Improving Health and Removing Toxins Through Naturopathic Medicine with Dr. Heather Sandison ND

Improving Health and Removing Toxins Through Naturopathic Medicine with Dr. Heather Sandison ND

Removing Toxins to Improve Health

Dr. Heather Sandison, who earned a Naturopathic Doctorate from Bastyr University, joins Daniel Schmachtenberger on Collective Insights to discuss medicine and health, particularly when it comes to nutrition and the removal of toxins. Dr. Sandison details how easy it is come into contact with toxins in our modern day environment. While many physicians think a detox may often be necessary, one aspect is usually overlooked — the proper balance of nutrients in the body. Daniel and Dr. Sandison talk about why this balance is so important and how naturopathy can help.

Dr. Sandison is the founder and medical director of North County Natural Medicine. Her healing philosophy blends modern research and diagnostic techniques with time-tested modalities including manual therapies, botanical medicine, hydrotherapy, diet, exercise, and lifestyle coaching. She is guided by a certainty that our bodies are designed to heal. Dr. Sandison’s passion is to guide and support patients as they co-create strong foundations for optimal health through sustainable lifestyle changes and integrative medicine.

Connect with Dr. Heather Sandison:




In This Episode We Discussed:

  • Toxins

  • Reducing toxic burden

  • The impact of nutrients on neurotransmitters

  • Neurochemistry

  • The effects of a zinc-copper imbalance

  • Methylation

  • Improving health and supporting wellbeing

  • NAD IV therapy

  • Nutrient deficiencies

  • The rest, digest, and heal state

  • Reducing gut inflammation

  • The Dr. Bredesen approach to cognitive decline

  • Hormones

Show Notes:

  • 0:00 Intro

  • 4:30 An integrative approach to psychiatry, mind, and brain wellness

  • 10:04 The nature of toxins and how they hurt you

  • 18:43 The best ways to get rid of toxins

  • 30:23 Taking in the whole problem to help people detox

  • 34:43 Pathogens affecting mood and emotion

  • 46:14 Balancing neurochemistry with the right nutrients

  • 1:05:39 The benefits of NAD+ therapy

  • 1:16:51 How gut inflammation affects the rest of the body

  • 1:26:51 Dr. Bredesen’s work on Alzheimer’s and cognitive decline

  • 1:38:00 Helping with hormones

  • 1:45:14 The “big picture” reason for people to get healthy

People Mentioned:

Dr. Dale Bredesen

Dr. Bill Walsh

Julia Ross

Dr. Ritchie Shoemaker

Leroy Hood

Datis Kharrazian

Dave Asprey

Related & Recommended Links:

Walsh Research Institute

Argonne National Lab


Montreal Cognitive Assessment Test

Institute for Systems Biology

North County Natural Medicine

Episode Transcript:

Daniel S.:All right. Welcome everyone to Collective Insights. My name is Daniel Schmachtenberger, I'm with research and development here at the collective and we have Dr. Heather Sandison with us today. Delighted to have Heather here. Heather is a naturopath and the medical director of North County Natural Medicine here in San Diego, Encinitas [00:01:00] area where Neurohackers headquarters are located.

We recorded the podcast with Heather and released it a little while ago and it says part one. It says part one really because the podcast just cut off technically afterwards so we lost this really lovely two-hour conversation into a complex systems model of medicine, how to do complex medicine that Heather and [00:01:30] I have worked on over the course of years together. We'll redo that one at some point. Based on the little portion of that we called part one that was released in the questions that came in, most of the questions were actually related to closer to the actual field of Qualia which was kind of neuropsych and understanding mood and cognition and brain and mind.

We're just going to go ahead and dive into this time rather than talking about the future of medicine we're at large. [00:02:00] We're going to talk about the future of integrated mind, brain wellness, integrative psychiatry, psychopharmacology, et cetera. I want to do our disclaimer upfront, which is this podcast is for education entertainment only. Nothing here should be considered medical advice even though we're talking about medicine. Even though doctors here, you're not hearing anything that is in the context of you being the patient and getting direct [00:02:30] feedback and et cetera, so definitely go talk to a qualified healthcare professional about anything that's going on for you. Also, as we talk about the term future of psychiatry, we're talking about how to affect physiology, brain chemistry and ways it affect mind, emotion, psyche.

Heather is coming to this work as a naturopath not as psychiatrist. She works with a MD psychiatrist in her practice and psychologists and many other specialists. [00:03:00] Her practice is really focused on doing the things that are not currently done in most of psychiatry or psychology, which is looking at deeper underlying biochemical dynamics that can lead to nervous systems functioning sub optimally. That ends up also giving insights about how to make them function more optimally for things like sleep, pain, anxiety, depression, brain fog, all kinds of interesting things.

That's what we are going to dive into today. [00:03:30] It is a delight for me personally to have Heather here on the show because she has indulged me the things that I wanted to do from research with people finding a way to, in the medical clinic actually practice some of the wacky stuff. We've been able to develop things in this space together so Heather, thank you for being with us today.

Heather S.:Daniel, thank you so much for having me. It really is such a treat to get to [00:04:00] talk to you and about medicine in particular. It's always fun so I think that the universe is on our side when we had to record the second time because it means that we just get to dive deeper and have an even bigger conversation about it in how we can help your listeners and anyone out there who's interested in optimizing the function of their brain.

Daniel S.:Okay. Let's talk about if you wanted to just do an initial sense of what does an integrative [00:04:30] approach to psychiatry to mind, brain wellness look like. If we're looking at emotional issues or cognitive issues, how do you see that tier one?

Heather S.:Yeah. When I see a patient, so a great example is the patient I saw recently, who had some cognitive decline. She was struggling with dementia. Cognitive decline, I mean, significant, so she was having trouble even carrying on a conversation. I'd ask her a question like, "Do you have bowel movement every day?" [00:05:00] or "What did you have for dinner last night?" She would start to answer and then even before she could express herself, before she can answer my question, she would forget what the question was.

I don't know if you've ever been in a conversation with someone like that. They start to answer and then they say, "Wait, what was your question?" It was really heart breaking she couldn't remember her husband's name, her friend's names. We said, "Okay, where do we start?" I think her husband was very overwhelmed, the patient was clearly frustrated. [00:05:30] It would be overwhelming for anyone. Where do you start? Is there a magic pill? A lot of people are hoping that there is just one thing they can do to get better.

Really, I don't think that that's not an option right now. What we have is the model that you and I have discussed over the years and that Dr. Bredesen in this case has presented the end of Alzheimer's. How do we look at all of the factors that could potentially contribute to a patient's cognitive decline and then systematically go through them?

I typically start [00:06:00] with toxins and the reason I start with looking at toxins is through … well, there's number of reasons but one is because they are tier one, they are causal. Number two, is they're mostly ignored by the conventional medical community. There's a lot of people who have come in who have never had their toxic burden addressed. This patient, in particular, she did not have bowel movements every day. She had bowel movements about once a week and that's a really foundational place to start because she wasn't eliminating toxins. Even the normal day-to-day toxins that every cell produces, [00:06:30] the hormones that we need to get rid of, but any sort of metabolic waste we need to get rid of, that was piling up and up in her.

In addition, she had a mouth full of amalgam. We know that there was some heavy metal exposure over the years. She was 74 years old, so she had accumulated … she had decades to accumulate things. Then, on top of that, she lived in a moldy home.

Those were very clear places to start for me. For another person, they might be experiencing [00:07:00] cognitive decline or anxiety or depression or insomnia and maybe they've had a recent hysterectomy so they no longer have ovaries that are producing the hormones that we need to maintain balance there. Thorough intake, and that's why I ask my patients to give me a full 90 minutes for intake and fill out the paper work in advance is because there is so much complexity to this.

There's also a lot of simplicity and that paradox of both, right, if I can get enough information and sometimes it is very straightforward and so we have [00:07:30] to get that information first and determining the first step in terms of testing or even some therapeutic intervention really depends on the story. On what the exposures have been and maybe what healthy things have been taken away like in the case of someone with hysterectomy, healthy hormone levels.

Daniel S.:Okay. When we think about what things affect someone's emotion or affect their thinking, we say okay, "Well, emotions [00:08:00] and thinking are mediated in the nervous system via certain neural networks and certain neural chemistry," so we start thinking about brains and nervous systems and we realize the brains and nervous systems live inside of a body which lives inside of an environment.

Then, whether there's mold in the environment, whether there's environmental toxins in the environment, what's going on in the physiology anywhere from a genetic level to hormones to deficiencies of nutrients to toxicity to movement patterns to chronic pain that could lead to inflammation …

Heather S.:Infection.

Daniel S.:… all of [00:08:30] this might be part of the picture. Since you mentioned toxins as one of the early things to look at, there are going to be some people who are comfortable with that topic, some who hasn't heard of it and some who are quite skeptical because the word toxins in the kind of science based, the thing that calls itself science-based medicine or evidence-based medicine oftentimes [00:09:00] thinks about toxins and particularly the way that certain people in the alternative health that are not necessarily doing the most science packed version of alternative health to talk about which is we need to do a cleanse to get rid of toxins that basically is a voodoo term.

Let's talk about when we say toxins, what do we mean? How do we know that it's actually happening? What is the difference between toxins as you're talking about them and the kind of acute exposure [00:09:30] that a toxicologist might look at?

Heather S.:Yeah. The way we think about toxins is they come in three flavors. We have heavy metal toxins. We have bio-toxins, which most of the time we're talking about mold toxins or mycotoxins but there are others that are out there. Then third, we have our chemical toxins. Things like petrochemical, styrenes, benzenes, plastics, other environmental toxins that you might think that might be in the water [00:10:00] or might be in makeup, might be in other chemicals that we're using.

When I break those down, you can certainly have some dose dependent toxins where if you get a heavy high amount that can easily lead to death. If you had heavy metal poisoning that lead to death then that's possible. That's why we worry about lead paint, that's why we took the lead out of fuels, that's why they've gone away from mercury and the amalgams in thermometers. [00:10:30] We know that mercury exposure can kill you.

When you have a very high amount, death is possible. When you have low amounts, it is also possible that there is degradation of the system so the toxins are influencing that system. Typically, they are fat soluble and so you'll have multi-systemic symptoms come up that are probably vague at first. If the toxin continues to come into the system then it can build up and up and up especially if genetically, you mentioned genetics a little bit ago, especially if genetically, [00:11:00] you don't get rid of them as well as your neighbor or your friend or even a family member. Those toxins that they build up can start to accumulate and can create more and more detrimental symptoms.

People who experience effects in their immune system, they might get sick more frequently, they might have autoimmune condition showing up, even things like cancers can show up, it's a high toxic burden. The immune system can be affected, the brain and the nervous system, so [00:11:30] numbness and tingling, twitching, and muscle spasms, all of these sorts of things can come up and certainly, cognitive decline. Just because of the fact that most heavy metals are going to be fat soluble and bind to fat soluble tissues. Also our glands, our glands are very fat soluble so things like thyroid and other hormones can be affected when metal bind there.

