Dr. Justin Marchegiani and Evan Brand talk about depression and anxiety. Listen as they discuss some of the possible root cause of such condition. Understand the mechanism of depression and anxiety medications and learn why they may not be the best possible solution to the problem.
Gain an understanding on how diet, especially a vegan diet, becomes an important factor when dealing with depression. Explore how gut infections relate to depression and anxiety symptoms and know some of the natural solutions and recommendations in addressing depression and anxiety.
In this episode, we cover:
00:56 Medications mechanism
03:40 Vegetarian Diet and Depression
05:41 Gut Infections and Depression
14:00 Natural Solutions
18:18 Low Thyroid and Mood Issues
Evan Brand: Hey man, I am great. We had a fun off-air chat. So I’m excited to chat with you about this important topic today— depression, anxiety, you know, mental health in general. But we’re gonna—
Dr. Justin Marchegiani: Uh-hmm.
Evan Brand: ..specifically focus on depression, anxiety. As I was telling you, the center for disease control, they change the ranking over the past couple years. Now depression is the number one leading cause of disability. It's actually grown over heart disease. It used to be heart disease was number one. Now depression is number one leading cause of disability. So that's pretty alarming. I predicted this about four- five years ago I could just see the trend of society and now, it's happened and it’s official.
Dr. Justin Marchegiani: Totally. Depression is really important because a lot of the medications that are out there. I’m just gonna pull out my little Bluetooth headset here—all the medications that are out there, typically, only treat the symptoms. So you kinda have medication from like the 80’s called tricyclics, right? And these tended to—to work with a little a side effects that a lot of the current days SSRI’s or SSNRI’s, right? These are medications that work on blocking the reuptake of serotonin and norepinephrine or dopamine. And essentially it's allowing more neurotransmitters to sit in between the pre- and the postsynaptic neuron. So neuron—neuron, pre-post- right? Before, after and then you have all this in between area called the synaptic cleft or the uhm—essentially that's where a lot of the neurotransmitters would hangout. The longer those guys hang out in that area, typically, what happens is you’re gonna have uhm—a recycling of those neurotransmitters at a higher level. So the longer those neurotransmitters sit in that neuro- synaptic cleft there, the faster they get broken down. So that's why over time, a lot of antidepressant medications have to go up because of the fact that those met—those chemicals are being broken down at a much faster rate. Does that make sense?
Evan Brand: Yup. Well, the problem is, too, these medications they’re not addressing the root cause now. I know in some cases, they could be life saving therapies because they pull people out of a super deep depression or maybe they were suicidal. But as time and time goes on, the percentage used to be 80% of serotonin was coming from the gut and then it jumped up to 85 or 90% and then now, I keep seeing new literature coming out that the percentage is almost close to hundred percent now of serotonin from the gut. So we really have to address any gut infections we have to test for those, we have to find them, we have to fix them. If we really want to get to the root cause, the brain, of course, is a factor, but man, the gut seems like the biggest factor to me.
Dr. Justin Marchegiani: Oh, it’s a major factor. And again, uh— one of the listeners here in the live chat brought up a lot of the shootings that have been happening recently. Yeah, these medications have a black label-warning, black box warning on them for suicidal tendencies, violent acts, these kinds of things. So it can really alter someone's physiology and biochemistry were it may predispose them to—to these kind of violent act. So, again, I look at these type medications really only being used in a life or death kind of, “Hey, we’re gonna get this person stabilize so that they don't do something that they’re gonna regret.” But then we have to work on getting them off these medications and get to the root cause.
Evan Brand: Yup. Well said.
Dr. Justin Marchegiani: And that really has to be the end goal. We need to have a transitional goal in mind so we can get to the root cause whether we start adding in specific amino acids, amino acid therapy. A lot of these neurotransmitters they come from amino acids. So there's kind of just like the replacement model of, “Hey, let's add more amino acids into buildup serotonin and dopamine in the brain so you feel better.” There's that component, right? And that may be really important especially if you have a lot of malabsorption, like you're not breaking down proteins and fats, you have low stomach acid or enzymes. It may also be important like you're a vegetarian or vegan and you're not getting enough of these high-quality proteins and animal source which tend to be the most nutrient dense. So there’s a lot of different things that may drive that from an amino acid perspective. And you talk about 90+ percent in the gut. The question is, “Can that serotonin cross the blood brain barrier?” I’m not sure we know if it can. From what I understand, it can’t. But uhm—a lot of the precursor amino acids like tryptophan, and/ or 5-ACP can cross the blood brain barrier.
Evan Brand: Uh—got it. Okay. I guess, so you brought the vegetarian/vegan point. This is huge. You and I both work with so many vegetarians and vegans and sometimes, they're just not willing to add-in things to the diet. So whether it's like egg or even fish, they just don't want to add it in. And I've seen the most depression anxiety problems from vegetarian and vegan. So I wouldn't even say it's like just a coincidence anymore. I mean I've seen it so often that it's just—it's it's— gotta be causation in this— in this aspect.
Dr. Justin Marchegiani: Well, you’re gonna always get higher quality amino acids, proteins from animal products. It’s just how it is. Uhm—you’re not to get a whole bunch of anti-nutrients with them, right? The way animals defend themselves with teeth and with claws. The plants defend themselves are with anti-nutrients, compounds that make it harder to break down uhm—their constituents. The lectins, phytates, mineral blockers, anti-nutrients. They make it hard to break down some of these plant. That's how plants kind of survive, right? Animals survive through uh—claws, and being able to run, fight and flee. But once you have an animal, right? Once you already killed it and you get that meat in the table, it's not gonna possess the same amount of anti-nutrients. And it tends to also have just pure protein and fat where a lot of the plant-based proteins are gonna have a whole bunch of carbohydrate along with it. Unless you're doing like a pea protein powder or rice protein powder where the starch component has already been removed from the proteins.
Evan Brand: Yup. Yup. Well said. Uhm—let’s talk about some of the gut infections. How this could relate into depression, anxiety symptoms. We could talk about H. pylori. We had a question about that, too. So, we’ll go ahead and address it. How can H. pylori cause depression? We know that it's gonna reduce stomach acid. If it’s reducing stomach acid, even if you are eating those good quality organic pastured animal proteins, you’re not gonna digest those. So you’re gonna have undigested food particles creating the leaky gut situation that can stress out the liver. We know there's a link between mood issues and the liver. Sometimes it's fatigue, sometimes depression, sometimes anger, irritability uh—things like that. And then you’ve got the aspect of the aminos. So I just already hit on. If you're not digesting these proteins, that first domino could be affected all because of your low HCl production due to the H. pylori then all the sudden, you have no amino acids. Now, you’ve got no raw materials to manufacture neurotransmitters. So this is huge.
Dr. Justin Marchegiani: Hundred percent. So—so there’s a couple different components, right? Dan writes, “Can H. pylori cause depression?” Yeah. Well, number one, it’s gonna do it by a couple different ways. Number one, it’s gonna lower stomach acid and enzyme levels which make it harder to break down proteins and healthy fats which you know, fats tend to be a really important building block for the brain. And the proteins tend to be the building blocks for the neurotransmitters. So if we have decrease in the raw material of the brain, right? And we have decrease in the neurotransmitter raw material, then we’re gonna have issues with optimal mood health, for sure. Number two, is a lot of the uhm—bacterial components of H. pylori have what I call lipopolysaccharide or endotoxins, which can cause depression by itself. It does it through going to the brain and creating inflammation to the brain. It passes through the gut junctions, creates leaky gut, goes to the brain creates inflammation and create mood issues in the brain. It also can uhm—it also can just create leaky gut and which can increase the immune system. And when the immune system is kinda over reactive, it can suck up a lot of energy. And when your energy is lower, it tend to have more likelihood of being depressed and being anxious. Typically, lower energy and depression tend to come hand-in-hand.
Evan Brand: Yup. I had H. pylori have multiple parasites. So we had a question from Dawn. He was asking what parasites are the most destructive and what parasites would cause the most amount of depression. I don't know if we can rank it like that 1-2-3. Number one is gonna cause the most depression but I know when I had Giardia and I had cryptosporidium, I had weight loss, I had H. pylori, I had fungus, I had Candida, I had SIBO, you know, pseudomonas and bacterial infections. I was just very, very, you know, not right in the head. My sleep was off which then affect my energy, which then affected my mood. So it's hard to say like was it chicken or egg. These parasites cause depression or was it the fact that my sleep was disrupted, therefore I wasn't actually waking up rested. And that made me tired and depressed. Uhm— Justin, do you have any comments to add about that, like parasites, could you rank them at all, saying crypto or Giardia's worst than dientomoeba or blasto in terms of the amount of depression it creates?
Dr. Justin Marchegiani: Well, I would definitely say you—your parasites that are tending to cause more problems because they tend to be a little bit more endemic. They tend to cause more information. But regarding in which ones, it’s hard to say. I've seen people have other parasitic infections that cause more problems uhm— than what they typically say on paper. Like some people have uhm— Dientamoeba fragilis but that's typically one that may not cause a lot of symptoms. So the question is, well, why did it cause a lot of symptoms for you and not the other person. So, again, things like histo and crypto, it tend to cause more problems, but sometimes you may have a less virulent type of parasite infection and it may cause just as many issues for you. So the question is if you have an infection and you have symptoms, especially if you have an infection and you have digestive symptoms, we got out work on getting the digestion better and then fixing the infections next.
Evan Brand: Yup. Well said. So we have a question about “Is it possible to for your partner to give you a parasite or if it enters your body while your system fight it off?” The literature is not clear on parasitic infections. Now Justin can tell you about like some of the correlations we’ve seen where partners have infections. We know 100% H. pylori is passed all the time. 90% of the time, I have someone that shows up with H. pylori, the spouse eventually has to get involved. We have to get them tested and we end up having to create a protocol for them, too, because I've had people where we create a protocol, the H. pylori's gone on the retest of the stool and then the symptoms come back a few months later. We do another stool test, then all of a sudden H. pylori's back again like what the hell happened. Typically it's the partners. So then we have to get the spouse, boyfriend, girlfriend tested. They usually are the source and also we create a protocol for both of them and all of a sudden they get better. Now parasites, though, I don't know. Justin, what’s your thoughts on passing all the parasites you know, kinda back and forth between each other? What have you seen?
Dr. Justin Marchegiani: Yeah. I think that's a 100% probable. We see it a lot with our chronically ill patients that tend to get reinfected over and over. That's a factor that we always look at to make sure we get the partner, the spouse addressed coz you can definitely pass it back and forth. And I'm more worried about the inflammation, I’m more worried about leaky gut, I’m more worried about the LPS and the endotoxins making the way to the brain and creating inflammation and symptoms there. I'm also worried about just of the maldigestion, not breaking things down well not having enough stomach acid, enzymes, bile salts. So just affecting the digestion, number one. Affecting the leaky gut, number two. And then eventually making its way to the brain. Leaky gut will also cause leaky brain and that could also create more symptoms as well.
Evan Brand: Yup. Well said. I mean the leaky brain thing, most people don't talk about it. I think we've— we've hit or— we've hit on that topic on many episodes but I don't think we've done a full one. So maybe we should add that to the list. The whole leaky brain episode. But, people, you do want to realize, if you have leaky gut and this could just be caused from non-celiac gluten sensitivity. If you're eating gluten, we know that’s creating the leaky gut situation. That's creating leaky brain. If you take a GABA supplement and you get relaxed from it, you have a leaky brain. And that's not good. Because then you're sitting in traffic, you’re breathing in diesel fumes and other pollutants. That stuff is having direct access through the blood brain barrier, which normally would protect you so that the integrity of that barrier is super important. Uhm—there’s another question here about depression. Could it be caused because of a lack of dopamine? Is supplementing with tyrosine sufficient enough to help depressive moods? Yes and no. The thing with the amino acids is it's like a spider web. So if you do start modifying serotonin, things can get messed up with dopamine. If you just start pounding L-tyrosine, that doesn't necessarily mean that it's gonna fix your problem either. So, really, you wanna get organic acids test first and figure out what's going on coz we can measure dopamine. A lot of people think they have low dopamine but it's actually too low serotonin or some people have low serotonin and they think that it's that. But it's actually not. It's actually low dopamine instead. So, vice versa. I hope that made sense. But across the board, you could be low in GABA, you could be low in your catecholamines, you could be low with your norepinephrine, epinephrine, you could be lower cortisol. So even cortisol can be a component of depression because if you've got adrenal problems, that cortisol rhythm is too low, your batteries aren’t charged or you've got too high cortisol, or your cortisol is all over the place fluctuating high and low, which could all be due to these infections. That's the perfect recipe for depression. So tyrosine may or may not be the solution for you.
Dr. Justin Marchegiani: Totally. And I have one article here. It talks about dietary proteins having a substantial effect on the composition of gut bacteria. And they talked about for instance, suggestion of intake of dairy and meat protein at recommended level may be beneficial to maintain balance composition of gut bacteria compare with soy protein. Now, again, some of the studies are rat-based so it’s not gonna be a direct correlation, but having a healthy gut bacterial level may decrease some of that gram-negative bacteria which is some of the not so nice uhm—bacteria that tend to cause more of the LPS, right? The lipopolysaccharide and endotoxin. So if we can get the gut bacteria more in the balance, that may decrease the LPS, help with healthier gut integrity, help with less LPS getting into the brain, which creates a mood issues that way, too.
Evan Brand: Yup. So did you want to go into some of the natural solutions now? I mean, we've hit on neurotransmitters a bit. We hit on infection, so finding and fixing those. What about some of the free stuff, like just exercise alone just increasing BDNF, getting the movement, getting the blood going. I mean that’s huge.
Dr. Justin Marchegiani: Totally.
Evan Brand: I mean exercise has change my life.
Dr. Justin Marchegiani: Yeah. I would say that the BDNF, the Brain Derived Neurotropic Factor really helps with mood, helps with healthy, uhm— myelination, improvement of brain building uh—keep staying away from grains is really important because that can decrease blood flow up the garden hose. It’s called the carotid artery to the brain. If we decrease blood flow, we’re gonna, one, not be able clear out inflammation as well. We’re also not gonna be able to bring oxygen and nutrition to help the brain, too. So gluten is a big one. I would say, of course, your amino acid, serotonin 5 HCPL tyrosine, of course, B6 is really important. And if we’ve got bacterial imbalances that will affect B6. Also, healthy probiotics can help with gut inflammation. Remember inflammation in the gut will create inflammation in the brain. So healthy levels of Lactobacillus, bifida bacter, probotics will help cool down inflammation in the gut, which may help decrease some of that that glial site activation in the brain, which again is—is an inflammatory cell in the brain. It’s a white blood cell that it's in the brain called the glial cells and when those get activated, it can create uhm—brain fog and it can also create mood issues, too.
Evan Brand: Oh, I wanna go back to the diet piece. So there is a piece of literature out there, a study of 9,700 vegetarians including some vegans, they were twice as likely to suffer from depression as meat eaters even after adjusting for variables such as job status, family history, and number of children. And then it goes on to talk about the lower intake of omega-3 fats, B12 and folate, which all can affect depression risk. Uhm—so on that note of the Omega 3’s, yeah, DHA, fish oil supplement could be helpful, but also, you've got pastured meats. You know, grass-fed beef alone contains so much more Omega threes than your standard typical low-quality meat. So, that is a really, really good piece of the puzzle.
Dr. Justin Marchegiani: Yeah. Uhm— definitely getting 3 to 4 servings, 4 ounces of healthy fish per week is gonna be great, wild Alaskan, sockeye, skipjack tuna, you know, kinda high selenium to low mercury type of fish. You can just google that, high selenium to low mercury fish. It’s typically the higher ones are gonna be like the uhm— the shark pilot whale, those things, swordfish are gonna be much higher in mercury to selenium. Skipjack’s gonna be great. Wild Alaskan sockeye is gonna be great. Cod, Haddock, Sole. These are all gonna be higher selenium, lower Mercury. That’s great. And if you want to be on top of it more, you can do your 2 to 4 g of fish oil per day is excellent. That will have EPA and DHA in it. You know the ones like my Omega supreme has lipase in it. It's also a triglyceride form, so it's better absorbed, number one. LS oxidation, number two. And then the actual lipase will help you break it down in case there’s some fatty acid, you know, the digestion uh— digestive compromise things going on in there, too.
Evan Brand: Yeah. Well said. If you’re buying fish oil supplements, people, if it smells fishy, throw that stuff out. It's garbage. It's ethyl ester form. If you go to Target, Walgreens, uh— any of these big box stores and you’re buying fish oil, it's crap. Do not waste your money. Buy professional grade supplement. Check out Justin’s site, justinhealth I've also got one, evanbrand Just look us up. Find our stores. And we've got good fish oils because if you're not doing professional grade, you’re wasting your money and there's actually literature now that if it is an oxidized rancid fish oil, you're actually creating more inflammation when the whole goal is to suppress inflammation and help depression. You’re making it worse if you’re doing the low-quality like a Kirkland's or a Costco or Sam's Club or these big box uhm—fish oils, vitamin Shoppe, GNC. All those guys. That’s all consumer grade. It's all ethyl ester. That's not good. You want triglyceride.
Dr. Justin Marchegiani: Exactly. And Teresa mentions a low T3. So if you have low thyroid levels, poor T4 to T3 conversion, right? Or lower thyroid or active fiber hormone T3 or tri iodo thyronine, that's important. Low thyroid can create mood issues. It can create depression. So we’d want to get to the root cause of why the thyroid is low. It could be just a combination of an autoimmune issue driven by gluten and other infections it could be a nutrient conversion issue like selenium and vitamin A, copper, zinc, magnesium. It also could be uhm—you know, gut bacteria issue. It could also be a stress issue like cortisol, right? So adrenal function has major effects on mood, too. If the adrenals are hyper or hypo functioning, there could be some mood issues there. It could be fatigue, it could be anxiety, it could be depression, it could be a combination of all three. Typically, anxiety and depression tend to come together. Some people can have them just individually where they are either anxious or depressed. But some people they tend to ebb and flow between the two.
