Episode 15: What Does the Microbiome Have to do With Treating Anxiety and Depression?

Hello, and welcome to The Better Biome Podcast where we explore the universe within.

We're your hosts, Dr. Nicole Beurkens.

And Kiran Krishnan.

And on today's show, we're talking with Dr. Peter Bongiorno about depression, mental health and the microbiome. Dr. Peter Bongiorno graduated from Bastyr University after completing five years of medical training in naturopathic medicine and acupuncture. He authored Healing Depression: Integrated Naturopathic & Conventional Treatments, the first comprehensive textbook designed to teach physicians how to use the science and art of natural medicine to heal depression. Dr. Bongiorno is vice president of the New York Association of Naturopathic physicians, a member of the American Association for Naturopathic Physicians, Physicians for Social Responsibility, and has a diploma in acupuncture. He helped create the first elective Natural and Integrative Medicine Class at the Mount Sinai School of Medicine, and regularly guest lectures to medical students about natural medicine and acupuncture. He has been regularly interviewed on national and local television as a natural medicine expert, and writes for national media. He regularly writes articles for the Dr. Oz and Sharecare websites, and as an invited expert blogger at Psychology Today. Dr. Bongiorno is also a major contributor to the third and fourth editions of the Textbook of Natural Medicine. Such a pleasure to have you here today. Welcome!

Thank you! Thanks for all the great work you do.

Oh, thank you. I've been excited about this conversation. As somebody in the mental health field myself, this topic is really near and dear to my heart, to really educate people about the connection between things like nutrition, physical health, the gut microbiome and their mental health. I'd love to start by just having you share a bit with all of us about how you came to be doing the work that you're doing today.

Oh, gosh, I would say there were two roads: The road that got me to natural medicine was, actually I was doing research at the National Institutes of Health. And while I was there, I had a girlfriend who actually had multiple sclerosis. We were both around 23 years of age at the time, and she was diagnosed with chronic progressive multiple sclerosis, which is the more difficult type, it's the kind that you kind of get worse and you don't really get better. And at the time, because I was affiliated with the National Institutes of Health, the NIH, I knew some doctors in different fields in the Eye Institute and places like that, because she was having trouble with their vision. Different people had different recommendations. And one of the last doctors said, "Well, you should probably go get a wheelchair while you still have a chance to walk in and do that yourself." And so she, on her own, started looking for other things, and had a classmate who was very interested in naturopathic medicine, something I'd never heard about and actually, frankly, sounded like quackery to me. I had no background in natural medicine, no interest in it. I was very kind of science-based in my thinking about medicine. When I would go to a health food store, they kind of smelled funny to me, and that's all I knew about health food stores. But I saw her get better using these natural things, and the naturopathic practitioner who was working with her talked to her about stress and diet, of course, and the foods she was eating and sleeping and all of these things that at the time, didn't make much sense. And I remember looking up an article about food and multiple sclerosis, and finding this article by a guy named Swank, who published in a German journal, over 40 years, he looked at multiple sclerosis patients. And what he did was he put them either on conventional care, or gave them a low saturated, high unsaturated fat diet, and I think a multivitamin with extra B's in it. And what he found is that the people who got the conventional care went on to have what you would expect in terms of exacerbations and disability, and the people who had the low saturated, high polyunsaturated or good fat diet, went on to do much better and had very few exacerbations. And I remember reading this horrible thing thinking "Gosh, why didn't any of the neurologists talk about this? This is pretty clear information." And that was my aha moment. Gosh, this is something I wanted to do. And interestingly, in terms of mental health, I was at the Mental Health Institute. I was studying clinical neuroendocrinology. So we were looking actually at how stress affects the brain, how it creates inflammation. But I was looking at it from a very kind of research standpoint, I wasn't thinking very holistically, even though that sounds kind of holistic. But then when I went through naturopathic school, I got out in 2003, I started practicing, and what I noticed is that almost all my patients are on some kind of anti-anxiety or antidepressant. There really wasn't much information about how to treat people naturally for anxiety and for depression. So that's actually how I started collecting information, and what I realized was I had written a chapter for a textbook on the subject, and I realized that was probably the only combined information out there about that — because I had to pull it from all these different sources, I didn't see anything else about it. So that's when I decided to write my own book on that, as I was treating these patients and seeing what was going on, I was starting to learn "Oh, this does work. St. John's Wort actually does work", and things like that. And yeah, it's been 16 years, and it's been quite a journey, and I'm very thankful to the patients who have come in to see me and trust me with their care. I feel like every year I'm learning more and more, and really, in the last couple of years, it's just an explosion of information about the microbiota and what's going on with the germs in our digestive tract. I have really solidified what I learned 16-20 years ago, that digestion, and healthy digestion can really help your brain.