When we switch to talking about biotoxins, a lot of people are [00:12:00] familiar with botox. Botox, it paralyzes your muscle that's why we use it to prevent wrinkles in the forehead. We can inject botulinum toxin. Biotoxins are the toxins produced by a living organism. We can measure these. We can also measure heavy metals. We can measure these toxins and how much we are releasing, typically, we're measuring mycotoxins because water damaged buildings will have molds present and that molds will then produce a toxic [00:12:30] substance that we can inhale, that we can be expose to and then that can accumulate just like a heavy metal.

People get a little confused, it's not the mold that's causing the problem, all the time, although that can and that's sort of a separate issue. It's the mycotoxin, the toxin produced by the mold that can be this fat soluble toxin accumulating in your body and wreaking havoc causing fatigue and headaches and nervous system problems, hormonal problems, all of these things. That's also the other thing that makes it confusing is that patients [00:13:00] have so many symptoms. They go to neurology, they go to dermatology, they go to endocrinology, they go to all the specialists because of their symptoms and it's hard to get somebody to put all the pieces back together and say, "Oh, there might be one root cause and that could be a mycotoxin exposure."

We can measure that in urine and that's relatively inexpensive to do these days. For a long time, it was at seven, $800 to do and now it's about two, $300. That makes it a little bit more accessible for people to find out. Then the third one, [00:13:30] the third flavor as I like to think of them, of toxin, is the benzenes and styrenes that I was referring to. Again, we can test those in the urine. You can get a measurable amount and there are some degrees of normal in there particularly, for environmental region. In Southern California, you tend to see more of these toxins showing up that are associated with petrochemicals, with fuels, I think, because most of us live in close proximity to i5.

If you talk to Great Plains or any of the labs that run these tests, they'll say, "Oh yeah, environmentally [00:14:00] we'll see things that are elevated around military bases like perchlorate and often ends up in the water there. In California, the State of California actually, the herbicides and pesticides were quite high during the drought that we experienced for a number of years. Then when the drought went away, across the board you saw that level of herbicides and pesticides go down and everyone tested in California may thought that that was because of the drought, there was a higher concentration in the water table and so you were seeing that in the entire [00:14:30] population of California, which is pretty unreal that we all needed a little extra glutathione during those years.

Daniel S.:Extra glutathione to deal with extra glyphosate.

Heather S.:Yeah, exactly.

Daniel S.:Two kind of important topics I'll just reiterate in there. There's a difference between acute clinical toxicity, someone is actually doing agricultural work and they spray the glyphosate in their face and they actually [00:15:00] have to go do active medical detox work because whether they're going to die or they're just in acute symptomology there and very clear acute symptomology. That could be to any of the kinds of toxin tried, this usually happens in industrial setting or something like Flint, Michigan or somewhere the toxicity load is very high, very fast.

There's exposure, two things, that are actually damaging to biology so we call them toxins, that are not at a high enough level to create really obvious [00:15:30] acute symptomology but they're still having an effect on the physiology and that effect can cascade over time and can also accumulate over time.

Heather S.:Precisely.

Daniel S.:We're looking at subclinical, subacute but clinically relevant toxicity. That's across all these categories. That's one kind of important thing. The other one is that this is not an issue that has been the same forever. This is a modern, a recently modern issue because when you're talking about organic toxins, [00:16:00] meaning hydrocarbon-based toxins, whether we're talking about benzenes and styrenes or PCBs or fallates that didn't exist pre-industrial revolution. In fact, every year we're inventing so many more of those kinds of chemicals.

Heather S.:As we produce the pharmaceuticals these toxins develop … well, the bacteria, the anti-fungal that we put in the paints that causes all of these microorganisms to mutate in a way that they create even stronger toxins, basically, [00:16:30] as they become more resistant to the pharmaceuticals or the antifungals are in paints or whatever we're doing to mitigate these issues. Those organisms respond, they fight back and it's hard to keep up because they are replicating so quickly and they're genetically adapting so quickly. As humans, we have much longer lifespans, we can keep that quite as quickly. We have to be good about making sure our emunctories, our organs of [00:17:00] elimination are open and able to deal with that as best as they possibly can.

Daniel S.:If you didn't catch the reference something I said that was super important is the idea that toxins from herbicides, pesticides, pharmaceuticals, industrial manufacturing affluence are new. We can all get that, that makes sense. Molds, it's like, whoa, it seems like we have been dealing with mold for longer than humans have been around by a lot. It's one of the oldest types of organisms, why would we have not evolved [00:17:30] in some kind of harmony with it. The primary hypothesis in the space is that most molds, not all of them, but most molds in our evolutionary environment were not that problematic to us. Then they started getting problematic, we started seeing rise in biotoxin issues not that long ago.

In the '70s in the west in particular, US we started putting fungicides in paints to keep fungus, to keep molds from growing inside but it didn't mean that mold wasn't going to grow. It just meant the mold had to mutate [00:18:00] just like MRSA has mutated to be able to still live in the presence of antibiotics but that mutated form now is something that we have no evolutionary history with and its byproducts are something that we didn't co-evolve with.

Heather S.:Exactly. The buildings also are more likely to harbor molds these days. We use a lot of dry wall and one little pipe gets missed in the plumbing. Or a lot of times, people will have sprinklers next to their house and then now it's getting wet everyday on the edge of the house [00:18:30] and eventually, that turns into mold on the inside or mycotoxins that are developing inside the wall that can actually end up in the area that you're living in. They're in filters, HVAC systems, we've created homes where their environments for these organisms to thrive.

Daniel S.:Training of more energy efficient, making homes very sealed obviously, increases these dynamics and …

Heather S.:Yeah, one of the best things you can do [00:19:00] to reduce toxic burden is to open up the windows and doors and get that fresh air flowing from inside out. One of the most toxic places you can be is inside a building, so get outside, open the doors.

Daniel S.:If you open the doors, you normally think, "Well, aren't I looking at air pollution from cars and from co-factories and the air outside worse?" We wish that was the case. If you live right next to a freeway, it might be the case. The paint inside even independent of the fungicide [00:19:30] just has these things called, VOC, volatile organic compounds so does the carpet, so does your couch.

Heather S.:Furniture, yeah.

Daniel S.:… on your bed. When it comes to living in the present environmental toxin, how does one start to assess that and mitigate it?

Heather S.:Yeah, great question. I'm a doctor that talks a lot about bowel movements because I think they are so, so, so important. [00:20:00] I mentioned the emunctories and that's my fancy word for organs of eliminations, those are your bowels, liver, kidneys, lungs and skin and lymphs. Opening up each of those pathways for elimination is so, so, so important. We can get really profound results with complex cases, complex medical cases can get better like the woman, Linda, I was telling you about at the beginning of the recording.

She was so much better in just four weeks all because she started having regular bowel movements [00:20:30] because she got a little bit more exercise. She was sweating every day. All of these things can really facilitate getting those that's sent out of the system. The way I think about it, it's kind of like, we got the tap on and the sink clogged. The number one thing, 75% of all environmental medicine is turning the tap off, figuring out what the exposure is. That's why the tests come in so handy.

If we think that there's a toxic exposure based on the conversation we have, based on your exposures [00:21:00] then we'll test and we'll look, figure it out. There have been times when I can't figure out what's going on and we have to do a lot of testing and pinpoint something. Then, the testing points us to the exposure versus the exposure pointing us to the testing. Sometimes we have to go back and forth with that a little bit. It can be a little mystery to solve.

We need to figure out what that exposure is and turn the faucet off, stop the exposure. If the faucet is on and the sink is clogged, it's overflowing into symptoms. That's just bound to happen [00:21:30] at some point. Then, after we have the faucet off and even sometimes more, we need to unclog that drain. Bowel movements every day.

Liver support. Phase one, phase two liver support, glutathione and sometimes the other antioxidants are fantastic, we can also measure those, we can measure nutrients and this is how nutrients come into the conversation around toxins and toxic burden. If you don't have enough nutrients then … the liver is so amazing. The whole body is incredible but the liver is so cool because it will actually [00:22:00] slow down the detox processes if you don't have the nutrients to keep up. Because some of those secondary metabolites, alcohol is a great one to illustrate this example.

When you drink alcohol, it goes to your liver and it's turned into acetaldehyde. Acetaldehyde is actually more toxic to you than alcohol is. Lots and lots and lots of toxins are that way, where the secondary metabolite, the second thing that the liver makes with the toxin you ingest is actually more toxic. [00:22:30] In all of its inherit wisdom, which I think is so cool, the liver actually slows those things down. That means that you're going to have more circulating toxin. What we have to do is make sure those nutrients are there for the liver so none of that happen, so we can avoid that problem. Bowels open pooping every day, liver supported by nutrients.

We've talked a lot about saunas and sweating, rebounders, anything that we can do. Exercise, of course, it's [00:23:00] such a great way to get circulation going. There's countless ways to get us sweat, just put some sweats on and try to get up and get that sweat going then cleansing with cool water to get the toxins off, to close those pores just so you aren't reabsorbing it. Breath work is certainly helpful, again, alcohol is a great example here. We use breath analyzers to measure that toxin in your system and that's true for lots of toxins. CO2 is even a toxin [00:23:30] in large amounts in the body. Taking mindful breaths, having a breath practice can be really, really, really helpful in terms of getting the toxic broken down.

Then water, drinking enough water is good for both kidneys. Making sure that you're getting lots of filtered high quality water from a non-contaminated source. Also, making sure it's not in plastic that it's in glass, ceramic or stainless so that you're not absorbing more chemicals from the plastic. [00:24:00] A few things to think about there.

Daniel S.:Okay. Looking at the topic of how do we decrease exposure and how do we decrease exposure in our environment, obviously, we just beg the question of water filters and air filters. I'll come back because I want to do more of a holistic picture on neuropsych first then we'll drill in deeper to the parts of it. Just because you mentioned one part a number of times and I don't know that it's obvious for everybody. When you said bowel movements [00:24:30] and why it's important to have bowel movements. I think anyone who hasn't had bowel movements for a period of time has a first person sense that that's not that pleasant.

In terms of the relationship of the liver to the bowels and to the bowel movements and what's happening, why is it important for toxin elimination in particular with bowel movements occurring?

Heather S.:I love this because I get to use a really big fancy word. Enterohepatic recirculation. What that means [00:25:00] is that the liver does all this amazing processing of all your toxins and then spits it out into the gallbladder, if you have one, or the bowels as a toxic sludge called bile. Bile goes into your gut and if it sits there for a long time, so if you're constipated, if you're not having a regular bowel movement, then the body, again, in all of its wisdom, it will reabsorb that because there's valuable stuff in there, stuff like cholesterol.

Over an evolutionary period, we don't always get [00:25:30] enough fat and so the body needed to conserve that fat and it had a reason for wanting to be able to reabsorb bile, because bile does contain cholesterol. That cholesterol is the building blocks for lots of sex hormones and stress hormones and things that we need to heal and be healthy. If you're constipated and you absorb too much of that, one you'll have high cholesterol, but there's toxins in there. That's that toxic sludge and the liver has already done all these hard work to get these toxins out and ready for elimination, which is actually having the bowel movements. [00:26:00] If it's just sitting there, if you're not having that bowel movements, then it will come back into the blood steam.

