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How Gluten Impacts Mental Health with Kelly Brogan, MD
This week’s Gluten Free School Podcast episode will cover these topics:
00:28 — Introducing Dr. Kelly Brogan who shares her experience with postpartum thyroiditis (Hashimoto’s) and how this led her to reexamine diet’s connection with brain health. She is passionate about the relationship between gluten, women’s health and psychiatric issues.
04:16 – The types of patients and health issues Dr. Brogan typically works with, and her treatment philosophy.
05:33 – How gluten (gliadin) stimulates the nervous system and causes health issues of all sorts.
08:30 – Examples of physical and psychiatric manifestations linked to gluten.
10:38 – The gut/brain connection, how the balance is effected by diet, and the root cause of mental illness.
12:09 – The importance of understanding how gluten triggers the immune system and inflammation wreaking havoc in different tissues in the body, like the brain.
12:56 – The role of the thyroid in mental health, the overlap of Hashimoto’s among those with celiac disease or gluten-sensitive.
15:04 – How to find out and properly test for thyroid imbalance.
17:29 – Why eliminating gluten can be so powerful, how to start and is it reasonable to expect to successfully remove accumulated antibodies.
18: 29 – Other food can be (gradually if needed) removed from the diet for optimal mental and gut health.
19:31 – Sugar and refined carbs, the role of blood sugar balance and its relation to thyroid.
20:54 – Why thyroid and autoimmune disorders are so common post-partum.
24:02 – What women struggling after giving birth can do to start feeling ‘right’ again.
27:33 – Discussing the safety of taking medication while breastfeeding, and what are the alternatives.
31:22 – How to connect with Dr. Kelly Brogan and get a copy of her book A Mind of Your Own HERE!
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COMPLETE TRANSCRIPT
Jennifer: Hi, everyone. Welcome back to the Gluten Free School podcast. I’m your host, Jennifer Fugo. Today, we’re going to talk about how gluten can impact psychiatric issues. I have a really awesome guest. I’m actually incredibly excited to speak with her. Her name is Dr. Kelly Brogan.
She’s an undergraduate from MIT and she studied Cognitive Neuroscience and worked with Harvard undergraduates to create a public forum for discussion of alternative medicine directing conferences for the Hippocratic Society.
She then attended Cornell Medical School where she was awarded the Rubin Scholarship for Psychiatric Oncology and began her work in reproductive psychiatry where she then went to do a residency at NYU Bellevue Hospital.
She has a long list of working with women, going to different schools. She lectures. She’s been published in the field of psycho-oncology, women’s health, perinatal mental health, alternative medicine, infectious disease. She’s board certified in psychiatry, psychosomatic medicine, as well as being board certified in integrative and holistic medicine.
My goodness! Thank you so much, Dr. Brogan for joining us. I feel so honored to have someone who is so well-schooled. Man! You write awesome articles. That’s how we ended up here. Thank you so much for joining us.
Dr. Brogan: It’s a total pleasure. Thank you, Jennifer.
Jennifer: So why don’t you tell us a little bit about why you are so passionate about these issues around gluten and women’s health and psychiatric issues because I know they go hand-in-hand, you know they go hand-in-hand, but why did you get so interested in the first place?
Dr. Brogan: I think you’ll find that most doctors who have come to the other side (meaning that they’ve moved away from conventional medicine and started practicing in a more enlightened way) have done so because of a personal health crisis.
My big sob story was that I developed postpartum thyroiditis, which is called Hashimoto’s and up until that point, I had literally eaten whatever I wanted, whenever I wanted. I never had any weight issues. I felt pretty fine. I had subsisted on a diet of Red Bull, coffee, McDonald’s and candy for my entire residency in medical school and career. I was really caught off-guard by this diagnosis and the prospect of taking thyroid hormone for the rest of my life.
At that point, I have become interested in alternative medicine and interested in what it had to offer, but I really didn’t know much of anything about diet other than I was raised Italian and I was raised with conventional Italian home cooking.
Jennifer: I totally understand that.
