Holistic Psychiatry Podcast

In this episode, I have the pleasure of speaking with Dr. Neil Nathan about the intersection between brain symptoms and complex illness. Dr. Nathan has practiced medicine for over 50 years. He is one of the leading experts in complex chronic illness and mold toxicity — author of the bestselling Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivity, and Chronic Environmental Illness and The Sensitive Patient's Healing Guide. I am grateful to call Dr. Nathan a mentor and colleague. His pioneering work has been responsible for my healing from chronic illness, as well as that of many patients I've treated. Together, we co-lead a small peer group (within the larger mentoring group he provides with Marie Matheson, ND), supporting practitioners who treat those with complex chronic illness.In this episode we discuss:03:43 – Dr. Nathan's path to understanding complex illness11:20 – Why complex illness is rising and underrecognized19:30 – Why new medical ideas take decades to reach patients23:15 – Mold, Lyme, and long-COVID: the “big three” root causes25:58 – The limbic-vagal-mast cell “trifecta”30:31 – Are some people born more vulnerable?44:39 – The risk in “just do limbic retraining” advice47:35 - Biochemical contributors49:26 – Structural root: jaw and cervical instability53:58 – Differentiating Between Mold, Lyme & Long-COVID58:49 – A message of hope, and where to learn moreFull Transcript belowYou can find Dr. Nathan's books, consultations and mentoring program through his website at neilnathanmd.com. If you'd like to help get this information out into the world, please consider liking, sharing, or commenting.Until next time,CourtneyCourtney Snyder MDDr. Courtney Snyder MD is a holistic and functional child and adult psychiatrist and host of the Holistic Psychiatry Podcast and can be found at courtneysnydermd.comMedical DisclaimerThis podcast is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having.Full TranscriptDr. Nathan's Path to Understanding Complex Illness03:43Courtney: I'm so glad we're doing this, and I feel like it's long overdue. As you know, in the mental health space in psychiatry, there's a lot of recognition of a dysregulated nervous system, threat response in the body, but oftentimes that's attributed to external forces or trauma, and not necessarily internal threats that we see, obviously, in complex chronic illness, which we'll be talking about. There's also not the recognition of the relationship between physical symptoms and brain-related symptoms. So I know you're going to help us connect a lot of these dots. As we sort of just lay the groundwork for what complex chronic illness is — when in your path did you start to recognize the distinction, when was the beginning of your work and appreciation of complex health issues?Neil: Okay, there are two answers to that question. First, when I went to medical school, my hope was to become a healer. And I was very disappointed that when I got there, I realized they weren't going to teach me to be a healer. And back then I used to question my professors at medical school — why do you do it this way, and how is that? And I kept feeling in all of our interactions that we were missing something. And my professors would go, “Okay, Mr. Wise Guy, smart guy, what are we missing?” And I'd go, “I don't know, I just know we're missing something.” Later I would come to recognize that we were missing the emotional and spiritual component to whatever was affecting people in their illnesses. And I have language for it now — I didn't then. The person in medical school who influenced me the most was Elisabeth Kübler-Ross, who I view as my main mentor in medical school. She, unlike anyone else, had a one-and-a-half-hour seminar once a week. Back then there weren't video cameras — you were in a small confined room with a two-way mirror, and you're sitting there watching someone do this. And she would simply interview one of her patients. She was a psychiatrist, but she was the only one in medical school who demonstrated how to really listen to people, how to really communicate with them, and not have this standard review of systems — here's my questions, here's your answers, and that's what I do, and this is what I write up. She was really listening. She was trying to really take in, okay, what happened to you, and what's going on with you? So I would want to give her credit as a role model to change how I learn to listen. Okay, that was step one.I'm going to fast forward to the early 1980s. And I am, at that point, the medical director of a regional pain clinic. And we are starting to see a whole bunch of patients who had this complicated process of fatigue, unrefreshed sleep, irritable bowel syndrome, and pain migrating all over their body. And back then we called it fibrositis. Now we call this fibromyalgia. And so whenever medicine encounters a thing that they don't know what they're looking at, it's psychological until proven otherwise. And people would get therapy, and they would take antidepressants and anti-anxiety agents. Didn't help much. And so it became clear to me that we didn't understand what this was at all. It was not psychological. Something was going on in their bodies — now I recognize it as an inflammatory process. Back then there was no concept of that at all. And then, slowly, in the early nineties, we began to find pieces of the puzzle to understand what was triggering fibromyalgia. I was working back then with Jacob Teitelbaum, who did a lot of work with chronic fatigue and fibromyalgia, and we both independently came up with an understanding that a deficiency of magnesium, DHEA, adrenal issues, thyroid issues, sex hormone deficiencies, GI dysbiosis, and food allergy — if we looked at those and treated those, the majority of people with fibromyalgia got cured. It was different for different patients. It was not like there was one thing that caused it. And as time evolved, we began to realize that there was lots of other biochemical imbalances in the body that would contribute to this kind of a process that represented chronic fatigue and fibromyalgia.We discovered that Lyme disease and coinfections was a huge piece of that. And later still we discovered that mold toxicity was a huge piece of that. And so my understanding of the complexity — and it's not really confined to chronic fatigue and fibromyalgia at this point, we're really talking about almost all chronic illness — with a huge psychological component to that. So we've begun to understand this as essentially some version of inflammation. And if we start to really dig into what are the potential causes of that inflammation, we can make a huge impact for them. So this is a multi-year evolving understanding of how a person's genetics, biochemistry, physiology impacts their whole being in every way. And that inflammation extends to the nervous system, contributing greatly, if not causing directly, a large number of what are now called psychiatric diagnoses.Courtney: Right. So even among those patients that you were seeing — you were seeing, I'm assuming, depression, anxiety, brain fog?Neil: Yeah, the vast majority of our patients with mold toxicity have brain fog and anxiety, depression, OCD behaviors, mood swings, depersonalization, derealization. I mean, all of that is super common in our patients.Complex Illness Is Rising — and Underrecognized11:20Courtney: Do you feel like this is more recognized now — or do you feel like the number of people being hit with these complex health issues is increasing — or both?Neil: Both. I would love to say that the medical profession is increasingly recognizing all of this as important, but that recognition is coming very, very slowly. The majority of folks out there, if they were to list the symptoms that they had, their doctors would basically look at them like, “I have no idea what's causing it, so this must be in your head.” And that is the message they're getting from their physicians at this point. So many patients are being gaslighted, so many patients are being told it's in your head. And the repercussions of that are the family is hearing that same message, and the families become less supportive of those people, because they're saying, “This is not real, so why would I support you? This is still in your head, go get your head fixed.” And they're wrong, and it's really a travesty. But so yes, very slowly, this awareness is growing. There are now more medical meetings that I'm aware of where psychiatrists can learn more about this than there were ten, fifteen years ago, for sure. But not enough — it's still not enough.The other part of that is some of the main triggers for this inflammatory process are increasing. So we're seeing more and more mold toxicity, we're seeing more and more Lyme and coinfections, partly because the environment that we are all exposed to has gotten extremely increasingly toxic. So it's now known, for example, that there are 350,000 new chemicals in our environment than existed 70 years ago. The vast majority of those have never been tested for safety in human beings. So human beings have a tremendous amount of chemical exposure that they never had before. Human beings have a tremendous amount of EMF, electromagnetic exposures that they never had before in the history of the human race. So these exposures are cumulative. Our major organs, like our liver and our kidney, that have to deal with toxicity, are overloaded. And so, yes, we are seeing an epidemic of a whole bunch of these conditions. In children, we are aware that autism has skyrocketed — it went from one in several thousand kids to one in thirty kids in many states now have autism. And forgive me, but the pediatric profession is not taking this seriously. It's like, “Yeah, that's sad, it's unfortunate.” It's like — really, you don't want to look at this? This means one in every three kids born are getting autism — does that not concern you? But, forgive me, the medical profession is very slow to embrace new information, and that is really to the detriment.We're seeing an epidemic of Alzheimer's, Parkinson's, ALS, all of which involve neuroinflammation. We've seen already an epidemic of chronic fatigue and fibromyalgia. And all of these things are interrelated, because — yes, I'm supposed to be an expert on mold toxicity, and I probably am — but mold toxicity doesn't exist in a vacuum. You have mold toxicity as one of multiple environmental toxins we're being exposed to. It is simply one of the most common, the easiest one to diagnose, because we have tests for it. We don't have tests for the hundreds of thousands of chemicals out there. We're just beginning to be able to have some tests that will tell us what's in someone's body that might be making them sick.Courtney: Right, right. And I would imagine that this typical medical model of looking for one cause to autism, one cause to dementia — it's a completely different way of thinking. When you get away from that and you look at complexity of the human body, that way of thinking holds back the research, it holds back any progress.Neil: What I think is helpful for people to look at is: we are all uniquely, biochemically, genetically different. And so the same inflammation in one person could trigger cardiovascular disease, and another person could trigger Alzheimer's, and another person could trigger chronic fatigue. So we need to take a step back and go, okay — and this is not a brand new idea. For the last ten years, there are many papers in the medical journals that are saying chronic illness is almost certainly an inflammatory process. Now, it hasn't really integrated into what people are being taught in medical school or in their residency program. But this is not a brand new idea, and there's tons of medical research documenting that.What behooves us as physicians is to look at every human being and go, “Okay, this is your named chronic condition — what are the triggers for you?” We have to kind of be like a medical detective and dig in and go, okay, what's triggering your inflammation, so I can treat the cause — not put a band-aid on it, which is, forgive me, in the psychiatric field, taking antidepressants and benzodiazepines. That's a band-aid. It's a helpful band-aid, it could be a very important band-aid, help someone to function. But you really need to be looking at, okay, I have this great band-aid, but wouldn't it be nice to actually cure this? And I think that would be, for me, to your audience, Courtney, my take-home message — which is always look for the root cause, because it is possible that we will find that root cause, and you won't have whatever name you've been given, depression, anxiety, OCD, for the rest of your earthly life. Maybe.And I've treated thousands of people successfully here. So this is not — I've had one or two successes here — we're talking thousands of people that have responded to this way of practicing medicine, with fabulous results. People who've been literally bedridden, incapacitated by their illness, are now out there working again and being with their family and living full lives. So that's the take-home message.Courtney: Right. Which makes it so satisfying to treat. And I mean, I can speak to that, having experienced it personally. But at the same time, you do get pushback from other areas of medicine that don't give it necessarily credibility, even though people, on the other side, are thriving and healing, and it's really amazing.New Medical Ideas & Research Take Decades to Reach Patients19:30Neil: You know, the history of all science, including medicine, is: new technology, new drugs are fast-tracked to get into our lives. Ideas, not so much. Typically it takes a generation — twenty, twenty-five years — for a new idea to come into acceptance. And the first reaction of any science, medicine included, is to get into denial, which is, “There isn't enough data to support this concept, and I can't be perceived as practicing bad medicine by embracing a concept that isn't proven yet.” But that means that all of their patients are going to have to wait twenty years — until suffering — until that person goes, “Now there's enough evidence, now I can learn how to do this, and now I'll begin to help you.” I'm not wired that way. I'm wired that if I have a suffering person, and I have something that I can offer them that might help, I'm going to try it. I'm going to do it in the safest way I know how, but I can't leave someone dangling for twenty years and say, “I'm sorry, I have to wait until my profession figures out what to do.” That's not me.I worked at the medical school at the University of Minnesota Duluth for eleven years. And I was not only on the faculty, but I was on the committee that determined what new information was put into the curriculum. For example, AIDS was just coming into vogue at that particular point, and it was obvious that we needed to have courses on AIDS for the medical students, because this was big. What a lot of people wouldn't understand is that each department in a medical school fiercely guards its time allotment. Everyone gets a certain number of hours, and they're not open to adding new things or giving up any of their time slots for anything new. And so what I would watch is, as new information came into the medical school, each department fiercely refused to add any new lectures in their department, or give up any of the time that they had to anybody else to add that information. So we're talking about university politics now — this is not even medicine, this is people guarding their turf. And I don't even think that would occur to any consumers, that that would happen like that — well, certainly, why would that happen in a medical school? Well, it's because human beings are responsible for each department, and they guard their own turf. So it's a kind of an insidious process about how new information isn't embraced by the profession, to go into the medical school curriculum.Mold, Lyme, and Long-COVID: The “Big Three”23:15Courtney: I want to come back to what you were saying about inflammation being at the core of chronic illness and complex chronic illness. And when it comes to complex chronic illness, whether it's SIRS or mast cell activation from mold or Lyme, we talk about multiple systems being affected — the central nervous system, gastrointestinal tract, endocrine, skin, just you name it. If the inflammation then is from a source of oxidative stress or a major insult — would you say that mold toxicity is the most common, or would you put Lyme or now even COVID on a par with that, as far as the deepest roots causing the inflammation? Not that the chemicals, metals, and everything else we're being exposed to aren't at play.Neil: In my experience, those three are the biggies — mold toxicity, Lyme with its co-infections, and long-haul COVID. Those are the three most common. Of those, in my experience, mold is the most common, and the one that has to be treated first if you have some or all of them. So, for example, in people who have long-haul COVID or Lyme, often their body will not respond to that treatment optimally until you first get the mold out. So there's a little hierarchy of what we do, in what order. And then within that hierarchy, there's also an order in which we do things for people to respond optimally. So, for example, mold toxicity will trigger — and Lyme and Bartonella will do the same thing — limbic dysfunction, vagal nerve dysfunction, and mast cell activation in most of our patients. Not all, but in most. And the longer they have it, the more likely those things are going to get triggered. Once somebody does not feel safe — and the systems that we have in our body to monitor that safety and to keep us safe are the limbic system, the vagal system, and mast cell activation — we have to get the body safer, or it will not be able to take what you need to take to treat mold or Lyme or long-haul COVID. People will literally shut down — their limbic system will essentially go, “Mm, I see what you're trying to do there, and I can't let you do it, because I'm not sure that's safe.” And it will literally not allow people to do it.The Limbic-Vagal-Mast Cell “Trifecta”25:58Courtney: So with one of those, or a combination of those, on board, these threat mechanisms would be kicked up — mast cell activation, limbic system dysfunction, autonomic nervous system dysfunction. If they look similar, or a timeline isn't easily helping parse out what might be primary, how able do you feel to make the distinction — versus if mold is present, starting there?Neil: If we look at our patient's symptoms, they will point us clearly to whether there's a limbic or vagal or mast cell piece, to be specific. The limbic system's job involves primarily monitoring and regulating and keeping emotion and sensitivity in check. So any symptoms that involve those two things are limbic almost by definition. So on the sensitivity side, if someone describes an increased sensitivity to light, sound, touch, smell, chemicals, EMFs, food — they're already telling me my limbic system is dysfunctional. In some ways it doesn't matter what the cause is; if someone has this increased sensitivity, regardless of the cause, I know we have to treat their limbic system first.On the vagal side, the symptoms would primarily run into symptoms that involve the autonomic nervous system, which would involve things like temperature dysregulation, palpitations, insomnia, POTS, blood pressure dysregulation, or symptoms that involve the gastrointestinal tract, because the vagus nerve controls almost the entire intestinal tract. So any GI symptoms — gas, bloating, distension, reflux, diarrhea, constipation, abdominal pain — again, that would lead me to go, the vagus is involved here. So by listening to my patient's symptoms, I can immediately know what's dysregulated here, and what my first treatment arm will be — to get the limbic and vagal systems back up and running again at a safer level, because otherwise our patients aren't going anywhere. They can do binders and antifungals and antibiotics for Lyme, and they will get worse. Their body will basically go, “I know I might need that, but why are you doing that? I can't even get to a place of safety to respond. I'm on self-preservation mode here.”And in the mast cell category — again, all of the same symptoms that could be mold or Lyme or long-haul COVID could also be mast cell. Again, it's a multi-systemic process. A tip-off, which I find very helpful, is if someone describes a symptom that comes on immediately after eating, sometimes while eating. Nothing causes that kind of reaction that fast except mast cell activation. Allergy — and most people, if they do have some symptom that comes after eating, they're going to be thinking, “It must be what I ate, what did I just eat?” But it's not food allergy, it's mast cell activation. In that context, many of our patients have already observed that they can eat a particular food one day and have a very strong reaction, and the next day, same food, nothing. And they'll go, “That doesn't make sense — if this was allergy, I ought to react the same way every time.” And so that is classical mast cell activation, which fluctuates. So — for the first part of your question — that's what I'm looking for. When I take a history, when I talk with patients, I'm going to really dig into: are they already manifesting symptoms that clearly tell me what we need to do first, to get them safer, so that now they can respond properly to the treatment that will really get at their root cause.Are Some People Born More Vulnerable?30:31Courtney: I know you take deep timelines when you meet with someone, so you're really accounting for a lot. But one of the things that I think about a lot is: who is most vulnerable? Do some of us come into the world already with a vulnerability similar to Elaine Aron's highly sensitive person model? And then maybe there's trauma, early attachment disruption — and already vulnerabilities — but then the toxic load that we're all experiencing. But then something like mold or Lyme then hits. And then, all the years and all the patients you've seen — I'm curious how many you feel already had sort of a vulnerability. Not that they ever had to really become sick necessarily, but already had a vulnerability.Neil: Honestly, I would say most. Our limbic system evolves from the time we were in our mother's uterus, so that almost no one has had a perfect childhood. And so whatever someone has had to deal with in childhood — it could be recurrent ear infections or throat infections, or it could be a surgical procedure, or it could be parents, both of whom worked and they didn't get enough time, or they could be abusive parents, sexually, physically, verbally abusive — whatever someone has been exposed to, that forces their limbic system to have to deal with it. Because that's the job of the limbic system, is to keep you safe. So your limbic system is basically going, “Okay, I'm just a little thing here, what do I need to do to cope with this?” And so their limbic system slowly, inexorably, becomes more and more hypervigilant to protect them. Let's say someone had an alcoholic parent, and they would come home, and you were never sure what their status would be — and so you'd kind of hold yourself back from that, which is, “I've got to see what this person is showing me, is it safe for me to come up and give them a hug, or do I want to hang out in my room for a bit until whatever this is settles down?” That's the beginning of this limbic hypervigilance process. And then it just goes on through life. So that if you've had difficult relationships, or surgeries, or severe infections, or anything in the physical or emotional or spiritual plane, a betrayal of some type — the limbic system becomes slowly more and more and more hypervigilant, when the straw hits the camel's back. And that straw could be COVID, or Lyme, or mold toxicity, or another infection of some type — that's the straw that breaks the camel's back. At that point the limbic system goes into shutdown, which — we know the vagal system goes into shutdown, literally, that's something the vagal system is trained to do. It's “okay, we are so unsafe that I'm shutting down my systems here.” And so that predisposes to illness. But I want to tie that back to inflammation, which — a lot of people don't understand that the vagus nerve, for example, controls inflammation in the body also. There are branches of the vagus that go to the spleen, to the gut-associated lymphoid tissue, and to the thymus, all of which are major immune organs. And if the vagus is dysfunctional, inflammation can rage out of control. So again, this comes back to understanding this complexity of inflammation, and how we need to both understand it and know where it is we want to look to get at that inflammation. So there is a profound interconnected limbic-vagal-mast cell piece. Each totally connects to the other. There's an interaction between the thousand biochemical mediators that mast cells make and the nervous system itself. So I call this interconnection the trifecta, which is: you can't just treat the limbic system in a vacuum, because if you're not also looking at the vagal and mast cell system, your treatment may be a little bit helpful, or it might not even work at all, until you combine all three — so that you really understand this is a package deal here, in terms of how we work with it.There was one more piece I wanted to add, Courtney, to understanding the inflammation piece: whether or not someone gets mold toxicity or Lyme or COVID depends on how robust their immune system is. So you could have a family living in a moldy environment — one person is really sick, several are a little bit sick, and one is not sick at all. And the one who's not sick at all can easily go, “I'm not sure what's wrong with you all, but I'm fine in this environment, it can't be my environment because I'm fine.” And what they're not understanding is: yes, they are fine, as long as their immune system stays robust. For the others, they were at risk for all of these conditions because their immune system took a hit. And for many people who were living in a moldy environment, during COVID, for example, when we isolated and people were spending twenty-four hours in their home rather than the eight hours out, they were many now being exposed to more mold at home than they were before. I don't think people began to think about that or look at that. So in that environment, whether or not they were affected depends on the hit they took. Now, the things that will hit an immune system to weaken it, and allow whatever's there to manifest, are: COVID was a biggie, any severe infection, a surgical procedure, childbirth, menopause, or any emotional upheaval will weaken that immune system, and then the immune system loses containment, and now we are off to the races. So what I try to convince people who are living in a moldy environment who are well is that they're living with a ticking time bomb. Should they take an immune hit, they will be just as sick as their family member who they're kind of lording it over, which is, “I'm not sick, what's wrong with you?” You'll be right there yourself if you take that hit — to try to help them understand, yeah, you're okay for now, but once your immune system weakens. So I'm trying to tie together the immune system, its ability to regulate inflammation, and this whole process here.Courtney: Right, right. Which I guess is why we call it complex, complex illness.Neil: It is the way human beings are. We're not making up a new word of complex illness — illness was always complex. We're just beginning to understand how complex it always has been.The Limits of Treating Symptoms Alone44:39Courtney: Right, so there's communities out there addressing mast cell activation. There's communities out there addressing POTS and dysautonomia. Communities out there addressing OCD and more obvious limbic-type issues. And then there's the whole mental health field. And the dots aren't getting connected. I mean, I've yet to see someone with OCD — I think it's like eighty to ninety-five percent have mold toxicity as part of the picture.Neil: You know, an example — and I won't name names — is there's an eminent pediatric physician who is very well known for his work in autism, who thought he was ADD his whole life until he recognized that he had mold toxicity and started taking antifungals, and all of a sudden his brain went online and he doesn't have it anymore. So that's just a very clear example of what you're talking about. And what we are talking about is: it's absolutely essential that all people who work in the medical field, all healthcare providers, embrace this complexity, because if you're only working on a piece of it, you will help some people to a certain extent, but you will not help people optimally. I mean, that is the absolute bottom line.The understanding that mast cell activation was huge came in 2016, when Larry Afrin wrote his book, Never Bet Against Occam. It was a huge game changer. When I read his book, it was like, “My goodness, I've been missing this in my patients.” And the whole world embraced this information, so that every medical center in the country now has a mast cell activation clinic. However, they're looking at it as a single thing with a label to it, and they're treating it just that way. They have not recognized that if they don't add limbic and vagal work to it, their treatment is not going to be adequate. And so, yes, they're helping people, but absolutely not optimally. And to make it worse, very few of those clinics have recognized that what's causing mast cell activation, which absolutely needs to be treated, is mold toxicity and Lyme. So people go to these clinics and get a certain amount of help, but they're not being treated comprehensively, which is a pet peeve of mine — which is, come on, if you're going to have a clinic, understand the whole interactions of whatever name it is you're working with. If you're going to be an ENT specialist, understand everything that impacts that area. If you're going to be a cardiologist, understand everything that impacts it. And we just don't see that. We see people kind of in their little box — “No, no, I've learned this, this is what I do, this is how I work” — and it's just unfortunate that they're not looking at the bigger picture.Courtney: Right, I think add to that PANS and PANDAS, because in psychiatry, people feel like they're deep diving because they're getting to PANS and PANDAS. It's like, okay, you've got to go deeper than that, because even those conferences, they talk about the need for treating relapse, and it's just going to keep reoccurring.Neil: I mean, they're using IVIG to help. That's nice, but they're not getting to cause. And we know when PANS and PANDAS first emerged on the scene, it was all about strep, and that was the focus for a long time. But as time emerged, it was very clear that this was a neurological inflammation triggered — here we go, broken record — Lyme, mold, other infectious agents had to be looked for. And if we treated those, you could cure PANS. It wasn't something that needed IVIG for the rest of your earthly life.Courtney: Even among those, would you say very often mold is underlying the mycoplasma, the candida?Neil: I think mold is one of the most missed components to illness that I can think of. If I have a goal in life, it would be to raise the consciousness of our profession as to the importance of mold toxicity, how common it is. We're talking millions and millions of people who are not diagnosed, because their doctors don't know about it, and therefore are not making the diagnosis. I'd love to see the consciousness get to the point that someone would present with these complicated stories and a doctor would say, “Why don't we think about mold toxicity?” That would be the most important thing I would have done in my career.Courtney: Yeah, well, you're certainly raising awareness.Neil: I'm working — it is slow. As we said, I'm working on a twenty-year generational issue here.Courtney: You've mentioned that the underlying source needs to be addressed, but the nervous system and immune systems need to be addressed. So one of the things that comes up with limbic system retraining is: I've had people hear the message that if they just address their limbic and autonomic nervous system, then they wouldn't need to address what I see as an ongoing threat, such as a mold toxin. So I'm hoping you can speak to that, and the importance of these programs, despite that.Neil: Sure. A couple of the better-known limbic retraining programs, the coaches get a little bit zealous about — “limbic retraining is so important, this is all you need to do alone, don't even do anything else, just do limbic retraining.” And I suspect that there are a handful, very few, but a handful of people who've gotten well just doing limbic retraining. If, for example, if you had mold toxicity, if it was relatively new, if you had not colonized, and you moved out of your mold exposure soon, it is possible that the limbic retraining would help reboot it to the point that your immune system rebooted itself and you'd be fine. I believe there are a few people like that. The vast majority of people who have limbic dysfunction — you need to do limbic retraining and vagal retraining. You may also need to do mast cell retraining, and please look for the cause of that. Those are downstream effects, those are not named diagnoses that you treat alone and it fixes it. Please look for at least mold and Lyme, which are the two most common things that are triggering this at this point. And people are getting the wrong message if they think they need to do it in a vacuum. To make it worse, they're being told, “No, no, just do limbic retraining, that's all you need.” And the truth is, no, you need to combine limbic retraining and vagal rebooting and mast cell activation most of the time. And of course you've got to get back to cause.Courtney: Right, I mean I try to liken it to — if they were in an abusive relationship or toxic relationship, they wouldn't just limbic-system their way out of that, if there was an external threat.Biochemical Contributors47:35Neil: No, you've got to fix what's primary here. I want to add to this discussion — we're focusing on inflammation from toxins and infections, but there are also other biochemical issues, some of them downstream, that need to be looked for and addressed in order for people to recover completely. So, for example, Lyme and mold will trigger kryptopyrrole issues, or imbalances in the ratio between zinc and copper, or they'll trigger methylation issues super commonly. And I just wanted to expand this discussion — I know it's complicated enough, but I don't want to oversimplify it either — that there are other biochemical things that we want to be looking for, because they're treatable, and they will help people to heal faster, if we're also addressing methylation, the need for zinc, the need for magnesium or B6 — those are common components of this whole process here. And so I just want to kind of tie that all together for a moment.Courtney: No, I'm glad you did, because those are topics that I talk about here, so it's important to connect those. The other thing I see, because I integrate the Walsh approaches with treating people that have complex health issues, is zinc seems so amazing when it comes to mast cell activation — making sure that's optimized. As well as connective tissue — and that was something else I wanted to ask you about — is structural issues that can be impacting the autonomic nervous system. I just see a lot of people — I inquire about it because I had it myself — but who have upper cervical instability as part of this whole picture.Structural Contributors49:26Neil: Again, all of these things are interrelated, and the physical structure can prevent people from moving forward in several different ways. One is the structure of the jaw and the face — the body puts a priority on teeth occluding properly. And if the teeth don't meet just quite right, and the jaw is a little bit out of structure, people often talk about TMJ — the body basically freaks out, it goes into sympathetic overdrive. And for some patients — it's not common, but I've seen several dozen — where the jaw had to be realigned by a combination of dentists specially trained in this work, working with osteopathic physicians, to realign the jaw. Often in those patients, they couldn't respond to the limbic and vagal treatment until their jaw got realigned.Same thing is true with what you're talking about, as cervical cranial instability, which is basically a weakening of the ligaments at the base of the skull, where it attaches to the first cervical vertebra. Now, these are all again intertwined — for example, it begs the question of what weakens those ligaments. And the answer is: if you have mast cell activation, some of the materials that the mast cell makes weakens the ligaments. So the ligaments get weak, and where the skull attaches to the first cervical vertebra, instead of being pulled apart, like ligaments do, it collapses. And that influences the blood flow to the brain, the nerve flow to the brain. And again, the body recognizes that as a priority, and often you can't get that better — you can't get limbic and vagal response until that gets fixed.So there are a bunch of structural issues that also need to be looked at, when people become overly sensitive and are not responding properly. And there's more in that area. So, for example, there's a chapter by Tasha Turzo, who's an expert on the jaw structure. There's a chapter in there by Andy Maxwell on cervical cranial instability. So that book would give people a really good overview of how complicated things are, and they might, chapter by chapter, get a clue of, “I haven't looked at this piece yet.” I mean, we haven't talked about oxalate or salicylate imbalances, which can add to that. So I just think that is a resource for folks that could really help them understand how they've gotten where they are, and understand the path out.Courtney: Right, right, because not everyone has all of these areas, but certainly could be held back or have a unique something that they could be getting relief from early on in the process. So I think it's both, to the degree that people are able to learn, and your book Toxic, too — it's like an encyclopedia, even if someone doesn't read straight through it, they can go to the mast cell section, or they can go to the Bartonella section.Neil: It was intended to be a readable way to understand this complexity, because it basically will talk about almost everything we've talked about today, and help people to get better understanding. I mean, we've talked about the bigger picture today. We didn't talk about, okay, how do you diagnose Lyme, how do you diagnose mold toxicity, how do you diagnose long-haul COVID, and most important, because this is very complicated, how do you decide which of those is the biggest player that you want to address first?Distinguishing Between Mold, Lyme & Long-COVID53:58Courtney: Right, I have shared resources on diagnosing mold toxicity. Would you comment on your last point — how do you recognize, are you using specific testing that you want to reference, the RealTime?Neil: I do. But I would emphasize, we're taught in medical school that if you really listen to patients, ninety-five percent of the time you will make the diagnosis by history alone. And I don't want to get too focused on testing, because listening to the patient and having them describe in detail what they're going through will really give you the little pieces you need to tease it apart to a certain degree. That's only possible to a certain degree, because there's a huge overlap between the symptoms of Lyme and Bartonella and mold and long-haul COVID and mast cell activation. Huge overlap. So there's little teeny pieces that will tend to lean more in one way than another. And honestly, that's what's required from all of us, literally years of study, to really get a handle on — someone will say something, okay, that's much more of a mold symptom than it is a Lyme symptom, something else. So I do encourage people, if they think they might have mold, to get a urine mycotoxin test. That has revolutionized our ability to make these diagnoses.Courtney: Would you still set RealTime as the preferred? That's what I've communicated to this audience.Neil: I would. Any test can help make the diagnosis, but for follow-up testing, the only one that's been really consistent is RealTime. And you want a follow-up test, so you want to know what your baseline starting is, and then you want to know, okay, am I getting these toxins out of my body? From my perspective, you know that you're done treating it when that RealTime comes back reading not present in every category. We have better tests now for Lyme than we've had in the past. Years ago, our tests were inadequate to say the least. And the CDC recognized years ago that the tests were so inadequate that it was basically a diagnosis made by a physician by examining all of the history and information that you had. That was enough — you didn't need a lab report to make the diagnosis of Lyme disease. A new test that I'm particularly fond of is Bruce Patterson's fourteen-panel cytokine test. This is a test that measures cytokines, which are the molecules of inflammation — cytokines are made by your immune system to deal with, or fight, different inflammational causes. And so what Dr. Patterson has discovered is there's a pattern of cytokines that we see with long-haul COVID, which is different than the pattern we see for Lyme. And I'm working with him now on the pattern for mold. So we can literally look at that test and look at, okay, what is inflaming this person primarily now, because I'm looking at that inflammational pattern, and I can literally read that. Some of my patients will have all of those on a particular test, or only one, but it really helps tease apart what is — I call it public enemy number one for my patient, what do I need to address as root cause right now. So our science is improving as we go here.A Message of Hope — and Where to Learn More58:49Courtney: And that's huge. Before we go — I think all of your books, but I'm thinking specifically about Toxic and The Sensitive Patient — all the information you generously share gives people a lot of hope who've been struggling out there. And I think your mentoring and teaching so many of us helps extend some of that reach. Is there anything you'd want to convey to people out there in the throes of chronic illness who are feeling hopeless and not getting the feedback from their doctors that this is something they can get beyond?Neil: Sure. My take-home message is always: everything we talked about today is treatable. Is there hope in there? You bet there is. But if you are not getting the help you need from whoever you are seeing, find someone who understands these things. For example, I do have on my website a list of physicians that I've trained over the years that I'm comfortable that they really know what they're doing — it's a growing list. There's someone like Courtney, who's been trained for years to do this, she's good at it. Find someone who knows what they're talking about, so that you can get someone who does embrace this complexity, and will look at it in its entirety, and then get you moving in the right direction, doing the right things in the right order. To me, this can be done. I mean, I have personally helped to cure four or five thousand people with mold toxicity, and an equal number of people with Lyme disease. So we can help the vast majority of people that we're seeing. So, regardless of how long you've been sick, if you haven't been properly diagnosed and you haven't gotten the right treatment, you can be helped.Courtney: Right, right, that's great. And for physicians out there who are interested in learning more about complex chronic illness — are there resources you would point to? I'll be sharing your books, because I think those are great references — but also how people can find what you're doing currently.Neil: Sure, my books — particularly with this discussion, Toxic and The Sensitive Patient's Healing Guide would be the two most appropriate. I would add that I have just finished writing a book on this whole subject of inflammation. It's currently being edited, I hope it'll be out by early next year. So if you stay tuned to my website, I'll let people know when that's going to be available. And I think, Courtney, what you're referring to is: I do have a mentorship program for healthcare providers. We now have three hundred and fifty-plus people in the mentorship program, it keeps growing. You were in one of the first groups — we started with eight, and then people kept wanting to get in on it. So we welcome people to join. If you go to my website, which is simply neilnathanmd.com, there's a whole thing which talks about the mentorship and how to sign up for it. So I certainly welcome people who want to learn more.Courtney: And then you offer consultations and professional consultations also?Neil: I do. My consultations — I am, at this point, since I'm semi-retired, not seeing people directly. But I do offer consultations with a patient and their primary treating physician — so we all get on a Zoom together, and we will go over the details of that person's history and their lab work, and I will help outline a treatment program that looks to me like it will get people well. And actually, Courtney, I actually do a lot of that — I'm not really retired, my wife will tell you. I stay pretty busy. I love helping people. I love being able to take this complicated information and tease it apart, so that I can help people to understand what they need to do, in what order, in order to get better.Courtney: And we're all grateful — grateful that you've followed your path, because so many people have benefited personally and professionally. So thank you for bringing your wisdom and expertise, really appreciate it.Neil: You're very welcome, happy to do that.You can find Dr. Nathan's information, consultations, and mentoring program through his website at neilnathanmd.com. If you'd like to help get this information out into the world, please consider liking, sharing, or commenting.Until next time,CourtneyCourtney Snyder MDDr. Courtney Snyder MD is a holistic, functional, and environmental psychiatrist for children and adults. Find her at courtneysnydermd.com and on the Holistic Psychiatry Podcast on all major platforms.Medical DisclaimerThis podcast is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com

