Introduction to Integrative Psychiatry & Nutrition for Mental Health

0:00 [Music] Today we're discussing integrative psychiatry and nutrition for mental health. If you want to learn more about how to improve your mental health, go ahead and subscribe to this channel. I'm Dr Nishi Bhopal. I'm a physician specializing in integrative Psychiatry and sleep medicine and I'm the founder of Pacific integrative Psychiatry. We're an online mental health practice in California and we see adults with anxiety, depression, and sleep issues, and we also provide nutrition services for mental health. Today I'm joined by two of our team members at Pacific integrative Psychiatry. We've got Josh Habansky who's an integrative psychiatric nurse practitioner and then Ailar Poormoghaddam who is a certified clinical nutritionist. Both of them have training in integrative and functional medicine, so I'm excited to chat with you guys today because

0:46 we're all passionate about Integrative Health, functional medicine, and helping people beyond the usual conventional treatments that we typically see in the Psychiatry world. I'd love to hear from you Josh what what is integrative Psychiatry what does that mean to you what does that mean for a patient because I know a lot of people are not really familiar with that term and there's also integrated Psychiatry and integrative Psychiatry those two terms often get mixed up so maybe we can try to clarify that for people as well today yeah so I'll start with your second question first um integrated Psychiatry is actually when Psychiatric Services are embedded in like a primary care setting um so someone will be able to see their primary care provider

1:33 maybe also a therapist and then also a psychiatric provider in the same practice integrative Psychiatry is in my opinion a more holistic a way of kind of looking at someone's mental health symptoms whether that is depression anxiety insomnia PTSD OCD ADHD anything like that so whereas conventional psychiatry tends to focus more on like neurotransmitters and how they play a role in in people's symptoms and and that's kind of where uh pharmacotherapy comes in into play in integrative Psychiatry and functional Psychiatry we're really

2:19 we're really looking at all different kinds of inputs so yes we're thinking you know biologically we're we are thinking about neurotransmitters we're also thinking about hormones um and if those are optimal we're thinking about nutrient deficiencies food sensitivities um the you know the health of our gut there's so much more talk on the gut brain axis the past you know decade or so and um so we're thinking about people's biology that way we're also thinking about sleep um not just the quantity of sleep but also the quality because that plays a huge role in in how we feel day-to-day in terms of our mood energy anxiety we're also thinking about people's spirituality and you know that's not just limited to religion

3:07 but also just you know how we make meaning and and how we connect with other people so that could include things like mindfulness meditation grounding um being part of of a community of some kind overall that's kind of how I think about um integrative Psychiatry and the the difference in as opposed to kind of conventional psychiatry yeah it's it's really helpful to hear all those different aspects and one of the things that I always say about integrative Psychiatry is that it's just good Psychiatry like there's nothing special or unique or new agey about it I think sometimes people think it's maybe a little bit Fringe but actually it's just really good medicine and it's looking at all these different aspects

3:53 that you just listed out and it's so interesting about the gut brain access like you were saying in the last 10 years there's been a lot more interest in that because when I was in med school I won't say how long ago that was because it sounds like a really long time now but when I was in med school um I so I went to a school in Cork University College cork which is in Ireland and they have a huge Research Center on the gut brain connection basically on gut health and so back then they were doing a lot of really interesting I mean they still are but there were there's a lot of really interesting research coming out on this whole gut brain axis so in our Psychiatry lectures they actually did talk about the gut um so it's really cool to look back I didn't realize that that was such a new new idea it wasn't really mainstream yet at that time so that was really fun and even

4:43 in between classes we would walk through this microbiome uh building where they were doing a lot of this gut brain access research so that's the um UCC microbiome uh lab So speaking of the gut brain access ilar that is one of your um core areas of specialty and you help patients in our practice for that so can you tell us a little bit about what is functional nutrition because I think a lot of people have heard of nutrition but maybe not functional nutrition so what is that yeah so you know one of the things that I love about our practice and what makes us really unique is how we can kind of incorporate gut health mental health which should really just be called Health you know because it's it's all part of your overall health and What Makes Us healthy as individuals so when you combine functional medicine and nutrition together you can really

5:31 look at gut health and the role that it's playing and improving not just your physical health but also your mental health uh and nutrition is really the core I believe of functional medicine and what really goes on in the body and the gut microbiome and the role that it plays and this term gut health has just been growing so much over the past few years and people are getting curious about their gut health they're asking their Primary Care Providers to help them heal their gut health but their hands are sometimes tied and the resources are limited but also the time is limited in a conventional medicine setting so I've worked in conventional set um I've worked in conventional medicine settings and what I've realized is that patients want that individualized care but you're really limited with your time and you don't have access to all these great Laboratory

6:19 Testing supplements right nutrients that we can utilize to help really support the gut microbiome and our mental health as a result so defining what functional medicine is I think is really important as a start to understanding what functional nutrition is so functional medicine really allows us to dig deeper and find the root cause of a lot of chronic conditions especially so we don't really just look at symptoms but we look at what are the symptoms telling us or not just what symptoms are happening but why are they happening so that's what functional medicine allows us to do and it's not just a Band-Aid method where we cover up the symptoms with medications drugs we actually try to use a holistic approach as Josh mentioned looking at sleep spirituality lifestyle diet

7:05 exercise and then where nutrition can come into this is what are you eating how are you eating how are you preparing your meals right what do your meals consist of are you eating mostly Whole Foods or are you eating more processed packaged Foods because you don't have time to prepare your meals so through a functional nutrition approach we can utilize the functional medicine studying and using the right questions doing the overall assessment we use questionnaires that can give us a lot more answers and then we really focus in on improving the gut health improving the gut microbiome so that we can allow our bodies to properly generate these hormones and neurotransmitters that can positively impact our health yeah and it's really cool to

7:52 see you know to see what both of you do with your patients like how you both approach your patients because you both share this focus on gut health and nutrition and using that as a foundation to support people with their mental health and um so that's really cool because I think that's a unique aspect of our practice that someone could come in and work with Josh and if they need help with medications or other things he can support them with that and also help support them with the gut health and nutrition piece and then have them also work with ilr for more specific guidance on on the nutritional aspects as well so there is really like a tag team kind of approach so so Josh can you tell us a little bit more about what do you help patients with like what are most of the people that you're working with like what are they struggling with and and

8:40 um what are some of your areas of focus yeah yeah people come in with with all sorts of um complaints and also goals a lot of times I'll hear people tell me that they are just feeling a lot more down than usual um maybe you know they're just not enjoying how things are going um really feeling like they're just kind of going through the motions um a lot of people are also struggling with anxiety a lot of worries um feeling really stressed either by you know what's going on in their lives their work um um a lot of people I see also have physical health issues that that end up causing them quite a bit of distress too a lot of people are not sleeping as

9:29 well as they would like to be sleeping also energy is a big one a lot of times people um just feeling kind of run down even if they do feel like they're getting adequate sleep they kind of feel like they're eating a relatively healthy diet but still just not feeling very energetic um so where I start with everyone is just you know doing a really thorough assessment um finding out about their history medical history mental health history family history um and then also just get a really uh a really good snapshot of what's going on now the kind of stressors they're dealing with um any kind of stress management practices they have and

10:16 then figuring out their priorities and taking it from there I I really think that um like comprehensive lab work is is a really important place to start you know nutrient deficiencies um and you know blood sugar imbalances and um and you know things along those lines even you know even really low cholesterol which um there's quite a bit of literature on low cholesterol being a risk factor for depression even um suicide and suicidal Behavior so doing really comprehensive lab work to start um treating and addressing any nutrient deficiencies or other imbalances that come up and um and then kind of taking it from there we have access to a lot of

11:05 specialty functional lab testing so for some people that's that's appropriate and um and then just kind of start chipping away and and monitoring for for progress with interventions that we use and that might be medications it might be supplements a lot of Lifestyle things um so that's kind of where I start yeah and it's it's really helpful to hear your approach because I think one of the um maybe the misconceptions people have about holistic or integrative Psychiatry is that it's anti-medication um or they you know shouldn't take medications or you know things along these lines but actually medications can be life-saving in many cases and um it's not about you know eliminating medications necessarily for some patients that actually might

11:54 be appropriate um tapering off but for other people it's really about using medications as a tool but also implementing all of these other things as tools as well and not ignoring these other aspects right which you know oftentimes introducing those other kind of lifestyle modifications and really dialing in nutrition um those things can actually be helpful for for people who are very very motivated to reduce their medications or discontinue them ultimately um I have a lot of people come to me also maybe they've been on a medication for a long time they um they really would like to get off they're they're doing well but there you know are some

12:39 areas of improvement and that's something that I really enjoy doing too is just supporting people through that um discontinuation process yeah it's it's so you know as we were discussing it is really helpful to look at all these different aspects and it's interesting you brought up blood sugar because ilar and I were just talking about that um before we started um this chat together and just the impacts of fluctuations in blood sugar and how that can affect mental health but again tying that back to nutrition and gut health so ilar could you share a bit more about how you work with people and why people come to see you what are some of the more common issues that you work with yeah so you know when we talk about blood sugar management it's oftentimes patients don't come in and say hey I'm having a really hard time managing my my blood sugars or they don't

13:26 come in and say you know I'm having metabolic issues it's you'll hear more of the symptoms that they're experiencing and the signals their bodies are sending them as long as they take the time to pay attention and listen to it and what happens oftentimes is these problems become so chronic over months or even years until a lot of our clients actually decide to come see an integrative Specialist or someone that can really dig deep and figure out what's going on so a lot of the common symptoms I hear have to do with the digestive system common symptoms like bloating gas constipation diarrhea abdominal pain and when they become more frequent to a point that it's bothersome that's when the clients tend to come to me and they're asking okay am I allergic to something am I sensitive what's going on do I have an infection so we really have to do an assessment

14:15 and see okay what other symptoms are involved because that gives us the whole picture of what's happening it's usually not just in the digestive tract people might have difficulty focusing as Josh mentioned they might have mood swings or they might have difficulty focusing so those are some of the most common symptoms or when when it comes to metabolic issues people might just say you know I was losing weight and it was going really great and now I'm just stuck and I can't seem to lose any more weight and that's where we can do a more holistic assessment looking at their lifestyle their exercise utilizing things like stress levels and sleep that you would address in your sessions and then as far as how I approach it so one thing I really like to do is uh a questionnaire through

15:02 the Institute of functional medicine that gives me all the symptoms a patient is experiencing from start to finish because what they're reporting is the ones that are more severe or more bothersome but they might forget to mention a few things that can also be important and taken into account so doing this assessment gives you more information plus a lot of times what conventional medicine setting doctors or non-hallistic practitioners don't have the time to do is really ask what are you eating right so they'll say okay are you getting protein to help control your blood sugars and patients will say oh yeah you know I eat chicken I eat fish I hate eggs but they're just saying that because they eat it a couple times a week they're not saying okay for every single meal I'm getting enough protein and my blood sugar is being managed so

15:48 what I do is a 24-hour diet recall or sometimes I'll ask patients to give me three days in a row of what they're eating and that gives me a better assessment of okay how are you really eating and giving me an honest answer about what your schedule looks like how big are your meals how frequently are you eating so those are some of the approaches I take and then really getting into talking about what gut health is so a lot of time I like to explain the gut brain connection and what's happening inside the body so that we can understand why we're making these changes and once a client really understands what they're doing but also why they're doing it usually they'll have a more successful chance of complying with treatment methods and then also being successful

16:34 um in the end for improving their overall health uh and as I mentioned you know when it's chronic a lot of times people are just so frustrated and they want like a quick fix so medications and supplements can be helpful for that but we can't just use that to cover up a poor diet we can't use that to cover up two hours three hours of good quality sleep or really high stress levels so we can utilize those things but we really have to do a digger uh dig deeper and do a better assessment to really fix the root cause which often is a poor diet or lifestyle habits that need to be changed that's a really great point about the supplements because sometimes we will see this happen where someone doesn't want to take a medication so it gets replaced with a supplement but we're still

17:24 missing all of those other aspects of getting enough sleep you know establishing good lifestyle habits and all of this so integrative Psychiatry and integrated medicine is not just about using supplements instead of medications but again it's this true sort of holistic approach and I think one thing that's that's really cool that I've seen you do ilr is that you're really and Josh does this as well I mean you both do this really well is meeting the patient where they where they're at um because I saw one of our patients this morning and she didn't necessarily want to go into all of the Precision functional testing that you offer but she just wanted to know what should I eat for breakfast what should I eat for lunch I have anxiety I have depression it's overwhelming for me to go to the grocery store and figure out what I should be eating every day so can you help me

18:10 with that so you're able to do that with people start the basics if that's what they want or go into the really kind of you know deep Precision biohacking kind of space as well and I've seen both of you you do this yeah definitely and I always try to kind of understand not just the diet exercise piece but what does your day-to-day look like so I ask clients you know do you work do you work from home do you have kids right so what does your schedule look like and are these goals really realistic so one thing I talked about a couple weeks ago was how realistic is it to eat Whole Foods every single day right so eating fruits and vegetables good sources of protein healthy fats and oftentimes for many of us that's not realistic and a lot of times people will get

18:58 down on themselves and say you know I had you know frozen meal from Trader Joe's I messed up and you know that's that's not really something that's going to affect you long term I would say it's more so about what you do more consistently and what you do most days of the week so that's where I try to meet the client where they're at and set a realistic goal whether it's about diet or even something really important like hydration which oftentimes gets overlooked so clients will always say you know when I ask the question of okay how much water are you drinking a day the most common answer I get is not enough so people know they're not drinking enough water but they're not really willing to take that step of increasing it someone who's drinking three cups of water a day I can't

19:44 just say okay you're gonna drink 12 cups of water a day but where are you working do you have access to a restroom let's be realistic about that goal so increasing it from three cups to four or five cups is more realistic than going from 3 to 10 or 12. definitely and Josh so I'm curious to hear um your thoughts as well on on some of these issues and also I think one of the more common issues that that we see in our practice is people being in this fight or flight response like activated what we would call the sympathetic nervous system just a lot of anxiety I mean we work with people in California people have high stress high pressure jobs their mind has to be active all the time for their work or that you know they need to be thinking about things on meetings and so it just puts them into this this chronically activated State

20:33 um so nutrition can certainly play a role with that so I'm curious to hear your thoughts on that and just generally how you might support a person like that using your integrative approach um all really good points and um I mean I totally agree with um the idea of meeting people where they're at like we're not you know I'm not gonna ask somebody who right now is skipping breakfast and lunch to you know have three course meals for every meal of the day it's just not gonna happen it's not sustainable so might sound great on paper but that's not where I'm starting like I was talking with someone earlier today and um currently like she's not having breakfast and not

21:18 wanting to spend a ton of time preparing we talked about like what's the bare minimum we can we can do and so we ended up talking through like two or three eggs and some avocado and that's easy enough um hard-boiled a bunch of eggs at the same time and and you have them ready to go um so that's that's an example but I I also agree um a lot of us are not taking time throughout the day to just kind of slow down I know um you had a video on this the other day and it's it's you know we often feel like we don't have the time you know to do something but the truth is we we actually don't have the time to to not like take time to slow down um the time we get

22:05 back from maybe spending a minute um like doing some deep breathing that the return on investment is like really significant for that um and so oftentimes in kind of tying it in with digestion when we're in a sympathetic State when we're really really like uh anxious or if we're like running from meeting to meeting or if we're driving we're not we're not getting into the parasympathetic um uh side of our nervous system which which is the rest and digest and when we're not doing that when we're not relaxed when we're eating we're actually not doing as good of a job as we could with digestion and absorption and assimilation

22:55 um because when we're feeling really stressed we're not we're not producing the hydrochloric acid that we need in our stomach to really break down protein and um take advantage of those amino acids and so yeah with a lot of people we just start with you know three deep breaths before every meal you know trying to more often than not eat without distractions you know not being in in you know on our phone or or driving just kind of having that time to be kind of sacred and it's hard to imagine that the way we eat would affect how we kind of make use of the nutrients uh as much as what we're actually eating but it really is true it really makes a big difference and I know ilar um probably has has some more

