#62 Obesity Medicine: Lifestyle Medicine: Ketogenic Diet

Today I will be covering a very controversial topic, the ketogenic diet. I thought it appropriate to discuss it now while I was going over nutritional aspects of mental health. So, first I'll talk about carbohydrates; what they are, what they do, do we need them. Then, I'll talk about what the ketogenic diet is, how to do it, and what conditions there is some evidence that it may be useful for. At the end I'll talk about how to do it safely if you want to try it on your patients; what conditions are contraindicated with the ketogenic diet and what labs you will need to monitor for safety. I'll give you my unbiased opinion on the subject, but I'm sure people will disagree with me on both sides; some will think I'm too harsh on the diet, and some will say that I'm too much in favor of it, but I walk the gray line as best I can as with everything. I see the good and I see the bad, and this is my perspective.

#61 ADHD: Medication Aspects to Consider

On today's episode from my ADHD season I will be talking about the aspects to consider when deciding which medication to choose. I'll talk about why you might consider amphetamines versus methylphenidate. Next, I'll discuss aspects to consider when getting a patient to the correct dose of the medication. Also, these medications have a wide range of how long they work for, so there's a lot to consider when deciding which one to pick. Finally, there a whole host of other things to consider: ability to swallow pills, adverse effects, coexisting disorders, what time of day its most important for the medication to work, cost and availability, and more! This episode will introduce you to all of the aspects you need to consider when selecting the right medication for the patient in front of you. Next, we will begin discussing the medications, and I will be talking about all of the concepts in today's episode as I discuss each med, so I think this will be a really helpful overview for you. Enjoy!

#60 Obesity Medicine: Lifestyle Medicine: Nutrition Recommendations

Today I will be continuing with the lifestyle medicine series, and I will be continuing to talk about nutrition. I will discuss the general way of eating that I advocate for most people, which is a plant-based diet. This doesn't mean no meat products. It means a diet of at least 90% plants. And I acknowledge that it isn't for everyone, but on the whole this is the diet that will lead to a healthier body and mind. I will discuss the principles of this diet, and I will give examples of the types of foods that are in it. I'll talk about fermented foods, fats, omega-3s, proteins, fiber, nutrients, and healthy snacks. I'll give you an idea of the kinds of foods that I think you should eat more of. There's no need for supplements for most people; just whole healthy foods. And we aren't done with this episode. I will be discussing more healthy foods in future episodes, the ketogenic diet, and also the unhealthy foods and what good replacements for them would be. I hope this inspires you that eating healthy can be affordable, fun, easy, delicious, and improve both body and mind. Remember food really is medicine, and if you eat better, you may not need to take any! Have a listen!

#59 ADHD: Non-Pharmacological Treatments

On today's episode from my ADHD season I will be discussing non-pharmacological treatments of ADHD, so basically everything that isn't medication. I'll start off going through the treatment algorithm from stage 0 to stage 5. Today's episode will be stage 0, the first line treatment. It's better to not use a medication if we don't have to, so let's learn what those options are. I'll talk about lifestyle modifications with some details on diet where I'll talk about artificial colors and preservatives as well as melatonin, magnesium, zinc, omega-3 fatty acids, as well as a well-rounded whole foods diet. I'll also talk about some supplements that have been looked at but there really isn't any evidence for. I'll also talk about caffeine. We will go over some coaching strategies of behavioral and social changes to help manage ADHD symptoms. Lastly, I'll talk about eTNS (external trigeminal nerve stimulator) and some digital therapies like Endeavor. I think you will learn a lot and if medication is not an option or not preferred, then these are the things that we have evidence for, so please have a listen!

#58 Obesity Medicine: Lifestyle Medicine: Nutrition Introduction

This is the episode that I've been waiting a year to do. I'll be talking about Lifestyle Medicine as a treatment for obesity, mental health, and overall health and chronic illnesses. These are techniques that will benefit everyone and are fairly easy and cheap to do. They are also fairly simple. A lot of folks want to make this stuff more complicated that it is so that they can make money off of you selling their programs and supplements, but here at This is Your Brain on Drugs, we don't play that game. We give you free information to make this important information available to everyone. Today I'll start with the introduction. I'll talk about Integrative Psychiatry, Lifestyle Psychiatry, Nutritional Psychiatry, and let you know the nuances between these overlapping concepts. Then I'll get into the nutrition piece of Lifestyle Medicine, and we will have several follow on nutrition episodes from here. If you think you know everything about what to eat and what's good for your body and mind, I think you will definitely find more information in this series. I've made this as science-based as it possible with this subject, so please havek a listen!

Quick Take #4: September Updates! Part Deux: New Study on the Benefits of Drug Treatment of ADHD, Case of ChatGPT-induced Bromide Poisoning Psychosis, Another Study of the Ineffectiveness of Gabapentinoids, New GLP-1 Study Results, Wearable Lithium Sensor, New Formulation of Lecanemab, and MORE!!! 

Welcome back to part two of my September edition of my psychiatry quick takes episode series. It's been a busy couple months in the news, so I have several more tidbits for September. Today I'm going to talk about a new study on long-term medication treatment of ADHD, psychosis caused by bromide poisoning after consulting ChatGPT, more information about kanna, another study showing that gabapentin just doesn't work that well, a new formulation of lecanemab for Alzheimer's which is easier to take, the latest trial results on the next likely GLP-1, oral orforglipron for weight loss, a fascinating case of a woman who had a fecal microbiota transplant and ceased to have symptoms of bipolar disorder, a new wearable lithium sensor to be hitting the market, and a new synthetic opioid thats 50 times stronger than kratom to be on the look out for. Please have a listen!

#57 ADHD: Adult ADHD

Today we switch back to ADHD and I will be talking about adult ADHD. I'm an adult psychiatrist and I practiced in the military so this was one of the largest issues that I treated as many of my patients were younger folks, many of which struggled in school prior to joining the military. There isn't a lot of formal education on this topic and yet we see tons of online information of folks talking about how they have adult ADHD and that if you answer these few questions this way then you have adult ADHD, so there's a lot of misinformation out there on this topic. It's a topic that wasn't really discussed at all until the last few decades and many still deny its existence at all. I'm going to talk about it in depth on this episode and I think you will find it very interesting and hopefully different than what you may have heard before. We will dive much deeper than the DSM definition which is mostly designed for children, and I will talk about how someone's life with adult ADHD looks so that you can pick up on the subtleties and make the best diagnosis in order to treat patients with the best care possible. So please have a listen!

Quick Take #3: September Updates! Part 1: Old Drugs For New Indications (Ketamine, Strattera, Flexeril) And Some Antidepressants On The Horizon (Nelivaptan and Seltorexant)

Welcome back to my second episode covering several snippets of breaking news on psychiatric medications. In these episodes I don't deep dive like normal, but instead cover several important breaking news items that affect psychopharmacology and give my quick take on the news. Some of this will be trial results, FDA updates, interesting papers that were recently published, and anything else I can come up with. I have a ton of updates since the last episode. So much that I had to break it up into two episodes. The next one will be out next week. Today I'm going to talk about new approvals of old medications from new ketamines KETARx and Nrx100 to Tonmya(r) (cyclobenzaprine) for fibromyalgia. Then, I'll also talk about some combination products containing atomoxetine (Strattera(r)) for obstructive sleep apnea. Lastly, I'll then go into a couple medications with new Phase II trial data for depression. First is a unique vasopressin 1b antagonist and the second is a selective orexin receptor antagonist. I do a bit more discussion on these topics than in the previous update episode because honestly I'm not happy about a lot of this and I want to use these new approvals to talk about the deeper issue of how these drug companies manipulate to make money. Please have a listen!

#56 Obesity Medicine: Medical Effects of Obesity and Assessing the Obese Patient

Today I will be presenting my second episode on obesity medicine. I will go over how obesity reeks havoc on every system in the body, what medical conditions are increased by being obese, the increased risk of psychiatric disorders from obesity, and the long list of cancers that are at increased risk from obesity. I think you all will be surprised just how much obesity impacts health. Many of you may not be aware of how linked obesity is with psychiatric illness. Also I think you will be surprised just how many types of cancer are affected and how strongly. After that I will talk about how to do a thorough assessment, basically the history and physical, for a patient with obesity. We need to rule out other causes, assess motivation for treatment, and assess common comorbidities. This is great foundational information that I think you will find super helpful!