Bruce Bassi#FuturePsychiatryPodcast discusses novel technology and new ideas in the field of mental health. New episodes are released every Monday on YouTube, Apple Podcasts, etc.
Summary
Nutritional psychiatry is an emerging field that examines the connection between food and mental health. Research shows that a healthy diet can improve symptoms of depression, anxiety, and other mental illnesses. Nutritional psychiatry aims to incorporate dietary interventions as a part of mental health treatment. By identifying the specific nutrients and dietary patterns that affect mental health, patients can make informed decisions about their diet to support their mental health.
Chapters / Key Moments
00:00 Intro
04:10 Common misconceptions about Vitamin B12
06:49 B12 and Folate deficiency leads to hypopituitarism
07:14 Role of b12 and folate in osteoporosis
07:35 Role of b12 and folate in ATP Production
08:01 B12 cutoff values are too low
10:28 Understanding B12 deficiency markers
15:39 What impairs absorption of B12?
18:55 Biologic reasons B12 affects mental health
22:21 What vitamin regimen would you recommend to individuals with depression?
23:27 Folic Acid Affects L-Methylfolate in Crossing Blood Brain Barrier
25:49 Changes in B12 Absorption with Age
28:26 Vitamin D
29:34 Intermittent Fasting and Gut Microbiome
31:01 Benefits to Intermittent Fasting
35:21 What causes b12 / folate deficiency?
Introduction to Nutritional Psychiatry
[00:00:00] Bruce Bassi: So for a consumer, it, it seems very hard to figure out which [manufacturer] to select because not only might the percentage that’s listed not be the amount that’s being absorbed, it might be paired with another molecule that would prevent it from being absorbed very well. And then the manufacturer might not even have the amount in it that they’re saying that they have in it.
[00:00:19] Sheldon Zablow: Correct.
[00:00:20] Bruce Bassi: Given all of this confusion, how does one navigate that?
[00:00:23] Sheldon Zablow: The best way I tell people is—
[00:00:26] Bruce Bassi: So welcome to the Future of Psychiatry podcast, where we explore novel technology and new innovations in mental health. I’m your host, Dr. Bassi, an addiction physician and biomedical engineer. If you’re joining for the first time, I’d greatly appreciate if you subscribe and share with your friend network and social media. Also, additional resources, a full transcript and a discussion forum can be found on our website. Thanks for joining us and I hope you enjoyed the discussion today.
So today we have Dr. Zablow. He is a nutritional psychiatrist. He moved to San Diego in 1982, started a practice in adult child and forensic psychiatry and supervised fellows in child and adolescent psychiatry as an assistant professor at UCSD medical school for 30 years and received two teaching awards. As his practice progressed, he developed a clinical interest in micronutrients and how they contribute to psychological and neurologic health. He used his platform to explore developments in medical science called Nutritional Psychiatry, and has a book called Your Vitamins Are Obsolete. So welcome, Sheldon.
It’s nice to have you.
[00:01:30] Sheldon Zablow: Thank you very much, Bruce.
[00:01:32] Bruce Bassi: So what did you mean by your vitamins are obsolete?
[00:01:35] Sheldon Zablow: Well, let, let me tell you how I got into this. It was a very interesting story. I had a patient came to my office. She was had a moderate degree of depression and she was doing well, responded well to the antidepressant. And then because she had some obesity problems and was looking at starting to develop diabetes, the, she decided she wanted gastric bypass.
So she had a bypass done and the bypass was successful. But after the bypass, her depression returned her face started looking gray, her hair started turning gray. She started having a lot of problems, and we couldn’t figure out what in the heck was going on. And I said, just bring in all your medicines and all your vitamins.
And as I was looking through them, I realized that she was taking 8000% of the B12 she needed to take. And I said, well, why are you taking so much? And then I realized, Once we tried to figure out what was going on that she really wasn’t taking enough. That 8000% that it says on the bottle was really just 80%.
And because she had the bypass, she was absorbing even less. So this woman was going towards significant depression, suicidal ideation, unable to work, and it turns out it was a B12 and folate deficiency. And they had just recently come out with a prescription form of that. And so I had some samples. I gave it to her, and within a month her hair color turned dark, turned back, her hair got thicker, her nails got thicker, her depression went away, her fatigue went away, the color of her cheeks returned.
She returned to to normal for her, and it was quite remarkable. So that’s starting on the road to try to find out why, why these nutrients are so important and how they’re critical to understanding depression, anxiety, lack of response to antidepressant medications, but also understanding how it ties into other health problems.
As you know, a psychiatrist, when we treat people with depression, anxiety, most of the time they have comorbid conditions. Heart disease, kidney disease, inflammatory diseases, autoimmune illnesses, things like that. And so I found out with these vitamins that their other illnesses responded better to the treatments their doctors were prescribing.
So it got me interested in the, to the nutritional overlay, the importance of these nutritional these essential B vitamin nutrients as a foundation for mental and physical health.
[00:03:55] Bruce Bassi: Very nice. So you started on this journey because obviously I, I think as a psychiatrist you probably realized we had some deficits in our baseline set of learning from medical school and even residency when it comes to nutrients in psychiatry.
[00:04:10] Common misconceptions about Vitamin B12
[00:04:10] Sheldon Zablow: Exactly. And one of two things before I forget, is two basic foundations of all of medicine that we were taught and, and is still in the Merck Manual, if you go online, two things.
One is that the body stores three years worth of b12. Okay? Do you remember having heard that before?
[00:04:28] Bruce Bassi: Absolutely. Yeah, I
[00:04:30] Sheldon Zablow: okay. So what happened was this.