It's going to go back to your liver, one, you're asking your liver to do yesterday's work, take our yesterday's trash. Two, it's recirculating, so now we have this opportunity presented where those toxins that your liver was so smart to get rid of, they're now going back in the blood stream where they can go up to your brain, they can go to your big toe, they can go to your heart, they can go to your … you're exposing your organs. They can get stored in your bones now instead of where we want them, which is outside of your body.

Daniel S.:[00:26:30] Good. When we come back to how do we support the body detoxing and saunas and like that, we might go deeper. That is at least an initial source of thinking about exposure to toxicity and this can now be [inaudible 00:26:48] things that the body is supposed to be exposed to just being exposed to too much, which we didn't talk about like sugar.

Heather S.:Yeah.

Daniel S.:Or like any food that we're eating too much of. It can even be our own metabolic [00:27:00] waste products if the body can't clear them because it's already dealing with too much load or it can be these exogenous sources that we're talking about. One of the things that's kind of interesting is that when we look at the toxins that we commonly find in blood or in urine or in breast milk, most, all of them either are endocrine disruptors or carcinogens or neurotoxins. When we think about the effect on health, obviously, we're going to see [00:27:30] effects on all kinds of systems.

When we think about the effects on the nervous system in particular, right, in the neuroendocrine system, we see this widely. When people are coming to you and you run … most people who are coming to you don't work in industrial factories. They have normal kinds of exposures. What percentage of people are you finding meaningfully elevated toxins of some kinds?

Heather S.:Unfortunately almost [00:28:00] all. Yeah, unfortunately almost all people that I see have some degree of elevated toxin if we're measuring. To be fair, we're measuring because we think that it might be there, but nearly all of my patients have some degree of elevated toxins whether it's mycotoxins, the heavy metals or the chemical toxins.

Detox is a great place to start with most people. [00:28:30] That's why, is because toxins are so ubiquitous in the environment. Not to scare people, I think that this is manageable and if we are doing a good job eating the right foods and making sure that we're not getting toxic foods, opening the windows, having daily bowel movements, getting plenty of sleep because that's a time when our body is upregulating a lot of these detox processes. Then, people can live healthy happy lives, don't get me right.

They are ubiquitous and they are in the system. Toxins are causal, [00:29:00] certainly, but they're not all mutually exclusive. We can also have self-infections and sometimes the first step is that the toxic exposure maybe as a child or through a hobby or whatever it is, styrene, amalgam, through poor detox genetics. Something has predisposed us to this toxic burden that now had affected our immune system. Now it's affecting our neuroendocrine system. That makes us predisposed now to an infection.

Then this infection, these self-infections, particularly [00:29:30] are things in the line category. It's like herpes viruses, there's a whole host of them. Those can start to produce their own toxins. We have this self-perpetuating problem that it's going to lead to more and more symptoms down the road. Is that what you're referring to?

Daniel S.:Yeah. The first part of the question is just, how ubiquitous is it and …

Heather S.:Very.

Daniel S.:… [00:30:00] the insurance of being ubiquitous and even when we're looking at say what someone's level of fire retardant in their blood is. We say, it's not that bad, it's in the 50th percentile, what that means is it's average across everyone that is in orders of magnitude more than anyone in our evolutionary time period had exposure to. There is actually a whole normativity problem in the fact that the average is actually already …

Heather S.:Right. Like what [00:30:30] I was explaining with in California during the drought, everybody had this ridiculously high herbicide and pesticide and glycogen levels, right? For some people, they still were able to maintain healthy lifestyles. For other people, that was probably debilitating and they had no idea why.

Daniel S.:If we don't get into addressing any of the other parts, let me just look at effects of appropriate detox. The first thing is, if someone has elevated mercury versus elevated led versus elevated [00:31:00] styrene or mycotoxin. We don't get rid of them optimally in the same way. There are some overlaps. Everybody needs bowel movements and sweating and et cetera.

If we just identify toxic exposure, we work to shut off the sink so that we're stopping the exposure source and then we work to detox. If we didn't address their genetics or their deficiency or infection or hormones or anything else, how much improvement do you see with just that [00:31:30] component?

Heather S.:Yeah. Two things here, one, I don't see that always being enough. Usually, by the time people make it to my office, they've been through a cleanse, they've done a lot of this. There's something else that's still not quite clicking and so we have to be a little bit more aggressive or let's dig a little bit deeper. The other piece of it, I never do one thing at a time. It's important to me that every patient comes back and say, "Hey, Dr. Sandison, I feel [00:32:00] way better." I have this constant like my entire day, I want to give people everything that I can possible can so that they can feel better yesterday. I also don't want to overwhelm them either financially or just like when you're not feeling well and you have brain fog and like you're juggling being a mom and working and all of these other things and not getting enough sleep, then a thought of adding 18 things to your daily schedule. It's just too much.

I have to figure out this balance [00:32:30] for every individual that comes into my office and say, "How much can you take on to do?" It's never just one thing. We're always going to help support whatever the pathway is that appears to be dysregulated. If someone has sleep issues, then I'm certainly going to try to help a ton with the sleep. That's also so foundational, so bowel movements and sleep are so foundational. If you don't have your sleep regulated and you're not getting enough rest then nothing is going to get better.

I would go after that pretty aggressively [00:33:00] and start a detox program. Detox program always includes all of the emunctories and potentially something that's very specific especially if I have a good lab back. Those that's lead, the approach is going to be different. It's going to be more EDTA. Versus if it's mercury, we're going to use more DMPS which are chelating agents. These tests are so helpful because I can be that much more specific. There are some things that are applied to almost everyone in terms of turning up detox processes and then [00:33:30] there are other things that are really specific if we can identify what the toxin is.

Daniel S.:Obviously, all of this is deeply outside of the realm of what we would consider in psychiatry. Unfortunately, in psychiatry, we're normally not looking at testing at all. We're doing some, usually sadly minimal symptomatic assessment, some DSM diagnosis and administrate the drug. Before giving someone a dopaminergic or an SSRI, there isn't even a test that is [00:34:00] looking at something like serotonin levels let alone what other things might be going on. This is all …

Heather S.:I have to hand it to some of the psychiatrists that started running the genetic testing and they pick a med based on how you metabolize things based on a few SNPs. I have to say, they're trying. They're making an effort.

Daniel S.:That's already speaking to the cutting edge … to the forward part of the bell curve.

Heather S.:Right, yes.

Daniel S.:Yet, things that would be underlyingly causing some of [00:34:30] the neuropsych dynamic which is why the person's issue has gotten over time or whatever.

Heather S.:Mercury can cause psychosis. It's probably in the DSM somewhere.

Daniel S.:Mad hatter's disease is the acute version of that, right? Just like mad hatter's disease as an acute version, the subclinical version of it is the slow progression into some more dynamics.

Okay. You mentioned toxicity and then you've also mentioned, but let's get into [00:35:00] pathogens and deficiency. When we're looking at the underlying causes of why our nervous system could get dysregulated. Again, we're talking here about someone's mood and emotion. Their psychological state and their cognitive state, right, neurocognitive psychiatric type things. We're looking at the physiology, we're not looking at the psychology, which we'll get to in a little bit, it's how do we know when someone's depressed if it really is primarily trauma and [inaudible 00:35:29] psychologic level. How [00:35:30] do we know if it's physiologic, some of those feedback loops.

As we just say, looking at the way that physiology is affecting psychology and we're still looking at the actual high level causes. Of course, it might cascade into an issue with serotonin or an issue with dopamine or an issue with neuron summation that affects all the receptor sites for serotonin and dopamine. The question would be, okay, what is the underlying source of the neuroinflammation that is doing that? Or what's affecting the conversion factors? We mentioned [00:36:00] that toxins, which basically means too much of something for what the genetics evolved to be able to process well, where now, they have to go into pathophysiology. Some altered function to deal with the presence of that thing. Altered function might have a psychiatric as well as other types of symptomology.

Talk about in terms of other tier one kind of causes, pathogens, you mentioned a little bit about, again, we're not talking about acute infection, [00:36:30] right?

Heather S.:The chronic self, yeah, infection. Certainly, you're going to cause fatigue. I think another piece there is they can cause pain and inflammation. If you're fatigued, if you're in pain, if you're inflamed, you don't feel good. Nobody feels like getting out of bed with that. You feel irritable, cranky, it's hard to sleep. Again, you get in a self-perpetuating roller coaster of horrible symptoms. I feel for my patients that come in [00:37:00] with this laundry list of neurological-psychological issues. They can't work, it's hard to be in relationships, it's hard to get along with anybody, it's hard to get anything done and have that feeling of self-worth if you really just don't feel good every day.

Or if you can't predict the days you're going to feel good and the days that you're not, it's hard to hold the job down. The self-infections, that's a whole long conversation about what can come up there. Nutrients, I get a little more doused about because I [00:37:30] think there's so much low hanging fruit there. I think that that's why I'm drawn more towards the nutrients is because it's not that expensive, so it's really accessible to a lot more people that I think realize. Then, it works really quickly. Within about two, three weeks people have a noticeable change, a noticeable shift.

Daniel S.:All right, hang on. We'll get there.

Heather S.:Okay, all right. All right.

Daniel S.:You have to at least do a broad overview so people at least have some [00:38:00] sense. People have a sense that there is this thing called the gut-brain axis that's becoming popular. There's a few different dynamics going on but the microbes are part of it, that the microbiome is a part of it, that microbiome is involved … that there is good bugs. They're involved in the production of neurotransmitters and not just production of neurotransmitters but things like the processing of nutrients that help brains work.

[00:38:30] Then, the idea that there are subclinical infections, that's just not really a common idea, like a kind of environmental toxin wasn't really a common idea.

Heather S.:Right, yeah.

Daniel S.:Whether we're talking about dental or nasal or GI pathogens or blood-borne pathogens, let's just touch …

Heather S.:Okay, great.

Daniel S.:Is that actually a thing? How do we know it's a thing? Again, this is something that's always been or is a little bit more common [00:39:00] currently. Just a little bit.

Heather S.:Ubiquitous use of antibiotics and we were talking about their being antifungals. There's antifungals on foods, on your clothes, on your couch. Microbial agents are everywhere. Again, just like we're talking about in the environment, in our environment, in our body, there are MARCoNS and MRSA which are very drug resistant pathogens. [00:39:30] There's two things here going on. One is colonization, so it's not an active infection. It's not actually in your system causing an infection. Colonization of some of these organisms can also lead to inflammation. That's when they live on the mucosal surfaces and there's some degree of normal colonization maybe, but there can also be imbalances in that.

There's too much of a good thing or a totally absent good thing or too much of a bad thing. It's a very complex milieu [00:40:00] of good and bad bugs in the mucosal system. We talk about gut mucosa a lot. I think one thing people forget is the sinuses are another mucosal system that's connected to the gut and also the Eustachian tubes. Women certainly have vaginal ecosystem is another place where things can be off often frequently and that can create feedback loops to the brain. Then, the skin is another place. [00:40:30] All of these places we are thinking about microbes, fungal …

Daniel S.:I was just pointing to dental.

