Functional Medicine Approach to Depression and Anxiety with Dr. Michael Gruttadauria: Rational Wellness Podcast 285
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Dr. Michael Gruttadauria discusses a Functional Medicine Approach to Depression and Anxiety with Dr. Ben Weitz.
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2:24 Dr. Gruttadauria first saw a patient with severe depression six years ago. He was 23 years old and he seemed to have a lot going for him but he was severely depressed. He had been to see a number of doctors, was going to talk therapy, and had been on multiple medications and nothing was helping him. He had a good job, had a girlfriend, and was in a band that had just signed a record deal. He was also working out five days per week and was eating a healthy diet. And he did not have any childhood trauma and had a great childhood. Dr. Gruttadauria concluded that this patient’s depression must be physiological rather than psychological. He ran a series of labs and looked at stool testing and epigenetics. This patient had MTHFR, gut dysbiosis, food sensitivities, and issues with nutritional deficiencies. After correcting these things with a diet, lifestyle, and nutritional supplement approach, his depression was gone in six weeks.
6:34 The Neurotransmitter theory of depression. Patients with anxiety and depression are often prescribed medications that typically increase serotonin levels in the brain, such as the SSRIs, since the hypothesis is that depression is caused by a deficiency in serotonin in the brain. This hypothesis that mood disorders are caused by deficiencies or imbalances in the neurotransmitters not only is not true, but even if it were, it doesn’t get to the root cause, which is why do they have a neurotransmitter imbalance? There is a concert of neurotransmitters that function in the brain. Glutamate gets the brain excited and GABA calms the brain and then there are all these dimmer switches, which are serotonin, dopamine, acetylcholine, glycine, and all these other neurotransmitters. All of these neurotransmitters are made from amino acids contained in protein foods. Tyrosine makes dopamine and tryptophan makes serotonin. But you have to go through a series of biochemical steps to make that happen. So, if our epigenetics are skewed, which we all have these epigenetic weaknesses called SNPs, you may have a genetic predisposition to make a little less serotonin or dopamine than somebody else might. Or if your diet’s deficient in protein, or you have a gastrointestinal issue and you’re not digesting and absorbing protein, you’re not going to have the building blocks for these kinds of transmits, or you have nutrient deficiencies that affect your ability to methylate, this will keep you from producing these neurotransmitters. And if you don’t produce enough serotonin, then an SSRI medication will not have much effect.
17:06 When we look at the underlying physiological triggers for mood disorders, first we need to understand that inflammation is an underlying factor in all chronic illness, including mood disorders. Depression is essentially an inflammatory disorder, essentially chronic neuroinflammation. Over time, neuroinflammation will become neurodegeneration and we end up with Alzheimer’s and other neurodegenerative diseases. We need to look for the some of the underlying triggers for inflammation, which includes diet, toxins, and gut function. If we don’t assess the gastrointestinal system, we are missing the boat. There is such a connection between the gut and brain that if the gut is on fire, the brain is on fire. One of the things that happens is a change in our nervous system from parasympathetic dominance to sympathetic dominance, which slows down the motility of the gut, which adversely affects the microbiome. Dr. Gruttadauria prefers using the GI Map stool test to assess the microbiome and gut health. By treating the gut, we are not treating depression but restoring health, which results in less depression.
23:37 Diet. If the patient is starting with the Standard American diet and they are eating junk food and drinking 3 cokes a day and they live on Ring Dings, then just taking away all that processed food will be a massive shift. And getting people to drink water is a big shift for a lot of people. Many people only drink soda, coffee, and juice. Reducing chronically elevated blood sugar is an important thing. We also need to remove food sensitivities. The dietary approach that Dr. Gruttadauria feels is best is a paleo style diet with lots of plants and significant amounts of protein. If we can get people to eat vegetables and lean proteins and we can get them to drink water and go out in the sun and exercise 20 to 30 minutes a day, probably we’d knock out 50% of the depression and anxiety.
25:15 The importance of Sleep and Circadian Rhythm. The brain has two pacemakers. One is driven by movement and the other is driven by light. We have receptors in the back of the eye called melanopsin receptors that pick up light, transcribe it, and drive the hypothalamus. And it drives an area of the brain called a super charismatic nucleus, which generates this day night cycle. Most of us have overexposure to blue light due to indoor lights, due to looking at our phones and computer screens, and due to staying up and watching TV till late. This can dysregulate our cortisol melatonin rhythm, and that changes everything about our brain.
30:23 Nutritional Supplements. Nutritional supplements are recommended that testing shows they are low in, such as vitamin D, omega 3, vitamin B12 or magnesium. Dr. Gruttadauria likes to use herbals to reduce bacterial overgrowth in the gut, followed by gut healing protocols. If patients have a lot of inflammation, he will use fish or krill oil. He will also use anti-inflammatory nutritional products like Boswellia or Inflammatone by Designs For Health. He likes protein shakes like MediClear by Thorne, which is a pea based protein with a lot of vitamins and minerals. Dr. Gruttadauria also often recommends free form amino acids. He often recommends magnesium threonate, which does a good job crossing the blood brain barrier. He also likes the product NeuroCalm by Designs For Health, which helps with anxiety. Of course, chiropractic adjustments are also very helpful in normalizing the nervous system. He will sometimes recommend low dose lithium orotate at a dosage of 5 mg per day, which can be very helpful and is quite safe at this low dosage.
Dr. Michael Gruttadauria is a Doctor of Chiropractic with a Board Certification in Chiropractic Neurology and he is on the Advisory Board of Functional Medicine University. He is the CEO and Director of The Optimum U, which is his private practice in New York. Dr. Gruttadauria is also the Founder of the SameHere Global Functional Doctor’s Alliance, which is an international mental health non profit dedicated to spreading the word about mental health and not just mental illness. Practitioners interested in joining this alliance can send him an email to firstname.lastname@example.org.
Dr. Ben Weitz is available for Functional 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.
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.
Hello, Rational Wellness podcasters. Today, we have an exciting discussion on a functional medicine approach to anxiety and depression with Dr. Michael Gruttadauria. Dr. Michael Gruttadauria is a doctor of chiropractic with a board certification in chiropractic neurology. He’s on the advisory board of Functional Medicine University, and a CEO and director of the Optimum U. Rates of depression and anxiety in the United States were already quite high, but then the pandemic hit that we’ve just lived through since 2020, and we’ve seen an increase in the rates of these disorders by approximately 28 and 26%. Depression is a mood disorder involving feeling sad, that is distinct from normal mood swings and short term emotional responses to the daily challenges of life. Depression can be dangerous to your health, especially if it’s severe. It can result in the depressed person suffering and being unable to perform well in school, work, and social life. Severe depression can even lead to suicide. And every year, over 700,000 people die by suicide in the United States. Anxiety involves fear or uneasiness of future situations and problems and can lead to behavior that avoid situations that might trigger this anxiety. This can also affect job, academic, and personal relationships. And 62% of Americans report feeling anxious at some point in their lives. Dr. Gruttadauria, thank you so much for joining us. I hope I pronounced your name correctly.
Dr. Gruttadauria: Yes. You did a really, really good job. I’m very, very happy to be here, and I really appreciate you having me on.
Dr. Weitz: So, how did you get interested in treating patients with mood disorders?
Dr. Gruttadauria: Oh my goodness. About probably six years ago, I was in my office and I had a patient call me up and say, “One of my friend’s sons is really in trouble. Can you see him?” And I said, “Sure, I’ll be happy to see him.” And she goes, “No, can you see him tonight?” And I said, “Yeah, what’s up?” And she said, “He’s tremendously depressed. He’s at the end of his rope. He’s been to every doctor. He’s been on every medication, and he needs to meet with you.” So, I said, “Sure.” So after hours, in walks this young man and his mom, and just this handsome, vibrant, young 23 year old man. And I sit down and we start talking and he’s telling me about his life. And he says, “I graduated from college and I have a great job. I moved back in with my parents. I work with my dad on the weekends. I work out five days a week. I eat a healthy diet. I have a girlfriend. I’m in a band, a rock band, and we just got signed to a record label.”
Dr. Weitz: Wow. Sounds like he’s got everything going for him.
Dr. Gruttadauria: I said, “It sounds to me like you have the perfect life. What am I missing?” And he said, “Every morning I wake up with this overwhelming feeling of dread and loss of energy and lack of motivation, and I just have a hard time going on, and I’ve had some really dark thoughts. And I’ve been on multiple medications and nothing has helped me. I’ve been in therapy.” And I said, “Tell me about your history. Have you ever been traumatized, emotional, physical, any kind of trauma?” He said, “No, I had a great childhood. I’ve never experienced any real trauma.” And that’s when the light bulb went on. And I said, this is physiological. Something is wrong with this young man. This isn’t… And I’m going to challenge the idea that depression and anxiety are diseases, because they’re looked at as… These labels are given to people, and it’s almost as if it’s a disease, but we can’t send somebody for an MRI or a blood test to look for depression or anxiety. They don’t exist, because really, depression and anxiety are the culmination of a series of dysfunctions that happen in the nervous system as a result of what’s going on emotionally, what’s going on in our environment, what’s going on epigenetically, what’s going on with our diet. All these factors all play in, and the perfect storm comes together to form what we label as anxiety and depression. So, I went on to do a whole series of labs and we looked at his stool testing and we looked at his epigenetics. And of course, he has MTHFR and he has gut dysbiosis and he has food sensitivities, and he has multiple issues with nutrient density and so on. And literally within six weeks, this young man’s depression was gone. And I said, “It’s amazing that you’ve been feeling this way for three years.” He goes, “No, I told you it was three years, but I never told anybody. It’s been eight years that I’ve been suffering with this. I just never wanted to tell anybody.”
So, we have an epidemic of these issues, these anxiety and depression. But again, we really need to start looking at mental health and not just looking at the disorders. Because what that does is it creates a barrier. It says Americans constantly promote the fact that one in five people has a mental health disorder, anxiety, depression, bipolar, whatever it might be. But what that infers is that 20% of people have this problem, and the rest of us 80 percenters are fine. And that’s just not true because we’re all impacted by stress. We’re all impacted by lifestyle challenges. And the fact that we’re sitting down and lying down 90 plus percent of the day, and we don’t get enough sunlight exposure, we eat food that’s toxic, and all of the different challenges that we have in American living, and it’s no wonder that we have such a high rate of mental health challenges. And we just need to start talking about it because we hold it in. And as a result, it only gets worse.
Dr. Weitz: So, his depression wasn’t caused by a deficiency of Prozac?
Dr. Gruttadauria: Exactly, exactly. And it’s funny. It’s great that you say that because I use that term all the time. You certainly do not have a Prozac deficiency. And it’s incredible because they’ve actually just recently come out and said, “Well, that whole serotonin hypothesis where we have a serotonin deficiency really isn’t true.” So, for the last 30 years we’ve been giving people SSRI medications, literally hundreds of thousands of them every year, and they give people some relief, some-
Dr. Weitz: But that’s a predominant theory of depression and anxiety, is that they’re caused by neurotransmitter imbalances or deficiencies.
Dr. Gruttadauria: So, then the question from our perspective, from a functional medicine perspective is, why does somebody have a neurotransmitter deficiency?
Dr. Weitz: Right.
Dr. Gruttadauria: I mean-
Dr. Weitz: What’s the root cause? Yeah.
Dr. Gruttadauria: What’s the root cause? Why? I mean, we know that serotonin and dopamine, modulatory neurotransmitters. We have… The brain gets turned on by glutamate and it gets turned off by GABA. Those are the on and off switches. And then we have all these modulating, if you think about it as almost like dimmer switches, serotonin and dopamine, acetylcholine, glycine, all these other neurotransmitters, and they’re made from protein. They’re made directly from amino acids. Tyrosine makes dopamine and tryptophan makes serotonin. But you have to go through a series of biochemical steps to make that happen. So, if our epigenetics are skewed, which we all have these epigenetic weaknesses called SNPs, you may have a genetic predisposition to make a little less serotonin or dopamine than somebody else might. Or if your diet’s deficient in protein, or you have a gastrointestinal issue and you’re not digesting and absorbing protein, you’re not going to have the building blocks for these kinds of transmits, or you have nutrient deficiencies because we know that methylation, this process called methylation is involved. So many different pieces of the puzzle that are just not being looked at. You walk into a psychiatrist’s office and you tell them that you have depression, and within 15 minutes, you’re pretty much walking out with a prescription.
Dr. Weitz: Right. Now, interestingly, they’re often walking out with a prescription for SSRI, which is designed to increase serotonin, but there’s actually one medication on the market that decreases serotonin and seems to have equal efficacy as the medications that increase serotonin.
Dr. Gruttadauria: It’s crazy because actually, what they’re doing is… An SSRI medication is actually designed to make the serotonin that your body has in the synapse between the nerve cells stay in there longer.
Dr. Weitz: Right.
Dr. Gruttadauria: The uptake inhibitor, and it stops it from being taken up into the following cell. But what if your body’s not producing as much as it should to begin with?
Dr. Weitz: Right.
Dr. Gruttadauria: You get the label of treatment resistant depression.
Dr. Weitz: Right.
Dr. Gruttadauria: Because you’re resistant to the treatment we’re trying to give you, which is the standard of care, well, now you have treatment resistant depression, and we don’t really know what to do with you. Maybe TMS, maybe we’ll try ketamine next, maybe we’ll try electroconvulsive therapy. And you have all these other things that are trying to kill the depression, which is, again, the symptom that happens as a result of all these others.
Dr. Weitz: Yeah, it’s interesting that ketamine and low dose hallucinogens are the new treatment for depression.
Dr. Gruttadauria: Right. And that’s the whole thing. If we step back and we think about the word treatment, what are we actually treating if we can’t see it? We’re treating the symptom and we’re never really looking for the root cause.
Dr. Weitz: Right.
Dr. Gruttadauria: That is the biggest challenge that we face in a functional health environment, is working with people that have these mental health challenges and helping them to understand and make changes to their lifestyle when they feel at they’re worst. So, it’s not that easy.
Dr. Weitz: Right. So, when you have a new patient who’s coming to you, say, with depression, how do you assess them? How do you decide what testing to do?
Dr. Gruttadauria: So, I’m very lucky to be working in an environment where I work very closely with psychologists and psychiatrists. So, a lot of times, they’re in counseling, because as a functional medicine practitioner, I want to make sure that they have the emotional support that they need. And we look for integrative psychologists, people who are looking to do breath work and who are really open to the ideas of functional medicine, as well as yoga and all these other techniques, because we need to rearrange the way the brain is working. It’s not just about talk therapy. It’s a great modality, but it’s one of many. What I do then, because I have this background in neurology, I always want to assess the brain because these are really neurological issues. And what we see is, and there was actually just an article recently in Psychology Today, can concussion cause depression? And the answer is yes. And actually, this happened to me, Ben. When I was in graduate school, I was in a car accident, and I went through a windshield, believe it or not.
Dr. Weitz: Oh wow.
Dr. Gruttadauria: And after having head injury, neck injury, and about three months of rehabilitation, I was back and everything was fine. And one day I’m driving in my car and I have this massive tunnel vision, my heart starts to pump, and I’m having what I thought was a stroke at 22 years old. And meanwhile, I was in the best shape of my life, I was competing in body building, I had the great… Everything was fine. And I get to the hospital and they tell me I have a panic attack. And I said, well, I just went through a windshield. And they said, no one thing has nothing to do with the other. And for about five years, I had emotional dysregulation, up and down, up and down, and everybody just wanted to throw drugs at me. And I said, I know that this is due to my head injury. I smashed my head. And they didn’t want to know about it. So, from a functional neurological perspective, we look at brain stem issues and we look at eye movements and we contract them and videotape them. We look at computerized balance assessments. So, we really need to get an idea of what’s going on in the brain. Then we need to look at blood, urine stool, food sensitivities, toxicology, all these different things. And everybody’s different, so we don’t have to run every test on everybody, but it really starts with the questions. Tell me about your life. What’s happened to you? Tell me your story. And that brings me to really this amazing organization that I work with, which is called Same Here Global. A few years ago, I was posting all about depression on my Facebook page and I get on one of the posts from a gentleman that I really never met before. His name’s Andrew Pleener. And he reaches out to me and says, “Listen, I’m an integrative psychiatrist in Florida and I work with a gentleman named Eric Cuson who started an organization called Same Here Global. Can you tell us why you are working with people with depression when you’re not a psychiatrist or a psychologist?” And I gave them the whole overview of the functional medicine, functional neurological approach, and then I put together a presentation. And they said, “We want you to build a network of like-minded doctors. We want you to find functional medicine, functional neurology, integrative medicine, anybody who is interested in helping us to get this message out.” And really, the story behind Same Here was that this gentleman, Eric Cuson, was a big time executive in the sports world. He was on his way to becoming the the CFO of a major basketball franchise, one of the NBA franchises. And at 38 years old, wakes up and basically has a nervous breakdown. Had no idea why. Everything was great in his life. And he started the merry go round of going to the best doctors. And literally 52 medication combinations later and two and a half years, had to move back in with his parents because he was unable to function. And he was told by the doctors at Cornell in Manhattan, “Your last resort is electroconvulsive therapy.” Nobody ever did any blood tests on him. Nobody looked at his stool, nobody did epigenetic testing. Nobody did anything but prescribe medication for this guy.
