Do Natural Medicines for Mental Health Really Work?

Introduction to Mental Health and Naturopathic Care 0:00

Hey everybody, Dr. Rob here. I'm with a luminary in the field of mental health, naturopathy, dr. Peter Bongiorno. i'm excited to have him. He has over 20 years experience. We're going to cover a plethora of different topics. The big one's going be mental, health and mental illness. Dr Peter, my pleasure. Hey, Dr. Rob, it's great to be here. Thanks for having me. Well, let's hit you with some factoids. In the US, over 50% of adults with mental illness receive treatment annually. 30 out of 50 million people receive that annual care.

One quarter of the U.S. adults, 23.4 million, experience mental illnesses in 2024. Symptoms of depression and anxiety. So if it is anxiety, I suffer from mental Illness. What is going on? Well, anxiety is really the tip of the iceberg, right? It's symptoms, but it's just telling you something's out of balance in your body. And really, I think a good practitioner tries to figure out, well, what are those out-of-balance factors for each person? And I think it varies for everybody. It can be, of course, stress and psychological.

There's a piece of it, it could be digestive issues. it can neurological and mitochondrial issues, nutrient deficiencies, excess of nutrients, inflammation in the body. The list can go on and on. So many possibilities and permutations and combinations of those things. So why are mental health approaches gaining traction, natural mental approaches? Well, I think the main reason is because people are finally starting to realize that the conventional care model, although it might work in really emergency type situations, doesn't really work for most people who have mental-health concerns.

So some of the things I've read, and I'd love you to comment on this, in the idea of mental health approaches, dedicating traction, natural, of course, limitations of symptom suppression models, rise in polypharmacy and patient dissatisfaction, functional psychology, addressing the driver's inflammation, gut hormones, nutrient status, just like you said, And the role of lifestyle in resilience. The baton is yours, my friend. I want to be clear, you know, for anyone taking medications, don't just stop medications.

You want talk to your prescribing doctor. And I think in very urgent care situations, it's certainly proven that medications could save lives, so people who are very, very depressed, want hurt themselves, possibly suicidal, wanna hurt somebody else, medications clearly play a role. Outside of that severe situation in mild to moderate cases, it's actually been shown that medications don't really work much better than placebo.

Root Causes of Anxiety and Depression 2:50

And what we also know is that there are a lot of natural substances even as single therapies that can work just as well as the medications in those cases which is really maybe about five or ten percent better the placebo at the most. So by themselves whether using a natural remedy like an herb or something, or you're using a conventional medication, we still need to sit down and say, okay, what are the underlying issues for this particular person that is the reason why they're having this change in mood?

Great point, great point. Really getting to what we all love to refer to as that root cause or root causes resolution, the Emphasis of functional medicine implication. When is medication necessary and when isn't it? Because people always ask like, when do I take a drug? When do i take the natural supplement? And when I mix the two together? Sure. And that's a great question. In urgent situations, you know, let's say you have Someone who's very very depressed you have a you know peri-menopausal woman who is very?

Depressed has to take care of her children Maybe she has no support around she can't even get out of bed let alone You know like when I when i give recommendations I want people to work on changing their food, going to exercise, getting to bed early. When you feel that way and you can't even get out of bed, thinking about doing those things is just too overwhelming. In cases like that, sometimes the medication could boost you up enough just so you could get outta bed and then start working on the underlying issues, whether it's exercise or a better schedule or eating better or going and even getting those blood tests to figure out what the underlining nutrient deficiencies are.

You mentioned blood tests, here we go. Let's actually move the needle clinically. I'll hit you with one. Nutrient status, B12, folate, ferritin, vitamin D, magnesium. Yeah, I mean, those are all things I like to see with patients. You know, you mentioned ferridin. Ferridine is storage of iron. And iron issues can be very important in a lot of patients, either iron that's too low or actually iron is too high and can a little bit toxic and contributing to inflammation in the body. B12 is very, very important for how the body eventually makes neurotransmitters.

There's a few steps to that, and also even how it makes red blood cells and carries oxygen. Magnesium is critical for people to make sure that their anxiety levels stay in check. It's an important part of how nervous system stays calm, how muscular system stay relaxed. Yeah, and then folic acid, I think you mentioned as well, is very, very important as, well and how people make neurotransmitters in their body. Let's talk about the big hormone or vitamin, if you will, vitamin D. Vitamin D, yeah. So vitamin I know we call it a vitamin.