So I was trying to find out about the that, and I wrote I communicated with Dr. Koons who wrote the textbook on vitamins, and he said, yeah, it stores it. And I said, but how does it store it? And where does it store it? And as I started asking him, he was saying, you know, “really, I’m not sure” he’ll have to check into it.
So the ultimate thing we, I found out and he supported was that the liver doesn’t really store three years worth of B12. And what’s actually very interesting was actually a noun verb kind of misunderstanding that is, the liver has a store of b12, which means it contains a lot of b12, but it doesn’t store b12.
So if you took a person’s liver and you put it into a blender and you took out all the b12, it would have indeed the equivalent of three years worth. It has three years store b12, but it doesn’t store B12 because it’s water soluble. You can’t store water soluble vitamins. But we’ve all been taught that, well, if you’re missing B12 or you’re going into the hospital for extended time or you have any kind of problem, don’t worry about it.
Your body has three years worth and it’ll just make that up. Well, it turns out it doesn’t have a three years worth. It doesn’t store it, it doesn’t donate it.
And it’s very interesting they’ve done studies, they take people with normal B12 folate levels, and they put them on a vegetarian diet and within a month they can start to see the cellular changes in the blood and neurologically of a B12 deficiency, so there’s not a three years worth.
Another example is when people inhale– recreationally inhale nitrous oxide. It stops the B12 from being used. Well, how can it do that within a couple of weeks if there’s a three year store of B12 in the liver? So that’s one of the foundational things that I thought, I thought with my patients, and it turned out I was very mistaken. But like you say, we are not sometimes taught these little in intricacies that are the foundation.
Another one is the liver has the largest concentration of B12 in the body. And we’ve all been taught that. Well, it turns out the liver has a lot of B12 because all the hepatocytes are using all that b12. That’s why it’s not stored, because all the hepatocytes are using b12. But it turns out the largest concentration of B12 is in the pituitary five times the concentration that’s in the liver. So what this says, as soon as you start having a deficiency of b12, it affects the pituitary gland first.
[00:06:49] B12 and Folate deficiency leads to hypopituitarism
[00:06:49] Sheldon Zablow: So one of the first symptoms is mild hypo-pituitarism, and so that can show up with any of your hormones. The most common one being thyroid hormone. So often people come into my office and one of the things we check when people have chronic depressions, we have to check to make sure thyroid’s working okay.
Well, it turns out their thyroid could be working okay. Or they might have a thyroid abnormality and they’re taking a thyroid supplement, but that supplement is not gonna work unless they have enough B12 and folate.
[00:07:14] Role of B12 and Folate on osteoporosis
[00:07:14] Sheldon Zablow: Another example, people come in and they have osteoporosis of concerns about brittle bone, and their doctors put ’em on a vitamin D and vitamin C and a lot of calcium.
But unless they have B12 and folate, the treatment for the osteoporosis won’t work. So this is again, a foundational thing about B12 and folate. You need B12 and folate for all the other things to work.
[00:07:35] Role of B12 and Folate on ATP Production
[00:07:35] Sheldon Zablow: Another example is ATP production. So ATP, of course, is the energy molecule of the cell.
Well, B12 and folate are required for the manufacturer of atp. So if you don’t have enough B12 and folate, what happens is the first thing you have is cellular fatigue, which turns into whole body fatigue.
So, and then I have one more thing. Cause these things are popping into my mind, so I wanna make sure I, I mention them.
[00:08:01] B12 cutoff values are too low
[00:08:01] Sheldon Zablow: Another thing, we’re mistaught in American medicine, we’re taught below, I forget, it’s some kind of mini moles or something like that. Below 200 we’re diagnosing people with B12 deficiency, okay? And the reason for that is below 200 on our lab scales, that’s when the megaloblastic anemia shows up. That’s when you can look at a cell and say, oh, well you have anemia and it’s due to b12. Well, it turns out deficiency actually starts once you get below 500. Once you get below 500, that’s when the nerve cell damage starts to take place. So if doctors are waiting on their lab test to get below 200 to diagnose a B12 deficiency, they’ve already missed many, many months of nerve damage already occurring before it shows up on the lab test.
It’s interesting. In Japan, they use 500 below 500 as their clinical definition of B12 deficiency. Where in the United States we go down all the way down to below 200 for deficiency. So these are all the things that I thought was my foundation for medicine and practicing psychiatric medicine. And it turns out I was mistaken.
So I had to relearn this by reading this textbook every single page of this textbook and reading all these other texts to find out what is really going on here and why did my patient have the problems? That gastric bypass patient, and why did she respond the way she.
[00:09:16] Bruce Bassi: Mm-hmm. Yeah. I wonder why Australia uses even lower threshold or cutoff.
[00:09:22] Sheldon Zablow: I think it has to do with the anemia, but it’s not good clinical care is the, the nicest way I can put it.
[00:09:31] Bruce Bassi: Yeah, absolutely. So, you know, b12, folate very highly correlated with depression when those are in deficiencies
[00:09:40] Sheldon Zablow: That’s right.
[00:09:41] Bruce Bassi: And what might lead you down a path of. Say you have an average individual, they’re not a vegan. How would you know whether or not you should test for B12 folate levels in their body? If just present with depression and otherwise healthy individual without any neuropathies.
[00:10:00] Sheldon Zablow: That’s a whole nother can of worms. And the reality is B12 testing is very inconsistent between labs and the results you get don’t really tell you a whole bunch. So let’s look at folate first. If I ask for a folate test, what they’re gonna do is they’re gonna tell me the blood level of folic acid. Well, that’s not what the body uses. Folic acid is the synthetic vitamin and L, methylfolate is the vitamer. Are you familiar with the term vitamer?
[00:10:25] Bruce Bassi: I am after having read your book, but maybe audience isn’t.
