James Maskell: Hello and welcome to the Big Bold Health Podcast. We are making health personal in a world of disease, and today we’re going to be talking about brain health. Now in our series, we have been now focusing on leaders, female leaders of the health movement, people who have been on the cutting edge, really changing our understanding about how to create healthy body parts. And in this case we’re going to be talking with Dr. Hyla Cass, who is a very well-known integrative psychiatrist, and lecturer, and product creator, and a lot of strings to your bow, Hyla. So, throughout this podcast we’ll be talking about this shift away from a disease centric health system to a health centric health system. And so, I guess the first question I wanted to ask you is, what is specific to the brain in terms of what does it take to create and maintain a healthy brain?
Hyla Cass: Well, what’s interesting is it’s connected. The brain is connected all the way through to the whole body. And, it’s so interesting that psychiatry, the way I was taught it, is from the neck up; you’re treating brain symptoms. And, that’s not where the issues are; the issues are how is your body doing, how is your overall health? And so, the good news is that whatever you’re doing for your overall health, you’re also doing to benefit your brain.
James Maskell: Yeah, absolutely. And this conversation, you’ve been in the business of helping people recover from psychiatric illnesses, and they’re coming in probably expecting the pharmaceutical cure. What sort of a shift is that for the people that you come across to start thinking about creating a healthy brain and bring that brain back to health?
Hyla Cass: Well, what we know is that nature is the best pharmacist, and our bodies just know how to heal.
James Maskell: Yeah.
Hyla Cass: So, take away certain problems, certain issues, certain lacks, replenish with the right nutrients, with exercise, with sleep, all of that, and the body responds just beautifully. So, we don’t have to cover over symptoms with medications that then have their own problems, side effects and whatever, dependency, tolerance; and I see a lot of addiction too. So, it’s wonderful what we have learned over the years and that we can prevent so much of what we’re seeing now in terms of mental illness, brain degeneration, dementia—we can prevent a large part of it.
James Maskell: Jeff, I think you guys have known each other for quite a while. Am I right on that one?
Jeffrey Bland: Yes, it goes back three decades, we were just doing a little mental arithmetic here. But Hyla is an extraordinary colleague, friend, leader in the field and a co-collaborator in what I would consider this new model of health creation. And so, Hyla, it’s really for me a personal pleasure to have this opportunity to sit and chat about this journey that we’ve been on collaboratively. I think one of the things that I take away, and we were reminiscing a little bit about the first time that we met, which I think was at your place in Malibu. And, you were hosting a variety of what then were kind of renegade thinkers, 30 plus years ago, and now many of the things that we were talking about then, that we’re considered renegade, have now come to be really considered right in the stream of new thinking, of current thinking.
Jeffrey Bland: And, I believe that it’s really important to have a person of your stature and experience to talk about how you reflect on these paradigm shifts changing. You’ve been kind of a chronicler of watching the shift over time, and there’s still a big push back up by certain quarters within the field saying if it’s not the way we say it, it doesn’t exist. But we’ve seen more and more people coming into this field; the movement towards us is a lot greater than the movement towards them. So, how would you see, from your perspective, this transition having occurred where health creation, and what I would call personalized prevention has started to become much more commonplace?
Hyla Cass: Well, first of all, the science supports it. And so, we’re seeing a lot more on lifestyle. We’re seeing the American Cancer Society talking about eating your vegetables—I mean, that was unheard of. So, even the very conservative organizations are looking at lifestyle, and that’s really where to start. I have to say that for myself when I’m treating patients, just doing lifestyle modifications, the sleep, the exercise, the good diet goes so, so, so far in actually reestablishing good mental health. So, guess what? They didn’t have a Prozac deficiency.
Jeffrey Bland: Well, it’s interesting. There are so many institutes now, very esteemed research clinical institutes that are actually taking on board clinical trials, as you say, in lifestyle for brain function. And there’s a wonderful study that was published called the MIND study [Mediterranean-DASH Intervention for Neurodegenerative Disorders] out of University of Chicago and Northwestern medical schools, in which they showed clearly that you could prevent the onset of dementia by lifestyle dietary intervention.