It's actually a neurosteroid. So it actually acts on the nervous system. One of the things that's most important in terms of what we're talking about is vitamin D is an important cofactor in how the body makes serotonin from tryptophan. So tryptophan is an amino acid which we take in naturally through food, through proteins, and that gets brought to the brain and gets converted into serotonin. And without enough vitamin D, it's very hard for your body to make seratonin, And when we think about medications, you know, many of the medications for anxiety and depression are designed to stop enzymes that break down serotonin Now, if we don't have enough vitamin D, it's going to be hard for your body to even keep up to make serotonin.

So that's such critical vitamin just for that purpose alone. Amazing. I'll give you some inflammatory markers, C-reactive protein, HSC- reactive protein and homocysteine. Yeah, so C reactive is a good general inflammatory marker. Again, these are all things I like to see when I work with a patient at first. And if inflammation is generally high in the body, then I know we've got to start looking at the gut, because the cut is where that inflammation really starts.

When Medication Is Necessary 7:00

HSCRP stands for high sensitivity C-reactive protein, and that is an important inflammatory marker in blood vessels. And it's been suggested that when that's high, that that might even be more important than looking cholesterol in terms of risk of heart disease. And then finally, you mentioned homocysteine. So homocysteines is another inflammatory marker in blood vessels, and oftentimes it can suggest that there are low B vitamins in the body, or B-vitamins that just aren't available in body. Sometimes it suggests that their certain genetics that can make a person predisposed to have higher levels of homocysteine.

And the reason why that's important from a mental health standpoint is that when you see homocistine is high, that suggests to us that other pathways in the body may be a bit blocked in terms of being able to make neurotransmitters the way they need to be made. Interesting. So we're talking about methylation possibly having an adverse effect on mental heath. Exactly. Yeah, or a lack of methylation in this particular case, right? depending on which way you go, right? You mentioned gut testing, microbiome, tell me the impact that has, which I believe is the epicenter of your health, SIBO, small intestinal bacterial overgrowth, and some other permeability markers that you like to discuss.

Yeah, I love that. You mention it's the epi-center, because when you learn about, when go to medical school and you learned about embryology, what you'll learn is that when the sperm and the egg get together, They make a few cells, and those cells eventually become a tube. And that tube becomes your digestive system. Then from that digestive, everything else grows. All your other nervous system grows, your bones grow, muscles. So everything comes from the gut. You said it exactly right. It really is the epicenter of everything.

When it's not right, the body is not. And I would say the bacteria that grow in there, which far outnumber us in a way, are probably the epicenter of that digestive tract. It really shows whether the function is good or not good. And when we run functional medicine tests to look at the bacterial, what we're really trying to understand is what is going on in the lining of the digestive track and how can we bring balance to it, because it's a very important aspect of how the brain is controlled via the vagus nerve.

The vagous nerve is cranial nerve 10, and it connects the gut to the bring. And the bacteria and the metabolites that get made by the bacterias send signals that go through the vagus nerve and go to brain and create changes in our behavior and our mood. Pretty amazing stuff. Yeah, I always like to talk about the idea of the gut-to-brain axis, which is really the microbiota, as you said. Gut via vagus nerve to brain axis is the superhighway to health. And obviously, the vagous nerve, there's a tremendous impact on rest and digest, but people forget the right vaguous nerve has a and how people act.

So it's fascinating.

Key Nutrient and Inflammation Markers 10:20

What about SIBO, small intestinal bacterial overgrowth? That seems to be on the rise. Yeah, so small intestine bacterial growth is a condition where the bacteria that should be in the lower gut, in a colon, start to kind of climb up. The way I explain it to patients is it is like a our digestive system is like an escalator. An escalators should always be moving in one direction, in this case from the top down. And as you know, if you try to climb up from the bottom of an escalator that's moving downward, it's kind of tough to climb up the escalater, right, because it is constantly moving toward you.

But if the escalator slows down or even stops, then it it easy to climbing up. And that is what happens with bacteria. You know, bacteria just like to roam and they like take over new ground. The bacteria, when the escalator slow down, meaning the digestive peristalsis, the movement that's naturally moving downward, stops or slows down, then the bacteria can climb up. And bacteria that should be in the colon end up in a small intestine, end in up the duodenum, which is that little part between the stomach and the small intestines, or even ends up into stomach itself.

