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Natural Solutions for Anxiety and Depression with Dr. Peter Bongiorno: Rational Wellness Podcast 146

Dr. Peter Bongiorno discusses Natural Solutions for Mood Disorders like Anxiety and Depression with Dr. Ben Weitz.

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Podcast Highlights

4:45  Rate of anxiety and depression are rising today, esp. among teens.  When depression becomes severe, you wonder about suicide, but suicide rates that been soared, despite the use of all of these antidepressant drugs being prescribed.  In fact, some of the SSRI (serotonin reuptake inhibitor) drugs are known to increase suicide rates.  These drugs do have benefit, esp. in urgent care situations, where they can be life saving.  SSRIs are commonly used for depression and anxiety, but for mild to moderate depression, they work about 30-35% of the time, which is a hair more than placebo.  Usually after 2-5 years these drugs tend not to work as well. And these drugs are not getting to the underlying problem, even if that is a serotonin imbalance. You still want to ask, why did your serotonin get out of balance?  If we can treat the underlying causes, then that is a better solution, which is why the Functional Medicine approach can be so helpful.

7:52  The neurotransmitter imbalance theory of depression is questionable, since brain chemistry appears to be much more complicated than some think, since we have drugs that increase serotonin levels, drugs that increase norepinephrine, dopamine, GABA, and reduce glutamate levels that all seem to have some efficacy. In fact, there is even an anti-depressant that decreases serotonin levels that seems to have equal efficacy to drugs that decrease serotonin levels. Dr. Bongiorno points out that the older tricyclic antidepressants are actually more effective for depression. For anxiety, while anti-depressants are not very effective, the benzodiazepines, like Xanax and Ativan, are fairly effective. But the problem with these drugs is that you can’t take these drugs long term because they have a lot of side effects, they are very addictive, and they stop working after a while. If the Ativan stops working, they may get put on Xanax and eventually other, stronger drugs.

10:25  Natural Treatments for Anxiety and Depression. Diet, sleeping, and exercise are all important factors that affect the risk of depression and anxiety.  The digestive tract is super important, since most of the neurotransmitters are produced in the digestive tract, and diet directly affects digestive health.  While dietary recommendations are best individualized, in general, the Mediterranean style diet is probably best and it has been shown to raise GABA levels, which is the calming neurotransmitter.

12:32  Balancing blood sugar is very important for patients with mood disorders.  If blood sugar is not balanced, insulin will be elevated and this can drive inflammation.  While it is popular in the Functional Medicine world to do intermittent fasting and skip breakfast, Dr. Bongiorno finds that “for mood, it’s really helpful to have a good breakfast, to have a good lunch and have a smaller dinner.”  It is best to have meals based on healthy proteins with healthy fats, in addition to some healthy carbs, like whole grains and beans.  Dr. Bongiorno pointed out that if you look at the diets where people live the longest in the Blue Zones, they include some healthy carbs like whole grains, beans, and legumes.  For patients with mood disorders, getting some of those carbs are really helpful to keep the serotonin levels up.

18:12  Lab testing can help us to sort out some of the underlying imbalances that might lead to anxiety and depression.  A full lipid/cholesterol panel is important since if cholesterol is too low, this can lead to hormone deficiencies.  If the HDL goes below 35, LDL goes much below 90 or total cholesterol goes below 190, that can be negative for the brain. In our drive to lower our cholesterol levels to lower heart disease, we are pushing cholesterol levels too low for optimal brain function and cognitive function and this can be playing a role in mood disorders. Labs should also include a good iron panel, vitamin D, RBC magnesium, Carnitine, B12, salivary cortisol test, and sex hormones like estrogen, progesterone, and testosterone. Melatonin levels are helpful when there are sleep problems. 

24:29  Sleep.  Dr. Bongiorno mentioned that he emphasizes the importance of sleep in all of his books and makes it the first chapter. If people aren’t sleeping, it’s very hard to make them feel better. The first thing that needs to happen is that your patients need to be sleeping and pooping every day before you can fix any other problems. It is important to go to bed no later than 10 or 11, since most of our melatonin gets released somewhere between 8:30 and 10:30, which is needed to get into a deep sleep state.  If you stay up late playing video games that cause the elevation of our dopamine and our norepinephrine, which are neuroexcitatory, you will much more likely have mood disorders. We need to respect our normal circadian rhythm if we want to have a good sleep pattern. wearing blue light blocking glasses at night can be helpful, esp. if they are looking at their phones, computers or TV.

29:00  There is a therapeutic benefit to spending time in nature, which the Japanese call shinrin yoku.  Molecules known as phytoncides are emitted in a forest and we breath them in and they get into our bloodstream and they help our immune system to work better and balance our neurotransmitters. Just standing on the earth, grounding, changes our electromagnetic field and has therapeutic benefit.

30:25  Exercise has been shown to be as effective as the leading antidepressant medications.

 



Dr. Peter Bongiorno is a Naturopathic Doctor and Acupuncturist and he is the co-director of InnerSource Natural Health and Acupuncture, with offices in New York City and on Long Island. He also works with clients via phone and Skype. He’s written a number of books, including Healing Depression in 2010 and Holistic Solutions for Anxiety and Depression in Therapy in 2015, targeted for physicians, and How Come They’re Happy and I’m Not, and Put Anxiety Behind You: The Complete Drug Free Program, both for patients. His website is DrPeterBongiorno.com.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.



 

Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates. To learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Rational Wellness podcasters thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please go to Apple podcasts and give us a ratings and review. That way more people will be able to discover the Rational Wellness podcast. If you’d like to see a video version, please go to my YouTube page. If you go to my website drweitz.com, You can find a complete transcript and detailed show notes.

Today our topic is in integrative approach to mood disorders like depression and anxiety with Dr. Peter Bongiorno. Depression is a mood disorder characterized by a persistent feeling of sadness and loss of interest. According to the journal, the American Medical Association, in 2013 16.7% of adults filled one or more prescriptions for psychiatric drugs with most being anti depressants. This prevalence is higher among women than men.  An estimated 3.2 million adolescents aged 12 to 17 in the US had at least one major depressive episode representing 13.3% of adolescents. Anxiety is characterized by feelings of worry, nervousness or fear that are strong enough to interfere with one’s daily activities. Anxiety is even more common than depression with 19.1% of US adults having experienced an anxiety disorder in the last year and 31.1%, having experienced an anxiety disorder sometime in their lives.

