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0:02
Chip: Neurotransmitters are the chemical messengers that your body really cannot function without. You just can't. And so from our experience, you got to have enough
0:18
of these chemical messengers around and they have to be in the right balance of release and reuptake in order for the system to work really properly. And it's also important to have the right HPATG balance as well, right? So, hypothalamic, pituitary, adrenal, thyroid, gonadal, as of alphabet soup, I just build out all of those things, work together
0:52
in this beautiful symphony that is our body. And actually, one of the really fun things about this job is that using these tests, you really get to see how hard the body works at homeostasis and balance and you see how the neurotransmitters and hormones interact and they work toward balance in the body. As a matter of fact, imbalance in the system in this, I would say all important system actually can lead to, I think, a lot of the particularly proinflammatory and degenerative
1:28
diseases that we see in the office every day. Carrie: Dr. Chip Watkins. Welcome to the Root Cause Medicine Podcast. I am so excited to talk to you today about neurotransmitters because I get a lot of questions about it and I thought who better than to have one of the experts on but you. Chip: I appreciate that. Yeah, looking forward to it. I think this will be fun and hopefully folks will take away some stuff that will be applicable and fun to
1:56
entertain at parties and that sort of thing. Carrie: Well, I've heard you lecture before, so I know it will be entertaining and applicable. So this will be good, actually, for those who don't know who you are and I've never heard you speak before, why don't you give us a little intro, what you do, how you got into this, what you stand for, and then we'll jump into the questions.
2:15
Chip: I am an MD. Masters in Public Health and Health promotion actually from Loma Linda in California. And then I just have always had an interest in integrative medicine. I mean, in my mind, it doesn't matter how people get better again, as long as it's not some sort of crazy, off the wall, wacky thing that potentially could hurt people. But I guess what I'm saying is the room doesn't have to be filled with light in order for me to walk in. If you crack the door and some
2:55
light goes into that corner, I go, that looks pretty good there. I'm going to try that. So, I mean, like any kind of therapies like that that I think makes science sense, and that won't hurt patients, by golly, I'll probably try them. And so that's kind of been my attitude and trained in family medicine some 30 years ago. Yes, I'm an old guy,
3:19
but just the integrated side of things has always been really interesting to me. And I was in kind of a standard family practice and started doing functional medicine. And I was in a group with five other guys and one lady, and they'd be on call and get questions from my patients, and they're like, what is this stool test? I don't know. What is all my patients here? And so anyway, one evening, that led to the principal partner coming over to my house,
3:57
and over a beer, he kind of said, you know, Chip, we might just kind of want to part ways. I'm not saying you're not. It's just we don't know what to tell people when they call at night. And I was like, okay, that's fair. So anyway, at that point, I called a friend of mine at the time, Great Smokies lab up here in Asheville. And I said, well, my schedule just opened up. And Brad Rackman said, well, yeah,
4:28
come on up. I said, their losses are gained. And so I became director of medical education, went on to be medical director. Great Smokies, now Genova, wasn't here in Asheville,
4:39
then went back to Greensboro after some time and had a very successful integrative practice there,
4:50
started doing Sanesco testing. It was interesting. I was a big neuroscience guy, and it probably made me a bad word, I think there are so I was a big neuroscience guy, and one of their Gold members or whatever Sanesco came in, and I was like, okay, no, give you a try. Let me pick five patients, do a urine split between the two companies, and kind of whoever gives me the best results that
5:29
match the clinical state most, I'll go with. And that's, I thought, did a really, really good job.
5:36
And I'll just say this parenthetically too. I'm also a member of CDC's Cliac, which is the clinical laboratory improvement advisory committee on the board of Cola, which is
5:58
laboratory accreditation. So what I wanted to say was not whoopi, but that there's a lot to laboratory medicine that I did not know going into great smokies. And now Sanesco, and I would say particularly in the integrated space, you have to be very careful who you're working with because
6:22
a lot of labs do their own controls, ie. For Sanesco. We get them from Baxter Science doing homegrown stuff, right. We send out samples every month to one of the world's best QA labs, bio Rad, and they run our samples on their HPLC machines and after we run it on ours, kind of compare and we have to stay in a certain percentage to make sure that we check the box and that we are okayed by them. So yeah, there's just a lot to it. And I would just say as a practitioner, if there
7:08
are practitioners out there to listen, to ask some questions about your lab, where do you get your controls from, what kind of quality control do you do those sort of things? So yeah. Oh and then so
7:24
I had this integrative practice, Sanesco came by and then as things happened, my wife's work situation changed. We moved to she's from Waynesville, North Carolina. Kind of in the background there you can see we moved back to western North Carolina and actually Sunesco is in Asheville and so I'm Chief Medical Officer at Sunesco and the rest is history. Carrie: Here we are talking about hormones and neurotransmitters.
