Episode 15: Integrative Medicine

This transcript was generated automatically. Its accuracy may vary.

Cara Lunsford

Oh, hey, nurses. Welcome to the Nurse Dot podcast. Giving nurses validation, resources and hope. One episode at a time. So today on Nurse Dot podcast.

Dushyant Viswanathan

How many individuals are saying that their type two diabetics are reversing? It's a reversible, preventable, unnecessary disease.

Cara Lunsford

Joining us today, Dr. Jeffrey Becker and Dr. Dushyant Viswanathan. Dr. Becker and Dr. Viswanathan share how they first got involved with the integrative medicine field and how they used it to take a holistic approach to health, addressing and treating the whole person, body, mind and spirit. I'm your host, Kara Lunsford, registered nurse and VP of community at Nurse Com.

Oh, hi.

Dushyant Viswanathan

Hi. Hi. Are sorry, guys.

Cara Lunsford

I was just. And look at you in your scrubs looking all official.

Dushyant Viswanathan

Yeah, I used to wear suits everywhere every day. Hospital rounds in the morning and then office in the afternoon and then video, telemedicine and stuff. I was a suit guy every day until COVID. Now there's a media worthy virus, and I don't want to wear a suit anymore. So now you come in scrubs.

Cara Lunsford

Oh, this is great. Well, I was just telling Dr. Becker, Jeff, about you. And I was giving him a little background on how I know Dr. Viswanathan. I was going to just start off by saying, like, we call you DV mainly because probably most people don't pronounce your name well.

Dushyant Viswanathan

Yeah, yeah, yeah, right. Actually, it's such a poetic name. The strength of this one I have in my six year old is learning how to pronounce his own last name finally. And when I started my career, it's like it was quicker and easier to just because I feel like a medical service is a service to others. It's not really about me.

Right. And so if people saw DV and they could just move on with that, then we could get into the chief complaint and then. HB I know that, you know.

Cara Lunsford

It is actually a pretty cool name. So I will say like DV, like, I don't know, I maybe I've just like grown to kind of love it. So I'm just like, Hey DV, hey DV. But I also really, really love the poetic ness of your full name because it's, it is really lovely. So this is just really, really exciting for me to have you both here.

I recently met with Dr. Becker and I drove out to Santa Barbara where you live, and we had the nicest lunch and you taught me so much about ketamine therapy, psychedelics. You know, I just learned so much from you. And so when we were trying to figure out, like, okay, well, what episodes do we want to have for the podcast?

And I was kind of outlining the different episodes. I was like, I have got to have an episode about integrative medicine. Dr. Viswanathan, tell me, like, how long you've been in integrative medicine and maybe like what inspired you to kind of move away from other types of maybe more like Western medicine, I guess you would say, Yeah.

Dushyant Viswanathan

Well, I never really moved away from it. I never was in it also. So I watched my mother when I was a child. That was my mother. She was very attracted to naturopathy matters and her primary care doctor was a master path. She passed away of hydrocephalus and I had an excellent nurse at the bedside with my mother.

And in her last year, you may have heard of her. Kara Lunsford, amazing nurse. Anyway, my mother was naturally connected to our natural and natural panic medicine. Her primary was a natural path in Thousand Oaks. It was pretty well known. He passed away like probably about five or six years ago. So she was always in that space. But she kind of embraced Western medicine, conventional mainstream medicine.

Also. I think as she got older, my father had breast cancer, male breast cancer, which is which is deadly. But he had a slow growing tumor. So how she managed him and managed our family and then how she changed my food lifestyle so my asthma went away. I just kind of saw my mother's mind as a dynamic force, regardless of whether she was listening to a doctor or a dentist do their thing or listening to an astronaut do his thing or whatever.

But ultimately my mother's mind was in charge of her world. So I think that was my main teaching, right? So I was kind of in that frame of mind. I was into yoga and I was a physical trainer before I went to med school and I already had a patient base. I wouldn't call them. I had to call them with clients back then.

But in my mind there were patients, you know, I was of service to them and I was thinking about food early on in life and things that we now know are common sense about the impact of processed food versus like plant based organic food is just a different sort of environment. We know that now. But back in the nineties, maybe it was lost on some people that so that was so important.

So that's where I was. And then I entered medical school and it was too materialistic for me. I went to med school when I was 20 at UC San Diego and I actually dropped out. I was it was too materialistic for me and I had to do other things. I had to expand my mind. I had to travel, I had to make myself a better person before I got into that.

And I could see how the whole the medical school and the university establishments are gearing people towards research, gearing people towards industry. And I wasn't there yet. I mean, I knew that I would get there eventually, but then I wasn't really ready for that. So I had to get myself mentally, emotionally, spiritually ready for the industry of medicine, right.

