most important tools I have for helping my patients optimize their health is testing. And that is why I love what Rupa Health is doing. Functional medicine testing can require placing orders with lots of different labs and it can kind of get really complicated for doctors and their patients to easily access results and keep track of everything. But Rupa Health has totally streamlined that process. Looking at hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, and so many other internal variables can help us find the most effective path to health and healing. I'm really excited about that now and I can finally take advantage of these tests without the hassle of the confusion of going through so many multiple labs. Rupa Health is the place for functional medicine practitioners to access more than two specialty lab tests from over 20 labs like Dutch vibrant America, Genova, Great Plains and more. It's 90% faster, letting you simplify the process of getting you the functional tests that you need and giving you more time to focus on your patients. This is really a much needed option in the functional medicine space and it means better service for you and your patients. You can check it out with a free live demo with a Q&A or create an account@rupahhealth.com that's R-U-P-A-Health.com You're unique, which means your health and wellness plans should be unique too. But it can be tough to optimize your health and nutrition programs because it's often difficult to get the data you need. And even if you do get your numbers, you actually have to understand them and then be able to make meaningful action based on them. This is where Inside Trackers comes in. Inside Tracker is a wellness tracker that uses science and technology to deliver ultra personalized healthcare guidance. They can analyze your blood, your DNA, your lifestyle habits, and give you actionable recommendations to help you meet your health and wellness goals. They'll tell you what you need to do. do and why, and you can track your progress and adjust your plan based on real-time feedback from your own body. Since 2009, their science team at Harvard Tufts and MIT have been bringing personalized nutrition and wellness to the world with their powerful evidence-based digital platform. InsideTracker is simple, customizable, and most importantly, it's based on you and your body. If you're curious about getting your own health program dialed in to meet your unique needs, I highly recommend checking out InsideTracker. Right now, they're offering my community 20% off at insideTracker.com/DrHyman. That's I-N-S-I-D S-I-D-E-R-A-C-K-E-R.com/DRHMAN. And you'll see the discount code in your cart.

Hi, this is Lauren Fagan, one of the producers of the Doctor's Pharmacy Podcast. We're often told that eating well can prevent diabetes, heart disease, and cancer, but the correlation is just as strong when we look at the effects that diet and lifestyle have on our mental health. While the conventional medicine approach to treating these issues is to prescribe pharmaceutical drugs, The truth is that making positive changes to our diet and lifestyle can be just as, if not more effective, and they don't come with the unwanted side effects. In today's episode, we feature three conversations from the Doctor's Pharmacy on why looking at gut health, diet and our genes are all important in treating depression and other mental health issues. Dr. Hyman speaks with Dr. Uma Naidoo on the role of inflammation and healthy gut bacteria on the brain with Dr. George Papamichael on why our genes play a role in brain health and what we can do to and with Dr. Drew Ramsey on how food choice can either promote or prevent depression. Let's jump in.

There's an incredible bunch of studies that were looked at by psychiatrist Stephanie Chung and her colleagues that looked at gut health and depression. And they found that people with major depressive disorder had about 50 different types of species in their gut microbiome that were different from the control groups that didn't have depression. And a lot of recent research shows that these bacterial species are associated with high quality of life and often depleted in people who are depressed. And bacteria that cause inflammation are found in a lot higher numbers in people who have depression. So can you talk about what these studies showed and the connection between this inflammation and depression? Because, I mean, I saw a study recently that just made me crazy, which was using TNF alpha blockers for depression, which are these powerful drugs that cost 50,000 a year they use for autoimmune disease to shut off inflammation. Like, why not deal with the source, which is the gut?

So talk about what these studies show.

And and how this connection exists between inflammation and depression?

So the more that we learn about the gut, the more that we realize there might actually be certain specific bacteria that are involved with the positive drive of depression versus the negative drive. I wanted to actually mention the study, and the reason I'm talking about it is that it's linked to this in the sense of how people don't realize the impact of certain gut bacteria and a food mechanism that can help you. A study that looked at yo-yo dieting, and this becomes significant because my patients who come in who've gained the weight from, say, a medication don't know how to get off it and they might start to lose weight and then they gain it back. And the sort of yo-yo piece of dieting has also happened with, say, reality TV shows and people don't realize that they could actually be a mechanism in the gut. The study that was done and published in Cell sometime this year showed that in particular lean mice and mice that had gained weight, they identified that certain gut bacteria were driving this and it was almost for want of a more elegant word, like a fat memory coded in the bacteria in the gut. Then they found that if they fed back proper and certain antioxidants, that the inflammation caused by this gut memory improved. I think that what is so cool about this is it's one of those studies that directly showed a mechanism where antioxidants worked in a positive way. I think that for me, it goes back to the Stephanie Chung study and those that have shown the multiple bacterial species, a quality of life factor, lowering of depression. And, you know, I think I appreciate what you've been saying all throughout this conversation, Mark, because going into this, you know, I think that I didn't, when I said at the beginning, you know, the illness that I had didn't lead to the book. It was because I wasn't sure that there was a book. I had been doing the work.

Yeah.

But it was some of the work that I, that got more publicity that led to my writing the book, because I knew the science was It was then what this did for me is it pushed me to look at, like you were saying, 700 references condensed to over 550 because there was science behind it. And sometimes we get pushed to the side as complementary alternative or soft science, but there's real data behind it. And I think that the more we can explain that to people and have them try things that, It's not going to harm someone unless you have an allergy to try a different diet and to use these mechanisms to feel better. And we can be highly specific in some of these situations.

Yeah, exactly. And what you're saying is so when you said it was so important because if you're looking at trying a drug that's very expensive or that has potential risky side effects, the bar is a lot higher than saying, why don't you stop eating sugar and gluten? and eat some vegetables and fiber and fix your gut. And the evidence is there. We may not have large randomized trials, but we have a lot of evidence, like you said. And the kinds of studies that are done now are just so compelling and so beautifully done. And I remember one of the studies I looked at was the SMILES trial, which looked at just swapping out people's normal processed food diet with more whole foods. And it was as good as any antidepressant, right?

Exactly. It was as good as a 9 to a person and they added in counseling and coaching. So you had, you know, you followed this diet and then they also had someone check in with you and ask you some questions and see how you were doing. So, you know, a lot of, say, weight loss programs have built in coaching now because there's this almost contact part and accountability part that is very helpful to people. There was a great trial done by my colleagues in Australia and I think that, you know, one of the things that we're trying to do more of is really larger human trials. The difficulty is that how to capture some of the actual food that people eat becomes a little bit of a challenge. And so, you know, I think that.

We'Re... Because we're not lab rats, you can't just lock us away and feed us the same diet.

Feed us the same diet. Exactly.

Free living humans are hard to study.

It's hard to this study, it's different if you're prescribing, if you're doing a pharmaceutical trial. And there's also a lot more funding that goes to pharmaceutical trials and very little incentive that goes to nutritional science and nutrition epidemiology studies. There's definitely a difference. And so I do think that with the studies we've looked at, even if the numbers are small, we've looked at the science and tried to pull out for people facts that will be digestible to them that they can actually take home and say, well, I can try to do that. And at the end of the day.

You know.

I think we can always find a study that's pro one thing on the same day a study that's against the same thing. It's how we interpret it for people and show them the balance of what has worked. And that's where clinical, you know, like you said, with so many patients that you've treated, that's where the clinical piece also becomes so important.

Yeah, it's so interesting. One of the things that you sort of write about and talk about is the role of the amygdala, which is our fight or flight reactive part of our brain that is what gets us into trouble if we're not able to manage that fight or flight response. And what seems to be going on today in our society, and I'm just literally thinking of this hypothesis now in my head, it is increasing division, conflict, divisiveness, reacting out of fear, anxiety, and our society seems to be falling apart based on this incredible increase in this kind of behavior, which I've never seen before in my life. I mean, there's always difference of opinion and so forth, but this is just very different. And I'm wondering if it correlates with the increases in processed food in our diet, changes in our gut microbiome over the last 50 years, the changes in, for example, glyphosate which is over the last few years has a powerful gut microbiome destroying properties, which is basically weed killer that they use on 70% of our crops. So, I can go on antibiotics. I mean, there's so many things that are gut-busting things. Do you think there's a correlation between the microbiome and the amygdala and you think it's related to this change in our diet and do you think it's connected to all the changes we're seeing.

