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The Mental Health Crisis No One’s Talking About with Dr. James Greenblatt, MD · hol+ with Dr. Taz MD | The Future of Medicine is Holistic

• (00:00) Most psychiatrists don't do any testing. There are mental health clinics where they do not allow their doctors to do any blood testing. Wow. And I'm assuming you're doing consistent testing on your patients. I I couldn't evaluate a depressed patient without looking at hormones, without looking at nutritional deficiencies, without looking at a list of 15 or 20 factors. (00:26) So someone comes in sad, they don't think about hormones, nutritional deficiencies, iron or B12 or vitamin D all associated with depression. Our mental health model doesn't look at any objective testing is just prescribing medications. Vitamin B12 is one of the greatest tragedies in medicine because not only do most people not do the blood test, but the norms are very off. (00:48) They're depressed. They go to a PCP. They get a blood level of 220 and someone says it's normal and they struggle for years and then somebody who understands B12 sees them, gives them a B12 shot or two and the depression lifts. I mean, what's the block? I mean, the research is there. (01:06) Why are we not doing this? That's been my career question. My next guest, Dr. James Greenblat, MD, is a board-certified psychiatrist and a pioneer of integrative and nutritional psychiatry. As you said, the research is there. The only answer that that I have is that the pharmaceutical influence and model is so strong and and also so easy. (01:31) I mean, think about there are 10-minute med checks that some of the telealth companies and some of the outpatient clinics will pay for it. So, docs, nurse practitioners are seeing psychiatric patients for 10 minutes. All you can do is prescribe another medicine. For more than three decades, he has treated patients with ADHD, depression, anxiety, and eating disorders using personalized protocols that combine conventional care with targeted nutrients and labg guided precision. (01:56) He is the author of multiple books, including Finally Hopeful, which is out soon, and Finally Focus, which may help parents everywhere. Could we say if you are requiring more than one pharmaceutical medication for your anxiety or depression, you need to do a deeper dive. Could we make that statement or is that not fair? No, absolutely. (02:17) I mean, people coming out of hospitals average five psychiatric medications. Go. Uh there are kids now being put on seven or eight. We talked about tellaalth. Sometimes these short visits, you don't have time to stop a medicine, so all you really can do is add another one. Oh my gosh. And um please join me in welcoming Dr. (02:37) Greenblat to the show. Dr. Greenblat, I am thrilled to have you on the show today. We know that we are in the depth in the midst of a mental health crisis like no other. I don't know if there's been another one in history before. And we need help. You know, I think I meet people every single day in practice who if they're not suffering from some kind of low-grade anxiety, it's going on or moving on to depression, moving on to things like eating disorders, moving on to so many different other conditions. (03:06) And sort of the paradigm I feel of just doing counseling or just doing therapy is kind of not working. And I want to take some time to dive deeper into what's happening out there and what our options and solutions are because I know as if as a physician I'm frustrated. I can't imagine what patients are feeling like and what even the rest of the medical community is feeling like. (03:30) So I'm really happy you're on the show today and excited to get your viewpoint. You have a book coming out called Finally Hopeful. So talk to us a little bit about how you are seeing this evolving mental health crisis, why you think depression is so on the rise and then we can go from there. Sure. It's great to be with you. (03:49) I I think I've shifted the term rather than a mental health crisis because being a psychiatrist for 30 years, I've been seeing it for 30 years. I've changed the term which I think is more meaningful right now to the model of our treatment is in crisis. Oo. So our current model as you suggested psychotherapy or we put the psychiatrist or primary care doctor medications. It just hasn't been sufficient. (04:17) So we have such large numbers of patient that haven't been benefited from psychotherapy or medications. And that's the model of care that you and I been involved in integrative functional medicine that has to get into the treatment plan for treating depression. And that's been what I've devoted my career to. So having a career that spanned 30 years, you don't really think the incidence is up necessarily of people having anxiety and depression. You know, am I understanding that correctly? You don't really think that I feel like it's (04:50) more and more and more people, but you're saying really the number of people might have been the same. Our model is just failing us. Well, no, it's absolutely increasing. That that's clear to me. But I think when the press uses those terms or researchers uses those terms, all we get is more stats about how it's increasing and nobody's looking at why. (05:16) And that's where I think the model of care is just band-aids. And how do how do we get here? Like why do we think the model of care exists the way it does today? I know you and I think very differently about how to take care of somebody who has anxiety or depression, but I'm just curious because I feel like the field of psychiatry and the field of just dealing with mental health disorders continues to go through these tumultuous times so to speak, right? Like so I'm curious