Dr. Brogan: Yes, exactly! So it was really the first time that I decided I had the wisdom thankfully at the time to go to a naturopath to consult her about this diagnosis and what to do about it. The first thing that she told me was, “I need you to come off of gluten and dairy for three months.” I barely knew what that meant apart from the fact that I had studied Celiac disease in medical school for my boards and couldn’t imagine why that was relevant to me.
So that was the beginning and that’s when I started to research this issue because I wanted to know that what she was telling me was based on any sort of evidence. I was really blown away by how much there is out there. Since that time five years ago, now there’s just mountains of papers compelling me to convince all of my patients, essentially friends and family to develop some sort of concern about the role of this agent in their health.
Jennifer: You have a private practice. So what kind of patients are you typically working with?
Dr. Brogan: So the patients that I work with are women. Most of them are between 30 and 60 I would say with the focus in the baby-making years. I see women who come to me because of my expertise in the role of hormones in mental health.
Hormones is broadly interpreted, right? So thyroid, cortisol, sex hormones. For the most part, they are either taking medications and not seeing the results that they want, they’re considering coming off of medication either for pregnancy, or because they’ve had enough or they’re not interested in medication; they prefer natural treatments and they want some guidance.
I think the word on the street is I take seriously the data that supports my interventions and recommendations and I think that that helps them to feel that what we’re doing here isn’t some sort of like woo-woo hippie, new age business. It’s results-oriented, so that helps.
Jennifer: You have studied extensively how the nervous system can be affected because you’ve gone through your own issues. It’s so inspiring too to know that someone could come to you and hear your story and go, “Wow! This woman who happens to be my doctor now, she gets me.”
So how does gluten in your experience stimulate the nervous system and start causing problems?
Dr. Brogan: Yes, it can masquerade as a psychiatric issue in many different manifestations – indirectly and directly. It becomes a very complex chicken-or-an-egg situation when you have gluten affecting hormones and you have gluten affecting brain tissue. At the time when I was diagnosed, thankfully, I didn’t have the experience of depression.
Really my primary symptom was incredible cloudiness and fogginess and forgetfulness. I have to mail checks to cab drivers in Manhattan because I forgot my wallet at home, I was double-booking patients, things that were very uncharacteristic for me.
So one of the things that I’m sure you’ve even discussed here and what’s very interesting me is how particles in gluten (gliadin), how when that is left largely undigested which happens if we think about it 80%? What can happen is it can pass into your bloodstream and it can infect parts of your brain that are loosely termed opiate receptors.
For that reason, in the literature, it takes on a version of the term gliadorphin, which refers to the fact that it has almost like morphine effects in the brain. We think that that directly accounts for some of the psychiatric symptoms that can manifest when people have gluten-intolerance or sensitivity, but also could account for what makes food containing gluten so addictive and so difficult to stop eating.
I get calls and emails every day from patients that I have asked to stop eating gluten who are really struggling to withdraw. And again, I’m sure you guys have spoken about this here, but it can be a very real phenomenon. To me, as a psychiatrist, looking at food as an addictive agent is important. That’s a red flag when your body is freaking out because you’ve stopped eating something that really has probably no other health benefits to offer.
So that was the beginning of the investigation for me.
Jennifer: When you say psychiatric issues, could you give us some examples for someone who is like, “I’m not sure what that looks like…”
Dr. Brogan: What that means, yeah.
Jennifer: Yeah, what does that mean?
Dr. Brogan: Yes, that’s a great question. So in terms of the scientific literature, it can mean a huge array of things – everything from OCD to schizophrenia to bipolar disorder, depression, anxiety and then neurologic issues like seizures and migraines, neuropathies, issues of balance that are called ataxia.
So in the literature, there’s linking of gluten to all of these different manifestations. But in the real world, when I say psychiatric issues, what I’m talking about is on the anxiety spectrum, feeling like you’re spending most of your day in a state of alarm, really feeling worried all the time, maybe overly focused on specific worries, maybe there are even certain behaviors that you feel you have to do to calm yourself down, rituals that would bring you into the obsessive-compulsive realm.
Then there’s the other side of that coin, which is more depressive symptoms where you’re feeling fatigued and foggy and slowed down and heavy and even things that you expect to be pleasurable just aren’t, they just fall flat.
