The Dr. Hyman Show - Is Anxiety All in Your Head, Or Is It In Your Body? with Dr. George Papanicolaou

Episode Date: May 1, 2020

The body and brain are one interconnected system, which means you can’t treat anxiety effectively by using only drugs or psychotherapy. You need to treat the body, because the body and brain are one interconnected system. Unfortunately, conventional medicine plays the name and blame game. It says, you are “anxious;” you need an “anti-anxiety” medication. But saying you are anxious explains nothing about why you have anxiety. Functional Medicine takes a different approach. By taking a detailed history and personalized approach, it seeks to get to the root of the issue.   In this episode, Dr. Hyman sits down with his colleague, Dr. George Papanicolaou, to discuss how they treat patients suffering with anxiety.  George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital. He is also an Institute for Functional Medicine Practitioner. Upon graduation from his residency he joined the Indian Health Service. He worked on the Navajo reservation for 4 years at the Chinle Comprehensive Medical Facility where he served as the Outpatient Department Coordinator. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He practiced with a philosophy centered on personal relationships and treating the whole person, not just not the disease. He called that philosophy “Whole Life Wellness”. Over time as the healthcare system made it harder for patients to receive this kind of personal care Dr. Papanicolaou decided a change was needed. He began training in Functional Medicine through the Institute of Functional Medicine. In 2015, he established Cornerstone Personal Health – a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou to join The UltraWellness Center in 2017.  This episode is sponsored by AirDoctor. We need clean air not only to live but to create vibrant health and protect ourselves and loved ones from toxin exposure and disease. Learn more about the AirDoctor Professional Air Purifier system at a special price at www.drhyman.com/filter In this conversation, Dr. Hyman and Dr. Papanicolaou discuss: The conventional medicine vs Functional Medicine approach to treating anxiety Why making yourself more psychologically resilient makes you more physically resilient How Dr. Papanicolaou treated a patient with panic attacks, difficulty focusing, and bloating  DNA testing to determine how your genes might be influencing anxiety How gut issues, including SIBO, IBS, and gluten sensitivity, can lead to anxiety  Urine peptide testing  How Dr. Papanicolaou treated a patient with, anxiety, brain fog, hair loss, and fatigue  How anxiety can be related to hormones and autoimmune issues For more information visit drhyman.com/uwc

Coming up on this episode of The Doctor's Pharmacy. We do know that the bacteria in our gut make serotonin for us. So one of the things we want to think of when we're looking at people with anxiety is, let's look at their gut. Welcome to The Doctor's Pharmacy in this special episode of House Call. And today we're talking about anxiety. If you have anxiety and you suffer from anxiety, it may not be what you think it is. We often think it's in our head, but turns out it may

be somewhere else. And today that's what we're going to dig into with Dr. George Pepinicolaou, one of my colleagues here at the Ultra Wellness Center, extraordinary physician who's doing such great work here and taking care of patients in such a way that we are just seeing extraordinary results. So welcome, George. Mark, it's a pleasure to see you in the flesh, particularly during these times. Six feet away. We are six feet away and everybody's wearing masks besides us, so we're good. Yeah.

So I'm so excited to talk about this topic because years ago, I wrote a book called The Ultra Mind Solution, which is how to fix your broken brain by healing your body first. And what I discovered through my years of functional medicine practice was that when I was treating my patients for their physical problems, their digestive issues, their hormonal imbalances, their food sensitivities, whatever it was, nutritional deficiencies, that they would report back to me, God, my anxiety is gone. My depression is gone. My ADD is so much better. My OCD is better. My bipolar symptoms are better. My memory is better. And I'm like, well, what's going on here? And I began to really think about it and realized that we talk about the mind-body effect, which is sort of an incorrect way of thinking about it. Maybe we talk

about the body-mind effect, which is how the body affects the brain. But neither of those really explain what's going on. It's really a system. Your body is a system. the body affects the brain. Right. But neither of those really explain what's going on. It's really a system. Your body is a system. The body affects the brain. The brain affects the body. And it's a complete synergistic system. And if you don't think about it holistically, you're actually going to treat people by dealing

with the downstream symptoms and not the upstream causes. Absolutely. So I began to really learn about how these physical issues can explain psychological symptoms and how we often attribute psychological or emotional problems to symptoms that are really physical. And then when you treat the physical cause, all these problems go away. That doesn't mean we all don't have psychological issues, but it's a lot easier to deal with them once you've cleared up all the garbage that's actually causing these symptoms.

