Functional Medicine Research with Dr. Nikolas Hedberg, DC

In this episode of Functional Medicine Research, I interview Dr. Robert Hedaya about overcoming PTSD.  Post-traumatic stress disorder is an extremely difficult condition to manage but Dr. Hedaya and I discuss multiple approaches that can help patients with PTSD get well.  We discussed how PTSD is defined, how it changes the brain, QEEG guided laser, neurofeedback, loneliness, social isolation, social media and much more.  I always love having these kinds of conversations with psychiatrists and other mental health professionals because I believe it is the most overlooked aspect of functional medicine today. Below is a transcript of the interview on overcoming PTSD: Dr. Hedberg: Well, welcome, everyone to "Functional Medicine Research." I'm Dr. Hedberg and really looking forward to today's conversation with Dr. Robert Hedaya. I first heard him speak at the Institute for Functional Medicine last year on PTSD and so I wanted to have him on the show to talk about that. He is a medical doctor. He's been on the cutting edge of medical practice, psychiatry, and psychopharmacology since 1979. With the publication of his first book, understanding biological psychiatry, in 1996, he pioneered the use of functional medicine in the psychiatric field and he is now pioneering the use of G-guided laser treatment of neuropsychiatric disorders. Dr. Hedaya is a clinical professor of psychiatry at Georgetown University Medical Center where he's been awarded the teacher of the year on three occasions while teaching courses on affective disorders, cognitive therapy, and one of my favorite topics, psycho-neuro-immuno-endocrinology. Since 1983, he's on faculty at the Institute for Functional Medicine, the author of two additional books, "The Antidepressant Survival Guide," and "Depression: Advancing the Treatment Paradigm," and he's the founder of the Center for Whole Psychiatry and Brain Recovery. Dr. Hedaya is an editorial volunteer for Advances in Mind-Body Medicine and Alternative Therapies in Health and Medicine. He's been featured in local and national media on things like "20/20", "60 minutes," "Vogue," "The New York Times," and "The Washington Post" on many occasions. And he's a frequent nationally and internationally recognized speaker. His website is wholepsychiatry.com. Dr. Hedaya, welcome to the show. Dr. Hedaya: Thank you very much for having me. Dr. Hedberg: Excellent. So, like I said, I heard you speak at IFM last year and was really interested in your research and studies on PTSD. Why don't we start by you just talking about how your career evolved from traditional psychiatry into functional medicine and now using some cutting-edge treatments for treatment-resistant depression, dementia, PTSD, chronic fatigue, and technologies like laser? Dr. Hedaya: Okay. Well, it's been a long arc and I would say that the main thing is that I always try to follow where the science guides me, what's the truth that as far as I can best make it out to be. So, rather than being afraid of stepping outside of the box, you know, I just feel it's my responsibility, as a clinician, helping people to always try to do the right thing, and the right thing for me means doing what the science dictates, and sometimes it's benched to bedside science. Sometimes, you know, like translational medicine, sometimes you have the studies, but following the principles of biology and physiology and sometimes you have to take a leap because you can't wait until the studies are there. So, the way it started for me was, 1983 about, I was treating a woman with panic disorder and she was not really recovering. And panic disorder is pretty easy to treat. Whether you use cognitive behavioral therapy, which I was using, or medications or combination of the two. So, it was about a year and she wasn't getting better and she paged me, I had a beeper back in those days, on a Saturday night, I was at a wedding and dancing and my beeper went off and looked and...

The ferritin test may be the most important blood test you ever get, especially if you have a thyroid problem. When I began my training in the diagnosis and management of internal disorders immediately after graduation, one of the first things we studied heavily was blood chemistry analysis.  My teachers always stressed the importance of taking a careful look at iron levels in the blood and a rare test known as the ferritin test. What is ferritin? Ferritin is an iron-containing protein and is the primary form of iron stored inside your cells.  Even though there is a small amount of ferritin released into your bloodstream, it is an accurate marker of how much iron is actually stored in your body.  Iron is primarily stored in your liver, muscles, spleen and bone marrow but if you have too much it can accumulate in your organs and the brain. You either have too much iron, too little or just the right balance in your body and the ferritin test can give us an excellent picture of how much iron is actually stored in your body.  Iron is found in your red blood cells but it also accumulates in your organs and tissues. Iron is important for healthy oxygen transport throughout your body so you can see how vital it really is for your health.  Too little iron will result in anemia which basically means that your red blood cells cannot carry enough oxygen to your cells and you start to develop signs of oxygen deficiency.  Signs of anemia include: Weakness Dizziness Headaches Pale skin Fatigue Low body temperature Memory loss Hair loss Poor brain function Hypothyroidism Adrenal fatigue Spoon-shaped finger and toenails Smooth tongue Burning sensation in the tongue Sores at the corners of the mouth Dry skin Shortness of breath Ringing in the ears (tinnitus) Leg pains Chest pain Pica (cravings for specific substances, such as licorice, chalk, dirt, or clay) Too much iron can have the opposite effect because iron creates a lot of oxidative stress which is basically too many free radicals that create inflammation.  These free radicals eat up your antioxidants like vitamin C and E creating deficiencies. Menstruating females lose a small amount of iron every month during their cycle so they tend not to build up too much iron in their bodies.  However, iron levels can get too low when your diet is deficient in iron and you have absorption issues due to things like gluten and gut infections.  I tend to see low ferritin levels quite a bit in chronically-ill women who are still cycling but it is also common in postmenopausal women who never restored their iron levels before entering menopause. Since men do not have a menstrual cycle, we are the most at risk for accumulating iron.  As iron builds-up in a man’s body he may develop the following symptoms as it accumulates in the brain and other body tissues (most of these also apply to women): Brain fog Fatigue Low sex drive and erectile dysfunction (iron accumulates in the testicles) Mood swings, especially anger Digestive problems as iron builds-up in the gut Anxiety Depression Fatigue after meals (insulin resistance) Memory loss Joint pain Weight loss Abdominal pain Hair loss Congestive heart failure Iron is extremely “heavy” in the bloodstream so it forces the heart to work harder as it pumps this heavy metal through your blood vessels resulting in blood pressure changes and more inflammation in your arteries. This is where the ferritin test is so important because it can tell us if there is too much or too little iron in your body.  It’s a simple blood test but rarely ordered during general check-ups and standard blood panels however I believe it is one of the most important and overlooked tests in medicine today.  This is why I include it in every patient’s blood panel even if it was normal within the last year.