And yet maintain my core. So I eventually went back to medical school. This time I was ready and it was easy because I was ready and so I did what they needed. So that's that's the key. I just get what they needed. So same thing with residency. And I remember doing yoga in the hospital, parking lot under the trees with patients who were leaving the clinic, and I was doing yoga meditation with them and then as a resident.

And then I was also putting central lines in. And because that hospital had only residents running the ICU. So there were no there was no specialty backup. So as a second year resident running the ICU, that required me to like, get materialistic, get physical, get completely Western. I'll never forget the moment when I had a septic shock. Pneumonia patient and I intubated the lady myself, put the central line in myself, managed the whole thing.

I had excellent nurses behind me. I've been blessed to have amazing nursing relationships throughout my career. I'm so blessed for that because I don't know what I would do without nurses. It's like we were completely helpless, especially in residency, because the nurses have watched residents come and go as like little babies coming in, you know, thinking they may know something and realizing they don't, then learning something a little bit and then leaving with a bigger ego than they started and then a little more knowledge than when they started.

And then watching the next group of idiots come in and the nurses just watched that. And I've seen the I've seen nurses just like having an understanding of generations going by and and I'm still in touch with them. Some of my nurses from when I was an intern. But I remember how how, how wonderful I felt when I was able to put central lines in.

And I remember like when I was 17, when I was I did a phlebotomy course my first time, I put a needle into somebody and I remember getting woozy and nauseated. You know, I had a vagal response to blood. I 17 And then like, fast forward four years later, I'm putting a central line in. I got a little over me walking out, Go have a drink.

You know, it's like it was like a transformation. It's a wonderful experience, you know? So I love the ICU, you know, I still work in an ICU every morning, so I'm still enthralled by Western medicine. It's it's just not the solution for the chronic disease epidemic, you know?

Cara Lunsford

Yeah. Yeah, absolutely.

Dushyant Viswanathan

Yeah. So I'm still in it. You know, I have contracts with major players in the world, in the health care world and stuff, so. But I'm in it. But not of it, you know.

Cara Lunsford

Yeah, that makes sense, because that's what integrative medicine is, right? It's like this incredible balance between it's not saying all this or all that, which is what I really love about, you know, what I've learned from you, Dr. Viswanathan, and also what I what I've learned from Dr. Becker. Dr. Becker, I'm going to ask you the same question.

So something very similar, like how did you find your way into a more integrative psychiatry?

Jeffrey Becker

Well, it's interesting. There's a I think there's an amazing similarity in the story here. And I'm going to get to something in a second because I think we might even have the same doctor in common in terms of our mothers. But I watched my mother really, really improve her health after seeing a doctor in Thousand Oaks named Philip Taylor.

Dushyant Viswanathan

Taylor Yes. Dr. Taylor Yes.

Jeffrey Becker

I grew I grew up watching. You know, I was in the office when watched the way he solved problems and basically the testing that he did, he was essentially it was functional, not as much integrative as functional and really looking at molecular mechanisms, metabolism, vitamins, things like that. And and also just common sense advice, allergies and things like that, food as medicine.

But he had a an authority that was just unequivocal. I mean, you could tell he knew what he was doing and he was beloved. So when I went to medical school, I was deeply interested already in how molecules work in our body and how we can use that to provide leverage to the actual natural healing mechanisms in the body instead of bringing something from outside of the body that has never existed on the earth to solve a problem.

Let's just start with what might be not working properly in the body and maybe we can apply that leverage first. And again, it's not either or, I think deeply appreciate. I mean, you're way more deeply involved in the physical aspect of the human body than I am in general. But I very much believe that if we're going to be effective doctors, we have to truly not just give lip service to the idea of of understanding body, mind and spirit, or really like tissue and flesh, you know, mind and spirit in terms of providing options for patients to heal and not jumping to things to the wrong kind of balance, really?

In some ways, yeah. You know what? This is amazing because it really shows how influential a doctor can be or a practitioner can be or, you know, any any of us that are providing good care in the community, how we can inspire young people to do the right thing and kind of open their eyes to alternatives.

Dushyant Viswanathan

Yeah, absolutely well-said.

Cara Lunsford

Yeah, that's a mind, body and spirit. I mean, we know that there is a huge epidemic of chronic illness and we also know that there is a huge epidemic of mental health illnesses as well. And you could kind of venture to say that I guess mental illness and chronic illness, there's a lot of overlap there and kind of like which comes first, the chicken or the great, it's kind of like, do you fix them both at the same time?

If you fix one, are you going to get results physiologically? For example, if you have somebody who has chronic depression and you help them to fix their chronic depression, what are some of the maybe physiological things that they've been experiencing? How are those things going to become alleviated and then vise versa, like from the other way? DV Can you weigh in on that at all?

Dushyant Viswanathan

Well, I think there's having this particular discussion with a integrative psychiatrist along with integrative medical doctor, both who have embraced their own personal journeys and see our patients almost through our empathetic lens, reflecting our personal journeys is probably the way to answer that question. You can almost argue either way, whichever comes first. Well, I see it often as dominos.

If you have dominos where there's a bunch of dominos all in a sphere and an arc, you tap it on one over here, you'll end up affecting the domino over here. So if you start with approaching a patient's sort of psycho therapeutically and maybe from the perspective of simply therapy, right, sometimes that will be a domino effect that will lead to better habits and better lifestyle and maybe better metabolic conditions.

Right. I think that's the whole reasoning with the Endocrine Society, for example, recommending if patients are trans transgender, we're being told by the guidelines to proceed with gender altering medications because of their mental health or their lack of mental health may be the biggest threat to their lives than, say, the side effects of, say, using hormones to change gender.

Right? So there is a recognition that in that context that the mental health must come in a way be prioritized first. But I have also seen some situations where, let's say a simple example of a woman who's having such violent hot flashes that she can't sleep and is irritable during the day. And it's now there's a lot of stress between her and her husband.

And that's going to affect maybe if she's happy, happens to be not that she has to be, but if she happens to be the person preparing food and that the husband has medical conditions and now the food in the home is deteriorating and now the men's agency is going up, you see like dominos effects. It can work in different ways as a metaphor, right?

So simply using a hormone treatment for this one person could improve things in a domino effect and ultimately translate to the family being better. So it depends on each particular person. In my experience, the patients come to us and not a shaman, for example, for their particular problem because they have this expectation that their body is not working well and doctors are in charge of the body and they trust doctors.

People trust doctors, people trust nurses more, by the way, statistically. But number two, profession after interest is after the nurses as doctors. So people trust doctors with their authority and so on. I think there's too much trust in the authority of a doctor. I see patients who violate their own experience and their own truth by listening to what authority doctor says who's met them for 5 minutes.

I find that offensive a little bit. Sometimes. And so in a way, they're presenting their preconceptions to us. And my job is to listen to what that preconception is and meet them where they're at and and I have a personal experience where there are some cases where if you have the right solution in the wrong moment, you may be unsuccessful in making that helping that patient get better.

And so in my world, the chronic disease world is the long game, you know, And so what we decide to do in a particular moment, it must sort of embrace where the patient is at their baseline in their perception and build trust and kind of guide them in the right direction because I see becoming healthy means a total change of the physiology, because their symptoms are a reflection of their pathophysiology, which means that to become healthy is a must be a reflection of a change in that that that is theology that is sustainable.

And now you just have a normal human physiology, which is healthy, normal human physiology with well-regulated normal physiology, I would say is a short definition of health. And to get there requires this transformation and sometimes you just have to be charming with the patient and make them like you so that we're going to work together. And sometimes they tell us what their solution is.

Sometimes they tell us, Yeah, I eat garbage. And my my response is, well, you know, I actually had an asthmatic in today and she was like, yeah, I don't have any no sick contacts. And, you know, I don't have no asthma in my family. And then like giving me all this explanation of why she should not be having an asthma attack.

And then I asked her, what do you eat? And she said, I eat a lot of junk food. And I said, There's your explanation. There's your explanation. I mean, you know, so you're telling, you know, and William Osler, the founder of Internal Medicine, the guy who put Johns Hopkins on the map, he says something so wonderful. He said, listen to your patients, because they're telling you what the diagnosis is.

Cara Lunsford

Yeah, exactly. It's kind of like that thing of like, listen to what someone's telling you, because most of the time, you know, you won't be surprised later if you really listen at the beginning because people tell you who they are. And I think to what you said, something really stood out to me was about building trust, because when somebody trusts you, they open up, they share, they're candid, and then you learn more about them, which then helps you to make diagnoses and help them help to create a care plan for them.

And so Dr. Becker, how do you see this, like in terms of from the psychiatric standpoint, when someone is dealing with certain types of psychiatric disorders and then how you have seen maybe paralleled or common, I guess, physiological disease that seems to frequently accompany these psychiatric disorders.

Jeffrey Becker

So I think that, yeah, I think it's worth taking a step back and explain, you know, my my sense of where psychiatry went a bit wrong. When I was in my training, we bandied around the term biological psychiatry as if we were practicing biological psychiatry because we were applying a molecule to a behavioral pattern that was being produced by the brain, essentially.

Right. And if you think about that, that's not particularly biologic. Really what it is is applying a molecule to a behavioral pattern that's produced by the brain. There's no labs involved in that. There's no thinking in terms of the brain as being a metabolic organ, that the brain is actually probably the most complex organ in the body. I think that's kind of unequivocal.

