About James Greenblatt, MD
A pioneer in the field of integrative medicine, James M. Greenblatt, MD, has over 25 years of experience treating patients with mood disorders and complex eating disorders. An acknowledged integrative medicine expert, Dr. Greenblatt has published several books discussing the scientific evidence supporting the use of nutritional interventions in psychiatry.
Dr. Greenblatt’s expertise in the areas of biology, genetics, psychology, and nutrition as they interact in the treatment of mental illness has lead to numerous interviews by the media on television as well as in written articles for consumer audiences.
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Books Discussed in this Podcast
Interview Show Notes
02:34 Minerals and Neurologic Health:
Zinc, magnesium, chromium, lithium in particular and copper are sparkplugs, cofactors for neurotransmitter syntheses. They provide a structural role in the brain and a functional enzymatic role. Our brains are the most metabolically active organs in our body. Without adequate trace minerals, the brain does not work as well. Animal and human studies demonstrate this.
03:47 Causes of Mineral Deficiencies: Due to modern agricultural practices, the soil is depleted of minerals. Environmental toxins also play a role. Environmental toxins and plastics bind zinc and impair absorption. Vegans and vegetarians sometimes do not get enough zinc in their diets. Stress, sweating, and exercise can cause us to lose minerals. Processed foods lack trace minerals. Magnesium is a common nutrient deficiency in mental illness due lack of magnesium in the soil and stress. Increased cortisol lowers magnesium.
05:47 Sauna Therapy and Mineral Loss: Sauna therapy and hot yoga are great for eliminating toxins, but we are also losing minerals. Supplementing with minerals, especially zinc and magnesium, needs to be part of the process. Electrolytes, sodium and potassium are lost as well.
07:25 Nutritional Lithium and Mental Health: Nutritional lithium is in our soil, tap water and is critical in functions throughout the body, but mostly in the brain. It is measured in micrograms to milligrams. Pharmacological lithium used in psychiatry are given in much higher dosages, 600 to 1800 milligrams, with significant side effects. It is one of the best treatments for bipolar, but it could induce irreversible kidney and thyroid disease. Low dose lithium has huge benefits across many neurological and psychiatric illnesses. Studies of drinking water show a correlation between mental health and the amount of lithium in the water. Practitioners recommend 5 to 20 mg of lithium orotate per day to treat symptoms of irritability, mood disorders and for the prevention of Alzheimer’s.
09:39 Lithium and Brain Chemistry: BDNF (brain-derived neurotropic factor) is a peptide that is an incredible biomarker for mood, memory and the health of the brain. Lithium stimulates BDNF and stimulates the genes to produce BDNF. Lithium has anti-inflammatory properties in the brain. It modulates many neurotransmitters: serotonin, dopamine and glutamate. It works on an enzymatic level in the brain and effects many genes associated with brain function.
11:43 Lithium to Optimize Brain Function: A healthy person could take 1 or 2 mg for a safe and effective dose. For anyone over the age of 50, 5 to 10 mg is clinically appropriate. Dr. Greenblatt has never seen side effects, blood levels are not raised and it is easily absorbed. In some places, this is already in the water supply.
12:36 Lithium and Alzheimer’s, Parkinson’s, and ALS: Lithium stimulates some of the enzymes to break down the beta amyloid that is accumulating in the brain. It also stimulates cleanup and repair mechanisms in the brain. This makes it helpful for some of the underlying causes of dementia and Alzheimer’s in particular. Theories are diverse and sometimes contradictory. However, the accumulation and the neurofibrillary tangles impairs neuronal functioning. Alzheimer’s develops over 30 to 40 years, so it is challenging to treat. Lithium can be used early to prevent the illness.
16:07 Testing for Lithium: Dr. Greenblatt checks his patient’s hair samples for lithium. Some patients who have no detectible levels of lithium have family histories of bipolar illness, substance abuse or other illnesses.
17:26 Filtered Water: Dr. Greenblatt is seeing an increase in lithium deficiency and believes that filtered/bottled water may be one cause. Along with other trace minerals, we should be adding them into our diets.
18:30 Mind Body Medicine: In his new book on depression, Dr. Greenblatt speaks to nourishing the brain and also nurturing the mind with helpful mind body approaches. Practitioners often have a favorite treatment and tend to push that on everyone. We need many tools in our toolbox to treat patients that are struggling with depression. His most successful patients utilize both the nutritional and mind body approach.