[00:10:28] Understanding B12 deficiency markers
[00:10:28] Sheldon Zablow: Okay. So vitamins are the different forms of each vitamin. So you can have synthetic forms like folic acid and the natural form like L methylfolate.
So what happens if you order blood tests? Folic folate, they’re gonna give you folic acid in the blood, but that doesn’t tell you if there’s enough folate, L methylfolate in the blood cell. So the more accurate test, it’s called a red blood cell folate level, and that would tell you if you have enough. And for b12 you could order b12, but you don’t know what kind of B12 they’re actually measuring and what kind of system they use and how consistent that is to what else is going on.
So what I tell people is, it’s better to look at other things. And one of the other things, we’ll, two other things we’ll look at are homocysteine. So homocysteine is a waste cell cellular waste byproduct of cell metabolism, and it builds up B12 and folate, metabolize this toxin into a non-toxic byproduct that’s used by the cells.
Okay, so some people have an increase in homocysteine and that tells me whatever their b12 test, or the folic acid test is telling me if their homocysteine is up, they needed to be treated with B12 and folate. And the other one along those lines is called MMA methylmalonic acid.
But going back to homocysteine, homocysteine is very interesting. Is that, increases a homocysteine. I encourage people to put homocysteine in any illness in their browsers, be it dementia, heart disease, autoimmune illness. homocysteine is a factor in all those things. So one of the ways homocysteine shows up is women will come in, they’re depressed, they’re anxious, they’re having difficult time.
And I ask them what medicines you’re taking and they’re saying, well, I’m taking birth control pills, or they’re a little older and I’m taking hormone replacement therapy. Well, if they’re taking those medications, those medications block the conversion of the synthetic folic acid into the natural L methylfolate, and when that’s blocked, their homocysteine goes up.
So their homocysteine goes up. When their homocysteine goes up, two things occur. One is they have inflammation of their endothelial cells, all the cells lining their blood vessels, and for some reason, the homocysteine increases the thickness of the blood. It increases the viscosity. So you have two reasons for having thicker blood.
Well, guess what? Women who are taking birth control pills or women who are taking hormone replacement therapy are at greater risk for blood clots, heart disease, strokes, pulmonary embolism. And it’s this dynamic that contributes significantly to that.
So when I first start practicing, psychiatry did, now this came out in 1971 in Lancet.
And so when birth control pills came out and I first started psychiatry, and I, I was made aware of this, I forget how, I required every patient I saw to make sure they were taking B12 and folate with their multivitamin, thinking that they were getting enough in their multivitamin. I was mistaken.
So I knew that this homocysteine was gonna be a challenge for ’em.
So I wanted to make sure they were taking that. And then after I started doing this nutritional psychiatry exploration, I made sure they got the bioactive forms, L methylfolate, the bioactive forms, methyl cobalamine to make sure they have that, to keep their homocysteine down.
Go back to your question. What other things do you look at? You can look at blood. What I do is I make sure I’ll check for homocysteine and also check for MMA and the– while we’re talking about blood tests, the other test I would suggest is to test for MTHFR. That’s the enzyme that converts the synthetic folic acid into the natural L methylfolate.
And about a third of people have inefficiency in the MTHFR enzyme. To the extent that they might have an increased level of homocysteine due to this genetic abnormality. Well, I will tell you that when my little granddaughter grows up and she eventually gets married and wants to have a child, I will know her MTHFR status.
And I think every woman who goes into an obstetrician’s office should have an MTHFR because they are being prescribed prenatal vitamin. People who are coming to see us for depression are being prescribed multivitamins with folic acid in it, with the understanding of their physician that they have plenty of folate because they’re getting folic acid will.
If 30% of people have a MTHFR deficiency and they can’t convert the artificial folic acid into the natural folic acid, if a pregnant woman has this, now she’s at risk for postpartum depression, preeclampsia, gestational diabetes, and her unborn child is at risk for premature birth, cleft palates, birth defects, all those things that go along with folate deficiencies.
So there’s a high public health intervention that needs to be made, just as require blood, blood types for pregnant women, we should require MTHFR determinations for every woman who wants to get pregnant.
[00:15:16] Bruce Bassi: Hmm. So I was reading your book outside about all of the benefits of B12 and folate and. I quickly realized that there’s so many benefits, it’s it’s a no-brainer to, to take
[00:15:29] Sheldon Zablow: That’s what I, that’s thought. That’s what made me have to write the book I kept was wishing, oh, please, somebody else write the book. Please write it. I don’t wanna have to do that. But nobody was doing it, so I, that’s what I did.
[00:15:39] What impairs absorption of B12?
[00:15:39] Bruce Bassi: I, I ran inside and I grabbed some B12 and folate and checked out the bottle and it said that it has vitamin C in it. And I remember reading just a few pages earlier. That vitamin C and iron impair the absorption of b12.
[00:15:54] Sheldon Zablow: Exactly. So what I say is the supplements are poorly made. They’re poorly dosed. So if you take B12 and vitamin C and iron, and you mix them in a mixer, which is what they do at when they’re producing it. Those three substances will form a macromolecule. That is a large molecule that can’t cross from the intestines into the bloodstream. It can’t cross the barrier there because it’s so big. That molecule is so big. So you think you’re getting it, but you’re not getting it.
Now the other thing with vitamins that they don’t tell you, if you look on your label, it might say you’re getting a hundred percent of your required B12 by taking this.
Well, the reality is they basing that a hundred percent on how much b12, assuming you absorb whatever they have, there is good b12. They’re, they’re assuming that you’re gonna absorb a hundred percent of what they put in their pill. The reality is the body can only absorb 1% of B12 in the tablet. So while my patient’s label said she was taking 8000% of the b12, 1% of that is 80%.
