Episode 93: The Immune system and Mental health with Dr. Emily Gutierrez

00:00    this is the one thing podcast and I'm your host Dr Adam Rinde the one thing podcast brings together leaders in functional and naturopathic medicine to discuss actionable information that may unlock puzzles in the areas of gut health brain health metabolism and Longevity please note these episodes do not replace the opinion of your doctor they are not intended to diagnose or treat any condition please discuss this information with your provider and and discuss your own unique personal health history before adapting this

00:35    information please subscribe to our episodes so that you can stay on top of the most current information in these areas of medicine hey everybody Dr Rinde here welcome to this week's episode of the one thing podcast it's really interesting to be back with this current episode very timely um so many people are struggling with changes in their mental health this time of year with changes in weather changes in seasons and always wondering why is this happening um during certain times of the year and the immune system is doing

01:20    funny things this time of year and many other changes in activity changes in weather changes in light so lots to think about when thinking about the immune system and mental health I couldn't think of a better person to have on than our guest Dr Emily Gutierrez who I met through intellix DNA she's an expert and understanding how nutrition interfaces with the immune system and mental health so she looks at genetics nutrition and how they impact people's mental function specifically in conditions of

02:05    neurodiversity ADHD anxiety depression autism uh pans pandas she knows her stuff with these areas and in this episode she really painted a really good structure to think about how to interface with mental health through balancing the immune system um and looking at different drivers of the immune system and interesting enough uh neurotransmitters such as glutamate seem to be a big player in this world of uh mental health and we talk deeply about that which genetics are involved with activating the immune system what

02:46    environmental triggers are also involved with activating the immune system and its impact on Mental Health she has a lot of amazing experience she's got all the pedigrees that you would want in a practitioner as far as her education um she's affiliated with John Hopkins University is advanced in functional medicine and pediatric nursing I think you'll really see and hear an expert um at work when we discuss this topic this episode was recorded over video and we are referencing a slideshow so I encourage you to to also watch this

03:31    on YouTube if you're not doing that already and also you can um listen in on the podcast as well in the audio version I hope you enjoy this episode as much as I did um please subscribe and like to my channel and forward this to the many people who are struggling with trying to understand the puzzle of mental health so without further Ado welcome to this episode of the one thing podcast Dr kerz welcome to the one thing podcast I'm so delighted to be here with you awesome thank you for having me you're welcome so we met uh through

04:10    intellix DNA and some of the uh coursework that you teach there and um it's just been really great learning from you and I'm excited about our topic today and the things that we were planning on talking about I just would love to get started um hearing first off like all the things that you're involved with because you do quite a bit and it would be great just to kind of learn kind of what that looks like what what is your what is your daily life consist of and all the different things and projects you're

04:45    involved with well I do have my hands in a few different pots that's for sure my primary uh right now is I do have a pediatric functional medicine practice in Austin Texas we've been open for about a decade and so I have a busy Private Practice I also um am a co-owner of a a supplement company neuron nutrients so lots of work goes into that with formulation and um all of the things it's it's kind of it's definitely been uh more work than I anticipated when we started but it's actually been really good uh and then of

05:27    course I'm a mom and I have two kids one that's a young adult and one that's an older teenager and I'm married and I have a couple of really naughty beagle dogs that some work every now and then so yeah I also teach I also teach some I teach some at the University uh Texas at Austin uh sometimes I'll be a guest speaker and then I'm adjunct faculty at the Johns Hopkins University in Baltimore so I teach on integrative and functional medicine to their nurse practitioners and that's pretty awesome because they

06:03    get content that is so different than everything that they're learning and I really really enjoy that because really one of my core missions in life is how can we bring this type of information to people that are learning how to manage patience just some of the core core things that are so important for Health and Longevity yeah wonderful yeah along those lines how far back does your your journey to integrative and functional medicine go what was some of the early Sparks to that well probably like most of us that

06:42    are in this field it's through um pain and suffering that I found this and the first real um time of pretty um intense suffering in my life was postpartum and I say that with also holding the space for it was the most it was the best decision I ever made to have a baby and I won regret it for one nanc but healing from pregnancy and postpartum was um really really really tough on my mental health I had depression and even a touch of postpartum psychosis and you know it was really discovering all the things that helped

07:23    me really get out of it and not only get out of it temporarily but stay out of it so I went on a big journey of learning what else besides psychiatric medication could get me back to balance and to the best mental health I could possibly have and were you already a health care provider at that time I was definitely was but I I you know it was 20 years ago so the the depth and breadth of my knowledge of what I know now is so wildly different I would say I know 90 to 95% more today than I did then and did you grow up um in

08:05    traditional medicine kind of with a traditional medicine Viewpoint or were you did you have some early influences in integrative or natural medicine functional medicine I would say I grew up in more traditional definitely more traditional in fact you know my my undergraduate my graduate and my doctoral degree are very very alpath schools and I say Al apathic in concert with traditional yeah I live in Austin and we like to keep weird here that's the city so I you know when I first went into practice delivering Primary Care to

08:45    Pediatrics I would have a lot of parents that challenged me a lot on what I was ask you know I was telling them to do or advising them to do and so much to where there were times I didn't want to go into a room because it was a well check with a family that was going to question me about vaccines and ask me about essential oils and vitamins and I was so woefully unequipped to have those conversations all I felt was Defensive um and not collaborative so when I got to John's Hopkins they you know my do my my

09:19    doctorate is in translational medicine which basically from what we know to how we practice how can we improve outcomes because the gap of knowledge to translation and a practice is you know about two decades at least so my problem was I didn't know how to deal with all of my tree hugging oil rubb and crunchy par so yeah I needed went on a journey of of really how to how to bridge that Gap and do it scientifically um thinking at a little bit of the woo you know mhm yeah I mean it's Austin and Seattle I think where I live uh share

09:59    that in common you know the um patient population is looking for a wide array of answers to their health and you know it's like yeah the patients push us to to learn and grow and stretch and find other answers yes I love it that you said that because I think really good providers their their patients are some of their best teachers if we're willing to listen and not think oh we're the provider we should know it all um we're right and you're wrong but if we can really listen and hear what they're

10:37    saying and take in their experience and collaborate and do our own scientific research I mean it is really what leads to the best outcomes yeah yeah so before we dive into more about talking about mental health and the immune system and I I love to just sort of frame this conversation because I think there's some um reverence that goes around any discussion about mental health you know it's it's like some people are only you know especially parents with kids that are specially abled or various other challenges um

11:20    might just have their hands completely fil full and they hear a talk with all these new Solutions and it just can be like oh my goodness I I just need to find a way to have to feed my child breakfast or get them dressed today can we just frame this just sort of like the context of the world that we're about to discuss um and how challenging it is and how much we you know how much that is seen and understood yes I'm glad that you're bringing that to light because we're about to get pretty sciencey for sure

11:57    yeah and what's what the parents want to know at the end of the day is what can I do at home what are steps can I make and and really hopefully some parents will just shift their mindset and their framework of potentially things that could be contributing to dysfunction so hopefully we will keep it to where we feel like there's some actionable things that parents can do or at least things that can be um on their mind as they're thinking through their their child's or their own chronic illness

12:30    yeah and I think along those lines is um it's it you know there are going to be waves of times and stages where you can do more or less and just having a way to organize the information and keep it somewhere too just for reference so that you can nibble at it as you go I mean I think that's the best we can ask um when we're trying to uh uh deal with challenges is you know to to kind of nibble away at it and um you know get make some use it and use information but what I find is um people learn and then

13:13    they forget what where they put what they learned so it's always good just to kind of have like a special file or place where you can go back to information and review it um because um there's just so much coming at people these days yes definitely I agree wholeheartedly well great well if you could share with us um how the how mental health is just from a big picture standpoint how mental health is influenced by the immune system and vice versa you know just kind of paint that picture because a lot of people think oh

13:50    mental health take this medication to stabilize it or what have you and and the discussion stops there it's like you're anxious take this you're depressed this you have uh a kind of a neurodiverse presentation there's this medication and it's like okay well there's this there's the solution let's see how it goes let's talk about kind of the under the underworld of mental health and how the immune system kind of plays a role if you could set that up for us yes well the monoamine hypothesis of

14:30    depression is is quickly going away and what that means is it's not all about a lack of Serotonin or too much or too little dopamine and most every chronic disease most of us no matter what field or genre of medicine that you're in will agree that inflammation that goes a barent or is not regulated can cause chronic disease and the brain is not especially the brain is not um excluded from that so when our immune systems have stress on them and it we get stress from multiple different factors and we'll go

15:09    through some of that but when it gets stress and that stress is not quickly resolved in a way that brings us back to homeostasis or our balance that stress can cause inflammation in the brain in the brain then can have some remodeling um and reworking of how the network are going and what presentation you have and you know as far as depression unfortunately we know that about 30% of people respond to anti-depressants and if you're put on them which I prescribe them I'm not 100% against them that you're likely to have a response at

15:47    first and then they don't work as well and you might need a higher dose which might mean that you have a higher side effect profile and then they just may quit working at all and if that's our only solution for depression we're in trouble because a lot of people struggle with their mental health and hopefully this this talk will help people put into context that the immune system is part of that picture it's not reductionistic the way that it's one pill for one ill or you know if you have ADHD here's your

16:20    stimulant it's so much more complex in that yeah and you've been so generous to provide us a slideshow today you know or kind of a some Imaging images to look at as we learn and talk um so I I'm really looking forward to that and those of you who are listening to this on the podcast um audio you'll be able also to find the um the presentation or slides on uh the um on YouTube and so we're going to be talking through these and so we referring to some images you can kind of follow up on YouTube and watch that as

17:02    well um so I'm going to share sort of this overview um that uh you've provided for us um and you can kind of start talking about that the kind of more big picture things about how systems biology fits into this topic so we're going to zoom out here a little bit just so you get the context with how I think about health in general and I believe that our systems are always talking and interacting and when you have dysfunction in one system it can affect the other um a lot of people have heard the gut brain

17:43    connection and that's one it's the gut talking to the brain and there's a there's a mechanism for that but when I look at a child or a young adult or an adolescent I I look at them and I think okay there's five big things that I'm thinking about and the first is you know what are they what was the genetic um risk coming into the situation and we all have variance in our genes I'm sure you guys have talked some about genes on this podcast and none of us are born with zero variants or genetic mutations

18:22    we all have them and they do set us up for risk of certain things depending on where those variants are so our genes kind of set the stage and then how we feed our body and to grow our body especially when we're a baby a toddler an adolescent how we are growing our body is so very important because nutrition which you know I cannot ever give a talk without talking about nutrition because it's such a basic fundamental yeah and nutrition isn't just about macros and um calories it's about energy balance

19:03    it's about giving our body what it needs to have certain processes work in our body and our nutrition is put into our gut and that's another pillar because if your gut is is has dysfunction in it whether it be that you have you know an overgrowth of harmful bacteria or you have a lot of inflammation or you're honest L just not feeding your gut things that it isn't reactive to and isn't allergic or sensitive to then there's a whole host of things that can happen from that and your gut is also

19:41    known as your second brain and also known to be the biggest player in your immune system and your immune system is always trying to defend what is coming into your body repair it and keep it in that homeostatic balance and lower the infl inflammation not all inflammation is bad but inflammation that is uncontrolled can have a dilar is effect it can be very harmful to our body and while in you know traditional medicine we're only taught about lead levels above five and like super terrible harmful toxicity that's that's

20:22    pretty rare we're not really taught about all the toxicity that's a low-lying amountain communities and our homes and our in our environments every day and toxicity burdens our immune system as well different types what you're breathing what you're putting on your skin what you're ingesting what you're swallowing what you're drinking so toxicity plays a big role because also whatever you ingest that's toxic that's burdening your immune system you have to eliminate and elimination plays into

20:53    that as well so the Five Pillars are really your genetic risk how are you balancing your energy with nutrition how's your gut functioning what's your immune system doing playing a role in that and how is your total toxic burden and anyone we have to have that in context around what we're not going to get into a lot today which is what's your family system what's your past trauma what is your social and emotional um lifel um the whole psychology of the human is so fascinating and it's in the

21:29    center of that and that always has to into context yeah yeah I really like this flow because um it's you know being grounded in nutrition because you know that's such uh Foundation of way that um we interface with our health you know hopefully every 3 to 4 hours you know we're thinking about fuel or what have you and some people might be less or more what have you but um it's just really nice because a lot of people are so confused when they're struggling with like a a puzzle as to like where to

22:11    start you know it's just such a such a challenge and if you start in a place that you're not ready for it might make things worse and so I think um you yeah so let's talk about that it is such a foundational piece you know even from the first day of life when you're exposed to formula or mother's milk it it's a foundational piece to how your your microbiome establishes you know where you colonize through the vaginal Canal if you had if you were fortunate enough to do that then did you you know if you were

22:49    drinking mother's milk you know what was her total toxic burden going into those first days of breastfeeding and those first months and years so nutrition is just it it is literally what sets up our foundation for health and you people that don't believe that nutrition is important you just have to ask them one simple question what happens if you don't eat we die it's it's really important and it's more complicated than just the keto diet or you know the um gluten-free dairyfree diet there's a

23:22    there's a lot of things about nutrition that are very specific to the individual and for kids especially they have selective eating otherwise known as picky eaters um and then the density their nutritional density can be very very weak you know you can have a very overfed and undernourished child in fact you know I have a a kiddo that is not you know growing very well but very overweight and the you know eventually he saw endocrinology and there they were just like there's no way you have celiac disease and we did a panel and it lit up

24:01    like a Christmas tree because they couldn't they couldn't um they couldn't conceptualize that this child is overweight but has malabsorption issues at the same time but it's really just the diet and what they were eating you know so also we have to put into context that nutrition is one thing but how you absorb it in your gut is absolutely another so you're working with a lot of children and um you know kind of you're were talking in that previous example about limited diets and what have you so

24:37    um yeah what do you see as the common nutrient deficiencies well this is actually very very robustly um reported in the literature so and I see it in clinical practice over and over and over again like the more you do this the more more it's uh you think well do I even really need a lab because I can I can absolutely kind of predict where this child is at and we see that a lot of a lot of people are deficient in Iron zinc magnesium fatty acids B vitamins and vitamin D so the the the way that you can tell this

25:21    is certainly through serum testing looking at Labs but even nutritionally on an exam you can look at nail if you have those white spots any like ridging brittle nails um iron deficiency is so common in a growing child and menstrating woman are just you know a vegan or people that don't really eat a lot of iron-rich foods so there's there's just really a lot of common deficien you see and all of these things that we're talking about have a role in the immune system all so yeah you know and in uh specially

25:59    abled populations or what have you I mean it's there's so many challenges with nutrition so I think you know the texture smell taste which is a whole other podcast kind of topic but um you know I I just think it's important to realize that it's not the parents fault or that they're being bad parents or you know in some case there's there's kind of a balance between ownership of what we buy at the store and trying foods and challenging foods and various things but there there needs to be some special

26:37    care and some patients is that correct yes parents have to realize that you are not responsible for what your child eats you are responsible for what you provide them to eat yeah so if you just give up and get Takis and Dr Pepper because they're GNA you know that's really on you you they're they're a child but I understand the vulnerability of wanting to provide that and not having the hassle of the Tantrum and I truly believe more and more of this work that I'm doing I just believe that selective eating has a lot

27:14    to do with neuroinflammation and I really think it's more of an OCD pathway and and that's why I feel like I've seen a lot of good results when we really start to address the CD and the inflammation the picky eating gets better and and zinc is one of those that's known if you're zinc deficient it has a lot of um it has a lot of similarities to anorexia and nervosa so zinc alone can change the way that food taste but yes an immune system a nervous system that has a lot of sensory sensitivity to it the textures the feels

27:52    the smells of the food um kids are going to have more trouble with it typically but there's it's not hopeless you can change it as you get into the work I love that framework um just from a standpoint of knowing and having some uh empowerment of how to think about those situations and you know thinking about OCD or anxiety and you know we we have so many tools to support those conditions even though they're very challenging ing um at least you know just throwing out the term as you know I have a picky eater or you know my

28:34    child's averse to eating knowing that those are some of the roots of it is really helpful thanks for pointing that out it's uh it's good and I know um learning about the insense out of zinc too has been really helpful too about how it interfaces with our neurotransmitters absolutely what are what are some of your thoughts about um genetic vulnerability or genetic risk for having immune disregulation there are some people that have genetic variants that make pathogen exposure more vulnerable to their immune

29:13    systems and therefore brains for example you know there are variance and Pathways um a lot in the literature you're going to read about turum necrosis Factor Alpha and Inter luuc and six Maybe the one you were referring to is the mbl2 or something called Manos Bing lectin 2 and this one's really interesting because it's a gene that actually you can recognize that there's proteins on the surfaces of cells and those proteins are you know recognizing viruses and bacteria and fungi and yeast and once our immune

29:52    system really recognizes that there's an infection there it can um it can activate the the lectin pathway which is part part of our complement system and our immune system so it helps us to get rid of infection and to control inflammation from it so if you have one of these variants in your Manos spining lectin 2 you're less likely to recognize that there's a pathogen there and you're more likely to have inflammation that's uncontrolled and you're more at risk for something called um an

30:25    incopy which means you have an infection and then later you have a brain inflammation from that infection also as autoimmune andyl opathy wow yeah so I mean for people who are new to um polymorphisms or genetics and all the the terms that we're talking about so you know just in basic terms um you know we all having this these risk factors would mean that for for example someone might be um more at risk for promoting or pushing out more tumor necrosis Factor Alpha and then vice versa the other um Manos Binum

31:07    lectin 2 more at risk for producing more of that and um so tnf Alpha is uh something that you know we're seeing a lot with um post uh coid syndromes and other conditions like elevation of that what's it feel like to have tnal Alpha up like in your body is it do you have a do you have sort of a way that you can sense it and clinically well if I'm fortunate enough to be able to draw blood on someone I can see it in their blood and and remember I'm seeing it in their serum or their peripheral blood and not in their

31:45    brain right often when someone has an elevation of this inflammatory or proinflammatory molecule or cyto kind you're going to see things like um motor ticks vocal ticks are both um obsessional thinking more of the autoimmune en sephtis I talked about which can be have it that in itself has has kind of a basket of symptoms like selective eating um you can have a lot of separation anxiety you can have a regression in actually being able to um control your bathroom like either wetting the bed or or having um urinary

32:26    accidents during the the day so often we'll see that it's an inflammation but in in research we've shown when they look at studies they look at the brain in Vivo in vitro in humans you know turoc crosis Factor Alpha is a little cyto kind or inflammation molecule that really can get through that bloodb brain barrier so when it's activated a whole host of things happen and I think we're going to get in a little more to that but the next one inter six mhm yeah that's that's if if there

33:07    that's one that's mentioned so much in chronic inflammatory conditions and I'd love to kind of just hear your rundown on interlukin six it's interesting the study that I I I put on the slide there they looked at a very very large cohort of people and their hypothesis was you know does interlukin six and high variance in the brain actually remodel the brain and what they found was there is less gray matter in the brain and more cortical thickening in the brain so we know interlan 6 is another one of those

33:44    inflammatory molecules that can get through the brain and really stimulate the microG GLA which is the immune cells of the brain and this has been associated with things like vascular dementia autis ISM and uh schizophrenia over and over again okay and so there's going back to the beginning of our discussion we had talked about how there's these different areas systems to balance and so the gut and the Brain have this interface and um How do you see the gut playing a role in this mental health picture the gut is one of one of the

34:38    sayings in functional medicine I'm sure you know is where you don't if you don't know where to begin begin in the gut yeah and why is that is that because people are putting inflammatory things into the gut is that because there's an imbalance of bacteria in the gut really when I think about the gut to the immune system system to the brain I think a lot about disbiosis and disbiosis means you have a flora or a type of bacteria in there that's that's not beneficial to human health and in fact these strains of bacteria

35:13    often are gram negative bacteria and they can emit something called a lipopolysaccharide and when you have more of this like kind of inflammation from these gut bugs it can really make your gut more leaky or increased intestinal permeability and it can also just that inflammation gets into your body and then that inflammation can get into your brain so the translocation of that inflammation from the gut becomes systemic and then it can really just upregulate autoimmunity or kind of flip that switch to autoimmunity so when we talk about

35:55    balancing the gut for the brain bra it it's important to understand what is your what does your microbiome Garden look like and I really think that we're getting better at doing that I don't think we're quite we've nailed it as far as like knowing a 100% what's in your microbiome right and I don't know if you experienced this with your patients but sometimes you can find a lot of gram negative flora and they're asymptomatic or have no symptoms what do you find yeah I do and um so I think about

36:34    either one of two scenarios is um that inflammation is kicking up another system's inflammation so a lot a lot of those patients I'll see will have skin disorders or um like an eczema or psoriasis that's going on and they're like my gut's fine um because there's more front page news than the gut there's yes um you know that once the skin is involved a lot of other things lose focus because that's such an such a debilitating process to go through um and then I also sometimes think well

37:10    what maybe the the barrier is really healthy um and that particular person might be having might be stabilizing all that uh that um LPS at this moment because they might have a good healthy gut barrier with good mucus and um maybe the they're just not it's not breaking at that point yeah and and there's the test zulin right that maybe you could do to see alongside this but all that testing is it gets expensive for the patient and it's not really in those our mainstream Labs like lab core and Quest have you

37:50    ever run a zulin from those mainstream Labs I haven't seen it offered um at least stool zulin I haven't I haven't checked for serum zulin I usually have to order a special lab um like serx or someone like that to get some good zulin markers that's right I I hope it's um to me that's the translational Gap right there is that we are not offering that to uh the masses it's it's not like a an annual screening is how high is your zulin because I think that you know zulin is one of the prot that breaks

38:27    down when the gut barrier has um Integrity issues and we can measure it in Blood and stool um but I would argue that it might be as important as a cholesterol panel in some yeah and I think we're getting some really good ways to use all of the proteins that are involved with gut permeability you know the ones that we know like audin and um zulin and it's just fascinating to uh figure out um you know this intestinal barrier piece it's sort of I think always a question of what came first is the intestinal barrier what's driving the

39:15    problem or is the pro is the problem the the Upstream problem driving the intestinal barrier issue so it's it's very tricky um to to kind of find out where to start but like in a case like this like gut brain AIS don't you think like starting that uh both systems need to be supported to support each other it's a two-way relationship right yes the bidirectional communication of the gut in the brain absolutely so it's hard to know what is the chicken and what is the egg in this situation sure and of course there's

39:57    infection you know sometimes I'll see a white blood cell count on a patient that's eight or nine and and typically the lab value is at least greater than 10 to really think about systemic inflammation in the blood but it's just elevated enough that when I go and look at the gut there's all the infection there's where I see it I even seen infection in the nose like strep throat and the nose so the truth is is we're all going to get infected all of our lives for the rest of our lives and

40:30    that's okay in fact the earlier year you have some viruses in childhood the better your immune tolerance is later in life and and there's a period of quote unquote training the immune system when you're little um we don't want to put our kids in a bubble in fact what we saw during the pandemic is those kids that were young and spent two years inside they finally all went back to preschool or daycare and they got sick every month and and they were just had the opportunity for exposure so it it's been

41:01    a couple of hard years with infections for kids but most of them did really well didn't end up in the hospital didn't die they were very resilient from it and we can't protect ourselves from infection forever and ever it's gonna happen we're g to get viruses we're going to get coid we're going to get the flu we're gonna you know hopefully not get strep throat as adults over and over but children certainly do and then we're going to possibly eat some contaminated food or drink some contaminated water

41:29    and and get a protoo infection so and I would argue that some environmental toxicants are like infections for our body as well so it's not if we're going to get infected it's how we handle and regulate those infections once we have been exposed I think that's yeah I think that's really helpful to hear because um you know there's this balance between avoidance and you know resilience or sometimes I don't like that word but the sort of the avoidance and then just kind of putting yourself into the world and

42:08    um supporting the body's response to these threats um so I really like that you frame that you know we're we're all going to be exposed to these these uh viruses bacteria protozoa over time and uh you know that it's it's about helping the body deal with them right exactly exactly and some people have rare things like hypog gamma globul anemia where their innate immune systems are low and they have low IGA and IGG and IGN but those that's real and those are immune molecules that help to regulate

42:49    infection it's not as uncommon to have IGA deficiency where your immune system doesn't have as much IGA in fact if you have an Epstein bar virus that is pretty acute it can actually diminish all of your IGA you can do a serum study and see that someone doesn't have any IGA at all um but it's not innate it wasn't inheritable that they're dealing with so our immunoglobulins fluctuate based on exposures and some of us are born with less than others but that can your body can adapt over time yeah

43:27    I'm glad you bring that up because I think you know that's often something that is checked later when someone's not responding like we would expect right so you know they find out that oh they're just chronically low in IGG or IG um is that sort of How It's typically found out is just more of the more complex cases or is it starting to be screened earlier in my practice it depends on the history because if you're a Kido that's had lots of ear infections chronic sinus infections um I'm going to check it way

44:08    earlier and and there are things that you can do about it I mean in severe cases people get infusions called IVIG which is a imunoglobulin infusion and sometimes that's the one therapy that helps a kid with an autoimmune en seyis in the brain come back to homeostasis so but there's also imunoglobulin you can put in the gut from cow blood called immunolin that's my second favorite imunoglobulin well it's my first actually because I don't I used to do IVIG with kids and I I'm now just really referring to the

44:43    rheumatologists that have infusion centers if they need it but you can put it into your gut which those immunoglobulins will go to work for you despite knowing anything about the gut any type of bacteria any type of protozoa so we can ingest them um you can take certain probiotics like sacr bardi to increase the amount of IGA in your mucus right in your gut epithelium so there are some interventions that we can do but I would I I would really want to say this to all parents too because in this work I don't know if you found this but you

45:24    know sometimes our patients are so afraid of any medication at all because you know of the corruption of big Pharma and and all the influences that we all have to to reckon with and reconcile with however not every medication is evil and if your child has strep throat please don't ever not treat it because group hemolytic strep can can actually you know it can affect the heart it can definitely affect your brain it's really really dangerous if you have an acute strap infection and you don't heal it

46:04    now when it comes to the gut and having infection I think that there are some good things that we can use that are not antibiotics to balance the gut right what's your favorite go-to when it comes to like bacterial disposes and balancing gut Flora do you have a go-to yeah I mean I think there's always um a judgment that I always make about how stable the person is um and so sometimes I'll spend time just supporting and stabilizing a little bit but when it comes to purely antimicrobial herbals um I'm a big fan of uh oregano

46:46    oil um also clove oil um berberine um those are usually really good burin is a bigger kind of gun I hate to use that word but yeah it's a bigger kind of stronger medicine than we think so you kind of have to with that one I'm a little bit more uh cautious but oregano and clove do wonders and you know especially you get them in the um Soft gel form and stabilized so that they don't um irritate the stomach yes and hopefully your patient can your patient can swallow pills so they don't have to actually yeah going

47:30    and then tinctures you can use tinctures along yeah right um that that's true um there's also tinctures for people who you know can't for kids who don't do pills yet or what have you um but yeah it you know it's it's really interesting I'd love to kind of take this moment and ask you something that just came up while you were talking is that um so there's there's a someone I learned from that has a Perry n Nicholson he has this um program called stop chasing pain and I'm always

48:06    wondering if someone's going to come out with this this uh motto with in this world of neuroinflammation and of stop chasing infections I'm I'm wondering if that's ever going to kind of come about like where the focus isn't so much on like finding the bug and killing it versus is doing more balancing and helping the immune system deal with these threats what do you think about that is is that a are we are we approaching an era where we we can shift out of just like the the stop chasing infection mode I'm sorry the chasing

48:44    infection mode yes I I hear exactly what you're saying and it's really a very thought provoking and interesting question I think that if you have a extremely acutely ill patient like someone that has lobular pneumonia and a fever of4 and their O2 sats are less than 90 you need to give them that IV seph triaxone yeah IV antibiotics to get them to where they're able to function but if it's a you know somebody with depression that seems to have chronic gut disposes to me it's about well how can

49:22    we shift the floor in a positive way how can we get more floor that's good to out compete the bad and what how can we increase your immune resilience so you're not so uh vulnerable to continue to pick up one infection after the the next so it's an it's a really interesting question I think that set and setting depending on who the patient is and what it what the um scenario is would really lean I'd really lean into you know what what is the most appropriate thing at that time but I hear you in the integrative World we've

49:59    gone from okay so what antibiotic can we use to what herbal can we use to kill this and I don't know if you saw doctor's data it's a lab that I use I'm not sure if you use doctor's data they put that they called it an antibiogram and they they took all of their school studies and they showed because they do a culture and sensitivity with both medications and herbs and they did it and they said profound ly if you look at that list I thought it was so brilliant that they gave it to us that um depending on the

50:32    Flora that they found like clubs and pneumonia or clostridia what was the agent that worked the best in most patients yeah grapefruit seed extract won it won yeah it won however if you look at grapefruit seed extract you got to be real careful about what kind you use because some of them are not Ive at all yeah and you know it's also very broadspectrum so it's going to take down a lot of things with it and so yeah it's um I I think it's it'll be good for us to kind of realize we have those tools

51:13    and learn when to use them appropriately but not overuse them because we can just fall right into the Trap of um you know overusing antibiotics call it an herb call it a med it's it's you know qu yeah I mean there there are some benefits to the herbal medicines that we don't see with antibiotics so like a number of them like clove is actually a Prebiotic and um it's one of the it's actually I did a ranking of the list of prebiotics it's actually I think one of the um richest forms of richest

51:48    polyphenols there is and um so we do get other benefits right for using herbs for this purpose like some they some of them are anti-inflammatory some of them are are Prebiotic or polyphenol Rich so they're not just uh antimicrobial in nature so it's nice to know that we're you know providing other support with these herbs but yeah um it'll be just interesting to see like like you're saying is if we get to a point where you know sometimes for these conditions we're we're um boosting the immune

52:22    system and boosting the defense versus just kind of taking down the threat um it's more of like a Terrain approach I guess yes yes I wholeheartedly agree and immune activation and mental health I mean just to kind of recap a little bit of where we've been is you know the gut plays a role because of the bacteria the translocation um we see this definitely um the immune system playing an ex a role in health with pans pandas as as I was talking a little bit about before and in inflammation you know some of the

52:59    players that cross through the brain those inflammation molecules tumor necrosis Factor Alpha interlan 6 they can play a role in pathogenesis and it has a lot to do with what happens in the brain after it becomes inflamed okay so what are your Specialties is pans pandas um and um you you your um kind of organization of these conditions um because I think a lot of people get confused we've had a couple other podcasts that discuss pan and pandas but um can you walk us through how this is sort of a I would say model for us to really

53:47    understand the immune system and um mental health yes I think it's a really striking example and I know this this discussion isn't about pans pandas so I'll be really brief but in a nutshell when a child's Behavior suddenly changes you can um they usually have a basket or a manifestation of some symptoms like OCD restrictive eating behavioral regulation problems deterioration and school performance even urinary problems like frequency or bed weding and it's it's like parents say you know what happened to my child

54:28    they were happy healthy doing well and then all of a sudden we have all these problems and a lot of times those kids have gotten an infection that hasn't been treated and the inflammation from the infection has made their brain have inflammation in the basil ganglia so they have a variety of different symptoms that they're dealing with and I put on this slide also this happens in kids with autism and unfortunately what happens in autism is they think oh their autism got worse let tell you autism usually doesn't get worse once you have

55:03    your initial presentation of it everybody has good or bad days but if you have a regression if you're doing things like You're stemming more or you're not having any more be developmental gains maybe you've lost some you have a lot of um aggression you're no longer sleeping these kids with autism get lot they people don't think a lot about infection in them they just say oh it's their autism but I I would argue that point that it's physiological stress on them most likely on their immune system that it's

55:38    infecting the way that their brain is functioning yeah so helpful to to hear that and understand it because um you know coming from an immune system Centric um point of view then you know it helps you kind of figure out how to help this child balance right they don't need more antis psychotic medication they might need yeah they might need some anti-inflammatories they might need um an antibiotic they might need they might need you to go on the hunt to see where the infection is just even a simple you know throat culture and swab at the

56:19    pediatrician and another striking example of this of the immune system in the brain is there is something actually I don't know if you've ever heard of it before i' I've recently learned about it in the past year called regressive Down syndrome if you heard of that I have not so it's a child that has Down syndrome that all of a sudden has worsening of their Down syndrome sounds familiar right worsening of their autism well what they're finding out is they give these kids IVIG and it normalizes

56:51    them wow right amazing it is amazing so helpful because um it you know it's it's just such a help helpless State for the child or you know even an older um like an adult with autism or teen with autism or adult with Down Syndrome Etc where they're you know they're making progress maybe doing more activities and then to have a setback and just to know that this is an area to look into first right and I I'm so excited for some of the research that's been done in regressive um a child that has

57:32    regressive Milestone say they're happy healthy going along at two to three years old they have a regression well there has been some case studies where they've given those children IVIG and it normalized their development so they were never diagnosed with autism because it normalized their development and for the listeners that don't know what IVIG is it's that it's that blood infusion you get and it's immunoglobulins that are from thousands and thousands of people so it's like rescuing your immune

58:03    system from whatever is burdening it and IVIG can save lives for sure we usually give it in the hospital but you can give it in the outpatient setting and it's it's one of the most um significant um therapies it's extremely expensive you don't do it lightly but I just bring it up to to show the role of even the immune system in developmental delay in autism you know I'd love to see a study some day where we take a cohort of kids and we give them IVIG right away when they regress and wouldn't that be

58:39    amazing if they all no longer had an Autism uh diagnosis or they got their Milestones back yeah yeah and IVIG is you know again another major topic of that deserves like a a lot of discussion and you know like a podcast kind um and I you know there there's a lot of good information about it in Pediatrics though so it's you know there's there's a lot of great info for parents out there to to learn about it yes and one thing that we haven't talked about yet that is probably Central to my thinking

59:16    in disorders is is glutamate so when the brain is inflamed it causes activation of our immune cells called the microa and the inflammation that we see again is around these cyto kindes these inflammatory things like tumor necrosis Factor inter Lucan 6 sometimes interferin um they all have too much glutamate so glutamate is one of our excitatory neurotransmitters but it's by far our most abundant neurotransmitter in our brain and you can get something in your brain called glutamate excitotoxicity so when glutamate is

59:57    excited so the the micral dump out glutamate some people have genetic predisposition not to do well with regulation of glutamate at Baseline because they have variance in those Pathways but as your Gia is dumping out glutamate typically your astrocytes basically help to bring in the glutamate so do your excitatory amino acid Transporters these are mechanisms to clear and regulate glutamate but when there's consistent activation of the microa and it's not cleared there becomes an apparent response and what happens is is we can

01:00:34    remodel the brain so instead of being in that pre-post synaptic excitation the brain can really be stuck with high glutamate in post synaptic excitation and the asites atrophy the amino acid transfers aren't working and there's this prolonged amount of inflammation and there was a study done I think it's on this reference slide it's one of my favorite it's literally I think maybe if you go one or two more it was a study done by the National Institute of Mental Health and um really a provider at at Emy one of the

01:01:16    Physicians yeah it must be on the if we go back I see I see Haron and and Miller yes yes I don't know for you guys that really want to geek out on Neuroscience this is one of my favorite articles I've ever read um they're from Emery University School of Medicine and they collaborated with the um National Institute of Mental Health and it's really a synopsis of what we've learned about how glutamate can remodel the brain and its role in mental health uh I had to read it two or three times to

01:01:48    grasp all of it and I I will confess I fell asleep a few times because it's soothing when you're reading it it but yeah it it just really is I find this to be so true clinically and it's good to see I and you know I think also we're getting uh some data back on some organic acid test that can kind of lead us to some crumbs of clues that glutamate is excessive I mean it's definitely not a home run for sure test but um you know that I always um I find it somewhat helpful and and then we have

01:02:29    uh some tools to help stabilize neuroinflammation and support these Pathways which is exciting yes and you must be talking about quinolinic acid correct yeah that's the one that I'll that will give me a clue that glutamate might be going a little wild in the brain yes well you can see they even talk about quinolinic acid in this article which I was very excited about yeah that's great and and yes we there are agents to remodel the brain that are helpful for lowering glutamate for sure that picture on the screen is is is a

01:03:11    visual of pre- synaptic microG and um glutamate toxicity and then over time in the later stage how it can remodel the brain and keep you in this excitatory excessive glutamate um place so I thought it was a really good picture if you want to you know dial into it you can see all the little inter lucans and and the AST sites Etc yeah so if we're gonna simplify it so know it's we we talked a lot about a lot of big things so let's simplify it uh for the listeners the truth is we all have a genetic predisposition we all have a

01:03:55    genetic vulnerability and you guys know that you know depression runs in our family or schizophrenia or Parkinson's or neurodevelopmental delay or decline can run in families um we we are all have our own in of one with genetics for sure we're all we all come into this world very uniquely and then how we feed our bodies from the very beginning to the very end really makes a big difference in our immune and our gut plays a big role with inflammation and disbiosis especially when we have disbiosis and we

01:04:32    have a lot of lipopolysaccharides or those High inflammatory molecules that agitate the gut lining and then we're all going to be exposed to infection but is it underrecognized or is it poorly treated or is it the terrain that needs some help and then if those things aren't adequately really addressed you can have this a barent inflammation so inflammation in the brain the microG GLA all those inflammation molecules we talked about and with more inflammation you have more glutamate and you can have more glutamate excitotoxicity in the

01:05:07    brain which eventually can lead to remodeling so my job for my patients and and your job for you is to is to try to control the terrain as best as you can and as providers we can tell you things to do and not to do but honestly what you decide to do is what's going to make the biggest difference yeah your daily decisions right and I think also using your provider to establish the priorities so that you know you don't have a million things going at once um I see a lot of people who will pick up books and podcasts and you know

01:05:51    information you know from reading and I mean I've been a medical parent you know so I know what it's like where you're like up all night looking for answers and bringing that back to the provider and saying you know what where should I start with all this all of it seems reasonable at some point or some place but it's always helpful to have someone who we call it um one of my really good friends calls it someone who can stay above the water and just kind of see there's nothing more that'll keep you up at night when you

01:06:24    have a child you know doct Googling looking for the best answer and then when you know the keywords to put into the browser it can get really really tough as a parent after yeah especially now with chat GPT it's like okay now you have a Google bestie it's like oh no I haven't gone down that path yet sounds oh good yeah I mean it's there's some really cool stuff for reading research papers which I am like a big fan of um but as far as like the general chat gbt it's um really good for like basic

01:07:01    information but it it can also just um make you feel stuck that is the vulnerability for sure especially being a healthc care provider the more you know the more you realize you don't know if you're really really searching and and the more it just kind of leaves you vulnerable because you think about all the possibilities that it could be for you or your child or your loved one it can be a real vulnerable place to to to be for sure absolutely so we can do things you know we can increase our Baseline resilience

01:07:36    we can optimize our nutrition our diet we can pay attention to the gut we can treat infections when they come we can try to decrease the toxicity in our environment we can work on trying to regulate our inflammation which all those prior steps help with inflammation we can work on glutamate modulation or trying to downregulate it and we can support neurotransmission and what I think is really really important to say is when you're trying to get unstuck from this glutamate load if you think about the the um example of ketamine you know

01:08:16    ketamine is our most powerful glutamate modulator we have um other than there are some other outpatient medications like amantadine and M Mantine those actually can work really well as well but really like very powerful glutamate modulation is ketamine and we know about 30% of people that do ketamine for depression can they can cure their depression however if you do ketamine assisted Psychotherapy or you put a therapist with it your recovery rate's about 80% it almost doubles and that's because you're not

01:08:52    stuck in those path ways that AB barent thinking pathway that Loop that Groove you're able to free yourself dissociate from it and start to rework how you're thinking about you know your thought patterns and and and how your brain is stuck in places that are dark and not serving you so therapy is so important but it's important to help you remodel your brain physiologically and I think that can get lost W it's so great and I think knowing uh being linked up with uh therapists that understand neuroplasticity and

01:09:33    those Pathways would be really helpful if there was some kind of organization that you could refer us to that oversees that that that would be really helpful because I think a lot of people are open to learning more about that I know that integrative psychiatric Institute and Boulder actually is doing some training of providers for camine assisted Psychotherapy it's it's kind of a buds word lately because everybody's getting really excited about about the potential and the help that you can have

01:10:04    and really it comes down to glutamate modulation so it it really it really is an underpinning for this this talk about how does glutamate become a barent what's all the Upstream things for it and there are supplements I mean there are supplements in acetal cysteine in particular or Knack um give higher doses of knack helps the microglia not dump out so much glutamate into the brain that's the mechanism that it works okay y but doses of KNC matter you know we're talking 2400 milligrams to 3,000 milligrams a day people wul underdose it

01:10:42    um other things like magnesium threonate uh can cross through the bloodb brain barrier has some glutamate modulation so does torine and then you know sometimes increasing Gaba can help to giving enough activated B6 giving some eleanine so we do have some supplements um they can be helpful um if dosed at the right time and the right dosing for the right patient and indication they can be helpful absolutely yeah and I think that you know people knowing which agents like you've just mentioned can actually get

01:11:21    into the get through the bloodb brain barriers really helpful and also quality too like the you know the brands that you select and the supplements that you use to make sure that um you know you're getting what you're you're purchasing is all the because a lot of times people will say well I tried that or I tried this or tried that did you dose it correctly maybe maybe not did you use a quality brand was it um batch you know was the batch what it said it is so um all these factors really play a role so

01:11:56    I always think like if you're starting on this journey and working with someone even if you've tried something really um listen to the provider's selection of nutrients and um dosing before um and you might have to reapo it and try it again yeah you're speaking of uh the fancy word pharmaco vigilance in the supplement and you know we have neuron nutrients as our as our supplement company and I can tell you it is the Wild West out there even in the United States so um Quality is really important

01:12:30    and some people just test the batch they don't do every batch that's that's um manufactured and then what are you sourcing but being a a a a very a consumer that has a really critical eye is very important if you're trying to treat something and you're trying to take it for health you do want to know that what you think you're getting you're actually getting and things like even say saffron you know crocus sativus is known to be a natural SSRI it has really exciting research around bloodb

01:13:02    brain barrier permeability helping with serotonin synthesis but what's the extract how much is the extract like is it 0.3 is it 2% is it a branded form like you gota in order for efficacy you got to really dial in and know what you're getting especially with your bees we we could talk another hour about B vitamins so I know we're about running out of time so we can just we can stop yeah before I completely let us off the hook I just I love imunol Lin so I would just kind of love for you just to talk a little about that because it's

01:13:38    it's just been such a a great addition to our therapeutic um tool chest I love it too because it's immunoglobulin so we're not having to get it IV we're getting it from cow blood it's dried into a powder Amun Lin is actually the the trademark so you'll see any product really on the market they're the only ones that make it and and Tera Health makes it it is serum dry bovine immunoglobuline it has lots of IGG in it a little bit of IgA and a little bit of IGM but it just goes to work for you it's a powder you put into

01:14:16    your gut and if you have gram negative bacteria if you have high lipopolysaccharides if you have sibo or SEO if you have Junction issues I mean it's really it's it's a pleotrophic it has so many different roles and guess what excellent source of protein so you know yeah one gram of amolin is one gram of protein so work really really well we created a product called balance gut support and I have been prescribing immunolin which is in the form of interam it's the prescriptive form because it's a little bit higher of a

01:14:51    dose and uh they I just really love the company I've and and they sell it to some manufacturers out there you can get their product so that if I'm going to make a gut product you know I don't know what probiotics people need but I certainly know that most of us need a little immunoglobulin from time to time and I put some Prebiotic fiber in there as well because that helps us to thrive The Beneficial Flora um you know the good bugs to change the terrain so I should it terrain changer now that we've

01:15:24    had this there we go that's good yeah well this has been really fun and amazing to to go through um this journey with you and kind of get your view and the way you you see the mental health and um the immune system interfacing so thank you so much for for all this um I'd love just to kind of get some closing thoughts and then just hear um how you like people to follow your work and how they can kind of uh keep up with um some of your companies and the things that you're involved with well first of all thank you for

01:16:04    asking me to be on the podcast I I always like to geek out with other providers that know a little bit about this um and clearly you're one of the experts so I appreciate you having me on um I'm you can find me at neuron nutrients I'm always um I'm trying to blog pretty often um I'm anything that I have on there has a monograph which it has peer-reviewed references and um I'm very meticulously detailed about why I did what I did and what quality is in things so you can find me there you can

01:16:38    find me on Instagram for neuronutrition associates um we also have an Instagram for neuron nutrients but I I seem to do a few podcasts every now and then I'll I'll I'll definitely be um posting those on either platform and my practice is neuronutrition Associates and I'm in Austin Texas so I have a health coach that just started that's taking patience um I still am taking patience I I have a little bit of a wait list so you might have to wait um to get in to see me but I have H my health coach can do a lot

01:17:13    before you get into the door to see me as well so that's always a good beginning yeah well great well you're so understated about how um how much you're infu infuencing all of us and helping so many children and families I mean I think you're a Beacon of Hope for people to really get good information and and simplify it and like you said um with your especially translate the information into action and into clinical results so it's been really helpful because I know the population of neurodiverse uh the neurodiverse

01:17:50    population is just needing something so solid you know because there's there's so much information and some of it's very confusing but and thank you so thank you for all that you're doing yeah thank you so much it takes a village takes the patient the provider it takes it's it takes a village so thank you very much you're welcome thank you so much for tuning in to this week's episode of the one thing podcast please share these episodes with your friends loved ones colleagues patients Healthcare Providers any one

01:18:23    who you feel might benefit from hearing these informative interviews we tend to learn best from people sharing things with us that's often the first time it's introduced so don't hesitate if these the content of these episodes reminded you of someone that might benefit from It Forward the the episode to them and I'm sure they'll either appreciate it or be appreciative that you've thought of them so once again we'll look forward to seeing you next episode on the one thing podcast and again much appreciation for

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