Season 4, Episode 3: The Intersection of Mental Health and Gut Health with Dr. Oscar Coetzee

Evelyne: Yes. Last time, we did a popular episode on functional lab testing and GI Health, and we started talking a bit about mental health as it relates to GI Health. Today, we’re talking more about the metabolomics testing component as it relates to mental health conditions, including anxiety, depression, and ADHD. Remember that you can find the entire transcript and video of all of our episodes on our website podcast.designsforhealth.com. Dr. Oscar Coetzee has over 25 years of experience in psychology and nutrition and is currently serving as the Senior Director of Clinical Education at Designs for Health. We are very grateful for that, it’s awesome having you. His academic credentials include faculty positions at Georgetown Medical School, Notre Dame University, and the University of Bridgeport. Born and raised in South Africa, Dr. Coetzee’s educational background includes bachelor’s degrees in criminology and psychology, master’s degrees in psychology and human nutrition, a PhD in holistic nutrition, and a doctorate of clinical nutrition.

He’s recognized as a pioneer in nutritional science focusing on metabolic syndrome, intestinal permeability, type 2 diabetes, sports performance, and chronic inflammatory diseases. I did just read your shorter bio, there’s a lot more. And interestingly, since we are talking about mental health today, you actually started your professional career at Fair Oaks Hospital in New Jersey, where you served as a drug counselor, suicide intervention advisor, and codependency specialist for two years. How did that experience shape your professional life after, and is that why you went into nutrition?

Dr. Oscar Coetzee: Yeah, it’s actually an interesting story. So I finished up my master’s degree and I was doing my residency at Fair Oaks Hospital, as you said, as a drug and alcohol counselor. And there was a doctor there, his name was Dr. Mark Gold, and he was a very integrative doctor, ahead of his time. He was a psychiatrist. And I went to him because I worked under him, and I said to him at some point, “I think I want to pursue my PhD in psychology because I wanted to do a doctorate.” And he at that point actually said to me, “The more I investigate psychiatry and mental health, the more I realized there’s a massive component that’s missing, and that is the nutritional sciences.” And I know that you and I have had these conversations over lunch because I’ve always had a keen interest in nutrition even prior to my degrees, and that triggered something because he was mentioning B vitamins, and vitamin D, and some of the nutrients.

And he already mentioned some basic things about gut-brain health in those days. And I was like, “Yeah, yeah, yeah.” I’m thinking potentially, but yeah, probably still going to pursue a PhD in psychology. And then ironically, my mom got very ill at that time and I flew back to South Africa where I’m from, and that brought the reality to me that there’s another side of medicine that nobody is looking at and investigated some of the things that my mom was dealing with, and realized that there was a massive nutritional component to that. And that was probably the bigger inspiration of me to pursue the nutrition side of things. But then that whole Mark Gold thing in the back of my head was always like, “You know what? Integrate both of them.” And that’s pretty much where I am today. I’ve legitimately integrated the whole area that I now call psychonutrigenomics, where I look at the psychology and the nutrition and then the genomic aspects of it as it relates to mental health.

I’m actually doing a webinar this week on psychonutrigenomics and the sports performance side of it. And it’s interesting, I was doing some research today on that topic, again, as you prepare for your presentation, and kind of shocking how little information there is about that. If you put in mental health, and sports performance, and nutrition, you put those three words in as searches, it’s like 300 articles that come up, and then about 200 of them are not related, it’s just picking up a word here or there. So we’re definitely in our industry with functional testing, as you mentioned, metabolomics and these GI things, that’s the missing component that we need to push this area of, or this component of mental health, to the next level. So all the practitioners that are listening, even though we’re not having a degree in that area at this particular point, I think we are all, effectively and indirectly, working on mental health because we’re working with a nutritional component, we’re working with the gut and the metabolism, and all those things are highly interrelated with mental health.

Evelyne: Yeah, that’s so interesting. And it makes me think… I mean, you were at Fair Oaks Hospital a while ago. I’m not saying you’re old, I’m just saying… I’m assuming it was a while ago. Obviously, in our field, we’ve been talking about this. I’ve been in, I guess, this field for 20 years, in professional supplements for almost 13 years, and I feel like I’ve been hearing about this for a long time. Do you feel like in the psychiatry field, things are changing, or is it still just the same?

Dr. Oscar Coetzee: No, no. No, no.

Evelyne: Okay, that’s encouraging.

Dr. Oscar Coetzee: Yeah, no, it isn’t. So I did this whole presentation in Australia on mental health because it’s really a passion of mine, because I have that big background in psychology, even though I built my practice around metabolism and all those things, that is clearly where the business side of our industry lies, because 75% of people suffer from metabolic syndrome, et cetera, et cetera. But when I was in Australia talking about this topic, it became very clear to me that the biggest missing element that we have in our industry is really getting to the bottom and understanding the integration and the inter-mapping of these particular associations in overlaps. I’m not sure if I’m really answering your question. Throw that at me again, the last piece of your question there.

Evelyne: In, I guess, the traditional psychiatry, or even psychology field, are they implementing some of this? Do you see that changing?

Dr. Oscar Coetzee: What I was meaning to say. In that presentation, I actually have some slides that address that. So in 2010, there was an article published in one of the main psychiatric journals, and that article mentioned that it would really be very important for the industry of psychiatry to start investigating nutrition. Okay. So this was published in 2010. And then in 2021, they brought out an article that tied in omega-3s, brain-derived neurotropic factor, zinc deficiencies, minerals and vitamins, the microbiome, this massive article that they wrote, and said, “This is the new future of psychiatry.” And I was thinking to myself, we’ve been saying that since 2005, and finally, that’s coming out. So yeah, the whole industry of psychiatry is legitimately working towards, I think, integrating this.

And I think it’s a prime time for us to stop this battle back and forth between psychiatry, psychology, and nutrition, and this one is sitting on this side of the fence. And you know how it works. It’s really high time to combine them because there’s a place for all three of those, and that’s my little three-legged bar stool theory of the psychiatry, psychology, and then the nutrition component.

Evelyne: Yeah. I want to dive into that more. And I think it’s very encouraging as functional medicine practitioners, as nutritionists, to work together with psychiatrists, to do what’s best for the patient.

Dr. Oscar Coetzee: I keep saying that. I keep saying that a lot of physicians want to go into the field of integrative health. And I think one of the best things to do is really integrate nutritionists as a part of the practice because it’s such a big component of integrative health.

Evelyne: Yeah. So you’ve said it now a couple of times, you talk about mental health as a three-legged stool, so the psychotherapy, psychiatry, and psychonutrigenomics, tell me a little bit more about that psychonutrigenomics part and everything that makes that up.

Dr. Oscar Coetzee: Okay. So because of my years working in the field of Psychiatric Institutes of America for Fair Oaks Hospital, under the banner of the Psychiatric Institutes of America, I saw the benefit of psychiatry, there’s definitely a benefit to psychiatry. There’s a benefit to some of the medications that sometimes are needed in individuals, especially if they’re going through severe drug withdrawal, and if they’re going through severe trauma-based depression and anxiety that is maybe contributed by sexual abuse, or verbal abuse, or physical abuse, real severe deep-rooted trauma. I’ve seen psychiatric medication do a phenomenal job with some of those patients. Then at the same time, in the same building, you should have a psychologist or a psychotherapist that can talk to that person about some of those emotions and some of those experience so that there’s a let out effect, and that person can express some of those suppressed emotions. And that’s extremely helpful.

But none of those things can effectively work if that person is completely depleted in nutrients. Because if you’re trying to make a person happier, and their microbiome is a mess, and they’re not producing enough tryptophan and tyrosine, or they’re not absorbing enough of that through proper diets, or they have low stomach acid, or they don’t have enough vitamin Bs or vitamin C, and all these little nutrients that play such an important role with our mental health, then it makes those two legs of the bar stool very difficult to perform. So the psychonutrigenomic component is actually the combination of all three. So think of the piece that you sit on the chair, the top of the chair, that’s the psychonutrigenomics, because that combines the working of the psychiatry, the psychology, and the nutrition. So one leg of the bar stool is legitimately just nutrition.

And then if you combine all three of those, and you put the top of that share on top of it, now you have stability because all those things now can work together. And they cannot work without each other. And if you do the proper investigation on each level, let’s say, in my mind, what I’d like to see in the future is an absolute organization that focuses on this area of mental health. So in a clinical office, a person will come in and you’ll do an evaluation on their nutritional status, their psychological status, and emotional status, and short term, they might need a psychiatric medication. The objective in the long term is clearly to help that person maybe not being on as many medications and work with a nutritional status and then balance it out.

And once again, let me just make it clear, I am not anti-psychiatric medication, I’m just saying that I feel sometimes, that is given as a first intervention before any part of the third leg of the stool is investigated. So we’ve done a reasonably good job at the two legs of the bar stool, but we’ve completely left out the thing that is the engine that drives the efficacy of those other interventions.

Evelyne: I want to dive a little bit deeper into some of these nutrient areas that you talked about. So I know that we could go into so many, you mentioned a few already, and we are going to be focusing on anxiety and depression first, and then ADHD little bit later, though I know that there’s overlap with these as well. What do you think are some of the most underrated nutrients that may actually help with anxiety and depression? When a patient comes to you, where would you start?

Dr. Oscar Coetzee: Well, I would say, let’s call the three key ones would be B vitamins, because B vitamin deficiency almost matches neuropsychiatric disorder symptomology to a tee. So if you look at the B vitamin deficiency symptomology, and you look at neuropsychiatric disorder symptomology, as a general overview, very similar. So B vitamins in its totality. Vitamin D, vitamin C, which is sometimes not really seen as one of the important ones, and Omega-3. So if I can just go back to my top three. So my top three would be B vitamins, vitamin D, and then the third one for me would be omega-3s. Those would be the three key ones for me when it comes to covering my bases. So in addition to that, then I would definitely say that if we can call this a vitamin, it isn’t really, but fiber is really underrated, magnesium, zinc, iron, all play really, really important roles when it comes to mental health as well.

Evelyne: I feel like the fiber, it’s so basic, but when I was watching the training that you did for us for the reps, I was like, “Oh, yeah.” We know it’s good for our gut health and for our general health, and we know that almost no American gets enough fiber, but I think we don’t often think about the link to mental health, but it makes total sense.

Dr. Oscar Coetzee: Well, everybody knows… every listener and every listener’s patient knows about the gut-brain connection, that’s out there in the world of social media, that’s spoken about all the time. So if we really believe in that, then we really need to understand, well, okay, if we believe in the gut-brain connection, what’s feeding the gut? And what’s feeding the gut inappropriately maybe is a better question. So if we look at the average intake of fiber in the United States of America, it’s 16 grams per day. If we look at ancestral intake, it was between 50 to 120 grams per day. Now, that’s excessive. But I would definitely say that if you’re not reaching 35 to 50 grams per day of fiber, either in supplemental intake or dietary combined with supplemental intake, you’re probably not giving your body the proper substrates in the gut to be able to help produce these things.

Now, understand how it works. So you give these little acids to the gut microbiome, they extract what they need for their survival, then they produce short-chain fatty acids to us, but they also stimulate the bacteria like Lactobacillus and Bifidobacterium to help us produce more aromatic amino acids in the form of tryptophan, tyrosine, and phenylalanine. And when you look at tryptophan, it converts to serotonin, and then tyrosine converts to dopamine and then to epinephrine and all. So it’s really a big, big thing. And if you look at the statistical data on the increase of anxiety and depression to the modern diet, it’s pretty correlated. Now, I know correlation isn’t causation, but you’ve got to wonder a little bit as baseline, if we maybe not overlook one of the most important things.

Evelyne: I’m sure we have a lot of correlations when you look at modern diets and look at specific items, whether it’s fast food, or just changing intakes of different things and fewer vegetables, I’m sure they’re all correlated with those. Because we’ve seen such a rise in anxiety and depression, and then just the way the world is today. I feel like everybody’s just running around, just stressed and frazzled. I have a question about… so the nutrients you mentioned in the beginning, what is your go-to approach? Are you automatically going to supplement with B vitamins, vitamin C, fish oil, fiber, or are you going to look at an organic acids test? Are you going to do an omega check? Are you looking at blood work? What is your approach?

Dr. Oscar Coetzee: Yeah, I think what we don’t want to do, if we really want to make this a scientific endeavor, this whole psychonutrigenomic evolvement, we can’t just have generalized approaches. Now, I’ve mentioned those three, vitamin D, the B vitamins, as major players involved with mental health, but you can’t just assume that everybody is deficient in that. So yes, the first thing that I would want to do is I would want to investigate the obvious things, like standard blood work, I would like to look at blood sugar. Dysglycemia or blood sugar dysregulation mimics a lot of anxiety and depression symptomology. So you want to fix the blood sugar, then you want to look at the dietary intake of that individual and determine what is your actual fiber intake. And then in addition to that, I would definitely want to run two tests.

Two tests are extremely important for me when I deal with mental health, and I do them consistently, which would be the metabolomics test, because I can look at neurotransmitter conversion, I can look at all the B vitamins, I can look at detoxification pathways, I can get a general understanding of the microbiome by looking at the last section of that test. And then I look at energy and mitochondria, so I can get an idea of how glucose is playing a role. So that’s a really key one for me to look at. And then in addition to that, I obviously want to look at the gut, because I can look at some of those… Am I low in those Lactobacillus and Bifidobacteria that help me convert those aromatic amino acids, or are there inflammatory issues in the gut that could be driving that? But in addition to that, before you do that, Evelyne, you probably want to also investigate the thyroid. Hypothyroid is highly correlated with depression and anxiety symptomology, and then anemia, that’s another very overlooked thing. I don’t know anybody with full-blown anemia that isn’t fatigued, depressed, and lethargic.

So we have to try and start to figure out what is really anxiety and depression, and what is an underlining nutrient deficiency that might be feeding symptomology that matches or mimics some of that? So as baseline professionals, you want to make sure your patient isn’t anemic, they aren’t hypothyroid, they aren’t dysglycemic phase one, then you can go dig into your metabolomic testing, your GI testing, your fiber analysis, your protein micronutrient assessments. But I think those are the things you really want to address. And the reason that I’m saying that, I have seen life-changing personality uplifts by people just using thyroid medication short-term because they’re so hypothyroid, or they’re not converting T4 to T3 enough. And this, again, is where I’m feeling that medication has a phenomenal place in this move towards optimizing your mental health. But you really need to cover those major things first before you even go into the functional testing.

Evelyne: I have so many follow-up questions for you, but you just reminded me of one that I was going to ask a little later, do you have any favorite stories of where you implemented a rather simple change, maybe just a few supplements, a few diet tweaks, where the change was just remarkable and maybe even surprised you?

Dr. Oscar Coetzee: Yes. We haven’t even spoken about this at length yet, but there’s a couple. I can give you a couple of scenarios… Let me go back to the thyroid story. Okay. So I had a client came into my office one time, and I was looking at a blood work. And she’s a consistent patient of mine, so she’s been with me for many years. I know her personality, she’s vibrant, she’s exciting, she’s fun to be around. And she physically came into my office and you could see that the rug has been pulled right from under her. Now, I knew at that particular point, it might not have been a baseline nutritional thing because I’ve been working with her for many, many years on helping her nutritionally get where she needs to be, and when we look at the blood work, we found that there was a T3 conversion issue.

So I’m going to give you the medication example. So basically, I reached out to her physician and I said to her, “Listen,” and I’m looking at this, “is there any chance that we can maybe consider a short-term use of Cytomel for her until I help her get back on her feet?” And she legitimately called the doctor the next morning, it was all taken care of because I have a really good relationship with this physician. And four days later, she walked into my office and hugged me and like, “My life’s back. I’m great.” Then we started working on the selenium conversion and started doing a couple of nutraceuticals. So that’s one story that I can give you. The other story that I can give you is a patient that came to me that was completely housebound, very anxiety-ridden, not very happy with even talking to me.

I put her on a psychobiotic. At that time, I was able to convince her to take a psychobiotic while I’m investigating all these other things that we spoke about, and had immediate improvement. Now, I still worked on all the other things in six months to give her optimization, but I’ve had great results with…there’s two different approaches, the psychobiotic, and the other person, I had her get a T3 medication to give her the uplift. I can give you hundreds of examples of cases where people came in with anemia that wasn’t picked up, and we just worked with iron. Immediately, the anxiety and depression improved. Hypothyroid, you work with those conditions or you regulate the blood sugar. So now it sounds super simplistic, but you can move the needle on those.

Now, I’m talking more about dysthymia, like these anxiety and depressions of people, “I don’t really know why I’m anxious and depressed. I have a good job. I have a good partner. I have a happy dog or a cat. I have a home. I don’t know why I’m sad and depressed all the time.” So that’s where this is really important. The really deep-rooted psychological cases definitely might not move the needle as quickly as we did with some of these, but probably 60% of our mental cases that come into our office are these cases. They’re just there by virtue of what they’re eating, or they depleted because of environmental toxins, or herbicides, or pesticides. It’s all around us.

Evelyne: Thank you for sharing those. When you were talking about the B vitamins earlier, something else popped into my head, because I know you’re a fan of genomic testing as well, and people can be low in vitamin B but there’s a genetic component. And my follow-up question to that is, so when it comes to B vitamins, and so many other things, there are certain SNPs that can also affect how the gene is expressed, turned up a little bit more, turned down a bit more, and so are you in your patients looking at gene function in the beginning or is that something at the end? And then the follow-up question to that is, if you know that they do have a SNP in these certain things, are you always needing to support them, versus maybe a shorter term supportive B vitamins?

Dr. Oscar Coetzee: Yes. So first part of the question, read that to me again, just so that I have them correct.

Evelyne: Oh, I’m not reading it, I’m just thinking out loud right now. Well, basically, when you’re assessing B vitamins, you’re usually using a metabolomics, specifically, the metabolomic spotlight, so looking at organic acids in urine, but then at which point are you also looking at the genetic expression?

Dr. Oscar Coetzee: So in a perfect world, if you’re working with mental health, you want to do all three, you want to have metabolomics, GI, and genomics. That’s really the perfect world. So if you’re looking at metabolomic testing, and you’re looking at methylmalonic acid, and you’re looking at formiminoglutamic acid, those are B12 and folate indicators, B12, B9 indicators. And if you see that those things are out of range on a normal test, like your metabolomics test, that could indicate that you might have an issue with MTHFR mutations, that could also play a role with the COMP gene that is working with catecholamines. And then there’s downstream and upstream effect on all those interactions from a genetic standpoint. But in addition to that, there’s other genes that you want to look at. You want to maybe look at something called a TPH1 gene that has to do with serotonin.

You want to maybe look at TPH2, TPH1, DDC, dopamine decarboxylase genes. You can look at circadian rhythm genes, like CLOCK genes and ARNTL genes, and their individual SNPs, because all those things are going to play a role with mental health, and there’s a slew of them that I’m not mentioning at this particular point. So in a perfect world, if you have the gene and you can see if that person is homozygous or heterozygous to that gene and SNP, then you can see that that has been expressed by looking at the test. Because if they have the active gene indicator genetically, and then you look at the test, and you can actually look at the functionality or the expression of that gene. So it’s fantastic when you have the genetics and the metabolomics because you can actually see what’s expressed and what’s not expressed.

So that can give you a much clearer picture when you’re working with a client or a patient. So that would be the perfect world, but it just isn’t. So if I can do only one test, if I only have a couple of dollars to spend on mental health, I have to go to metabolomics, because it gives me an indication of neurotransmitter health, it gives me an indication of microbiome, it gives me an indication of the glycolytic, and energy, and mitochondrial pathways, and all those things play a role with anemia, blood sugar, microbiome. So that’s really the perfect test, in my point of view, for baseline mental health evaluation from a functional perspective.

Evelyne: You mentioned several SNPs there that I’m not familiar with, or I’m sure I saw them at some point and they promptly exited my brain. And I want to dive more into neurotransmitters, but my follow-up question… and I guess this would probably be individualized, but if you see that a patient is currently expressing some of these genes, but you know they’re present, so that potential is always there that that gene is expressed, and I guess, that also depends on lifestyle and so many things, and the nutrient interactions, and the inflammation, but I guess I’m asking once you’ve gotten a patient to this better place, then will you recommend that they stay on a certain supplement, like a B complex, for example, based on the genetics?

Dr. Oscar Coetzee: Yes. Yes. So I absolutely see where you’re going. So let’s say, hypothetically, you’re working with somebody over a period of time and they cannot afford to do all the testing. Eventually, I’m going to get to genetics because that’s the maintenance protocol. I need to know what the underlining things are that have permanency that we might need to address forever. So yes, in that particular case, if that person has certain defects in the genes that need to be overridden or assisted in expression, then definitely, you would give that person a nutraceutical for long-term use, and then check in with them periodically. Because you never want to get to a point where you feel like you’re giving a person too much. But generally, with a genetic thing, it’s hard to give a person too much because they have a deficiency or a defect to be able to do it in an optimized way.

Evelyne: Yeah, thank you for that. And I guess it’s a difficult question for a podcast, especially where we are speaking in general terms and we know that so much of what we do is individualized care. So thank you. Before we dive into the neurotransmitters, there are a couple of areas that I would like to touch on as related to anxiety and depression. The first one is circadian rhythm, I’d love to talk a little bit more about that. The second one is inflammation, especially… well, I don’t know if you would loop these together, but inflammation and then BDNF. Can you talk about how those relate to anxiety and depression?

Dr. Oscar Coetzee: Yes. So let’s talk with BDNF, brain-derived neurotropic factor. So brain-derived neurotropic factor can be stimulated by the use of omega-3 fatty acids, and zinc actually is another one that assists in that. If you have low brain-derived neurotropic factor, you have depression. So that is 100% correlation. So low BDNF equals depression. That’s a known fact. How do we naturally or nutritionally stimulate BDNF? Omega-3s and zinc. So there’s a very, very strong correlation between brain-derived neurotropic factor and depression. The second one that you asked me about was what?

Evelyne: Well, they’re inflammation and circadian rhythm.

Dr. Oscar Coetzee: Okay. So inflammation is highly driven in anxiety and depression. And generally speaking, if you go into the literature, most of the literature is going to support high LPS drive in the brain. Now, how we get those LPSs there is not really complicated to figure out. So if you have a lot of overgrowth of gram-negative bacteria in your GI tract, the natural cell cycle of a bacteria has a die-off period, they are going to die. When they die, they produce lipopolysaccharides, and these lipopolysaccharides are endotoxins. Now, if you have permeability, you have leaky gut, then those LPSs tend to get into the bloodstream, and then that drives a lot of interleukin and inflammatory reactions because your body doesn’t want them there. The problem with LPS, it has the ability to cross into the blood-brain barrier and create brain inflammation, and then this brain inflammation drives whatever maybe the genetic predispositions are.

So if you are more prone to be anxious, LPS is going to drive anxiety. If you’re more prone to be depressed, LPS is going to drive that. If you’re more prone to have some other neurological disorder, LPS tends to drive it. So it’s almost like LPS is always going to pick your weakest point of your body or your genetics, and it’s going to go for that. So in order to reduce the allostatic load of this LPS that we get into our systems, we really need to focus on the gut. There’s not much that we can do about the LPS that’s already been released in the body, we need to reduce the inflammatory drivers that are there. That’s where the gut test comes in so we can physically look at the amount of LPS overgrowth from the gram-negative overgrowth. Then as you know, there’s several nutraceutical protocols that you can have to be able to do that.

Now, the other inflammatory issue that’s already in the system is where curcumin, omega-3s, or any other things like an anti-inflammatory diet would be helpful. So it’s not like I’m saying the LPS, and the blood, and the brain just let it go, that’s where a lot of these other nutritional interventions can help that inflammation, but you want to stop the leak, the legitimate leak that is getting into the system. That’s the major driver of that. But if you were to go into PubMed literature, Evelyne, and you look at LPS and brain inflammation, LPS and mental issues, LPS anxiety, you’ll find hundreds of studies on it. So it’s legitimately something that is very pertinent in the literature. So that’s the inflammation connection.

Evelyne: So last time, you actually shared on our episode a little bit more about the LPS and anxiety, which I found very interesting, and since we recorded that probably about 10 months ago or so, where it aired about 10 months ago, I’m wondering, since you’ve now looked at so many more tests in the meantime, have you consistently seen a correlation with the higher LPS-producing bacteria on the GI spotlight and those symptoms when you talk to practitioners?

Dr. Oscar Coetzee: Anecdotally, 100%. Yeah, because you have to say anecdotally because we didn’t really run it to clinical trial. But yes, there’s no question about the fact that when… let’s just go to my clinical practice. If I look at people that come to me now, about 45% of my practice is now mental health. It’s just what my practice has become known for. And yeah, I would say, if I have to put a number to it, probably 85 to 90% of the cases are clear cut LPS overgrowth bacteria in that section of the spotlight test. But in addition to that, what you also see is low Akkermansia generally, you see low commensals generally, and then you see a reasonably rundown immunological system in the gut as well by looking at secretory IgA.

So those ones tend to be the consistency that I see in most of those tests. It’s very seldom, if ever, that a person with severe depression or anxiety comes in and the gut looks amazing. There’s definitely always something that is a standout there. So I really think it’s a fantastic assessment tool when you want to dig into the gut-brain association to the anxiety and depression or ADHD indicators.

Evelyne: Absolutely. And with the inflammation, I think it’s probably both, but is it that there’s some sort of inflammation already present and that leads to anxiety and depression? Or does anxiety and depression cause the inflammation?

Dr. Oscar Coetzee: I think it could be a bit of both. So rephrase the question. So what you’re asking is inflammation in the brain, is what we’re talking about, right?

Evelyne: Or even in the gut, just general inflammation, wherever it’s occurring. Because if it’s in the brain, it’s in the gut, right?

Dr. Oscar Coetzee: Yeah.

Evelyne: So if we are experiencing inflammation, then does that lead to anxiety or depression? Or if somebody gets an anxiety and depression, say, it’s from something situational that has happened, does that then create inflammatory markers to go up… or does that lead to inflammatory markers to go up?

Dr. Oscar Coetzee: Yes, definitely. I think you can legitimately argue both sides very well when it comes to that question. That would probably be a pretty deep discussion on its own. But in my opinion, the inflammation is actually the more pertinent driver of the anxiety and the depression, because that inflammatory response is creating physiological response in your body to compensate, and then that physiological response in the body to compensate depletes more nutrients, that then drives more issues because of nutrient deficiencies, and the anxiety, and depression. So if I have to argue when I would probably argue that route a little bit more… and it’s not necessarily that you think, “Well, the inflammation is the thing that’s really driving the anxiety and depression,” the inflammation then creates compensation. The compensation, as I said before, starts to steal from Peter to pay Paul. And that vicious cycle that never goes away is eventually what leads to more and more deeper symptomatology of the anxiety and depression.

So I really believe that, look, inflammation is part of healing, so we should have inflammation. We have to have that bell curve where there’s a spike and then there’s a come down. In our world, unfortunately, there’s no come down, it stays on that high level of inflammatory issues. And this is where I also think a lot of this unresolved C-reactive protein and sed rate markers that people can’t figure out why it’s always high. I often get people coming to my office like, “My doctors cannot figure out why my sed rate’s high, why my C-reactive protein is high, why my inflammation markers are so high, because I just don’t have any other indicators.” And I think it’s this consistent homeostatic battle to compensate, because we’re never really getting rid of the antigen or the origin of the thing that’s driving the inflammation.

Evelyne: Since you mentioned the resolving inflammation, and maybe I should know the answer and I’m forgetting, but could you use specialized pro-resolving mediators to address some of this? Has that been studied in depression and anxiety?

Dr. Oscar Coetzee: Yes, without a doubt. As a matter of fact, some of those mediators I have personally used in much more severe brain inflammation conditions with great success. And when I’m talking about that, I’m not talking about your standardized anxiety and depression state, which I don’t try and minimize, I’m talking about conditions like multiple sclerosis, ALS, myasthenia gravis that really indicate the efficacy of that.

Evelyne: So would you use it more in somebody who has comorbidities that would be considered autoimmune or inflammatory conditions?

Dr. Oscar Coetzee: Yes. Yes. Definitely.

Evelyne: And then I wanted to go back to something you said about the brain-derived neurotrophic factor really quick. I think sometimes, or a lot of times, we think of raising that with nootropics and specific brain nutrients, but I love that you just talked about omega-3s and zinc. So simple and we sometimes forget about, or I know I sometimes forget about those basic things. So thank you for mentioning that.

Dr. Oscar Coetzee: Yeah. I just think that before we go to the advanced stage intervention, let’s make sure that the baseline is covered. And that’s part of this whole thing, is it’s great to give a person tryptophan, or 5-HTP, or something like that because they have anxiety or depression, or you want to give them GABA for anxiety, or maybe tyrosine, because you’re trying to get better dopamine out of it. But sometimes, that’s like the end result, so that’s not that different for me than giving a person a medication. What I want to get clear out of this whole mental health thing, you have to have this standardized baseline that needs to be covered before you go there. Because that person might be anxious because they’re lacking B6, not because they’re lacking tryptophan, because we require B6 to convert tryptophan to serotonin, and the same thing from tyrosine to dopamine.

So this is why I want to cover the Bs, the Ds, the Cs, the magnesium, the zinc, the iron, the omega-3s. And if you look at the statistical data in the world, that’s a deficiency worldwide in all those nutrients. So if you now look at the proportionate increase in anxiety and depression on the world versus the proportionate increase of those baseline things, then why aren’t we focusing on that first? We’re building roofs on homes before we’ve even discovered what the foundation should look like. We have to start at the foundation. So you were asking me earlier, “Have I seen some miracle cases?” Every single case that I have covered these bases on, I’ve had an improvement in mental health. So for my patients, when they come into my office, they have a scoring sheet on their mental health, and a simple thing, it’s like an out of 10 score.

And let’s say they come in at 2 out of 10, or 1 out of 10, or zero out 10, every single person that I’ve worked with, with my foundational truths, has increased it by 50%, wherever that point differentiation was. So if they were at 2, they’re at 4. If they had 3, they’re at 6. So they’re not at 10 yet, there’s still work to be done, that’s maybe where the tryptophan comes in, or the GABA comes in, or the additional end product, so to speak, that works with that component comes in. I’m just saying that we need to look at the foundation first. This is phase one, it should always be phase one, and it should be consistently practiced. And I’m not saying that I have the answer to everything, it’s just that with these foundationals, you’re never going to have perfect outcomes, unless you permanently take a person on maybe a nutraceutical or a pharmaceutical.

Isn’t the idea behind anxiety and depression not to have a person on a permanent nutraceutical unless there’s a genetic variant that you and I spoke about? Isn’t that the idea? The idea is intermittently using things for balancing or at times that you know that you’ll be lower, or maybe you exercising more so you need to compensate more. But that’s the truth of anxiety and depression to me, is you should be able to function one or two days without taking anything if your foundation is properly balanced.

Evelyne: Absolutely. Really quick before we move on from this part, the circadian rhythm relationship to anxiety and depression. Can you touch on that?

Dr. Oscar Coetzee: Yeah, that’s probably one of the strongest combinations. So there’s several genes involved with that. The first thing that is involved, there’s something called a CLOCK gene, which is easy to remember because it’s a clock. And then there’s also an ARNTL gene with several steps on it that people just naturally don’t sleep well. What we do know in the literature is that short sleeping immediately drives dysglycemia. Dysglycemia is blood sugar dysregulation. Blood sugar dysregulation leads to more anxiety and more depression. If you look at the statistical data between type 2 diabetes and blood sugar dysregulated individuals and depression and anxiety, it’s trifold, it’s a massive increase. Also, from a relaxation standpoint, a brain rejuvenation standpoint, theta waves, the delta waves, they all need to work in synergy. Now, what we have seen in the literature that seems to have an incredible effect on the circadian rhythms is psychobiotics.

So psychobiotics somehow has a natural way to get those circadian rhythms to get back into check. Now, how do you improve circadian rhythms? Look, you have to improve certain lifestyle decisions, you have to improve sleep hygiene, you have to educate people that they can’t be reading science journals, or watching a horrible horror movie before they go to bed, or gaming. Those things cannot be done if you want to get into a consistent circadian rhythm. And I think if we’re talking about circadian rhythms, we need to look at the stress connection. I was just today, again, looking at some research, and that is the number one driver of depression in people, is their inability to deal with stress. That’s what the research paper showed. It’s family, financial pressure, all those things that we normally assume. Inability to deal with stress is far outweighing anything that anybody’s dealing with.

So if we go a little bit deeper into the circadian rhythm, what else makes you not sleep? Well, the inability to shut down your stress response. Your HPA axis is in overdrive. So you’re in this fight or flight state, so your body just cannot get to that calming effect. So circadian rhythm is probably the measurement, at the end of everything, to see if you’re working effectively because it’s going to address the proper conversion of tryptophan to melatonin. So your B6 has to be good. You’re going to have to not be in an HPA overdrive to be able to have proper circadian rhythms, cannot have elevated cortisol to be in proper circadian rhythms. So it’s almost like if your circadian rhythms have improved, you’ve really hit the jackpot on really getting your mental health to improve.

Evelyne: Yeah, thank you for that, so important. And making sure we get sunlight in the morning, at sunset. Yes, all of those things that we go outside at all.

Dr. Oscar Coetzee: And honestly, Evelyne, anything you can do to improve that, yoga, meditation, acupuncture, earthing, grounding, whatever, all those things I feel have scientific validation to improve circadian… So whatever works for that individual is really something that needs to be investigated.

Evelyne: Definitely. I know that we’re actually almost running out of time, and we haven’t even gotten to the ADHD portion. But I do want to mention, you did a phenomenal webinar for us recently on adult… well, and a little bit on child ADHD, and you can find that on designsforhealth.com if you’re logged in as a practitioner. So I’m going to kind of loop the anxiety and depression and ADHD into this question. We’ve talked about neurotransmitters a couple of times, and with neurotransmitters, I feel like when we’re using medication, we are traditionally going to the different neurotransmitters, we’re working on serotonin, or we’re working on dopamine, and then I know that those… well, some studies show that they don’t work, or they work just as well as a placebo, or there are some other mechanisms, like actually lowering inflammation that are maybe more responsible or just as responsible for these results.

And so I’m wondering, from a supplement standpoint, we also sometimes use some of the things that would increase neurotransmitter function. So how do you determine… I think you’ve said you’re already working on the baseline, that’s the most important, but once that’s out of the way, what is your method of determining how and where you work with neurotransmitters? I know that’s a complicated long question,

Dr. Oscar Coetzee: Yeah. So I’m probably going to throw a little bit of an argumentative statement in here that people open up for discussions. Okay, here it goes. So we spoke about genetics and we spoke about these underlining things that could cause these imbalances in our body, that eventually lead to this neurotransmitter conversion of epinephrine, norepinephrine, dopamine, serotonin, and GABA. Those are the key things involved with ADHD, anxiety, and depression, and that’s consistent. So my opinion is that when I treat a patient for mental health, I don’t look at ADHD, anxiety, or depression at all anymore, I look at your genes, I look at your status currently of the expression of those genes by looking at metabolomics, and then your gut health. And then I work with those components. So if I see that you need B6, I’m going to give you B6. And that might improve a person that has genetic predisposition for ADHD, but that same B6 might improve the person that has a genetic predisposition for depression over ADHD. You understand what I’m saying?

So I’m trying to move away from this categorization that ADHD needs this protocol, and depression and anxiety needs this protocol. I don’t think it really works like that. I just think that your susceptibility as an individual mentally has very much to do with your genetic predispositions and then your nutritional status, and it’s going for your weakest point. And if your weakest point genetically is ADHD, you’re going to have symptomology of that. Now, am I saying that there aren’t other outside exogenous things that could maybe have more of an ADHD look? No, I’m not saying that at all, I’m just saying that if you look at the literature for ADHD, it’s focused on what? Epinephrine, norepinephrine, dopamine, serotonin. What are we focusing on for anxiety and depression? Epinephrine, dopamine, norepinephrine, serotonin, and GABA. It’s not really that different.

And what I’ve seen is if I approach it from that baseline nutritional thing covering all the holes that I feel are outstanding, then that person that came into my office for ADHD, the ADHD is improving. The person that came into my office for mental issues with depression, that seems to be improving. So I’m not saying that I don’t believe depression and anxiety and ADHD don’t exist or they’re all the same thing. I don’t say that at all. I just say that some of us have no hair, some of us have blonde hair, some of us are tall, some of us are short. So there’s going to be things that are going to affect us differently, and that’s just the approach that I’ve taken on this whole mental health. And since I’ve got out of that cocoon to try and fix ADHD, or I’m an ADHD expert, or I’m a depression anxiety expert, now I’m just a foundational expert.

I work with a foundational basics, then I go into your genes and see if you have susceptibility of certain things mentally, and then I will work with those things individually and see what the outcome is. How you want to title a term your condition is completely up to you, but I see commonalities in each one of these things. Now, I know that you’ve had people on the podcast that have areas of ADHD, and there might be more elements that they are aware of than I am aware of, but I’m not trying to make myself a specialist in any area of mental health, I’m trying to make myself a specialist in the nutritional coverage of what drives mental health. That’s what I’m doing. And whatever the outcome is of that is the outcome of it.

Evelyne: Yeah, that’s great. Lots to think about and ponder. And I do want to ask you a little more specifically, because it has come up on the show before, but when you do see somebody who maybe has some conversion issues, or when you see it on whether it’s a metabolomics test or you see it in their genomics test, if there are issues with, say, dopamine or serotonin, then will you go to some of those precursors in higher dose with patients?

Dr. Oscar Coetzee: 100%. Yeah, certain-

Evelyne: Amino acids? Yeah.

Dr. Oscar Coetzee: 100%. Look, I am not scared to go pretty aggressive with dosing. If I see that a person needs dopamine boosting by virtue of genes and by virtue of what I’m seeing on a test, yeah, I’ll go aggressive with that, absolutely. So I’m not trying to say that I will not use something that is the precursor to dopamine, or a nutrient, or a supplement that can help dopamine boosting or serotonin boosting, I use it all the time, it’s just not my first step. It’s not my phase one step. That might be my phase two or my phase three step. So yeah, absolutely, I’m a complete believer in a reasonable amount of oversaturation if there is a deficit or a deficiency in a particular area of a neurotransmitter. And it works very effectively. If you pick the right thing, it could work very well.

But what you really have to be careful with is if a person is in, let’s call it mental overdrive, so psychological overdrive, they’re in a stressed and worried state… or they’re in a stressed and tired state, and some of those symptoms will be a little overlapping. You’ve got to be careful with where you go with those nutrients, because if you give the person calming nutrients when they are run down, that is not exactly what you want to be doing, you want to give the calming nutrients in the overstimulated state, you want to give the feeding… governing nutrients in the state of deficiency, you need to know where you lie. And that’s why I feel metabolomics really helps me, because it can give me an idea if you’re stressed and worried, or stressed and tired. So I don’t make those mistakes, and the reason that I say that is because I have made those mistakes.

I have gone purely by symptomology and assumed that this person is low in tryptophan and then go that route. And then that has worked sometimes, and sometimes, it hasn’t. And you don’t really want to play those games with people that are already susceptible to more anxiety of something doesn’t work. This is a population where you have to be correct, you can’t really experiment. It’s not like a weight loss game, “Hey, sorry Ms. Brown, you only lost two pounds, but next month, you might lose 10 pounds.” This is not that game. These people come to you because they are depressed and anxious, and the results need to be produced very effectively and quickly. And unless you have methodology to get there and make sure that you don’t make those mistakes, I think you’re setting yourself up for problems. Not heavy-duty problems, it’s just like your patients are not going to be happy with the outcomes. Right?

Evelyne: Great points. Yeah. And I think as practitioners, we all have different strengths. I was trained in herbalism, so before doing more of the amino acids, I might go more to the adaptogens and Nervines, rather than some of those. So that’s just what I feel more comfortable with, for example.

