Treating OCD From A Functional Medicine Perspective with Dr. George Papanicolaou

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

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. Hey everyone, it's Dr. Mark. I know a lot of you out there are practitioners like me, helping patients heal using real food and functional medicine as your framework for getting to the root cause. What's critical to understanding what each individual person and body needs is testing, which is why I'm excited to tell you about Rupa Health. 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 optimize health and reverse disease. But up till now, that meant you are usually ordering tests for one patient from multiple labs. and I'm sure many of you can relate how time consuming this process was and then it could all feel like a lot of work to keep track of. Now there's Rupa Health, a place for functional medicine practitioners to access more than 2000 specialty labs from over 20 labs like Dutch, Vibrant America, Genova, Great Plains and more. Rupa Health helps provide a significantly better patient experience and it's 90% faster, letting you simplify the entire process of getting the functional medicine lab tests you need and giving you more time to focus on patients. this is really a much needed option in functional medicine space and I'm so excited about it. It means better service for you and your patients. You can check it out and look at a free live demo with a Q&A or create an account at RupaHealth.com that's R-U-P-A-Health.com Now, so many of my patients wait until they're sick to finally take care of their health. I've even had doctors, many doctors as patients, who just wait for their problems to get worse and worse and receive a diagnosis of a disease before they take any action. well, that's not the path to health. We can live longer, healthier, happier lives if we just prevent the imbalances in our bodies in the first place. And nutrition is a key part of this. And many of us don't get the optimal amounts of nutrients through our diet alone, even a whole foods diet. And then when you add in all the stressors we're up against, like work demands, toxins, lack of sleep, we're even more likely to have nutrient deficiencies. So one of the things I use every day to optimize my intake of vitamins and minerals and phytonutrients and pre and probiotics is AG1. from Athletic Greens. It's a comprehensive superfood powder with a special blend of high-quality whole food ingredients that work together to fill the nutritional gaps in your diet. It's specifically designed to support energy and focus, aid with gut health and digestion, and support a healthy immune system. I've made AG1 part of my daily ritual because I feel better knowing I have a little extra nutritional insurance to complement my healthy diet. It also gives me a nice boost without feeling overstimulated. I like to think of it as a huge leafy green salad shrunk down to a simple glass of water that I can take anywhere. Right now you can get a free one-year supply of Athletic Greens Liquid Vitamin D and five free travel packs of AG1 when you make your first purchase. Just go to athleticgreens.com/hyman. That's A-T-H-L-E-T-I-C Greens G-R-E-E-N-S.com/hyman. Now let's get back to this week's episode of the Doctor's Pharmacy. Welcome to Doctor's Pharmacy. I'm Dr. Mark Hyman and that's Pharmacy the N.F. A place for conversations that matter. And if you or anyone you loved or know has struggled with OCD or obsessive compulsive disorder, you better listen up. Because we're having a great conversation about what to do about it. The answers might surprise you. For sure. It's not the typical take the drugs and cross your fingers and hope for the best. They don't really work anyway, which is the typical approach. And today we have the privilege of having none other than Dr. George Papam: Nicolaou, who's one of our key physicians at the Ultra Wellness Center in Lenox, Massachusetts. He's a graduate of Philadelphia College of Osteopathic Medicine. He's board certified in family medicine. He's certified in functional medicine. He's done all kinds of cool stuff like work on Native American reservations and.

Founded his own practice and has come to work with us a number of.

Years ago and he's just an awesome dude. So welcome, George. Mark, it's always a pleasure. Thanks for having me today. Okay, so OCD is a problem and it affects people and it really ruins their life. It takes over their minds in ways that control their thoughts, their behaviors, their actions and their lives. And it's a really vexing problem for a lot of people and it's also one that is hard to treat with traditional medicine. So 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.

So 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. 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. Then you have the compulsions. 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 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. 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 sized 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.

And the compulsions, like 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 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 woman, just in particular, was so striking. She never cleaned her house 'cause she didn't wanna move anything off the floor. 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'd think she was a crazy person. When you talk to her, she seems reasonable and nice. But you go into her home and it's like a nightmare. and it was really unexpected what we found worked for her, 'cause 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 wanna look at? 'Cause 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, you know, these kids often remain financially dependent. And so they, like, 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, 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. We know that there are other causes that are being studied, and these are one of the, so genetically, so there aren't 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 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 be able 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, and they did DNA analysis of their stools, and they found that people with OCD had a very low abundance and and variety of the key bacteria in the microbiome versus their control group. 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. 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 some of the, and there's another bifidobacteria species. And so now 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 they did 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 colonies, abundance of particular colonies in their gut, and they had limited diversity. Again, no abundance, no diversity. With the same people, they had a matched group, and the other group had a lot of diversity, a lot of abundance. 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 have 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 sort of 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 and observing. And then, and then I began to sort of dig into the research, and now the research sort 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 antifungal. 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 get someone an antibiotic and antifungal and their psychiatric problems would 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 amazing.

Yeah, you changed your compulsion. Now she's a cleaning 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, some people get arthritis, some people get OCD. And one of the things that you 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 at 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, 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 tics because tics often go along with it, right?

Yep. Yep. 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, you know, a fair amount of trauma as a 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 and made it very difficult for her to have a social life. She came in and of course as part of the workup, we like, you know, we do stool analysis, we do nutritional analysis. I look for toxins like heavy metals, chemical toxins that could cause a disruption in the gut microbiome like glyphosate. We can measure that. Then we look for stealth infections. And there are markers that we can use to determine if somebody has been infected with Strep, even though they might not have current symptoms. So I do stealth 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.

Absolutely, yeah. 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. Look for genes that have variations so that when they make their proteins or enzymes, 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. If we can find those, they might be having an impact as well. Those are tests 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 messed up down in her gut.

Yeah, the gut was messed up, and 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 the brain gets inflamed, you can also trigger autoimmunity, and now you can start making antibodies against self antigen, and that can include the brain. So dysbiosis, leaky gut, did the nutritional analysis, and she was low in B6 and zinc. And we know B6 and zinc are really important for brain function, particularly neurotransmitters. And so. And then 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. Oh. And that enzyme worked really, really slow. So she had a buildup 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 variance, 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 fight or flight right away and they get anxious and they can get panicky and agitated, 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, 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. 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. 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, rhamnosus, reuteri, 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. So, it has a twofold purpose. So, 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 to allow her brain to account for that slow acting gene and having done all those things, you know, she also did some cognitive behavioral therapy and she had a complete turnaround. By the middle of her, 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, amazing. And, you know, that speaks to the fact that, you know, we really have really not addressed psychiatric problems effectively in this country, that we, 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. 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. That calmed everything down. She started to struggle near the end of the year. We put her on 5-HTP, and she made a complete turnaround. She did great. She's going back to school. I think, yeah, 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 are going to have lasting change and I think people aren't having to feel like they're stuck in these horrible mental conditions and it's worth digging in. Even though it's a little bit dated, I think the AlterMind 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.

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 go, is it good?

Is it good? I haven't looked at it in years. That was like a download from God. I literally sat in my office, in my house, and I sat for three weeks at 12 hours a day, and I just unloaded everything in my brain that was there after doing this for so many years and all the patients and their stories.

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. So anyway, this has been a great conversation, George. I hope if you've been listening and you have any struggles with OCD or other mental health issues, that this has been heartening and that you've understood that there is maybe a path forward. And I would encourage you to explore with a functional medicine doctor. You can find one on the iPad website. You can come see us for a little bit backlog, but we'd love to see you at the Ultra Wellness Center. We have five Physicians. We five nutritionists who've been doing this for 20 years, probably more experience than any other practice. And it's in the beautiful Lenox, Massachusetts. So it's pretty nice to go to. And if you all have listened to this and you know someone who's struggled with these issues rather than sort of just keeping this to yourself, share this podcast with them, let them know there's hope and a way of thinking about this differently. Subscribe wherever you get your podcast, leave a comment, have you overcome your health issues, mental health issues. We'd love to hear from you and we'll see you next week on the Doctor's Pharmacy. 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 send it 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.

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