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A Thousand Miles - How I Became a Holistic Psychiatrist

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“The journey of a thousand miles begins with a single step.”

― Lao Tzu

I don't recall that step...maybe it was when I first asked for help for my daughter.... or maybe, when I decided to stop asking - when I realized that conventional medicine did not have the answers for us. Either way, my experience into illness and healing forced me to let go of many assumptions and expectations I had about the world, about life and about myself.

My hope in starting this blog is to share what I've learned so someone else won't have to search as I have these past ten years.  Though at times frustrating - the seeming snail's pace of such a pursuit - there are many who will never look beyond what is in front of them, many who will never cross paths with those who
might point them in unexpected directions and many who when given leads, will never pursue them.   If you are reading this, perhaps you too are a seeker.
By way of background...

When my daughter was born, I closed my psychiatric practice to be home with her.  Much of our next few years, however, would be clouded by her recurrent ear infections, allergies, gastrointestinal symptoms, and frequent changes in her speech, cognition, memory and personality along with my own (best described as symptoms of fibromyalgia) - neck pain, stiffness, fatigue, episodic nausea, dizziness, palpitations, headaches and sinus infections.   My daughter's cognitive changes (however subtle to others) and my intermittent neurologic symptoms which began to affect my ability to climb stairs, made me anxious...at times, very anxious.  While I can't speak for the doctors we saw, I suspect many concluded that we both suffered from my being an overly informed neurotic physician.  I always knew, however, that whatever was going on with each of us was systemic (affecting the brain and body) and inflammatory in nature.  I also knew, had I been one of those doctors (before learning more), I likely would have concluded the same.  Inevitably, I chose a different path.

As the Quakers say, "Way closes, way opens."   I'm grateful to many of those we saw early on.  But for their lack of answers, I would not have relentlessly delved into the latest research on the gut-brain axis, the micro-biome, epigenetics, autoimmunity, inflammation, oxidative stress, metal metabolism, nutrient deficiencies and overloads and neuroplasticity.  Much of this information will take years to make it into mainstream medicine.  

My experience of being sick and having a sick child and the empathy that inevitably follows, drive me to share this information online.   Without the internet, I wouldn't have crossed paths with the many teachers who led me to my current understanding about brain related disorders.  Many of these individuals became experts out of a practical need to help their child and/or themselves.  There was the child psychiatrist and author who helped his autistic son with a candida diet and whose work started me down the path of the gut-brain axis. Then there was the functional medicine doctor near Asheville, my husband met through business. His wife, also a physician, recommended we look at the work of a doctor in England who cured her son's autism with diet (now the fairly well known GAPS diet) and which led me to the research on the micro-biome.  Because of the internet, I found a local functional medicine physician who was a great help and who directed me to a cardiologist whose online protocol for elevated ammonia levels turned out to be an important piece to our puzzle.  Online, I also connected with a chiropractor who specializes in clinical functional neurology and who continues to teach me about neuroplasticity.

Similarly, I  found my now good friend and colleague, Dr. Judy Tsafrir, a holistic psychiatrist in the Boston area, who already had been incorporating nutrition into her work for some time.  I reached out to her, not for medical advice, but for advice on starting a holistic psychiatric practice.  She mentioned the physician training at the Walsh Research Institute in advanced nutrient therapies which we both attended.  At the time, I didn't appreciate how effective and important the work of Dr. William Walsh in methylation, metal metabolism and nutrient deficiencies and overloads would be in my own work.  Nor did I realize how relevant this would be to understanding the roots of my and my daughter's symptoms.  

By no means was I traveling alone nor would our healing processes be possible without the unending love and support of my husband, Marty.  

Though the challenges of the last ten years could have been much worse, I wouldn't wish them on anyone....except maybe someone who wants to overhaul their entire way of living or who wants to find their deepest purpose, or who wants to learn about the rapidly evolving scientific research that will eventually change the way we approach human health.  As Kierkegaard says and my husband likes to repeat, "Life must be lived forward, but can only be understood backwards."

My wish for anyone reading this, is that your pursuit of health, happiness or whatever you seek, lead you to peace and a desire to help others traveling their thousand miles. 

Until next time,

Courtney


Copper Overload - Too Much of a Good Thing

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Courtney Snyder, MD

Who knew...copper, the essential trace element important in the synthesis of neurotransmitters, respiration, immune function, energy metabolism and growth, could wreak so much havoc on the mind and body? 

I never gave much thought to copper until it presented itself to me in the most delightful way...a dream of a copper tiled ceiling - the most memorable dream I've had.   Copper ... "associated with the goddess Aphrodite/Venus in mythology and alchemy, ...symbolic of love, balance, feminine beauty and artistic creativity."  So taken with this dream, I painted a mantel copper.  

We eventually moved and left that copper mantel and dream behind.  Ten years later copper resurfaced at the Walsh Research Institute where Dr. William Walsh was teaching about copper overload - one of the most
common biochemical imbalances found in brain related disorders.  "In most persons, blood copper levels are kept in a narrow range through the action of metallothionein, ceruloplasmin, as well as other proteins. Unfortunately, many persons have a genetic inability to regulate copper levels and a serious copper overload can result." - William Walsh, PhD.

It is well understood that neurotransmitters play a role in psychiatric conditions.  It is less well known that nutrients impact neurotransmitters.   

Copper is a cofactor in the synthesis of norepinephrine:

                                      Dopamine Beta-Hydroxylase
         DOPAMINE -------------------------------------------------------------> NOREPINEPHRINE
                                    Copper, Vitamine C and Oxygen

Because of this, when copper is elevated,  dopamine levels decrease and norepinephrine levels rise. Having these neurotransmitters out of balance can result in a whole range of problems including anxiety, panic, paranoid schizophrenia, bipolar disorder, depression, ADHD, and autism.   This doesn't mean that all depression (or these other diagnoses) are caused by copper overload.  Dr. Walsh's database of chemistries on 10,000 psychiatric patients, show for example, there are five biochemical phenotypes of depression - undermethylation, overmethylation, copper overload, pyroluria and toxic metals.   His research did find, however, that overwhelmingly women with postpartum depression had elevated copper levels.  

The reason for this? - A strong relationship between estrogen and copper.  Copper promotes the production of blood vessels (important if a woman's body thinks she's about to carry a baby).  When estrogen goes up (ie. puberty, pregnancy, or with birth control pills or hormone replacement) - there's no problem....unless a woman can't normalize copper afterwards. This can be compounded with each pregnancy and likely explains the tragic news stories of seemingly healthy women who in the midst of a postpartum psychosis harm their children.  Much less extreme would be the women who have emotional or other health problems that begin after the birth of their child.  This can also be the culprit for girls who develop inattention, anxiety, panic or depression around the onset of puberty.

The rest of the body is not necessarily spared.  When you consider that copper is neuro-excitatory (think copper wires conducting electricity), it's not surprising that too much is associated with muscle and joint pain, headaches, brain fog and other symptoms often associated with fibromyalgia.  Too much copper can also interrupt the cell's energy cycle and cause fatigue, ie. chronic fatigue syndrome.  When you consider that copper promotes vascularization, it makes sense that many women with fibroids, excessive menstrual bleeding and even cancer very often have an abundance of copper (for tumors to grow, they need blood vessels - for blood vessels to grow, they need copper).  

Men and boys can have copper overload as well. This may look like hyperactivity, inattention, impulsiveness...sometimes even anger or violence.  A mother and son with copper overload can have very different manifestations.

While I've mentioned genetic vulnerabilities and estrogen, there are other exposures that can raise copper including multivitamins with copper and drinking water, especially if from copper pipes or well water. Copper is also in some algae treatments for swimming pools and high in certain foods such as chocolate, seafood, avocado, beans, nuts, lamb and organ meat.  When copper overload seems to be affecting multiple family members - ie. a child, a parent and a even a grandparent (copper is being studied in both Alzheimer's and Parkinson's), there is likely a genetic defect related to metallothionein, but a shared exposure is also possible. 

If copper overload is so prevalent, why isn't it being identified and treated in conventional medicine? First - physicians rarely check copper levels unless they are looking for the rare and most extreme form of copper toxicity called Wilson's Disease.  If they did check levels, many cases of copper overload would not be identified. The Pheiffer/Walsh normal range that we (those who have trained with the Walsh Research Institute) use is narrower than the range provided by most labs.  The way we measure copper is by checking plasma copper levels and ceruloplasmin (a protein that binds copper).  From these, we calculate the percentage of free/unbound copper.  It is this free copper that is causing the problems.  Someone can have a normal copper level (using a standard lab range, or even the Pheiffer/Walsh range) and still have very high free copper. Through the work of Dr. Walsh, it was found that normalizing to this more specific range could significantly improve symptoms for a large number of people.

Aside from high copper foods, other dietary factors can also be at play, such as zinc and/or protein deficiency.  Zinc helps regulate copper and protein is necessary to have enough ceruloplasmin to bind with copper.   

So, what can be done?  I'd like to say, "zinc, zinc, zinc...." however, it's more complicated than that. Knowing someone's zinc level is helpful, otherwise you may not know how much (if any) zinc they need. Too much zinc, too quickly can rapidly mobilize copper and a cause worsening of symptoms.  Excess zinc can cause anemia. We use other nutrients as well to help normalize copper.  Knowing Vitamin D levels and thyroid functions are also important. If abnormal, these will need to be corrected in order to more easily correct the copper overload.  In short, treatment involves: 
  • limiting exposure to copper
  • starting an individualized nutrient protocol based on the person's clinical presentation, labs, age, weight and how well they absorb nutrients. 
Normalizing copper can take 2 months, but clear improvement often starts as early as 3-4 weeks.

As for my copper dream -  I was pregnant with my daughter at that time.  Thanks to copper, there was a good blood supply for her and she grew into a healthy baby.    It's likely, however, that is when my own copper levels were starting to rise.   Eventually, I would reach that copper ceiling and for me that meant severe headaches, muscle pain, fatigue and a range of neurologic symptoms that I was previously unable to find help for.   But for checking my own levels upon returning home from my training, I may have never known, just as many others may never know.  


To find a physician trained in treating copper overload, (or if you are a physician interested in training in the evaluation and treatment of biochemical imbalances), visit walshinstitute.org.

From Struggle to Stillness (With the Help of a Heron)

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Courtney Snyder, MD

Have you ever tried so hard to solve a problem, that you couldn't see the answer right in front of you?

I had that experience after a long period of pursuing health challenges for my daughter and me.   We'd made good progress and with my new found energy and focus, I quickly shifted my attention to something else to relentlessly work on - my career.   I knew I didn't I want to return to the kind of psychiatric practice I had previously.  I couldn't imagine an alternative, despite just having spent a good part of a decade immersed in the relationship between nutrition, the gut-brain connection, and autoimmunity.
To give myself a mental break from problem solving, I read, "EAT, PRAY, LOVE".  I was only 8 years behind. There were many things I loved about that book, but none more than the moment Elizabeth Gilbert asks for a sign and gets one.  This was something I'd never considered.

After dropping my daughter off at school one morning, I drove near the Ohio River.  Irritated with my persistent goal directed thoughts, I wondered, "If Liz can ask for a sign and get one, ...why can't I?  So after a lifetime of believing I somehow controlled things, I asked (to whom I didn't consider - G-d, the universe, my soul, the air) "Please,...just give me a sign."  Within seconds, a large heron flew over the hood of my car.   

Knowing a sign has presented itself and knowing what it means are two very different things.  I read about herons.  There were many interpretations - some conflicting.  All that mattered, however, was the one that connected with me - the heron's ability to stand extremely still.   When not flying (and assisting in divine intervention) it just stands.... without moving.....seemingly forever.  No impatience.  No 'making things happen'.  No sticking it's head hastily in water searching around for fish.  The heron simply waits for the right moment.  Then and only then, does it move quickly and seize that moment.

The image of a motionless heron allowed me to finally call off all attempts to figure out and solve my problem. Instead, I waited...and waited.  Eventually I could see that what I'd been living and learning while away from psychiatry was exactly what I needed to bring to my work.  My life which had been an uphill push soon began to unfold more effortlessly.   I still need that image of the heron to remind me to stop and trust that the answers will come.

I have no doubt that letting go and choosing stillness lowers my stress (and stress hormones) and has a positive impact on my health.  This mind shift doesn't require a belief as much as acceptance, humility and a little practice.  For me it also required being open to an event and making meaning of it.  If you're seeking answers in your own life, consider staying open to your signs however they present themselves.  

During a difficult time, Paul McCartney's mother, who died when he was 14, came to him in a dream. Her name was Mary and she inspired the lyric.....  

"When I find myself in times of trouble, Mother Mary comes to me
Speaking words of wisdom, let it be....
.....
There will be an answer,...
let it be"

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Psychiatric Medication  and Why, Behind Every Great Neurotransmitter is a Great Nutrient

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Courtney Snyder, MD
 
Psychiatric medications are a good thing ...for a lot of people....at least at this time in the history of medicine. They save lives and alleviate suffering and pain.   
The current understanding is that such meds increase or decrease the activity of neurotransmitters  - chemicals produced in nerve cells which allow cells to communicate with one another.  Some of the big players are serotonin, dopamine, norepinephrine, GABA, glutamate, and acetylcholine.  Think of them as the words spoken between nerves.  Some are excitatory (you know the type) - they tell the next nerve to fire, "GO! GO!" Others are inhibitory, telling the next nerve cell, "Whoa, slow down."   Some do both, depending on who they're talking to.  

Let's look at a couple examples of medications and how their impacts can be farther reaching than intended. Ritalin, like many meds for ADHD, increases dopamine activity between the cells.  This can help improve attention and decrease hyperactivity for many.   Some people, however, have too much dopamine activity already. Increasing it further can cause psychosis, ie. paranoia or hallucinations.  Traditional treatments for psychosis, such as Thorazine, worked by lowering dopamine activity.  But if lowered too much, a person could develop Parkinson's like symptoms.  Parkinson's is due to insufficient levels of dopamine in certain parts of the brain. There's a fine balance and different parts of the brain need different amounts of these neurotransmitters.  

Another example would be the commonly prescribed Selective Serotonin Reuptake Inhibitors (SSRIs), such as Sertraline/Zoloft, Fluoxetine/Prozac, Paroxetine/Paxil, etc. They increase serotonin activity with the intent of improving mood or decreasing anxiety.  Yet again, there are some people with depression who have too much serotonin activity and can get dramatically worse on such medication.  We're not all the same.  The blanket increasing and decreasing of neurotransmitters can have some unintended consequences aside from annoying side effects. But until fairly recently, it's been the only option.

The greatest limitation of medications, however, is that they don't address the deeper problem. Why exactly are those neurotransmitters out of balance in the first place?  Symptoms are our bodies way of telling us, "something's not right." The ADHD child who goes on as an adult to have depression and then many years later perhaps even dementia, didn't just have bad luck, they had a biochemical problem that affected them differently at different times in their life. Though likely helpful, none of the medications addressed their individual biochemical imbalance. 

So what do I mean by a biochemical imbalance? Neurotransmitters aren't autonomous. Just as words require letters to exist, neurotransmitters are made of nutrients and require nutrients to communicate with the next cell. For a variety of genetic and environmental reasons, we may be deficient or even overloaded in certain nutrients  - amino acids, vitamins, minerals, and other natural biochemicals.

Here's what they do in the brain:

(1)  Nutrients play a role in the synthesis of neurotransmitters:

Take a look at B6 which is needed to make serotonin, dopamine and GABA.  


                                          L-Amino Acid Decarboxylase
5-Hydroxytyrptophan ----------------------------------------------------> SEROTONIN
                                                            B6

                                L-Amino Acid Decarboxylase
L-DOPA -------------------------------------------------------------------> DOPA
                                                           B6

                                     L-Amino Acid Decarboxylase
GLUTAMIC ACID -----------------------------------------------------------> GABA
                                                            B6

While you could tweak these neurotransmitters with multiple psychiatric medications, you could also take a simpler and more refined approach to normalize nutrient deficiencies or overloads. 

Copper Overload can cause too much dopamine to turn into norepinephrine, resulting in low dopamine activity [think ADHD] and increased norepinephrine activity [think high anxiety].

                                      Dopamine Beta-Hydroxylase
DOPAMINE ------------------------------------------------------------> NOREPINEPHRINE
                                        Copper, Vitamin C, O2

It's not uncommon for people to be on a stimulant (ADHD medication) and an SSRI antidepressant (for anxiety).  Instead, the problem could be addressed by normalizing their copper levels.

(2) Nutrients are involved in the neurotransmitter reuptake process at the synapse - the space between the nerve cells. (more reuptake, means less activity)
For example:
- Methionine and SAMe (serotonin reuptake inhibitors) = more serotonin activity.
- Folate = reduced serotonin, dopamine and norepinephrine activity.
   
Not less important, but too large for this post to hold:
(3)  Certain nutrients are antioxidants that protect the brain from damage.
(4) Nutrients amazingly play a role in genetic expression - ie. whether certain mutations are expressed or not.  

And though crucial, when it comes to the brain, there aren't a lot of nutrients to think about.