These numbers for rates of anxiety have been rising in the US. Depression and anxiety are typically treated within conventional medicine with medications like antidepressants such as Prozac, Zoloft, and Lexapro. These are among the most commonly prescribed medications in the US. The number of people taking these medications has been rising rapidly. Recent statistics show 64% increase in the number of people taking antidepressants in the last 15 years. 12.7% of the US population took antidepressants in the last month and older adults took them in even higher numbers.  Most of these antidepressants were originally approved by the FDA for short term usage, and there are only a few studies that lasted longer than a few years. But yet many patients are being placed on these drugs indefinitely. It’s very difficult to get off these drugs. A large percentage of patients who take them report severe withdrawal symptoms when trying to wean themselves off or are unable to wean themselves off.  One of the focuses of our conversation today will be whether these drugs are actually effectively treating the causes of depression and anxiety and what alternative treatments might be available, taking a holistic or functional medicine approach. Either as alternatives for patients who do not want to take these medications, or perhaps to make these medications more effective.

Dr. Peter Bongiorno is a Naturopathic Doctor and acupuncturist and he’s the co founder, co director of Inner Source Natural Health and Acupuncture with offices in New York City and on Long Island. He was a researcher at the National Institutes of Health in the department of Neuroimmunology. Then he went to Bastyr University to study naturopathic medicine and acupuncture. He’s written a number of books, including Healing Depression, in 2010, and Holistic Solutions for Anxiety Depression, as well as How Come They’re Happy, and I’m Not and Put Anxiety Behind You The Complete Drug Free Program.  Dr. Peter is a sought after speaker and he spoke at the A4M conference in Las Vegas in 2018 where I saw him speak. Dr. Bongiorno, thank you so much for joining me today.

Dr. Bongiorno:                   Oh, gosh, it’s my pleasure.

Dr. Weitz:                          Why do you think rates of depression and anxiety are so prevalent today and especially anxiety seems to be rising among teenagers?

Dr. Bongiorno:                   I mean, there’s no question that anxiety and depression rates are just soaring. It’s really interesting because as you alluded to at the statistics, we’re using more and more of these drugs for depression and anxiety every year. Yet, more and more people are getting anxiety and depression every year. If you look at, for example, depression, one of the things you worry about the most, of course, is suicide.  Suicide rates have soared. There’s a few studies that look at rates from between 2007 and now. We’re seeing these incredible jumps and even in just the past few years. Despite the fact that all of these drugs are being used and more and more are coming out on the market, the endpoint, which we’re most concerned about is only becoming more and more of a problem.

Dr. Weitz:                          In fact, the side effect of some of these drugs is that they actually increase suicide rates, right?

Dr. Bongiorno:                   Yes. So now they’re putting black box warnings on things like SSRIs which are serotonin reuptake inhibitors, which are commonly used for depression and anxiety. But now they’re showing that in younger people, they may actually increase suicide rates. In fact, it started out with very young people like teens and adolescents, and now they’re bringing it up to young adults that they’re seeing this concern with.  It’s not to say that medications don’t have their place. Sometimes when someone is in a real urgent care situation, and there’s really no other choice, then sometimes a drug can be life saving. It’s not that they’re completely not useful and always a bad idea, but they’re certainly being far overused. They’re not getting to the underlying problem. For many people, they might numb the symptoms when they do work.  For example, depression, in mild to moderate depression, which is when SSRIs are used the most, they work about 30 to 35% of the time, which is maybe a hair more than a placebo would work. Even in those cases, at some point, it’s usually within two to five years, those medications tend to not work as well anymore anyway. At some point, you still have to say, okay, we have to figure out what’s going on. Even for people when they work in the case of depression, you still want to sit down with these person and say, well, what’s the reason things went awry.  If an SSRI fixes serotonin, and that helps, you still want to ask, but why did the serotonin get out of balance to begin with? These are the questions that aren’t being asked. Instead, people are just being put on medication and sent on their way. Then once it stops working, it becomes a crisis.

Dr. Weitz:                            You wonder if this whole concept of these mood disorders actually being caused by neurotransmitter imbalance is really valid. If you think about the fact that we have drugs that increase serotonin, you talking about SSRIs. Then we have drugs that increase Norepinephrine. Now we have drugs that increase dopamine. We have drugs that affect GABA, glutamate. We even have drugs that decrease serotonin and seem to be equally effective. You just have to wonder what do we really know about the complexity of brain chemistry? It certainly doesn’t seem to be as easy as just increasing serotonin production.

Dr. Bongiorno:                   No, absolutely right. It’s interesting because the drugs that seem to work the best, not great, but certainly the best of what are called tricyclic antidepressants, which are the old ones. They just seem to basically raise everything. So it’s just pull everything up and hopefully it will help somebody feel better. The problem with those drugs is that they do have a lot of side effects, which is why they are considered first generation not really used so much anymore.  Like I said, in mild to moderate depression, which is the vast majority of use of these prescription drugs, it only works maybe 30, 35% of the time tops. Anxiety, on the other hand, benzodiazepines, drugs like Xanax and Ativan, they do work. If somebody takes one of those, they get calmer. But the problem with those drugs are, is you can’t keep taking them. You get addicted to them, they stop working and need more and more, and I can’t tell you all the patients I see on the same path trajectory.  They’re young, they get anxious, they get put on an Ativan. The Ativan doesn’t work, they get put on Xanax. Now they get withdrawal at night, they have trouble sleeping, so they get put on Klonopin, and then the Klonopin stops working so they get put on Tramadol or something even stronger. Trazodone and just… We keep upping the ante and these gets stronger and stronger to the point where people, they can’t get off them but they’re not working anymore either.  I can’t say how many patients I’ve seen in that situation as well. It’s just a testament to the fact that the body is not being treated to heal. It’s just being treated for symptoms. That doesn’t work.

Dr. Weitz:                            Right. Let’s get into some of the natural approaches. What role does diet play in depression and anxiety? What’s best type of diet to control it?

Dr. Bongiorno:                   The first thing I want to say is that there’s a lot of factors that play a role. You just touched on a major one. Diet, if people are sleeping, whether they’re exercising or not. Certainly what’s going on with their thoughts, play a role, environmental toxicities, inflammation in the body, digestion, hormonal balance, nutrient deficiency. When I look at a patient, I try to assess all of these different things at the same time and figure out for them, what are the factors that are contributing to what we’re calling anxiety or what we’re calling depression.

