The Dr. Hyman Show - Is Poor Gut Health Or Sleep Issues Driving Your Depression, ADHD, And More?

Episode Date: October 10, 2022

This episode is brought to you by Rupa Health, InsideTracker, and Pique Life.   Instead of using a pharmaceutical drug, what if your doctor knew how to look deeper to find out what is causing your depression, ADHD, or anxiety? While there is a time and a place for drugs, they can have significant side effects and may not be as effective at correcting an underlying imbalance in the body. Functional Medicine practitioners look at gut health, genes, diet, hormones, and so much more to create a thorough healing plan.   In today’s episode, I talk with Dr. Uma Naidoo, Dr. George Papanicolaou, and Dr. Drew Ramsey about how diet and lifestyle can be both a cause of and treatment for depression and other mental health issues.   Dr. Uma Naidoo is a Harvard-trained psychiatrist, professional chef, and nutrition specialist. In her role as a clinical scientist, Dr. Naidoo founded and directs the first hospital-based clinical service in nutritional psychiatry in the US. She is the Director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital (MGH) and Director of Nutritional Psychiatry at the Massachusetts General Hospital Academy while serving on the faculty at Harvard Medical School. Dr. Naidoo is the author of This is Your Brain on Food. ⁣   Dr. George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is board certified in family medicine from Abington Memorial Hospital. Upon graduation from his residency, he joined the Indian Health Service. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He began training in Functional Medicine through the Institute for Functional Medicine. In 2015, he established Cornerstone Personal Health—a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou joined The UltraWellness Center in 2017.   Dr. Drew Ramsey is a psychiatrist, author, farmer, and founder of the Brain Food Clinic in New York City, offering treatment and consultation for depression, anxiety, and emotional wellness concerns. He is the author of three books, most recently the award-winning cookbook Eat Complete: The 21 Nutrients That Fuel Brain Power, Boost Weight Loss, and Transform Your Health.   This episode is brought to you by Rupa Health, InsideTracker, and Pique Life.   Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com.   Right now InsideTracker is offering my community 20% off at insidetracker.com/drhyman.   Pique is offering up to 20% off plus free shipping on their Pu'er bundles at piquelife.com/farmacy.   Full-length episodes of these interviews can be found here: Dr. Uma Naidoo Dr. George Papanicolaou Dr. Drew Ramsey

Coming up on this episode of The Doctor's Pharmacy. If you're looking at trying a drug that has potential risky side effects, the bar is a lot higher than saying, why don't you stop eating sugar and gluten and eat some vegetables and fiber and fix your gut? Hey everyone, it's Dr. Mark. One of the most important tools I have for helping my patients optimize their health is testing. And that is why I love what Rupa Health is doing. Functional

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We're often told that eating well can prevent diabetes, heart disease, and cancer, but the correlation is just as strong when we look at the effects that diet and lifestyle have on our mental health. While the conventional medicine approach to treating these issues is to prescribe pharmaceutical drugs, the truth is that making positive changes to our diet and lifestyle can be just as, if not more effective, and they don't come with the unwanted side effects. In today's episode, we feature three conversations from the doctor's pharmacy on why looking at gut health, diet, and our genes are all important in treating depression and other mental health issues. Dr. Hyman speaks with Dr. Uma Naidoo on the role of inflammation and healthy gut bacteria

on the brain, with Dr. George Papaniklaou on why our genes play a role in brain health and what we can do to support them, and with Dr. Drew Ramsey on how food choice can either promote or prevent depression. Let's jump in. There's an incredible bunch of studies that were looked at by psychiatrist Stephanie Chung and her colleagues that looked at gut health and depression. And they found that people with major depressive disorder had about 50 different types of species in their gut microbiome that were different from the control groups that didn't have depression. And a lot of recent research shows that these bacterial species are associated

with high quality of life, often depleted in people who are depressed. And bacteria that cause inflammation are found in a lot higher numbers in people who have depression. So can you talk about what these studies showed and the connection between this inflammation and depression? Because, I mean, I saw a study recently that just made me crazy, which was using TNF alpha blockers for depression, which are these powerful drugs that cost 50,000 a year, they're used for autoimmune disease to shut off inflammation. I'm like, why not deal with the source, which is the gut? So talk about what these studies show, and how this connection exists between inflammation and depression. So the more that we learn about the gut, the more that we realize there might actually be

certain specific bacteria that are involved with the positive drive of depression versus the negative drive. I want to actually mention a study, and the reason I'm talking about it is that it's linked to this in the sense of how people don't realize the impact of certain gut bacteria and a food mechanism that can help you. A study that looked at yo-yo dieting, and this becomes significant because my patients who come in who've gained the weight from, say, a medication don't know how to get off it, and they might start to lose weight, and then they gain it back. And the sort of yo-yo piece of dieting has also happened with, say, reality TV shows, and people don't realize that there could actually be a mechanism in the gut.

