Sayer Ji
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Confessions of a Renegade Psychiatrist

Confessions of a Renegade Psychiatrist

I felt this sensation in the pit of my stomach – it was a combination of sympathy and anger – listening to Annie tell me, through tears, about her postpartum journey into the world of psychiatry. 

Three separate psychiatrists dismissed me when I expressed concerns about taking an addictive medication like Klonopin.  It's been two years, I can't get off it, I'm on 4 psych meds and I feel worse than I ever did before I started this treatment.

Annie was ushered into the promise-filled halls of psychiatry 3 months after the birth of her first baby when she began to experience racing heart, insomnia, vigilance, irritability, and a host of physical complaints including joint pain and hair loss.  No one did bloodwork, asked about her diet, or cared about any of the myriad observations about her body and its changes in functioning.  This was a "head-up" intervention. I believe women deserve better.  People deserve better.

Most patients who come to me for treatment of depression and anxiety do so because they want answers.  They want to know WHY they are struggling. The closest they will be offered by their prescribing psychiatrist or primary care doc is some reductionist hand waving about serotonin imbalances.  I think it is time to speak to these patients with respect, truthfulness, and to offer them more than a life-long relationship with a pill (or pills as it will inevitably become over the years).  First, let's review some basics:

Depression is Not A Serotonin Deficiency

Thanks to direct-to-consumer advertising and complicit FDA endorsement of evidence-less claims, the public has been sold an insultingly oversimplified tale about the underlying driver of depression.  Here's how we know depression is not a serotonin deficiency corrected by Zoloft:

  • There has never been a single study, in humans, to validate the theory of low serotonin in depression.  Low levels are found in a minority of patients.
  • An antidepressant marketed as Stablon, increases reuptake of serotonin (reducing serotonin activity) and appears to be equally effective as those that decrease it or have no effect on it at all.
  • Manipulation of serotonin levels (depletion or enhancement) do not consistently result in a depressive syndrome.
  • These medications are used to treat an impossibly non-specific and broad array of illnesses from obsessive compulsive disorder to anorexia to premenstrual dysphoria to bipolar depression to irritable bowel syndrome.
  • Antidepressants of all categories seems to work about the same regardless of their presumed mechanism of action with about 73% of the response unrelated to pharmacologic activity.

You might wonder: Well, then how is it that antidepressants are a billion dollar industry and I have all these friends who are so much better on them?  Some pioneering individuals have investigated the data supporting antidepressant efficacy and have made compelling arguments for what is called the "active placebo" effect accounting for "breaking blind" in placebo-controlled trials.  In short, the expectation of relief and subsequent change in symptoms experienced by "responders" is related to perception of side effects.  This analysis suggests that antidepressants may only have 10% efficacy above and beyond the placebo effect.  When you also consider the suppression of negative studies (permission of sedatives in trials, replacement of non-responders, and allowance of placebo washout) by pharmaceutical companies, you may start to worry that you have been sold a bill of goods.  When inefficacy, long-term risks, increase in suicidality and violent behavior are taken into account, it is a marvel to observe the star-power of these medications.

What Is It Then? Inflammation!

Inflammation is a buzzword, and a 41 million+ Google hit for a reason:  it appears to underlie just about every chronic disease plaguing Americans today.  A contribution of genetic vulnerabilities likely determines who develops heart disease or cancer or obsessive compulsive disorder, but many researchers are convinced that depression may have a significant inflammatory component.  Just as a fever is one of your immune system's mechanism for eradicating intruders, suppressing a fever, in no way, serves to resolve the underlying infection or to support the body's return to balance.  Similarly, suppressing symptoms of depression does not achieve rebalancing, and will likely result in the Whack-a-Mole phenomenon of shifting symptoms, and protracted resolution.

There appears to be a specific subset of non-responders to medication who have measurable markers of inflammation as explored in this study. We know that medications such as interferon given to patients with Hepatitis result in significant levels of depression and even suicide, and we know that anti-inflammatory agents such as infliximab or even aspirin can result in resolution of symptoms.  Investigators like Miller and Raison have discussed, in a series of wonderful papers, the conceptualization of depression as "sickness behavior" with accompanying social withdrawal, fatigue, loss of appetite, decreased mobility.  Recent meta-analyses have identified at least 24 studies which have correlated levels of inflammatory cytokines like CRP, IL6, and TNFalpha with states of depression.

What Drives Inflammation?

What causes inflammation in the body that can affect the brain?  This is the subject of an excellent book, and, it turns out the list is long, but these are the contributors that I see most commonly in my practice:

Sugar

It's in almost every packaged food.  Seriously.  Look for it and you will find it.  It may come with different labels – cane sugar, crystalline fructose, high fructose corn syrup – but it's all sugar.  The way the body handles fructose and glucose is different; however, which may account for why fructose is 7x more likely to result in glycation end products or sticky protein clumps that cause inflammation.   In addition to the above mood and anxiety rollercoaster, sugar causes changes in our cell membranes, in our arteries, our immune systems, our hormones, and our gut as I discuss here.

Food Intolerances

Gluten, soy, and corn have been identified as allergenic foods and a leading speculation as to how these foods became and are becoming more allergenic is the nature of their processing, hybridization, and genetic modification rendering them unrecognizable to our immune systems and vehicles of unwelcome information.  Gluten (and processed dairy), when incompletely digested, result in peptides that, once through the gut barrier can stimulate the brain and immune system in inflammatory ways.

Autoimmunity

The epidemic incidence of autoimmune disorders in this country is a direct reflection of environmental assault on our system.  The body's ability to determine self from other starts with the gut and our host defenses there.  Unfortunately, it doesn't end there because autoimmune disorders typically have psychiatric manifestations.  This makes sense – the body's immune system is misfiring, and the immune cells of the brain (called microglia) are following suit.  Beyond rampant inflammation, autoimmune disorders such as Hashimoto's thyroiditis (more here) also result in symptoms related to damage to tissues.  Low or erratic thyroid function can cause anxiety, depression, flattened mood, cloudy thinking, metabolism changes, and fatigue.  Sometimes even the presence of immune system misfiring can predict depression as was noted in this recent study where women with thyroid autoantibodies in pregnancy went on to develop postpartum depression.

Before You See A Psychiatrist

Diet

Do a 30-day diet overhaul.  If you feel committed to the cure, eliminate these provocative foods: corn, soy, legumes, dairy, grains.  What do you eat?  You'll eat pastured/organic meats, wild fish, eggs, fruit, vegetables, and nuts/seeds.  If this is not revolutionary, then you may be someone for whom nightshade vegetables, nuts, or eggs are inflammatory.  If that seems entirely overwhelming, then start with dairy and gluten.  If that is too much, then gluten is my top pick.

Coconut Oil

Introduce 1-2 tablespoons of virgin coconut oil to give your brain an easy source of fuel that does not require significant digestion.  When your brain is inflamed and your sugar is out of balance, your brain cells end up starving for nutrients to make energy.  This can be an effective shortcut.

Turmeric

I use this spice in therapeutic doses, but it has recently been demonstrated to be as effective as Prozac (I will discuss in a future post!). If you cook with it, use pepper and oil (red palm, coconut, olive oil, ghee) for enhanced absorption. 

Fermented Foods

Naturally fermented foods like sauerkraut, kimchi, and pickles as well as kefir and yogurt if you are dairy tolerant are a source of beneficial bacteria that can retrain the gut to protect you from unwanted pathogens.  A recent study demonstrated that these bacteria can, indeed, affect brain function.

Detox Your Environment

Here's an important way to call off the dogs of your immune system.  Give it less stimulation.

  • Filter air and water
  • Purchase products free of known carcinogens and endocrine disruptors such as parabens, TEA, fragrance (pthalates), sodium lauryl/laureth sulfate, triclosan
  • Eat organic produce, pastured meat/dairy
  • Make your own cleaning products from household vinegar, baking soda, tea tree oil, or purchase similarly simple products
  • Avoid eating or drinking from heated plastics
  • Avoid cell phone use
  • Avoid processed foods and sugar, consume low-mercury fish
  • Carefully consider risks and benefits of any elective medical interventions

Promote Healing Messages

I have developed an appreciation of the body's ability to work towards balance when obstacles are removed.  An important obstacle is the stress response that is activated by many of the above factors as well as perceptions of busy-ness, lack of downtime and community support, and trauma.  Take 10-20 minutes a day (or even 2!) to promote the relaxation response by breathing in with a count of 6 and breathing out with a count of 6.  Imagine the air flowing in and out through your heart and cultivate a feeling of gratitude.  The benefits of this practice have been well-studied by Heartmath Institute.

Psychiatry has long suffered from pseudoscience and propaganda.  From an embarrassing history of pathologizing human behavior, applying crude "treatments", and imposing beliefs about societal welfare on vulnerable populations, we haven't come very far in the past century.  Incidence of mental illness is rising, partly from changes in diagnostic criteria, commercializing mental illness, collusion between doctors and patients around the "quick fix", and partly because our bodies and minds are crying out in protest about this toxic world we live in.  Take control of your body to heal your mind – take back your health and bear witness to the power of a lifestyle renaissance.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of GreenMedInfo or its staff.

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A change is desperately needed



I find it appalling that mainstream psychiatry doesn't even look at body/blood chemistry and just slaps on a pharmaceutical and/or label. I've seen this with my mother, two daughters and several close friends. To not even acknowledge that the body systems are intricately connected is medical malpractice, in my view. Thank you Dr. Brogan for bringing this to the public. You affirmed my deepest fears about this profession.

Fermented Legumes



What about fermented legumes ? What about natto, miso, tempeh, tofu ? What about other beans fermented with the same spores for natto ? I never tried natto, miso, tempeh before but recently bought a natto starter and was considering fermenting some pinto beans with it nowadays.

How About folate!



Depression is not a serotonin deficiency but it can very well be a folate deficiency!  These are the basics, people, and Dr. Brogan is spot on in detailing them!  Having said that, I did all of these, and more, including cleaning up candida.  With MCS, however, the depression, anxiety and all that was horrible.  We in the alternative medicine camp have to be very conscious of not doing the same thing as allopathic medicine: advocating a one-size-fits all approach.  Fermented foods were totally life threatening to me.  Little did I realize that I had an MTHFR defect as well as multiple defects in the Methyl cycle.  Fermented foods produce formaldehyde and ethanol as by-products and these interfere with proper methylation.  Folinic acid and 5-mthf plus methionine finally made the depression and anxiety vanish!  I still have MCS of course, but to finally be free of this aspect as well as free of horrible skin problems is a God Send.  I would encourage Dr. Brogan and every holistic psychiatrist and practictioners to look into both folate deficiencies as well as MTHFR defects in their patients. The literature is replete with information on folate deficiencies/dependencies as a hidden cause of depression and anxiety.  See Dr. Ben Lynch's website at mthfr.net

Methylation



Yes, I totally agree. Methylation and mitochondrial support are the backbone of my supplementation recommendations. For most with these defects, fermented foods that are properly prepared and maintained are beneficial, but I'm glad that you figured out how to refine your diet to relieve symptoms.

 

Best,

KB

Inflammatory, but meat and fish?



The more I read about all our chronic diseases the more the root cause of inflammation comes up. Cancer, heart disease, arthritis, mental illness, etc. all seem to stem from (a) poor nutrition and (b) toxic insults. It also makes sense that the brain and the body are not separate, as the phrase "mental illness" implies. Your article brings all this home -- it is very insightful and refreshing to read this from the POV of someone in the psychiatric profession. So if we are on the same page, then I find it very odd that you would include dairy and animal products, where the evidence is all in indicting animal protein and dairy in inflammation. Esselstyn, Ornish, Campbell, Barnard, et. al. are all about inflammation. 

Meat/Fish



  Mainstream nutrition does not differentiate commercial feedlot products from grass fed free range organic meats, milks, eggs, cheeses...big difference in fat balances and inherent antioxidant/mineral qualities.

Dietary guidelines



Hello!  Thank you for the feedback.  While there is no "one diet" for chronic disease, you'll find that those who treat autoimmune disorders, and the brain, specifically (myself, David Perlmutter, Kharrazian) and even Seyfried who has brought attention to brain cancer and the ketogenic diet, are all concerned about returning to a diet that supported the population before the epidemic incidence of chronic disease we experience today.  I have a strong focus on fatty acids  (brain, hormones) and thus an interest in a "high natural fat" diet.  The closest approximation to what I recommend and have had clinical success with (and follow myself) is the Perfect Health Diet.  This calls for high fat and moderate carb from resistant starches, and organic proteins. The source of meat and animal foods is of utmost importance, obviously.  Grains and legumes, being relatively "new" foods containing lectins can be problematic for those with inflammatory disorders.  The diet typically calls for elimination of legumes and grains.  It's very hard to do that without incorporation  of animal foods, a unique source of fatty acids, b vitamins, choline, zinc, etc. I do not recommend dairy products unless they are raw, and even then, casein can be problematic. For the most part, when people go on a "plant-based diet" they are controlling for a number of food quality variables and health behaviors that can confound data.  That's why nutrition data has to be looked at with a discerning eye.  I prefer to look at millions of years of what our genome expected to see in our stomachs.  Hope that helps clarify.  Be well,

KB

Oxalate



Many of the foods you suggest are high in oxalate and it can cause inflammation and depression(thanks to a user of this site who made me aware of it, I already knew that more oxalate meant lower pain threshold, I'm one with low pain threshold) as far as I know. Can you tell anything about it ? Just found this link about this issue:

http://lowoxalate.info/

I've also read intestinal permeability and antibiotics may be blamed for excess oxalates absorbed and reduction of oxalate degrading bacteria and high levels of fructose increase generation of oxalate in the body. I want to be sure that a diet free from gluten, cow's milk(I read from a few sources that it is "cow's" milk that cause increased intestinal permeability instead of milk including http://dogtorj.com/g-a-r-d/the-g-a-r-d-made-simple/ and know that the other 3 biggest problem foods are soy, gluten and corn), soy, corn, avoidance of NSAIDs, antibiotics and consumption of high levels of fructose can be enough to avoid excess oxalate harms or know what may be enough to avoid excess oxalate harms. I'm not sure whether consuming heat treated A2(sheep's or goat's) milk products is good or bad but I consume them, especially in the form of yogurt and cheese. I also do not consider store bought pickles, sauerkraut, kimchi a source of probiotics due to heat treatments but I'm also too lazy to ferment my own vegetables so far.

Thanks for the good article and comments :)

Note: I assume all Dr Brogan wrote is true for both sexes in equal proportions

Consider toxic loads



Hi Dr. Brogan, I didn't see mention of heavy metals in your article. You will find direct correlations between metal burdens and mental "burdens" as Hg, Cd, As, Al and Cu are present in wide segments of the population. Hair analysis is a valuable tool to detect highly inflammatory levels of metals as well as common deficiencies in Mg and K.

See   http://www.greenmedinfo.com/blog/cleanse-flush-sweat-mobilize-chelate-detoxand-heal

 

Even once physical aspects are reconciled, we still must deal with the collective narrative and its mind bending departure from reality.

 

Best, Capt. Randall

Pseudoscience and Propaganda



After years of struggling with liver disease I took my health into my own hands. I used the internet and began researching the best way to improve my health and address the disease. Basically, I found that our medical system was, as you suggested, full of pseudoscience and propaganda! Addressing issues such as "Oxidative stress, better known as inflammation is involved in all disease" as suggested by forbiddenhealing above has helped give me a clean bill of health that I never would have generated by continuing the traditional medical system's practice. I have been republishing these articles of importance on my managed Facebook page call Skinny Liver. If anyone is interested in how I managed to defeat my liver disease give it a peek. Thanks again for giving us an honest and informative article on "Real Science" and not another pseudoscience guiding the sick toward the greedy pharmaceutical companies. By the way, ever wonder why cures for diseases are never found anymore?  

 

Yes, Inflammation



   Oxidative stress, better known as inflammation is involved in all disease...Best first aid is to begin megadosing Vitamin C/ baking soda to raise body charge.  A hair analysis usually shows the presence of metals and deficiencies in Mg/K/I. Chlorella and clays are added to the Vitamin C regimen to lift depressions and restore mental function. B vitamins, cannabinoids, omega 3s and sat.fats help w nervous system regeneration. See my articles under "R", GMI author page.

 

Instead of drugs, look into the foundational role of the ego in opposing the higher consciousness and common sense. If you can recognize pain-generating fear-based egoic behaviors, they can be reined in.

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Sayer Ji
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