LET'S TALK MENTAL HEALTH

Mental health conditions are some of the most common types of conditions I see in clinical practice and are inseparable from chronic illness. This is because a large component of mental health conditions are driven by inflammation and health problems in the body can create inflammation in the brain. Inflammation with the brain interferes with production of neurotransmitters, neurological immune reactivity, and can interfere with sleep. This underlying inflammation can manifest as a number of different mental health conditions. When addressing mental health, it is essential to explore what is going on in the rest of the body. Here are some of the things I evaluate when working with a mental health condition:

• Nutrient Levels, Gut Health, Diet, and Lifestyle

• Genetics

• Toxins, Hormones, and Trauma

Nutrient Levels

Healthy nutrient levels are the foundation of mental health. Nutrients are involved in helping us make and break down our neurotransmitters as well as in the reduction of inflammation. Studies assessing the effect of micronutrient supplementation on ADHD revealed that 60-80% of patients responded positively to that supplementation, demonstrating how powerfully nutrient levels can impact mental health. Some of the most important nutrients to consider when addressing mental health are: 

• Omega 3 Fatty Acids: Omega 3 fatty acids are a type of polyunsaturated fatty acids known for their many health benefits. They are found in foods like fish, avocados, olive oil, and nuts. Research has demonstrated that people with anxiety and depression have lower levels of essential fatty acids. Further research has demonstrated that giving Omega 3 supplementation decreases risk of psychological disorders converting to psychosis by 80%. In addition to their clear beneficial impact in reducing symptoms of mental health conditions, Omega 3’s benefit the brain by reducing inflammation and helping promote the production of healthy nerve cells and cell membranes. 

• B Vitamins: B vitamins are involved in maintaining the health of the nervous system in a number of ways. Vitamin B6 is one of the most relevant nutrients to the nervous system as it assists your body in making and breaking down neurotransmitters. Specifically, it is involved in the synthesis of neurotransmitters like serotonin, melatonin, dopamine, and GABA. Vitamins B12 and B9 are other important mental health nutrients. Both are involved in a biochemical pathway, known as the methylation pathway, that indirectly supports mental health by creating precursors to neurotransmitter production; helping reduce levels of a chemical called homocysteine, which has been linked to anxiety; and through supporting detoxification. Other B vitamins also contribute to mental health. Vitamins B1, B2, and B3 have natural anti-anxiety properties. Vitamin B5 is involved in the breakdown of histamine, which can promote anxiety when too high. 

• Vitamin D: Vitamin D is one of the most important nutrients for supporting mental health. It is synthesized by exposure to sunlight, but not well obtained through diet. Deficiency of Vitamin D increases risk of anxiety and depression. 

• Magnesium: Magnesium is my go-to for all mental health conditions. It is a naturally calming nutrient that helps your brain break down neurotransmitters associated with excitation and stress. It additionally helps make the neurotransmitters serotonin and GABA. 

• Minerals: Minerals are important for helping clear intracellular inflammation and support healthy thyroid function, both of which can have secondary impacts on mental health. Specifically, zinc deficiency increases risk of anxiety and depression and zinc supplementation has demonstrated to be beneficial in ADHD. 

I start all mental health protocols by running a micronutrient panel. You can purchase one here.

Gut Health

Have you ever heard the gut called the second brain? Your gastrointestinal and nervous systems develop from the same embryonic tissue for the rest of your life. Your gut has its own nervous system called the enteric nervous system which communicates with your central nervous system. In fact, your gut sends more information to your brain than your brain does to your gut. In addition to educating the brain through nervous system signals, the population of good, bad, and neutral bacteria (microbiome) in your gut interact with your nervous system. Changes in this bacterial population can increase risk of anxiety and depression. It can also cause changes in immune activation and hormone production that can interface with the brain to create mental health symptoms. Finally, many of our neurotransmitters are actually made in the gut. Most notably, around 75% of your serotonin is made in your gut and changes in gut health can cause changes in mental health. 

For most mental health protocols, I run a GI panel.