Diet is clearly one of them. Our digestive tract is such an important place in terms of making the neurotransmitters. If neurotransmitters are off, we really want to start thinking about the digestive tract. What we eat and what we put in our mouth, of course, is going to play a huge role and how well that digestive tract functions. To answer your question, if I don’t know a patient and someone asked me well, what is the best diet? I would start with something probably like a Mediterranean style diet.  Mediterranean style diets are shown to be very beneficial to help raise GABA which is the calming neurotransmitter. It helps lower inflammation. We know that inflammation that goes to the brain can play a really strong role in all kinds of mood disorders. The Mediterranean diet really provides a lot of nutrients, a lot of good fiber for the microbiota in our body, which is clearly an important part of how we can balance neurotransmitters in our brain. Without knowing a person, if I had to pick a diet and didn’t understand their sensitivities, I’d probably start with some version of the Mediterranean style diet.

Dr. Weitz:                            Good. What are some of the dietary factors that play a role here? I know in your book you talked about the importance of balancing blood sugar.

Dr. Bongiorno:                   Yes, blood sugar is very vital because what I find is a lot of people who have both anxiety and depression, their blood sugar tends to bounce around a lot or sometimes their insulin, which is the hormone that takes the sugar out of the blood and puts it into the cells, can get very high for some people and that can also drive a lot of inflammation. Eating in a balanced way can be very useful.  Now everybody’s different, of course one size doesn’t fit all. But usually I find if patients are very susceptible to mood changes when they don’t eat, then the first step is really to make sure you’re eating throughout the day at least three good meals and definitely a good breakfast. I tell a lot of patients: eat like a king for breakfast, a queen for lunch, and a pauper for dinner. It does work because I find when people eat a good breakfast… I know right now, with intermittent fasting, sometimes it’s become desirable to not eat and have a breakfast later so that you lessen your hours.

Dr. Weitz:                            Yes, very popular, especially in the holistic Functional Medicine circles. We skip breakfast so we have a longer period of time between dinner the night before and lunch without eating.

Dr. Bongiorno:                   That could be fine for some people therapeutically if they want to lose weight. But I always like to check in because if they have mood issues, and especially if they have mood issues associated with not eating, then we might want to modify that for them. Again, everybody is different and there’s no one size fits all and that might be great for some people, and not so good for other people. But I find for mood, it’s really helpful to have a good breakfast, to have a good lunch and have a smaller dinner.  Make those meals very healthy protein based, whole foods, good healthy fats, and also some healthy carbs. If you look at the diets really where people live the longest in the Blue Zones, they don’t really get rid of all the carbs. They tend to eat good whole grains, beans, legumes and things like that. I find for my patients with mood, getting some of those carbs are really helpful to even keep the serotonin levels up. Everybody’s different, but I think for mood that’s a good general rule.

Dr. Weitz:                            I think it’s important that you’re emphasizing the benefits of carbohydrates because especially in the last five 10 years, carbs have been demonized as some of these low carb diets have become more and more popular like the paleo diet and the ketogenic diet. People are really seeing carbs as just completely evil. I think we need to rethink that and realize that carbohydrates can play an important role, especially healthy carbs or low glycemic ones that have a lot of nutrients and fiber and can be part of a healthy diet.

Dr. Bongiorno:                   Yes, absolutely. When I was a student over 20 years ago, I had the opportunity to spend time with Dr. Atkins in his center in New York.

Dr. Weitz:                          Okay, Mr. Low Carb himself.

Dr. Bongiorno:                   Yes, the guy who really figured out that not eating fat and eating all of these bagels was a bad idea. Nobody was talking about it. He was a very nice man. The thing that I learned in his clinic is that therapeutically, using very low carb can be really helpful and get people out of crises when there’s a lot of inflammation, when there’s heart disease, things like that, but for the long term, it’s not always a good idea. I think even Dr. Atkins himself started people on a pretty strict diet and then eventually put them on a more modified diet.

Dr. Weitz:                          That’s not information that you hear a lot.

Dr. Bongiorno:                   Yes. Now you hear about eating a lot of bacon and stuff but I don’t think that’s what it was really about there.

Dr. Weitz:                          Right.

Dr. Bongiorno:                   I think that’s interesting. All of these tools can be used therapeutically for the right person, but we really have to say, as a practitioner, do I want everyone not eating breakfast? Maybe some people that works, some people that’s a disaster. We really have to tailor.

Dr. Weitz:                          I’ve been in the healthcare field for 30 years. When I first got into it, the big thing was, everybody said because they skip breakfast, they don’t have time, they rush off to work. One of the big keys was you have to eat within that first hour of eating, you have to have small meals or snacks and now skipping breakfast, which was a bad thing is now supposedly the good thing. It’s funny how these things go in cycles.

Dr. Bongiorno:                   Yes, as info comes out, the pendulum keeps swinging. The truth is, it’s all can be useful and it’s all could be not appropriate. It all depends on the patient. Everyone is different. That’s really what’s in a sense, I think what’s fun about our job. We get to sit with the person. It’s really an honor to spend a lot of time with this patient, learn about their life and their history. Then, based on our knowledge, help them figure out what really works for them.

Dr. Weitz:                          Exactly.

Dr. Bongiorno:                   That’s what’s exciting to me about the job.

Dr. Weitz:                          That’s great. We have all these different complicated factors, and you just touched on a bunch of them. One of the ways to sort this out, besides taking a detailed history is to do some lab testing. What do you think are some of the most beneficial lab tests that help sort out patients with anxiety and mood disorders?

Dr. Bongiorno:                   Well with blood work I definitely like to do a good cholesterol panel. Believe it or not just to find out to make sure it’s not too low. Because cholesterol is the major molecule your body uses to make your other steroid hormones. Sometimes I worry it’s too low. I know regular doc’s worry about it’s too high. In fact, HDL levels, when they’re low, that’s actually considered a marker of depression. You want to have good lipid levels.