From Dr. William Walsh, PhD (whose work I am referring to throughout this post):
"..only about six or seven (out of the more than 1000 important nutrients in the body) ...seem to have a dramatic impact on mental health. I used to be bothered by the fact that the same chemical imbalances kept turning up in different conditions.... It turns out that each of these nutrient factors is directly involved in either the synthesis or the epigenetic regulation of a neurotransmitter in the brain. That was really good news. If we had to study over 200 possible chemical imbalances and cor­rect whatever we found, designing treatments would be very difficult. Fortunately, we can focus on six or seven nutrients, and by balancing them, we can help most people with mental disorders." 

When it comes to the brain:
Deficiencies in Zinc, Methionine, Folic Acid, B6, B12, Se, Glutathione, Vitamins C and E can be a problem.
Excesses/overloads of Copper, Folic Acid, Iron, Methionine, SAMe, and toxic metals (lead, mercury, cadmium) can be a problem.

Yes, that's right - one person can have depression due to folate deficiency (too much serotonin, dopamine and norepinephrine activity) while another person can have depression due to excessive folate (not enough of these neurotransmitters).  This is again, why people respond differently to certain medications - some get better, some no response and some get worse - sometimes dramatically so (think school shooters recently put on an SSRI antidepressant who may have been folate deficient with too much neurotransmitter activity already).  Similarly, multivitamins are good for some people and not good for others, especially when it comes to brain related disorders.  

Many factors, both genetic and environmental, can produce nutrient imbalances.  Addressing nutrient levels through biochemical or nutrient therapies isn't just about checking levels and then normalizing them, though that's an important part.  It's also about addressing the genetic expression (more on methylation in a later post) that may be contributing, addressing gut health (and the absorption of nutrients), diet and environmental exposures (which can run the gamut from toxic chemicals to toxic relationships). None of this negates the benefits of psychiatric medications.  Nutrient therapies do allow some individuals to not need medication, some to eventually come off medication and others to be on fewer medications at lower doses with less side effects.  

I'm not a spokesperson for the Walsh Research Institute, but I do feel strongly that the work of Dr. Walsh and his colleagues, Dr. Albert Mensah and Dr. Judy Bowman will dramatically shift the way mental illness is understood and treated.  There are too few of us in the US who are trained in these specific treatments, which need to become more accessible.  I highly recommend the Physicians Training program to any physicians treating brain related disorders (CME credit is approved by the American Medical Association). To find a physician in your area, visit the Walsh Research Institute Resource List.

Giving and Living Without the Strings of Expectation

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By Courtney Snyder

Expectation - the pervasive force that can deflate some of our happiest moments. Expectation makes us hold too tightly to what we think should happen or how we think someone should respond to something we've done. Disappointment often follows. ...But, do we have to live with expectation? 
I started wondering about this while volunteering with my family alongside a couple whose organization gives food, friendship and dignity to people living on the streets. Without naiveté about addiction, mental illness and homelessness, this couple never seemed to question whether or not they should give.  Their intent was to serve.  How many of us have questioned the best way to give to a homeless person fearing if we give money, they’ll spend it on alcohol, drugs or cigarettes. While it makes sense, not wanting to participate in a possible addiction, it also raises an important question - Are we actually "giving" when we need to have certainty of the outcome?  

A situation closer to home may be that of an extended family member or friend asking for money.   Do we give the money and then feel angry when they send us a postcard from Hawaii?  Or, do we choose not give, deciding that doing so would cause more harm than good to the relationship.  Or, lastly, do we give the money freely as a gift and decide that once we do, the money is theirs to use as they see fit?  I don’t think there’s a right answer for every relationship, but I do think giving is more satisfying or at least less aggravating when given without expectation.

Less dramatic, though still with the potential for annoyance, can be those times when we send of a lovely gift that is never acknowledged or give sage advice to a friend who manages to do the complete opposite.  

The problem with expectation isn’t just that it binds our giving, it also binds our lives.  We have expectations tied to our next five minutes, to our week, our year, ...our lifetime.   When that plane doesn’t leave on time, we can get wound up or we can take the attitude that 'life happens' - maybe there’s something to learn here or maybe there’s something better that’s going to happen instead.  As the Yiddish saying goes, “Man plans and G-d laughs.”  However you define or don’t define G-d, it’s obvious that those who “roll with it” lead happier and less stress filled lives than those who don’t.

I’d love to say I excel at this zen way of being.   I don’t.  But I do think the struggle is one worth having. When I wrote my last post, I did so with the intent of sharing what I thought was useful information.   As always, when I was done I clicked the "Publish" button. (For a blogger, this moment is akin to sending part of one’s self out into the world - always with the possibility it may be read by many or seen only by one’s adoring dog.)  Needless to say, after publishing that post, expectation reared it’s ugly head and my focus shifted to whether the post would be read and appreciated.   How quickly something born out of service and even humility can turn into something about ourselves...if we let it.  A blog motivated by a need for validation quickly becomes a blog less worth reading ...or writing.  

What would happen if we let our gifts fly like helium balloons that were never really ours in the first place? What if we were more like anonymous philanthropists or those people who secretly pay the check for strangers at another table? What if … when we push that "Publish" button, we let go and simply look forward to the next time we have something to share?



The Microbiome - A Universe Unto Ourselves

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By Courtney Snyder, MD

What is the microbiome and why are so many researchers studying it's impact on human health including mental health?  How can we take care of it?  And, what can it teach us about fear, the importance of diversity and our relationship with the natural world?

The microbiome is the collection of microbes that live on and in our bodies.  There are estimated to be 100 trillion in our gastrointestinal tract - about ten times the number of cells in our body. Spread out, it is believed these microbes could cover a football field.  Though there are an estimated 500 -1000 different species, only one third seem to be common to most people.  The other two thirds are specific to each one of us.  So, along with our unique experiences and genomes, we have unique microbiomes.
How did we get all these micrrobes?  It's generally thought that in utero we are sterile. At the time of birth, our mother’s vaginal fluid (which also has fecal microbes) get’s into our mouth and thereby seeds our gut microbiome - a messy arrival into the world, but miraculous nonetheless.  We go on to acquire more bacteria from our mother’s skin during breast feeding and still more by sticking things in our mouth as we explore our new world.  Nature’s intent, as you can see, is a healthy level of "contamination" - not a germ free existence.  By the age of three our microbiota has become pretty stable and similar to that of an adult. It will continue to evolve with us into adulthood and change in response to our diet and our environment.  

Until our recent history, people didn’t think about the microbiome, nor did they need to.  The microbes quietly got their own needs met while doing their part to maintain health.  After discovering bacteria and infection, we began to fear microbes - all of them - and we went on to successfully wipe many of them out without making any distinctions. Now scientists are trying to figure out which bacteria are helpful, which are harmful, and which are just hanging out. They're are also trying to understand how cesarean sections, antibiotics (and other medications), hand sanitizers, a Westernized diet and less time getting dirty in the outdoors relates to the explosion of chronic health conditions from allergies, eczema, asthma, other autoimmune, gastrointestinal, cardiovascular, neurologic and psychiatric conditions as well as cancer. While the microbiome isn’t the only factor at play, it seems to be up there with genetics and environmental factors when it comes to human health and illness.  There is still much to be learned.
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These three are constantly interacting with one another.

So, what are those beneficial bacteria doing for us as we’re giving them room and board? It turns out a lot.

Protective Barrier - between our bodies and the rest of the world.
  • neutralize a number of toxic substances including carcinogens and metals from the environment
  • absorbs toxins produced by pathogenic/bad microbes
  • reduce ph - the acidic environment makes it difficult for pathogenic microbes to thrive
  • inactivate histamine 

Interact With the Immune System
  • helps the immune system respond appropriately to invaders through a number of cascading events. Without a healthy microbiome a person is immunocompromised, ie. more susceptible to infection, which sadly can mean more antibiotics and further disruption to the microbiome.  The result is a vicious cycle many are unknowingly living out.
  • prevent opportunistic/bad bacteria (which may be harmless in small numbers) from getting out of control.
  • helps the immune system distinguish between friend and foe so that the immune system isn’t inadvertently going after the body.  Think autoimmune conditions.

Integrity of the Gut Lining
Lack of healthy microbes can result in a permeable gut lining  - a “leaky gut”  - whereby infection, undigested food, toxins, or metals can get into the blood and travel to other parts of the body. The result can be a wide range of inflammatory conditions.

Absorption of Nutrients 
such as magnesium, zinc, selenium, copper, calcium, manganese, sulphur, phosphorus, iron, potassium, sodium, B vitamins, folic acid, fatty acids, and glutathione, to name just a few.

Synthesis of Nutrients
including many B vitamins, K and various amino acids.

Digestion
Without beneficial flora, we would be unable to digest carbohydrates.  Microbes help us to digest certain proteins - ie. casomorphines (from milk) and glutomorphines (from gluten).  If these proteins remain undigested and make it through a "leaky gut" they can interfere with brain and immune function.  In psychiatry, this has been studied in autism, depression, schizophrenia and explains why many with these conditions benefit from a gluten free and casein free diet.

Interacts With the Endocrine System 
which impacts how we respond to stress.

Interacts With the Nervous System
in a number of way.  One is by making certain neurotransmitters.  Less friendly bacteria can also make toxins/byproducts and inflammatory molecules that can negatively affect brain. This is why constipation or not having regular bowel movements is especially problematic for brain health.

Influences Metabolism  
Metabolism relates to how our bodies acquire energy for cells which allows us to grow, reproduce, survive and respond to our environment. Just one example - obesity is increasingly being understood as a result of gut flora imbalances.

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In short, an unhealthy microbiome can leave the brain (or any other part of the body) vulnerable to infection, toxins, metals and even undigested food particles that make it through the permeable gut lining and cause inflammation. Add to this an exaggerated stress response - ie. elevated stress hormones. Then add deficiencies of nutrients that play a role in the synthesis of neurotransmitters and deficiencies in antioxidants that protect the brain and things can get pretty complicated.

If within each of us is a world of microbes, what can we do to support the good guys who promote health and peace in that world and how can we prevent the problematic microbes from gaining too much power?  

Like many, I unknowingly killed off many healthy microbes when I took antibiotics for recurrent sinus infections a few year ago.  For me, a range of neurologic symptoms followed.  I believe the damage to my microbiome and the secondary nutrient deficiencies unmasked a genetic vulnerability.   Had I known then what I know now, I would've put my energy into improving my gut flora (and replacing specific nutrients) rather than further harming beneficial microbes.

Here's what I try to do now:

Be careful not kill off good microbes
  • avoid unnecessary use of antibiotics, acid blockers and anti-inflammatory medication. 
  • try to choose organic unprocessed foods free of pesticides, other chemicals and antibiotics, etc.
  • avoid being excessively clean

Increase the number of good guys
  • probiotic food
  • probiotics
  • prebiotics or prebiotic foods (ie. food for beneficial bacteria).
  • get outside in the dirt (For some that may be gardening, for other's - mud wrestling.)

Support the good guys through supporting diversity
  • instead of eating a typical Westernized diet which has been shown to lower diversity (and increase inflammation),  choose foods: high in various types of fiber (ie. a range of vegetables, fruit, nuts, beans, seeds).  Fiber gives the healthy microbes something to do.  Choose whole foods , ie. foods with the least amount of processing.  The more a food is processed the more rapidly that food will be absorbed high up in the gastrointestinal tract.  This translates to less work for gut microbes and they want something to do.
  • exercise has been shown to increase diversity of microbes.

Not lend support to the bad guys (lest they grow in numbers and crowd out diverse populations)
  • avoid sugar and refined carbohydrates (some experts would go as far as to say avoid grains all together).
  • don’t use artificial sweeteners which are being shown to impact the microbiome and seem to contribute to obesity. 


Aside from promoting health, our relationship with the microbiome can teach us about the destructive nature of fear in our lives. It encourages us to honor diversity in ourselves and in our world.  Lastly it is an ever present and humbling reminder that we are part of a miraculous natural world  - one we live in and that lives within us.



Note to Daughter: If You Feel Someone is Creepy, They Probably Are

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In these next couple weeks, as we help our children collect needed supplies for school and other activities, let us remember to have inner authority high on the list.  (I wrote this post for my other blog few years ago, but hope it is still useful now).

Reclaiming Inner Authority in a Hierarchical World Gone Mad
(November 10, 2011) by Courtney Snyder, MD

Last week I saw a clip from the Jimmy Kimmel Show in which he asked parents to post videos to Youtube of children’s reaction after they (the parents) tell them they've eaten all their Halloween candy.  From an overwhelming number of videos posted, Kimmel shared a few.  Why were those parents so up for a task in which they inflict emotional pain on their children, video tape it and share it with the world?   Who was so insensitive to them when they were children? 

“It was just a joke,” “Where’s your sense of humor,” “You’re no fun,” is how some might respond. Those  children likely hear these things (if not worse) when they express their feelings. The message sent and received, “Your feelings don’t matter.”   When children hear this enough, they eventually turn away from their feelings and themselves.  They'll likely teach the same to their children.  
This sick kind of “Pay It Forward” gets compounded by our broader culture of hierarchies.   The result of adults blindly following ranges from unfulfilled lives to utter destruction as is only starting to be uncovered at Penn State.  Such devastation requires more than a sick predator or predators and more than authority figures who value image (theirs and their institutions) over morality; it requires "normal" adults who listen to authority before they listen to themselves.

Considering the number of people who've turned away from their better judgment throughout history, it's easy to believe the world hasn't just gone mad, but has long been mad.   I have to believe there's a greater kind of 'Pay It Forward', where by listening to ourselves we show our children and those around us that they can and should as well.

Until about a year ago when my daughter would say she didn’t like someone, I’d be quick to defend that person (even if I agreed with my daughter).   “He or she was just being (whatever)," "They are just that way...", or "They didn't mean to..."   I said this out of fear that she might become disrespectful to adults - to authority.   Unknowingly, I was shutting her down.   As she (and I) have grown, I’ve learned that her perception  (like most children) about people is usually spot on and that she won’t be disrespectful to others - her father and I aren’t, even when we don't like someone.  I've learned that one of the most important things I can do as her mother is to listen to her – to her voice - the voice that will be her inner voice as she moves into adulthood.  

If my life were to end tomorrow, I'd hope I've done everything I could to teach my daughter to follow her heart - something I write about often.  But a happy and useful life isn't simply about following what brings you joy, it's about avoiding what brings you misery.  So to my writings, I have to add:

If you feel someone is creepy, they probably are.

If you feel someone is mean, they probably are.

If you feel someone is overly friendly, they probably are.

If you feel someone makes everything about them, they probably do.

If you feel that something is wrong, it probably is.

If you feel someone has hurt your feelings, they have. If you want them in your life, tell them how you feel. A true friend and loved one wants to know. The responses "You are so sensitive,"  "You're overreacting' or "I was just joking," are not acceptable.

If you feel someone is finding humor at your expense, they probably are.  Beware of people who enjoy practical jokes and hurtful sarcasm.

If you feel someone's feelings take up so much room that there's no room for anyone else's, they probably do.

Don't make excuses for other's behavior.

Beware of people and institutions that idolize and follow blindly.

Beware of people who care more about their image or their institution than they do about people.

If you find yourself in a relationship with someone who hurts your feelings and doesn't want to understand your hurt, don'
t tolerate it.  It will be up to them to self reflect, seek therapy or do whatever they have to. If you want to help them, know that the most helpful thing you can do is to not allow them to hurt you.  

If they don't change and they may not, move on.

Life is short.

There is an abundance of kind and loving people in the world.  You won't find them if you're wasting your life with those who don't know how to love or care.

The quality and value of your life will be determined not only by who you choose to spend time with, but by who you choose not to spend time with.  
Listen to your feelings and you will choose well.





Epigenetics, Methylation, MTHFR & the Brain, Made Easy...er

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Courtney Snyder, MD

Before I delve at length into the amazing process of methylation and it’s impact on personality and mental health, I'll lay some groundwork.  For those who don't need or want such background, I've tried to make it easy for you to hit the highlights or jump ahead to your own starting point. 
GENETICS

Genetics is basically the study of how parents pass some of their characteristics to their children.  Genes are the units by which this occurs. The job of a gene is to make a specific protein.  We have two of each gene -  one from our mother and one from our father.  Every cell in the body has the same genes, but only some of those are used/expressed in each cell.  This selective expression is what allows our brain to be a brain and our liver to be a liver and not the other way around.

Despite our incredible diversity, we all generally have the same genes as everyone else of our same sex.  We are only about 0.1% different from one another.  SNPs or Single Nucleiotide Polymorphisms are genetic mutations that developed over thousands of years. Of more than 10 million SNPs identified in the human genome, most of us have more than (but closer) to one thousand.  Those that are expressed explain some of our differences including our unique vulnerabilities to certain health conditions.   If you’ve ever looked at your SNPs, this can be a bit frightening.  For many, doing so can cause more harm than good.  Most of these mutations or SNPS are never expressed and have no significant effect.  Walking around mistakenly thinking you are destined for a serious or fatal health condition when you're not, can be problem.

EPIGENETICS

Until recently we believed our genes and mutations were written in stone.  We now know that during pregnancy, chemical bookmarks (methyl groups) can attach to DNA to enhance or inhibit gene expression in each tissue.  Environmental insults in utero can produce deviant bookmarks resulting in more serious conditions or birth defects.  Throughout our lives, a severe environmental insults can alter these bookmarks and produce an epigenetic disorder.  Such insults can be psychological/emotional (inadequate or disrupted attachment, trauma, severe stress) or physical (exposures to toxic metals, radiation, chemicals). This field of research is called "Epigenetics" and it is revolutionizing our understanding of cancer, heart disease, developmental disorders such as autism and psychiatric disorders all which seem to be epigenetic in nature.

With this comes good news - we have a degree of control over the expression or the turning on or off of our SNPs.  Many disorders previously thought of as genetic and untreatable, are actually epigenetic and treatable using certain nutrients that powerfully affect gene expression.  

METHYLATION

The most dominant factor in epigenetics is methylation.  This is a biochemical process, which occurs a billion times every second, and involves the addition of a methyl group to an atom or a molecule.  Meet methyl with it's carbon and three hydrogens:
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I'm including a "simplified" diagram below, only to make two points about the process of methylation:

#1 - It’s complicated 

#2 - There are number of genes (in colored boxes) which collectively determine how much methyl someone has.  Certain genes, including the infamous MTHFR, if expressed can result in undermethylation (not enough methyl), while others, such as CBS, if expressed can result in overmethylation (too much methyl).
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The most important methylation gene is MTHFR.  While having a mutation at the C677T location can result in someone having undermethylation, this isn't necessarily always the case. For example, I’m homozygous (have both genetic mutations) for MTHFR C677T, though I am much closer to being overmethylated. The presence of the genes matter less than whether they are or not they are expressed. What matters most is the net sum of all of the methylations genes that are being expressed. 

Accurate diagnosis of someone’s methylation status is essential for treatment.  A convenient and simple marker for methylation status is the whole blood histamine test.  This is because methyl is the primary mechanism for destroying histamine.  If you have a low histamine level, your methyl is too high.  If your histamine is high, your methyl is low. 

Aside from playing a role in whether or not our genetic mutations are expressed, methylation is essential for almost every system in our body, including:
  • repairing DNA
  • replenishing of compounds that our body uses to detoxify (to eliminate toxins from our body)
  • keeping inflammation (the bodies innate immune response) in check
  • maintaining stable mood and influencing our personality. This is due to the relationship between methylation and neurotransmitter activity. 

METHYLATION IMBALANCES

A database of 30,000 people by Dr. William Walsh, PhD (referred to by some as the father of methylation) found that 60-70% of people have normal methylation, 22% undermethylation (too little methyl) and 8% overmethylation (too much methyl).  Abnormal methylation doesn’t translate to mental illness.  Many highly successful CEO’s and athletes are undermethylated and many talented artists, writers and musicians are overmethylated.  Of individuals with behavioral or mental disorders, however, 70% have a serious methylation imbalance.  This is due to the impact of methylation on both genetic expression and on neurotransmitter activity.

Nutrient therapies for methylation imbalances aim to normalize methylation, which normalizes neurotransmitter activity, which can alleviate symptoms.   For example, methionine and SAMe are serotonin "re-uptake inhibitors" and thus increase serotonin activity at the receptor site.  Folate reduces synaptic activity of serotonin, dopamine and norepinephrine at the receptor site.  For me, as a psychiatrist, this is incredible.   For many struggling with brain related disorders, addressing methylation can mean never needing to start on medication. For others, treatment of a methylation imbalance can mean coming off or being on less or fewer medications.  

What has been both fascinating and satisfying for those of us who have trained with Dr. Walsh, is being able to often predict someone’s methylation status even before seeing lab results. 

UNDERMETHYLATION:    [Think low methyl, high folate and low neurotransmitters (serotonin and dopamine) activity.]

Symptoms & Traits:
  • Obsessive compulsive tendencies, ritualistic, perfectionistic, dietary inflexibility
  • Very strong willed, competitive at sports
  • Calm demeanor with high inner tension
  • High accomplishment or family history of high accomplishment
  • Seasonal allergies and high fluidity in eyes and mouth   (remember - high histamine)
  • Good response to serotonin reuptake inhibitors, ie. Prozac, Paxil, Zoloft, Celexa

The Incidence of Undermethylation:  
  • 98% of those on the Autism Spectrum
  • 95% of those with Antisocial Personality Disorder
  • 90% of those with Schizoaffective Disorder
  • 85% of those with Oppositional - Defiance
  • 62% of those with Anorexia 
  • 38% of those with Depression

Treatment: 
Nutrient therapies, which include methionine and/or SAMe, aim to increase methionine and increase serotonin activity.  Because folate reduces neurotransmitter activity and these individuals are already low in neurotransmitter activity, folate should be avoided.  In fact for better brain health, these individuals do better on a high protein diet (and thus high in methionine).  They should avoid supplements that contain folic acid.  
******Because multivitamins usually contain folic acid, they're problematic for many individuals with mental health symptoms.  They contain copper and copper overload too, is very common in brain related disorders.

OVERMETHYLATION:   [Think high methyl, low folate and high neurotransmitter (serotonin, dopamine and norepinephrine) activity.]

Symptoms and Traits:
  • High artistic or musical ability
  • Hyperactivity, high energy, verbose 
  • High empathy for others, good neighbor, noncompetitive in sports
  • Food and chemical sensitivities, but absence of seasonal allergies and dry eyes and mouth
  • Adverse reaction to SSRI’s (Prozac, Paxil, Zoloft, Celexa, etc.) as well as Methionine and SAMe

The Incidence of Overmethylation:
  • 64% of those with Panic Attacks
  • 52% of those with Paranoid Schizophrenia
  • 28% of those with ADHD
  • 18% of those with Depression

Treatment:
Nutrient therapies aim to increase folate and thus lower what is high neurotransmitter activity. Most important is folic acid, which reduces neurotransmitter activity. Niacine/niacinamide also lowers dompamine activity. These individuals will do better with a high folate diet (veggies and fruit) as opposed to a high protein diet.

THE FUTURE OF PSYCHIATRY

Knowing that someone is depressed or psychotic or manic doesn’t tell you if they are undermethylated or overmethylated. It also doesn't tell you if they have copper overload, metal toxicity or pyrrole disorder - the other common biochemical imbalances.  If everyone with depression took an antidepressant that raises serotonin activity, those with undermethylation would likely have significant benefit, however, those with overmethylated would likely get worse. Tragically for some, this can mean suicide or even homicide. Currently in conventional psychiatry, there's no specific way to know who those people are. Dr. Walsh's biochemical approach removes that guess work. His database and research informs physicians on how to evaluate and treat methylation disorders (and other nutrient imbalances) using targeted nutrient therapies.

The fact that many conventionally trained psychiatrists are testing for MTHFR C677T and using the highly promoted methylfolate (Deplin) show that the psychiatric field is starting to grapple with these important concepts. However, adding Deplin to an antidepressant is missing the mark. Some may benefit; many will not and some will get worse. Again a mutation at the MTHFR gene doesn't tell you someone's methylation status.  Also, if someone is undermethylated and depressed and likely low in serotonin, they can become more depressed if given more folate.   To quote Dr. Walsh (from an interview on the ACN website)

"... blindly using methylfolate (Deplin) for patients with C677T MTHFR or other weakened enzymes can produce negative results in patients afflicted by low serotonin activity. Folate supplements including Deplin tend to drive serotonin activity even lower.... The bottom line is that methylfolate and other folate supplements are very effective in enhancing methylation for autism and other conditions that are not dominated by low serotonin activity."

***
Thank you for sticking with this lengthy post.  My hope with some of these early articles (ie. on the microbiome, nutrient therapies and copper overload) is to provide resources and background for those wanting to better understand these complicated issues. Having done this, I look forward to more specific and shorter posts. 

Until then,
Courtney

If you'd like to go deeper into these topics, I recommend the following book and youtube videos:

Nutrient Power: Heal Your Biochemistry and Heal Your Brian - book by William Walsh, PhD

The Role of Methylation and Epigenetics in Brain Disorders - video presentation by William Walsh, PhD

"MTHFR and Mental Health: Understanding the Overall Effect of Individual Genetic Mutations SNPs" - video presentation by Dr. Albert Mensah

If you're looking for a physician trained in this area or are a physician interested in training, visit the Walsh Research Institute.



5 Minutes a Day

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By Courtney Snyder, MD


I never like to hear, “You should….," Whether it’s a well intended friend, or a facebook link on how to “IMPROVE YOUR HEALTH IN JUST 5 MINUTES A DAY.”    The suggestion that anyone knows the right answer for all of us is annoying. When it comes to health and happiness, there's no one size fits all.  Some of us need more protein, some of us need more vegetables; some of us need to minimize toxic exposures, some are less vulnerable; some us need more routine, some of us need more spontaneity; some of us need more self care, some of us need to give more of ourselves; some of us need better boundaries, some of us need more intimacy.  Within each of us is a knowing of where that balance is.  The trick is being open to new information, while trusting and listening to that knowing part of ourselves.

All that being said, I do believe that whoever you are, IF YOU DO THIS ONE THING FIVE MINUTES A DAY, IT WILL IMPROVE YOUR HEALTH AND HAPPINESS! If you think you just heard the enthusiastic voice of the television spokeswoman selling the latest exercise gadget, then you've heard correctly.
For the exercise I'm promoting, you just need a piece of paper and something to write with.  List five things you are grateful for at the end of each day - something that happened, something you saw, something you ate, or felt, ...someone’s expression.  Stop there, expand on those items or send a thank you note to someone involved.

The link between gratitude and happiness and health may be obvious for some, but for many of us, having that motivation to take five minutes requires science...hard science.  Positive psychology is the scientific study of those who are thriving.  Some of the strongest research in this field has been done in the area of gratitude. Robert Emmons PhD, at UC Davis, is the world's leading scientific expert on gratitude. He and other researchers have found consistently and overwhelmingly that those who use very simple gratitude practices are:

  • Physically healthier - ie. they have stronger immune systems, lower blood pressure, improved sleep, better self care and exercise more.  
  • They have more joy, optimism and are more alert.  
  • In their relationships, they are more helpful, generous, compassionate, forgiving as well as more outgoing and less isolated.  

Gratitude is simple and accessible.... to everyone - not just the enlightened or the religious.  It is part of the human experience - just as eating, moving and sleeping are. If this sounds like an exaggeration, consider the daily life of someone who is ungrateful. Really think about their physical and emotional health and their relationships.  That kind of life is not what nature intended.  While most religions have gratitude practices built in, you don’t have to believe or even consider a higher power to know that many, if not most, of the good things in our lives, lie outside of us and are either given to us by others, or by nature (or beyond depending on our beliefs).  While gratitude is joyful, it is also a humble reminder that “it’s not all about us.”   
Gratitude elegantly connects our mind and body. The simple act of writing down 5 "grateful's" doesn't just lift our mood, it's rewires our brain.  We start to scan our days, our world and our lives differently. There are plenty of us who can excel at identifying, judging and picking apart all the negatives in our days.  But are those the neuronal connections that we really want to be strengthening?  If you do tend in this direction, you may want to “Fake it ‘til you make it” and practice noticing the good in your life. Give this practice at least 4 weeks for it to become habit - for those neuroplastic changes to occur.... then keep doing it.

Helping a child create this habit will serve them now and into their future.  It may even save their life. Share "grateful's" at dinner, at bedtime or write them down and put them in a glass jar to serve as a reminder that life is about abundance - not scarcity.  Let this practice remind them and you, that life is a gift.

Below is a 10 minute interview of one of my medical school professors before his death.  Dr. Frank Kretzer lived a life of gratitude - one that many of us will forever remain thankful for.  


(The lines he's referencing are from Lord Alfred Tennyson.)

“Flower in the crannied wall,
I pluck you out of the crannies,
I hold you here, root and all, in my hand,
Little flower—but if I could understand
What you are, root and all, and all in all,
I should know what God and man is.” - neuro

Pyrrole Disorder - Shyness, The Irish and The Mind-Body Connection

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By Courtney Snyder, MD

Historically we've considered mental health and illness as coming from either one's life experiences or coming from one's genetics or biology.  We've mistakenly considered the mind separate from the brain and the brain separate from the rest of the body.  We are more interconnected than those outdated views suggest.  Our physical health impacts our brain health. Likewise, we experience emotions (fear, anger, sadness, and joy) not only in our brains, but in our bodies.  Emotions influence our brain's biochemistry, and our biochemistry impacts our emotions and how we experience our lives. 

PYRROLE DISORDER

A perfect example of this is Pyrrole Disorder - a biochemical abnormality that causes the overproduction of 
pyrroles.  Pyrroles are a metabolite of hemoglobin (a protein in red blood cells that carries oxygen throughout the body).  Pyrroles are not a problem and do not cause disease.  We all have them. They do however, bind Vitamin B6 and Zinc.  When pyrroles leave the body (through urine), they take some B6 and zinc with them.  This is not a problem either.  The problem comes when pyrroles are being overproduced for genetic reasons or because of physical or emotional stress.  This can lead to severe B6 and zinc deficiencies.  
B6 AND ZINC

While there aren’t many nutrients that seem to directly affect neurotransmitters and brain functioning, zinc and B6 are two of the biggies.  B6 is needed to make the neurotransmitters Dopamine, Serotonin and GABA in the brain.  Zinc also a great impact on the brain (and deserves a blog post of it's own).  Separately, zinc is in important for the gastrointestinal and immune systems, both of which influence brain health.

CAUSES

As I mentioned, stress can cause an increase in the production of pyrroles. Anything from severe trauma to even lower levels of stress such as starting a new school or job or anything from an underlying medical condition to a cold or even a growth spurt can cause pyrroles to increase.

For some, especially those with more severe elevations, it's believed there’s a genetic component. Interestingly the Walsh Research Institute has found that Pyrrole Disorder is especially common in people of Irish and Scandinavian descent.  The reason for this is unknown. (That I'm of Irish descent (50%) brings Pyrrole Disorder particularly close to home for me). 

More commonly, however, high pyrroles are a result  of high oxidative stress.  Oxidative stress occurs when there is an imbalance between free radicals (molecules that can destroy cells or impair biochemical processes) and our bodies ability to detoxify them or to repair the resulting damage.  

Most brain related conditions involve high oxidative stress.  This is why Pyrrole Disorder is associated with Anxiety Disorders, Alcoholism, ADHD, Autism Spectrum Disorders, Bipolar Disorder, Criminal Behavior, Depression, Down's Syndrome, Epilepsy Tourette’s, Learning Disorders, Oppositional Defiant Disorders, Psychotic Disorders, Substance Abuse and Schizophrenia.  

Elevated pyrroles can be a result of these, but at the same time, can worsen these conditions. Pyrrole disorder is one of the handful of biochemical imbalances that affect brain functioning.  For example, in depression we may see undermethylation, overmethylation, copper overload, pyrrole disorder and/or metal toxicity.

From the Walsh Research Institute of over 30,000 patients:

ADHD - 18 %  (18% of individuals diagnosed with ADHD had elevated pyrroles)
Behavioral Disorders - 28 %
Autism - 35%
Depression - 24%
Bipolar Disorder - 35%
Schizophrenia  - 30%
Post-Traumatic Stress Disorder - 12%
Alzheimers Disease - 14%
Healthy Controls (no psychiatric symptoms) - 8%

SYMPTOMS

Most individuals with pyrrole disorder do not have all (or even most) these symptoms.  Some of these are more apparent in childhood; others are more obvious in adulthood.


Stress Control
  • poor stress control and avoiding stress because of low stress tolerance
  • socially anxious, shy or fearful (high inner tension) since childhood
  • avoiding crowds or larger groups
  • uncomfortable in new situations or with strangers
  • severe inner tension
Sensitivity
  • sensitive to sunlight and bright lights
  • sensitive to loud noises
  • sensitive to textures
  • sensitive to odors
Mood
  • irritability and/or temper
  • bouts of depression
  • obsession with negative thoughts
  • mood swings
Sleep
  • tendency to stay up late
  • little or no dream recall
Appetite
  • morning nausea
  • tendency to skip or delay breakfast
  • affinity for spicy and salty food
Learning
  • poor short term memory
  • reading disorder or history of reading disorder
  • history of underachievement
Nails, Hair and Skin
  • white spots on fingernails
  • premature graying of hair
  • very dry skin
  • acne
  • pale skin, inability to tan
  • psoriasis
  • stretch marks on skin
  • poor wound healing
Hormonal
  • delayed puberty
  • poor growth (or growth spurt after the age of 16)
  • abnormal or absent menstrual periods
Body
  • abnormal fat distribution
  • poor muscle development
Pain
  • “stitch in side” when you ran as a child, spleen area pain
  • joint pain
  • cluster or migraine headaches
Illness
  • frequent colds, infections or unexplained fever or chills
  • autoimmune disorders
Family
  • Irish or Scandinavian descent
  • for females - all siblings are sisters or having look alike sisters
  • for males - a mother with only sisters or having look alike sisters

Many of these including this last one - a preponderance of sisters in the family - can reflect zinc deficiency. For a woman to carry male offspring to term (and not miscarry), she has to have adequate levels of zinc (necessary for testicular growth).  Zinc deficiency can also cause infertility in men. Zinc supplementation has been shown to improve sperm count and sperm motility. And interestingly, men with lower sperm counts and slow sperm speeds have a greater likelihood of having daughters. Relative to fertility treatments, addressing a possible zinc deficiency may be a simpler way to get closer to the root of the problem.