Kiran Krishnan 00:06:30 holistic approach to managing mental health One of the things that this brings up to me — You're talking about a natural approach, a more holistic approach to managing mental health. I know one of the things that's really great about the natural approach is really its focus on root causes, rather than managing symptoms and patchworking, if you will. So in your view, what is driving this epidemic, if you will, looking at root causes of mental illness that we have?

Yeah, it's a great question. If you look at the information from the CDC, from 2003, through today, suicide rates alone have skyrocketed, and suicide rates in women especially, have doubled. And so you think about it: We have more drugs than ever to treat these conditions, and yet, one of the greatest endpoints that we're concerned about is getting worse and worse and worse. So there's a few drivers for that: One is certainly the whole opioid epidemic, it has been a part of that. But even without that in place, it's still a big issue, and it really comes down to, not one issue, there's no one thing driving it. It's our lifestyle, the foods we're eating, the stressors we have, the lack of sleep, the lack of exercise. When I work with each patient, I explain to them that very typical example of the iceberg. And your mood is really the tip of that iceberg. Everything that's going on underneath is really what we're interested in, because for one person, the reason they can have depression or anxiety could be mostly stress and event-related information issues. For another person, it could be sleep, for another person, it could be lack of exercise, for another person it could be nutrient deficiencies, for another person, it could be genetic predisposition, for another person, it could be inflammation, and on and on and on. And in my job is really to sit down with these persons, listen to their stories as best as I can, and really try to understand: Okay, out of all the factors I know that can be contributors, which 7 or 8 or 10, or 15, or maybe 20 are the ones that are contributing to the syndrome that we're calling a mental health problems.

Sure. Yeah. And does family history play a lot of role in this as well?

It certainly can. In my experience, most cases, no, though. I think for the very, very deep cases, like for example, if I hear of a patient who really was anxious since she was three years old, I've seen these children, and now she's 25, and still very anxious, then you have to start to say, "Okay, there's definitely more of a genetic predisposition there." And if you hear the and had this issue — but honestly, for the most part, most cases, it's not true. In most cases, it's not that strong of a family history, or when it is a strong family history, it's because most of the people in the family are having the same environmental experience, and maybe foods and things like that.

How you're talking about it is such a different way than most people are used to hearing about things. We have this manual of diagnoses that we use, and there's this commonly held idea out there both by patients as well as people in the healthcare community that these are definable conditions. And we talk about it as if depression is a serotonin deficiency in the brain, based on the treatments that we typically use, right? It's like, "Well, of course you feel this way, you have depression." But what you're talking about is really tipping that upside down and saying, actually, depression is just a name that we give to symptoms that can rise from lots of different causes, which is not how people are used to hearing about that.

That's a great example you give, because we think about depression like "Oh, it's a serotonin deficiency." Well, if you really look at the literature, serotonin drugs to treat it work, maybe 27 to 35% of the time, just a hair more than placebo. And interestingly enough, and this isn't talked about in the media: Drugs that do the opposite of serotonin reuptake inhibitors work equally as well.

Crazy.

So what it tells us is that, okay, well, maybe 30% of the time, low serotonin is an issue. And in those patients — look, there are times when drugs can be miraculous for patients. And I think in certain urgent care situations, they're definitely a godsend. So I'd want anyone listening — First of all, anyone listening who's taking a medication shouldn't stop their medication, number one. And number two, if you are taking medication, and it's helpful, use that as a blessing and say, "Okay, now I need to figure out why my serotonin was low." And that's where we want to talk about all those other factors, and that's what my books talk about, and that's really what I sit down and work with each patient on.

Just a much more hopeful way of talking about it, because I see a lot of patients, and I'm sure you do as well, who this diagnosis has sort of defined them, right? It's like, well "I've been given this diagnosis of depression and or anxiety, or bipolar, or whatever it might be." And they've been told "This is a problem that you're going to have for your entire life." And it sort of defines them. And what you're saying is, there are lots of things that are within our control that we can do to dig into these root causes and address them.

Yeah, absolutely. There's so many factors, and for each patient, it's a whole different set of factors. But they are little controls that we have. I remember, a couple of years ago, when vitamin D research started really coming out becoming popular and conventional doctors started running it. Everyone thought, "Oh, that's the answer." And in mental health, they thought the same thing, "Oh, we're going to start getting people vitamin D, and they will get better." And what we found is: Not really. But I do believe vitamin D is an important neurosteroid that plays a role in what goes on in the brain, but it's not the only factor. So that's just one of many that we need to figure out.

Krishnan Is anxiety the beginning of a snowball effect for mental health? 00:13:00 Yeah. Now, when you're looking at the clinical progression of these conditions, does it typically start with anxiety that then leads into depression, and then the suicidal ideation and all that comes down later, and it triggers with anxiety first?

I think in most cases, it is the continuum you just suggested. I think people will go on for years with anxiety at some level. It basically kind of burns their system out. Their body kind of resets to the anxiety to try to deal with it, to try to cope and get through. But as the body resets, inflammation tends to go up, nutrients get depleted, the adrenal system doesn't work so well. What we find in a lot of cases, people start sleeping poorly because their circadian rhythm gets all out of balance. And these are all signs that this anxiety is progressing. So even if they're not getting outwardly more anxious, we see with these other issues going on that yes, this is getting worse. And some people will get to the point where they kind of get so burned out, that they just don't feel they can cope anymore. And those are the people who don't want to get out of bed anymore, and typically stay in bed more. A lot of times, I'll talk with conventional psychiatrists, and they'll say, "Oh, well, these depressed people sleep too much." Well, they're in bed too much. They're in bed because they're not getting any sleep. They're sleeping so poorly. And so I find that really working on their sleep can be a great advantage. So it really is a continuum, I think, in most cases. Now, having said that, I do think there are patients who have depression, who from the get go, and like I said earlier, at a much younger age, had signs of depression, were very depressed. And I think that is a different situation. It's not really on that anxiety to depression continuum. I think they're more genetically based, in terms of what's going on with their pathways and how they make neurotransmitters. Oftentimes they have mitochondrial issues. The mitochondria are the energy packs that all our cells need, and our nervous system, especially, needs those energy packs working well. So when we have predispositions to poorly functioning mitochondria, that's also going to play a role in depression.

Kiran Krishnan How does Trauma affect mental health? 00:15:15 Now, do you find that in a lot of your patients that are dealing with anxiety, that trauma has some root in that subsequent anxiety that they experience?

Yeah, absolutely. Especially childhood trauma, what they call adverse childhood events. And prenatal stress, when you're in the womb and your mom's really stressed out, that's going to change the set points of your stress system, too. So absolutely, traumas will play a significant role. And if we know what the traumas are, and the patient remembers the traumas, and of course going for the right therapy to work on that. I've seen things like EMDR work especially well for that. And then if we don't know the traumas, then sometimes even working with people who have clairvoyance, and then sometimes energy healers can pick up things and help the patient move through certain feelings and memories that are stuck, that they themselves don't even know. So I say bring it all in, whatever seems appropriate that certainly won't hurt and can help, we need all of those tools because mental health is so multifactorial.

And has become such a prevalent problem. I mean, I think we've just seen so many more people, and the statistics bear that out, as you mentioned, presenting with these kinds of issues. How brain function is related to gut microbiome health 00:16:45 I want to get back to something that you mentioned earlier in the conversation about the gut, the microbiome — that whole connection, because I think that that's a really new idea to a lot of people, especially people who are struggling with these symptoms, the idea that something going on in their mind or something with their brain could be related to the physical things happening in their body. I'd like to talk about that for a bit.

