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Episode 39
The Doctor's Farmacy: House Call

Panic Attacks: Biology or Psychology?

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We are living in an age of anxiety; and we know that stress wreaks havoc on our health in so many ways, physiologically, emotionally, and mentally. For many people of all ages, stress can lead to anxiety and debilitating panic attacks. While conventional medicine typically treats anxiety and panic attacks as a diagnosis, Functional Medicine views anxiety and panic attacks as symptoms and seeks to get to the root cause underlying these issues.

In this episode, Dr. Hyman sits down with Dr. George Papaicolaou to discuss the Functional Medicine approach to treating panic attacks. They explore the range of physiological considerations they explore when treating patients who are experiencing panic attacks, as well as how adverse childhood experiences (ACEs) and trauma can be treated to reduce anxiety and eliminate panic attacks.

George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital. He is also an Institute for Functional Medicine Practitioner. Upon graduation from his residency he joined the Indian Health Service. He worked on the Navajo reservation for 4 years at the Chinle Comprehensive Medical Facility where he served as the Outpatient Department Coordinator. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He practiced with a philosophy centered on personal relationships and treating the whole person, not just not the disease. He called that philosophy “Whole Life Wellness”. Over time as the healthcare system made it harder for patients to receive this kind of personal care Dr. Papanicolaou decided a change was needed. He began training in Functional Medicine through the Institute of Functional Medicine. In 2015, he established Cornerstone Personal Health – a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou to join The UltraWellness Center in 2017.

This episode is sponsored by ButcherBox and Dr. Hyman’s Sleep Master Class.

When you sign up for ButcherBox today, you can get 2lbs of wild-caught Alaskan salmon free in your first box. Just go to butcherbox.com/farmacy.

In this modern world we place too much value on staying busy and deprioritizing sleep, which is why Dr. Hyman created his first ever Master Class. It guides you through the most important steps to getting better sleep, starting today. Get free access to Dr. Hyman’s Sleep Master Class at drhyman.com/sleep.

In this conversation, Dr. Hyman and Dr. Papanicolaou discuss:

  • What are anxiety and panic?
  • How conventional medicine typically treats anxiety and panic
  • Patient cases they have treated
  • How diet, hormone and blood sugar levels, nutrient deficiencies, gut issues, inflammation, and other physiological issues can lead to anxiety and panic attacks
  • Foods and supplements to reduce anxiety
  • The important role of sleep, exercise, and meditation in reducing anxiety and panic attacks
  • Adverse childhood experiences (ACEs) and trauma
  • Emerging therapies for treating anxiety and PTSD, including CBD, psilocybin, and EMDR

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. George Papaicolaou

Dr. Papaicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital, Abington, Pennsylvania. He is also an Institute for Functional Medicine Certified Practitioner. Dr. Papnicolaou established his own practice: Cornerstone Personal Health dedicated to the Functional Medicine Model. Dr. Hyman invited him to bring his expertise and twenty years of experience to the UltraWellness team. He specializes in treating the root causes of many conditions including Neurodegenerative disorders, ADHD, PANDAS/PANS, gut and hormone health.

Show Notes

  1. Is One Minute Of Meditation Enough?
  2. How do psychedelics help you reach enlightenment or at least happiness?
  3. Magical Magnesium
  4. How to Naturally Support a Child with Anxiety
  5. Top 5 Lifestyle Changes to Combat Anxiety and Depression
  6. Adverse Childhood Experiences (ACEs)
  7. Multidisciplinary Association for Psychedelic Studies (MAPS)

Transcript

Dr. George Papanicolaou:
When we think about anxiety, we always have to be thinking about what’s happening in the gut, and oftentimes people who are anxious will have GI symptomatology. They’ll have nausea. They’ll have loose stools. They’ve been diagnosed with irritable bowel syndrome, and they have anxiety connected to it.

Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman. That’s pharmacy with an F, F-A-R-M-A-C-Y, and today’s a special episode of house call with Dr. George Papanicolaou from the UltraWellness Center, and we’re going to talk about panic attacks and anxiety.

Dr. Mark Hyman:
This is the age of anxiety. I, in the last year have felt more anxiety and stress than I felt in a long time, given the state of the world and the state of affairs in our environment with our health, with our economy, with COVID, with the political situation. Whatever side you’re on, it’s kind of crazy, and it creates a lot of stress.

Dr. Mark Hyman:
On top of that, so many Americans suffer from trauma in their childhood. We call this adverse childhood experiences, growing up in dysfunctional homes, growing up in abusive homes, growing up with alcoholics or drug abuse. Just so much has really caused us to live in this age of anxiety, and it’s so common. So George, tell us a little bit about how common is anxiety and what does it do to people’s lives?