EVALUATION AND TREATMENT

Diagnosis of Pyrrole Disorder is based on both clinical information as well as a urine test that measures kryptopyrroles.  Treatment involves a nutrient protocol that includes zinc, B6, P5P (a form of B6) , Evening Primrose Oil (Omega-6's) as well as antioxidants.  Though Fish Oil or Omega-3 fatty acids can be beneficial for many others, they can worsen symptoms in individuals with Pyrrole Disorder and should be avoided.  


No less important is addressing factors that may be causing high oxidative stress (ie. an underlying illness, diet, gut flora imbalances, intestinal yeast overgrowth, etc) or emotional stress. Psychotherapy, lifestyle changes, exercise, mindfulness, learning to prioritize and develop coping skills can all go a long way. Unaddressed stress, can leave a person persistently pyrroluric, and thus deficient in zinc and B6.  In some cases, such as during times of change, illness, and even growth spurts, stress dosing is needed.  This involves temporarily raising the dosages of zinc and B6/P5P.  

GOING FORWARD


Though first identified in the 1950's and first treated using zinc and B6 in the 1980's, Pyrrole Disorder is still relatively unknown. Until one year ago, I had never heard of it, though I'm sure in my previous practice, I saw many children and adults who would have benefitted from this understanding.  
For many of those who do receive treatment, a lifetime of chronic inner tension, anxiety and fearfulness can begin to change within a few days to a couple of weeks of starting the nutrients.  What was once impossible becomes possible. 


For more information, a lecture "Facts and Myths About Pyrrole Disorder"  is given by my mentor, Albert Mensah, MD.  He is an internationally recognized expert in the treatment of biochemical imbalances for brain related disorders.  If you are looking for a physician in your area trained in evaluating or treating Pyrrole Disorder or are a physician interested in training visit the Walsh Research Institute Resource Page.  (Practitioners knowledgable in Pyrrole Disorder are not limited to those trained at the Walsh Research Institute.) 

Sugar Spelled Backwards......

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​By Courtney Snyder, MD

...is Ragus - an Aran Island's word for 'desire' or 'urge.’  The Aran Islands are off the west coast of Ireland and have little to do with this post, except maybe to help draw in unsuspecting readers.

Like me, you may wonder,... "Who really wants to read about the problems with sugar?"

Over these past four weeks, I considered many approaches:

I’d be inclusive and point out that despite great individual variability in how our bodies react to foods, science is showing that limiting or avoiding sugar makes good sense for...well...pretty much everyone.

I thought I’d be investigative - I’d give an excessive list of names for hidden sugar on food labels.  I’d give examples of how much sugar is in “savory” foods - ie. 1/2 cup of tomato soup has 3 tsp. of sugar.  For those into calculations, 4 grams = 1 tsp.

Maybe I’d go all conspiracy theory - I’d focus on the seemingly coordinated effort between the US Government and the food and pharmaceutical industries who sit regularly around conference tables discussing effective strategies for destroying human health for profit. 

Maybe some would rather fear the fine white crystals themselves - I’d focus on the addictive qualities of sugar  - how sugar hijacks the reward centers in the brain - not unlike heroin and cocaine.  I’d talk about how if you give cocaine addicted rats, the choice between sugar and cocaine (which you probably won’t do even if you knew any cocaine addicted rats), they go for the sugar.  

But if you’re reading this, while noshing on halloween candy, you already know that the more you eat, the more you crave, the more you eat, the more you crave…..You don't need a rat.

Isn’t research really the most convincing, though?  So I started collecting the studies on the relationship between elevated blood sugar and the brain for those who might enjoy excruciating details about how sugar seems to keep brains cells from communicating with one another or how elevated blood sugar levels are well associated with cognitive decline and dementia. 

Still, all this can be difficult to focus on, especially if one’s blood sugar is well up there.

Besides, it’s not just about the brain.  So I thought I'd broaden the discussion and explain why many are saying sugar and refined carbs are the major drivers not just in dementia, but in most chronic health conditions - ie. heart disease, diabetes, obesity, autoimmune disease, cancer, psychiatric conditions (ie. depression, anxiety, ADHD, etc).

I’d explain how the trillions of gut microbes in our gut happily reorganize themselves to accommodate a diet high in sugar.  Certain microbial populations begin to flourish (including fungi like candida/yeast), while others start to shrink...all leading to a microbiome lacking in diversity  and if there’s one thing pretty well known about the microbiome -  DIVERSITY MATTERS. And that lack of diversity seems to contribute to INFLAMMATION and AUTOIMMUNITY ….(by creating a perfect storm of leaky/permeable gut, exaggerated immune response, nutrient deficiencies and exposure to toxins including those made by some of those pesky microbes).

Weeks into this and curious why I hadn't pulled all this together, I realize ....what I have to say is not only annoying, it's not particularly useful.

In the world of health and nutrition, it's easily forget that sugar isn’t just sweet, it’s something that connects us to our family, our friends...our communities.   We celebrate holidays, birthdays and life with sugar.  

Avoiding or even limiting sugar is a huge challenge.  I know.  My own avoidance of sugar has affected my relationships and celebrations. As much as that stinks, the benefits for me have outweighed the losses. Being chronically sick, in pain and exhausted negatively impacted my life and relationships much more than forgoing sugar has.

Many who are struggling with health issues and/or sugar craving already know there’s a problem.  Their body is or has been telling them.  Though some can benefit from specific interventions for dysbiosis (that imbalance of gut microbes), ....what they and other struggling need is simple... They need a family member or friend or group of people who are trying to improve their own health through nutrition - the most basic of which is limiting sugar.  

Our culture offers little support for those striving for healthier lives.  Especially challenged are parents trying to improve their child’s health (and microbiome which may be poor for a variety of reasons including cesarean section birth, antibiotics, etc.) Well intended family members, teachers, coaches and even bank tellers with lollypops can unknowingly create stress (or illness) for that child. 

So, perhaps the only thing this post really needed to say was,….”If you do one thing to promote your health and healing or your child’s, make sure you don’t do it alone.  Look for ways to connect regularly with another person who is trying to do the same and who wants you to succeed.” 

Keeping it Simple (& Child Friendly) in the Kitchen

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Courtney Snyder, MD

​Though steeped in nutrition professionally and personally, I don't like to spend a lot of time in the kitchen. Most of what I prepare has very few ingredients, though the ingredients are whole (unprocessed).  And most of my food preparation has very few steps.  I'm hoping my culinary limitations, which I've honed over these past few years, will be useful to someone else.

Before getting into the below "recipes", I should add,
I believe...
  • Eating is personal.  Food carries individual meanings for all of us.  We need to move beyond "good" and "bad."
  • Sharing solid information about the relationship between food, nutrients, the micro-biome, and their relationship to inflammation in the body (and brain) have more impact than telling someone what to do.  
  • There's not a perfect diet for everyone.  We're all different.  Some of us have difficulties regulating trace metals in food, some - methyl/folate imbalances, some (probably all of us) - imbalances in our gut flora, some - gastrointestinal candida/yeast overgrowth, some - histamine intolerance, some  - food allergies or food sensitivities.  Needless to say, the below recipes won't be for everyone.  
  • Too, when it come to ingredients, we're all at a different places - ie. conventional, organic, grass fed, etc.  Start with what works for you at the moment.   There's no perfection here...or anywhere else for that matter.   
  • Changing what we eat is a process, one that requires replacing food, not eliminating it.
​And lastly,
​I believe...
  • Celtic sea salt is magic.  When asked, "What did you DO to this chicken"  My answer, "Salt....celtic sea salt."
My "must have" kitchen gadgets -
  • a Nutribullet  or similar for making nut butters, nut or non-gluten grain flours, avocado dip, plantain tortilla chips.
  • a dehydrator for drying nuts (I soak them first - for how and why to prepare nuts, see my Dec. 8n Facebook post)

​All of these recipes are gluten free, all but one (the ranch dip) are casein free.  None of these recipes use grains (unless you replace nuts with gluten-free grains) and therefore would be relatively consistent with the GAPS diet and the SCD diet - diets that avoid grains.  Many of these recipes would also work with a Paleo Autoimmune Diet and most, (except those with banana, honey or yogurt) would work for a candida/yeast free diet.
Chicken Wings
  • spread out cut wings in glass pan
  • sprinkle celtic sea salt & lemon juice (or Vitamin C powder)
  • cook at 375F for 1 hr
Plantain "Tortilla Chips"
  • 3 plantains, 2 T coconut oil & 1/4 tsp salt 
  • process into a paste and spread thinly on parchment paper on baking sheet, use knife to make squares
  • cook at 400 until crispy (25 min). 
Steamed Veggies
  • put cut broccoli or whatever in metal strainer on top of pot filled with 2 in. water
  • cover with lid
  • boil water to steam as long as you want
  • sprinkle with salt & lemon juice (or not)
Apple Crisp
  • peel, slice & add cinnamon & lemon juice to 6 green apples.
  • put in glass square pan with sm. pieces of butter/ghee - 2T
  • sprinkle clumpy mixture of ground pecans, butter, cinnamon, salt and stevia (to taste)
  • cook at 350 covered for 30 min, uncovered for 15 more
Carmel Candy
  • stir 1 C butter & 1 C honey constantly over medium heat (it will come to a rolling boil)
  • Stir for 10 minutes
  • pour into glass pan(s), cool at room temp, cut into small pieces
Wrap Ups
  • serve large pieces of lettuce with:
  • small bowls of ground meat, diced or roasted chicken, chopped hard boiled eggs, tomato, cucumber scallions, avocado, ranch or avocado dip
Roasted Chicken
  • whole chicken in crock pot
  • celtic sea salt & pepper (on it)
  • cook - high setting 6 hrs
Chicken Soup/ Broth
  • 3 leg with thigh pieces in lg. pot
  • cover with water
  • celtic sea salt & pepper
  • once boils, put to simmer - 2.5 hrs
Chicken "Noodle" Soup
  • Add spagetti squash to chicken soup (remove bones if you don't like a big leg bone in your soup)
Vegetable Soup
  • add garlic and cut veggies (leak, carrots, broccoli, zucchini, etc.) bring to boil and simmer for 25-30 minutes
Bread/Muffins
  • Mix 3 C ground nuts, 1/4 C soft butter or coconut oil, 4 eggs, 1/4 tsp salt
  • Cook in greased loaf pan or at 300 for 1 hr
  • Last night I ground quinoa and millet into flour to use instead of nut flour and added an extra egg and it worked.  
"Spagetti" (Squash)
  • cut off stem end & then cut in half
  • scoop out seeds
  • cook face down on baking sheet at 375 for 25 min. or until fork just pushes through skin
Meat Balls
  • mix ground meat, egg, celtic sea salt, garlic*
  • make into balls
  • cook in covered skill with broth or water
  • cook uncovered to brown outside
Spagetti Sauce
  • Simmer tomatoessalt, garlic (granules or minced), oregano, basil, butter/ghee/olive oil in pan on stove top for as long as you want
Broiled Veggies 
  • put diced butternut squash, onion & green apple  OR cauliflower and orange pepper or asparagus on baking sheet,
  • sprinkle with olive or coconut oil, salt and pepper
  • push around periodically
  • cook at 375 until it's how you like it
Banana Bread
  • Do bread recipe over there​<<<<
  • add in 2 mashed bananas, 1 tsp cinnamon and 1/3 cup honey or less and/or add stevia to taste. 
Cookies
  • Mix 1 cup pecan butter, 1 egg, pinch of salt, stevia or honey to taste
  • cook at 350 for about 10 min
Ranch Dip
  • Whole yogurt
  • Mix in celtic sea salt, garlic granules, onion granules and pepper to taste
  • serve with cut cold veggies, diced chicken or wrap ups or use as a salad dressing.
Avocado Dip
  • avocado, lemon juice or Vit. C powder & celtic sea salt
  • blend in processor
  • serve with diced chicken, cold cut veggies or with cubed chicken breast
Cubed Chicken for Dipping
  • cook diced white meat, little butter/ghee & celtic sea in skillet until brown (may cover initially to get inside cooked
  • serve with avocado or ranch dip
Fries
  • Cut sweet potato, rutabaga or butternut squash into sticks.
  • Cook at 375 on baking sheet with 1 Tb coconut oil & salt until crispy.  Toss periodically.
Pancakes/Waffles
  • mix 3/4 C nut butter, 1/2 C pureed zucchini/other squash/plantain, 3 eggs & salt to taste (add more eggs if want thinner)
  • cook in skillet in butter/ghee/coconut oil
Lemon Ice
  • lemon juice & a little stevia over ice cubes
  • blend with Nutri-bullet into a snow consistency

​After each of these, I would add..."or something like that."   Use these as ideas, experiment and make them your own.  
 

Purpose and 'Our Fleeting Moment Here on Earth'

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Courtney Snyder, MD

Purpose, Healing and Happiness

Whatever language, symbolism or religious framework we use or try not to use, many of us believe there's a reason each of us are here ...at this time, in this place and with these people.  Though I think a lot about the details of health, I fall short on the bigger picture of healing if I forget that our wellbeing depends on much more, not the least of which is having a deep sense of purpose in our lives.

Purpose can energize us. It is a reason to do the hard work; to get out of bed.  It lowers stress and it’s associated physiologic responses. Futility is stressful.  So is incongruence - the mismatch between our natural abilities and passions and what we’re actually doing. With purpose comes a clarity about what and with whom we want to spend our time. 
Where to Find It
Perhaps one of our jobs in this lifetime is to figure out our purpose.  What are we uniquely suppose to bring to the universal table? Some of us have known our purpose from childhood.  Some of us, only after slowly peeling away the layers. For some, this work will take a lifetime.  Others may never seek it out or hope someone else will.  Yet, there’s no family member, friend, colleague, therapist or even guru that knows where our unique purpose lies.  While there are many useful psychotherapeutic models, many won’t directly speak to purpose in our lives. Exploring wounds, identifying and expressing feelings effectively and identifying certain thought patterns and learning alternatives are all very important.  But, if “What are you doing here…in this world, right now?” isn’t being asked, then opportunities for deeper healing and happiness are being missed.  

Celebrating the Ego
It takes effort to resist the predominant cultural mindset which values achievement, wealth, appearances and getting ahead.  This ego driven existence starts early.  We put our youngest of souls into the rat race, never considering how to help them unwrap their greatest gifts - gifts that were intended not just for them (and their families), but for the larger whole.

But for the ego (a/k/a fear), there'd be no trick to leading a life full of purpose.  The ego asks, “What will they think?” and “What will they say?”  ...Whoever they are..., the ego assures, they will judge. We respond accordingly, follow the “should's,” avoid the failures and follow the ego down an empty path. We hope the approving pats on the back will sustain us.  They never do.

Crisis
Unless we find ourselves in a crisis - a loss, a death, illness or the possibility of our own death, we often don’t listen to a deeper part of ourselves.  If crisis doesn’t come, middle age will -  parents will age or die, children will become less dependent, and the self-important work will start to feel unimportant.  Ladders to climb are replaced with mortality and the inevitable question, “Is this all there is?”  

The Soul Laughs
Our soul loves all this upheaval.  Only then can it's questions be heard.  “What are you bringing to the world?”  “Why do you matter?” The soul wants to take us to a more satisfying form of happiness - one that accepts that suffering and hard work are part of the gig.  The soul doesn’t avoid the human condition. It wants us to get over ourselves and not worry about perfection. It laughs at approval.  The pats on the back mean very little except when they convey genuine human connection.  The soul believes we’re here to get some things done, to love the other souls we connect with along the way and to have gratitude for all that life has to offer.  

Service
So what if the soul has it right?  What if it’s not about us?  What if it’s not about what we can get, but what we can give?  What bold and fearless risks would we take if fear/ego wasn't holding us back?   What if instead of waking each morning with taxing thoughts of stress and worry, we thought instead about how we can bring whatever we have to others.  This might include saying hello to a stranger, caring, teaching or loving another person, creating something that will change millions of lives for the better or maybe it involves focusing on our own healing, so we can get well and help other’s who are suffering. Unfortunately, it takes scientific research to tell us what we already know -  that the act of giving and doing good deeds has positive impacts on health and happiness.  

An Intentional Shift
While a crisis can shift us to a life of purpose, so can the daily practice of asking questions like:  “Why am I here?” “Why do I have this goal?”  “Is this choice ego driven or soul driven?”   Keep in mind self care is usually for the greater good.  

A practice I do is to write down 2 lines each morning about how I hope/intend to bring whatever it is I think I have to offer.  Similarly, at the end of the day, I jot down a couple of thoughts on how I think that went. Not unlike a daily gratitude exercise, this practice can create neuroplastic changes (changes in the way our neurons are connected) and in doing so, move us to a different way of thinking about our days and life. 

Inspiration
Inspiration for me has come in many forms, but mostly from those people who humbly and with a quiet confidence live out impactful lives. Those are the people, I think, the world desperately needs.  I think the world is waiting for us to be those people.




Dietary Recommendations & The Meaninglessness of "Good For You" Foods

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Courtney Snyder, MD

​We’re not necessarily the same animal we once were.  And, in many respects, especially when it comes to food, we’re increasingly different from one another.  Describing a particular food (or nutrient) as “good” for you, depends on who “you” are.  Due to our varied experiences, exposures (ie. to antibiotics, toxins, etc.) and genetics, we’re not all the same.  The latest superfood may benefit some, but it may make others ill.  Our complicated relationship with food can’t be discussed without considering inflammation, oxidative stress and epigenetics - the three exploding areas of medical researc
h. 
The Microbiome, Inflammation & Food:
Inflammation is what happens when our bodies mount a protective response against an invader or trauma - ie. like when you get an infection or cut your finger.  It’s all good, unless of course the immune system starts attacking things that aren’t necessarily dangerous.  The result is damage to the body and brain, which we think of as autoimmunity. 