Sure. Well, I think the first book about it that became public was by a guy named Gershon, and I think it was in the early 1990s. He wrote a book about serotonin and how serotonin is made in the digestive tract, and how what goes on in the digestive tract will greatly affect what happens in your brain as a result. And before that, no one had really talked about what they call the enteric nervous system, enteric meaning in the gastrointestinal tract. And since then, there's been an amazing amount of robust research showing the very, very strong connections between the nervous system in the digestive tract, what goes on in the digestive tract, and what goes on in the brain. And now what we know, for example, if there's a lot of inflammation in the digestive tract, we'll find a lot of inflammation in the brain. It's interesting, because in the early 90s', when I was at the National Institutes of Health, we were studying stress, and we were looking for how stress turns on inflammation in the brain, because previous to that, it was really thought that the brain was sort of this black box that was very protected, and that the immune system didn't really get in and get out. And things that went on in the brain didn't show up in the body and things that were going on in the body wouldn't show up in the brain. And now we know that's completely not true, that there's plenty of areas where what they call perivascular areas, these areas have vessels in them that come from the body, that touch the brain tissue and that have a lot of exchange. And now we know there's a lot of direct routes between the digestive tract and the brain. And what we know is that what happens with the digestive tract, like how balanced the germs are, the microbiota and the digestive tract are, will directly affect what is made, and what happens in the brain. And similarly, what goes on in the brain will affect both behavior and will affect directly what's made in the digestive tract. So it really becomes bidirectional: What goes on in the gut affects the brain, what goes on in the brain affects the gut.

Yeah. And there's more evidence coming out that microbes play a direct role in causing anxiety-like behaviors, right? I mean, there's Campylobacter, which is a common foodborne illness. One of its main effects is creating a sudden panic attack and surge of anxiety. And this is a bacteria that's a foodborne pathogen, typically from chickens, coming in and when it sits in your gut, it can produce neurotransmitters and chemicals that can actually make you feel anxious. Right? Fluoroquinolone antibiotics, one of the known side effects is causing anxiety and maybe even depression, and recently I read an article on something called arachidonic acid EPA ratio. So that is a ratio that measures inflammatory markers, not only in the gut, but then how it translates to the circulatory system. They were looking at elderly patients in nursing homes who were depressed. And they found a really strong predictive value in looking at the inflammatory marker to predicting not only the presence of depression, but the degree of depression. And so I think what you're saying in terms of the tie between the types of microbes, the balance that exists in the gut, and then of course, the inflammation that you mentioned, seems to have a direct impact on the brain. There's that gut-brain connection, you must see that in kind of the holistic approach in managing mental health, right?

Absolutely. And there are tests you can run to help take a look at that. There certainly are stool tests that are very valuable to see what's going on balance wise in the digestive tract. And then bloodwork. Looking at different inflammatory markers can be very useful. And then you can even look at the genetics of a patient to see if they're more prone to having more inflammatory issues as well. Now we have so many tools to look at these different factors. And I think the doctors who are really doing a good job are the ones who are saying, well, we have got a lot of tools. Now, there's no one thing that's fixing everything. But if we use them all together, we can create a personalized profile for this particular patient, and then create a recommendation plan that's really going to go specifically after what they need rebalanced. So it's really exciting. It's a very exciting time.

You talked about, in general, some of the areas that you look at with patients as part of that toolbox. But let's delve into that a little bit more, about nutrition, sleep, those kinds of things. For people who are listening, and are saying, "Wow I've had all these symptoms. I've maybe been diagnosed with depression or other kinds of mental health issues. I haven't heard any of this before", what do you think are some of the fundamentals in some of these key areas that regardless of specific genetics, or whatever, that are helpful to people? 00:22:00

Well, the first two things when a patient comes in for anything, if I hear they're not sleeping, and if I hear they're not pooping every day, those are the first two things to work on. It doesn't matter what fancy tests we might run or look at. And we have to start with that. And if I had to pick a third, I would say finding out if they love their work, if they're happy at home. So those three things, I would say the top ones to start with, because usually if you have those in balance, other things will fall into place. If I hear someone's not sleeping, I really want to work on that first, because so often, when you have somebody who's not sleeping, and you can get them to sleep even a couple more hours at night, it really changes things for them, and some symptoms and things will drop away. And then the ones that are left, then that's what you need to work on. So sleep, poop, and happiness. Those are my top three.

Speaking of sleep, what about sleep in itself is so important? Why do we need to pay attention to that?

It's a good question. I think for many years, people didn't know why we needed to sleep, we just did. Right?

We just know we do it everyday. Yeah.

But now we understand that there's a lot of things that go on while we're sleeping. We power down so other processes can happen. We power down so that the mitochondria, which are those energy packs right in our nervous system, can fix themselves and clean themselves up and break down and make new ones. We power down so that our system can de-inflame and can detoxify. Sleep is when your brain detoxifies. If you're not sleeping, a lot of things — like there's one thing called glutamate, which will increase in great amounts and will stay up unless we're sleeping enough to kind of clean it up and get rid of it, and glutamate is a good toxin. It's a good neurotoxin. It's one of the most prevalent neurotransmitters in the brain, and we need some, but when there's too much, then it becomes a problem, and it'll contribute to anxiety, depression, schizophrenia, bipolar, all of those things. So we need sleep so our body can do those things.

And people will come in and they'll say, "Oh, yeah, I sleep fine." And then you dig into it and it's "…well, now that I take Ambien every night or I'm on Trazodone," or whatever. You're talking about a different kind of sleep. You're not just talking about "We need to make sure you're in bed sleeping with the medication." So just to be clear, because people say, "Oh, yep, I'll just go in to my physician and say I'm not sleeping and they'll give me something, and I can check that one off. Okay, I'm sleeping now!"

Yeah. And it's interesting because of those drugs, they're shown to increase all mortality by about 300%. So there's one study that showed — and I don't want to scare people, but it's important to take this seriously: 9 pills over 6 months can increase mortality by 300%, and more can be up to 500-600%. These are big, big numbers. And these studies, we're looking at getting rid of the other confounding factors, like if people smoked, if they have heart disease, etc. So what they're finding is that the medications to sleep are very, very problematic. And it makes sense because you can hit yourself over the head with a baseball bat, and that will put you down for a while, but it's not healthy. This is sort of the same thing. What it's not doing is it's not promoting good sleep architecture, the phases of sleep that we need to get into, the different waves of sleep that allow our body to go down, really detoxify, come out a little, do some dreaming, and then wake up in the morning. That's a good, healthy sleep. And the Chinese would say an hour before midnight is worth two after midnight. So I really try to help people promote that early evening sleep, trying to get to bed by 10. And I know for some people that is shocking. I know, I was in a rock band for years. I would go to bed at 5, 6 o'clock, or sometimes I'd even go to bed. I always thought I was a night owl and that's who I was. And then I had my own issues with anxiety, and one of the things I learned how to do was start getting into bed, and I find even till today — that was 20 something years ago, even today, if I'm going to bed late too often I'll start to feel jittery. Some of those feelings come back, because then that's my body's way of saying, "Get some sleep." Really important.

You also practice acupuncture. So can acupuncture be helpful in helping people with the shutdown process, and working on the meridians? 00:26:55

Yeah, absolutely. In fact, that was one of my experiences when I had issues with sleep. I found acupuncture was very good just to help me get to sleep and get a few more hours. In my practice, I mean, everyone's a little different, but while I'm working on naturopathic recommendations, the sleep, the exercise, the foods, all the things you've been talking about, the vitamins all that, I usually have people come back at least once or twice a week to get an acupuncture treatment for two reasons: One is because I get to check in with them a little more often to make sure things are getting done that need to get done at home, and two because I like having an energetic treatment that's very balancing, that doesn't require anything from the person. Even when you meditate, you still need to kind of sit and breathe and it requires a little bit of work. But the acupuncture is great, you just lay on a table and you let somebody else — it's very passive, which is good because I like having that. And I find people do feel better faster when they get regular acupuncture while we're working on the underlying issues. So doing both together, I find works even better than either one by itself.

Yeah, so my kids are prone to motion sickness if they were driving through a mountain or going on a boat or something like that. And so we give them the Sea Bands, right? And they work amazingly well, better than Dramamine would, because Dramamean, the kids, it will just knock them out so they won't enjoy it at all. And it's working on an acupressure point on the wrist.

Yeah. Pericardium 6.

6, okay, is there an acupressure point that you could mention to the audience, that they can either put pressure on, that helps people relax, helps them calm down?

Yeah. I mean, a good point: I was actually here in the city during 9/11. I was actually in school, I was still in naturopathic school, but I happened to be in on that day because a cousin of mine was getting married, and I was staying at my brother's who had an apartment on 70th. And so somebody called us to turn on the TV, and of course we saw all those awful, awful things going on. And I remember one of the announcers, when the first building fell, said something to the effect of, "Oh maybe it's a nuclear explosion." I was thinking to myself, "Well, I'm just not that far away. This is it for us." And I always carried — because I was in school, it was acupuncture needles, and the point that I used was this point here, there's a point right in between, it's kind of the third eye point. So if you take your eyebrows and you kind of follow them to the center, there's that third eye point. Very, very calming point. It's a good point to press for relaxation.

So you just press on there for relaxation. Funny enough, there's a lot of Ayurvedic massages and things that they drip oil on that third eye as part of the relaxation technique.

Yeah, absolutely. So let's say, if I had to pick one point, that would be it. I would say as a second one, getting a little lavender essential oil and putting it on the bottom of your foot. Kidney 1 is down there, and that's a very grounding point as well.

Okay. Yeah, very interesting. And that's something people can do sitting in traffic, as they're getting frustrated with the cars in front of them. Right? Just kind of press for a moment.

Well what I tell patients is "Red is for rest." In New York City, you — I use that one all the time.

Why is pooping daily important for mood and mental health? 00:31:00 You mentioned that a second really important piece is that people are pooping every day. And again people go, "Oh, well how's that going to help my mood or my anxiety?" Or some people say, "Well, I've never done that. I've pooped twice a week for my whole life. How does that make a difference?" Why do you feel like that's such an important starting point for people?

It's definitely not what I feel. I mean, the research really bears that out. There's plenty of studies that talk about constipation, IBS, and constipation, and higher rates of anxiety and depression. Studies in the elderly that show the same. So I remember, when my brother — I had two elder brothers, and when we were very young, one of my older brothers would say "Yeah, when I don't poop, my brain gets fuzzy", I never forgot that, and I always thought about that. And then when I was writing one of my books, I actually put it in my book as I was talking about this. Yeah, when you're constipated, your brain gets kind of fuzzy. And it's hard to think. I think anyone listening probably knows that. But I think our bodies get used to things, it's sort of like when we don't drink water, we stop getting thirsty, we kind of get used to it. It's still not good for us. But we get used to it, we run at a not-so-good level as a result. And definitely the same with being constipated and not moving your bowels every day. And I think in conventional medicine, you even read the textbooks, and they'll say two to three a week is okay. It's passable. And it's not passable. We really do need to be moving everyday. There's no way we can get rid of the toxins that our liver is putting out. There's no way we can balance hormones, and there's certainly no way we can keep the microbiota in balance and keep those germs in balance there.

Not to mention the potential for continued purification of the fecal matter sitting in there over time. If you have a patient who comes in and is sleeping pretty well, but is not pooping, then what are some of the things that you look for them to do?

The first step is water. A lot of people are just dehydrated. I'll explain to patients that if you don't have enough water, your body — the colon's job is to extract water from the poop, especially in times when there isn't enough water around, because we're animals, right? And animals are made to deal with harsh conditions and the colon really tries to help by pulling the water out so that this way we don't dehydrate. So unfortunately, that gives people a sense that they don't need to drink as much water. So the first step is water, making sure they're getting that in. And the second step is usually working on stress, because even if people are eating all the right foods, if they're really stressed out — when you're running from a bear, you shut your digestive tract down, because you're not thinking about eating, you're thinking about saving your life. So when we're chronically stressed, our gut is chronically shut down. And then the movement, the peristalsis, which is the movement of the food through the gut really slows, and then water is naturally pulled out of it because it's sitting there longer. So working on stress and getting people to either meditate or work on why they're stressed, or get a massage, or I have people do castor oil packs on their stomach, things like that to help bring the circulation back to the digestive tract is really useful. And once you start working on that, then we might start adding fiber, especially if they're low fiber, and I'm careful not to do that first or in large amounts, because even if people aren't eating fiber, if you start giving them a lot of fiber at one time, they're not going to be happy. I remember when I was in my 20's and I started getting interested in health, I said to myself, "Oh, I've got to eat beans, and I was coming off of eating pizza and burgers. And so I started eating beans and oh my god, I was really unhappy, even though it's good food, you can't do that. Sometimes you have to start slow with the fibers. And for some people, there's different types of fibers, there is soluble and insoluble. So when you listen to their symptoms and you start giving them certain things and you hear how it changes their symptoms, then you know what course to take, because again, if that microbiota is really unhappy in there, and you start feeding the the bad ones, they're just going to make more bad ones. So it's all about balance.

You'll turn a lot of them to gas, and they'll make you unhappy.

Problematic diet 00:35:25 From a food standpoint, what are some of the things that you see patients coming in with these kinds of symptoms — What are some of the big, problematic things as far as how people are eating?

Well, I would say, probably one of the first challenges is getting enough essential fats. Good, essential fatty acids. In fact, one of the hot pieces of research right now circulating the conventional psychiatry world, is how if you have a patient who isn't doing well on an SSRI, you can give them essential fatty acids, and then they start doing better, which makes me think, well, maybe if you just gave him the essential fats to begin with, they probably would start doing better.

And there's some good studies on that, too.

And there are plenty of good studies on that, on B6 and Zinc. Anyway, yeah, I could go into that. So essential fats are definitely a challenge. I see a lot of kids come in their late teens, and they just don't eat fish, and they don't really eat a lot of plants either, and maybe they're not good at converting the plants, even if they are eating them, to essential fats. So I do find getting good quality fish and possibly even supplementing with some fish oil in there can be very, very useful. Then I think also getting in the fiber is going to be vitally important, just to help the microbiome balance, which is going to help all the neurotransmitters balance in the brain. If I don't know a patient or someone just asked me for general recommendations, and I don't know anything about them, their history or their sensitivities or anything, I'd probably recommend some version of the Mediterranean diet. That seems to have the best research, and seems to be the most sensible and the most balanced. So that's certainly a great place to start. It has a lot of essential fats in it, a lot of healthy oils, and a lot of fiber.

And I mentioned earlier, the study on the arachidonic acid EPA ratio in the elderly with depression. There was a follow up study to that, where they then supplemented fish oil to those individuals and saw that that ratio improved quite dramatically. The inflammation went down, and then the depression symptoms got way better. And it was just the fish oil component. And then there are connecting studies to that showing that just the essential fatty acids in the fish oil actually modulate the microbiome, and that modulation, that that changing of the population, if you will, seems to have an impact on the resulting reduction in depression.

That's really interesting. I haven't seen that. It makes a lot of sense. I wonder how it does that exactly.

That's what's really interesting, because you don't think of microbes as metabolizing fat all that much. And that fat wouldn't necessarily have an impact on the microbes, right? But there's more and more research coming out that certain types of polyunsaturated fatty acids are actually, in some ways, prebiotics for certain microbes.

Yeah, I was wondering if it was actually just changing the environment, maybe making it a less inflammatory environment around it or something.

Yeah. So what you're already seeing in clinical practice is now kind of being validated in the research field.

That's very exciting. I was coming in through naturopathic medical school, and there's so many things that we've learned that just weren't validated. I remember our teachers saying, "Look, this there, you're not going to find research studies on this, but we see these things work." Now little by little, we're starting to see the research validation of all these naturopathic and old anecdotal remedies and things, and understanding why it works.

Yeah. And I think a lot of that is driven because when you look at traditional Chinese medicine, Ayurvedic medicine, naturopathic medicine, a lot of its centers around the gut, right? Gut health and the gut. And the microbiome has become this juggernaut in the scientific community. I mean, we have 50,000 published papers in the last five years. I mean, there's no other topic in science or biology that has that much research activity, and as we dig further into the microbiome, and do all of this research, we're basically validating what 1000 year old medical practices have been saying. So it's really great that people like yourself that are writing books on this topic and on natural medicine and the holistic approach are getting that kind of practice more out there. So speaking of that, how can people learn more about the work you've done? What are some of your books? I think you've written more than one. What are some of your books that you would guide people towards to kind of understand this holistic approach better?

Well, I have two books for the public. One is called Put Anxiety Behind You, and that's obviously about anxiety. And then the other book is for depression. It's called How Come They're Happy and I'm Not? So that's more geared towards depression. And for physicians, I have a textbook that's published by Norton, and that's called Holistic Solutions For Anxiety and Depression, and it really goes through the same material that's in the public books, but it takes a deeper dive into the research and the mechanisms and things like that. Put Anxiety Behind You, and How Come They're Happy and I'm Not,

And they are available on Amazon?

Yes. And they're in Barnes and Noble as well.

Great resources.

Both excellent resources, I highly recommend them. I do recommend them to people. It's been such a pleasure to have you with us today to talk through all of this. I know our listeners found it very helpful. So thank you for being here.

Great. Thank you so much. And to the listeners, I just want to say if anyone has anxiety and depression, I know it's very, very difficult, and it feels like it's something that is hard to move off you, but there are still so many things to try and do, and I just really encourage the listeners to keep working on it and find a practitioner who hears you for who you are and wants to look at all those factors because they are out there, and things can change.

There's significant hope.

Awesome. Such a wonderful message. Thank you so much. And thanks to all of you for joining us for today's episode of The Better Biome podcast. Tune in next week to continue with us as we journey through the universe within.