58. Functional Medicine for Psychiatric and Neurological Issues with Dr. Achina Stein

In today’s podcast, Dr. achiness Stein, author of What if it’s not depression leads us through the maze of mental health psychiatry issues and neurological inflammation with an expert. If you thought hormones were part of the picture you are right, but only along with food stress, infections, and more. How can we address neuroinflammation when it manifests as depression, brain fog, and mental health crises? That’s what Dr. Stein is here to talk about.

Welcome to functional nutrition and learning for kids, your podcast for areas of functional medicine and learning, both explored and unexplored. I invite and I host this podcast from the perspective of a parent of a child with a disability as a chemist, and as a functional nutrition practitioner. Today as you learn about functional medicine root cause issues that relate to mental health. I really want to encourage you to search for my TEDx talk titled who decides how smart you are? Because when we have our legs firmly planted in the presuming competence model, this helps us navigate functional medicine with more ease and surety. I’m so excited to welcome Dr. Stein to this podcast.

Dr. Stein is an osteopathic physician who graduated and has been in practice as a Board Certified psychiatrist for 25 plus years. Her osteopathic roots set her apart from a conventional psychiatrist because of her use of the osteopathic philosophy, and biopsychosocial treatment approach. She has much experience using psychopharmacology working with the prison population, community mental health centers with the chronic and persistent mental health population, and geriatric psychiatry and patient population.

She’s understood the limitations of treatment with medication and she’s continuously searched for other modalities of treatment. She was propelled by her son’s health crisis in 2010 when she found functional medicine, which resolved all of his health problems, and she’s been practicing functional medicine since then.

Dr. Stein is a distinguished fellow of the American Psychiatric Association and was awarded the exemplary psychiatrist award in 2008. She’s lived in Rhode Island since 2000, with her husband and three young children. And she’s currently in private practice in Rhode Island and is co-owner of functional mind LLC, with a nurse practitioner, Sally Davidson, and I’m so excited you joined us today for this podcast. Dr. Stein, I kind of want to start off with the question what are the gaps in conventional psychiatry that propelled you initially to seek functional medicine training?

Dr. Achina Stein:

Well, well, you know, the gap. I came to realize, you know, through serendipitously through, you know, some of the issues that I was running into in terms of dead ends, you know, leading up to dead ends in terms of my patients, you know, sometimes I think we, as a doctors think that we, that the person that is experiencing some of the symptoms that they have are going to be chronic and lifelong. And I’m not one of those doctors, that assumes that I feel like I have to keep digging, and I’m one of those diggers and keep looking and keep looking for solutions.

I came to realize at some point that I was up against some things that I didn’t know the answers to. So I started to look for alternative ways of healing, and in the realm of integrative medicine and integrative psychiatry, so that in parallel, you know, really put my face to face with my own son’s mental health crisis. And that really took me down the road to a type of model of therapy or treatment called functional medicine. And because I’m a psychiatrist, I call it functional psychiatry.

Right. And it is a field, you know, nutritional psychiatry kind of overlaps. It’s a new field again, these were pioneers in this field. But it was a it really answered a lot of the questions that I always had in my mind about patients not getting well, not knowing the answers, and not knowing where to find them. So when it occurred with my own son. Of course, when it’s your own son, you really, really really dig. And when you find when you experience that so what happened with my son is that he had an acute mental health crisis where he became overnight acutely depressed, and suicidal.

Basically standing on a ledge five stories up ready to jump and that was like overnight and that doesn’t usually happen, usually, there’s the quell, at least that’s we, what we know it to be. And just from being a psychiatrist, it’s, it’s extremely rare for someone to have to feel that way overnight. It’s usually because of some serious stressor, like a breakup, or an acute, you know, serious loss or something like that. But this wasn’t the case. And but what clued me in as this being very different from the classic symptoms of major depression, right was the fact that he could no longer read.

Oh, so his, he just couldn’t read anymore. And this is a kid who read books avidly and he had a memory like a photographic memory. And, you know, once he read something or heard something like on the radio, it was like, right there, you could repeat, it wasn’t able to do that either. So had incredible brain fog, as well as not being able to read so.

So when, you know, I had to take him to, I took them to a psychiatrist, traditional psychiatrist, and he was put on an antidepressant and anxiolytic, he was put on sleep medication, so we ended up being on four medications. And he was no longer suicidal, and the depression got a little bit better, but he became very anxious, and he just couldn’t attend anymore. So he’s also put on a stimulant that was the fourth medication. And we had put all of his books on audio so that he can continue to go to school because he couldn’t read. And, and that took me down a road, serendipitously to meeting a gentleman by the name of Edward blev, attend who’s in Massachusetts, in Newton, Massachusetts.

At the time, the practice was called visions, health care. And I happen to meet him just because of my own patients and wanting to find other ways of treating my patients through an integrative route. And when I learned about all the things that he did with his patients, it was it really opened my eyes like, whoa, and I, I asked to shadow him, and I saw, you know, I met with him, you know, and his patients every Tuesday for a period of three to six months, and I realized that I had to bring my son there. So my son had treatment with him. And long story short, he was able to resolve all of his symptoms within a lot of symptoms very quickly, within a couple of months. And, but ultimately, it took, it took a year to come off medications completely, and then two years for his ability to read to return. So you’re probably thinking, Well, what happened?

Yeah. So you know, you know, he wasn’t necessarily you think your kids healthy, but really, in retrospect, he wasn’t the healthiest child. And I only learned that after the fact he had severe constipation from a baby. And to the point where he sat on the toilet, like a bird, you know, with his feet up on the toilet, because that’s when you’re squatting, that’s the best position to actually have a bowel movement. And his, he had severe eggs, much to the point where his, you know, his hands looked like, like reptiles, you know, so his skin was so inflamed. And, you know, he, he enjoyed being a part of dinosaurs because he was into, you know, into dinosaurs at the age of four. So, I mean, we just thought, well, that’s just him. You know, that’s

Vaish:

symptoms of off gut health issues at the beginning, but those are not things that were ever talked about as identifying or correlating to brain health.

Dr. Achina Stein:

Right, right. But it’s it those are certainly symptoms of inflammation in the body. And the thing is, he was the kind of eater that ate only white food, white food, pasta, rice, popcorn, dairy, all dairy products, he hardly ate any vegetables at all. If there was one vegetable that all three of my children ate was broccoli, with cheese on it, of course.

Vaish:

Rice but broccoli is actually great.

Dr. Achina Stein:

Exactly. That’s the only vegetable that that that they would eat. So for him, my other children would eat vegetables, but,  he was very, very stubborn about the foods that he would eat. And so And besides that, he was very restless. He would be he would rock um, I remember his kindergarten teacher telling me that he doesn’t listen. Or he’s not he’s stubborn and is not maybe have a hearing problem because when they call his name, he doesn’t respond and, and so and he would be he would rock and when they were For Storytime circle time, he would be rocking back and forth, back and forth, back and forth. And there would be times when he would be at the dinner table, and he would suddenly stand up.

Like, why are you standing up and sitting right back down? So he had this, this restlessness, and can’t, it couldn’t explain it, we just thought, well, that’s just him, you know, that’s just who he is, you know, we kind of accepted it. And after a while, we just thought that was his normal, and that that was all normal, but it’s not any of that is normal, none of it, you know, so. So, you know, what happens is that when, when a child hits puberty, that’s a whole remodeling of your body and your mind, you know, the hormones change, and it’s, it’s a huge load to the immune system.

The immune system gets taxed during that time. And it was at the age of 14, that he had this explosion of symptoms that was really brewing for a very, very long time. And so it was at the age of 14, that he started it affected his brain is inflammation, because of so puberty is a time where, where, and it’s not just puberty, but you know, pregnancy postpartum. And well actually postpartum, not necessarily pregnancy, because the progesterone in pregnancy can, it’s actually protective.

It’s when the progesterone drops, and you have the baby that you began having symptoms, but then there’s menopause and intercross. So there is a period of hormonal periods that can trigger these immune tilts, it’s a tilting of the immune system where it goes, Ah, I can’t take it anymore.

Vaish:

So your body in that, because I feel like this could just take our conversation into a different realm. And I’m really happy to do that. Because when whenever you’re going to these Biomed or functional conferences that are artists in specific, you actually want when you know, you have these times when parents sit in groups and talks, you actually have a different group of parents, that’s 13, zero to 10, or zero to 12. And then there’s 12 to 18. And they’re facing a whole different set of symptoms. So can we please talk more about that? And a little bit about what changes? And what people might expect? Do things? Can it be the opposite? Where a child that’s really dysregulated? Might experience regulation after puberty?

Dr. Achina Stein:

Mmm, that’s interesting. That’s an interesting question. That hasn’t been my experience. You know, and it hasn’t been my experience. Because you have to remember that the people who come to see me are people who have gone from doctor to doctor to doctor. And, and it’s to a point where like, they just have me come to a dead end. And so and the people are who are so dysregulated, that there’s nothing that helps them not even medication, or they’re so overmedicated that they can’t function. They don’t have any quality of life. So that’s the population that ends up coming to see me.

Vaish:

You’re starting to do this, your sample set is that is the people that are struggling with these issues. So you wouldn’t necessarily see somebody that got better after.

Dr. Achina Stein:

Right, right. Yeah, so that was like, that’s why I’m saying, you know, it’s like this funnel of people that come down, that have specific issues that come to see me, and it’s because they haven’t been addressed by other avenues, so to speak. So. So to answer your question, in a long-drawn-out way, what conventional medicine doesn’t provide is, what is how is the body functioning? You know, so food, and what are you putting in the body? So food is medicine, and a lot of people don’t realize that you know, that food could cause inflammation. And I know you talk about that quite a bit in your podcasts. And so I’m sure your audience knows a lot about that. But what creates inflammation is not just food, there are also infections, there are chronic infections, and there’s a difference between chronic infections that sort of, you know, it’s like a kindling effect.

It’s almost like I describe it as the war between India and Pakistan, like there are no bullets firing, right? It’s like the Cold War, right? You have this fence with armies on both sides facing each other and you know, and you know, as soon as something moves but there is no fire, there’s no firing. There’s no actual war going on. And so, your body you know, can come to a stalemate with certain infections and they lay low But they occupy your immune system and it creates a burden. So that can cause chronic inflammation. And most conventional doctors don’t look for that.

They don’t know how to look for that. On they address acute infections that cause fever, high white blood cell count, you know, there’s all of these other indicators for an acute infection. So there are foods that cause inflammation, chronic infections, toxins. So there are different kinds of toxins, there are emotional toxins, so internally emotional toxins externally in terms of fighting and like within the family.

Look at COVID, you know, the COVID is a, it’s an emotional toxin in terms of how it’s preventing us from living our lives. And that can be extremely stressful. But then there are other types of toxins as well like pesticides, and heavy metals, and our food is contaminated with lots of toxins, our environment is contaminated with lots of toxins, and then there’s stress. So, stress, foods, infections, toxins, stress, and those things can cause dysregulation of our hormones, it can cause an increase of a particular hormone called cortisol, which is released after adrenaline. So when you’re under stress, your adrenaline goes up. And then Cortisol is released to manage your adrenaline.

If you have chronic stress, then you have cortisol across the board. And that, you know, so that can, that is a hormone that causes an imbalance of all your other hormones. So when I see a person, I look at those five areas, and that spells the word shifts, so stress, hormones, infections, foods, and toxins. And yeah, it’s important too. And so our goal is to shift the paradigm of how you approach the body in terms of healing, but, but it’s an easy way to remember that. So, you know, when my son was being treated, we looked at all of those areas and addressed all of those areas. And the beauty of this is that he was able to come off the medications now, he absolutely needed the medications to stabilize, and there’s no doubt absolutely needed it.

But he doesn’t need them long-term, it was a good way to it’s almost like, you know if you break your leg, you need a cast to set it. But eventually, you come out of that cast, and you do some physical therapy and do some lifestyle changes to support the healing of your broken leg, or whatever it is that the cast is on, you know, so that you don’t have to be in the cast long term. And so I see medications now, as being a temporary solution.

Sometimes it can be yours. But you know, but temporary, as long as you’re doing the work, and it’s a lot of work to change your diet, it’s a lot of work to change your lifestyle. Some people aren’t willing to do that. So So then they’re going to stay on medications and some medications, take care of all your symptoms, great if you’re not having side effects, and the benefits outweigh the risks, and you’re not having side effects.

That’s your choice. There’s no judgment, you know, but there’s there are a lot of people who seek me out because their medications aren’t working, or they stop working, or they have side effects, or they’re on too many medications and no, or there are lots of risks that they’re concerned about on a long term basis. So it’s those people who really want to do the work to be able to make those changes.

Vaish:

And would it be accurate to say that the medications aren’t really addressing why the symptoms have come in the first place, but they are being a bandaid on helping the symptoms stabilize?

Dr. Achina Stein:

Yes, they stabilize the body, they stay in the brain. And it suppresses. So when I was a conventional doctor, I thought that the medications actually treated a problem that was permanent, that it could it like once you have it, you can’t ever make it go away. And so you had to take medications in order to treat it. And it’s not really the case. It’s I’ve proven it over and over and over again, that the medications are, you know, sometimes necessary, absolutely necessary. And sometimes people come to me because they think, Oh, I’ll take them off their medications. And after doing an evaluation, I’ll say, Nope, you need to stay on vacation, and I’ll explain why they need to stand mitigations. And so so there are you know, but there are many people where you know, they’re able to reduce medications or come off medications but based on, you know, doing a complete evaluation, and doing the work that’s necessary to bring their body back into balance of body, mind, and spirit back into balance and allow for that to happen.

Vaish:

Yeah, and this I think it’s so important because the biggest thing that you’re talking about is the mindset shift as well, but we’re in conventional medicine We’re talking about the disease as a permanent state of affairs, which is fixed by certain drugs.

Whereas in functional medicine, the first mindset shift is that we’re not at war against medication. And the second one is that you will make a differentiation between chronic and acute conditions. And the fact that you’re going to be treating the root cause symptoms, which you explained was the shift analogy. What do you call that pseudonym?

Dr. Achina Stein:

No. acronym, acronym?

Vaish:

The shift acronym. Thank you. And, and while at the same time seeing maybe you’ve been off the medications, maybe you don’t depend on that, but you’re still addressing the root cause of inflammation in your body. Right, right. I did have a question. Do you, in your practice, distinguish between the terms mental health and brain health? And I feel like in conventional medicine, they seem to be talking about two different things. But to me, it feels like it’s the same thing. What do you What’s your stance on this?

Dr. Achina Stein:

Yeah, to me, it’s, it’s well, you know, you’re talking about psychiatry versus neurology, right, I suppose. Yes. And to me, it’s like computer software and hardware. So I, they’re interrelated.

You can’t separate them, you really can’t. And so in this, it, you know, imagine how robots work, you know, if the hardware is not working, they’re going to glitch. And so I see mental health symptoms as glitching, just like neurological symptoms are glitching. And, and you can address those, but on the part that is, you know, is that’s the software is our experiences, it’s our, our memories, it’s our emotional connection to things, it’s spirituality. So all of that is all connected, you can’t really separate that out, you just can’t, you know, so, in fact, you know, you could have a spiritual crisis, and that can cause emotional and neurological issues.

Right. I mean, that’s what conversion therapy conversion is, you know, conversion disorder is, is like losing your voice, you know, neurologically, you know, it appears to be a neurological problem or, or physical problem, but it could be mostly psychological, or spiritual cause affecting you. So, how can you separate that out? You know, it’s, it can I don’t see it as a separate problem. So

Vaish:

I’m glad you brought the spiritual aspect in it because I think that makes a huge case for when autistic children are treated with respect when you assume competence when you assume intelligence because if you don’t do that, there’s no amount of nutritional or functional medicine that is really going to help them optimally function. Because if they’re continuously treated as children with intellectual delay, which, in my mind is a very rare scenario, because there’s this innate intelligence accessible to everybody. So this part about respect and about, equal education, and learning opportunities becomes equally important because of the linking of the spiritual, the emotional, and the neurology, the psychiatry, as you said, so thanks for being right.

Dr. Achina Stein:

Yeah, I don’t ever see that. In fact, I don’t like the fact that we have siloed all of our organs not only have we split the brain, and split the brain, the head of our bodies then we’ve siloed every single organ and functional medicine is really about how they all function together and having the harmony of all your organs. And it’s the orc. So it’s how it functions like an orchestra, you know. And so in an orchestra, you can hear, you know, which, which instrument is of the, my stroke and hear which instrument is off, you know, and but how do you get that back into balance and alignment, and now in alignment, so I think ultimately, it is having a whole-body approach that’s the most important and understanding how you can you know, basically, to me function is how you can address all organs.

The gut is the highway to that it’s the interface between the external environment and internal environment because the gut lining is the interface between the outside and the inside, whatever you’re putting in your mouth, you know, from the outside or anything that enters your body from the outside.

It’s intimately connected to the inside through one cell layer of the gut lining the entire site, right, you know, so, I my analogy for that is is customs in the airports right. So, the interface between one country and another country is covered by customs or particularly if you’re flying in, right, you have to have a passport in order to come into the country. And you have to, and all your luggage has to be about, you know, looked at and to make sure that you’re not bringing anything hazardous. And believe it or not, your immune system is at that one cell layer thick of your gut. And it’s like customs, it checks and makes sure everything that’s passing through is alright. And so if that falls apart, that is the beginning of the disease. And

Vaish:

so better analogy would be either a corrupt customs official or it would be an overactive, somebody that’s just over scanning everybody, something like that.

Dr. Achina Stein:

Well, I would say that the customs officials don’t are no are not there. They’re not Manning, they’re not there to check your passport. And they’re not there to check your luggage. So you just can come right in. So when there’s a disease that can cause what we call increased gut permeability. And it’s also known as a leaky gut syndrome. That’s the non-medical term. So people can look that up if they want leaky gut syndrome. And for many years that their people, a lot of conventional doctors and researchers thought that that was quackery, and it doesn’t exist. And but you know, in recent years, there’s been a lot of research to support increased gut permeability.

There is a landmark paper by Dr. Alessio Fasano who talks about how autoimmunity gluten and how gluten can trigger increased gut permeability and how it’s connected to autoimmunity and other illnesses as well. So a lot of problems result in increased gut permeability, and that, so digestion is, is really important, making sure that one you’re eating all the right foods, but also that you’re digesting them appropriately. And that food, particularly protein, and fats for mental health issues, and as well as autism and learning disabilities, is really, really important for the brain. But you can even if you added those foods if you need to make sure that those foods are being assimilated.

And so your gut lining has to be top-notch. And, you have to be able to have enough hydrochloric acid, which triggers bile salts and triggers pancreatic enzymes. And that combination is what you know, allows you to assimilate all of those foods efficiently. So first, you have to make sure you’re eating the right foods, and then you want to make sure that you’re actually digesting them. And those are really important.

There are things that get in the way of digestion. And, you know, I don’t know if your audience knows, but 80% of your serotonin and other neurotransmitters are made in your gut, you know, the precursors are made in your gut that your brain needs. And the other thing that innervates the gut is the vagus nerve. And so if the vagus nerve, which is the 10th cranial nerve is, is not functioning properly, you’re not going to have this bi-directional feedback between your brain and your gut. So that is really, really important.

I look at all of that to make sure that those things are functioning, and most conventional doctors have no idea. No idea. So yeah, so that’s, that’s functional medicine in a nutshell. And what we do is, so we want to remove what’s causing inflammation, foods, infections, toxins, stress hormones, we want to replace what’s missing, you know, which is vitamins, nutrients, minerals, phytonutrients.

In particular, we want to re-inoculate the gut microbiome, the microbiome is this rainforest of bacteria that actually are the manufacturers of all your neurotransmitters. And vitamins, you know, and so a lot of times people’s microbiomes are off. And so and that could be off because of taking lots of antibiotics, repeated rounds of antibiotics, steroids, or just not eating the right foods. And so, foods, infections, toxic, you know, and so sorry, as I was talking about remove, replace re nakulan and gut microbiome and then you want to repair the gut lining. So if you have increased gut permeability, you want to figure out why does that person has increased gut permeability? What are the things that have happened to cause that and reverse engineer that but then you want to repair?

We want to repair that lining and there are ways of repairing that lining and then rebalancing what threw the whole system off in the first place.

Vaish:

So so that’s an excellent summary of I was going to ask you a question if a parent is, is, you know, if you have a child that has hit puberty and especially if the child perhaps is autistic and is experiencing a sudden dysregulation, and this happens in many children with disability, especially because they’re already experiencing a little bit of a, you know, many of them have got issues to start with, what would be the first steps that you do, but I think you just listed out the, your, the shift, you know, the shift.

Yeah. Wasn’t the pseudonym acronym. Okay. Yeah. And you, you talked about the four R’s. Did you say that remove? Replace, yes, yes, re-inoculate, repair, and then rebalance. Right. Yeah, that’s the fifth or, yeah. So and that is, and then hope to remember that a diet is and a lot of people would like to do this with just pills and supplements alone. But do you think this is possible to do any of these steps? Is, is food and diet an integral part of this protocol?

Dr. Achina Stein:

Oh, diet is absolutely an integral part. Yeah, I, you know, I, I actually don’t take patients unless they’re willing to make changes in their diet.

Vaish:

And it’s not exactly and it’s not easy, but it needs to be done.

Dr. Achina Stein:

Absolutely needs to be done. And particularly in the population that I see. I started off with a gluten and dairy, gluten, dairy, and probably sugar-free diet, you know, so that and lots of vegetables. So sometimes people aren’t willing to remove things. So I actually say, Well, let’s start adding things. Add lots of vegetables, put it all in a blender, make a smoothie, put some protein powder, and let’s start with that, you know, so I mean, I think if people are willing to start somewhere, that would be the place to start green smoothies. fantastic place to start, you know, protein shake with greens, and lots of healthy fats, avocado, coconut oils, you know, oils, those all that are fantastic for the brain. Yes. So nuts. Yeah.

Vaish:

This is so amazing. I’m so glad that we had this conversation because it’s this is a topic, even though you talked about a lot of things that I’d been hoping somebody would talk about, you especially address this, this huge issue of this post-puberty and this is how this hormonal shift can just throw everything out of balance in a child that’s struggling with the balance in the first place. So yes, and yes,

Dr. Achina Stein:

the inflammations are already there. So I know that when a child when they want to when a girl hits puberty, they have men arc, if they have intense, you know, you know, any kind of PMS, that right there is, is the way to know that she has inflammation even before way before that because you’re, you’re a balance of estrogen and progesterone already off.

When you make cortisol on you, and you have chronic production of cortisol, it steals from progesterone first. So then it becomes an automatic imbalance of estrogen and progesterone. But another reason why estrogen-progesterone might be imbalanced is because of estrogen disruptors. So if you’re exposed to a lot of plastics, you know, BPA and other, you know, other pests, pesticides and things like that, then your those bind to estrogen receptors causing this imbalance of estrogen and progesterone. And so right there, it’s going to cause PMS. And believe it or not, people don’t realize that PMS is not normal. This is not normal. I cannot tell you how many people don’t realize that it’s not normal. menopause, maybe.

Vaish:

It may be common, but not normal. So the thing Yeah, it is a common difference

Dr. Achina Stein:

Between normal and common. Exactly. No, obesity is not normal. It’s common, but it’s not normal. And, and yes, you know, we want to have people respect people who have issues with weight, you know, and not treat them differently. But that doesn’t mean that it’s healthy or normal. So, you know, so, I mean, I know that’s a really, really sensitive issue, but I think it’s important for people

Vaish:

To and I think it’s important for us to work out language around that, that it is okay, it happens. But it isn’t something and if we accept it, we also strive to bring ourselves into balance. Exactly. Yeah.

Dr. Achina Stein:

Well, put.

Vaish:

Thank you. Where can people where can listeners find you

Dr. Achina Stein:

and how they can? Oh, yeah, my book. My bookies,

Vaish:

we’re not on video though. We’re only on audio. So Oh, okay. Sorry. I didn’t know that.

Dr. Achina Stein:

So what if it’s not depression? Your guide to finding answers until Lucians you can get that on Amazon Kindle as a Kindle download. It will be coming out on audiobooks in the next month or so. And paperback will be available in May of 2021 in bookstores, and I guess also on Amazon, but you can get a free download from my website at www.FXnmind.com. That’s the website for a functional mind LLC. And that’s how you can find me.

Vaish:

So the book is called What if it’s not depression, and you can find it at www.FXnmind.com and visit by Dr. Cina? Stein? Yes, yes.

Dr. Achina Stein:

And our Amazon Kindle, if you want all the hyperlinks that are available through the book, the Kindle versions are better there are lots of resources there. So you don’t have to type in every you want information instead of typing every web link, you know, what is it called? URL? That’s the word. We’re helping each other find where it is today.

Vaish:

Thank you for listening. I now know the difference between an acronym and a pseudonym. See you next week. I’m your host Vaish music was by Maitri Gosh. Bye.