Dr. George Papanicolaou:
As you said, anxiety is extraordinarily common. It’s probably one of the most common psychiatric diagnoses that patients will come to an office for. They will sometimes come in with more of a depressive presentation only to uncover that a large part of their depression is driven by anxiety and fear in life. It’s extraordinarily common. You can see it in all age groups, and it’s very debilitating. When you have really bad anxiety, it’s extraordinarily debilitating, particularly if it is associated with panic.

Dr. Mark Hyman:
Yeah, and like 40 million Americans walking around with anxiety all the time.

Dr. George Papanicolaou:
That’s a huge number.

Dr. Mark Hyman:
I think that’s who have an anxiety disorder, not just the normal run-of-the-mill anxiety that we all deal with. There’s a lot of people within that, about 5%, who have panic attacks, which is really terrible. What is a panic attack?

Dr. George Papanicolaou:
A panic attack is going to be that overwhelming anxiety. I’ll start with anxiety. Anxiety is a general sense of fear that something bad is going to happen. It’s beyond just stress. It’s a general fear, a neurotic fear, an unexplainable fear that something bad is going to happen. Panic is when it’s overwhelming. It has a physiologic connection, where you have this overall sense of doom, you have palpitations. You can actually get it so bad that you may not feel parts of your body. You may begin to fear you’re going to die.

Dr. Mark Hyman:
You get anxiety, numbness, tingling, palpitations…

Dr. George Papanicolaou:
[crosstalk 00:03:08] Shortness of breath.

Dr. Mark Hyman:
Shortness of breath.

Dr. George Papanicolaou:
Sweating, chest pain.

Dr. Mark Hyman:
Your heart’s racing, chest pains.

Dr. George Papanicolaou:
Pressure.

Dr. Mark Hyman:
Feeling like you’re going to die.

Dr. George Papanicolaou:
All of which I had in 1987, right before my neuropathology test in med school.

Dr. Mark Hyman:
Wow.

Dr. George Papanicolaou:
My wife and I were living in Overbrook, and I woke up in middle of the night. I couldn’t feel the entire left side of my body. I was sweating. I was short of breath. I was in a complete panic. I said, “Honey, I’m going to die. You got to get me to the emergency room.” She drove me to the emergency room of my medical school.

Dr. Mark Hyman:
Oh my goodness, that was so embarrassing, I bet. This is not that uncommon. Dan Harris, who’s a really well-known journalist and TV journalist who’s on 20/20 and Dateline. He’s on NBC and The Today Show, and he literally, on live television, in front of 5 million, people had a full blown panic attack.

Dr. Mark Hyman:
He eventually figured it out and learned about meditation and wrote a book called 10% Happier, and he’s got a podcast, 10% Happier. I’ve been on his podcast and he’s been on mine, and it’s incredible how powerful these sensations and feelings can be that disrupt your life. But there are ways to fix them, right?

Dr. George Papanicolaou:
Yes.

Dr. Mark Hyman:
What does a typical doctor do when someone comes in with a panic attack or anxiety disorder? What do we say in medicine to do?

Dr. George Papanicolaou:
Yeah, so when you have 10 minutes to see a patient and you have a caseload of 28 more patients to see, and they say they have anxiety, that’s used as a way to catch up. You give them a pill. You tell them to go find a therapist and you tell them to follow up in three months. That’s typically what happens in primary care.

Dr. Mark Hyman:
They get Adavan or Valium.

Dr. George Papanicolaou:
You’ll get an anxiolytic. People commonly know them as Klonopin, Adavan.

Dr. Mark Hyman:
These are sedatives, essentially.

Dr. George Papanicolaou:
These are sedatives, essentially.

Dr. Mark Hyman:
Right, it’s a sedative. It’s like Valium, right?

Dr. George Papanicolaou:
Buspar, which is a non-benzodiazepine anxiolytic.

Dr. Mark Hyman:
It’s a different category.

Dr. George Papanicolaou:
It’s a different category.

Dr. Mark Hyman:
But then they also throw at them a lot of antidepressants, right?

Dr. George Papanicolaou:
Yeah.

Dr. Mark Hyman:
So the usual, like Prozac, Paxil, Effexor, all these things that are treating these symptoms.

Dr. George Papanicolaou:
The symptoms without-

Dr. Mark Hyman:
They’re just affecting your brain chemistry without dealing with the cause. Right?

Dr. George Papanicolaou:
Exactly.

Dr. Mark Hyman:
Then they have side effects. The benzodiazepines are highly addictive, like Valium. They can lead to dementia or they cause cognitive impairment. The antidepressants can lead to weight gain and libido issues and all kinds of problems, so it’s not like a free ride.