Heather S.:Dental, thank you. Yes. I thought you couldn't hear me, my mic. No, dental. Absolutely. I was at the dentist this morning and she was like, "You know, we need to look at this." The water pick, that's what I went home with, with some hydrogen peroxide in it. I have a bunch [00:41:00] of tips. The kimchi juice, it's one of my favorite things. It's so cheap, it's so easy. I heard about it from a friend of mine who's an acupuncturist and it hits so many of my patients who have had sinus infections, long term chronic sinus infections. You just take a q-tip, put it in some kimchi and then stick it into your nose. There is a particular pathogen, don't ask me to try say that name but there's … not a pathogen, there's a particular probiotic that can colonize the sinuses that can reduce inflammation and stop those chronic sinus infections [00:41:30] really in a profound way for about five bucks from the health food store. That's a fun one.

Do you have other directions you want to go with pathogens? We could go stool testing, MARCoNS testing, the testing is a bit long. We can do placebo testing, breath testing, pyloric …

Daniel S.:Again, just to have a sense since part of the … when we think about infection in a modern medical allopathic sense, we think of acute infection. Or if we think of a long term infection, it's something like [00:42:00] hepatitis C or HIV or something that we know we have.

Heather S.:Hep C, a lot of people don't know they have it actually. That can be a chronic long term infection, yeah.

Daniel S.:In the same way, the hep C over the course of a long period of time can affect people's health radically. There's a lot of things that are in the category of subclinical, we don't usually test for them … have an effect. I want to ask the question similar to toxins, when people are coming in with psychiatric [00:42:30] presentation or other chronic complex health dynamics and you go ahead and start testing for pathogens, whether we're talking about bacteria, parasite, viruses, et cetera. Gut, dental, blood, how often do you see some kinds of elevated pathogens meaning active, living infection in our system?

Heather S.:Every time we look. Again, it's like the toxins. If we're looking, we're looking because we think it's probably there. If [00:43:00] people are sick, there's usually some degree of imbalance in the flora. Whether it's in the gut, in the stool or in blood, in some pocket there is an imbalance. I don't know if that's always causal. We've already said this a few times during this conversation but I really do think that the toxins at this stage typically, not always, it's either genetics, nutrients, toxins, something else typically sets the stage so that that infection then can [00:43:30] take hold. A lot of these things that we're looking at are things like CMV, CVV, EBV, CMV, Epstein-Barr, cytomegalovirus, the ones that cause mono, herpes viruses, even lyme, the borrelias, these are pretty ubiquitous in the environment. Most people have been exposed to these at some level.

There's a newspaper from late 2017, I think, in the last 18 months and it was talking about how borrelia is in [00:44:00] not just ticks but it's in fleas and mosquitoes and pretty much all of these vectors have some degree of borrelia that they can transfer to us. Why is it? This is similar to the molds, that one person is affected symptomatically and then another person isn't? I think there's a couple things that play into that. Again, these are tier one causal level parameters. It's the toxic burden. It's the genetic predisposition and it's the nutrients, either too much or too little. Too much sugar is going to create a wonderful [00:44:30] environment for yeast to grow in. Too little protein is going to create a totally different environment something else is going to grow in.

Whether or not methylate, going back to genetics is going to create another environment that might predispose you to some other pathogens. Those pathogens are there and we want to treat them. We want to be aware of them. We want to understand the immune system. I don't feel like they're always the cause. I think that there are some other element that makes people more susceptible. [00:45:00] That's why one person can get it by a Lyme-infected tick and be debilitated and then another person could get bit by the same tick or another one that's infected and not really manifest the symptoms. That's why I like playing in the arena of the nutrient and genetics and toxins.

Daniel S.:Yet, when we're doing these complex cases, actually, noticing the infections and working with them ends up being something that almost always is part of the picture.

Heather S.:Yes, that's true especially [00:45:30] gut. Especially gut infections, I say that and then all of last summer, all I did was treat parasites. That's actually been really, really fun because I love seeing people get better and so many people got better and these were people that have been to specialist after specialist after specialist and weren't getting anywhere. Then, we treated them for parasites and they made leaps and bounds in improvement. That's very satisfying, I love that.

Daniel S.:All right. [00:46:00] Now you may go into nutrients.

Heather S.:Okay. Thank you. Bill Walsh, love him and the neurocognitive psycho-emotional piece, testing the Walsh Protocol is usually where I start. The reason I start there is because it's so profoundly effective. It's been the most profound thing that I have introduced into my practice since starting. We're looking at just five parameters, it's relatively inexpensive testing. We're looking at whole blood histamine [00:46:30] and homocysteine to measure methylation status. We're looking at zinc and copper and not just for those numbers, those finite numbers but for the ratio between them, making sure those copper and zinc ratios are squared away. Then looking at urine kryptopyrroles.

We talked about nutrients and how that might affect levels of neurotransmitters. Zinc and vitamin B6 are the two cofactors that are necessary for converting glutamate to GABA. This is a super simple way to illustrate [00:47:00] how much of a role nutrients have on our mood. Glutamate is very important. It's one of our most abundant neurotransmitters. I think it is the most abundant neurotransmitter. It comes from glutamine, one of the most abundant amino acids in our system. Glutamate is helpful. It helps us to pay attention, it helps us to focus, it helps us with a lot of things but it also causes anxiety and particularly when there is too much of it. Glutamate, very simply and easily with enough [00:47:30] B6 and zinc turns into GABA.

GABA is that feeling that you have after a glass of wine. A feeling that I have after a glass of wine where nothing is as big of a deal anymore, you can just sit back, relax. It's that Friday afternoon feeling. That's GABA. That helps you to get to sleep. If you don't have enough of it, if you cannot convert that glutamate to GABA, you won't get there. Everything will feel like a bigger deal and it will be difficult to sleep. Measuring zinc and B6 is [00:48:00] very important directly but urine kryptopyrroles are also a reflection of this.

Urine kryptopyrroles have nothing to do with neurotransmitters except that they are part of the breakdown of hemoglobin and it requires, that metabolism of kryptopyrroles, requires zinc and B6 just like the neurotransmitter processes. What we can do is assume that if you have a high number of urine kryptopyrroles then you're not making that conversation because you don't have the cofactors to do it. [00:48:30] We can assume that that's probably also happening in the brain and with the balance of neurochemistry there. We add the zinc and B6, surprise, surprise. The profound results are really, really satisfying for me to see in practice.

It's so fun when I have a mom come in and tell me, "Thank you. I'm so much nicer to my children. I'm so much nicer to my husband." It's really, really wonderful. It's just so nice to see people who can get back to work and get back to doing the things that they love and [00:49:00] connecting with the people they love because their neurochemistry is balanced. It doesn't have to be a benzo, it doesn't have to be an SSRI. It doesn't have to be something that has side effects that make you feel fat or make you feel numb to the world.

You can just feel more like you're self. I had a child come in not that long ago and he said to me, he said, "Now I feel like I [00:49:30] control my brain instead of my brain controlling me." That was really so sweet to hear. That's why I like to talk about the nutrients.

Daniel S.:You're talking about the ratio of zinc to copper and you talked a little bit about some things that zinc does. Zinc is involved in conversion of glutamate to GABA. It's also involved in the conversion of amino acids into neurotransmitters across several other ones, tyrosine into dopamine, 5-HTP into serotonin. [00:50:00] The ratio of zinc to copper is important. There are some people that are deficient or excessive ratio wise in either direction and need treatment differently. Can you speak to that a little bit?

Heather S.:Yeah. This is more common in women. More often than not it's a female who comes in. Typically, there's a hormonal component so women who are very sensitive to hormones, the picture is post-partum depression, onset [00:50:30] with either puberty or menopause, pregnancy or cyclic every time a woman gets her period or ovulates she has extreme anxiety or depression. One of the things you can look for is white spots on your finger nails. That's one of the indications that there might be a zinc copper imbalance.

That is so simple and easy to treat. Women and men too experience this, I don't want to exclude them but they don't have to live like that. What we do is we [00:51:00] measure. The zinc should be slightly higher than the copper and we use a specific lab, we need to know what you're looking for there. What happens is that naturally, in the environment, like oysters are a great example. They have lots of minerals. They have both copper and zinc and so do greens. They come into our system in about a one to one ratio, which is exactly where we want them. We want slightly more zinc than copper but they're at about one to one. [00:51:30] What I'll see is that women will have copper that's double and triple the zinc. It's a genetic predisposition.

That's another thing that I ask all of my patients is was there any mental health in your family? How about substance abuse? Because a lot of times, there's a lot of alcoholism. People are self-medicating. If there's a lot of substance abuse, people are trying to feel better. They're trying to find something to get rid of that discomfort. It's not anyone's fault. It's not [00:52:00] that you were eating the wrong foods. These foods come into our system and that's one to one ratio. Then genetically, we sometimes sequester the copper. That can often throw off these ratios. It means that when you are eliminating, which hopefully you're doing every day, you are getting rid of the zinc but not the copper. You're hanging on to the copper. Every oyster you eat, you hang on to 1.5 of the copper and get rid of a bunch of the zinc. Now our ratios [00:52:30] are off.

That's what we're looking at. People ask, "Do I have to be on this forever?" The short answer is yes, pretty much. We want to keep testing but it's a genetic thing. It's a genetic predisposition to sequester the copper typically and to release more of the zinc, to eliminate more of the zinc. We have to correct that with supplementation. It's very inexpensive. A bottle of zinc can be 10, 12 bucks for 30 days.

Daniel S.:For those who are [00:53:00] interested in the specific part of nutrients which Heather mentioned, the Walsh Institute, the work of Bill Walsh which is moving forward the body of work of Dr. Pfeiffer from Harvard and many people. Dr. Walsh has a number of YouTube videos where he describes overmethylation and undermethylation and kryptopyrrolia and different dynamics. Really fascinating where you can learn more about it if it seems something you'd like to pursue testing further.

Heather S.:[00:53:30] Yeah. He's great. Just to let your listeners know, Dr. Walsh has been doing this since the '70s. He's got 35, 40,000 patients in his database. This is not some esoteric maybe this works nutrient kind of peripheral medicine thing. No, this is the largest mental health database on the planet. It's a nobleship, lots and lots and lots of literature, lots of research. Dr. Walsh has worked with people on all ends of the spectrum both optimizing [00:54:00] function and then in creativity, neuroplasticity, then also on the opposite end with horrible psychosis, schizophrenia, bipolar disorder. I see patients that suffer with that as well. We can get some really profound results and this has a ton of experience and wisdom behind it. We didn't just make this up last year. Do you mind if I talk about the methylation piece because I think that's an important one.

Daniel S.:Sure.

Heather S.:A lot of questions come [00:54:30] up about that because, MTHFR is like the Kim Kardashian of SNPs. It's so famous. Everybody is talking about the MTHFR, single nucleotide polymorphism, the SNP. I see my patients running to a lot of trouble there. They assume that because they have one polymorphism, one variant or one a mutation, I don't think of it as mutation. We're all genetic miracles. They fact that we're here is amazing. There's one SNP that's not the [00:55:00] wild type and they think, "Okay I got to get myself all these methylated B12 and methylated folate." The issue is that folate in any form, if there is depression will actually downregulate serotonin. You might have a little bit of upregulation temporarily but over time, any form of folate whether it's methylated or not is going to downregulate serotonin.

