TRY THIS To Overcome Anxiety & PREVENT BRAIN INFLAMMATION | Todd LePine

If you have an acidic brain, that causes anxiety. The number one thing that you can do for people who have panic attacks and anxiety is regular exercise. Anxiety can be triggered by a variety of different things. It can be related to a person's genetic predisposition. There are some people who are more anxious and sort of hardwired. I call them squirrely, the people who are always vigilant and watching out. There's a natural sort of personality that each of us have. Some people who have anxiety, when it becomes pathological, From an evolutionary standpoint, it's actually good to have anxiety. You're watching out so that you don't get eaten by a saber-toothed tiger. It's okay to sort of watch out. But if we're in an environment that's not hostile to you, you don't want to have anxiety 24/7. It's okay to have anxiety when you need to be vigilant. But if you can't turn up that hypervigilance, and there are some people who actually also have difficulty in detoxifying stress hormones, I can almost literally predict if a person has a catechol-O-methyltransferase deficiency. Now, COMT, that's a big mouthful, but COMT basically means that when you're under stress, your stress hormones linger in your body longer. So that sort of fight or flight response that you get when you're anxious, it just basically is like a merry-go-round. It just sort of keeps circulating in the person's body and they remain sort of anxious all the time. So it's natural if you get more adrenaline, you're gonna get more anxious. If I shot you with adrenaline, you would get on edge and that edge should go down as your body detoxifies those stress hormones. But there are some people, they can't detoxify those stress hormones. So those are the people who mind-body types of behaviors where meditation, deep breathing exercises, visualization, relaxation are really, really key for sort of dialing down that anxiety that they have. Also other things that are highly tied in are gut bacteria. Some of our gut bacteria when they're out of balance have been shown to increase anxiety because they actually consume a compound in our gut called GABA. GABA is that compound that helps with relaxation. So if you have an imbalanced gut it can trigger anxiety type symptoms and I've had a lot of patients who've come into me not necessarily with, you know, my stomach hurts or whatever, but when I test them and I ask them and I treat their gut and get their diet back into balance, their anxiety sort of melts away. In my training, I was trained to treat anxiety with prescription drugs. So, you know, some of the medications would include the benzodiazepines, things like Valium and Xanax. And they, yes, they do treat anxiety. And there are times when I will use those prescription medications under, you know, a really, like, let's say somebody's in an accident and they, their system is so hyped up that they need something to sort of short-term calm them down for a couple of days. That's perfectly appropriate. But on a long-term use, they actually have more disadvantage. So the things that I'll work with them nowadays, besides just giving a prescription medication, is looking at their nutritional biochemistry, looking at a gut analysis, teaching them deep breathing exercises. The other thing, which is also really another thing that I've learned in my coming and going, is that anxiety is also related to the brain PH. So if you have an acidic brain, that causes anxiety. Now, most people say, well, how do I know if I have an acidic brain? Well, we've all experienced having an acidic brain is an example of that is when you go as a kid and you go underwater and you hold your breath. And if you hold your breath to see how long you can hold your breath underwater, the thing that you get at the end when you quote run out of air, you get this incredible, oh my God, I've got to get up. I've got to get oxygen. Well, guess what? That actually does not happen because of low oxygen. It happens because the carbon dioxide builds up in your body and carbon dioxide causes an acidic brain. So that acidic brain is telling your body that we need to, there's panic is going to happen. So things that you can do to prevent your brain from becoming more acidic, which is a strong trigger for anxiety, is regular exercise. The number one thing that you can do for people who have panic attacks and anxiety is regular exercise with interval training and that teaches the body how to clear out those acid buildup, what we call organic acids in the brain, which then decrease anxiety. Functional medicine, it's not a sexy term, but I like to tell patients that it's really about creating health as opposed to treating disease. Because when patients come to doctors, they come in usually with some kind of symptom. I have pain, I'm tired, I'm overweight, I can't remember, whatever. And then you're sort of, you know, say here, take this pill, try this, see if it works. Without asking the question, well, you know, what kinds of things are you doing or what kind of things are you not doing that's causing you to go down this path of ill health? Because our bodies are really incredibly designed to have resiliency and we also have health built into it. Our bodies naturally want to be healthy. So if you give it the right, you know, things in terms of sleep, nutrition, exercise, movement, relationships, all those things create health. And when we're out of balance, we are dysfunctional and our bodies are dysfunctional. And when we bring back that balance back into the body, then our bodies are optimally functional. So that's really what functional medicine is. People also, you know, I say, well, what do you do? And I say, I do clinically applied nutritional biochemistry. That's what I do in lifestyle medicine. I tell people how to live their lives in a healthy fashion. I've always been pretty aware of my own health and I've always exercised and always tried to eat right. I don't eat right 100% of the time. I like my potato chips and my ice cream and my beer every now and then. But it's a matter of balancing things and I don't think that when you're trying to eat the right diet, is there a right diet for everyone? No, there's no right diet for everyone. Everyone's different. Some people can tolerate gluten and other people it's like arsenic or kryptonite. So is that one size fits all kind of a diet that you give to everyone. And diet is really important. Diet is really, I think, a foundation of functional medicine because I can prescribe all the supplements, I can give all the prescription medications, but a person eats a crappy diet, they're never gonna get healthy. Some of the tests that I'll do for patients who come in complaining of brain symptoms is really just observing the patient. So I'll just observe the patient, I'll see how their languaging skills are, are they able to engage in a conversation, do they laugh appropriately, what's their mood like? So you can read a lot of what's going on in the patient. As far as some of the tests that are go, I would say probably organic acid testing, amino acid testing, fatty acid testing, gut health testing that we do here, and then also genomic testing and toxicology testing are some of the key things that I look at when a patient comes in complaining of brain symptoms. What we do in functional medicine is really we dig much deeper. So traditional tests, you know, blood chemistry panel, CBC, liver function tests, cholesterol and thyroid tests, those are all good tests, but functional medicine really gets into the underlying complexity of biochemistry, nutrition, functional metabolomic analysis, genomic analysis. So it's really much more complicated. you have to dig deeper to really uncover what's going on with a person when their brain's not working. The gut-brain connection is a big, big part of depression. No, so how do we label depression? What does depression mean? When somebody says, I'm depressed, it basically means that your brain's not working and your mood is not normal. You're either flat or you're sad or you're depressed and you're isolated and withdrawn.