like give us a little bit of an overview of how this field has evolved and what's different about the way that you practice. (05:49) Sure. I mean I think psychiatry has gone in cycles over a hundred years because we don't understand the brain. So we desperately try you know whether it's shock treatment or uh what happened you know in the 70s and 80s is medications. (06:09) So we started developing safer medications so it was easy to prescribe Prozac and some people got better. So we got stuck on that kind of pharmaceutical what I call symptombbased approach. someone sad. So we give them an anti-SAD medication. Initially it was Prozac. Now we have many and getting stuck in that symptom based model. It just missed so many underlying causes of depression. That's the focus of my book and my career. (06:34) Are there ways that we can look at underlying causes? Doesn't mean medication might not be helpful. Therapy might not be helpful. Both are helpful but often not enough. What are some of the gaps that you're seeing when a patient comes to you, you know, uh, having a history of depression or even anxiety? I know the two can bleed into one another. (07:00) You know, what as you're evaluating some of these patients, like for me, for example, one of the things that I keep seeing over and over again is so much of this depression being triggered by changes in hormone levels, right? like high androgens in our young in our young people like our young girls or low estrogen you know as women change through different phases of life and we're seeing like the onset of of depression or depressive symptoms you know so that's a gap that I see on my end what do you see on your end frequently well if we just take what you just said you actually think about what's (07:29) happening in the body and think about hormones most psychiatrists don't do any testing so someone comes in sad they think about hormones, right? So, we can think of many hormones, thyroid as well, and in my career, nutritional deficiencies, whether it's to iron or B12 or vitamin D, all associated with depression. (07:49) Our mental health model doesn't look at any objective testing. It's just prescribing medications. There are mental health clinics where they do not allow their doctors to do any blood testing. Wow. And I'm assuming you're doing consistent testing on your patients. I I couldn't evaluate a depressed patient without looking at hormones, without looking at nutritional deficiencies, without looking at list of 15 or 20 factors, things we've learned in medical school, right? Right. You know, we know iron deficiency to (08:23) there was a multiple choice test. What causes depression? In medical school, we checked hormones, iron, and thyroid. But as practitioners, mental health practitioners are not doing testing. And is it not I mean what's the block? Is it not covered by I mean the research is there. (08:42) You can't even say like so many people will throw well this is not evidence-based and that I mean the research is there. There is evidence-based research when it comes to connecting the dots between nutritional deficiencies and depression or hormones and depression. Why are we not doing this? It's been my career question. As you said, the research is there. So, we don't have that argument and it's been frustrating for me, certainly frustrating for patients who are struggling. I think things are changing a bit. (09:11) The only answer that that I have is that the pharmaceutical influence and model is so strong and and also so easy. I mean, think about there are 10-minute med checks that some of the telealth companies and some of the outpatient clinics will pay for. So docs, nurse practitioners are seeing psychiatric patients for 10 minutes. All you can do is prescribe another medicine. (09:35) Okay. I'm going to ask you a controversial question. How do you feel about this sort of explosion of the quick teaalth visit? You know, we now have it niched out for lots of different areas, right? You can do a quick tellahalth visit for your GLP1. You can do a quick tellalth visit for your hormones. Apparently now you can do a quick tele health visit for your psychiatry medications as well. (09:59) I'm just curious as someone who's a veteran in the field like how you feel about some of that care. Uh concerning would be the the you know overarching word. Absolutely. I mean it takes hours to to take a psychiatric history. Um because not only are you looking at the person as an individual but as a integrative functional doc we want to look at their uh biology and their genetics. (10:25) So it really takes a long time. Yeah. I I have the same issue and I think you and I are aligned on something. You talk about the whole body map, right? You talk about how we can quickly try to understand the whole body. I talk about, you know, sort of the five bodies is what I talk about and how they intersect and intertwine to create all kinds of different conditions and presentations, you know, but tell us what you mean when you say the whole body map. (10:49) What are you referring to there? Well, sometimes when I give talks I have first slide is just a picture of a neck and I call it anatomy 101 for psychiatrists just to help people understand that you know what happens in the brain affects the body and vice versa. (11:08) So it really is just looking at all the lifestyle, nutritional and and genetic factors that affect that individual. And if you ignore one, and too many of our colleagues are just overfocused on just one part, the genetics or the hormones, but everyone's different. And that's kind of the core of my work is being able to look at their individual different genetics and biochemistry to treat depression. (11:32) Are there types and patterns that you're seeing? Like