In our society and this incredible conflict? I just can't help but wonder if that's true. I like And I think this is a worthy hypothesis to think more about. Certainly the rates of depression and anxiety, substance use and possible abuse of partners or people in the home increased during COVID A very short survey was done during March by the American Psychiatric Association and we haven't yet collected enough data. to comment on the rates of increase of mental illness. However, separate to that, the overarching increase of disability, as you were speaking about early on in our conversation, has increased. And, you know, what has changed in the world? Well, what has changed in our lives and in the world is how we eat. That has been significantly different. Our dinner plate size from the 1920s and 30s has changed from nine inches to about 12 inches. And if you have, you know, family who come to visit you from overseas, they'll want to share the appetizer or share the main course because the portion sizes here are very different. So if you think about how our food is evolved, then you know you talk about the high fat and the low fat issue. You talk about, you know, the use of glycolate in our crops. All of that combined with high fructose corn syrup and everything that has happened Yes, our diets have changed. I sincerely think that how we eat, not to be too cliched, but it really does impact how we feel. And I think the level of irritability, anxiety, agitation, depression, has, whether it's diagnosed or not, whether it's treated or not, has increased in society. It's almost as though people are just more on edge. And how can it not be linked to our brain and how we eat?

For sure. I remember talking to Bruce Ames, who's one of the leading scientists in the world, incredible guy, probably in his late 80s now. And, he was doing studies of high fructose corn syrup on the gut. And, he had this finding, which was striking, which is typically when you get fructose and fruit, it's a sugar and fruit is combined with glucose. So, when you just have pure fructose, which is rarely found in nature, which is found in high fructose corn syrup. It's free fructose, which is very different than what you find in fruit. It actually requires energy to be absorbed by the gut and uses up ATP, which is the energy molecules. And he said because of the increased volume of high fructose corn syrup, it literally is punching holes in the gut because the tight junctions, which are keeping the gut from being leaky, can't stay together because it's an energy dependent process that gets interrupted because all the ATP, the energy that's used to keep the gut lining together gets used to help absorb the fructose. I don't know that's true, but it was a fascinating theory. And I was like, it makes sense because it's about 15% of our sugars and our calories is high fructose corn.

I mean, corn syrup, which is terrible. And it's in everything. It's in everything that you don't even realize. And that's, that's where I think I really feel that it has to be part of it. I don't think it's the only thing, and I don't mean to seem like I have blinkers on, but I do think that even diagnoses in childhood disorders has increased. So all of that has to make a difference, as well as the facts around childhood obesity and things like that.

Well, let's talk about the childhood mental health issues because, you know, I. I grew up, you know, 60 years ago, and there was that one kid in the class who was kind of a troublemaker, and nobody else was pretty okay. And now you go to schools, and the school nurse is like a pharmacist. She's dispensing all these psychiatric medications, antidepressants, ADD medications to kids. One in 10 kids is on ADD medication. I mean, you look at the kids' illnesses. It's not allergies or eczema anymore. It's depression and obesity are the kids' main chronic illnesses. It's frightening. And so how would you say this ADD crisis, which is exploding, is connected to diet? And how do you tend to treat these patients?

So I have, I see, I'm an adult psychiatrist, but what I know about these disorders is that- A lot of.

Adults have ADHD too.

Exactly, so I do, as I said, I do deal with that. However, one of the interesting studies showed us that we've always thought, well, sugar drives the agitation and the almost hyperactivity. There are significant studies that showed that that wasn't the cause. And I found that really fascinating because I had always thought that that was a, to me, that was a clear link.

I mean, just go to a birthday party when kids are eating cake and ice cream.

Exactly, so it seems sort of counterintuitive. But I think it starts at exactly where we've been going in this conversation. It starts with what they're eating, what's happening in schools. When the funding to school lunches are changed, there are industries that then moving vending machines to schools. And so kids who want a snack and where the lunches have changed are naturally driven to, well, I'm gonna get a candy bar, get a bag of chips or whatever it is. So there are things that have happened in society separate to the processes of high fructose corn syrup and all of that and they added sugar, then the food labeling laws and the pushback from industry around the food labeling laws where they're wanting to show large labels, the quantity of added sugar so people became more aware. If we take it to the children in our society, they've basically grown up with all of this. So unless they've grown up eating the regular diet that most people eat in this country, they have therefore eaten, you know, glycosylates, they've eaten, you know, all of these processed ingredients, all of this added sugar, and how could they not be obese? So how, you know, it's almost, it's a setup, sadly it's a setup for failure. There isn't anyone, you know, to blame about it. It's that how do we change that? How do we truly have them eat in a different way? I have a member, the newest member of my extended family, his parents basically decided that he shouldn't initially eat sugar until maybe he went to his first birthday party or something like that. And he eats fruit. He loves berries. And if you gave him an ice cream, he would probably eat it because he's little, but he doesn't really know that taste. And it begs the question, if you have these different taste receptors and things, but if you haven't grown up with that super sweet taste that we have in all of our foods, if you're not avoiding them, then what do you do? You know, and I'm really curious to see how he grows, because he eats, he loves fresh fruit, he loves whole foods. And it's just, again, it's because his parents have done this. So, you know, it's a big question. It's a bigger question than I have the answers to.