In this episode, I have the pleasure of speaking with Andy Mort. I think you will appreciate his wisdom, poetic way with words and sense of humor. Andy is a UK-based songwriter and musician whose work as a creativity coach explores the intersection of high sensitivity, creativity, and the influence of culture.Aside from sharing some of our own experiences with high sensitivity and gentle rebellion, we discuss various ways those of us with high sensitivity (as described by Elaine Aaron) might better align with our nature. We also discuss:* 00:00 — High Sensitivity and Its Misconceptions* 01:54 — The Concept of Differential Susceptibility and Environmental Impact* 03:47 — Andy Mort's Journey Into Understanding Temperament and Sensitivity* 07:05 — The Discovery of the Highly Sensitive Person Trait and Its Biological Roots* 09:58 — The Idea of Being a Gentle Rebel and Leading With Authenticity* 14:51 — The Importance of Creating Supportive Environments for Sensitive People* 19:47 — Creativity as a Form of Self-Expression and Nervous System Regulation* 25:07 — The Role of Sensitivity in Leadership and Group Dynamics* 29:58 — The Challenges and Opportunities of Sharing Creative Work* 34:46 — The Societal Narratives Around Sensitivity and Self-Acceptance* 39:57 — The Importance of Community and Support for Sensitive Individuals* 45:06 — The Concept of Gentle Rebellion and Aligning With One's Nature* 49:45 — Closing Thoughts on Sensitivity, Creativity, and LeadershipFull transcript included belowWhere to find Andy Mort:*

With it being back to school season, this topic feels especially timely. In this episode, I have the pleasure of speaking with family advocate Tracy Spiaggia, founder of Slingshot Health Coaching, about recognizing high sensitivity in children and how to support sensitive children and their parents.We discuss the core traits of the Highly Sensitive Person (HSP) trait, Tracy's great “power strip” analogy for sensory overload, and why the tripping of the power strip (the stress response) can look different in different children (fight, flight, freeze, or shutdown). We talk about challenges that may point to high sensitivity — school behavior problems, breakfast refusal, perfectionism, somatic complaints — and the practical framework Tracy uses with families to sort the “immovables” in their lives from what can actually be changed.We each share our own experience growing up as highly sensitive children, and how we each began our parenting journey largely unaware of this trait. We address the importance of awareness and self-compassion for parents. And, we close with commenting on the value of identifying and addressing pyrrole disorder- a fairly common biochemical imbalance in those with highly sensitive who are struggling with brain and physical symptoms.Timestamps:0:00 Introduction to high sensitivity and its importance2:04 Recognizing high sensitivity in children and adults3:58 Parental support strategies for sensitive children5:52 Stress response styles and their impact7:56 The physiology of high sensitivity and overstimulation9:59 Creating modifiable environments for thriving12:06 The evolutionary purpose of high sensitivity14:04 Practical tips for supporting sensitive children in school and home15:58 The importance of self-awareness and compassion in parenting18:04 The role of nutrition and physical activity in sensitivity management20:02 Supporting adult highly sensitive persons22:11 The power of community and shared experiences24:04 Overcoming shame and embracing sensitivity as a strength25:59 Practical steps for creating supportive environments28:00 The importance of ongoing learning and adaptation29:53 Closing thoughts and resources for further supportIntroductions (0:00)Dr. Courtney SnyderWelcome to the Holistic Psychiatry Podcast. I'm Dr. Courtney Snyder, a physician and holistic child and adult psychiatrist. In this episode, I have the pleasure of having a conversation with Tracy Spiaggia, who is an experienced health coach who works with families. Using Elaine Aron's term of the highly sensitive person, HSP, Tracy and I will discuss high sensitivity in children. This trait, as Tracy will mention, occurs in about 20% of the population. Tracy and I both consider ourselves to be highly sensitive, so in addition to sharing our professional experience, we'll also share insights from our own childhoods, as well as insights from parenting highly sensitive children. Tracy is currently a candidate for a PhD in what will be Whole Health Leadership. She's a Functional Nutrition and Lifestyle Practitioner, Certified Integrative Attachment Theory Coach, Brain Health Specialist, National Board Certified Health and Wellness Coach, and the author of the book From “Chained to Changed. Break Mental Strongholds and Transform Your Life Through Faith.”CourtneyWe have so many intersections in terms of what we care about and are interested in — nutrition, functional medicine, attachment, families.TracyWhy I hang on every word you put out.CourtneyThank you. Thank you.CourtneyOne of the things that I was thinking about is how much people do to support children that have all these different issues, but there's not a lot of recognition of high sensitivity in children, nor what their unique needs are. They're living in a world that's not designed for high sensitivity. As we talk, we can help raise awareness about what that looks like — how to recognize when a child is highly sensitive, and not in a symptomatic, pathologic frame, but really, that's who they uniquely are. And then we'll move into how to help people make choices to support these children so that they can thrive, and also recognize the situations where they're probably not going to thrive as easily.TracyCorrect. And then how, as a mom and dad, can I modify my expectations on the child and give them a lived experience that best aligns with their sensitive nature — so that they can become who they're supposed to be, not vicariously living through the child, especially if you're a non-sensitive parent.CourtneyWe should talk about both — when the parent is also sensitive, and then when they're not necessarily, ‘cause there's different dynamics that would come up.TracyYes, yes, yes, absolutely. Especially if the sensitive parent never knew — hello, never knew anything about HSP. And so you're raising your children, and then when you come to find out, like, your whole brain just explodes in. And then I just kind of really became a completely different parent, almost on a dime, finding this work. And I felt the most free I've ever felt in my life when I came across the work. So yeah, we'll talk about that too.Growing Up Without an Awareness of the HSP Trait(3:21)CourtneyI know — I think like you, I look back and there's things I would have done differently. Now having a daughter who's twenty-one, certainly learning when I did has helped her, and this information helps her even make her own choices at this point. When I thought about parenting, it also made me think about being a highly sensitive person, and my own experience as a child, because there certainly wasn't language back in the sixties and seventies.TracyHere's a great example. I'm going to make it personal instead of hypothetical. My parents — we came from a household where my dad was a police officer, my mom stayed home, four kids, money was super tight. And so the summer would come, and I now, as a seasoned mother, I can only imagine how she'd be like, almost dreading it — like, “oh my gosh, they're all here.” So we would have to go to swim team ‘cause it was free from the town. We'd have to go to the town pool. We'd have a choice — we weren't asked, “you're going to swim team.” And if my memory serves, it started super early, maybe seven, eight o'clock in the morning. Back then I was just a bag of bones, I was so thin, and that water was freezing. I had no idea why I was so terrified to perform in front of others, but that's part of the HSP. Like I shared earlier — when I came across this work and all of the questions that were asked to see if you fall on the spectrum of HSP, I'm like, yep, yep, yep, yep, yep.But when it was my turn to compete, I would nine out of ten times not show up on my block. I would hide in the bathroom. I'd even get good at climbing up on top of the toilet with the door closed, so if my mom came in — you know, you can't see feet. So I would hear my name being called, like, “McMurray, block three,” and I wouldn't show up the vast majority of the time, because I'd rather the punishment on the back end than have to endure a public display of competing in swim team.So I give that as an example — if a parent were skilled, the first time I don't show up for my competition, there should be some really safe but powerful questions being asked, like, “hey, what's going on for you? I noticed you weren't there, you didn't show up.” Obviously you're not doing that to — the parent should be able to say, “obviously you're not doing that just to irritate me,” but we take it all so personally as exhausted parents. But if they were skilled, they could ask questions, and I'd be able to say to them, “this is really scary for me, I don't want to do this, I don't like getting into the pool at seven in the morning, I'm freezing, I'd be blue, I don't like this, I don't want to do this.” And then they'd say, “my goodness, okay, you don't have to do this anymore, you can come and stay home and we can figure out what you enjoy.” I didn't grow up like that.So that's an example of a rule I made up to the game of life — if something is bringing you to the brink of sheer terror, just don't show up for it, go hide somewhere. That's one example of how I started to cobble together rules of the game of life so that I could survive it.CourtneyAnd that's so interesting, because in my own early life, I think I cobbled the rule of “you just do it no matter what.” That has its own problems, because you don't even become aware — you just persist through what's quite uncomfortable. Whether that's sporting events, public speaking, which for me was a complete nightmare — anticipating, many months in advance, a book report or something like that. And I think, even looking back, I could say, “I had anxiety as a child.” But when you think about high sensitivity, and you think about the context with which one is trying to navigate — which is highly stressful, chronic, and in some cases severe stress — that doesn't have to even be anxiety. It could just be a severely, chronically stressful situation, trying to be in a world of extroverts. In my family I was the youngest of four, and I was the only one that was highly sensitive.It's Not Anxiety. It's Physiology. (7:53)TracyAs you describe that, I don't hear an anxious child. I hear a physiology. I hear the brilliant design of the physical body, that your alert system was working perfectly well — trying to say you're living a life that's antithetical to who you are, but you're kind of being forced along for the ride. If there's a lot of children, those at the tail end just kind of get bolted on, as opposed to being seen — not all the time, but most of the time — because parents are just human beings with finite resources and probably very little skill, and are just trying to seriously survive the day.CourtneyYeah, exactly.TracyTrying to survive the day. So the kids just get bolted on, but it's the meaning that we make out of just being bolted on, or being told what you're doing. And so I don't hear anxiety — I hear a physiology that's working beautifully, because your body continuously alerted you to the reality of having to show up in a world where you're not asked, you're told what you're going to be doing, but it goes against the nature you were given.And this is why — I really do have a moral conundrum with just jumping straight into pharmaceutical prescription, because the body's brilliant. It's not broken. So if we have chronic depressive episodes, if we have peaking anxiety, there's something to hear. There is something to be listened to before we go trying to dull and mute all of those sensory, dashboard-like signals. There's something there. And so I feel like those states have been kind of villainized — “get rid of it at all costs” — where it's like, if we can stay in the uncomfortability while we remain super curious and highly supported, you're going to be able to have that body communicate to you where you're living out of order. Could even be a diet that's out of order. If your relationships are okay, and you scratch your head like, “hmm, I feel great with my family, my parents hear me, they see me, I feel heard and seen, I don't feel judged, I'm doing the things I like, I'm not being forced to do things I don't like” — then it's time to say, okay, maybe there's certain foods that I am or am not eating that the body is trying to alert you to, to give you your best life.CourtneyRight — and it can be an alignment of all of those factors.TracyOf course. And it's like a snowball at the top of a mountain that builds to this ginormous thing by the end, because it just collects and builds momentum as it goes down. That's what I try to help parents see — either for themselves, beginning in childhood, or what's going on for their own child, especially the non-sensitive parent coming in with the sensitive child, saying “I don't know what's wrong with him or her, fix—” And it's like, no, no, no, no. You're the most important person on planet Earth. It's me helping you relate to your child in a way that will turn those signals down, because they finally feel seen, heard, understood, unconditionally accepted. And then you will move to create an environment that lets the body relax.The Traits I Look For — and the Power Strip (11:08)CourtneyYeah. So let's talk about HSP first in adults, and then how that translates to children — because the reality too is that chronic stress in childhood has different implications. The pillars that I think about — and a lot of this is abilities as well as potential liabilities — ability to process a lot of information, being a deep thinker, feeling things deeply, problems with stress tolerance, and then sensory sensitivity, whether that's picking up on the emotions in a room or sensitivity to bright light, loud noises, textures. People don't have to have all of these to fall on the spectrum. Being empathic, tuned into other people's feelings, maybe even being more emotionally reactive.TracyI wonder how you'll feel about the way I try to explain it to the clients I work with, because it is — when you're not interested, you and I could geek out on this for a whole week straight with no naps. But you have to really capture the essence of what we're trying to share with people so it can change the way they live and operate and relate to other people.So the way I offer it in a layperson's framework: I point to a particular outlet on the wall, with one lamp plugged into it. An electrician, when they wire a house, the same number of volts is going to come out of each outlet — the lamp is the only device plugged into that one outlet, drawing its 120 volts, and it lights the lamp, and the lamp is fine. But over here by my desk, there's still only one outlet, but I need many, many things to operate off that 120 volts. So I have a power strip, and in that same 120-volt outlet, I have the power strip with five things plugged in. And it has a mechanism — this is the whole purpose of the power strip — to shut down when I'm trying to draw too much energy out of that same outlet.We have the same thing built into our nervous system. When the world is tugging and pulling at a highly sensitive nervous system — through forced clothing that has seams, a rough turtleneck — I'll talk from personal experience, like being in a wet, sandy bathing suit on a hot beach. I just wanted to be dead. It was so overstimulating for me. I am the power strip, and life is plugging in without my permission — stealing bandwidth, stealing nervous system resiliency from me. So then when I'm left with the last thing to be plugged in, which is like, “hey, come for dinner,” and it's something I don't like — that could trip my whole nervous system. And the uninformed family members: “you're always the problem, it's always you.” And it's like, no, you don't understand all the things that were plugged in before that, stealing all of that nervous system bandwidth from me. This last thing is what you observe, but that was what tripped the nervous system.My stress response style, by nature, is fighter — so that trip will manifest in your preferred stress response style. For me it's combative. For other people it could be complete shutdown, or “I'm getting out of here” and they flee. Other people, they dissociate — they just kind of freeze, they're there but they're not there, nobody's home. That's where that innate preferred stress response style shows up when the power strip trips. And then what we do is we assign — “that's their personality.” And it's not their personality, this is their stress response style. You have to get curious about each person — how much bandwidth do you have before you trip, how much is stealing from you? Some people could wear a wet bathing suit and just lay there, nothing plugged into their strip. Me — “when do we get to go back and take a shower? Please, can I leave?”So that's the analogy I use: examine yourself, then consider your child. Do you believe they're a one-outlet person, where life is good and nothing else is going to get into that outlet? Or are they a power-strip person, where there's all kinds of opportunity to plug into that same voltage, causing that person to go into a sympathetic-dominant state.CourtneyRight, right, right, that's great. Really helpful — you and I are good examples from our own experience, because I was more the shutdown-and-comply kid. So less obvious — I think both are struggling in different ways. Some children it might be more externalized, and others it might not be at all.TracyYeah, and then not at all — unfortunately, parents can easily miss that and say, “you're such a good girl, you're such a good boy.” They're actually in shutdown. They have no voice.CourtneyExactly. Right — or having headaches and stomachaches, somatic-type symptoms.TracyAbsolutely, absolutely. See that all the time — I'm sure you do too.What Families May Notice First (17:16)CourtneySo we should talk about what types of problems people might notice before they actually notice the sensitivity itself — whether that's meltdowns, withdrawing from activities. What would you say are common things families come to you with that relate to this?TracyThe most common would be problematic behaviors in school. Being woken out of a dead sleep, refusing breakfast because you're so high-stress, under-rested — it's almost like a nauseous feeling. So unknowingly, they send their child into an incredibly stressful environment, undernourished, without any nutrition on board to blunt the effects of all that myriad stress — all those plugs going into that power strip. A lot of parents will bring their child in — mothers, let's just say it's almost always moms — “help me, they're not allowing my child to come into the mainstream class.” And I'm like, has anybody, including the school counselor, gotten curious around energy reserves, the status of stress, the nutrition that's on board? If the child is refusing to eat, we need to really look at that, because there is stress that has got to be pruned from this child's life, so their biochemistry normalizes to the degree where they can tolerate a small breakfast to start.That's not normal human behavior, to break your fast upon waking and have a nauseous reaction to food. You have to understand that body is communicating, once again, brilliantly — it's deprioritizing nourishment and digestion and prioritizing stress response. People don't understand that. So I'd say one of the most common is just combativeness or non-compliance in these domains of life, in school, or when I tell them to do such and such at home. And listen — there's going to be some non-pathological defiance. That's normal, progressive development for a child. They test the boundaries, depending on their temperament, because they're always on a trajectory to individuate. Once they get to around eight, nine years old, and that nervous system's cement has kind of cured a little bit, now they're looking out into the world to figure out, “who am I, I want to separate a little bit from this family of origin and figure myself out.” That may look like being difficult or combative, but they're trying to individuate.Sometimes when I hear myself talk, Courtney, I feel badly for the child, but I also feel badly for us parents, because we're calling parents higher and higher to awareness and education when they're so exhausted trying to pay the bills, keeping the lights on, food in the fridge — who lost their job, who's getting a divorce, who has an incurable disease. And at the same time I'm trying to call you higher with your parental skills so you can better attune to your child. I know how that lands on a tired parent, because I was hurt too. But we have to understand that the reason we'd have that type of response to this information is because nobody supported us when we were little. So we just learned “this is life, buck up and deal with it,” and we live from those rules we cobbled together as a kid — “I guess I just have to figure it out on my own.” And a parent, unknowingly, is doing the same thing — telling this struggling little child, “figure it out, man, I'm spent, I'm tired, I can't.”CourtneyI mean, ultimately this should make parents' lives easier if they can understand what the needs are of the child, so there's not meltdowns at school in the cafeteria where it's so loud, or on the school bus — there would be just peace overall for everybody.TracyYou're a hundred percent right, and that is the critical message. If there's any takeaway from this conversation for your listeners, it's — it will get a little worse before it gets better. And that's true with any healing journey. You broke a bone, okay, it's gonna hurt, I have to reset the bone. It gets worse before it gets better. But when you come alongside professionals like you and I, we have a path, a strategy to bring you along — we'll hold you really well during the worse part, but then you will be liberated into not just a future, but potentially a legacy that you can completely change. You can leave this mark as a patient person, a considerate person, a forgiving person, a compassionate person — all of the beautiful traits of the highly sensitive get to just flourish unabated if we create an environment for it.Self-Compassion and the Family Timeline (24:27)CourtneySo it can be meltdowns, or children withdrawing from activities. It could be perfectionism almost, or self-consciousness — being so in tune and observant that they might assume everyone else is as observant, and be highly self-conscious or perfectionistic about themselves or even others. Is that something you see in the families you work with?TracyJust as much. The perfectionism, the overachievement, the over-giving. These kids need to be able to look to us when they're in crisis — “I'm freaking out, but you're steady, you're the rock I can cling to.” So if we freak out when they freak out — and listen, a lot of what I'm sharing are insights after I've made the mistakes. I would give anything to know then what I know now, but I can't go back. So I did a lot of things right, but I did some things not so great. And now I repackage and repurpose the mistakes into something we can offer to the world — “moms, dads, you don't have to make the same mistakes I did, you can learn from me.” And I believe God will honor that, and even allow forgiveness and grace and mercy to flow in my children towards me for the things I didn't do well.CourtneyI think those are really valuable conversations to have — one, for parents to be able to apologize and teach their children the value in that, but also just this own self-compassion, that we're all doing the best we can. And it leads into this idea of — if you're a highly sensitive parent with a highly sensitive child, which would have been my experience — there are a lot of both gifts in terms of recognizing their needs, and also a lot of challenges in terms of not wanting to project too much onto them what their needs might be. I think there were times when my own concern about how the world operates in relation to sensitive people was almost problematic, and other times where I was sort of going along with the culture. I think it can go both ways, and the main thing is just to be conscious of it if you're a sensitive parent.Sort the Immovable From the Modifiable (30:36)CourtneyWhich actually leads us to this idea of what types of choices might parents make that would help support a child who is highly sensitive — whether that's in the home, at school (there's not always a lot of choice in terms of school options), or activities. I think that's worth grappling with — the real practicalities of, within a home, how might things be different if someone's going with the flow versus recognizing, “I have a child that's highly sensitive.”TracyYeah, I think it's important — I don't think we stated it — if there are listeners new to the concept, only about twenty percent of the population is thought to have this trait, and that trait lives on a spectrum. So if you're in the twenty percent, we have to explore how full you are on that spectrum. This journey is very unique and individualized — you have to study each individual child and each parent separately to know exactly what you're working with. I think the next step would be to make a two-column list: these are the immovable, unmodifiable realities in our lives. “This is where we live, we're a two-income household, I'm a single-parent house, I have to go to work, you have to go to public school, I don't have resources otherwise” — okay, that's an immovable reality, put it in that column, because it is what it is, and that doesn't set you up for a worse outcome. We have to start appreciating that none of us are a victim, we're all victors — if we just do the work of taking inventory of the reality of our lives and create a schematic of sorts, we all will be given the same opportunity for thriving and flourishing. Nobody's at some gross disadvantage — I know some people might think I'm talking financially, but I'm really talking about inner resources.CourtneyI was just going to say — even if a child is in a public-school setting, there are still ways to create some downtime in their life, versus going from school to activity to activity to lots of stimulation.TracyA hundred percent. Even within the school experience, you can ask for certain accommodations — and we do this all the time. If you have a profoundly highly sensitive child who's being flooded with fluorescent lights, sitting in hard chairs amongst peers who are loud — if it turns out the mom and dad say, “you know what, I think it'd be really helpful if they could just get a 10-minute snack break, high protein, moderate fat, not sugar,” and maybe 10 minutes with the school counselor to recharge that battery — exactly. So you might have public school as an immovable, but that doesn't mean it's not modifiable. You can still branch it over to the modifiable and figure out what aspects of that day are draining the nervous system resilience and causing chronic stress, and what's modifiable there. Schools have really embraced their role in improving mental health outcomes, by and large. So as long as you advocate for your child in a respectful and reasonable way, there are aspects of this immovable reality that can be modified to give some resilience back to the child. But the most influence is obviously going to come from their home environment and experiences.CourtneyJust thinking through this lens can impact what choices are available to people.TracyPeople by and large have no understanding — again, because they're not interested in this sphere of learning and knowing. They have very little understanding and appreciation of all of the modifiable factors of their daily lives. It's like removing one plug from a really burdened power strip — that's what we try to do, remove some of the plugs we can, proactively, to give some of that bandwidth back to the child. That's what makes this work very customized, very individualized. I do groups — I don't know if you do groups — so it's more affordable and accessible, and I'm saying the same thing to larger groups of people, and they can begin to process the information and create their own customized strategy.CourtneyYeah — and in the groups, they can hear each other, and there's some degree of support, because that's the other huge part — however people can find like-minded people and families, and it sounds like your group is a way to do that.TracyYeah, it normalizes your experience — and don't we all, frankly, want that as adults and parents, but even more so a child wants to be normalized. There's nothing wrong with you that you get really overstimulated on the beach, in the sun, in a wet sandy bathing suit for eight hours straight with very little food. There's nothing wrong with you — there's something profoundly wrong with that experience. So it takes the shame off, and if we can throw off the shame, the body feels liberated to start to migrate its way back to parasympathetic — maybe we can actually take a deep breath, because we're not in imminent danger.It's Not a Flaw — It's a Design (36:34)CourtneyRight. So things like being mindful of downtime, opportunities to be in less stimulating environments. Routine can be important too, as far as anticipating and knowing something's not going to come out of left field and derail things.TracyCritically important, I think.CourtneyAnd I think about it even with this idea of “they're going to have to live in the real world” — many adults wouldn't choose for themselves to be in situations with a lot of people and a lot of loud noise. Working adults are better able to recognize a preference for certain types of work, depending on what's practical for them. But we expect children to do what every other child is doing, and expect them to thrive in that way. Most adults aren't living in “the real world” like that.TracyEspecially today, with remote working, where you could be a grown adult making a wonderful salary right from the comfort of your own living room — at least for my generation, there was obviously no such thing.CourtneyAnd we haven't talked about how many strengths come with this, and how many strengths and abilities can be lost trying to navigate or fit into a world that's largely not built around high sensitivity. As the research shows, this is evolutionarily here for a reason — everyone should want people with high sensitivity to be thriving, and want the children to have the opportunity to thrive.TracyAbsolutely. Another really helpful point for your listeners: when Dr. Aron discovered the trait, researchers have continued to discover it in over 100 species of animals and insects, and that work continues. This is something innate in all creatures, and it's brilliant — not too many of us, but just enough of us to sound the alarm for dangers that the non-sensitive can't see coming. We can see the headlights of the train where these people are oblivious, standing on the tracks. So to live in a world without people with these fine, highly tuned senses to alert the masses — it's kind of like the carbon monoxide detector in a home. You probably don't pay much mind, but let me tell you, when it goes off, it's saving your life. We are the carbon monoxide detectors. We are the ones alerting you long before you're aware there's danger afoot. It's a gorgeous trait — I wouldn't trade it for anything.CourtneyYeah.TracyI really wouldn't. It fills me with so much purpose and passion, and I'm able to move through this world and feel so deeply — really high highs, yes, really low lows, but I feel alive. I don't feel kind of in that middle of “meh.” I'm never meh, that's never me. I think it's a beautiful thing if people can get over the stigma the world would probably want to attach to it.Pyrrole DisorderCourtneyRight, right, right. And I'll just mention too, for people who are highly sensitive and struggling maybe with mental health or physical health issues, in part because of chronic stress — the issue around pyrrole disorder, which is more common in those of us who are highly sensitive, results in specific nutrient imbalances that are not difficult to treat. That doesn't apply to everyone we're talking about, but some people dipping into more severe issues could really benefit from that kind of information.Where to Find Tracy (41:04)TracyMy goodness — to me that's almost the lowest-hanging fruit. That's why I love functional nutrition — trying to repair a familial relationship is hard work, but elevating your zinc and B6 levels, that's pretty low-hanging fruit.CourtneyI know, right, right. Tell everyone how they can find you, the work that you do — do you have an active group right now that you're working with?TracyNo, we'll kick off the next group — I run them in the fall and in the spring, so the next group will kick off, I believe, mid-September. They can find me — my practice is called Slingshot Health Coaching, after the David and Goliath story in scripture. Slingshot Health Coaching on Facebook and Instagram — I'm not a huge social media person, but there's a presence there. Website is just slingshothc.com. Anybody can book a complimentary call to explore — you have to meet the person, make sure the chemistry is good, that I'm actually the right practitioner for you. That's available to anybody, and you can certainly subscribe — I send out a fair amount of content by email, and I run a lot of complimentary studies and things people can do for free, to build community.CourtneyGreat. Thank you so much.I hope you enjoyed our conversation. As always, I welcome your thoughts and questions. Until next time,CourtneyCourtney Snyder MDResources:* Tracy Spiaggia at Slingshot Health Coaching* High Sensitivity Through 3 Lenses (HSP, Pyrrole Disorder & RCCX Theory)→* Elaine Aaron - The Highly Sensitive Person (website)Dr. Courtney Snyder MD is a holistic, functional, and environmental psychiatrist for children and adults. Find her at courtneysnydermd.com and on the Holistic Psychiatry Podcast on all major platforms.Medical Disclaimer: This newsletter is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Are you someone who at times has great productivity and hyperfocus, but at other times can barely focus and get things done?Do you have problems focusing and getting things done unless you're under pressure? Do you tend to procrastinate?Do you, after periods of high-intensity work — whether that's physical or mental — crash and burn out afterward?Do you feel that you dive deeply into an interest, but then lose interest and don't know what just happened? Do you have serial interests, or even serial relationships?Do you feel you have great abilities — you're a quick learner, you go deep when you're pursuing something you're interested in, perhaps you're even gifted — but then feel unable to harness those abilities and gifts, and feel like you're on a roller coaster between hyperproductivity and an inability to focus and have motivation?These are common patterns that I see in my practice, and they relate to arousal. I'm not referring to sexual arousal or emotional arousal, but arousal as far as our neurophysiology being in a place where we can ideally act — where we have focus, motivation, and energy — and not low arousal, where you can't focus, and have low motivation, and low energy, nor hyper arousal, where we're excessively focused in a physiologic stressed state. Many people find themselves fluctuating between both ends and having problems finding that sweet spot in the middle that allows them to sustain their interests, sustain the goals they've set for themselves, and harness their greatest gifts. Many of these individuals are extremely gifted — deep divers, can even be obsessive about their interests. But it can take that depth for people to function at a high level.This newsletter and podcast are for educational purposes and aren't a substitute for professional medical advice, diagnosis, or treatment. Please talk with your own doctor about any medical or psychiatric concerns.What You'll Learn* (0:00) Recognizing the pattern of hyperfocus and burnout* (3:43) What arousal actually means, physiologically* (4:26) The RCCX connection* (7:03) The crash, and why it happens* (10:11) Finding our sweet spot — practical tools that helpRecognizing the PatternThere's a sweet spot of arousal where we have focus, motivation, and energy. On one side of it is low arousal — brain fog, low motivation, low energy, something that can look a lot like ADD in both children and adults. On the other side is hyper-arousal — when we have excessive focus and drive, often accompanied by physiological stress.Many of the people I see fluctuate between both ends and struggle to find that middle place. They tend to have deep interests. They can dive deeply into something, even obsessive about it, and can have difficulty disengaging. When there is not enough stimulation, they tend to get bored. They often don't enjoy small talk.What Arousal Means PhysiologicallyWhen we talk about what can be happening here — when we are stressed, and again, when I'm talking about arousal, that's a degree of stress, and we're aiming for an optimal level of stress where we get things done and can enjoy what we're doing. What impacts arousal? One is cortisol. If we have adequate levels of cortisol, that gives us adequate energy. Along with cortisol, catecholamines fluctuate — things like norepinephrine, which gives us motivation, and dopamine, which helps us focus. Think of these three as moving up and down together for the most part. There are other things that can impact them separately, but generally they're increasing together, and they can be decreased or low at the same time as well.The RCCX ConnectionThe best explanation I've found for why some of us find ourselves at either end of the arousal spectrum and not easily in the middle sweet spot, is RCCX theory, developed by Dr. Sharon Meglathery. This is a theory I've described in previous newsletters and podcasts — it makes the connection between a gene for hypermobility, a gene for 21-hydroxylase (an enzyme in the hormone pathway that produces cortisol), and another gene that relates to autoimmunity. People don't have to have all of these genes affected, but I'd say the most important one, from a psychiatric and brain-symptom perspective, is 21-hydroxylase, needed for the production of cortisol.If we have a weakness on this gene — and it appears that likely 20% of people do — that could give us a baseline low cortisol level. It's not as if we can pin this down to a single variant; there are likely a number of places on that gene that could be affected, and it's not something that can currently be measured through genetic testing except in research settings. But if we have that weakness, we could still make adequate cortisol under stress — until we push it too far. Say, on one of these hyperproductive days, we push too far, and then we overwhelm that enzyme, and we don't have enough cortisol.So why would people who struggle with this already tend to be deep divers? It appears that a vulnerability in that enzyme, 21-hydroxylase, could have affected brain development in utero and in early life — causing higher androgens and spiking cortisol that can affect particular parts of the brain, including the amygdala, which senses threat and can contribute to this high-intensity difficulty putting on the brakes once we're under stress. So these individuals, when they're working on something, may have difficulty stopping — and then when they're not able to keep producing the cortisol to meet the demands they're placing on their physiology, they hit a wall.The Crash — and Why It HappensWhen the enzyme can no longer keep up with the demand, cortisol and those neurotransmitters drop — that's the crash: low energy, poor focus, no motivation. For some people, hitting that wall can also trigger mast cell activation, through another mechanism I've talked about in a previous episode. There's a hormone in the brain, corticotropin-releasing hormone (CRH), that tells the adrenal glands we need more cortisol. When that happens, CRH can bind to mast cells — inflammatory cells in the body — which release histamine and inflammatory mediators that can cause physical symptoms, and worsen fatigue and brain fog. Not everyone has this happen; most people with mast cell activation have something else going on too, like a biotoxin exposure.This isn't only about a single hard day. Zoom out, and I've seen people who were high-functioning — even hyper-functioning — for years, doing remarkable things across work, family, and adventure, before hitting a wall they never fully recovered from. Often there's something else quietly using up their stress capacity underneath it all: mold or biotoxin exposure, mitochondrial dysfunction, a chronically stressful relationship, early attachment disruption, or even codependent relationship patterns that keep someone chronically stressed.Once someone hits that wall, it's common to unconsciously reach for something to bump cortisol and those neurotransmitters back up — compulsive eating, carbs, seeking stimulation online, risk-taking, or calling the one person who reliably stirs up drama. Beyond the physical crash, there's a bigger cost: most people aren't recognizing this as their neurophysiology. They're experiencing it as being inconsistent, self-defeating, self-sabotaging, or a self-esteem problem, rather than recognizing it as a very common physiologic pattern involving our stress hormone pathways and neurotransmitters — and the bigger loss is all the abilities and gifts people aren't able to harness because they're on this roller coaster.Finding the Sweet SpotThe first thing is to notice. Notice when you feel in that hypo-arousal state, when you're having difficulty getting things done, and then recognize what you're reaching for — is it carbs, is it eating, is it substances, is it the internet, is it risk-taking, is it the dramatic friend who stirs up trouble? NoticeAlso notice when you're in a state of hyperarousal — doing an activity, powering through without being able to stop, unable to take breaks. If you're observant enough, you'll notice your muscles tightening around your neck and shoulders, and simply not being able to relax. When we notice which state of arousal we're in, we know what tools we have access to, to help modulate it.For High ArousalWhen you're in a state of hyperproductivity, the last thing you want to do is take a break. But to sustain a degree of productivity, it can require putting that intensity aside and taking a break, so the wall isn't hit. Another approach is to alternate high-intensity work with low-intensity work — step away and move if the work is on a computer. It can help to chunk activities: set goals, and after reaching them, stop and take a break, rather than letting a project sprawl deeper and deeper. It's also important to assess your stressors — stressors aren't all negative, but if we're not pacing, if we're not setting aside time to calm our nervous system, we can still hit that wall. It's really important to set an intention before starting — how it's going to be broken up, setting a timer for how long before a break — to really be intentional.For Low ArousalJust recognizing that low baseline arousal can already have us thinking creatively about how to increase it. Do we need to change the setting where we're working? Do we need to find a way to make what we're doing more interesting — what is the why? Make it more creative. When we have that low arousal, instead of reaching for food or surfing the internet, we could instead have a creative outlet that's stimulating and raises our arousal without being harmful to us. Movement is a way to raise arousal — getting up and moving around can help. It can also help to chunk activities and put a timer on; sometimes the challenge of getting something done in a certain amount of time will raise arousal on its own.Everyone's approach to this, and what works for them, will be different. But I do feel like this understanding can help us all recognize how we function best, recognize when we're in that under-arousal or hyper-arousal state, and modulate — all with the intention of not being on that roller coaster, and instead finding that place in the middle where we can be in a state of flow, enjoying what we're doing, finding meaning and purpose in it.I'd love to hear your thoughts and experience. Have you found things that help you find your own sweet spot? Until next time, take care.CourtneyCourtney Snyder MD is a Holistic and Functional Child and Adult Psychiatrist who offers non-patient consultations to individuals and practitioners nationally and internationally in addition to her treatment practice serving FL, IN, KY, OH. Her educational content, shared through her website, Substack Newsletter, the Holistic Psychiatry Podcast and her YouTube Channel reaches readers and listeners in over 160 countries.Resources* RCCX Theory & Psychiatry. Dr. Sharon Meglathery* RCCX Theory: Hypermobility, RCCX Theory, Mental Health & Complex Chronic Illness* Recent newsletter on Hypersensitivity: High Sensitivity Through 3 Lenses (HSP, Pyrrole Disorder & RCCX Theory) This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

