Improving Depression & Anxiety with Dr. Jesse Armine: Rational Wellness Podcast 066
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Improving depression and anxiety with Dr. Jess Armine using a Functional Medicine approach.
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Podcast Highlights
4:30 Dr. Armine explained that he loves chiropractic, but he always felt this draw to what we call Functional Medicine and what drew him in more was his son who developed schizophrenia at age 14. He has a high IQ and was very talkative but when he got treated by conventional psychiatrists with medications, he would just sit there on the couch rocking and became a non-entity. He had to find a better way, so he dug into the research and consulted an integrative psychiatrist and he developed a methodology of treatment that looks at both ends of the disease process down to the core molecular level, which he applied to his son. And his son was able to graduate college and now he is an incredibly functional person who runs his own business and leads a normal life.
6:58 Dr. Armine found that in his son’s case, chronic, neurological Lyme was an important factor that he had to deal with. They also had to deal with strep and biotoxins. His son also had gained a lot of weight because of the medications and all the fat created increased inflammation, so losing the weight also helped.
8:57 Common mood disorders like depression and anxiety are caused, at least in part, by neurotransmitter imbalances, with serotonin being an issue for depression and too much adrenaline or too much dopamine being an important factor in anxiety. Dr. Armine has developed a model of practice that looks both at neurotransmitters and at the the causes of altered neurotransmitters like exposure to chemicals, heavy metals, benzene, mold, fungi, bacteria, parasites. Also various psychological factors like being brought up in a non-nurturing environment or being exposed to yelling, abuse, social isolation, and PTSD can be important factors. All these stressors can affect the cell and neurotransmitter imbalance. (Neurotransmitters are substances that transmit neurological impulses from one nerve to another.) Dr. Armine believes in addressing both the causes of neurotransmitter imbalance just mentioned and also supplement with nutraceuticals to boost neurotransmitter levels.
17:32 Dr. Armine uses urinary neurotransmitter testing, which has been criticized as not reflecting the level of neurotransmitters in the central nervous system. But taking a brain biopsy or getting a spinal tap is not practical for use in clinical practice and urinary neurotransmitter levels should be correlated with symptoms and treated as biomarkers that tell you about trends, rather than as absolute levels.
21:12 Organic acid testing is helpful to let you understand metabolism. You can see what’s being absorbed, what’s not being absorbed. You can see the reasons why. You can see the mitochondrial pathways.
23:38 Genetic testing also helps him by giving him a heads up into what areas might have problems. MTHFR does one thing and one thing only. It takes 5,10-methylenetetrahydrofolate and turns it into 5-methyltetrahydrofolate. That’s it.
35:30 Treatment should always involve improving leaky gut. You can use digestive enzymes, a demulcent herb, colostrum, and a probiotic. Fix Lyme if it’s there. You need to treat the foundation of the body first, which means decreasing various stressors to the body, by cleaning up your environment. Drinking good water with as good a water filter as you can afford. Check your house for mold. You have to heal the cells with vitamins and minerals that can get into the cells and phospholipids to rebuild the cell walls. You want to consider mitchondrial function. Autoimmune Paleo diet works well to reduce inflammation, but it doesn’t work for everyone. If they have neurotransmitter imbalances, you should treat the inhibitory neurotransmitters before the excitatory, which means you want to increase GABA. You want to either use the liposomal form from Quicksilver Scientific or the 4-amino-3-phenylbutyric acid form of GABA that came out of Eastern Europe, such as PheniTropic from Biotics or Kavinace from Neuroscience. For serotonin it’s better to use 5-HTP than tryptophan, since the tryptophan pathway can lead to quinolinic acid, which is a nasty excitotoxin. You can take SSRIs all day long, but if you are not producing enough serotonin, it won’t work.
Dr. Jess Armine is a Doctor of Chiropractic and a Registered Nurse and has been in healthcare for over 37 years. His focus is using a Functional Medicine approach to treating various neurological and immunological conditions in patients with a focus on taking a careful history, lab work, and also looking at genetics. You can contact Dr. Armine at his website DrJessArmine.com Dr. Armine offers new clients a free 15 minute consultation to see if he can help them and he does consultations via phone or Skype.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcripts
Dr. Weitz: This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube and sign up for my free eBook on my website by going to DrWeitz.com. Let’s get started on your road to better health. Hello, Rational Wellness Podcasters. Thank you so much for joining me again today. Dr. Ben Weitz here, and for those of you who enjoy our Rational Wellness Podcast, please go to iTunes and leave us a ratings and review and go to YouTube and sign up to become a subscriber to our YouTube page, which is Weitz Chiro, or you can search for Rational Wellness in YouTube.