7:54
Chip: Yeah, it's been fun. Carrie: Which actually, I mean, we're definitely going to get in testing because I get asked that a lot around can I test my brain hormones? I know I can test my cortisol, I know I can test my estrogen, but can I test my brain hormones? But first, before we even get there, people have heard of the word serotonin. Maybe they know brain hormone. But I'm using the word neurotransmitter. Can you explain what exactly a neurotransmitter
8:22
is and maybe what are the big ones, what are the ones we need to know about? Chip: Yeah, serotonin, the happy hormone. Everybody knows serotonin, right? But these neurotransmitters are chemical substances that are released at the end of a nerve fiber. A nerve impulse comes down and that's their signal to release these things called synaptic vesicles. And then the synaptic vesicles have the neurotransmitters in them at which point
8:54
they kind of diffuse across the synapse or the neural junction and cause a transfer of that nerve impulse across the synapse to another nerve fiber or maybe a muscle fiber or some other structure gland. And so by definition they are truly neurohormones. That is, they're made somewhere else. They travel through the bloodstream
9:25
and they have an effect somewhere else. Right. So neurotransmitters are the chemical messengers that your body really cannot function without. You just can't. And so from our experience, you got to have enough of these chemical messengers around and they have to be in the right balance of release and reuptake in order for the system to work really properly and it's also important to have the right HPATG balance as well. Right. So hypothalamic, Pituitary, Adrenal,
10:06
thyroid, gonadal, as an alphabet soup, I just build out all of those things, work together
10:16
in this beautiful symphony that is our body. And actually one of the really fun things about this job is that using these tests, you really get to see how hard the body works at homeostasis and balance and you see how the neurotransmitters and hormones interact and they work toward balance in the body. As a matter of fact, imbalance in the system in this I would say all important system actually can lead to, I think, a lot of the particularly pro inflammatory and degenerative
10:52
diseases that we see in the office every day. Carrie: So give us a rundown of these hormones
11:03
right. We mentioned serotonin but lets people have heard of GABA, glutamate sort of roll through and even symptoms that might be associated just so people are aware like, wait a minute, I have that. No one ever talked to me about that I have that symptom. No one ever talked to me about that before, which we hear all the time. Chip: Well, again, we certainly think about mood disorders, particularly depression, anxiety, but kind of the bread and butter of family medicine
11:39
is depression, anxiety, panic, all these stress related issues, sleep problems. I mean, I think like close to 70% of primary care visits are driven by patients psychological issues, right.
11:58
And of course it's only gotten worse in the pandemic. But also things like memory issues
12:05
or sleep problems or sexual function, cognition, attention,
12:11
salience, why we do what we do that has to do with dopamine and the reward system and those sort of things and the list goes on. But I've got to also say, speaking of bread and butter
12:24
conditions of perimenopause and menopause oh my gosh. I mean, you can do a practice just doing perimenopause and menopause and actually I think mine almost was, but
12:37
I just don't think we do it terribly well in this country. I just don't. And then you think about
12:46
the hormones effects on neurotransmitters and so for instance, estrogen is nature's SSRI, right? It works exactly like an SSRI and keeping more serotonin around. You think about Progesterone and its main metabolite ally pregnenolone being one of the most powerful gaba A agonists in the world. You think about testosterone and its effect on serotonin, dopamine and sexual function and norepinephrine and all of those sorts of things. So yeah, these things are
13:28
definitely interrelated. Carrie: And we hear this too. I mean, in my practice, predominantly it was females and they would come in saying I'm having hormonal issues, PMS, let's say, or I think I'm perimenopausal or headed into menopause. Inevitably, one of the top three symptoms they were having was my depression seems worse, or my anxiety is worse, I'm less motivated than I used to be, or my panic is worse than like they've always, maybe low grade had it.
14:00
Sometimes I would have patients who'd never had it, they'd never experienced anxiety, hit 45, and all of a sudden they were like, what is this thing I'm having?
14:09
Chip: I think we oftentimes see it as early as 35, maybe younger these days, because the first thing to go when your ovaries go is your progesterone levels start dropping, right? That's the first thing. And again, we just mentioned how important progesterone is to our GABA function.