Dr. Weitz: Of course.
Dr. Gruttadauria: And afterward, he ends up in an integrative psychologist office because nothing worked. He was just as bad as he was. He was worse. And they said, “Tell me about your story. Tell me about your life.” And it was really interesting to him that they didn’t just say, “Tell me about your depression,” because he realized that it wasn’t just about the label. And he tells the story… He’s much better at telling it than I am, but essentially when he was a little boy, he had an older brother. His older brother ended up getting cancer, and his family was in this tumultuous, crazy situation for years, multiple years. Eventually pulls out of it. Then, so it was like his life was upside down for years, tremendous amounts of stress as a young kid. Then the same brother was in the back of a Jeep when he was in high school. And the Jeep gets into an accident, he has a head injury, he goes into a coma.
Again, the whole family is in total, total upset. And then in college, the brother ended up having a relapse of his cancer. So, it was literally like a decade of massive amounts of stress. And the way the psychologist explained it was, imagine you were at a mud wrestling event and you’re in the front row. You’re not wrestling, but every time somebody throws somebody down, it splashes onto you. So, time the event is over, you are just as covered in mud as the person in the wrestling match. And that hit me so hard. I thought that was the greatest analogy. And that stress causes changes in us. It causes changes in our brain, in our nervous system function. We end up in a constant fight or flight mode. We end up with changes in our adrenal glands, neurochemistry. Everything changes as a result of stress. And unless we get to the bottom line and help people to not only understand what’s going on in their bodies, we can actually reverse these things. And that’s what we do. And it’s like magic when you get to help somebody that nobody else has been able to help, because we’re really just looking at a common sense approach to restoring health versus treating illness.
Dr. Weitz: So, let’s go through some of the underlying physiological triggers and things that you might see coming back from testing that’s going to help you treat patients for these mood disorders like depression and anxiety. List off some of the most important factors. One thing I want to touch on is blood sugar balance.
Dr. Gruttadauria: Yes. So, inflammation is… And I know you’ve talked about this hundreds of times on your podcast. Inflammation seems to be an underlying factor in all chronic illness, including mood disorders. Depression is actually an inflammatory problem. So, when we have chronic inflammation… Inflammation is essentially a chemical and cellular response to injury, and it’s normal. It’s a very healthy response. It’s part of the immune system. But when it becomes a chronic problem, then it changes our biochemistry overall. And when chronic body inflammation gets to the brain, it causes something called neuroinflammation. Now, the brain has its own immune system, and we have these things called microglia, which are these supportive cells that react in such a way that it creates this ongoing chronic neuroinflammation. Eventually, that newer inflammation causes changes in brain function, so people show up with brain fog, chronic fatigue, anxiety, depression, headaches. All those things are all as a result of changes neurologically. Eventually, that neuroinflammation will become neurodegeneration and we end up with other things like Alzheimer’s disease and other neurodegenerative diseases.
So, we need to understand what is somebody’s inflammatory load? Where do people get inflamed? They get inflamed through their diet and toxins, through many different factors. But one of the biggest things really is gut function. And that that’s really almost the foundation for everything. If we don’t assess the gastrointestinal system, we are missing the boat. There is such a direct link between the gut and the brain that actually, in functional medicine, and I’m sure you’ve said this a million times, the gut’s on fire, the brain’s on fire. They work together. There are more neurons, more nerve cells in the gut than there are in the entire spinal cord.
Dr. Weitz: So, how do you assess the gastrointestinal function?
Dr. Gruttadauria: Yeah. So, one of the things that we know happens is when we have these issues, we usually have a shift in nervous system function toward sympathetic dominance. So we have a sympathetic and parasympathetic nervous system and they work opposite each other. When sympathetic systems high, parasympathetic is low, and vice versa. We’re only supposed to be in sympathetic mode one 10th of 1% of the time. It’s really like an emergency mode. And we’re supposed to live in a parasympathetic dominance, meaning rest and digest. Our body’s supposed to be at rest and we’re supposed to have this normal digestion. But when we’re in this hyper stress mode where we’re in the sympathetic dominance, we can test for that. We can look at heart rate variability, we can look at pupil diameter. We can look for all these other things that tell us about sympathetic nervous system function.
But what ends up happening is we have a shutdown of the gut. So, if we slow down secretions in motility of the gut, now we have changes in what we call the microbiome. And the microbiome is this bacterial colony that we found in the late two thousands that we didn’t even know existed. We used to think that all bacteria was bad, so we got crazy about antibacterial soap and Purell and taking antibiotics every time we had a sniffle. Now, what we realize is for decades, we’ve been damaging this amazing organ that we have called the microbiome, which is a collection of bacteria and other microbes that actually have a relationship with us and live inside of us.
Dr. Weitz: Just think about all the damage to the collective microbiome from the use of 20 zillion tons of hand sanitizer over the last couple of years.
Dr. Gruttadauria: Just think about it, right? And again, we are so vigilant about this-
Dr. Weitz: And Lysol and all these other chemicals.
Dr. Gruttadauria: I mean, it’s crazy because we’ve been brainwashed into thinking that all bacteria was bad and we need to sanitize everything. I remember as a kid, mom used to spray my whole room with Lysol. “Sleep on that pillow.” I’d be like, “This pillow smells like Lysol.” [inaudible 00:21:41] that in every day. Sorry, mom. But as it turns out, we are exposed to so many chemicals, so many.
Dr. Weitz: How do we assess the microbiome? How do we assess the gut? Is it a stool test? Is it other testing? What do you [inaudible 00:21:56]?
Dr. Gruttadauria: Stool testing is number one.