Dr. Oscar Coetzee: And look, I’ve used adaptogens very effectively in stress and worried people, extremely effective. But yeah, again, that’s where the expertise comes in. But I would state this, again, that start with baseline. Make sure all the baseline things are good before you go there. Or in addition, if you feel from your clinical experience and what you know as an herbalist that, “Hey, I’m going to give these people Nervines, or I’m going to give them adaptogens because I know it’s going to just bring it down. And at that time, I’m going to start working, making sure that all those other things are compensated.” By all means. It’s just that you need to address… because I can assure you that every patient that comes into an office with mental issues have baseline problems. There is one, two, maybe five of those categories that are out of whack, that is a consistency.

Evelyne: I have just one more main question for you, because I don’t need to ask you the questions that we ask every guest because we went over it last time, unless there’s some supplement that you are loving that you started taking in the last 10 months that you can’t stop talking about. But the question I have for you is, if you could design a study on anything right now related to mental health and you had unlimited money to do it, what would that be?

Dr. Oscar Coetzee: Well, first of all, I would like to have the ability to measure all three of those tests pre and post. Now, you don’t have to do genomics post, but I would definitely want to do a study probably of about six months in duration, and maybe have a couple of arms in the study. I would maybe look at nutrition on a whole food level. Now, I’m going to have compliant patients, this is a completely perfect world that you’re creating. So I would love to look at whole food nutrition cooked by maybe a chef for one arm of the study with no nutraceutical.

Evelyne: Sign me up.

Dr. Oscar Coetzee: Okay. Then I want to have an arm in the study that’s looking at nutraceuticals… Now, we’re trying to cover certain vitamin and mineral deficiencies in our inclusion criteria. So we’re going to have that. It’s going to be nutrients with a proper, let’s call it, non-inflammatory diet, but it’s not perfect. And then I would like to have nutraceuticals with people that don’t change their diet at all. You follow? So I want to look at standard American diet, maybe with nutraceuticals, nutraceuticals with maybe an anti-inflammatory diet, and then just a whole food diet, and have these parameters to be measured at the end of the study. That would be very interesting to look at, see how everything plays a role. Now, in the whole foods study, you’re going to have the right amount of fibers, the B vitamins, and everything that you need from a nutritional status.

Now, whether those people are going to extract those nutrients is a big question. And then in the middle, you have the nutraceuticals with a good diet, and then the nutraceuticals with a bad diet. So you have an optimal diet, a decent diet, and a crappy diet. And trust me, you’re going to find people to do the crappy diet study for sure, because they want to eat the bad stuff. Some of the other things that we maybe didn’t touch on today, I think sometimes the question comes up, when do you sporebiotics versus-

Evelyne: Oh, yes, I meant to ask you that. Yes.

Dr. Oscar Coetzee: So sporebiotics… we’re talking mental health. So sporebiotics are fantastic to use when you are working with intestinal permeability. So when those people have full-blown intestinal permeability, very elevated zonulin, sporebiotics are phenomenal at helping to regulate tight junction regulation. It’s quite exceptional. And there’s actually a reasonable amount of studies that support that. So sporebiotics are used for me, so I’m going to use it a lot because a lot of people have permeability. Normal probiotics, without doubt, if you look at the literature, substantial amount of literature saying this strain, that strain, this combination strain is fantastic with anxiety and depression. And that’s logical because most of them contain Bifidobacterium, Lactobacillus, and that’s the aromatic amino acid, tyrosine, tryptophan conversion thing. So yeah, without doubt, unless a person has small intestinal bacterial overgrowth or some sort of an issue with handling probiotics, by all means, it’s definitely a natural antidepressant. And then the third category would be psychobiotics. Psychobiotics are individual strains of certain specific strains of psychobiotics that have been shown to really work directly on the brain.

And that’s where these little components come in, like peptidoglycan and some of these exopolysaccharides where the immune system is analyzing it, breaking it apart, delivering it to those areas in the brain, and then helping mental health. The probiotic… prebiotic we already discussed from the fiber standpoint, without a doubt. So the entire biotic category, prebiotic, probiotic, psychobiotic, sporebiotic is massive when it comes to these conditions.

Evelyne: Yeah. Thank you for answering that. I went off of my questions and just had a conversation with you. So thank you for that. And thank you, Oscar, it’s always so great to talk to you. We will have to do this again another season, for sure. And I love that you always bring it back to the basics, but also that it’s always a nuanced conversation. So thank you. And since you are our senior director of education, and we mentioned the Genomic Spotlight, the Metabolomics Spotlight, the GI Spotlight, I just wanted to mention that those are available through Designs for Health. And Oscar and his team are available to do clinical consults on those, which has been so helpful with a lot of practitioners I work with here in San Diego. So I did want to mention that this is not a sponsored podcast, but you and I do both work for Designs for Health, so I had to throw that in there.

Dr. Oscar Coetzee: Yeah. Look, I know that that is clearly something that sounds strange from two people that work for the same company to promote, but I’m also still a practitioner, and I still run my practice and I use these tests consistently for these investigative reasons. And I do them because they’re affordable and they’re effective. They’re effectively pinpointing things that I can’t see and that I can’t guess about anymore.

Evelyne: I also wanted to mention one more resource. You created this Psychonutrigenomics Flow Chart, and I think that’s very helpful. And so if you are listening, if you have a Designs for Health account, you can contact your functional medicine consultant to get that from them. If you don’t have a Designs for Health account, you can sign up and then you can ask your functional medicine consultant for that. So thank you, Oscar. Again, this was a great discussion, I really appreciate it. And thank you for tuning into Conversations for Health today. Check out the show notes for resources from this show, and please share this podcast with your colleagues. Follow, rate, or leave a review. And thank you for designing a well world with us.

Dr. Oscar Coetzee: Well, thanks for having me. Have a good day, Evelyne. Thanks, everybody.

Evelyne: Thank you. You too.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence-based, cutting edge research and practical tips.