Diet & Lifestyle

Diet and lifestyle are the foundations for healing from any condition and are essential to healing from mental health conditions. Here are a few lifestyle conditions that must be in place to heal your brain: 

Diet

Studies show that the more you eat the western diet, the higher your risk of anxiety and depression. One of the mainstays of a western diet is processed carbohydrates and sugars. Think breads, noodles, cookies, crackers, chips, sodas and more. Beyond these junk foods, many foods that we would think are healthy like salad dressings or protein bars have added sugar in them. Consuming these foods can create blood sugar swings. When you eat a processed carbohydrate that rapidly converts to sugar in your body, your blood sugar rapidly increases, only to drop shortly thereafter. Symptoms of unstable blood sugar can be similar to those experienced during anxiety. Not only can food create symptoms similar to anxiety, it can also interact with neurotransmitters in a way that promotes anxiety and depression. Certain foods, especially those high in sugar, stimulate the release of happy and reward neurotransmitters in the brain. When these neurotransmitters are imbalanced in our brains, we might find ourselves gravitating towards foods that force the release of these neurotransmitters. However, the effects of this are temporary and can create a neurotransmitter excess followed by a neurotransmitter deficit, only worsening the symptoms of our anxiety, depression, or ADHD. 

In addition to processed carbohydrates and sugars, the western diet is rich in Omega 6 fatty acids. These are heavily processed oils that come from plant foods. Start reading ingredient labels and you will see that oils like canola, sunflower, safflower, soybean, and peanut oils are added to nearly everything. While Omega 6 oils are not intrinsically bad, they compete with Omega 3 oils. When you have an excess of Omega 6 oils in comparison to Omega 3 oils, which most people do, you block the anti-inflammatory actions of Omega 3 and promote inflammation. We know that inflammation negatively affects the brain. 

Due to poor farming and food industrial practices, modern food is also frequently a source of toxins and preservatives. While research is still ongoing as to the impact of these things on the brain, preliminary studies suggest that these types of compounds are toxic to the nervous system and may worsen mental health conditions. 

If food can create disease, it can also help reverse it. While there is no one diet that I recommend for mental health conditions, whole foods rich in nutrients, antioxidants, proteins, and anti-inflammatory fats can help reduce symptoms of mental health conditions. Because industrial food processing removes much of food’s nutritional value, nearly any whole food you eat will be rich in nutrients in comparison. Additionally, they offer these medicines: 

• Antioxidants: Antioxidants are compounds found in plant foods that help neutralize the inflammation created by reactive, charged particles. While there are many types of antioxidants, I generally look for color as a sign that a particular plant food is rich in antioxidants. Carrots, peppers, tomatoes, pomegranates, and berries all get their color from antioxidant compounds. Antioxidants are being used increasingly in integrative and conventional medicine for their powerful impact in healing the brain. 

• Proteins: Sources of high quality protein can also be helpful in supporting mental health. Neurotransmitters are made from amino acids, the building blocks of protein. Therefore, getting adequate amounts of protein can support healthy production of neurotransmitters. While animal proteins are not the only source of brain healthy proteins, certain foods like turkey and chicken are especially supportive of neurotransmitter production as they contain tryptophan, a precursor to serotonin. 

• Anti-inflammatory oils: If you eat the right type of fat, it is a brain superfood. Our nerve cells are coated in a fatty substance called myelin. Our cell membranes are also composed of fat. These fatty barriers facilitate communication between cells. Our our sex hormones, which can also create symptoms of anxiety when imbalanced, are also synthesized from fat. Healthy fat, omega 3 fatty acids, are intrinsically anti-inflammatory. When we are deficient in these fats, we have increased risk of anxiety and depression and when we increase consumption of them, we can help heal the nervous system in many ways. Some of my favorite forms of Omega 3 fatty acids include wild caught fish, avocados, egg yolks, walnuts, and olive oil. 

Lifestyle

Exercise:

Did you know that exercise can be as effective as pharmaceutical drugs in reducing symptoms related to anxiety and depression? For this reason, I always recommend that my patients with mental health conditions have some type of movement practice. Exercise does not have to be intense or strenuous to provide a mood benefit. Something as simple as a walk has proven benefit in improving mood. Exercise can help discharge stress, balance hormones, and help regulate your nervous system to decrease fight or flight responses. To supercharge a mental health workout, exercise can be paired with the health benefits of getting outdoors. 

