Vitamin D

Most people don’t realize that Vitamin D is actually a hormone that is made in the skin specifically from UVB radiation from the sun. UVB light from the sun is the primary source of Vitamin D for most people today.  Because of this there are many factors that can interfere with a person getting vitamin D. Some of these include anything that directly blocks absorption of the sun's UVB rays like sun screen, dark pigmented skin, even living in northern latitudes because in the fall and winter months UVB radiation does not enter the atmosphere.  This essentially includes anywhere north of florida.  Age, body fat percentage, and genes can also limit natural vitamin D production in the body.  All of these factors combined make it difficult to recommend a daily amount of vitamin D for the general population.  Ultimately the best way to know for sure what an individual's need for vitamin D is to have a blood level checked and tracked.  Typically when checking blood vitamin D levels anything less than 30 ng/mL is considered deficient, and anything between 30-80 ng/mL is considered adequate.  I usually recommend vitamin D blood levels somewhere around 40-60 ng/mL. There are dozens of studies to back up those numbers that represent a myriad of health benefits from Vitamin D levels in that range.  So assuming that most of us are deficient in vitamin D, how do we get those numbers up to an optimal level?  In general it takes about 1000 IUof D3 per day to raise blood vitamin D levels by 5ng/mL.  So if a person is at 30ng/mL then they would need to supplement with 2000 IU of Vitamin D3 daily in order to increase their blood vitamin D levels to 40ng/mL which again is optimal.  Low Vitamin D levels have been associated with a myriad of problems to include Seasonal affective disorder, dementia, many cancers, sore and weak muscles, tenderness of the bones and osteoarthritis, autoimmune disorders like multiple sclerosis and fibromyalgia, high blood pressure, heart disease, diabetes, and frequent infections.  Ultimately Vitamin D deficiency or just suboptimal Vitamin D can cause so much suffering and is so easy to treat!  So get a blood level to find out where you are at and if needed get more sun (safely) or supplement, you can thank me later. 

Mold and Mycotoxins

We all know that mold is gross, it looks ugly, can be smelly, and is just in general unpleasant.  Having said all that, is it really all that bad?  Can it actually cause issues in human health?  If you have a pet you may have been told about mold or mycotoxins by your vet. Pet doctors seem to get more training to recognize and treat mold infections than traditional “med school”.  As it turns out molds and their toxins can cause significant problems in humans. There are more than 100,000 species of molds, of those there are only about 24 that can cause health problems in humans.  That doesn’t sound so bad, however molds can grow in almost any environment including cold and warm climates, wet and dry environments. Also those pesky mold spores seem to be pretty much everywhere.  Mold spores can grow on just about anything once they get wet, that is where the trouble with mold begins.  Once mold spores get a foothold they reproduce and create more spores.  Worse than that they carry along with them Mycotoxins.  It is the Mycotoxins that can really cause health problems in humans as they are toxic to the human body.  People who live in or work in areas that have been affected by mold growth can develop many symptoms and medical problems. Mycotoxins seem to damage the neurological system first and most abundantly. Research has shown that mycotoxins can caused and worsen ASD, Alzheimers, ALS, MS, Fibromyalgia, chronic fatigue syndrome, depression, adjustment disorder, and many others.  Unfortunately many of these patients are misdiagnosed as mycotoxins aren’t even considered by PCPs and psychiatrists.  So what happens to them?  They get stuck in the cycle of symptom -> pill -> failure -> new pill -> failure -> specialist -> more pills -> failure and on and on and on.  In the case of chronic disease, especially mental health/neurological problems, mycotoxicosis should always be considered.  One last thing, it is pretty clear in the literature that a blood test for mycotoxin antibodies is the gold standard and much more accurate than the urine test.  