So if you're, just an example, everybody knows, if you are tired and you haven't slept, you can't focus as well, you feel depressed, you're more irritable. That's sex. I mean, is that because you're depressed? Yeah.

Or you have dementia? No, it's because you didn't sleep, right? And it's an easy example, but there's so much more that we know about actually how the body affects the brain. And we're going to dig into that today with Dr. George, particularly about anxiety. And so traditionally in medicine,

when you have anxiety, what's the general approach that we have? General approach is you've got five minutes to see your patient. They tell you anxiety, and great, you're on an SSRI or some other anxiolytic. What's that? An SSRI is a serotonin-specific reuptake inhibitor. And all it does— It's an antidepressant.

Prozac. It's an antidepressant. It's Prozac. It's Lexapro. It's Citalopram. it's prozac it's lexapro it's citalopram it's all those things that everybody out there is taking all the hams yep it's the hams and they uh basically all they do is they allow the serotonin that's in your brain to do its work longer but it doesn't account for why isn't there enough serotonin in the brain to begin with great question that's the difference between regular medicine and functional medicine.

Instead of going, oh, the cause is not of serotonin. Let's get the serotonin up. Right. No, the cause isn't there's not enough serotonin. The cause is something else that's causing the serotonin not to be okay. So what's causing the low serotonin? Right. So that can be any number of things.

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

So the difference between, you know between functional medicine and the conventional approach to anxiety is that we are going to say, and I know I do this and have been doing this for years, anxiety is just a symptom of other problems. And the cases that we're going to go over, anxiety was a part of the presentation, but it allowed me to get into the history and figure out what was causing it and in both these next cases we're gonna see that there are multiple things causing it it's never one thing so so that's the difference. So you mean it's not just a Prozac deficiency? It's not a Prozac deficiency Mark, it is not it is it's usually a deficiency or it is a an addition of a toxin into the system that can either be a relationship or it can be a xenoestrogen or it can be lead or mercury or it can be bacteria. But it's never just anxiety.

Right. And it's never just one thing. Right. Right. So that's the other thing is, you know, we often sort of are reductious in our approach in traditional medicine. We go, well, you have anxiety. That's what's causing you to feel anxious. No, that's just the name of what your symptoms are.

The causes are multiple, right? I mean, maybe it's one thing. Maybe it's just you've got too much lead in your system. But it's often many, many different things that are all reflecting imbalance in your system. And that's the difference between functional medicine and traditional care is functional medicine says, how do we restore balance in the system? How do we take out the things that are causing imbalance? And how do we add the things that are going to restore balance?

And that's the difference. And we use a very in-depth set of tools, both through a detailed history and ask a lot of questions that normally don't get asked. Like, were you breastfed? You know, were you eating too much tuna fish eating too much tuna fish? And these are the questions we ask that are different. And then we do diagnostic tests in functional medicine that are helping us to reveal causes, not just sort of, do you have some terrible disease? But we want to

know, like most of the tests, you go to your doctor, they go, oh, your tests are fine. You must be fine. Well, your tests that your doctor does typically are only abnormal if you're really sick. Like for hospitalized patients, you'll see an abnormal electrolyte or a normal kidney function or normal liver. Unless you're really sick, these tests are pretty normal. So we look at a different set, pull the veil back. I mean, there are thousands and thousands of metabolites in your blood. And to think that you know what's going on by looking at 30 or 40 on a typical blood test is a joke. Right, and in fact, Mark, 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, and a biochemical event, you know, it's reductionistic. Right. It's no serotonin in the brain, serotonin reuptake inhibitor works for you, And a biochemical event, it's reductionistic. It's no serotonin in the brain. Serotonin reuptake inhibitor works for you.