Time in Nature: Most of us intrinsically notice increased physical wellbeing when we spend time in nature. Nature is full of healing colors and sounds which help soothe our nervous systems. Being outside also increases our exposure to sunlight. Sunlight helps us make vitamin D, a vital nutrient for mental health. Sunlight also programs our circadian rhythms for balanced sleep, another essential component of mental health. In general, time in the sun has also been demonstrated to improve mood and reduce anxiety and depression. 

To learn more about the health benefits of getting outside, check out this video. 

Sleep:

 Sleep is one of the most important factors in healing from any disease and mental health is no exception. When we are sleep deprived, our brains become inflamed, making us more vulnerable to neurotransmitter disruptions. Sleep deprivation has been associated with increased risk of anxiety, depression, and other mental health conditions. It can also impact our daily mood, increasing anger and irritability and decreasing resilience to stress. Sleep disruptions often go hand-in-hand with mental health conditions, since the neurotransmitter imbalances that promote mental health conditions can also disrupt sleep. 

Stress: 

Increased risk of anxiety and depression are two of the major risks of chronic stress. When we are stressed, it can impact our cognitive function and make us less able to cope with the emotional changes we are experiencing. Stress actually changes the electrical circuitry in the brain to impact the health of the brain and the entire body, including systems like your endocrine system and your metabolism. For these reasons, stress management is a foundational therapy to healing from mental health conditions. This may look like scheduling time to do things you enjoy, learning to set boundaries or say no, dealing with emotional issues that create stress, or practicing mindfulness based therapies.

Trauma

I ask almost every patient if they have a history of trauma because trauma has a profound impact on the body, especially mental health. Trauma can be physical or emotional and can range from something like a car accident, to loss of a loved one, to abuse. Trauma activates the fight or flight arm of our nervous systems. This is the part of your nervous system programmed to respond to danger. The problem with trauma is that your brain can struggle to process it and file it away as a past experience. Consequently, your nervous system gets stuck in fight or flight and you begin reacting to non-threatening things in life as if they are dangerous.

Symptoms of a fight or flight response can include elevated heart rate and blood pressure, tense muscles, decreased digestion, and feeling on edge. These are symptoms that overlap with and can create anxiety. Long term, your body may struggle producing stress hormones in levels that match your fight or flight response. Your baseline stress hormone levels can decrease, promoting depression. Childhood trauma can also interfere with healthy production of neurotransmitters and hormones, poising your brain to be more susceptible to mental health conditions long term. In a study evaluating the health outcomes of adverse childhood experiences, higher trauma scores increased risk of anxiety and depression by almost 5 times! 

Not only can chronic stress created by trauma impact mental health, it has far reaching impacts on physical health and can actually prevent healing. If you have a history of trauma, this needs to be addressed alongside the physical aspect of mental health. Some of my favorite therapies for addressing trauma are brain spotting, EMDR, and somatic therapy. If you are unsure, if you have trauma, this quiz is a good place to start. Although it only evaluates for childhood trauma, it may help you identify what trauma is.

You Need To Calm Down (anxiety) supplement starter pack: 

• OptiMag Neuro

• Liposomal CBD

• Liposomal Curcumin

• RelaxMax 

Happy Pills (Depression) supplement starter pack:

• OptiMag Neuro

• 5HTP - cannot be taken with some prescription drugs. Consult with your doctor before adding in 

• Monopure Fish Oil

Genetics & Neurotransmitters

Neurotransmitters are the chemical messengers our brains use to communicate. They regulate many states of mind including happiness, alertness, pleasure, sleepiness, reward and much more. While lifestyle, environmental exposures, and endogenous health conditions can all impact neurotransmitters, genetics can also play a role. For individuals with longstanding mental health conditions and family histories of mental health conditions, I evaluated genetic variants that could be impacting neurotransmitter levels and mental health. 