I recently joined Annika Taylor on The Wellness Rebel Podcast to talk about mold toxicity, and how it can cause not only physical symptoms, but also brain symptoms such as anxiety, depression, OCD, brain fog, mood swings, and in more severe cases, psychosis.Watch the full conversation above. Below is a recap of our conversation, along with the resources we discussed along the way.Chapters:0:00 Introduction to Mold and Mental Health1:47 Understanding Mold Exposure and Illness5:13 Personal Journey with Mold Illness8:40 Sources of Mold Exposure12:12 Physical Symptoms of Mold Toxicity18:54 Mental Health Impacts of Mold Exposure25:32 Identifying Mold in the Environment32:28 Treatment Options for Mold ToxicityI. What Is Mold-Related Illness?Mold-related illness can be broken down into three distinct categories that often get lumped together: mold allergy, mold toxicity, and mold colonization. Mold allergy, which most people are familiar with, is a reaction to outdoor or indoor mold spores. Mold toxicity is different: it happens when mycotoxins actually accumulate in the body, something that appears to affect roughly 25% of people who can't effectively remove the toxins on their own. This explains why one family member in a home with mold can get seriously ill while another in the same house is fine. Third is the lesser-known mold colonization, where mold spores take hold directly in the sinuses or even the GI tract. That means a person can be out of a moldy environment for years and still have an internal source of toxicity.II. My Own Mold StoryMy interest in mold began around 10 years ago when I was diagnosed with mold toxicity. For years prior, I had been dealing with chronic fatigue, symptoms of fibromyalgia, and vague neurological symptoms that neither my doctors nor I could explain. My daughter was also having complex chronic health issues that initially looked like developmental regression. Understanding the microbiome and dietary changes were helpful to both of us, as were the Walsh Research Institute's nutrient-based interventions, but the real turning point came when the topic of mold toxicity came across my radar in 2016.Mycotoxin testing and testing of our home and my office confirmed that we had significant exposure and toxicity, which we were treated for and benefited significantly from.III. When a Partner Isn't on Board: How Mold Treatment Affects the Whole FamilyOne thing that doesn't get talked about enough is how difficult it can be for someone to get out of or address an exposure if their spouse or partner is not on board. In my own case, I was fortunate — my then-husband was agreeable, especially when he realized how much clarity, decisiveness, and even sense of urgency I had. We'd dealt with significant health issues for a long time, and I didn't want something irreversible to emerge that would leave me in regret for not acting sooner. We acted on that instinct.We were very lucky to find that we were eligible for insurance coverage, which covered an extended-stay hotel while we had our home remediated. For a lot of families, that's not the reality. If a partner isn't on the same page, it can become one of the biggest reasons someone doesn't end up leaving a house with mold — whether that obstacle gets talked about openly or not. There are those who don't believe mold toxicity is real, and those who don't want to believe it's real (consciously or unconsciously). Education, input from those with expertise, or even seeking couples therapy can be necessary.It is important to remember that part of the treatment, namely addressing mold in the home, impacts the whole family.IV. Where Mold Hides: Common Sources of ExposureFor most people who test positive for mold toxicity, the primary exposure is likely environmental, as opposed to mold in food. Leaks under sinks, problems around windows, roof leaks, chimney flashing, damp basements, and high ambient humidity are all common culprits. High humidity left unaddressed can be a big problem. Estimates of the percentage of homes that mold have crept up over the years, from 50% to 75% to, as some consultants now say, essentially every building to some degree. I've seen a couple of children with developmental issues who had mold in their mattresses from bedwetting.V. The Physical Symptoms of Mold ToxicityMold toxicity often shows up as sinus issues (especially with colonization), asthma, and — notably in young children — recurring croup (spasmodic croup) and ear infections.Many people with mold toxicity also develop mast cell activation, which triggers an exaggerated immune response affecting the skin, respiratory tract, GI tract, and/or bladder. Racing heart, air hunger, and stomach pain can occur. Neurological complaints can include electric "jolt" sensations, numbness and tingling, headaches, light sensitivity, and temperature dysregulation.Many of these symptoms overlap with Lyme disease, EMF sensitivity, and other chronic conditions. The immune dysregulation caused by mold toxicity can contribute to a vulnerability to Lyme and its coinfections, Candida, SIBO, PANS, PANDAS, and more.VI. The Brain and Mental Health Symptoms of MoldBrain Fog, Fatigue, Anxiety, OCD, Psychosis, Mood Swings, Developmental Delays & Cognitive DeclineI don't know what psychiatric symptom mold toxicity can't cause. Brain fog and fatigue are especially common, as is anxiety. For some, mold toxicity can contribute to psychosis and/or dramatic mood swings. In children, mold toxicity can look like ADHD, anxiety, or developmental delays.I see mold toxicity as something that aligns with — and amplifies — someone's existing genetic vulnerabilities rather than acting alone. Most of the patients I see with severe conditions like schizophrenia, bipolar disorder, or severe OCD have mold toxicity as a contributing factor, though, again, rarely the only factor.The Neurotransmitter ConnectionMold toxicity can drive up pyrrole levels, which in turn depletes zinc and B6 — two nutrients essential for neurotransmitter functioning. It can also worsen copper-zinc imbalances through oxidative stress and interfere with methylation, both of which also impact neurotransmitter functioning.A Client's Story: OCD and a Hidden LeakAnnika recalls when she became interested in helping those with mold toxicity. She shares the story of a friend whose severe, debilitating OCD — along with episodes of derealization and out-of-body sensations — turned out to trace back to black mold discovered behind a washing machine, the result of an old water leak. Once they addressed the mold, the connection became clear in hindsight.VII. Mold Toxins Can Create a Threat Response in the Body & BrainWhile we can have threats on the outside, mold toxicity is a threat we can have on the inside. When we are under threat, three systems tend to get activated: the immune system (as discussed with mast cell activation), the limbic system, and the autonomic nervous system. The limbic system puts the body into a vigilant, threat-scanning state — and for some people, that vigilance surfaces as OCD (an unconscious attempt to "make things right" when the body senses something is wrong), health anxiety, or a diffuse sense that something isn't okay.The autonomic nervous system, meanwhile, can get stuck in fight-or-flight or shutdown mode instead of rest-and-digest. Annika is careful to frame this not something to fear, but something to understand — the goal isn't panic, it's empowerment.VIII. Testing for Mold: Home and BodyTesting Your EnvironmentIf there's visible water damage or visible mold, extensive testing usually isn't necessary. Generally, where there is water damage or water retained in a space, there will be mold growth. The priority becomes proper containment, and remediation. If there is no known issue and someone has mold toxicity (which could be from an old exposure), I recommend the ERMI-style dust test (I use Mycometrics), which measures water-damage-associated spore counts against outdoor spore counts from a simple cloth dust sample.I caution against relying solely on air sampling from a home inspector, which I and many of my patients have found unreliable by itself — surface or dust testing gives a clearer picture. Petri-dish testing (I use Immunolytics) can help pinpoint which room is affected, though it misses a couple of important mold species.Testing Your BodyFor testing mycotoxins in the body, I use RealTime Labs, an at-home urine test that screens for five toxin families. Annika discusses her experience with another company, which showed false negatives — a patient with a "no mold" result went untreated for years while ongoing exposure continued.To improve the accuracy of the test, I sometimes have patients do a sauna session or take glutathione in the days leading up to testing, to help mobilize toxins — though this isn't appropriate for everyone, particularly more sensitive patients.IX. Treatment: Binders, Antifungals, and DietEnvironment:Once someone has a positive test and a known or suspected source, I recommend having a consultant (separate from the remediation company, to avoid conflicts of interest) create a remediation plan — ideally with proper containment so the remediation process itself doesn't spread spores further. After remediation, a retest should be done to confirm the space is actually clean, ideally at the remediation company's expense if it isn't.Binders:On the body side, treatment typically starts with binders — chosen based on which toxins showed up on testing — such as bentonite clay, activated charcoal, chlorella, or cholestyramine (a prescription option that binds ochratoxin particularly well). I start sensitive patients low and slow, since mobilizing toxins can temporarily worsen symptoms.Antifungals When Appropriate:Depending on the response and whether colonization is present, treatment may progress to nasal or systemic antifungals.Diet:Because colonization is so common, minimizing sugar and refined carbs is very important, since these feed Candida and mold colonization directly. Foods with higher trace mold content — corn, peanuts, dried fruit, aged meats and cheeses, coffee, and non-shelled nuts — are also worth limiting, along with high-histamine foods for those who are histamine-reactive.X. Where to Learn MoreAs Annika emphasizes: this isn't about fearing every corner of your home — it's about being empowered with the right information.And as always, I welcome your thoughts, experience and questions.Until next time,CourtneyCourtney Snyder MD is a Holistic and Functional Child and Adult Psychiatrist who offers non-patient consultations to individuals and practitioners nationally and internationally in addition to her treatment practice serving FL, IN, KY, OH. Her educational content, shared through her website, Substack Newsletter, the Holistic Psychiatry Podcast and her YouTube Channel reaches readers and listeners in over 160 countries.Resources* Dr. Courtney Snyder's blog: How Mold Toxicity Impacts the Brain* Home mold test (dust sample / ERMI-style)* RealTime Labs mycotoxin urine testing* Mold Symptom Questionnaire (Dr. Jill Crista)* Mold Clean-Up Guide (Dr. Jill Carnahan)* Finding mold consultants & remediation professionals (ISEAI)* Annika Taylor's website: Nourished by NatureMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your own physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