14:33
And as a matter of fact, you and I have given a lot of progesterone to women, even as an anxiolytic or something, to help them sleep at night. You can give it to them at night, and it's very helpful for rest and that's that GABA function. You kind of march down 5-10 more years, like you say, around 45, when the ovaries really start going, you start seeing this drop off of estrogen. And I just talked briefly about estrogen's effect on serotonin function. And so
15:10
start getting this irritability, right? Start getting this difficulty sleeping, you start
15:16
forgetting where you left the keys or where you left the car. Obviously, I don't mean to laugh, but sometimes you have to laugh at yourself, I guess. But it's a difficult transition for a lot of women. And I'll just put in a plug for lifestyle stuff, too, in my practice, and I'm sure in yours, too. The ladies who really tried to watch their weight and tried to exercise regularly, tried to get that good sleep, just seemed to sail
15:52
a lot better through menopause than those who eat a lot of junk food and dumpsters and those sort of just an observation, though. Carrie: I had the same observation. And honestly,
16:05
again, I'd say the majority of people who are listening to the podcast are women. But
16:11
men experience this, too. They're not excluded from this discussion as their testosterone drops, as their alcohol increase or intake goes up, as their sleep is terrible. It absolutely, we've all experienced it. If you have a man or men in your life and as they get older as well, there may be more anxiety, more they may manifest differently, less motivated, more irritable. Chip: Yeah, and even the sexual drive in terms of dopamine is a big
16:41
one. But testosterone again hits serotonin, dopamine and norepinephrine pretty strongly
16:49
in women, too. We see as that menopause goes on, actually, the hormone with the highest relative amount in the body becomes testosterone at menopause after menopause. And so that's where the
17:10
what's the electrolysis and this sort of thing, a little bodily hair that we're not now, where did that come from? And men start losing their hair, women start . I joke with the galley cuts my hair. It's like my ears are growing faster than my hair in my head. But anyway, yeah. And so you asked about what are the big ones that we need to know about in terms of neurotransmitters and there are really like 40 neurotransmitters in the human nervous system and probably over
17:46
100 what I call neuroactive substances. If you talk about peptides and that sort of thing, that all interact with the system. But I'd say some of the most important neurotransmitters are slowing, which has turned out to be actually a bear to stabilize and to measure consistently. It's really, really hard. We've yet to really perfect that one. But Norepinephrine epinephrine works more as a hormone than aero or hormone, but certainly
18:19
has some neuro hormone effects. But then dopamine GABA, glutamate, serotonin, glycine and probably histamine. And then we also break all those kind of down into two main categories of inhibitory and excitatory neurotransmitters. Inhibitory being serotonin, GABA, gamma aminobutyric acid and glycine. And then your excitatory being where your Norepinephrine epinephrine glutamate
18:54
dopamine kind of swings both ways. Histamine can kind of go down either pathway, too, but
19:03
big lump is excitatory and inhibitory. Carrie: And I think as people are listening to this, it always surprises when I educate. I talk about something, let's say
19:14
magnesium, a magnesium supplement. And I'll say, well, magnesium glycinate, which has glycine glycinate just calming to the system. And then it's a lot of light bulb moments for people like, oh, my gosh, I didn't realize that my magnesium supplement, or if I take glycine to supplement, I knew I felt calm, but I didn't know why and helped my sleep and I didn't understand why. And it's again, inhibitory and then histamine, as you know. But histamine is all over social media with
19:42
mass cell activation or high histamine. And so it's immediately demonized, kind of like estrogen. But the reality is we don't want zero histamine. Chip: Absolutely right. Carrie: We need some histamine. But it is like goldilocks. And the three bears. We want it to be just right no matter what. Chip: Yeah, and I was listening to a lecture a few days ago about histamine and reflux and that sort of thing. But the old type of histamine, these h
20:25
two receptor blockers, like Pepsin or Zantac, those sort of things. Call your lawyer if you've been on Zantac. But the h two blockers are much more specific. The earlier ones, the Benadryl type, h one receptor blockers actually hit the h two blockade and acetic choline as well. So that's another one of the reasons they kind of make you a little bit sleepy, because they're nearly specific anyway. Carrie: Yeah, man, benadryl that'll knock me out
21:01
for a lot of people, for sure. We talked about nutrients are needing to be in the right balance and having too much or too little can be an issue. So how do we even make them in the first place? I think this is important for people to understand. We talk about hormones like estrogen, and I have explained where it comes from and males and females and other podcasts, but a neurotransmitter is a little bit different in the way it's created.
21:26
Chip: Yeah, these substances. These neurotransmitters are synthesized by enzymes. There's a whole different whole list of enzymes they're synthesized from. Most of them start out as amino acids. Right. And so where do you get amino acids from? Diet? There's only one place. And keep in mind, too, these SSRIs and SNRIs and all these medications do nothing to increase the levels of serotonin in your body. In other words, your total store or your bank,
22:09
if you will, or fill in the bathtub. They don't do anything to fill that bathtub.
22:17
They basically stick a plug in the bathtub to keep it from draining out. Right. But they don't add any of this is the only way to add neurotransmitters to your system is by amino acids. And that's either through your diet and you probably have to drink a lot of milk and eat a lot of turkey to get enough tryptophan to increase your serotonin levels, but certainly you can. And after your Thanksgiving meal or a couple of weeks ago, if you loaded up on turkey,
22:51
quite a bit of tryptophan in that. So that's why you watched the football game on the couch, right? Yeah. These things start out as amino acids, but they're synthesized by these enzymes that are in the cytoplasm, the innards of the cell, with the exception of norepinephrine. Talk about that in a second, I guess. So these neurotransmitters can be synthesized and then packaged for storage in these things called synaptic vesicles that kind of live in
23:24
the it's called the presynaptic terminal, using enzymes that are present in that terminal and then in the neurons that release norepinephrine, which is one of the catecholamine neurotransmitters. Once Dopamine is packaged right, then a membrane bound enzyme called dopamine, beta hydroxylase, actually converts dopamine into norepinephrine. So it's a little bit different. So unlike the other neurotransmitters, norepinephrine is actually synthesized within the vesicles,
23:58
not in the cytokine. Anyway. That's important. But like Dopamine, the rate limiting step in the synthesis pathway is the activation of an enzyme called tyrosine hydroxylase. And it's important to remember that these again, these neurotransmitters do come from amino acids in our diet. And the neurotransmitters, again, can be lumped into a couple of different groups. The amino acid neurotransmitters, and then what are called the biogenic amines or the monoamines.
24:37
Right. So the amino acid neurotransmitters are glutamate, glycine and GABA. Interestingly, glutamate and glycine can be used to synthesize other proteins all over the body. Right. GABA is actually a metabolite of glutamate, which also always struck me really interesting, that the most excitatory neurotransmitter, glutamate, is the substrate go through the enzyme for the most inhibitory neurotransmitter, which is GABA. Just that's kind of cool. But GABA
25:19
is not used in any other protein synthesis that we know of. So then the biogenic amines or monoamines are serotonin, your catecholamines dopamine, norepinephrine, epinephrine, and then histamine,
25:36
for what that's worth. Carrie: Well, and I think it's really important for people to realize amino acids come from diet that, one, the food you choose to eat, and two, the status of your, let's say, gut health are really important to the creation or not creation
25:56
of these neurotransmitters. Chip: Absolutely, yeah. Gut health on so many levels is important and is kind of the, I guess I would call it foundational.
26:15
So, yeah, it's important to have your gut health. And remember, too, that neurotransmitters, a lot of the neurotransmitters are made in the gut as a matter of looks like about 95% of serotonin is made in the gut, and about 50% of both GABA and dopamine are made in the gut. Right. So, yeah, gut health is important, and there's really some interesting research, too, Carrie, I'm sure you're aware of it with these probiotics, right, and their effect on depression and anxiety,
26:55
at least as an adjunct. But certain strains seem to be quite helpful. Some of the lactobacillus and bifidobacterium seem to be quite helpful with anxiety and depression. Carrie: And what I find frustrating, but you probably do, too, is as we're talking and as people are listening to this and they're like, okay, I understand that my everywhere hormones, my male and female hormones play a role in my brain hormones and vice versa. And I understand
27:32
that diet plays a role in how I make these hormones, and I understand that gut health also plays a role in how I do or don't make these hormones and how I absorb. And our microbiome, our probiotics could be helpful in certain nutrients and increasing proteins and things like that, but yet none of that is talked about, right? It's here, take this SSRI. I'm not knocking someone's SSRI or SNRI their antidepressant medication or even anti-anxiety if they're on
28:03
some sort of Pam, right? El Praza lamb Xanax, et cetera. But at the same time, for those people who are on those medications, was any of this discussed with you? Did anyone talk to you about, oh, you're depressed? It could be related to these neurotransmitters, which could be related to these hormones. They go back and forth, which could be related to your diet, your gut. Let's do all of the above and really course correct this. And it frustrates me when I read
28:32
literature and I listen to experts like you, and I'm like, Why is this not talked about? Why is this not first line? Chip: Why? Carrie: Yes. You know, the next obvious question is, can you test neurotransmitters? People are going to say, I know I can test my hormones, so can I test my neurotransmitters? Is that possible? Chip: Can you test for neurotransmitters? Yes,
29:17
and thanks for asking. I have my favorites, for sure, like artists. But there's a number of ways you can test neurotransmitters. Again, I think the way we do it is probably best. But you can test platelets. About 2% of serotonin, for instance, is carried in platelets. You can test blood.
29:40
Some think you can spot test blood, and you may be able to. I just think the research is still coming around on this one and it's kind of early in the game in my estimation.
29:56
You can do Pet scanning, imaging these neuroreceptors. Again, this is really cool stuff.
30:08
You can really look at these neuroreceptors is the only way to do it in vivo is through this Pet scan. But there are obviously limitations there, like money and then there's urine, right? And you can collect 24 hours urine. You can collect a spot urine and you can test neurotransmitters themselves or you can test metabolites, right? So we use a spot urine and actually test the neurotransmitters themselves. That's always made kind of more sense to me.
30:44
Go to the source. And then with subsequent tests, we use the spot urine. It's certainly easier than carrying around a little bag for 24 hours. So we do a spot urine, and then on subsequent tests, we ask people and suggest people do the test about the same
31:03
time of day. And that said, so many things can affect these neurotransmitter levels, everything from our diet to our level, to our hormone levels, to our lifestyle, to our gut health that we've been talking about. The kidneys can synthesize and metabolize about all of the neurotransmitters, and yet we have used our model in well over 100,000 patients and are satisfied. It's a good test. Maybe it's not a great test, it's certainly not a diagnostic test, but it's a good
31:40
clinical tool. And what I mean by that is you got a patient, you test them, they got a number, you do an intervention, give them supplements and work on their lifestyle and all the things that we do, and then you retest them, same patient, and then we've got a new number. And so it allows patients to see what's going on with them. So many times when you're finished going over one of these tests
32:13
with your patients, I can't tell you the number of patients who have literally cried and said, why hasn't my doctor done this test before now? I mean, this makes total sense now. Now I understand why I feel the way I feel or why I felt the way I felt for the last however many years.
