Podcast: E5: P1 - Three Pillars of Functional Psychiatry

Listen to the episode here: E5 - Three Pillars of Functional Psychiatry - https://apple.co/3te4BWE

Hey there, I hope you're having a wonderful week so far. Welcome to episode 3.1 of the Integrative Mental Health Therapy podcast with Dr. Tiffany. I'm coming off a wonderful weekend with Dr. Karazian, live streaming with him and going over functional medicine principles for depression, anxiety, and all things mental health. This is my umpteenth training with him and many like him, but it's always amazing to learn what's cutting edge, what the research is saying, and what the status of things really are at this time. Being with other professionals around the world doing the same kind of work inspired this update.

Again, this is my private podcast. This is going out to those of you who have either worked with me in the past, are still working with me, or maybe haven't checked in with me in a while but are still using a lot of the interventions that we've come up with together. Sometimes I know that this is being shared with people who are near and dear to you that you want to get into my care so they can see there are other interventions available to help them heal their brain and feel better.

I'm going to do a three-part series again. That way, I don't overwhelm you because Dr. Karazian has his three pillars, very similar to my three-leg stool, which is neurological, physiological, and psychological. We have another kind of three-leg stool, three pillars approach here with his method. It completely makes sense. If you think about our intake that we've been talking about in the last couple of episodes, many of you received recommendations from me that went right into, okay, from a physiological perspective: I need you thinking about sleep, I need you thinking about your diet, and I need you moving and integrating these exercises.

What was really interesting coming off of a week with Dr. K was how important these three things really are when it comes to saving your brain and unwinding the processes of mental health issues. Working with me, you learn that it's a complex explanation. It's not one thing. I wish it was one thing. I wish I could just give you a supplement and you'd be all better, but I think you know that's not how this works. It's all the things—genetics, history, and all those things that show up in the moment that make it so you’ve got to do all the things to have the life that you want.

Let me interrupt myself to share this from a training I had with Dr. Amen recently. He spoke about how he used to go into schools and show pictures of the brain to kids, usually in the 12 to 14-year range. He'd ask them, "Which brain do you want?" and show the brain of someone using drugs—marijuana, alcohol, someone eating poorly, not exercising, not sleeping. Then he'd show the healthy brain, the one where they’re doing all the things. Inevitably, one of the 14-year-old boys would say, "Well, if I have the healthy brain, I don't get to have any fun. You want me to not have fun."

Dr. Amen would reply, "Healthy brains have healthy lives, and those healthy lives have the things they want. Let’s talk about what fun is. Fun is being able to have the job you want, go to the school you want, have the girl or guy you want, and keep them because unhealthy brains don’t know how to keep that partner. Healthy brains have freedom and families. Unhealthy brains are erratic, in and out of jail, and have problems with the law. Unhealthy brains may get the girl or guy but don’t know how to keep them. You have to figure out how you want to define fun because unhealthy brains don’t have a lot of fun."

He then went on to do a SPECT scan on Dennis Rodman. Rodman had the same response: "Doc, you want me to not have fun. I want to have fun." Dr. Amen replied, "Dennis, your version of fun has landed you in my office in another rehab stint. We’ve got to work on how you define fun."

So when I tell you that story and I tell you about Dr. Karazian's three pillars, and I tell you about how in my intake I said you gotta do X, Y, Z, and maybe you're like, "Boy, that Dr. Tiffany, she's not having a lot of fun," I want you to keep in mind this definition of fun, this definition of self-care. As we go through this three-part series where I go over his three pillars and do a deeper dive, keep that in mind.

Dr. Karazian’s three pillars, based on research and everything he's looked at when it comes to depression, anxiety, bipolar, OCD, and neurodevelopmental challenges of ASD and ADHD, are exercise, sleep, and blood glucose stability. Exercise, sleep, blood glucose stability. I want to talk about sleep.

We will get to exercise in the next episode and then blood glucose stability in the final episode, but let's talk about sleep. We have a number of problems with sleep that show up in my practice. How we get to these problems, some of these deep dives that we all do with these labs and getting to the deep functional medicine root causes, I want you to keep in mind that yes, those things still matter. Sleep helps with those things.

Many of you know I have an autoimmune condition. One of the things I have to do is sleep like it's my job. I have to take sleep extremely seriously. Yes, I still have this autoimmune condition that impacts my brain health and can impact my mood. However, sleep, a very simple thing, helps to unwind the problems and helps to minimize triggers. That's how you want to look at this. Yes, anxiety is the diagnosis. Yes, that could be caused by all the deep things that we look at in session. At the same time, sleep will help with stabilizing the neurology.

There’s difficulty getting to sleep and difficulty staying asleep. I want to talk about those issues and then I want to talk about how much sleep. Let’s maybe even look at it from that perspective. What is the minimum amount of sleep that I want you to have? A minimum of six hours. Some of you need nine to ten, I know that. But a minimum of six—on average, the sweet spot, present company included, is about seven to seven and a half. I actually don’t feel good if I get eight to eight and a half hours of sleep. It's just too much sleep.

All of us are different. We’ve got melatonin that helps us stay asleep and fall asleep. Then we have the cortisol awakening response. Our brain releases cortisol in the morning. For some of us, just because of our circadian rhythms, we need different amounts of sleep to hit that sweet spot. Now you know how much sleep, right? You know that this is going to play into your mood. If you're tired and irritable from lack of sleep, you might have problems with depression or anxiety that day. You may be more symptomatic in other ways from a mental health perspective.

Sleep is our first line of defense and knowing how much sleep you need so that your brain can do its processes of detoxing at night. Your brain has to heal itself. There’s something called glymphatic detox. You have to do that on a daily basis. Every night, your brain actually decreases, it shrinks a bit, and it cleans itself out. You have to go to bed at a predictable time for that process to happen. Sleep is super important when it comes to this mental health journey.

We know how much sleep we need. Then there’s the issue that people have of not being able to fall asleep. If you're not falling asleep, there could be all kinds of issues playing into it, and those could be deep, problematic issues. I want to go over some strategies to help you fall asleep.

Go to sleep every night at the same time, within 30 minutes, same time. Bedtime really needs to be before midnight. It has to be before 12. If you have a family member who has anxiety, is having attention issues, and they are going to sleep between 11:30 and 2:00 AM, that’s too late. They’ve gotta go to bed before midnight. We need them asleep between 10 and 11 o’clock. Go to bed at the same time. Wake up at the same time. Yes, even on the weekends. To my parents, I know that’s not what you want to hear, but that will help with falling asleep because of the cortisol awakening response where the brain and adrenals release cortisol and the brain wakes up in the morning, and melatonin output.

We have to get those synchronized. We’ve got to get the circadian rhythm predictable. It would be nice if we could align ourselves with the sun and the moon, but we’re really out of whack with that. So, we’ve just got to be intentional about how we do this. Eat your meals at the same time every day. This will help you with falling asleep. If you're eating too close to bedtime, it’s going to cause blood sugar surges and make it difficult for you to fall asleep. Your meals need to be at a predictable time with about a two to three-hour window before bedtime. This is really important. Digestion and sleep are not compatible. They need to be spaced out.

Work out at the same time every day. I prefer, and this gets me into the groggy, waking-up groggy, not able to get up people, that you work out in the morning. If you're finding that you have a hard time waking up in the morning, I want you to try to do some jumping jacks first thing when you get up, some wall squats, something that immediately gets some cortisol going because you can be a little groggy when you try to get on this new sleep schedule. You may

 be a client that’s post-concussed, has neuroinflammation, and just has a really hard time getting up. I want you doing something immediately, even if it’s not your morning exercise, even if this is just to get you to wake up.

Again, with that groggy waking up, you can get lamps. There are sun lamps that gradually release light to help gently wake you up and end up with the room pretty bright in the morning. That’s going to help release cortisol. I also have some strategies—again, this is my private podcast—where I can work with you around licorice root. Some of you have done licorice root with me in the past to help get that cortisol response going in the morning. You can have that on your nightstand and take it immediately. Waking up has a lot to do with being able to fall asleep.

Make sure that you are avoiding blue light right before bed. Put the electronics away an hour before bed. I know you don’t want to hear this, but this is just like sleep 101. You can’t be watching TV. You can’t be on the phone. You can’t be on a laptop or iPad an hour before bed with all that blue light. There’s a lot of research around blue light, and then you think you're going to be able to sleep. We’ve got to get you to put the devices away. No stressful conversations right before bed. Make sure that the temperature in the room is cool. Some of you are quite sensitive to EMFs. Those of you with mitochondrial sensitivities and issues are going to have EMF sensitivity. So, that’s electronic magnetic fields from the phones. Make sure the phones and iPads are in airplane mode. Same thing with the watches. That will really help. Be really mindful of what you're doing right before bedtime.

If you're having a hard time staying asleep, that has a lot to do with nocturnal hypoglycemia. It has a lot to do with blood sugar dropping overnight, which will exacerbate depression and anxiety during the next day. Make sure you're not missing meals. That’s why we’re going to talk about blood sugar. Make sure you're eating consistently. You may even need to have a little almond butter or coconut oil, olive oil, some sort of fat right before you go to sleep. Make sure that you're not drinking water too close to bedtime. We may need to look at doing things that are calming right before bed, like stretching, deep breathing, binaural beats, listening to relaxing music, meditation, and you may need some GABA support right before bedtime.

Going to sleep at the same time is super important, staying asleep is super important, and waking up at the same time is very important to help you manage your mental health. We will pick up with the next episode here and keep going with these three pillars. I am so grateful, as always, for your time, attention, and support. Thank you for your continued feedback about the podcast. Until next time, be well.