You can’t consider this type of inflammation without considering the microbiome - the trillions of microbes, viruses and fungi that live in and on us.  When the microbiome is thrown out of balance (i.e. by antibiotics, stress, diets high in sugar and carbohydrates) inflammation ensues. Without a diversity of beneficial microbes lining our gastrointestinal tract, it can become porous or “leaky” and allow into our bodies food particles the immune system doesn’t recognize.  The result is an inflammatory response that can persists and lead to chronic health problems.

The part of the body hit the hardest is usually impacted by our genetic (and epigenetic) vulnerabilities.  For you it might be the joints (rheumatoid arthritis), for me maybe the protective covering on the nerves (multiple sclerosis), for someone else the lining of the gastrointestinal tract (Crohn's or ulcerative colitis). Though rheumatologists, neurologists and gastroenterologists address these separately, many, if not most people with autoimmune disorders have inflammation damaging more than one area of their body.  Often that part of the body is the brain.  The psychiatric field to date has not seriously addressed autoimmunity. Many with autoimmune conditions struggle with depression, anxiety, fatigue and “brain fog.” Likewise, many people diagnosed with a mood, anxiety or attention disorders, like ADHD, are unknowingly struggling with inflammation of the brain.   
 
So, what do you eat if you want to minimize inflammation in your brain and elsewhere?  You basically want to eat for your microbiome which means, eat foods that promote a diversity of microbes.  A diverse microbiome is a measure of health and a marker for longevity.  You want to eat a diet that promotes beneficial microbes and prevents the overgrowth of problematic ones.  Such foods are high in fiber (giving those microbes something to do)  and are “whole” meaning that little or nothing as been done to them. Consider processed food as partially digestedand more readily absorbed.  If you're a microbe you’d choose an apple over apple juice any day.  Foods high in refined carbohydrates (ie. the white stuff - bread, pasta, etc.) and sugar tend to feed and increase more problematic microbial populations that limit diversity and thus contribute to inflammation.  If you’re spending much time in the aisles as opposed to the periphery of your grocery, you’re probably getting a highly processed diet. 

We know the Western diet is low in fiber, highly processed, and high in refined carbohydrates and sugar.  We also know the typical Western microbiome has low microbial diversity. If we have a “collective consciousness,” it is undoubtedly being impacted by the fact that we’re collectively inflamed. 

When you hear about other specific foods that are considered highly inflammatory, imagine foods whose particles are more likely to cause an inflammatory response when there is “leaky gut.”  Think gluten, casein (in dairy), nuts, eggs, corn nightshades (potatoes, tomatoes, eggplant), etc. Many people with autoimmune symptoms or other symptoms of inflammation benefit from withholding these foods while they heal their gut and gradually reintroduce them to see which they tolerate and which they don’t.  For some, eliminating grains (as in the Paleo Diet) and minimizing the amount of natural sugars (ie. even from fruit) can also be necessary to bring down inflammation.  

Food & Oxidative Stress:
If you’re eating whole food, especially organic whole food, the issue of toxinssomewhat takes care of itself. Oxidative stress occurs when there’s an imbalance between free radicals (molecules that can destroy cells or impair biochemical processes) and our bodies ability to detoxify them or to repair the resulting damage.  If you read aloud the list of ingredients on the side of a box of processed food, you can be sure your ancient microbiome doesn’t know what you’re talking about either.   Our bodies were never intended to deal with pesticides, additives, preservatives, dyes, etc.  Even if toxins didn’t harm the microbes, many will make their way into the body and add to oxidative stress  - more so if the gastrointestinal lining has lost it’s integrity due to antibiotics or other insults.
 
There’s no way to completely avoid toxins in our air, water, food, and through our skin.  The best we can do, aside from staying calm and carrying on, is to limit those exposures.  Eating whole foods with the least amount of pesticides, antibiotics, and hormones can have a big impact.  Preservatives, additives and dyes and the like won’t need to be avoided if you’re eating whole food.  Sugar and highly processed oils (ie. vegetable oil, corn oil) are the most extensively studied foods that have been shown to negatively impact the brain by increasing oxidative stress. 

Just as we don’t all have the same integrity of our microbiome, we don’t have the same protective systems (ie. antioxidants) to defend against oxidative stress.  You and I can be exposed to the same toxins in the environment.  You may have normal development through your toddler years and I may regress into autism. You may thrive in your adult years.  I may get cancer.   Because of our genetic differences, to say a chemical, metal, etc. in our water, our food, our air or in our vaccines is safe is a bit ridiculous when you realize how different we are.  
Most people with brain related symptoms have high oxidative stress.  A “psychiatric” symptom can be the first indicator of problems emerging elsewhere in the body - problems that may not become evident for years.  Psychiatric medications do not address root cause.  If a child is truly hyperactive, impulsive and can’t focus, there’s something wrong - the child isn’t well.  You can decrease a child’s symptoms with medications, but that doesn’t mean you’ve made the child well.  

Food and Epigenetics:
We’re all amazingly similar in terms of our genetic makeup except for somewhere around one thousand plus single nucleotide polymorphisms, many of which can determine how vulnerable we are to certain diseases. While we’re all walking around with our own collection of these, most will never be expressed. The “expression of our genes” refers to epigenetics.  While our DNA can take centuries to change, an epigenetic event (ie. the turning on or off of a gene) usually happens in an instant as the result of an environmental insult such as trauma, a toxic environmental exposure or even a significant change in the microbiome. 

Most forms of cancer, cardiovascular disease and psychiatric conditions are epigenetic.  The biochemical process that drives epigenetic expression is called methylation.  To oversimplify, methylation relates to how much methyl we have. This can impact how tightly or loosely DNA is coiled.  This degree of uncoiling (which is impacted by nutrients) impact the expression of our genes.
 
Dr. William Walsh, PhD of the Walsh Research Institute discovered that 70% of individuals with psychiatric conditions have a methylation imbalance - ie. too much methyl (overmethylation) or too little (undermethylation).  While we can impact such imbalances with nutrients, diet is important as well.  Those who are undermethylated benefit from more protein (a source of methyl) and less folate as in leafy greens, while those who are overmethylated (and folate deficient) benefit from more of a plant based diet that is higher in folate and lower in methyl. When Shakespeare said, “One man’s meat is another man’s poison,” he could have said, “One undermethylated person’s meat (with all it’s methyl) is an overmethylated person’s poison.  

Food Intolerance & Other Food Challenges
We’re all aware that some people will have full blown allergic reactions to certain foods, such as nuts, shellfish and eggs.  And, as I mentioned , if someone has “leaky gut’ they may have inflammatory reactions to a number of foods. Still, challenges around certain foods can get much more complicated.  

I commonly see people with copper overload or toxicity which can cause an array of psychiatric symptoms. Trace metals like copper or zinc are occur naturally in our bodies and food.  Copper can be high because of excessive exposure.  More often, however, it seems to be due to high oxidative stress and/or genetic factors. An antioxidant in the body which regulates trace metals can be overwhelmed by oxidative stress or simply not be working up to speed because of a genetic vulnerability.   Foods especially high in copper include chocolate and shellfish.

Some individuals can struggle with an overgrowth of candida - a fungus that occurs normally in the gastrointestinal tract which can over grow after antibiotics. This may cause reactions to a number of foods, including those that are the products of fermentation (ie. alcohol, coffee, aged cheese, soy sauce, etc.), malt, as well as sweets or other foods high in carbohydrates. 

Others may have problems with foods that are high in histamine (again foods that are products of fermentation, but also avocado, lentils, strawberries, to name a few).
  
One food issue that (for those susceptible) can significantly be made worse by “healthy” foods and juicing relates to foods high in oxalates.  There are a number of people struggling with fibromyalgia, chronic fatigue, vulvodynia (chronic pain or irritation of the vulva) or autism who unknowingly have problems with oxalates which combine with calcium to form crystals. Though oxalates are associated with kidney stones, they  seem also to store up and wreak havoc in other parts of the body for many who will never have a stone.  The cause in most cases seems to relate to the loss of a particular microbe (due to antibiotics) that would normally break down oxalates. Foods high in oxalates are some of the notoriously healthy ones like spinach, raw carrots, raw celery, kale, sweet potatoes, quinoa, blackberries, and nuts to name a few.
​                     ​

So whether it’s methyl, folate, copper, candida, histamine, oxalates or whether it’s food allergies or sensitivities or any of the food related issues I didn’t mention, know that we’re not all the same.   As you can see, our genetics, oxidative stress and an alteration in the microbiome can create complicated and overlapping food issues.  If you've never had such problems, be grateful, and be compassionate with those who do.  Don't take it personally when someone won't eat that amazing dessert you created. And, if you're that someone who's starting to recognize the relationship between what you eat and how you feel, know that usually with careful investigation many of these issues can be figured out.  Thanks to the evolving research and greater access to information, there are growing numbers of people finding symptom relief, improved functioning and even restored health. First, however, they had to let go of the idea that there is one way to be.  They had to let go of the idea of super foods, super diets and super anything else.  We're more complicated than that.


Lunch with Dr. William Walsh - His Story, Discoveries & the Future of Nutrient-Based Psychiatry

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Courtney Snyder, MD

I first met Dr. Walsh in the fall of 2014, at his second physician training course here in the US.  At the time, I was uncertain how useful nutrients would be in my psychiatric practice.  What I learned seemed too good to be true.  Upon returning home, I gradually began evaluating and treating specific nutrient imbalances in adults and children with depression, ADHD, anxiety, bipolar disorder, autism spectrum disorders, and so on. To my repeated surprise, most patients - children and adults alike improved… significantly - some dramatically, including those whose symptoms had failed to respond to other treatments.  
My interest grew. I wanted to learn more about Dr. Walsh’s story, his discoveries and his thoughts on the future of psychiatry.  I also wanted to express my gratitude.  Aside from the impact on my career, Dr. Walsh’s work has been pivotal in my own healing, and my daughter’s.  Lastly, I wanted to understand how those of us trained (now around 150 in the US and 500 internationally) might raise the visibility of his work, so more doctors could learn and more people could benefit.  This article is my attempt to do that.  Dr. Walsh generously met with me over lunch in Naperville, Illinois, not far from his office.  

***

If we are given three acts to live out our lives, Dr. Walsh has and continues to use each to it’s fullest potential.  His story is one of relentless curiosity, hard work, and fruitful collaborations.  As I spoke to him in this less formal setting, I came to appreciate his deep sense of purpose and compassion - a compassion born out of his own painful experiences involving family members who significantly benefitted from nutrient therapies.  

Dr. Walsh started on his professional path at the Institute of Atomic Research at Los Alamos Scientific Lab before obtaining his PhD in chemical engineering….not medicine…. not neuroscience...and not nutrition. Like many pioneers, his “outsider” background provided him a fresh perspective - one unencumbered by conventional thinking.  

He went on to Argonne National Laboratory and with an interest in crime and violence, began volunteering at the Stateville Penitentiary in Illinois.  There he eventually led 125 volunteers and launched an ex-offender program.  It was through this program, he met prisoner’s parents who would plant the seeds of his earliest discoveries.

Many of the prisoners, he noticed, came from well functioning families, not families struggling with trauma, poverty or other adversity.  Some parents recalled knowing there was something wrong with their child as early as the age of two.  They had other children who were thriving.  Why are some more vulnerable to criminal behavior from their very beginnings?  

With this curiosity, Dr. Walsh met Carl Pfheiffer, MD - at the time, the world’s leading expert in nutritional science.  On they day they met, Dr. Pfheiffer nominated for the Nobel Prize. They would collaborate for the next 12 years.  Dr. Walsh brought ex-convicts just out of prison, Dr. Pheiffer analyzed their biochemistry and together they developed individualized treatment programs.   

By 1989, Dr. Walsh, along with physician colleagues, opened the Pfeiffer Treatment Center, where they began using Dr. Pfeiffer’s nutrient therapies to treat violent behavior in children.  When coexisting ADHD symptoms and even learning problems started to disappear as well, they expanded their work, eventually to include depression, anxiety, bipolar disorder, schizophrenia, autism (and in more recent years Alzheimer's and Parkinson's).  In 18 years, they evaluated and treated 30,000 patients.  This resulted in 3 million chemistries -  the world's largest database on nutrient levels in individuals with mental disorders.  Within this, were nutrient levels on more specific populations, ie. 3600 individuals with depression. Dr. Walsh has seen 6500 autistic children, more than anyone in the world.  His database even includes 25 serial killers and mass murders.  He’s  assisted the FBI and Scotland Yard and has designed nutritional programs for Olympic and professional athletes.

Though there are more than one thousand nutrients important in the body,  Dr. Walsh found, as he says, "..only about six or seven ...seem to have a dramatic impact on mental health. I used to be bothered by the fact that the same chemical imbalances kept turning up in different conditions.... It turns out that each of these nutrient factors is directly involved in either the synthesis or the epigenetic regulation of a neurotransmitter in the brain. That was really good news. If we had to study over 200 possible chemical imbalances and cor­rect whatever we found, designing treatments would be very difficult. Fortunately, we can focus on six or seven nutrients, and by balancing them, we can help most people with mental disorders."  

But, there was more,   Dr. Walsh discovered that most types of psychiatric conditions are epigenetic, meaning they involve a sudden change not in the gene itself, but in the functioning of a gene(s).  Epigenetic conditions typically don’t go away.  This change in functioning occurs as the result of an environmental insult either in utero or later in life.

Dr. Walsh's work has yielded more discoveries than will fit in this article.  Here are a few:


  • 70% of people with serious psychiatric conditions have a methylation imbalance - relative to 30% of the general population.  Such an imbalance can occur if there is too little (undermethylation) or too much methyl (overmethylation) - a molecule that comes from methionine which is present in protein. Methyl dominates gene expression.  More specifically, 95% of individuals with autism, OCD and antisocial personality are undermethylated.
  • 90% of people diagnosed with a mental disorder have either low-normal levels or are deficient in zinc. This nutrient is not difficult to measure, nor to normalize.
  • There are 5 biochemical phenotypes of depression - undermethylation, overmethylation, copper overload, pyroluria and toxic metals.  This explains the different responses to antidepressants such as SSRI’s (serotonin reuptake inhibitors).  Some people get worse.  Some don’t respond at all.  Getting worse can mean suicide or even homicide.  A young man carrying out a school shooting not long after being put on an antidepressant is likely overmethylated (folate deficient).  They can be identified by an inexpensive blood test, and be treated with a different family of medication, or more ideally, treated with folate, cyanocobalamin and niacinamide.
  • Similarly there are biotypes for schizophrenia and ADHD, each requiring different treatments.  
  • Overwhelmingly, women with postpartum depression have elevated copper levels. This relates to the close relationship between estrogen and copper.  In Dr. Walsh’s outcome study of hundreds of women with postpartum depression, 85% improved after copper levels were normalized using nutrient protocols.  

In his years of experience, he says that more than 80% of people with ADHD and depression report significant improvement within three months and that more than 70% can eventually wean off psychiatric medication without a return of symptoms.

For more information, “Nutrient Power: Heal Your Biochemistry and Heal Your Brain.” by William Walsh, PhD

So what do you do when you have answers that could impact one of the biggest health crises in the modern world?   Well, if you’re Dr. Walsh, you consider the words of Gandhi: “When the people lead, the leaders will follow.”  He started the Walsh Research Institute with one goal being to train 1,000 physicians around the world in his advanced nutrient protocols.  He explained to me his thinking.  If he trains 1,000 doctors and they each treat 2,000 people,  then 2 million people could potentially benefit and go on to share their experience.  Eventually the leaders will follow.    

If Dr. Walsh’s nutrient protocols are so effective, why hasn’t conventional medicine gotten on board? Though Dr. Walsh has spoken at the American Psychiatric Association Annual Meeting and his physician training is certified by the American Medical Association for Continuing Medical Education, there are still obstacles. Unlike research into psychiatric medications, which is well funded through the pharmaceutical industry, research into nutrient therapies doesn’t have a strong profit motive.  Equally problematic is the standards of current research which address one variable at a time.  Our bodies and biochemistry are more complicated than this model allows.  Rarely does someone have just one nutrient imbalance.  Nutrient protocols/treatments are individualized and involve multiple nutrients/multiple variables which is quite different from one medication to treat one disorder.  This later type of research makes even less sense when you understand that one disorder, for example, depression, is actually 5 different disorders.

Such obstacles don’t seem to deter Dr. Walsh.  Nor does his age.  “You know, ...I’m old,” he says.  I hear this as a humorous comment on the number of years he’s been here and not a comment on his level of engagement in his work and life.

How could we have an impact sooner - before an environmental insult starts an epigenetic disorder? How could we identify those at risk?  Some forms of autism start in utero, however, there are a large number of infants who start out with normal development and then regress into autism. An environmental insult such as an infection or toxic exposure may result in an alteration in gene expression.  Dr. Walsh hopes to look at where on the DNA these epigenetic changes are occurring.  Knowing this could help identify future infants at risk, so that interventions could be made to prevent an epigenetic event and thus autism.

