An Integrative Psychiatry Approach to CBD and A Healthy Microbiome

Episode Transcript

Dr. Nicole Beurkens: 

Hi everyone and welcome to the show, I am Dr. Nicole, and today we are going to talk about integrative psychiatry. The practice of using complementary and natural treatment approaches alongside medical approaches for addressing symptoms in children and adults. If your child is on medications or you are working with a psychiatrist in some way, this information is going to be very useful to you. And if you are a parent who has maybe been recommended for you to see a psychiatrist for your child, you will also really benefit from having the information that we are going to talk about today. You know, it’s a challenge as there aren’t many psychiatrists practicing in this way, but the number is growing and there are so many benefits to families who are able to seek out physicians who can use these combined approaches. So on the show today, I have my friend and colleague, Dr. Hyla Cass, here to talk with us about how she practices as an integrative psychiatrist, the kind of approaches she finds helpful, and specifically how she has been incorporating certain types of nutrients and supplements, including CBD, with patients. 

So let me tell you a little bit more about her. She is a physician, psychiatrist and frequently quoted expert on natural approaches to mental and physical health. She combines the best of leading-edge natural medicine with modern science in her clinical practice, writings, nationwide media appearances on print, TV, radio, podcasts, summits — the whole deal. She helps individuals withdraw from psychiatric medications and substances of abuse, or helps them avoid medication altogether, through the use of targeted nutritional supplements. She has created a unique, high-quality line of supplements, including CBD hemp oil extract. Dr. Cass is an advisory board member of the journal of cannabinoid medicine and the author of several popular books, including 8 Weeks to Vibrant Health, Supplement Your Prescription, Natural Highs, The Amazing Itty Bitty Guide to Cannabis and The Addicted Brain and How to Break Free.

It’s such a pleasure to have you on the show today. Welcome, Dr. Cass!

Dr. Hyla Cass:

I’m so happy to be here, thank you so much for inviting me. 

Dr. Nicole Beurkens: 

I’ve been really looking forward to this conversation because of this issue of finding practitioners, particularly people who specialize in the field of psychiatry who can best guide parents and kids on their journey with these kinds of symptoms. It’s a big issue and it’s a challenge to find people who really understand how to combine these treatments, so I really have been just excited to have this conversation. I’d like to start out by having you share a bit about your background and actually, what led you on this path towards practicing psychiatry in a more integrative or complementary type of way. 

Dr. Hyla Cass: 

Interesting question. First of all, I always wanted to be a doctor. My dad was a doctor, and I thought that was very important. The kind of work he did, healing people, was just amazing to me. And he practiced at home, so I got to see what people looked like before and after. So that was one part. He was quite an inspiration to me. Then I ended up going to medical school and became interested in psychiatry because I really wanted to know how people tick. What makes us be the way we are, how we behave, the way we are, and so on. And then, in psychiatry, I was trained actually in psychodynamic therapy more than medication. So I wasn’t — and I’ll have to say brainwashed because I see current physicians in training are learning that drugs are the only way. Well, we learned about psychotherapy. Somewhere in there, I actually began to look at diet and nutrition. Pretty unusual, but there were some leaders out there. I’m looking at supplements as well. People like Carl Pfeiffer, Abram Hoffer — they were my early inspirations. 

What I noticed was that when people were on medication, and when I trained and when I Was in residency and in my early practice — We didn’t have the vast array of medications that we have now. They have a lot of side effects and they weren’t that effective. And I look at this and say what’s wrong with this picture? I began to look at blood sugar, and how blood sugar imbalances actually fostered mood swings. People would get highly anxious, they would get depressed, all kinds of things just because of the blood sugar balances. And by learning the right way to eat, the right foods to eat, the right nutrients to take — Lo and behold, they no longer had their mood issues. 

So that’s powerful! They didn’t need a drug. More and more, I was seeing people come to me who were on a load of drugs, all interacting with each other, not giving the end result that the person wanted, and the doctor would keep raising the doses, adding new ones, changing them, and you just have to use your powers of observation. Now look, maybe the ones that were doing really well were the ones who came to me. I don’t know. But reading what I’m reading out there, there is a lot of disillusionment about medication. It doesn’t really keep the promise. The truth is that we are biochemical. We are mind, body, spirit and body chemistry. And if we can make the biochemistry work for us, we have it all built-in, we have the best natural pharmacy inside us. And I see the job of a physician is to mobilize that inner pharmacy and make it work for the individual in a way that’s natural. So they’re not going to have side effects, not going to have adverse effects. You can have a targeted effect that’s predictable because you know what you’re doing. You’re really enrolling that person’s physiology and biochemistry. 