32:30
Carrie: So when I was in practice, I ran neurotransmitter testing and I loved it. I found it immensely helpful. Patients found it immensely helpful. Sometimes, as we know, we just need to see it on paper. One to validate. I would have so many patients go, so I'm not crazy. I'm like you're not. Well, no, I never thought you were crazy, but no, you're not crazy. You definitely have some imbalances, though, and let me walk you through what this means. And I would get pushback
33:01
and this is my next question I would get pushback from colleagues who would say, well, there's no way that the urine testing is an exact replica of what's happening in the brain, because they're made all over. I said, I know. I understand that when I'm doing testing, because it's a whole body, it's a whole system that I'm working with. And I know these hormones are all over, and all over
33:26
they feel like crap. So when I test, I know I'm looking at the system as opposed to like a spinal tap maybe looking in the brain, because their depression is all over, not just in their head, it's in their gut and their skin and their joints, in everything. Their anxiety is system wide in their symptoms. So I'm okay with that. Chip: Yeah, there are a number of studies and little sprague dolly rats and that sort of thing, that they put a little rat Ng
33:59
tube down them and they for speed them five HTP. And in 2 hours they test their blood, they test their peritoneal fluid, they test their CNS, and serotonin levels bump up. So, I mean, not many patients are really willing to stand in line and for that they don't really want to have their peritoneal fluid checked or their CNS. Yet there have been studies done in animal models that these things actually do have a significant improvement. For instance, serotonin.
34:36
Yeah, the other thing I would say is, if there are non believers,
34:44
call me and we'll get you ten tests at a reduced rate or something and let you really try it, because I guess I've done over 4000 of these tests on my own patients. And again, isn't a great drop dead test. It's a good clinical tool, like I said. And we've got some really interesting research, unpublished, but 20,000 patients looking at their levels. We did a
35:23
cohort study looking at a group of patients, I think it was, I think 800, who went through our
35:35
kind of plan. So they did testing, they used our stuff. They weren't taking, they were medication naive, right? They weren't taking any SSRI anxiety medications. Went through three tests and then we looked at 14 different quality of life measures. Some people call them symptoms, but the FDA doesn't like that. Anyway, it's 14 quality of life symptoms. Things like sleep and depression and agitated depression and anxiousness and those sorts of things. I mean, it's amazing.
36:17
I'll say this too. The first round we went through and we published to our customers, it wasn't a formal thing. And our customers called back and said, my patients do a lot better than what you're talking about. We kind of thought about it and then we like, oh, right. So the way we do this is every patient gets a questionnaire. And so there's a Likert scale, four point Likert scale, one being
36:52
low, four being severe. So we just put all comers together in that first round. I e. Men were asked questions about menopause or whatever that's kind of included, and it shouldn't have been. So anyway, when we did it a second round, we did kind of gender specific question and then looked. At the Likert scale, it was amazing. Everything probably from 40% in those 14 different areas 14% to, like, 72% improvement over those eight weeks, which is as good or better than any
37:35
medication I've ever used. And so there's that nagging problem with reality. It's like, well, here's the model. Here's a bunch of patients who went through it. Here's a bunch of patients who got better. Here's their scale that they improved. What do you say about that? No, it doesn't work. Yeah, it does work, and it's okay if you disagree, but we've also got thousands of practitioners across the country that have been using this test for a number of years.
38:07
And again, it's a good clinical tool. Carrie: As my old boss used to say it's:
38:14
Tools like this are like looking into different windows at the same house. Chip: Nice, right? Carrie: So it's a good view into an area that you wouldn't have had a view into otherwise. Chip: Absolutely. Yeah. That says something really similar. That I mean, that this test gives us a window into the neuroendocrine system that we heretofore just really haven't had. So it's not like the be all, end all is a piece of the
38:43
puzzle. You still got to do the gut stuff. You still got to do all the other things that we're talking about. But this is a significant piece of the puzzle, I would say. Well. Carrie: And for somebody listening who maybe is or isn't on medication, it doesn't matter. But they're listening to this and they're going, my depression is not much better. Or like it's really interfering with my life, my anxiety, the panic that I experience, the insomnia that I'm having,
39:07
whatever symptom quality of life issue that they're having, listening to this going, Hold on.
39:15
These are the symptoms I'm having. And I've never had this worked up. I was offered a medication or nothing or maybe counseling, which is great, but if it's not working or not working that well,
39:27
this is why I love having you on for one, because I think there are a lot of struggling people right now, and they don't know where to go. And this education isn't out there. And unfortunately, their primary care isn't talking to them about it. Their OBGYN isn't talking to them about it. It's just they don't have the time and the education for it. And so that's why to give somebody a
39:48
different option, another view into their what's happening, I love that. So now that we've got this far, let's talk about, like, how do we improve the situation if somebody is listening, going, Great. If I do the test or now I'm understanding these neurotransmitters, what are things I can change in my life or my diet or other areas I need to look at to really help turn this cruise ship around?
40:18
Chip: It's always more complicated than, Here, take this supplement. Carrie: Right. Dang it. Chip: The thing about functional medicine is we really do try to look at people as a whole, and that includes their trauma scores and those things even from childhood and all the things that can continue to affect us into adulthood.
40:44
So, yeah, it's complicated, but so and we still don't know a lot about the causes, the underlying causes. I mean, the name of the show is Root Cause, right? We don't look a lot of the underlying causes from these mental illness things, and there's certainly a lot of holes in our understanding and our ability to fix these things, right? But you got to start with the basics. And I would say that means from a naturopathic standpoint, cleaning up the gut
41:21
and cleaning up the diet. So nobody can deny the fact that simple carbs make you feel better. They do, right? And because the literature shows us that when blood sugar goes up, serotonin goes right up with it. And so all those people that you had on the Atkins diet or a keto diet
41:46
who feel like crap sometimes, that's for real. I mean, people can actually get depressed on these very carbohydrate restricted diets. That's an interesting thing about carbohydrates, too. There are essential fats and there are essential amino acids, protein, right? There are no essential carbs, but they really do make us feel better. And I think that's why people reach for potato chips and popcorn and M&Ms and screaming yellow zonkers, right? They do make you feel better.
42:26
That's not to say you should self medicate with simple carbs, building a diet with complex carbohydrates and balancing your fats and proteins and all those sort of things, and all those wonderful people at Rupa Health can actually help you with that. You got to mind your gut, and you may need some testing there. It's always a question when I'm talking to practitioners, what do I do first? Do I take care of the gut first? Do I take care of the neurotransmitters first?
42:55
It's between you and the patient, really. But I kind of say I like patients to feel better. That way they come back to me. So dealing with the neurotransmitters, I think, is a great place to start in terms of helping people feel better, particularly if they're not getting better. Well, then you start looking at things like, well, maybe heavy metal testing, because cadmium and aluminum and mercury and lead can really gum up your these enzymes that all have bivalent
43:32
Co factors, things like magnesium or calcium or zinc or whatever, and these heavy metals really will gum those up. And so it's the type of thing that your patient, if you've got this level and you've given them supplements and whatnot, and you're expecting to see it, their level is higher and they're not particularly after a couple of times you start going, what's going on here? So again, looking at the gut, looking at heavy metal testing, we know that exercise raises serotonin.
44:05
It also raises things like BD and F the brain drive neurotropic factor, right. Which also may be playing a part in mood. So again, this whole depression thing is much more than a deficiency in any of the neurotransmitters, for sure. I want to try to keep your weight down because these toxins
44:28
that we're talking about are really stored in your fat and can certainly have an effect on your overall health, particularly if you're heavy and then you lose a lot of weight, a lot of these toxins will actually come out and cause you to be sick.
44:47
Carrie: I've definitely seen that. I've had a variety of women who have done whatever plan
44:56
or program and if it's a more rapid weight loss, I have several over the years who have said,
45:06
this week I lost 5 or 7 lbs because it's the rapid program and I feel terrible headache and bites, rashes and acne and what's going on? I said, well, you had a fat soluble toxins stay in the fat and you've just broken that apart. You're clearing it out and now they're circulating. So we need to address that. Chip: Yeah, drink plenty of water. Carrie: Drink plenty of water, 60oz of good water if you can.
45:34
Chip: And again, we tend to self-select people who want to go this route and clean up their diet and tend to be a little bit more motivated than my basic family practice patients. These types of things are just really all impactful. And again, I would call them foundational
45:56
to getting you on your road to wellness and then we can kind of add supplements
46:05
and those types of things on top of that. Another question that people ask a lot is do I need to stay on these supplements forever? It's a good question and I would say probably not. If you do these things that we're talking about doing contemplative, walking, taking up meditation, those sort of things are all again very important and you may get your body back to homeostatic place that is good and you may not need them or you may need a lot less of the neurotransmitter
46:45
support over the years. And some people don't make any changes, believe me. Imagine that. And they will probably do better and feel better. And that's another thing you can do. The testing can actually be kind of a mild post where, okay, here's again, your patients probably don't do this, but mine will actually stop the stuff that helped them feel better. So they come in six months later and they go, you know, Doc, I'm kind of back to feeling bad again. Really?