She wasn’t taking 8,000%. She was getting 80%. So every day she took her pill, she was taking less and less of what she needed.
Now the reason is B12 from a supplement is only absorbed by passive diffusion. B12 in food is absorbed by an active transport system. It’s, as you know, it’s a very complicated, intricate, and an amazing system. It starts as soon as the protein enters your mouth. Your body starts making a cascade of different carriers to carry that B12 from your mouth into your stomach. Another protein is made intrinsic factor that carries it from, that’s made in your stomach, that goes with the food, and in your intestine that intrinsic factor grabs the B12, so it can go into the bloodstream.
Once it’s in the bloodstream, there’s another transporter protein that grabs it to transport it to the cell. So all these steps need to go on, but the first step is getting it into the blood. And the labels are misleading people by having you think if you take a hundred percent, you’re getting a hundred percent.
They’re telling what’s in the tablet and not what you’re absorbing. And physicians, I didn’t know. Other physicians don’t know that people aren’t told that your label is misleading you.
So going back to what you’re saying about combining them, so therefore when I tell people to take these natural substances, be it the ones they can get a Costco or the ones they get online, the natural methyl cobalamine and the natural l methylfolate, what I tell them, it’s critical to take it by themselves.
So I tell my patients, take it in the twice a day in the morning and at nighttime. Okay, yeah, you’ll take a little bit more than you need, but your body’s only gonna use so much that only stays in your blood system about six to eight hours, your body will grab whatever it can, but whatever it doesn’t grab, it’s gonna be peed away.
So if you take it twice a day on an empty stomach, you’re not gonna have other vitamins juice, something, vitamin C and juice. You’re not gonna have other foods interfering with the absorption, and that’s the best way to do it. B12, folate by itself twice a day.
[00:18:51] Bruce Bassi: Interesting. That’s, that’s really good advice. I really appreciate that.
[00:18:55] Biologic reasons B12 affects mental health
[00:18:55] Sheldon Zablow: Let me mention some other things that b12, it’s critical for B12 to do what it does in the nervous system. So the different ways. If you don’t get enough B12 and folate, it’s gonna affect the practice of psychiatry because the cells aren’t gonna be working well. So, as I mentioned before, B12 and folate are required for the manufacturer of neurotransmitters.
So if you don’t have enough B12 and folate, you’re not gonna make neuro enough neurotransmitters. Your patients are going to be antidepressant nonresponsive. They’re gonna have treatment resistant depression. Okay? So that’s one thing.
But another interesting thing that I didn’t know is that when your body doesn’t have enough B12 and folate, you develop this anemia, this megaloblastic anemia.
Well, what goes along with the abnormal red blood cells are a lot of premature platelet plate platelet production. A lot of platelets premature platelets are being made. And what premature platelets make is they make MAO. So you have this B12 and folate deficiency that’s causing a massive spike in MAO.
And as we know, MAOS break down neurotransmitters. So you have two reasons for having a, a neurotransmitter deficiency by having B12 and folate deficiencies.
The other thing B12 and folate does is that maintains the myelin coating of the nerves without B12 and folate, that’s why the nerve damage starts way before the anemia starts because the coat, the myelin coat on the neuron starts to break down, and it also interferes with the production of Neurites.
Well, I didn’t know what neurites was until I started reading this stuff, so it’s the little axons and the dendrites. Those two things are called neurites. So the thing we’re learning in modern, the future of psychiatry is, well, it’s not so much about neuro neurotransmitters. It’s about connectivity of the cells and, and antidepressants help the connectivity of the cells.
Well, it’s chicken of the egg. They actually do both. But connectivity is very important. If you don’t have enough B12 and folate, your connectivity drops way off, and that’s another reason you’ll have a treatment resistant depression.
[00:20:52] Bruce Bassi: Mm-hmm. So for a consumer, it, it seems very hard to figure out which manufacturer to select because not only might the percentage that’s listed not be this, the amount that’s being absorbed, it might be paired with another molecule that would prevent it from being absorbed very well. And, and then the manufacturer might not even have the amount in it that they’re saying that they have in it.
[00:21:14] Sheldon Zablow: Correct.
[00:21:14] Bruce Bassi: Given all of this confusion, how does one navigate that?
[00:21:17] Sheldon Zablow: The best way I tell people is go to consumer lab. It’s one word with a capital L. So one word, capital L, consumer lab. And they do the testing on all these things and I would follow the recommendations. So what happens is as opposed to maybe some other testing centers they get requests to test vitamins, and what they do is they go to the store and buy the vitamins off the shelf.
They don’t want the manufacturer sending them a select box of their vitamins. So they go to the store, they buy the vitamins in the store, they take it to the lab, and they independently test it. So that’s a remarkable group.
[00:21:50] Bruce Bassi: The government should be doing that .
[00:21:52] Sheldon Zablow: of course the government should, the government should be doing a lot of things to help people and make health easier for people. But they’re not, and certainly there’s lobbyists and other people that intervene in preventing testing and truth and testing being available to people, which makes it even harder for patients and physicians treating their patients. Physicians wanna help their patients. They wanna give ’em the best information they have, but we’re not getting the best information to the, to the physicians to help their patients as best as they can.
[00:22:21] What vitamin regimen would you recommend to individuals with depression?
[00:22:21] Bruce Bassi: Would you recommend this to all of your patients who have maybe depression, low energy, difficulty concentrating, which is probably 90% of my patients.
[00:22:29] Sheldon Zablow: Every single one. So let’s say somebody might have a genetic abnormality or they might have predisposition. So for instance, they could be taking other medications that interfere with it. I recommend this to all my patients because if I, I don’t know about it’s hard for me to order an MTHFR and order a, a homocysteine, an MMA and make sure I get all those and get those back and get them back in time and see the patient again.
But what I do know is if I make sure that through a prescription or a recommendation that they start taking this B12 and folate, that’s the insurance that is, I don’t have to worry about their MTHFR, whether they have it or not. I know they’re getting the kind that is going to– as soon as they take it within 15 minutes, it’s gonna go into every cell in their body.
This another thing people don’t realize is that folic acid and cyanocobalamine don’t cross the blood-brain barrier. If you get the natural forms, it goes across into the blood-brain barrier within 15 minutes because it’s water soluble. Every cell is getting it, and every cell is gonna respond.
[00:23:27] Folic Acid Affects L-Methylfolate in Crossing Blood Brain Barrier
[00:23:27] Bruce Bassi: And in fact, you said in your book, more folic acid can prevent the absorption of the L methylfolate?
[00:23:33] Sheldon Zablow: Exactly. So sometimes doctors will say, well, let me see what their folate level is. And they do a test and it’s the folic acid level, which can be very high. But if they wanna measure the intracellular level, they have to go to a red blood cell l methylfolate level. So what happens in recent studies show that there might be too much folic acid in the blood that’s blocking the blood brain barrier, which prevents the natural folate from getting across into the brain.
So that’s confusing doctors like, well, it couldn’t be a folate problem because their folic acid levels are very high, but we don’t know. The only way we would really, really know what’s going on in the central nervous system is take a little csf, maybe take a little brain biopsy and look at those cells, but nobody’s gonna be doing that in outpatient psychiatry.
So we get around that by just giving them the real stuff.
[00:24:19] Bruce Bassi: So you would recommend a patient would take the L methylfolate if they haven’t done genetic testing before rather than the folic acid.
[00:24:26] Sheldon Zablow: Right. Exactly. Still get the testing, anyway, I think it would be important, but it sidesteps all the, those concerns. So, so let’s talk about some of the reasons that people have a B12 and folate deficiency, for instance.
One of the interesting things that, that I was not aware of, but it’s very important as is an increase in BMI an increase in weight, excess adipose tissue absorbs folate. It just pulls it in. So you could have somebody who thinks healthy, and has enough folate, but they don’t because of their obesity. So one of the studies I read, and once you have this understanding, you can filter studies in ways you never were aware of. So at at my at my office, at my apartment, in my mailbox, I got this journal from the Journal of Burn Therapy.
Okay. And it was a physician had lived in my apartment before I did. And guess it was an old subscription. So I’m looking at through the table of contents, and one of the questions in this research study is, why do obese women have greater difficulty– obese people in general have a greater difficulty in wound healing from burns.
And they were asked in the question, nobody had the answer. Well, I had the answer. It’s because they had low folate. If you have excess tissue that’s absorbing the folate, you can have decreased wound healing because you can have epithelial inflammation due to the higher homocysteine. So you’ll find connections where you never thought there could possibly be connections between poor wound healing and, and obesity.
[00:25:49] Changes in B12 Absorption with Age
[00:25:49] Bruce Bassi: And what about with age?
[00:25:51] Sheldon Zablow: And with age. Very interesting. So what happens with the age is a couple of things. With age, your brain shrinks. And a lot of people don’t know that. Oh yeah, it really does? Yes, it shrinks. But B12 and folate, those who have higher B12 and folate levels have a lower rate of shrinkage. Another thing that happens with age is your liver actually shrinks.
I was talking to a physician about this, and he’s treating a lot of older people. He had no idea that the liver shrank up to 50%. And older people, well, that means less metabolism by the liver, less conversion of synthetic vitamins into natural vitamins.
All the different functions that the liver does to cleanse and promote health in an individual decreases with age because the liver is smaller, which means people are more susceptible to external stresses, lack of protein, lack of nutrient, pollution, alcohol, excess weight, prescribed medications, all those things can affect people more with age. Cognitive decline– put in B12 and folate deficiency and cognitive decline in dementia, and you’ll see that there’s a lot of B12 and folate deficiency in people.
Now, what are reasons older people have b12 and folate deficiencies? Part of it is when their livers are small, their stomachs also stop producing enough acid. It’s not the same amount of acid. So they can eat a great piece of steak when they’re 70 years old, but if your stomach doesn’t make the acid to break down the proteins, to take out the b12, you are not gonna get enough b12. So that’s what happens also.
And then there’s instances of what I call voluntary and involuntary vegans. Voluntary vegans are the ones that choose to eat non-meat diets for a wide variety of reasons. And good for them, except their health is not so good because they’re not getting enough of the natural B12 and folate. You can’t get that from a vegan diet. And the other category, the the involuntary vegans are those people who are limited income or they live in rural areas. They live in urban areas that they don’t have access to fresh meat, fresh seafood fresh vegetables, and those are what I call involuntary vegans. And physicians need to be aware and their assumptions that involuntary vegans, they’re not getting enough protein, they’re not getting enough nutrients, they’re not getting enough vitamins in their food that we all assume they were and could get. So that’s another important awareness.
Now, the intervention, the cost of getting a good form of B12 enough of it, and a good form of folate is only a couple of dollars a day. It’s not that much, and that intervention could save a ton of money on healthcare costs and morbidity for patients.
[00:28:26] Vitamin D
[00:28:26] Bruce Bassi: So it sounds like you’re very well versed in b12, folate, and what about vitamin D? Can I get your take on that?
[00:28:32] Sheldon Zablow: Vitamin D is a little bit more confusing. I’m not as, so much as an expert in that. It’s really critical what I tell people about vitamin D: take the supplements, take it as directed. Make sure you take it as directed with plenty of fluids and all that kind of stuff.
But the best source of vitamin D is the sun. That gives you the right kind that your body is already made to get. So what I tell my patients is, as soon as you find a sunny day, go out in the sun and lift your shirt up so you get sun on your back. People don’t like to get sun on their face because of course they’re, they’re concerned about skin damage and pre-cancerous lesions and things like that.
People don’t realize this is very interesting that using the sun to make Vitamin D is photosynthesis. We always think of photosynthesis like in plants, but it’s really photosynthesis. You’re taking the sun to synthesize a vitamin. Well get that vitamin D on your, on your back as often as you can. 15 minutes. Again, a good sun, couple times a week, and I think that’s the best dose. Otherwise, you have to take supplements, take good supplements, make sure you take the way it’s supposed to be taken.
[00:29:34] Intermittent Fasting and Gut Microbiome
[00:29:34] Bruce Bassi: So let’s talk about intermittent fasting real quick. I feel like that’s a very popular topic. I’ve never been able to intermittently fast. I love breakfast and my hunger pangs get the best of me in the morning. But you mentioned that even when you consume the same amount of calories, if it’s confined to an eight hour window, especially animal models, it actually reduces aging and helps people basically utilize energy more efficiently to be use using fat stores instead.
[00:30:03] Sheldon Zablow: It, it does a lot of things. One of the interesting things it does, it changes the microbiome, the bacteria of your intestinal system. It changes the balance. If you’re having food coming in, you know, let’s say you’re having food coming in 16 hours a day, well, you’re overfeeding your microbiome and your gut.
And therefore the bad bacteria are outpacing the good bacteria because they have so much food and that’s gonna affect all other systems of your body by having a out of balance microbiome. And so if you limit the food intake, then the healthy biome kind of takes over. And you can see this in your mouth, that when I started this, I didn’t have a lot of cavities, but everyone, you know, every couple years you’d get a cavity here and there, their places the doctor would warn you about.
And when I started intermittent fasting, I haven’t had a cavity. Maybe since I’ve been doing this for 6, 7, 8 years now, and it’s because my mouth gets rest. The biome of my mouth is not overwhelmed by bad bacteria that like all that sugar and the carbohydrates I’m putting in there and my mouth health and therefore I, my gut health is so much better.
[00:31:01] Benefits to Intermittent Fasting
[00:31:01] Sheldon Zablow: So intermittent fasting, so what’s good about it is– it’s a more, if you wanna say, natural way for your body to kind of take in food.
If you think of us, in our cavemen days, we weren’t sitting around eating all day long. We’d have little snacks now and then, but there was the big hunt. You’d go out, you’d hunt, you’d eat the food, you’d come back and you’d stay safe and warm in your cave.
We weren’t snacking all the time, but our systems still think we’re in those in the Savannah still think we’re in the mountain someplace and we gotta be nervous every time we don’t have food. And I keep having to remind myself when I do my intermittent fasting that the refrigerator’s just a few feet away. I’m not gonna starve.
So I have to make sure I don’t get in this argument with my body. My body says, watch out, you’re gonna starve here. And I’m trying to tell it intellectual. No, no, the refrigerator’s right there. I can get something anytime I want. I swear I’m not gonna let you starve. So you have this discussion all the time.
It’s hard to start intermittent fasting because we’ve been, we’ve been trained to have that a little bit in the morning. So what I tell people is just start your, there’s no rush in this. You don’t have to like do it within a week or a month, or even a year. Just do it little by little. So delay your first intake.
If you’re used to having something at nine o’clock, delay it till 9:30. Delay it every day by half an hour, then 10 o’clock. Your body’s making all these hormones to get ready to process the sugar coming in. That comes in every day at nine o’clock. Well, if it doesn’t come there, your body gets little, the hormones get a little out of balance, the and, and so when it’s 9:30, say, oh, okay. I tell people, do it little by little by little and try to get it down to an eight hour window. If eight, eight hours is 11 o’clock, when you first have your breakfast, when you break fast with breakfast at 11 o’clock, then it’s seven o’clock. Okay? That’s your eight hours.
If you want to lose weight, you have to decrease your food intake time from eight hours to seven and a half hours to seven hours. Okay. If you’re stable with your weight and you, and you have the metabolism that can tolerate more of a swing, then you don’t have to worry about, oh, I can eat in an eight hour win, eight and a half hour window. I get all my calories an eight and a half win hour window.
Going back to those studies you were referring to, what they did is they took mice. This was over here in San Diego at Scripps research. They took some mice and they said, okay, we’re gonna take two groups of mice. Exactly. Identical. We’re gonna give one group of mice their calories during eight hours, all their calories during eight hours.
The other group of mice, same amount of calories, but we’re gonna spread it out over 24 hours. Those that consumed over 24 hours had an increased risk of autoimmune illnesses, diabetes, cancer, dementia, and all those cardiovascular illnesses, all those different illnesses that are associated with getting older.
The intermittent fasting mice, that healthier profiles and low instances of all those illnesses. They’ve replicated that to some human studies now, and the studies are very similar.
Not everybody can do it. Some people are so sensitive to blood level drops when they get up in the morning, if you have a busy day and you have to get up in the morning and you have to concentrate all the way through till 1230, intermittent fasting might not be the best thing for you, okay? You might have to do it on weekends, or you might have to narrow your windows down in different ways. People that need peak concentrations, particularly at the beginning are going to have a difficult time concentrating once you get used to it you can tolerate the slow decrease in food from nine o’clock to 10 o’clock to 11 o’clock.
I started this and my wife started this. I was getting to 11 30, 12 o’clock without eating, and she couldn’t go without a breakfast. And then slowly she started doing it and she was complaining the whole time, but slowly she was creeping her time back. It took her a long time, and now she can go to one or two o’clock, and at, at 1230 I’m bugging her, it’s time for lunch. She says, I’m not ready. One o’clock, please. I gotta eat. I’m, I’m dragging here. Let’s get something to eat. And she says, okay, I have to talk her into it. And now she does it better than I do.
[00:34:45] Bruce Bassi: is it an all or nothing there with the intermittent fasting?
[00:34:48] Sheldon Zablow: Not at all
[00:34:50] Bruce Bassi: like a little bit creamer in your coffee? Does that, is that count as breaking your fast?
[00:34:54] Sheldon Zablow: it does not. The the rule they say, and it’s not a hard, fast rule. The rules I’ve read is if you have less than 50 calories, less than 75 to 50 calories in the morning, so you have your coffee with a little creamer, whatever, that should not break the fast. So that’s certainly okay for people. And coffee’s so important for people.
Not being a coffee drinker, I don’t understand it. But my wife’s a big coffee drinker and she’s quite successful with her intermittent fasting and has little creamer in her coffee every day and does very, very well. So,
[00:35:20] Bruce Bassi: Very nice.
[00:35:21] What causes b12 / folate deficiency?
[00:35:21] Sheldon Zablow: There’s a lot of different reasons for having a B12 and folate having reduction in B12 and folate. A couple of those reasons are prescribed medications. So for instance, metformin prescribed to moderate blood sugars and diabetics. Well, your doctor’s prescribing metformin for the diabetes, but the metformin’s decreasing B12 and folate.
We know diabetes causes peripheral neuropathy, and it does that because it interferes with the myelin formation at the very, very end of the toes. Well, your doctor’s giving you something for diabetes that’s gonna make the peripheral neuropathy worse without realizing you’re already probably low in B12 and folate because you’re diabetic and you have increased adipose tissue and your doctor’s giving you something that’s making it even worse. Though it’s controlling your blood sugar, your nerves are getting worse.
What I say to doctors, what I say to every patient that’s taking Metformin, being treated for diabetes, you need enough B12 and folate.
Other things I’ve mentioned, hormone replacement therapy, birth control pills. The other big one is GERD treatment medications. So H2s and PPIs, they also block B12 and folate.
So let’s say a woman comes into your psychiatric practice, 50 years old. She’s on hormone replacement therapy. She’s taking she’s a little bit overweight, she’s taking a Metformin she smokes a little bit, drinks a little. And she has all these factors going on.
Well, she has a lot of different reasons. And she’s taking ppi cause she has like a little bit of reflux. With all these things going on, she has 3, 4, 5, 6 reasons for having a B12 and folate deficiency. And then her doctors wonder why she’s has a resistant depression.
The doctors wonder why she’s depressed and her weight’s up. Doctors wonder why she’s not responding to treatments for her autoimmune illness. So sometimes all these factors, it’s not one factor that’s gonna cause it, but all these factors gonna add on each other, and you could have a patient in your office that is just not having a, a chance at all of using B12 and folate properly, even if they get the right kind, because they’re having all these different things, these prescribed medications that are interfering with their ability to metabolize and use B12 and folate.
So, so the important thing is, is getting methylcobalamine and l methylfolate. Now, where can you get it?
Costco has a great basic methylcobalamine.
The l methylfolate, you have to go to more specialty stores, go online. But again, I would go to Consumer Lab and find out which ones they recommend because what they say in their pill is not often what’s in the pill in consumer lab is a straight shooter and calls it as it is.
[00:37:52] Bruce Bassi: Interesting. Yeah, and I was surprised to see some NSAIDs too. You mentioned in your book Ibuprofen and Naproxen also affect b12.
[00:38:00] Sheldon Zablow: Right. Exactly. Insights. Yep.
That’s
[00:38:02] Bruce Bassi: I probably could have thought of certain times that I took an nsaid, you know, around the time of a meal and probably just totally wiped out the B12 that I could have gotten that meal.
[00:38:11] Sheldon Zablow: Exactly. Yep. Right.
So it’s interesting. It makes you think you’ll, you’ll see, you’ll, different articles will come up in your literature, and you’ll start making connections that nobody has made before. It’s, it’s gonna be fascinating once you have this knowledge, not just you, but all physicians, all medical people, once they know this, a world will open up to them and how to better help their physicians.
[00:38:31] Bruce Bassi: And you made me start to think about in more depth some of the psychiatric medications that need to be taken with food. And after Googling it and researching it, there is also Effexor and Viibryd should be taken with food. And I don’t necessarily always counsel my patients on that with those two.
and it, it seems like, you know, say somebody decided that they wanted to start intermittent fasting, they were taking Effexor in the morning, and they suddenly have headaches and they’re more depressed and anxious and they have no idea why.
[00:39:01] Sheldon Zablow: Right. Yeah. Intermittent fasting’s very tough. If you have to take the medicines twice a day and it, it should be taken with food. So what I would do is I’d say, well, it should be taken twice a day. Does it have to be taken in the morning? Maybe it could be taken at lunchtime. And, and, and later. So it doesn’t have to be in the morning.
Maybe you can delay to your first intake at noon, something like that. But that it gets tricky and every, as you know, that’s one of the challenging and challenging things and interesting things about psychiatry is every patient that walks in the door is different and they have their own unique world and circumstances that contribute to the picture that they’re presenting with coming into your office.
So each person needs a kind of a unique program for them that works with their, their diet, their environment, their family.
[00:39:44] Bruce Bassi: Yeah. Online I know of a drug drug interaction checker. But do you know of any interaction checker for absorption of medications with supplements in the body?
[00:39:55] Sheldon Zablow: I don’t, I can’t think of one that pops into my mind.
[00:39:57] Bruce Bassi: I think you need to start one.
[00:39:58] Sheldon Zablow: Yeah, there you go.
[00:39:59] Bruce Bassi: That be your next phase of this project.
[00:40:02] Sheldon Zablow: Right. That’s that’ll be in my second edition.
[00:40:04] Bruce Bassi: Because, I mean, there’s just so many, so many tables and you can’t keep track of the, the acidity, the, the food itself, whether the, there’s a calcium or other cat that chelate the substance.
[00:40:17] Sheldon Zablow: It’s so confusing. It’s so confusing. That’s why what I typically do is anytime I see a patient come in, I say, look, I’m gonna touch base with you in a week. I’m not gonna charge you. I just need to know within a week, are you tolerating it? What’s working, what’s not working? Are you taking the way you’re supposed to?
And that increases my success rate tremendously just by letting the patient know that I’m interested. I’m, I’m connecting with you. And this is an ongoing process. It’s not your, take these pills, come back and see me in three months. I mean, you know, antibiotics. You could take antibiotics. And the doctor says, take these, take these for 10 days, call me if there are problems.
Well, psychiatric medicines, there’s a whole bunch of factors in taking the medications, and these people are still living their lives and, and all the ups and downs that goes with their lives. So I always feel comfortable just touching base, just a brief contact by phone. Any questions?
So when I tell people about little bit about side effects, when I prescribe medications, my caveat is anything that happens that is you think is unusual or different, we’re gonna look at that and consider whether it might or might not be a side effect. I don’t know if I’ll be able to give you a hundred percent answer to that question about this medicine with the side effects cause things change so much.
But I’ll talk to you about anything that comes up that you have a question about and we’ll do it a week after our appointment. I have a smaller practice, so not everybody has the luxury in their different clinical settings with university settings and and busy practices to do. But if you let patients know that if something’s different happening, then you don’t have to go through the list of every single possible side effect with the medication, just let them know, I will talk to you about anything you consider a side effect
[00:41:49] Bruce Bassi: That’s awesome
[00:41:49] Sheldon Zablow: That helps both of us. It lowers my anxiety.
My anxiety’s up. It’s not a good thing.
[00:41:54] Bruce Bassi: I appreciate you providing such clarity to a really confusing topic that we don’t know enough about, and it’s, there’s not enough research on, and we don’t, frankly pay enough attention to also as psychiatrists. So your book was really nice to read, very easy read, and it also provided a very comprehensive look at nutrition in light of other holistic factors such as stress, inflammation, which we haven’t even broached that topic very much yet. But, how might people find you if they wanted to reach out? out
[00:42:26] Sheldon Zablow: When my book came out, I was open to all these questions and then people were asking me all these clinical.
[00:42:31] Bruce Bassi: Clinical
[00:42:31] Sheldon Zablow: then my anxiety went up cause I wanted to give ’em the best answer possible.
And then I started getting a dialogue with people different, well, I tried this and I didn’t work and I tried that and I didn’t want to answer a few questions to not answer them.
If people have questions, I will give you my address. They can write me. So if it’s that important a question, they’ll write me. I’ll look it over and I’ll do the very best I can, which is 302 Washington Street, suite number 613, San Diego, California 92103.
[00:42:59] Bruce Bassi: Very nice. Or they can just photocopy a page in your book, bring it to their primary care doctor and say, Hey, what do you think about these recommendations? And have a dialogue and maybe even teach them something.
[00:43:09] Sheldon Zablow: Exactly right. I think that would be the way to do it.
[00:43:12] Bruce Bassi: Yeah.
[00:43:13] Bruce Bassi: Awesome. Well, thank you for your time. I appreciate you to talk to me talk to the audience too.
[00:43:19] Sheldon Zablow: If people direct questions to you and you think, well, that’s a really good question that we didn’t have a chance to cover, certainly send it off to me and I’ll, I’ll, I’ll give you an answer. Any, anything you’d like.
[00:43:27] Bruce Bassi: Absolutely. Are you working on book number two, perhaps?
[00:43:30] Sheldon Zablow: there might be a follow up to this. I’m looking at different things. So, a wide variety of interests. There’s a lot of things. One is on longevity and, and how the level of vitamins in your system could give you an indication of how much longer you have to live. And that’s an interesting topic.
[00:43:48] Bruce Bassi: Very, very good topic. Yeah. I’m sure that we could tie that into a lot of current research and current startups in that, in that industry as well. So maybe we’ll have to have you back on in a year from now. Talk about that topic.
[00:44:00] Sheldon Zablow: That’s right. I will tell you further research in that area, it’s really fascinating. The vitamin levels change.
So very quickly, I’ll say this, we know that when you’re dead, all your cells are dead and all of them to stop reproducing. We know when you’re born, all your cells are reproducing, except some cells like brain cells and things like that.
Okay? So we know the end point and the beginning point, and there’s a certain period of time in which the production and the, the senescence, the death of the cells are occurring at the same rate, and that’s through most of our lives. Well, at some point the death rate increases more than the production rate.
Okay? We know the endpoint well. It’s when that process starts, when the cell death rate is greater than the production rate and the end. But there’s a point in there in which the level of nutrients in your body is telling you where on that mine you. do you follow what I’m
[00:44:47] Bruce Bassi: Yeah.
[00:44:48] Sheldon Zablow: And that’s what I’m exploring now.
[00:44:51] Bruce Bassi: That’s awesome. So it keeps you busy. I’m sure.
[00:44:54] Sheldon Zablow: Yeah. Interesting stuff. The nature of science and psychiatry. It’s always changing. Always learning. It’s great. It’s the best.
[00:45:01] Bruce Bassi: Well, thank you for being on the show.
[00:45:03] Sheldon Zablow: Thank you, Bruce. It’s a pleasure.
