Functional Psychiatry in Action: Real-Life Healing Stories with Tracy McCarthy, MD

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'll be speaking with Dr. Tracy McCarthy, MD, a board-certified psychiatrist and Institute of Functional Medicine certified physician with over 2 decades of experience. She's the creator of the Natural Mood Solution online program and the founder and medical director of Dr. Tracy McCarthy Functional Medicine. Dr. McCarthy is dedicated to helping adults suffering from depression, anxiety, brain fog, fatigue, digestive issues, and hormonal imbalances by identifying and addressing the overlooked causes of these chronic symptoms. But before our conversation, if you haven't yet followed or subscribed to the show, be sure to do so. If you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoach.com, and sign up for my newsletter. Be sure to look out for an open the first newsletter you get or you'll get put on the non-responder list and not get future emails. And if you signed up and aren't getting emails, try unsubscribing and resubscribing. You'll also get my free ebooklet, Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. And if you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the show notes and take that. Now on to the show. Welcome to the podcast, Dr. McCarthy.

Thank you so much for having me. It's a pleasure to be here.

Yeah, it's my pleasure too.

So I think you're the first psychiatrist I've had on the show and I have heard of integrative psychiatrists, but I've never talked to one. So I'm curious what the practice of a functional medicine trained psychiatrist looks like and how you got into functional medicine from psychiatry.

Yeah. Well, it's a story. There was a time where I didn't understand if one could be a functional medicine psychiatrist. So, you know, let me go back and tell you how I got into functional medicine in the first place and how I ended up in doing what I do now. So, you know, I was a regularly trained allopathic medical doctor. I went into medical school, really excited about finding out what goes wrong in the body and how we can fix that and how people heal. And the first few years of medical school were pretty satisfying that way, learning a lot of pathophysiology and it was really interesting. But then as it went on and my training progressed, things became much more about identifying sort of constellations of symptoms and labeling that with a diagnosis and then matching that to a pill and the the asking of why is something is going on became less and less part of it. A lot of that is because people will say, we don't know why, but this, the pharmaceutically driven focus is part of why I think that question gets pushed to the side too much. Because if you look in the research, there often is some hints about why, and there are people doing great research. Well, so this was increasingly frustrating to me and my patients who often were saying, hey, well, why do I have this? Or do I have to take this pill for the rest of my life? Or maybe medications were helping only partway, or they were having a lot of side effects. So a lot of scenarios where that wasn't satisfying. Luckily, around that time that that was happening for me, I came across the research on the role of inflammation on so much chronic illness, and I got really excited and I got very interested in the role of nutrition and lifestyle in changing that inflammation. I started to make changes in my own life and was like, wow, I feel like so much better after I eat. I don't have to. I can unbutton my jeans or, you know, my energy is staying better. And, and, um, and then as I learned more, I started to hear about these doctors using these approaches and these philosophies and this research called functional medicine providers. And I ended up training with the Institute for Functional Medicine and, um, gone on to do tons of additional trainings in integrative and functional medicine, but it did confuse me. In my early days in functional medicine, because I also hadn't met any psychiatrists doing this initially. And I kept asking myself, well, will this work in psychiatry? And now I kind of laugh that I thought that, but it was, it was really a result of my training. We were all very, you know, our conventional medicine is very siloed. People don't talk to each other, right? You've got your gastroenterologist over here and your cardiologist over there and your neurologist over there. And it's like very separate as if the body is in these separate zones, you know, we know that's not really true. And so, you know, now I'm at the point, we joke in functional medicine that we know everything causes everything. So it's like in any one person, constellation of triggers can show up as a different set of symptoms compared to somebody else. Right. So of course inflammation can manifest as depression or anxiety, and there's tons of research to support that. So as a functional medicine psychiatrist, I am focused on finding the root causes of the patient's symptoms. What are the imbalances in the body? You know, what are the nutrient deficits? What are the microbiome imbalances? What are the toxin exposures? Like what's not working right? And really focusing to address that as well as relieve symptoms. You know, people need urgent help with symptoms often, but then you wanna go deeper and ask why and help them resolve that and, and empower them really to be healthier. And that's what's so fun about it is it's a partnership. They get to really learn what helps them be healthier and make changes that result in just feeling much better.

Awesome.

So were you practicing as a psychiatrist when you were in allopathic medicine?

Yes. I got real interested in functional medicine as a resident psychiatrist. So I was going through my, you know, traditional psychiatric residency at that And I think I did my first Institute for Functional Medicine training when my second kid was like 1 year old. It was a couple years after residency. Mm-hmm. By then I had had an interest for several years in nutrition and had been reading and, you know, consuming everything I could on the topic. But that's when I got serious about it. And yeah, I was a hospitalist, a hospital-based inpatient psychiatrist. Mm-hmm. So my focus was working with pretty severely mentally ill, usually involuntarily committed patients who were experiencing psychosis or mania and, um, really needed stabilization, you know, to be able to access basic things like food and shelter. And so that was the focus of my work, but this led me in a really different direction. I would've loved to have been able to help them with these tools, but the system was not set up for that. I could not really pick what they were feeding them in the hospital, you know, would've liked to have done. So I learned pretty early on as I was training that I needed to open a practice so that I could actually apply what I was learning and help bring that to my community. And that was the beginning of a whole nother journey.