 



 

Dr. Weitz:                            We’ve been having a great discussion, but I’d like to take a minute to tell you about the sponsor for this episode. I’m thrilled that we are being sponsored for this episode of the Rational Wellness Podcast by Integrative Therapeutics, which is one of the few lines of professional products that I use in my office. Integrative Therapeutics is a top tier manufacturer of clinician designed, cutting edge nutritional products, with therapeutic dosages of scientifically proven ingredients, to help patients prevent chronic diseases and feel better naturally.

                                                Integrative Therapeutics is also the founding sponsor of Tap Integrated, a dynamic resource of practitioners to learn with and from leading experts and fellow clinicians. I am a subscriber and if you include the discount code Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99, instead of $149 for the year. And now, back to our discussion.

 



 

Dr. Weitz:                          What level of HDL is considered a marker for depression?

Dr. Bongiorno:                 Under 35.

Dr. Weitz:                         Okay.

Dr. Bongiorno:                  It depends on the lab tests but around there, around under 35.

Dr. Weitz:                         Interesting. It’s interesting because today you hear the latest drug, the PCSK9 inhibitors, which when combined with the statin we get your LDL below 40.

Dr. Bongiorno:                  Low low low.

Dr. Weitz:                         Exactly and there’s problems with getting your LDL level too low.

Dr. Bongiorno:                  What are we doing to the brain, right?

Dr. Weitz:                          Right.

Dr. Bongiorno:                   It’s just not a great scenario for the brain.

Dr. Weitz:                          Is there a level of LDL or total cholesterol that you like to keep the body from getting too low on? Is there a cut off?

Dr. Bongiorno:                   I like to see the total cholesterol at least around 180. I think is a good place to be in and maybe LDLs around 90.

Dr. Weitz:                          Oh, wow. Okay.

Dr. Bongiorno:                   Maybe 100. It just really depends. Because we’ve been lowering them and lowering them and lowering them. I’m not sure we’re seeing the benefit of that. But we are seeing the detriment to the brain and cognition and cognitive function. It’s… I mean, I think there’s still a lot to be learned there so I’m still open but-

Dr. Weitz:                            Probably plays a role in the rise in neurodegenerative diseases like Alzheimer’s and Parkinson’s.

Dr. Bongiorno:                   That’s what it seems to be. It’s-

Dr. Weitz:                            Okay. So besides lipids, what other…

Dr. Bongiorno:                   Good iron panel and iron storage. Of course, vitamin D. Then I like to look at thyroid, a full thyroid profile, not that thyroid is perfect in terms of lab testing, but I think it’s good to see where it is in terms of labs and then correlated with how people are feeling clinically.  Certainly look at things like red blood cell magnesium.  Carnitine is another amino acid that I like to look at. B12 certainly. Then I like to do a full hormonal panel. I like to look at the four or five point cortisol test, see how people’s stress hormones are doing throughout the day and see what their circadian rhythm looks like. Especially for women looking at the estrogen levels. But even in men seeing what the estrogen level is is important too, because that’s important for serotonin and serotonin receptors.

Progesterone in women as well is really important for the calming GABA neurotransmitter, testosterone for both men and women can be very important for the brain. Melatonin levels are useful especially when there’s sleep issues to see what’s going on there. Pretty full profile and then depending on the patient, there could be other things they might want to look at like histamine levels, mitochondrial function, mold toxicity.  Everyone’s history is a little different. Then that might give me clues. Unfortunately, there’s so many tests you can do. You can’t run them all on everybody. You need to listen to the history and then start looking down those roads first.

Dr. Weitz:                          How do you assess mitochondrial function?

Dr. Bongiorno:                   I mean, you could start with things like lactic acid, which is an easy test. Pyruvic acid, which you can do with blood work. Certainly looking at CoQ10 levels. CoQ10 levels, believe it or not, if they’re low, that can suggest mitochondrial issues or if they’re too high. Because if a patient starts taking CoQ10 but their levels are high, that usually means the mitochondria is in some sort of distress.

Dr. Weitz:                          Interesting.

Dr. Bongiorno:                  Things like that. Then now there’s more specific mitochondrial profiles and genetic profiles that look at mitochondria as well. I’m starting to learn more about those two. It’s pretty exciting stuff.

Dr. Weitz:                          Right, there’s that Mitoswab test that’s available now.

Dr. Bongiorno:                   Have you used that test?

Dr. Weitz:                          I haven’t yet but I interviewed the doctor who came up with it, Doctor Ganeshan.

Dr. Bongiorno:                   Oh it’s terrific. Things like that I think are really fascinating. For a lot of patients too, I see especially when they have a lot of sensitivity to noise and light, as well as being very fatigued, looking at mitochondrial function, I think is a really great idea.

Dr. Weitz:                          Yes good. You mentioned sleep, how important is getting good quality sleep for us?

Dr. Bongiorno:                   If anyone’s ever looked at any of my books, sleep is the first chapter. That tells you how important it is. Sleep is… If people aren’t sleeping, it’s very hard to get them to feel better.  Sleep is absolutely imperative. The two things that I look at for patients is if they’re not sleeping, and if they’re not pooping every day, that has to be worked on first.  No matter what they’re coming in for, because I find is really hard to fix anything.  If those things aren’t happening.  Sleep is really… It’s where our brain detoxes and where it de-inflames and fixes things.  That’s where our mitochondria fix themselves and rebuild. It’s critical.

Dr. Weitz:                          Do you use devices to help assess sleep?

Dr. Bongiorno:                   You mean like wrist devices..

Dr. Weitz:                          Yes.

Dr. Bongiorno:                   There are a few different ones. I haven’t found anything that has been especially useful yet. I don’t think they’re quite there yet. I mean, it’s interesting. But to tell you the truth. Usually just by getting a good story from the patient, you’d like to figure out what’s happening with the sleep.

Dr. Weitz:                          Check out the Oura Ring.

Dr. Bongiorno:                   Oura Ring?

Dr. Weitz:                          Yes.

Dr. Bongiorno:                   Okay. I’ll give that a try.

Dr. Weitz:                          Does it matter what time we go to sleep?

Dr. Bongiorno:                   I think it does. I mean, in Chinese medicine, they’ll say an hour before midnight is worth two after midnight. Our melatonin gets released somewhere between probably 8:30 and 10:30. If we go to bed too far after that, we start to lose the beneficial effects of melatonin to get into a deep sleep earlier. We end up staying in more surface sleep that lasts the whole night. Even if we’re sleeping, the sleep isn’t going to be deep. Getting to bed earlier is definitely advantageous because we’ll get into a deeper sleep.

