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Integrative Approach to Anxiety & Depression with Dr. Peter Bongiorno: Rational Wellness Podcast 235

Dr. Peter Bongiorno speaks about an Integrative Approach to Anxiety and Depression with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on November 18, 2021.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 

 

Podcast Highlights

9:45  Let’s start with what’s going on right now in the world and how the current global pandemic has impacted mental health in the US.  Because of COVID we are seeing incredible increases in both anxiety and depression up to 8 fold.  Drug use has also quadrupled, as have suicide rates.

13:42  The neurotransmitter theory of depression and anxiety.  This is the theory that low serotonin or low dopamine or low norepinephrine is why someone is depressed or anxious or is suffering with other mood disorders and that prescribing medications that increase the levels of one of these neurotransmitters, such as SSRIs like Lexapro or Zoloft or Prozac.  In the case of anxiety, these drugs work maybe 60 or 70% of the time but for the treatment of depression they work maybe 30% of the time, which is only slightly better than placebo.  And such drugs are addictive, tend not to work over time, and they have various side effects, such as sedative effects, gastrointestinal effects, and sexual dysfunction. Why wouldn’t you try a natural approach? 

16:03  And even if it really is a neurotransmitter issue, why are these neurotransmitters low or out of balance?  What stressors does that person have that might be playing a role in their mood?  What is their environment? What are their toxicity levels?  What is the inflammation in their body? How is their gut working?  Are they getting enough sleep?  What’s their hormonal balance?  What foods are they eating? What is their mitochondrial function, and is that a part of why maybe their brain and their mood is suffering? What are their genetic makeup, and is there anything we can learn from that that can help us get a better idea of how we can support their body and the pathways in their body? Are they exercising?  So even if the neurotransmitter theory has some relevance, we still should ask, what is the underlying cause of the neurotransmitters being off?”  And there are clearly a percentage of patients where neurotransmitters are not a major factor and, other than counseling, conventional psychiatry has no other tools to help these patients.  That’s where Functional Medicine can really shine.

23:19  Dietary Factors.  The first dietary factor is blood sugar dysregulation, which can play a role in triggering depression and anxiety.  If patients are insulin resistant, their pancreas will tend to make a lot of insulin and they’ll have wild fluctuations of their blood sugar. This can play a direct role in triggering anxiety and depression and it can also trigger other hormones, such to trigger changing levels of cortisol, which can also stress their bodies and cause anxiety and depression.  Such patients should be eating a good amount of protein, healthy fats and some complex carbs regularly throughout the day.  Such patients may not do well on intermittent fasting. And the Standard American Diet is very pro-inflammatory and that is going to change what is going on in the brain and in the hypothalamic/pituitary/adrenal axis.  What we eat will greatly affect how our brain communicates with the nervous system, the hormonal system and the immune system.  While each individual’s diet should be different, in general, a Mediterranean diet tends to reduce inflammation and this will help with anxiety and depression, as Dr. Sanchez-Villegas showed in the early 2000s. (Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A, et al. Association of the Mediterranean Dietary Pattern With the Incidence of DepressionThe Seguimiento Universidad de Navarra/University of Navarra Follow-up (SUN) CohortArch Gen Psychiatry. 2009;66(10):1090–1098. doi:10.1001/archgenpsychiatry.2009.) Here is another paper that reviews this topic in detail published in 2020:  Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review.

26:11  Vegans.  Vegans can manage their blood sugar by including beans and nuts and seeds, which contain protein. They can do smoothies with vegan protein powder. And some people do not need as much protein.  When it comes to histamines, some people with high histamines will have more anxiety, so they will do better with a lower protein diet.  Dr. Bongiorno finds that 10-15% of the time histamine is a problem with his patients.  He will include serum histamine in his lab work.  Sometimes patients will mention that they take Benadryl at night and this indicates this person may have high histamine.

28:48  The microbiome and gut health are very important for our moods.  The microbiome plays a strong role in the production of neurotransmitters both in the gut and immune signals that go to the brain to make neurotransmitters.  When there is a lot of inflammation in the gut that modulates neurotransmitter levels, the microbiome can help to modulate that inflammation.  A researcher in the thirties or forties published some studies on how clams can keep their muscles working so continuously to keep their shell closed and they discovered a chemical that they called enteramine, with entero standing for the gut. They learned that enteramine is what helped change motility in the gut and this was later renamed serotonin and then they found that it also happens to be in the brain and plays a role in our mood.

Some say that since the neurotransmitters produced in the gut don’t make their way into the brain, that gut neurotransmitter production has no effect on mood.  But research indicates that the enteric nervous system (the part of the nervous system that surrounds the gut) sends out a lot of signals through vagal nerve stimulation that affect neurotransmitter production in the brain.

32:53  Iron. When Dr. Bongiorno was a student he recalls a patient with depression and the clinician ran an iron panel and found out that both the serum iron and the ferritin were very low. He gave her some iron and within a month she was off her antidepressants after being on them for many years.  Iron is the center of the  hemoglobin molecule that allows you to carry oxygen in your blood. If you don’t have as much iron getting to your cells, your brain will shut you down so you don’t use as much oxygen, which leads to higher rates of depression and anxiety.

34:27  It is very difficult to get off of antidepressants, esp. if you have been on them for some time.  One reason is because if you have been taking antidepressants for a period of time, the receptors become down regulated. The other issue is that you deplete the precursor molecules that you need to make neurotransmitters.  This is also why these drugs tend to have poop out syndrome, which means that they work for while and then they stop working.  It is important to fix the underlying reason why they stop working whether it be low iron or low vitamin D or low B6 or not enough sleep, etc. it is much harder for people to get off these drugs.  You would never want to just take a patient with depression off their medication, because they will likely feel much worse. It is best to work on these underlying issues and get them feeling the best they can on medication before even considering having them slowly wean off their medication, but only with the prescribing physician participating.  Make sure that you work on the underlying issues first. Make sure they are getting good, quality and quantity of sleep. Make sure they are exercising, managing their stress, going to therapy, doing some relaxation work, and eating a healthy diet.  Dr. Bongiorno likes to do a fair amount of testing, including looking at iron levels, red blood cells, B12, vitamin D, B6, inflammatory markers, histamine, hormones, melatonin, glutathione, etc. We may want to do an elimination diet or do food sensitivity testing. We will want to do a good stool test and other gut testing. Dr. Bongiorno has been using the GI Map stool test lately, though he also likes the stool tests offered by Genova Diagnostics and Vibrant America labs.  We want to get the gut as healthy and balanced as possible.  We may want to put patients on amino acids to support some of the neurotransmitters. We may want to put people on blood sugar supportive nutrients to help stabilize blood sugar or whatever the underlying issues are. 

38:39  When it comes to trying to wean off medications, you might not want to do it in the winter, when the days are shorter and darker and serotonin levels are at their lowest.  This is why it can be helpful to use a light box in the winter.  As animals, we’re designed to hibernate and sleep longer in the winter.  It might be better to wean off medications in the spring when the light is longer and the light gets brighter, which stimulates serotonin levels.  This should only be done with your doctor.

40:42  Circadian Rhythm.  Dr. Bongiorno will use either salivary or urine tests to look at cortisol levels throughout the day.  Depressed patients may have very high or very low cortisol levels.  You may have some patients who can’t get out of bed in the morning but are wired at night and can’t sleep. Circadian rhythm is very important to mood disorders and getting people in balance with nature and with the day is a great idea.  You should avoid having a lot of bright lights at night when you should be winding down to go to bed.  You should also avoid eating late, since this also stimulates cortisol.  Most people need 7 1/2 to 8 hours of sleep per night. People who get a lot less or a lot more tend to have more anxiety and depression. 

45:18  Coffee.  People who suffer with anxiety will tend to do better with less coffee. Coffee will usually make them more anxious.  On the other hand, people who drink 2 to 4 cups of coffee a day will have lower depression rates while 7 to 8 cups will increase rates of depression and anxiety.  But it is better to build up their adrenal glands so they have natural energy, rather than overstimulating them with coffee.

51:15  Lab Testing.  While recommended lab testing is different for each patient, some of Dr. Bongiorno’s favorite labs include Hemoglobin A1C, fasting glucose, insulin, RBCs, WBCs, a liver panel incl. GGT, iron panel incl. ferritin,  full thyroid panel, inflammatory markers, including erythrocyte sedimentation rate, C-reactive protein, and Interleukin-6.  Fecal calprotectin on a stool test.  Celiac panel. Amylase and lipase. Vitamin D, zinc, zinc to copper ratio, RBC magnesium, B12, methylmalonic acid, which is marker for B12, and an advanced lipid profile.  Estrogen, testosterone, progesterone, pregnenolone.  While high cholesterol can cause problems, lowering cholesterol too much can be harmful since the body may be unable to make these important hormones that are crucial for the brain and for good mental health.

55:11  Hormones.  Hormones are critical for mental health.  Estrogen plays an important role in the levels of serotonin in the brain and whether serotonin is being made in the areas of the brain that need it.  Higher estrogen levels change the amount of monoamine oxidase to keep serotonin levels high. Progesterone does the opposite.  This is another example of the nice yin and yang balance between estrogen and progesterone.   Men also should have a certain level of estrogen and they have six times the level of estrogen in the brain that women have. Progesterone supplementation for men has not been shown to be helpful.  If Dr. Bongiorno is working with a postmenopausal woman, he will typically work on the basics like sleep, exercise, diet, stress reduction, because those things oftentimes will help. Secondly, we want to support the liver because the liver is what processes the estrogens. And oftentimes when the liver and the microbiome are out of balance, we’re going to see improper levels of estrogen. For example, if there’s beta-glucuronidase levels are out of balance, that’s going to change estrogens and there’s going to be a lot more recirculation of excess estrogens.  If there’s a lot of candida, candida acts as false estrogens, so that’s going to change the balance of estrogens.  So we want to fix all of those things.  So without even touching hormones, we can oftentimes fix the hormones.  After all that, if we want to tweak the hormones it is better to start with a touch of pregnenolone or DHEA, which can feed the rest of the pathways.  If progesterone levels are low in relation with estrogen, then the herb, vitex, (aka Vitex agnus-castus, aka, chasteberry,) does a great jobat a dosabe of 220 mg once or twice per day.  There are studies in premenstrual dysphoric disorder showing it works really well. There’s other studies in perimenopausal depression showing that it worked just as well as SSRIs.  Also, rather than using an SSRI drug if needed after lifestyle hasn’t gotten to where you want to get, it is better to see if tryptophan (500 mg twice per day) or 5-HTP (50-100 mg a day) might be a better way to stimulate serotonin production.