It's got enormous famous metabolic needs, similar actually to the heart and a lot of the kinds of treatments, natural treatments, molecules that are important for heart health like Coke, you ten, magnesium, zinc, these kinds of things that really deeply matter are as important, maybe even more important in the brain. And the brain is behind something that we call the blood brain barrier.

It's like a black box. So we have this kind of really difficult situation where we know one of the most complex metabolically demanding organs that is very, very sensitive to nutrient depletions is essentially out of our ability to test in a way that we can test other tissues. Now, that being said, even when we're talking about cardiology and things like that, blood labs lie a lot.

I mean, it's one compartment of the body. And I think it's really important for everybody who's in training to really remember that you're looking in one compartment and you're not even looking at cells, you're looking at serum. A lot of times when you're looking at actually be carrying compartment, that compartment that's delivering stuff, it's kind of like looking at what's going on in the cars in the street, looking in the trunks, looking in the outside, the cars, looking at how fast they're moving and whether there are enough resources on the streets.

But you're not looking inside the cells and you're not even looking at the specific tissue a lot of times that you're interested in. So when doctors in psychiatry do draw labs, they sometimes don't realize that they're looking at a compartment that cannot be compared to the brain. Actually, the most important studies that show what's going on in the brain are postmortem brain tissue studies matched to age matched control.

That's when you really get a read on what's going on in a lot of disorders, like, for example, in schizophrenia, it's been shown in postmortem brain tissue, in frontal lobe compared to age matched control that B12 levels are somewhere around one eighth of normal, you know, 15% compared to controls. This is frighteningly low B12 levels. B12 being very, very important for methylation, very, very important for myelin health.

You see this in autistic patients as well compared to age matched controls. So behind that blood brain barrier, we have this tissue and it's like we're shining a light down in the basement through a window and trying to decide what's going on in the attic. Right. It just doesn't work. So you need to use different kind of ways of approaching and a functional approach to mental health.

But this is what I would say very clearly is I went into psychiatry thinking that I was going to be able to use medicines almost like a shaman. I was so interested in receptors and I thought how amazing this is going to be. We can add a little bit of this and a little bit of that and we can make people healthy.

And what I found was that was a complete false premise because what you're doing is you're introducing exotic illness molecules to a very, very complex system, and you're altering the system really rapidly. I mean, depending on the molecule, sometimes frighteningly fast, like with benzodiazepines, even things that are reasonably safe, like accessorize change receptor densities, it can be very, very difficult to get off of.

And I found over time I was interested in psychedelics. I was before my time. So the healing power of them was very apparent to me. They really improved my life. They really they changed my life deeply in undergrad and I knew that there would be a time when these would become available to us as treatments. But in the meantime, I was going to be a psycho pharmacologic shaman.

And then I found out again it did not work. And so I really went dive deep down into the metabolism aspects of the brain and I started there. Now, if somebody is in an emergency situation, I do think that's what psychiatry does. Well, we resolve acute conflict, acute crisis relatively well if we're if we're paying attention to things and we know how to use our basic pharmacologic toolbox, we can help people feel better pretty quickly.

We can get them out of danger, we can buy time, but we don't make people well generally with the meds over time we don't. We can help them not feel as bad. We don't generally do that good of a job of helping people feel good. And that's where really I think the integrative stuff really matters. I'm hoping that over time psychiatry wakes up to this a bit and just expands.

Our toolbox is there are all kinds of things that we can use to help people feel, well, you know, methylation, genetic analysis can get a very good read a lot of times on on the kind of missing functional insufficiencies that you see in nutrient status that is really affecting the entire body. Honestly, and especially the brain, again, is a very fundamentally demanding organ regarding energetics.

So I started in the middle, I started at the top, came down to the middle, and now I'm down it. Now I start at the bottom. I really start at the foundation of health, which is molecular. And then, you know, again, I will intervene with acute meds. I mean, I think they have their place and I do use meds I don't use I have a much more subset of meds that I'm comfortable with.

And when I was in residency. But there are good medicines. But then if you do those things, you know, people's spirits actually can expand. And I think that the psychedelics and ketamine become available as well. And then when people do transcend and they receive very important information about who they are and what they should be doing in the world, they come back to a body and mind that can actually actuate that.

And I think this is this is a mistake that's happening a bit in the psychedelic community, is they think that actually just showing someone that transcended space or helping them experience that transcendent space will heal them. But a lot of people come back and they're in bodies that are sick and it may very well may help them to actually improve their diets, get more exercise, do these kinds of things.

But that's a heavy lift. And a lot of times, you know, they don't even they don't know how to do that yet. So I think it's all things at once, if you know, if possible.