Dr. Weitz:                           This refers to our natural circadian rhythm, right?

Dr. Bongiorno:                   Mm-hmm (affirmative).

Dr. Weitz:                           That’s why the body secretes the melatonin when light comes down.

Dr. Bongiorno:                   Yes, but our eyes recognize when it’s evening and when it’s nighttime, and that starts that whole process of melatonin. Melatonin really is a master hormone that tells our body it’s time to go to sleep. Then Once it does that, then it starts all those processes I mentioned before about detoxing, getting rid of inflammation and fixing the brain and all that.  It’s one of the reasons why these computers that we’re on and all this blue light, and TV watching and games. I had a patient I was working with yesterday, who had pretty… He was in his early 20s, had pretty significant depression the first time I’d seen him. For the last couple of years, he’s up every night just playing games till late. Of course, his sleep is completely disrupted. That seems to predate a lot of this mood.  I know it sounds simple, but that routine has got to get changed, and it’s hard because those games they raise our dopamine. They raise their norepinephrine and we get addicted to them. Between the addiction of those neuro chemicals and the excitement of the game and then that changes of our circadian rhythm, then we get into these patterns then we wonder why we don’t feel good. Very disruptive.

Dr. Weitz:                           Do you recommend blue light blocking glasses or using red light bulbs or things like that?

Dr. Bongiorno:                   Yes, absolutely. In fact, with the patient I spoke about yesterday, that’s one of the things we talked about is looking into blue light glasses. Because when people are in a certain pattern, it’s usually hard just to ask them to completely stop something. They’re not ready and frankly, they’re addicted to it. We do it in steps, right?  Something like lessening the amount of time, using blue light glasses is a good place to start.  If possible, I’d like to get people to shut all the screens and blue lights an hour before bed, and if they want to read they could read by an orange light or an orange red light. Just enough light so that they could see but not a color in the spectrum that’ll suppress our natural melatonin. Right.

Dr. Weitz:                           Let’s see, in your book you talk about therapeutic benefit of being in nature like taking a hike.

Dr. Bongiorno:                   Yes, the Japanese have a term for it, it’s called shinrin yoku. What they recognize through studies in Japan and elsewhere is that the forest and nature emits these molecules they called phytoncides. We actually breath them in, they get into our bloodstream, and they interact with our immune system and help our immune system work better and interact with our nervous system and balance our neurotransmitters.  There’s clear benefits from a research and scientific standpoint of getting into nature. We all know that it just makes us feel good. There’s no question about it, but there’s real reason for it. I know. Dr. Sinatra, I don’t know if you’ve talked to him at all. He’s a big proponent now of grounding. Taking your shoes, your socks off, going to the sea putting you’re feet in the sand.

Dr. Weitz:                           Yes, one of the doctors in my office, Dr. Howard Elkin, he worked with him on that grounding study.

Dr. Bongiorno:                   I love it. It’s great stuff. That’s getting into nature and just changing your whole electromagnetic field and getting together with the earth. Our bodies respond very positive with it.

Dr. Weitz:                           What about the role of exercise for depression and anxiety?

Dr. Bongiorno:                   Exercise alone has been proven to be as effective as any of the medications by itself. We know the medications for depression don’t work so great and for anxiety, they do work well and so does exercise. Exercise is just… It’s an interesting thing. As I’m learning more about depression, I’m learning how there’s something… You know that mTOR, mammalian target of rapamycin?

Dr. Weitz:                           Yes.

Dr. Bongiorno:                   There’s a molecule in our body that’s mTOR that shuffles between building us up and breaking us down. We need this balance of both. Exercise has really been shown to create that balance for that. It helps us clean out when we need to clean out, and then build back up when we need to build up. That has very beneficial effects on the nervous system. For anxiety and depression, exercise is just such a key, especially in the way that it burns our stress hormones.  Let’s say you’re anxious, in the wild, if we’re anxious, I feel my heart beating and I get very stressed and upset and I see a bear behind me. That would be the reason why I’d feel that way and I’d run. I burn off those stress hormones, burn off that norepinephrine. Get away from it, and then feel calm.

Well, in today’s society, we have those feelings, and we get very stressed and anxious, but we’re not burning it off. We’re not doing anything to release it. So It does build up in our body, and then it comes out as panic attacks, and anxiety attacks. In most cases, in my opinion, depression is really just anxiety and overwhelm that gets to the point where a body can’t take it anymore.  We start to almost decompensate for all that overwhelm and then we get depressed. Anxiety and depression are almost two sides of the same coin in most cases. Exercise is just a brilliant way to help remedy that.

Dr. Weitz:                            I think exercise is overlooked as a solution for so many problems. Everybody’s into fasting these days. One of the benefits is something called autophagy, which is where you break down yourselves to rebuild yourself. Exercise is the original stimulator of autophagy. You don’t necessarily have to starve yourself.

Dr. Bongiorno:                   The only thing I would say for my patients is if you’re not getting enough sleep, don’t trade sleep or exercise. Make sure you’re sleeping first, and then get up and go exercise.

Dr. Weitz:                            Right, what type of exercise? Do you think it matters?

Dr. Bongiorno:                   From the studies I read, all exercise is good. Certainly up to what a person can do. I generally recommend doing something you enjoy, because if you do something you enjoy, you’ll continue to do it. What seems to be the most beneficial is actually having a mix where people are doing strength training, and are doing cardiovascular. In the mitochondrial studies I’ve seen, to build optimal mitochondrial function doing both seems to be optimal.  We were talking about testing. I wanted to ask you, what do you think about the urinary neurotransmitter test to get a sense of what’s happening with neurotransmitters?

Dr. Weitz:                            Yes absolutely. I think tests all have their value and have their limits, but I do think looking at neurotransmitter testing through urine can be very helpful.

Dr. Bongiorno:                   Okay. Then what about the role of the gut and the microbiome in mood disorders? What we’re learning now and every day I see new papers on the microbiome and the microbiota. There’s little bacteria in our digestive tract we’re finding, plays such an important role in keeping the environment of our digestion proper. That environment is really key to how sending signals to our brain that helps our brain create the right neurotransmitter balance. Also that environment in our gut also plays a really strong role in how inflammation happens in our body or doesn’t happen.