47:19
Are you still doing what we talk about? No. So here's a test that when you were feeling good, let's see if we can get you kind of back there and then we can move on from there. But I mean, change is hard. I mean, change management is difficult. It just really isn't. People are going to relapse. It's just part of the name of the game. Carrie: Human nature. Absolutely human nature. Yeah. Two of the things I wanted to just touch on one, the brain derived neurotrophic factor
47:48
for people listening, BDNF, that's a good thing. We like BDNF. So if you are Googling, what is BDNF? Or extra? You will see positive things. We like that. And the other thing, when you mentioned simple carbs, I just thought of somebody I talked to last week that they realized they put two and two together on their own. They were just sharing their story. They weren't a patient. That they were consuming a lot of sort of junk, quick fixes, sugar, what have you in their snacks and
48:23
the up and down of their blood sugar all day long was making their anxiety through the roof. And they just thought they were in a phase of life or it was hormones or something was happening
48:34
with their anxiety until they realized how often they were jacking up their blood sugar through the day so it would go up and then crash down. So she was swinging from hyperglycemic to hypoglycemic and she said, my anxiety was through the roof. And she said, once I got that under control, once I realized it really worked to eliminate that, she said, my anxiety went from about a ten to about a two. And I was like, oh, yes, I forgot about that. Yeah, for you.
49:03
Chip: Oftentimes patients, when they're on that sugar roller coaster, too, it's the typical thing, particularly if their adrenals are flagging a little bit, right. They have lunch and they have coke and pizza with a side of Fritos and about 2:00, yeah, crash down, but your crash is right. And then what do people do? Well, they go down to the Starbucks and get a double espresso. I mean, think about anxiety going through the roof a lot of times with all the self
49:35
medication, it can be an issue, for sure. Carrie: Absolutely. And then it messes up their sleep and then it just gets it to a whole circadian rhythm circle that once you recognize it, thankfully, the good thing is you can get off of it, you can make the changes. And one of the other things you said, too, that I wanted to one of the questions that I get often is, you know, that paper came out not long ago sort of saying, talk about Serotonin and SSRIs and
50:02
these antidepressant medications are not the thing and Serotonin is not we've been attacking it all wrong. And I love that you said we can't just pin one hormone to this. Like it's not low. Serotonin is the reason for all depression. I mean, they work as a symphony, as you said. Chip: It's much more complicated than that. And that review, I mean, it's good for headlines, right? Yeah, it worked debunking
50:39
the whole serotonin imbalance theory. But I think it's important to not jump to conclusions about the efficacy of antidepressants, particularly these SSRIs and surfing some of the therapies that we and approaches that we've been talking about today because they haven't been studied.
50:57
Again, I'm not sure you need a five year, 5000 person, double blind, placebo controlled study to show that five HTP increases serotonin. And I hope, and I don't think that that study will mean that doctors will stop prescribing antidepressants as a treatment option. Some of these things have been absolutely life saving for the right person. Right? But I think it does call for more research
51:29
as to why antidepressants work the way they do. And keep in mind too, that that study didn't conduct any new experiments or even it wasn't even a meta analysis. They conducted an umbrella review
51:45
the first time I actually heard that. So that some, but not all of the meta analyses related to serotonin were included. Carrie it's interesting too, that there was also a recent meta analysis that concluded that the serotonin transport gene variations do play a key role in depression risk, particularly in combination with stressful experiences across a person's life. But that study didn't get nearly as much attention to it. I think it's fair to say, given that study, that
52:21
the science of serotonin's exact role is far from settled. And again, this study only looked at SSRIs. They didn't look at things like five HTP. And there are tons of studies on five HTP tryptophan elimination diets and those types of things that go back 30 years. And again, like we just said, oversimplifying. To say that depression is just a serotonin deficiency isn't fair either.
52:49
It's just a lot we don't know. One thing that I think was interesting out of that
52:59
study was that it showed that antidepressants over the long haul actually can decrease serotonin levels. And I've seen that for years on an SSRI for one, two, three years. Another key point, these drugs were never meant to be years long. I mean, most of the studies were eight to twelve weeks because that's all they were studied before they came out. So keeping people on these things forever, I think, can potentially do harm to their neural pathways unless the nervous system is
53:36
supported in some way. But the typical story that you hear is patient goes into the doctor and says, doc, under press, well, let's give you this 20 milligrams of fill in the blank. I think there are 28 different SSRIs. Now the Prozac, we'll give you 20 milligrams Prozac 3,6,9, 12 months later the patient comes back and says, you know, Doc, that helped me, that really helped me for a while and that just doesn't seem to be working anymore.
54:06
Well, let's increase the dose to 40. 6-12 months later, the patient comes back and says, seems to be working again and I got a nice bump there for a couple of months and didn't seem to work. All of us increase the dose to 80 back and says, okay, thanks, I have no sexual function now.
54:23
Okay, well, you need, wellbutrin, because that'll raise your dopamine and give you your sex drive back. Great. 3,6,9, 12 months later, patient comes back and says, still not real. Okay, well, then let's add the atypical antipsychotic, right? Yeah. Patient comes in, drooling next time. So we just get people on this drug train, right? If you look at those people's
54:47
serotonin levels, for instance, oftentimes they are in the basement and you are literally flogging a sick horse. So give some substrate into that situation by giving some five HTP and whatnot. And then that medication works a whole lot better if it has something to work on. And you can usually cut back on the amount of pressure you're taking. And again, just want to say that is something that you do need to discuss with your doctor if you're going to do five HTP and
55:17
something like an SSRI or SNRI together. So just something to keep in mind there. Carrie: And the same goes for if you're listening to this and you're like, that's me. I've been raising my dose and I'm now, Manuelbutrin, I'm going to stop. Don't stop. Don't stop. Talk to your practitioner, talk to your doctor, be responsible. Don't cold turkey these things. That's not a good idea either. All right, so my last question about this, because
55:42
we've been talking a lot about a five HTP, and before everybody runs out and buys five HTTP
55:48
is when you make serotonin, when you make dopamine, again, as you said, they work as a symphony. It's about balance. And so do you in your experience with the thousands of thousands and thousands of tests that you've done, do you find you're often supporting both serotonin and dopamine at the same time? Is it as simple as just taking five HTP? Right? People are going to run to their nearest supplement store after listening to this. So I want to be very
56:18
careful that they don't screw themselves up. Chip: And you have to be careful. I mean, Sanesco is kind of one of our bylines or slogans is, it's all about balance, because we really do believe in balancing these neurotransmitters. And you do that through the lifestyle changes and that sort of thing that we've been talking about. And through supplementation, there are
56:41
supplements with something called lacuna perians in it, which is about 20% L DOPA by weight,
56:49
it will raise dopamine like nobody's business. And then you do need to kind of gosh, we could spend a lot of time talking about the kind of the typical thing that you see in patients might be wired and tired. Their serotonin levels are low, their Norepinephrine levels, epinephrine levels are high, their dopamine levels are low. And so how do you kind of work on balancing that stuff? Well, I guess, but yes, you can help raise that serotonin. And then also the reason you need to
57:27
do testing is to kind of help balance that out, right, so that you can get some of the excitatory stuff. We have excitatory and inhibitory formulas and then it's a bit of an art, people where they need to be. But yes, very important to balance things out and to kind of keep in check on things. And I would say over the first year, probably could expect your doc to do three, maybe four
57:55
tests and then once you kind of get where you need to be once or twice a year after that. And again, plus minus on the supplementation, depending on how well you do with some of your lifestyle changes and that sort of thing. Carrie: Nice. Excellent. And I will ask this on the Sanesco site, do you have a find a practitioner link? Do you have somebody's listening and goes, oh, I know my GP won't do any of this. How do I
58:22
find somebody that understands neurotransmitters? Chip: What a great question. I do believe that you can call customer support and they do have customers that would say, yeah, in
58:38
Marin County or whatever, you've got three people that do this kind of testing or whatnot? Carrie: Okay, because that's also another really common question that I get is I love my OBGYN, but this is not their area of expertise. I'm in the zip code, I'm in the city. Can you help point me to somebody? And so I always like to give resources for people
58:57
around the particular topic. Where can you go find somebody? Chip: There's lots to read on the website, too. It's actually quite good. This is kind of a whole new language that you have to learn. And there is a learning curve. Got some really good training materials for practitioners that will help you kind of get your sea legs and that sort of thing. Carrie: All right, well, speaking of which, how do people find you? How do people find Sanesco?
59:28
Give us all your details. Chip: Sanesco.com.
59:35
Yeah, it's actually Sanescohealth.com, I think now if you could Google Sanesco and that would come up. And again, there's lots there's a practitioner portal and a patient portal. They have different kinds of materials and resources that you can delve into whether you're a practitioner or a patient. Talks about the formulas and all those sorts of things. Talks a little bit about our quality assurance and those sort of things that we talked about at the top of the
1:00:09
hour. So, yeah, lots of good information there. Carrie: Amazing. Well, Chip, thank you so much for being on the Root Cause Medicine podcast. This has been immensely helpful because like I said, I have been really frustrated lately reading some literature on what has been known around depression and just neurotransmitters for decades. And yet that information is not translated very well. It's not into the consumers. So I love having you on so people can go,
1:00:36
wait a minute, that's me. I didn't know there were really good options out there. Besides, here, take this pill. That's actually not working. Chip: Again. It's taking care of the whole person as you well know, and it's getting all those other things. It's never just take this supplement or this medication for sure. Carrie: If it was only that easy. I always joke, I promise if there was a magic pill, I would not gatekeep. I would give it to everyone. But sadly,
1:01:05
there was not one magic pill. Chip: It's funny. A lot of our patients also say I don't want to take any medication. Take $500 a month of supplements, they won't take any medication. Yeah, that's overkill too, right? So I had a naturopath friend tell me in his sleep, you're taking more than five things. You may want to talk to your doctor about that. Carrie: Get a little more get reevaluated. Absolutely. Well, again,
1:01:33
thanks for being on. I sincerely appreciate it. I know everyone's going to learn a lot out of this. Chip: Good. Thank you. I really appreciate you having me on. It was fun.
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