20:45 Testing for Minerals: Hair mineral analysis is helpful in determining lithium levels, copper/zinc ratio and calcium/magnesium ratio. There is value in organic acid testing for vitamin B12, vitamin D, iron and hormone function, as well as for amino acid and fatty acids. For the hair test he uses Trace Elements International and Great Plains Lab. For organic acids, amino acids, fatty acids and food allergy testing, he uses Great Plains Lab.
23:07 Low Serum B12 and Mood Disorders: B12 deficiency is one of the biggest tragedies of modern medicine. It causes permanent mental illness and neurological damage if it is not addressed. A normal B12 level should be over 1200. Dr. Greenblatt uses injectable B12 with patients who are very deficient. The cyanocobalamin version is discouraged. Hydroxocobalamin is preferred to methyl as an injectable since the methylcobalamin can be activating. In sublingual the adenosylcobalamin, hydroxocobalamin and methylcobalamin all seem to increase B12 levels.
25:54 Mineral Supplementation: A healthy person without psychiatric symptoms who may be losing minerals does not need large dosages: 30 – 60 mg zinc, if copper is normal 2 – 4 mg of copper, 200 – 400 mg magnesium, and 400 mcg chromium. Better absorption occurs when nutrients are taken with meals twice each day.
28:11 Lowering Cholesterol: Diabetes and cardiac doctors believe that the lower the cholesterol the better it is for us. The FDA finally put a warning on statins that they have cognitive side effects. Very low cholesterol (under 130) tend to be associated with depression, suicide and drug use. We need to make sure that we are getting adequate fat in our diets. Cholesterol is critical. Sixty percent of the brain is fat. It is an important part of all cell membranes. In addition, serotonin receptors and oxytocin receptors are stabilized with cholesterol molecules. Without adequate cholesterol, neurotransmitters do not work optimally.
30:23 Nutritional Ketosis for Brain Health and Mental Health: Lower carb diets help in weight loss and benefits many psychiatric illnesses. There are no essential carbohydrates. However, there are essential fats and essential amino acids. The ketogenic diet has been shown to be helpful in seizure disorders. The literature is just beginning to come out. Clinically, Dr. Greenblatt would not want his patients to constantly be in a state of ketosis because of potential kidney function complications. For short periods of time, it can be beneficial.
31:43 Omega 3 Fat Supplementation: Dr. Greenblatt does not think that mega doses of omega 3s are helpful. He recommends 3 to 4 grams per day for those of us who do not eat fish every day. Higher doses creates an imbalance with other essential omega 3s and even 6s. Omega 3s have incredible potential for a wide range of psychiatric illnesses. Excessive omega 3s can be offset by taking GLA in the form of evening primrose oil, black currant or borage oil.
35:26 Hormones and Psychiatric Illness: The psychiatric community is focused on the neck up. Part of a workup for a patient, particularly one struggling with depression is a hormone assessment of thyroid function, for males testosterone and for the precursor DHEA. Low levels of DHEA is predictive of depression. It is a precursor to all of the hormones in our bodies from cholesterol. Dr. Greenblatt does not work with female hormones as it is a more specialized. DHEA supplementation for 3 to 6 months while other nutrients and diet is addressed, can benefit many who are struggling with mood disorders. Testing is necessary.
39:11 No One Treatment: Many persons with depression may have different underlying causes. No one supplement or pill is the answer. It must be personalized. Medicines are a last resort. Nutritional foundations have to be looked at carefully.
42:21 Dr. Greenblatt’s Favorite Nutrient and Botanical: OPC flavonoids in grape seed extract, red wine, and green tea have tremendous benefits, including enhancing the integrity of the blood brain barrier, anti-inflammatory properties and anti-histamine properties. Combined sources are better than single sources. Rhodiola is used for depression and ADHD with incredible results. These are an important part of Dr. Greenblatt’s practice.
45:51 Dr. Greenblatt’s Morning Routine: Morning is when his brain is the sharpest. That is when he does his writing, reading and thinking. He does his exercise and meditations in the afternoon and evening.
47:31 Dr. Greenblatt’s Elevator Speech with a Powerful Politician: He would relate to them the current understanding of omega 3 and psychosis. Psychosis is poorly treated around the world, including here in the US. Omega 3 fatty acids have been shown to prevent psychotic illness in young adults.