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And now let's get back to this week's episode of the Doctor's Pharmacy. 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 communication in your brain. They can determine mood, they can determine cognition, they can determine memory.

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, look at the genes in multiple different areas that can impact neurodegeneration, your mood, and your addictive qualities. 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 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.

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. Catecholamines, right. So the adrenaline, noradrenaline, or epinephrine. Dopamine. Dopamine. if those can't be properly processed by 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, well then you can fix it, right? How do you fix it?

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

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 the way he 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 COMT gene has an 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 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, and he had a hard time with, you know, focus in general. So, I thought that he had a dopamine 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 his 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. And 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 COMT defect that over-processed 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 in his gut that you mentioned that were relevant. how does his gut play a role in his brain health?

Okay, so 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 baby.

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 middle of night.

So like when you got apple cider and like 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 thick.

It's like one cell between you and a sewer, basically. Right, basically it. And it's very tightly controlled, so the 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, the leaky brain causes General neuroinflammation.

And then the overgrowth. Wait, wait, wait. What you're saying is, 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 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 figure 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, we had this sort of pejorative 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 where we called supertentorial, which means it's in your head.

Right.

And, and so it was kind of a medical inside joke. And it was very judgmental or pejorative. It was. And what we found was that actually it's the opposite that, that when you look at, and this 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 irritable bowel that's causing your 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.

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 probiotics.

Because then they tend to fight in there. 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 just 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 kind of 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 Helen Center. And it's amazing how many things it can fix. So in this case, the patient had more psychological issues, ADD and.

And the bloating anxiety. And that was, that was definitely. The SIBO was driving this. The SIBO was driving part of the anxiety. It was sort of like, again, you have this genetic predisposition. You're, you're under lots of stress, which is one driver. Yeah, you have. 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. Before you tell that, I'm not going.

To give you that.

It's really interesting.

I want to talk about sleep apnea 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, right? 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 3:00, 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 what's going on in your life as well. I work on Wall Street and I'm like, work hard all day and I don't eat much. And then 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. to lay 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. Because you say you have anxiety or panic attacks, doesn't necessarily mean 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 pain.

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, So, now.

These are not tests you'd get at a traditional doctor. No, you do not get these at a traditional doctor. They're 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 called, they're.

Smaller than proteins called peptides. That's less than 100 amino acids.

Yeah, 50.

50? Yeah, so that's 50.

Yeah.

Okay, what do I know?

I'm not gonna argue with you. I don't know.

It's been a while since I took biochemistry. All right, 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. Wow. He also has- Now wait, wait, wait. So 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 cryptopyroles. So, what are cryptopyroles? 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 cryptopyrole. Well, cryptopyroles 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 cryptopyroles and you have lots of cryptopyroles, when cryptopyroles leave the body, they take B6 and zinc with them. B6 and zinc are really critical cofactors 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.

Yeah.

And it tells you what's happening that is due to the defect or the lack of B six and the lack of zinc.

This is really what we call nutritional psychiatry.

Right. It is. And his cryptopirals were way off the charts. And so I can't reverse that, but I can supplement him with B six and zinc. Yeah, because 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 B six 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. so maybe it's not Prozac that he needs, 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. Yeah. 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. And 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 gonna make it harder for you to function the next day. Not only are you gonna 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 underdiagnosed. 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. And your airway is narrow or it's right?

Yeah.

And so he had sleep apnea and he'd been snoring all his life. Point being, his sleep apnea- maybe it's.

ADD and anxiety was probably related to his sleep.

He always steal my thunder, Mark.

No, it's good. He's like, read your mind.

Yeah, you read my mind.

So, it's- I slept last night, so.

I'm like- 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 fixed his sleep apnea, we fixed his urine peptides, we fixed his cryptopyrils, 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. And then if they need to tune up, we can see them periodically. But most of the time, we give people the ability to fix the things that have been going wrong. we teach them how to take care of their bodies based on their own unique characteristics. And then they do great. And part of the problem in functional medicine is you don't often get long-term patients because they get better. And then like, what happened to you? Why didn't you call me? He's like, oh, I was better. I was like, oh, you were? Oh, great. It's like, I'll find out like five.

Years later, they'll call me for something. I'm like, what happened to you? I know. That's been hard for me because in my traditional practice, you know, family practice, I raised a generation of patients, you know, two generations of kids and families, and I saw people over and over and over again.

But that same problem.

Right. With the same problem.

You manage their disease.

Managing them with their medicines. And so we had a really good relationship, right? Here, people get better and then you don't hear you.

Yeah, that's part of the problem. So, it's like, yeah, we don't manage diseases. We want to get rid of them. If someone's listening and they have depression, anxiety, mental health issues, issues. What are the ways of eating that actually cause a problem? And then we'll get into what are the ways of eating that actually can fix the problem.

Yeah.

And then we'll get into the solution. Such a great question. Let's start with the problem at the end of your fork before we tell you the solution. And the problem at the end of your fork, a lot of people know those words that, you know, everybody knows I'm about to say sugar, everybody knows I'm about to say trans fats, everybody knows I'm about to say processed foods. And so the- Surprise, it causes everything.

Cancer, diabetes, Alzheimer's, and depression.

And I think what's really been striking to me as a psychiatrist interested in behavioral change and as an eater and as a parent, how do you change those from being concepts to being behavioral and action-oriented items in your own life? And so what's causing the problem very simply is not getting enough of the right nutrients. And I would argue for a lot of Americans, missing a set of nutrients. Americans are not- Americans are not getting phytonutrients because they're not eating plants. Americans are not getting seafood because they eat 14 pounds per year, period. And it's fish sticks. It's not the seafood that we would want them to eat. This is not shrimp ceviche and wild salmon. And they also, there's I think a problem that isn't just around the food choice but is around, I would say, the missing spirituality of food. and that people have, we've lost our soul about food and when you tell people to eat well, there's a notion that, well, that costs too much or it takes too much time or I don't know how to do it. And I think those are our missing lies.

Yes.

And I think it's just, I mean, my mama taught me how to cook and she's taught me that recipes start with olive oil or butter, garlic and onions.

Pretty much.

And then you add in, you put in some vegetables in that and you're good, right? You put in some meat that you're good. You, and so it's pretty much how I cook. Yeah, I mean, I think it, and what I'm, I'm shocked by things like when we make our lentil soup at home, we make a lentils, carrot, celery, and that's it. We put it in a crock pot. And I love serving that dish for people like, wow, what's in here?

Right.

It's like, it's lentils. Yeah. Carrot, celery, a little pinch of sea salt. So anyway, those are what's on the end of the fork that's causing the problem is, first of all, people aren't eating with the fork. People aren't taking a deep breath and engaging their digestive system and people aren't in any way offering up gratitude or thanks for most people. Some of you all are out there doing that. But the number of times as we did when we were, we had that wonderful dinner with well and Good and we sat there and I'm sitting there next to Abby Bernstein and I'm thinking like, I've been out in the Midwest, like you don't eat until you say grace. And I said, let's have a moment. And everybody's ready to give thanks and bow their heads for a moment. She said such a wonderful grace to our food for us. those kind of things, it's not just that that garbage is on the, you know, it's not even in your fork, it's in the package that you're eating, or that it's on the go. It's that we've lost that notion of where it comes from and valuing that and honoring that. And we're doing a better job as, you know, honoring the farmers who grow it, you know, who are, you know, these silent heroes. You know, talking about a healthcare crisis, I mean, talk about physician suicide. I mean, the biggest threat to farmers right now is farmer suicide. I mean, we're just losing dozens of farmers a day. It's the number actually came out, there was a little confusion, like what's the top risk group for suicide? Was it farmers or doctors? And I was like, either way, it's just awful.

So is there data, science, proving that sugar and processed foods cause mental illness?

Well, let's talk about the data set that there is. The big data set and there's controversy about this data set is correlational data. And the controversy is that's really misguided us with a lot of nutritional policy per smart folks looking at that. I really like the writing of Gary Taubes and Peter Attia who kind of look at the science behind correlational studies and have some serious questions. But if we're going to think about that data as being useful, that data is very clear. When you eat more processed foods, which means simple sugars, trans fats, and a lot of simple carbs in all those ways that it's not just sugar folks, it's like, you know, fructose syrup. I love corn syrup solids.