Today, our topic is how to deal with mood disorders like depression and anxiety by trying to balance our neurotransmitters. Depression is characterized by persistently depressed mood or a loss of interest in activities, and it affects more than three million Americans per year. In fact, it’s been in the news a lot. There have been a series of celebrity suicides, so depression is really in the news. Anxiety is characterized by feelings of worry, nervousness, or fear that are strong enough to interfere with one’s daily activities. Depression and anxiety are typically treated by mainstream medicine with medications like selective serotonin reuptake inhibitors, also known as SSRIs, like Prozac, Zoloft, and Lexapro, which are among the most commonly prescribed medications in the United States. According to a new analysis of federal data by the New York Times, long-term use of antidepressants is surging in the United States. Some 15.5 million Americans have been taken the medications for at least five years, and the rate has almost doubled since 2010. Most of these antidepressants were originally approved by the FDA for short-term usage, and there was only a few studies lasting longer than a few years, but yet many patients are put on these drugs indefinitely. It’s very difficult to get off these drugs. A large percentage of patients who take them report severe withdrawal symptoms when trying to ween themselves off or are unable to ween themselves off. Other than talk therapy, what other approaches can help such patients?
This is why I’ve asked Dr. Jess Armine to join us today for a functional medicine approach to dealing with mood disorders. Dr. Jess Armine is a doctor of chiropractic and a registered nurse, and he’s been a healthcare professional for over 37 years. He’s trained in chiropractic, anhelation, genetic research, neuroendo immunology, functional medicine, applied kinesiology, and cranial manipulation. Dr. Armine is one of the few specialists in the United States specializing in correlating genetic SNPs, which are single nucleotide polymorphisms like MTHFR with neuroendo immunology. He also correlates this with acquired mitochondrial dysfunction and cell wall integrity to help identify hidden imbalances–that’s a mouthful–hidden stressors in the body. He develops individual treatment plans specific to the health history and physiology of each patient. Dr. Armine, thank you so much for joining me today.
Dr. Armine: Thank you for the opportunity for being here and talking to your listeners, and that was a great introduction. Thank you so much.
Dr. Weitz: Thank you. I’d like to give a quick shout out to the chiropractic profession because this just occurred to me this morning. For some reason, some of the smartest doctors in the functional medicine world, like yourself, are chiropractors.
Dr. Armine: Yes.
Dr. Weitz: I just recently interviewed Dr. Tom O’Bryan, Dr. Michael Ruscio. We were talking a little bit about Dr. Kharazzian, so anyway, for whatever that’s worth. Dr. Armine, what got you so interested in researching and treating mood disorders?
Dr. Armine: Well, when I became a chiropractor, chiropractic is wonderful. I always had a really good time with it. Always felt this draw to what we now call functional medicine. It’s something that interested me because I could put the puzzle pieces together, but essentially, what threw me into high gear was my son, who is now 31, developing schizophrenia at about age 14. I did exactly what every good father should do. I took him to the doctors and this child with 160 IQ who was glib and had frankly exceeded me intellectually when he was 10 became a nonentity with the medicines. He would sit there on the couch just rocking. I’m a fairly spiritual guy and I looked up at the spirit of God and said, “This disease is squaring with the wrong daddy.” I apologize for the bad word. I launched into studies and as it would happen, I had a lot of good people put in front of me and I learned an incredible amount of stuff that as you mentioned, the neuroendocrinology concepts, neurotransmitter analyses, and so forth and so on, that helped me develop a methodology of treatment that looked at both ends of a disease process right down to the core molecular level. I applied this with my son. Of course, I worked with an integrated psychiatrist also, and between us, he graduated college. He became an Eagle Scout when he was younger. He was a director of a nature program in the Boy Scout camp. He now runs a business on his own and he is himself. He still has some issues, but you know something? He’s a functional, incredibly functional person. He is my hero, actually.
Dr. Weitz: That’s a great story.
Dr. Armine: He really is. That’s why I’m here. That’s where my passion in the circles that I run in. If anybody comes to them and they have severe neuropsychiatric challenges, they tend to refer them to me because that’s my passion, figuring out why, the base reasons, and the downstream effects is my passion. I like to think I’m pretty good at it.
Dr. Weitz: If you don’t mind my asking, were there one or two keys that you thought were really helpful in your son’s case?
Dr. Armine: Yes. Number one, like I said, he was an Eagle Scout, so to think that he didn’t get bitten by a tick is kind of foolish. Lyme disease, neural Lyme, was one of the issues. The medicines made him gain weight like crazy, and just the adipose tissue increased inflammation to a degree, and to think inflammation like a forest fire. Once it gets going, once it gets really going, and you’re out in California so you have a feeling for this. I’m in Pennsylvania. We don’t see forest fires, but they will just get so hot that they’ll burn everything, even things that aren’t supposed to burn. It feeds on itself. We know why now.
That’s in the whole cell danger response thing. We can interrupt that, but the keys were chronic cerebral inflammation, what’s now called chronic inflammatory response syndrome, that can be done by biotoxins, by Lyme, by strep, by so many things. Those were the keys to putting the fire down and then replenishing. Yes, it was done with medicines and nutraceuticals because of the severity of the pathology, and as I’m explaining neurotransmitters, you’ll see why. Those were the keys. The keys were cleaning up his physiology, because let’s face it, the bugs don’t like a normal environment. They like their own environment. If you can do that and take care of what the bugs have done to you, the damage they’ve done, reversed or in other words, work in both ends, even the most severe pathology … He was suicidal. He was seeing demons. This is a boy that I would committed suicide myself. That’s why he’s my hero. I meet very few people who can go through that and survive.