As we were saying before, the foods we eat are certainly the first key towards that. But then, there’s other things that we can do as well. There’s specific foods that help raise the microbiome in different ways. Then there’s certain fibers specifically that can help that process. I think there’s so much that we still have to learn about it. But the way I think about it is the microbiota in there, is like this garden.  When you have a garden that has certain plants that are too many and other plants that aren’t enough then it creates a lot of imbalance and it’s not a very productive garden. But when you have a very balanced garden, with all different plants and species, that’s usually when you get the most productive use out of it.

Dr. Weitz:                            There are supplements on the market like probiotics that claim to specifically improve mood. What do you think? You think it’s early for those?

Dr. Bongiorno:                   I think a lot more studies have to be done. I think the most compelling studies… There’s some small clinical studies that are showing things like lactobacillus and bifidus can increase GABA levels in the brain. Even though those studies aren’t large, there’s a number of them now that are pointing in the same direction. I think using basic keystones like that seem to make sense.  Now there’s some other studies coming out with a few other strains, which I think still need to be replicated I’m very interested in. It certainly does make sense. One thing we do know though is that the strains… A lot of the streams of interest, we’re not actually capable making into a supplement, at least at this point. My general idea, my general tact is to give patients the probiotics that we know can be helpful, that are basic Keystone strings, and then make sure we’re filling in with all the proper fibers and vegetable matter and fermented foods that can help add all those other and help our body make all those other strains that we probably can’t supplement on our own.

Dr. Weitz:                            Outside of probiotics, let’s go over some of the most beneficial nutritional supplements for mood disorders.

Dr. Bongiorno:                   Okay, well, I mean certainly the basics, having a patient take a multiple vitamin, a good B complex with a [inaudible 00:37:26] is a great idea. Then certainly a fish oil as well as the probiotic. Those to me are the basics probably for most patients to at least get started.

Dr. Weitz:                            Fish oil has quite a bit of studies showing benefits for brain health as well as for mood disorders.

Dr. Bongiorno:                   Yes, in fact, the newest studies right now coming out of the psychiatric journals are showing that in patients who are treatment resistant, meaning that they’re on a drug, but the drug isn’t working, when you give them fish oil, then the drug seems to start working. Which makes me think, well, maybe if you just gave them the fish oil and without the drug, you probably get them feeling better too.

Dr. Weitz:                            Right.

Dr. Bongiorno:                   So I’m not sure… Anyway.

Dr. Weitz:                          What about the best… What’s the most effective dosage for fish oil and also, do you think it matters? As far as, I keep seeing studies showing well, EPA is really better. No, DHA is better.

Dr. Bongiorno:                   No.

Dr. Weitz:                          Do you think we know if it’s better to have just a balanced EPA, DHA or if it’s better to have more of a concentrated EPA or DHA?

Dr. Bongiorno:                   It’s a good question. I think the studies are fairly clear that EPA levels of around 1000 to 2000 milligrams are a good idea with the associated DHA that would normally come with that in a regular fish oil. Maybe like a 1000 milligrams of EPA, around 300 milligrams a DHA. I usually shoot for that ratio, and then depending on the patient, starting with either 1000 milligrams or 2000 milligrams of the EPA.  It seems pretty clear to me that for anxiety and depression, looking at those levels of EPA seem to be the best. I know in children, sometimes giving higher levels of DHA can be useful for certain cognitive reasons and attention deficit. For those specific sometimes I think, a higher DHA might have some benefit. But I think in general for anxiety and depression looking for those higher EPA levels, which frankly, are what comes naturally in fish oil seems to be the way to go.

Dr. Weitz:                          Can you get those levels of EPA DHA from vegetarian sources?

Dr. Bongiorno:                   I find it pretty difficult to do so. It’s not that easy. My strong preference when possible is to use fish oil. If I have a patient for ethical reasons or other religious reasons, or for allergies, they can’t take fish oil, then we’ll use other vegan oils and try to make up the difference. I’ll give patients things like ahi oil which has a reasonable amount of EPA for a vegetarian source.

Dr. Weitz:                          What’s it called?

Dr. Bongiorno:                   Ahi flower.

Dr. Weitz:                          Never heard of that one.

Dr. Bongiorno:                   A-H-I flower oil.

Dr. Weitz:                          Okay.

Dr. Bongiorno:                   There are few vegan vegetarian version that are out there that are a little higher. A lot of people are cognizant that they need to get those essential fats. Unfortunately, and I discussed this in my books, a lot of patients who have mood disorder, they’re not very good at converting the vegan oils into the EPA. So because they have the delta desaturate enzyme, genetically maybe isn’t working as well.  For those patients, unfortunately, it’s really important to try to get the EPA indirectly as possible.

Dr. Weitz:                            You mentioned B vitamins, you monitor some of those genes like the MTHFR and the COMT, and so many others?

Dr. Bongiorno:                   I do. For a lot of patients, I do run the genetic snips to take a look at that. Again, I think a lot of that is in its infancy, I think to look at one gene snip and say, okay, you need this vitamin [inaudible 00:41:36] another, I think it’s very premature because there’s so many gene interactions that we don’t understand. But I think it’s helpful. In other words, if you see a patient who has a snip of the COMT, and a snip of the DRD and a snip of the Chip the fan hydroxylase enzyme. You see they’re testing… all their neurotransmitter there low. They’re depressed. It starts to add up. [inaudible 00:42:04] the gene cell that they’re probably not keeping them up and certainly their testing shows it’s low and clinically they’re low. Then we know we have to work on that. I like using it to just basically inform.

Dr. Weitz:                            Quite a clinical picture, but don’t place too much importance on just any one particular gene.

Dr. Bongiorno:                   Yes, absolutely. I mean, what I’ve learned in this job is not to be religious about anything I’ve learned. Because as soon as I get a little religious and they go, this is what people need. Then it turns out not to be correct. I find you have to always be flexible and look at the patient first and then look at all this testing as part of information to help make the best choices.

Dr. Weitz:                            What about-

Dr. Bongiorno:                   Another thing about genetics, I think in the future, it’s going to be more and more useful.

Dr. Weitz:                            Yes, I totally agree. What about other fatty acids like GLA?

Dr. Bongiorno:                   GLA actually has been shown to be very useful in alcoholism, to help patients… A lot of people who are alcoholics, one of the reasons why they drink alcohol is because it artificially raises prostaglandins, these feel good molecules as well in our body and in our brain. What’s been shown is that when we take things like GLA and certain oils in that realm, that we can actually help ourselves make those natural prostaglandins. I’ve seen patients with alcoholic tendencies and things like that do really well with those oils.  They’re also very good for hormonal balancing like a primrose oil. When you see women who have mood issues, and they also have menstrual cycle disorders and things like that, I like using those. So yes, they’re definitely helpful.

Dr. Weitz:                            What about vitamin D?

Dr. Bongiorno:                   Vitamin D, it’s the sunshine vitamin. It’s the sunshine… I remember Alan Gabby. You know, Alan Gabby?

Dr. Weitz:                            Yes.

Dr. Bongiorno:                   He used to give us… He used to tell us that John Denver said sunshine on my shoulder made him happy. That was the best study on vitamin D there was. I mean, vitamin D it’s a neuro steroids. It’s important for so many factors in our brain, and in our body. I think, by itself, it doesn’t cure depression if it’s low, and you bring it up or anxiety, but I think it is a major factor that needs to be looked at. I remember when I was in school, 23 years ago, naturopathic school, they talked a lot about vitamin D. When I got out to New York, nobody was running vitamin D 16, 17 years ago. Then I was just so amazed after all the things I’d learned about how wonderful it is. Now it’s nice to see that people are running it. That it’s a common thing to look at now even in conventional medicine.

Dr. Weitz:                            Right, absolutely. What about some of the most important minerals like zinc and magnesium?

Dr. Bongiorno:                   Magnesium is I think a must for most people with anxiety. It plays a role in helping relax the muscles, and it plays a role in helping the brain form GABA. There’s just so many effects all over the body with magnesium. I typically use magnesium glycinate which is very calming form. Sometimes I’ll use magnesium threonate which does seem to have an even more calming effect. I know when I take it’s very relaxing, the magnesium threonate. I’ll use that with some patients, especially if they’re really anxious.

Dr. Weitz:                            What dosage of magnesium do you like?

Dr. Bongiorno:                   Depending on the patient, I’ll usually start with 250 milligrams maybe in the evening before bed. Especially if there’s sleeping issues. I am careful though sometimes magnesium can cause loose stools. Different forms of magnesium might be better for that than others. But other than that, magnesium is usually a really nice choice for patients for both anxiety and depression. It’s good for blood sugar balance. Lot of benefits.

Dr. Weitz:                            Yes, I think the glycinate has less bowel issues.

Dr. Bongiorno:                   Yes, absolutely. What was the other [inaudible 00:46:24]?

Dr. Weitz:                            What about so many other minerals?

Dr. Bongiorno:                   Zinc is such an important co-factor in so many places. Zinc is really important to the digestive system as well. I do like to look at that zinc to copper ratio. I do find with most patients with mood issues, you’ll see a very low zinc to copper. Sometimes you’ll even see patients with high copper and high copper can be a problem in terms of estrogen balance and that can throw off serotonin as well.  Zinc itself is a co-factor for making the neurotransmitters too. For all those reasons I like To check Zinc when it’s low or low normal, I typically will supplement with Zinc. I don’t supplement too high. Usually just 15 to 30 milligrams [crosstalk 00:47:10].

Dr. Weitz:                            What is the zinc to copper ratio you like to see?

Dr. Bongiorno:                   At least one to one and preferably I think a little bit higher.

Dr. Weitz:                            What if the copper is too high? Do you ever use things like molybdenum or other things to lower the copper?

Dr. Bongiorno:                   Usually I’ll start with zinc. Then if that doesn’t work, then bring in things like molybdenum or just a good minerals formula, obviously, copper.

Dr. Weitz:                            What about lithium orotate?

Dr. Bongiorno:                   Lithium is one of my favorites for anxiety. It seems to be quite safe and it’s not… Just for everyone listening, when we talk about lithium, we’re talking about lithium orotate which is a mineral, which is used in very low doses. Maybe 15… I’m sorry. Five to 20 milligrams in adults.

Dr. Weitz:                            And you’re saying which is different than the prescription lithium?

Dr. Bongiorno:                   Right. Prescription lithium is lithium carbonate, which is a much higher dose of lithium, maybe 900,000 milligrams plus carbonate which is a separate drug on town. Lithium orotate it’s been used for a long time. It’s quite safe, it’s even safe in children. What they saw many years ago in the early part of the 19th century is that places that had high levels of lithium in the water-

Dr. Weitz:                            There’s a crackling coming from your microphone somehow.

Dr. Bongiorno:                   Oh really? Okay. Is that any better now?

Dr. Weitz:                            I think it’s better if you hold it.

Dr. Bongiorno:                   I might have been moving it around there. Thank you. What they noticed is that areas in the United States and even around the world that had higher levels of lithium typically had… Still doing it?

Dr. Weitz:                            Yes.

Dr. Bongiorno:                   Let me see if I can adjust it. I don’t hear it from here.

Dr. Weitz:                            Okay. We’ll keep going.

Dr. Bongiorno:                   Any better?

Dr. Weitz:                            Yes right now I don’t hear it.

Dr. Bongiorno:                   Okay. I’ll stay still. Lithium was… In places where lithium levels-

Dr. Weitz:                            Need some lithium pill.

Dr. Bongiorno:                   Yes, I do. That’s why I play the drums. It helps me get some of that.

Dr. Weitz:                            Okay.

Dr. Bongiorno:                   So yes, lithium is just one of those things that in higher levels seem to lower… There’s less rates of suicide. People are generally happier, less anxiety, less depression, in fact, Seven Up the beverage was originally lithiated water.

Dr. Weitz:                            Really?

Dr. Bongiorno:                   Yes. Then when I think they decided to take the cocaine out of Coca Cola, lithium they said, okay, we’re not putting anything in these beverages anymore. We don’t know what this stuff is. They took it out but actually lithiated water was around for a long time as something to just help people generally feel happier.

Dr. Weitz:                            Wow. Interesting.

Dr. Bongiorno:                   Sometimes for the young children, I’ll have parents soak thyme, the herb thyme which has high level of lithium in it. You can soak it in olive oil for a month or so and then you could spoon out, maybe a teaspoon and put it on food once a day and you’ll get a couple of micrograms of lithium out of it.

Dr. Weitz:                            Really? Interesting.

Dr. Bongiorno:                   Is there any downside to using lithium orotate? I mean, in those levels, it doesn’t seem to be. I know early on I always was interested in checking kidney function and thyroid because we know the drug can cause problems with those but lithium orotate those levels. I haven’t seen anything. The literature that suggests a problem and I certainly haven’t seen it in patients.

Dr. Weitz:                            Cool. What about use of amino acids as precursors for neurotransmitters.

Dr. Bongiorno:                   Amino acids, to me thinking about using amino acids is similar to thinking about using drugs, right? Because we use drugs to stop the breakdown of a lot of those neurotransmitters. We want to use amino acids to more naturally bring up the levels of the neurotransmitters which makes sense if you give the body the precursor, it will help to make its own.  I think that makes sense to me. I think it’s safer and more gentle on the body than drugs. Certainly not as strong as drugs are but I think if you’re using it in combination with all the therapies we just talked about, it can be very supportive. I find tryptophan is… I have a patient who did well on an SSTRI, but for some reasons, they don’t want to stay on it or they’re having side effects. Transitioning to tryptophan can be really helpful.  Instead of just taking everything away from them and removing the drug, you can bring in the tryptophan and slowly lower the drug and raise the tryptophan. If we get all the basics right, the sleep, the diet, the exercise, it’ll work.

Dr. Weitz:                            And use tryptophan or 5-HTP.

Dr. Bongiorno:                   It depends. Theoretically 5-HTP should be better because it’s closer already and the pathway to serotonin. But I do find a lot of patients seem for whatever reason to do well with tryptophan. I tend to use maybe equal amounts. At night if people have sleeping issues, I tend towards more of the tryptophan. I can’t explain why that’s better.  I know, there’s some studies that suggest that there’s a lot of inflammation in the body, you might be better off using 5-HTP. Because the certain pathways, one pathway that’s called the [inaudible 00:52:45] pathway suggests that if you use tryptophan it could actually create more inflammation. But I have to say clinically, I find tryptophan generally seems to work better. I’m open to either.

Dr. Weitz:                            Interesting. What about some of the other neuro transmitters. Any of them you find particularly helpful? Any other amino acids?

Dr. Bongiorno:                   Yes, I like using tyrosine sometimes. I created a formula that uses tyrosine in combination with mucuna. I find that can be really useful… Let’s say you have a patient who did really well in wellbutrin, then dopamine’s low. Their genetic show they’re probably low. The neurotransmitter test show they are low, using things like tyrosine and mucuna can be very helpful for that purpose.

Dr. Weitz:                            What about GABA?

Dr. Bongiorno:                   GABA, I find for some people it works well, for other people it doesn’t. Theoretically, I’ve read if you have a leaky gut, then GABA can work well because it gets to the brain. You need both the leaky gut and a leaky brain barrier. Both of those it works.

Dr. Weitz:                            That’s what Dr. Kharrazian says. Right?

Dr. Bongiorno:                   Yes, but GABA I think can be very helpful. A lot of times they’ll use GABA and lithium orotate together, or sometimes I’ll even use GABA with [inaudible 00:54:04] seem to work really well together.

Dr. Weitz:                            What about some of the herbs like St. John’s-wort?

Dr. Bongiorno:                   St. John’s wort is the most studied herb of all time, and it’s very solid evident. It’s interesting. I just read an article in the Washington post which I wrote a letter to the editor about. Basically it was this woman who’s a nutritionist who is basically saying how supplements don’t work. One of the experts that she quoted was saying how St. John’s-wort really has no studies suggesting it works.

I read that and I was just amazed. I’m like well, apparently that person isn’t looking at PubMed at all. There are scores of analysis and scores of meta analysis. Then there’s a bunch of a meta analysis of the meta analysis all Showing that St. John’s-wort head to head to the SSRI’s most commonly used antidepressants work just as well in mild to moderate depression with much less side effects.

It’s amazing to me that a major paper like that could have this kind of information, it just shows you the bias that these people have going in. Again, if you want to challenge me on that, you could say, well, you just told me the drugs themselves don’t work much better than placebo. That’s true. What I’m saying is, St. John’s-wort, I think, has an effective rate at least as well as the drugs, but it doesn’t mean it’s the whole story.

That’s why I don’t want people to get the idea of oh, I don’t feel I have anxiety, I have depression. I’m just going to take St. John’s-wort and go along my way. No, we still need to work on sleep and exercise and our thoughts and going to therapy and the right foods. Then with St. John’s-wort, I think it’s a slam dunk. It works great.

Dr. Weitz:                            Right, and you’re really bringing up the importance of employing the entire functional medicine model and not thinking you can reduce it to just simply taking a particular supplement. If all you do is take a particular supplement like St. John’s-wort instead of taking an antidepressant, you just practicing an inaugural form of the same type of limited medicine.

Dr. Bongiorno:                   Right, exactly. That’s exactly right. It might work and that’s great, but I still encourage everyone listening to still dive into all of those basics and make sure those are right because that’s why things probably got out to begin with.

Dr. Weitz:                            Right, great. I think we’re done here. Any final thoughts-

Dr. Bongiorno:                   No, I mean-

Dr. Weitz:                            … listeners and then how can those listening contact you, find out about your books, your programs and how to consult with you?

Dr. Bongiorno:                   Okay. Well, first of all, I want to thank you for doing the work that you’re doing and getting out all this great information to people. For anyone listening, anxiety and depression, it’s not easy. I think these are the toughest conditions because when you’ve had it, and you’ve gone through it, it feels very insurmountable sometimes. For those people, I want to say a couple things. One is, if you’re taking drugs, don’t just stop taking them. Because that’s never a good idea. That can be dangerous.  You always want to continue, but I want to let you know that there are practitioners, there’s naturopathic doctors, functional medicine doctors, and they have answers that I think are more holistic and can really help. So that it is really worth pursuing this thinking. I do see daily how it can help people. Don’t give up and please do keep working on this because it’s absolutely worth it and you’re absolutely worth it. As far as contact information. My clinic website is www.innersourcehealth.com. That’s I-N-N-E-R S-O-U-R-C-E health.com. Our phone number is 631-421-1848. It’s really been such a pleasure to be here. Thank you so much.

Dr. Weitz:                          You’re welcome. Thank you, Dr. Bongiorno.

Dr. Bongiorno:                   Okay. Have a great day.

 

 

 

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