Here’s how it works: 

Genes code for proteins and those proteins have different jobs in our body. One class of proteins is enzymes. The job of enzymes is to speed up a biochemical reaction. When it comes to neurotransmitters and inflammation, enzymes can help make them or break them down. When you have a variant (variant is a change in its DNA sequence that can affect the function of the protein  it codes for) in a gene, the protein it codes for may not work optimally. This can cause the biochemical pathway that protein runs to go either faster or slower, leading to too many or too little neurotransmitters, or too much inflammation. Changes in neurotransmitter levels and inflammation can both impact the brain. It is also important to understand that enzymes use nutrients to run, just like cars use gas. So, nutrient deficiencies can further worsen problems created by genetic variants. There are a few genetic pathways that I focus on when it comes to mental health: 

Methylation

You may have heard of the MTHFR genetic variant. MTHFR is one of many enzymes in a process called the methylation cycle. The methylation cycle helps our body: make and break down neurotransmitters, synthesize DNA and intracellular energy, make nitric oxide, detoxify, and reduce inflammation. So, it's important. Variations in not just the MTHFR gene, but any of the genes involved in the methylation pathway, can lead to impacts on mood. Here are some of the main ways the methylation pathway impacts mood: 

• The methylation pathway makes a compound called SAM-e that helps our brains eliminate stress neurotransmitters. Studies have shown that SAM-e can help reduce anxiety and depression. 

• The methylation pathway also makes a compound called BH4 which is important for the production of serotonin, our happy neurotransmitter, and dopamine, our reward neurotransmitter. 

• The methylation pathway helps clear something called homocysteine, which can contribute to symptoms of anxiety when it is too high. 

• Methylation is also required for detoxification. Buildup of toxins can impact our mental health. 

COMT

COMT stands for catecholamine methyltransferase, which is the name of an enzyme that breaks down dopamine, epinephrine, and norepinephrine in the brain. These neurotransmitters are responsible for reward sensation and stress response. COMT variants are some of the most common I see contributing to anxiety in clinical practice. Common COMT variants are down-regulations, meaning the enzyme breaks down neurotransmitters slower than it should. These higher levels of neurotransmitters can create anxiety and hyperactivity. They can also create things like racing mind, increased focus, high performance, and perfectionism. However, because there are so many of these neurotransmitters hanging around, your brain slows synthesis of them. This depletes your reserves of these neurotransmitters, causing you to be less resilient to stress and more susceptible to depression. With COMT variants, you may experience anxiety and depression in cycles. Magnesium and SAM-e help COMT run faster. 

OXTR & Empathy

Ever felt like you are an empath? As an empath, you may find yourself extremely sensitive to the emotions and environment around you. You may unconsciously pick up on things other people are feeling but not saying, and internalize those emotions as your own. Being an empath can be a special gift, but it can also be exhausting. Believe it or not, there is a real biological basis to this! OXTR stands for oxytocin receptor. It is responsible for regulating the actions of oxytocin in our bodies, a powerful chemical for feeling bonded. However, OXTR variants can also impact the way our bodies utilize serotonin, our happy hormones. When you have OXTR variants, you may be more empathic, causing you to use your serotonin more quickly. I have seen biological empaths have difficulty getting in touch with their emotions, have compulsive behaviors, or having defiant behaviors because they do not know how to process the way the world around them is impacting them. Without lifestyle boundaries, this can lead to low serotonin levels, which are associated with depression, overwhelm, cravings, weight gain, and sexual dysfunction. I see a dramatic difference clinically when supporting OXTR variants with serotonin precursors such as 5HTP. 

GAD & Glutamate

When I think of anxiety, racing mind, and alertness, I think of glutamate. Glutamate is a neurotransmitter that keeps neurons in our brains firing. High levels create problems; in extremely high levels, glutamate is lethal. At non-lethal elevated levels, glutamate is toxic to the brain and imbalances in glutamate can be a trigger for seizures. The brain keeps glutamate in check by converting it to GABA. When I think of GABA, I think of calm and relaxation-that feeling you get when you are on the beach in Hawaii. The primary enzyme responsible for converting glutamate to GABA is GAD, but glutamate levels can be broken down by other enzymes and biochemical pathways as well. Variants in and of these enzymes can create excess glutamate, which presents as anxiety, racing mind, and insomnia. They can also create symptoms of low GABA such as restlessness, ruminating thoughts, muscle tension, and self medicating (for example, with alcohol). Conversion of glutamate to GABA is dependent on Vitamin B6 and magnesium and supplementation with these nutrients is often helpful in cases of glutamate imbalances. In more extensive cases of glutamate imbalance, supplementation with GABA and natural products to reduce glutamate can also be helpful. 

Histamines 

We usually think of histamines as responsible for creating allergic reactions. This is true, but histamine is not limited to this process. It has many other jobs as well. Histamine is also involved in digestion and central nervous system processes, such as sleep wake cycle. Have you ever taken a Benadryl or other antihistamine and felt sleepy? This demonstrates the role of histamines in wakefulness. Clearly, we want enough histamine in our bodies. However, as in the case of allergies, too much histamine is not good either; too much histamine in the brain can also promote anxiety and insomnia. There are 3 primary pathways by which histamine is broken down. Variants in the genes that create the enzymes that run any of these three pathways can create excess histamine and impact mental health. Histamines in the brain may also be upregulated by certain types of gastrointestinal infections, mold toxicity, or presence of inflammatory genetics. 

Inflammatory Genetics

Did you know that your body makes intracellular inflammation every day just by running its normal biochemical processes? Some people make more of this inflammation due to genetic variants that I will not discuss here. Inflammation is a general term for specific chemicals. Inside the cell, some of the chemical compounds that create inflammation include peroxynitrite, superoxide, and hydrogen peroxide. These are inflammatory due to their reactive charged particles which can damage DNA, cells, and proteins. Thankfully, our bodies are equipped to clear this inflammation using a system of enzymes, most notably SOD and catalase enzymes. If you have genetic variants in these enzymes, not only can inflammation accumulate but it can be converted to even more inflammatory compounds. One of these compounds is peroxynitrite, which is associated with over 60 chronic illnesses. These high levels of inflammation can create imbalances in neurotransmitters and promote mental health conditions. 

I assess genetic variants using the Functional Genomics Test. 

Hormones

Like neurotransmitters, hormones are chemical messengers that our body uses to communicate. Because they have activity in the brain, hormones can impact mental health. To better understand hormones and how they can impact mood, check out this blog post on hormones. Here is a brief overview of how hormones can impact your mood: 

• Thyroid: Having too much or too little thyroid hormone has been associated with both anxiety and depression.

• Progesterone: Progesterone is a naturally calming hormone that acts on GABA receptors in the brain. Functionally deficient levels of progesterone are a common cause of anxiety and insomnia. 

• Testosterone: Not just for men, testosterone is important for female wellbeing including mood and libido. Deficiencies in testosterone for men can promote symptoms of depression. Deficiencies in women can promote anxiety. 

• Cortisol: Cortisol is our stress hormone. When we are under chronic stress or have a nervous system stuck in fight or flight, cortisol can become imbalanced and promote anxiety or depression. 

Toxins

Modern life is full of toxins. All of us are exposed. Factors like genetic susceptibility, diet, stress levels, and level of exposure influence how much those toxins impact us. Toxins can be found in food, synthetic fragrances, and cleaning supplies. They can also come in the form of heavy metals, environmental mold, and pesticides (click each of these for sources of exposure). All of these toxins have the potential to create inflammation and neurotransmitter imbalances in our nervous system. While each of these toxins have their own unique mechanism by which they can promote mental health conditions (see individual blog posts for all the details), here are a few ways they can generally impact our nervous system and mental health: 

• Nutritional Depletion: Eliminating toxins from the body requires nutrients. When we have a high level of toxins, nutrients necessary for maintaining healthy brain chemistry are instead diverted to clear toxins. 

• Increase Blood Brain Permeability: Many toxins either cross the blood brain barrier or increase its permeability. When blood brain permeability is increased, the brain is no longer protected from inflammation in the rest of the body and quickly becomes inflamed itself. 

• Interferes with neurotransmitter metabolism: Many toxins have the ability to increase excitatory neurotransmitters. These are the neurotransmitters that keep our brain cells firing and promote anxiety. These same toxins can also decrease production of calming and happy neurotransmitters. 

• Cell and Neuron Toxicity: Toxins can decrease the health of cell membranes and nerve cells, vital for cell communication and maintaining brain health. 

• Mitochondrial Damage: Mitochondria are the motors of our cells. They create energy and are damaged by toxins. Virtually all chronic illness is associated with mitochondrial damage including diseases of the nervous system such as Alzheimer’s Disease and other dementias, Parkinson’s Disease, and autism. 

• Interference with Methylation: Toxins can interfere with biochemical pathways central to mental health including, but not limited to, methylation. 

• Neurotoxicity: In general, toxins can create broad spectrum damage in the nervous system promoting symptoms like tremors, decreased IQ, problems with coordination and motor function, sensory interruptions, slowed reaction time and more.