Dr. Weitz: What’s your favorite stool test?
Dr. Gruttadauria: I’m a big fan of the GI Map.
Dr. Weitz: Okay, yeah, that’s what I use too.
Dr. Gruttadauria: Yeah, so the GI Map is really… It gives us a really good appreciation for what’s going on in the gut. So, we have this whole healthy bacterial colony. We know that we have other bacteria that can live inside of us, just at low levels. It’s okay. Our body can handle it. But sometimes we have an overgrowth of bacteria and we have an undergrowth of healthy bacteria. We can end up with parasites and yeast and just functional disconnection in how the gut is supposed to function. And then next thing you know, you have reflex back to the brain because the communication between the microbiome, the immune system and the nervous system is so powerful that everything changes as a result of the gut. So, it’s an amazing test. I mean, I tell all my patients, five years from now, this is going to be standard of care. Right now, we’re the only ones doing it.
Dr. Weitz: I think maybe 15 years from now, because how long it takes for conventional medicine to change.
Dr. Gruttadauria: Yeah, it’s really a shame, but I think people are amazed when we have this initial conversation about how we’re going to approach this. And again, I’m not treating depression. I’m restoring health to people.
Dr. Weitz: Right.
Dr. Gruttadauria: And it’s a huge distinction between those two things. And they really understand that that’s what I want. I want to feel good, I want to feel healthy. And what we need to do is figure out where the imbalances are. And at a very basic level, what you and I do is we take away what’s hurting people and we give them what we’re missing.
Dr. Weitz: Yeah.
Dr. Gruttadauria: The body does the magic. We’re just facilitating it.
Dr. Weitz: So, let’s talk about diet. What’s the best dietary approach for depression and anxiety? And I’m sure it depends on each person.
Dr. Gruttadauria: Well, of course, but it really depends on what’s going on with that person’s diet when they start. So, if you have somebody come in and they have the standard American diet and they’re eating fast food and drinking three cokes a day and five coffees and they live on Ring Dings, I mean, just taking away that stuff is a massive shift.
Dr. Weitz: Right.
Dr. Gruttadauria: Blood sugar, elevated blood sugar, chronically elevated blood sugar causes chronic inflammation. So immediately, their whole body shifts. Getting people to drink water, which is a shocking thing. We take that for granted, but it’s… You’d be surprised… I’m sure you’re not, but many people would be surprised that people do not drink any water.
Dr. Weitz: Absolutely.
Dr. Gruttadauria: Soda, coffee and juice, and that’s it. No water. So with somebody like that, it’s real easy. We just got to do a cleanup. But sometimes people have challenges to foods that they think are really good for them, but their body’s reacting negatively, so long term gut dysfunction creates changes in actually the intestinal lining and we end up what’s commonly called is leaky gut, which is an intestinal permeability problem. Now, people can react to foods that are usually good for people, but it might be terrible for them. They have a sensitivity to eggs or dairy or common foods, and that’s creating this chronic immune system dysregulation. And again, the immune system and brain are one in same. They worked so hand in hand.
Dr. Weitz: How important is sleep and circadian rhythm?
Dr. Gruttadauria: Oh my goodness, I’m so glad you brought that up. The brain has two pacemakers. One is driven by movement. So every time we move, signals is sent to the brain and it powers it up, and the other one’s driven by light. And we have receptors in the back of the eye called melanopsin receptors that pick up light, transcribe it, and actually drive the hypothalamus. And it drives an area of the brain called a super charismatic nucleus, which generates this day night cycle. And we know that this rhythm that we were born to have on a regular basis is so imperative to normal brain function. But if you think about the overexposure to blue light that we have due to technology, due to indoor lights, due to staying up and watching TV till two o’clock in the morning, it disregulates our cortisol melatonin rhythm, and that changes everything about our brain. We have so many challenges to live in a technological-
Dr. Weitz: What do you about restoring circadian rhythm for your patients?
Dr. Gruttadauria: The number one thing is, again, depending on what their lifestyle is like… I mean, you have people that work the night shift. And we know, I mean, studies are very, very clear that people who work the night shift disrupt the circadian biology and they have poor health outcomes over the long term. So, one of the things that I do is I have people wake up when the sun comes up and sit outside for 15 minutes and watch the sun come up. I know if people are like, “Oh my god, that’s so early.” Listen, do you want to get your brain back? These are the things you need to do. And then after dark, we have them wear blue blocking glasses. So, you could get inexpensive pair of 100% blue blocking glasses on Amazon for 20 bucks. But it’s really, really important that they wear it to reduce the amount of blue light.
So, in any room, in any room that we’re in right now, we have this white light, but white light really is made up of all the colors of the rainbow. But in order to make a computer screen or an iPhone stand out against the rest of the room, it has to be very powerfully driven with blue frequencies. And those blue frequencies are very damaging when overexposed. It’s like eating… They’re fine when it’s combined with everything else in white light, but if you just have blue, it totally messes us up. And I’m sure these studies are never going to come out because there’s so much money being made in technology that nobody’s ever going to admit that we’ve been really messing up by having this massive overexposure to technology.
Dr. Weitz: And what about the importance of sleep?
Dr. Gruttadauria: Well, I mean, we need to restore sleep. That’s when the brain regenerates itself. So, I think when we help people to get their circadian rhythms back, then their sleep becomes restored. But again, how many people come in when they have these chronic mental health challenges and they’re on six to 10 different medications? They’re on medications for pain, they’re on medications for sleep, they’re on medications for stomach problems, they’re on medications for the anxiety or the depression. So, I mean, at what point do we realize these medications and this particular combination of drugs has never been studied in this particular person’s chemistry and their epigenetics. So, how much of that is contributing to their problems? Another study that came out that said they tested a thousand different medications and realized that 25% of all of the common these thousand common medications have antibiotic like effects on the gut microbiome. So, even though they’re not antibiotics, 25% of all drugs damage the microbiome.