Great. And that's it. Or Valium. 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 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've got to go deeper. Absolutely. And at the Ultra Wellness Center here in Lenox, we go deeper. Now we're doing all virtual consults, which is great. So if you're a new patient and you want to come and see us, you don't have to schlep all the way to Lenox. We can do it all virtually, and you can get the tests you need and and we work with a great team we have doctors actually been really it's really been interesting and amazing it's

almost like you have more focus and more of the attention of the patient there's there's a whole different dynamic that occurs that has its own benefit when you do it but when you do it you know by zoom yeah we do zoom right yeah and i 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. Papanikolaou. I got what I was looking for. So it's been really a positive experience. It's true. I did my first, you know, five patients last week doing Zoom. And it was like, wow, this is awesome. Yeah. You know, it's great. And I think it's not the same as being in person but it was really quite good so i feel like we really have the ability to take care of patients and particularly now more than ever and people are feeling anxiety people are feeling

worried and and there are real things right you lose your job you your economic you know resilience is threatened by what's happening the economy your your fear of getting sick and your health issues i mean so these are real absolutely psychologically hard times oh yeah but but 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 it, 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 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 can, they have the time and you can actually deal with the lifestyle issues much easier, not traveling. I mean, for me, I don't travel anymore anymore it's like i agree it's been it's been a renewal for for you know me and and and a lot of my friends we've talked about 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 you know and so fast before yeah you know and you're like wow like i don't have to wake up on saturday and do like a soccer tournament for the whole weekend you know and i i don't have

to be rushing off to, you know, all these practices at night or to this class or to, and I've noticed a difference in my own kids. They are more relaxed. 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, and so I get to tell you these, I have disease mysteries this morning, right? So it starts out with anxiety, but did anxiety really, is that really the culprit? Or is there, you know, is there a secret hidden person or character in this plot that's causing the problem? You're like the Sherlock Holmes of medicine. I love you. So, so, so that's, that's. So tell us about this patient. He was 32.

So we're going to jump to the case. We're going to forget about what I was going to 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 his major complaint was, I have panic attacks, particularly at night.

And when I'm having panic I'm also feeling bloated and distended no interesting that was his main reason for coming in it he's panic attacks and then during the day I'm finding maybe a harder time getting my work done I've become a really intricate part of the business of our that we do and a lot of responsibilities 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. Well, 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, no, his senior year of high school. So then he went to college where he had a little bit more control oh and he found some friends who had adderall and he tried adderall oh and bingo that'll help and bingo he was a force to call it speed yeah in college he he actually

did well through through college but after college um 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 traditional psychiatrists you go there's have anxiety have panic attacks they're not like well um 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 so there's this thing that i call pattern recognition so when i hear when i 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 Rorschach. And I have to then, you know, have a pattern recognition and say, oh, this is starting because of the experiences I have with people. Yeah. I begin to see these patterns and I can start to see that, you know what? Yeah, there's something going on in this guy's gut. Oh yeah. And there's, there's some sleep issue going on here.

It's not just anxiety. It's not just, I can't sleep. There 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 know.

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

Wait, wait, wait, wait. So you're saying that your DNA controls your mood, anxiety, and your... It can. Hey, everyone. It's Dr. Hyman here. Now, I know we're all focused on being as healthy as possible during this unprecedented time. And that means drinking clean water, eating loads of anti-inflammatory foods, and it also means keeping our homes clean. Now, I've been doing my best to keep my family safe while indoors. And for me, this means using an air filter. Now, we know that toxic air particles can contribute to cardiovascular disease, lung disease, and even neurodegenerative diseases like

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the lab, and it's called DNA Mind. Right. So tell us about what is this DNA mind and what did 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. Exactly. So DNAMind will look at the genes in multiple different areas that can impact neurodegeneration, your mood, and your addictive qualities. And so we look at very specific genes that are well-researched. And we understand that if they do have variations what those variations will mean and then what we can do about it

and then informs me what I can do about it those genes are actionable you get a 23andMe you get 5000 genes you don't know what 4999 of them do and so we only test or DNA Health only tests actionable genes in critical areas so this is really an important point because you know people are talking about dna and personalized medicine and most of its noise right so we we actually have genes that are common in the

population that have clinical impact that we know a lot about and how to modify the expression of those genes and change what's going on so that you have a positive clinical outcome as opposed to just checking your 20,000 genes and not only what half of the mean or 99% of the mean like you said i mean there one there's one in particular is very common when people have anxiety and what what is it mthfr and there's also c-o-m-t catecholyltransferase. And that's a big mouthful. But essentially that gene. He's really good. That gene is involved in metabolizing the stress hormones, adrenaline.

Yeah, the catechol. And catecholamines, right. So the adrenaline, noradrenaline, epinephrine. Dopamine. Dopamine. And if those can't be properly processed by the body, you get a buildup of these stress hormones. 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 so nervous. And I said, you must have that gene. And she's like, I do. And I'm like, but then you can fix it, right? How do you fix it?