Awesome.

So I'm gonna start with the general, which is how does gut health impact mental health and vice versa?

Yeah. Oh my gosh. Hugely. And I'm sure that we still only know the, the, just the tip of the iceberg on this. You know, there's so much research coming out all the time about the microbiome and its roles. And, and when we talk about gut health, we're talking about several things, right? We're talking about the microbiome, which I'm sure your listeners know, but just in case, is all the bacteria, fungi, viruses, even parasites in our gut. But it's also our digestion and how well the gut is functioning in that sense. Are we absorbing our food? Are we breaking it down? You know, the gut has a lot of components to it, so it affects mental health in a number of ways and indeed overall health. If we are not able to break down and assimilate our food and our nutrients, then we are definitely operating at a deficit, right? Like neurons need certain things to function well, like B vitamins and magnesium and zinc and cholesterol, all kinds of things. And if we aren't getting those in the diet, so if we're not eating them, We, we're not gonna have 'em, but we might be eating a great diet but not actually absorbing it well or breaking it down well. That's something I see quite a lot on testing I do with patients. And so, you know, the gut is not doing its job there adequately, then your, your brain's gonna suffer. It's not gonna have what it needs to work right. You know, you won't have the hormones you need or the, you won't have the amino acids you need for neurotransmitter production. So that's one way you see it impacts. But the microbiome is the biggie here. You know, the bacteria that we acquire through vaginal birth and then through breastfeeding, and then as we grow with time, we are acquiring this very diverse microbiome. Ideally, it's doing so many jobs for us and they make— these bacteria make a number of compounds. And many of these are signalers to our own immune system and to our nervous system. Some of the things they create are actually neurotransmitters like GABA. GABA is a relaxing, calming neurotransmitter. The right bacteria could be producing this for your benefit. They make cytokines, which are inflammatory messengers. And some of these are going to turn up inflammation in the body and other ones are going to turn it down. So the level of that's going to be important. They can be producing toxins like endotoxins, like something called lipopolysaccharide, which if that's getting through a leaky gut into the bloodstream is gonna be extremely— it's like putting lighter fluid on things. It's gonna be very incendiary and light up your immune system. So they communicate a lot with our, our whole body through the production of different compounds. These can be absorbed across the lining of the gut into the bloodstream, and fascinatingly, these compounds can also travel up the vagus nerve to the brain. This part always just blows my mind that there's this chemotaxis, they call it, where the chemical is actually traveling up a nerve. So, you know, there's multiple ways in which the microbiome is impacting our body and that our gut in general is impacting our body and our brain is not, you know, in a special glass case immune to what's going on. Right. I mean, yes, we have a blood-brain barrier, but many, many, many things get it through that. And the gut has a massive impact on it, which is why they call it that gut-brain axis. That's a, it's a two-way street. It's communication between the gut and the brain. Yeah.

So that, I'm pretty sure I, you addressed very much what goes from the gut to the brain. What about from the brain to the gut?

Yeah, great question. So that vagus nerve that I mentioned where the chemicals can be traveling up it, this is the primary way. The, the brain communicates with the gut. It's a cranial nerve, which means it comes out of our cranium, out of our head from the brainstem, and it innervates our entire thorax, you know, our, our chest and our abdomen. So all of our organs are, are innervated by the vagus nerve. So it's in charge of hormone production in your endocrine glands. It's in charge of slowing heart rate and slowing breathing. And most importantly to this discussion, it's in charge of digestion and gut motility, meaning like moving things along at the proper rate in the gut and that the gut, you know, squeezing correctly at the right time. That's very important. And so that, that, you know, that vagus nerve is not online. And I'm afraid in lots of people with serious stress and trauma, that vagus nerve has been really impacted in the tone. We say the vagus nerve is not good. Then this is, uh, you're operating at a deficit. You don't have that great brain input that's needed for optimal functioning of those organs. Mm-hmm. Okay.

So I've been trained on the organic acids test and how it can show issues like deficiencies of serotonin, which is known to be one of our feel-good neurotransmitters. And the idea behind SSRIs or selective serotonin reuptake inhibitors, which keep more serotonin in the brain. But lately I've been hearing on my functional medicine podcast that anxiety is not a serotonin deficiency. So my question is, is anxiety ever a serotonin deficiency or is it for certain people?

So that's a great question. I think anxiety is something that's very heterogeneous and there's a lot of reasons that people have it. And I do think the focus on sort of, I, I don't tend to focus on neurotransmitter imbalances as a root cause because I feel like First of all, the, that theory about SSRIs has really been debunked, that that's, you know, that, that we have a chemical imbalance and that that's what they fix. When people respond to an SSRI, we see that certain inflammatory cytokines have been reduced. So there's something happening with inflammation getting reduced in people who are responding. But the other reason I don't tend to focus on that is because that's not really the root cause. Even if you're having too much serotonin or not enough, you know, or too much dopamine or not enough. Why is that imbalance occurring in the brain? What is the trigger for that? Is it lack of raw materials, like not enough amino acid precursors for making those neurotransmitters? Is it inflammation affecting the regulation of these? Is it microglial activation? You know, which is like immune response in the brain. So that's kind of how I tend to focus. So, you know, I'd say it's probably, it could be anything really because it's people, it's gonna be different in different people.

Right. So if somebody does show up with, say, a tryptophan deficiency, is that something then you would supplement?

If it was very clear that that was a deficiency, sure. Yeah. I, I do tend to look more globally. Like I will tend to see, hey, you aren't really, you know, you, all of your precursor, what, what I would say on organic acids test, you're looking at metabolites in the urine, right? So I would say if I see low neurotransmitter metabolites across the across the board, I feel like there's a problem with protein breakdown and digestion.

Right.

That's where I tend to focus is on that, that breakdown and digestion, obviously ensuring they are also getting enough protein in the diet. And I might encourage them to use something like collagen peptides as an easy way to augment that. Or sometimes we use amino acids as well. It depends. Hmm.

So getting back to that whole root cause question then. What, what root causes do you find are common with anxiety?

You know, one of the number one things I find is blood sugar. That's a really big issue. So many people are running around with blood sugars swinging up and down. They have no idea. They're riding the blood sugar roller coaster, I call it. This is a real common problem in our society where we have a lot of insulin resistance and people can have levels of insulin resistance that aren't aren't obvious enough to show up when they get testing like hemoglobin A1C or, you know, their fasting insulin. And if that's all anybody's looking at, then you won't see sometimes the whole story. So I'm a big fan of doing continuous glucose monitoring in my patients.

Mm-hmm. Mm-hmm.

And actually trying to help them see what happens after a meal. You know, you might get a huge spike in blood sugar after a certain meal, and then half hour later that blood sugar's plummeting. Guess what happens when it plummets? You, you release adrenaline because you have to rescue a low blood sugar then, and that feels terrible. That's, you know, anxiety producing. It's, yeah, that's when people get tired often after a meal, then they, they can get shaky. And it's also a reason that a lot of people wake up at night. It's a common trigger for insomnia. And I've really seen that in working with my patients. I say, look at the glucose monitor in the morning and watch what happened overnight. Like, take a note of when you woke up. Oh, I woke up at 2. And then you look and you're like, oh, your glucose spiked at 1:30 and then it dropped. And then that drop is what woke you up when the adrenaline was released. So that's a big one. And I, you know, there's such simple steps you can take to fix that. It's, it's wonderful when you can help somebody shift that because suddenly they're feeling so much calmer, like getting them eating protein with each of their meals, making sure they're digesting that if that's the issue. Um, making sure there's adequate fats and then just really adjusting the carbohydrates for that person individually. Like how much can they tolerate? Making sure that those glucose spikes aren't going too high after a meal. You know, there's other tools we can use too, like resistant starch and, you know, there's blood sugar sensitizing supplements, but really it's mainly about the food. And, and also stress will do the same thing. Stress can cause the blood sugar to spike and drop. So just that awareness really helps people make different choices. I've definitely seen people where they say, you know, my gosh, as soon as I cut the sugar out, my anxiety completely flattened. And this is a person I'm thinking of who'd been decades of anxiety treatment at a very intensive anxiety center. She'd gone to multiple times and it was the sugar. It was so simple for her. It's not always that simple, but Sometimes it is. Mm-hmm.

Any other root causes that come to mind beyond the sugar?

I mean, a lot of things, toxins, mold is a huge source of toxin that I see. I wish I could say that's rare, but it's really common. Lots and lots of buildings have some kind of water damage, mostly unbeknownst to people. And these mycotoxins or mold toxins can accumulate in the body and they dysregulate nervous system functioning, immune functioning. They just dysregulate your detoxification pathways. And so as they accumulate, they start showing up as a lot of weird symptoms and absolutely anxiety is one of those. It's a real common one.

Yeah.

Okay. Hey, this is Lindsey here. Just letting you know that if you're tired of dealing with digestive issues like bloating, indigestion, soft stool, diarrhea, constipation, reflux, IBS, IBD, or the numerous health conditions that come about when your gut is off, like brain fog, weight gain, UTIs, fatigue, mental health issues, or complex conditions like fibromyalgia and ME/CFS, that's my specialty. With my 3 or 5 session gut health coaching packages, we'll discuss different stool and functional medicine tests to find out the root cause of your symptoms. I'll interpret the results and provide clear explanations, empowering you to make informed choices for your gut and overall health. And together we'll develop a customized action plan based on your test results so you can find relief and regain your health and vitality. I come from a functional medicine perspective, trying to incorporate the latest peer-reviewed research and educating you on protocols used by functional medicine practitioners, but devoting lots of time and support to my clients the way a doctor simply can't. If you're interested in a 3 or 5 session coaching package, you can sign up for complimentary 30-minute breakthrough session. Or if you can only afford one appointment at a time, you can book an initial 60-minute consultation. Links for those are in the show notes. Now back to the show.

So this applies both to anxiety and depression, but how can you tease apart the physical causes of mood disorders like anxiety and depression versus the circumstances of a person's life that are setting them off? Like when I had some serious health concerns and no primary care physician, I was in a new location. I started having panic attacks at night, but as soon as my concerns were allayed, then those panic attacks went away. So yeah, you know, I don't Yeah.

Yeah. I mean, I never want to downplay the role of the psychological factors. They're enormous. And these, these really aren't separate, right? Like when we have stressors, these are mediated through hormones in our body. They're even mediated through what happens in the gut. Our gut changes, our microbiome changes when we have stress. So these are huge factors. We all can think of situations where someone had the depression that was really situational, you know, we would call it was very clear what the trigger was. So those are always important to look at. But I think the other thing to think about is like, hey, are you doing the things to address that and you aren't getting better? That's, that's my mission really is to help people understand the overlooked physical causes because they may be going to the doctor. I think a really common scenario is they're going to the doctor about their depression or anxiety. They're given a medication and they're hopefully encouraged to get therapy. Hopefully they do that. You know, all of us benefit from therapy, but are they still stuck or do they want something beyond the pill? Maybe they've done a lot of therapy, but guess what? Therapy's not gonna fix their B12 deficiency. So it's like if you're making certain progress but you're plateauing, or you're wanting to look at all the areas at the same time, okay, I'm going to address these stressors because I do know they're important, but what else can I do to support my system? Because the thing is, if we have these physical issues going on, we're more vulnerable to the psychological stressors. You know, we're less resilient. I mean, we're, we can be much more irritable when we have the wrong microbiome and then everything's harder. So they interact a lot.

Yeah. So how can you help somebody who has debilitating anxiety or depression that has a legitimate and ongoing cause, like a serious health issue, for example?

Well, I think you got to meet them where they are first of all. And then you look for the lowest hanging fruit and Are they getting the support they need for that health issue? I mean, a lot of times, really, one of my most important roles is seeing someone and validating what they're actually going through. And sometimes they're not even having that happen with their serious health condition. So that's the beginning part of healing right there is like acknowledging this is really happening. I'm not going to gaslight you. You know, I see this. What are we doing to help build your resilience and there's so many great tools out there that we use that just for the mindset part of this, you know, and for the nervous system calming. And so helping them kind of up their resilience and their resources. And at the same time, beginning a process of appropriate place to start testing. What are the pieces that are missing? And here's the thing, when you're talking about someone going through a significant health crisis, the things that are driving their depression may be the same physical causes driving the other health issue. Or it's overlapping. That is very common. You know, I work with lots of patients where maybe they're coming in for the depression or the anxiety, but when we work on the underlying issues, now their energy's better, their hormones are more balanced, you know, their periods don't hurt in the same way, their gut is feeling better. These are all connected. So I, it, to me, it's always about the holistic view and looking at the whole person and seeing where are the gaps. That we can intervene on, you know, most easily first and go from there. Okay.

So what would you say are the underlying causes of depression that you see most commonly?

Well, I think inflammation is huge here and some of that is real nutrient deficiency is one piece of that. The most common nutrient deficiencies I see that trigger depression are lack of certain B vitamins. I mentioned vitamin B12. That's a really important one because people really produce, they're, they're much less able to absorb B12 with age because of issues with their stomach and producing something called intrinsic factor that's required for absorbing B12. But also a lot of medications deplete B12. So here's a, a really common one, metformin. That's a great medication for diabetes. Lots of people are on that for their glucose, has some longevity benefits, but it depletes B12. So you gotta take B12 if you're on it. And I've met people, I've had patients absolutely like, I, oh, I've worked on my blood sugar. I've been doing so much better. But then the last 2 months I'm so super depressed. You know, this is when I'm meeting them and I find out what they're taking. I'm like, did anyone ever tell you to take B12 with your metformin? Well, well, no. And you know, 2 weeks later they're feeling a whole lot better with that B12. But it's not just B12, it can be B6, it can be folate, which is another B vitamin. These, these are big players. And then besides the B vitamins, minerals are really important. Magnesium, I see zinc plays a major role here, and also omega-3 fatty acids. They're really critical. And this comes back to that theme of inflammation. I know I sound like I'm repeating myself when I talk about inflammation, but it's such a common issue here that, you know, omega-6 fats, they're everywhere. We don't have any problem getting enough of those. We need both types, right? But omega-6s are everywhere. They're ubiquitous cuz they're in every seed oil, the canola oil, corn oil, every restaurant meal, every exactly. Yeah.

Takeout meal. Every chip. Yes.

Every chip, every cookie, except for the 3 that have avocado oil.

Yeah.

You, you just cannot, um, you know, it, it's very easy to find them and most people are overburdened with them. And I always describe it to people as like your, your immune system's like a, a car and the omega-6 fats are like the gas pedal. And the omega-3 fats are like the brakes and you need both, right? If you say you sprain your ankle, you need to mount a response with inflammation and then you need it to go away when it's healed. So you need to turn it on and turn it off. But most Americans are driving around in a car with like pedal to the metal and they don't have any brakes at all because yeah, they don't have any omega-6 cuz they're not eating the fish that contain those. And that's really the main source for that. And so. That's what we're working to balance. So if you can really increase your omega-3s and work to reduce the omega-6, that's the part a lot of people forget about, right? They might take fish oil and usually not enough, I would say, but they, they'll take it and they don't realize they need to work on those processed foods that you're talking about and really eliminate those. And at least at home, choose the fats that don't have those to cook with to, you know, so you can control it. That right there, boy, people feel a lot better when you get that oil change done. You know, over switching that out, that really is gonna lower inflammation.

An oil change. I like that. Think about in the car. So can, do you have any stories of past patients with anxiety or depression who got better that you could share?

Oh yeah. I think of one of my early patients was a real dramatic case and a cool functional medicine case cuz there were several pieces, but this is a lovely lady who came to me with anxiety and she actually had panic attacks. And she also had irritable bowel syndrome with diarrhea. And she had been someone who loved to travel. And because of her panic attacks and because of the irritable bowel syndrome, where she never knew when she was gonna need a bathroom, that combination just ended her travel. And it really bothered her. And she was on, I think it was Lexapro, which is a common antidepressant, anti-anxiety medication. And she'd stayed on it cuz it had kind of helped, but not enough. She still obviously had a lot of symptoms. So she came to me about this and we found a number of things. We found that she had an overgrowth of yeast in her gut. We found that, you know, when I looked at her timeline, which we take in functional medicine, we go back and say like, hey, when did these symptoms start? When were big events in your life? When did you have all these? When was surgery? When did your parents get divorced? Whatever these things were, we map it out so we can see the connections. And it became really clear that her anxiety had started like a year or so after she'd had her gallbladder removed. And so she had followed the standard recommendations of like a low-fat diet after removing the gallbladder. But what this meant was she began to really lose out on fat-soluble vitamins like vitamin D and K2 and A. When this had a big impact on her functioning, vitamin D is huge for mood. And this also really shifted her microbiome because now we're not having the sort of same foods coming down the pipe. And she had that overgrowth of yeast. We treated that overgrowth. We worked on the digestion. We supported the digestion of fats. We kind of made up for that missing gallbladder. We were able to get fats back in the diet, which she definitely needed for her neurons to work right. There were a few other changes I'm forgetting right now, but those were the big ones. And really within a couple months, her anxiety was totally gone. Her panic attacks were gone and her diarrhea. Had resolved. And then she was telling me she was flying with her grandson, she taking trips, and it was like her life was back and that was it. She knew what to do to stay healthy after that.

Awesome. Cool story. So are there particular tests you like to use to diagnose the things going wrong digestively or the yeast?

Yeah, so there's so many tests out there, but the panel I like to begin with, with patients is I do a very comprehensive blood test that looks at inflammatory markers and some nutritional markers and blood sugar and hormones, zinc, copper, things like that. And then I use an organic acids test like you mentioned. I like that a lot in particular for the yeast or for molds. It does a good job of telling us about colonized fungal species much better than a stool test does. And I like also that the organic acid test tells me about mitochondrial function. And some of the detoxification pathways. That's helpful. And then I do do a comprehensive stool test, which is always interesting to see people's results where you really can see if there's digestive impairment. You see the imbalances in bacteria. Sometimes you find some interesting parasites. Just today I saw a tapeworm from a dog in a patient. So that was, she wasn't too happy to see that. That's rare, but these things do show up. And we can treat them. It's helpful to find out what's triggering the inflammation because there were inflammatory markers on that test because she was having this pathogen. So that's where I start. Mm-hmm. Sometimes it makes sense to go further down certain pathways, like, like evaluating mold toxins, for example, or other environmental toxins, or to look at metabolism of hormones with something like a Dutch test. And sometimes it makes sense to do some additional genetic testing.

Mm-hmm. Whose stool test do you like?

I have used them all, I will say, and they're all pretty similar. I really have used them all. I, for a, most recently, for a long time I was using Genova's GI Effects and I, they were taking so long to get the test back that I ended up switching to the Gut Zoomer from Vibrant America, which does have a bit more pathogens on it. And I like that. Mm-hmm. I used to use GI Map in the past. Didn't like the way they reported calprotectin though. That wasn't standard, so. And the Doctor's Data 360 is very good as well. I mean, you can get good information from all 4 of those tests.

Yeah.

Yeah. No, I actually have started using the US Biotech GI Advanced Profile cuz it's kind of got everything that's on the GI Map, everything that's on the GI Effects, and it's sort of in between price-wise.

That's good if it's in between price-wise. Yeah. Yeah. Yeah.

And I've started using the Tiny Health Pro because they do a full metagenomic sequencing plus then they have all the digestive health markers. So it's kind of like the best of all worlds. And again, it's like very reasonably priced. I think it's like an L3.

Oh, that's great when it's reasonably priced. Yeah.

Yeah. And then you can get it on Rupa. So anyway, so, and whose organic acids test do you like?

Oh, well the, I use Mosaic, which was Great Plains.

Mm-hmm.

Yeah.

Okay.

What portion of anxiety and depression do you think is genetic?

Oh, I love this question because I think a lot of people feel like they're doomed because of their genes. And I, I beg to differ on that. I think we, you know, we all have our predispositions, the things that we are most likely to get, like, you know, we say, okay, my family might really tend to get diabetes or autoimmune disease or depression, but these things are epigenetic. There are things turning these genes on and off. And so your genes are not your destiny. You hear different numbers like, oh, genes are like 10% of the puzzle. I don't know, you know, in any one person it could be different. I've also heard a sort of morbid analogy, like the genes load the gun, but the environment pulls the trigger. It's a little violent. I don't like that, but it is, I think, putting it in perspective that it is just one piece and that we should not feel like we have to settle because of our genes. And, but in fact, there's so much we can do to influence the expression of those genes.

Mm-hmm. So I see a lot of people, you know, and obviously a lot of kids are diagnosed with ADHD these days. Are there like root causes that you see for that?

Oh yeah, that's a, that's a really interesting one and, and complex to me. I feel like there, for some, I think there's some really good research to suggest that there's a zinc and copper imbalance occurring there that if you're interested in knowing more about that, I would look into the Walsh Research Institute. They have a huge database and have done a lot of research on that and have had a lot of success. Success with correcting that zinc-copper ratio and helping ADHD patients.

Dominant in, in which one?

They tend to be low in zinc with high copper.

Okay.

And there's evidence also about metals playing a role. And there are some ADHD patients where it looks like dairy intolerance is part of the problem. I think it's another heterogeneous group, you know, that I think we have these sort of common endpoints of a label, but people arrive there differently, you know, different things to look at, but there are common themes.

The podcast that published today was with someone who looks at genetics and just helps people figure out how their genetics might be playing into their health issues. I had her look at mine because she had a unique set of skills that I was interested in, and she asked me based on my genetics, do you have trouble focusing? And I'm like, No, I, I can focus well. I'm, I'm, you know, I get my work done. I've done well in school and all that. And then my husband was like, are you kidding me? You're like squirrel, squirrel, squirrel.

Don't you love it when the spouse is like, what? I know I've had that moment before too. No, I know.

And I'm like, I am a little easily distracted. So she suggested I take dopamacuna, which I've been playing with. Is that something you use?

I have not that exact product. No.

Okay.

That's interesting. How are you liking it?

I, I don't, I, maybe I'm focusing better, but it was one of these things where it didn't feel like a disability of sort.

Yeah. Well, that's the question too, right? About like neurodivergence and neurotribes. Like there is a lot of question there too. Like, you know, I think about kids with ADHD and sometimes I feel like this is trying to put a square peg in a round hole in our school system, you know?

Mm-hmm.

But, but at the same time, they're creative and they have different Right, exactly. And you don't wanna squash that, but somebody is really having neuroinflammation, then you wanna support them with that, right? So I think it's, right. I think it's, I think it's really heterogeneous, you know.

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Yeah, yeah. So yeah, no, I mean, I think that it's possible I'm concentrating better, and it's one of these things where you if I'm talking about something and then something else comes up, like I will not know where I was. Like I will need somebody else to bring me back to the original topic. So, or go onto tangents when I'm telling a story. So I think it's something I could use a little help in. So if it helps, we'll see. We'll see. But anyway, yeah, just to, just to bring up my dopamine, do you do it and use any things like amino acid precursors to bring up dopamine or is, is that again, not root cause enough for you?

I, it's not my focus. Like I do tend to go deeper with, cuz again, I'm like, well, why are you low in that? Like what's the That's the thing. But that is, I mean, if somebody truly like genetically runs that way, that they, they're always gonna be low. I mean, that, that zinc copper situation is kind of like that where sometimes genetically they will really just need higher levels of zinc supplementation, you know, or you meet people.

Yeah.

Really need higher levels of methylfolate, for example.

Mm-hmm.

So there is a place for that for sure. But I, I don't, I don't wanna miss the underlying drivers of the imbalances, you know, which is usually some kind of. Toxin infection combination trauma.

Mm-hmm.

It's all part of it.

Yeah. Yeah. No, I always ran low on, on organic acid. I think I've done 2 tests and both times my dopamine was low, but I never again felt like there was any— my serotonin was low too. I never felt there was any issues with me.

Yeah. And it's complicated, you know, with the urinary organic acid test, you're looking at metabolites in the urine, right? They're not telling you the brain concentration of, right, right. We are having to infer, you know, and I mean, it can give you some ideas of things to try and then see. Mm-hmm. But then you really have to see clinically, how did it go?

Yeah. So I've heard some functional medicine doctors talk about certain root causes of schizophrenia that may be treatable. And I'm curious whether you've found that there are some typical root causes for schizophrenia or if you've had any patients who've recovered to any extent.

Great question. And I'm excited that more people are talking about that. Some of the most interesting work done by— on zonulin, you're probably aware of, you know, zonulin is like a leaky gut marker and the work by Alessio Fasano on this pediatrician who's done a bunch of the research on this. And we think about celiac on his research, but then a lot of that research was also done on schizophrenia and like no one ever talks about that. And I'm always thinking, okay, this is an autoimmune disease. Why don't we treat it as such? You know, why don't we look at that? And what's interesting is if you look at some of the original work from Dr. Abraham Hoffer before we had Haldol and these medications, the antipsychotics, they would do different kinds of sort of fasting treatments or elimination diets and people would clear, you know, so there was some trigger in those cases, like dietary trigger that was playing a role. So, you know, I've always been very interested in that and now we're seeing some emerging research about the role of mitochondria and like ketogenic diet being impactful, not just for bipolar where I've kind of long expected to see it. And that's because, hey, ketogenic diet works for seizures. The medications for bipolar are anticonvulsants, just like for seizures. They raise ketones. Like, why wouldn't that work? Well, we're finally— those studies are coming out now and it's really exciting. But this same approach is working in schizophrenia in these studies. And it's really about brains that are unable to utilize glucose properly and getting them a fuel source that they can utilize. And it's another example of how. This, a common trigger will express differently in different people, different symptoms. I mean, I have a patient who has schizoaffective disorder, so essentially both bipolar and schizophrenia, and gluten is a major trigger for her. She gets much more psychotic if she has gluten. It also triggers like projectile vomiting in her. She has numerous reactions to it. So her learning that has been really, really helpful. In starting to control symptoms. Mm-hmm. So those are some of my thoughts about that.

Okay.

And anything else to say about bipolar and, and root causes?

Well, I do think this ins— this brain insulin resistance is a big one that we're gonna see more and more about. But then there's some other cases where it's really like infectious, like Lyme can be, you know, you can cause mania and people are not realizing it's that, or NMDA encephalitis. Like there's other causes that can manifest as mania.

And really, what was the initials before encephalitis?

NMDA receptor.

Oh, okay.

I hope I'm saying that correctly. I hope I'm right thing, but there's encephalitis that can do that too. But here, what the thing I think is kind of funny is we're like, ooh, these are like the exceptions. I never really believe that because there's always a reason somebody's having this. It's not like there's just like run of the mill bipolar and then there's these special ones that have a cause. They all have a cause. We just haven't figured it out, you know?

Yeah. Right. In other words, bipolar is not a thing.

Yeah.

I mean, they have a bunch of underlying stuff creates the symptoms that we call bipolar.

Yes, exactly. They have that symptom cluster. They have that mania, they have the depression and the cycling, but what's causing that brain malfunction basically.

Yeah. So how do hormones play into mental health issues?

Hugely is what I would say. I see that every day. I mean, just looking at menstruating women and the degree of premenstrual symptoms, whether it's PMS or it's PMDD, which is premenstrual dysphoric disorder, which is more official psychiatric diagnosis where you really have extreme, you know, much more strong mood symptoms or irritability in the week or so leading up to your period. I see a lot of that. It's a lot of related to estrogen dominance. So too much estrogen, not enough progesterone or both. There's lots of reasons for that. The gut comes into play here again where the gut is impacting metabolism of estrogen. And so estrogen isn't getting taken outta the body properly and it gets recycled and it, you get high levels. Also xenoestrogens from plastics, you know, parabens and phthalates. These toxins are contributing to the estrogen burden and then we deplete our progesterone through high stress, not enough sleep. And so, mm, imbalance is just really common and it shows up for a lot of women. That's just one example, but I see it a lot. PCOS is another hormonal imbalance in women where polycystic ovarian syndrome, where they tend to have high androgens and irregular cycles. A lot of problems with hormone levels there. But you know, when we're talking hormones, we're not just talking sex hormones, right? We're not just talking estrogen and progesterone. Also testosterone is one of the sex hormones and low testosterone absolutely will cause depression in a man. Mm-hmm. But we are also talking about thyroid and cortisol and insulin. All of these hormones are key and are part of the picture and they interact. Mm-hmm. And DHEA, there's another one, you know, that's a precursor for testosterone and made in the adrenal gland along with cortisol and affects immune function so much. So it's about, for me, looking at that full picture, you know, and in my training with functional medicine, you really work on the cortisol and the insulin first before you do much with sex hormones. That said, I'm a big fan of hormone replacement therapy in menopause. I think it is a game changer for women.

Mm-hmm.

A disservice was done to them with the Women's Health Initiative. Studies toward when everyone stopped their hormones. I, I just see how impactful they are, how much better people feel.

I heard a podcast recently where they were talking about not just hormone replacement therapy, like the estrogen patch that your OB-GYN's gonna give you, but like going beyond that, like, like supplementing estrogen to the point where you're back where you were when you were menstruating.

That is a great question. I think there's a lot of research that really should needs to be done here, but I don't know if it's all gonna get done. The hormone research is rife with issues. Like for example, you look at a study on progesterone and a lot of it will actually include progestins, which are synthetic and not—

Right, right.

—kind of progesterone. And with estrogens, you run into this problem that study may include oral progesterones and not just transdermal. Like we, you know, I feel strongly transdermal is much, much safer and better than oral. Or they'll include Premarin, which is the horse's estrogen, not human estrogen. So these are complicated. And what the current practice is, what I see is a woman may come to me on HRT, hormone replacement therapy, that was sort of titrated to her symptoms. So she went through menopause, she was having hot flashes and, you know, symptoms, and she was given a patch and they arrived at a dose that felt good and that's where she's at. No one ever checks a level. That's not what they do in OB-GYN. Practice, but I always do check a level. And so I'll see them be at like 34 or 40. That, that, I feel like that's the common number I see when people are kind of like, I feel better. But if you look at the functional medicine research going on with reversing cognitive decline, they're using much higher numbers of estrogen for those people who need that, what we call trophic support or that growth support for hormones from estrogen.

They might do. Yeah. I mean, what, what should people be shooting for?

People? Well, I mean, I don't think we can say what any one person shoot for, so I don't wanna say that. But I will say that like in these studies, they're often somewhere between 50 and 80, for example. Mm-hmm. Obviously it's got to be right for that person and be balanced out by the progesterone and, and not be causing symptoms. But I think there's a lot of room for study here. I think these are very important compounds and they have huge impacts. Progesterone's a potent neurosteroid. Like we don't treat it that way. It's, it's really awesome what it can do. So. I think it's an area that I hope we'll see more and more research done. And I am happy to see the sort of grassroots resurgence of people saying, I want my hormone replacement. And there's some good people on the forefront advocating for that. There's some great OBs out there writing about it. So hopefully we're gonna see people's brains and bones and bodies protected a lot more now.

Yeah. I mean, it's sort of a funny issue because in every way with functional medicine, we're talking about sort of restoring what would be our natural health if we didn't have such terrible food and environment, et cetera, et cetera. But in this one area, it's kinda like, it's not really natural that so after somebody goes through menopause that you then put them back on the hormone their body doesn't have. Yeah. But at the same time, it's gonna probably keep them alive longer and healthier longer.

So, yeah, I, you're so right. And I have two thoughts about that. One is really in functional medicine, we look at everything is, is just a tool. So is it a good tool or a bad tool? Like the shades of gray, we aren't— I'm certainly not anti-medication, right? There's some medications that are wonderful tools. It's for the example of like low-dose naltrexone, right? But other medications are really terrible. These are tools and we can be agnostic about them. I am not trying to recreate the Paleolithic era here. We don't live in that time and that's not what we need to do. However, I did go into functional medicine from the my introduction to it really was from the ancestral health movement. Yeah. I was like, well, what's natural? That was kind of my paradigm cuz it made sense to me. And so I was like, why would you keep taking hormones later? But then as I trained with people and I learned, and then I saw the impact, I could not help but have my mind vastly changed. I cannot tell you how helpful hormones can be for patients, like game-changing for their brains and their functioning. To me it's like, if this can be done safely and well, this is protecting people's cognition and their bones and like the benefits are usually outweighing the risks. Obviously everybody's an individual and that has to be worked on with their own doctor, but yeah, that's where I've come to.

Yeah. So I understand you have a freebie for my listeners. Do you wanna tell 'em about that? Oh yes. Yes.

Find it in you. Yeah. Like I said, my goal is for people to be aware that there's these overlooked causes. Of depression and anxiety, because no one talks about them. You go to your doctor and you're told to take a pill and maybe get therapy and a discussion. And I want people to be empowered to know what else to look for. So this is my free guide about top 10 overlooked causes of depression and anxiety. And you can find it at drtracymccarthy.com/top10, and that's T-O-P and then 1-0.

Okay.

And that, we'll put a link in the show notes.

Yeah. Wonderful. And that's just a place to get you thinking, where might I be having a gap that I can start working on? Mm-hmm. Yeah. And it's just a really good place to start.

Okay. And, and then, so your website is drtracymccarthy.com?

Yes. My, my practice website is drtracymccarthy.com, and for that freebie, it's backslash top 10, T-O-P-1-0. Okay. Yeah.

And it's T-R-E-C-Y.

That's right. Yes. Okay. Any final thoughts before we close?

No, just, it's been a pleasure to talk with you and to geek out on these favorite topics of ours here. Indeed. Worth people knowing about that, you know, I think you are like me where it's like people can be empowered and make so much change in their life when they have more knowledge and people, I just feel like people deserve to know what's out there.

Yeah. Yeah.

No, I've had friends with debilitating anxiety and I, I really wished they would've followed the functional medicine route and maybe they did to some extent. I don't know. Because you, you have people saying, oh, I did everything. I tried everything. And you're like, did you try everything in the allopathic medical system or did you really try everything? Yeah.

Because if you do everything outside of it, it is an amazing long list. We didn't talk about a ton of different modalities, you know, from tapping to psychedelics to, I mean, there's just so many things, right? And right. You know, we focus on the functional medicine components, which I think need to be looked at, but there's just, there is so much. So don't give up, people. Don't give up. Yeah.

Yeah. Well, thank you so much. I think there's a lot of good, good tidbits here for people. Oh, you're very welcome.

Thank you so much for having me. My pleasure.

This topic really speaks to me because I'm of the mindset that there's a solution for every problem.

So I love the kind of work that Dr. McCarthy's doing and the hopeful stories that she brings. If you'd like to support the podcast, you can buy supplements at a discount from my FullScript Dispensary, order tests at a discount from my Root Health Labs store, or use my affiliate links to iHerb, which is available worldwide, or Amazon. And just to note that you can use my Amazon link to buy anything, not just supplements, and support the podcast. So I'd love it and really appreciate it if you'd bookmark my link and use it for regular Amazon purchases. If you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my Gut Healing Facebook group, or join my newsletter list at HighDesertHealthCoaching.com, as well as follow me on X, Instagram, TikTok, and Pinterest. Links for those are in the show notes. Thanks for joining me today, and here's wishing you all the perfect stool.