Not unrelated, Dr. Walsh describes a time when there will be a simple test done during routine physicals to identify those on the verge of an epigenetic disorder.  Proactive treatments, ie. nutrient therapies, could then be given to prevent many disorders from ever beginning.  Dr. Walsh’s upcoming ebook will discuss cancer, heart disease, autism, PTSD and other epigenetic conditions.  

Treatment and prevention of epigenetic disorders, however, isn’t a cure. While many of us are catching up to the reality that nutrients can impact genetic expression, Dr. Walsh is attending conferences on the latest cancer research. He’s listening closely to researchers who in their labs are resetting those epigenetic bookmarks that have been altered.  This essentially is what is required to cure cancer and other epigenetic disorders.  It is unknown how long it will take before this science makes its way into clinical practice.  Here again, the bulk of research dollars goes toward developing more pharmacotherapies, in this case chemotherapies.

***

Before our chat ends with Dr. Walsh returning to his own research, I wonder out loud, “With less than 500 doctors in the world using his nutrient protocols, who will carry on this type of research?”  Of those trained by the Walsh Research Institute, most of us are practitioners, not researchers.  He notes there are a few trained MD’s who also have their PhD’s (and thus have trained in research) and a few physicians who are already taking a leadership role in the Walsh Research Institute online group discussions. Mostly, however, he doesn’t know, nor does he seem particularly concerned. I think instead he’s wisely focused on the more impactful questions of the day - the questions he’d like to get answered - questions that could make all the difference in the life of a child or an adult and their families.



Low Zinc - The Most Common Nutrient Imbalance in Psychiatry

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“Zinc Deficiency is by far the most frequently observed chemical imbalance in mental health populations” - Dr. William Walsh.

Zinc is a trace metal. We need it to live. Unlike toxic metals, it’s supposed to be in our bodies and in our food. It’s especially important for proper functioning of the brain, the immune, endocrine and digestive system...really the entire body.

​As a psychiatrist, I think a lot about zinc, because more than 90% of people with depression, behavioral disorders such as ADHD, autism and schizophrenia have low normal to deficient zinc levels, as do many elderly individuals and those with dementia.
Delayed growth, temper control problems, poor immune function, epilepsy and learning problems have also been associated with zinc deficiency.

Most physicians don’t check plasma Zinc levels - if they do, the normal lab range is quite large - ie. (56- 134). When Dr. William Walsh and colleagues measured nutrient levels in tens of thousands of patients with brain related disorders, they found that most were falling in the low normal to deficient range. If they corrected the zinc level to the range where the general population mainly falls, they saw significant improvement in brain related symptoms.

Zinc plays a role at the barrier between the blood and the brain, is necessary to make certain neurotransmitters, keeps copper levels in check (which if high can negatively impact neurotransmitter levels) and much more.

Correcting zinc levels is not difficult. Those of us who treat brain related disorders using Dr. Walsh’s protocols will start with checking zinc and copper levels (as well as a few other nutrients). Treatment is done gradually and levels are monitored. Some individuals can have symptoms associated with detoxification or lowering of high copper levels.

“In working with thousands of violent children, we learned that most families report significant improvement once zinc levels are normalized.” - Dr. William Walsh

Sadly, many individuals suffering from mental illness or have children suffering are not aware of these findings. I noticed the below article today from a mainstream medical publication, which gives me hope this type of information may be starting to get out there.

Courtney Snyder, MD


Zinc Levels Linked to Depression in IBD Kids.“Children and adolescents with ulcerative colitis may see an increase in depression as zinc levels decline....”

Hypermobility, RCCX Theory and One Journey From Illness Towards Wholeness

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by Courtney Snyder, MD

The human body is a mystery.  As much and as fast as we’re learning, we still know very little.  This post is about a recent discovery.  I call it a “discovery,” because I’ve lived out what this theory holds to be true, as have a number of patients I work with, and perhaps some of you reading this.  RCCX theory is quite complex.  The best I can do is share my personal experience with the hope that doing so will help make this information more accessible.

We all have traits that make us different - whether it’s our appearance, how we react to our world or the natural abilities we possess.  Some traits, we may take pride in, others not so much.  Ask me why I’m flexible and I’ll tell you I did gymnastics when I was young.  Why do I have low blood pressure? I exercise regularly.  My flat feet?  Just one of those genetic things.

​As a child I worried...a lot.  In my second year of college, I could have been diagnosed with depression.  I’m the kind of person who can’t watch Cirque du Soleil without turning away for fear I’ll witness someone plunge to their death.
 

Never had I imagined each of these traits could be related, or that they would foreshadow a ten year health struggle that I’m only recently coming out of.
I was 37 when my health problems began. Recurrent “urinary tract infections” came first - then recurrent sinus infections and with these recurrent antibiotics.  Infertility led to a diagnosis of ovarian cysts and endometriosis.   The cesarean section birth of our daughter was quickly followed by a reaction to a pain medication, then a reaction to the medication for the reaction to the pain medication before a raging cellulitis/skin infection on my abdomen. There was the mild chest pain and tingling sensation in my left arm that led to an extensive cardiac workup. Next, came subtle difficulties using my fingers and hands.  More dramatic neurologic symptoms came after 2 courses of antibiotics - leg weakness, changes in vision, severe headaches, nausea related to the position of my head, which at times required effort to hold up, and episodes of heightened anxiety and racing heart. Later, it was swelling in my legs and “air hunger” - the feeling that you can’t get a deep enough breath. Sprinkled throughout was intermittent brain fog, which for me meant difficulty finding words, problems with driving directions, problems retaining what I’d read or heard and at times forgetting what exactly what it was I was doing.  Often present - a blanket of fatigue  - an invisible resistance that made even drying my hair a challenge.  Much of this couldn’t be validated with typical labs and imaging.  To all but my husband and daughter, I didn’t appear “sick.”  Respite came in the form of long (at times 3 hour) naps that would have been blissful but for my pounding and irregular heart beat.  

Trying to understand chronic health issues for myself and my daughter during ten years away from psychiatry and medicine, led me to functional and holistic medicine.  Everything I learned helped us and helped me help others when I did return to practice. Unfortunately and fortunately, there was always more to be unraveled.  The gastrointestinal candida/yeast overgrowth led me to the micro-biome which led me to nutrient imbalances (elevated copper, low zincmethyl/folate imbalancepyrrole disorder, etc.), which led me to bio-toxicity (in my case, mold toxicity), which led me to mast cell activation….which led me to things I had that I didn’t even know there was a name for.  Each step moved me closer to health, but none could explain why instead of just one or two or even three of these, I had them all.  This was also true for a handful of patients coming to my office for help.

Occam's razor is a problem-solving principle attributed to William of Ockaham (c. 1287–1347), an English Franciscan friar, philosopher, and theologian. His principle basically says - “Among competing hypotheses, the one with the fewest assumptions should be selected.”

How could so many problems be distilled down into one unifying theory? 

“Do you have a history of trauma?”  an internist once asked me after hearing my symptoms.  My cholesterol in the 400’s and my abnormal neurologic exam made it difficult to chalk this all up to being “in my head.”  I realized he must be referring to the landmark ACE study, which links childhood adverse events with adult chronic physical and psychiatric conditions.   “I suppose it depends on what you consider traumatic,” I responded...For me, sitting through the first 20 minutes of “Bat Man Returns,” for me was trauma.

I’ve been lucky.  I’ve not been neglected, nor physically, emotionally or sexually abused.  I did not have a time in my early childhood when I was separated from my parents who by all accounts loved and wanted me and my brothers and sister.  I was never bullied.  There was no trauma in the obvious sense of the word.
 

If not childhood adversity, then could there be another unifying theme for what at times felt like the seven plagues? Maybe the universe wanted me to learn intimately….about ALL of these conditions... so I could help others.  At least that would bring some purpose, some reason. 

***

The recognition that I fell on the hypermobility spectrum came only recently. I began noticing a number of health issues I'd struggled with, namely MCAS/Mast Cell Activation Syndrome and POTS (Postural Orthostatic Tachycardia Syndrome) also occurs in people with Ehlers Danlos (ED) - a group of genetic connective tissues disorders which can result in loose joints, stretchy skin and abnormal scar formation.  I am flexible (which is likely why I gravitated to gymnastics). I don’t have Ehlers Danlos, but I would say I fall on that spectrum, meaning I likely have an affected gene, but not affected enough to warrant that diagnosis.

MCAS/Mast Cell Activation Syndrome results when mast cells release a range of immune mediators including high levels of histamine.  The result can be wide range of hard to diagnose symptoms throughout the body including migraines, diarrhea, sinus pain, burning eyes, syncope/fainting, distractibility, brain fogirritability, interstitial cystitis (feeling like you have a urinary tract infection when you don’t actually) to name just of few. It looks different in different people. There are many who suffer from this much more than I have.  If you know anyone who seems to react to “everything” they may have a mast cell problem.

POTS/Postural Orthostatic Tachycardia Syndrome  is a condition in which a change in position from lying down to upright results in increased heart rate.  Symptoms can include palpitations, lightheadedness, nauseaheaviness in lower legsblurred vision or cognitive problems (due to decrease in blood flow to the brain).   Such symptoms can get worse with prolonged sitting, standing, alcohol, heat, exercise or eating a large meal. 

Many people with MCAS and/or POTS are diagnosed with Chronic Fatigue Syndrome, also called Myalgic Encephalomyelitis, as I would’ve been, had I persisted on the conventional/allopathic path. 

***

Each time I thought I was improving, I would be humbled by a severe headache, or overwhelming fatigue. Over years (literally years), I learned this was a battle I couldn’t win,  in part because it was at battle with myself.  

Instead of fighting, I simplified - removed everything that didn’t matter to me...I lost energy for and couldn’t tolerate TV, stuff, ego driven aspirations…. I let go of relationships and activities that were no longer meaningful for me.  By necessity, I made my life simple and closer to what nature had intended.

Too, I realized my excessive focus on my health, was reinforcing a belief that I had total control over the outcome.  Instead of putting my remaining energy into trying to further fix my biochemistry,  I started to grow a spiritual life - through writing and eventually reading books by spiritual writers. I learned to trust and listen to myself.  This brought moments of peace I couldn’t find in functional medicine forums or illness related facebook groups.  

Two weeks ago, while enjoying a whimsical book, the author charged me to ask (and expect) the universe to deliver a gift...within 48 hours.  The universe was to respond, “My pleasure.”   Not wanting much in the material sense, I was curious, what (if anything), I might receive.  After all I’ve described above, you’d think I’d have something to ask for...I didn’t...I’d mostly stopped looking and stopped grasping.  I was relatively at peace.

Within one hour of my request, I happened upon the work of Dr. Sharon Meglathery and her RCCX theory. There it was - my gift.  Brilliant.  It was all right there and in many ways, my story was all right there. 

Dr. Meglathery is a psychiatrist and internist with a health history very similar to my own.   Her theory explains a great deal for the many of us with both hyper-mobility (or with a family member with hyper-mobility) and an unusual mix of chronic health issues.  While I pride myself in my ability to connect the dots, here was someone who’s harnessed this ability tenfold.  We spoke at length by phone.  Aside from her obvious intellect, she’s remarkable in her generosity of spirit and sense of moral responsibility to get this information “out there”.

According to her theory, the “co-inheritance of a cluster of highly mutable genes,” collectively referred to as RCCX, “may confer vulnerability to familial clusters of overlapping syndromes of chronic illness (hyper-mobility, autoimmune disease, Chronic Fatigue, MCAS, POTS, and psychiatric illness, etc.).” Basically there’s a cluster of genes that are inherited together, they each can mutate easily and because they're big players, if they do have a mutation, they can make people vulnerable to wide range conditions and symptoms.

That these genes are inherited as a block as opposed to being inherited separately, doesn’t mean a mutation in one causes a mutation in all.  There does, however, seem to be a high rate of co-inheritance of mutations in two of the genes - the gene that relates to hypermobility and the gene that relates to an impaired hormonal stress response that can result in chronic physical or mental illness.  

This makes hyper-mobility an especially important marker for physicians and other practitioners to consider when meeting anyone seeking help for chronic medical or psychiatric conditions.  This seemingly unrelated trait, can be big clue as to what's going on.

And for those who are not ill, hypermobility may suggest a vulnerability to becoming ill (physically and/or mentally) after acute or chronic stress.


While the conditions (described below) can occur in one person and/or sporadically throughout families with this RCCX gene cluster, women are usually impacted the most.  One person (ie. myself and Dr. Meglathery) in a family can seemingly be hit the hardest.

The genes (oversimplified):

(1) C4 - codes for complement C4 - a protein involved in the immune response.  A mutation here could result in autoimmunity - the immune system overreacting and essentially becoming destructive to specific areas/functions of the body such as in Type 1 diabetes, multiple sclerosis and rheumatoid arthritis, to name a few. 

(2) TNXB  - codes for tenascin, a protein involved in collagen architecture.  A mutation here could cause hyper-mobility to varying degrees (from none to Ehlers Danlos).

(3) CYP21A2 - codes for an enzyme, 21-hydroxylase which is pivotal in hormonal pathways involving progesterone, and less directly androgens.  A mutation here is associated with an “exaggerated stress response in the setting of low basal cortisol." This is best described by a woman I see, as  “tired but wired.” Seemingly, only one copy of this gene (meaning from one parent) is necessary for someone to be vulnerable to medical or psychiatric illness after severe acute or prolonged stress.  
 
“I posit that a child carrying a CYP21A2 mutation has the same brain as a child raised in adverse circumstances,” says Dr. Meglathery before describing the structural differences in the brain including enlarged limbic structures (amygdala).

In utero and infancy, the brain (of someone with a CYP21A2 gene mutation) is exposed to low basal and spiking cortisol levels which leads to a brain that is essentially wired for danger, not unlike the brain of someone with PTSD.  Decreased cortisol levels result in the brain releasing ACTH (Adrenocorticotropic hormone) and CRH (Corticotropin-releasing factor) - a hormone involved in the stress response.  When stress is too high or too chronic, the pathway is overwhelmed and brain inflammation occurs.

This decreased ability to deal with stress, according to Dr. Meglathery, “raises one’s susceptibility to PTSD/Post Traumatic Stress Disorder  or other forms of disordered emotional processing.”   Associated psychiatric issues cover the full range from anxiety, panic, OCD, depression, bipolar disorder, ADD/Attention Deficit Disorder, hyperfocus, autism, sensory processing, and psychosis. 

The overwhelm of this 21-hydroxylase (the enzyme that’s not working up to speed) can trigger an inflammatory cascade resulting in all of the conditions mentioned above ie. MCAS, POTS, CFS/ME, (as well as chronic inflammatory and/or biotoxin illness as is seen in Lyme Disease, Mold Toxicity, Epstein Barr Infections, etc.).

RCCX Theory will likely change the way we think about chronic physical and mental illness.

***

While I’ve worked with many children and adults with early trauma and disrupted attachment, I’ve also worked with many who didn’t have this (known) history, but seemed wired as if they had.  Some were told by therapists they must have had trauma they couldn’t recall.  Some even decided they were abused as a way to make sense of their lives.

At the “expense of emotional processing and possible psychiatric illness,” Dr. Meglathery describes a potential for "brilliance and high intellectual capacity.”  She says, “With increased threat detection and enhanced stress response, if present in moderation, comes some gifts, including enhanced empathy, ability to hyper-focus/obsessions/special interests and unusual abilities (often in music, arts or abstract thinking).” 

I’m not the only person in my family with some seeming “out of blue” abilities.  And while I’ve claimed few of these, I’ve quietly wondered how it is that I was able to write music and make art without formal training. And, yes, at times in a hyper-focused and obsessive manner. 

Also striking is the uncanny tendency for those with the RCCX phenotype to marry or have friendships with others on the RCCX spectrum.  If you are someone who falls on this spectrum, your relationships will likely confirm this.

***

But is this theory worth knowing?… Is it fatalistic, self-indulgent, or is there something of use here?  Is there a reason to share this information...not in 25 years when this gets fleshed out by geneticists, but right now? 
 

I’ve had tremendous benefit from dietary interventions, exercise, specific targeted nutrients, appropriate treatments for infections and toxicity, and multiple lifestyle and supplement strategies to lower my histamine levels. I’ve also made lifestyle changes including, as I said, simplifying (everything), reducing stress, doing more of what I love and building a spiritual practice that reminds me that I control very little in this world, and that I'm part of something larger than myself - here for a purpose...no matter how flexibly inflexible or brilliantly brain foggy I may be on a given day.  Had I known this theory, would I still have changed my life?.. or would I have accepted that much of my destiny was in my genes?

I might actually have changed my life sooner.  I might have welcomed a “good reason” to take better care of myself.  I might have taken the phrase "daily stress” more seriously.

My lifestyle changes and spiritual growth helped me - to put it in more physiologic terms - “shut off my acute stress response,” which was making me sick.  And according to Dr. Meglathery, “If you can figure out how to do that, then the whole cycle of elevated CRH (the stress hormone), inflammatory cascade, Mast Cell Activation Syndrome, and elevated progesterone decreases (not gone but lessens).” 

I wrote this post, because I do believe this understanding can move people more quickly to a diagnosis/es, assist in more effective targeted treatments and help those already in treatment recognize their vulnerabilities and adjust their lifestyle choices accordingly.

There are many roads to healing.  One is the path of intellect and information.  There are endless online groups overflowing with smart people who have a great deal to share.  Such groups have helped me connect some dots.  They’ve also kept me focused on illness.  Another path is more mindful, spiritual, or however you want to call feeling at peace in your self and body.  In my own healing, I used and still use both.

I look forward to using the new tools and understanding that Dr. Meglathery’s work brings me for my own health, as well as those who come to my office.  I’m already asking patients, “Are you hyper-mobile, double jointed, extra flexible, have lax joints or is there anyone in your family that you know of who does?”  I’m surprised at how many actually are, or say they aren’t before they unintentionally demonstrate to me that they are.

Dr. Meglathery’s theory has taught me many things, but perhaps none more necessary than the acceptance that my greatest vulnerabilities which have brought me some of my “darkest days” are intimately intertwined with my greatest strengths, which have brought me joy and purpose.  Instead of shying away from some of my abilities, I’m more likely to claim them now.  In all, her discovery has moved me closer to a sense of wholeness - something I wish for anyone reading this.

Thank you to Dr. Sharon Meglathery, her patients and to all of those who are helping to move this information forward.

For a more detailed explanation of Dr. Meglathery’s work, as well as a list of associated conditions, visit RCCX Theory at: http://www.rccxandillness.com/

Excavating the Soul in a Hazmat Suit

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Courtney Snyder, MD

When I think about the soul, I think about Silence, Stillness, Solitude and perhaps the most important - Simplicity.  I could list all that comes between us and our respective souls: twenty-four hour news, busy schedules, people pleasing, stuff, stuff and more stuff...but if you’re like I was, you don’t need a list, you’re living it.

Our bodies (brain included) have not evolved as fast as the demands of modern life.  We’re not biochemically, physiologically, emotionally or spiritually designed for these times.  Those “S” words are more than lovely notions, they’re essential for our health and humanity. To be disconnected from our soul is to be disconnected from our purpose, our potential and our joy.  The world, however, is desperately needing us to tap into our greatest of all resources.

But how do we approach that part of us we’ve neglected for so long?  Where do we start?  Clearing the way can be like weeding a garden… or it can be like a raptor ransacking a nest in one fell swoop.  I’ve done both.
My impulse to start clearing came when I was 44 and veering into midlife.  Six years had passed since I’d closed my psychiatric practice to be at home with our daughter - just long enough to lose site of a professional identity that once anchored me.  I didn’t know where I was going.

As I thought about my life, I began noticing the amount of time, energy and attention “stuff” took from me - buying, moving, returning, dusting, looking for, putting away, maintaining, replacing the batteries for, being distracted by, and in some cases feeling bad about.  I decided to simplify my life, starting with clutter. I trusted that the physical and seemingly mundane process of going through one drawer at a time would help me find my way.  “Does this rubber band ball matter to me? Is this important to me? Do I need it...NOW? Is it meaningful ...NOW? Is it beautiful to me...NOW? Does this item add to my current life or does it take away from it?”  With these repetitive questions, I was rewiring my brain.  

Old letters, awards, papers, photos...stored in boxes - each kept me tethered to the past -  to a person that no longer existed…thankfully -  a do gooder, people pleaser, mostly A student (which sadly I knew because some of those papers were report cards...from elementary school), the pianist who was terrified at each recital, the gymnast with natural ability who never soared due to low confidence and sprained ankles, the girl who got the “S” (satisfactory) instead of “E” (excellent) for class participation, the friend who saved letters and pictures, but never kept in touch particularly well.   That validation seeker lived in boxes...heavy boxes that I carried with each move.  

Then there were the items in my closet that kept me oriented to possibility - the future.  The plum velvet sequined topped dress, tags intact.  One day I would look amazing at some formal event.  I could just see me…standing there...completely bored, because in the real world standing around making small talk isn’t my thing. Such items gave me a tinge of pain, not because I wanted the image, but because of the waste - someone else could be having the time of her life in them right then...just not me, not then and maybe never.

Feeling ready to cut the cords from the past, imaginary future and even shame, I purged. I also tried to teach my daughter to be thoughtful about the her own items and spaces. I wish this transition was as graceful as it may sound.

Eventually this carried over to decluttering the more emotional and psychologic aspects of my life. With time, I started to hear what was emerging from inside.  First this came in the form of art, writing, poetry and songs and then later, in the form of ideas of a psychiatric practice that was more holistic.  A practice that made sense ... to me.

Despite all of the above, our next move highlighted how much stuff remained. Some had quietly crept into our lives since that first decluttering and some I’d still hung onto all while patting myself on the back for how much I’d gotten rid of.

***  3 years later ***

“When you’re in a fire, you have no choice when to leave your home and belongings,” I tell my husband. “At least, we have that choice.”   Finally, a possibility that I could move beyond what had been fatigue, brain fog, pain and neurologic symptoms.  Leaving carried the possibility that our daughter would no longer complain, “I don’t feel good,”  “My eyes hurt,”  or “I’m having my breathing problem.”

Feeling a bit like the Von Trapp Family Singers, we left that evening  - not across the Alps, but across town for a hotel that had reduced rates for extended stays.  The disaster we found ourselves fleeing from was a six by six inch section of  wood with a couple of toxic mold species fighting it out…all while spewing invisible mold spores covered with toxins into the air.. into the HVAC system … throughout our home and ultimately into my daughter and me.  We both tested positive for toxic levels of mycotoxins.

Instead of asking is this meaningful, beautiful, or useful, the questions my husband and I asked, while donned in hazmat suits and respirators, related to survival…”Could this make us sick?”  “Could this kill us?” we joked (in part) ....“Could the (unseen) toxic mold spores be removed?”  “Was this worth the trouble and expense to clean?”

Some families upon learning they have mold toxicity will leave with only “the clothes on their back.” Others will do some minimal remediation.  We did what we thought was best for us at the time.  In the end, 80% of our belongings were gone.  Along with the remaining 20%, we were left with gratitude to have each other, the hope of restored health and the ability to return to our house after nine weeks.
​ 

We also had more space - not only in our home, but also in our schedules and in our lives - space that allowed and still allows us to breath, think and be - space we’re not eager to fill.  We’ve taken time and are exceedingly particular about what items we allow into our home. We’re also exceedingly particular about who and what activities we allow into our lives. 

For anyone reading this - “May you live all the days of your life,” (Jonathan Swift).  If you’re longing to transform your life, I hope this post speaks to you.  What if you had to leave it all and get down to what really matters in your brief time here on earth?   What (and who) matters to you right now - not 10, 20 or 30 years ago and not next year or in ten years.  Right now.

Mold Toxicity - Depression, Anxiety, Fatigue, Brain Fog & Inattention

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"Light Showers on Tidy Town" paper, acrylic on 24 x 48" canvas "Inspired by the coastal towns of Ireland."
By Courtney Snyder

One of the challenges of writing blog posts that explore root causes of brain related symptoms is that what we are learning is constantly evolving.  There's so much we still and will never know.  Another challenge - everything is interconnected. The best I can do is to write about these root causes separately. While some contributing factors can occur in parallel, one condition is often leading to other downstream conditions that themselves contribute to things like depressed mood, anxiety, mood swings, brain fog/inattention and so forth.  

Mold toxicity is a perfect example.  It can contribute to Pyrrole Disorder due the stress it puts on the body.  It can lead to elevated copper by overwhelming one of the antioxidants in the body that regulates copper.  Because it interferes with the immune system, it can lead to a susceptibility to candida/yeast, Lyme and its co-infections.  It also frequently worsens Mast Cell Activation (see my last post).  I consider it a root of the roots.  In my daily work, I find mold toxicity to be very common.  Here’s why - ​
Water Damaged Buildings
It is estimated that 50% of buildings have water damage.  Where there is water damage and retained moisture, there is an ideal medium for toxic mold to grow rapidly and produce spores which carry toxins. It isn’t just the infamous black mold, or Stachybotrys that’s a problem.  Aspergillus, Penicillium, Fusarium, and Chaetonium also make toxins that can be acquired through inhalation, ingestion or through the skin. Mold in buildings is often not visible. It can be in a crawl space, an attic, behind a wall, or under a sink. It can be within a component of an air conditioning system or even duct work.  The spores can disseminate easily. They don’t necessarily stay, for example, in a damp basement. Outside mold has checks and balances and also isn’t concentrated in a contained space.

Mold Toxins  
Once acquired, the toxins enter cells and start an inflammatory process and make it harder for the body to detoxify.  There’s evidence that mold can colonize the sinuses and possibly the gastrointestinal tract. This would explain why for many people, simply getting out of a moldy environment is not enough to alleviate symptoms. Not only do they continue to have toxicity, they may also be harboring toxin producing mold.  If that wasn’t enough, some will also have mold allergy.


Implications
In one water damaged home, not every family member will necessarily be impacted.  Seemingly 25% of people are unable to make antibodies to mold toxins. Add to that the 50% of buildings that have water damage, and you have a lot of people who are unknowingly becoming toxic while spending time in affected homes, schools, workplaces, cars, dorms, and nurseries.  When you consider the masses of people returning to water-damaged homes after floods, the implications of this evolving understanding is staggering.

In a world with so many other insurmountable challenges, I wish this weren’t true.  There are many who argue that it isn’t.  For me, this truth, that mold toxicity is a big part of what is making many people sick, is reinforced every day in what I do.

This type of information won’t disseminate like mold spores.  Few people will ever identify mold toxicity as the source of their health problems.  Fewer will be able to do what is required to heal.  I remain hopeful someone out there will benefit from happening upon this information.

The Vulnerable
For the 25% of people who don’t mount a typical immune response to mold toxins, antioxidants and strategies to enhance detoxification don’t necessarily remove these toxins.  Mold toxins basically go from the body, to the liver and gallbladder where they are bound to bile and sent out into the gastrointestinal tract. The bile, however, is recycled (as a means of conservation), and thus take toxins back into the body.

Symptoms of mold toxicity impact many parts of the body.  Often there are many symptoms that seem unrelated, which is why many who are unknowingly dealing with this, end up seeing multiple specialists and are left feeling their doctors think it’s “all their head.”  The diagnosis of anxiety or panic, depression, obsessive compulsive disorder, ADHD/ADD and conversion disorder are fairly common. I empathize with doctors who have been trained to relieve symptoms as opposed to seek deeper root causes.  Still, I do think all physicians (myself included) can benefit from realizing and saying repeatedly, “There’s so much we don’t know,” or even “I don’t know why you are having your symptoms.”  The lack of humility or inability to admit one doesn’t have the answer, sadly can lead to some doctors to discount symptoms as “psychiatric” or even blame their patients for feigning their symptoms.

Personal Experience
My own foray into this topic, came in 2016 when I started to hear about mold toxicity from some of my functional medicine colleagues.  While looking for resources, I took the VCS/Visual Contrast Sensitivity APTitude Screening Test at Dr. Ritchie Shoemaker’s website, Surviving Mold.  Dr. Shoemaker is the pioneer who has brought this important problem to the world’s attention, starting with his book, “Mold Warriors.”   The VCS test is a screener for biotoxicity. Other biotoxins (such as from Lyme), metal toxicity or even a gluten sensitivity can impact this test.  Passing it doesn’t mean you don’t have mold toxicity, but failing would raise suspicion.

The fact that I failed the test and had a number of symptoms suggestive of mold toxicity, wasn’t enough to start me down the path of exploring mold toxicity for myself.  Like many, I gladly opted for denial. What such a reality would mean for myself, my family and home was more than I wanted to consider.  One year later, a colleague suggested I consider mold toxicity for my persistent low grade neurological symptoms.  Fast forward 3 years and through my and my daughter’s healing processes and I’m now regularly diagnosing and treating mold toxicity in adults and children.  Repeatedly, I’m surprised at just how common this is in those with brain related symptoms.

I've been fortunate to have as a mentor, Neil Nathan, MD - one of the leading experts and pioneers in this area. Because of my early joining, I’m grateful to be considered a Full Founding Member of the International Society of Environmentally Acquired Illnesses or ISEAI.  

Despite the growing knowledge about mold toxicity, available testing and treatment, we still know very little. This area of medicine is in its infancy and we are collectively learning more every day. Even among the pioneers, there is debate about the testing, evaluation, treatment and whether mold colonizes in the body.  The below information I share is based on my own education, as well as my personal and professional experience.

SYMPTOMS
It is worth noting, many of these symptoms overlap with mast cell activation (described briefly in my last post). Mold toxicity is a very common driver of mast cell activation. While there seems to be a genetic component to mast cell activation (fitting with RCCX theory), it has been the experience of many of us, that mold toxicity will take it to another level and that when you treat the mold toxicity many of the mast cell symptoms settle down.

  • Highly sensitivity to a wide range of things such as scents, medications, supplements, emotional triggers, weather changes, etc.  This is likely because of the mast cell activation, but also because the toxins not unlike a traumatic event, can prime the brain for danger.  By this, I mean, the brain knows something is wrong and is sending danger signals, but it doesn’t know what the danger is. I have met many mold toxic patients who are exceeding vigilant, but not necessarily about mold, because that simply wasn’t on their radar.  Instead, they have other contamination fears, obsessions about their health, paranoia and so forth.
  • Fatigue
  • Brain fog
    • In children can this look like ADHD or ADD
  • Cognitive decline
  • Anxiety and depression
  • Mood swings
  • Headaches
  • Symptoms very specific to mold toxicity, though they don’t have to be present.
    • Electric shock sensations
    • Ice pick-like pains
    • Vibrating or pulling sensations running up and down the spine.
    • Numbness and tingling
    • Balance and dizziness without other identifiable neurologic conditions
    • Atypical Parkinson's Disease
    • Atypical ALS
    • Psychogenic seizures or pseudo-seizures​​
  • Tics, spasms and seizure like events
  • Sensitivity to bright light and light touch
  • Suspected or Diagnosed PANS/Pediatric Acute-Onset Neuropsychiatric Syndrome
  • Chronic sinus congestion
  • Gastrointestinal symptoms
  • Coughing, chest pain, shortness of breath
  • Muscle weakness and pain
  • Joint pain and morning stiffness
  • Excessive thirst
  • Frequent urination
  • Appetite swings
  • Rapid weight gain
  • Night sweats
  • Body temperature dysregulation
  • Impotence

The diagnosis of fibromyalgia, or chronic fatigue are both common.  In 2013, Dr. Joseph Brewer, an infectious disease specialist and also a pioneer, found that 93% of 112 people with Chronic Fatigue Syndrome had elevated levels of mold toxins.

Diagnosis:
While there are some inflammatory markers that can be tested, many of us instead now use urine mycotoxin testing, to identify which toxins are present.  Knowing which toxins are present impacts which binders are used to remove the toxins.

Treatment:
  • Evaluating one’s current environment is essential.  Many people have learned the hard way that they’re unable to heal if they stay in a moldy environment. There are some ways to start to evaluate indoor environments using plates and/or ERMI testing.  My preference, however, if at all possible, is to have a certified environmental consultant visually inspect, and do air sampling or swab testing if indicated. They will also have the ability to identify temperature gradients behind walls and under flooring using infrared light, which can point to contained moisture and thus likely mold. In consultant who is independent from a remediation company (and thus does not have a conflict of interest), can give direction to a remediation company of one’s choosing if needed.  They can direct how to contain the space as the mold source is removed so that exposure isn’t increased, as well as indicate which areas of the home and contents that have been exposed. Likely they will retest after the remediation is done. The door to my previous office didn’t have a good seal between the door jam and the concrete below. When it rained, water made its way into the sub flooring.  Water damage wasn’t evident nor considered until the hardwood eventually started to buckle. Prior to this, however, every time someone walked across the threshold, an invisible “poof” of mold spores carrying toxins was released into the air.  
 
  • Binders are chosen based on the mold toxins that show up on the urine test. Examples include bentonite clay, activated charcoal, chlorella, cholestyramine, and colesevelam HCI.  The doses are determined one at a time. For some very sensitive people, only tiny amounts are tolerated, though still effective. The duration of binders can go beyond one year.  This is not a quick fix. It takes time and patience, but for most people there is steady improvement. “ I’m now able to read again and remember what I read,” I’m exercising again,” or “I can eat a wider range of foods without reacting,” are the types of initial observations that reflect the beginning of the healing process.  For some people, the binders help move them toward healing, while for others who seem to have had colonization, such as in the sinuses, antifungal treatment steps may need to be added.
 
  • Antifungal treatment when necessary in the form of nasal sprays and/or antifungals for the gastrointestinal tract to address candida which is also frequently present.
 
  • Diet - As with candida/yeast, mold will thrive on a sugar and a high carbohydrate diet.  Though there is a great deal of individuality when it comes to food, most people with mold toxicity seem to do best with a whole foods diet of lean protein and vegetables along with an avoidance of sugar and limited carbohydrates.  Of those who also have mast cell activation, some will benefit from a low high histamine diet
 
  • There are many other potential pieces, such as treatment for mast cell activation and other down stream effects (mentioned earlier), as well as strategies to address the acute danger response (limbic system dysfunction) that mold toxicity can cause.

The duration of treatment depends on a number of factors, including age, severity of symptoms, sensitivity, and the presence of other conditions such as Lyme, Bartonella, Candida and even methylation imbalances.  For some the treatment can be 1-2 years, though again, the improvement usually starts long before this. Children tend to have quicker responses and may only need 6 months of treatment.

Anyone who makes this journey will tell you, “It’s a process” - one that can start out with a mix of relief and overwhelm.  Relief to finally be finding answers and overwhelm about the larger implications for one’s family, home and the items in their home.  Over time, however, through education, and hopefully improved mental clarity and energy, a new reality starts to set in.

​Moving Forward
I once wondered how I would feel safe in future homes or offices, given how common indoor mold is. Part of my concern likely lessened by removing the toxins which would diminish the danger response.  Also, I've found  (as have others) that if we pay attention, our bodies will tell us when there's a problem. The environmental consultant, with whom I work closely, knows that if I walk into a home or office and say, "There's mold here," that even if it's not visible, when he runs air samples, there will be elevated spore counts. For me the cues are increased heart rate, very mild nausea and a subtle buzzing sensation in my body.

Indoor mold has taught me many things, but none more powerful than this - if we pay close attention, our bodies will tell us much of what we need to know. We can call it intuition, or we can call it an acute inflammatory response to an environmental exposure.  Perhaps they're the same thing.  For me it doesn’t matter.  At this point, I simply trust it.


Resources
For more information on this topic or to find a physician in your area, see the International Society For Environmentally Acquired Illnesses / ISEAI website, or google “Mold Literate Doctors (or Practitioners)”

If there is one book that clearly, comprehensively and compassionately covers what is being learned about this complicated area, it is -
Toxic - Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivity and Chronic Environmental Illnessby Neil Nathan, MD

I would also recommend Jill Carnahan, MD’s Definitive Mold Clean Up Guide
https://iseai.org/your-definitive-mold-clean-up-guide/

Undermethylation & Strengthening the Right Brain in a Left Brain World

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“Mary Poppins Goes To the Beach” -Made by combining pieces from 3 collages in my Impermanent Art Series.
By Courtney Snyder, MD

​Half of my work day is spent honing in on details. For each person I evaluate and treat, I’m considering multiple symptoms, lab data, contributing factors, and treatment interventions. Left unchecked, this amount of detail hurts my brain - figuratively and literally. This type of work might be considered “left brain“ and appealing to someone who is “undermethylated,” which I am.


The other half of my work day is involved with addressing how, from a spiritual perspective, we:
  • lower our stress by learning to let go and stop grasping for outcomes
  • learn to feel at home in our body
  • learn to connect with others
  • find peace in this world
  • find purpose and meaning in this life
  • live in the present
  • feel part of something larger than ourselves
By spiritual, I mean our inner life. My writing and teaching about the intersection between neuroplasticity and spirituality is essentially about how we exercise those parts of the brain that relate to that inner work. Instead of honing in on details, this is about pulling back and looking at the bigger picture of our lives and our humanity. This right brain work feels good.
Psychological Risks of Functional Medicine Approaches
While identifying root causes can be important in a healing process, there are risks. The amount of details involved can be overwhelming. It can put some people at odds with their body; giving them a sense that the goal is to exert control over their biochemistry and microbiome, as opposed to bringing them back in balance as much as is possible. The details can lead to the notion that there is a “right way” - that if we do everything right, everything will be fine. Those who are “undermethylated” are especially vulnerable to this type of black and white thinking. Such thinking can get in the way of healing and the experience of wellbeing. Most people I treat are undermethylated.

Methylation
Methylation relates to a biochemical process (involving methyl and folate). It is pivotal in the functioning of detoxification pathways, the repair of DNA, the breakdown of histamine, epigenetic expression (“the turning on and off of genes), and neurotransmitter activity.  Families with methylation imbalances have a higher incidence of psychiatric conditions, neurodegenerative diseases, cancer and cardiovascular diseases such as strokes and heart attacks. The understanding of the relationship between methylation and brain related symptoms comes out of the work of Dr. William Walsh, PhD and the Walsh Research Institute.

Undermethylation
Undermethylation can result in low neurotransmitter activity (relative to overmethylation in which there is too much). This low neurotransmitter activity can be a contributing factor in brain related diagnoses such as depression and ADHD, but also bipolar disorder, schizophrenia and various forms of addiction.  

We all fall on a spectrum of how “methylated” we are. About 70% of people with brain related symptoms have a methylation imbalance (most of which are undermethylated), compared to 22% of the general population. Most physicians, CEOs, attorneys, accountants, engineers, and competitive athletes are likely undermethylated. If you’re interested in functional medicine blogs and reading this, you too may be undermethylated.

Multiple genes determine our methylation status (MTHFR being just one). An overgrowth of Candida in the gastrointestinal tract can also contribute as well. Candida makes a toxin that inhibits methylation. Antibiotics, because of their potential to kill off beneficial bacteria that can keep candida in check, could thus exacerbate undermethylation. There is also evidence that early caregiving plays a role. One study found that mice who weren’t “licked and groomed” by their mother were more likely to be undermethylated and anxious, versus those that had appropriate caregiving and had normal methylation and were calm. Heavy antibiotic use, a Western diet high in sugar and carbs (which feeds candida) and the low value placed on early caregiving in our culture is a recipe for an undermethylated collective.

Symptoms of Undermethylation (Rarely does someone have all of these)
  • Obsessive compulsive tendencies
  • Ritualistic
  • Perfectionistic
  • Dietary inflexibility
  • Very strong willed (“needs to be right”)
  • Competitive
  • Prone to phobias
  • Social isolation
  • Calm demeanor with high inner tension
  • Tendency toward addiction
  • High accomplishment or family history of high accomplishment (one can certainly be undermethylated to the point that they are unable to accomplish very much)
  • Seasonal allergies and high fluidity in eyes and mouth (this is because methylation breaks down histamine, thus if you are undermethylated you likely will have more allergy symptoms)
  • Good response to serotonin reuptake inhibitors, ie. Prozac, Paxil, Zoloft, Celexa (due to low neurotransmitter activity)
  • If there is a thought disorder (psychosis) - delusions are present as opposed to hallucinations
  • Poor concentration endurance

Diagnoses Associated With Undermethylation
The Incidences of Undermethylation (from the Walsh Research Institute)
  • 98% of those on the Autism Spectrum
  • 95% of those with Antisocial Personality Disorder (think sociopath)
  • 90% of those with Schizoaffective Disorder
  • 85% of those with Oppositional-Defiance
  • 62% of those with Anorexia
  • 38% of those with Depression (The Walsh Research Institute identified 5 types of depression from a nutrient standpoint), of which undermethylation is the most common. The others are Overmethylation (folate deficiency) - 20%; Copper Overload - 17%; Pyrrole Disorder - 15%; Toxic Metals - 5% and “Other” - 5%
  • 55% of those with ADHD have a methylation imbalance (either undermethylation or overmethylation)

Identifying Undermethylation
Assessing for undermethylation is done through a medical evaluation - a careful review of symptoms and traits and a whole blood histamine lab test (which is usually elevated in those with undermethylation). If necessary, a methylation profile - also a blood test - can be completed. Often, however, those with undermethylation can be recognized before doing labs and in some cases even before taking a history. Questionnaires completed with great detail, an exceedingly neat appearance, and beautiful penmanship can be clues to undermethylation. I’m pointing this out, not as criticism, but to make the point that our biochemistry shapes us is surprising ways.

As I mentioned I'm undermethylated, fitting with my being a physician. My art also points to undermethylation in that my collages have repetition, precision and a calculated balance of light, dark and medium colors. Whether you like or dislike my art may depend in part on your own methylation status.

Treatment of Undermethylation
From a biochemical and nutrient standpoint, the way we address undermethylation is often to provide nutrients that compensate for deficiencies in the methylation cycle - Methionine, S-adenosylmethionine, Magnesium, Calcium, and Vitamin B6 to name a few. For some individuals with high homocysteine levels, this level has to brought into the optimal range before undemethylation can be addressed.

We also use dietary interventions including a relatively high protein diet (methyl is from protein) and avoidance of folic acid, and high folate foods for those with depression. This isn’t with an intention to change someone’s personality, but rather to alleviate symptoms that are impacting one's functioning and quality of life.  

Undermethylation and the Left Brain
Though both brain hemispheres are continuously working together in complex ways, there are attributes which are more strongly associated with each side. In the most primitive sense, we’re using our left brain when we reach out to grasp a berry. We’re using our right brain when we scan our environment, notice the berries over here, the nuts over there, and the lion in the distance that could be ready to ruin our day.

Though undermethylation is a biochemical difference, it has many traits consistent with those of the left hemisphere. Similarly, the diagnoses associated with undermethylation generally are the diagnoses associated with right hemisphere dysfunction (and thus a relatively overfunctioning left hemisphere).

A brilliant book about the right and left hemispheres is “The Master and His Emissary - The Divided Brain and the Making of the Western World” by Ian McGilChrist, MD, a Scottish Psychiatrist.

The Left Brain Personified
To oversimplify Dr. McGilChrist's work, if we were to personify the left brain, it may be like that someone who

Attention:
  • Has narrowly focus attention as opposed to a broader and more flexible mode of attention.
  • Is detail oriented.
  • Prefers what they know and prioritizes what they expect (as opposed to having a vigilance for whatever exists out there).
  • Prefers single solutions that fit with what they already know (as opposed to having flexibility of thought and an array of possible solutions).
  • Has difficulties disengaging (consider addictions, including to internet).
  • Sees parts (as opposed to as a whole).
  • Takes things more literally (as opposed to seeing things in context).
  • Doesn’t grasp humor or metaphor (as opposed to appreciating these).

Relationship to Others:
  • Is more concerned with categories and types (as opposed to concern about uniqueness and individuality). Think about stereotyping and the current extremes of our political divide.
  • Has social interactions that reflect less regard for the feelings, wishes, needs and expectations of others. Think of cell phone usage, social media, and the escalating meanness the internet allows.
  • Is superficial in terms of their social engagement.
  • Has at times unchecked meaningless excessive speech.

Relationship to Objects:
  • Need to collect and an over-concern about getting and making. Think about our culture’s love affair with consumption.
  • More concerned with man-made objects (than with living individuals).
  • Has an affinity for what is mechanical.

Relationship to Body:
  • Sees the body as a sum of parts; not having a whole body image.
  • Has an excessive appetite for sex or food (out of keeping with the person’s nature).

Emotions & Outlook
  • Is angry or detached emotionally (as opposed to happy, sad or fearful).
  • Has a more optimistic view of self and future (even if unwarranted).
  • Is competitive.
  • If depressed, has an apathy as opposed to sadness.

Relationship to the Future
  • Fears uncertainty and lack of control. Needs certainty.
  • Need to be right/correct.

The Left Brain Perspective
As you can see, the left brain sees the world quite differently than the right. The left brain would have it's sights set on success, titles, money, objects or anything else that feeds the “I.” It will also have us obsessing over our health, excessively surfing the internet for answers, and micromanaging every everything we put into our body. It doesn’t have the ability to see the “big picture,” which the right hemisphere does. Therefore, it has a hard time pulling back far enough to see how it’s way of thinking may be getting in the way.

As Dr. McGilChrist's book points out, while our western culture would have us believe the left brain is the master. It is not. The left brain ideally is working for the right brain. As Einstein said, “The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honors the servant and has forgotten the gift.”

The Right Brain Perspective
When we are viewing the world more from the right brain, we are in the moment, experiencing ourselves as part of something larger than ourselves, feeling connected to humanity, seeing the bigger picture or our lives, and feeling in tune with our bodies (not hyper-focused on parts of our body or on our biochemistry). It is predominantly from the right brain that we create, laugh, cry and experience wonder, curiosity and awe.

A totally right brain existence can be problematic as well. Still, bringing more of a right brain perspective can bring an ease to life that the left brain never will. Too it can lower stress hormones and inflammation.

If you are someone grasping for “success” as our culture sees it, keep in mind that the most successful (in all senses of the word) are going to be those who make decisions from the intuitive right brain and then use the left brain to essentially get the details of the job done. If you are just honing in and never pulling back to see the big picture, you’ll miss a lot, not the least - your life - your fleeting moment here one earth.

It’s arguable if the soul resides anywhere within us, it would be in the right hemisphere; while the ego would be in the left. Just as the left brain isn’t bad, neither is the ego. It’s just not an effective place from which to make decisions. It’s a different experience, and even outcome, to do something to serve oneself (a project, a career, a relationship) than to do it with the purpose of serving others or a higher good. It’s one thing to choose a path because it’s impressive and another to choose a path because it’s aligned with who we uniquely are. If you’re unsure if you operating from the soul or the ego, pay attention to how you feel - uptight, stressed, or open and trusting.

So how might we find peace “in the right hemisphere,” especially in a world and culture that would have us grasping, pushing, doing, fixing, getting, worrying, and clinging to outcomes from our left brains? I’ve listed some ideas. You may have your own that resonate specifically for you.

Exercising the Right Brain

1. Simplify - Practice letting things go and growing clarity about what matters and what doesn’t - especially if our left brain has collected a lot of things, a lot of titles, a lot of ego supporting, though unsatisfying relationships

2. Gratitude Lists - Move our brains beyond ruminating, getting and planning to a place of gratitude for what is.

3. Letting Go - We can recognize when we are clinging to outcome and clinging to certainty. We can recognize this for what it is - an illusion of control. Let them go of worries as if they are balloons or write them on a piece of paper and dropping them in a box - call it what you want - a “God Box” or a “I Control Nothing Box.”.

4. Practice Mindfulness - Being only in the moment: savor every bite of a meal, sit and listen to music while doing nothing else. When you go reflexively for that phone, that food, that purchase - ask yourself who's driving: your left brain or your right brain?

5. Notice Others - Not as separate, but as part of the same humanity. Consider their experience, their struggle and how they might feel. Look into their eyes. Be with them and resist interrupting or imposing your agenda, opinion or need to fix them.

6. Be Embodied - Notice your breathing. Notice when you have a strong emotion what you experience in your body. Acknowledge any anger you may have towards your body. Be grateful for you body, consider it as a home for you mind, your heart and your spirit. Sing. Dance. Stretch. Move.

7. Exercise - Not to look good, not to be better than, but to simply be in your body. Experience your wholeness and the wonder that you even exist.

8. Be in Nature - Savor the beauty. Be humbled by your small place in the natural order of things.

9. Do Something Spontaneous: Just follow your gut and see where it takes you. Take a walk without a destination. Write in a journal whatever pops into your head. Do anything that you normally think of as frivolous.

10. Shift Your Intention - Instead of doing something to get what you want or accomplish what you want, shift your thoughts to how what you are about to do can serve a higher good. Perhaps even invite the universe to use you for a higher good. This is a great way to take the pressure off because it moves you beyond performance to feeling supported by unseen forces within and outside of you.

Likely anything you think of that feels good is going to be relatively right brain [I don’t mean any addictive type behavior that leads us to checking out from our feelings - which would be left brain.].

Inner Work and the Right Brain
For many of us, these types of “exercises” or what I would call inner work is done in isolation. It was for me, until I read the following quote by Parker Palmer:

“First, we could lift up the value of “inner work.” That phrase should become commonplace in families, schools, and religious institutions, at least, helping us understand that inner work is as real as outer work and involves skills one can develop, skills like journaling, reflective reading, spiritual friendship, meditation and prayer. We can teach our children, something that their parents did not always know: if people skimp on their inner work, their outer work will suffer as well.

Second, we could spread the word that inner work, though it is a deeply personal matter, is not necessarily a private matter: inner work can be helped along in community. Indeed doing inner work together is a vital counterpoint to doing it alone.”

Exercising The Right Brain But With Others
Upon reading this, I felt “called” (a concept my left brain would find amusing) to start a discussion group, called Pragmatic Spirituality. My husband and I have facilitated these discussions for the past 2 years. Marty works with organizational and leadership development. He too is undermethylated and thus has a tendency toward his left brain, at least by history. Facilitating and being part of this group has shifted us both gladly in the direction of the right brain.

Neuroplasticity
Given the repeated messages we get from our left brain culture, we all have deficits when it comes to our brain hemispheres. Because of neuroplasticity, however, we essentially can rewire neurological pathways by getting those neglected neurons firing. This is the neurobiology of spiritual growth.

Holistic Psychiatry
All that being said, I also take supplements to help address undermethylation. I eat a diet high in protein (to increase methyl) and I work to minimize inflammation and toxicity which I, like most undermethylated individuals, are more susceptible to. None of these strategies, however, feel as good as those that heavily rely on the right brain. Like many people with undermethylation, I've had times when I've found myself engaged in repetitive and potentially addictive activities such as wasting time on the internet and overeating. This was much more frequent when I was in the throws of inflammation.

By addressing inflammation and shifting to a more right brain perspective these tendencies have subsided. Now, I more easily recognize when I need to see the bigger picture. To do so has allowed me to be more effective, has improved my health and made everything more meaningful, including writing these blogs. What at times was a relatively perfectionistic and self conscious pursuit, is now an enjoyable process. The start of this blog was an open attention to what interests me and what seems to be a need of those I see and who read this blog. The middle involves a narrowing of my attention to the nuts and bolts of the topic. The end is a pulling back, letting go and having a sense of peace that I've given what I have to offer, however small, to something larger than myself.


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If you're interested in learning more about the Pragmatic Spirituality and Leadership discussion groups that Marty and I facilitate locally and remotely, please visit: PragamaticSpirituality.com.

To learn more about methylation, visit - "Epigenetics, Methylation, MTHFR & the Brain, Made Easy...er"



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