Dr. Weitz: That’s awesome. What causes the common mood disorders like anxiety and depression?
Dr. Armine: Well, even though there may be arguments on both sides of the issue, there is no question that neurotransmitter imbalances cause mood disorders. Remember that the neurotransmitter imbalances don’t happen by themselves in a vacuum. They happen for reasons. Typically, we think of depression as being a serotonin issue. We think of anxiety as being too much adrenaline or too much dopamine. It’s not always like that. It’s really a matter of balance. The neurotransmitter balance is what you’re looking for, and also the imbalances will cause mood disorders. The resulting mood disorder is based on genetic predisposition with something causing that genetic predisposition to express, which is usually the neurotransmitter imbalance and the resulting mood disorder. If we look at it in a line like that-
Dr. Weitz: By the way, doc, what are neurotransmitters?
Dr. Armine: Okay. Neurotransmitters are substances that transmit neurological impulses from one nerve to another, okay? Very simply, nerves are not connected. They have a synapse. We’re not going to use big terms. They have a synapse. The neurotransmitters, the chemicals are sitting in warehouses called vesicles.
Dr. Armine: When a nerve impulse comes down, it comes down, somebody at the synapse, I always call them the warehouse guy, the guy with the hardhat, says, “Hey, send me some,” I’m from Brooklyn, okay, “Hey, send me a bit of serotonin here. I’ve got to get this over there,” right? The serotonin vesicles will release some serotonin into the synapse, take that information, go to the other nerve, and the nerve impulse continues. When that neurotransmitter, that substance goes off the receptor, it’ll sit around in the synapse and does one of a few things. It either hangs out with its buddies for a while or it gets broken down by COMT, Catechol-O-methyl transferase, or MAO, monoamine oxidase, or it gets reabsorbed. That’s the reuptake, so it can be reused again. That’s the normal process. Your food intake, your amino acid intake goes into the axons of the nerve and produces neurotransmitters, and so people have a good understanding of it, I’m going to share my screen for a real, real short visual. Let me hit slideshow.
Dr. Weitz: Okay.
Dr. Armine: We’ll handle this from the current slide. Okay. This is the stressors that can affect the cell. This is what causes all the problems. This is from the metabolic features of cell danger response by Dr. Naviaux, who’s at the Metabolic Disease Center at the University of California San Diego. He discovered all the things that can damage a cell, as you might expect, for chemical, physical, heavy metals, benzene, microbial, mold, fungi, bacteria, parasites, parasites is a biggie, by the way. What most people fob off as being non-essential or not significant are the whole psychological constructs of yelling, abuse, isolation, PTSD. People who have been brought up in a non-nurturing environment, people who were exposed to various forms of abuse, either on a single or ongoing basis, will damage the cells just as much as microbial or chemical influences.
This is a little animation. We’re going to talk about dopamine here. Dopamine is created in the axon, as you can see. It’s degraded by monoamine oxidase, but you see the little vesicles where it is stored. When dopamine is necessary, those vesicles will release dopamine into the synapse so that the dopamine in this case will go into the receptors, do their thing, and then either get degraded or get reuptake, like I told you before. Now, this is optimal activity, and on a scale, this is what it looks like. Your neurotransmitter stores are good. The activity is just fine. When you encounter stressors, the stress increases the neurotransmitter activity. In other words, more neurotransmitters are needed at the synapse, and the stores become depleted. This is a process that takes some time. You have high activity. You’re able to respond to the stress, and it’s a good thing. If you’ll notice the scale, the activity goes quite high, and the neurotransmitter stores start dropping. When you have chronic stress, the fact is that the stressors use up the neurotransmitters rather quickly and we can only produce neurotransmitters at a particular rate, even if there’s no problems, even if the system’s perfect. We can only produce it at a particular rate. What you have here is optimal looking activity because the stores are decreasing, and they’re decreasing rather chronically. Look at the scale again. The scale is the neurotransmitter activity starts dropping, the stores are dropping, but you don’t even have symptoms yet. This is the thing. You don’t have symptoms yet. This is happening way before you have symptoms.
Now, when the stores are depleted, you have inadequate neurotransmitter levels because the stores have nothing in there. The warehouses have nothing in there, so it doesn’t matter how hard you try, there’s simply low activity. Now, this is where you get symptoms where the neurotransmitter stores have bottomed out, the activity has bottomed out, and now you become depressed, now you become anxious, now you have whatever. Reuptake inhibitors, if you go back one slide, go back two slides, sorry, prevent some of the reuptake and give you optimal looking activity because what they’re doing is preventing the reuptake by inhibiting some of the receptors that would tell you to reuptake the serotonin or dopamine or norepinephrine, whatever it happens to be.