And testing for SIBO will look at where that bacteria is. And the problem is, is when we have bacteria that should be in the colon and other places, it causes havoc with function. People get a lot of bloating. They get reflux sometimes. Even can get stomach pain. Bile movements just aren't great. I think it's very important to work on that because there's a strong association between small intestinal bowel overgrowth and irritable bowel syndrome, and there's a very strong association between irrital bowel and mental health concerns.

Wow. So let's get to the big question everybody asks me. Are probiotics enough to help with mental heath? Prebiotics and probiotic are a better choice, yes or no? And then the idea of a postbiotic like a short chain fatty acid with the gold metal being butyrate. Right. Yeah. And the answer to all of those, it really depends. I think I think if someone has pretty significant mental health issues just popping a probiotic supplement, probably isn't going to get the job done. Because we need to figure out, okay, if the microbiome is off, why is it off?

Are we not sleeping enough? for us. Again, are we nutrient deficient? There's so many reasons why the digestive system gets out of whack. Maybe we've been stressed since childhood, maybe there's a lot of early life stress and trauma that originally shut down the digestive tract that we need to work on and kind of move through so that this way this energy in our body that have been holding from this stress can move so this the way the digestive track can start working. So I think just giving a probiotic, it might be helpful.

You know, certainly we're trying. Usually it can't hurt. But typically, we want to really look at those underlying issues. And then you asked about prebiotics. Yes, sometimes pre biotics help. Prebiotic are basically the fibers and things that help the feed the good bacteria in your gut. So, and when we eat healthy fiber, you know, from vegetables and fruits and things, we're giving our gut prebiotics. And then you mentioned postbiotic. Postbiotics are the metabolites and the things that the bacteria make, like short-chain fatty acids.

You mentioned butyrate. Butyrates and short chain fatty acid like that are what help signal that vagus nerve to create good communication between the gut and the brain and then a healthy brain. So those are all good choices. It just really depends on what the person needs. You know, it's funny. I graduated school 26 and a half years ago. And if I thought that I would be talking about the vagus nerve, the great nerve of the body, There's no way I would have been able to portend that. It would be without question impossible, but in having a conversation now, realizing where our field has gone and what people have to consider is, it's illuminating for me.

But reeling it back into labs that actually move the needle clinically. How about hormone contributors? Thyroid, cortisol rhythm, some sex hormones? Yeah, so all really important, right? Thyroid has receptors throughout the body. Especially with depression, you know, when people have low mood, thyroid is very, very important to check into because there are people who just have a low-mood because of suboptimal thyroid levels. Thyroid is also very for moving the gut. So sometimes when you have issues with the guts and constipation or even SIBO, it could be because the thyroid level are slow or low.

So that's certainly one very important endocrine organ to take a look at. You mentioned cortisol. Probably almost all my patients who I see with mood issues, I like to check cortisol levels, either through urine or through saliva. And not just one time point, but I'd like check it throughout the day because there's a very strong association between different dysregulations in cortisol and why people have mood issue, why why people have these anxiety feelings where they kind of feel like out of touch with their body, where I feel just kind a foggy, when they feel exhausted all the time, or where the feel revved up all time.

Those can all be related to cortisol. Plus, cortisol is such an important regulator of your blood sugar. And blood sugar, especially with anxiety, can play a really strong role when you have great fluctuations in bloodsugar. You mentioned one more. What was the third one? Sex hormones.

Gut Health, Microbiome, and SIBO 16:20

Sexhormones, things like estrogen, progesterone, testosterone. vitally important for both men and women. Well, men, actually not so much progesterone, but men's and woman's testosterone and estrogen are really, really vital. Estrogen helps the brain in both women and men produce serotonin and produce proper seratonin receptors. Testosterone is very, very important to mood as well. There's a precursor to testosterone called DHEA. And that's also quite important to check. DHEA is a hormone that helps you balance cortisol in the brain.

So when you get stressed out and your cortisol spikes and abates the brains, DheA can help meet it there and help not create too much of a negative effect on thebrain. And especially when people are chronically stressed, it's really important make sure DHeAis working and functioning. Those are all reallyimportant and the balance of them all are very important as well. The idea of homostasis is critical to overall health, whether it's medical, naturopathic, chiropractic, whatever. That resounds interesting.

So you mentioned sleep. What's mitochondria's effect? Mitochondria is the powerhouse of the cell, and many people forget mitochondrial also support immune health. in reference to mental health issues, mental illness. Yeah. Well, when you asked that question, my first thought is how important is sleep to the mitochondria is what I was thinking about. Because when we sleep, you know, and every book I've written on mental, health books, I don't mean to interrupt you reading several books. I kudos for you.

You busy beaver, man. Thank you. Yeah, well, you know, the information's got to get out there. The first book I wrote was in 2008, and it was a textbook on depression. And I'm proud of that book, I think, especially because there had never been a book about integrated medicine for depression, a text book that actually culled all the literature and kind of put it together. So that one I am actually quite proud. Since then, as the literary changes and as things come up, I think it's really important to keep updating things.

In fact, I'm working on a new one now because it has been a couple of years. But in every book I've written, the first chapter is on sleep. Because what I've learned is if people are not sleeping well, it's very difficult to help them get better with mood. And sleep, as you mentioned, is really important for the mitochondria. That's when our mitochondrion break down properly and clean up and recycle and build better mitochondrial. You know, I'm sweating a little bit because I just got back from the gym.

And the thing about going to the gym and going exercise is that when you workout, you work your muscles and your muscle call on your mitochondria for more energy and more nerve signaling. And then when we go to sleep, Your body figures out, okay, now I have to build better, stronger mitochondria because this guy is exercising and he needs more power and that's why we exercise, right, in a sense to help keep our nervous system healthy and build our mitochondrion. But if we're not sleeping enough, let's say I go exercise but I'm only getting five hours of sleep.

Not good, because now my system's not going to get a chance to build what it needs to, repair what needs repair, clean up and detoxify what is needs do. So I always tell patients, don't ever trade sleep for exercise. Make sure you're sleeping first. That's number one. Number two is make sure we're pooping. Right. So sleep poop, that's number one, number two, really almost any condition that you're working on, those are the top two to start with. Most of the neurodegenerative diseases, the key symptom is constipation.

That goes back to our talk about vagus nerve, because our parasympathetic systems are down, our sympathetic system is off. We're not going to poop when we're sympathetic, we are going pooping when parasympathetic. It's a nice full circuit conversation. I always do it in the middle of the podcast. We do the rapid fire, but you're a New York guy, so I don't have to speed you up. Here we go. Rapid fire segment. One nutrient you test most often for? Most of them. Vitamin D, we'll start there. What's the most overused supplement in mental health?

Overused Supplement? I would go with SAM-E, you know, because SAME I think it has a very special use and needs to be used specifically. Underestimating root cause is not sleeping enough. There you go. First question you would ask a new patient in your office. If I could wave a magic wand, what would you use that magic one to fix and balance? Wow, I love that. I concur with that, What will change in mental health care over the next decade? Things like this, just getting the word out, letting people know there are solutions.

first three lifestyle interventions before supplements, because everybody wants to go buy a supplement. Yeah, sleep, exercise and drinking water. Some basics. When do you refer out versus cold manage? I'll refer it out when someone is very unstable and I don't believe they can take care of themselves and do the naturopathic things that we're going to talk about. The single biggest mistake clinicians make in functional psychiatry. Missing the basics, you know, really focusing on sleep exercise, water, good food.

First three labs you would run in most cases. We spoke about a lot of labs, so everybody wrote them down. They'd go on and go, oh my god, where do we go? Yeah, it's hard to say. If I had to pick, you know, start with the basics, right? A good CBC, look at red blood cells, probably look out inflammatory markers, and probably at some vitamins. Yeah I mean, everyone's so different. So functional medicines framework for mental health, I'm going to give you a little bit more time. We'll go off the rapid fire.

So root cause hierarchy. I am going put inflammation at the top. Im going say gut permeability to HPA axis, dysregulation, micronutrient insufficiency, and toxic burden. so I can repeat those, Im doing a legwork for you because Im just trying to say I should probably write these down because im going forget what you just said.

Hormones, Cortisol, and Mitochondrial Health 23:00

Root cause Hierarchy, inflammation, we'll start with that. Am I answering that question? Is it a question. Yeah, it was an open-ended. Oh, okay. So, inflammation. What's been shown, if you look at the literature, even post-mortem studies on people with mental health issues, typically there's a lot of inflammation in the brain. And there are reasons for that. There is something called the blood-brain barrier, and that blood brain barrier can get leaky. In fact, when I was at the National Institutes of Health, I did research in the 1990s, we were studying stress on rats.

And we found that the areas in the middle of the brain called the hypothalamus had all these vessels that were the blood-brain barrier. We found there was a lot of inflammation and a lots of immune cells that kind of firing off when the animals were very, very stressed out. One of things that we also did, interestingly, is we gave the animal something called lipopolysaccharide, LPS. which is a bacteria coat that will get the immune system very riled up and inflamed because then the system thinks there's bacteria invading.

And when they got this lipopolysaccharide, the blood-brain barrier really lit up, and the areas in the middle of the brain called the hypothalamus really led up and very much stressed out these animals. So these are things that we've probably, what was that, 1990s, was it like 30, 40 years ago? God, time goes by. And so we really have known for a long time how important inflammation is as a root cause of behavioral changes and mood. I think that most of our patients suffer from inflammation and I believe one of my credos is to manage and modulate inflammation.

I'd think Americans are inflamed and most if it comes from the environment and in their environment, all the ultra-processed foods, which hopefully now with the food pyramid getting turned upside down, we get rid of that. They just had a study that came out last night that spoke about ultra processed foods interestingly enough and you can eat 320 more calories. As long as it was real food and you took out the ultra-processed food to no detriment to your health. So fascinating stuff. The next topic is gut permeability and dysbiosis.

And incidentally, LPS, I nicknamed it something for you, El Diablo. El diablo, oh I like that. The devil. Yeah, so gut permeability, you know, the other name for that is leaky gut. And finally, it's getting its due. You know I remember when I graduated naturopathic school and I came to the East Coast, I started giving lectures and probably a year or two in I gave a lecture at a medical school here in the New York, New Jersey area. And I talked about leaky gut and its association with different conditions.

And, and I remember a resident there, you know, just got up and said that he thought it was complete hogwash. He'd never heard of leakey gut. It makes no sense. And I remember thinking, well, the presentation I'm showing you has all literature from medical journals. It wasn't some kind of a small article in the New York Post or something. it was an actual medical journal article. So I didn't really understand why doctors didn' really know about it. Now I am very happy to see that gut permeability is getting its due and that people are starting to understand this.

And what they're understanding is that when there are imbalances in the gut, that those changes can create a lot of inflammation. Where do those imbalanced come from? It comes from stress, shutting the cut down and not allowing food to be properly digested, even healthy food. Many times I'll have patients come in and say, I can't eat anything. I eat the healthiest food and I still am very, very inflamed. Why is it that? Well, sometimes stress shuts the guts. Then we don't make the enzymes we need.

Maybe we're not chewing our food the way we needed to. it's not getting broken down, and then when it gets into the gut, it creates in a lot of inflammatory reactions. And then over time, that firefight that goes on in there starts to break down the walls of the got, then it actually pokes holes in it, those holes create an ability for whatever's in the get to get into bloodstream and go to parts of body and cause inflammation. What percentage of your patients that are having some issues have either a leaky gut or some sort of intestinal permeability?

Yeah, that's a great question. I run a stool test probably on a good 50% of people I see. And I would say maybe 25% percent of those, you see clear evidence of leakey gut from the stool tests, 25, 30%. which is probably higher than the general population, but then again I'm seeing people who aren't feeling good. Well, I don't know that it's not much higher because Fasano, who did studies on zonulin, a great GI doctor from Harvard, and his studies revealed about 21 percent, zonulin, occludin, candida, LPS, H.

pylori. So, I think when you start putting them all together, there's a large number of people that will have increased intestinal permeability. And to speak to the idea of SIBO, which they've heard before, my friend Dr. Warren Marks always says to me, Rob, don't forget if you have SIBo, it can cause leaky gut.

Rapid-Fire Clinical Pearls 28:30

I always remind Lauren, Don't Forget Whatever You Do to Your Gut, You do to your brain. Right. Right? Makes perfect sense. I don't do a blood brain barrier test often. How about yourself? You know, every once in a while I'll also run that, but not too often, yeah. Because I assume that once the gut's permeable that the brain is possibly following suit. Exactly. And I know there'll be some labs that want to kill me for this, and so please forgive me. robust on a lot of blood-brain barrier testing.

I'm not sure they call it a blood test. Right. You know, I think I am interested and I've run a few here and there and am trying to look for correlations. The first thing I thing about is when we run the test, is it really going to make a difference in the treatment we get. So that's the first, you know because obviously all of these things cost money and really try to be thoughtful of what my patients are spending on all this. And so if it's not a test we need, or like you said, if I don't feel I have complete confidence in it, then we'll start with other things that make more sense.

Well, we live in a triceratitis, you and I, so I can ask you a question. What do you think about Lyme disease's effect on mental health? Yeah, so Lyme disease, like many infections, can really be a contributing factor. I would say Lyne disease even more so because Lymedisease can affect the nervous system even greater and really lodge in there and cause what's called neurological Lymes. And neurological Lime definitely has a lot of overlaps with things like anxiety and depression. So, certainly something to look for, and if a patient's history suggests that it's possible, like you said, we live in an area endemic, meaning there's a lot of Lyme around us.

So if you have someone who likes the great outdoors, likes to take a hike in the woods on the weekend, or even has a lawn in a suburb, then we have to, you know, look that. Right, without question. That begs the big question, the long COVID question What about long COVID is and its adverse effect on mental health? Yeah, so long COVID definitely can contribute to a lot of symptoms that I would consider very similar to things like fibromyalgia and chronic fatigue. But you see a stronger correlation with patients who have gotten COVID or even sometimes gotten the vaccines.

So it's something to definitely think about. There's a test that It's called neopterin, it's a blood test. And sometimes I look at that and there's, you could look a lymphocyte to neutrophil ratios. It is not a perfect way to diagnose long COVID, but it can help. You know, and it could be part of how I decide whether I think someone really truly has long Covid or not. Either way, whether they have long covid or something else, there is no question that they are suffering, right? Because the symptoms are there and so we are going to work on it and help them feel better.

Let's talk about foods, let's about brain-soothing foods. We have five favorite foods for brain soothing. Once we fix the systems, we got organisms working right. Yeah. Well, anything that supports a good microbiome. So I think yogurts, whether they're regular dairy yoghurts like a Greek yogurt or a or dairy-free yogurt, if people really can't do yogurt. I mean, do dairy, then that's certainly an option. Sometimes I have people do goat yogurt for people who can handle dairy. So I like, you know, in general, fermented foods, I think are excellent, because fermented food have a lot of strains of bacteria that are very important in our gut, but we can get with supplements.

Inflammation, Leaky Gut, and Root Causes 32:20

When you asked the question before about how about a probiotic to treat mental health, one of the things I was thinking about is, gosh, they're good, but there's so many strains that you can't get in a probiotic that really can get through foods. I think fermented foods are very, very important, whether it's sauerkraut, kimchi, natto, miso, kombucha, things like that, and of course, yogurts. I always think about things that have good essential fatty acids. Of course, fish is at the top of the list for people who are not vegan.

I think eating good quality cold water fishes can be very, very supportive. And there's a lot of studies that look at that, that people have higher levels of fish and essential fat acids do better in terms of a lower risk of anxiety or lower risks of having high levels anxiety and depression. So and then nuts and seeds. I think a very important raw nuts. And seeds can be very helpful for mental health. Uh, I. Think that's five. Yeah, you got him. Let's let's finish up with some evidence based supplement strategies.

Mm hmm. Talk about some supplements for anxiety. like magnesium, which one? Theanate? Viscolicinate? What do you like? Yeah, so it really depends on the patient. If I have a patient who's extremely anxious, really hard to settle down, hard-to-settle-down at night, you know, like patients and, I had anxiety when I was in my 20s and I remember feeling like this almost kind of shaking feeling internally. And I like magnesium threonate for that. It's a magnesium that it suggested that crosses the blood-brain barrier a little bit better.

I think it's kind of shut down some of those feelings. If people just want more of a general calming than magnesium glycinate, can be a really great choice. Glycine is something that supports the GABA receptor, which is GA-BA stands for gamma aminobutyric acid, the calming neurotransmitter in the brain. So I think magnesium glycinate is great for that. I think if it's more muscular issues like if there's a lot of muscular tension along with it then using like a magnesium citrate can be very helpful for that.

I Think if people have a lots of constipation then use magnesium oxide. which kind of sits in the gut. It's the cheapest form of magnesium, it doesn't get absorbed as well, but it really pulls water with it and, you know, helps people move their bowels. And if that's part of the issue, why their brain isn't feeling so good, then magnesium oxide might be the best choice for them. How about some supplements for depression? Not in place of medications, but supplements, if you will. Well, there's a few supplements that have been shown head-to-head to work as well as SSRIs in mild to moderate cases of depression.

And all of them have shown to have less side effects. So when you think about it, it may make sense in those particular situations to try those first while working on all the underlying issues. And I'll use them specifically to the person, but in general, what's the most studied herb of all time? It's St. John's wort, hypericum, right? It is a beautiful herb. I think it's underutilized. One of the concerns with St Johns worts is because it affects how the liver processes a lot of medications, that we do have to be careful with it.

If people are taking anticoagulant medications or taking other drugs. You know, I had a patient who came in once and told me of a story where she was on birth control and had taken St Johns worte and got pregnant. with twins, so it can happen. So you've got to be careful with St. John's Wort, but other than the interaction with the medications, it's quite effective and has been shown in meta-analysis of meta analyses, meaning studies of many studies, how well it could work, or at least as well as placebo, which I said, by the way, The regular medications, maybe a little bit better than placebo, and I would say the supplements are the same.

A second one would be saffron. Saffron has some good studies head-to-head with SSRIs. Safron is a brilliant antioxidant. It's fantastic for the gut. Great for inflammation. And it's been shown to be a good modulator of neurotransmitters. In fact, I don't know, 10, 12 years ago, one of the first supplements I formulated was a supplement that had saffron in it. It was the formulation for mood that has saaffron.

Lyme, Long COVID, Foods, and Supplements 37:10

That's something I'm proud of too. So I've been using saeffron for many years now. SAMe, S-adenosyl methionine is also an excellent choice, especially when people have methylation issues. That's when it really does its best work. You need to be careful with SAME because it can induce mania. So if people are kind of on the edge or have more of a bipolar picture, you don't want to use SAM-e. but more of that pure depression, very, low mood, poor methylation. Sammy can be a great choice. And the last one I would pick, which again, head-to-head studies, is turmeric, curcumin, I should say.

Yeah, curcumin, which is the active ingredient in turmeric, also been shown very, very helpful. And we know curicumin has many, many effects on our physiology. Probably the top one is as an anti-inflammatory, Which really speaks to what you were talking about earlier, inflammation being such a top issue in mood cases, Yeah. Which is why I think cur cumin has been showing to be so helpful So I've got some high yield pearls that I took from Dr. Peter Bonjono in this podcast. Let's go through them.

Tell me what you think and rate them on a scale from one to 10. Okay. Treat sleep whenever possible. Oh, 10, ten being the best, right? Yeah, without question. Blood sugar dysregulation masquerades at times as anxiety. Yeah. I would give that like a six. What's up there? Chronic inflammation correlates strongly with treatment resistance. Oh yeah, I'd give that an eight. Overtraining and under recovery worsen psychiatric symptoms. Yeah, seven. And whatever you do, tend to your mental health issues.

Well, yeah I would give it a ten, because we don't have mental heath, it's really... In a way we don't have anything. We have to have our mental health to move forward. You know, we can have the healthiest physical body and be physically able, but if we're not, if don have motivation and the love of life, then It's hard to live and move on. I work with patients who, whether it's a lot of grief or just have a long-standing depression or even anxiety, it is hard. It is harder to move forward in life.

And I want your listeners to know that there is always something that can be done. There is support available. If you haven't found it yet, just keep looking. When you feel that way, it's the most heroic thing to keep moving forward. And you just take it a day at a time and you keep move forward and keep talking to people until you find a relationship with a practitioner that you feels really going to be the one to help move you in the right direction. It's out there. Don't give up. What a beautiful way to end.

Everybody, this has been great. Mental health conversation with Dr. Peter Bongiorno. We'll see you soon.