Cara Lunsford

Yeah, I totally agree, because I think if you just treat one too what you were saying, like if you just treat this and then you end up in a body that's sick and not thriving because of a variety of things, you're just going to be in this kind of vicious cycle. So in my mind, like, the best thing would be to have two people like yourself at the same time, you know, working together.

And I think that this is also something that in our current system we are not very good at. We're not very good at communicating among disciplines and having a plan and having somebody who's kind of quarterbacking that plan and then bringing all the people together, which can be much more successful for the patient if you have that. And so I think we need to be better about that, about bringing in disciplines and not needing to be like the one stop shop.

It's like, okay, like this is what I'm good at. And then here's what somebody else would be good at, and here's somebody who is an energetic Reiki master, and maybe that person needs to come into the fold. And acupuncture, let's bring an acupuncturist in. And, you know, I mean, with Dr. Viswanathan, you're already like, so good with things like meditation and yoga.

But in some situations, maybe integrating that type of person into the fold as well. I really think we just kind of have to rally around people better than we than we have historically. Oh, you can visit nurse dot com, for example, podcast to share stories, feedback and requests. As a valued listener, you will also receive discounts on nurse dot com courses and C use by using code nurse dot at the checkout.

Oh. So I want to ask you both, but I'll start with Dr. Viswanathan. I feel like I just I keep kind of like ping pong ing back and forth between you. So, Dr. Viswanathan, do you feel like there are some chronic illnesses that you feel have been really incredibly responsive to some of your integrative medicine approach that you feel like maybe people are not getting great response when they're just doing a solely a Western medicine approach, but you've actually found that you're having like better results for, for certain types of diseases.

Dushyant Viswanathan

Yeah, absolutely. I think the one that comes to mind immediately is IBS. I mean, IBS seems to be a difficult one for almost every GI doctor and I think many integrative doctors have. I mean, not just me. A lot have 100% success rate with IBS. It's one of the easiest ones. And because it does involve the psycho emotional, psycho spiritual aspects of the person, sometimes it's hard for jazzed up things to do.

So frankly, the reality is that patients exposure to the medical system in terms of the vast majority are through their insurance, and their insurance is going to list me as an internal medicine doctor, as a primary care doctor. And so like if they think about a primary care doctor that really involves referring, if you got a belly problem, go to a ballet doctor, you got a neuro problem, go to a neuro doctors.

And so the vast majority of people are going to go to GI. You know what? And if you need an endoscopy for a bleeding ulcer and you're dying, you need a GI doctor, not a functional doctor, like Dr. Becker was saying, like acute management. It's scintillating, beautiful. I mean, the reality is that we have very successful many chronic diseases from IBS to fibromyalgia and all of these symptoms, these diseases that the symptoms have become, the name of the disease.

You know, like we're taught early as an intern that that symptoms are symptoms and the signs and symptoms and then the diagnosis is something different. But now we've turned the symptom into a disease like fibromyalgia and and IBS and so on. You know, so these diseases often are these conditions are, we can argue that are functional and I would argue the autoimmune diseases are functional to you.

People flare even naturally people flare and then they get into remission and often they, you know, they move location and suddenly they're certain their allergies are better or they move low location, their allergies are worse or their lupus is worse, their joint pains are worse. Oh yeah, when it gets colder, my joints are worse. I'm in more pain.

So there's a natural oscillation to certain diseases like naturally and that reflect sort of the epigenetic impact of the environment on their health. And so those diseases, I would say don't go to only super subspecialists and pharmaceutical based doctors. I would go to, frankly, naturopaths, naturopaths should be your primary care doctor. And then, you know, if you need a microbiome specialist, I'd love to be.

That's my sweet spot. I have to now publish an article on a Graves reversal by balancing the microbiome, resolving micro toxicity. And this is like no thyroidectomy, no ablation. And the guy's also is all and, and I now have to publish this because it's like it's such a big deal and I don't want to read a paper because the papers have lead to what it leads to industry, and there's no industry going to be no one's going to monetize off of these people getting better, right?

So but I have to write this. And so there are so many cases, I just turn them into testimonials because I want people to know that with the right team they can achieve their health goals. And it's not about reversing paralysis. It's not like you have a paralyzed person with a gunshot wound to their spine that is somehow magically walking again.

That's not what I'm talking about. I'm talking about restitution of normal physiology, normal healthy physiology. It should not be a mystical thing. And the fact that even defining health is not something that's routinely done in medical setting. And so there are so many systematic aspects of why the population is not seeing integrative doctors first. But, you know, I was writing blogs ten, 12 years ago about how integrative medicine, functional medicine, doctors are the word that resuscitate ERs, we're the ones that are going to literally provide CPR to them, to this medical system because of just profound failure of of applying drugs that are perfect for a bleeding ulcer and applying them to IBS.