Dr. Nicole Beurkens: 

I love that. That term, that inner-pharmacy, mobilizing that biochemistry within the individual to really function optimally that’s really just a great way of thinking about that and it’s interesting. You were talking about, in your training, there’s been such a shift in the field of psychiatry over the last few decades from how psychiatrists were trained and what you’re talking about, more the psychodynamic therapies, those kinds of things until now, really most people’s experience with psychiatrists is just about receiving prescriptions, right?

Dr. Hyla Cass: 

Yes, absolutely. 

Dr. Nicole Beurkens: 

And I think that what you’re saying about the disillusionment of that is so true, because the patients that I see in my practice and the people that I’m interacting within my online community — many of these children, many of these adults have been on what I call the rollercoaster of psychiatric medication, the hamster wheel of psychiatrists in more conventional medical kinds of treatments, and they’re not getting better, and in many ways, they’re getting worse the more of these things that they take, and parents just go: “We’re doing everything we’re told to do but this isn’t getting better, and it’s such a frustration”. 

Dr. Hyla Cass: 

And what happened is that the pharmaceutical industry realized that they kind of used up the adult population, so much in many adults were using them as we were using them, they would keep developing new ideas about, well, if you have this, then you need to be on an antidepressant or an antipsychotic, or if your antidepressant isn’t working, take this antipsychotic. I mean, it’s crazy. So that’s how they were enhancing the market. But that got limited, so they began to lower the age of who they were addressing, so it began to be teens, and then children, and infants! And it’s horrifying, it is absolutely horrifying to take a young brain and put these very powerful medications that are — I’d say quite toxic. It’s scary. 

There’s so much that we can do with diet, nutrition, with diagnosing various underlying, say, infections. There are so many imbalances that can be caused. Heavy metals, chemical exposure, kids that are exposed to lead for example. You need to chelate out the lead. They don’t tell you about that. They don’t tell you that you can chelate out the lead. So in areas where there is led in the water, those children grow up and slow down mentally. 

Dr. Nicole Beurkens: 

Right. Here in Michigan, we’ve seen that with the Flint water crisis and in other areas too where that’s not getting better. And you’re right. No amount of Risperdal or other kinds of psychiatrist drugs is going to solve those problems. We need to get in and deal with those underlying issues, right? 

Dr. Hyla Cass: 

Yeah. 

 Dr. Nicole Beurkens: 

So you’ve touched on some of those things you mentioned as you were talking about your experience of moving towards an integrative approach. You’ve talked about blood sugar and you’ve mentioned some things about nutrition, talking about getting rid of the heavy metals. What are some of the driving factors the you see are most common, whether we are talking about kids with emotional and behavioral challenges, we’re talking about adults with these things — what are some of the things that you see are most prevalent, that are not getting addressed for people that really are driving symptoms. 

Dr. Hyla Cass: 

Yeah, which I kind of just mentioned, actually, various infections, viral infections, Lyme, bacterial infections, hormonal imbalance, low thyroid, there’s a whole checklist that any good functional medicine doctor is going to look at and test for. And there are the chemicals, the heavy metals. So many things can interfere with proper brain and body function.

Dr. Nicole Beurkens: 

So is it a good idea for parents when they’re being sent to see a psychiatrist — because that tends to be — sometimes it’s a pediatrician or a primary healthcare provider initially, but pretty quickly, kids get sent to a psychiatrist, especially if they’re having more mood issues, behavioral acting out, more severe ADHD, those kinds of things — is it a good rule of thumb for parents when they’re meeting with a psychiatrist or a healthcare provider to watch for what that provider is asking about and looking for. Am I being asked about these kinds of things? Because I think most people don’t have any experience with providers asking about that kind of stuff. What is your child eating? Asking about possible infections or health issues or gut health or any of those things?

Dr. Hyla Cass:

Yeah, unless you are really attending to the gut health and the diet of the child, you are not going to get anywhere. We know that. So it really depends on who you go to. 99% of psychiatrists are doing it the way we were just talking about. It’s a prescription. Period. The end. And in their mind, and in the mind of many people, how can nutrition and how can nutrients, how can an amino acid and some vitamins be more potent and more successful than a drug? Au contraire, it can be much more successful because it’s working with the body’s chemistry. So you have to choose your practitioner. You have to go to someone, and I do this with people: Help them find someone in their area. And you can just google, look at functionalmedicine.org, I have a place on my website also where it says ‘Resources’ and you can look at different organizations, naturopathic organizations, see an MD or an ND, naturopathic physician, and these are very well-trained. It’s a kind of medical school. It’s different from allopathic medicine, but they learn a lot of the same things we do as MDs, but they also learn a great deal about natural medicine — the use of herbs, how to look at gut health, and how the gut and the brain are so connected. 

Dr. Nicole Beurkens: 

Yeah, those are very helpful resources for people to find a practitioner and just to raise people’s awareness that people like you are out there. And it does take some seeking out. But often, you do need to go beyond whoever the first referral is that you get if you want to really look at these things in more depth. You just mentioned about the gut, and I want to talk about that, because I think that is something that you and I talk about in our practice, and with people all the time, but what a lot of people don’t realize, that connection between brain function, between behavior, emotions, thinking, all of that and the gut. As a psychiatrist, what do you find is so important about dealing with the gut? 

Dr. Hyla Cass: 

The gut is the source of a lot of our neurotransmitters, and in fact, the friendly bacteria in our gut help make a lot of the neurotransmitters. We have nerve plexuses in the gut. Our immune system, a large part of the immune system is in the gut. Very, very important. And we need to take care of it. The opposite is true, children eating junk have what’s called leaky gut, they have a lot of food allergies. We’re actually pretty much in trouble. So the microbiome is not healthy, it’s not helping to make good neurotransmitters, which appear to be transmitted actually via the vagus nerve, which is the longest nerve in the body, it goes from the gut to the brain. So all of that needs to be addressed. You’re not going to get that from a regular psychiatrist. Don’t expect it. There’s no point arguing with that or asking for something that they just don’t know. It’s not their training. They’re doing the best they can with the tools they have. And unless they have the extra curiosity to look at “Well, what is that happening? Let’s look under the hood?” Those are the people that go into more functional or integrative medicine, like me. I want to see what’s really going on, what’s contributing. 

And then we make interventions. We give specific nutrients. First of all, it’s healing the gut. These kinds of doctors that I’m talking about, they’re not psychiatrists. They don’t have to be psychiatrists. You can have a child who is referred, your pediatrician says they should see a psychiatrist — Hopefully, you’re seeing a more holistically-oriented pediatricians, you may not be — in which case, you go to someone who is, as I said, an MD who is practicing natural medicine or integrative medicine, functional medicine or an ND, and they will address the gut issues and infection and heavy metals and chemicals and all the things that can mess up one’s brain function, mood, behavior. And it makes an enormous difference. 

Also, here’s an interesting thing: I had a woman who was a worker in a place where I was having my meetings at, and she knew as a psychiatrist, she said her son had been told that he needed to see a psychiatrist to be evaluated for medication for ADD, and she was very much against it. So she asked me what she should do. And I don’t know the child and I didn’t know her, so I said, “Something you can try is some fish oil and my Focus product which has Tyrosine and Phenylalanine in it, which are precursors to dopamine, and dopamine is the neurotransmitter that is often insufficient in ADD. It’s not the only thing, but it’s very common. So she did that, and I supplied her with some Focus and some fish oil, and the next time I saw her, which was a month later, she reported back that the teacher was very pleased that she had actually — “I am very happy that you went to a psychiatrist and you got medicated, because clearly, he is doing so much better.” And she didn’t say anything. That’s the way it goes. 

Dr. Nicole Beurkens: 

I love that you shared that example because so many stories that we hear from parents, the same way, I had a parent email just last week saying her child had been giving a formal diagnosis of ADHD, even though those had been the symptoms all along. And she went to a school meeting and the first thing that the teacher and the principal said, “Okay, well now you have this diagnosis, so when are you starting him on medication?” And she said, “Well, that’s not my plan. We’re going to continue with the integrative approaches that we are doing because he is making progress”, but that mindset that so many people have, particularly in the schools, of “Oh, okay, you have this label now, or the symptoms, so what’s the prescription for it?” 

And it’s just so frustrating to me as a practitioner and it’s so disheartening for parents too to feel like they’re being so pressured that that’s the only acceptable option, whereas we know that there are so many other great things that they can do. And what’s interesting is that I’ve had that too where I’ll start a child on some supplements on an integrative plan to address symptoms like ADHD or things like that, and they improve, and the school then says, “What medication do you have him on? He’s doing so much better!”. It’s like he’s not on medication! We cleaned up his diet, we’re giving him fish oil, we’re making sure that he’s not overusing screen time. These are the things we are doing, and he is getting better. 

Dr. Hyla Cass:

Oh, and the big thing: Gluten and dairy. That’s simple. Maybe not so simple if you’re the mom. Getting your kid off it. But give the child a few weeks off of gluten and dairy and see how they do. Then you can have miracles. 

Dr. Nicole Beurkens:

Right, absolutely, yeah. And those things don’t have to take a tremendous amount of time to see the impact. 

Dr. Hyla Cass:

Right. And then when they go back on it, then they become symptomatic again. One of the big problems is split families where one parent is — first of all, sometimes it’s right in the home where the parents are differing, and other times it’s divorced parents. And that’s a very difficult situation. 

Dr. Nicole Beurkens:

Yeah, absolutely. 

Dr. Hyla Cass:

In fact, I’m trained in child and family, but I don’t see kids anymore, and in fact, also, my practice is virtual. So I’m really limited. I don’t like seeing children — I don’t want to treat even teens long distance because they haven’t usually chosen to be seen. And long-distance is just not adequate for kids. There are things that parents can do on their own. But if a child really is having enough problems that somebody thinks they need a referral, then they really should see someone in person, if at all possible.

Dr. Nicole Beurkens:

Yeah, and those pieces of integrated treatment plans, the psychiatry, the integrative medicine piece is one piece, but you’re also bringing up the components of family dynamics that need to be addressed. There are often many components of effectively working with families around this issue for sure. I wanted to go back to — we were talking about the gut, the microbiome, those things, and how when you have imbalances in the gut, leaky gut, those kinds of things, we can have lots of these brain symptoms. I’ve also read — there are studies that have come out now that I think supports what people like you and I have seen anecdotally as well, that a lot of the medications that these children and adults get put on for these problems also negatively impact the microbiome, and then we have this whole cyclical problem. 

Dr. Hyla Cass:

Yeah. It’s not just antibiotics at all. Many, many drugs do that. And if you don’t have a functioning microbiome, you’re in trouble because there are actually some formulas that you can take that are specific to seeding the gut with certain friendly bacteria that will make specific neurotransmitters. It’s coming down to that kind specificity. The other thing is, you asked me about CBD. CBD is very good for healing the gut, healing the microbiome and ending up with more positive messages from the gut to the brain. And the neurotransmitters begin to work better. CBD helps to regulate neurotransmitters. It’s quite a remarkable part, it’s part of the endocannabinoid system. We have an endocannabinoid system within us, that’s like our own CBD that we make ourselves and anandamide and 2AG. So there are these main two endocannabinoids that do this. They work all throughout the body to regulate immunity, they regulate pain, they regulate neurotransmitters. And very, very significant — and along comes CBD, or actually full-spectrum hemp oil, because CBD isolate is just CBD, it’s not the whole plant. And as we learn from herbal medicine, using the whole plant is really important. 

So my product is called Full Spectrum Hemp Oil extract, because it has CBD in it, but it also has some of the other cannabinoids, as well as the terpenes, and we also know that terpenes, which give plants their fragrance — tea tree oil or lavender or lemon, they all have their very unique flavor, which is also related to their healing benefit. So it’s a very complex and beautiful arrangement. 

So CBD is quite a powerful plant-derived, hemp-derived product that can be used in children. You just do a smaller dose than an adult, but it has a lot of impact on a lot of different systems, just because the endocannabinoid system is so ubiquitous in the body and it’s made for emergencies, it’s made for stress. If we are in an accident, if we hit ourselves on something, a cut, whatever — it goes into emergency mode, and you get these — the body starts to make more endocannabinoids that go to the place of the injury, and it also calms you down so that you are not overly stressed by the incident. So it’s a wonderful built-in de-stress component we really need to have. And some people, either genetically or through diet or through having excessive stress, have a low level of it. And these are the people that are more pain sensitive, that are more depressive, more anxious, may have migraines, all of these things are actually signs of a low endocannabinoid system. 

Our ways of measuring it, we don’t do it in a lab. Researchers have ways of doing it. Eventually, probably in the not-too-distant future, we’d be able to get levels, but we don’t right now, but you can tell just clinically. When all this — everything is going south, you are very likely low in endocannabinoids, and the best way to tell is to take some CBD, start off really low and just gradually build up and see what happens. People are surprised. I’ve had people sitting in front of me with tremendous anxiety. I say, “Would you be willing?” I remember this one young man. He was not happy to be there, but, as I’m saying, lots of teens are not happy to be brought in by their moms. So he felt very anxious. Had trouble sleeping, and he has actually been smoking a lot of weed. 

So I said, would you be willing to try some CBD? “Umm, yeah, okay.” Not very enthusiastic. So I gave him some under his tongue, and I said “Hold it for 30 seconds.” And then I continued talking to his mom and he was sort of slumped in his chair. About 10 minutes later, I went, “So, how are you feeling?” And he kind of tuned in, and said, “Oh, I really feel good. Wow, I haven’t felt this good in a really long time! I’m feeling relaxed and much calmer.” And here he was. He was actually a weed casualty because when you have, particularly in young people, when you have the levels of THC that are in the products that people are smoking now, it’s really high. It’s really hard on the system, and it’s totally out of proportion. 

In the plant, the original plant, there was a proportion of CBD, THC, and all the other cannabinoids. Because THC is a cannabinoid too, but the plant has been bred to be very high in THC, which is for many individuals, it will just tip them over. And the antidote is actually treating them with CBD, ongoing. That will also cut down on their craving for the weed. They’re craving the weed because of the anxiety, so it helps temporarily, but then it’s also making them more anxious, particularly when it starts to wear off.

So substituting CBD, or just adding it in — you have people who are smoking. You add in the CBD, and they are gradually going to feel less of a need. This happens. They stop smoking. It’s much easier for them to let go of their marijuana.

Dr. Nicole Beurkens:

I’m so glad you raised that because it’s something that I’m seeing clinically more and more in teenagers and in young adults, especially as marijuana is getting legalized, it’s much more accessible, but that same thing. I empathize and I understand why they are using it, especially if they tend to really struggle with high anxiety, with things like that, but then the trade-off of that is reduced executive function, the addictive piece, all of those things and what you’re talking about, of being able to use CBD as a helpful antidote, or help to meeting the needs of their endocannabinoid system — helping them balance their system so they can manage the stress better and not needing to use the marijuana, that’s such an important thing for people to know that that option exists. 

Dr. Hyla Cass:

Oh, and what’s more than that is it actually helps to release the THC from the synapse. So it’s not simply that it’s relieving anxiety so they don’t need weed — they’re very intimately related. So the CBD will displace the THC in a good way, because it’s giving a much better anti-anxiety effect than the THC was. They realize they feel better. When you feel better, it’s like, “Oh. I’m going to do what makes me feel better.” Some of these kids are smoking because of peer pressure. They may not have been that anxious that they were using it.” The other kids are doing it, it looks like fun and we giggle and we eat. It’s fun and games until it isn’t. 

Dr. Nicole Beurkens:

Right. And that idea that it’s a benign things, that oh, nobody really has a problem with it, it doesn’t cause issues — I see young adults in my practice who have been using marijuana for years who have pretty significant executive function problems in their frontal lobe as a result of that, and this idea of that it’s not going to harm you — some people are really more sensitive to it, right? And it really can cause problems for some people.

Dr. Hyla Cass:

Yeah, absolutely. 