Pretty much in between. To me, one of the most interesting studies was one that found that 27% of schizophrenics – so this is like pretty much as bad as mental illness gets, right? – is psychosis. So 27% of those folks had antibodies to gliadin, to that important protein in gluten. It goes the other way too. Fifty-one percent of Celiac patients develop neurologic or psychiatric dysfunction.
So there’s a real, again, sort of a chicken-or-an-egg phenomenon where there’s a lot of overlap here. There’s reason for us to believe that gluten may be a driver of a lot of mental ills.
Jennifer: We’ve talked a bunch to various experts about the gluten-brain connection.
Dr. Brogan: Yes.
Jennifer: But in your experience, could you give us your take on what the connection is in your book?
Dr. Brogan: The connection is what you’ve probably covered and I’ll give it a little bit of a twist. The connection is the gut brain axis. It’s the communication that happens—we think through something called the vagus nerve—that happens between the gut and the brain and there’s a bi-directional communication (so it’s a 2-way street). The ecosystem in your gut is very much determined by – guess what? Your diet.
It’s determined by specific elements of your diet. Something we could touch on is pesticides and genetic modification of foods that we now know can interfere with the types of bugs that are growing in your gut.
But in a very macro-scale, what you eat is very much a determinant of how your gut is functioning and the signals that are sent from your gut to your brain can be inflammatory in nature. We now have a very good and fascinating understanding of how inflammation really is at the root of most of these mental illness symptoms that I’ve just described. There’s some really interesting research going on in that arena.
I would say that probably the most important concept that I try to drive home to people is what you likely discussed which is this idea of molecular mimicry or how gluten can trigger the immune system and can trigger inflammation and then that inflammation and immune response can go on and wreak havoc in different tissues in the body.
One of those tissues is the brain and there are three different areas we have seen that can specifically be attacked. They have the names ganglioside, antibodies, synapsin and then something called GAD, which is responsible for making or relaxing a neurotransmitter called GABA. So it’s something you really don’t want to have antibodies against basically.
But then indirectly in an area of a lot of interest for me obviously personally, but also because about 85%-90% of my practice has Hashimoto’s (just because I’m looking for it and I always find it) is the the role of thyroid in mental health. So we now that Celiac patients as an extension of those who are gluten-sensitive are very likely to develop Hashimoto’s. There’s a huge overlap there.
We know how and why it’s happening. We know that there are a couple of different shared inflammatory mechanisms between the thyroid gland and the gut in people who are sensitive.
And we also know that indirectly, when you have damage to your gut from eating gluten, you are not absorbing nutrients as well. We used to think, “Oh, well that’s all that Celiac disease is about. It’s a malabsorption symptom” and now we know it’s an inflammatory disease.
One of the things that it turns out that you may not be absorbing well is selenium. Selenium is a critical component of thyroid function. It’s also very important antioxidant. It supports something called glutathione.
So there are inflammatory and then nutrient ways that gluten can mess with your thyroid. And once you develop thyroid disease, thyroid can look like again all sorts of psychiatric problems. So just to run through, if you have low thyroid function, what do you look like? You’re tired. You’re cloudy. You’re having slowed metabolism. You’re sleeping irregularly. Sometimes if you’re in the early stages of thyroiditis, you can have little pockets and spurts of anxiety that seems to come out of nowhere with racing heart and agitation.
And so this is otherwise called depression and anxiety and this is what sends people to their psychiatrist office when really what they should be doing first and foremost in my opinion is making some simple diet changes before they ever set foot in that office. Believe me, it’s not usually a revolving door once you get in the psychiatrist office. You’re probably going to be there for life. So I like people to have a high threshold.
Jennifer: And so if people find that their thyroid is off and say maybe they have – I mean, I know it’s not as common, but they have hypothyroidism in some respects. So it’s elevated production, hyperactivity of the thyroid. I can definitely see because I’ve written about thyroid issues.
Chris Kresser actually has in his website stating that one in eight women will be diagnosed with some sort of thyroid disorder. That’s massive! My father who’s a physician, he sees more and more women coming into his office who have thyroid disease. It’s astonishing how many people have this problem now.