Really what’s going on, what we really must understand is that by the time you have symptoms, you have incredibly low neurotransmitter stores and the reuptake inhibitor will work, give you optimal looking activity, but if you’re lucky, between five and 10 years before you simply have absolutely nothing, as these medicines do nothing to talk about why you’re like this, why you’re not getting the neurotransmitters that you’re looking for. When people argue about, “Well, neurotransmitters have nothing to do with mood disorders,” what they’re really saying, and they’re saying it inartfully in my estimation, what they’re saying is you should be concentrating more on the rationale or the reason for the neurotransmitter imbalances, neurotransmitter storage, however you want to put it. Instead of treating from the bottom end, by treating the neurotransmitter imbalance or the supposed symptoms, you should be looking at the rationale or the reasons or the root causes, if you will.
My theory, my method of practice, which has been really successful, is to identify and treat the root causes and treat why you’re not producing your neurotransmitters, and then as you can see, since you need to fill up these warehouses or vesicles, you need supplementation for a period of time, serotonin, let’s say. You cannot put enough tryptophan into your body to fill up those stores in anything like realtime. Unless you want to eat a turkey a day or three turkeys a day, it’s not going to happen, assuming that your GI tract will handle it. That’s how this actually works, so you have to look at things from both ends, both points of view.
Dr. Weitz: Interesting. How do you measure neurotransmitters in your patients and which lab do you like to use?
Dr. Armine: I can see that you like to open up Pandora’s Box of controversies, so let me address the unanswered question. I use urinary neurotransmitter testing. Urinary neurotransmitter testing, urine comes from the circulating serum of the body. Whether you do serum neurotransmitter, platelet neurotransmitter, or urinary transmitter, you’re taking it from the same pool. The ubiquitous argument is, and it’s usually against urinary neurotransmitters, is that they don’t represent central nervous system neurotransmitters. You know something? That’s absolutely correct. If you want to measure central nervous system neurotransmitters, you have to get cerebral spinal fluid or take a biopsy of the brain, which is usually a bad thing to do with people, especially in your office. Listen, I’ve been in ER, an emergency department nurse, critical care nurse. I was head nurse of coronary intensive care unit. I’ve been in critical care, so I know how to do a lumbar puncture. I’ve never done one. I’ve seen it happen, but to do a lumbar puncture to get cerebral spinal fluid is usually done with meningitis and stuff, is not a benign procedure. Frankly, you’re not going to do that on an office-based basis.
Urinary neurotransmitters give you a balance of what’s in the periphery and what’s in the central nervous system in order to be used as biomarkers. Biomarkers means that you don’t take the number as an absolute. You look at the pattern, what’s high, what’s low, what’s going on. You can tell the pattern, and then if you have somebody who has a particular symptom, you can correlate your nutraceutical or pharmaceutical intervention based on the pattern. The reason I use urinary neurotransmitter testing is because there’s been a ton of studies, a ton of research, and they have good databases. When I do a serum neurotransmitter test, and I’ll make my typical joke, dopamine is normal between zero and 140, which begs the question, if I have no dopamine, is that normal? I’m serious. That’s what it says.
If I see something that’s, I’m just making up numbers now, 15 to 140, does that mean 16 is normal? No. That’s low. By the way, our rule of thumb when you’re looking at your lab tests, use Armine’s rule of thirds. I have to put my name on something. Really, let’s face it, all right? Take that reference range. Just a rule of thumb. Not always, but it works pretty well. Take the reference range, divide it into thirds in your head. If your number fits in the middle third, it’s probably okay. If it’s in the lower third, especially the low part of the lower third, it’s suboptimal. If it’s in the upper third, it requires interpretation. I look at people and I look at their blood tests and say, “You know something? 12 to 16 hemoglobin, you’re 12.1. You’re 250 pounds. I don’t think that’s good for you. You don’t have enough blood cells. You’re not bringing in oxygen around.” They’re like, “But it’s normal.” I say, “It’s not normal.” That’s an average. That’s an average.
Dr. Weitz: No, that’s great. I love this. Armine’s rule of thirds.
Dr. Armine: I know it’s silly, but I just think Hashimoto has got his thyroiditis. Everybody’s got it, right? I said, “I’m going to put my name on something that’s pretty benign, but I’ll be remembered for it, so it’s okay.”
Dr. Weitz: What do you think about organic acid testing as a way to get a sense of what’s going on?
Dr. Armine: Organic acid testing, by the way, happens to be one of the better ways of discovering what is going on with your body physiologically. I’m also an expert in epigenetics. That’s where I’m known in the MTHFR community, and I’ve been with Dr. Ben Lynch for many years and did research, and his strategy and application was my invention. I gave it to him because he’s got money, I don’t, and he developed it. There’s a new one coming up that’s going to be better than anything that’s been previously here.
When you look at genetics, you’re looking at probabilities. You can look at a pathway and say, “Gee, that pathway might not do well under oxidative stress,” but you don’t know. Organic acid testing tells you because that’s the result of the pathways. So when it comes to the neurotransmitter part, you always have to remember that you’re looking at metabolites. Dopamine will metabolize either down the cascade of dopamine, norepinephrine, norepinephrine, epinephrine, metanephrine, all the way down to something called VMA, or we’ll go down the pathway where it becomes homovanillic acid, HVA, which is what’s measured. Always remember that pathway requires co-factors and co-enzymes, so that pathway requires SAMe, B1, B2, B3. If you don’t have enough of that, you might get a false reading, but you can read an organic acid test. You can see what’s being absorbed, what’s not being absorbed. You can see the reasons why. You can see the mitochondrial pathways.
Yes, if you correlate, remember, a test is only a test. You don’t treat tests; you treat people. Remember, doctors say that a lot, but then they treat the tests. If you walk out of somebody’s office with a shopping bag of vitamins, that doctor’s treating each line of a test. Before you spend 300 or $400, walk out. Do me a favor, because that healthcare provider is supposed to correlate your symptoms with the testing and then figure out what your body needs, and it’s usually not done by reading one line after another after another and then trying to supplement each line. Organic acid testing is one of the better ways of determining what’s going on with you globally to include neurotransmitters.
Dr. Weitz: How does genetic testing help in analyzing and treating mood disorders?
Dr. Armine: Genetic testing will give you a heads up into what areas might have problems, again, under an oxidative stress load. I say that a lot. Remember, oxidative stress is microbial stress. It is stress of biotoxins, of regular toxins, of the psychology. All of those things cause an increase in inflammation/oxidation compounds/oxidative stress.
Dr. Weitz: By the way, oxidative stress is also often known as free radicals, right?
Dr. Armine: Exactly. Free radicals, reactive oxygen species, reactive nitrogen species. There’s a bunch of names. It all comes from Durk Pearson and Sandy Shaw back in the ’70s, who wrote that big thick book called Life Extension.
Dr. Weitz: I remember that.
Dr. Armine: Yes. I actually read it. Oh my god.
Dr. Weitz: I did, too.
Dr. Armine: Even when I move around, books, I do everything online anymore, but I keep that book because it’s a badge of courage that I read it. I was like, “Aha.”
Dr. Weitz: I love that book, but one thing is I still have in my memory those horrible images of them showing what they look like.
Dr. Armine: No, no, please. It’s burned in my brain. It’s burned in my brain. Please, please. “Hi, I’m strong.” “No, you’re not. No, you’re not. Don’t show pictures like that. No, no, no. Oh god.” You want to get a mood disorder, look at those pictures. Of course, America came in, the American business came in and I won’t say a bad word, but took pieces of it and said, “Oh, you can take this and lose weight,” and that-
Dr. Weitz: Right. By the way, for those who aren’t familiar with this book, this was really the first book that came in and expressed clearly the relationship between free radicals and antioxidants and disease and this was the new key to solving a chronic disease epidemic.
Dr. Armine: Exactly. It was mainly about aging and how cells were injured, and they went and discovered the ROSs, reactive oxidative species free radicals, but guess what? This is why Dr. Naviaux, the panel I just showed you, he took that concept, brought it way out, not only described what created the oxidative stress, but what that oxidative stress did to the homeostatic mechanisms, what you got you ill, and what interfered with them and how you can go about interrupting the forest fire, which takes it way out into orbit. Genetic studies, well, you can look at different pathways. Those people who are stuck in the MTHFR paradigm, MTHFR does one thing and one thing only. It takes 5,10-methylenetetrahydrofolate and turns it into 5-methyltetrahydrofolate. That’s it. It’s not a deity. It’s not a devil. It’s not waiting in the tall grass to get you.
The reason that people misinterpret it is because when they first studied epigenetics, they looked at homocysteine, and they said, “Gee, high homocysteine is a cardiac marker. MTHFR is connected to that.” They only checked two variants, by the way, the C677T and A1298C, which are where they are in the particular person’s genome. They made a correlation that if we treat this, which you can’t treat it, that would be able to control the homocysteine, but that didn’t work out so well. Anybody who had any kind of chronic illness who was testing for this said they developed databases because the erroneous conclusion was if you have MTHFR polymorphisms or SNPs, that’s going to cause clotting, that’s going to cause different disorders, it’s going to cause foot fungus, which the last one’s a joke. That’s not true. It’s a combination of things because that’s one gene, one enzyme in a pathway, that folate pathway, going to methylation, going to methionine and doing methylcobalamin and so forth.
When you look at genetic studies, if you’re looking at a list of genes, it’s hard, but if you’re looking at it into the pathways, you can say, “You know, that pathway has a lot of polymorphisms, and if there’s a lot of oxidative stress, we’re not going to get the products we’re looking for, so maybe I should look in that direction.” Believe it or not, it’s predictive in that if you look at it properly, you can say to yourself, “Gee, this person’s mitochondria is kind of on the weak side, so let me look at the glutathione pathway. That recycling mechanism doesn’t look like it may be working. Let me see if that’s the reason,” because that person recycles glutathione, which is going to give you a lot of oxidative glutathione, and that’s going to block the mitochondria.
You can have a big old heads up of where to look and then how to intervene. It shortens the diagnostic process. Once you find out why, it’s difficult, but the how becomes easier. It’s that whole finding out why, and a lot of my medical colleagues tend to stop at a certain area. We all know that, since you’re a chiropractor, you’ll understand this, the medical physicians are taught not to say three words, “I don’t know.” They would rather look and say, “Gee, I can’t figure it out. It must be you.” Don’t ask me where that legal logic came from. “It’s in your head.” Yes, it’s in your head. They’re neurotransmitters. You’re blaming the patient because you can’t figure it out. Makes no sense to me whatsoever, yet if we look at the genetic pathways and don’t take them as godlike or absolute, you’re going to get a pretty good idea of how that patient will fail.
A little hint for you and your listeners. You can know the genetic pathways. If you want to know how they express, as they express differently in different people, you would see the pathways. Ask the person who they look like. If your daughter looks like Grandma Gale, for instance, ask about Grandma Gale and what kind of problems she had because they’re going to express that way. That’s the direction they’re going to go. Not absolute, but that’s the direction they’re going to go. If Grandma Gale was a schizophrenic who committed suicide, god forbid, and your daughter has chronic Lyme and has the same genetic disposition, you’ve got a problem that you might want to deal with a little bit more strenuously than if they just had a little bit of depression. That’s a little diagnostic clue that tells you why things happen the way they happen. It also gives you a big jump onto the how.
Dr. Weitz: I know every case is different and we have to take it case by case, but can you give us a little more detail in maybe some of your treatment protocols, say, treating a patient with depression?
Dr. Armine: Absolutely. Not even a problem.
Dr. Weitz: Let’s say we have a patient with mild to moderate depression. How would you work them up? Give us an idea of some of the types of protocols that you might use in treatment.
Dr. Armine: Absolutely. The first thing is in real estate, it’s always location, location, location. In medicine, it’s history, history, history. Sir William Osler in 1895 said, “Listen to your patient. He’s telling you the diagnosis.” He was one of the founding fathers of Johns Hopkins. One of the things they teach and they teach the practitioners is how to use historical information. That’s a lost art, by the way, because when you fill out a history form, nobody really looks at it and they go right to the chief complaint. You take a really good history. You look for temporal relationships. This happened and then that happened. This happened and that happened. That tells you where to look. It often tells you what’s wrong.
Dr. Weitz: By the way, for those of you who are not familiar, if you take the practitioner training program through the Institute of Functional Medicine, they really do preach taking a very detailed careful history starting with birth and childhood and everything else.
Dr. Armine: They do, and they also teach putting things on a timeline.
Dr. Weitz: Timeline, yeah.
Dr. Armine: When I took some of their courses, I’m sitting there and they put it all on the time line. I’ve been practicing like that for at least a decade before I did that, and as I looked at the little arrow, I said, “Not a bad idea. Good idea.” You’re forcing people to use it and then take the information. Now, if you take that information and if you have testing or if you do testing, it should be targeted to what your suspicions are. You have somebody who’s got depression, you know that you have a neurotransmitter imbalance, so if you have an organic acid test, the neurotransmitter test, and by the way, I used to use Pharmasan Labs, but they’re not in existence any longer. I tend to use Labrix right now. They do a pretty good job.
Dr. Weitz: Which is now owned by Doctor’s Data.
Dr. Armine: Yes, exactly, and Doctor’s Data does a good job. It’s a blood test, though, and they’re neurobiological amines. The Labrex is a urine test, which is a whole lot easier to get. You’re going to get the same information. You’re going to get the same patterns. You can also get from the urine the cortisol levels and the four point cortisol you can get from urine with the Dutch test, but you can also get the saliva test that will tell you what the adrenal cortex is doing, as well as the adrenal medulla because you’re going to get insight into that. What I’ll do is normally I’ll do an organic acid test if it isn’t already there because it gives me so much information. If they have the genetics, I’ll look at the genetics and see where the probabilities are, but that’s only telling me the why, why they’re like that. I also listen for what the probabilities are for their root causes. That’s really wide. People, once you develop a relationship with them, they will tell you everything and anything. You can almost tell somebody has had severe psychological trauma if there’s portions if their childhood they cannot remember. They blocked it out. I see this with women who’ve been abused sexually in their childhood usually by family members. It’s a terrible thing. I don’t have them talk about it or anything. I just recognize it as being a form of PTSD. I’ll listen for if they’re a camper or if they went out of the country and they had diarrhea and their stomach was never really the same. If they went to Cambodia, I know they got parasites. Let’s call a spade a spade. Lyme disease is rampant, but Lyme disease, you always have to consider. Don’t look at the maps because those are the CDC positives. Lyme disease is everywhere. They have found Lyme disease in the emperor penguins in Antarctica.
Dr. Weitz: Wow.
Dr. Armine: The ticks were brought over by the sea birds. Let’s face it. It’s everywhere, so you must consider it and you have to know how to test for it. You have to know how to read the test. You have to know which test to do at what stages, and that becomes a bit of a quagmire because Lyme disease diagnosis is a clinical diagnosis, not a testing diagnosis. There’s a whole mess of things that can cause it, thyroid problems, not just polymorphisms, strep, anemia. It’s endless. When you have that-
Dr. Weitz: Gut disorders.
Dr. Armine: Especially. Thank you very much. I appreciate it. Gastrointestinal leaky gut syndrome is the major reason. It can be primary or secondary. It can happen and then you have the problems, or you can have the problems and then the leaky gut can happen, but all the antigens getting through the gut into the base of the membrane cause immunological dysregulation that causes chronic inflammation, chronic neurotransmitter imbalances, a whole mess of things. When you’re treating somebody, regardless of what the testing says, it’s a good bet to treat leaky gut syndrome.
We talked about treatments. Well, treatments are based on treating the foundation of the body first, which is decreasing stressors, which is environmental stressors, drinking good water, getting good air, asking about their house, because a lot of people are sick in their houses and they’ve never tested for mold. It’s a very easy test to do. You don’t have to spend a lot of money. Generally, cleaning up their environment as best as they can within their means. We can have people buy horrendously expensive house water filters, but if they’re a family with three children with a single provider who’s bringing in the money, maybe just a Brita filter would be okay. At least you can get most of it, okay? Decreasing other kinds of stress, giving them advice in certain areas.
Some people need certain types of therapies, EMDR, EFT, things like that, then you want to heal the cells themselves because leaky cells, dysfunctional cells are a common ubiquitous issue. That’s supplying vitamins and minerals that will get into the cell and phospholipids that will help rebuild the cell walls. When you’re having gut problems, that becomes a real issue, so you start thinking about transdermal or liposomal products. Once you start attending to that, a lot of times, people start getting better just by virtue of the fact that everything begins to work, then simultaneously with that, I’m going to fix the gut almost in everybody because I haven’t met a person that doesn’t have leaky gut, regardless of what the leaky gut tests say.
By the way, that’s the worst test in the world. If you have a test that says you don’t have leaky gut and you have a chronic illness, throw it out. If you don’t believe me, here’s a way of thinking about it. Think of the risk benefit for that. What is the risk of giving somebody digestive enzymes, let’s say a demulcent herb, maybe colostrum or something else to heal themselves, a probiotic, versus what happens with leaky gut syndrome, which is chronic inflammatory response. No risk, and the probability of benefit if you seal up that gut is incredibly high. When you have that kind of safety profile, you treat the blessed thing. If you do that, you prevent antigenic entry, which lowers inflammation, which is what most of the body’s energy is just trying to do everyday is drop inflammation, and then it becomes more specific and individualized.
I’m always considering mitochondrial function. That is comparatively easy these days to support. You can use coenzyme Q10, PPQ, you can use a transdermal patch that has everything in it depending on the individual and their lifestyle, and you have to consider that and how well they’re going to take the nutraceuticals. You have to consider the nutrients that are going in. If they can’t absorb it, then give them things that are more easily absorbed, either on a protein powder basis or at least talk with them about being on an antiinflammatory diet. AIP paleo is kind of a typical thing that works with a lot of people, but doesn’t work with everybody. You have to be individualized about it, but you want to pull back from grains and sugar and go more on the antiinflammatory range. That’s easily looked up, and there’s a couple of books out there that are not expensive.
Then, I get real specific as to what I’m treating. It depends on what I’ve tested for. If we have Lyme disease, if we start getting to the root causes, and if we have neurotransmitter imbalances, the guidance for that is very simple. You treat the inhibitory neurotransmitters before the excitatory, which means you want to increase GABA. GABA, gamma-aminobutyric acid is the particular molecule that calms the human brain. That is available in a liposomal form from Quicksilver Scientific. It’s also available in phenolated form. Now, I know everybody argues with me about Phenocol or Phenoblast. The reason for that is that the common one is beta phenyl gamma amino butyric. That’s a big word. That’s the one you usually buy. It has all kinds of problems, but there’s another molecule, the form of 4-amino-3-phenylbutyric acid that comes out of eastern Europe. All the studies for those were done in eastern Europe and they were done in Russian. I happen to speak Russian and read Russian, so I read the studies, and they don’t have it. I’ve been using this stuff for decades. No problems whatsoever. It gets through the blood brain barrier. The reason things like Pharmagaba and the regular GABA is that they’re water soluble. They don’t get through the blood brain barrier. If you get better with those common GABAs, that’s proof positive you have a leaky blood brain barrier.
Dr. Weitz: What form of GABA are you talking about that’s used in Russia?
Dr. Armine: Well, let me bring it down to what you can get here. From Biotics, it’s called PheniTropic, from Neuroscience its called Kavinace. I’m sure a couple of other people have them, but those are the two products I use. It’s the 4-amino-3-phenylbutyric acid. People argue with me that it’s just a nomenclature thing, but I’m going to tell you that those molecules, the ones I’ve used have never had any problems, and I’ve been using them for decades.
Dr. Weitz: Either that one or the liposomal one?
Dr. Armine: Right. Liposomal works really well. I’ve had people like this in front of me. I’m like, “Open your mouth. Open your mouth.” Four sprays and I wait there for five minutes and then they’re sitting back going, “All right.” Remember, the difference between a benzodiazepine and giving somebody GABA is a benzo stimulates the GABA and intercepted to release GABA, and the constant use of benzos damages the GABA receptor. That’s why you have so many problems. Giving somebody GABA gives them what they need without stimulating the receptor and yes, you burn through it after a while.
Serotonin, you can give someone L-tryptophan or better yet, 5-hydroxytryptophan. What’s the difference? Early on, we were giving people just L-tryptophan, and some people were getting excitatory with it. In the late ’90s, Kelly Olson, PhD, who was the R&D director of Neuroscience found the pathway that tryptophan can actually connect to an enzyme called IDO. That enzyme, when it’s stimulated by inflammation, yeast, microbes, stress, will start looking for substrate, pulls the tryptophan out of the pathway, and creates kynurenic acid, which is neuroprotective, and then quinolinic acid, which is a nasty excitotoxin. Then, it produces NAD, which is B3, which I think is a hell of a way to get B3 for your body, to have to go down that pathway. The quinolinic acid is what creates the excitation, so under inflammatory conditions, tryptophan is pulled out of the pathway that should create serotonin, but it doesn’t. Part of it’s pulled out, at least, so you’re creating excitation on top of excitation from the microbes. That’s the reason people don’t use tryptophan, so when you went to 5-hydroxytryptophan, this tryptophan is metabolized with BH4 and iron and B6 to 5-hydroxytryptophan. It’s a one way pathway. If we use that, we can create serotonin, and then the serotonin will either get degraded or become melatonin. You need serotonin for practically everything. 80% of it is produced in your gut, which is one of the reasons we have so much serotonin problems, because we have so many gut problems, so you’re not producing enough serotonin. You can take SSRIs as much as you like, and yes, it will work for a while by increasing the serotonin, the synapse. You won’t correct your problem. That will fail. In typical medical thinking from big pharma, it’s not working, let’s give you Abilify. An atypical antipsychotic? Are you crazy? We’re not crazy. We’re just greedy. I know that, but you’re also crazy. Okay, if you say so, but you’re nobody. You’re a chiropractor. I’m like, “Whoever I can influence, I will.”
When it hits you, it’ll be like tsunami. Let’s do more. Let’s not fix you because we’re in a chronic disease management society. There’s no money in curing cancer. There’s money in treating cancer. There’s no money in curing diabetes. There’s money in treating diabetes. You ever wonder why there’s such a thing against Lyme disease? There’s no Lyme disease in Australia. You know why? They don’t allow the diagnosis. How can you have it if there’s no diagnosis? They have people believing there’s no Lyme disease there. Duh. In England, at least it’s turned around because of certain things, but for the longest time, somebody would get a positive Lyme test. They’d do their own test. It was always negative, and so they treated people for chronic fatigue and depression. The downstream effects. There’s more money in treating the downstream effects than there is in curing the disease. Yes, the consciousness is raised towards Lyme, but how many other things are doing that? We have to be our own advocates. The unfortunate thing is we’ve lost our general practitioners. We’ve lost our generalists who used to be the kings that coordinated everything. Now we have specialists, specialists, specialists, who are very, very good at what they do, but that’s all they do. They don’t coordinate with one another. The coordination of correlational, putting the dots together or the puzzle pieces together is left to the person who is least trained to do it, and that’s the patient themselves.
Dr. Weitz: That’s because of the insurance model that limits the amount of time that doctors can afford to spend with patients because of the reimbursement rates, which we didn’t talk about, but unfortunately that’s the reality of it.
Dr. Armine: They’re forced into eight minutes a patient to include the documentation time. You’re absolutely correct. Most of the doctors I know are frustrated as heck because if they can even tap at the chief complaint, that’s all they can do. They don’t have the time and they’re not allowed the time. That’s the whole thing. They’re not allowed the time.
Dr. Weitz: This is why I think patients would be best served, and by the way, I think I have to end it here, but I think most patients would be best served having both a conventional primary care doctor and a functional medicine doctor like yourself or myself and working as a team together because we can have some of the time that the primary care doctor doesn’t have because we’re not going to be limited by [inaudible 00:47:02].
Dr. Armine: Exactly. That’s coming to fruition. I see it in England now. I travel around the world training people, but I see it a lot in England now. I see it a lot here where there’s true cooperation happening. That’s what you look for in a functional medicine or a healthcare provider, somebody who is willing to advocate for you, do the correlation, and coordinate with your other healthcare providers.
Dr. Weitz: Dr. Armine, this has been a wonderful discussion.
Dr. Armine: Thank you.
Dr. Weitz: I’d love to continue it. Unfortunately, I’m up against a hard break.
Dr. Armine: I know.
Dr. Weitz: Can you tell us how practitioners and patients can get a hold of you and contact you?
Dr. Armine: Well, certainly. They can go to my website at DrJessArmine.com. What I offer that a lot of people don’t is I offer a 15 minute get acquainted session. You can schedule that. We can discuss your problem, and then I can tell you if I can help you or not, which makes me comfortable, makes you comfortable. That’s the way that people can access me. They certainly can go to my website and make an appointment. Most people speak with me on a little 15 minute get acquainted session and we can really determine in that short a period of time if this is an appropriate case for me. That’s the best way to get in touch.
Dr. Weitz: That’s great. Excellent, Dr. Armine. Keep doing the good work. I’ll talk to you soon. You take care now.
Dr. Armine: Thanks so much.