Right. Oh, how do you fix it? Oh, OK. So it's right? 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 a dopamine deficiency. So I put him on- And dopamine is one of the neurotransmitters that helps you focus, pay attention. And the COMT gene has an impact on that

because you can either metabolize your dopamine very quickly and keep it at a low level, or you don't metabolize it at all, like the norepinephrine, and you'll have high levels of it. And if you're, so each one of those conditions has a phenotype, or a way that you're going to appear if you have that. So in his case, he sort of like was distant

and didn't feel emotion all the time, and he had a hard time with focus in general. So I thought that he had 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. Building block for dopamine.

L-tyrosine's an amino acid. Correct. Correct. It's a building block for these neurotransmitters, which comes from protein. Exactly. So interestingly enough, when he comes back for his six-week follow-up to go over all his labs, one of the things he wrote in his medical update to me was that I'm not depressed, but I'm feeling things I've never felt before, and I'm a lot more tearful, and a lot more emotional, and I'm 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's allowing him to experience and feel emotion they didn't have before, and he's able to concentrate better. And this is a perfect example of functional medicine because it talks about how we personalize

based on genes, based on a person person's lifestyle and based on their Levels of their labs and we really create a customized approach for each person Yeah to target in like a medical detective on the things that make the most difference. Oh, yeah Yeah, just give him a simple amino acid, right? But it's like wow, how simple was that? But it was knowing that you need to do that. That was the key Yeah, and and here's the cool thing when I looked at his dna to go over those results with him he had the comt defect that you know that didn't process his that over processed his amino his amino acids uh that made dopamine and uh norepinephrine so it matched up so his genes matched up with his clinical picture, and he responded appropriately to the dopamine precursors.

But there were also 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. And 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 him discomfort and wake him up and like when you got apple cider and like the the bugs grow in there and it creates like that thing that you open up it like explodes right yeah sort of like that absolutely and so so he was also gluten sensitive so his we do a test to look for gluten sensitivity so now you 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 that's that barrier there's only one cell thick it's one cell like one cell between you and a sewer basically basically it and it's very tightly controlled so those 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 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 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 irritable bowel,

it's the irritable bowel that's causing irritable brain. Exactly. That's a very different frame of thinking about it. And that means you can fix it by fixing the gut, which is what you did with this guy. So tell us about that. So we fixed his gut. And the other connection there too, Mark, is when you have an imbalance of bacteria, remember up to 70% of your

serotonin can be made in the brain and serotonin does have a big impact on your mood. So he had multiple things going against him, all stemming from the gut. And so basically with the gut, we, and I don't want to get too much into the treatment for what we did for him, but we do. We're not. Tell us about what you did. So how do you treat the gut like that that fixed the brain? So the first thing you do is you alter diet.

So you put patients on what we call low FODMAP diet. And these are foods that are easily fermentable. So we take them off these foods and we put them on foods that are going to be easier for them to digest, not ferment. So you're not basically feeding the bad bugs their favorite food, which is starch and sugar. Right. Yeah. 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. Except I'm going to 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 then they tend to fight. You get a problem. So it's a careful balance. But it's basically change the diet. based. Or then they tend to fight in there. Yeah. You get a problem. Yeah. So it's a careful balance, but it's 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 even our prescription drugs, which can clear out the bad guys. So we got to do this, what we call weeding, feeding and seeding program, which is we basically get rid of the bad guys, we seed it with the good guys, and we feed the gut to get it healthy. We call it the 5R

program. And it's something we do really well here at the Ultra Wellness Center. And it's amazing how many things it can fix. So in this case, the patient had more psychological issues, ADD and anxiety. And the bloating, that was definitely the SIBO was driving. The SIBO was driving part of the anxiety. It was sort of like, again, you have this genetic predisposition. You're under lots of stress, which is one driver. Yeah. You develop SIBO, and stress can be one of the causes of SIBO. Yeah.

Then he also had the gluten sensitivity caused a leaky gut. And there was another piece to this is that he had sleep apnea. Yeah. Before you get to that, I'm not going to go there. It's really interesting. I want to talk about sleep apnea because it's a big issue. But the gut issue is so interesting because now in medicine, we are understanding, for example, if people take antibiotics, they get depression. That if your gut flora 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 improves. Depression.