Jeffrey Bland: There was a study in Finland, that is a very large study that got a lot of press in Scientific American a year ago. There’s a recent study that just was published in JAMA in, I think that was the June 25th issue of 2019, on a clinical trial in the United States looking at retention of cognitive function in older age individuals by, as you just stated, lifestyle intervention. So, these individuals that have said, “Well, there’s no proof about this. It’s just a bunch of speculation. The only thing we have proof of is drugs.” Which by the way, in the way of dementia, there’s never been a drug that’s proven to be successful. It looks as if like we have the weight of evidence on our side.
Hyla Cass: Absolutely. And, we look at the blue zones and what do they have? They have lifestyle, they have community, they have a sense of family, they have meals together. They exercise, they walk up and down mountains often. They walk places. Their water is clean, and not only not polluted, but also not with what we put in our city water. The things that we use to “decontaminate” the water as well as all the medicines and all the other things that are found in our water supply.
Jeffrey Bland: Yes, isn’t it staggering? We learn more about the Flint, Michigan situation to find out that it’s not just only Flint, right? That just happens to be a tip of a bad iceberg, and there’s all sorts of stuff below the waterline that we’re experiencing. In fact, in the Great Lakes water, they find that there’s enough metabolites from antidepressants that it actually influences the life of small microorganisms, which means we’re medicating, as you stated, our water supplies, which seems almost unfathomable that that would be the case.
Hyla Cass: And hormones. There’s hormones in the water.
Jeffrey Bland: Oh boy.
James Maskell: If you took it to its logical conclusion, Hyla, just the journey that you just described over the last 40 years, do you see that there’s a time approaching where a lifestyle first approach or an anti-inflammatory approach to mental health would just be the way that it’s done?
Hyla Cass: Hard to predict, but I’m certainly seeing a lot more of it than I did in the olden days. And, I’m still bucking a current in a way. I still have many people coming to me on medications that I then have to reframe all of their thinking. And, in fact they come to me because of that, and I help them with their lifestyle, and help them to detoxify from the medication. So, I have some undoing to do. And, what you’re talking about is, let’s have prevention from the get-go, so we don’t have to undo what’s been done. But in that process of undoing what’s been done, there’s been a tremendous amount of learning. So, we know what can go wrong, and we know now how to prevent it.
James Maskell: How would you compare the way that brains respond, a brain that is functioning sub-optimally, but has never been connected or used medication versus a brain that is suboptimal, but has had maybe a decade or two of medication. What is the resilience feedback like in those two situations?
Hyla Cass: Well, there’s no question that brain changes occur. In fact, people on benzodiazepines have a shorter life span, so can you imagine at least 10 years shorter lifespan from using benzodiazepines. So, other brain changes occur. You get depleted of neurotransmitters, or the brain messengers, brain chemicals. However, what we can do, we who do integrative medicine, we know how to replete and how to repair that brain.
James Maskell: Yeah, I know you’ve spent a lot of your last decade at least trying to get the word out to a much broader group than just the patients that you’re sitting opposite. What have been some of the things that you’ve learned along the way as far as communicating these new ideas to populations that may be either medicated or not, but are searching for a healthier brain?
Hyla Cass: It’s important to start in childhood, to start educating parents. So, I really try to speak to parents in whatever forums I can, for example, if a child is exhibiting any kind of “usually medicatable issue” from ADD, ADHD, whatever, again to start with diet and lifestyle. And, there are more and more parents who are doing that, and sometimes they’re having to buck a system that’s wanting them to medicate. So, we’re at a crossroads, and what you’re asking is when is it going to be weighted more heavily to the natural way, the way that we were made, the way that we were built, the way that responds so well to natural interventions. I don’t know.
Jeffrey Bland: So, Hyla, I’d like to take you back just for a second to, and I’m going to back in my experience. In 1982 I went to a meeting with Dr. Michael Lesser. You might remember Dr. Lesser?
Hyla Cass: Of course, yeah.
Jeffrey Bland: And, he was one of the founders of this whole concept of orthomolecular psychiatry, and the movement that was started in the late 70s into the 80s. And, we were in San Francisco at a meeting, I think it was the charter meeting, a founding meeting of this society for biological psychiatry. And so, we were very excited to think that you would approach psychiatry from a biological basis, thinking that this was going to be about how the brain worked and about nutrients and things. And, of course what it was, biological psychiatry, was the new drug, it’s the SSRIs.
Hyla Cass: Of course.
Jeffrey Bland: And we were both… I remember driving out of there with a state of disillusionment saying, “This is interrupting biology. This is actually not working with biology.”
Hyla Cass: Well, that’s what’s the crazy thing. For example, the SSRIs, the serotonin reuptake inhibitors, are actually depleting serotonin. So, these people become more depressed. So, what do you do? Up the dose, change the medication, add a medication, and you know, you’re off to the races of dependency and addiction to these drugs that it’s really hard to get off them.
Hyla Cass: So, the individual is not having the antidepressant effect, but they’re also not doing very well. So what they really need are precursors. They really need to have some 5HTP or some tryptophan and some B vitamins and magnesium, and zinc, and so on, and some of the other co-factors. You know when you’re baking a cake, you need a lot of ingredients. So, when you’re making a neurotransmitter like serotonin, you need these ingredients. And, that’s just natural and we know this. We’ve had the science for so long. So, when you give this poor brain that’s been abused with a drug—and that’s drug abuse, by the way—that when you give them the right ingredients, and they start to make serotonin, you can start reducing the medication. They feel better, and by the time they’re weaned off, they feel better than they have in many, many years.
Jeffrey Bland: Oh, you said something there that’s so interesting for me, and you remember this, I know I’m reporting now—I’m just reporting on what you already know, that this nutrient, 5-methyltetrahydrofolate, an active derivative of folic acid that has very brain active function. There was a clinical trial done of it along with antidepressants for depression, and the clinical trial was designed to see if 5-methyltetrahydrofolate was advantageous for the treatment of depression.
Jeffrey Bland: However, the way the study was done, and it was funded by the pharmaceutical company that makes SSRIs, is they had a placebo group, they had a group that got the antidepressant alone, and then they had a group that got the antidepressant plus 5-methyltetrahydrofolate, but they did not have a group with just 5-methyltetrahydrofolic. And, what they showed was that the combination of 5-methyltetrahydrofolate with the antidepressant worked best of all, but the real question that we all wondered is what happens if they didn’t have the antidepressant, they just had 5-methyltetrahydrofolate.
Hyla Cass: Similar study with thyroid. Giving people thyroid. So, thyroid actually helps the antidepressant work better, isn’t that interesting? But these people were hyperthyroid, and that’s all they needed was some thyroid.
Jeffrey Bland: So, James, I’d like to ask you, you’re obviously a different generation that Dr. Cass and myself, so you have a young family. And so, as you look at this, being born now and moving into this as a leader in this new generation, how do you see what we’re talking about, and translating it into your generation and the parents that are raising their children?
James Maskell: Yeah, look, I mean first of all the overmedicalization of children is something that seems like a really disturbing thing that’s happening, because ultimately those cases probably end up in the waste basket that is psychiatry. There might be a million reasons why you end up having a mental illness or what society would describe as a mental illness. That’s really nothing to do with brain health at all. We’re kind of in a weird time in the world, right, where maybe being mentally ill is probably an appropriate response to the stimuli that’s coming along.
James Maskell: Second, the death of community. Right. There’s so many great studies that I’ve been seeing, and this is something that I’ve been up to date with, is just the effect of loneliness on brain inflammation, right? Which leads then to depressive like symptoms. And we have over the last 200 years in America, just the destruction of communities to a point that you don’t even interact most of the time with people that you know, you get all of your goods and services from random people like your Uber driver or whatever. The world’s changed completely. So, it’s kind of a worrying time to be in it. But I think that one of the things you said, Hyla, that I’ve just come to appreciate, it’s just that, what a slippery slope that you get on once you’re on the medication train. And, ultimately there are so many ways that you can seek to maintain healthy behaviors before you ever get there, because it does look like a slippery slope from where I’m standing.
James Maskell: And, it’s something that I’ve experienced in my family, and what I want for my daughter is not to have to engage with the psychiatric profession at all. Right. And so we’re doing everything we can right now to build a healthy brain following the… I’ve got a couple of Hyla’s books in my house that I’ve read a few times.
Hyla Cass: Thank you.
James Maskell: So yeah, it’s a serious consideration. And, one of the things you said at the beginning was just how intertwined the brain is with everything, and how stresses all the way through the body end up in the brain, and then the brain signaling everywhere else. So, probably the most important thing, and I don’t think my daughter will be playing football.
Jeffrey Bland: Yeah. Well, there’s another part of this that I wanted to talk to Dr. Cass about, and that is, there are school systems now in the United States in which two thirds of the elementary school children, boys in the class, are being medicated for behavior related, what they consider dysfunction, which gets a label, somewhere in the DSM, as some form of ADHD or something of that nature. So, it begs the question, are we really seeing an epidemic of frequency? Why is it so frequent in boys? And, is it really the boy or is it the social system in which they find themselves that lead to the diagnosis that leads to the medication? And so, it’s a very complex duality, I think sometimes like a dog chasing its tail. You get into that vicious cycle. So, what is your perspective on how this all plays out?
Hyla Cass: A part of the problem too is that these children are being fed breakfast cereal, highly sugared breakfast cereal, and then they go to school, and that certainly makes them jumpy. And, they often don’t have recess, or they don’t have enough recess, and they don’t have enough sports in school, and they don’t have a way to work off their energy. And then they’re boys, they are boys, they have testosterone. Even little boys have some testosterone, and they need to have an outlet for their energy, and they don’t. The whole concept of schools, of children sitting in rows and listening, that is not how we learn. We learn through movement, through doing, it’s bizarre. It’s the factory model of schools. We no longer are in the industrial age, but we’re still having the industrial age education except for the more progressive schools.
Jeffrey Bland: Yeah, I think that’s such a really beautiful point for all of us to pay attention to. That when you talk about brain health, as you said in your introduction, it is the full environment of exposures and experience that really patterns the brain. So, it’s how we eat, think, look, act, breathe, all these various things, the community we have, as James was saying.
Jeffrey Bland: So, I think for people searching for answers, that’s why we want Big Bold Health. We want to be assertive and not passive about the concept that these solutions are available. You can achieve health, but you’ve got to be bold, you’ve got to be courageous. You can’t listen to the party line. You have to seek out your answers. It’s individual to the child or to the person, and not just take a formulaic approach. And, I think that’s why we’re sick and tired, so to speak, of being passive about this topic. We want to be aggressive and bold to really tell people there are options for health that are accessible to everyone.
Hyla Cass: And by the way, something else for the children is free play. Going outside and playing, hanging out with their friends, building forts, climbing trees, being in nature.
Jeffrey Bland: Yes.
Hyla Cass: Nature is a big healer and the big teacher.
Jeffrey Bland: Hear, hear.
Hyla Cass: In Japan, they do forest bathing—there’s an actual name for it, and other cultures do as well. Be in the forest. It’s so healing. We are made to interact with the plants and the trees and the earth, grounding, and so on. So, these are the things we need to really take advantage of to be fully healthy.
Jeffrey Bland: That’s beautiful. Thank you.
James Maskell: Absolutely. So, this has been Big Bold Health. We’ve been here with Dr. Hyla Cass. It will take some big and some bold action to step out of the norm and maintain a healthy brain in this current environment, but that’s what we’re here for at Big Bold Health. I’ve been here with Dr. Jeffrey Bland. We’ve had integrative psychiatrist Dr. Hyla Cass here. Thanks so much for watching. We’ll see you next time.