1:02:27  A diet that is too low in carbs can also cause problems with anxiety and depression by lowering serotonin levels.  Also, while gluten can be problematic, since patients with mood disorders are often sensitive to gluten, but if you place them on a gluten free diet too quickly, their symptoms may actually worsen, so they should be weaned off gluten slowly rather than all at once. 

1:04:32  Supplements.  Here are some of the most effective nutritional supplements for anxiety and depression:

1. Essential Fatty Acids.  Fish oil is very powerful and alone can sometimes cure depression or anxiety if people are deficient in them.    

2. SPMs.

3. GLA.  While omega 3s are so important, omega 6s are also beneficial and this is an omega 6 fatty acid that helps the body to make its own prostaglandins and this can help with mood. Patients who use alcohol to feel happier, GLA can often help.  

4. Probiotics.  Probiotics can help to improve gut health and to create a healthier microbiome, along with fiber and fermented foods.  There are studies showing that if you take a fecal microbial transplant from an animal who’s not depressed and give it to an animal that’s depressed and you can lift their mood and depression.  

5. B vitamins.  B vitamins are important for mitochondrial function for producing energy in the body, for methylation, and to break down our neurotransmitters and hormones properly.  Some B vitamins like folic acid may be able to help patients with schizophrenia.

6. Vitamin D.  If vitamin D is a neuro steroid and if it is low, it will be harder for the body to make serotonin and other neurotransmitters. If vitamin D is higher, there will be lower levels of anxiety.  

7.  Magnesium.  Magnesium is very relaxing and important for mental health, including for GABA levels in the brain and it helps with benzodiazopine receptors.  

8. Zinc.  Zinc is a cofactor for so many different reactions in the body as well as for gut health. The zinc to copper ratio is very important.  

9. Nutritional Lithium.  Dr. Bongiorno just wrote a paper about Nutritional Lithium in Natural Medicine Journal. CLINICAL APPLICATIONS OF LOW-DOSE LITHIUM, MENTAL HEALTH, COGNITION, AND MORE.   Nutritional Lithium (Lithium orotate) is great for teens with impulsivity, including for kids age 5 to 10 with anxiety in drop doses. It is very supportive to the brain. Research shows it may be protective for Alzheimer’s disease.  You can start with 5 mg for adults and 1 mg for children and for adults you can go up to 20 mg per day.

10. GABA.  Some say that GABA can only help if you have a leaky gut and leaky brain, because it is very difficult to get it into the brain.  But rather than trying to figure out if you have leaky brain, it is best to just dose it higher, such as 500-1000 mg 2-3 times per day.  You can also give GABA along with theanine and either lithium orotate or CBD oil.  Liposomal GABA seems to work well, but so do chewables.  

11. St. John’s Wort.  St. John’s Wort is very good for mood, esp. for depression.  It has gotten a bad name in recent years, since it affects the cytochrome P450 Liver detoxification pathways involved in the detoxification of certain medications and making them less effective, including Antidepressants, Birth control pills, Cyclosporine, certain heart medications, incl. Digoxin, some HIV drugs, some cancer medications, incl. Irinotecan and Imatinib, Warfarin, and some statins.  While it can decrease the effectiveness of some antidepressants, it can amplify the effects of SSRIs and MAOs and can lead to a dangerous elevation of serotonin called serotonin syndrome that can produce elevated blood pressure, fever, agitation, rapid heart rate, perspiration, diarrhea, and muscle spasms.  Patients who take St. John’s wort while on birth control may find that they are more likely to get pregnant.  But it is also a very good antiviral. It’s an anti-inflammatory and is great for mood.

12. Rhodiola.

13. Lavender. 

14. Saffron.

15. Berberine.  Berberine is an incredible herb that is beneficial for cholesterol, blood sugar, gut health, and it also helps with neurotransmitter production in the brain. Here is a good paper on this: Pharmacological effects of berberine on mood disorders.

16. NAC.

17. Neurologix. This is a product by Integrative that includes saffron, spearmint and a branded citicoline that helps with memory, focus and mood.

 

This is a powerful closing statement from Dr. Bongiorno:

“Yeah. I mean, to the clinicians out there, when you have a patient who, especially if it’s a challenging patient, always double down on the basics. Make sure that those are all taken care of. And just really look for the other underlying factors that maybe you haven’t looked into yet because there’s some reason why a person is feeling the way they’re feeling. And it’s really up to us as clinicians to kind of look at all those factors and really put it together because there’s practically always a way to help to get people to feel better. If not get them off medications, at least get the medication doses lowered which often could be a win, especially in things like bipolar. You’re creating so much less toxicity in the body.  And to any listeners there in the public who are suffering from anxiety, depression, mental health, just know that there’s still a lot of tools out there, and find a practitioner who just really cares and is listening and wants to look into those underlying factors because there’s always something else that can be done. And just don’t give up hope, and don’t give up thinking that you can feel better and feel like your best self.”

 



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 and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.



 

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, and to learn more, check out my website drweitz.com. Thanks for joining me, and let’s jump into the podcast.

Thank you for joining our functional medicine discussion group meeting tonight with Dr. Peter Bongiorno on an integrative approach to depression and anxiety, and I hope you’ll consider joining some of our upcoming meetings.  December we are not going to have a meeting, but January 27th, Dr. Aristo Vojdani will be joining us on why we should test the immune system, and I’ve yet to fill out the rest of the schedule for next year, so I’ve got to get going on that.  I encourage everybody to participate in the discussion by typing your question into the chat box, and then I’ll either call on you or simply ask Dr. Bongiorno your question when it’s appropriate.

If you are not aware, we have a closed Facebook page, the Functional Medicine Discussion Group of Santa Monica, that you should join so that we can continue the conversation when this evening is over.  I’m recording this event, and I’ll post it on my YouTube page, and I’ll include it in my weekly Rational Wellness podcast.  If you haven’t listened, please check out the Rational Wellness podcast and subscribe on Apple Podcasts, and if you enjoy it, please go to Apple Podcasts and give me a ratings and review.  I want to thank our sponsor for this evening, Integrative Therapeutics, which is one of the few brands of professional supplements that we use in my office, and so I’d like to welcome Steve Snyder from Integrative Therapeutics to talk to us a little bit about a few products. Steve.

 


 

Steve Snyder:                    Hi, everyone. Thanks, Dr. Weitz. I’m so excited because finally the topic is something we actually have something that’s pretty unique. Not the only time it’s ever happened, but this is really good. So the Zoom is telling me that you’ve disabled the sharing thing.

Dr. Weitz:                            Oh. Oh. Here. No. Let’s see. Here you go. Okay. You should be able to share now.

Steve Snyder:                    Okay. So just real quick, we actually have a product called Lavela that’s an oral lavender essential oil, and it’s got some really pretty impressive research in anxiety.  What’s unique about this is it was developed by our parent company in Germany, and if you know anything about supplements in Europe, you have to do some pretty significant clinical research to actually sell something over there, and this happens to be a lavender that we grow ourselves.  You can see from the name here, WS 1265. The WS is for Wilbur [Schuaba 00:03:09], and he happens to be one of our owners and also a pretty smart guy.  So he developed this… Lavela is what we call it in The States. Silexan is the trademark name, and it’s got some really, really great research in anxiety.  So it’s significant anxiolytic efficacy comparable to lorazepam and Paxil, so we’ve seen some great benefits associated with anxiety disorders, disturbed sleep, and other somatic complaints, stuff like that. It’s nonaddictive, non-sedative. There really are no side effects other than people tend to burp lavender.

That’s supposed to go away, but it is a thing. There’s a school of thought that maybe that olfactory part is part of the efficacy. Some people like it. Some people don’t, but it tends to go away.  Kind of here’s some of the… These are kind of the two big studies we’ve talked about, and it’s probably hard to see for you guys, but basically the one on the left is comparing Lavela with lorazepam, and this was 77 subjects over six weeks.  You can see we basically had a similar reduction in symptoms, and we had a similar response rate as well. So as you know the benzodiazepines and some of the other pharma stuff doesn’t work for everybody. We see about a 75% response rate with Lavela, so when it does work, it’s awesome, but it doesn’t work for everybody.  The subject on the right is compared to Paxil, and that one was with 539 patients, so a pretty big study at 10 weeks, and we saw the same thing. Similar results. No side effects.  People always asked, “How does it work?” This is one of those things. We’re not 100% sure, but what we believe is that it helps modulate the presynaptic calcium channels, so it’s regulating the release of neurotransmitters, and sort of modulating that response, and lowering anxiety through that mechanism.

We see typically one to two caps per day is all you need. We like to let people try it for about a week if we’re going to do a trial. Some people they say they feel it right away. Like I walk into offices all the time where they say, “Oh. I just took a Lavela. I feel great,” and that’s awesome. I’m not going to argue with them, but it really doesn’t work like that, but if they feel better, that’s good too.

So if people want to sample this product, we do let people try it. We have boxes that have 10 caps in a blister pack, and that’s typically what we have them give a patient, so we want to make sure somebody gets a response before they spend the money on it.

Then there’s a whole bunch of studies on it. It’s about over a thousand patients now, so everything from those studies I just showed you to, again, placebo. There’s also some open-label dose, 80 mg versus 160 mg, so it’s a pretty heavily clinically studied product, and so far it’s one of our flagships.  People ask how much. It wholesales for $35 for 60, so for some people that’s two months. For others, it’s one month, but still relatively inexpensive, and it’s available everywhere.  We love Emerson and Fullscript, but we also sell it direct, and again, if you want to try it, you can email me at steve.snyder@integrativepro.com, and we can send you some trial boxes. [This is for paractitioners only]

So that’s the Lavela, and then the other one I really quickly wanted to mention was Theracurmin, which is our high bioavailable curcumin preparation. It’s essentially a water-dispersible curcumin, so we get really high blood levels very quickly that last for a long time, and the reason I bring it up in this context is there was a recent study done at UCLA where they looked at men with age-associated memory decline, and they weren’t really looking for mood response, but the metric they used to check the memory also had a mood component to it, and they noticed a significant improvement in mood over the course of the study in these guys.  Theracurmin is kind of… There’s a lot of claims being made about curcumin out there. We call it the curcumin wars. We happen to have something that we can back up where a lot of people will say stuff, and then they can’t back it up, so that’s another one we’ll let people try.  There’s all kinds of clinical studies now on it because the pharmacokinetics is pretty well established, so everything from mood, to skin health, to liver function, to cardiac function. We’re trying it everywhere, and we’re putting it in a lot of stuff because with a lower dose, you can get some clinical results. That’s pretty much it. Thank you.

 


 

Dr. Weitz:                            Thanks, Steve. So now I’m going to introduce our speaker. We’re very happy to have Dr. Peter Bongiorno speaking with us this evening, and he’s a naturopathic doctor and acupuncturist in New York City. He also works with clients via phone and Skype.  He’s written a number of books including Healing Depression: Holistic Solutions for Anxiety and Depression in Therapy which is this book here, and this is like an incredible resource, really dense, with tons of information, so I refer to it regularly when I have patients with depression and anxiety.  He’s also written 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. That’s D-R-P-E-T-E-R-B-O-N-G-I-O-R-N-O.com. So Dr. Bongiorno, you have the floor.

Dr. Bongiorno:                   That’s a long name. I started getting bored while you were reading it. Thank you. Thank you so much for having me here. It’s really a pleasure. Thank you.

Dr. Weitz:                          Good. Good. Good. Good. So how do you want to get started?

Dr. Bongiorno:                   Oh, gosh. I mean, we could start with the… Let’s start with what’s going on right now.

Dr. Weitz:                          Okay.

Dr. Bongiorno:                   I’m actually…

Dr. Weitz:                          Is there anything going on right now?

Dr. Bongiorno:                   Well, not really. It’s pretty-

Dr. Weitz:                          Nothing to be worried about?

Dr. Bongiorno:                   No. No. In fact, right now I’m actually preparing a talk for… I don’t know. Do you come to the Integrated Healthcare Symposium in New York City?

Dr. Weitz:                          I haven’t been to that one yet.

Dr. Bongiorno:                   Haven’t been to that one?

Dr. Weitz:                          Yeah.

Dr. Bongiorno:                   So it’s one of the biggest integrated medicine conferences.

Dr. Weitz:                          It’s in February? Is that right?

Dr. Bongiorno:                   Yeah. It’s in February in New York City. Maybe Steve will be there.

Dr. Weitz:                           Okay.

Dr. Bongiorno:                   And Integrative ITI will be there.

Steve Snyder:                    We’ll probably have an army there.

Dr. Bongiorno:                   Great. I’m sure you guys will.

Steve Snyder:                    Yeah. 

Dr. Bongiorno:                   Yeah. You definitely need to be handing out Lavela and some cortisol manager while you’re over there.

Steve Snyder:                    Yep.

Dr. Bongiorno:                   So actually I’m preparing a talk right now for that conference, and it’s going to be about COVID and mental health because it’s just extraordinary what’s been going on in the past couple of years, the incredible increases in both anxiety and depression, like six, seven, eight-fold.  I think it was at its high point in January of last year or up to 42% higher rates of depression and incredibly higher rates of anxiety.  It’s lowered a little bit, but still way, way above …  Oh. That’s okay. So really anxiety, depression has skyrocketed. Drug use has absolutely quadrupled. Suicide rates. There’s so much to be done, and you could say, “Well, it’s the stress of COVID,” and I think that was a part of it, but I also think it was a testament to just the disease in our population, the unhealthy lifestyles and just the general inflammation that’s already been in our bodies, and then something like this comes up and just is sort of the straw that breaks the camel’s back, so for people who are already predisposed, it’s going to really increase these rates.  That’s something, especially in New York, that I’ve been seeing a lot of, practicing in New York City. It’s been phenomenal. It’s been quite an education.

Dr. Weitz:                            Yeah. And I think that’s something a lot of us in the Functional Medicine integrative world have been talking about which is not getting talked about a lot which is the fact that so much of our population is so unhealthy to begin with with poor diet, and lack of exercise, and the incredible high rates of people being overweight, over 70%, and high rates of diabetes or prediabetes and hypertension, and on, and on, and on, and those are the things that can play a role in predisposing us to depression and anxiety and also increase the likelihood we can have a worse case of COVID if we catch it. Low vitamin D levels. Lack of sunlight. Of course, keeping everybody inside, and not exercising, and not getting exposed to the sun, and etc., etc., unfortunately probably makes the situation worse.

Dr. Bongiorno:                   Yeah. Yeah. No question about it, so that’s one of the things that I’ve been working on right now is really putting together the information regarding the factors involved in why we’re seeing these incredible increased rates of anxiety and depression, suicide, drug use, domestic violence, and all of these things.

Dr. Weitz:                            Right. So I’d like you to talk a little bit about the neurotransmitter theory of depression and anxiety, and as we know there’s huge numbers of people on these medications.

Dr. Bongiorno:                   Yeah. So when you work with a conventional psychiatrist, and let’s say you have depression, and you go in there, and maybe you start crying, or you’re emoting some kind of thought, usually a psychiatrist will think to themselves, “Okay. Well, there’s probably low serotonin. Maybe low dopamine. Maybe low norepinephrine, so let’s give a drug, and let’s try to increase those levels of those neurotransmitters.”  In the case of something like anxiety, it works a higher percent of the time, maybe 60%, 70%, possibly 80% of the time when you give drugs like that.  Of course, as Steve had mentioned earlier, those drugs are addictive, and they tend not to work over time, and they can have sedative effects and other problems, which is the reason why if you have something like Lavela, which has been shown to be as beneficial without those kinds of effects, it’s certainly worth trying something like that. Right?

And then you have depression which antidepressants, especially SSRIs which are the mainly prescribed antidepressants, work maybe 30% of the time. Maybe a hair above what placebo’s been shown to use, and then we do have natural remedies, things like St. John’s wort, saffron, curcumin which also Steve mentioned earlier as well, and those have actually been shown in individual studies head-to-head with those medications to work equally as well, at least.  Now, of course equally as well still only means like 30%, maybe 35% at the most, so the question really that I have and what I think about when I work with patients is if it is a neurotransmitter issue, and those drugs work, why are the neurotransmitters off?  And the other question is in the percentages of patients that they don’t work, 30% to 40% are anxiety patients, upwards of 70% for patients who are depressed, what else is going on? That’s really, I think, what I’m interested in and what I work on with my patients.  

So when we want to look at neurotransmitters that’s fine, and if we can work with them and use some natural, less toxic things to help them balance, that’s good, but that’s still not getting to the underlying cause of why they got out of balance to begin with, if that even is the issue, and that’s where I like to think about, “Well, what are the other factors?”  So we want to take into account, of course, a person’s stressors which can certainly play a role, what their environment is, what their toxicity levels are, what the inflammation is in their body. How is their gut working? Are they getting enough sleep? What’s the hormonal balance that’s happening. What foods are they eating? What is their mitochondrial function, and is that a part of why maybe their brain and their mood is suffering? What are their genetic makeup, and is there anything we can learn from that that can help us get a better idea of how we can support their body and the pathways in their body? Are they exercising?

So even when we think about neurotransmitters and the neurotransmitter theory, which I think has some relevance and some credence, we still have to say, “Well, what’s the underlying cause of the neurotransmitters being off, if that’s even it?”  And then for that other percentage of patients where it’s maybe not playing as much of a role, what are the other factors because in conventional psychiatry, if it isn’t a neurotransmitter issue, and the drugs don’t work, there’s no other tools. There’s no other choice, and that’s why I love natural and functional medicine because there are so many other tools because we understand that there are so many other factors involved, and that it’s probably just not one or two factors that are contributing to the mood issue. It’s probably a number of factors that are contributing in small ways that synergistically is creating this syndrome that maybe we’re calling depression or calling anxiety, for example.

Dr. Weitz:                            Exactly. It sort of reminds me with the issues we’re having trying to deal with some of the chronic neurodegenerative problems like Alzheimer’s, and conventional medicine keeps looking for this one pathway and coming up with this one drug that affects that one pathway, and after just hundreds of billions of dollars of research, they’ve come up with nothing, and now we have this new drug that was just approved that does nothing to make anybody better. Best case, patients get worse more slowly, and 30% of the patients get swelling in their brain, and the first patient just died from this drug.  Yet we have a Functional Medicine approach which Dr. Dale Bredesen has finally published his study showing that patients actually improved. They didn’t just get worse at a slower rate, but it’s complicated, but that’s the beauty of a Functional Medicine/integrative approach looking at a number of different factors.  Not only do you end up improving your brain health, but you improve your overall health, and the same thing with a Functional Medicine approach for depression and anxiety.

Dr. Bongiorno:                   Exactly. Yeah, exactly. And Dale Bredesen who did that amazing work with the Alzheimer’s understands that it’s multi, multi-factorial, and that you have to look at a number of factors at the same time and work with as many as we can.  I think what the conventional care model when it comes to drugs doesn’t understand that there’s a lot of… That the body has a lot of redundancy in a sense, so when you give it a drug that works on a single mechanism, the body’s really smart at saying, “Okay. This is foreign. I don’t know what it’s doing, but we’re going to start working around it.” You know?  And so you need to give higher doses than is probably even healthy, so you end up with more side effects and less beneficial effect, and that’s the problem with the medications in general, and then I certainly see that with mental health, and it’s certainly seen in neurology when it comes to Alzheimer’s as well.

Dr. Weitz:                            And apart from all the other factors that we’re going to talk about that affect mental health from sleep, to diet, to exercise, etc., etc., even the neurotransmitter theory is just looking at one neurotransmitter like serotonin. It’s just a huge oversimplification about the way our brain and moods work. There’s a whole plethora of different chemicals that are all interacting in a very complex way.

Dr. Bongiorno:                   Right. Of course. As far as depression goes, if I had to pick a drug that probably did work the best for depression, it was tricyclic antidepressants, and those are the old antidepressants, and what they did was they kind of raised a lot of the neurotransmitters. They raised dopamine, and serotonin, and norepinephrine, and acetylcholine.  The problem with those drugs is that they were very… They were kind of toxic. You can’t give them to seniors because they’re especially toxic to older people, and again, even when they work, they work for a while, and then they kind of stop because like I said, the body figures out that it’s hand is being forced, and it doesn’t like that, so it kind of starts to work around these drugs.  So that’s why we need such a full, integrative, and holistic model that really just looks at the whole person.

Dr. Weitz:                           Now, we’ll get into your testing and theories, types of testing that you think is beneficial, but just on the neurotransmitters, do you think that’s a valuable thing to do to do the urinary neurotransmitter testing?

Dr. Bongiorno:                   Yeah. I mean, urinary neurotransmitters, I think, has some value. Interesting, in New York it’s very hard to get these neurotransmitter tests because of the laws in New York, so I don’t actually use them very much.

Dr. Weitz:                           Oh, really? Wow.

Dr. Bongiorno:                   Yeah. New York is a little toughie when it comes to a lot of these functional medicine tests, so I’ve actually kind of worked around them a bit, but the fact of the matter is is that there are neurotransmitter tests that I think can give you some clues, but you still really need to back it up with clinical relevance, and finding out how is this person feeling to really understand what’s going on. Urinary-to really understand what’s going on. Urinator transmitters, I don’t think give you a full picture of what’s going on in the brain, but they can suggest to you what’s happening in terms of breakdown and metabolites. So yeah, the more information we have the better.

Dr. Weitz:                           So let’s talk about some of the important dietary factors that can play a role in triggering depression and anxiety.

Dr. Bongiorno:                   Well, the first one that I see is just blood sugar dysregulation, especially when people have high insulin levels, insulin will drop your blood sugar. So people whose pancreas tends to make a lot of insulin because they’re insulin resistant, they’ll have these wild fluctuations and blood sugar, and that certainly plays a role in anxiety and in depression. That’ll play a role in triggering other stress hormones, changing levels of cortisol, and that can be very hard on the body and create a lot of stress and cause a lot of anxiety as well as depression. So, that’s the first thing I think about when it comes to it, so I like to make sure people are trying to stay away from simple carbs so that their blood sugar doesn’t go up and then come way down, and then making sure they’re eating a good amount of protein, healthy fat, and some complex carb regularly and throughout the day.

And I know sometimes for weight loss and metabolic health, that sometimes we need to do things like intermittent fasting, where we don’t have people eat for a number of hours of the day. For sometimes for people who have anxiety and depression, that doesn’t work for them, and you need to kind of have them do more of a grazing approach where they’re eating little bits throughout the day to keep their blood sugar stable. Everybody’s different. So what’s appropriate for one person isn’t appropriate for somebody else. And then as far as the foods themselves go, as we know, the standard American diet is really a disaster when it comes to for our health. It’s a very pro-inflammatory diet and inflammation is going to change what’s going on in the brain, change what’s going on in the middle of the brain, which is the hypothalamic pituitary adrenal axis.  So what we eat will greatly affect how our brain communicates with the nervous system, the hormonal system and the immune system. And that’s going to make a lot of changes in what goes on with our mental health as well. So I always recommend people have, if I don’t know a person and I don’t know what their individual needs are, and I had to just make a blanket recommendation, I would probably start with something like the Mediterranean diet. Sanchez-Villegas, in the early 2000s, did a number of studies out of Spain, which showed how the Mediterranean diet can prevent and even treat anxiety and depression as well as lower things like CRP and other inflammatory markers in the blood. So people who eat that kind of diet typically have lower anxiety, lower depression, less inflammation in the body. So, that’s a great place to start.

Dr. Weitz:                          How do you work with vegans or vegetarians given the importance of getting enough good quality protein?

Dr. Bongiorno:                   Well, it depends on the patient, as always.

Dr. Weitz:                          Of course.

Dr. Bongiorno:                   If we’re working with a vegan or a vegetarian, there’s beans, there’s nuts, there’s seeds.  We can also do smoothies with it, so it depends on the person.  Some people don’t have as much need for as much protein, and actually when it comes to things like even histamines, right, if people are very high histamine and they have a lot of anxiety then typically I’ll put them on a lower protein diet to lower levels of histamine. So, that could actually be helpful.

Dr. Weitz:                          Okay.

Dr. Bongiorno:                   So, it just depends. We have to strategize individually where people are going to get their protein from.

Dr. Weitz:                          How often do you find histamine is an issue?

Dr. Bongiorno:                   I would say a good 15% of the time, maybe 10 to 15% of the time.

Dr. Weitz:                          Okay.

Dr. Bongiorno:                   I do run histamine on practically every patient and I’ll do, as part of my intake, ask them a number of questions to find out. Sometimes I’ll have people who’ll come in and I ask them how they’re sleeping and they’ll say, “Oh, I’m sleeping great.” And then I’ll ask them, “What do you take? Do you take anything over the counter?” “Oh, yeah. I take some Benadryl at night. It really helps me sleep.” Great.  That’s kind of a clue that they’re probably high histamine, because Benadryl is an antihistamine.

Dr. Weitz:                           Right.

Dr. Bongiorno:                   If you don’t have really high histamines, it won’t affect your sleep too much, but if you’re high histamine, boy, you get the best sleep with that stuff. So I’m not recommending it as a plan, but I’m just saying it’s a-

Dr. Weitz:                           Right.

Dr. Bongiorno:                   So that could be a kind of a clue to find out as well. Plus if people have a lot of rashes and itching or urticaria, you can write on somebody’s arm and write your name on it with your finger. That’s how you know their histamines are pretty high.

Dr. Weitz:                           And will you use a specific low histamine diet?

Dr. Bongiorno:                   Yes. Yeah. So there’s a number of food that will either release histamine in your body or actually have high histamines in them. So it’s a little handout that I’ll give people and I’ll have them start with the foods that they tend to eat a lot of. And sometimes it’s even healthy foods, it could be even things like avocado, as well as typical ones that people know about are wine and cheese. But even there’s some healthy foods, fish can be high in histamine. So, I love people eating fish. It can be so healthy for you, but if they’re high in histamine, then that might be something we might want to limit.

Dr. Weitz:                          And so we often see patients with histamine problems who come see us with other gut disorders. How important is the microbiome and the gut for overall mental health?

Dr. Bongiorno:                   Yeah, so the microbiome plays such a strong role in the production of neurotransmitters, both in the gut and the signaling through the cytokines, the immune signals that go to the brain and help the brain also make neurotransmitters in different areas of the brain. So when there’s a lot of inflammation in the gut, that’s going to typically change levels of neurotransmitters in the brain as a result. And the microbiome will play a strong role in modulating that inflammation.

Dr. Weitz:                          Now given that the neurotransmitters in the gut don’t make their way into the brain, how important is the neurotransmitter production in the gut?

Dr. Bongiorno:                   Well, neurotransmitter production, that’s actually something that’s being hotly debated right now.

Dr. Weitz:                          Okay.

Dr. Bongiorno:                   And I’m reading the research on that. So there’s some researchers believe that it still does get into the bloodstream, and it also is in the enteric nervous system, right? So the enteric nervous system is that vast amount of nervous system that surrounds your gut and through vagal nerve stimulation, sends a lot of signals that go to the brain and then affect what goes on in the brain in terms of production of neurotransmitters and even inflammation.  So there’s seems to be a relationship between the production in the gut and the production in the brain, even though you’re right, directly… I remember when I first learned about most of your serotonin is produced in your gut and that’s what changes mood. And then as I learned more about it, I did learn, “Oh, no, it actually doesn’t get to your brain though. So how does it affect it?” But we think it’s through those other pathways, that it’s not maybe a direct relationship, but it does have an influence, a pretty strong influence.

Dr. Weitz:                            And it turns out there’s a huge amount of serotonin receptors in the small intestine. And in fact, stimulating those serotonin receptors actually helps improve gut motility. And so interestingly, patients with IBS for years were, because nobody really understood about CBO-

Dr. Bongiorno:                   Right.

Dr. Weitz:                          So IBS was seen as a psychological disorder, so patients were put on antidepressants and it turned out that the antidepressants actually did have some benefit by stimulating the serotonin receptors in the small intestine and helping patients overcome constipation and stimulate motility.

Dr. Bongiorno:                   That’s right. Yeah. I think it was actually in the thirties or the forties, I’m blanking on it. It was a female researcher that had published some studies on how the clam clench down and keep that muscles so strong, day in, day out. And what she found was basically what led researchers to what they called enteramine, which is serotonin. So entero stands for gut, right? And they found that entermine in the gut was what helped change motility in the gut. And they later renamed it serotonin and they found that it also happened to be in the brain and that it was a part of mood, but for a long, long time, the thinking was that serotonin’s main job was working in the gut for motility. Yeah, exactly.

Dr. Weitz:                          What about the importance of iron, for example?

Dr. Bongiorno:                   Yeah, so iron, I remember when I was a student, so this must have been about 24, 25 years ago. One of the very first patients I saw was this woman with depression. And I was talking to her after her visit because she was very, very happy, and I wanted to find out what the clinicians do for her. You know, I was a young, secondary clinician just learning for the first time. And she said, “Oh,” she goes, “Well, I was on antidepressants for many, many years. And the head clinician there had run an iron panel and looked at her serum iron, looked at her Ferritin, which is iron storage, and found her iron storage to be very, very low and her serum iron to be very low. And they gave her some iron, and no one had ever really looked at it, they gave her iron and within a month, she was off her antidepressant after being on them for years.

Dr. Weitz:                            Wow.

Dr. Bongiorno:                   And that was the first time I had ever heard that there’s an association between iron levels and mood. And of course, it may makes perfect sense, right? Cause iron is the center molecule of hemoglobin and hemoglobin is the molecule in your blood that you use to carry oxygen. So of course, if you can’t carry oxygen adequately, your body and your brain is going to kind of shut you down and say, “Okay, well, let’s lower that mood. Let’s shut that person down. So that this way, they’re not going to want to use as much oxygen.” So there’s much higher rates of depression when iron levels are low, and anxiety as well.

Dr. Weitz:                          Now you just mentioned somebody who was on antidepressants for a long period of time and got off. And that’s one of the issues with these drugs, is the difficulty of getting off of them once you’ve been on them.

Dr. Bongiorno:                   Right. Right. And I think that’s twofold, one is because when you’re on the drugs for a long time, the receptors for that particular neurotransmitter, they down regulate because your body knows there’s too much around than it would be doing on its own. So it down regulates some of the effects. So, that’s one issue. The other issue is that it does deplete a lot of the precursor molecules that you need to make the neurotransmitters. And that’s another issue.  And that’s why these drugs, and this is actually a medical term, they call it poop out syndrome. And that’s why these drugs are known to have poop out syndrome, meaning that they work for a while, and then they tend to stop working. And if you don’t fix the underlying reason why the neurotransmitters are off, maybe it’s iron, maybe it’s low vitamin D, low vitamin B6, not enough sleep, all these other issues, it’s very hard for people to get off these drugs because we haven’t fixed the underlying issues. When I have a patient come in and they’re taking medications, especially if they’re not having side effects, then the first thing we don’t want to do is just take them off medication, because they’re probably going to feel even worse than they already do. So what we want to do is, is leave them where they are and start working on the underlying issues and get those as well as we can, get them feeling a hundred percent with the medications they’re taking. And then we can start to have the conversation about how to healthily and slowly wean off the medication.