There are many things that can trigger.

And tie in with depression. Now, the thing that we're told when you watch television commercials for big pharma is that depression is a serotonin deficiency. All you need to do is take an SSRI, get your serotonin up, and we cure your depression. Guess what? That's not true. In the same way that heart disease is not a cholesterol problem, it's much more complex. And heart disease in the same way is really an inflammatory process. The latest data is showing us that depression is really an inflammatory process and it probably originates in the gut. So there's a huge connection between the gut and the brain and when the gut is not out of balance, when the bacteria, yeast and or parasites get out of balance, those things can trigger systemic inflammation. That systemic inflammation in turn can trigger withdrawal behavior. It can increase molecules in the body called cytokines. And it's sort of like when you get the flu and it's really, you're really sick with the flu and you want to sort or just withdraw, that's what you do, and that's what depression is. So depression, from an evolutionary standpoint, has a role that if you get really sick, you're gonna withdraw, you're gonna be depressed, you're gonna sit in a corner till your body gets over that sickness, and then you get healthy and then you're fine. When that process becomes more chronic, then we call that, we label that depression. But it's really an inflammatory process, and there are other things, the gut is highly tied in with depression in the brain. but there are other things that can also trigger depressive symptoms. Other things that can trigger depression is, believe it or not, not getting enough sunshine. So how do we spend our lives? How do we, actually, let's ask a better question. How did we evolve? So if you go back 10,000 years, we were basically outside pretty much 24/7. Occasionally we'd go into a cave. We were pretty much naked and we were hunting and foraging for our food. And we were in rhythm with Mother Nature. when the sun got up, we got up. When the sun went down, we went to sleep. And light is a huge factor. In fact, there's actually a condition called seasonal affective disorder. Seasonal affective disorder means that during the fall and the winter when there's less sunlight, you're going to become more depressed, you're going to withdraw more, you're going to sort of semi-hibernate. That's a natural thing when you think about it in an evolutionary standpoint. However, if you are in a building all the time and you never see the sun rise and at nighttime, you're on your iPad, your computer, your video games, and the sun never sets, you disrupt that circadian rhythm. And that is a big, big contributor to depressive symptoms. I think in today's world, there's lots of information. I mean, we get bombarded by information. So some of it goes along with aging to some degree in the same way that when I'm 70 years old, I can't run as fast as when I was 20 years old. So you may not be able to think as fast. You may not be able to recall a person's names or places. But What you really want to do is catch memory problems early. And I think one of the great talks that we went to at this year's Functional Medicine Conference was Dale Bredesen's talk about catching Alzheimer's early. And you really do that by asking a variety of different questions to the patient, doing a mini-mental status where you have the patient remember a series of numbers, have them draw a clock, and there's a variety of different things that you can do to determine early on is this person showing signs of cognitive impairment way before you develop Alzheimer's. And we have the same analogy that I don't want to wait till a patient has frank diabetes and their blood sugar is 230 before I treat them because guess what? The horse is out of the barn. It's a lot harder to treat a patient who's got diabetes when the diabetes presents as uncontrolled versus can I treat this patient, you know, when their blood sugar is normal, but after they have a meal, their insulin goes up, their blood sugar goes up. I can treat that very, very easily. early in the same way that you can treat Alzheimer's very easily and early before you have an end-stage process going on. Aging is inflammaging. What we call aging is really chronic inflammation affecting the body and in certain cases affecting the brain. We know it affects your joints because it's hard to get up from the chair when you're 85 years old and you haven't taken care of yourself or if you're overweight. so the autoimmune process is really continuum. So when you have inflammation