Dr. George Papanicolaou:
No, no, absolutely not. We end up having to deal… The biggest fear I ever have of patients being prescribed those are the side effects, the increased tolerance. Then you have to take more, and then you have to take even more because you get this increased tolerance in order to control your anxiety, and then you can’t sleep.

Dr. George Papanicolaou:
Now, you’re having difficulties because they disrupt your sleep. They disrupt your cognition during the day, and now you have to come off of those, and they’re extraordinarily difficult to wean off of, so it becomes a real dangerous area, too.

Dr. Mark Hyman:
They don’t even work that great.

Dr. George Papanicolaou:
No.

Dr. Mark Hyman:
Only between 15 and 45% of the time, and the other thing, I had a patient last night, I was seeing yesterday, and she’s on Adavan. She’s on Buspar. She’s on the antidepressants and she’s still anxious. It’s not like it fixes the problem. It’s like, if you have a broken ankle and you take enough pain medication, you might not feel it as bad, but the problem is still there.

Dr. Mark Hyman:
I think from a functional medicine perspective, how do we approach this? Because I was going to share a little case study, and then we’ll go into how we really think through this. I just remember this patient of mine was this hard-driving, sort of late 40s, Wall Street executive, and he’d just work hard all day. Didn’t have time to eat, eat very late at night, drink a lot, go to bed, wake up and do the whole thing again.

Dr. Mark Hyman:
Every day about four o’clock, he’d had this massive panic attack. He thought he was having a heart attack, palpitations, sweating, feeling he was going to die, short of breath, the usual. I just sort of asked him about his lifestyle, I said, “Well, [inaudible 00:07:26],” “Well, I do this and the whole thing. I eat so late. I’m not even hungry in the morning when I wake up, so I just don’t eat until four o’clock, and then I get these panic attacks.”

Dr. Mark Hyman:
I’m like, “Oh, well, maybe you’re hypoglycemic,” because he was a little bit overweight. He had this belly fat. We knew from that he had high-low insulin swings with blood sugar. These people tend to get high sugar, but they also go crashing low, and when you crash low, it’s a life-threatening emergency. You literally think you’re going to die, which means you’re going to run around and try and find food as fast as possible.

Dr. Mark Hyman:
He didn’t connect the dots, and all I did was have him shift his life a little bit to eat earlier, not drink so much, have some breakfast, eat food throughout the day. His panic attacks went away, so it may be as simple as that.

Dr. George Papanicolaou:
If you’ve never seen anybody hypoglycemic, they’re in a panic. They’re in an outright panic, and they get very confused and it’s a very scary place, seen it.

Dr. Mark Hyman:
It is. I’ve been there. I’m like, “I want some food now.” I think most of the time, it’s not really just that. Although, I’ve had a bunch of patients who it’s been really their diet and their sugar, but often it’s trauma and other things and other factors.

Dr. Mark Hyman:
As a functional medicine doctor, people coming to see us at UltraWellness Center, one of the things we’re looking at, what are the kinds of things that could drive anxiety? Because, clearly, there’s psychological reasons. You take a history for trauma and other kinds of stresses, but there’s a lot of physiological reasons.

Dr. George Papanicolaou:
Oh yeah, genetic and-

Dr. Mark Hyman:
Biological reasons why [crosstalk 00:08:54] stress.

Dr. George Papanicolaou:
Physiologic, biologic reasons. Absolutely.

Dr. Mark Hyman:
So it’s not maybe a mental issue, it’s a physical.

Dr. George Papanicolaou:
Yeah, and one of the most common things in a primary care setting that you’ll do is you’ll check somebody’s thyroid, and if they have hyperthyroidism, that would be an obvious reason. That’s one of the physiologic reasons that your-

Dr. Mark Hyman:
An overactive thyroid.

Dr. George Papanicolaou:
Yeah, overactive thyroid that you’re alluding to. But there are a whole host of other reasons that people can have them. A woman that might be estrogen dominant, so estrogen dominance is essentially when you can have normal estrogen and progesterone levels, but your estrogen relative to your progesterone is much higher and that can be there for several reasons.

Dr. George Papanicolaou:
It can be your baseline physiology, but it can also be impacted by the foods you eat, the cosmetics you put on your face, and the other possible what we call Xenoestrogens that you come in contact with in your day to day activities, because they’re everywhere. Women then, therefore, have too much estrogen. Estrogen impacts your stress hormone cortisol, and so that is the hormone that you really need to have a good modulation of your stress.

Dr. George Papanicolaou:
Women who have estrogen dominance can tend to have anxiety, and they don’t know where it’s coming from. So I look for estrogen dominance as a possible question.

Dr. Mark Hyman:
We know hormonal imbalances, like PMS and other things that are well known to cause irritability and anxiety and mood issues, so it can be hormonal like that.

Dr. George Papanicolaou:
Yeah, and so then I’ll also look for other possibilities. There are physiologic things like something called casomorphins and gluteomorphins, so that’s how you break down your dairy products like milk and how you break down gluten. You make these peptides, which are small proteins, and these particular peptides can pass your blood-brain barrier. They can actually affect your brain in such a way they can cause depression, anxiety, loss of focus, agitation, and irritability. We can look for those. Those are tests that functional medicine doctors do.

Dr. Mark Hyman:
Wait, wait, wait. So you’re saying that there are, when you’re digesting dairy and gluten, it doesn’t get completely digested properly, and it forms these little psychoactive molecules that go to your brain and mess with your head. Wow. And we can measure those byproducts in the urine to see if you are making those, and you see this a lot in autistic kids, but you can see it in other people too.

Dr. George Papanicolaou:
Absolutely. I see it in adults. I see a lot of autistic kids, and it’s one of my primary tests that I look for, and often addressing those issues are helpful, but I started doing with adults. I find it very frequently that they have casomorphins and gluteomorphin issues.

Dr. George Papanicolaou:
There’s another test that we do called kryptopyrrole test. When you break down iron in your body, which you need to do, when it’s done doing its job, you’re going to create a by-product called kryptopyrrole. Kryptopyrrole in and of itself is benign, but it takes out B6 and zinc, and B6 and zinc are critical to your brain function and managing and metabolizing your neuro-transmitters.

Dr. George Papanicolaou:
If you make too many kryptopyrroles, you’re going to be deficient in B6 and zinc, and the best way to measure that is [inaudible 00:12:15] using RBCs, your red blood cells, not just serum, and so it can be very hard to determine if you’re really zinc and B6 deficient. That’s another reason why a person could be anxious and not even know it, and it’s something that’s reversible.

Dr. Mark Hyman:
That’s right. YI think one of the things that you’re sort of hinting at that I want you to speak directly to is a lot of these things cause inflammation. What we’re learning now is that when the brain is not working, whether it’s depression, anxiety, ADD, autism, dementia, and I could go on and on, it’s usually inflammation. Inflammation, the brain doesn’t feel like a sore throat or a swollen ankle, it actually creates all these psychiatric symptoms that we then mislabel as emotional or psychological, but are actually physiological.

Dr. George Papanicolaou:
When I see it, see it every day in practice, every day at least one of my patients comes in and they have inflammation of the brain. How do I know it? Because they have inflammation in their gut, and we know that it is a very strong gut-brain connection. When we think about anxiety, we always have to be thinking about what’s happening in the gut.

Dr. George Papanicolaou:
Oftentimes, people who are anxious will have GI symptomatology. They’ll have nausea, they’ll have loose stools. They’ll have been diagnosed with irritable bowel syndrome, and they have anxiety connected to it. If you’re anxious and you have GI symptoms, most certainly if it’s a diarrhea-constipation picture, where you’re rotating between the two, sometimes having regular bowel movements, it’s going to be called IBS.

Dr. George Papanicolaou:
You’re going to be treated very just symptoms only for both of those conditions. When they’re really connected, and by altering the gut microbiome, by changing your diet and adding in foods that will enhance a normal, balanced, functioning non-inflamed gut, we can actually improve your anxiety as well.

Dr. Mark Hyman:
What you just said was pretty radical here, that we used to think, when we went to medical school, we were taught that people with irritable bowel syndrome, it was caused because they were emotionally unstable, that they were anxious and they had emotional issues. That’s what’s causing the irritable bowel.

Dr. Mark Hyman:
What you’re saying is the opposite. What you’re saying is that we’ve learned now, and this is well-documented science. We’ve learned now that if you have irritable bowel syndrome, meaning you have bad bugs in your gut, you have inflammation in your gut, you have leaky gut, you have food sensitivities, that this causes inflammation in the brain. So that basically an irritable bowel causes an irritable brain.

Dr. Mark Hyman:
That is actually the direction of the problem. Yes, of course, if you’re stressed, you can have gut issues too, because it’s a bi-directional system. But it’s important to understand that we mislabeled a lot of these things that have to be de-stigmatize from being emotional problems to being physiological problems. That’s really why I wrote my book, The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First, because you don’t know if it’s emotional until you fix the physical stuff.

Dr. Mark Hyman:
If you have high fibroid, if you have mercury poisoning, which, by the way, can cause anxiety and insomnia and all these other issues.

Dr. George Papanicolaou:
Absolutely.