Evan Brand: Yup. Well said. So if you have thyroid problems, you've got to investigate the gut, you’ve got to investigate the adrenals. We talk about that, but we can never stop talking about it because your conventional doc is not bringing this up. When you go there and you show up slightly off with your TSH, they’re not gonna say, “Hey, maybe you have gut infections. It's causing conversion problems. Maybe you have adrenal problems that's messing up your conversion of active thyroid hormone.” They’re not gonna say that. So we have to keep talking about it.
Dr. Justin Marchegiani: Hundred percent. And so outside of that, yeah, Tessa makes a note,
“Hey, I don’t have a thyroid.” Then you really have to make sure you're on a full-spectrum thyroid glandular and your T3 levels are at a therapeutic level, at least above 3.0 for T3 free. Ideally, I'll make sure T4 is above 1.0 That’s a really good starting point. And then James mentions, “What about Olympian labs omega-3 fish oil?” I’m not quite sure. It could be good, it may not. Typically, you get what you pay for. Number one, you want to make sure it's a triglyceride form. Number two and ideally you want to make sure it's in, you know, this is like a plus, like I , add in the lipase coz I have worked with a lot of patient that have compromised guts and I want to make sure they can break the fish oils down well. So that is another important component.
Evan Brand: Yeah I'm looking at it right now. I can't find any information about whether that brand is a triglyceride form or not. So I'll keep digging and see if I could find it. But, Justin and I were biased because we want people to get better. We have to actually follow up with our clients and speak with them. And if they're not getting better that comes back on us. And so we really want to use and we always use the highest quality professional grade formulas, which tend to have tighter quality control and better certain—
Dr. Justin Marchegiani: And also just better potency, too. I remember I had some issues in the supply chain because some of the nutrients that we were getting, were testing positive with some—some metals and some other not—not so nice compounds. So they sent it back to the manufacturer. So the nice thing is we’re always trying to look and make sure there's no other contaminations where let’s say a lesser quality company may just say, “look the other way and just let it go.” So we’re trying to put that quality control on it to ensure that there is not to be any extra crap in it that could throw you off, so to speak.
Evan Brand: Yes. So I ended up on the Olympia labs website here for this fish oil. It looks like and this is just to cheap, right? So if you see something for 30 bucks for a 120, that— it just sounds too cheap already. So to me, that tells me not gonna be triglyceride form. I read the entire description. I don't see one word that includes a triglyceride form. So to me, it's ethyl ester. You could always contact them and say, “Hey, is it up ethyl ester triglyceride?” But I’m gonna bet a hundred bucks that it’s gonna be ethyl ester which is inferior. You don't want to put that in your body.
Dr. Justin Marchegiani: Absolutely. But again, if you're doing three or four servings of 4 ounces of fish a week, you may not even need fish oil. Uh—again, if you have extra inflammation, or extra brain stuff going on, cognitive stuff, mood stuff, then I would recommend supplementing it. Just so you get extra bit on top of it. Just to ensure that you know, what you're getting is getting to where it needs to go. Is there anything else you want to add, Evan, about depression or mood stuff regarding functional medicine here?
Evan Brand: I think that's it. We hit the gut, we hit the adrenals, we hit the thyroid aminos, liver function, digestive, anti-inflammation. I think we've hit all, man.
Dr. Justin Marchegiani: Awesome. Well, hey, great talk today. We’re doing some quicker podcast so we can get more content out there to everyone. Hope you appreciate it. If you enjoy it, give us a thumbs up. Subscribe. Click on the bell now. With YouTube, they make it so you don't get a lot of the notifications of new videos and new content unless you are subscribed and you hit the bell. So click on that bell. Do it for Evan’s channel as well and myself. That way, you can get all this really good spoon-fed information for you guys to continue to improve your health and your friends and family health, too.
Evan Brand: Yup. If you need to reach out for a consult with Dr. J or myself, go to Justinhealth.com Evanbrand.com You can schedule consult with this. We’ll help you via phone and Skype. We work with people worldwide. We’ll help you get tested, get to the root cause. So look us up. Book a call if you need help. Don't try to piece it together for suffering. We’re here for you. So have a great day. Take Care.
Dr. Justin Marchegiani: Thanks, Evan. Take Care.