The study that was done and published in Cell sometime this year showed that in particular lean mice and mice that had gained weight, they identified that certain gut bacteria were driving this. And it was almost, for want of a more elegant word, like a fat memory coded in the bacteria in the gut. Then they found that if they fed back proper and certain antioxidants, that the inflammation caused by this gut memory improved. And I think that what is so cool about this is it's one of those studies that directly showed a mechanism where antioxidants worked in a positive way. And I think that for me, it goes back to the Stephanie Chung study and those that have shown the multiple bacterial species, a quality of life factor, a lowering of depression. And, you know, I think I appreciate what you've been saying all throughout this conversation, Mark, because going into this, you know, I think that I didn't, when I said at the beginning, you know,

the illness that I had didn't lead to the book. It was because I wasn't sure that there was a book. I had been doing the work. But it was some of the work that got more publicity that led to my writing the book, because I knew the science was there. And what this did for me is it pushed me to look at, like you were saying, you know, 700 references condensed to over 550, because there was science behind it. And sometimes, you know, we get pushed to the side as complementary, alternative, or soft science. But there's real data behind it. And sometimes, you know, we get pushed to the side as complementary,

alternative, or soft science, but there's real data behind it. And I think that the more we can explain that to people and have them try things that, you know, it's not going to harm someone unless you have an allergy to try a different diet and to use these mechanisms to feel better. And we can be highly specific in some of these situations. Yeah, exactly. And what you're saying is so important because if you're looking at trying a drug that's very expensive or that has potential risky side effects, the bar is a lot higher than saying, why don't you stop eating sugar and gluten and eat some vegetables and fiber and fix your gut? And the evidence is there. We may not have large randomized trials,

but we have a lot of evidence, like you said. And the kinds of studies that are done now are just so compelling and so beautifully done. And I remember one of the studies I looked at was the SMILES trial, which looked at just swapping out people's normal processed food diet with more whole foods. And it was as good as any antidepressant, right? Exactly. It was as good as an antidepressant and they added in counseling and coaching. So you had, you know, you followed this diet and then they also had someone check in with you and ask you some questions and see how you were doing. So, you know, a lot of, say, weight loss programs have built-in coaching now because there's this almost contact part and accountability part

that is very helpful to people. There was a great trial done by my colleagues in Australia, and I think that, you know, one of the things that we're trying to do more of is really larger human trials. The difficulty is that how, how to capture some of the actual food that people eat becomes a little bit of a challenge. And so, you know, I think that we're, we're not lab rats.

You can't just lock us away and feed us the same diet. Feed us the same diet. Free living humans are hard to study. It's hard to study. It's different if you prescribing, you know, if you're doing a pharmaceutical trial. And, you know, there's also a lot more funding that goes to pharmaceutical trials and very little incentive that goes to nutritional science and nutrition epidemiology studies. There's definitely a difference.

And so, you know, I do think that with the studies we've looked at, even if the numbers are smaller, we've looked at the science and tried to pull out for people facts that will be digestible to them that they can actually take home and say, well, I can try to do that. And at the end of the day, you know, I think we can always find a study that's pro one thing on the same day, a study that's against the same thing. It's how we interpret it for people and show them the balance of what has worked. And that's where clinical, you know, like you said, so many, the many patients that you've treated, that's where the clinical piece also becomes so important. Yeah, it's so interesting. One of the things that you sort of write about and talk about is the role of the amygdala, which is our fight or flight, you know, reactive part of our brain that is, is what gets us into trouble if we're not able to manage that fight or flight response. And what seems to be going on today in our society,

and I'm just literally thinking of this hypothesis now in my head, it is increasing division, conflict, divisiveness, reacting out of fear, anxiety. And our society seems to be falling apart based on this incredible increase in this kind of behavior, which I've never seen before in my life. I mean, there's always difference of opinion and so forth, but this is just very different.

And I'm wondering if it correlates with the increases in processed food in our diet, the changes in our gut microbiome over the last 50 years, the changes in, for example, glyphosate, which is over the last few years has a powerful gut microbiome destroying properties, which is basically weed killer that they use on 70% of our crops. So I can go on antibiotics. I mean, there's so many things that are gut busting things. You think there's a correlation between the microbiome and the amygdala and you think it's related to this change in our diet. And do you think that's connected to all the changes that we're seeing in our society and this incredible conflict? I just, I just can't help but wonder if that's true. I, you know, I, I, I like, and I think this is a worthy hypothesis to think more about.

Certainly the rates of depression and anxiety, substance use and possible abuse of partners or people in the home increased during COVID. A very short survey was done during March by the American Psychiatric Association, and we haven't yet collected enough data to comment on the rates of increase of mental illness. However, separate to that, the overarching increase of disability, as you were speaking about early on in our conversation, has increased.

And, you know, what has changed in the world? Well, what has changed in our lives and in the world is how we eat. That has been significantly different. Our dinner plate size from the 1920s and 30s has changed from nine inches to about 12 inches. And if you have, you know, family who come to visit you from overseas, they'll want to share the appetizer or share the main course because the portion sizes here are very different. So if you think about how our food has evolved, then you talk about the high-fat and the low-fat issue.

You talk about the use of glyphosate in our crops. All of that combined with high fructose corn syrup and everything that has happened, yes, our diets have changed. I sincerely think that how we eat, not to be too cliched, but it really does impact how we feel. And I think the level of irritability, anxiety, agitation, depression has, whether it's diagnosed or not, whether it's diagnosed or not whether it's treated not has increased in society it's almost so people are just more on edge yeah and how can it not be linked to our brain and how we eat as well for sure i remember talking to bruce ames who's one of the leading sort of scientists in the world incredible guy probably in his late 80s now and he was doing

studies of high fructose corn syrup on the gut. And he had this finding, which was striking, which is typically when you get fructose in fruit, it's a sugar in fruit, it's combined with glucose, right? So when you just have pure fructose, which is rarely found in nature, which is found in high fructose corn syrup, it's free fructose, which is rarely found in nature, which is found in high fructose corn syrup. It's free fructose, which is very different than what you find in fruit. It actually requires energy to be absorbed by the gut and uses up ATP, which is the energy molecules. And he said, because of the increased volume of high fructose corn syrup, it literally is punching holes in the gut because the tight junctions, which are keeping the gut from being leaky, can't stay together because it's an energy dependent process. It gets interrupted because all the ATP, the energy

that's used to keep the gut lining together gets used to help absorb the fructose. So I don't know if that's true, but it was a fascinating theory. And I was like, it makes sense because, you know, it's about 15% of our sugars and our calories is high fructose I mean corn syrup which is terrible and it's in everything you know it's in everything that you don't even realize and and that's that's that's where the um the where I think I really feel that it has to be part of it um I don't think it's the only thing but and I don't mean to you know seem, seem like I have blinkers on, but I do think that, you know, even diagnoses in childhood disorders has increased. So all of that has to, you know, has to make a difference as well as, you know, I grew up, you know, 60 years ago. And there was that one kid in the class who was kind of a troublemaker.

And everybody else was pretty okay. And now you go to schools and the school nurse is like a pharmacist. She's dispensing all these psychiatric medications, antidepressants, ADD medications to kids. One in 10 kids is on ADD medication. pharmacist. She's dispensing all these psychiatric medications, antidepressants, ADD medications to kids. One in 10 kids is on ADD medication. I mean, you look at the kids' illnesses, it's not allergies or eczema anymore. It's depression and obesity are the kids' main chronic illnesses. It's frightening. And so how would you say this add crisis which is exploding is connected to diet and how do you tend to treat these patients so I have I see my mental psychiatrist but what I what I know about these disorders is that a lot

of adults have maybe exactly so I do as I do deal with However, you know, one of the interesting studies showed us that, you know, we've always thought, well, sugar drives the agitation and the almost hyperactivity. There are significant studies that show that that wasn't the cause. And I found that really fascinating because I had always thought, you know, that to me that was a clear link. I mean, just go to a birthday party when kids are eating cake and ice cream. Exactly. So it seems sort of kind of intuitive. But, you know, I think it starts

at exactly where we've been going in this conversation. It starts with what they're eating, what's happening in schools. You know, when the funding to school lunches are changed, there are industries that are moving vending machines to schools. And so kids who want a snack and, you know, where the lunches have changed are naturally driven to, well, I'm going to get a candy bar and get a bag of chips or whatever it is.

So there are things that have happened in society separate to the processes, you know, of high fructose corn syrup and all of that and the added sugar. Then the food labeling laws and the added sugar, then the food labeling laws and the pushback from industry around the food labeling laws where they're wanting to show large labels, the quantity of added sugar, so people became more aware. If we take it to the children in our society, they've basically grown up with all of this. So unless they've, if they've grown up eating the regular diet that

most people eat in this country, they have therefore eaten, you know, glyphosates, they've eaten, you know, all of these processed ingredients, all of this added sugar, and how could they not be obese? So how, you know, it's almost, it's a setup. Sadly, it's a setup for failure. There isn't anyone, you know, to blame about it. It's that, how do we change that? How do we truly have them eat in a different way? I have a member, the newest member of my extended family, his parents basically decided that he shouldn't, you know, shouldn't initially eat sugar.

I thought maybe he went to his first birthday party or something like that. And, you know, he eats fruit. He loves berries. And, you know, he, if you gave him an ice cream, he would probably eat it because he's little, but he doesn't really know that taste. And it begs the question, if you, if, you know, we all have these different taste receptors and things, but if you not, if you haven't grown up with that super sweet taste that we have in all of our foods, if you're not avoiding them, then what do you do? And I'm really curious to see how he grows because he loves fresh fruit. He loves whole foods. And it's just, again, it's because his parents have done this.

So, you know, it's a big question. It's a bigger question than I have the answers to. Hey, everyone, it's Dr. Mark. Now, we all know how important gut health is. It's key to our immune function, our brain health, mental performance, and even our emotional health. And that's why I want to tell you about a new product from our friends over at Peak. Their fermented pu-erh tea contains naturally occurring prebiotics and probiotics to support healthy digestion and metabolism. Now, the problem with good pu-erh, it's hard to source.

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So the DNA mine is gonna 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. And- So you can tell if you're more likely to be anxious or more likely to be depressed or more likely to be an addict or, yeah.

Exactly. So DNAMind will look at the area, look at the genes in multiple different areas that can impact neurodegeneration, your mood, and your addictive qualities. And so we look at very specific genes that are well-researched and we understand that if they do have variations, what those variations will mean. And then- What we can do about it.

And then informs me what I can do about it. Yeah. Those genes are actionable. You know, you get a 23andMe, you get 5,000 genes, you don't know what 4,999 of them do. Right, right. And so we only test, or DNA Health only tests, actionable genes in critical areas.

So this is really an important point. Because people are talking about DNA and personalized medicine, and most of it's noise, right? So we actually have genes that are common in the population that have clinical impact that we know a lot about and how to modify the expression of those genes and change what's going on so that you have a positive clinical outcome as opposed to just checking your 20,000 genes and not only what half of them mean

or 99% of them mean like you said. I mean there's one in particular that is very common that people have anxiety and what is it? MTHFR and COMT. COMT, catecholamethyltransferase, 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 catecholamines. And catecholamines, right, so the adrenaline, noradrenaline, epinephrine, and 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 like 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, right. Oh, 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, 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. Correct, right. 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 person's lifestyle, and based on their levels of their labs. And we really create a customized approach for each person to target in like a medical detective on the things that make the most difference. And you just give them a simple amino acid, but it's like, wow, how simple was that? But it was knowing that you needed to do that

that was the key. Yeah, and here's the cool thing. When I looked at his DNA to go over those results with him, he had the COMT defect that didn't process his, that over-processed his amino acids that made dopamine and norepinephrine. So it matched up. So his genes matched up with his clinical picture and he responded appropriately to the dopamine precursor. So I thought that was fascinating.

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 distention. 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 discomfort and wake him up in a million times. So like when you got apple cider and the bugs grow in there and it creates that thing that you open up and it like explodes, right?

Yeah. Sort of like that. Absolutely. And so he was also gluten sensitive. So we do a test to look for gluten sensitivity. So now you have- And that can also cause anxiety and depression. Exactly. So now you have gluten and you have overgrowth of bacteria. The two of those can disrupt the epithelial barrier membrane

in the intestine. Basically, your intestine is a hollow tube and then the first layer is a layer of cells. That's that barrier. It's only one cell thick. It's one cell thick. Like one cell between you and a sewer, basically. Basically, yeah.

And it's very tightly controlled, so the cells can separate and then close. Separate and close to let things in and keep things out. So in his particular case, he has two things going against him. He has gluten sensitivity, which is gonna lead to leaky gut. He has 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. I mean, a lot of people call SIBO irritable bowel syndrome. Right now we have a better name for, you know, figuring out what it's caused by. And not all irritable bowel is SIBO, but what we found was that when I was in training, and I'm sure it was like this for you, George, we were taught that people with irritable bowel syndrome

were psychologically impaired, that they were anxious and that's what was causing their gut issues i'm embarrassed to say that and 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 super tentorial, 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. 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 the irritable bowel, it's the irritable bowel that's causing the irritable

brain. 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,

and I don't wanna get too much into the treatment for what we did for him, but we do. We're not, tell us about what you did. So how do you treat the gut like that that fixed the brain? So the first thing you do is you alter diet. So you put patients on what we call low FODMAP diet, and these are foods that are easily fermentable. So we take them off these foods and we put them on foods that are gonna be easier for them to digest, not ferment.

So you're not basically feeding the bad bugs their favorite food, which is starch and sugar. Right, processed foods. And so we do that. And then we also give them some probiotics. And you have to be careful with probiotics because they are bacteria and you are treating a bacterial

overgrowth. So I'm very careful about which- Except that we want 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 know, you get a problem. Yeah, so it's a careful balance, but it's basically change the diet, then we give them I'll tend to use spore-based probiotics. Because then they tend to fight, you know, you get a problem. 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 just, we use antibiotics to get rid of the bacteria. And those antibiotics can be herbal protocols. Sometimes I will use pharmaceutical grade, depending on what organisms, what gases are being produced

by what organisms. Yeah, so we actually look at breath testing to see what's growing. Is it hydrogen, is it methane? And then we can customize our herbal treatments or even our prescription drugs which can clear out the bad guys. So we kind of do this, what we call weeding, feeding,

and seeding program, which is we basically get rid of the bad guys, we seed it with the good guys, and we kind of do this, what we call weeding, feeding, and seeding program, which is we basically get rid of the bad guys, we seed it with the good guys, and we feed the gut to get it healthy. We call it the 5R program, and it's something we do really well here at the Ultra 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. 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. So I'm not gonna go there. It's really interesting.

I wanna 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, 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's amazing, right? And it doesn't mean that that's the cause of everybody's anxiety. It was a cause of his anxiety. I just remember another patient who I remember came in and he was like, every day at 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 like what's going on in your life as well. You know, I work on Wall Street and I'm like, work hard all day and I don't eat much. And then like at night I eat a lot and I drink a lot and then I go to bed and I wake up, I'm not hungry so I don't eat again till late. And then every day around the clock I get this panic. I'm like, maybe you're hypoglycemic, right? So why don't you eat breakfast? Don't eat till late. then every day around i get this pain i'm like maybe you're hypoglycemic right so why don't you eat breakfast don't eat till late stop drinking and like right panic attacks went away yeah so that was his problem but this guy was different he's different everybody's different

because you say you have anxiety or panic attacks doesn't necessarily 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 caused his pancreatitis. 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 just, 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. So- 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.

So urine peptides, when you break down your dairy products like milk, you break them down into whey and casein, but you break them down into other proteins and some even things that are smaller than proteins called peptides. That's less than 100 amino acids. 50. 50? Yeah, it's less than 50.

Okay, well, what do I know? I'm not going to argue with you. I don't know. It's been a while since I took biochemistry. So you have these peptides. And so if you break them down into certain peptides, particularly with milk, you break them down into casein morphins,

and these are these peptides that can cross your blood-brain barrier, and then they have an opiate-like effect on the brain, which can affect mood, cognition, and memory. So it's like you're stoned all the time on heroin. Right. He had really high peptides in his urine. Oh.

He also had some- Now wait, wait, wait. This is not an allergy to dairy. No? This is a whole different reaction. No, his body just breaks his- 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 and behavior, and then you can see them coming out in the urine because they're excreted in the urine. Bingo.

So it's really a different way of looking at this than traditional medicine. Yeah, and you're not gonna get this as a conventional doctor, you're just not. And so then I also checked 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 crypt 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 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

Yeah And so I can't reverse that but I can supplement him with b6 and zinc Yeah Because and we find when we do we take care of urine peptides and we take people off their dairy to avoid those and we Give them their zinc and to be sick back. We we add to the benefit, you know 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 Yeah, and he's getting better. It's just never one thing. And by the way, in order to convert tryptophan, which you get in your diet, to serotonin, the enzymes require vitamin B6.

So maybe it's not Prozac that he needs, but B6. Exactly. That's really important. So this is such a great case. He had ADD that got better. You target him with supplements like fish oil and other neurotransmitter support. You got his gut fixed.

You got his sleep apnea fixed. It's so great. This is such an amazing case. And I think- Mark, I just gotta say one thing. The sleep apnea piece is like another critical piece. I just have to say the one thing about sleep apnea is that, you know, what sleep apnea piece is is like another critical piece i just have to say the one thing about sleep apnea is that you know what sleep apnea is 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 REM sleep is where you're consolidating memory. And if you're not getting REM sleep, it's gonna make it harder for you to function the next day. Not only are you gonna be fatigued, but that part of your brain responsible for memory isn't gonna be working as well.

You're gonna forget your keys. You're gonna forget your tasks. You're gonna 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. Right. Yeah. And so, he had sleep apnea and he'd been snoring all his life. Point being is sleep apnea- Maybe it's ADD and anxiety was probably related to his sleep.

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, so I'm like- It's very possible that his snoring, his snoring as a kid was driving his ADHD, right? And as you age, we have a lot of adults

that are being diagnosed with ADHD. Some of them had it all their life. Some of them are developing it because of their sleep apnea. So we fixed his sleep apnea. We fixed his urine peptides. We fixed his cryptopyrroles. We fixed his gut. We got him off of gluten 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 gonna 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. Yep. 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 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.

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. They're out the door. So it's like, yeah, we don't manage diseases.

We want to get rid of them. If someone's listening and they have depression, anxiety, mental health issues, what are the ways of eating that actually cause a problem? And then when we'll get into what are the ways of eating that actually can fix the problem. Yeah, that's such a great question. Let's start with the problem at the end of your fork before we tell you the solution. And the problem at the end of your fork,

a lot of people know those words that, you know, everybody knows I'm about to say sugar. Everybody knows I'm about to say trans fats. Everybody knows I'm about to say processed foods. And so the- Surprise, it causes everything. It causes everything. Cancer, diabetes'm about to say processed foods. And so the- Surprise. It causes everything. It causes everything. Cancer, diabetes, Alzheimer's, and depression.

And I think what's really been striking to me as a psychiatrist interested in behavioral change and as an eater and as a parent, how do you change those from being concepts to being behavioral and action-oriented items in your own life. And so what's causing the problem, very simply, is not getting enough of the right nutrients. And I would argue for a lot of Americans missing a set of nutrients. Americans are not getting phytonutrients because they're not eating plants. Americans are not getting seafood because they eat 14 pounds per year, period. And it's fish sticks.

It's not yeah the seafood that we would want them to eat they're not you know this is not shrimp ceviche and wild salmon on uh yeah and they also there's i think a problem that isn't just around the food choice but is around uh i would say the missing spirituality of food and that that people have we've lost our soul about food and when you tell people to eat well there's a notion that well that costs too much or it takes too much time or i don't know how to do it and i think those are our missing lies yes and and i think it's just i mean i have my my mama taught me how to cook and she's taught me that recipes start with olive

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

It's like, it's lentils. Yeah, carrots, celery, a little pinch of sea salt. So anyway, those are, what's on the end of the fork that's causing the problem is first of all, people aren't eating with the fork, right?

People aren't taking a deep breath and engaging their digestive system and people aren't in any way offering up gratitude or thanks for the most people. Some of you all are out there doing that, but the number of times as we did when we were we had that wonderful dinner with well and good and we sat there and I'm sitting there next to you have you first eat and I'm thinking like I've been out

in the Midwest like you don't eat until you say grace right and let's have a moment and everybody's ready to give thanks and bow their heads for a moment she said such a wonderful grace to our food for us. So those kinds of things, it's not just that, that, that, that garbage is on the, you know,

it's not even your fork. It's in the package that you're eating or that it's on the go. It's that we've lost that notion of where it comes from and, and valuing that and honoring that. And, um, we're doing a better job as you know, honoring the farmers who grow it,

you know, who are, you know, these silent heroes, you know, talking about a grow it you know who are you know these silent heroes you know talking about a health care crisis i mean talk about physician suicide i mean the biggest threat to farmers right now is farmer suicide i mean we're just losing dozens of farmers a day it's the number actually came out a bit there was like a little confusion like what's the top uh risk group for suicide was it farmers or or doctors? And I was like, you know, either way, it's just

awful. So is there data science proving that sugar and processed foods cause mental illness? Well, let's talk about the data set that there is. The big data set and there's controversy about this data set is correlational data. And the controversy is that's really misguided us with a lot of nutritional policy per you know smart folks looking at that i really like the writing of gary taubes and peter attia who kind of look at the science behind correlational studies and have some serious questions but but if we're gonna think about that data as being useful that data is very clear when you eat more processed foods which means simple sugars trans fats and a lot of simple carbs in all those ways.

It's not just sugar, folks. It's like fructose syrup. I love corn syrup solids. Right. Now they changed the name of high fructose corn syrup. Right. It sounds like a corn kind of, like corn syrup. Corn's healthy.

It's a vegetable. Like maple syrup. And so those are the things that certainly we want folks to avoid. And what does the data say? If you eat highly processed foods, you have 50 to 100% increased risk of clinical depression. If you eat high glycemic index foods, there's a great study that came out, a colleague at Columbia looking at high glycemic index foods. So those are foods that just spike your blood sugar more. Those have a significant increased risk.

Individuals have an increased risk of depression, the Women's Health Initiative. So big, big study of women ages 45 plus. And so there's that correlational data, and it's just consistent. When you look at the meta-analyses of it, it's consistent that the food that we've created in the last 100 years leads to an increased risk or increased risk in that population of depression, same data for ADHD. Not as much data for anxiety disorders, which is interesting, but certainly feels true to me clinically. Then we move on to randomized controlled trials. And the reason this is of interest is, is on the molecular side, like in the mouse models,

we know this in the, I mean, you know, not having enough nutrients and putting lots and lots of fuel. What does a depressed mouse look like? Yeah. I mean, what depressed mouse looks like?

I mean, there's very, it's very clear what depressed mice look like is you stick them in little cages and they don't try and, and you put them into swim. It's a forced swim test. And when mice are depressed, they don't fight to get out. They just stop swimming.

They drown? We don't let them drown. But they would drown if you didn't fish them out. Whereas non-depressed mice, they're fighting to get out. That's what a depressed mouse looks like. So the randomized controlled trials that came out recently are exciting because we can say it makes common sense. We can say on a molecular level, it makes lots and lots of sense.

We can say it makes sense in the correlational data. But you and I know, Mark, medicine's not going to change until we have randomized clinical trials. And that's where folks like Felice Jacka and Michael Burke and the Food and Mood Center in Australia, they're really, I would say, the leaders in this, where they've completed a number of trials. Natalie Parletta is also not part of that group, but is a part of the leaders in this where they've completed a number of trials natalie parletta is also not part of that group but say part of the leaders in this and now they're putting down numerous randomized trials and creating resources for patients with mental health concerns like depression yeah to make sure food's part of the equation and their data looks quite strong and what i love about this is when the data comes out it's funny one of the big leaders in psychiatry um won't mention him by name but been very the data comes out, it's funny, one of the big leaders in psychiatry, won't mention him by name, but been very critical.

It's funny, there's a big post about how, and one of these health medicine review websites about how bad the trial was or how small it was. It's like fighting. Everybody's always criticizing each other about the study. And I was like, so when we don't have data, you say there's no data. And then when people do a really good trial, you want to pick it apart. Yeah. And there's some feeling that it's almost like, you know, folks have really. People don't like paradigm shifts.

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

Like you might be aware of Hiblin's work, which was from the NIH. Captain Joe. Captain Joe Hiblinlin is like a pretty cool guy he's the he's the leader of the what he calls himself the uh he is the uh servant he's the surgeon general's he's a soldier in the surgeon general's army there you go and he did these amazing studies looking at the rise of omega-3 omega i mean the rise of omega-6 fats refined oils and the decrease in omega-3 fats lead to violence homicide suicide uh and that changed behavior and i remember once coming back from you know somewhere and i had a letter on my desk in my office and it was from a prisoner who wrote me a letter who read my book culture metabolism way back when and said you know i was a violent

criminal in my life and i realized you I realized that when I changed my diet after reading this book in prison, I don't know how he did that, that he realized he was a very different person. And they've done prison studies where they feed prisoners healthy diets, and they reduce violent crime by 56%. If you have a multivitamin, it reduces crime by 80%.

In prisons. Yeah, you can just see the notion that we don't approach that, right? What is criminal activity violence? notion that we you know we don't approach that right what is criminal activity violence so some of it stuff we don't understand some of it certainly horrible character pathology but some of it when we think that this is a population that in general does not have good nourishment in general um you know does not learn a lot of mental health skills you know there's there's a way way that some of what's going on there is certainly just a result of a broken system of mental health care

and I would say a broken system of our culture. I've been inspired this month by the Benjamin Rush biography. And the reason is that I didn't know anything about Benjamin Rush. And Benjamin Rush is one of our youngest founding fathers. He is the second youngest signer of the Declaration of Independence and the only, I think the only physician signer. And he is our original American physician. They called him the American Hippocrates back in the day. And he's also our original psychiatrist. And he founded the first mental hospital and he helped us found this country on a very very simple principle which is that when we think about mental illness we can't put people

in asylums and say that they don't have spirituality or they're sinners or they're bad people that we as physicians are going to treat them as patients and we are going to care for them and that is just inspired me to really think about what's happening in our country and how bad our mental health has gotten and how we all know about it and we're just finally starting to talk about it. But we were founded as a place where we should have freedom to talk about this. I'll get you a copy of the Benjamin Rutherford. Yeah, it sounds fantastic.

It's like every doctor should read it. So, Drew, you wrote this paper. It was published September 2018 in the Psychiatric Journal. And it was really quite detailed in terms of its analysis of the types of foods and nutrients. So help us take this home. What are the things that you learned from there that are the most important nutrients we need? And what are the most important foods to help us get those nutrients and just in general to help us for mental illness? And so the simple, the paper's called

Antidepressants Foods, and folks can check it out, and it's an open source article. And I did this with my colleague, Dr. Laura Lachance, and quite simply, it's arithmetic. It's bean counting, and we went through all of the literature, looking at all of the essential nutrients, vitamins, and minerals, and did a literature search to say,

well, which of these have significant evidence that they can help prevent depression and that they can be used to treat depression? And there are 12 that we found. And I bet you could name all 12, Mark. They're the 12 we would expect. Omega-3 fats and zinc and B12, vitamin E, magnesium. Iron. Iron. And so, then we looked at just a simple, what a nutrient profiling system is, is it just tries, it's just a system for looking at what foods have the most of those nutrients per calorie. And then what a good nutrient profiling system does, and Dr. Lachance and I really wanted to create a good one because oddly there are, I think, 27 nutrient profiling systems in the world

that have been created. Some people have seen ones like the andy or nuval you know how many have been about mental health none none and so what we a good nutrient uh trifling system does looks at food categories so we're not saying kale kale kale kale and people say well i don't like kale you need too much of it exactly oh no it's toxic now now it's toxic work but what we say is leafy greens and so what we did is we scored um we looked at all of the all of the the top foods for these nutrients scored them and then created a list of the top plant and animal foods and so they're they're you know first of all they're the foods that top the list which i just think are are interesting like oysters clams and mussels are in the top five on the animal side and the reason we did animal foods is that no nutrient profiling system usually has any meat or any animals in it because it's all

based on calories usually and plants always have fewer calories but most people eat meat or seafood so we wanted to give folks a list of which which had the most nutrients why why were this shellfish the top ones top ones because they think about oysters why do they top the list you get 10 to 15 calories per oyster so let's just say you know six oysters 60 calories and for those 60 calories you're getting 768 milligrams of long chain omega-3 fats you're getting 340 percent of your vitamin b12 you're getting uh gosh at least a third of your iron you're getting 500 percent of your daily need of zinc. I mean, and on and on and on. You're getting some vitamin C in oysters.

Okay, let's go get some oysters. Yeah, exactly. All that for 60 calories. And that's just, and on the other side, looking at plants, like things like watercress top the list. And why just watercress? Lots of nutrients, no calories or very few calories. And so, that's a great example of nutrient density, those foods. And so, the food great example of nutrient density, those foods. And so the food categories that people should be looking for are things like leafy greens, the rainbow vegetables, more seafood.

And if you're eating meat and red meat, to look more towards wild red meats or grass-fed red meats. So this is fascinating. So the diet that prevents cancer, heart disease, dementia, depression, and fixes most chronic illness is the same diet it's it's really it's well it's where we got off in medicine we kind of separated out mental health and brain health from the right like like you're saying kind of like somehow the blood blame brain barrier was

like thou shall not pass like we we didn't think that sure those same all those same activities that we we think about in terms of our general health and the foods we want people to eat and the things we want people to do, move their bodies, connect, be part of their community. Yeah, that's key to your brain health and your mental health. Yeah. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review

below. Until next time, thanks for tuning in. 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. I'll only send it to you once

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