Right, and they changed the name of.

High fructose corn syrup. Right, it sounds like a corn kind of like corn syrup, you know, like maple syrup. And so those are the things that certainly we want folks to avoid. And what does the data say? If you eat highly processed foods, you have 50 to 100% increased risk of clinical depression. If you eat high glycemic index foods, there's a great study that came out, a colleague at Columbia looking at high glycemic index foods, so those are foods that just spike your blood sugar more, those have a significant increased risk, individuals have an increased risk of depression, the Women's Health Initiative, so big, big study of women ages 45 plus. And so there's that correlational data and it's just consistent when you look at the meta analyses of it, it's consistent that the food that we've created in the last 100 years leads to an increased risk or increased risk in that population of depression, same data for ADHD. not as much data for anxiety disorders, which is interesting, but certainly feels true to me clinically. Then we move on to randomized controlled trials. And the reason this is of interest is on the molecular side, like in the mouse models. You know this. Not having enough nutrients and putting lots and lots of fuel in any sort.

Of mouse look like.

What does depressed mice look like? It's very clear what depressed mice look like because you stick them in little cages and they don't try and you put them into swim, it's a forced swim test. And when mice are depressed, they don't fight to get out, they just stop swimming. They drown? We don't let them drown, but they would drown if you didn't fish them out. Whereas non-depressed mice, they're fighting to get out. That's what a depressed mouse looks like. So the randomized controlled trials that came out recently are exciting because we can say it makes common sense. We can say on a molecular level it makes lots and lots of sense. We can say it makes sense in the correlational data, but you and I know, Mark, medicine's not going to change until we have randomized clinical trials. And that's where folks like Felice Jacka and Michael Berk and the Food and Mood Centre in Australia, they're really, I would say, the leaders in this, where they've completed a number of trials. Natalie Parletta is also not part of that group, but they're part of the leaders in this. And now they're putting down numerous randomized trials and creating resources for patients with mental health concerns like depression to make sure food's part of the equation. And their data looks quite strong. And what I love about this is when the data comes out, it's funny, one of the big leaders in psychiatry, won't mention him by name, but it's been very critical. It gets really crit, it's funny, there's a big, big post about how in some, you know, one of these health medicine review websites about, you know, how, how bad the trial was or how small it was.

It's like fighting.

And everybody's always criticizing each other about the study. And I was like, so when we don't have data, you say there's no data. And then when people do a really good good trial, you want to pick it apart. And there's some feeling that it's almost like, you know, folks have really- People.

Don'T like paradigm shifts.

Well, I mean, is this how bad it's gotten, Marc, that we're at a paradigm shift? We're suggesting that our patients, our neighbors, our families eat well for things like when they're thinking about their brain and their mood and their dementia risk and their depression. Like we've gotten so far down the rabbit hole of medicine, that that's a paradigm shift.

Yeah.

Like, that's crazy.

It is absolutely nuts. And you're right, there's so much data. Like, you might be aware of Hiblin's.

Work, which was from the NIH where he showed the- Captain Joe. Captain Joe Hiblin is like- He's a pretty cool guy. He's the leader of the- He calls himself the, he is the servant, he's.

The Surgeon General's, he's a soldier in the Surgeon General's Army. There you go. And he did these amazing studies looking at the rise of omega-3, I mean, the rise of omega-6 fats refined oils, and the decrease in Omega-3 fats lead to violence, homicide, suicide, and that changed behavior. And I remember once coming back from, you know, somewhere, and I had a letter on my desk in my office, and it was from a prisoner who wrote me a letter, wrote, read my book, Ultra Metabolism, way back when, and said, you know, I was a violent criminal in my life. And I realized, you know, I. I. That when I changed my diet after reading this book in prison, I don't know how he did that. that he realized he was a very different person. And they've done prison studies where they feed prisoners healthy diets and they reduce violent crime by 56% if you give them a multivitamin, it reduces crime by 80%. In prisons.