So if you find out that if you have some sort of thyroid problem, would it be worthwhile to just maybe give it a try for a month or two and just say, “I’m going to take gluten now. I’m going to see how it goes and maybe then go back to my doctor before I start taking these extra steps of running to the psychiatrist office” thinking that you’re having a mental breakdown?
Dr. Brogan: Yeah, absolutely. A couple of caveats I would add are 1) how do you find out that you have a thyroid problem. This is part of the limitation. And people like Chris Kresser and myself, the way we screen for thyroid problems is different than is the case than a conventional internist’s office.
So checking for thyroid antibodies which have the names thyroid receptor antibody in the case of hyperthyroid that you mentioned or thyroglobulin or thyroid peroxidase antibody in the case of low-functioning thyroid, checking for those is critical because most conventional doctors don’t see a value to checking for that because it doesn’t change their intervention, which is just thyroid hormone if your TSH is over five basically. It’s a very black and white algorithm.
So checking for thyroid antibodies is very critical in my opinion if you have any suspicion that any of these symptoms might reflect what you’re going through.
And then I would say that recognizing that thyroid can account for some of the mental health symptoms that you might be struggling with be it insomnia, anxiety, fatigue, depression. So recognizing that this might be in the root and that getting to the resolution of that, I can’t emphasize enough how powerful eliminating this immune stimulatory class of grains can be.
So I couldn’t make the recommendation any more strongly. I would say my recommendation is typically to start – it depends how willing they are to jump on board – start with gluten for three months. I have a very high success rate with resolving antibodies in my patients and that’s something that’s really unheard of in the conventional medical literature. It’s almost something that nobody has even bothered to study because the thinking is once you have antibodies, you always do. But most of us in holistic medicine know that that’s not the case.
I start with gluten and then the second tier is adding dairy because of what’s called cross-reactivity between those two types of foods — dairy and gluten. And then the third tier is expanding to other prolamin grains – expanding to corn and also rice. If you want to take it even further, my general recommendation is normally to avoid highly genetically modified grains for the reasons I’ve mentioned before because we now understand that these heavily sprayed – not just grains, but foods like soy and vegetable oils and corn can disrupt function and poke little holes in your intestines and make way for all of these other food-based peptides to sneak through.
You can think of it that way and see what you’re ready for, but there’s almost no question in my mind that it would make a difference.
Jennifer: My big problem with the standard American gluten-free diet is it’s so loaded with sugar and refined carbs. Do you feel strongly as well?
Dr. Brogan: Yes, absolutely. Probably second to my focus on thyroid is my focus on what we call dysglycemia on the role of blood sugar balance. It’s actually very intimately related to thyroid because your adrenal function and your cortisol production is a major determinant of your blood sugar balance because you need cortisol to maintain blood sugar in times when you might otherwise dip, which happens when you eat a bagel, you eat a doughnut or you eat a gluten-free cookie. They’re all exactly the same changes.
So the best way to improve your adrenal health is to improve your sugar intake. And so in my practice, that involves increasing natural fats and cutting back on flours of all kinds – gluten-free or not. You just tick off so many things on the list when you take out flour because you’re probably taking out a lot of processed vegetable oil, you’re probably taking out corn and soy and you’re going to be eliminating gluten, so absolutely!
Jennifer: And so this is the thing. I read an article you wrote. You talked all about this issue of how thyroid issues can happen post-partum. A woman has a baby. It’s not all flowers and sunshine. Can you tell us a little bit about why this happens and your experience behind it? I think this is a topic that is sort of brushed under the carpet, nobody wants to talk about it, but it does happen. The more we bring light and shed light to this issue, I think it’ll make women who are struggling – well they’ll give them some answers, but it’ll also make them feel less ashamed to seek help.
Dr. Brogan: Yes, absolutely. And I think starting with Brooke Shields however many years ago, I think there’s more acknowledgement and acceptance that some 10% of women post-partum are struggling with anxiety, depression or more severe forms of obsessive-compulsive disorder, mania and even psychosis. So this has become a reality that is prevalent enough that we have to deal with it, accept it and try to provide resources for these women.
I’m very involved with a lot of what I call reproductive psychiatry, colleagues who essentially present women with three choices – do nothing (continue and see if it resolves on its own, which obviously is never going to be a popular choice), medication or psychotherapy. To me, that’s a very limited spectrum of choices and I’d like to expand the toolbox and really the way that I expand the toolbox is by recognizing the role of the immune system and of inflammation and this pathology. And it’s not just my idea. There are a number of really interesting papers that discuss the role of inflammatory processes and the onset of post-partum depression in certain women and right now we know that, as we spoke about, any of that starts with your gut.
So the deal with the immune system changes is that obviously, pregnancy, you have to grow a baby that has foreign DNA and so there are appropriate changes in your immune system that allow that to happen. And then over about six weeks post-partum, your immune system sort of bounces back on stage. That seems to be a time in concert with changes in sex hormones like estrogen where certain vulnerable women develop autoimmune disorders. In my practice, like I said, almost the entirety of my practice has an autoimmune disorder of one type or another. So it’s not even the 1 in 8. It’s really wild.
And again, I’m digging for it. Some people will argue if you never looked, they probably wouldn’t even develop other symptoms, but it’s a focus for me, so…
Jennifer: And do you find that a lot of these women, is there a connection between taking gluten out or maybe the incidence of thyroid issues? I’m just so fascinated by this topic because – I know so many women that are pregnant and just trying to support women in so many ways. I think we become very afraid to acknowledge we’re having problems. We’re struggling when everything should be happy. There’s this fear that maybe you’re losing it all or you’re losing it – whatever it is, your marbles. People don’t understand. They just tell you to suck it up. Things are going awry.
If someone is in that position, they’ve had a baby and they aren’t feeling right, what would be some suggestions aside from coming and hunting you down and saying, “I need to be your patient,” what would you suggest that they check out?
Dr. Brogan: Certainly what is echoed even in conventional circles is the importance of support. I have two small children, I’m lucky enough to have my parents very involved in my care. I can’t imagine how I would’ve done it otherwise.
Ancestrally, we used to have whole villages raising kids and I’ve heard psychologist talk about the ratio of four adults to one child being optimal. So that’s not what I see in my practice. Most of my patients with new babies are really doing it on their own and maybe at some point they’ll have a nanny who’s around or a babysitter who’s around for little pockets. It’s really insufficient support. So that’s a major non-diet related tip.
Apart from that, I like for people to really get back to basics on the lifestyle front. So things like incorporating tiny amounts of exercise, tiny amounts of meditation or relaxation or response breathing exercise. And then looking at this as an opportunity, sort of trying to get the whole family and the spouse excited about rehabbing their kitchen and really by extension, the rest of their household. So looking at what are toxic elements of their households whether it’s cleaning supplies or beauty products or their air or their water. Now it’s not only in their best interest and it’s not only going to result in changes to their well-being and mental health which is what I see 100% of the time, but it’s also going to be in the best interest of their newborn.
So I like to work on that level. I mean obviously I also use other non-medication agents that I feel have adequate evidence base whether it’s amino acids or herbs or B vitamins, but there’s a lot that you can do without seeing an expert and without even getting blood tests although I would encourage to have a low threshold to take the opportunity to investigate what else might be going on. As far as we’ve ever been able to demonstrate, post-partum depression is not a prozac deficiency. It’s not a new onset need for pharmaceutical. Until we know better what it is, it’s a really good time to engage in this model of sort of rehabbing your health more globally.
Jennifer: And just as a final note, if say the person goes to the doctor and are like, “Hey, you have a newborn, great! Look, we’re going to put you on some prozac or some happy drugs,” you can’t breastfeed. Is that correct? Is that the correct understanding? You can’t breastfeed if you take the medication route. That’s what I have read at least.
Dr. Brogan: Yes, it’s certainly a complicated question, but my fellowship and my conventional training was really in understanding what the data shows about safety of these medications, all psychiatric medications in pregnancy and in lactation. The truth is despite the fact my preference is always to use non-medication and I haven’t started a patient on a medication in over almost two years, but my colleagues who are experts in this area and I can certainly refer patients to the literature which looks at the fact that as far as we can tell, there isn’t anything dramatically dangerous.
All medications are excreted in breast milk, but guess what? So are pesticide, so are environmental contaminants, so are a number of other concerning agents. So it is possible to breast feed on medication. There hasn’t been a signal for dramatic danger or harm. Most anti-depressants for example test less than 10% of the maternal doze, which are thought of the threshold.
So it really comes down to is this your only option? Is there an effective alternative for you? Where do you fall in making that decision? I’m a staunch supporter of best feeding pretty much at all costs because I just don’t feel that there’s an adequate replacement. Companies have been able to come up with regard to supplementation. I do know about what risks we may have to contend with if it’s a woman’s choice to use medication.
Jennifer: Great! Well, that’s good to know because I think again, there’s a lot of misinformation. There’s a lot of confusion out there. It’s like what are our options? Is it safe?
Dr. Brogan: Absolutely.
Jennifer: Any mother, I can only imagine, my sister has had a baby, you want to protect that child from any harm and that’s got to be a question that needs to be asked… is it safe?
But I agree with you. I always think the first steps you should take (unless it’s an immediate emergency), you should really look toward changing the diet, changing lifestyle issues, changing the surrounding areas in your home that might be creating toxic fumes or gases or whatever and get that out first and see if that might be the problem and then taking the next step to medication.
Dr. Brogan: Yes, absolutely.
Jennifer: That’s just my thought process.
Dr. Brogan: No, absolutely. If I ever do prescribe a medication, it’s normally for like one to three doses of an anti-anxiety medication which acts immediately. Even in “emergencies”, anti-depressants don’t act immediately, so they’re not a great emergency control either, but they make doctors feel better and they make them feel like they’re doing something right because they’ve made this intervention, but they take many weeks to work.
So in many ways, even in an emergency setting, you can get away with very selective and discriminating use of medication to afford you some space for the whole family to make some changes. So yeah, I would agree with you.
Jennifer: Great! Well I know we’ve been chatting for a long while and I definitely want to start wrapping because I know that everybody loves these tidbits of information. Is there any place that people can go and find you and stay connected to you? I always think that’s so important, to be able to go and follow and connect with the person that they’ve gotten a chance to learn from. How can everybody find you?
Dr. Brogan: They can find me on my website, which is just my name. It’s kellybroganmd.com. I have a newsletter there that comes out monthly where I basically look at all of the latest literature from that month – and believe me, there’s a lot to sift through and try and make take-home points for everyone to use immediately for their health and wellness. And of course, I do a lot of blogging and other videos and little sort of pieces for here and now that might help. So that would be the best place.
Jennifer: Great! And everybody, seriously, go check out Kelly’s website. Dr. Brogan is a brilliant writer. That’s why we’re here. It’s because I read an article she wrote and my jaw hit the desk. I was so excited by what she was writing. I think she’s got a lot of information to share that will hopefully change the field of psychiatry and how they approach their patient. I think this would be great if we started to take more of a dietary and lifestyle approach to things. I think that’s something we all need.
So head over to her website. You can also check her out on Facebook and Twitter. Thank you so much, Dr. Brogan for joining us. I really, really appreciate it.
Dr. Brogan: So much fun! Thank you, Jennifer. I appreciate it as well.
Jennifer: Now remember, everyone to go over to iTunes or whatever platform you listen to me on. If you’ve got an Android, you can go over to a number of different apps and subscribe, rate and review this podcast and then head back over to Gluten Free School and leave your questions and comments on this podcast. Dr. Brogan has a vast array of knowledge that she shared today and I’d love to know what affected you the most. Was there something that jumped out at you or maybe you have a question about something that you’d like to dive deeper on. Leave that underneath this podcast.
Again, thank you so much for your time. I really appreciate it and I look forward to seeing you the next time. Bye bye.
The links referred to in this episode are:
Dr. Kelly Brogan’s Website — www.kellybroganmd.com
Get a copy of her book A Mind of Your Own HERE
Follow Dr. Brogan on: