Dr Saguil's lecture at Bikram Yoga Naperville May 2011

1. Nutrition and Mental Health RicSaguil, MD Bikram Yoga Naperville May 2011 We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

3. Cares what I have to say

4. Doesn’t Keep Me Waiting

5. Gives Me OptionsWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

6. The First Health Approach We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

7. Your Community of Care Ric Saguil, MD Jason Gruss, MD Tom Jordan, RD Katrina Christie, LCPC Jennifer Green, ND Joe Musolino, DC Amy Iaquinta, DC Nick Nowicki, DC Emery Paredes, PT Courtney Day, EP Yu Zhu, MD China Mike Blumberg, LCPC You

8. Physiology 101 Jill Bolte Taylor

9. You’ve got nerve!

10. The extension cords

11. Where the music happensThe Synapse

12. How medicines help

13. Drug Classes SSRI Lexapro, Prozac, Zoloft, Paxil, Effexor MAOI Marplan, Parnate, Nardil TricyclicsPamelor, Norpramin, Tofranil, Amytriptyline Atypical Abilify, Risperidal, Geodon, Zyprexa, Seroquel Other Classes Wellbutrin, Lamictal, Depakote

14. Top 5 classes of drugs purchased ‘08 Cardiovscular Central Nervous System Metabolic Agent Hormones/Hormone Modifiers Psychotherapeutic Agents 206,294,564 purchases, 27,953,909 buyers Medical Expenditure Panel Survey US Dept Health and Human Svs

15. Top 5 Psych Drugs 2009 Xanax 44,029,000 A Lexapro 27,698,000 A/D Ativan 25,868,000 A Zoloft 19,500,000 D Prozac 19,499,000 D/A Desyrel 18,873,000 D/A Cymbalta 16,626,000 D/A Seroquel 15,814,000 D/A

16. “My Bad”

17. Congrats! You now know the standard medicine approach!

18. Integrative The Saguil Approach History (more than 7 minutes) Search for other causes Thyroid Adrenal Nutritional Deficiency Metal Toxicity Food Allergy Abuse(teen) Rheumatologic (autoimmune) FMS (CRPS) Coexisting Mental Disorder LD/ADD PMS Drug Side Effects Behavioral Therapy Positive Psychology , CBT, EMDR(Imvmtdesensreprossg) Herbal/Homeopathic Medical Acupuncture Nutritional Medicine

19. Wellness Team Ric Saguil, MD Jason Gruss, MD Tom Jordan, RD Katrina Christie, LCPC Jennifer Green, ND Joe Musolino, DC Amy Iaquinta, DC Nick Nowicki, DC Emery Paredes, PT Courtney Day, EP Yu Zhu, MD China Mike Blumberg, LCPC You

20. Food and mood Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study 1,118 30-64 y/o Baltimore MD 24hr diet recall= diet quality significantly associated with symptoms of depression Dietary pattern and depressive symptoms in middle age 3486 participants participants in thehighest tertile of the whole food pattern had lower odds ofCES–D depression /high consumptionof processed food was associated with an increased odds of CES–Ddepression

21. Whole Foods Healing (from Healing with Whole Foods) Oyster shell (ca++) Grain (whole wheat, brown rice, oats) Mushrooms (chinese as an immune tonic) Silicon foods (barley gruel, cucumber, celery, lettuce, celery/lettuce juice all to improve calcium metab) Fruit (lemons, schisandra berries-wuweizi) Seeds (jujube seeds-suanzoaren, chia) Spices (dill, basil) Herbs (chamomile, catnip, scullcap, valerian) Animal Products (quality cow and goat milk, clarified butter-ghee)

22. Why “whole foods”

23. Why not processed?

24. Glycemic Index Theory and Processed Foods

26. Work it sugar!

27. Fast slow

28. Fast spikes in blood glucose = Fast drop in blood glucose

29. Emotional Rollercoaster from Food?

31. The First Health Performance Diet High Powered Oat Breakfast (Oatmeal, Flaxseed, Walnuts, Apples, Cinnamon) Greek Yogurt (140 cal, 14g protein) PVC Lunch: Turkey Sandwich, Vegetable Soup Afternoon Go-To: Cottage Cheese + Fruit Almonds + Cheese Stick Paleoshake (protein, almond milk, frozen fruit) PVC Dinner: 4oz Salmon, 1c Broccoli, Sweet Potatoes, 2 cups Spinach salad w/ Balsamic Tom Jordan, RD