And that's just one example of thousands of examples that have just happened in this hour among clinics around the country. Just during this hour, thousands of poor decision making. That's from their best intention. Like every doctor is trying to help their patients, but they're unwittingly making decisions that are going to harm that. Patients future self. And it's not their fault.

They're just doing what they have been trained to do. And it's really tragic. I've had one foot in the hospital, one foot in integrative medicine for ten years, and I can say that I wouldn't put a patient with a chronic disease with a conventional doctor ever. Okay. Now, the exception there, there are some exceptions, like if you have lupus nephritis, your kidneys are failed and you're in the hospital from lupus.

Now you need something very fast that'll shut off your immune system. Otherwise you're going to need dialysis. I can kind of argue with, you know, going to heavy immunosuppressants or biologics there, you know, But we're seeing like 19 year old children getting onto biologics for Crohn's before even like a routine assessment of their microbiome. It's a microbiome illness and then they're on that.

And that's like a major change to your body when you're on biologic. So and then once they're on biologics, like I'm not interfering with another doctor's care when another doctor does something to a patient, I'm never going to interfere and say, don't do what that doctor said. I'll never do that. But now we're in this place where okay, now we're going to manage the ramifications of this decision.

And it's challenging, but it's there's just so much suffering and we we could do better as a system, you know, So there's so many systemic aspects. But I mean, and I say this without boasting, integrative medicine fixes most of these chronic conditions. What endocrinologist then I have endocrine contracts with insurance companies. How many you know, endocrinologists are saying that their diabetes, their type two diabetics are reversing.

It's a reversible, preventable, unnecessary disease.

Cara Lunsford

It is diabetes is a preventable disease. And just and and it's funny how we'll come to realize this, you know, and then suddenly everyone says, well, yes, of course, it's a it's a reversible disease. But if you said that today about, oh, I don't know, some another type of illness, they'd be like like Crohn's, let's say Crohn's, for example.

They're like, well, it's not reversible, you know. It's like, well, no, it it is. First of all, it is. And then in five years from now, everyone might be saying, Oh, well, of course it's reversible. You know, it's like so it's like once everybody gets on board, well, then suddenly it's the truth, right? But when people are saying it early on and they're kind of yelling from the rooftops going, Hey, it isn't like this, or it could be different sometimes that's not popular.

Nobody likes when someone strays from the flock and sometimes we punish the people who stray from the flock and we shame them in some way. And I feel like what's really interesting about like what you're saying is also about how we start utilizing medications that have been historically used for let's use ketamine, for example. Ketamine has been used as an anesthesia for anesthesia for for eons, for a long, long period of time.

I mean, this medication is it's a compassionate use drug, isn't it? Isn't it like.

Jeffrey Becker

In World Health Organization, Essential Medicines. Yeah.

Cara Lunsford

Now they're realizing that this medication that is relatively inexpensive has a lot of other use cases specifically. And because you Doctor Becker are you sit on the board of the American society of ketamine providers correct?

Jeffrey Becker

Mm hmm. Yes.

Cara Lunsford

Can you just tell us a little bit, because you sat down and you explained to me in a way that made so much sense about why ketamine is useful for patients who are struggling with a variety of mental health disorders. And I have since then taken your words, and then I carry that along and I explain it to patients.

And I think because we have a lot of nurses that listen to this podcast, but also the general public as well, that this would be a really, really important thing for them to understand why this might be an option for themselves or for their patients.

Jeffrey Becker

Yes, it's you know, it's a it's a fascinating story that we discovered that an anesthetic used at sub anesthetic doses has such profound effects upon mood and such profound capacity to resolve suicidal crisis and individuals that are experiencing experience experiencing this at a dangerous level. A lot of people live with thoughts like that. But when people are in real danger, ketamine can be extremely helpful for resolving that crisis immediately.

Really? Honestly, it's it's it's astounding how effective it is. It it I will take a step back and explain that it's actual pharmacology is important to know if you're going to understand why it works in this way. It blocks one of the most important receptors that we've ever found. That is really the the single. It's the single kind of functional unit of memory.

So the NMDA receptor, when it gets activated, it causes calcium influx into neurons, and it's what causes what we call long term potentiation. It's how we learn. And there is a set of neurons that grows kind of in strength and control over our thinking called the gabaergic Interneurons. They're inhibitory and they gain a lot of control over way that we think and the stereotyping of the way that we think, the kind of patterning of the way that we think in an adolescence or early adolescence, kind of the tween years, and then really gains some steam when we become kind of 16, 17, 18 and to some extent, a lot of that frontal lobe executive function

kind of patterning that makes us who we are as mature adults kind of settles in, is almost kind of done by the time we're about 30. We can learn new tricks after 30, but it becomes harder and we're kind of becoming who we are all the way through that process. Well, that process can become overwrought and it can become overly constricted and overly circumscribed and stereotyped.

And, you know, you can imagine the kind of full range of who you were when you were young. You know, you could be kind of silly and dumb. You might be mean at school and then you really sensitive to another person. And and then we kind of settle into a much more specific persona, right? That's maybe a little bit more contained, you know, able to respond to the world with with kind of more specific patterns.

Well, sometimes those patterns are actually maladaptive. Actually, what we've learned is not good for us anymore. We might have taken on certain beliefs, certain ways of thinking about ourselves that are actually detrimental to seeing solutions in our life. Well, that patterning, again, is maintained very significantly by a certain set of neurons. It's kind of weird, actually, how specifically it's it's it's this neuron.

It's called the chandelier cell. Actually, it's fascinating. It's the only neuron that's ever been found that has a particular arrangement. Its inhibitor, and it has its axon around the axon of other neurons, because normally axons go down and they send information and other neurons can actually sample that information. It's kind of like I'm saying this, and then other neurons are saying, Oh, I'm going to listen to what they're saying kind of like, okay, I'm listening.

In this case, it's very different. This neuron, when it fires, it turns off other neurons. It literally has a kind of chokehold around the axon on the early axon segment of other pyramid of human cells. And one chandelier cell can control 300 pyramid cells and one chandelier cell can also communicate what it's doing to another chandelier cell through meld points.

They don't need to have synaptic information exchange across each other in order to tell each other what they're doing. Okay. So kind of weird once you start thinking about it, right? It's almost like a plastic matrix of control, right? These neurons sit at a slightly hyper polarized level. They're they're a little bit more excited than the neurons trying to control.

Makes a lot of sense if you're going to be a supervisor. Right. What that means is, is that the NMDA receptors that are on these neurons are open and that's where ketamine can get. If you give the right amount of ketamine, you don't give anesthetic dosing, but you just give enough. The ketamine goes preferentially to the supervising inhibitory neurons that control our thinking, turn down their influence and allow the pyramid cells actually to to experience a freedom that they normally don't.

And what they do is they start having a party, they start talking to each other in ways that they're normally not allowed to. And it's not just that they're talking more. They're talking to neurons across the brain that they normally are not allowed to, that that the stereotyping of the thinking, the kind of like if you have a conductor saying like you're not talking right now, you understand that like you up you know right.

That when the conductor goes away, all of a sudden everybody starts to get to riff and you've got like a jazz ensemble where everybody's kind of playing off of each other and there's no conductor anymore. But it's pretty wild. It's pretty wild stuff. So when that happens, then these neurons are able to break patterning. So a lot of that thought patterning that occurs in depression that can become so detrimental that, you know, I see this sometimes and it's actually literal.

People think I'm seeing it's a metaphor. People will come in with depression and they will tell you they're having the same five thoughts all day long. They're just thinking the same thing in a circle. It's actually kind of terrifying. I mean, in some ways it's kind of like a form of hell if you think about that, like to think about being that small, right?

So so all of a sudden, to have that control system lifted off and have all these neurons being able to talk to each other, it's kind of astounding. We see this in our fMRI. This is not like this is not debate. This is we know this is what's going on with ketamine. There's a lot of downstream molecular things that are causing the antidepressant effect.

You can get down into that. A lot of debate about that. But actually kind of what's happening in terms of release of neurons and this this increase in gamma activity in a relation throughout the brain. So just at that simple level, I mean, how how wonderful really, honestly and and what a relief. You can see why that would resolve suicidality so quickly in some people.

Right. And it doesn't always work. But I mean, it can be it's like suicidal thoughts are extremely kind of often obsessive and extremely repetitive. And to kind of break that pattern and bring in some fresh air, metaphorically in the neuro neurologic, you know, inner interchange. So now it's an amazing tool. I'm really, really feel grateful that we have were able to use this in psychiatry.

And we're now also starting to be able to use the psychedelics more or at least talk about them.

Cara Lunsford

And you explain to me which, you know, I gave you that I was like, Oh, so basically the chandelier smells like the mall cop. It's like over regulatory, you know, no fun in any none of the time. Like, you know, just got to put the kibosh on everything. Almost like the helicopter mom. Partly.

Dushyant Viswanathan

Well, you.

Jeffrey Becker

Know, we have no ego. Our ego needs to be well-designed and it needs to be strong, but it needs to also be able to be in service of the larger us, the large I right. So, you know, ego versus self or whatever. And so I think when we're healthy, our ego is in service and when we're not, it becomes its own kind of sometimes monstrous.

Cara Lunsford

CAGE Yeah. And so one of the other things I had asked you about, very popular right now, psilocybin, you know, people are talking all about ketamine is something that is more accessible. I would say right now, probably because it's a drug that's FDA approved, not FDA approved necessarily for that use, but it is an FDA approved drug, which means that it's more accessible psilocybin.

However, I did hear that one state is this true? One state approved it. Is there more than one state?

Jeffrey Becker

There's a lot of decriminalization around. And in Oregon and Colorado. Yeah.

Cara Lunsford

Okay. And then so you you were explaining to me as well like the difference between how ketamine works on that chandelier cell and how psychedelics work on the chandelier cell kind of in different ways. And I thought that that would be really interesting to share as well.

Jeffrey Becker

Yeah, I can. I mean, I think I can't explain that quickly. Having explained a bit how ketamine works, you can think of ketamine as kind of opening up an aperture and it is slightly excitatory on the into terms of what ends up happening on the the sea plane of thinking neurons we call pyramidal cells. It gives they get a little bit of a goose, they get a little bit of extra activity.

But not a lot. It's more really the release of control. You're opening up, you're opening up the space and things can kind of flow as they kind of want to. Psychedelics actually work in some ways almost in a yang to that end or in you know it's it's really it's you end up converging in terms of expanded consciousness but but almost the opposite way they tend to localize they tend to activate a certain receptor called the five key to a receptor.

All basic classical psychedelics are have been shown to activate this receptor. And that receptor, when it becomes activated, it causes that neuron to be able to fire more easily based on the same amount of stimulus. So let's say that, you know, 100 units of information have to come into this neuron to have it say, you know what, I'm going to share that information and fire right.

In this case, when psilocybin is on, go on board LSD, DMT, maybe it only needs 80 units of information. Maybe it only needs 50. It's going to be more likely to be able to push that signal. But that chandelier cell is still active, right? That chandelier cell is is not gone in terms of it. It's trying to do it's still trying to say, oh, I I'm telling, you know, and that Neuron is saying I'm going to say yes and it's going to say yes with some more volume.

And so that's a little bit like increasing exposure through the same size aperture. And it's probably why the psychedelics have a lot more. There's a lot there can be a lot more angst associated with them. I mean, can be very difficult ride because essentially the ego, this defensive system, this chandelier cell gabaergic inner neuron that it's having to submit to increased signal and it loses control.

And that can be very distressing I think to ourselves. And whereas with ketamine, it's actually the thing that's taking a nap, right? So yeah, ketamine is a lot gentler is why I like it. It's a very gentle tool for people that have been traumatized. It's a it's a way for them to get into the kiddy pool in terms of expanded consciousness and kind of learn, learn that they can be safe without with having giving giving up some control, that actually it's okay in there.

Cara Lunsford

And then what happens when there's both? Like, what if you what if you do both? Because I imagine that like I, I see the psilocybin is like pressure that's kind of forcing it open. Like you were saying, like, you know, which I think that that's why the ego's kind of like, hey, I don't want to be forced to muscle me into this situation, you know?

And then and then, you know, doesn't want to be strong armed into it. So what ends up happening if you kind of roofie it and then send out. So yeah, that's well, that.

Jeffrey Becker

Is.

Cara Lunsford

What nurses do.

Jeffrey Becker

It's definitely an underground technique and it's I mean, I think I would I would really caution, you know, when I say this that you have to be very careful when you're using synergistic mechanisms so like anything you know to blood pressure drugs you know or these two different mechanisms together, if anybody is ever going to do that you do you know way, way, way down on dosing because one plus one can equal five in a situation like that.

So but that is something that is a known thing in the underground to kind of game it easier on trade to psychedelics and also actually accentuated psychedelics so that you don't need as much as well. So yeah and some ways actually that may be a lot of the way that ibogaine works.

Cara Lunsford

I don't know much about ibogaine. What what is that?

Jeffrey Becker

Ibogaine is a kind of an odd one off. You know, it's not really considered a classical psychedelic, but it definitely is powerful, psychedelic, and it may have specifically NMDA receptor antagonism and two way agonism built into the same molecule, and it's got very kind of different properties than, you know, either ketamine or psychedelics, but kind of like maybe both put together.

Cara Lunsford

I just want to like I just want to thank you so much because I, I took a lot of your time, way more than I anticipated, but I hope it was really valuable for you as much as it was for me.

Jeffrey Becker

Super fun.

Dushyant Viswanathan

Yeah, very.

Cara Lunsford

So, thank.

Jeffrey Becker

You. What a pleasure. Thank you. So nice to know you. And thank you for thank you for making this happen.

Cara Lunsford

Thank you. Yes, thank you. Thank you, guys. Have a great weekend.

Dushyant Viswanathan

You too.

Cara Lunsford

Bye bye. If you are a nurse who enjoyed this episode and you have an idea for future episodes, you can connect with me by downloading the nurse dot com app. See you there.