Dr. Weitz: Wow.
Dr. Gruttadauria: Crazy.
Dr. Weitz: There’s a clinical pearl for you. So, I asked about diet, but is there kind of a dietary approach that you think this is… Forgetting about the person who’s just following a standard American diet and you’re going to clean it up, let’s say you got somebody who comes into your office and they’re suffering from some level of depression and they want to optimize their health. What kind of dietary approach do you think might be best?
Dr. Gruttadauria: After years and years and years of doing this, what I feel is the best approach is a paleo style diet. People have a plant based diet with a significant amount of protein. And I’m big fan of eggs and meat, and so on. And so I really feel like people need to be getting at least one to one and a half grams of protein a day per pound so that they’re able to maintain it. Because it’s not how much protein you take in, it’s how much you digest and absorb that really matters.
Dr. Weitz: Right.
Dr. Gruttadauria: So, we have to make sure people are digesting appropriately, so sometimes we’ll use digestive enzymes. We have to heal the gut. That’s a big, big piece. So, we have that dysbiosis and that inflammatory issue. But I mean, if we can get people to eat vegetables and we can get eat lean proteins and we can get them to drink water and go out the sun and exercise 20 to 30 minutes a day, probably we’d knock out 50% of the depression and anxiety.
Dr. Weitz: Right. There you go. I recommend a similar approach. I would call it a low glycemic Mediterranean diet. You’re calling it a paleo diet, but sounds very similar.
Dr. Gruttadauria: Yeah, very, very similar. Exactly.
Dr. Weitz: So apart from diet, we have nutritional supplements, and some can be of real benefit for depression and anxiety. Maybe you can talk about some of the benefits of specific nutritional supplements.
Dr. Gruttadauria: Okay.
Dr. Weitz: Obviously, it depends on the person.
Dr. Gruttadauria: Depends on the person, and a lot of times based on their labs. One of the things that we want to make sure is that they have a proper zinc copper balance, because that plays a big role in what’s going on neurologically.
Dr. Weitz: Now, do you measure serum zinc and copper or do you measure plasma?
Dr. Gruttadauria: Yeah, pretty much in every patient?
Dr. Weitz: Okay. Serum versus plasma? Okay.
Dr. Gruttadauria: And then the other piece is, a lot of times, especially if they come back and their high sensitivity CRP or ESR elevated or we find dysbiosis, we want them to be on an anti-inflammatory hype supplement program. So, we’ll use fish oil, krill oil. We’ll use Boswellia or Inflammatone, or other kinds of herbal supplements that we know can help with inflammation.
Dr. Weitz: Right.
Dr. Gruttadauria: Really good. And then I’m a big fan of the herbals to try to restore the gut. And then remove whatever we need to remove, and then eventually work on healing the gut. So, from a very straight point of view, I think… I don’t want to over supplement people because I feel like don’t want to use supplements in exchange for pills and medication.
Dr. Weitz: Right. Of course.
Dr. Gruttadauria: Our goal is to restore health.
Dr. Weitz: Yeah, we’re talking about once you’ve established more healthy diet, you’ve got them exercising, you’ve got them sleeping.
Dr. Gruttadauria: And I’m a big fan of protein shakes. So, I think that they’re a great meal replacement. I really am a big believer in intermittent fasting because we need to kick in this process of autophagy. Autophagy is like self-cleaning.
Dr. Weitz: What’s your favorite protein shake?
Dr. Gruttadauria: I’m a big fan of MediClear by Thorne.
Dr. Weitz: Okay.
Dr. Gruttadauria: Yeah, it’s a pea based protein and it has a lot of different supplements in it. So, when people are taking that, they get so much supplementation just from having to shake that they don’t really need a lot of extra, especially vitamins and minerals. I’m a big fan of amino acids, because again, we have to make sure that we’re getting a sufficient amount and that they’re in their free form. So, everybody’s different. Of course, we have this biochemical individuality, which is the premise of everything about functional medicine. But I mean, when we can approach a patient that has these kinds of challenges and we just apply some common sense and we break it down and restore the things that we know are out of balance, they all improve. And when they’re working with a good therapist and they start working on their lifestyle, it’s incredible what happens to people.
Dr. Weitz: What about magnesium for patients with anxiety in particular?
Dr. Gruttadauria: Yeah, that’s a great one. Magnesium threanate, which is seen shown to be crossing the blood brain barrier, I’m a fan of that. And you can take one during the day, two at night. There are other things that you can take. There’s something called NeuroCalm by Designs for Health, which is an herbal supplement that has a lot of different herbs to ease anxiety. So, yeah, we can definitely use those to try to handle symptoms, especially in the beginning. And then again, eventually, we kind of wean people off of that. We don’t want them to be dependent on supplements. We really want them to be able to have their body working efficiently so they can get what they need from food. I’m a big fan, obviously, of chiropractic. If somebody wakes up and their elbows stuck, they run right to the doctor. We have 20, 24 vertebrae in the spine and we don’t know if they’re moving or not appropriately, and the only way we do know is if we get an evaluation by a chiropractor. And what ends up happening is each time we move our body, we powerfully the brain and the receptors in the spine have… We have more receptors in the spine than in any other part of the body. So, that’s really responsible for a lot of brain function. So, evaluating somebody’s spine is also central to overall brain health.
Dr. Weitz: Great. I’m glad you mentioned that. That’s super important, and most people are not aware of that.
Dr. Gruttadauria: Yeah. So, we have non-constant receptors in the body. Our eyes, ears, nose and tongue are non-constant, meaning we can close our eyes and our eyes don’t work. But because gravity’s always working on us, our balanced system, our vestibular system and our musculoskeletal system are always active because we always need to resist gravity. So as a result, those are the two most powerful drivers of brain function. In fact, those are the two systems that allow for brain development in children. And we can see as children develop, they go from that lying on their back, and then we flip them over and they get some tummy time and they start lifting up their head. As they stand up and they resist gravity, the amount of receptive potentiation they get from having to resist gravity is what drives brain expansion. And then it’s not by accident that when they stand and walk, they also talk. So, it’s pretty incredible when we think about brain development and the musculoskeletal system.
Dr. Weitz: What about supplements like 5-HTP, Mucuna that help the body to naturally produce neurotransmitters?
Dr. Gruttadauria: So, I think that they all have their place. If somebody… We’ll run an amino acid panel and if they have really, really low levels of triptophan to fan tyrosine, I might use those particular things in addition to their shake to give them extra just those two. But as long as they’re taking it with… I never really want to put people on individual aminos because it creates imbalances. But if you add that in with an already established protein meal or shake, it gives them an extra boost because those are directly linked to the creation of these things. But methylation is a big deal, using something called 5-MPHF, like methyl folate, because you need methyl folate to drive conversion of these amino acids into neurotransmitters. That can be really helpful. So, there’s so much that we can do. Our toolbox is gigantic. And I think that when we step back and we look at the totality of the situation, we are able to apply individualized approaches to each patient.
Dr. Weitz: Are there any specialized products that sometimes you use to put things over the top? I’m thinking about maybe things like low dose lithium, saffron. There’s a number of supplements.
Dr. Gruttadauria: You are the best, you are the best, Dr. [inaudible 00:36:59]. Yes. Yes. Those things are outstanding. Lithium orotate, five milligrams of lithium orotate is… People hear the word lithium and they flip out because lithium carbonate at 300 milligrams is a drug, a very powerful drug.
Dr. Weitz: Right.
Dr. Gruttadauria: Lithium orotate is a mineral.
Dr. Weitz: Right.
Dr. Gruttadauria: There have been studies that show that people who live in areas that have low levels of lithium in the drinking water have much higher levels of depression, whereas people who live in areas that have higher levels of lithium in the drinking water have lower levels of depression. So, that’s definitely a good one. These are all really very interesting things that, again, go back to where we live. Where do we live on the planet too is-
Dr. Weitz: And then of course, some people have high levels of arsenic in their drinking water and that that’s a big negative for health. And maybe you could talk about heavy metals and some of the toxins that can be problems.
Dr. Gruttadauria: Yeah. I mean, it’s incredible just the fact that we continue to have amalgam fillings in people. And amalgam fillings are 50% mercury.
Dr. Weitz: Those are silver fillings for people.
Dr. Gruttadauria: Silver fillings. So, people who are probably over maybe 35.
Dr. Weitz: Most dentists will tell you that silver fillings are not a problem.
Dr. Gruttadauria: I know, and that interesting. Well, they’re not a problem because they’re actually really good at keeping the teeth healthy, keeping the teeth together from not breaking, but the fact that every time you drink something hot or eat something hot, it liberates mercury gas and then you inhale it is probably not that good.
Dr. Weitz: Right.
Dr. Gruttadauria: Mercury toxicity is a real deal. And usually, the only way we get to see it is by doing challenge testing on people where we give them like DMSA or EDTA and we look at a urinary challenge test.
Dr. Weitz: But DMSA is prescription only, right?
Dr. Gruttadauria: Right. Right. So, you’re working with integrative docs who can get these things done. But what’s interesting is sometimes you see a patient who has a mouthful of these amalgam fillings and I’ll run a mercury level and I’ll be astounded that it comes back literally two and three times the upper limit, which really tells you about how toxic they really are, because the body just can’t stand toxic metals in the bloodstream. It pulls it out of the blood and stores it in bone and fat. So, if it’s high in the blood, unless it’s a really acute exposure, that means that that patient is so burdened with metals that it just literally suppresses all function. It’s neurotoxic.
Dr. Weitz: So, what do you do about high levels of metals?
Dr. Gruttadauria: So, again, I’m a big, big fan of using binders.
Dr. Weitz: Right.
Dr. Gruttadauria: Binders are really, really important to help carry out things out of our system.
Dr. Weitz: Ultra Binder or something like that.
Dr. Gruttadauria: So, apple pectin and activated charcoal and the different types of clay.
Dr. Weitz: Right.
Dr. Gruttadauria: All these things, they’re all really great binders. And as long as a patient is moving their bowels regularly, because you can never ever want to detox a constipated patient. So, [inaudible 00:40:00] is getting everything moving, and then eventually using binders to help pull this stuff out.
Dr. Weitz: Use liposomal glutathione or something like that as well?
Dr. Gruttadauria: I work in an integrative practice, so a lot of times we’ll use IV glutathione, which is really neat. But liposomal… Yeah, I think all these things are all very, very beneficial. I’m a little on the fence about the glutathione only because I would love to see studies showing the amount that actually makes it into the bloodstream because it’s a small protein that a lot of times will just get digested by stomach acid.
Dr. Weitz: Well, originally years ago, we were told that glutathione could not be taken orally, was all going to get broken down, but supposedly that data has changed, and if you get the right liposomal formula, supposedly, it does get absorbed.
Dr. Gruttadauria: Yeah. Yeah. I mean, I’ve taken it myself, but again, I’d like to see that literature, because people are really smart these days. They want to know why they’re taking something and I want be able to tell them, “Here’s some literature.”
Dr. Weitz: We often measure glutathione levels as well.
Dr. Gruttadauria: That’s great.
Dr. Weitz: It’s included in a neutra eval or we’ll do it as part of micronutrient test.
Dr. Gruttadauria: Right. Right. Yeah, I mean, it’s a powerful antioxidant and absolutely essential for overall health and wellbeing.
Dr. Weitz: So, how important are hormones for mood disorders?
Dr. Gruttadauria: Well, we have two regulatory systems in the body, the brain and the endocrine system. So, when the hormonal system is not working well, obviously you can have changes in mood. We can see that with people who have… When women go from having a regular menstrual cycle to having abnormal menstrual cycles, their mood can change. And we’ve had patients like that. And a lot of times what we see is disregulation in the menstrual cycle and something like PCOS, polycystical ovarian syndrome, can radically change mood. So, yeah, I mean, it’s important to see that, and then, again, figure out why is this person having this dysregulation in their system? And I always go back to light because the master gland and the hypothalamus that that’s kind of running the whole endocrine system is driven by light, and an abnormal light environment is going to cause hormonal dysregulation,
Dr. Weitz: Thyroid, how important is that for mood disorders?
Dr. Gruttadauria: Very. And we always have to be cognizant of the autoimmune thyroid because when people have these chronic health issues and their immune system becomes dysregulated, and now all of a sudden they have thyroid problems, there’s a direct relationship between mood and thyroid hormone. And unfortunately, the standard of care in most doctors’ offices is to really just check TSH or TSH, and free T4. A lot of times you’re missing the [inaudible 00:42:58] because you’re not really seeing the whole picture. Somebody could have a normal TSH and free T4 and have very low conversion, and the T3 can be extremely low and nobody’s really even picking that up.
Dr. Weitz: Right. And to assess whether or not they have a autoimmune thyroids, you got to look at the antibodies as well, the TPL and the TGB.
Dr. Gruttadauria: Yeah. Yeah. And when people have chronic inflammation, a lot of times they end up with an elevated reverse T3. So, you have this inactivated thyroid hormone secondary to chronic inflammation. The other thing about chronic inflammation is it can actually cause tryptophan to go down a different pathway and not converted to serotonin. So, again, there’s so many interconnections between what’s going on with the overall health of the patient and what’s actually going on in their brain and their mood.
Dr. Weitz: Cool. I think those are most of the questions that I had prepared. Any other things you want to talk about?
Dr. Gruttadauria: No. The message that I really want to convey is that we’re all affected by stress. Every single one of us has different levels of stress. And not only do we have different levels of stress, we handle it differently. And we all have experienced trauma. There’s all different levels of trauma, and those traumas stay with us. We know that the body keeps the score. And so when we have trauma that builds up and we don’t know how to mitigate it, to release it, we don’t work on exercise and we don’t have a therapist or a coach that we can talk to, or we’re not really doing things to actively reduce that stress, it builds up and it shifts the nervous system. And then that nervous system controls and coordinates the rest of the body, and then it shifts your biochemistry. And you combine that with a lifestyle that’s really not conducive to health or an indoor over exposure to lighting or a lack of exercise or not drinking enough water.
I mean, these are all such common, common issues, and we really need to be able to talk about it. And I think that’s really the main message, is that we really want to get out and educate people as to we need to have this conversation about mental health. And you see… I mean, all of a sudden, you see out of the blue, all these stories about all these professional and collegiate and Olympic athletes having to take time away from their sport to handle their mental health, singers and all these different performers having to take time away because now they’re actually feeling emboldened by the fact that they want to tell people that this is going on because it’s the same thing going on with all of us. We are not immune. We’re all potentially affected by stress, and it’s important that we get that message out. And that’s why the Same Here Global organization is growing so rapidly. And I know that you reach out to a lot of doctors. And if there are functional doctors out there that would like to be involved in the Same Here Global Doctors Alliance, I would love to have a conversation with them.
Dr. Weitz: How did he find out about that?
Dr. Gruttadauria: You can go to samehereglobal.org and maybe you can put my email in the comments section and [inaudible 00:46:15]
Dr. Weitz: You got it. Actually, I have one more question. You were talking about drinking water. What about drinking coffee and alcohol? Are those negative or positive, or what do you thin their effect might be for patients with either depression or anxiety?
Dr. Gruttadauria: So, as a stimulant, coffee can actually create anxiety. But if people are okay with it and it’s part of their routine and they use it in moderation, I usually don’t have an issue with it. Alcohol is a depressant, and a lot of times people self medicate with alcohol. So, it’s incredible how we search for things to help us feel good. So when somebody has anxiety and they find alcohol, all of a sudden they realize, “Wow, this makes me feel normal,” which is really a shame because their body’s out of balance and they need to have alcohol to bring them down to a point where they actually feel like they can communicate, they can be out in public, and things like that. So, it becomes very addictive. The same thing when somebody has depression and they drink, they withdraw even more a lot of times. And so these things become really, really bad for us, obviously. It’s never a good thing.
Dr. Weitz: So, how can viewers, listeners get ahold of you, find out more about what you have to offer?
Dr. Gruttadauria: So, I mean, people can reach out to me on… They could see me on Instagram or on they my website, which is theoptimumu, the letter you, .com. And that’s probably always the best way to find me. And I would love to be able to continue this conversation at some point because there’s so many new things going on all the time in the mental health field. And I think that we as functional medicine docs are really at the forefront of the charge because we’re seeing it from a totally different perspective. And people are more aware these days. They don’t want to just take more and more medications. They don’t want to be on three different drugs at a time. They don’t want to be on that merry go round of, “This didn’t work, I feel like a Guinea pig. It’s just trial and error. Let me try to find the root cause of why I feel the way I feel.” So, I really am… I feel very fortunate that you asked me to be on your podcast and I want to really thank you so much.
Dr. Weitz: Absolutely. And one of the great things about the functional medicine approach, not only is there mood disorders likely to improve, but their overall health as well.
Dr. Gruttadauria: 100%.
Dr. Weitz: Okay. Thank you, Michael.
Dr. Gruttadauria: Thank you very much. I appreciate it, Ben.
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 rating and review. That way, more people will be able to find this Rational Wellness podcast when they’re searching for health podcasts. And I want it to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica White 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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