Yeah, you can see the notion that we don't approach that, right? What is criminal activity violence? So some of it's stuff we don't understand. Some of it's certainly horrible character pathology. But some of it, when we think that this is a population that in general does not have good nourishment, in general does not learn learn a lot of mental health skills. There's a way that some of what's going on there is certainly just a result of a broken system of mental health care and I would say a broken system of our culture. I've been inspired this month by Benjamin Rush biography and the reason is that I didn't know anything about Benjamin Rush. And Benjamin Rush is one of our youngest founding fathers. He is the second youngest signatory to the Declaration of Independence and the only, I think, I think the only physician signer. And he is our original American physician. They called him the American Hippocrates back in the day. And he's also our original psychiatrist. And he founded the first mental hospital and he helped us found this country on a very, very simple principle, which is that when we think about mental illness, we can't put people in asylums and say that they don't have spirituality or they're sinners or they're bad people, that we as physicians are going to treat them as patients and we are going to care for them. and that has just inspired me to really think about what's happening in our country and how bad our mental health has gotten and how we all know about it and we're just finally starting to talk about it. But we were founded as a place where we should have freedom to talk about this. I'll get you a copy of the Benjamin Rush book.

Yeah, it's fantastic.

Every doctor should read it.

So, Drew, you wrote this paper. It was published September 2018 in the psychiatric journal. And it was really quite detailed in terms of its analysis of the types of foods and nutrients. So help us take this home. What are the things that you learned from there that are the most important nutrients we need and what are the most important foods to help us get those nutrients and just in general to.

Help us for mental illness? And so the simple, the paper is called Antidepressants Foods and folks can check it out and it's an open source article. And I did this with my colleague, Dr. Laura Lachance, and quite simply, it's arithmetic. It's bean counting. And we went through all of the literature, looking at all of the essential nutrients, vitamins, and minerals, and did a literature search to say, well, which of these have significant evidence that they can help prevent depression and that they can be used to treat depression? And there are 12 that we found. And I bet you could name all 12, Mark. They're the 12 we would expect: omega-3 fats and zinc and B12, vitamin E, magnesium, Iron. And then we looked at just a simple what a nutrient profiling system is, is it just tries, it's just a system for looking at what foods have the most of those nutrients per calorie. And then what a good nutrient profiling system does, and Dr. LaChance and I really wanted to create a good one because oddly there are, I think, 27 nutrient profiling systems in the world that have been created. Some people have seen ones like the ANDI or NuVal, you know how many have been about mental health?

None. None.

And so what we, a good nutrient trophic level system does looks at food categories. So we're not saying kale, kale, kale, kale.

And people say, well, I don't like kale.

You can't eat too much of it. You're going to have a hypothyroidism. Yeah, exactly. Oh, no, it's toxic now. Now it's toxic more. But what we say is leafy greens. And so what we did is we scored, we looked at all of the, all of the, the top foods for these nutrients, scored them and then created a list of the plant and animal foods. And so, first of all, they're the foods that top the list, which I just think are interesting. Oysters, clams, and mussels are in the top five on the animal side. And, the reason we did animal foods is that no nutrient profiling system usually has any meat or any animals in it because it's all based on calories usually and plants always have fewer calories. But, most people eat meat or seafood so we wanted to give folks a.

List of which had the most nutrients. And, why would this shellfish, the top ones?

Top ones, because think about oysters. Why do they top the list? You got 10 to 15 calories per oyster. So, let's just say six oysters, 60 calories. And, for those 60 calories, you're getting 768 milligrams of long-chain omega-3 fats, you're getting 340% of your vitamin B12, you're getting, gosh, at least a third of your iron, you're getting 500% of your daily need of zinc, on and on and on. You're getting in some vitamin C in oysters. Okay, let's go get some oysters. Yeah, exactly. All that for 60 calories. And that's just, and on the other side looking at plants, things like watercress top the list. And why just watercress? Lots of nutrients, no calories or very few calories. And so that's a great example of nutrient density, those foods. And so the food categories that people should be looking for are things like leafy greens, the rainbow vegetables, more seafood. And if you're eating meat and red.

Meat, to look more towards wild red meats or grass-fed red meats. So, this is fascinating. So, the diet that prevents cancer, heart disease, dementia, depression, and fixes most chronic illness is the same diet.

It's really, well, it's where we got off in medicine. We kind of separated out mental health and brain health from the rest. Like you're saying, kind of like somehow the blood brain barrier was like, thou shall not pass. Like we didn't think that sure those same all those same activities that we think about in terms of our general health and the foods we want people to eat and the things we want people to do, move their bodies, connect, be part of their community. Yeah, that's key to your brain health and your mental health.

Yeah.

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in.

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