Thyroid hormones: T4 to T3

Many of us know the typical symptoms of hypothyroidism; depression, constipation, cold intolerance, chronic fatigue, weight gain, brittle hair and nails, brain fog/cognitive impairment, sexual dysfunction, etc.  Also most of us are familiar with the usual labs; TSH (thyroid stimulating hormone) and total T4 (Thyroxine) but have you ever been tested for “free” T4, “free” T3 (Triiodothyronine), total T3, or reverse T3?  The primary hormone produced by the thyroid gland is T4 however it does produce a small amount of T3.  Also T4 is converted to T3 in the body, primarily in the liver and kidneys by 3 enzymes. We can talk about the enzymes later. Why is this important?  It is CRITICAL because T3 is considered the “active” thyroid hormone that enters the cells in the body and actually makes an effect in the body.  Yes, some T4 will have an effect on receptors in the body however T3 is considered to be approximately 4 times more potent than T4. So if we only ever check TSH and T4 then we are not getting a full picture of thyroid function.  Also what's up with the “FREE” thing?  Thyroid hormones are bound to certain proteins in the body such as albumin and Thyroxine-Binding Globulin.  The majority of T4 and T3 will be bound and therefore unusable by the body.  So it is the “FREE” hormone that is unbound and actually makes a difference and should be monitored.  This is not to say that the total T4/T3 should not be evaluated, it is simply to emphasize that a full picture of thyroid function is needed in order to treat appropriately.  Unfortunately most PCP’s only ever check the TSH and T4 giving an incomplete picture of thyroid function and therefore leaving patient’s untreated and feeling discouraged.  I can’t tell you how many ppl I have spoken with and patient’s I have treated who were told their labs were “fine” when they can tell that something is wrong.  Many patients who suffer with depression, brain fog, etc. do not need an SSRI or a stimulant, they need a thorough, complete evaluation and treatment of the root cause. My initial lab panel for all my patients includes a thorough thyroid evaluation. As well as other biomarkers that impact mental health and how a patient feels on a daily basis. 

Magnesium

Magnesium gets overlooked in mental health, I’m honestly not sure why.  It is used all the time in conventional medicine for things like constipation and abnormal heart rhythms.  It is essential for over 300 enzyme reactions in the body, cell energy production, function of chemical pumps, and relaxation of muscles.  Basically if you are deficient in magnesium then your brain and muscles won’t function properly.  Magnesium has incredible stress-relieving capabilities and is useful in promoting relaxation.  I like to use it in all my patients with Insomnia, ADHD, ASD, and anxiety   Magnesium deficiency can be referenced in literally thousands of medical conditions.  The problem is that the body does not produce its own magnesium and unfortunately we eat a diet that is exceedingly magnesium deficient.  Foods that are high in magnesium include, but are not limited to, leafy green vegetables, whole grains, beans, nuts, and fish.  I like to tell my patients that all biochemistry in the human body runs on the synthesis of ingested nutrients. So eating foods that have no nutritional value will actually deplete our nutrient stores and not replenish them. Our bodies and minds WILL NOT run smoothly and efficiently if we are living on Red Bull and fruit snacks. Magnesium levels can be decreased in the body by excess alcohol and coffee, consuming too much salt, sugar, and soda. Even some medications like diuretics and antibiotics can decrease our mag levels, this doesn’t mean we should not take a prescribed med BTW, we just need to be aware.  Often supplementing with magnesium is the best way to go but there are numerous different types of magnesium out there.  The ones I recommend the most are magnesium citrate, magnesium glycinate, and magnesium L-threonate depending on the patient’s individual needs and situation.  People with severe heart disease or kidney disease should consult with their PCP for magnesium supplementation.

HPA-Axis dysfunction

Imagine a female patient in her 30s to 40s who has been experiencing significant fatigue and brain fog, weight gain regardless of diet and exercise. She also reports getting sick frequently - multiple times per year, for the past 3-4 years.  This would probably affect her mental health, likely causing depression and anxiety. She would likely feel helpless, confused, and frustrated and seek evaluation and help from her PCP.  This is a history that I have heard countless times!  An SSRI may be prescribed by her PCP for depression and anxiety. She may turn to excessive caffeine due to her fatigue and tons of vitamin C to boost her immune system. But would any of that address the root cause of her symptoms? 

As mental health professionals we are all familiar with the hypothalamic-pituitary-adrenal axis and its implications to mental health. This sounds to me like a classic case of HPA-Axis dysfunction, also known as adrenal fatigue. This is thought to occur when the adrenals have become overtaxed by excess cortisol release and can no longer produce appropriate amounts necessary for optimal body function. There is a principle of endocrinology known as the “cortisol steal” where the adrenals will steal from other hormones in order to make more cortisol. The hormone that usually is stolen is progesterone causing an imbalance of the progesterone to estrogen ratio. Also classically thyroid hormone is thrown off by excess cortisol levels. As you can imagine this can lead to a myriad of other problems with periods, mood, energy, brain fog, acne/skin problems, etc.