23:43 to share about that she speaks about mindful eating I already want to just piggyback on that yeah absolutely and you know this is one of the things that I was talking about as well a couple weeks ago saying there's so much focus on what we're eating and not so much on how and when we're eating so as Josh mentioned you know taking the time to really sit down and eat and slowing down while we eat right especially a lot of people are working you know nine to five jobs or eight to five jobs and they have 30 minute lunch break so they take some of that time to actually get out of the office if they have a chance to do that and then they eat their meal quickly because then they want to spend some time to sit there or like go on their phone or do something else so then the digestive system is kind of shocked at first because they've gone several hours without

24:28 eating and now they're just quickly eating a meal they're not really taking the time to chew that food and the digestive system has to release a lot of enzymes and acids as he mentioned and it gets shocked so then people are thinking well why am I bloated why do I have heartburn why do I have abdominal pain and it's because the digestive system is not getting a chance to go into that parasympathetic nervous system to really break down the food properly and then after the meal we return back to the work environment or we get up and we start doing another task so then we put our bodies into that stressful or sympathetic nervous system so I always say you know take the time to sit down while you eat first of all and if possible take the time to just sit after you eat I was talking to a client the other day and I said hey why don't you set a timer

25:16 on your phone for at least five minutes ideally 10 minutes after you eat to just sit there and do something relaxing versus getting up and going back to the workstation or getting up and doing another activity and see if that reduces the bloating because oftentimes we want to say okay well maybe I have an infection or like maybe I'm sensitive to a food that I'm eating but sometimes it's just slowing down while you eat and if you're really not able to do that consciously one thing that I recommend that's kind of silly to do but it does work is eating with your non minute hand if you've ever tried it it's like brushing your teeth with your non-dominant hand brushing your hair with your non-dominant hand we're not really well coordinated and it causes us to slow down when we pick up the food put it into our mouth and you consciously start to eat

26:02 slower and as Josh mentioned when you avoid the distractions like watching television going on your phone you're so focused on what's happening in front of you which is the eating and it causes you to slow down and maybe even chew your food more thoroughly we which prevents the digestive system from having to do all that work when it's happening in the mouth which is also part of the digestive system a lot of people think oh it's just like the gut and the stomach and you know the intestines but the mouth is part of the digestive system and a lot of enzymes actually are produced in our mouth so yeah I think mindful eating is something that a lot of people are learning about now but applying it is really tough so meeting the client where they're at and seeing okay what mindful eating Concepts work for you based on your schedule based on your lifestyle and how

26:52 is it something that you can stay consistent with not just for a couple weeks to get rid of your symptoms but how can it be a lifestyle change definitely and I've seen that tip of just waiting a few minutes like just sitting for a few minutes after you finish eating have huge impacts there's one patient who was struggling with a lot of indigestion and so I recommend it to him just just wait like two or three minutes or five minutes after you finish eating before you get up because I know a lot of us myself included I have to remind myself to just sit and wait otherwise I'm still chewing and picking up my plate and taking it to the sink and then washing dishes and I'm still chewing like it's just not good for the digestive tract right so just sitting there allowing your your body that that few minutes can have a huge impact so lots of great information thanks to both of you for for being here today and and sharing your knowledge I think there's a

27:42 lot more we could share so maybe we'll schedule another time to to go into other aspects but um so Josh works with patients across California we're fully remote so we're seeing patients via telemedicine within the state of California so he works with adults um basically 25 to 55 with anxiety depression sleep issues we can help with medication management and of course all of these other integrative aspects and then ilar same thing she's able to see patients remotely working with adults for help with nutrition and we really have this care team approach so you can see both of our um practitioners to get a fully integrative approach that I think is really unique at Pacific integrative Psychiatry so if anyone's interested in learning more check out our website

28:28 at pacificintegrativesite.com so thanks again to both of you yeah thanks for having me thank you