Dr. Mark Hyman:
If you have a [CBO 00:15:36] or bad bugs growing in your gut, if you have magnesium deficiency, which is a big cause of anxiety, you can treat those things and people will get better. From a functional medicine perspective, we’re looking at all these issues. When you go to the psychiatrist, they go, “Let me measure your vitamin D, let me measure your magnesium. Let me measure your fish oil. Let me look at your poop. Let me look at your heavy metal levels. Let me look at your hormones.”

Dr. Mark Hyman:
They didn’t do any of that. They go, “Here’s your Adavan, here’s your Prozac. We’ll see you next week or next year.”

Dr. Mark Hyman:
Hey everybody. It’s Dr. Hyman. Thanks for tuning into the Doctor’s Farmacy. I hope you’re loving this podcast. It’s one of my favorite things to do, and introducing you to all the experts that I know and I love, and that I’ve learned so much from. I want to tell you about something else I’m doing, which is called Mark’s Picks. It’s my weekly newsletter. In it, I share my favorite stuff, from foods to supplements, to gadgets, to tools to enhance your health.

Dr. Mark Hyman:
It’s all the cool stuff that I use and that my team uses to optimize and enhance our health, and I’d love you to sign up for the weekly newsletter. I’ll only send it to you once a week on Fridays. Nothing else, I promise, and all you do is go to drhyman.com/picks to sign up. That’s drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter. I’ll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Now, back to this week’s episode.

Dr. George Papanicolaou:
When I read that in your book, that brain disorders are really body disorders, that was just transformative in my thinking. That that was, this is transformative, and that’s when I really, that was one of the seminal moments of me changing the way I approached the care of my patients and drove me into functional medicine. That’s just a huge and important point to make, and I think that all the things that we’ve talked about are the body issues that we look at that affect the brain. There’s so much value in just understanding that simple point.

Dr. Mark Hyman:
Yeah, I think it’s absolutely true, and all these various things play a role. I think some of them are more important than others, and it really-

Dr. George Papanicolaou:
These are genetic components as well. We look at genetics, and we know that the genome is huge. We scraped the surface and there are things called single nucleotide polymorphisms that are basically a single peptide variation in your gene blueprint. Your genes are just, as you know, these blueprints and then these blueprints are made. They are only used to make proteins. Most of those are enzymes that cause all these great reactions to happen to our bodies.

Dr. George Papanicolaou:
Some of those reactions are really important to our neurotransmitters, work on our brain, and maintain a healthy balance. We know that there’s some snips that we look for in people with neuropsychiatric disorders like depression and anxiety that can have a huge impact on whether they have anxiety or depression. One of those is the COMT gene. When you have a variation in that, you can have variation such that…

Dr. George Papanicolaou:
This gene, as I said before, is a blueprint for an enzyme that breaks down neurotransmitters in your brain. If this enzyme is working too slow, you’re going to have a buildup of enzymes of your neurotransmitters in your brain. This particular buildup of dopamine and norepinephrine at baseline helps you stay focused and calm, but the least amount of stress can drive you into anxiety.

Dr. George Papanicolaou:
If we understand that about a person, there are actually nutritional, lifestyle and targeted supplements that can make a difference. That’s a key. Again, that’s one of those root causes that we’re looking for in functional medicine that you probably won’t get in conventional medicine with your primary care.

Dr. Mark Hyman:
No, not at all, and I think it really is a different thinking that we do with functional medicine. It analyzes problems completely differently. Before we assume it’s some psychological issue, we’re going to rule all these other things out.

Dr. George Papanicolaou:
Absolutely.

Dr. Mark Hyman:
We do an extensive evaluation that looks at your brain chemistry, amino acids. We look at adrenal function, thyroid function, food sensitivities, heavy metals, which mercury can… I had mercury poisoning. I know how much it cause me to have depression, anxiety, insomnia. We look at nutritional levels like magnesium, magnesium is so important. We look at the gut and the stool test-

Dr. George Papanicolaou:
Hormone balance in women is huge.

Dr. Mark Hyman:
Hormone balance, so we really do a very comprehensive view, and it’s amazing. That’s actually why I wrote the book, The UltraMind Solution, was I wasn’t thinking about all this stuff, but I was treating people with all these issues. I had gut issues, or I have this issue or a hormone issue, or I got heavy metals.

Dr. Mark Hyman:
Then they say, “Oh God, Dr. Hyman, my panic attacks are gone. My anxiety is gone. My depression is gone. My bipolar disease.” I’m like, “What? Really?” Then I was like, wait a minute. There’s something here, that the brain is actually responding to all these other things that are happening, that we are completely ignoring, and that’s the beauty of functional medicine.

Dr. Mark Hyman:
Magnesium is so important, because it’s the relaxation mineral, and I think 40-plus percent of Americans are-

Dr. George Papanicolaou:
Deficient.

Dr. Mark Hyman:
… low. If we drink alcohol, if we have coffee, if we don’t eat enough magnesium-containing foods, like-

Dr. George Papanicolaou:
If we take acid blockers.

Dr. Mark Hyman:
… mustard seeds, acid-blocking drugs for heartburn, nuts and seeds and all these things. Greens, we don’t get enough of these in our diet, and we don’t actually get the benefits of this important mineral, which we all need a lot of to function well.

Dr. George Papanicolaou:
Absolutely.

Dr. Mark Hyman:
And so that alone can be hugely effective. Let’s talk about what you would do with a patient after you sort of got all of this, what’s the general approach that we have with anxiety? Maybe you can talk a little bit about a few cases, but I just would love to get a general sense of what the step-by-step approaches to treating a patient after you’ve sorted through what’s going on.

Dr. George Papanicolaou:
Yeah. The key part is sorting through. As you know, as I’ve said before, when you come to my office in functional medicine, you get a very long history and timeline, and then we’re going to really look at the underlying root causes and conditions that might be resulting in the anxiety.

Dr. George Papanicolaou:
I always have seen anxiety as a symptom, not a diagnosis. I’m going to be looking for the underlying root causes. After I do that careful assessment of the history, then I’m looking at basic blood work, so that will include looking at it through thyroid, looking at iron levels, because low iron can lead to anxiety. I’ll be looking at blood counts.

Dr. George Papanicolaou:
Then I’ll do some functional medicine testing. I’ll do genetic testing, looking for those snips. I’ll look for kryptopyrroles. I’ll look for the casomorphins. I’ll definitely be looking at the gut microbiome. I’ll be looking if a person’s having GI symptoms and they’ve been diagnosed with IBS. There’s a very, a fair, large percentage of the IBS patients who actually have something called small intestinal bacterial overgrowth.

Dr. George Papanicolaou:
That can be associated with anxiety and depression and fatigue and irritability. We’ll check for CBO in part of their complete diagnostic stool evaluation, and microbiome evaluation. We’ll also look at hormone balance and adrenal function.

Dr. Mark Hyman:
You look at all that stuff, and then you take this patient and you sorted through, and you’re going to treat all these things separately. What’s a general place to start in terms of diet, lifestyle, supplements that seems to sort of help as a basic foundation? Because all those things have to be built on a foundation.

Dr. Mark Hyman:
If you’re detoxifying something or balancing their hormones, you’re really starting with the foundation of lifestyle. There’s a lot of really simple things that people do that can really work. I encourage people to listen carefully, because there’s things you can do without even having to go through all this.

Dr. George Papanicolaou:
I think the first place you really look as the diet, and the diet-

Dr. Mark Hyman:
Food is medicine.

Dr. George Papanicolaou:
Food is medicine. It’s the end of your fork, and we got to go there. I have patients that come in to me and tell me, “I eat a great diet,” but then we do a real deep dive into the diet, and it’s not great. They don’t realize that not eating organically or not being paying attention to the fact that you’re eating GMO foods that are altering your gut microbiome, that you’re getting glyphosate in the grains that you’re eating.

Dr. George Papanicolaou:
GMOs and glyphosate are microbiome busters, and so right there, I know you’re going to have a broken and imbalanced microbiome that could be impacting your brain. Why? Because 70% to 90% of your serotonin, which is a mood stabilizer in your brain, is actually made by gut bugs, and so we need to, we go there. Nutrition is going to affect your gut microbiome and what kind of nutrition? We got to get out of the processed foods. We got to get out the sugars as main things. We go after dairy, we go after gluten, those are really common inflammatory foods that will affect your brain.

Dr. Mark Hyman:
You go to all the stimulants, because all the things that could cause anxiety.

Dr. George Papanicolaou:
Caffeine, nicotine, vaping, those are lifestyle things. I just went down that path for a second, but exactly.

Dr. Mark Hyman:
Where would you start out on the nutrition stuff?

Dr. George Papanicolaou:
Nutritionally, I really drive people to a vegetable-based diet with whole foods, fish.

Dr. Mark Hyman:
But on the supplements, like what would you…

Dr. George Papanicolaou:
Supplements?

Dr. Mark Hyman:
What are you thinking, nutritional supplements?

Dr. George Papanicolaou:
So nutritional supplements, one of the first nutritional supplements I will actually think about using is vitamin D, because a lot of people are very low on their vitamin D. Vitamin D is definitely linked to depression and anxiety. You have to make sure their vitamin D levels are high.

Dr. George Papanicolaou:
I like fish oil. Fish oil is very important for the brain. It has EPA DHA. Both are very vital to neuronal function and maintaining health of your brain. They’ve been shown to improve people with ADHD, their anxiety and their inattention can improve when they have high doses of fish oil. Vitamin D, omegas, magnesium is definitely in my top three.

Dr. Mark Hyman:
Top of list, yeah.

Dr. George Papanicolaou:
Magnesium is very important for relaxation and de-excitation in the brain. I’ll use something called GABA. GABA is a neuro relaxant and can help people who have anxiety.

Dr. Mark Hyman:
It’s like a natural Valium.

Dr. George Papanicolaou:
Yeah, it’s a natural Valium. Those are some of my top four.

Dr. Mark Hyman:
[inaudible 00:26:12] like, things like 5-HTP, which has helped serotonin, which is [crosstalk 00:26:16]. That’s what tryptophan is sort of made from.

Dr. George Papanicolaou:
I’ll use adrenal adaptogens.

Dr. Mark Hyman:
Of course, there’s also the herbs like valerian and passionflower. There’s a lot of different things that can be effective, but we also really focus on the other lifestyle issues. We focus on stress and meditation, exercise is a great way to reduce anxiety. If you burn off all the stress hormones when you go for a jog…

Dr. George Papanicolaou:
Well, they have recent studies, as you know, recent studies have shown that exercise improves many different disorders, particularly been effective in treating anxiety and ADHD. Whenever I see a patient with either of those, the first prescription they get from me is 30 minutes of exercise every day.

Dr. Mark Hyman:
Yeah, absolutely, and sleep. The usual stuff, sleep, exercise, stress reduction.

Dr. George Papanicolaou:
The usual stuff.

Dr. Mark Hyman:
But now people aren’t doing it.

Dr. George Papanicolaou:
They’re usual, but they’re not being done. People don’t realize that, quite honestly, when I address the five lifestyles as the fundamental issues, I get people better just doing that.

Dr. Mark Hyman:
Yeah, and that’s so true. I think all of us experience stress and can experience anxiety and sometimes I do. I know I’ve just found ways to change my state. If I go on my bike, if I do a little yoga, if I do a meditation or even, my favorite is the lazy man’s way. I like to take a hot bath with Epsom salt, because that relaxes me or even a sauna or steam and then an ice bath. That just takes all the stress out of my system. It’s amazing.

Dr. Mark Hyman:
I can really sometimes feel the stress build up from the day, and I just feel a little agitated and wired. I do one of those things, and I literally come back and I’m just completely calm and centered and great. There’s a lot of ways to access that.

Dr. Mark Hyman:
I want to end on sort of a conversation about some of the advances that are there for things that aren’t necessarily just physiological, because we’ve talked a lot about the physiological, because it’s something that gets missed. People talk about therapy and all this stuff and that can be helpful, but there’s really emerging therapies I think are really worth talking about, CBD and some of the psychedelic-assisted psychotherapies and MDMA therapies.

Dr. Mark Hyman:
These are emerging and a lot of research is being done on these. In fact, there was just a study published recently in the Journal of the American Medical Association in Psychiatry that showed that psilocybin treatment was four times as effective as antidepressants. Can you talk a little bit about these? Because I think they’re so critical and they’re so ignored. They’re, I think, possibly the future of treating mental health disorders.

Dr. George Papanicolaou:
Absolutely.

Dr. Mark Hyman:
Because a lot of people who’ve experienced real trauma, whether it’s a war zone experience from a military vet or whether it’s someone who’s had abuse when they were younger or has experienced a real trauma in their life, PTSD can be a real phenomenon.

Dr. George Papanicolaou:
Oh, absolutely.

Dr. Mark Hyman:
It’s not just physiological.

Dr. George Papanicolaou:
Yeah. I was going to say, one of the things that we never have a chance to talk about is the trauma in people’s lives. Trauma is huge. I think adverse childhood trauma, adverse young adult, adult trauma is very undiscussed topic when it comes to a physiologic disease and mental health.

Dr. George Papanicolaou:
I’m always having my ears attuned to the possibility of an adverse trauma or traumatic event in a person’s life that they don’t want to talk about or can’t talk about. So it’s really critical and then-

Dr. Mark Hyman:
I want to say, people listening, they can look at how their childhood was and whether or not they really qualify as having adverse childhood experiences by going online and just Googling adverse childhood experiences test or ACE test. The CDC makes this available free. You can take the quiz and you can get a score and you can see, am I someone who’s got a high level of adverse childhood experiences?

Dr. Mark Hyman:
People who do tend to have more anxiety, more depression, more substance use, more eating disorders, more challenges in their relationships. I mean, it’s just all more chronic disease, more autoimmunity. I think it’s really important to understand this because if you have this, then it really is important for you to take control and take initiative to actually deal with this systematically.

Dr. George Papanicolaou:
It’s really critical, and we didn’t make that point. Before we get to these psilocybin, the CBD, people need to know that PTSD is different than anxiety and depression, and it’s treated differently. You have to go to a specialist type of therapist to help you work through that. There are not drugs that are effective at treating that, but we are going to talk about CBD, and particularly psilocybin.

Dr. George Papanicolaou:
There are other therapeutic interventions like EMDR, which is eye movement, dysregulation and hypersensitivity, re-sensitivity retraining, which basically is going to tap into the healing powers of the brain to help a person begin to make connections with their trauma and begin to heal. DNRS, which is dynamic neural retraining, does the same thing differently.

Dr. George Papanicolaou:
It begins to rewire the neural network of pain and associated with the trauma in the limbic system, where our emotions and our responses to emotions originate and perpetuate. There are definitely therapeutic interventions, beyond the typical that we have now that you wouldn’t have had in the past.

Dr. Mark Hyman:
EMDR can be effective. There’s also transcranial magnetic stimulation, which is using magnets to change the frequency of the brain, and that can also seem to help with PTSD. There’s a lot of options for people.

Dr. George Papanicolaou:
But now to the really cool thing that you brought up was the CBD and the psilocybine. Michael Pollan’s book, How to Change Your Brand, I think you’ve actually interviewed him here on your podcast.

Dr. Mark Hyman:
Yeah, How to Change Your Mind.

Dr. George Papanicolaou:
How to Change Your Mind.

Dr. Mark Hyman:
Which has been on the podcast, so you can listen more about his approach on that podcast with Michael Pollan.

Dr. George Papanicolaou:
In that book, he outlines the history of psilocybin since it was discovered by Albert Hoffman and in…

Dr. Mark Hyman:
LSD.

Dr. George Papanicolaou:
LSD, as LSD, but more recently, it’s now being approved for research. It’s being approved for use in people with anxiety, post-traumatic stress disorder, depression, and it’s being found that when you have people take guided psilocybin trips, they can begin to rewire how their brains work. They can begin to reconcile past trauma.

Dr. George Papanicolaou:
When they come out of their trip, the studies have shown, that their anxiety and their depression, their sense of fulfillment and happiness has increased. It’s maintained over a long period of time after one trip.

Dr. Mark Hyman:
That’s right. It’s pretty amazing after one treatment, it’s not like you take the drug for the rest of your life, like all these other drugs. I encourage you to explore this. There’s a website called Maps, which is psychedelic research that is being done around the country and around the world.

Dr. Mark Hyman:
I think there’s some states have decriminalized psilocybin. There’s some states that have approved it for therapy, like Oregon. I think we’re on the verge of a real breakthrough in psychiatric treatment-

Dr. George Papanicolaou:
Absolutely.

Dr. Mark Hyman:
… particularly for people with real trauma and PTSD. If you’ve been listening to podcasts, there’s a lot of information here about the real causes of anxiety, PTSD and mental illness in general. Things you probably haven’t heard about from your doctor, all the variable things that we discussed, from hormones to toxins, to the gut, to nutritional status in our diet and our inflammation in their brain and how all of these can be addressed to a very comprehensive, functional medicine approach. And how, if that really isn’t enough, there are all these other options, whether it’s transcranial magnetic stimulation, EMDR, psilocybin-assisted therapy, or even things like CBD oil, which is a safe, and it’s not illegal. It’s a derivative of the marijuana plant.

Dr. George Papanicolaou:
Huge benefits with my patients with anxiety.

Dr. Mark Hyman:
I think this is sort of a new age of psychiatry now, which is very exciting because the old one was pretty bad. I’m just so thrilled that at the UltraWellness Center here in Lenox, Massachusetts, we get to use these advanced approaches to really help so many patients with treatment for problems that they’ve struggled with for a long time and haven’t gotten solutions.

Dr. Mark Hyman:
George, thank you for what you do here. Thank you for your work and caring so well for all our patients. If you love this podcast, The House Call, a special edition of The Doctor’s Farmacy, please share with your friends and family. I know a lot of people want to hear this and also subscribe wherever you get your podcasts, leave a comment, how you’ve maybe had to handle your anxiety issue, what’s worked for you, what hasn’t, if you have PTSD, what you’ve learned about it, and we’d love to hear from you.

Dr. Mark Hyman:
If you like this podcast, again, keep listening, because we’re going to be here next week for another episode of The Doctor’s Farmacy.

Dr. George Papanicolaou:
Great talk, Mark.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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