Dr. Weitz:                          And then what are some of the strategies for that?

Dr. Bongiorno:                   Well, let me preface it by saying, anyone listening should definitely not do this on your own and make sure you work with a practitioner who’s very knowledgeable and certainly don’t just get off any kind of antidepressant or mood stabilizing medications, just blankly get off them because that’s generally not safe. So having said that, like I said, the first step is to really work on all the underlying issues, making sure sleep, exercise, stress, maybe going to therapy, doing some kind of relaxation work, changing the foods, and then doing a fair amount of testing. We want to find out what’s going on with iron, red blood cells, B12, vitamin D, B6, inflammatory markers, histamine. I like to look at hormone levels as well, melatonin levels, glutathione levels.  There’s so many things to look at and what I’ll find is that many of them will be just fine, but that there’s going to be a number of factors that are out of balance. So then we want to start working on those things, and that’s where we can use maybe a different approach with foods, especially if there’s food sensitivities. We want to heal the gut, lower the inflammation, maybe put people on amino acids to start supporting some of the neurotransmitters, put people on a blood sugar supportive nutrients to help stabilize blood sugar, whatever I think the underlying issues are. I do a lot of gut and stool testing, and if the microbiota are really out of whack or if there’s a lot of candida and yeast issues, we may want to work on those things.

Dr. Weitz:                          What are your favorite gut and stool tests?

Dr. Bongiorno:                   I’ve been using GI-MAP tests lately. I think that’s a good test. I think there’s a number of them out there. I think the Genova testing seems to be very good as well. Vibrant America has good testing.

Dr. Weitz:                          Yep.

Dr. Bongiorno:                   Yeah. And so looking at all the testing, trying to adjust the factors that we find that are out of balance, and then once people are on that plan and they’re doing better and better and better, then we can start to have the conversation about how do we wean off the medication? Is this a good time? We’re going into December here in New York, it’s pretty dark. It’s getting pretty dark here in New York and serotonin levels are at their lowest. So maybe right now isn’t the best time to start thinking about getting off SSRIs, if we don’t need to. If there’s a need, then certainly we can. But maybe if we can wait till the spring, that’d be good. So, so seasonality might play a role there too.

Dr. Weitz:                            Maybe you could explain how seasonality affects serotonin and mood?

Dr. Bongiorno:                   Yeah. So generally as the days get shorter and darker, serotonin naturally goes down. I think, as animals, we’re designed to hibernate. We’re designed to go to bed earlier and sleep longer. And that’s the interesting thing about the holidays, right? The holidays put us into needing to be more outgoing and more active than ever at a time when our bodies are looking to be the least outgoing and the least active. So, you combine low serotonin and the stressors of needing to do all those things, and you end up with rates of suicide and depression that are much higher during those times of the year than other times.  And then as the light becomes longer during the day and the light gets brighter and light gets more direct in the summer, that also stimulates higher serotonin levels. So generally people will have much higher serotonin levels in the summer than in the winter. That’s one of the reasons why light boxes can be very helpful in supporting people. And I have many of my patients that I’ll send little reminder calls in August saying, “Hey, make sure your light box works, because we’re going to want to start using that in a couple of weeks.”

Dr. Weitz:                            And so circadian rhythm, it has a lot to do with cortisol and melatonin. And can you talk a little bit about that? And do you ever do the salivary cortisol testing to take a look at that?

Dr. Bongiorno:                   Yes. Yeah, I do either salivary or urine tests to look at cortisol levels throughout the day. And in many patients who are depressed, they might have very high cortisol levels or they might have very low cortisol level, or actually the levels might just be very dysregulated where maybe they’re very low in the morning and very high at night. So you’ll have these people who can’t get out of bed in the morning and then they’re tired and wired at night and they can’t sleep at night.

Dr. Weitz:                            Right.

Dr. Bongiorno:                   And the whole idea of circadian rhythm is very important to mood disorder and getting people in balance with nature and in balance with the day is a great idea. It’s interesting because right now it’s ten after ten here in New York and I have this bright light over here right next to me that’s on. What a disaster for melatonin levels, talking about my circadian rhythm.

Dr. Weitz:                            Absolutely.

Dr. Bongiorno:                   But so that’s not a really great decision on my part, right? To have a bright light in the evening when I should be really winding down and having just maybe these amber lights or orange lights on, telling my body, “This is the time to go to bed.”

Dr. Weitz:                            Right.

Dr. Bongiorno:                   So one night it’s okay to do that. But if you do that many nights-

Dr. Weitz:                            Right.

Dr. Bongiorno:                   …then you start to set a poor circadian pattern and then maybe add eating late, right? Cause eating also stimulates cortisol. So, it’s funny, I got a dog for the first time about three years ago, and I never had a dog before and I brought it to a vet and the vet said, “It’s really important for the dog, that you feed the dog the same time every day. And that you take the dog out to poop the same time every day, because that’s going to make it feel confident. That’s going to make it feel safe. And it’s going to keep its system calm.”

And I thought to myself, “Gosh, that’s exactly the same with us human patients,” right? Us humans need a regular circadian rhythm, when we eat, when we go to the bathroom, when we get up in the morning, when we go to bed at night, when we shut the lights. All of those things, not only are good for general overall health, but they’re really important for our mental health.

Dr. Weitz:                          Now is the quality of sleep equally as important as the amount of sleep?

Dr. Bongiorno:                   Well, both are certainly important. The amount of sleep is going to vary depending on person to person. Generally most people do need, I think a good seven and a half to eight hours. And I think that’s been shown. It’s also been shown that people who get a lot less sleep or people who get a lot more sleep, tend to have more anxiety and depression as well. So there does seem to be a sweet spot, for most people, around seven and a half to eight hours.

Dr. Weitz:                          And somebody asks, what light box do you recommend and how do you suggest they use it?

Dr. Bongiorno:                   Oh gosh. I don’t remember the exact name of the light box. I usually send people links to it. And to tell you the truth, I don’t remember. I could tell you though, in general, I recommend a 10,000 lux light box. So lux is L-U-X. So 10,000 lux, which is the intensity at 30 inches. So if you look for a light box, 10,000 lux at 30 inches, or feel free to send me an email and I could send you the links, my emails is peter@drpeterbongiorno.com. What was the next question?

Dr. Weitz:                          Oh, is coffee- Oh, there’s another question for me. Somebody just ask a question, do you see people who are on antidepressants who are more apt to develop seizures?

Dr. Bongiorno:                   Do I see people on antidepressants who are more apt to develop seizures? Well, people who are on Wellbutrin would be a little more apt to develop seizures. That Wellbutrin has been shown to increase seizure rate and sometimes creates first seizures and people have never had seizures before. I don’t know. I haven’t seen that with the other medications.

Dr. Weitz:                          Is coffee good or bad for mood?

Dr. Bongiorno:                   Well, generally it depends on the person, right? So people who are anxious, for the most part, tend to do better with less coffee. It will make them more anxious. And people who are typically anxious who are affected by coffee, usually have a genetic polymorphism that you can even look at to see how well they break down coffee and how long it probably lasts in their system. But the research on depression is fairly clear that people who drink two to four cups of coffee a day will have lower depression rates than people who drink no coffee to maybe one or two cups a day. So depression-.

There’s no coffee to maybe one or two cups a day. So coffee seems to be protective when it comes to depression rates. Although that effect does start to change around seven to eight cups of coffee and actually increases rates of depression and anxiety. So seven to eight cups, that’s a lot of coffee. I don’t recommend that. One to two cups, I mean two to four cups a day for people who are depressed and the research seems to be good. Now having said that, as a naturopath, as a functional medicine practitioner, I also think about somebody’s adrenal glands, because when you drink coffee, it’s sort of like squeezing those adrenal glands a little bit. So you’ll get more norepinephrine, Ativan, you’ll get the brain to make more dopamine. But if people’s adrenals are very, very weak and already depleted and you keep pouring coffee in them, even for depression, that’s actually I think in the long term, might be more problematic.  So I personally with my patients, if I run the adrenal test and I see the cortisol is very, very low and their no epinephrines really, really on the floor, I don’t want to just give them coffee to kind of boost them up. I want to actually them nutrify them and give them things that’ll actually nutrify their adrenal so that they get the natural boost that we’re looking for. So if they’re not very, very depleted and then I think some coffee can help with the depression. That was a long-winded answer.

Dr. Weitz:                           That’s good. No thoughtful. Why does it seem like young people are just epidemic with anxiety in particular and also depression?

Dr. Bongiorno:                   Young people, what ages are you referring to?

Dr. Weitz:                           I’m referring to teenagers, but even young adults.

Dr. Bongiorno:                   Well, I think there’s a couple of reasons. So one is the sleep schedules, I was reading some research about teens and it seems like teens actually have a different circadian rhythm than the rest of us.

Dr. Weitz:                           Really?

Dr. Bongiorno:                   Teens would do better to wake up later and go to sleep a little later. And unfortunately the schedule is really designed to get up really early. So you have a teen who really naturally wants to get up later and they have to get up earlier and then in the evening they don’t want to go to sleep. Because it actually feels too early for them. So a lot of teens are very sleep deprived as a result.

Dr. Weitz:                           Now why would teens be programmed in that way?

Dr. Bongiorno:                   I don’t have the answer for that, but I’ve been doing more work on circadian rhythms and that’s one of the things that I learned and I can’t tell you why, but it’s something developmentally that when we’re younger, the kids tend to go to bed early and get up early. But then when they get a little older in their teen years, they tend to want to go to bed late and then want to sleep late and it’s not just a habit, it’s actual physiology. And then as we get into adulthood, that starts to shift and we start to want to go to bed a little earlier. So unfortunately these teens at these very critical years of growing are especially sleep deprived in general and then even more sleep deprived for their natural circadian rhythm.  So I think that’s one issue.

I think another issue is deplorable nutrition. There’s a number of studies now that show that the much higher rates of impulsivity, much higher rates of anxiety, depression in teens who eat fast food and eat a lot of poor quality foods versus teens who eat better quality food under the same circumstances.  I have a couple slides and some lectures where I talk about that and the really interesting studies that clearly, clearly show that. I also think in my opinion, the screens that we’re using and social media is also playing a strong role. And there’s a fair amount of research that’s showing that. I mean, look at all the stuff going on in the news right now about Facebook, sort of keeping down some research about the effects it does have on teenagers, especially Instagram, when it comes to self worth and looking at themselves and comparing them to somebody else and what the ideal person should look like and act like, and how many likes should they have.  It’s a lot, a lot of pressure. And plus I think just staring at these screens and the blue light that’s coming from them at night is further exacerbating that sleep issue.

Dr. Weitz:                            Do you think the EMFs might also be playing a factor?

Dr. Bongiorno:                   I’m sure that does play a factor. I mean, more and more research is coming out, showing how strong the electromagnetic frequencies are, especially from iPhones which so many teens have. Very little to no protection on the screen the whole time or having it right on their body somewhere most of the day, if not all the day.

Dr. Weitz:                            Right. So let’s go into lab testing. Let’s talk about in detail a little bit, what you think is a good panel to start with for the average person you’re seeing. And I realize everybody’s different and we’re going to focus on different things depending upon the history and-

Dr. Bongiorno:                   It’s tough. I do in my books, I do have a page where I give the panels that I generally like to see, because it is important. I’ll tell patients, or my readers, if it’s a page you can take out of the book or copy and hand it to your doctor and hopefully he or she will be able to run most of those. It is different for everyone. When I think about running labs, I like to look at blood sugar. So hemoglobin A1C, insulin, fasting insulin I think is very important.  Red blood cells, white blood cells, a liver panel, GGT, which can look at can be a surrogate marker for toxicities as well, and a full iron panel as we with ferritin, as we talked about before. A full thyroid panel, including thyroid antibodies, inflammatory markers. So things like erythrocyte sedimentation rate, C-reactive protein, Interleukin-6, especially if there’s depression. Looking at gut markers. Looking at things like fecal calprotectin. If I suspect there’s colitis, looking at celiac panel as well. Amylase and lipase, if I think there’s pancreatic involvement and then looking at vitamins, vitamin D, zinc, the zinc to copper ratio, red blood cell magnesium, vitamin B12, methylmalonic acid, which also looks at B12 in a different way. So there’s so many vitamins. We could go on and on.

Dr. Weitz:                          With the importance of lipids looking at detailed lipid panel.

Dr. Bongiorno:                   So detailed lipid panel, especially if I think there’s a lot of cardiovascular involvement and lipids. Not only to check to see if cholesterol’s high, but oftentimes to see if cholesterol’s too low, especially if people are on statin medications, because cholesterol is the precursor molecule to pregnenolone, which I also check on labs. And pregnenolone is the precursor molecule to all our important, other important steroid molecules. Cortisol through one pathway and progesterone and then DHEA and testosterone and estrogens through another pathway. And so I do worry for so many patients when the cholesterol’s too low, that they’re not going to have the ability to make all of those other hormones that we really need for good mental health.

Dr. Weitz:                          And there’s a big push in cardiology to get the LDL.

Dr. Bongiorno:                   Lower lower lower. 

Dr. Weitz:                          As low as possible.

Dr. Bongiorno:                   Right, because we look at one pathway and one mechanism and we don’t think about everything else.

Dr. Weitz:                          And yet they say there’s no research to show that statins have any negative effect on brain health.

Dr. Bongiorno:                   It doesn’t make sense. And I think what happens is when ideas are new, kind of the pendulum swings one way and then as more and more research comes aboard and we start to see, maybe this isn’t the right way we’re thinking about it. I mean, how many times have we seen this? We’ve seen this when they demonize fats, we see this with the margarine, when margarine was supposed to be so healthy for us. Things like that. And then we kind of go, it’s not really working out as well as it could have.

Dr. Weitz:                          What about the importance of the hormones?

Dr. Bongiorno:                   So hormones are critical to mental health. For example, estrogen levels really play an important role in the levels of serotonin in the brain and where the serotonin is being made in the brain areas that need it. When estrogen levels are high, it changes the amount of monoamine oxidase to help keep serotonin levels high. Progesterone actually does the exact opposite. So that’s why estrogen and progesterone have a nice yin and yang to them because they kind of balance each other. So looking at not only estrogen levels, but the balance of estrogen and progesterone in a woman is very important. Estrogen levels are actually important in men. Men have six times the level of estrogen in the brain that women do. So sometimes when we think about depression and serotonin and we also want to check on estrogen as well.

Dr. Weitz:                            So let’s talk out estrogen levels in men. Is there a number, do you like to see estrogen above 30 or is there a certain number you like to see? And is there any importance of progesterone levels in men?

Dr. Bongiorno:                   Progesterone levels in men there isn’t a whole lot to research on. It’s something I’ve thought about. And I do know when men are supplementing with progesterone, typically it’s not beneficial. That’s what I’ve seen so far, but it’s an interesting question. And I think it needs a lot more explanation and exploration. As far as estrogen levels, the way I think about it is we want to look at levels of cholesterol, pregnenolone, DHEA, then testosterone and then estrogen. And basically that whole pathway to kind of feed each other very nicely up until the estrogens. And if that pathway looks healthy in general, then I think we’re on the right path with men and women.

Dr. Weitz:                            Right. What about if you have a menopausal woman who’s having a tough time with depression and anxiety, do you ever recommend hormone replacement therapy?

Dr. Bongiorno:                   Possibly. I don’t typically like to start with hormone replacement therapy. So first we want to start with, obviously if someone’s really suffering and the hormones are so out of balance and they need something to help them feel better faster, then I would certainly consider hormone replacement. But in general, first we start with all the basics. Sleep, exercise, diet, stress reduction, because those things oftentimes will help. Secondly, we want to support her liver because the liver is what processes the estrogens. And oftentimes when the liver and the microbiome are out of balance, we’re going to see improper levels of estrogen. For example, if there’s beta-glucuronidase levels are out of balance, that’s going to change estrogens and there’s going to be a lot more recirculation of excess estrogens. If there’s a lot of candida, candida acts as false estrogens, so that’s going to change the balance of estrogens.  So we want to fix all of those things. So without even touching hormones, we can oftentimes fix the hormones.

Dr. Weitz:                            By fixing the gut.

Dr. Bongiorno:                   Right, exactly, by fixing the gut. And then making sure a woman is having bowel movements every day to making sure everything is getting out that needs to get out from the liver. And then if those things aren’t enough, then we can test hormones and see where they are and then make a decision about whether we want to tweak hormones a little bit. If pregnenolone is low and all the other hormones are low, then maybe start with a touch of pregnenolone and that can help feed the rest of the pathways. Or if we see that cortisol levels are actually normal or normal high, but the other side of the pathway DHEA is low, then maybe start with DHEA and see if we could feed the pathway.  So I try to feed the pathway earlier so that the body has more ability to make the decisions it needs to make.

Dr. Weitz:                            Right. So you might start with pregnenolone versus estrogen progesterone.

Dr. Bongiorno:                   Possibly. And I did want to say there’s an herb that I might try before either of those, especially if progesterone levels are low related to estrogen and that’s Vitex, also known as chasteberry, which does a beautiful job. There’s studies in premenstrual dysphoric disorder showing it works really well. There’s other studies in perimenopausal depression showing that it worked just as well as SSRIs. Although it does seem that, that the Vitex seems to work better for the physical symptoms along with the depression. Whereas the SSRI, at least in this one study, showed it was better. The SSRI was a little more helpful when it came to the mood symptoms versus the physical symptoms. So oftentimes when I’m using Vitex, I’ll use Vitex along with tryptophan and I find we can get both the mood and the physical symptoms in balance. So Vitex is a brilliant herb. It’s really wonderful.

Dr. Weitz:                            What kind of dosage do you find effective for Vitex and also for tryptophan?

Dr. Bongiorno:                   Sure. So for Vitex, I think it’ll depend on what kind of, if it’s an extract or what kind of preparation it is. Typically, it’s a capsules around 220 milligrams, so I’ll usually start with one or two of those a day and I’ll do it every day. I won’t dose it with the cycle, but I’ll just dose it every day. And then as far as tryptophan goes, if it’s tryptophan, I’ll usually start with 500 milligrams twice a day, and 5-HTP, maybe start with 50 to a 100 milligrams a day.

Dr. Weitz:                            In which do you find more effective, 5-HTP or tryptophan?

Dr. Bongiorno:                   That’s a great question. And it’s interesting because theoretically 5-HTP should work better. It’s a little further down-

Dr. Weitz:                            It’s a little further down downstream. Right.

Dr. Bongiorno:                   It’s a little further down on the pathway. And especially if there’s inflammation, it should be harder for your body to make serotonin from tryptophan than it should be from 5-HTP. But having said that, I find different patients respond differently. Oftentimes I start with tryptophan because I think I find it does work better, although not in every case. And especially for sleep, for helping people stay asleep, I tend to use more tryptophan. So having said that I’m always open because everyone’s different.

Dr. Weitz:                            Dr. Wasserman asks a question about diet and I think what he’s asking is, you mentioned somebody having too many simple carbs, but can a low carb diet also increase problems with anxiety and depression?

Dr. Bongiorno:                   That’s a great question. That’s absolutely true, because we need carbs to help make serotonin as well and a very, very low carb diet and someone who’s susceptible, can send them into anxiety and depression by lowering their serotonin levels. Some people who aren’t that affected, they can go very low carb, do a keto diet and their brain’s doing wonderfully. But you’re absolutely right that we have to be careful, especially people who teeter on depression and suicide. To put them on a low carb diet can actually lower their serotonin levels more and put them more into that mood disorder than they already are. The other thing I’ve seen in relation to that is gluten can also play a role in mood and people who come in depressed are often sensitive to gluten.

Having said that if you take them off gluten, gluten also creates these kind of morphine like compounds in the body and they affect the brain. And sometimes if you put people on a gluten-free diet very quickly, it’s almost like some taking somebody off of morphine and when they go through withdrawal, their symptoms will actually be even worse. So I do find if people are depressed or they have pretty significant mood disorder and we decide to take them off gluten, I do it slowly. I don’t have them come off of gluten right away all at once. I have them do it slow and I treat it like any other drug that they might be addicted to because I know we’re going to have withdrawal symptoms as well.

Dr. Weitz:                            Interesting. Interesting. That’s a good clinical pearl right there. I’m mean there’s been tons of clinical pearls tonight already. So let’s go into the most effective supplements for depression and anxiety. And I know you’ve mentioned a number of them already, but let’s start with fatty acids.

Dr. Bongiorno:                   So essential fatty acids. I think fish oil by themselves I don’t think can cure depression or anxiety in most cases, unless people are just so genuinely deficient in them, which a lot of us are. There’s a study that came out last August in one of the psychiatry journals showing that patients who are treatment resistant to SSRIs tended to do much better when they took fish oils. And now that also made me think, well maybe you could have just gave them the fish oils and didn’t even need this SSRIs. I mean certainly, essential fats play such a strong role in creating healthy membranes and healthy membranes in the nervous system are going to play such a strong role, an important role in mental health. So to me, fish oil is one of the basics.  When a patient comes in for a first visit, I had a young woman who came in today with anxiety, she doesn’t prefer fish. She doesn’t like to eat fish and we’re going to run some tests and do some of the things that we talked about. But I already put her on fish oil, unless I know a person’s allergic to fish, if they’re not really eating any fish and they’re not taking any fish oil, that’s an easy one to have them start taking some fish oil. Because I know in the long term that’s going to help.

Dr. Weitz:                            What do you think about SPMs, which are those derivatives from fish oil that help to reduce inflammation?

Dr. Bongiorno:                   Oh, those are resolvents? Is that the same as resolvent?

Dr. Weitz:                            Right. Exactly.

Dr. Bongiorno:                   That is a lot of intriguing information about that and my understanding is, and I haven’t used them a lot, so I don’t have firsthand experience with them yet. I just actually started bringing them into the practice. And I’m going to be taking them myself because I like to try everything first. But my understanding is not only does it help with inflammation, it also helps with the healing process as well, which I think is amazing. I’ve been reading the literature on them and I think there’s some substantial information then I could see why a number of companies have been working on bringing those out.

Dr. Weitz:                            GLA?

Dr. Bongiorno:                   GLA. Yes, so I talk about in my books, the importance of GLA, especially in production across the glandins, those are all also feel good molecules that our body naturally makes. And there’s a number of studies in people who are alcoholics. Alcoholics generally drink alcohol because it increases levels of PG2, which helps them temporarily feel happier and giving people GLA can be an important part of helping the body make its own prostaglandins and helping mood as well. So for example, when I see patients who have a strong alcoholic intake and that’s one of their drugs of choice to feel happier temporarily, I will start them on GLA.

Dr. Weitz:                          I think GLA is an interesting example of not throwing the baby out with the bath water. It’s been so much focus on Omega-3’s and the fact that Omega-6’s are too high. So we got to get the Omega-6’s low and I’ve talked to doctors who said why would you ever prescribe an Omega-6? And of course, GLA and evening primrose oil, these are Omega-6’s but they have important benefits too.

Dr. Bongiorno:                   In fact, typically the ratio of Omega-6 to Omega-3 should be three or four or greater something like that. So a healthy diet does have more Omega-6’s in the diet than Omega-3’s. I think so many of us are so deficient in Omega-3.

Dr. Weitz:                          There’s some debate as to what the ideal is. Some labs say under four. I know some people say it should be under two. There’s discussions of the cave men were really one to one.

Dr. Bongiorno:                   It’s funny. I’m scrolling right now. I’m reviewing a book for a friend of mine, who is putting out a book, a medical doctor’s putting out a book on skin health.  Was putting out a book, medical doctor was putting out a book on skin health, and I was just reading the section on omega sixes omega 3 and he put out the latest research. Dr. Mark Tager, I don’t know if you know him, wonderful guy. And he’s got a book coming out on skin health and yeah, I don’t know if I can find it offhand. But I was just reading that on the train coming back, looking, reviewing his book, so.

Dr. Weitz:                          Okay. So what about probiotics?

Dr. Bongiorno:                   So probiotics, it’s again, the first step to a healthy gut is certainly reducing stress, getting enough sleep, exercising, eating the right foods, eating enough fiber. Right? So probiotics by themselves can be helpful, especially when therapeutically if there’s diarrhea, if there’s high levels of a C difficile, for example, using individual probiotics can be useful for balancing things, but overall to really create a healthy microbiome, we want to do all those other basics first.

Dr. Weitz:                           Now you know of course there’s probiotics on the market that are marketed as specifically being beneficial for depression and anxiety.

Dr. Bongiorno:                   Right. Yeah, and there are a couple of studies. And I remember when those first ones came out, there was a company that came out with a line and there was one study. And I tell you, I mean, the research on the microbiome, the microbiota and probiotics have just exploded in the past couple years. So, yeah, I think there’s more and more coming out about that. I mean, and now there’s studies that in animals, if you take an animal who’s depressed and you do a fecal transplant from an animal who’s not depressed, that you can actually lift their mood and their depression.

So there’s definitely something there. There’s no question about it. Whether we can get all the strains into a capsule that we can take in and actually help repopulate, I think that still remains to be seen. But if we can get some of the Keystone strains in there and get the right fibers and again, work on people’s stress and all the other basic factors, I think, yeah, I think it does make a difference. And I certainly use probiotics as part of the regimen when I work with my patients.

Dr. Weitz:                           And some of the keystone species are starting to become available. I interviewed researcher company, Pendulum Therapeutics has, I think it’s the first anaerobic Akkermansia.

Dr. Bongiorno:                   Yeah, I saw that. Yeah. And that’s interesting to me. And again, is giving an individual one like that the most beneficial, maybe. I think of the microbiota as kind of like a garden in there. And so we have tomato plants and we have zucchini and we have peppers and maybe some cucumbers on the bottom. And then, we have the weeds, maybe the ones we don’t want in there too great a level. And some of those we can put in a capsule and give to people, and some of them we just can’t. Right. So we have to do it through fermented foods and we have to do it through just making sure people getting.

Dr. Weitz:                           Fiber and probiotics.

Dr. Bongiorno:                   Yeah. Right. So there’s so much we need to learn, but I think it’s really fascinating. And I’m interested.

Dr. Weitz:                           How about the importance of B vitamins, including folic acid?

Dr. Bongiorno:                   Yeah. So B vitamins, especially for mitochondrial function, for producing energy in the body, for methylation which we nee to make neurotransmitters, which we need to break down neuro transmitters, and break down hormones properly. So we need those B vitamins and in different levels. And they’re certainly worth checking as well. And if I know somebody’s very, very stressed out, it’s usually a safe bet to put them on a low dose B complex at least start because you know they’re burning through those B vitamins.

Dr. Weitz:                           I remember there being some research on folic acid maybe helping patients with schizophrenia. By the way, have you found it effective to use a functional medicine approach for patients with schizophrenia?

Dr. Bongiorno:                   Yeah. I mean, absolutely. Probably even more so because in conventional care, schizophrenia is really about just lowering levels of neurotransmitters. Right. So if we could understand what are the blockages of why maybe people aren’t breaking those things down in their own brain and using that information then yeah, absolutely. So the first step is, again, all of the basics. There’s research now in schizophrenia is also showing a lot of mitochondrial dysfunction. A lot of psychotic mental health disorders may have to do with the mitochondrial dysfunction. So that’s certainly a place I think about when I think about working with patients who have schizophrenia.

Dr. Weitz:                           And what are your first thoughts about trying to improve the mitochondria?

Dr. Bongiorno:                   I guess I want to first think about, well, why is their function impaired? Right. So we think it could be toxicity, it could be heavy metals, could be too much iron in their body. It could be very high insulin levels due to high blood sugar. It could be high adrenaline, high, norepinephrine and epinephrine levels due to stress. There’s a number of reasons why mitochondrial dysfunction can start. Too much inflammation in the body can certainly contribute as well. So we want to look at all of those factors and key in on which one of those are probably most likely for that particular person.

There can be genetic influences too. Although and so when I think about people who have had mental health concerns since they were very, very young, like 3, 4, 5 years old, then I think, well, maybe it’s more of a genetic component in terms of mitochondrial function. Not that we can’t help them, but that it’s probably less environmental and more genetic. But if it’s people who the mental health concerns started happening in their late teens and certainly in adulthood, then I think about it more as a secondary mitochondrial function, based on those other factors.

Dr. Weitz:                           What kind of testing for heavy metals and/or other environmental toxins have you found helpful?

Dr. Bongiorno:                   Well, I mean, the first place to start is a blood test to look for things like mercury and cadmium and arsenic and lead and aluminum and things like that. And the problem with blood tests is that you’re not really seeing what’s going on with body burden. But you are seeing what’s going on acutely. So if you find high levels acutely, then you know you have to start working on that. And then you could do urine tests, provocated urine tests to try to find out what really the body burden is after that.

Dr. Weitz:                           For years, I know we used to use the DMSA and do provocation testing, and now that that’s prescription only, it’s a pain. Is there a workaround? Have you found anything? Can you use glutathione or anything like that?

Dr. Bongiorno:                   I mean, I really, haven’t. Not something I think I know would be really reliable. So I’d be interested if anyone listening has, but I haven’t. Yeah, no, still DMSA, that seems to be the DMPS seems to be the best way to go.

Dr. Weitz:                           Right.

Dr. Bongiorno:                   Yeah, it was nice when the supplement companies had them. Right. We just used it. Check kidney function first. If that’s okay then do a provocated urine.

Dr. Weitz:                           Right.

Dr. Bongiorno:                   Right. They’re making it harder and harder.

Dr. Weitz:                           Importance of vitamin D.

Dr. Bongiorno:                   Yeah. So vitamin D has so many pleiotropic effects in the body. It’s needed for serotonin production, certainly. So when vitamin D levels are lower, it’s going to be harder for the body to make serotonin and other neurotransmitters. And then it’s very important in how we balance inflammation in the body. So that’s another point. It’s a neuro steroid. So the neuro steroids pregnenolone, DHEA, and vitamin D, when any or all of those are low, there’s some really fascinating research that shows the communication between the amygdala, which is the fear center of the brain and the prefrontal cortex change significantly and creates a lot more likelihood of anxiety and depression. So when neuro steroid levels are high enough like vitamin D should be, then there’s going to be a less likelihood of things like anxiety.

Dr. Weitz:                           Minerals, like magnesium, zinc, lithium?

Dr. Bongiorno:                   Yeah. I’m for them. I’m for all of them. So yeah, some magnesium is very relaxing. It’s important. Has so many levels of importance, if I had to pick one in terms of what we’re talking about, GABA levels in the brain. It helps with the benzodiazepine receptors. Zinc, the zinc to copper ratio, looking at zinc levels as a co-factor for so many different reactions in the body, certainly for gut health as well. And then, oh, you mentioned lithium, nutritional lithium.

Dr. Weitz:                           Right.

Dr. Bongiorno:                   Actually I just wrote a paper on nutritional lithium that was published in the Natural Medicine Journal. I’d be happy to send it to anybody.

Dr. Weitz:                            Oh, that’d be great.

Dr. Bongiorno:                   If anybody would like a copy of it. And also anyone listening, please do join me on Facebook and Twitter and Instagram as well.  And if you want to be on my newsletter, feel free to send me a note. I’m putting out a mental health newsletter, so I’d be happy to send it out. Won’t be selling you anything, just purely research as I read it, things that I’m excited about, I like to send to my friends.

Dr. Weitz:                            That’s great.

Dr. Bongiorno:                   Yeah. So nutritional lithium, I found very, very helpful in my practice. I’ve probably been using it for about eight years now, nine years. And it’s great for teens with impulsivity, even younger kids in the five to 10 age group, it can really be helpful for anxiety in drop doses. Very supportive of the brain. Now there’s even research showing it may be protective for Alzheimer’s later on. So I do use a fair amount of it with patients, and I’m finding good results.

Dr. Weitz:                            So this is the lithium orotate, right?

Dr. Bongiorno:                   Lithium orotate. Yep.

Dr. Weitz:                            And what kind of dosage do you find effective?

Dr. Bongiorno:                   I usually start with five milligrams for an adult, maybe one milligram for child. Yeah. Up to 20 milligrams a day in an adult.

Dr. Weitz:                            What about GABA?

Dr. Bongiorno:                   GABA the supplement?

Dr. Weitz:                            Yeah.

Dr. Bongiorno:                   Yeah. No, GABA can also be helpful. Some people theorize that GABA is only useful if you have a leaky gut and a leaky brain, because it’s very difficult to get into the brain. And, I haven’t seen enough leaky gut patients versus non leaky gut patients that I’ve tested to know for sure whether that’s true. My theory is if you give enough, hopefully some of it will get through. So usually at least 500 to 1000 milligrams, two or three times a day. So if I’m using GABA I tend to dose it high. I find low doses don’t typically do a whole lot by itself. I’ll often give it with theanine and maybe with something like lithium orotate or a CBD oil. So usually I’m using a few things together. But I do find, especially for patients who are very susceptible to the side effects of benzodiazepines, you really want to think about using other gentler things like GABA. And oftentimes you can even find a better result because it’ll help calm people down, but you won’t have the side effects.

Dr. Weitz:                            And there’s a few different forms of GABA on the market. I know there’s GABA chewables. There’s GABA that supposedly is better absorbed.

Dr. Bongiorno:                   Yeah. I’ve been using liposomal GABA, the kind that you can kind of spray.

Dr. Weitz:                            Okay.

Dr. Bongiorno:                   And I’ve been finding good results with that. I’ve heard chewables can be useful too. I haven’t used them but I guess it’d be the same effect, right. Using a chewable, you’re kind of getting it into the oral cavity and getting absorbed through there. So that would make sense to me.

Dr. Weitz:                            I guess, yeah, theoretically, if you kept it under your tongue, and let it dissolve there. What about any of the other herbs? And then I think we’re going to wrap it up in a couple of minutes.

Dr. Bongiorno:                   Okay. Yeah, other herbs, I mean, I know it sounds cliche at this point, but St. John’s Wort is a very good herb for mood, especially for do you know?depression. And it does work for anxiety.

Dr. Weitz:                            Why has it been given an almost a bad name, do you know?

Dr. Bongiorno:                   I think because it’s known to affect the liver and its ability to process other drugs. So I’ve done some formulations for companies, and I have one formulation to support neurotransmitters and for depression. And I purposely didn’t put St John’s Wart in it because I know it won’t be used. So when I use it in my practice, I actually use St. John’s Wort separately with it, because it does affect a lot of drugs more than others. So I think a lot of practitioners tend to stay away from it. I had one patient who came in, she took St John’s Wort while on birth control. And she got pregnant because it stopped. So there is a reason. It turned out she had twins and was very happy about that in the end so it worked out great.

Dr. Weitz:                            So St Johns Wort makes it easy to get pregnant.

Dr. Bongiorno:                   But I like St John’s Wort, especially now in the time of COVID, because also, it’s a good antiviral. It has anti-inflammatory effects plus it’s really great for mood. It’s a beautiful herb.

Dr. Weitz:                            And you mentioned using lavender. You also listed rhodiola saffron in your book.

Dr. Bongiorno:                   Yeah. So saffron, especially when there’s a lot of digestive issues. I have another formulation that I put together, and it has chromium, saffron, turmeric, berberine in it, and a little bit of rhodiola. And the idea of that is to kind of address blood sugar, gut inflammation, hypothalamic pituitary, adrenal access. And the berberine to kind to help promote neurotransmitters in a healthy way as well as helping the gut.

Dr. Weitz:                            So how does berberine promote neurotransmitters?

Dr. Bongiorno:                   So berberine, it’s not something that’s well discussed, but berberine actually binds to Sigma one receptors which help this pathway of chaperone proteins. It’s also helped neurotransmitter production in the brain too. So it is known to help.

Dr. Weitz:                            Berberine is an incredible herb.

Dr. Bongiorno:                   I mean, yeah. Cholesterol, blood sugar. Yeah, gut health.

Dr. Weitz:                            I mean, it’s a natural form of Metformin, so I use it for antiaging purposes as well.

Dr. Bongiorno:                   Yeah. I remember learning about it in school again, 25 years ago. And the only thing I remember learning about it was that it was a good natural antibiotic and kind of helped the gut heal at the same time. Yes. And now it’s just so much more. It’s great.

Dr. Weitz:                            And probably the other wonder nutrient is NAC which you mentioned in your book and seems to be beneficial for almost everything.

Dr. Bongiorno:                   Yeah. And NAC is so good that Amazon has taken it off their website. That’s how good it is.

Dr. Weitz:                            So, well…

Dr. Bongiorno:                   It tells you it’s pushing some buttons. Right?

Dr. Weitz:                            Well, I think the reason they did it is because when it was first approved, it was approved as a drug.

Dr. Bongiorno:                   Right.

Dr. Weitz:                            So hopefully the FDA’s not going to take it off the market. I mean, even though Amazon… To be honest with you, if Amazon said they were going to take all the supplements off of Amazon, I’d be quite happy.

Dr. Bongiorno:                   That’s fine with me. Yeah.

Steve Snyder:                    Can I just pipe in on that for a second on the NAC thing. We think it’s not a thing. We are not stopping making it. We will continue to make it.

Dr. Bongiorno:                   Great.

Steve Snyder:                    There was one study, like in the early sixties that they’re trying to say is the reason that they think it might be a drug. But they haven’t changed any regulations or any classifications or anything like that. It was just a bunch of warning letters last fall. Amazon, because they’re a forward facing, a retail facing company, that’s why they did it. And then Whole Foods Market is owned by Amazon so they did it. And then Thorne is kind of the supplement company that got caught up in it because they pretty much only do Amazon now. So that’s where it kind of the ball got rolling, but it’s another one of those mostly it’s an internet thing. And we are selling it like crazy. We can’t literally can’t make it fast enough, something to the tune of about 5,000 bottles a month.

Dr. Bongiorno:                   Wow.

Steve Snyder:                    So yeah. But it’s not going away. We were not worried about it at all. And we have a great one. It’s super inexpensive, 600 milligrams per cap. Check it out.

Dr. Bongiorno:                   Hmm, great.

Dr. Weitz:                          Maybe come up with a strategy to get Amazon to take more supplements off their website.

Dr. Bongiorno:                   I just wanted to say Steve, I really love the cortisol manager. I find it also works quite, quite well for my patients. And cortisol levels are high and something I’ve been using for a number of years is really good success too.

Steve Snyder:                    Thank you. It’s by far our biggest selling product. It also happens to be natural partners, biggest selling product and probably Emerson too. So it’s definitely our flagship for sure.

Dr. Weitz:                            And you guys also have a brain product that has saffron in it.

Steve Snyder:                    Yeah. So that one’s pretty new. It’s called Neurologix. I don’t know if you’ve seen it yet, but it’s a combination of spearmint, saffron, and and a branded citicoline. So it’s a pretty big anti-inflammatory part. The spearmint and Citicoline part work functionally and structurally, but the saffron is kind of an added thing because we feel like the mood is part of all of that. And individual ingredients have been shown to like it’s working memory, sustained attention, focus, some pretty impressive studies on this stuff. So it’s not cheap, because it’s one of the ones that doesn’t have caffeine in it. So it’s not a stimulant, but i blows people’s doors off. And that’s another one we have seven day trial bottles of, and people will notice it after seven days. And we are happy to let them try it because we know it works so, Neurologix.

Dr. Weitz:                            Okay. Thanks, Steve.

Steve Snyder:                    Yep.

Dr. Weitz:                            So Peter, this has been incredible. You’ve provided us with so much great information. Any closing thoughts?

Dr. Bongiorno:                   Yeah. I mean, to the clinicians out there, when you have a patient who, especially if it’s a challenging patient, always double down on the basics. Make sure that those are all taken care of. And just really look for the other underlying factors that maybe you haven’t looked into yet because there’s some reason why a person is feeling the way they’re feeling. And it’s really up to us as clinicians to kind of look at all those factors and really put it together because there’s practically always a way to help to get people to feel better. If not get them off medications, at least get the medication doses lowered which often could be a win, especially in things like bipolar. You’re creating so much less toxicity in the body.  And to any listeners there in the public who are suffering from anxiety, depression, mental health, just know that there’s still a lot of tools out there, and find a practitioner who just really cares and is listening and wants to look into those underlying factors because there’s always something else that can be done. And just don’t give up hope, and don’t give up thinking that you can feel better and feel like your best self.

Dr. Weitz:                            Thank you.

Dr. Bongiorno:                   Yeah. Thank you. Thank you so much for what you do and bringing these forums to people.

Dr. Weitz:                            Great. Thank you. And we’ll see everybody in the new year.

 


 

Dr. Weitz:  Thank you for making it all the way through this episode of the Rational Wellness podcast. And if you enjoyed this podcast, please go to Apple podcast and give us a five star ratings and review. That way more people will be able to find this Rational Wellness podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. So if you’re interested, please call my office 310-395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.

 

 

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