32. Whole Foods Non Processed Foods Healthy fats (O3) Fruits and Vegetables (7-10?) Legumes Grain (fiber) Tea(green) Fish/chicken (for beef/pork)

33. Omega 3 Fish Consumption and Depressive Symptoms in the General Population in Finland 3204 sampled results showed a relatively powerful and independent associationbetween fish consumption anddecreaseddepressive symptoms in this populationsample of 3,402 Finnish adults Omega-3 Treatment of Childhood Depression: A Controlled, Double-Blind Pilot Study Omega 3 fatty acids may have therapeutic benefits in childhood depression

34. Fatty Facts: ALA short chain fatty acids EPA DHA long chain fatty acids Conversion from ALA to E and D depends on how much omega 6 is in diet Proper ration omega 6/omega 3 = 1:1 1:4 US diet 10:1 20:1 3 gm EPA/DHA daily safe Alcohol, US diet, Stress (amphetamine/dopamine depleation)

35. In Mice Decrease in DHA = decreased glucose usage in the TempoparietalArea. Superior temporal gyrus = conflict resolution and decision making

36. Organic when you can

37. “Low and slow” exposure to allergen Elimination Diet Detox Diet

38. Piggy back products in/on your food Bacteria Pesticides Mercury Antibiotics Hormones Genetic contaminants (GMO) It may not be your allergic, could be your toxic

39. Go broke with Organics? Pay up now or pay up later US soil not as good as before The Metabolic Tune-Up: Metabolic Harmony and Disease Prevention 25% menstruating women – inadequate iron 10% us- inadequate zinc inadequate intake=metabolic disruption, dna damage in vivo Vitamin and mineral supplements improve the intelligence scores and concentration of six-year-old children There was a significant relationship between the amount of sugar diet and consumed in the improvement in intelligence scores when taking the vitamin/mineral supplement

40. Environmental Working Group www.ewg.org The Dirty Dozen The Clean 15

41. Documentaries: Food Inc. The Killer at Large The Hidden Epidemic Life Over Cancer (book)

42. Home stretch!

43. “Herbals” and Depression St John's wortfor major depressionKlaus Linde1, Michael M Berner2, LeventeKriston2 Editorial group: Cochrane Depression, Anxiety and Neurosis Group.Publication status and date: Edited (no change to conclusions), published in Issue 4, 2009.29 trials 5489 px, hypericum extracts tested in the included trials a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants Role ofS-adenosyl-L-methionine in the treatment of depression: a review of the evidence SAMeis superior to placebo and is as effective as tricyclic antidepressants in alleviating depression, although some individuals may require higher doses

44. “Herbals” and Anxiety Kava extract for treating anxiety Compared with placebo, kava extract as effective of the symptomatic treatment for anxiety although, at present, the size effect seems small, The data available from the reviewed studies suggest that kava is relatively safe for short-term treatment (1 to 24 weeks) Inositol treatment for panic disorder Pilot study using inositol for panic showed better than placebo response

45. Saguil Approach go-to’s for “mild symptoms” St Johns Wort SAMe Kava Kava Inositol/Rhodiola Valerian Melatonin http://www.naturopathic.org/

46. Trusted sites for reliable information: http://www.ncbi.nlm.nih.gov/pubmed/http://scholar.google.comhttp://naturaldatabase.therapeuticresearch.comhttp://naturalstandard.com/http://www.usp.org/USPVerified/dietarySupplements/

48. Omega 3 fish oil/flax seed oil

49. Supplement with multivitamins, D3!

50. Consider adding herbal (with help)

52. First Tier Blood Testing at FHA Metabolic panel CBC Lipid Thyroid panel (tsh, free t4, t3, thyroid antibody-iodine) Iron panel B12, Folate, Vitamin D (25OH), Magnesium IgG food sensitivity testing

53. 2nd Tier Testing Specific food allergy testing Autoimmune Panel Hormone testing (Martin Ave Pharmacy) Cortisol testing (Genova) Heavy metal toxicity Omega 3 level Spectracell Testing MRI Stress Testing

54. QUESTIONS? Optimum mental health is multifactorial….get a multi-disciplinary team! Next FHA lecture: Whole Foods Schaumburg June 18th, 200pm CONCERNS? COMMENTS? 2010 South Arlington Heights Road Arlington Heights, IL Phone: 847-593-3330www.FirstHealthAssociates.com

55. Bibliography Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry. 2010 Oct. 49(10):980-989. Higher Healthy Eating Index-2005 Scores Associated with Reduced Symptoms of Depression in an Urban Population: Findings from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study Marie Fanelli Kuczmarski, PhD, RD, LDN, Alexandra Cremer Sees, MS, RD Lawrence Hotchkiss, PhD Nancy Cotugna, DrPH, Journal of the American Dietetic Association Volume 110, Issue 3 , Pages 383-389, March 2010 Dietary pattern and depressive symptoms in middle age TasnimeN. Akbaraly, PhD The British Journal of Psychiatry (2009) 195: 408-413. doi: 10.1192/bjp.bp.108.058925 Longevity increased by positive self-perceptions of aging. By Levy, Becca R.; Slade, Martin D.; Kunkel, Suzanne R.; Kasl, Stanislav V. Journal of Personality and Social Psychology, Vol 83(2), Aug 2002, 261-270. Fish Consumption and Depressive Symptoms in the General Population in Finland AnttiTanskanen, M.D., Joseph R. Hibbeln, M.D., JaakkoTuomilehto, M.D., AnttiUutela, Ph.D., Ari Haukkala, M.Sc., HeimoViinamäki, M.D., Johannes Lehtonen, M.D. and ErkkiVartiainen, M.D. PsychiatrServ 52:529-531, April 2001 © 2001 American Psychiatric Association St John's wort for major depressionEditorial group: Cochrane Depression, Anxiety and Neurosis Group.Publication status and date: Edited (no change to conclusions), published in Issue 4, 2009 Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence American Journal of Clinical Nutrition, Vol. 76, No. 5, 1158S-1161S, November 2002 © 2002 American Society for Clinical Nutrition Kava extract for treating anxiety Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003383. DOI: 10.1002/14651858.CD003383

56. Inhibiting and facilitating conditions of the human smile: A nonobtrusive test of the facial feedback hypothesis. Strack, Fritz; Martin, Leonard L.; Stepper, Sabine Journal of Personality and Social Psychology, Vol 54(5), May 1988, 768-777. doi: 10.1037/0022-3514.54.5.768 Power Posing: Brief Nonverbal Displays Affect Neuroendocrine Levels and Risk Tolerance Dana R. Carney1, Amy J.C. Cuddy2, and Andy J. Yap1 Psychological Science OnlineFirst, published on September 21, 2010 as doi:10.1177/0956797610383437 Respiratory feedback in the generation of emotion Philippot P.; Chapelle G.; BlairyS Cognition and Emotion, Volume 16, Number 5, 1 August 2002 , pp. 605-627(23 Body posture effects on self-evaluation: A self-validation approach Pablo Briñol1,*, Richard E. Petty2, Benjamin Wagner2 European Journal of Social Psychology Volume 39, Issue 6, pages 1053–1064, October 2009 Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder J Benjamin, J Levine, M Fux, A Aviv, D Levy and RH Belmaker Am J Psychiatry 1995; 152:1084-1086 Copyright © 1995 by American Psychiatric Association Omega-3 Treatment of Childhood Depression: A Controlled, Double-Blind Pilot Study HanahNemets, M.D., Boris Nemets, M.D., Alan Apter, M.D., ZivaBracha, M.D., and R.H. Belmaker, M.D. Am J Psychiatry 163:1098-1100, June 2006doi: 10.1176/appi.ajp.163.6.1098 The Metabolic Tune-Up: Metabolic Harmony and Disease Prevention Bruce N. Ames The American Society for Nutritional Sciences J. Nutr. 133:1544S-1548S, May 2003 Vitamin and mineral supplements improve the intelligence scores and concentration of six-year-old children David Benton and Richard Cook Personality and Individual DifferencesVolume 12, Issue 11, 1991, Pages 1151-1158