and inflammation in turn can change the molecular structures of certain proteins in the body where the body then now perceives self as non-self and you start attacking your own self. So there really is this continuum between aging, inflammation, and autoimmunity and it's sort of all in one spectrum. It's not like we can put something in this box and say this is just autoimmunity and this is just the aging process. It's really sort of a continuum effect. So Lyme disease is a topic all unto itself. And the one thing that we, living in the New England area, especially in the Berkshires, we see a lot of patients with Lyme disease. And if you go back in history and you actually understand the history of syphilis, syphilis is a spirochetal disease, and it used to be called the great mimicker, meaning it could present any different way. It could present as a heart problem, it could present as an arthritic problem, it could present as a memory problem. And Lyme disease is a bacterium, which is a spirochete, and it has a tendency to go towards connective tissue and neuronal tissue. So a person who gets a tick-borne Lyme disease bacterium, oftentimes it can sit silent in the body, and then over time it can cause neuroinflammation. And I've seen patients come to the office here who have presented with multiple sclerosis is their diagnosis. Memory problems are early Alzheimer's. Patients who presented with Parkinson's type symptoms, and their true underlying cause was actually tick-borne Lyme disease. A functional medicine approach of Lyme disease is really multifaceted. I think one of the big things that you can do with that, with a patient who has Lyme disease, is improve their diet. There's some substantial evidence that a ketogenic diet in patients with Lyme disease can be highly effective because the bacterium, if you will, lives off of sugars. And a lot of neurodegenerative conditions that would take is another topic. But a ketogenic diet where your body goes into ketosis, where you're burning fat as opposed to burning sugars, can be very effective for switching the metabolism. So you think of your metabolism as like a car that you can either ride it with gas or you can ride it with electricity. and you can make that switch and you can flip it over and rather than burning carbs, you're now burning fat. And that process of burning fat is much more fuel efficient and a cleaner engine, if you will, and that allows you to help a variety of neurogenerative conditions like Lyme disease. One of the other things that I should mention is actually hyperthermia. This is sort of a little pearl that I learned is that most people who have Lyme disease, especially if it's chronic Lyme disease, they usually never develop a fever. And I always ask them, when was the last time you had a fever? They say, I can't remember the last time I had a fever. Well, how does your body get rid of a bug when it's sick? You raise the temperature. You cook the bugs, if you will. And hyperthermia, doing sauna therapy, in some cases over in Germany, they actually have boxes where they put people in and sort of raise the body temperature to provoke heat shock proteins and other things that stimulate the immune system to help naturally fight off the bacteria. So there's a lot of people who will be bitten by ticks, get infected, but never manifest with the disease. So it's not like everyone who gets a Lyme bacteria is going to have the disease. It's when the immune system is not working properly to identify and get rid of outside infectious agent is when you can then manifest as, quote, you know, Lyme disease. I had one patient who was a young girl who was, I'll never forget her, she was 20, 23, 22 when I saw her and she was a vegan. And she was hospitalized prior to seeing me, was put on, when she came in, she was on three psychiatric drugs. She was on anti-anxiety medications and she was not functioning well. When I did a full nutritional biochemical genetic analysis on her, that she was markedly deficient in amino acids. Amino acids are the building blocks of your neurotransmitters. She was deficient in fatty acids. So fatty acids are basically the fats that build the lipid membranes in the body, especially the brain. Your brain is mostly fat, and if you don't eat good fat, you're not going to have a functioning brain. And she was also deficient in trace minerals, and there was a lot of different nutritional underlying causes. She had B12 deficiency because she was a pure vegan. she had iron deficiency. And in her case, her, quote, depression was really mostly just a nutritional deficiency. And when I was able to identify her, she'd