A new paper entitled, “Impaired Vagal Activity in Long-COVID-19 Patients” sheds light on the vagus nerve’s involvement in Long-COVID-19. COVID-19 is divided into three phases of infection: 1. “Acute COVID-19” (signs and symptoms of COVID-19 infection up to 4 weeks). 2. “Ongoing symptomatic COVID-19” (from 4 weeks up to 12 weeks). 3. “Post-COVID-19 syndrome” (signs and symptoms persist beyond 12 weeks). Click here to learn more about the Hedberg Institute Membership. Study Methods 30 Long-COVID-19 patients were compared to 20 control subjects who never had COVID-19. 21 patients were classified based on their experience while having COVID-19 as mild/moderate and 9 as severe/critical. 7 patients had no/negligible functional limitations, 6 had slight functional limitations, and 17 had moderate/severe functional limitations. No significant differences were found among study subjects and controls regarding gender, demographics, medical history, drug use, and vital signs. However, previous studies have shown that females are more affected by Long-COVID-19. Heart rate variability was measured through ECG. Heart rate variability parameters are controlled by the parasympathetic nervous system. The sympathetic nervous system promotes inflammation through catecholamines and beta-adrenergic stimulation in contrast to the parasympathetic nervous system which is anti-inflammatory. COVID-19 causes an imbalance between these two systems, thus driving inflammation and a procoagulative state. Study Findings Heart rate variability was found to be lower in the Long-COVID-19 patients. Left ventricular ejection fraction was lower in Long-COVID-19 patients. When SARS-CoV-2 comes into contact with the eye, it may reach the central nervous system via the trigeminal nerve. And when the virus contacts the nasal mucosa, it may reach the brain through the olfactory nerve. It may also travel to the central nervous system via the vagus nerve from the respiratory system, the heart, the digestive system, the kidneys, bladder, uterus, and testicles. This occurs through neuronal retrograde transport to the axonal terminal. SARS-CoV-2 has been detected in the vagus nerve, thus persistent damage to this nerve could explain impairment of the parasympathetic nervous system in Long-COVID-19 patients. SARS-CoV-2 can also invade the brain through a dysfunctional blood-brain barrier, which has been damaged by cytokine storm. SARS-CoV-2 binds to the ACE2 receptor found in the respiratory airway, lung, vascular endothelia, kidney cells, and small intestine. ACE2 receptors are also found in neurons and glia in the brainstem regions responsible for cardiovascular function and regulation. SARS-CoV-2 neuronal invasion drives epinephrine and norepinephrine from the adrenal gland known as the “catecholamine surge” which causes cardiovascular, lung, and brain injury. NT-proBNP levels were found to be increased in Long-COVID-19 patients, which reflects myocardial strain due to increased vascular pressure. This persistent myocardial strain may drive the dysautonomia, or it could be due to increased ischemia and inflammation. D-dimer can have prolonged elevation in Long-COVID-19 patients, which can lead to increased thromboembolic complications. Dysautonomia, neurotropsim, inflammation, and the persistence of a procoagulative state with an elevated myocardial strain may explain vagus nerve impairment in these patients. However, the authors state, “...it remains unclear whether dysautonomia associated with Long COVID-19 directly results from post-infectious immune-mediated processes or from the autonomic-virus pathway.” The authors call for research on evaluation of cholinergic nerve fiber damage in Long-COVID-19 patients to confirm impaired vagal activity. How to improve vagus nerve function? I have patients do a variety of exercises throughout the day such as singing, humming, gargling with water,