Depression and especially serotonin-related depression, it's somebody that's responded well to an anti-depressant like an SSRI, they will not do well with folate. I see [00:55:30] a lot of psychiatrists giving out folate. In this case, a lot of well-intended providers, patients reaching for folate when I don't think that that's a good idea, I think it's actually contraindicated. MTHFR, it can be meaningful but it is only instructions. It is not actually what's happening and that's why I like using Walsh's work because it's the phenotype, it's what's actually happening in the system.

When we measure histamine and homocysteine, we're looking at parameters [00:56:00] of things that need methylation in order to be metabolized. We can assume if they're quite high especially if both are quite high then methylation is not happening. If they're very low then it means too much methylation is happening. This is important from both a nutritional standpoint. We might not have enough methyl B12 in the system, we might not have enough SAM-e, S-adenosyl methionine, we might not have enough trimethylglycine to methylate if we're under methylators. Or we might be doing too much of that too [00:56:30] quickly.

Both of those are an option. I think when you are only looking at MTHFR, that question only goes in one direction. Everyone says, "I don't methylate. I don't methylate. I don't methylate." Even if you just have one SNP which isn't true. That's potential but we want to look at it as a phenotype. The other thing here is that methylation from a nutritional standpoint, methyl B12, methyl folate, TMG, SAM-e, all of these things are really important from just a level of do [00:57:00] you have enough?

The other piece here is that they turn on and off genetics. When I see a patient and I start doing a Walsh treatment plan, I expect there to be change within about two weeks. That's typically because of that nutritional component. At about six months, we get a plateau. What's happening between two weeks and six months is that there is a shift in the genetic expression. That is because of those methyl donors. When we add more methyl donors, it starts to change what genetics get expressed. [00:57:30] We talked about single nucleotide polymorphisms being the instructions and the potential. Those instructions and potential, it gets turned off or on based on methylation and some other things. Some other complex things turn on and off certain sections of your genome. Methylation is certainly a very, very important one. That's why I don't want to be too reactive and we want to see how things play out when we started the Walsh protocol. People are still [00:58:00] getting benefit, four, five and six months later.

Daniel S.:Yes. Dr. Walsh's approach to methylation is really in its own category which is looking at holistic methylation levels. He talks about under or over methylators rather than looking at which specific part of the methylation pathway might be up or downregulated. When we look at the genetics, you might see a particular gene is overexpressing and another gene is underexpressing but you've got a dozen genes to look at that are obvious [00:58:30] and then several dozen other genes that are related in the combinatorics. It's an advancing field.

Heather S.:Absolutely.

Daniel S.:Early. I think being able to factor people's genetic predispositions while looking at what's expressing at the level of chemistry is a sage approach to start.

Heather S.:Certainly. Even in the breakdown of histamine, we need B vitamins and we need zinc and we need vitamin C. [00:59:00] It's not just about one nutrient, it's about making sure that people have a robust healthy level of all of the nutrients that are required for these things. We can get specific when we have the right numbers in front of us.

Daniel S.:Something that I want to just share with listeners here regarding Dr. Walsh's work. Walsh is a person that really started pioneering this concept of methylation work a long time before 23 [inaudible 00:59:28] ubiquitous and we're looking at methylation genes [00:59:30] as well as this whole idea of kryptopyrrolia and et cetera. It was actually studying Walsh's work that had me decide to … it was a major step in having me start Qualia. It was specifically work he did with Argonne National Lab studying criminal mental illness and looking at neurochemical and neurostructural patterns predispose different types of criminal mental illness.

[01:00:00] We look at violent psychopaths or violent sociopaths or violent schizophrenics and say, if someone has an impulse control disorder they normally have empathy but they can't do impulse control versus someone who really never has empathy, they have dissociation dynamics, versus someone who has psychosis. Are there any patterns that we can identify chemically that are the same within that class, that are both different in normal people and different in the other classes [01:00:30] that we could actually start treating and maybe preventing?

The answer is not a perfect yes to everything with a single pill, but the answer was actually radical yes to a lot of things. Meaning, we know some famous cases where there's a person who is a totally well-adjusted normal person, didn't have any kind of violent traits and then had some violent show up seemingly out of nowhere. Washington shooter is a classic example. He said, [01:01:00] "Look at my brain." They looked at the brain and they see a brain tumor that is pressing on specific regions of the brain involved in things like impulse control. Brain tumor is removed and the violent tendency is gone.

It actually brings up a very deep question from a jurisprudence point of view of do you punish that person? Do you do brain scans routinely for people as a way of preventing criminality? Right now, we're looking at mass shooting cases. We were looking at the correlation of mass shooting cases with recent psychiatric medicine [01:01:30] prescriptions where someone is put on an SSRI for the first time within three months before the shooting happens and we say, "Oh, one of the side effects of the missed prescribed SSRI is homicidal tendencies."

Heather S.:And suicide …

Daniel S.:Suicide or homicide.

Heather S.:suicidal tendencies. I think that … I personally have been affected by that; friends who have been put on SSRIs and then commit suicide. I think a lot of people have experienced that, know someone who's suffered. [01:02:00] Yeah, the … keep going, but I want to talk about the benzos as well.

Daniel S.:This really was core to Qualia. I was looking at … we were looking first at just what are all of the things that affect human experience in terms of macroeconomics, in terms of education, in terms of governance, in terms of all kinds of psychology dynamics. One of the things that don’t just affect human experience but also affect human behavior, predispositions [01:02:30] for behavior. When you see that, of course something like impulse control or empathy is going to mediate how somebody behaves and of course that runs on their own networks and is mediated by chemistry. Almost everybody knows that their behavior is different in ways that can be dangerous on drugs, certain kinds of drugs, or if their hormones were out of balance they might access certain emotions a lot easier, other ones a lot harder.

What we're starting to explore is how do we, and with this whole conversation is about [inaudible 01:03:00] [01:03:00] a lot together, is how do we support the health of the nervous system and the physiology in a way that doesn't just support the health of the nervous system and physiology but it supports both the felt sense of subjective wellbeing of the people, their fundamental neuropsychological capabilities and also their predispositions because basically violent and shady behavior is actually a sign of an unwell person. Dr. [01:03:30] Walsh is one of the pioneers in that space.

Heather S.:Yeah, certainly. He did find patterns in that study in the criminal justice system. He was [inaudible 01:03:37] patterns and certainly urine kryptopyrroles were one of the common themes and low zinc and copper.

I was at a conference last fall and there was a presentation about a Syrian refugee camp, the food that's being delivered there and how low in nutrients it is and how high in glyphosate because, of course, they're [01:04:00] getting shipped from overseas that have been genetically modified and laden with herbicides and pesticides and that they were seen shift in behavior in that community. It wasn't totally related and you could press it out because you had some communities that were getting the greens from overseas in other people that there's actually a black market for non-GMO grains in these refugee camps because notice how they feel. They feel so different and it affects the [01:04:30] population and the behavior of people in that population profoundly. Then there's trauma and then there's nutrient deficiencies and then these horrible situations and this … certainly community, but this separation from home and so many awful things happening, how do you break those patterns?

I think part of what we're recognizing is that toxins and food and then poor nutrients on a population level [01:05:00] can certainly create more pathology which is a heartbreaking pathology, and so we're doing what we can, certainly, to be part of the solution.

Daniel S.:Beyond the Walsh stuff …

Heather S.:Mm-hmm?

Daniel S.:when you talked about nutrients-

Heather S.:Yeah.

Daniel S.:and deficiency. What else? Low fatty acids, low amino acids, low trace minerals of other kinds, what else do you look for?

Heather S.:Depending on your insurance, [01:05:30] my team does such a good job looking at whose insurance covers what, and they work with lots and lots of labs to try to get people the most information for the least amount of money. Depending on that, we look at different things. We can look intracellularly, we can look in the extracellular space, we can look in hair. We can look … if we're looking at T cells versus hair, we're looking at different lengths of time and averages over that time.

Really, it depends [01:06:00] how we look. We look at that based on a number of factors and again, based on your diet and exposures. What do I think that you might be getting enough of or not too much of? What diets have been helpful for you in the past? What have you tried? What have you not tried? There's a few ways that I measure and get information about nutrients.

NAD plus is one that comes up a lot in mental health and stress and addiction disorders. NAD plus is nicotinamide adenine dinucleotide. [01:06:30] There's been a bit of research going on in Australia with that and I've been using it in my clinic. There are people all over the U.S. that are using it. It's to prepare people for detox programs. It's not detox that they were talking about but more of an in-patient detox from drugs and alcohol.

NAD plus is done by IV. What I've seen is, basically whenever there is very, very high stress, whether it's mental or emotional stress, or maybe [01:07:00] a surgery, a stroke, or addiction, long-term addiction, people deplete their B vitamins, and one of the primary ones is this NAD. It's vitamin D3. It's a form of niacin. When we replete that, when we flood the body with it, all of a sudden stress resilience goes back up and people feel normal again. They start sleeping better, they have less anxiety, less depression, and feel much more resilient to stress whenever that come up. Of course, stress is a normal part of life. I did it recently and it was a game changer.

Daniel S.:[01:07:30] Mm-hmm (affirmative). Yeah, so the NAD IV therapy. A lot of people listening to this have probably seen the product Elysium which is nicotinamide riboside which is a precursor to NAD you can take orally. Even just taking just nicotinamide or niacin which is why it's actually been used in orthomolecular mental health for a long time. There's a number of things that it does. This isn’t just mental health. This is associated [01:08:00] with longevity and …

Heather S.:Antiaging and skin. Yeah, lots of things.

Daniel S.:This particular pathway of any NAD plus, NADH inside of cells actually is one of the main pathways for re-doxing one, so oxidation reduction signaling and so it's like an aging pathway if you get the NAD plus to NADH ratios in better place such as healthier younger selves. Being able to do it orally is nice. Being able to bypass that and go straight to [01:08:30] end byproduct straight into the vein is a cool therapy.

Heather S.:It's profound. Like the Walsh where it can … I mean, if I have to put them in order, it would be Walsh number one and NAD plus number two. The profound effects I've seen with patients are … I will get emotional if I talk about it too much but it's just so amazing to see someone's life shift in a matter of three days and see them have that resilience, build that resilience back and be able to take on the world again and share their gifts with the world after [01:09:00] just three days of getting IVs.

Daniel S.:Just two other quick ones on nutrients because I think they are ones that not a lot of people are somewhat aware of. Fatty acid deficiencies.

Heather S.:Mm-hmm (affirmative).

Daniel S.:Fatty acids in the nervous system.

Heather S.:Cholesterol numbers. This is where I really have a beef with the conventional community. Cholesterol under 200 is only the goal if you have heart disease or diabetes. It is not the goal if you are [01:09:30] a healthy human. Cholesterol under 115, I start to worry that you have depression, that you will have erectile dysfunction, that you will … I hope you don't get hurt because it will be difficult for you to recover from that if you don't have enough cholesterol.

Cholesterol is the background for sex hormones and stress hormones and it is so necessary in the right amount. Now, their ratios in total cholesterol doesn't tell us a whole lot. We need to look at the fractionated levels, the small density LDLs. How is your HDL? [01:10:00] What does your apoB look like? There's a lot of numbers. What are triglycerides looking like? Those are more important to me than total cholesterol. Anytime, I see someone on a statin, I'm doing everything I can to get them off in a safe and healthy way. That is a contributing factor to cognitive decline. It is a contributing factor to dementia. It is a contributing factor to depression.

Good healthy amino acids and fatty acids are so, [01:10:30] so, so important. Also, the brain is made of fat, right? We all know this. Brain is made of fat. Signaling systems require fat. We've got to have enough fat. Even people trying to lose weight, you have to have enough fat to lose weight. I know it's little counterintuitive but it is necessary.

Daniel S.:Omega-3 omega-6 ratio?

Heather S.:Yeah. We measure leak all the time. We definitely want to … Most of my patients, by the time people see me they’re pretty well-educated about this for the most part, but yeah, you want your omega-3s [01:11:00] in your diet to be higher than your omega-6s. You're going to naturally have more omega-6s, and you need them. Don't get me wrong. They're necessary as well, omega-3s, 6s and 9s. We want them all in a nice healthy balance. You are naturally going to have more omega-6s than 3s, but in the standard American diet there is way, way, way more omega-6s, immensely more and so we have to actively be very selective and conscious about what we choose to eat so that we don't tip that [01:11:30] balance in our bodies.

Daniel S.:Yeah, I think most people don't even have to test to get on a DHA supplement. That's a generally good idea.

Heather S.:Yeah.

Daniel S.:One of the other pieces of nutrient based psychiatry that penetrated the mainstream well was Julia Ross' amino acid therapy [crosstalk 01:11:52] cure. Tyrosine, 5-HTP, DLPA [inaudible 01:11:58].

Heather S.:Yeah, so we [01:12:00] need substrate. We need substrate, right? We've been talking about NAD plus, zinc, and B6. Those are cofactors. If we think about … if you take yourself back to chemistry class, whenever that was, and you have A plus B and you want to turn A plus B into C, you sometime need a cofactor like B6, zinc, all of these things. If you don’t have that cofactor, you're not going to make [01:12:30] C, but if you don’t have A or B, you're also not going to make C, right?

The backbones of our neurotransmitters are the things that you were listing also but the 5-HTP, the glutamine, all of these things are going to turn into neurotransmitters in our brain and they're typically amino acids. We need to get amino acids from somewhere. If you enjoy a meat-free, animal-free diet then you have to be getting them from plants, thinks like quinoa, beans, rice. You’re an expert [01:13:00] on this. What are some other great plant-based proteins? Soy …

Daniel S.:All of the vegetables are going to have some amino acids, not complete proteins. Your algaes are going to be complete proteins because complete protein, you can obviously get isolates of the protein portions with things like pea protein and rice protein, algae protein. Otherwise, it's usually mixtures of seeds, nuts, legumes, those kinds of things.

Whether someone is getting dietary protein from plant sources or animal sources, [01:13:30] if someone is getting enough dietary protein, does that necessarily translate to us seeing healthy amino acid ratios in their blood?

Heather S.:Yeah. Again, it goes back to genetics. It goes back to these co-factors and other nutrients. No, not necessarily. You do not always make the right amount of the right brain chemistry just because you have the right diet. No, I will say it makes a huge, huge, huge difference.

One of the first things that I do for anyone [01:14:00] with anxiety and depression is they have more protein. Where are you getting your protein from? How often are you having it? Blood sugar spikes and drops, not having enough of the substrate. All of these things can certainly contribute and it's such an easy quick healthy way to get some balance in the system. Every two-hour is high protein, high fat, high fiber, lots of veggies. If you struggle especially with spikes and drops in blood sugar, then that can be super balancing for the brain and nervous system.

Daniel S.:[01:14:30] Okay, so we've talked about subclinical, subacute toxins, subclinical subacute pathogens and subclinical nutrient deficiencies meaning none of these would normally be diagnosed as acute pathology but any of them can lead to a dysregulation in the system that leads to more susceptibility to more of them.

Obviously, the deficiency of amino acids even if you eat enough protein might be a GI absorption issue because of infection in the gut, right?

Heather S.:Poor genetic. [01:15:00] Yeah, absolutely.

Daniel S.:The infection in the gut might have been from glyphosate exposure messing the gut up, and so we can see this cascade start to happen.

Heather S.Stress, I think stress is another important one to point out here because if you are in that fight-flight free state and you don’t go into your rest, digest, and heal state, if you don’t have that dynamic ability to bounce back and forth between your parasympathetic and sympathetic states then you won't create enough digestive enzymes and you won’t absorb enough of your nutrients [01:15:30] and you won't have enough of the substrate. You won’t have enough of those amino acids. Regardless of what you choose to put into your body, you'll never get enough into your bloodstream if you don't get to that rest, digest, and heal state. It also it's going to predispose you to, yes, more nutrient … excuse me, more flora imbalance because you're not digesting so more things are fermenting. There's going to be more yeast and there's going to be pathogen overload.

I'm a naturopathic doctor so, of course, I'm going to start in the gut and make sure [01:16:00] that that's functioning.

Daniel S.:Okay, so I want to come back to stress in a minute, but since you just mentioned the gut, we've talked about the gut-brain access from the point of view of bacteria. Microbiome, very common to people who have deficiency of microbiome because of chlorine in water, because of antibiotics, because of et cetera; but obviously, the connection between the gut and the brain is lots of things. Are the nutrients getting into the blood? Is toxicity getting in the [01:16:30] blood because of leaky gut dynamics, inflammation, enteric nervous system?

I want to talk about the inflammation part for a minute because that's, I see, one of the deep reasons naturopaths are going to look at the gut to start. I think another breakthrough that has happened in our understanding of psychiatry in just recent years is starting to understand how ubiquitous neuroinflammation is in psychiatric presentation. You've got now all kind of communities of rheumatologists saying maybe depression is just rheumatology of [01:17:00] the brain, right? It's kind of neuroinflammation. Talk about that a little bit.

Heather S.:Yeah, I think …

Daniel S.:Each of them and the causes of it and …

Heather S.:Yeah, so zonulin is one of these fancy things that we can test in the gut nowadays. That gives us a little bit of a sense of whether you have a leaky gut. Most people who have a leaky gut probably have a leaky blood-brain barrier as well.

What we're talking about are these members that separate different pockets of the body so that it separate your gut. We're all basically [01:17:30] glorified donuts, right? There's this hole in the middle and nothing is actually inside of you until it has crossed that gut barrier. Inflammation in that gut barrier shows up as those cells. They're called cells because when we found them … when we created the [inaudible 01:17:47] and looked in that petri dish and saw the cells, they looked like cells in a cell block. They were all lined up next to each other like a proton. There was a security [01:18:00] gut there determining who would come in and who would go out, so there's a lot of selectivity.

When we have an inflamed gut, these cells get bigger, they get less square, there is less security determining what comes in and out. I think it is like a promiscuous barrier, it's just like letting everything in. That is going to lead to more information and potentially cross reactivity. The immune system is going to get alerted that there are larger macromolecules crossing this barrier, going into the bloodstream and it's not self, it's [01:18:30] not food, it's not a nutrient and so the immune system needs to attack it and that can lead to lots of inflammation.

That gut inflammation that can be caused by … most commonly it's going to be antibiotics, stress, alcohol and then gluten, zonulin. Zonulin is in wheat containing products. You can put zonulin in that petri dish with those gut cells and you can watch those tight junctions start to disappear. Super important that if there is an inflammatory process [01:19:00] going on, to eliminate those wheat containing products for the most part, and especially if there's autoimmune processes associated with that, some more systemic inflammation probably starting in the gut.

Reducing that inflammation and there's a whole host of other things. We talked about the four most common, the stress, the alcohol, the gluten containing products and antibiotics contributing to inflammation in the gut. There's a lot of others, but if you just got a hold of those ones, that you could make a lot [01:19:30] of progress.

Some great things to reduce inflammation in the gut, aloe, licorice, glutamine. We talked about glutamine as a substrate for neurotransmitters, but it's also really, really great for healing leaky gut as is collagen. Some of those bone grafts that are very popular nowadays can be super helpful for reducing that inflammation both in the gut and then systemically because that gut … all of those things are actually helpful for the blood-brain barriers as well, but that [01:20:00] gut barrier is going to contribute. If that's inflamed, everything else is going to be just because of that process of what's getting absorbed across the barrier.

Daniel S.:Coming from another direction, let's talk about inflammation and mold exposure and mycotoxins.

Heather S.:Inflammation everywhere, anywhere. I think I'm not really sure exactly what you're …

Daniel S.:We can have inflammation start in the gut?

Heather S.:Mm-hmm (affirmative).

Daniel S.:But we can have it start from lots of places?

Heather S.:Mm-hmm (affirmative).

Daniel S.:[01:20:30] Right? Obviously inhaling mycotoxin into the nasal sinus, lung we can get massive inflammatory dynamics and so the brain fog and the depression and the secondary symptoms associated with mold are largely believed to be inflammatory mediated.

Heather S.:Mm-hmm (affirmative). Yeah, and we can measure those so that Shoemaker contributed a lot of that to the fields of mold and mycotoxins. He looks at downstream effects, and instead of measuring [01:21:00] directly the mycotoxins, he's looking at a host of inflammatory markers like C48, TGF-beta 1, what else is on that panel? MMP-9. I mean the list is long, but we're looking both centrally so stimulating hormone coming from the brain from the pituitary, hypothalamic access and then also things in the periphery that are reflective of complement cascades and other things to show us that there is inflammation happening both [01:21:30] in the central nervous system and then also in the periphery that can be leading to symptoms pretty much in every system of the body. It all starts with inflammation. It starts with that reaction.

Daniel S.:Talk about sugar inflammation.

Heather S.:Sugar … the yeast piece, I mean, is huge. Too much or too little of anything, the body is going to try to protect itself from, but sugar [01:22:00] definitely is going to contribute to inflammation in lots of ways. First of all, getting on this up and down, sugar high, sugar low, can contribute to all kinds of discomfort but also just having sugar is going to feed yeast in the system especially too much of it and the wrong types of it.

The whole conversation around fake sugar is of another issue and how that's, true enough, signaling to the brain. I think all chronic disease, [01:22:30] there is imbalance in the signaling systems, there is imbalance and inflammation.

Inflammation is a good thing. I don’t want to forget that part of the conversation that … Even something like acupuncture, I love acupuncture. If there's something wrong with me, that's where I go first. The whole premise of acupuncture is that you create this micro acute inflammatory process and that turns on the immune system. It turns on this response system. It turns on this inflammatory process that is meant [01:23:00] to lead the healing. It's designed that way. You're supposed to get red and it's supposed to be inflamed, and it's supposed to hurt a little bit so you protect it, and you're supposed to bring attention and energy there. That’s the whole point.

The issue with inflammation is when it becomes chronic and there's this long-term signaling dysfunction, this pattern that's off that leads to long-term pain, long-term swelling, long-term symptoms. Those are the things that we're [01:23:30] measuring especially with the Shoemaker panel and then go ahead with sugar.

You're looking at insulin, you're looking at all kinds of parameters. Certainly, triglycerides are part of that picture. Hemoglobin A1c, the glycosulation of things in the bloodstream and organs can certainly cause damage, so glycosulation is that, like with hemoglobin A1c what we're measuring is the amount of sugar on your red blood cells and glycosulation is that process by which sugar attaches to things [01:24:00] and not in of itself is inflammatory and can damage tissue. Is that kind of where you're going with that?

Daniel S.:Mm-hmm (affirmative).

Heather S.:Yeah, so that's why -

Daniel S.:[inaudible 01:24:09]

Heather S.:With that?

Daniel S.:Yeah, each advanced glycation.

Heather S.:Yeah, advanced glycation end products. Exactly. That's why people have to cut their toes off when they have diabetes. That's why they lose their vision is that glycosylation. That's how it affects the heart and blood flow to the heart when you have baby.

Daniel S.:[01:24:30] Now, you're talking about acute … I mean, acute and chronic is something we've been talking about across this whole conversation, right?

Heather S.:Mm-hmm (affirmative). Yeah.

Daniel S.:If there's an acute signal and then there is a response and then it's addressed, awesome. If there's an acute signal and it doesn’t get addressed and it continues or builds up then, now obviously, we're in pathophysiology rather than just homeostasis.

If we talk about pain, obviously pain is supposed to trigger an immune response to some tissue that got [01:25:00] damaged to both, maybe immobilizer, right? Or to move, to trigger a motor neuron response. You move the hand away from the fire or you don’t move into walking on the sprained ankle anymore. Then the swelling is bringing the regenerative anabolic processes there, right?

Heather S.:Exactly.

Daniel S.:Now, if we don’t actually get fixed it … Say we've got some knee injury where there's real structural damage in the knee or damage in the back and so there is ongoing pain and inflammation, just that fact of permanent pain and [01:25:30] inflammation from something like a structural issue can end up … I mean, most people think of it as demoralizing and of course it can affect sleep quality, but that's actually going to produce -

Heather S.:Cortisol.

Daniel S.:cortisol and inflammatory chemistry in the blood. Some of which will cross blood-brain barrier, have neuroinflammatory effects and so something as seemingly prosaic is that the actual physical therapy required or maybe the PRP or surgery or whatever it is to the [inaudible 01:25:57] structural issues can be one of the components.

Heather S.:[01:26:00] Yeah, absolutely. Yeah, structure … we haven't really talked about that as a causal level issue that tier one … Our list of tier one things, we've included the toxins, the infections, the nutrients, the genetics and structures. We talked about stress even but structure is certainly one of those. I think the genetics is the molecular structure but structure from a chiropractor's point of view or physical therapist's point of views argue in alignment. Is the signaling going to be working? If your head [01:26:30] is caught like this, so your head is way [inaudible 01:26:32] the rest of your body, then are you ever going to get enough blood flow and nutrients, all of these things that we've talked about. Are you ever going to get enough of them there and then the waste out of your head if that structure is off?

This is one of the things that Dr. Bredesen talks about in regards to cognitive function, is the vascular and structural. Trauma can also be a component of this, but vascular dementia [01:27:00] is actually something I sort of celebrate not because it's happening but because we can do something about it, right? if we can get the structure in place, if we can get those arteries unclogged, we can get good blood flow both in and out of the brain, then we can make so much new- we can get so much movement and so much healing to happen.

Daniel S.:We talked about major contribution of Walsh's work. You've mentioned Bredesen protocol a couple of times. Could you just speak to what it is?

Heather S.:Dr. Bredesen has [01:27:30] been working with Alzheimer's and his wife is an integrative function medicine doc and he's a researcher and medical doctor. He's been studying Alzheimer's for decades. He has put together a comprehensive approach to how to end Alzheimer's, how to stop cognitive decline, and it's certainly easier if we can start earlier on.

Like I was telling you about my patient Linda, she had a 2 out of 30 on her MoCA. A perfect MoCA [01:28:00] score is 30. This is the Montreal Cognitive Assessment Test that we use routinely on patients with any sort of cognitive decline. She has the APOE Genetics, so she's got genetic predisposition to Alzheimer's, she's got strong family history, she's got all these toxins that I've told you about and she had advanced cognitive decline. A 2 out of 30 is really, really heartbreaking. She did not remember where she was, what day it was; really simple things. She couldn't name a lion or a rhinoceros or a camel [01:28:30] when she saw a picture of them.

Advanced cognitive decline, we can still do something about it which has been so helpful. Thank you Dr. Bredesen because he gave me the competence to even approach a patient like that and say, hey there's something we can do. Sure enough, she came back four weeks later and she is doing so much better just by taking this Bredesen approach which is comprehensive.

We're looking again at trauma, at toxins, at trophic factors. Is there enough of the hormones and [01:29:00] the hormone balance. This can be … We're looking for glycosylation and metabolic imbalances and then we're also looking at the genetics.

The way Dr. Bredesen describes it, he says that there is 37 holes in the roof and we need to look at each of those systematically and plug those holes. You made a great point, we've talked about this before.

Like was the case of Linda, I experienced this over the last couple of weeks with a patient. Once you start plugging some of those holes, they really start … the body is so incredible. [01:29:30] It starts to heal itself. We get a little bit of encouragement and then eight holes should close up, and then nine holes and then 10 holes and then it starts to … It's like a snowball effect in the right direction. It's really amazing and inspiring and hallowing to see the body heal.

Daniel S.:Dr. Bredesen's work is really neat because it's taking various things that have been known about integrative and naturopathic and functional medicine applied to a very complex area of neurocognitive [01:30:00] decline. It is not only with Alzheimer's but other neurodegenerative work with that kind of approach is helping and actually really formalizing at getting doctors trained and being able to get a large body of data.

We have some friends that are medical doctors. They are actually working on doing the clinical studies of Bredesen approach with Leroy Hood's organization, the Systems Biology Institute. One of the things that's really tricky nice for the listeners who are having this question come up, hey [01:30:30] why don’t I see more published literature in clinical trials on these kinds of approaches is because since they are personalized approaches it's very different than give everyone the same amount of a particular drug and then look at, in effect, compared to a placebo on a large, of a blind randomized trial if we're talking about something like copper-zinc ratio where it can actually be too high in either direction and if you give someone the wrong thing, you make them worse rather [01:31:00] than better than testing to know what's going on and then creating personalized treatment is actually the whole gist, right?

It’s not here's a pill for a symptomology presentation. It's here as a whole comprehensive personalized program for a personalized presentation so we have to test just the methodology of assessment, interpretation, treatment and recursion. That requires a different kind of science because nobody is giving the same protocol. It's very [01:31:30] hard to placebo control that. It's hard to get a large clinical data trial which is why a place like Systems Biology Institute is trying to do the science here but we really are … The limits of what the way we have done scientific medical epistemology can do which is if we're not just trying to do one synthetic drug assay treatment but how we actually respond to what clinical presentation looks like comprehensively at a cost level. It’s a deeper kind of science.

Heather S.:With the systemic approach, yeah, it does not limit [01:32:00] self to the randomized placebo controlled trials paradigm. Dr. Bredesen, I think I shared his story with you when we had spoken in the past. He was working with a team in Australia to apply this. They were in the whole process of getting a trial, the three of their IRD. He was talking to them and they were just about to finalize the protocol, and they said, "Hey, you know Dr. Bredesen, we can't do this. There's way too many variables." He's like, "All [01:32:30] right, that's too bad." They're like, "Send us your protocol because we want to use it on our parents and our grandparents and everybody we know. We want them to use this because we get that it works but we can’t do the trial because it doesn’t fit into our model." People are saying that out loud.

We need some physiology, right? We need to put all of these pieces back together. This is not reductionist medicine, it's not reductionist science. It's putting all these complex pieces back together. It [01:33:00] is complex, yes, but there's a [inaudible 01:33:01] in here. It's also very simple. It's going back to those foundations of having a bowel movement every day, getting enough sleep, dancing and sweating and getting exercise, laughing, spending time with the people you care most about.

All of those things that are so foundational to good health are the foundations of Dr. Bredesen's work too. We can measure all of these complex parameters, we can get really specific about it. There's a lot we can do but I think it's also empowering [01:33:30] to take a step back and say, well those foundations are so integral to that too.

Daniel S.:Yeah, the obviously very advanced complex disease is different but people just feel shitty, right? Subclinical depression, subclinical anhedonia. It's amazing how much better they feel oftentimes when they go camping with friends. Obviously their genetics haven’t changed. They have a genetic chemical imbalance. There might be chemistry that's imbalanced but [01:34:00] it might be the kind of chemistry that comes from the combination of environmental exposure, not sweating and stressing out all the time.

Heather S.:I was going to say, or they might just be living in a moldy building or moldy house because that is the first thing I tell anybody who's considering testing for molds, is one of the best things you can do, the least expensive test is to go spend a weekend in the desert in a tent. If you feel better, and then when you come back to your house and you feel worse, then it is very likely that there is an environmental component to that illness.

Daniel S.:So long as you isolate for [01:34:30] a few of the things like, did you get away from the family while you were gone and you have stressful family [crosstalk 01:34:35] hate your job or other parts of your life that [crosstalk 01:34:37].

Heather S.:That's a good point. That is a good point.

Daniel S.:All of which is critical in looking at psychiatry. This is one of the key things, is just like there are many people where they don’t know there's mold in the house and they're just not going to get better no matter what the fact you do if you don’t address their environment, and it might not be obvious.

Most doctors aren’t going to … they might ask, are you sleeping well, [01:35:00] right? But do you have any kind of sense of meaning in your life or do you dread, what is the nature of your relationship like? When we look at how much of our neurochemistry, given that we are tribal beings and our illusionary biology is actually created in response to other humans too, fair amount of exposure to eye contact too. You actually just can't do a good job of medicine without looking at their environment, their diet, and [01:35:30] how much … if they are spending four hours a day on Facebook feed, we have pretty clear stats that they’re going to be depressed.

Heather S.:Yup. There are kids playing video games, yeah. That psychology piece, I can't do all of these alone certainly and I refer out quite a bit. I refer out for neurofeedback. In psychology, I'm actually working with a psychiatrist right now. We are creating a formal collaboration to help people get off of benzodiazepine so people who are having trouble with sleep or anxiety, we're working together. He [01:36:00] does the med management but he's also a psychologist. He is helping with cognitive behavioral therapy and other psychotherapy. He's got a blend of modalities that he uses based on the patient presentation.

I commend with the Walsh Work, the nutrient balancing and potentially the NAD plus. The most difficult part of getting off any medication is that first step and then that last step, so we often try to do the NAD plus IVs then to help people out. [01:36:30] When he and I were talking about formalizing this offering, we were trying to figure out how to keep the cost down. How do we make this accessible to as many people as possible because so many people are on benzodiazepines, and benzodiazepines actually contribute to anxiety then they get worse. It's like a narcotic, like an opiate, making the pain worse over time. Benzos actually make anxiety worse. They also contribute to dementia especially when they are used long term. They were never designed to be used long term. [01:37:00] They get handed out a lot. We want to make this super accessible for people because we understand the risk.

We started talking about, hey what can we cut out? Can we cut out the psychotherapy? We just came to know, we can't. You can’t cut out the psychotherapy. Doing that, it's hard work but doing that where it could really taking … using a mirror and getting that self-reflection of how is my brain working, what are my ingrained thought patterns, am [01:37:30] I being mindful, and even have those … I mean, there are so many great wonderful neurofeedback. There are so many great approaches to how do we change the way the brain is firing, to go in a more positive, more collaborative, more creative direction; but certainly, psychotherapy is a great approach.

Daniel S.:One more thing about physiology that is … that is one of the really common thing, we see being able to help people quite quickly is hormones.

Heather S.:[01:38:00] Oh, yeah.

Daniel S.:Obviously, hormones aren't going to be tier one usually. There is something … someone might have been exposed to a toxin that is a hormone destructor, right?

Heather S.:Yeah.

Daniel S.:We [inaudible 01:38:11]

Heather S.:Again, ubiquitous.

Daniel S.:But a lot of people are used to thinking about hormones with menopause. People getting on HRT or men getting on TRT later, and of course the effects of that are profound. People get on it. Women with endometriosis [01:38:30] start to think about it, but not just sex hormones, right? Sex hormones, adrenal hormones, thyroid hormones, neurohormones, being able to assessed them and work with them. Talk about that a little bit.

Heather S.:I'm grateful. Anybody who has in insurance, basically we can get all of those labs run for almost no money so it's a no-brainer to screen those. That's also something I celebrate. If it's just a thyroid thing, it's just so … it's relatively simple to [01:39:00] fix that, to find some balance especially if I'm working with a patient who's willing to do the work and change their diet and get the exercise and go to sleep a little bit earlier. That's almost … it's good news. If you're depressed and you're gaining weight and you're hair is falling out and you can barely get out of bed in the morning, if it's a thyroid problem, it's a relatively simple fix. That's good news in my book.

Also, if the … We were talking about adrenal hormones. [01:39:30] That cortisol regulation and DHEA, there's a lot of things coming out. Even saltwater balance and blood pressure regulation and whether you have enough blood going to your brain. We talked about that from a structural perspective, but even from a blood pressure perspective. If you stand up and you can't get enough blood to your brain, then it's hard to have enough energy to go through your day. The adrenals are responsible for all of those pieces.

Looking at that, measuring that, again those are secondary things [01:40:00] like you mentioned. I want people to feel better yesterday and so we're going to support you in as many ways as we can with replacements of those things, but I don't think of them as primary, as causal. Hopefully that's temporary. My plan is always if that support is temporary, that I would like to help support your body to getting back to balance so that it creates enough of its own adrenal hormones, cortisol, [inaudible 01:40:27]. All of these things need to be created by [01:40:30] you, your thyroid and ovaries or testicles depending on your flavor.

My primary goal is getting you back to that place where your body creates that in its own balance, but if we need to, we certainly will supplement while you're on the path.

Daniel S.:Supplementing with aging is obviously kind of a philosophically deep and interesting topic and it's been medically the topic where people have had questions about increase [01:41:00] of carcinogenesis or whatever but which has actually been getting a lot clearer, that there are safe ways to go.

Heather S.:Yeah. It's a long conversation, I think, that is really based on the individual. It's sort of like vaccines. What is your risk-benefit ratio here? Woman who had a hysterectomy in her 30s who has a family history of Alzheimer's and dementia and osteoporosis and she has never had any breast cancer in her family or ovarian or uterine cancer has a very [01:41:30] different risk ratio to somebody who went through menopause at 55 and has lots and lots of breast cancer in her family history and maybe she is BRCA positive. Those are very, very different situations where the risk and potential benefit of replacing hormones is a totally different equation.

Now, there are lots of things like herbs. I have patients who have changed their diet and got more exercises and they're hot flushes go [01:42:00] away, but for the most part I think that when I'm having a conversation about hormones, hormones are very protective. They're anabolic. They're associated with youth and good function. They're associated with the creation of healthy happy selves wherever we are in the body, whether it's the brain or the skin or the gut. I think I probably will lean on the side of being willing to work with people on hormones more often than not.

Daniel S.:[01:42:30] You mentioned thyroid as being something that is relatively easy, obviously, if we're looking at autoimmunity of the thyroid. It's a little harder than just imbalance in the thyroid, but how likely is it that a person who has had basic thyroid numbers run at a GP and said everything was fine and then come in and do a deeper thyroid panel and see that everything is not fine?

Heather S.:I got a mixed bag on that one [01:43:00] but it's very, very, very common for someone to say, "Oh they told me that my thyroid is normal." Usually what's happened is there has been one TSH, which is thyroid stimulating hormone, that's the hormone coming from your brain telling your thyroid how much thyroid hormone to make. If all you do is a TSH you have no idea about the thyroid hormone in the system, you have no idea if there's any autoimmune process, you have no idea if you're creating reverse T3 instead of T3.

I look at eight parameters on the thyroid. Typically, [01:43:30] a conventional is going to look at one, maybe two. They might look at a T4. Usually they're only looking at T4 if you're on levothyroxine or some synthetic thyroid replacement.

The answer to that is usually people are not getting a thorough workup for their thyroid and it's so sad. I had somebody this week who told me that her conventional doc said, "Oh, it doesn't matter if you have Hashimoto's. There's nothing different that we're going to do." Well, hypothyroid disease is one thing [01:44:00] and Hashimoto's is another. Hashimoto's can fluctuate between hyper and hypo. It's an immune system disorder; it's not a thyroid disorder. It's just that your immune system happens to be attacking your thyroid.

The focus of our treatment, if we want to get to a causal level, is going to be with the gut and with the immune system in reducing that inflammation and that cross reactivity from an immune perspective. There's a lot of different … the Kharrazian and Bowthorpe and Brownstein [inaudible 01:44:28] is a new one. [01:44:30] There's a lot of experts out there, there are a lot of books out there and there's a lot of … They all disagree with each other, basically. What I found in my clinical experience is that they're all right some of the time for some people, and so figuring out which approach is going to be best for you takes a little bit of trial and error.

Some of the experts say iodine is brilliant; give them lots and lots and lots. Other people [01:45:00] say never ever, ever iodine with Hashimoto's, and so making sure that the foundations are in order, that the immune system is well supported, the liver and adrenals are well supported, and then potentially adding some iodine but probably not at 12.5 mg. That's not my style, not my preference although I see some people on it who do great. It's just a matter of determining what the right approach is for you. I can understand the confusion out there around Hashimoto's because there's a lot of [01:45:30] contention and a lot of disagreement even among the experts in that community.

Daniel S.:It's such a fun area of medicine to work.

Heather S.:It is. I love it.

Daniel S.:To help some with heart disease is obviously beautiful, tough and [inaudible 01:45:50] beautiful. You can, no matter what it is, help people get out of suffering or avoid it this great, but psychological suffering has such a unique [01:46:00] type of painful characteristic to it and having someone be able to get out of anxiety or out of depression or be able to look towards old age without looking towards Alzheimer's and loss of their awareness of self. It happens to be one of the most complex areas because it requires looking at the whole physiology, and the nervous system happens to be the hardest thing for us to do diagnosis. Again, it’s most complex, but it also happens to be a place where [01:46:30] the changes in function are just so profound to changes in quality of life.

Heather S.:I couldn't ask for a better job. That is my very favorite part of it, is getting to see people return to their life and more balanced and share their gifts with the world. We were talking about mass shootings and that's just one of the many, many, many problems that our human population is facing. That is my why. That is why I practice this medicine, it's because [01:47:00] we need people showing up who can offer their gifts to the world, who can offer their solutions. When you don’t feel good, when you are suffering with anxiety and depression and insomnia and … well, actually insomnia might help but if you don't sleep, you will have more time to solve the world's problems. If you aren’t feeling good, it’s really difficult to share your gifts with the world.  We want people who can show up and do that.

Daniel S.:For listeners that are interested to take this further, I just want to share on [01:47:30] almost all the topics, if you're interested in the mold, there's a whole universe you can study. You can go to Dr. Shoemaker's site, you can look at the Moldy Documentary data Asprey put together or you can just Google. It will take you to a lot of places. If you are interested in Dr. Walsh's stuff, you can go there or Dr. Bredesen's stuff. There's a lot of area to study.

I again want to say, don't start trying to put medical programs together for yourself [01:48:00] based on anything that you already hear. Don't try and change your meds, et cetera. Do educate yourself and then if with your education you decide that you want to get support, get diagnostics, go deeper, one of the things that we're working on here at Qualia is finding all the docs that we can that have really good training and integrative neuropsych work so that when we tell people, "Hey, this isn't medical advice. Go talk to your doctor," we can [01:48:30] actually have doctors that we can recommend people to.

In the meantime, if you look up functional medicine doctors, integrative doctors, naturopaths in your areas, see if they do any of the methods that we've talked about here, see what they're YELP reviews are, talk to them. That's a good step. If you happen to be in the Southern California area and you want to … One of the common problems as people start to get into deeper integrative medicine is they find something that actually works more [01:49:00] than never in an area where nothing worked previously. They get so excited about that, that that becomes kind of the favorite treatment so everyone has adrenal stress or everyone has thyroid disorder or everyone has a gut-brain axis disorder.

While it might be true that almost everyone has something going on there because it's an interconnected system, being able to really look at the whole thing and know how to prioritize those work with those together is just a radically different thing. There are unfortunately not that many medical facilities [01:49:30] that are doing a decent job of yet. There are fortunately some starting to work at it.

The website is

Heather S.:That's correct. Yeah, or hello@northcountynaturalmedicine will get you an email to my front desk; 760-385-8683 will also get you a girl in the phone, very sweet, [Melanie Jamie, Melanie 01:49:58]

Daniel S.:If people are interested and want to [01:50:00] go actually pursue some diagnostics, see what's going on, whether it's to address some real symptomology or whether it's to address prevention or optimization. A lot of people don't experience having cognitive decline but it doesn't mean that they're at their cognitive optimum either or the psychological optimum degree of greatness is higher, and [crosstalk 01:50:21].

Heather S.:Also if there is a family history. If there is a family history of mental health disorders, that there's a family history of Alzheimer's or dementia, I would love to see you sooner [01:50:30] rather than later and prevent the suffering.

Daniel S.:Well, Heather, thank you for coming and for joining. This is fun as always.

Heather S.:Thank you. Thank you so much for having me.

Daniel S.:I look forward to our next conversation, other topics of complex medicine.

Heather S.:And continued collaboration. I'm so grateful for Qualia. That's helped a ton of my patients as well, so thank you for what you guys are doing.

Daniel S.:All right. Bye all.

Heather S.:Good night.

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