actually been hospitalized and was in the hospital for three weeks, and never once did she ever have any kind of nutritional testing done. And she was thrown with all these, you know, the SSRIs and the benzodiazepines, and, you know, it sort of put the lid on the symptoms, but it didn't really cure her, if you will. so that was a really good case where this young person was really on the path towards long-term pharmacology and I was able to get her off of her medications and get her back to feeling whole and happy. So there are a couple of things that people do every day that's really affecting their brain health in a negative way. In today's society, what we do is we are out of rhythm with Mother Nature and I see, probably see one of the biggest things is people complain of fatigue and I ask them, well, what time do you get up and what time do you go to bed? and I think light pollution, especially for young kids on their iPads, on their iPhones, on their computer games, on their TVs late at night, that suppresses melatonin, which is the hormone that sort of helps to induce sleep. It's also a natural antioxidant. So just having good sleep hygiene is really, really key, I would say, for affecting one's health in a good way. The other thing is probably just inactivity. People spend lots of time sitting, you know, most people's activity for the day is moving a mouse. You just, you know, you can just move a mouse on your computer and that's about all they're moving. And that's not a good thing for your body when you do that. So I don't have energy is multiple, there's multiple reasons for that. I mean, patients come in and say, you know, I'm tired. And there are, you know, there's a whole laundry list of different things that can cause people to have low energy. The thing that we get our energy from is our mitochondria. So it makes me think, hey, maybe your mitochondria, which produces ATP, which runs our body, and if we run out of our ATP, we will die instantaneously. That's why people die of cyanide poisoning. So it can kill you in a matter of minutes. I think about low B12. I think about thyroid. I think about their sleep. I ask them, you know, do you snore? If someone's overweight, if they snore, maybe they have sleep apnea. those are all different things that can do it. Are they pounding down alcohol and caffeine? Those things disrupt the sleep so a disrupted sleep can also cause no energy. Are they not exercising? Some people say, I'm too tired to exercise. Well, guess what? Exercise will actually give you more energy. So those are all different things that come to mind when someone says, I'm too tired or I don't have the energy to do things. The best things to do, I think, to keep your brain sharp is to exercise. Exercise is the best medicine, but it's a hard pill to swallow. So exercise actually has multiple effects on the body. What it does is it increases oxygen and increases removal of toxins. And this is happening on a very, very small level called the arterioles, where the capillaries are. And when you exercise, all those blood vessels dilate and they bring in oxygen, they take out the waste products. So when you're not exercising, you really are sort of, if you will, building up toxins in the body. Another thing that is highly important for helping with health is to keep mentally sharp. So using your brain to sort of think, doing puzzles, engaging in conversation, reading books, you know, the brain's like a muscle. If you don't use it, you lose it. So it's really important to keep the mind stimulated, but not overstimulated, not sort of like I call, you know, sort of like multitasking and doing a whacK-A-Mole kind of a thing, which most people are doing every now and then. Community is really important and community happens on a family level, it happens in a neighborhood level, and it happens in a broader context. So there's a wonderful book called Alone Together by Sherry Turkle. and she talks about how technology in some ways brings us together but it's also making us separated. So real connection, and I call this vitamin O, vitamin oxytocin. Oxytocin is the thing that mammals get when they're in community and they're touching one another and they're hugging each other and they're sitting down and eating together. That sharing, social bonding that happens, that glue that cements us together is really, really important. You look at the blue zones. That's what blue zones is really, the striking thing is they have that sense of community and that sense of purpose and cohesiveness and, you know, we're a social animal. We need that, you know, that vitamin O is really, really important.

Most doctors won't even get a blood test for anxiety. You know, they don't see it as anything other than a psychological event. Right. And so, or, and a biochemical event, you know, it's reductionistic.

Right.

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 antidepressant or anti anxiolytic 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. At the Ultra Wellness Center here in Lennox 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 Lennox, we can do it all virtually and you can get the tests you need and we work with a great we've done.

It's actually been really 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 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 Nicolau. I got what I was looking for.

So it's been really a positive experience a lot. It's true. I did my first 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 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 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 the time and you can actually deal with the lifestyle issues much easier. I mean, for me, I don't travel anymore.

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, 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. 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. So, it starts out with anxiety, but did anxiety really, is that really the culprit or 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. -Wow. -Interesting. -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 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 problem 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, 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, and Bingo, he was a force.

I used to call it speed.

Yeah.

In college.

He actually did well 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, there's anxiety, panic attacks, they're not like, well, did you have traveler's diarrhea? Did you get bloating? And was it connected to your gut? And 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 have a pattern recognition and say, oh, this is starting because of the experiences I have with people. I begin to see these patterns. and I can start to see that, you know what? Yeah, there's something going on in this guy's gut.

Oh, yeah.

And 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 that also clues me into, where am I going to 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. Your DNA predisposes you to different conditions and states of being. So, we actually at the Telomere 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 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 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 it 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.

Do. Right.

Right. And so we only test or DNA health only tests actionable genes in critical areas.

So this is really an important point because, you know, 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 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, people have anxiety and what is it? MTHFR.

And there's also- and CMT.

CMT, catechol methyltransferase. That's a big mouthful, but essentially that gene- that'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 body, you get a build up 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 how do you fix it?

Right. 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 I, 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, you know, 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 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 he had a hard time with, you know, focus in general. So, I thought that he had a 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 the Overalls 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.

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. We really create a customized approach for each person to target in like a medical detective on the things that the most difference. You just gave him 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 didn't process his, 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. So 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 the middle of the night.

So like when you got apple cider and like the bugs grow in there and it creates like that thing that you open up and 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.

There'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 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 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 we had this sort of pejorative term called the functional bowel disease, which wasn't like functional medicine. It was just like, meaning it's like we had this sort of secret code word. We called it supertentorial, which means it's in your head.

Right?

And so it was kind of a medical inside joke and it was very judgmental and pejorative. It was. And what we found was that actually it's the opposite. 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 the irritable bowel.

That'S causing your brain.

Exactly. That's a very different frame of thinking about it.

And also, so 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. 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, so, so.

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 going to be easier for them to digest, not ferment.

So, you're not basically feeding the bad bugs.

You're not feeding them. 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 bacterial overgrowth. So, I'm very careful.

Set them up and kill the bad guys first, right?

Yeah, you want to 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 they tend to fight in there. You got 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 kind of do this, what we call weeding, feeding, and seeding program, which is we basically get 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, and the bloating anxiety. 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 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. Before you touch this, I'm not going to go into this.

It's really interesting. I want to talk about SIBO because it's a big issue. But the gut issue this 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 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 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 not because you say you have anxiety panic attacks doesn't necessarily. And somebody else that 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 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. You do not get these in traditional medicine. 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.

Yeah, 50. 50?

50.

Yeah.

Okay, what do I know?

I'm not gonna 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 that 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 gonna 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 then 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 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. 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 your 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. So, maybe it's not prozac that he needs but B6.

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 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 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.

And 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.

Can you please steal my thunder, Mark?

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

Yeah.

You read my mind.

So, it's very possible that his snoring as a kid was driving his ADHD. 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 cryptopyrals, 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 know, 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, family practice, I raised a generation of patients, 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 medicine. And so we had a really good relationship. Here, people get better, and then you don't hear you have to go to the doctor.

Yeah, that's part of the problem. So it's like, yeah, we don't manage diseases.

We want to get rid of them.

Get rid of them. And that's the beauty of functional medicine. For most of the time, you can do this. We have a little bit of time with them. I want to go through this next case. It's so great. It's another woman with anxiety and brain.

Fog, hair loss, and fatigue. So tell us quickly about her. Yeah, I'm going to tell you quickly about her. so the key piece to her was that very healthy woman who had her symptoms of anxiety, fatigue, and hair loss start probably about 10 months after one of her babies, I think her last baby was born. And so again, I said, so when do you think this all started? We look for the trigger. And once we can find a trigger, when's the last time you felt healthy? that's a starting point for me to start looking for clues. It's like playing clue. Did it happen in the library? Did it happen in the kitchen? Did it happen in the garage? And so getting that first point where she thinks her life changed, that being 10 months after pregnancy, first big clue because women can get an autoimmune thing called postpartum thyroiditis, which is an autoimmune immune process. So with hair loss and fatigue, I'm thinking...

Brain fog.

Brain fog. I'm thinking there's at least an autoimmune process going on here. So I got that first clue going.

And it turned out she had problems, right?

She did.

But another key part was her irregular periods. So she had been having irregular periods for most of her life and she had lots of PMS and around those periods of time she'd have brain fog. So I started thinking about, okay, hair loss, fatigue, anxiety, she's a 42 year old woman, I started thinking about her hormones. I started thinking about all the stress she's under with her kids, cortisol, relationship to estrogen, relationship to thyroid, I knew there was a hormonal piece. And she had recurrent hives. Recurrent hives means, yeah, definitely something autoimmune is going on because we know hives can come from autoimmune processes. can come from stealth infection. We're gonna look there. It can come from gut. Yeah. Right? Candida in the gut. Okay. Interestingly enough, get her hormones back. This is where she's estrogen dominant.

What does that mean?

Estrogen dominant means that you can have normal levels of estrogen and progesterone, but relative to one another, estrogen can be much higher than the progesterone. And estrogen is really good for a woman. It gives her nice thick hair, it makes her skin look beautiful. It helps her maintain her vivaciousness and her energy. But when you have way too much of it and not enough progesterone, then it can cause bad things. It can have impact on your thyroid because it blocks thyroid hormones from getting to the receptors and doing their job. It can cause fat deposition and lead to insulin resistance. as much as you try and lose weight, if you're estrogen dominant, you're gonna be that patient that says, I do everything Dr. Papadopoulos. I can't get rid of weight.

But I find out they have your regular period. Well, that's how they make cows fat for slaughter, right?

The steer, they give them estrogen. Look, estrogen, PMS, you and I have talked about this.

PMS is not normal. It's not correct.

And it affects 75% of women. It's not a normal condition. So why do you get it? One of the big things is xenoestrogens. So, xenoestrogens means xeno means guest or stranger or foreigner. I like to call it stranger.

Like xenophobia.

Yeah, because it's like xenophobia because women who have xenoestrogens have stranger danger. I call it stranger danger because now you got these strangers creating a dangerous environment for you. And, what's that dangerous environment? Estrogen dominance will lead to stimulation. It creates a cancer-causing zone and it increases your risk for breast cancer. Estrogen-positive breast cancers. And so, it's really a big issue. And when you have that many women having PMS and a lot of those women can have estrogen dominance, it's a very important thing.

And the symptoms are common. They get heavy bleeding because you have more estrogen, which means more blood, more clots, you get premenstrual migraines, you get breast tenderness and fluid retention, really common symptoms.

And guess what this woman had? She had endometriosis.

Which is another symptom of it. And that's an autoimmune disease.

Estrogen stimulates the breast so you can get fibrocystic breast disease, it stimulates the uterus so you can get uterine fibroids which is a buildup of uterine muscle.

Tissue and you can get endometriosis. She had the endometriosis. Which is estrogen tissue like uterine tissue growing in other parts of your body.

Right, outside of you, you can grow inside your uterus, outside of your uterus, on your ovaries, and even attach itself to your intestines. So she had this estrogen dominance along with this underlying autoimmune issue. And then I thought, well, her gut is an issue. And she didn't complain about her gut until I started asking her questions about it. and all of a sudden, well, yeah, I do get bloating, and I do get distension, and I do have a food baby every once in a while. All right, well, you know, it's sounding like a C-BO.

So it reminds me of that patient who was like, you have trouble with your digestion?

No.

She's like, how often are you regular? She was like, yeah, I'm regular. I said, how often do you go? She was, once a week. I said, that's not regular. She was regular for me. I go every week. I'm like, that's just what people think of as normal and it's just not normal. Yeah, you may be normal for her, but it's not optimal.

Yeah, you learned to live with what you got.

So she in her mind didn't think she had gut problems, even though she did. She did when you dig into the story.

So here's where it all comes together is that when we get her testing back, we do something called a complete diagnostic stool analysis. And it looks at your complete gut microbiome and it will measure different bacteria, all the different species, but it also can find Candida. Now, since I suspect that there's yeast. Or yeast. There's different forms.

It's not all Candida. There are all kinds of species.

So, different yeast that can grow in the gut. And so, I tested her for the most common one, which is Candida. I did, and it's hard to find. So, I did an antibody test. I did her stool test. and I looked for it on one of her organic acid tests that we do. Found it positive in all three. What does Candida do? Candida metabolizes progesterone.

You know, breaks it down.

It breaks it down. You have less. So here's an estrogen dominant woman who has Candida causing her hives and her fatigue and her brain fog is partly, and it's chewing up her progesterone, increasing and making her her estrogen dominance worse. And estrogen dominance itself, those high levels of estrogen can cause anxiety, they can cause depression, mood swings, brain fog, and all the things that she would experience. That's amazing.

So everything tied together with her.

So I fix her gut, I get rid of her Candida, her hives go away, and then I start treating estrogen dominance. And with that, so you fix the gut and the hives go away.

It just said that like that, whatever. But people suffer terribly with hives. And it have terrible yeast issues. And it can be debilitating. I had this woman, she had this angiodema thing, which is like hives on steroids, literally. It's like terrible. And she had a terrible gut, same thing. She had terrible yeast issues. We cleaned up her diet, we fixed her gut, we got rid of the yeast, and it just went away. And she went from this bloated and inflamed person to just looking beautiful and strong. And it's so easy, actually, when you know what's going on. Instead of taking all these antihistamine drugs and steroids and epinephrine shots, it's such a mess when you look at traditional approaches to this. And when you dig in, and it's different for different people, but if you find out what the issue is, it's actually resolved pretty quickly.

And it was just, she wasn't even coming complaining of that, right? No, that's the point. Both of these cases came in with anxiety as one of their top two complaints. And that's what you said, I'm sorry. That's what you said. I was tapping. So, you know, anxiety, it's just never just anxiety. It's just never one thing and it's the body affecting the brain. And so, she was just a really good case that everything sort of seemed to connect and she also had gluten sensitivity. And gluten, her hair loss was a big issue. She had alopecia areata, which is an autoimmune process. So, with the hair loss, gluten is.

One of the biggest causes of that.

Exactly. It drives, it can actually drive the body to make antibodies against the hair follicles in your scalp and you lose them. And what's the conventional treatment for that?

Steroid injections. Yeah. I've had patients literally go bald. And then we figure out it's gluten. They get off gluten and within months it all comes back and they get a full head. I had this one patient come in with a big hat and a scarf and she was playing a trick on me because I hadn't seen her in a while and she was completely bald last time I saw her and she lifted her scarf off and she had big full head of hair. I'm like, that is amazing.

That is cool. Yeah. And so within six months, this woman's hair actually started slowing down, and by six months, she was growing hair back.

If you love that last video, you should check out the next one for sure on getting the root cause of all disease.

There are a lot of diseases that we can't do much about, and in particular, the neurodegenerative diseases, Alzheimer's, Parkinson's, Lewy body, frontotemporal dementia, PSP, on and on, where we.