As a holistic and functional psychiatrist, I see many people who are highly sensitive. Most are deep divers into information and able to connect a lot of dots. Many are gifted. Many struggle with overwhelm and low stress tolerance. Some struggled with anxiety, inner tension, or feeling “too much” for as long as they can remember. Some feel different - that they don't fit in.As a holistic and functional psychiatrist with over twenty years in practice, I've worked with thousands of highly sensitive adults and children. Most are deep divers into information, able to connect a lot of dots — many are gifted. And yet many struggle with overwhelm, low stress tolerance, anxiety, or inner tension that has been there for as long as they can remember. Many feel different, like they don't quite fit in. What I've found is that sensitivity itself is rarely the problem — it's the seeming vulnerability to brain-related or physical conditions. Over the years I've found three different models to be especially useful in explaining some of the vulnerabilities and the strengths of those of us who are highly sensitive: Dr. Elaine Aron's work on the Highly Sensitive Person (HSP), the nutritional medicine concept of Pyrrole Disorder, and Dr. Sharon Meglathery's RCCX Theory. Each looks at a similar group of traits through a different lens — psychological, biochemical, and genetic, respectively.Before I start, I want to emphasize that sensitivity is not a pathology or a diagnosis. It is actually a trait that has existed across human history for a reason. My goal is not to pathologize it, but to understand it — and to offer tools to those who have these traits but who are struggling with a condition more prevalent in those with these traits. As I go through these three frameworks, the overlap will be obvious and I'll highlight what each of these has to offer that the others don't.What You'll Learn* The HSP model provides validation and a language for sensitive individuals.* Pyrrole Disorder involves an overproduction of pyrroles, leading to nutrient depletion of nutrients critical for neurotransmitter functioning.* Pyrrole Disorder is common in brain-related conditions.* RCCX Theory connects genetic vulnerabilities to sensitivity and chronic illness.* Stress amplifies the experiences of highly sensitive individuals.* Understanding these models can lead to effective treatment options.* There are meaningful paths forward for those who are highly sensitive.Chapters* 00:00 Understanding High Sensitivity* 02:26 The Highly Sensitive Person (HSP) Model* 10:23 Exploring Pyrrole Disorder* 18:18 RCCX Theory Explained* 30:11 Intersecting Models: HSP, Pyrrole Disorder & RCCX Theory* 34:40 Conclusion and Path ForwardI. THE HIGHLY SENSITIVE PERSONIn the early 1990s, psychologist Dr. Elaine Aron identified a personality trait she called Sensory Processing Sensitivity (SPS) — and the people who score high in it she called Highly Sensitive Persons, or HSPs.This is not a diagnosis. It is a trait, present in roughly 15–20% of the population. It has been found across more than 100 species — from fruit flies to primates. This tells us it is evolutionarily conserved — it confers survival advantages. In any social group, having members who are wired to notice subtle cues, process information deeply, and detect threats before others do is extremely valuable. Fitting with this, many of these individuals, who also struggle with complex chronic health issues are considered the “canaries in the coal mine” since their bodies react to environmental triggers (environmental toxins, chemicals, or stressors) long before the rest of the population.Dr. Aron captured the core features of this trait in an acronym she called DOES:D — Depth of processing: HSPs think deeply, reflect before acting, and notice subtleties that others miss.O — Overstimulation: Because they process so thoroughly, HSPs reach their threshold more quickly in high-stimulation environments.E — Emotional reactivity and Empathy: HSPs feel emotions intensely and are highly attuned to the emotions of those around them.S — Sensitivity to subtle stimuli: They pick up on things — in their environment, in social dynamics, in the body — that others simply don't register.As you can see, traits that are super powers, can become liabilities. The deep diver who loses sight of the big picture. The empath who absorbs everyone else's energy as their own energy becomes depleted. The person who withdraws from the world because the stimulation has simply become too much.HSP ResearchBeyond the clinical observations, there is now a growing body of neuroscience and genetic research supporting this trait. There is evidence that the brains of sensitive people are doing more, processing more and feeling more.fMRI studies (Acevedo, Aron et al., 2014) have shown that when HSPs view emotional images — particularly photos of loved ones expressing happiness or sadness — their brains show significantly greater activation in regions associated with awareness, empathy, and sensory integration.Twin studies show that Sensory Processing Sensitivity (SPS) as defined by Dr. Aron is approximately 47% heritable. Small studies as opposed to large genome wide studies have focused on genetic variants involving dopamine and serotonin systems, such as a serotonin transport gene, a dopamine receptor gene, and COMT, which codes for the enzyme that metabolizes dopamine and norepinephrine.While this hints at a biochemical dimension, the HSP framework doesn't address this as directly as the other two models I'll discuss, nor does it explain the higher prevalence of physical health conditions in those who are highly sensitive.Research published in 2026 (Matsuzawa et al.) found that individuals high in SPS had substantially higher rates of depression (13.8%), anxiety disorder (10.5%), and developmental disorders, such as ADHD and ASD, compared to the general population.Despite this overlap with developmental disorders: unlike, ADHD, HSPs typically have excellent concentration in quiet environments. And unlike the social deficits described in ASD, HSPs tend to have heightened social attunement. They often feel too much of what's happening in social situations, not too little, even if they respond awkwardly at times.Research shows that high sensory processing sensitivity is associated with more frequent physical symptoms — back pain, fatigue, digestive issues, frequent illness.What This Framework OffersThe HSP model has given millions of people validation and a language for these traits that has allowed them to shift from “what is wrong with me” to “this is how I am wired.”It also offers an evolutionary reframe. High sensitivity is not a mistake and is not pathologic. It is a feature of the human population that has served us.What it doesn't offer is a biological explanation for why some sensitive people suffer so acutely — or a path toward biochemical intervention. II. PYRROLE DISORDERPyrrole disorder is a biochemical imbalance that has been recognized for decades, though it remains largely unknown in mainstream psychiatry. It involves an overproduction of pyrroles — metabolic byproducts that, on their own, are not a problem. When they are high, however, they can result in a depletion of zinc, B6 and a few other nutrients.First identified in the 1950s and first treated with zinc and B6 in the 1980s, pyrrole disorder is one of the most common nutrient imbalances found in brain-related conditions — and one of the most treatable. Yet most people who have it have never heard of it. I learned about pyrroles in 2014 when I first trained with the Walsh Research Institute.The Importance of Zinc, B6 & MagnesiumVitamin B6 is required to synthesize dopamine, serotonin, and GABA — three of the most critical neurotransmitters for mood regulation, anxiety, and stress response. Zinc plays a profound role in the central nervous system, the immune system, gastrointestinal tract (which we now know has its own significant influence on brain health) and connective tissue (joints and skin).Pyrrole Disorder Traits & SymptomsThe most consistent feature is low stress tolerance. People with elevated pyrroles are often described as those for whom life seems harder than it should be, every transition can be destabilizing and every large group or new environment feels like too much.The overlap with the HSP profile is striking, but here, we start to see not only traits, but symptoms.- Socially anxious, shy, or fearful since childhood, with severe inner tension- Sensitive to bright light, loud noises, textures, and odors- Avoids crowds, strangers, and new situations- History of reading difficulty- Poor short-term memory- Underachievement- Irritability, mood swings, bouts of depression- Tends to stay up late; little or no dream recall; morning nausea- White spots on fingernails; very dry skin; stretch marks; poor wound healing- Joint pain- Frequent infections or autoimmune tendenciesMost people with pyrrole disorder don't have all of these symptoms — but the inner tension, the high sensitivity, and low stress intolerance are very common.What the Data ShowsThe Walsh Research Institute has collected data on over 30,000 patients. Elevated pyrroles were found in:* 18% of those with ADHD* 24% of those with depression* 28% of those with behavioral disorders* 35% of those with autism* 35% of those with bipolar disorder* 30% of those with schizophrenia* 12% of those with PTSDAnd in only 8% of healthy controls — meaning those with no psychiatric diagnosis.What Causes Pyrrole Disorder?For many, there appears to be a genetic component, but for others, pyrroles appear to have increased due to high physiologic or emotional stress. Examples include candida overgrowth or other forms of gut microbial imbalances, mold toxicity, heavy metals, chemical exposures, illness, emotional trauma, major life transitions or even growth spurts in children.What This Framework Brings UsRelative to the HSP framework, an understanding of pyrroles gives a specific, treatable biological mechanism. When zinc, B6, Magnesium and other nutrients are depleted, we know how the brain's neurotransmitter functioning is affected — and we know what to do about it.Treatment from a Walsh Research Institute trained practitioner typically involves a nutrient protocol of zinc (based on zinc and copper testing), B6 or its active form P5P, and other nutrients for pyrrole disorder and other nutrient imbalances identified. For many patients, a lifetime of chronic inner tension and fearfulness begins to shift within days to a couple of weeks of starting the nutrients.Treatment doesn't change one's personality, but it can improve social discomfort, overwhelm, the anxiety, the depression that has been layered on top of that sensitivity.Where zinc deficiency can impact a lot of the physical conditions that appear to be more common in those who are hypersensitive, it doesn't fully explain the significant hormonal, inflammatory, connective tissue symptoms and autoimmunity we see in many who are hypersensitive.III. RCCX THEORYRCCX theory has been proposed by Dr. Sharon Meglathery, MD — a psychiatrist and internist whose own complex health history (which is very similar to my own) led her to one of the most compelling explanations I've encountered for why hypersensitivity, neurodivergence, psychiatric conditions, MCAS (Mast Cell Activation Syndrome), EDS (Ehlers Danlos Syndrome), POTS (Postural Orthostatic Tachycardia Syndrome), CIRS (Chronic Inflammatory Response Syndrome) and/or CFS (Chronic Fatigue Syndrome) and autoimmunity tend to cluster together in certain individuals and families.RCCX refers to a module of four genes on chromosome 6. Three of them appear to be particularly important to our health, and two of those have very high rates of mutation.The Three Key Genes(1) TNXB codes for a protein involved in connective tissue. Variants range from subtle joint hypermobility to Ehlers-Danlos Syndrome. But connective tissue isn't just about joints — it's also about the permeability of the gut-blood barrier, the blood-brain barrier, and vulnerability to upper cervical (neck) instability, which can put tension on the vagus nerve and affect the entire autonomic nervous system.(2) CYP21A2 is the most important gene in the module when it comes to psychiatric conditions. It codes for 21-hydroxylase, an enzyme needed to convert 17-hydroxyprogesterone into cortisol. When there is a mutation — and there can be many, of varying degrees — the body may struggle to meet the demand for cortisol under stress. A weakness on this gene could have two primary effects:First — The theory holds that many people with CYP21A2 mutations, even without hypermobility, may develop what Dr. Meglathery calls a “brain wired for danger” — essentially, a nervous system calibrated toward threat detection from early in life, with minimal trauma required. A mutation on CYP21A2 may essentially result in relatively higher androgens impacting the amygdala — the brain's fear and emotional center. Studies have found that hypermobile individuals (who often carry TNXB mutations) have a larger-than-normal amygdala.Second — because of this mutation, the body may not be able to keep up with the body's need for cortisol (especially when under stress). This deficit causes the brain to release corticotropin releasing hormone (CRH) to signal the adrenal glands to produce more cortisol. CRH binds to mast cells and activates the immune system — leading to secondary brain inflammation. This is the inflammatory pathway that can result in a number of secondary health issues including MCAS, CIRS, POTS, CFS and more.(3) C4 is involved in immune response and autoimmunity, and has been linked to schizophrenia. This gene variant is not as common as the first two referenced, though I do see a number of families who also have autoimmunity impacting multiple family members.The CAPS Psychological ProfileDr. Meglathery uses the term CAPS — CYP21A2 Mutation Associated Neuropsychiatric Spectrum — to describe the psychological profile she has observed in people with this genetic vulnerability. These traits can exist long before any formal psychiatric diagnosis, and they are not inherently pathological. - Anxiety and over-arousal during times of stress — high adrenaline, insomnia, sometimes manic-like characteristics- Under-arousal during low-stress periods — leading to ADD presentations, compulsive behaviors, or thrill-seeking to raise arousal- High emotionality, sensitivity, and reactivity to environmental stimuli- Sensory processing difficulties — typically over-stimulation in loud or chaotic environments- A strong ability to read emotions in others, paired with social awkwardness in response- Easily affected by events others would consider minor — an offhand comment, a disturbing movie- A tendency toward nonconformity- Special abilities: gifted musicians, scientists, creatives, systems thinkers- Hyper-focus and obsession with areas of deep interest, often leading to remarkable accomplishments- High tenacity and determination, when not derailed by overstimulation or past trauma- Strong emotions — positive or negative — that can manifest as obsessional worrying, harm avoidance, OCD tendencies, or very high standards for self and othersDr. Meglathery also notes — and I have observed this clinically — that people with this profile tend to find each other through friendships, partnerships and marriage. They are drawn together by shared sensitivities, emotional depth, and intellectual gifts. This means children are likely to receive a tendency towards CAPS from both sides.Women who are appear to have CYP21A2 mutations often have a male-pattern finger length ratio — the ring finger longer than the index finger — a possible marker of androgen exposure during development.What RCCX OffersRCCX theory offers the broadest biological framework we have for understanding why sensitivity, psychiatric vulnerability, and complex chronic illness so often travel together in the same people and families. It connects the nervous system, the immune system, the hormonal system, and connective tissue under one genetic umbrella.It also points toward specific interventions: nervous system regulation (limbic retraining, vagal work), mast cell management, and addressing the downstream biochemical consequences of cortisol dysregulation.The limitation is that genetic testing for variants on the gene for 21-hydroxylase is not yet widely available, which is why this isn't a gene that you'll see referenced when it comes to HSP, though I would argue it is likely the most prevalent. RCCX remains a clinical theory — but one that explains the constellation of traits and symptoms of most of the people that I in my practiceIV. WHERE THESE MODELS INTERSECTWhere Might Pyrrole Disorder and RCCX Theory Meet?The symptom overlap is almost complete: poor stress tolerance, sensory sensitivities, anxiety, inner tension, connective tissue symptoms, frequent infections, autoimmune tendencies. Relatively low zinc would impact most of these shared symptoms, but there may be a potentially deeper connection.21-hydroxylase contains a pyrrole-like structure — heme — within it. Could a mutation resulting in abnormal 21-hydroxylase lead to a buildup of abnormal heme-like compounds, contributing directly to pyrrole disorder? This is not proven, but in an exchange about this with Dr. Meglathery, she indicated that she also believes there is a strong association, and the biochemical logic is compelling.This matters, because we know what helps pyrrole disorder. We have a treatment — treatment that can complement what RCCX theory makes evident — that the stress response has to be addressed.Stress (again from any cause - physiologic or emotional) is the great amplifier across all three models. Stress worsens the HSP experience, and tips the CYP21A2 mutation from manageable to destabilizing (through the hormonal consequences and the inflammatory cascade) and yes, it even causes pyrroles to increase.BRINGING IT TOGETHERFor someone who is highly sensitive, and struggling with brain related or physical symptoms or conditions, pyrrole disorder and even RCCX theory are worth considering because they offer tools and start to answer, “What Can We Do About It?”The three frameworks work together:The HSP model offers validation and language. It shifts the frame from deficit to difference. It reminds us that sensitivity is not pathology — it is a trait with evolutionary value, and it comes with great strengths.The Pyrrole model offers a treatable nutrient imbalance. It explains, at the neurotransmitter level, why stress hits harder for these individuals. Treatment doesn't take away the sensitivity; it lifts the weight that has accumulated on top of it.The RCCX model offers the broadest systems view. It connects the dots between what the body is doing — the immune activation, the hormonal dysregulation, the connective tissue involvement — and the psychiatric and psychological profile that tends to accompany it. It also provides additional tools: nervous system regulation, mast cell support, hormonal awareness.If any of this resonates — the sensitivity, the inner tension, the feeling of always being at the edge of overwhelm — please know that there are roots to explore and meaningful paths forward.If you are looking for someone trained by the Walsh Research Institute knowledgeable in assessing for and treating pyrrole disorder (and other common nutrient imbalances impacting brain health), or learning more about Dr. Aron's work on HSP and Dr. Meglathery's RCCX theory, I am providing those links below.And as always, I welcome your thoughts, experience and questions.Until next time,CourtneyAbout the AuthorDr. Courtney Snyder MD is a Holistic and Functional Child and Adult Psychiatrist who offers non-patient consultations to individuals and practitioners nationally and internationally in addition to her treatment practice serving FL, IN, KY, OH. Her educational content, shared through her website, Substack Newsletter, the Holistic Psychiatry Podcast and YouTube Channel reaches readers and listeners in over 160 countries.ResourcesWalsh Research Institute: walshinstitute.orgRCCX Theory — Dr. Sharon Meglathery: rccxandillness.comDr. Elaine Aron — The Highly Sensitive Person: hsperson.comOther Sources: Acevedo et al. 2014, “The Highly Sensitive Brain,” Brain & Behavior | Matsuzawa et al. 2026, Psychiatry & Clinical Neurosciences ReportsMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this episode, Dr. Courtney Snyder, a Holistic Child and Adult Psychiatrist discusses:- The research into Adverse Childhood Events (ACEs) and health outcomes (at a population level)- How early adversity can impact our physiology, biochemistry and thus neurotransmitter functioning- Why ACEs scores are less meaningful at an individual level- The role of Positive Childhood Experiences (PCEs) on mitigating the effects of adversity in childhood- The gift of neuroplasticity and resources to help teach/train/rewire our nervous system to feel safe.Chapters00:00 Introduction to Holistic Psychiatry01:25 Understanding Adverse Childhood Experiences (ACEs)07:07 Impact of Early Stress on Physiology and Biochemistry16:27 The Role of Positive Childhood Experiences21:01 Vulnerability to Trauma and Genetic Factors22:05 The Power of Positive Experiences in HealingPositive Adaptive Childhood Experiences Study 2019 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747474/To learn more visit:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

It is increasingly understood that our brain health is dependent on our having healthy nutrient levels. But how do nutrients actually impact our neurotransmitters.We might assume that certain nutrient levels would cause certain symptoms or conditions. Instead, what we find are biotypes - one condition is often associated with a small handful of imbalances. For example, the biotypes of depression from the Walsh Research Institute, included undermethylation, overmethylation, pyrrole disorder, copper overload and metal toxicity. And reversely, one nutrient imbalance can contribute to a range of brain symptoms. Copper overload, for example, can be a factor in ADHD for one person, but for another contribute to panic or insomnia and still another rage or tantrums. There are some conditions, however, that have a very strong associations with specific nutrient imbalances. In this newsletter, I will address:* 5 Ways Nutrients Impact Neurotransmitter Functioning* Psychiatric Conditions That Can Almost Predict a Specific Nutrient ImbalanceThe data comes from the Walsh Research Institute. Nutrient Imbalances Can Be Due to Too Much or Too LittleI use the term nutrient imbalances, because it's not just about deficiencies of certain nutrients. Specific nutrient overloads can impact brain health as well. This biochemical diversity means we don't all have the same needs when it comes to diet and supplementation. Some of us, for example, can benefit from folate, but for others with excess folate, supplementation could worsen depression and anxiety. Those with copper overload can similarly have worsening of symptoms with copper supplementation, while others will have a need for copper.What Causes Nutrient ImbalancesWhile it might seem that this is all about our intake of nutrients, we can come by these imbalances genetically. We can also acquire deficiencies and even overloads through high oxidative stress. This is when our body (including our brain) is dealing with too many insults, resulting in a depletion of our inherent antioxidants leaving us vulnerable to DNA and thus cell damage, inflammation and their consequences). Copper zinc imbalances and elevated pyrroles, which results in relatively low zinc and B6, are signs of oxidative stress. Often an imbalance appears to have multiple causes. For example a woman with high copper causing high anxiety, could have a family history of high copper conditions (post partum depression, ADHD, angry outbursts) and thus have a likely genetic vulnerability. She may also, be taking a multivitamin with copper, eating a lot of chocolate (high in copper) dealing with high oxidative stress and not the least, be on an oral contraceptive (added estrogen can make copper go up).5 Ways Nutrients Can Impact Neurotransmitter FunctioningNutrients often function as co-factors, helping certain enzymes do their job. Specific nutrients are needed: * For production of neurotransmitters. Vitamin B6, for example is needed to make serotonin, dopamine and GABA. B6 can be low in pyrrole disorder and thus contribute to a range of symptoms.* To convert one neurotransmitter to another. Copper is needed to turn dopamine into norepinephrine (think adrenaline). If we are high in copper, we could have relatively low dopamine and high adrenaline states, which is what is seen in ADHD.* To support enzymes involved in the breakdown of neurotransmitters. For example MAOA is an enzyme that needs Vitamin B2 to do its job breaking down serotonin, dopamine and norepinephrine. If these aren't broken down, there could be problems with activation and anxiety.* To help receptors do their job. Receptors are what neurotransmitters bind to, resulting in a impulse being sent down the nerve cell. Zinc and magnesium help regulate the NMDA receptor. If not well regulated, there can be high activity, which can look like thoughts getting stuck - ruminations, obsessions in OCD, cravings in addiction, and even delusions in psychosis.* Regulate the expression of genes for serotonin reuptake receptors. Folate causes an increase in the expression of these genes (and thus production of these receptors). This results in more serotonin being picked up and less available between nerve cells. This could be a problem for someone who already has low serotonin symptoms. SAMe, on the other hand, does the opposite and it can function like an SSRI.Why One Diagnosis Isn't Always Associated With One Imbalance* Psychiatric conditions appear to have various causes. If someone comes to me with a diagnosis of depression, for example, that only tells me what type of symptoms they likely have. It doesn't tell me if those symptoms are related to high copper, a methylation imbalance, elevated pyrroles, candida, a misaligned upper cervical spine , mast cell activation, mold toxicity, metal toxicity, hormone imbalances or a combination of any of these…….or something else.* More often multiple factors appear to be aligning. It is not uncommon, for example, to have candida or mold causing high pyrroles causing low zinc, leading to high copper, and as an aside also be undermethylated.* One “root cause” can contribute to a range of conditions and symptoms. Some people with high copper are diagnosed with depression or anxiety and others with ADHD. Some people who are undermethylated have OCD, others depression and still other schizophrenia. Very often, people will be have multiple diagnoses fitting with an imbalance. “Comorbidities” in psychiatry are the norm, rather than the exception.Despite all of this, there are certain nutrient imbalances that occur so commonly in certain psychiatric conditions that they can almost be predicted . Data From Walsh Research InstituteSimply knowing someone has a mental health condition makes it more likely that they will have a methylation imbalance - more often undermethylation.The Walsh Research Institute has looked at the methylation status of 30,000 over 40 year and found that 70% of those with mental illness exhibit a methylation imbalance (undermethylation and overmethylation). This is relative to the general population, in which 30% had a methylation imbalance.Other Data From the Walsh Research Institute:* History of Postpartum Depression - 95% have copper overload* ADHD - 68% have a copper zinc imbalance* Autism Spectrum Disorder - 98% undermethylation, 98% low zinc* Antisocial Personality Disorder - 95% undermethylation, 95% pyrrole disorder, 95% low zinc* Oppositional Defiant Disorder - 85% undermethylation* Schizoaffective Disorder - 90% undermethylation* Anorexia - 82% undermethylation* Schizophrenia - 70% undermethylation* Violent behavior - 78% high copperEvaluation & Labs Are Still ImportantNone of these are 100%. And, again, there is rarely one contributing factor, so a comprehensive evaluation and lab testing are still important. Even if I am fairly confident that someone is low in zinc, I don't recommend starting zinc without checking zinc and copper levels. Starting zinc too rapidly can mobilize high copper and worsen symptoms. If copper is low, zinc can cause a further decrease.Also, there are occasions when it can be difficult to address an imbalance, without addressing another contributing issue first. For example, I see some patients who are unable to tolerate treatment of undermethylation until they begin treatment for candida or mold.There is always so much more data to share, when it comes to the Walsh Research Institute. I look forward to discussing biotypes of depression, ADHD and schizophrenia in a future episode.As always, I welcome your comments and questions.Until next time,CourtneyTo learn more about my discovery calls, non-patient consultations, and treatment practice, visit:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In light of the recent lawsuit against Meta and YouTube/Google, I want to share an overview of some of the research into the impacts of screen media on the development and mental health of children and teens. But more, I want to provide support and resources for parents.In this episode, I discuss:* The recent and expected deluge of lawsuits against social media platforms* Research into:* Infants and toddlers and screen time* Online learning in schools* Amount of time online in teens pre and post COVID* Chatbots and generative AI* Children's exposure to pornography* EMF, which has a greater impact on children than adults* Support and resources for parents (see below)* The importance of aligning with children and teens around shared goalsReferenced Resources* Boston Children's Digital Wellness Lab* The 5 M's of Digital Wellness* Family Digital Wellness GuideAssessing and Lowering EMF ExposureEMF and the BrainAs always, I welcome your thoughts and questions. I learn a lot from your comments.Until next time,CourtneyTo learn more about my discovery calls, non-patient consultations, treatment or to inquire about mentoring, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this short episode, I discuss the relationship between accelerated aging “oxidative stress.” Oxidative stress is what accelerates aging, promotes chronic illness, including brain related conditions, and depletes our energy, focus and quality of life.Our left brain would like to control our bodies and the natural order of things, while our right brain would have us paying more attention to our embodied short existence on this planet. Instead of focusing on “anti-aging,” we could consider ways to lower oxidative stress (in a relaxed way). Here, I comment on:* The double bind of aging in these times* What oxidative stress is* Signs and health conditions associated with oxidative stress* Causes of oxidative stress* General ways to address oxidative stress (more on this in future episodes)* The importance of lowering oxidative stress in a relaxed way (so as to not have undo stress increasing oxidative stress!)I look forward to sharing more details on limiting exposures, and supporting our antioxidant and detoxifications systems in future episodes.As always, I welcome your thoughts and questions. I learn a lot from you.Until next time,CourtneyTo learn more about my discovery calls, non-patient consultations, treatment or to inquire about mentoring, please visit my website at:CourtneySnyderMD.comReferenced Resources:Understanding the Impact of Toxins on the Brain and Brain DevelopmentMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this episode, I encourage clarity, as our news is flooded with information about released files. I address concerns about the normalization of abuse through language, emphasizing the importance of correct terminology to protect victims and prevent further harm. I also discuss the role our biases play and offer tools for awareness and advocacy.Chapters00:00 Language & The Blurring of Lines in Abuse02:50 Desensitization & Normalization 04:18 Understanding Consent and Age of Consent (Legal Perspective)11:21 The Role of Bias in Language15:20 Call to Clarity and ResponsibilityWords matter. The language we hear seeps into our unconscious and has the ability to make what is horrific palatable. It has the ability to take something as horrible as child sexual abuse and human trafficking and gradually start to make it seem almost normal.Listen carefully and you will hear this shift in the public discourse around the release of millions of documents about many of our world's wealthiest and most powerful people abusing children and adults. You will hear a blurring of the lines - of what it means to be a child and what it means to be abused, assaulted, and trafficked. You will also hear a clouding of the distinction of who is responsible when abuse occurs.I'm concerned that the coverage — the amount and the language used (even by the well-intended) — is normalizing what we can't normalize. This blurring of lines only emboldens perpetrators who are out there right now. It puts more children and adults at risk. It prevents more victims from reporting abuse and it further harms anyone who has been abused.This episode is my attempt to counter that normalization, encourage clarity, and provide tools to help you recognize the types of words and phrases that blur important lines.EliteWe obviously live in a society that idealizes those with money, power, and celebrity. We project our innate gifts and greatness onto a few. We turn over our inner authority. We even project our inner wisdom onto bedazzling marketers posing as wellness and spiritual gurus.Those with the most depraved behaviors in our culture have our fascination, while humble, service-driven leaders are largely ignored. Should we be surprised that a group of sociopathic “elites” are leading many of our institutions?Our collective idol worship has helped elevate, support, and protect those who've harmed not only their victims, but all of us who rely on their institutions.Will these recent discoveries help us change course? How our society handles this open abscess will either lead to greater clarity and healing - or it will manage to infect us further.DesensitizationInevitably, this story, with all of its far-reaching implications, will be in the news for a very long time. The more we hear something, the less shocking it becomes.The amount of media content on this topic (even if in the direction of needed justice) is already leading to a collective desensitization. We are losing sight of the severe harm caused to the victims and survivors. (I include “victims,” because not everyone survived.)NormalizationA thoughtful popular podcaster who identifies as someone who wants justice for the survivors and accountability for the perpetrators said: “He may have had a sexual relationship with an underaged woman.” This podcaster is just one of many using this type of language. Even Steven Inskeep, a seasoned journalist with NPR, described the victims in the sex-trafficking case as “underage women.” After a number of listeners spoke out, NPR did an autopsy of sorts to understand how (in the line of editors and checks), this ended up being read on air. NPR made a public apology, explained how this ended up being read on air and what they were doing to prevent it from happening again.Many journalists recognize a need to understand and use appropriate language. But, most in independent media, who are actually investigating and discussing the files, aren't trained journalists and many are unintentionally contributing to the normalization of abuse.To say, “He may have had a sexual relationship with an underaged woman” blurs more than one lineFirst, adults and children do not have sexual relationships. Adults sexually abuse children. It is increasingly important to have clarity on this singular point and to have words that reflect this clarity.Saying “he had a sexual relationship with…,” implies that the child was able to consent.● Children are unable to consent as indicated by the law.○ Consent = voluntarily, actively, and knowingly agree to or grant permission for a specific act, proposed by another. There is more to the legal definition, which I'll get to for adults, but here, that doesn't matter, because, again, children are unable to consent.○ There is a significant power imbalance between children and adults○ When a child is abused, they are being harmed in that moment and will have enduring impacts from the abuse (emotional, psychological and physical).Along these lines “child prostitute,” and “child porn”, suggest consent. Saying instead that a perpetrator sexually abused, exploited and trafficked a child and saying sexual abuse materials recognizes that children are unable to consent.Second, “underage woman” is an oxymoronI can only imagine this term is being used to describe a physically mature teen. It's as if an adult is saying, “She looks like a woman to me.” It doesn't matter how physically mature a child looks, they are still a child. A child can not consent regardless of their physical appearance.But what about the phrase, “underage girl”?An “underage” girl is a girlThere is no reason to add the word “underage,” here. Children are children. If underage is being added, it is blurring that fact. Child, girl, boy, or minor are the terms to use.If we hear “underage woman,” or “underage girl,” over and over again, before we know it, we may be saying it without even thinking.What could the podcaster have said instead?“He may have sexually abused (or sexually assaulted) a child,”Age of ConsentIf children can't consent, you might be wondering about situations, such as a sexual relationship between a 17-year-old girl and an 18 year old teenage boy.Age of Consent = the age at which anyone can consent to anyone older.Depending on the state (here in the United States), the legal age of consent is anywhere from 16-18. But, even for states in which the age of consent is 16 or 17, there are laws that specify how much older the “older” person can be to whom the 16 or 17-year-old is consenting.The information coming out of the files is about perpetrators who were clearly well beyond 18 and early adulthood. In fact, they were old enough to have achieved prominence in their respective fields.What about the women who were of “the age of consent”? Here's where I'll share with you the complete legal definition of consent. (Since children are unable to consent, I didn't share the qualifiers yet).Consent means to voluntarily, willfully, and knowingly agree to, approve, or yield to a proposition or action proposed by another. Consent is given by a person with legal capacity without coercion, fraud, or duress. It requires active permission rather than passive submission or absence of resistance.So when Megan Kelly, an attorney/media personality, describes many of the victims as “barely legal” (as opposed to teenagers who were unable to consent to much older adults or young women who were coerced), the law would say, this is not legal and is abuse - a crime.From Normalizing to CelebrationAnother podcaster/journalist/academic who is seemingly on the side of the victims and survivors completed what seemed to be an appropriate and serious podcast by inviting his audience to share in the comments if they found anything “spicey” in the files. He smiled as he said this.Spicey = exciting or entertaining, especially through being sexually suggestive or involving conflict.“Spicey,” goes well beyond normalization to tantalizing. I don't think this is something he intended to communicate and I don't think he is unusual in this regard. You could say his listeners got a glimpse in the window - of feelings as he read the files.Our Words Are a Window Into Our Biases…and there are some windows, we may not want people looking in. We all have biases. It is simply part of human nature, part of the associations our neuronal connections have made. Our biases are influenced by our families, childhood experiences, our culture and what media content we consume. Our biases in this case, are also influenced by whether we have children or not and their ages and gender. I had to wonder, for example, if an adult who has a daughter would be as likely to say, “underage woman or underage girl,” than an adult who doesn't.Those who deny they have biases are more susceptible to their problematic impacts. We can all be more aware of how our own biases show up. The language we use is just one of the ways. Collectively, we can ask ourself, how do we consciously or unconsciously think about● children? Are they separate beings with their own potential and their own lives who are in their most critical developmental stage or are they less than adults and not worthy of the same respect and care? (This can also be a window into how worthy we were made to feel as children)● young women? Do we think of them differently than young men? Are we more okay with blurring the line between girls and women than between boys and men? How often would someone say “underage man,” or “underage boy” when it comes to sexual assault?● consent? Do we say she was “involved with” or use words like “prostitute” or “escort” when all evidence points to the person being trafficked?● abuse? Do we use language to describe the victim , such as “she was in a relationship with,” or do we use language to describe the actions of the abuser, he “assaulted”, “raped,” “coerced,” “exploited,” or “trafficked” her or him?● human trafficking? Do we even think about it? Do we even realize that, after drug trafficking, human trafficking is the second-largest criminal enterprise in the world? But for my medical license requiring me to stay informed about trafficking and how to recognize it, I may not be aware.A Call to Clarity & Responsibility While language can further diminish our humanity and recognition of human suffering, it also has the ability to elevate compassion and bring clarity to what matters most in a given situation, in this case the sanctity of childhood, the suffering of others and finding ways to prevent it.Though I rarely comment much on social media sites, I have felt a need, in this case, to do my small part to help bring clarity. When I notice language that normalizes abuse, I kindly point it out and offer an alternative, hoping maybe the person will even pay it forward.We all have the opportunity to notice when people unintentionally use language that blurs the line between children and adults, or suggests that victims are responsible. We don't have to let our silence suggest agreement. We don't have to go along or let it stand. We can all do our part to counter the eroding psychological, emotional and moral guardrails that prevent abuse from happening.We can also thank those who haven't lost sight of what is at stake. I noticed one young podcaster/attorney used words that convey the gravity and horrific nature of what he had been reading in the files. He appeared depleted and even sick, because he was. He hadn't lost sight of what the files are about - the systematic abuse of children and women by the very people our society chose to elevate to power. Nor had he lost sight of his responsibility to the survivors, to his listeners, to our humanity and to the truth.Wishing all of us the ability to maintain clarity in these challenging times.CourtneyAs always, I welcome your insights and observations. There is much more that can be said about this topic. To learn more about my discovery calls, non-patient consultations, treatment or to inquire about mentoring, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this episode, I discuss panic attacks and underlying vulnerabilities that can increase the sensitivity of our alarm system. * What is a panic attack and what does it feel like? * What neurotransmitters are involved?* What is panic disorder?* What nutritional, genetic, and hormonal factors can be at play?* What types of inflammation and toxicity can lead to panic attacks?* How do the immune, limbic and autonomic nervous system contribute?* How does insecure attachment, trauma and stress interact with these other vulnerabilities?Takeaways* Panic attacks occur when the brain's alarm system is overly sensitive.* Physical symptoms of panic attacks can be debilitating and terrifying.* Underlying physiological factors contribute to vulnerability to panic attacks.* Neurotransmitters like norepinephrine and GABA play crucial roles in panic disorders.* Hormonal imbalances, especially in women, can increase the likelihood of panic attacks.* Mast cells are involved in the immune response and can trigger panic symptoms.* Biotoxins, such as mold toxins, can contribute to mast cell activation, limbic system dysfunction and autonomic nervous system dysfunction* Limbic system dysfunction can lead to heightened anxiety and panic.* The autonomic nervous system regulates our fight or flight response.* Emotional stressors and trauma can contribute to panic attacks, but appear to be aligning with other physiologic vulnerabilitiesChapters00:00 Understanding Panic Attacks03:07 Physiological Factors Behind Panic Attacks06:00 Neurotransmitters, Nutrient Levels and Panic Disorder08:52 The Role of Genetic Variants & Hormones in Panic Attacks12:07 Inflammation and Panic Attacks14:53 Mast Cells - The Bridge Between the Immune & Central Nervous Systems18:06 Biotoxins and Their Impact on Panic21:00 Limbic System Dysfunction and Panic24:11 The Autonomic Nervous System's Role26:45 Emotional Stressors and Panic AttacksAs always, I welcome any comments and questions. Your interests and what you care about helps guide the information I share. Also, its really nice for me to be in conversation and learning from you.Until next time,CourtneyTo learn more about my discovery calls, non-patient consultations, or mentoring, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

As the new year gets rolling, I've been trying to make room for what I call “the soul.” To me, this means being more receptive to those mysterious synchronicities, insights, and feelings so easily missed when I keep myself busy and distracted. Sometimes this energy comes from within, and sometimes it's a “postcard from God,” as Walt Whitman would say.Bernie With His Plough & The Great Horned OwlIt could be a lyric that aligns with something on my mind. The other day, I heard Elton John sing the lyric about the howling old owl in the woods (from “Goodbye Yellow Brick Road”). Though I've heard the line many times before, this time was different. Recently, each night when I take my dog out, I hear the haunting sound of a great horned owl in the woods behind my house.But what do I do with that synchronicity? Is it the owl itself - a symbol of wisdom, intuition, mystery, and the ability to see beyond illusion- that I should listen to? Maybe it's the lyric Bernie Taupin wrote for Elton about a desire to leave the superficial ego-driven world behind and return to a more grounded life - a more authentic self. Bernie was ready to leave the yellow brick road of striving for success. He wanted to go back to his plough and back to the howling old owl in the woods.Maybe it's both - the haunting sound of the owl and a longing to return “home.” Maybe the owl's saying, “Leave me alone already and just honor the mystery.” Maybe Bernie is telling me he'd love my simple, quiet life in rural Kentucky, a life that at times doesn't feel full enough.Contemplating Solitude With MertonA couple of days ago, while doing Qigong (meditative movements similar to Tai Chi), I wondered if there is a place nearby where people gather and move in these gentle ways. The first place that came to mind was the Abbey of Gethsemani, which is not far from here. Finding a group of monks, at least Trappist monks, doing Qigong, would be quite unlikely. Maybe if Merton were still around.Gethsemani was made famous by Thomas Merton, an influential spiritual writer and Trappist monk who lived at the monastery for 27 years. Four of those years, he spent mainly in his hermitage - a secluded cabin in the woods. “Not all of us are called to be hermits, but all of us need enough silence and solitude in our lives to enable the deeper voice of our own self to be heard at least occasionally.” - Thomas MertonBefore entering the Abbey at 26, Merton was worldly, raucous, and rebellious. Like Bernie and many of us, he struggled with the tension between a simple, humble life and a desire to engage with and influence the outside world.While at Gethsemani, Merton wrote over 70 books about contemplation, prayer, Eastern religions, interfaith dialogue and social justice, including his famous autobiography, “Seven Story Mountain.”What do I do with that? Merton did all of that while living a quiet life right here in my neck of the woods. Hmmmmmm….Reclaiming That Girl That Used to Be MineSometimes the soul provides a shift in how we think about ourselves and our lives. Sometimes, however, a postcard cuts right through all the analysis and goes straight to the heart.Yesterday, I saw a video reel of Sara Bareilles and Rufus Wainwright singing, “She Used to Be Mine.” Though I'd heard parts of this song before, I never stopped long enough to listen. Last night, with my reclaimed intention of receptivity, I did. Instead of landing on some great insight, I found myself in tears. Quickly, I pulled myself out, before sliding right back into those tears, tears that I realized I was grateful could still flow.When was the last time I cried? And why was I crying? And, why were so many of the people in the audience crying? The song is about losing one's self, and losing the connection to the child we once were - a universal loss that can make some of us ache, even at the age of 58, when we think we've done such a brilliant job of putting all of those parts of ourselves back together.Though no longer recognizing herself, she still remembers the girl she used to be. She sings with tenderness about that girl's imperfection, effort, goodness, and self-reliance. She questions what life would have been like if she could rewrite the ending for that girl.Sara Bareilles wrote this song for the 2016 Broadway musical, “Waitress.” The lead character sings it at the end of the second act when she has hit rock bottom. She is lost and struggling to remember who she is. Through the song, she mourns the loss of herself before starting to gain footing and for a moment taps into the strength and grit of that child she starts to reclaim.The story isn't over. We all have an opportunity to write the next act and to extend unconditional affection for the child that she describes as messy, but kind, lonely most of the time, but more, she is all of this “mixed up,” and “baked in a beautiful pie.”Why Here & Now?My long-held hope in sharing information online has been to balance the mind and spirit (the right and left brain). In recent times, I've leaned into the left-brain science. That's what people tend to read or listen to. That's what people need and can't easily find elsewhere. I'd forgotten, however, that expressing myself from my heart is something that I need. It is who I am. My own health and healing required much more than scientific information. It would be dishonest to only share part of that story.Even as a child, writing was my lifeline. It helped me find my place in the world. It gave me peace. That child wouldn't need to make sense of why the owl speaks to me at night. Or, why Bernie showed up with a plough in hand. Or, why Merton put down his pen and stepped out of his cabin to greet me in the woods. Or, even why Sarah, dressed as a waitress, crossed my path while singing a song I'd be sure was written just for me.But, I'm not only that child. I'm all grown up and can't help but wonder why these particular energies showed up now, beyond the fact that I created some space for them to do so? What would they have me know? I think, to embrace paradox and to remember that we are physical beings of this world, and also spiritual beings who transcend it. We need connection, and we need solitude. We are adults shaped by a lifetime of experience, and still vulnerable children filled with wonder and sometimes hurt. We are light, and we are shadow. And as Sara would say, we are all of this “mixed up and baked in a big beautiful pie.”Wishing you wholeness as you make your way through this year,CourtneyTo learn more about my discovery calls, non-patient consultations, or mentoring, please visit my website at:CourtneySnyderMD.com This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

SummaryIn this episode, I discuss copper overload, a common yet often overlooked contributor to various mental health issues, including postpartum depression and ADHD.The referenced data comes from the Walsh Research Institute, which studied nutrient levels in 30,0000 people with brain related symptoms, and found a small handful of nutrient imbalances repeated showing up. Copper overload was the one of those imbalances.I explain the relationship between copper and zinc, and how elevated copper can impact neurotransmitter functioning. I also address the symptoms of high copper, potential causes for its elevation, methods for assessing copper levels, and treatment strategies to manage copper overload effectivelyTakeaways* Copper overload is prevalent in mental health conditions.* High copper levels are linked to postpartum depression.* Copper affects neurotransmitter functioning, specifically dopamine and norepinephrine* Zinc is essential for regulating copper levels.* Symptoms of high copper include anxiety, insomnia, depression and rage.* Dietary sources of copper include shellfish and chocolate.* Oxidative stress can elevate copper levels.* Copper and estrogen have a significant relationship.* Assessment of copper involves specific lab tests.* Treatment includes nutrient protocols and reducing exposure.Chapters00:00 Understanding Copper Overload10:36 Identifying Symptoms and Conditions Related to Copper21:10 Assessing and Treating Copper OverloadTranscriptAs always, I welcome any comments and questions, as these help guide the information that I share.Until next time,CourtneyTo learn more about my discovery calls, non-patient consultations, or mentoring, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this episode, I discuss:* Mold related illness, with a focus on mold toxicity and mold colonization* The wide range of brain symptoms (and other symptoms associated with mold toxicity* How we can become exposed to toxic mold even when we don't see mold growth* Why not everyone with the same exposure doesn't become toxic* How mold toxicity is diagnosed* How we can test our environment for mold* The four core aspects of treatment: removing exposure, using binders to eliminate toxins, addressing fungal colonization if present, and adjusting diet to avoid feeding mold and candida, which often is present in those with mold toxicity* The importance of addressing mast cell activation, limbic system retraining and vagal nerve interventions for those who are highly sensitive to treatment interventions* Practical steps such as air purification, humidity controlIn the next episode, I will be reviewing research exploring the connection between mold and brain related conditions — and address the question, “Does mold enter the brain, in those who are not obviously immunocompromised?”Rarely does mold toxicity occur in isolation. It will often contribute to other root causes, such as mast cell activation, electromagnetic hypersensitivity, multiple chemical sensitivity, increased pyrroles, worsening of copper zinc imbalances, decreased methylation, and an increased risk of other microbial activations or autoimmunity.As always, I welcome any comments and questions, as these help guide the information that I share.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this episode, I explore compulsive caregiving from an attachment perspective. This is a more subtle form of insecure attachment that nonetheless affects one's ability to thrive and enjoy healthy relationships. Related terms include over-functioning, codependency, and Nice Guy / Good Girl Syndrome.This is the fourth of a four-part series on how our experiences with caregivers in the first three years of life can impact our emotional regulation, beliefs about ourselves, and adult relationships.Here I discuss:* How early attachment experiences shape compulsive caregiving and the “parentified child” dynamic* How over-functioning, people-pleasing, and codependency share a common root in early life and are an attempt to manage attachment anxiety* How physiologic differences, especially of those who are highly sensitive (HSP/Highly Sensitive Person), may make them more vulnerable* The similarities to other addictive and compulsive behaviors* Where this attachment style would fall if placed on the attachment spectrum* The beliefs, emotional states, behaviors, and communication styles that can be present when someone struggles with compulsive caregiving.* The physical and psychological toll of the often-present chronic stress and emotional repression* Tools and interventions that can help one move towards healing and thriving* Specific resources that support awareness and recovery, including The Drama of the Gifted Child, Adult Children of Emotionally Immature Parents, and Codependent No MoreAs always, I welcome any comments and questions, as these help guide the information that I share.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comLinks to related content:Compulsive Caregiving, Over-functioning, Codependency & Nice Guy/Good Girl SyndromeMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

I am happy to share a recent conversation I had with Dr. William Walsh about his new book, “The Essence of Bipolar Disorder,” where he lays out his discovery into the cause of Bipolar Disorder, a condition with fluctuating high and low mood states that has baffled researchers and psychiatrists.Dr. Walsh, the president of the non-profit Walsh Research Institute, is an internationally recognized expert in the field of nutritional medicine. Dr. Walsh's work in nutrient-based psychiatry began while collaborating with the renowned Carl C. Pfeiffer, MD, PhD (a pioneer in the field of nutritional psychiatry) to develop individualized nutrient protocols, originally focusing on violent and criminal behavior before expanding to ADHD, depression, anxiety, bipolar disorder, autism and schizophrenia. Dr. Walsh went on to study more than 30,000 patients with mental disorders, acquiring an unparalleled database of more than 3 million chemical assays during his clinical and research work. From this database, Dr. Walsh discovered the biotypes of depression, ADHD and Schizophrenia.Dr. Walsh has conducted chemical analysis of more than 25 serial killers. He has assisted medical examiners, Scotland Yard, and the FBI. He has designed nutritional programs for Olympic and professional athletes.In this episode, we discuss:* Bipolar Disorder, how it differs from other psychiatric conditions and why it has been so challenging for psychiatric researchers to understand.* The strong inheritance of Bipolar Disorder (despite a single gene never having been identified).* Dr. Walsh's journey uncovering the cause of Bipolar Disorder, which started with studying the related neuroscience research, followed by a review of the emerging genetic research, specifically, the GWAS (Gene-Wide Association Study), which identified many genes related to bipolar disorder, to a focus on the ion channel genes, DNA repair genes and finally Bipolar Disorder as a “channelopathy.”* The alignment of genetic vulnerabilities involving ion channel genes and DNA repair genes and oxidative assault.* How the weakness of DNA damage genes can contribute to other health issues, accelerate aging, and lower life expectancy.* How weak ion channel genes can also contribute to high oxidative stress.* Bipolar Disorder as a “channelopathy”, and the explanation for switching from euthymia (normal mood) to mania to depression and back to euthymia (from a neurotransmission standpoint)* How this information impacts treatment and prevention.Related Content:Wash Research InstituteLunch with Dr. William Walsh - His Story, Discoveries & the Future of Nutrient-Based PsychiatryBreakthrough Theory of Bipolar DisorderAs always, I welcome any comments and questions, as these help guide the information that I share.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this episode, I discuss the anxious (ambivalent–preoccupied) attachment style — a pattern marked by intensity, dependence, and a longing for reassurance.I address how this attachment pattern develops, how it can appear in adulthood, and what kinds of therapeutic and holistic supports can help someone move toward a more secure attachment style. Specifically, I discuss:* How inconsistency in early caregiving (and even threats or experiences of abandonment) can lead to an anxious attachment style and problems with emotional regulation.* The key differences between anxious and avoidant attachment patterns* What the infant-toddler attachment research revealed about early caregiving and attachment dynamics* How anxious attachment can manifest as overwhelm, and fear of abandonment in adult relationships* Links between attachment and biochemical factors such as inflammation, methylation, high copper, high pyrroles, mast cell activation, and even biotoxin illness such as mold toxicity.* Psychotherapy approaches that promote regulation and security — including learning about healthy boundaries* The importance of structure, daily routines, and developing a reliable “inner parent”* Mind–body strategies such as guided meditation, goal-focused journaling, and creative learning* How addressing both emotional and biochemical roots can support long-term healing and resilienceWith awareness, compassion, education and support, we can rewire our nervous system toward greater calm, clarity, and self-trust.As always, I welcome your thoughts and questions.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

What do the TV and film characters Don Draper (Mad Men), James Bond, Miranda Priestly (The Devil Wears Prada), and Rick Blaine (Casablanca) have in common? Each is a fairly good illustration of the Avoidant-Dismissive Attachment Style portrayed in film.In the last episode, I discussed how our experiences with caregivers during our first three years of life may continue to impact our ability to regulate emotions and form beliefs about ourselves and others. More deeply, I address how attachment shapes our neurophysiology - specifically our right and left hemisphere differentiation, our limbic system (“lizard brain”) and our autonomic nervous system.In this episode, I will focus more closely on one end of the attachment spectrum - the avoidant-dismissive attachment style. I'll discuss:* How, in the early research, attachment was measured in toddlers and adults* How avoidant-dismissive attachment appears to develop* What it looks like in relationships* Personality Disorders that, if present, align with this type of attachment style* Similarities with undermethylation and how avoidant-dismissive attachment style may relate to undermethylation* The role of psychotherapy, group work, and supportive relationships in healing* Other tools, practices, and choices that can support healing.* How awareness of these patterns can transform not only personal well-being but also parenting and family dynamics across generationsOne theme I return to often is that growth is always possible. While avoidant attachment may develop early in life, it does not define a person forever. With curiosity, growing compassion, and the willingness to practice new ways of relating to ourselves and to others, we can expand our capacity for connection and begin to feel more whole.In the next episode, I look forward to discussing the other end of the attachment spectrum - the Anxious-Ambivalent (Preoccupied) Attachment Style.As always, I welcome any comments and questions, as these help guide the information that I share.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comLinks to related content:Methylation & Brain HealthUndermethylation Myths, MTHFR & The Great Folate DebateMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Lately, I've been thinking about the increasing use of the term “dysregulated.” This is an effective term that expresses having difficulty accessing calm in the body and brain after a stressful situation. When we think about nervous system regulation, we often overlook the fact that its foundations are largely built in the first years of life. Though we don't “remember” this time, it continues to influence us as adults.The good news is that, even if our early experiences weren't ideal, we can still move toward greater attachment security, and thus better emotional regulation, positive beliefs about ourselves and others, and healthier ways of relating.In this episode, I discuss:* What attachment is and why the first three years are so foundational* How our nervous system develops through our early attachment experiences, specifically,* Right and left brain differentiation* Limbic system* Autonomic nervous system, which includes the vagus nerve (that puts us into rest, digest and connect)* The main attachment styles and how they shape our beliefs, emotions, and behaviors* The influence of early stress, high cortisol life-long regulation* Why culture's "left brain dominance" can leave us disconnected from empathy, embodiment, and nuance* Practical ways we can start to nurture secure attachment and grow more self-compassion, even later in lifeFor me, this is not about blaming parents but about understanding the impacts of arguably the most important time in our lives. This is also a reminder that it is never too late for us to learn to become responsive caregivers to ourselves.If you have a specific situation, concern or question that you would like me to react to in a future newsletter/episode, please email that to support@courtneysnydermd.com. Names will never be shared.Until next time,CourtneyTo learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comCourtney Snyder, MD This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Lately, I've been thinking about how detrimental the medical field's compartmentalization of our body systems is to understanding what's really going on.Today's episode is for anyone who has seen multiple specialists for various symptoms and still feels unwell, and for anyone interested in connecting the dots between seemingly unrelated health concerns.In this episode, I discuss:* A letter from someone with wide-ranging symptoms who has seen multiple specialists without answers or seeming movement towards healing.* Why the traditional medical system has become compartmentalized into over 130 specialties, and how this model affects diagnosis and treatment* How psychiatry and neurology have diverged, despite both addressing the brain and nervous system* The limitations of the term mental illness and why I prefer to talk about brain symptoms* A comprehensive look at symptoms often considered psychiatric-including emotional, cognitive, behavioral, and sensory ones-and how these may reflect broader systemic issues* How neurotransmitters work, factors that can influence too much and too little neurotransmitter activity, and why biochemical imbalances often underlie both psychiatric and neurological symptoms* My hope for the future of healthcare.If you have a specific situation or concern you would like me to address in a future newsletter/episode, you are welcome to send it to support@courtneysnydermd.com.Until next time,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.com This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

I hope you're enjoying a lovely summer. In recent months, I've been taking time away from writing and teaching to help my parents (who are in their late 80's), while continuing my practice, consultations, and mentoring. I find myself learning over and over again that I can't do everything I want. I have great empathy for those of you caring for family members, tending to your health (and perhaps theirs), working, and still trying to make room for your passion. A big part of my passion is sharing information with you here.To date, I've talked about the details of my work and how I approach mental health. Today, I thought I'd take a step back and comment on the broader picture of psychiatry in its evolving forms.In this episode, I discuss:* The education of psychologists versus psychiatrists and child psychiatrists* The decrease in psychiatrists who provide psychotherapy* The difference between Conventional/Allopathic Medicine and Functional Medicine* The difference between Conventional, Functional, Holistic, and Integrative Psychiatry.* The meaning of Nutritional Psychiatry & Environmental PsychiatryLastly, I explain why I prefer the warmer and rounder term, Holistic Psychiatry, and what that means to me.With Gratitude For Your Ongoing Interest,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.com This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Previously shared as a paid newsletter in May 2024. In previous newsletters, I've addressed many of the more common contributing factors to brain symptoms, including high pyrroles, copper-zinc imbalances, methylation imbalances, candida overgrowth, mast cell activation, mold and other forms of toxicity, and genetic variants, such as COMT and MAOA.Supplements can be needed to address each of these. Medication can also be necessary when treating mold and mast cell activation.But what happens when someone can't tolerate a supplement or medication because it worsens or creates new brain symptoms? Why, for example, could someone have problems tolerating B6 or SAMe or Methionine. Why might someone have problems with folate, niacinamide, glutathione, certain herbal treatments, antidepressants such as SSRIs, probiotics, antifungal medication or binders such as bentonite clay, activated charcoal, chlorella or cholestyramine?In this newsletter, I'll discuss:* Five common reasons a supplement or medication may worsen symptoms.* Specific supplements and medications that are more likely to do this.* How reactions may point to root causes.* Treatment steps that can improve tolerance.There can be a wide range of brain symptoms that can occur when someone is having an adverse reaction, such as fatigue, brain fog, depression, anxiety, agitation, and even psychosis or mania. I'll use “reactivity” to refer to this range of possibilities. While physical side effects can also occur, the focus here will be on brain symptoms.5 Common Reasons Supplements or Meds May Worsen Symptoms1. Immune ReactivityOur immune system is intertwined with our central nervous system. When our body's immune system reacts to a toxin, microbe, injury, or trauma, we can have inflammatory brain and physical symptoms.“Feel Like I'm Reacting to Everything” - Mast Cell ActivationIf someone is experiencing severe immune reactivity, such as mast cell activation, they may react to many supplements and medications, as well as triggers in their environment and stress. The number of triggers can help point to an exaggerated immune response. In my practice, this high immune reactivity is usually driven by mold toxicity.For many with this obstacle, starting very low and slow can prevent reactions. For others, interventions may be needed to lower immune reactivity and stabilize mast cells. This, however, can require certain supplements. For those who can't tolerate those treatments, limbic system retraining programs help calm the immune system so people can move forward more easily.Sensitivity & IntoleranceIt is possible to have immune sensitivity (or even allergy) to a supplement, though I find this less common. Herbal supplements, for example, which are high in salicylates, may cause symptoms in those with salicylate sensitivity. Certain probiotics have bacterial strains high in histamine. This is an issue for those with histamine intolerance.2. Too Much or Too Little Neurotransmitter ActivitySome people with brain symptoms have high neurotransmitter (NT) activity, and some have low. Common NT's include serotonin (5-HT), dopamine (DA), and norepinephrine (NE). I use the term “neurotransmitter activity” because it's not just about the amount of neurotransmitters present; it's also about the amount of receptors present that pick up NTs and remove them from the space between nerve cells.High Neurotransmitter ActivityToo much neurotransmitter activity can cause brain symptoms such as mania, psychosis, agitation, anxiety, panic, obsessions, compulsions, and hyperactivity. Reactions can occur if supplements or medications are given that further increase NT activity.Examples include:* Overmethylation* Slow COMT (involved in clearing DA and NE) and/or slow MAOA (involved in clearing 5HT, DA and NE)A variant on COMT and/or MAOA doesn't mean they are being expressed.What Increases Neurotransmitters?* SSRIs (Selective Serotonin Reuptake Inhibitor) increase serotonin activity* SNRIs (Serotonin and Norepinephrine Reuptake inhibitors) increase serotonin and norepinephrine activity.* Stimulant medications such as Ritalin and Adderall increase dopamine activity* SAMe and methionine increase serotonin and dopamine activityRemember that there can be times when there is a mixed picture, such as when someone is undermethylated and has a slow COMT.Low Neurotransmitter ActivityReactions can occur if supplements or medication decrease the neurotransmitter activity when it is already low. This could look like depression, apathy, fatigue, and brain fog.Examples include:* Undermethylation* Fast COMT (involved in clearing DA and NE) and/or fast MAOA (involved in clearing 5HT, DA and NE). The NTs are getting cleared too fast.What Decreases Neurotransmitters?* Folate, a nutrient that is good for a lot of people happens to be a big problem for many with psychiatric conditions. Most with underemethylation have low serotonin symptoms (depression and/or anxiety). While folate can help methylation, as an unfortunate aside, it can also further lower serotonin activity. Folate is in most multivitamins and B Complex vitamins. To learn more: Undermethylation, MTHFR & The Great Folate Debate.* Niacinamide can lowers DA and NE.Looking closely at someone's symptoms and traits and assessing methylation through bloodwork can help determine if NTs are too high, low, or mixed and what types of treatment to consider.3. Poor Detoxification or Toxic OverloadZincZinc is one of the most powerful tools I use in my work. Some people can easily tolerate it, while others can struggle. Here are some reasons someone may not tolerate zinc.* High copper—Zinc mobilizes copper. Moving too much copper at once can increase copper symptoms (anxiety, anger, hyperactivity, insomnia).* High toxicity—Zinc is a strong antioxidant. It is needed for the genetic expression of one of the most important antioxidants in our body, metallothionein.It took me 8 months to get my dose up to an optimal range, which is certainly not the norm. I unknowingly had significant mold toxicity at the time.When I start someone on zinc, I slowly build it up over 3-4 weeks. For some (like myself), even this is too fast.GlutathioneThis is the other major antioxidant. If someone is having difficulty tolerating it, they may have problems with detoxification and significant toxicity (metals, biotoxins like mold, and chemicals). These can start to be addressed in several other ways.BindersThese include bentonite clay, chlorella, activated charcoal, and cholestyramine. They bind toxins, especially mold toxins, in the GI tract. If they are started too quickly, the toxins they are supposed to remove get stirred up, which stirs up symptoms. When people say they can't tolerate certain binders, they usually weren't started low enough.There are others, but these are the most common in my experience.4. Underlying Microbial or Microbiome IssueB6B6 is very important for brain health. It is needed for making serotonin, dopamine, and GABA. We use it in all the Walsh nutrient protocols to varying degrees. In the last 10 years, we've seen a decrease in B6 tolerance. It's not clear why. I'm including it in this section because the reactivity is suspected to be related to the microbiome. Perhaps in recent years, we have had collective damage to our microbiomes from toxins and rising EMF exposure. We don't know.The good news is that P5P, the active form of B6, is usually well tolerated. In my practice, I rely heavily on P5P. I will occasionally use it in combination with B6 (if tolerated) for those with especially high pyrroles.Methionine and/or SAMeBoth are used, though usually not together, to help address undermethylation. I suspect candida or mold when someone is having difficulties tolerating either of these. These nutrients are usually better tolerated once candida and/or mold are addressed (or are starting to get addressed).5. Die-OffAnything that kills off microbes, such as candida or mold, can cause a “die off” of those microbes, release toxins, and worsen symptoms. Antifungal supplements, antifungal medication, and probiotics may cause this type of reactivity. Antifungal medications include nystatin, diflucan, itraconazole, and amphotericin B.Herbs and food-based supplements can have antimicrobial effects. Turmeric is one example. There are many others, so it's always worth checking. Worsening symptoms might point to an underlying fungal or other microbial overgrowth. It may also suggest that appropriate binders may be needed first.Addressing or preventing die-offs could mean supporting detoxification, starting binders if necessary, and, again, starting low and going slow.Antidepressants, interestingly, have been shown in labs to have antifungal effects. This does make me wonder if some people who can't tolerate them are having die-off.Root CausesKnowing someone's history of reactions can help point to underlying root causes.As you can see, there are typically ways to help someone tolerate and go on to benefit from a needed supplement or medication.As always, I welcome your thoughts and experience.Until next time,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your own physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

We are living in a world that feels increasingly “left-brained.” Though both hemispheres are constantly working together, they have distinct values, traits, and ways of operating the world. In this podcast episode, I discuss:* The different attributes of the left and right hemisphere* How can we recognize which hemisphere is taking the lead in a given moment* The advantages of letting the right brain take the lead* How we strengthen our right hemisphere with the help of neuroplasticity (and specific (enjoyable) activities).* The added benefits of doing this in community.Related to this topic, I look forward to sharing information soon on an upcoming discussion group called “Strengthening the Right Brain in Left Brain Times.” In the meantime, as always, I welcome discussion right here. Please feel free to comment and to help me get the value of the right brain out into the world.Until next time,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter and podcast episode is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

OCD, or Obsessive Compulsive Disorder, is a debilitating condition that involves intrusive thoughts and time-consuming, repetitive behaviors. It impacts 80 million worldwide, 2-4% of the US population or 1 in 100 people here in the US.It can be difficult to overstate the suffering caused by OCD, not only for those with this condition but also for their family members. In addition to the distress caused by the obsessional thoughts and compulsions, there can be shame and loss - loss of more meaningful, purposeful, or pleasant thoughts and behaviors. and loss of time connecting with others or engaging in purposeful or enjoyable activities.Other conditions associated with obsessive-compulsive disorder include:* Body dysmorphic disorder* Skin picking* Trichotillomania (hair pulling)* Hoarding* Hypochondria* Olfactory reference syndrome (an irrational feeling or belief that one emits a foul smell and often attempts to remove the odor).It´s not unusual for someone with OCD to have other conditions, such as:* Other forms of anxiety* Depression* ADHD* Autism spectrum disorder* Eating disorders* TourettesResearch suggests that having OCD raises one´s vulnerability to developing dementia. Many other brain conditions, however, also appear to increase this vulnerability similarly.Treatment ChallengesOCD is particularly challenging to treat. Of those with OCD, 60% do not respond to typical therapies (often medication in combination with psychotherapy involving gradual exposure to that which is being avoided). Typical medications include:* SSRI´s (Selective Serotonin Reuptake Inhibitors) -e.g., sertraline, fluoxetine, fluvoxamine, citalopram, paroxetine* Tricyclic antidepressant - clomipramine* SNRI - (Serotonin and Norepinephrine Reuptake Inhibitor) - venlafaxine* Atypical antipsychotic medications are sometimes addedMedication is combined with CBT (Cognitive Behavioral Therapy), which involves exposure and response prevention, or CBT is used alone.As you can see, most medication approaches aim to increase serotonin activity. Serotonin, however, is just one of the neurotransmitters involved. What has become increasingly clear from the research is that OCD involves abnormal activity at the NMDA receptor - a glutamate receptor.NMDA & GlutamateThe NMDA receptor is found throughout the brain. Glutamate, the primary excitatory neurotransmitter in the central nervous system, binds to the NMDA receptor. NMDA and glutamate are involved in synaptic plasticity (creating neuronal connections), learning, memory, and motor function.The synapse is the space between communicating neurons. Presynaptic neurons release glutamate, which binds to the NMDA receptor on postsynaptic neurons. This results in a cascade of signaling events that lead to “neuronal excitation.” The problem arises when this receptor has too much (or too little) activity. In the case of OCD, there is too much activity.Implications* Dysregulation at the NMDA receptor appears to play a role in OCD, depression, PTSD, schizophrenia, bipolar disorder, and substance use disorders.* Weak memory extinction can result from high activity at the NMDA receptor. While memory is a good thing, we can have problems with too much memory - or rather, problems putting our memories aside. This can look like thoughts getting stuck, for example:* Intrusive thoughts in OCD* Flashbacks in PTSD* Delusions in psychotic disorders* Cravings in addiction.* Neurodegenerative disorders, such as Alzheimer's, Parkinson's, and ALS, have also been linked to NMDA receptor malfunction.Methylation & NMDAThose who are undermethylated, especially those with OCD or addictions, have high activity at the NMDA receptor. To remind you, undermethylation is a biochemical process with many functions, including the breakdown of histamine, support of detoxification, and support of serotonin activity. When someone is undermethylated, they can tend to have allergies (from high histamine), be perfectionistic, competitive, strong-willed, have obsessive-compulsive tendencies, be ritualistic, have dietary inflexibility, and have high accomplishment or have family members with high accomplishment. Undermethylation can contribute to the low serotonin activity seen in OCD. Simply addressing undermethylation, like merely addressing serotonin, will only bring partial benefit. To address undermethylation, those of us trained by the Walsh Research Institute, use SAMe and/or methionine, B12, B6, magnesium, and antioxidants. We address this before starting methylation treatment for those with high homocysteine. But how can we also decrease activity at the NMDA receptor?Blocking NMDA & Normalizing Glutamate ActivityEsketamine or Ketamine, which has been getting much attention in recent years, can impact the brain in various ways; however, its primary mechanism is as an NMDA blocker or antagonist. For some, it can serve as a rapid-acting and highly effective antidepressant. It can also decrease OCD symptoms. Other NMDA-blocking drugs include memantine and dextromethorphan (combined with bupropion). Lamotrigine can decrease glutamate release and has been used as an adjunct medication for OCD.Nutrients, however, play an important role in the NMDA receptor. NAC or N-acetyl cysteine is a precursor to glutathione and, thus, an antioxidant. It is also anti-inflammatory and a binder for a particular toxin made by candida and mold. But, it is also a potent NMDA antagonist (decreases activity at NMDA) and has been shown to reduce obsessions and compulsions of OCD. It has also been studied in alcoholism, opiate addiction, cocaine abuse, gambling disorder, shopping disorder, cigarette addiction, and trichotillomania. It has been used by itself and as an adjunct to medication therapy. NAC has become part of the Walsh undermethylation nutrient protocols for those with OCD and/or addiction.Zinc also plays an important role in regulating functioning at the NMDA receptor. The Walsh Research Institute found that 90% of those with brain symptoms had relatively low zinc. Dosing of zinc is determined after testing plasma zinc levels using a narrow range (the Walsh/Pheiffer range differs from typical lab ranges). Zinc is checked in conjunction with copper. Zinc has been found to improve treatment response in those with OCD treated with SSRIs. Zinc can be depleted because of very high oxidative stress and/or high pyrroles, which also cause low B6. Because B6 is needed to make serotonin, pyrroles are also important to address if elevated.Inositol is a nutrient involved in the serotonin and glutamate signaling systems. It, too, is beneficial for OCD symptoms; however, it can require very high doses.The challenge of research, as you can see, is that these approaches are all looked at in isolation, as opposed to, for example, addressing undermethylation, optimizing zinc, decreasing activity at the NMDA and addressing sources of oxidative stress.Candida & MoldAside from undermethylation, low serotonin activity, and high activity at the NMDA receptor, those with OCD appear to have high oxidative stress, as is the case with most brain-related conditions. One of the more common sources of oxidative stress I see in my practice is candida overgrowth in the GI tract, which often follows antibiotic exposure and /or mold toxicity due to water damage causing seen or unseen toxic mold. Because mold and candida (yeast) thrive on sugar and a high-carb diet, symptoms can fluctuate with sugar or carb intake. How might candida and mold intersect with the NMDA receptor? Mold and yeast can contribute to high histamine states. Histamine can increase activity at the NMDA receptor. EstrogenFor women and teen girls that I see with OCD, there is often a fluctuation in their OCD symptoms with their cycle. Typically, their symptoms worsen during the times of the month when estrogen is the highest. This may be because estrogen can increase activity at the NMDA receptor.PANDAS & PANSWhen a child has an abrupt onset of OCD symptoms, PANDAS and PANS should be considered.* PANDAS = Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections* PANS = Pediatric Acute-Onset Neuropsychiatric SyndromePANDAS and PANS are autoimmune conditions, meaning the immune system is acting on the body, in this case, a part of the brain called the basal ganglia, that involves an acute onset of OCD symptoms. Other symptoms can include restricted eating, mood symptoms, regression in academic or social skills, and motor tics. While triggers are often viral, bacterial (strep in the case of PANDAS), candida,or other microbial source, what is underlying the dysregulated immune response to such microbes, in my experience, is mold toxicity. SummaryBecause OCD can be difficult to treat, my hope in sharing this information is to raise awareness that effective OCD treatments can require a multifaceted approach that includes:* addressing methylation (and high pyrroles if present) to improve serotonin activity* decreasing activity at the NMDA receptor* by optimizing zinc* using supplements or medication* addressing sources of inflammation and high histamine* address sources of oxidative stress - trauma, stress, toxins, inflammation If you find this information helpful and would like to help me get this out into the world, please consider sharing:As always, I welcome your comments, questions, and experience.Until next time,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter and podcast episode is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

This past week, I had the pleasure of attending the Advanced Course for Walsh-Trained Practitioners. To date, 1,200 practitioners from 75 countries have been trained using the Walsh approach.For those unfamiliar, the Walsh Research Institute, founded by Dr. William Walsh, has looked at the nutrient levels of over 30,000 people with brain-related symptoms and found a surprisingly small number of nutrient imbalances (low zinc, high copper, high pyrroles, and methylation imbalances) that repeatedly show up. We address these imbalances in those with depression, anxiety, panic, obsessions, compulsions, inattention, brain fog, hyperactivity, autism, dementia, psychosis, and mood swings with significant and, at times, dramatic results. Bipolar disorder, however, because of its shifting in neurotransmitter states from mania and depression, can be particularly difficult to treat. More than nine million Americans have been diagnosed with bipolar disorder. This severe condition can lead to drug or alcohol use, financial or legal problems, discord in relationships, work and school instability, and/or suicide attempts or suicide. The course typically begins with an acute onset, followed by episodes of mania and depression, which often worsens in severity over time.In this post, after describing bipolar disorder, I will use Dr. Walsh's Comprehensive Theory of Bipolar Disorder, recently shared at the Society of Neuroscience, to explain:* the cause of bipolar disorder* the reason for the onset, persistence, and increasing severity for many over time* the reason for the increased risk of other health issues* the reason for the switch between manic and depressive states* how this information impacts treatment and preventionBipolar DisorderIt is important to note that the type of bipolar disorder I am referring to here is Bipolar I, a condition in which there are discrete episodes of mania often followed by episodes of depression. Such episodes can occur rarely or even multiple times a year.Manic episodes usually last a week up to several months and include three or more of the following:* increase in activity, energy, or agitation* distorted sense of well-being or self-confidence* needing much less sleep than usual* usually talkative or talking fast* racing thoughts or flight of ideas (jumping from one topic to another)* easily distracted* poor decision-making- e.g., excessive spending, risky sexual behavior* may become psychotic (have a break from reality)Hypomania has less severe symptoms which have less impact on functioning at work, school, social activities, and relationships. Having hypomanic episodes is not sufficient to warrant a diagnosis of Bipolar I.Depressive episodes, which often last a couple of weeks but can vary, include five or more of the below symptoms that are affecting functioning at work, school, social activities, and relationships:* depressed mood (sad, lacking feeling, hopeless, irritable, angry, or tearful)* marked loss of interest or enjoyment of activities* weight loss or weight gain (without dieting or overeating)* too much or too little sleep* behavior slowed down or restless* fatigue - loss of energy* feelings of worthlessness or inappropriate guilt* problems concentrating or making decisions* suicidal thoughts, plans, or attemptsBipolar II Disorder is a different condition. This diagnosis is given when someone has at least one major depressive episode and at least one hypomanic episode. Depressive episodes are often longer here. There is never a manic episode. Despite its name, this is not a milder form of Bipolar I. Biochemically, it is considered a different disorder.Rapid cycling is used to describe bipolar disorder when, in the past year, there have been at least four episodes of switching from mania or hypomania to depression. This can describe either type I or type II (depending on the presence or absence of mania). As with many other diagnoses, the terms came from seemingly related symptoms instead of a root cause or biochemical understanding.Dr. Walsh's comprehensive theory, which I'll describe, focuses on Bipolar I, in which there are manic episodes usually followed by depressive episodes. For those who struggle with mood swings changing within a day or a week as opposed to discrete mood episodes of mania or depression, pyrrole disorder should be considered.Genetics or Epigenetics?Having a first-degree relative (parent or sibling) with bipolar disorder raises the risk of developing bipolar disorder. After thirty years of genetic research, however, a gene for bipolar disorder has not been identified. The genetics are more complicated. It appears there are many genes involved.2021 Genome-Wide Association Study (GWAS)These studies compared the genomes of about 5,000 individuals with bipolar disorder and about 8,000 (controls/individuals without bipolar disorder). Over time, more and more “bipolar” genetic variants have been identified. By 2021, there were 64; however, there are expected to be hundreds. Of these 64 genetic variants, 49 are DNA repair genes and antioxidant genes that occur throughout the body (not just the brain). Just as it sounds, DNA repair genes make enzymes that repair DNA. Antioxidant genes make enzymes that support our protective antioxidant systems. Many of these genetic variants are also associated with cancer and other conditions impacted by DNA damage. This would suggest that those with bipolar disorder come into the world with a vulnerability in their ability to repair DNA damage (which translates to cell damage, tissue damage, and, in the case of the brain, neuronal damage. An event, however, is required to shift this vulnerability to illness.Accelerated DNA DamageWhat damages DNA? Free radicals and thus oxidative stress. To remind you, oxidative stress occurs when our body's inherent antioxidant systems are overwhelmed or depleted by free radicals (due to an insult - a toxic exposure(s), source of inflammation, or trauma). A depletion of our protection leaves our cells and DNA vulnerable to further oxidative stress and damage. If we have variants on protective genes, then we can be even more vulnerable.Numerous studies have found high levels of superoxide, hydroxyl, and ONNO (peroxynitrite)free radicals in those with bipolar disorder.This vulnerability to DNA damage also explains why many with bipolar disorder have a higher risk of other health issues, including heart disease, breast cancer, multiple sclerosis, kidney failure, immune disorders, migraines, gastrointestinal illnesses, and others. But What About the Other 15 Genes? Genetic Weakness on Ion ChannelsThe remaining identified genes are more specific to bipolar disorder and relate to ion channel genes. Ion channels exist on the neuronal membranes, allowing potassium, sodium, and calcium to move in and out of the nerve cell. This movement creates an electrical charge that travels down the cell, releasing a neurotransmitter into the space between that neuron and other neurons to communicate with the next cell(s). OnsetHere again, an epigenetic event (toxic exposure, trauma, significant illness, etc.) leading to oxidative overload impacts the production of the proteins used in these channels, which affects the movement of ions in and out of the cell (more specifically causing flooding of potassium ions (K+) outside the cell) leading to hyperactivity of that nerve. This is why Dr. Walsh's theory considers bipolar disorder a channelopathy.EuthymiaEuthymia - when the mood is neither manic nor depressed - interestingly, appears to be the first mood state after the onset of the condition. The flooding of K+ outside the cell leads to hyperactivity of neurons for serotonin. However, that doesn't appear to cause symptoms since serotonin inhibits or keeps the activity of dopamine, norepinephrine, and glutamate in check.ManiaThe onset of mania starts to occur when the serotonin neuron hyperactivity (from the K+ flooding outside the cells) starts to fizzle out. What follows is a reduction in the inhibition of the neurotransmitters (dopamine, norepinephrine, glutamate, and others) that cause widespread neuronal hyperactivity, which causes manic symptoms.Eventually, the declining serotonin activity becomes the dominating force and triggers depression, which may persist for some time. Eventually, the serotonin nerves return to hyperactivity (again keeping things at bay), resulting in a stable mood - euthymia. Progression of Illness It is well known that preventing manic episodes can prevent the severity of the condition from escalating over time. Dr. Walsh's theory also addresses why.Aside from impacting neurotransmission, the problems occurring at the ion channels are also associated with further DNA damage. This means that each episode can potentially add to the DNA damage. Add to this typical DNA damage (for all of us) that comes with aging. A typically untreated original and often persistent insult (such as a toxic exposure), events occurring at the ion channel, and aging can lead to the progression and increasing severity of illness.TreatmentAs with any theory, the inevitable question becomes, how does this impact treatment? Allopathic or mainstream psychiatry uses medication approaches that aim and usually succeed at stabilizing mood. Again, this is important because of the consequences of mania or depression but also because of the potential physiologic damage caused by ongoing episodes. What isn't typically addressed in conventional psychiatry are:* Sources of oxidative stress. Does this person have mold toxicity, Lyme, metal toxicity, candida or other microbial overgrowth, chemical exposures, high EMF exposure, trauma, and/or chronic stress that are continuing to deplete protections and contribute to DNA damage? These are the types of issues that those of us who consider ourselves functional and environmental psychiatrists address.* Support for the antioxidant system. As with any brain condition, robust antioxidant support is indicated to address free radicals, but in this case, it is also indicated to prevent further DNA damage and to protect the ion channels. * Nutrient imbalances in varying combinations are typically also involved, such as methylation imbalances (often overmethylation), pyrrole disorder, and copper-zinc imbalances. Each of these can be exacerbated by high oxidative stress, which is a further cause of oxidative stress.Research into targeted antioxidants will be needed to build upon Dr. Walsh's research. The free radicals (superoxide, hydroxyl ions, and ONNO) are more easily addressed in the body than in the brain. In the meantime, in addition to more typical antioxidants, NAC (which inhibits activity at the glutamate receptor) and MT (metallothionein) promotion therapy (a combination of glutathione, zinc, B6, and specific amino acids) are expected to be beneficial.PreventionBecause bipolar disorder appears to be an epigenetic DNA damage illness (caused by major oxidative overload), early antioxidant treatment in those who are vulnerable to bipolar disorder may prevent the onset and development of this disease. It won't be long before such vulnerabilities can be identified, as early as infancy.For more on the work of Dr. William Walsh and the Walsh Research Institute Practioner Resource Map (, visit: https://www.walshinstitute.org/As always, I welcome your comments and questions.And if you would like to help me get this information out into the world, please consider sharing.Until next time,Courtney P.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

“The journey of a thousand miles begins with a single step.”― Lao TzuIn this episode, I share my journey through illness to health and how this shaped my work as a holistic psychiatrist. My wish for anyone listening is that your pursuit of health, happiness, or whatever you seek leads you to peace and a desire to help others traveling their thousand miles.Until next time,CourtneyCourtneySnyderMD.comMentoring This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Recently, an interview by Christiane Amanpour caught my attention. It was with Coralie Fargiat, the director of “The Substance.” Though I haven't seen this 2024 body horror movie (nor do I intend to), the story brings up several teaching points about the left brain, undermethylation, neuroplasticity, and our collective obsession with beauty.The movie is about an actress, Elizabeth, who loses her job hosting a fitness television show when she turns fifty. She has “aged out.” While in the hospital after a car accident, someone directs her to a product - the substance - a neon green liquid that will allow her to bud off a younger version of herself - Sue. The rule is that Sue can only go out into the world for one week at a time, alternating each week with Elizabeth while the other lies dormant. Not surprisingly, Sue has more advantages in the world (that Elizabeth inhabits), including replacing Elizabeth on her former TV show. Increasingly, when it's time to switch, Sue breaks the one-week rule. This results in part of Elizabeth's body becoming increasingly deformed. The culmination is a grotesque battle of gore between the two, who initially were instructed to remember, “You are one.”In the interview, the director, Coralie Fargeat, discusses her personal experience:“I turned 40 and was more impacted than ever about what it's like to be a woman, the feeling that if I wasn't young and pretty and sexy, I would be totally erased from the surface of the earth. So there was this kind of emergency, this vitality to the things I speak about in my film.”Research supports this thinking that beautiful people are treated better and thus have more advantages. With the use of photoshopping, social media filters, and even plastic surgery, many teens and young adults are experiencing neuroplastic changes that are making real people, including themselves, appear increasingly off or even grotesque. Left Brain“The Substance” is a left-brain nightmare. It shows us the self-destructive path the left brain can take us on, especially in a world that tells it exactly how things should look. Elizabeth, the main character in the movie, is rigid in her thinking, addicted to an image of herself, perfectionistic, and highly competitive. In some ways, these left-brain attributes have served her, but unchecked, they destroy her. If the left brain were a person, it would have the following traits and perspective on appearance: (These traits are oversimplified and pulled from Dr. Iain McGilchrist's work) - * Detail-oriented, narrow focus of attention - “That doesn't look right.”* Prefers what it knows and prioritizes what it expects - “I should look this way.”* Has difficulties disengaging - “I can't stop thinking about this and how to fix it.”* Sees parts (as opposed to the whole) * Sees the body as a sum of parts * Doesn't have a whole image of the body (as found in those who have damage to the right hemisphere)* Is competitive - “I need to look better than they do”* Fears of uncertainty and lack of control (As you can imagine, this is a problem for anyone human and thus who will age)The left brain will set its sights on beauty, success, titles, money, objects, or anything else that feeds the “I.” Because the left brain can't see the “big picture,” it has a hard time pulling back far enough to see how its way of thinking may be getting in the way. The Right BrainOur ability to feel embodied is a job for our brain's right hemisphere. When the voice in the movie reminds Elizabeth, “You are one,” it may as well be speaking on behalf of the right hemisphere.Our right brain allows us to have compassion, including self-compassion. It honors diversity and differences. It can see the bigger picture of our lives that involve multiple developmental stages. It can sit with uncertainty. It knows that our imperfections and differences promote connection with actual humans.UndermethylationLeft brain tendencies strongly overlap with undermethylation traits. Methylation is a biochemical and cellular phenomenon that serves many important functions. If we “undermethylate,” we can have more difficulties breaking down histamine, more difficulties detoxifying, and lower serotonin activity. Methylation is impacted by a number of genes, the most well-known being MTHFR.Undermethylated traits include perfectionism, obsessive-compulsive tendencies, being highly competitive, having ruminations, and addictive tendencies. The NDMA ReceptorThose of us who are undermethylated can have high activity at the NMDA receptor, resulting in a problem with “memory extinction” or letting go of a thought. This could look like obsessive-compulsive tendencies (including those seen in body dysmorphia) and addictive tendencies. High histamine (again due to undermethylation) can increase activity at this receptor. Low zinc, high estrogen, and low magnesium can also be at play.I suspect Elizabeth is undermethylated and has high activity at the NMDA receptor. Both could be assessed for and treated (in part) using targeted nutrients. I say, in part, because the brain training / neural training that occurs through social media is difficult to override if someone is still “using.” Interestingly, EMF exposure (from phones and wireless technology) can increase histamine, further driving these issues.Neuroplasticity and Images of PerfectionThe more images of beautiful images of people we see, the more those images become the norm in our mind, and the more any deviation from that norm will stand out as problematic. This was already a problem with the photoshopping of celebrities and models. But now, with social media filters, teens and young women aren't just comparing themselves to celebrities and models; they're comparing themselves to a filtered image of themself.Filters can create larger eyes, bigger lips, more angular jawlines, whiter teeth, slimmer faces, and smooth and even skin tones. Research into the use of filters:* Millennials are predicted to take 25,000 selfies on average over their lifetimes* About 90% of women aged 18-30 report using beauty filters before posting selfies on social media. * Repeated interactions with filtered images and associated beliefs and worries are increasing the risk of mental health issues such as:* depression* social anxiety* reduced self-esteem* appearance anxiety* body dysmorphia* increase of plastic surgery* 62% of plastic surgeons report that their patients wanted cosmetic procedures because of dissatisfaction with their social media profiles* Snapchat dysmorphia” is what plastic surgeons are calling the act of taking a picture of one's self and using a filter.* Selfies are the leading cause of plastic surgery among young people* Girls who routinely shared self-images on social media had considerably higher body dissatisfaction relative to those who share selfies less frequently. * Body Dysmorphic Disorder among young women has been linked to social media use.In short, the research shows that investing in one's self-presentation on social media is often a harmful practice. The more one does it, the more damaging it tends to be. It encourages hyperattention to unrealistic beauty standards and a desire to change one's physical appearance. This problem of hyperattention to unrealistic beauty standards isn't just a phenomenon of teenage girls and younger women. I´m 57 and understand these things, and still, I´ve had to be intentional about how much attention and neuronal wiring I put into what increasingly feels like defying the very full and lovely reality of my current age. A SequelIf I could write a sequel to “The Substance,” it would be about how Elizabeth (the main character) gets off screens and finds a group of real women (her age and older) that she comes to trust, finds refuge, and who she is inspired by. Instead of looking through a lens of culturally defined beauty, she is struck by the strength, courage, and peace they never could have embodied at a younger age. These women who inspire and shape her would like Helen Mirin (79), who corrected a podcast interviewer after they said to her, “But you are young at heart.” She tells him that no, she is not….”My spirit is the age that I am. When you say 'youthful', I'm not full of youth. I'm full of the life that I've lived up to this point.As girls and women, we need these women in our lives. We can do our part to become these women - the desperately needed embodiments of the right brain. Wishing you peace and wholeness,CourtneyCourtneySnyderMD.comP.S. This Saturday begins the mentoring group for MDś, NDś, DOś, NP and PAś. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com

Recently, I was having a conversation with my daughter - who's 19 - about the mental changes in a family member with memory loss. I commented that it can feel like a long goodbye, as they seem less like themself. Even as I said that, it didn't ring true. She quickly responded, “When are we ever ourselves? It seems like we're always changing.'“Her comment, which did ring true, got me thinking a lot this week about the elusive “self.”Who Am I? Who are You?My genes and early life experiences have shaped me. The arrival of hormonal changes around puberty changed me. My friendships changed me. After puberty, hormonal cycles played a role in changing my personality throughout the month. My education changed me. Love, marriage, and motherhood changed me. My work changed the way I make sense of things. For example, I'm sure optimizing my zinc level changed me into someone more comfortable around people. Addressing mold toxicity increased my energy, so everything wasn't so hard. Addressing methylation lifted an apathy that came with toxicity. When I was in the throes of mast cell activation and inflammation, I was different. For 3 days at a time, feelings of “doom” and head and neck pain colored my world. When the flare passed, “I” was back.Sickness changed me into a more compassionate person. Despite this, I was determined to return to who I was before chronic illness. No one tells you that's not possible. We may heal, but we don't going back to a former self. Sickness forced me to let go of certainty and let go of identity so I could approach life with greater ease.Menopause lessened my intensity, possibly because less estrogen would have increased the ability of COMT and MOA-A to better clear catecholamines (which increase tension and, for some, hyperfocus). The need to go - go - go softened.I miss how much I could once do. I don't miss believing that everything mattered more than the present moment.Even on a given day, our “selves” change. “Morning Me” is calm, has plans, and sticks with a routine. The “3-4:30 pm Me” is slower and less sharp. I've come to design my schedule to take care of both. “Me on Too Many Carbs” is self-conscious and judgmental and looks for things to complain about, while “Me on Less Carbs” is more at peace with what is.The challenge, of course, is to accept whatever perceived “self” shows up at a given time of day and not banish the moment with judgments about who we think we are. When we can do this, we can extend that grace to others.Who Is This Person?If you are a parent or have a partner or spouse, you've likely noticed the changing personalities of those you love. When my daughter was three, she was struggling with episodic cognitive and mood changes, as well as some developmental regression. Though not apparent to most people, in my mind, she was “herself” only about one out of four days. This was evident in her clear thinking, playfulness, humorous comments, and ability to draw a stick figure. This was who I perceived “her” to be. I felt connected to her.But for three of the four days (for a good part of the year), she was forgetful and didn't engage in imaginative play. She was irritable and anxious. Her speech was slurred, and she couldn't draw a circle. It was as if I had repeatedly lost her to an imposter with whom I found connecting more challenging.Ideally, I would have been more present and better connected to all her “selves.” But that's not often who shows up when we're in survival mode. I am grateful to my analytical, driven, and detail-oriented left brain, which ultimately found the help and answers that allowed her to return to her developmental path. I did, however, have to let that part of me go (in our relationship), for her and my well-being.There is No Fixed SelfWith these recent thoughts of the elusive “self” came a need to rekindle my relationship with one of my favorite mystics - Leonard Cohen. Though I've heard the interview (quoted below) several times, I was surprised at how different it resonates at this stage in my life.After commenting on how he no longer struggles with chronic depression, he explains why that is.“We don't determine what we are going to see next, or hear next, or taste next, or think next, or feel next. Yet we have the sense that we're running the show. So if anything has relaxed in my mind, it's the sense of control, or the quest for meaning. My sense is there is not a fixed self. There is not one whom I can locate as the real me. And, dissolving the search for the real me is relaxation, is the content of peace….But these recognitions are temporary and fleeting, and, you know, …….we go back to thinking we know who we are.”The Right & Left BrainI love how Leonard Cohen unknowingly speaks about the differences between the right and the left brain. His right brain can't locate a real him; for this, he is glad and at peace. The sense of control he refers to is mainly from the left brain, where the ego resides with its self-focus, striving, and clinging. And though the right brain is ideally the master and where we ultimately find peace, we still reflexively return to the left brain as we “return to thinking we know who we are.”BuddhismIf Leonard Cohen sounds Buddhist, he is. Though Judaism remained integral to his spiritual life, he steeped himself in Eastern spiritual and religious practices. From the ages of 61-65, he was a Buddhist monk.I'm not Buddhist, nor do I promote specific religious beliefs or structures. But, I am beginning to understand why the doctrine of "no-self" - the idea that there is no permanent self - has helped many people worldwide. The doctrine doesn't claim that we don't exist, but it does deny ordinary claims about human identity that bring inevitable tension and, for some, anxiety.Instead, according to the doctrine, the self is considered a collection of ever-changing mental, physical, and emotional processes that interconnect with other factors. I can't help but think that among those other factors are changes in our nutrient levels, microbiome, hormones, epigenetic expression, levels of inflammation, and oxidative stress.Self-Focus & the No-SelfHave you ever noticed the difference in how you think and feel when alone with your “self?” Have you ever stopped and noticed how fleeting your thoughts and feelings are? Who were you in those minute-by-minute moments when you were excited and then when you were frustrated? Who is even doing the noticing? Now, think about how you think and feel when you are in the flow of satisfying work or taking a walk, in friendly conversation, helping someone in need, or petting a dog. In those moments, we don't need a self to orient ourselves in the world. In those moments, we are in the world.As human isolation increases, we become more self-focused. We are more in our heads and not in the world. Isolation has our left brain taking us on a tedious pursuit of who we think we are or should be. Our left brain wants an identity to hang its hat on as if that will make everything right in our world. And from this identity, we judge ourselves and others, making it more challenging to connect,….if we let it.SufferingBuddhism connects the concept of self to great human suffering.Think about how much of our attention and energy we spend to find ourselves. We strive to be authentic. Many of us have been bucking up against a self we believe we didn't have much say in creating. And many of us succeed in finding new ways of being in the world that feel more aligned with who we think we are.But many of us will reach a point where we realize the self we've been excavating or creating is fleeting. Our perpetual growth has been walking hand in hand with a falling away of self and identity. We find that all we ever had - and have - are our moments.PresenceWiring a brain to be present in such moments takes practice. It is when we practice noticing and paying more attention to the people and the world around us. It's when we notice what we see, hear, and even smell. It's when we are immersed in a conversation or our work. It is when we are creating anything or listening to music. It is when we experience compassion, which includes self-compassion. It's not all about good feelings. To be present is to sit with anger, sadness, and fear as they arise. They, too, shall pass, especially if we don't try to deny or resist them.Being present is the antidote to the self. Being present is an antidote for suffering.Wishing you moments of presence and the ability to hold everything, including your sense of identity, more lightly in the New Year.CourtneyCourtneySnyderMD.comMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com

In previous podcasts, I've discussed the more common underlying factors that can drive brain-related symptoms. These factors, or “roots,” each have their constellation of symptoms and traits.Because children's brains and bodies are still developing and because they don't have the same degree of hormonal influences, some of their symptoms and associated psychiatric diagnoses will differ from adults with the same imbalances. As you'll see, inattention and hyperactivity and the diagnosis of ADHD can be the manifestation of a number of these root causes.Though I'll discuss these common imbalances separately, more than one can be present. Below are the most common imbalances I see in my work. Teenagers' symptoms tend to resemble those of adults.Each of these topics is linked to a more in-depth description if needed.* Undermethylation* High Copper* High Pyrroles* Mast Cell Activation* Candida* Mold Toxicity* Electromagnetic Hypersensitivity* OvermethylationFood sensitivities can be present and result in a range of symptoms; however, one or more imbalances are also usually present and underlying the food sensitivities.To learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com

In the last podcast, I discussed sources of toxins and how they can impact the brain and development.In this podcast, I'll focus on ways to reduce exposure. I say reduce because there is no way to completely eliminate our exposure to toxins. This reality can be liberating for those who struggle with perfectionism.If you're new at this, feel good about starting. Avoid feeling bad about what you haven't done yet. (Negative thoughts aren't great for detoxification;)For me, lowering exposures has been a stepwise process. When I began, I had to avoid overwhelm and resist trying to do everything at once.Though I've familiarized myself with the most researched toxins and their specific health impacts, I try to focus more on what I can do to avoid them so I can get on with life and not think about them.Some of the most researched toxins (last I checked) include mercury, lead, arsenic, cadmium, PBDEs, organophosphates, glycerophosphate, BPA, BHA, BHT, PCBs, sodium benzoate, butane, tartrazine dye, potassium bromate, ADA, BVO, yellow food dye number's 5 and 6, red dye number 40, bovine growth hormone, synthetic hormones, ractopamine, phthalates, parabens, phenylenediamine, oxybenzone, acrylic, DEA, triclosan, PFAS including PFOS, benzene, chlorine, chloramine, ochratoxin, trichothecenes, aflatoxin, chaetoglobosin, gliotoxin, and zearalenone.Electromagnetic fields, though not “toxins,” are considered toxicants, which have similar impacts on our bodies and brains. I've previously shared how we can start to assess and lower those.To learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com

Recently I saw a humorous reel of a man going through his day. As he does, you hear his inner dialogue. He's trying to prepare a healthy snack, but at every turn, he's stopped by his voice pointing out exposure to toxins - in the packaging, the water, the skin of the fruit. Eventually, he sits down and opens a bag of chips.Can we lower our exposure to toxins (and support detoxification) and not live in fear? I think we can. We can all hold this heavy topic lightly and do the best we can, knowing that there's no perfection here.“If we are going to live so intimately with these chemicals, eating and drinking them, taking them into the very marrow of our bones - we had better know something about their nature and their power.” - Rachel Carson in “Silent Spring” (1962)In this episode, I'd like to help you better know something about the nature and power of the chemicals and heavy metals that we're exposed to. I'll discuss* The cumulative effects of our exposures* Sources of toxins* Oxidative stress* How toxins contribute to chronic health conditions, including psychiatric conditions* Impacts on the developing brain* How oxidative stress can be measuredTo learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Recently I saw a humorous reel of a man going through his day. As he does, you hear his inner dialogue. He's trying to prepare a healthy snack, but at every turn, he's stopped by his voice pointing out exposure to toxins - in the packaging, the water, the skin of the fruit. Eventually he sits down and opens a bag of chips. Can we lower our exposure to toxins (and support detoxification) and not live in fear? I think we can. We can all hold this heavy topic lightly and do the best we can, knowing that there's no perfection here. “If we are going to live so intimately with these chemicals, eating and drinking them, taking them into the very marrow of our bones - we had better know something about their nature and their power.” - Rachel Carson in “Silent Spring” (1962)In this newsletter, I'd like to help you better know something about the nature and power of the chemicals and heavy metals that we're exposed to. I'll discuss* The cumulative effects of our exposures* Sources of toxins* Oxidative stress* How toxins contribute to chronic health conditions, including psychiatric conditions* Impacts on the developing brain* How oxidative stress can be measuredIn a future newsletter, I'll dig deeper into ways to avoid exposures and ways to support our organs of detoxification and antioxidant systems.How Toxic Are We?From the EPA / Environmental Protection Agency - Of the more than 40,000 chemicals used in consumer products in the US, less than 1% have been rigorously tested for human safety. (Here is the US, the approach is to put chemicals into food and other products and not study, regulate or limit them unless health concerns arise). For those few chemicals that have been banned, we can still be exposed. For example, we continue to be exposed to DDT- a pesticide banned because of concerns about its impact on human health. It has polluted the earth's atmosphere, oceans, streams, and wildlife. We come into the world with a toxic load. The Environmental Working Group's “Body Burden” 2004 study found an average of 200 industrial chemicals in umbilical cord blood per baby. These included polyaromatic hydrocarbons, dioxins, furans, pesticides, chemicals from flame retardants, industrial lubricants, plastics, consumer product ingredients, and wastes from burning coal, gasoline, and garbage.The following toxins are found in almost all children* Mercury - 89%* Lead - 100% The more present, the lower the IQ. Now, it is agreed there is no safe level of lead. * PCB's (banned in the 70's but still around) - 100%* BPA - 96%* PBDE's flame retardants - 100% of children. As body burden increases, a child's IQ decreases.* Organophosphate pesticides - As the body burden increases, the IQ decreases.Toxins & Their Impacts Add UpToxins are problematic for all of us, but especially for those of us whose brains are in the process of being formed. The chemical industry says the effect is subtle and of little consequence. If, however, you consider a bell curve for intelligence and you shift it to the left because of lead exposures and then you shift it to the left some more because of organophosphate pesticides and then again for PBDE flame retardants, our collective drop in IQ and human potential becomes much more striking. And that's just when you're only considering 3 studied toxins and only when you're considering IQ and not things like self-regulation or behavioral control, coordination, or even empathy.Sources of ToxicityThis is worth considering, again, not to live in fear, but to lower our exposure…in a very matter of fact and relaxed way. Fear doesn't lower our toxicity, it more likely slows our detoxification. Exotoxins - Toxins that we ingest, inhale, or absorb from outside of us* The air we breathe - e.g., mold toxins if water damage in a building, pesticides, if we live near farms or use certain household products, or heavy metals in areas with a heavy traffic* The water we drink - e.g. heavy metals, chemicals* The food we eat* Pesticides, herbicides* Additives, preservatives* Chemicals from packaging* The products we put on our body, face, hair. For example, most lipsticks contain lead. A recent study found heavy metals in common tampon brands* The products and chemicals we use in our house (cleaning solutions, fragrances) or on furniture and clothing (flame retardants)Endotoxins - toxic chemical by-products of microbes in our gastrointestinal tract.Examples could be mold (in our GI tract or sinuses) and yeast, however, even some beneficial microbes can release chemicals your body must manage.These all add up.What Is Oxidative Stress?Oxidative Stress occurs when the toxic load in our body is greater than our body's inherent defense mechanisms can handle. The toxic load might be heavy metals like lead, mercury, cadmium, or arsenic, microbes such as viruses, bacteria, and fungi, injury, inflammation, EMF, and/or emotional stress. On the deepest biochemical level, oxidative stress is when our inherent antioxidants are insufficient for what they face, namely an excess of chemical free radicals.Free radicals:* Highly reactive, unstable atoms or molecules can damage or destroy proteins, cells, DNA, and other essential biochemicals.* They cause damage by stealing electrons from other atoms in cellsHow Toxins Can Cause Damage* Displace minerals - such as displacing calcium in our bones, resulting in weaker bone structure. With bone loss (in the 40's and beyond), those toxins are released into the rest of the body.* Damage enzymes, so they don't work right. Our bodies depend on enzymes to make things happen. All of our physiologic processes depend on the functioning of enzymes.* Damage cell membranes, which affects their signaling and communication.* Damage DNA - think cell death, aging, and degeneration* Damage organs - including those organs that are necessary to detoxify (gastrointestinal tract, liver and kidney) and the brain* Impair our ability to detoxify* Cause inflammation with all of it's consequences (including disrupted communication between nerve cells and neurodegeneration)* Impact gene expression* Interfere with hormone receptors on cells * Deplete our protective antioxidants making us more vulnerable to future exposures.Developmental & Other Brain ImpactsChildren are especially vulnerable to toxins such as metals, as their blood-brain barrier has not matured. Developmental consequences of high oxidative stress include autism, decreased IQ and/or ADHD and behavioral issues. Chemical toxins can interrupt neuronal connections, and interfere with the development of brain cells and their receptors that neurotransmitters (serotonin, dopamine, and GABA) bind to. This impacts cellular communication. High oxidative stress can also deplete two of the main antioxidants, glutathione (GSH) and metallothionein (MT). You've likely heard about glutathione, but metallothionein proteins are pretty amazing as well.* Metallothioneins* Required for pruning, growth, and growth-inhibition of brain cells in early development. This is required for the development of brain cells and synaptic connections.* Prevents mercury and other toxic metals from passing the intestinal and blood/brain barriers. * Supports immune function* Regulates the homeostasis of copper and zinc.* Prevents casomorphine and glutomorphine getting into the brain, which causes inflammation.Degrees of Vulnerability Not all children with the same exposures in utero or after birth will develop autism or ADHD. Not all adults with the same exposure will develop mental illness, dementia, cancer, cardiovascular disease, autoimmune conditions, obesity, diabetes, other chronic disease or accelerated aging. We all vary in terms of our ability to detoxify. Given the same exposure, some of us (at times very few) will be hit very hard. This may be because of the difference in our nutritional status, which we come by, in part, genetically, but also by what we eat and how healthy our microbiome is. We differ in terms of how permeable our first line of defense - our gut is, which can have to do with how inflamed our gastrointestinal tract is, how healthy our microbiome is, but also the integrity our connective tissue (which holds us together). We all have varying degrees of functioning of liver enzymes involved in detoxification, and vary in terms of how much glutathione we make or have available. We vary in how much our inherent antioxidant system's capacity has been used or depleted. Do we have a lot of reserves, or is our system overwhelmed and unable to protect us? We vary in how much emotional trauma we've experienced and hold in our bodies - more specifically, our autonomic nervous system. Chronic stress hormones and an overfunctioning of our sympathetic nervous system can keep our detox organs from working at full speed.We can also vary in how much stored toxins are becoming mobilized. Toxins can store in our brain, bones, blood, and fat. Toxins in fat can become mobilized when we lose weight, while toxins in the bone can be mobilized when we start having bone loss (beginning in the forties). While many toxins can move out of our body quickly, many stay in our cells, our bones or fat and take longer to remove.We also vary in where we live in the world, and our socioeconomic status. The European Union has stronger regulations on chemicals than the US. You won't find Mountain Dew and chlorine-washed chicken in the EU. If you're eating Skittles or M&M's in Europe, they're colored with natural ingredients like turmeric, but if you're eating them here in the US, you're ingesting Yellow Dye no. 5 and no. 6, which have been linked to allergic reactions, as well as hyperactivity in children. Not surprisingly, we have more chronic health conditions here in the US.Markers of Oxidative Stress:You might be wondering - “Can we prove that someone has high oxidative stress, beyond their having a chronic health condition or psychiatric condition?” We actually can measure oxidative stress. A good example of this type of research comes from the Walsh Research Institute.After evaluating 6500 individuals with autism spectrum disorder. Dr. William Walsh looked at around one hundred chemical factors using blood, urine, and hair. Of 800,000 chemical test results, he found the following biochemical imbalances (relative to healthy controls). Each is associated with elevated oxidative stress.* Decreased Glutathione and Cysteine* Elevated toxic metals* Depressed SAMe/SAH Ratio* High copper and low ceruloplasmin* Depleted zinc and Metallothionein (MT carries zinc around, and they are often low together)* Elevated pyrroles* Low B6, C, and Selenium * Elevated Urine Isoprostanes (damaged fats - DHA)The Collective Despite our differences in vulnerability, this topic of oxidative stress is about all of us all the time. It's about the toddler in an inner city apartment putting lead dust from old paint in their mouth, and the child in the suburbs rolling around in the grass doused with pesticides. It's about the teens using toxin containing body products and the adults spraying Round-up on their yard.To some degree, we are all managing or not managing, the toxic load we've been handed. The best we can do is to be informed and do the best we can….without having it rule our life.In a future newsletter, I'll share:* ways to limit exposures* ways to support our organs of detoxification* ways to support our antioxidant systemUntil next time,CourtneyCourtneySnyderMD.com This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Likely you've heard about the importance of muscle strengthening in the prevention of bone health. What is less known, however, is the relationship between the health of our muscles and the health of our brain. In this podcast, I'll address:* Evolution and the types of activity that our bodies were designed for* Causes of sarcopenia or muscle loss* The relationship between sarcopenia, cognitive decline and Alzheimer's* How role our muscles play in blood sugar regulation and lowering inflammation* Low grip strength as a marker of psychiatric illness and neurodegeneration* Building muscle and address oxidative stressTo learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

“If the only prayer you said in your whole life was, ‘thank you,' that would suffice. - Meister EckhartIn recent years, the benefits of practicing gratitude have become more widely known. During this time, my experience has expanded to include two more “radical” forms of gratitude that I'd like to share with you.In this podcast, I'll address:* The increasing importance of gratitude in these times* Examples of gratitude practices* The many benefits* Children and gratitude* Aspirational gratitude* Radical gratitude* Spiritual bypassingTo learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Our gut microbiome forms a dynamic ecosystem of trillions of microbes, including bacteria, viruses, archaea, and fungi, in thousands of species—many of which have existed long before humans.While research into the microbiome has gained traction only in the past twenty years, our ancestors recognized the connection between digestion and emotions, mood, and behavior. Historical practices like fecal transplants date back to Ancient Greece and 4th century China.By the 18th century, the concept of the gut-brain axis was already recognized, and in the 19th century, physicians acknowledged the influence of the gastrointestinal (GI) tract on mental well-being. However, the 20th century saw a regression in this understanding, with scientists asserting that it was the mind affecting the gut instead.It wasn't until the 21st century that we reconciled these views, acknowledging that both can be true. The brain impacts the gut through the autonomic nervous system, while the gut influences the brain through its microbial inhabitants.So, how exactly does the gut microbiome affect the brain beyond its role in nutrient absorption? This influence is largely through three primary mechanisms.To learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

The way I think about it:We come into and leave this world accompanied by our souls. While here, one of our tasks is to maintain our connection to that inner wisdom, which guides and nourishes us in a world that otherwise can feel harsh and cold. Our soul doesn't judge us or try to fix us. It doesn't need us to be more or do more. Its unconditional love is akin to an adoring dog who only wants us to stop, be present, and see what it sees.The challenge is the neuronal wiring we develop from cultural inputs that discount this vital relationship with ourselves. We're trained to project onto others our strengths and even our shadow. We find ourselves disappointed when others can't carry that weight of our expectations.If this most vital relationship is neglected, our human connections suffer. Our relationships may feel shallow or intense and dramatic. We'll resent and blame others unconsciously for losing ourselves. Unaddressed, this comes out in the form of hurting others, or it gets repressed and fuels addiction, a range of symptoms, and chronic health conditions.Instead of rom-coms about finding the perfect person and living happily ever after, we need more stories about people falling in love with themselves. “I complete me.” The healthiest relationships are between people who honor this need in themselves and each other.Below is a blessing I print and include in birthday cards to those I love. To me, it speaks to the soul. This week, I share it with myself and with you - in honor of your arrival.Birthday Blessingby John O'Donohue (late Irish poet and, I would say, mystic)If you'd like to hear his lovely voice reading this, listen here at 8:15“Blessed be the mind that dreamed the dayThe blueprint of your lifeWould begin to glow on earth,Illuminating all the faces and voicesThat would arrive to inviteYour soul to growth.Praised be your father and mother,Who loved you before you were,And trusted to call you hereWith no idea who you would be.Blessed be those who have loved youInto becoming who you were meant to be,Blessed be those who have crossed your lifeWith dark gifts of hurt and lossThat have helped to school your mindIn the art of disappointment.When desolation surrounded you,Blessed be those who looked for youAnd found you, their kind handsUrgent to open a blue windowIn the gray wall formed around you.Blessed be the gifts you never notice,Your health, eyes to behold the world,Thoughts to countenance the unknown,Memory to harvest vanished days,Your heart to feel the world's waves,Your breath to breathe the nourishmentOf distance made intimate by earth.On this echoing-day of your birth,May you open the gift of solitudeIn order to receive your soul;Enter the generosity of silenceTo hear your hidden heart;Know the serenity of stillnessTo be enfolded anewBy the miracle of your being.”To learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

There is a wealth of information about sleep. In this podcast, I'll highlight aspects I find especially interesting and significant.  * The Pineal Gland* The Seat of the Soul* Flouride* Melatonin* Creating Melatonin* Cortisol* Brain waves* Falling Asleep & Waking Up* REM (rapid eye movement) versus non-REM sleep* Sleep cyclesIn a future episode, I will delve into tools and techniques for optimizing sleep.To learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

After sharing my favorite books for engaging the right brain last year, I thought I'd now share some for stimulating the left brain. Anyone familiar with functional medicine knows the vast landscape of information—some empowering, some daunting, some helpful, and some even alarming. Yet, feeling inundated or fearful isn't conducive to healing and well-being.Just as pairing protein with carbs helps to stabilize blood sugar levels, balancing left-brain reading with right-brain material can be beneficial. Otherwise, we risk becoming overly focused on the minutiae of healing, which can increase stress and diminish the bigger picture of our lives.The books mentioned are designed for those seeking insights for themselves or loved ones, as well as for clinicians aiming to better serve their patients. Each book has helpful information, practical tools, and well-founded hope.To learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In previous podcasts, I've discussed many root causes of brain symptoms, none of which exist independently from our hormones.  In this podcast, I'll address the impact our sex hormones - estrogen, progesterone, and testosterone - have on our neurotransmitters.   I'll also discuss how changes in our hormones can impact our personalities and mental health over our lifetime.  While there is a great deal of diversity in our hormonal states, there are obvious similarities for those born female and similarities for those born male. Hormones are an exceedingly complex topic. I will be oversimplifying.To learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.comDisclaimer:This podcast is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Our limbic system (commonly called the lizard brain) plays an important role in our safety. If it's over-functioning, however, we can feel chronically unsafe.Previously, I discussed how the autonomic nervous system (ANS) puts us into fight, flight, or shut down when we feel threatened. The ANS operates largely outside our brain; however, it communicates with our limbic system, which is in the brain. In this newsletter:* What is the limbic system, specifically the amygdala, and how does it keep us safe?* What symptoms and conditions occur when the amygdala is over-functioning? * What does the limbic system have to do with high immune reactivity and mast cell activation, multiple chemical sensitivity, and electromagnetic hypersensitivity?* Are some of us born with an overactive amygdala?* What environmental inputs can lead to limbic system dysfunction?* How can we take advantage of neuroplasticity to address this dysfunction, feel safe in our bodies and environments, and become less reactive to food, chemicals, light, loud sounds, EMF, and other environmental inputs?What Is the Limbic System?The limbic system is a group of interconnected structures deep inside the brain (and just above the brainstem) that govern our emotions, motivation, sense of smell, and behavior.  Evolutionarily, the limbic system is considered the oldest part of the human brain.  It has been identified in fish, amphibians, reptiles, and early mammals. The structures include the thalamus, hypothalamus, basal ganglia, cingulate gyrus, hippocampus, which consolidates short-term memory into long-term memory, and last but most certainly not least, the amygdala.The Amygdala* a major processing center for emotions, especially fear, anxiety, and rage.* helps identify potential threats and trigger appropriate reactions, such as the "fight or flight" response.* stores emotional memories, especially those related to stress and fear.* helps with social interactions and interpreting information about others.* involved in learning by fear, and is necessary for acquiring both active and passive avoidance of conditioned responses.* assigns value to objects and activities; plays a role in making judgments, including social, moral, and aesthetic judgments.What is Limbic System Dysfunction?This is when neuronal pathways have been reinforced from repeated threatening inputs. What is perceived as threatening starts to become generalized. This can look like:* high anxiety and even obsessive-compulsive symptoms, such as contamination fears, disordered eating, body dysmorphia* hyper-vigilance or being excessively alert to anything perceived as a threat* excessive fear related to:* one's symptoms* one's body* food, medications, or supplements* environmental exposures, such as chemicals, mold toxins, or EMFBecause of the interconnection between the central nervous system and our immune system, once someone has developed limbic system dysfunction from toxic exposure or trauma, they can become hyper-reactive to a wide range of stimulation, including light, sound, smells, foods, supplements, medications, chemicals, and electromagnetic fields.  As you can see, this becomes self-perpetuating. As a person has more reactions, often in the form of mast cell activation with its wide range of symptoms, they become more vigilant and avoidant to try to prevent symptoms. This adaptive response, however, further reinforces a hyper-vigilant limbic system.What Does It Feel Like?I can speak to this personally, as I had limbic system dysfunction from mold toxicity (from a home that had water damage) and then later in a new Smart house with high radio frequencies and dirty electricity. Even before I knew I had mold toxicity and was being exposed to mold, my thoughts repeatedly landed on themes around safety. I knew something was causing me to have severe fatigue and headaches, but I didn't know what. “I shouldn't eat that, I shouldn't go there, I shouldn't, I can't, I better not.” I thought if I could control things, I would be fine. Everything and everyone felt “too much.” It was hard to be with people. When our body feels threatened, we are not at rest, digest, and connect. It's difficult to be present. That's a problem because the less we connect with others, the more room in our minds for rumination and reinforcing those fear pathways. My symptoms of pain, fatigue, and anxiety caused by mold toxins and EMF were helped and made worse by the limbic dysfunction that developed. If you've ever been “limbic,” you know it's all-consuming and exhausting, not just for you but for your spouse, partner, children, and close friends.Can We Be Born with Limbic System Dysfunction - “Wired For Danger?”RCCX is a gene module (cluster of genes) that appears to be at the foundation of many psychiatric conditions and complex chronic health conditions, such as mast cell activation syndrome (MCAS), chronic fatigue syndrome, chronic inflammatory response syndrome (CIRS), and postural orthostatic tachycardia syndrome (POTS)The RCCX gene module includes a gene for hypermobility (especially bendable or double-jointed), a gene for 21-hydroxylase - involved in stress hormone pathways, and a gene related to our immune response and autoimmunity.  Hypermobility is a red flag but not a requirement.A weakness in 21-hydroxylase can result in higher androgens (such as testosterone) in utero and thus impact the developing brain, specifically the amygdala. Studies have found that those with hypermobility have a larger than normal amygdala, which fits RCCX theory.   This would suggest that many of us come into the world with an amygdala that already has us on high alert. The disadvantage of the resulting global sensitivity is the greater potential for health consequences. However, there can also be advantages, including being highly intuitive, observant, creative, and empathic. Another seeming result of high androgen exposure in women during development is a finger length ratio more typical of men (the ring finger is longer than the index finger when looking with the palms up).   Perhaps the male finger length ratio in women and girls suggests a vulnerability to developing limbic system dysfunction.Neuroplasticity - Friend or Foe?Neuroplasticity is the incredible ability of our neurons to form new connections and modify the strength of existing connections. More simply put, it is the ability of our brain to rewire itself. Our experiences, thoughts, and behaviors drive these neuronal connections. As you'll see, neuroplasticity can work against us and take us into or further into limbic system dysfunction, or it can help us find our way out of limbic system dysfunction.How Do We Develop Limbic System Dysfunction?I do suspect that many of those who go on to develop limbic system dysfunction already had a vulnerability from the start; however, environmental inputs - exposures or trauma - can reinforce those neuronal pathways of fear and avoidance. Such experiences could start as early as the first three years of life.  Perhaps one's attachment experiences left them feeling unsafe and uncertain that the world was safe. There could have been trauma. Over time, toxins could have left the body feeling chronically threatened. We see this with biotoxins, especially from mold and Bartonella, but also with Lyme and other co-infections. We also see this with high EMF exposure and chemical exposures. Though we call it dysfunction, hypervigilance can lead people to their answers. Had I not been “limbic,” I probably wouldn't have discovered I had mold toxicity, but once I did, I had to teach my brain and body how to feel safe again,… perhaps even safe for the first time.Limbic System RetrainingJust as pathways of fear and vigilance can get reinforced over time, so can pathways of safety and well-being.  Limbic system retraining programs are structured programs with exercises, education, and support to help retrain the limbic system. They are incredibly helpful for most people, even those with an active “threat” like mold toxins in their body.  That doesn't mean that actual external threats don't need to be addressed. Just as I wouldn't recommend someone stay in a traumatizing relationship, I also wouldn't recommend someone stay in an environment in which they are getting significant exposure to mold toxins.Limbic system retraining programs can be done at home online. Common ingredients include raising awareness of thoughts and triggers, interrupting those thoughts (with or without movements), and a visualization or mood elevation. All of these require practice. The three programs that I have patients look into and which many of us who treat complex illness have the most experience with are:* Dynamic Neural Retraining System (DNRS)* Gupta Program* Primal Trust Though these vary somewhat (DNRS is the most structured, Gupta brings in meditation, and Primal Trust brings in more vagal nerve interventions and trauma-informed practices), they are all effective. It comes down to fit and which program the person feels the most drawn to and, thus, will be most inclined to do.  While an hour a day may be recommended by the programs and maybe most helpful, it does not have to be “all or none.” Even ten minutes a day to start can still be helpful.For patients who are so sensitive that they can not tolerate any supplements, binders (for toxins), or medications to calm down their immune and/or nervous system, limbic system retraining and vagal nerve interventions for eight weeks usually can allow them to move forward. Again, because the immune and central nervous systems are so interconnected, as the limbic system calms down, so do mast cells, inflammation, immune reactivity, and the many symptoms that they can cause.  Who Benefits From Limbic System RetrainingLimbic system retraining programs - specifically the Dynamic Neural Retraining System, not surprisingly, were first used for Multiple Chemical Sensitivity (MCS), Chronic Fatigue Syndrome (CFS), Electromagnetic Hypersensitivity Syndrome (EHS), and Fibromyalgia. They are also used for Mast Cell Activation Syndrome (MCAS), Chronic Inflammatory Response Syndrome (CIRS), mold toxicity and other biotoxin illness (Lyme and it's coinfections), Post Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD) and more generally for: * Those who have experienced physical, psychological or emotional stress and trauma and who are now suffering from a chronic health condition* Those with chronic depression and/or anxiety* Those with chronic painHow to Help Children Limbic System DysfunctionOlder children and teens can benefit from doing limbic system training program with a parent. My daughter and I did DNRS together. Our conversations about it were reinforcing and still shape how we each think about how to support our neurophysiology.  For younger children, following the steps may be more difficult. Programs like Brain Tap and Dr. Stephen Porges' “Safe and Sound” program can be very helpful. Honoring Our Limbic SystemBefore I close, I would again point out that our amygdala - beyond keeping us safe - is the source of many of our gifts - our sensitivity, intuition about people, and inner knowing. Those of us who come into the world “wired for danger” are also wired to see things others may not see and feel things others may not feel. We can use such gifts to serve a higher good. Whether or not you struggle with limbic symptoms, I hope something here helps you appreciate your limbic system so that it can help you find peace and purpose.Until next time,Courtney To learn more about the roots brain-related symptoms and discover surprising paths to healing, consider becoming a free or paid subscriber.Medical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

“Addicted” - “exhibiting a compulsive, chronic, physiological or psychological need for a habit-forming substance, behavior, or activity.” Like other health conditions, addiction is multifactorial. It is the result of an alignment of root causes. In this newsletter, I'll discuss:* Substance addiction and behavioral addictions* Why addiction is not simply about dopamine and why there are multiple addictive personalities* How & why we differ in our physiologic response to substances* Our culture's shaming and punishment of addiction while fueling addiction* The role of attachment disruption, trauma, emotional dysregulation, and social isolationSubstance AddictionWhen it comes to addiction, you might expect me to talk a lot about dopamine.  Not all substance addictions are the same, however. Opioids act very differently on the body than alcohol, which acts differently than cocaine.  Some substances are more addictive than others, and even more so in certain people.  For most people, marijuana is less addictive, while alcohol, cocaine, and opioids are more addictive. Addictive Substances:* Alcohol* Caffeine* Cannabis* Hallucinogens* Sedatives and Hypnotics/Anxiolytics* Inhalants* Opioids* Stimulants* TobaccoSeemingly, 10-20 % of people who try substances will have problems with addiction. Our genetic makeup and the expression of our genes will impact how we react to substances, just as they will affect how we metabolize specific medications or environmental toxins.  We could, for example, have a weak enzyme that slows our metabolism of alcohol and results in our becoming more intoxicated more quickly.  We may have high neurotransmitter activity that we're trying to calm down with substances, or we may have low neurotransmitter activity and are taking substances or even carrying out certain behaviors that increase our neurotransmitter activity.   Behavioral AddictionWhile we can become severely addicted to substances, we can also become addicted to behaviors or the feelings brought on by the behavior or anticipation of the behavior. Examples of Behavioral Addiction:* Food addiction* Sex addiction* Love and relationship addiction* Codependence is considered a relationship addiction in that relationships are often one-sided, emotionally destructive, or even abusive.* Exercise addiction* Body dysmorphic disorder* Health addiction* Shopping addiction* Gambling addiction* Work addiction* Video game addiction* Internet addiction* Smartphone addiction* Social media addiction* Porn addiction* News addiction* Information addiction* Self-harm addiction* Extremism is also felt to overlap with addictionWe can become addicted to anything that spikes the reward chemicals in our brains.  If we're not sure if we're addicted, we can ask ourselves, “Is the compulsive behavior having negative consequences?”The severity of our addictions falls on a spectrum.  I may not have a gambling addiction where I am putting myself at financial risk; however, I could be addicted to sugar, which I know negatively impacts my health, gives me brain fog and fatigue, and causes me to check out of my relationships, including my relationship with myself. Culture: Shame & Punishment The last thing that we need if we are addicted to a substance or behavior is shame and punishment. Our culture still tends to see addiction as a moral failing or even a sin that can be removed with punishment.  This thinking leads to simplistic consequences such as rejection by family and friends and even imprisonment.  The same happens with other forms of mental illness, but in this case, there is even less understanding, less compassion, more anger, and more disdain.Culture: Fueling AddictionMeanwhile, most of us are becoming more addicted - addicted to our cell phones, social media, divisive stimulating news and information.  We have more information coming at us than we can process.  Our brains are flooded with catecholamines as we stay in highly stimulated states. One of those catecholamines is dopamine, which will drive motivation and have us in pursuit of “more.”  While there may be a type of pleasure in that pursuit, it's not a joyful or even content type of pleasure. When we are in pursuit, we are not present in our lives.   Many of us can barely process our moments, days, and lives in these modern times. For many, what was a life of memorable moments (positive and painful) has become a blur of days quickly passing by. Before we've had time to process what has happened, what we've experienced, or what we've felt, our minds are in pursuit of the next thing we need to know or have.With addictive technology comes the marketing and its messages - “more food, more sex, more youth and beauty, more health, more money, more success, and even more love - the elusive movie kind.  We are forgetting how to be satisfied and tolerate uncomfortable feelings.Attachment & TraumaWe haven't all had the same early attachment experiences. Some of us have experienced childhood trauma. We don't know what safety feels like. Two-thirds of those with opioid addiction have childhood trauma. This doesn't account for the trauma that can occur before verbal memory, which is usually not reported.Childhood trauma impacts our autonomic nervous system, our limbic system, and our hormonal stress response. Before we even experience a stressor, our baseline neurotransmitters may already be too high. Our trauma, in combination with our genetic variants, may result in high neurotransmitters that we may try to calm down with our addiction, or our trauma, in combination with our genetic variants, may have us seeking out stimulation so we can feel more alive and connected.Social IsolationPart of our understanding of addiction comes from the work of American psychologist Dr. Bruce Alexander, who did the “Rat Park” study.  Previous research had already shown that when rats were put in solitary confinement and given a choice between water and heroin or cocaine, the rats repetitively consumed the drug-laced water until they overdosed and died.Alexander realized that the problem may not be the rats but the environment.  Rats are social animals, just as we are.  So, he created “rat parks,” where the rats could roam, play, socialize, and have sex.  Despite being given the same access to the two types of drug-laced water, these rats preferred the plain water.  Even if they did drink the drug-laced water occasionally, they never did obsessively, nor did they overdose.  The social environment was protective against addiction. If we want to help those with addiction, we need to think about connection. If we want to help ourselves with an addiction, we need to think about connection.Emotional RegulationOur ability to regulate our emotions (increase calm and decrease fear and anger) comes through interactions with other humans - safe humans. Ideally, we learn to regulate our emotions during our first three years. When we were distressed as infants and toddlers, we communicated that distress through our cries and facial expressions, our caregivers responded, and our physiology returned to a sense of calm and safety. This repeated process - not necessarily perfect, but “good enough” - resulted in our internalizing that early relationship and, with that, an ability to recognize our feelings, trust others, feel worthy, respond to uncomfortable feelings with coping skills, and return to our baseline emotional state.  Without this skill we acquire through attachment, we can become overwhelmed by our feelings or detached from our feelings. Our experiences, genetics, and temperament will impact which direction we go.There is not one “addictive personality” but many addictive personalities. Some of us will be highly sensitive, and others will have a low level of sensitivity. Some of us will become overwhelmed by stress or stimulation and use addictions as a way to try to calm our emotional and high neurotransmitter states.  Others will seek sensory stimulation or risk-taking to bump those neurotransmitters and increase the feeling state. Of course, our biochemical differences impact this as well:* For those of us who are undermethylated, we may find that we are sensory seeking, have high activity at the NMDA receptor, and find ourselves craving whatever has come to have meaning or has left a mark on our neurophysiology.  * For those of us who are overmethylated, we may have the desire to calm things down, slow our racing thoughts, and lower our high neurotransmitter activity.* For those of us with high pyrroles (and or CAPs profile), we may feel socially anxious or overstimulated and desire to feel calm and comfortable, but at other times, we may feel brave and invincible.“Being bold and adventurous and being sad and cautious seem like opposite personality types. However, these two paths to addiction are actually not mutually exclusive. The third way involves having both kinds of traits, where people alternatively fear and desire novelty and behavior swings from being impulsive and rash to being compulsive, fear driven, and stuck in rigid patterns. ……My own story spirals around this paradoxical situation: I was driven enough to excel academically and fundamentally scared of change and of other people—yet I was also reckless enough to sell cocaine and shoot heroin.” - Maia Szalavitz We need to think more broadly about addiction, just as we would any other health condition.  We need to address the underlying physiological root causes, meet our human need for connection, and learn ways to experience, tolerate, and cope with our very human and necessary feeling states.  In this week's paid newsletter, I look forward to discussing cases to illustrate how various neurotransmitters can be at play with different substance addictions and how targeted nutrients can be used in the treatment of addictions - both substance and behavioral. Until next time,CourtneyIf you'd like to dive deeper into the root causes of brain symptoms, consider becoming a paid subscriber. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

It can be easy to forget that medical professionals are vulnerable to stress, burnout, and even physical and mental health issues. Though we expect them to be well, physicians have a relatively high rate of depression. Physician suicide is twice the rate of the general population.I'll argue that doctors have biochemical and environmental factors contributing to their strengths and vulnerabilities.Though I'll focus on physicians in this newsletter, much of what I'll discuss applies to other medical professionals and caregivers.  In this newsletter, I'll address:* The higher rates of depression and suicide in physicians* How undermethylation is likely a strong contributing factor* How early family dynamics may be at play* A medical culture that leaves physicians unsupported and reluctant to seek help* SolutionsTo learn more about the root causes of brain symptoms and the consultations that I offer, visit courtneysnydermd.com Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

“Exterior building maintenance is crucial for preventing mold from growing inside a building” - Jerry Parker, CEIC, CMRTwenty-five percent of people appear to be susceptible to mold toxicity - a surprisingly common cause of brain symptoms, including brain fog, fatigue, depression, anxiety, mood swings, OCD, panic, and psychosis. Many chronic physician health conditions can result as well. In my experience, mold toxicity is the most common cause of mast cell activation. Mold toxicity should also be considered when there are new-onset mental health issues in college students exposed to mold in their dorms or apartments.Jerry Parker is a Certified Indoor Environmental Consultant (CIEC) and Certified Microbial Remediator (CMR). Jerry has been helpful to me personally and professionally and has taught me a great deal about the environmental aspects of mold. Jerry owns Environmental Solutions Group, LLC, which has served residential and commercial clients for the last twenty years. He is about to launch an educational and consulting platform, 4 Indoor Air Quality LLC.In this newsletter and podcast, Jerry and I discuss:* why mold prevention isn't just about keeping water out; it's also about moving water away from the foundation* ways to ensure rainwater is moving away from our home and its foundation * landscaping and vegetation* gutters and downspouts* roof and siding integrity* chimneys* cantilever fireplaces and bay windows* doors and window sealing* siding and deck attachment* the importance of regular self-assessmentsAt a later date, Jerry and I will discuss mold prevention with a focus on the interior of our homes.Let us know if you have any questions or comments on mold prevention (exterior or interior).Have a good week,CourtneyTo contact Jerry Parker CIEC, CMR: email - info.4IAQ.com 4IAQ.comRelated Content:* Mold Toxicity: Depression, Anxiety, Brain Fog & Fatigue (free)* Mold Toxicity & the Brain (free)* Mold & Candida in the Brain (paid)* Environmental Mold Myths (paid) This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Skin conditions are common in those with brain-related conditions. Most of what you'll find about this relationship is the suggestion that one is causing the other. It is believed, for example, that the stress of having a skin condition can cause depression and anxiety, which makes sense…..or that the stress of the mental health condition is causing an increase in stress hormones or inflammation that then leads to skin symptoms. This also makes good sense.In this podcast, I'll argue that skin and brain symptoms have shared common roots - one in particular. By brain symptoms, I'm referring to depression, anxiety, panic, OCD symptoms, brain fog, inattention, hyperactivity, mood swings, psychosis, and cognitive decline. I'll address:* the many ways zinc (important in brain health) impacts the skin* skin symptoms associated with specific “roots” of brain symptoms, including:* low zinc and high pyrroles* high copper* mast cell activation* candida and mold* methylation imbalances* Electromagnetic hypersensitivity (EHS)* Bartonella* how traits such as flushing, early graying, or a pale complexion can suggest vulnerabilities to the brain symptoms (Obviously, not everyone with these traits has brain symptoms, but for those who do, these traits can point to likely underlying contributing factors)* how certain acne treatments can worsen mental health conditions* the importance of understanding shared root causesIf you'd like to add to the discussion, I always appreciate your questions and comments.Have a great week,CourtneyFor information about non-patient consultations and treatment, visit: CourtneySnyderMD.comRelated Content:What Physical Symptoms Tell Us About Brain Symptoms (paid)Zinc & The Brain (free)Labs For Evaluating Brain Symptoms (paid)Medical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Eric Windheim, BA, BBEC, EMRS, RFSO is a Certified Electromagnetic Radiation Specialist and Certified Building Biology Environmental Consultant. He is the founder of Windheim Solutions, which provides inspection, testing, and remediation of problematic EMFs. In this episode, we discuss smart meters, which are digital devices that measure electricity usage in real-time, and wirelessly send that information to the utility company. Smart meters are sometimes used for gas and water.Though there are four harmful types of electromagnetic fields—radiofrequency (wireless), electric fields, magnetic fields, and dirty electricity—smart meters use radio frequencies.Brain symptoms associated with EMF exposure include insomnia, memory problems, irritability, depression, personality changes, inattention, fatigue, confusion, headache, ringing in the ears, dizziness, numbness, and tingling.Problematic EMF can impact the brain in many ways. It causes oxidative stress and neurotoxicity. It disrupts our immune system, innate electricity, hormones, microbiome, limbic and autonomic nervous systems, and the blood-brain barrier. EMF can also contribute to elevated blood sugar.The good news is that there are many ways we can lower our exposure.In this newsletter:* Eric shares: * How he became an electromagnetic radiation specialist.* The story of smart meters * His role in a national victory with Sacramento Municipal Utility District, the first municipal electric utility to allow customers to regain the use of analog meters. * We discuss the following questions:* How do you “opt-out” and return to an analog meter?* What can you do if you have to have a smart meter?* What can you do if you're getting radio frequency exposure from your neighbor's smart meters or other wireless devices?* What meter can measure radio frequencies in and around your home?* How can you find an electromagnetic radiation specialist?If you'd like to join the conversations, consider sharing your experience or questions.Have a good week,CourtneyMentioned Resources* Windheim EMF Solutions* WIndheim EMF Solutions Youtube Channel* Building Biology Institute* EMF & the Brain* Electromagnetic Hypersensitivity - A Lesser Known Root Cause* How We Can Start to Assess & Lower Our EMF Exposure This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

I recently had the pleasure of being on the Nourished By Nature: Mind Body Wellness Podcast with Annika Taylor, a holistic health practitioner. After sharing with Annika how I became a holistic psychiatrist and how I define holistic psychiatry, we discuss:* The Walsh Research Institute's data on nutrient levels of 30,000 people with brain-related symptoms, and what were found to be the most common imbalances (One or more of these imbalances is present in about 90-95% of the patient's that I evaluate for brain-related symptoms).* The Walsh biotypes of depression. How I test for the copper-zinc imbalances, pyrrole disorder, and methylation imbalances.* High copper and its relationship to ADHD, anxiety, depression and post-partum. depression, anxiety and psychosis.* Pyrrole disorder - symptoms, traits and treatment.* How methylation impacts brain health.* Under and over-methylation symptoms and traits.* Treatment of under-methylation.* How this understanding can remove the stigma associated with mental health conditions, and provide healing and hope.In recent years, Dr. Walsh discovered that undermethylation is increasing in the population while overmethylation is decreasing.If you'd like to add to the discussion, I always appreciate your questions and comments.Have a great week,CourtneyRelated Resources:Annika Taylor - nourishedbynature.comWalsh Research InstituteFor links to specific topics address see links in the description above. Medical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.In this newsletter and podcast episode, I focus on the prevention and treatment of Alzheimer's. Because this condition starts prior to the onset of symptoms, and because having almost any psychiatric condition appears to raise our vulnerability, many of the tools mentioned relate to other brain symptoms and conditions as well.“What we call Alzheimer's disease is actually a protective response to a wide variety of insults to the brain: inflammation, insulin resistance, toxins, infections, and inadequate levels of nutrients, hormones, and growth factors.” - Dale Bredesen, MD  (The End of Alzheimer's Program: The First Protocol to Enhance Cognition and Reverse Decline at Any Age)In this newsletter, I'll discuss:* Medications used in mainstream medicine * Lifestyle and functional medicine approaches to preventing and treating Alzheimer's* Feeding the brain - The ketogenic diet and intermittent fasting* Exercising the body and brain* Sleep and sleep apnea* Hormonal deficiencies and dysregulation* Oral health* Toxicity, depletion of antioxidants and oxidative stress* Brain inflammation If you have any questions or comments (or topic suggestions),…If you know someone who may benefit,…Have a great week,CourtneyMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having.Resources mentioned:* Precision Medicine Approach to Alzheimer's Disease: Successful Pilot Project* Reversing Alzheimer's: The New Toolkit to Improve Cognition and Protect Brain Health by Dr. Heather Sandison * The End of Alzheimer's by Dale Bredesen, MD* Walsh Research InstitutePrevious newsletters/podcast episodes mentioned:* Alzheimer's: Factors We Have Control Over* Regulating Blood Sugar For the Brain* Intermittent Fasting & the Brain* Exercise & the Brain * Oxidative Stress & the Brain* Lowering Brain Inflammation This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

Alzheimer's is a neurodegenerative disease. It involves the death of brain cells and the eventual loos of brain tissue. The brain changes begin twenty years prior to the onset of symptoms. This is important, because we do have control over what appear to be most of the contributing factors. In this newsletter and podcast episode, I'll address:* The incidence of Alzheimer's* What happens in the brain* The course of the illness* Biomarkers used for diagnosis, even prior to the onset of symptoms* Mild Cognitive Impairment (MCI) due to Alzheimer's* Risks* The role of the APOe4 gene* The role of Insulin resistance in the brain* The role of oxidative stress* The role of inflammation* Evidence of a fungal presence * How these factors may be working togetherIn the next episode, I'll discuss mainstream treatment, as well as functional/integrative/holistic approaches to target blood sugar regulation, oxidative stress, inflammation and even the presence of mold and candida.Feel free to add to the discussion with your questions or comments.If you know someone who may benefit from this information, please consider sharing.Have a good week,Courtney Mentioned Resources:* Alzheimer's Association Facts & Figures* Meet the Switching Mice: They Flip Their Glia APOE4 to APOE2* Mold & Candida in the Brain (free)Other Related Newsletters:* High Copper, Metallothionein, Cancer & Mental Health (paid)* Lowering Brain Inflammation (free)* Regulating Blood Sugar For the Brain (paid)Medical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your own physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this newsletter and podcast episode, I share the simple yet powerful tool of intermittent fasting. Here, I discuss:* The types of intermittent fasting with a focus on “time restricted eating,” in which fasting is extended to 12-16hours a day (from the more typical 8-10 hours).* Why it makes good sense from an evolutionary standpoint.* What it has to teach us about our metabolism and our brain's use of energy.* The health conditions it is has been shown to be beneficial for.* The many mechanism by which is impacts the brain.* My experience with intermittent fasting.* When fasting can become problematic.If you have experience with intermittent fasting (or questions), please consider adding to the discussion. Have a great week,CourtneyP.S. For paid subscribers watch out for a midweek post on other ways we can work with our body's metabolism and rhythms to improve blood glucose regulation, which is particularly important when it comes to brain health. Additional Resources:* The Effects of Intermittent Fasting on Brain and Cognitive Function* Intermittent Fasting as a Potential Therapeutic Instrument for Major Depression Disorder: A Systematic Review of Clinical and Preclinical StudiesRelated Content* Exercise & the Brain - 10 Ways Exercise Improves Our Mood, Lowers Anxiety & Protects Our Brain.Medical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your own physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

My purpose in this video is to remind us to protect our mental health, our physical health and our relationships this election season. We have a natural impulse to pay attention to danger. News networks and social media take advantage and profit from this instinct.Here in the US, we are facing five months of what can be highly stressful. Some will have an increase in anxiety, depression, anger and addictive behaviors including news addiction and internet addiction. If we care about lowering toxic exposures, lowering our stress response and thus inflammation, then these next five months offer a great opportunity. If we care about setting healthy boundaries between ourselves and the negative or self-serving energy of others, these next five months are a great time to strengthen our boundaries. In this video, I discuss:* What is happening in our body and brain when we engage with fear-inducing content.* Media literacy to remind us what we easily forget when we're under the influence of media that aims to get and keep our attention.* How the echo chamber of news and social media is rewiring our brains, and reinforcing left brain tendencies.* What we can do to lower our exposure and it's impacts, and..* How we can call in the right hemisphere while doing our part to better the world we're actually living in.If you'd like to add to the discussion, please….Have a good week, CourtneyTo learn more about this and other factors contributing to brain symptoms or to receive these newsletters in your mailbox each week, visit www.CourtneySnyderMD.comRelated Content:Left and Right Brain: Knowing When to Call in the Other HalfUndermethylation & Strengthening the Right Brain in a Left Brain WorldMedical Disclaimer:This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your own physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe