The following case studies should give a sense of the powerful ability of nutritional and other body-mind interventions to improve “mental” as well as “physical” health.
A depressed patient: The Case of "Dopey Debby"
- A highly experienced cognitive-behavioral therapist referred his patient “Debbie”, a 27 year-old single depressed woman who wasn't gaining insight, despite a good mind and good motivation. So the therapist knew that something was "biologically" wrong.
- For the past 7 years Debbie had been unable to get out of bed until mid-afternoon, due to the profound fatigue she was experiencing, with prolonged crying spells, and terrible “brain fog”.
- Debbie had managed to graduate from college, but it was difficult. This depression kept her from working and she had to rely on her wealthy family to pay for an apartment in Manhattan. She hated being dependent, and was not “gaming”.
- On taking her history it turned out that for many years she was eating chocolate about 4 times a week. It was her “consolation”, but she agreed to go off it. That was the only “prescription”: No antidepressants, no nutraceuticals. Just discontinue this very likely “trigger” food.
- For the first three weeks Debbie totally abstained from chocolate. She immediately started to improve, had no trouble getting out of bed, and did not have any crying spells or brain fog. For the first time in years, she felt well enough to invite some old friends over for a dinner party.
- While out shopping for the food, she decided to pick up a chocolate cake for dessert, reasoning that “Just ‘cause I can’t have it, doesn’t mean that they can’t”. Then while serving the cake, she thought "One little piece for me, what could it hurt?". She spent the next three days in bed, crying and depressed, and plagued with brain fog.
- That was the last time that she ever had chocolate. Within 6 months she enrolled in a Ph.D. program, and became a clinical psychologist.
- By the 2nd year off of chocolate she met and married a wonderful man, and she kindly sent me postcards of the wedding, and of the births of their first and second children.
- She told me that she had been smart and precocious as a pre-teen, but that around the time of puberty she became sluggish and out-of-it. So much so, that her sisters gave her the nickname “Dopey Debbie”.
- What she realized in retrospect was that it was around puberty (age 12) that she had begun to crave chocolate, and to eat it with regularity.
- So from age 12 to age 27, she lived a life of emotional misery. As is so often the case, she never made the “connection” that what she was eating could be disturbing her mood. And at 27, within a few days of eliminating this obvious trigger food, she enjoyed a complete transformation of her quality of life.
- Most of my colleagues would have put this woman on an antidepressant. They would have been “justified”, as she did have every diagnostic feature of “Major Depressive Disorder”.
- Debbie’s case is very representative of what my practice is like. I look for “trigger” foods. In the vast majority of cases, I find them.
- If there’s no trigger food, then nutrients and herbs will often clear up depression, anxiety, PMS and the like.
- If the food restrictions and supplements don’t help enough, then of course I’ll consider prescribing an antidepressant. It’s a blessing to have prescription meds available, as a “backstop” if the nutritional approach doesn’t work. But I have been finding, in the more than 40 years I've been in practice, that this nutritional approach works in the vast majority of the cases.
A dementia patient brought back from oblivion by nutrients, herbs, and medical foods
In 2011 I ran into a colleague I had not seen for 30 years. She told me that her husband, a psychiatrist now 79 years old, was in a nursing home due to very advanced dementia. All food and liquids were fed via an external “PEG” tube inserted through the abdominal wall. This tube had been placed when his third stroke (a year earlier) had knocked out his ability to swallow (as well as his ability to walk). The doctors, hospice workers, and relatives had all been urging the wife to stop tube-feeding him, i.e., to let him go.
When I first evaluated Dr. T, he did not know his wife's name or his own name. He was incontinent, unable to walk, unable to feed himself, and in fact would not let anyone put food in his mouth (for he knew he would gag). He did not recall that he had been a physician. When I asked him to draw the face of a clock, he stared blankly and did not comprehend that he should take the pencil I was offering him.
I started him on a step-wise program of nutrients, herbs, and medicinal foods. Some of the products chosen have the ability to step up the metabolic activity of neurons that have been powered-down by the disease process; others have the ability to increase blood flow in the brain; still others have the ability to serve as an “alternate fuel” when the brain cannot process glucose; and so on.
A week after starting the first few items in the regimen, Dr. T got out of the wheelchair by himself, walked on his own power to the kitchen counter, took a piece of the vegetable fennel, and started chewing on it. The aide was ready to pull it out of his mouth, but the wife said "Let's see what he can do." He was able to chew and to swallow it. From that point on, the wife was able to take him to restaurants, where he was able to feed himself.
By the end of the second month he had learned his wife’s name as well as his own name. He regained sphincter control, no longer needing a diaper. In the past, when they took him along on shopping trips, he would sit passively in the passenger seat until they brought the wheelchair around so that two people could haul him into it. In contrast, now he was able to open the door and get out on his own power, and to walk right over to the wheelchair.
At three months, on an early April evening, he and his wife were sitting outdoors. When it turned a bit cool, he told his wife "I’m cold." She put her jacket on him. He said "Thank you, I love you." She said, "I didn't know that." He replied, "Well now you do." The wife sent me a letter, writing "Thank you for giving me back my husband."
She took him to concerts (including Radio City Music Hall), which he enjoyed tremendously. One of the highlights for me, as a physician, was their Xmas party in 2013: He was standing up, chatting with his guests, and walking freely to and from the dining room table. Keep in mind that this man had been on his way out, with hospice, doctors and family urging the wife to “pull the plug”.
A Migraine patient
Lois, a 62 year-old woman, had been suffering from migraines for over 20 years. Conventional migraine medications had done very little to relieve her suffering. I have been treating her for mild cognitive impairment (e.g. trouble recalling words). During her second year of treatment with me, I learned one day from the medical literature that patients with cognitive impairment tend to have low levels of Brain-Derived Neurotrophic Factor (“BDNF”), which is a very important growth factor for neurons; and I also learned that certain foods and herbs have been shown to increase the brain's production of BDNF.
Therefore I had my patient start on one of the herbs known to increase the brain’s production of BDNF. A month later the migraines were down by about 50% in frequency and intensity. That clinical success made me wonder if migrainers happen to low in BDNF. I did a web search, and found that it was already well-documented in the literature that migrainers do in fact have low levels of BDNF! By the 6th month after starting that herb, the migraines were virtually gone.
BDNF is so important for the repair and maintenance of neurons that the scientist who discovered its existence won the Nobel Prize for her discovery. Therefore, speaking as a physician who tries to relieve suffering (and by natural means whenever possible), it is very satisfying that this herb I'd given my patient has eliminated her migraines, and probably did so by increasing her brain's production of BDNF.
ADD and ADHD
A 22 year-old woman was referred for treatment of her Attention Deficit Disorder (ADD). On IQ testing she had scored extremely low in reading comprehension, which explained why finishing college had been excruciatingly difficult for her. She now wanted to become a Physician’s Assistant, but was terrified of the difficulties she would experience in comprehending the vast amount of material she would have to master.
The first thing I do with patients with ADD or ADHD, whether children, young adults, or adults, is have them eliminate all artificial additives (colors, flavors, or preservatives). This is the Feingold Diet. That change did not help this patient.
The next thing I do with ADD/HD patients is have them remove chocolate and dairy from their diet, because those foods naturally contain “lectins” (inflammatory proteins) that reach the brain and disrupt cognition and/or behavior. That approach didn’t help this particular patient either.
Then the next thing I do with ADD/HD patients is to prescribe rational dosages of a few select vitamins, minerals, amino acids, and/or fatty acids. Double-blind studies (including one that I myself had published in 1990) have shown these nutrients to be helpful. But this approach, like the others, yielded no benefit for this patient.
About 4 months into the treatment, she asked if I might know of any herbs that have a stimulant-like effect. She had gotten samples of Adderall (an amphetamine) from college classmates, and it had always helped her to study. She did not want to go on stimulants if she could avoid it, but she liked their effects, and was hoping for a natural way of getting that effect. At that time I was just beginning to explore the use of an adaptogenic herb that has been shown in controlled studies to improve focus and academic performance.
She started that adaptogenic on a Thursday of a given week. She called me three days later, on Sunday, to say “Dr. Carlton, this is the first time in my life that I’ve been able to sit and study for three hours in a row, and to retain everything.” She called again on Tuesday (5 days into this treatment) to say “Doctor, please don’t be angry at me. I don’t need to come back, because the herb is working. I am not angry at you. In fact I will refer patients to you. The herb is working, and I am now ready to take on graduate school! Thank you so much!”.
A 40 year-old business executive, who happens to be a “jock”, was distressed by the inordinate amount of anxiety he was feeling. A conventional psychiatrist would see that some portion of his anxiety was from the stress of having a dysfunctional and manipulative boss who was making life tough for everyone at work, and that another portion of his anxiety was from the stress of having a second child on the way with the first born being only about 2 years old. However, taking an integrative look at the “whole person”, I was able to readily see that:
- The patient was barely eating, having a skimpy breakfast at home, no lunch at all, and not having dinner until he got home from his commute around 9 PM. Such paultry eating can lead to low blood sugar episodes (hypoglycemia) that induce the body to release hormones (such as adrenaline) that will break down stored glycogen so as to rapidly increase blood sugar levels. However, that surge of adrenaline can provoke feelings of intense anxiety, shakiness, and a sense of impending doom. I therefore urged him to have 5-7 relatively small meals per day, with emphasis on protein and good fats and oils (keeping carbs to a minimum).
- The patient did not have any “tools” for regulating his mood and calming himself. I therefore urged him to start taking yoga classes, even though – as a jock – that seemed to him kind of a “sissy” thing to do.
- I also put him on some herbs and some nutrients that have been shown in the literature to have a very calming effect.
- On the psychological level, I gave him guidance for making a “business case” to his boss that hiring additional staff – so that he (my patient) could allocate work and thereby be more efficient – would be good for the bottom line of the company, and, therefore, for the boss himself. [As opposed to asking the boss to do this out of the goodness of his heart, since there is no heart to begin with and any such request would fall on deaf ears.
He sent the following text message 5 days later: Have gone to yoga 3 straight days in a row. Love it. Improved diet, and eating frequently is also beneficial……You should be a doctor. ; - )
He made the “business case” to the boss. Four days later he texted: The boss has agreed to a hire and asked for a job description.
Three weeks later he texted again: “I’m feeling much better, lost almost 10 pounds in the past month with less drinking, more yoga and a better diet. Cheers to that, and thank you for all the help.”
This case illustrates the multi-layered approach of integrative psychiatry that I use: Take care of the body and the mind:
- through healthy eating,
- through nutrients and herbs that improve resilience,
- through tools for self-regulation like yoga, and
- through psychological guidance on healthy strategies for dealing with toxic people.
Pre-Menstrual Syndrome (PMS)
PMS has been one of the easiest conditions for me to treat. I’ve never formally tallied the results, but I think the success rate is at or about 100%. And the results come quickly, within a month or two. It has been my observation (supported in many instances by objective findings in the medical literature) that PMS is due in part to an inflammatory state in the body:
- This inflammation is worsened by rich foods like chocolate, cola, and dairy (that the women often crave),
- This inflammation is quenched (blunted) by nutrients and herbs that stabilize the platelets (the blood’s clotting cells) so that they are no longer twitchy and so are less likely to release their inflammatory messenger chemicals into the bloodstream and into the tissues.
When my patients overcome their resistance to getting off of chocolate, cola and dairy, and when they start taking the recommended nutrients and herbs, within one or two menstrual cycles they no longer experience either the pre-menstrual mood changes (such as irritability) or the pre-menstrual physical changes (such as breast swelling and tenderness) that had previously plagued them. Many women have told me that they would be caught surprised and unprepared when menstrual blood started to flow, because they no longer experienced the irritability or swelling that in the past gave them some warning that the period would come on in a couple of days. This of course was a very pleasant “surprise” for them.
Conditions that respond to legalized Medical Cannabis
Medical Cannabis is a blessing for a wide variety of debilitating diseases. I am licensed by the State of New York to recommend it for eligible patients.
Elsewhere on this web site you’ll find a link to a draft of the introductory chapter of a book I am in the process of writing, on the commonsense use of Medical Cannabis.
Here is an example of a case in which I have been involved:
Jenna is a 14 year-old girl who, from early childhood, had been suffering from intractable seizures. The severely abnormal foldings of her brain’s cortex had been causing her to have 50 – 100 seizures per day, despite brain surgery and the use of over 15 different anticonvulsant medications over the course of her life. She was constantly mopey and lethargic, in part from the frequent seizures, and in part from the severe side effects of her numerous anticonvulsants. In school she was taking kindergarten-level classes.
- I facilitated her getting approval for medical cannabis from a dispensary. I recommended that she start with oral extracts of a strain of cannabis high in cannabidiol (CBD, which is not psychoactive), and very low in THC.
- Within two weeks of starting to ingest the CBD-rich oil, her seizures had declined from the 50-100 per day at baseline, to just 1 every eight days or so. Along with that blessed result, there was a tremendous brightening of her mood; a noticeable increase in taking initiative (e.g. she told her mom she wanted to speak to her grandparents); and a huge improvement in activities of daily living (e.g. she told her mom that she would blow dry her hair by herself – for the first time in her life – and she enjoyed looking in the mirror as she was grooming herself).
- Her mother phoned me with joy and gratitude in her voice, saying “I finally have a 14 year-old daughter.”
You can imagine how gratifying it is for me, as a caring physician, to see my patients gain so many benefits, and from a natural compound. All the more so when nothing else had worked!