The functional psychiatry approach to this case involves a detailed intake plus specialty lab testing to narrow down the root cause and lifestyle adjustments to balance the patient's HPA-Axis as well as other hormone imbalances. Here’s the catch, “Adrenal Fatigue” isn't a recognized medical diagnosis, however it is a well known problem in Integrative and Functional psychiatry. For this reason her PCP may miss the root cause of her symptoms, leaving her feeling hopeless.

Low Testosterone

If I were to ask you what you thought was the #1 thing that would cause anxiety, depression, mood problems, and generally negatively affect a man’s mental health, what would you say? 

I don’t think there is a clear answer but I also think you could make a fair argument for sexual performance. Poor sexual performance will have an incredible impact on a man’s mood and mental performance. All my sex therapists out there know this all too well! There are a number of things physiologically that can cause this but by far the most common root cause is low testosterone. 

Testosterone touches every cell in a man’s body, it gives drive motivation, performance, stamina, etc. Testosterone is responsible for a male physique, deep voice, and body hair. When men have adequate levels of testosterone they perform better both physically and mentally. Now I’m not talking about steroids or supraphysiologic levels of T, if you want that feel free to visit the local low T center. What I’m after is a typical physiologic level of T to illicit normal body and brain function for a male. 

If the T in a given male is low what is the root cause? It’s usually not just 1 thing but a number of lifestyle problems; poor diet, sedentary lifestyle, multiple endocrine disruptors, gut inflammation, porn addiction, excessive video games, etc. Lifestyle changes alone can often move the T number from “low normal” to optimal in a matter of weeks. If needed, a course of T replacement, natural T stimulating medication, or supplement can make a world of difference in a man’s life. It can save marriages, careers, relationships, and even lives.

Men don’t like to talk about it but the statistics don’t lie: 

• Over 6 million men suffer from depression per year, but male depression often goes underdiagnosed.
• More than 3 million men in the US have panic disorder, agoraphobia, or any other phobia. 
• Men account for 75-80% of all suicide deaths

Thyroid function and depression

Did you know that depression is am extremely common finding in patients with hypothyroidism? The thyroid gland is the master regulator of almost all functions in the body.  The thyroid gland is responsible for the release of noradrenergic and serotonergic transmitters. These neurotransmitters are responsible for energy, motivation, blood pressure, heart rate, and many other processes in the body.  For our purposes we are interested in their effect specifically on mood. Research has shown that SUBCLINICAL hypothyroidism can affect these levels, not just classic or overt hypothyroidism.  In fact, in patients who are depressed, there is a correlation with the incidence of subclinical hypothyroidism being present.  The majority of these patients are undertreated or not treated at all. Studies have shown that there is a relationship between serotonin and thyroid releasing hormone that works in a negative feedback loop. The degree of hypothyroidism is correlated with the degree of depression meaning that patients who are hypothyroid are more likely to suffer from treatment resistant depression. Unfortunately these patients will be prescribed SSRI after SSRI or SNRI or antipsychotic without relief.  We all know someone who may fit this description.  A thorough assessment for overt hypothyroidism as well as subclinical hypothyroidism is a part of our BASIC lab evaluation as it is much more common that most people realize.  Don’t even get me started on Hashimoto’s!

ADHD is a Neurobiological Disorder

I would like to set the record straight; ADHD is a neurobiological disorder, not a behavioral problem or a disciplinary problem. The American Academy of pediatrics recommends parental emotion training/ behavioral training for young kids with behavioral concerns and/or ADHD.  For kids 6 and under the AAP actually lists the emotional/behavioral training above medications, play therapy, and other psychotherapies.  In order to do this type of coaching/training there are certain training/credentialing that a therapist must complete to meet the AAP specific recommended therapy.  Children's Hospital of Colorado Springs has a clinic that is behavioral/psych specific here in Colorado Springs that does this type of parent training/emotion coaching.  Insurance coverage for this service is typically not great or so I am told, so parents will often end up paying out of pocket anyway.  Using emotion coaching principles has been very helpful to me and my wife in our family with my crazy children.

Post-partum Mood Disorders

Do you know a mom who feels their absolute best when they are pregnant? Only to “feel off” in the postnatal stage? The endocrine system and mental health are undeniably tied together. Specifically, hormonal changes following childbirth can have a significant impact on a mom’s mental health. Most people don’t realize that there are dramatic endocrine changes that occur during gestation, labor and postnatal phase. For this reason, hormonal therapies are not to be ignored in the treatment of postpartum disorders. 

The ratio of progesterone to estrogen is known to affect behavioral, emotional and cognitive functioning.  Progesterone is the most abundant hormone in pregnancy. After birth the blood progesterone concentration drops dramatically. Research suggests this is a hormonal explanation for postpartum syndromes. 

For this reason, estrogen, progesterone, thyroid hormones, and others are part of our basic lab work-up for any woman-especially if she has had a baby within the last year. Any woman who “feels off” should have a thorough hormonal evaluation.  If you know a woman who fits the bill, have her call for a free 15 minute consultation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992410/ 

How Nutritional Lithium can improve mental health

Nutritional lithium is a trace mineral that can have positive effects on mental health. It is not the same as prescription lithium, which is a strong medication used to treat bipolar disorder. Instead, nutritional lithium is found in very small amounts in certain foods, water, and supplements. Research shows that it can support mental well-being and even help with mental health disorders.

What Does Lithium Do in the Brain?

Lithium affects chemicals in the brain called neuromodulators, which are like messengers that help your brain communicate and function. Two important neuromodulators are dopamine and serotonin.

• Dopamine is often called the "feel-good" chemical. It helps you feel pleasure, focus, and motivation. However, too much dopamine can cause problems like anxiety, impulsive behavior, or even psychosis. Nutritional lithium helps to balance dopamine levels, preventing it from becoming too high or too low. This balance is important for staying calm and focused.
• Serotonin is another brain chemical that helps regulate mood, sleep, and feelings of well-being. People with low serotonin levels may feel depressed or anxious. Nutritional lithium can increase serotonin activity in the brain, which may improve mood and reduce symptoms of depression and anxiety.

How Does Lithium Protect the Brain?

Lithium does more than just balance chemicals. It also protects brain cells and helps them grow stronger. This is called neuroprotection.

• Lithium helps increase a protein in the brain called BDNF (brain-derived neurotrophic factor), which encourages brain cells to grow and stay healthy. This may help repair damage caused by stress or mental illness.
• It reduces inflammation in the brain. Inflammation is linked to many mental health problems, such as depression, anxiety, and even memory issues. By lowering inflammation, lithium helps the brain work better.
• Lithium stabilizes mood by helping brain cells communicate more effectively. It does this by strengthening the connections between neurons, the cells in your brain that send signals to each other.

The Bottom Line

Nutritional lithium is a simple and natural way to support mental health. By balancing brain chemicals like dopamine and serotonin, reducing inflammation, and protecting brain cells, this trace mineral may help improve mood, focus, and overall well-being. While it’s not a replacement for therapy or medication when needed, it could be a helpful addition to a healthy lifestyle.

Neuroplasticity: Rewiring the Brain for Better Mental Health

Neuroplasticity refers to the brain’s ability to reorganize itself by forming new neural connections throughout life. While once thought to be static after childhood, research now shows that the brain can change and adapt in response to learning, experience, and injury.

In mental health, neuroplasticity offers hope for recovery from conditions like depression, anxiety, and PTSD. Cognitive Behavioral Therapy (CBT), mindfulness, and even physical exercise can promote neuroplasticity, allowing individuals to "retrain" their brains to function in healthier ways. For example, CBT helps patients identify negative thought patterns and replace them with healthier, more positive ones, literally rewiring neural pathways.

How to Harness Neuroplasticity
Activities like learning new skills, engaging in regular physical exercise, and practicing mindfulness have been shown to enhance neuroplasticity. Therapies designed to encourage new ways of thinking, such as CBT, are also effective at harnessing neuroplasticity to improve mental health.