It's amazing, right? And it doesn't mean that that's the cause of everybody's anxiety. It was the cause of his anxiety. I actually remember another patient who I remember came in and he was like, every day at three o'clock, I get terrible panic attacks. I'm so anxious. I feel like I'm going to 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 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 and I'm hungry so I don't eat again till late. And then every day around the... I get this panic.

I'm like, hmm, maybe you're hypoglycemic, right? So why don't you eat breakfast? Don't eat till late. Stop drinking. And like, I get this panic. I'm like, hmm, maybe you're hypoglycemic, right? So why don't you eat breakfast? Don't eat till late. Stop drinking. And like, panic attacks went away. So that was his problem. But this guy was different. He's different.

Everybody's different. Just because you say you have anxiety or panic attacks doesn't necessarily mean. 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, your anxiety always is going to be just your SIBO.

It's never just one thing. This was a contributor to a gentleman who had a genetic predisposition, but he also had some metabolic findings as well. He had things that we call cryptopyrroles, and he had urine peptides. Wow, what is that? So I got to tell you. Now, these are not tests you'd get at a traditional doctor. No, you do not get these at a traditional doctor.

The ways of looking at brain function through the urine that are so helpful, what are the things you're producing? So tell us about them. Yeah, so urine peptides, when you break down your dairy products like milk, you break them down into um to whey and casein but you break them down into other proteins and some even things called there are smaller than proteins called peptides that's less than 100 amino acids 50 50 yeah okay well what do i know i'm not gonna argue i don't know it's been a while since i took so 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. Now, wait, wait, wait. This is not an allergy to dairy. This is a whole different reaction. No, his body just breaks- 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 going to get this

as a conventional doctor. You're just not. And so then I also checked him for cryptopyrroles. So what are cryptopyrroles? Well, your red blood cells break down periodically. And when they break down, they have iron in them. And that iron has to be metabolized. Everybody does it.

One of the metabolites is a cryptopyrrole. Well, cryptopyrroles are benign and they're going to go out of your blood, you know, 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 cryptopyrroles were way off the charts. And so I can't reverse that, but I can supplement him with B6 and zinc. And we find when we do, we take care of urine peptides and we take people off their dairy to avoid those and we give them their zinc and their B6 back, we add to the benefit. We fixed his gut. We take care of his urine peptides. We take care of his cryptopyrroles. And now we're putting all these pieces together and he's getting better. It's just never one thing. And by the way, in order to convert tryptophan, which you get in your diet,

to serotonin, the enzymes require vitamin B6. Yes. So maybe it's not Prozac that he needs, but B6, right? Exactly. That's really important. So this is such a great case.

He had ADD that got better. You target 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 got to 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 read. And that's sleep apnea. And it's underdiagnosed. We think that it's only obstructive sleep apnea, which is one of two forms of sleep apnea, only occur in obese people, but it can occur in thin people because it's not just the weakness of muscles in the throat that cause it, but also the upper airway. And your airway is narrow.

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 you always steal my thunder mark no it's good it's like reading your mind yeah you read my mind so it's i slept last night it's very possible that his snoring 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 fixed his sleep apnea.

We fixed his urine peptides. We fixed his cryptopyrroles. 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 I'm like, what happened to you? Why didn't you ever call me?

He's like, oh, I was better. I'm like, 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, you know, in my traditional practice, you know, family

practice, I raised a generation of patients, you know, two generations of kids and families. And I saw people over and over and over again. With the same problem. Right. With the same problem. You manage their disease. Managing them with their medicines. And so we had a really good relationship.

Right. Here, people get better. And then, you know, here, they're gone. Yeah yeah it's part of the problem it's like it's like yeah you we don't 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 you you can do this i i we have a little bit of time with i want to go through this next case it's so great okay it's another woman with anxiety and brain fog hair loss and fatigue so So tell us quickly about her. Yeah, I'm going to tell you quickly about her.

So the key piece to her was is that very healthy woman who had her symptoms of anxiety, fatigue and hair loss start, you know, probably about 10 months after one of her babies, I think her last baby was born. Yeah. And so, again, she, you know, 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 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 going to look there. Got it. 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.

And 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. Papadnikolaou, I can't get a raise of weight. But I find out they have irregular periods. Well, that's how they make cow's fat for slaughter, right? Right. The steer, they give them estrogen. Look, estrogen, look, PMS, and you and I have talked about this, PMS not normal it's not correct and it affects 75 percent of women right and it's not a normal condition so why do you get it one of the big things is xenoestrogens so xenoestrogens means

xeno means you know guest or or stranger or foreigner i like to call it stranger. Like xenophobia. Yeah, it's like xenophobia. Because women who have xenoestrogens have stranger danger. I call it stranger danger. Because now you've 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. Yeah.

And it increases your risk for breast cancer. You know, 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 topic. And the symptoms are common. Like, you get heavy bleeding,

because you get more estrogen, which is more blood. More clots. Right. You get premenstrual migraines. You get breast tenderness and fluid retention. Really common symptoms for PMS. And guess what this woman had? She had endometriosis. Which is another symptom of, and that's an autoimmune disease. Yeah. 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, on the 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 sebo so okay reminds me of that patient was like you have trouble your

digestion no she's like she said um are you how often are you regular she's yeah i'm regular i said 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 people think of as normal and it's just not normal yeah you learn maybe no for her but it's not optimal yeah you learned you learn to live with what you got yeah you know so so she in her mind didn't think she had gut problems even though she did she did when you dig into the story right so so here's here's where it all comes together is is that when we get her testing back, we do something that's 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 suspected that— Or yeast. Or yeast. And there's different forms. It's not all candida. There are all kinds of species of yeast you can find. Yeah. Or yeast. And there's different forms. It's not all Candida. There are all kinds of species of yeast you can find.

Yeah, different yeast that can grow in the gut. And so I tested her for the most common one, which is Candida. 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 a positive in all three. What does Candida do? Candida metabolizes progesterone. I mean, it breaks it down, so you have less.

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 estrogen dominance worse. And estrogen dominance itself, those high levels of estrogen can cause anxiety that can cause depression mood swings brain fog and all the things she was experiencing 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 restrogen dominance and with that you fix the gut, her hives go away, and then I start treating her estrogen dominance. You fix the gut and the hives go away. You just said that like that, whatever. People suffer terribly with hives and have terrible yeast issues, and it can be debilitating. I had this woman, she had this angioedema 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 like, it just went away. And she went from like this bloated, inflamed person to just looking beautiful and normal. And it's so easy, actually, when you know what's going on.

And instead of taking all these antihistamine drugs and steroids and epinephrine shots, it's like, 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 and 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... And 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 like literally go bald. Right. And then we figure out it's gluten.

They get off the gluten and within months, it all comes back and they get like a full head of hair I had this one patient come in with a big hat and a scarf and she was kind of 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 a big full head of hair

that is amazing within six months this woman's hair actually started slowing down and by six months she was growing hair back. So you did a lot of things for her. You treated her gut and you got rid of the yeast. You got the estrogen balanced. How do you do that?

So estrogen balanced. So basically, you want to help her metabolize her estrogens better. So there are different compounds that we can use. So I use one of those compounds called diendomethane. You can also use... And what is that? That sounds like a big word, like a big drug,

but it actually comes from... Broccoli. Broccoli. It's a broccoli pill, basically. And why is that so great? Because... It helps with detox. Yeah, so broccoli contains

these compounds called... He's quizzing me. No, no, no. In front of all you people, I'm getting quizzed. I'm trying to get you to share. So it causes, it creates the ability of the body to detoxify the estrogen, like you said. And it helps with these compounds that are called glucosinolates and sulfluorophanes and indomethanes.

So diindomethane is one of those compounds. And it's been actually shown to reverse cervical cancer. It helps with hormone balance, detoxify estrogens, it's amazing. So I detoxify her estrogen so I get her estrogen down by metabolizing it better and we can also use something called calcium deglucorate which will bind it and so then... We're also getting rid of sugar and starch and processed food. Right, we got it. Yeah, I was going to end with and of course we changed her diet and put her on an autoimmune

paleo diet but going back to the estrogen dominance and then depending on the woman she might need a little bit more help so then i'll add some some i want to increase her progesterone so i'm getting her estrogens down i am increasing her progesterone by getting rid of her candida but she might need some help so i might give her something um like chaseberry so chaseberryberry is um it's an herb it's an herb um uh vitex vitex yeah yeah so it's called vitex and it will actually help promote your body to make more progesterone and sometimes i might need to use some low low level progesterone cream topical you know topical just before her cycle um or yeah so and And that can help. And we did those things for her and her periods, she no longer had breast tenderness. She wasn't having heavy bleeding and

things just really, this was a remarkable case. It seems like a miracle, but it's not. It's just good functional medicine. And what's fascinating is she was 42. And what happens with women as they enter their 40s, their cycles start to change. They don't ovulate every time. They get lower progesterone. They have more stress. Their diet breaks down.

So you end up with these estrogen-dominant patients, and they get, you know, fibroids and heavy bleeding and, you know, regular cycles and migraines. This stuff is so easy to fix using a functional medicine approach. Right. So I think... These are exciting cases. These are very amazing cases.

And it just sort of shows you that through the lens of functional medicine, you can have insights into the root causes of why people have common symptoms with uncommon solutions. Except in functional medicine, there are common solutions. This is true. And at the Ultra Wellness Center here, Except in functional medicine, they're common solutions. This is true. We've been doing this forever. Yeah. And at the Ultra Wellness Center here, we were so lucky to be able to use this model

to treat our patients. And now we're actually doing it all virtually, which is awesome. So we can actually help you whether you live in Timbuktu or whether you live in New Jersey or Russia, we can actually help you from a remote distance. And we have a great team of doctors, nutritionists. We have physician's assistants and health coaches, nurses, really are capable of taking care of these issues remotely. And we just love helping people because it's so satisfying and fun for us.

Oh, yeah. The sad part is we don't get to see them as much because they get better and then they leave and go live their lives, which is what we want anyway. But we feel a little bit lonely sometimes. But I think, you know, we really want people to understand that they don't have to suffer. If there's so many people needlessly suffering from chronic problems that have solutions that you just need to know how to dig a little deeper for. And that's why functional medicine is the future of healthcare.

This is not some fringe approach. It's not alternative medicine. It's not integrative medicine. It's looking at the biology we have through the lens of systems thinking and systems medicine and biology. And that gives us really a leg up on everybody else to be able to understand the complexity of human biology, but understand that there are common themes that we can fix, the gut and optimize nutrition, optimize hormones, and deal with different imbalances. And we do that so easily and well.

And it's just so satisfying. And George, you've been such a great addition to the Ultra Wellness Center. And I'm just so happy to have you here helping these patients. These are such amazing cases. And it makes our job so fun. And most of the time, being a doctor is tough because you get incremental benefit. And you can help people suppress symptoms. And they do okay, but you're constantly managing them.

They don't just get better. And I think that's the unique part about functional medicine is that there is a way out for so many people who suffer needlessly. And I just encourage people not to just accept the status quo. Yeah, and don't accept a diagnosis and don't accept a single treatment for your diagnosis, particularly if you're not getting better or you're just being maintained. Remember that there are doctors like us that are functional medicine doctors here at the Ultra Wellness Center that are going to realize that we have to ask the question why. We have to unpack the mystery of those integrated systems that require so much support and they work so well

together, but when they're out of sync, things can go wrong. And we can figure that out. And you should really don't accept the status quo, as Marcus said, and seek help with a good functional medicine doctor. And we're always willing to do that here at the Ultra Wellness Center. That's right. You can go to ultrawellnesscenter.com. You can go to the Get Started page, learn about all our services. And we're just so happy to help. And I think for those listening, just remember, you're not alone out there suffering from all this stuff, that there are solutions. And sometimes it takes a while for people to find the right place. But I just hope you understand that if you have some diagnosis, just don't accept that. If you have anxiety or if you have PMS or you have irritable bowel or whatever it is, hives. I mean, these are just symptoms. They're not diseases. Diseases are

these labels, these names we give to things that really have no connection often to what the cause is. And so functional medicine is really about digging deep into the causes, sorting through all that. And we just are just so happy to be able to do this kind of healthcare. It's really the future of medicine. Yeah. Don't accept the coverup. You'd have hives and your doctor says, hey, take Zyzal for the next 10 years. That's a coverup. Which by the way, costs like $20,000 a year. Yeah. That's a coverup. Get help. Yeah. Great. All right. Well, you've been listening to the doctor's pharmacy, our special episode of House Call with Dr. George help. Yeah, great. All right, well, you've been listening to The Doctor's Pharmacy, our special episode of House Call with Dr. George Pepinicolaou.

And we're here at the Ultra Wellness Center sharing a lot about what we're doing. And we're just excited to share this with you. If you love this podcast, please share it with your friends and family on social media. Leave a comment. We'd love to hear from you. Subscribe to every great podcast.

And we'll see you next time on The Doctor's Pharmacy. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements, to gadgets, to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter.

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It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.