are you able to, you know, for somebody listening, you know, if they're trying to understand, well, that's a lot of information. And there are a lot of different factors. How do I synthesize this information, make it applicable to me? Are there some general patterns that you're seeing that are getting missed? Yes, but it does take time and it is complicated. That's challenging. (11:55) And that's why I wrote the book Finally Hopeful try to outline some of the things uh individuals can do, ask their doctor. You know, vitamin D is obviously in the news. Um, and people talk about it for bones and calcium, and now we can talk about it for immune function, but the research on vitamin D and depression and dementia and suicide is 30 years old. (12:20) Vitamin D is required to make serotonin, the neurotransmitter that everyone's talking about that we focus on with medications, and that information is not available. So, just advocating for some simple nutritional tests can, I believe, make a huge difference. um for many individuals. (12:39) Well, let's go through a quick checklist for both the patient and the clinician, right? Because again, this time pressure if you're in the conventional system, you know, you don't have that much time maybe with your provider. First of all, when someone is experiencing symptoms of depression, let's start there. What are your like top five indicators that you may be depressed? What what are you telling patients over and over again? Well, I would think looking at a series of blood tests, so vitamin B12 Mhm. (13:04) is I've used the term one of the greatest tragedies in medicine because not only do most people not do the blood test, but the norms are very off. So I think what's your norm? I'm curious. Over 500. Me too. I was like everyone needs to be over 500. I say that all the time. There's too many individuals. (13:23) They go to they're depressed. They go to a PCP. They get a blood level of 220 y and someone says it's normal and they struggle for years and then somebody who understands B12 sees them gives them a B12 shot or two and the depression lifts. So sometimes it can be that simple, not always. (13:47) And are you seeing these low B12 levels, you know, just in people that are like over 50, over 60, or is this even happening in like children and young adults? I know we're seeing it in children, adolescence, adults. It's a little more common in in vegan diets, but not necessarily. We see a lot of heavy meat eaters that have B12 deficiency. We see pernicious anemia, an autoimmune disorder. (14:10) Um, sometimes we don't know the cause, but we see the blood test and replete the B12 and patients feel better and they do better. Something so simple and cheap. It's not expensive. Exactly. Not expensive at all. What about vitamin D? Because you've mentioned that. (14:28) What is an optimal level for somebody dealing with depression? Well, the first goal is is testing, right? So many people don't test and I've seen undetectable vitamin D and darker skinned uh individuals. We've seen very low levels. I I try to get levels between 40 and 60. Okay. Um but certainly in the mental health world, anything under 30 we would try to treat. And I think you also mentioned in your book, you mentioned the importance of iron and thyroid. (14:52) Are there rough guidelines for that that somebody listening could maybe go back to their labs and look and see if they're falling in the right ranges? I I think for both of those the lab values are guides and and can be helpful and but nobody's testing. So if they tested at least um as a psychiatrist I might send someone back to their PCP and said you you have low thyroid you need treatment. (15:16) Um the iron I think the levels work. It's just getting those tests. We just don't think of iron deficiency in a 32-year-old adult, but we see it. And even with thyroid, you know, I feel like that range is not where it needs to be. You know, a normal TSH can go as high as five. And I find many people do better when their TSH is somewhere between one and two. (15:43) So I don't know when it comes to the context of depression if you have a goal TSH or something that you've seen consistently that would be helpful for both the clinician and the patient to follow. No, no, I agree. Absolutely. The TSH numbers are really, you know, outdated. So, we look for something under two. And in psychiatry for 30 years, even with normal thyroid lab values, we have augmented our treatment with thyroid hormone. (16:14) And that's been something we've been doing for many, many years, although it's now forgotten because now we just augment with another medication because medications are so easy and common. They had advertisements on TV all the time. So just add the second medicine versus adding the right nutritional strategy or the right hormone strategy on top. You know, I'm curious too about and we can go into medications in just a moment, but with the different classes of anti-depressants and the many things that are out there currently, do the medications themselves compound nutritional deficiency? Like for example, if you're on Prozac or Wellbutrin or, you know, um what's the other one that's out there right now? (16:52) There's so many that are out there right now. If you're on one of these medications, are they in turn making a nutritional deficiency worse? Are there things people should be thinking about if they're on their anti-depressants and maybe noticing some things are a little bit better, but some things are a little bit worse? Yeah, I'm not sure that the the side effect profile of the anti-depressants, which is long um and it it gets in the way of compliance, people trying to stay on these medicines for a long time, is not necessarily related to nutritional deficiencies. What we have found though (17:23) and the research goes back many years is nutritional deficiencies will result in a poor response to the anti-depressants. Oh interesting going back to B12 and iron and D or other nutritional deficiencies as well. Um other as well I mean folate was the one that was mostly studied. If someone had low folate they didn't respond to the anti-depressants as well and they had a higher relapse rate. (17:52) So nutrition plays an important role and a big part of my career has been in the field of eating disorders where we've had you know malnourished individuals men and women and medicines don't work at all and and there's no approved medications even anti-depressants so with eating disorders which is another touchy area right where I honestly see more failures than I see successes and when it comes to medication management and psychiatry management your passion about eating disorders. I feel like you spent a big portion of your career for those who don't know in (18:23) the field of eating disorders. Let's talk about that for a second because I think it fits under the umbrella of depression and what's happening here. You know, what are you seeing in that field? What's happening in the eating disorder world? You know, same questions like is the incidence up or is it again a model failure where we're just not tackling it correctly? And I almost feel like this is what's I was just talking to a patient last week where her 30 I think her daughter's now 30 32 years old and has two three-year-olds and now has (18:52) a 15-month-old and went on a GLP1 to lose I guess the baby weight. Got quote unquote addicted to it. had a past history of an eating disorder and got down to 90 lbs and liked the way she felt around 90 lbs until the whole family had to do an intervention, you know, to say like, okay, this is now an eating disorder. (19:19) So, some of the conversation of today around like even the use of GLP1s, which in a positive sense has helped people lose weight, in a micro dose has helped reduce inflammation, is it adding to the eating disorder conversation, too? Just curious what your perspective is. I ask like five questions in that statement but anyhow so tackle it however you'd like but big important questions eating disorders have been in the field of inpatient and residential treatment for 25 years and I think to put in perspective it is most life-threatening illness in psychiatry so and it's the highest risk of suicide (19:49) in psychiatry so we talk about depression bipolar and addiction but eating disorders are where these kids are dying oh my gosh And um it's it's tragic because our model of care there I think is stagnant. There are no medications that are approved. (20:08) But the treatment model is throwing multiple medications at patients. And the current model is really just calories. So restoring weight whether it's in a hospital or on a day program there is absolutely no discussion about the micronutrients that have been lacking or genetically have a high requirement for. (20:32) So in my work we have found dramatic changes by providing micronutrient supplementation on the path to treating eating disorders. So is that treatment model, let's talk through that a for a second. So someone comes in with an eating disorder, maybe they're at not an advanced stage, but a a medium stage where they're food restricting or they're binging, one of the two. (20:56) Do they will they take are they compliant with the micronutrient pro? Like what what is your experience there? Like will they take the things you're telling them to take is question number one. And if you are telling them to take things like what are some of those key things that they should begin with? Uh great question and it depends on where they are in their eating disorder but um most of my career has been looking at the trace mineral zinc as actually a causitive factor for the progression of an eating disorder. And so when you help a patient understand (21:27) some of these nutritional deficiencies are affecting their digestion, their sleep, their anxiety, and zinc is related to all of those. It's important for sleep and melatonin for digestion and for neurotransmitter synthesis. The patients will take it. (21:50) Now many eating disorder patients might not take a supplement or two supplements if I tell them this is going to help them gain weight. Right. Right. Right? But if I help them understand that their anxiety and their sleep and their digestive problems will improve, then that starts the process of kind of micronutrient supplementation to support recovery and eating disorders. So interesting because I feel like it's kind of a backwards approach, right? Like many people will start with treating with an anxiety medication or a depression medication first for an eating disorder before they think about (22:22) the supplementation component. Mirroring what you were talking about with depression. So if you had to line out for somebody with an eating disorder or a parent who has a child with an eating disorder, these are the couple of things I would begin with. (22:40) What would you say? Well, most patients with eating disorders have avoided fat if not one year, two year, 10 years. So, essential fatty acids are critical. So, omega-3 supplements would be um number two after zinc. Okay. So, zinc, the omega-3 supplements and a a B complex would be kind of the top essential. Yeah. How do you feel about Delin or methylolate? Well, I think um in our work with both eating disorders and depression, we do look at kind of genetic varants, the MTHFR gene to see if someone has a hard time processing folate and and so it's part of our practice every day. I find some of the um medical (23:22) foods like Depplin sometimes too high a dose and some people can get um agitated tolerate it. Yeah, but we do recommend supplementing with lmethylolate particularly for those with those genetic variants. So mainly for MTHFR, SNIPS is that probably the main group. Uh for those of you deplin it comes in now prescribed doses of 7 and a half and 15 milligrams I believe. (23:49) And we are using it in practice to help with our MTHFR which is a gene that kind of we've talked about it before on the show. It's a gene that sort of dictates the rate at which we become inflamed, how we detox, how we use particular nutrients. (24:08) Is there an overlap between MTHFR and eating disorders or between MTHFR and depression? Absolutely. And again, research for years. This is not new. It's not new, but it's not incorporated into our, you know, practices. So, addiction, depression, um, I don't think there's research on eating disorders, but I've actually seen it. (24:33) And the most common thing I've seen being in a hospital, psychiatric hospital for 30 years, those that get to the hospital because they didn't because they failed outpatient treatment, a lot of them have that MTHFR variant and by adding folate to their treatment model, the medicines work better. Wow. So adding folate and is it methyl folate that they should be adding? Correct. Right. And there's that's a differentiator from just regular folate. (24:54) What about adding glutathione to their treatment protocols? And this is straight from our exam rooms for everybody. I hope I'm not boring everyone, but these are things that we're testing. We're looking at MTHFR. We're looking at folate, methylolate levels. We'll look at an omega-3 level in the context of, you know, different mental health issues. (25:12) But do you find glutathione, which is a problem many people with MTHFR have, it's an antioxidant that supplies energy to the cells. Do you find that replacement of glutathione in some form has made a difference for either population, the eating disorder population or the population with depression? Yeah, with our eating disorder patients, it's usually not commonly prescribed because there's only a few supplements that we can recommend, but absolutely for depression and with just some concerns around those with molds and other kind of um infections that don't respond as well. but critical for our (25:46) depressed patients and many of our other patients. And do you like do you like adding it in orally or topically or through an IV? These are so many of the options that are out there now. Yeah, the IVs have been challenging, you know, for many of our patients. So, it's usually um the uh PO lip liposomaal liposomaal. Okay. Excellent. (26:08) So again, it's the micronutrient first approach. It sounds like is what you're advocating for when it comes to eating disorders and depression. Is there a second level of things that we should be thinking about? Would it be hormones next or where would we go next? You know, I think genetic testing has really kind of um uh dramatically changed my practice. (26:34) I mean for years I've been looking at MTHFR and genetic testing to predict which medication someone might respond to. Um but more recently been very involved in neutrogenomic testing. So looking at how you metabolize B12 or vitamin D or vitamin C and uh being able to really identify a personalized kind of treatment protocol. So tell us a little bit about that. (27:00) So if I for example give somebody vitamin D or folate or vitamin C or any of these things, I'm not guaranteed that they're going to do well with it. Tell us tell us what you're seeing on those neutrogenomic profiles. Yeah, I mean I think in practice we see it all the time. Everyone's different. We can give the same 10 people walk in the office, we give them 5,000 international units of vitamin D and someone levels go way up, someone doesn't budge. (27:27) And um we have tremendous genetic differences. And the more we dig deep to look at those genetic differences, then we know this individual needs to take 10,000 units of vitamin D daily because of these three genetic snips, they call it. Someone else might do okay with a lower dose. So by building that kind of profile, it just enhances treatment. (27:52) And we've been doing it in cancer, right? Not that I'm an expert, but I just know they've been personalizing treatment for 20, 30 years, and it's revolutionized outcomes, right? In mental health, again, it's just symptomatic based. Take this medication or go to this therapy. So there are now some neutrogenomic um platforms where we can you know develop that personalized treatment model. (28:20) Can a patient ask for those in a clinic setting or do they need or do they order it on their own? Like what are your what what do you advise if they don't have access you know? Well I think it's always challenging but the the the answer is always find a integrative and functional trained psychiatrist and mental health professional and and there are growing numbers. (28:37) uh it's really much easier to say that now than it was 10 years ago, certainly 20 years ago. So genetics are a big part of the conversation. In practice, we've been doing uh we flip-flop doing two different tests that can match genetics to not neutrauticals as much, but map genetics definitely to medications. Do you find value in that kind of information? And I think we use Gene site then we use PGX1 and you know we brought them both in at different points of the practice. Do you use those when it comes to medication management and how reliable (29:10) do you think some of those tests are? Yeah, I've been using them from day one of the Genomine. Okay. Um even before they were commercial I was um involved in looking at it. So I've done hundreds thousands of patients and it's helpful. Um but this neutrogenomics provides just a just much much deeper dive. Neutrogenomics. So that's the word we should be all thinking about. Okay. (29:33) Looking at neutrogenomics. Is there are there a couple of tests you recommend going to or? Yeah. The group we've been using is called Intellix DNA. Intellix. Okay. And um they've been around for a while, but now people are um much more actively understanding um the complexity and how it fits into mental health. (29:51) So recently we had a guest on talking about um psilocybin and mushrooms and we've also had people talking about MDMA and we've also had people talking about ketamine and lithium oritate right and I and I'm lumping them all together just because at least in my head you know as a clinician the way I think is you know sort of nut nutrient load and what's happening there hormonal balance and is there anything happening there that we need to tackle you know, medication matching based on genetics, that type of thing. But I'm (30:25) not that comfortable going into this next toolbox. Can you tell us a little bit about some of these what we are considering or what I think culture is considering more novel approaches to depression or even eating disorders and where they fit into the mental health paradigm. (30:46) you know, whether it's your opinion on psilocybin, on ketamine, you know, on any of these other substances, on lithium oritate. Can you just fill us in on on what you think? Sure. Uh, let's separate separate from, let's say, the ketamine, the psychedelics. Um, I've been following that literature and and working in a hospital. Most of the time I'm seeing people that have failed those treatments really. (31:12) Um, so and and I gave a talk at a psychedelic conference once and presented cases of people who failed because of just what we were talking about early. No one tested their B12. No one tested their thyroid. So giving someone ketamine without that workup to me doesn't make sense. And that's what I've seen a lot. So I think there's some optimism around ketamine. (31:32) But I do think there are clinics that are popping up that are abusive. And I've seen people get ketamine shots for a week, weekly for a year. Um, and it did did damage. It's not helpful. What's the premise of ketamine? Why why is it supposed to work? Um, well, I mean, it's an anesthetic and it has kind of very quick acting onset and we kind of know some of the neurochemistry and it does improve depression. The question is again there's no look at underlying cause. (32:04) It's that kind of band-aid. And I think because it's simple and there's a financial incentive that there are clinics that are now just abusing it. But I've seen positive results with ketamine. Uh but more people just kind of looking for that magic pill. And the psychedelics the same. I've heard great stories. (32:26) I've followed the research. I think there's potential, but I think some people are looking at the magic bullet. The lithium oritate is a completely different nutritional supplement that is so it's a nutrition. So and remember when we hear lithium we think old school lithium right like where you're prescribing lithium for bipolar disease and all that other stuff. Lithium oritate is different. Correct. Okay. (32:52) So lithium we think of either batteries burning you know in Right. Exactly. Um or but it's it's a natural element. it's, you know, it's in the earth's crust. It's been around for billions of years. Um, and so we know lithium is an element. And then most of us think of lithium as this medication that causes side effects for bipolar illness. That's called lithium carbonate. (33:18) But lithium oritate is a nutritional supplement and it's something that I learned when I was in medical school from Jonathan Wright. If you remember that name, but he was kind of the grandfather of this field. Okay. Okay. He was writing about lithium oritate and I remember reading about it when I was in college before medical school. (33:43) So I've been reading and um and when I went into practice prescribing it um and because it has tremendous potential for mental health. Now, in the last few months, major studies came out of Harvard discussing lithium oritate as a preventative um supplement for dementia, Alzheimer's. Wow. And how does Okay, same question. (34:07) How does it work? What what's it doing? Um and is there a natural food source for it if it's a if it's considered a nutritional supplement? It's interesting because lithium um is mostly in our water supply. So, if you drink tap water, which really doesn't exist nowadays, right? You get a little lithium and it's small amounts in our food supply. Um, but most of it's probably in our water. (34:26) But now with the filters and the bottle water, we're getting less lithium. So, it is considered a supplement. We probably get a couple milligrams a day in our diet. Mhm. And the amount in the water around the world has been tested and shown to be related to mental health outcomes. Really fascinating. So we have literature from 1980 from countries all over the globe. (34:54) If there's low amount of lithium in your drinking water in that community, low lithium, higher rates of suicide. and and Japan and Lithuania and Greece, all over the world and repeated studies, low lithium, and then more recent studies, um, low lithium, higher rates of dementia, Alzheimer's, and and just from your drinking water. Wow. (35:26) And then this major study came out of Harvard where they were able to demonstrate that Alzheimer's patients had low lithium in the brain and lithium supplementation with oritate, not any other form, actually reversed the neuropathology of autism. Really? Yeah, it was dramatic. It got um a lot of press and people are excited and for me it was a little frustrating because every academic colleague read the paper. (35:52) It came out in nature. Okay. And said this was amazing. Great. But they all ended it by saying it's too early to recommend lithium orate to our patients. It's not too early for the patient struggling. Absolutely. And I laugh because I've been prescribing it to children. Right. Hey, what's the dose for children? What is the recommended dose? Well, I I start everyone on at at the physiological dose of 2 milligrams. (36:16) Okay. So, it's it's it's safe. It's what some of us get in our diet from eating, you know, foods. And then sometimes we we titrate it up to five or 10 15 milligrams. I think somewhere over 10 milligrams. You probably should be working with a professional. But absolutely quite convinced lithium oritate is safe at these dosages of two to 10 milligrams. This is groundbreaking. (36:44) Now what about in the eating disorder community? Does lithium oritate have a role for those patients as well? Absolutely. So the the symptom that I've used lithium oritate mostly for is irritability. M you know something we see across right every diagnosis but there's no official name but that's kind of the hallmark symptom so kind of mood liability irritability um and that's where I would recommend lithium oritate. (37:09) Fascinating. So lithium oritate is really not in the same category as the ketamines and the you know some of the other things we're we're seeing. Is there anything else on the horizon that you're excited about when it comes to, you know, depression or eating disorders as things that are hopeful, you know, for the future? I'm hopeful if we go back to the basics really. (37:36) If we just look and test, there's so much information that we have where we could help individuals and lithium oritate, I think, is part of it. All the tests we've talked about is part of it. You know, I think the research I is exciting about different um psychedelics and things that are helpful, but without kind of the foundation um it's likely not going to make a difference. (37:59) Fascinating. And in your book, Finally Hopeful, tell us what you're hoping to to relay there and the information that, you know, somebody reading could learn. Sure. It's really just trying to help individuals summarize what we call functional psychiatry. (38:17) Looking at the root cause and just taking medications might not be enough. So we would just list some of the tests you and I have discussed. Checking your hormones, checking your B12, vitamin D, magnesium, zinc. And so we go through it um written for patients and consumers so they can understand one is not their fault. the psychiatrist we use the term treatment um refractory kind of blaming the patient right you're refractory to our meds and so we tried to kind of put together a plan that individuals can uh follow and and doctors can appreciate what's your opinion on the polyfarm (38:57) pharmacy of mental health meaning you know the multi-layered medication approach that many of I see many patients on right? They're on an SSRI, they're on another medication, maybe an added clonopin or Xan. I mean, it's like medication after medication. It's like medication stacking is probably what we should call it. (39:18) You know, what is what is your thought there? And I'm I'm stretching here, but you know, could we say if you are requiring more than one, you know, pharmaceutical medication for your anxiety or depression, you need to do a deeper dive. Could we make that statement or is that not fair? No, absolutely. I mean, people coming out of hospitals average five psychiatric medications. Oh my gosh. (39:40) Their kids now being put on seven or eight and we talked about teleaalth. Sometimes these short visits, you don't have time to stop a medicine, so all you really can do is add another one. And so, it's really sad and I don't think it makes any sense. medications can be incredibly helpful, but if you need more than one or two, then yes, let's dig deeper and see if we can um provide you some benefit. (40:11) Yeah, I think, you know, it's such a challenge and I want to really challenge anyone watching or listening to us because I think we're in a culture that wants quick everything. You want quick medicine. You want quick fixes. You want quick We haven't even talked about GLP once, so we probably need to talk about that. (40:29) But you want quick weight loss, you know, you want all these quick solutions, but part of the mission of the show and a mission of a lot of the work I do is how do we unwind that wiring within us to want those fast and easy answers? Because I think as the medical community, the business community, everybody continues to run in that direction, you know, and I did an episode even about AI and our doctors going to be relevant. (40:48) And I think as as everyone runs in that direction, I think we're going to continue to be disappointed with the results because unfortunately the h or fortunately the human body is interconnected and if we don't understand how all these things work together, we continue to do a disservice no matter how fancy or sexy the technology is, you know, and so I hope anyone watching or listening to us is is kind of paying attention. (41:14) Well, you're essentially saying we got to slow down. We have to take a holistic approach. We have to look at all the determinants starting with nutrition, moving on to hormones, then thinking critically about medication and medication management and adding in some of these other things that are a little bit gentler on the body to make a difference, you know, when it comes to depression and even eating disorders. (41:37) So, you know, I hope I hope that message is getting across because I know it's it's counterculture, so to speak. Are you hopeful that we're going to be able to change medicine and the delivery when it comes to your field? Yeah, I mean things are changing. I mean now we're giving lectures at traditional psychiatric conferences. (41:55) Um our traditionally trained psychiatrist and young doctors are looking for this information. Well, that's encouraging for sure. And I want to quickly I know we're almost on time, but there are two populations I feel like I want to talk about. Actually before you even walked in I was talking about a study around dopamine and dementia Alzheimer's and the connection between the two and how you know inadequate dopamine production and regulation is connected to some of this dementia Alzheimer's. (42:20) Is that something that you've seen as well? Yeah, absolutely. I mean I think of what in in our work it's usually rather than focusing on one neurotransmitter the building blocks of all the neurotransmitters are are similar right these the amino acid precursors you need to obtain from your diet right as we age sometimes our patients aren't digesting protein adequately so they become deficient in a lot of the neurotransmitters and that you know gets complicated um the progression of any illness but certainly dementia. I mean we know as (42:58) you know dementia is a 30 40 year progression of an illness. So anything we can do along that path whether it's lifestyle or nutrition to support a dopamine and all the other neurotransmitters um will support even those genetically vulnerable. (43:21) And then last population that I want to touch on, and I know we could do whole hour episodes on this, is the ADHD population. We've got everyone going on ADHD medications at all ages and all stages. Where does that land in this conversation around mental health and around eating disorders? Well, that's been kind of my specialty for 30 years. I wrote a book, Finally Focused, and we got another second edition coming out. So when I wrote the book, well let me go back. (43:46) When I started looking at nutrition ADHD as a child psychiatrist, I didn't have any research. I just had clinical opinion from colleagues around the country. So it was only in like 2017 and 18 where the research started supporting nutritional effects of a of ADHD. And now 2025, we have all the research we need to say things like ultrarocessed foods contributes to ADHD. (44:12) Sugar- sweetened beverage contributes to ADHD, magnesium deficiency contributes to ADHD, you know, screens, sleep dep it's a population that can definitely be helped by looking at a functional medicine approach. It doesn't mean medicines might not be necessary, but there's just so much that parents can do and pediatricians and child psychiatrists can do to support ADHD. (44:41) Is there overlap between childhood ADHD and then adolescent eating disorders and then adult depression with women? Absolutely. You know, our ADHD girls don't get picked up early because they're smart and they're not behavior problems. So they kind of shift into untreated into high school. (45:08) And there's a very high correlation between ADHD and and binge eating disorder and other eating disorders. So that kind of poor impulse control gets away with eating issues. And then they might not get addressed or treated till high school or college sometimes or now they're maybe, you know, 30-y old women who realizing, oh, I have those symptoms. So the eating disorder connection, particularly binge eating disorder, is very high. Wow. (45:32) And then lithium ore that you mentioned earlier, does that help with ADHD too or not necessarily? Oh, absolutely. That's where most of my career has been. Not the inattentive type as much, but the impulsive, irritable, angry kids um that have ADHD respond really well to the lowdosese lithiumate. Wow. I hope this is a hopeful conversation for anyone listening for parents that are struggling with children that might have ADD, ADHD, even autism or eating disorders or for adults that have been struggling, you know, with depression. I think I think the (46:06) message is that there's so much that the body is capable of doing and correcting when we give it what it needs, but the sort of band-aid approach is is what leads to to treatment failures and to feeling hopeless, you know. So your book finally hopeful is laying all this out. (46:28) So I encourage everybody to pick up a copy and dig deep and even your book Finally Focus might be something that a lot of parents need too because again you know we care about the health of the whole family. It's so interconnected to everybody living in that dynamic. Where can people find your book, learn more about you, tell us a little bit more? Sure. My website is at jamesgreenbloodmd. (46:45) com where my books and I have some um courses for parents and then for any professionals we have an educational platform psychiatry redefined.org where we're training doctors how to do a functional psychiatry approach. Incredible. So needed today and I hope that doctors everywhere if you're listening to the show you'll jump in. We we've got to change medicine. (47:09) I am so concerned about the future of how we are treating patients and how we're practicing medicine. So, thank you for taking time out to be here today. I really appreciate it. And for everybody else watching and listening to this show, remember we post new videos every week. And please don't forget to rate and review it and share it with your friends. We'll see you next time. (47:26) Thank you so much for listening to this episode of Whole Plus. If you haven't already, please take a moment to subscribe to this podcast to engage with the community. Followive Plus and check out our website plus.co. That's holus.co co for more resources and information on holistic health.