Dr. Nicole Beurkens:

So, as you’re talking about the endocannabinoid system, it made me think back to the gut, this idea that we need to be in balance, right? We need to have the right balance of things in our gut to be healthy and have our brain function well. And the cannabinoid system needs to be well-balanced, right? As you’re talking about it, I’m thinking some people’s endocannabinoid systems are out of balance, or as you said, they’re just so low that they’re not allowing them to respond to the stressors and things in life, and then they develop symptoms. Is that a helpful way to think about it, this idea of balancing that system?

Dr. Hyla Cass:

Absolutely, yeah. We need to fill up the reservoir. If you are low in it, you are going to be more susceptible to everything. They did a study on people who were affected by 9/11. Those who had the worst PTSD compared to those who had no PTSD had a very big difference in their level. This is where the researchers can measure endocannabinoids. So the ones who developed PTSD had really low endocannabinoid levels. Ones who were sort of really immune to it, who managed to deal with it much better did not. And in fact, it’s also a treatment for PTSD. So in this research study, it was simply to measure, not to treat. So that was not part of the protocol, but the other part of the protocol could have been to treat those individuals, the ones with a low reservoir, with the PTSD and give them the hemp oil extract. And that would have been really very useful in helping to treat the PTSD. I think it also helps to do certain trauma therapies, which you are familiar with, and not the topic for discussion today, but if you use that — I always use biochemistry along with any other modalities: Education, talk therapy, trauma therapy. It just makes it all go better. 

Dr. Nicole Beurkens:

Yeah. I totally agree. It just makes the person — it helps them be in a better space to take in and make use of all the other therapies that they’re doing when you have the body in balance and working well, it’s such an important foundation for everything else. 

Dr. Hyla Cass:

Well, you’re operating on all cylinders. You can take in the therapeutic concepts and you can change your behavior. You have some control. So very important like in addiction treatment centers where they are giving medication to help people get who are off of their substance abuse of alcohol, cocaine, meth, whatever, marijuana — so they end up being given medication. That is not the answer, because that gives them a cloudy brain that isn’t working very well. It’s interfering with the microbiome, so they’re not making their endocannabinoids there. So I see it as being counterproductive unless it’s an acute phase where it can be life-saving. That’s a different story. 

But for example, with alcoholics, you have to treat them with medication at the beginning so they don’t have seizures, but actually, I think CBD could do a really good job there, but that’s not part of any protocols yet, so I’m not going to stick my neck out on that, but I think it’s a very good adjunct. CBD is a really good adjunct in treating addiction and helping people to restore a brain that they probably haven’t had in years, if ever. 

Dr. Nicole Beurkens:

Well, and you’re talking about it in so many ways that it can be used to help people with very serious kinds of issues, addiction issues, coming off of medications, but even just for balancing your normal stress and anxiety responses, and I’m thinking of all the parents listening. We know that parents of kids who have developmental, mental health challenges, any kinds of special needs tend to be under a lot more stress, you used that term, the depleted reservoirs, that describes a lot of the parents, their resources, their internal resources are depleted. And so even thinking about full-spectrum hemp oil with the CBD being even a beneficial resource for parents who may not have any particular diagnosis or whatever but are just looking at ways to support their systems too.

Dr. Hyla Cass:

Yes, absolutely. 

Dr. Nicole Beurkens:

I want to have you touch on something that I think is an important part of this conversation because we have come to an era where CBD or things called CBD are available everywhere from gas stations to video stores to online and I think there is a quality component of this discussion that is important, right? Like all CBD products are not created equal. So could you talk about what people should look for to have a quality, effective CBD product that they might use for themselves or their kids. What are the things people should be looking at there?

Dr. Hyla Cass:

Well, we don’t buy it at the gas station. There are very good brands around. We have supplement companies that we all use that make good products because they have to. Everything is totally tested. You want a product that’s been tested, where you can ask for a certificate of analysis, which means that someone — the product was sent to a lab and it was analyzed for what was in it and it had all the right things in it and not the wrong things. So that’s pretty standard. Then, taste is important. I was finding that the taste of most of them were pretty bad, like grassy —

Dr. Nicole Beurkens:

Like dirt, sort of!

Dr. Hyla Cass:

Yeah. And for many people that was sort of a turn off. They couldn’t do it. So I actually developed one that is lighter. It’s in a lighter oil, it’s an MCT oil and it has a light lemon flavor, so that’s more tolerable. 

Dr. Nicole Beurkens:

It actually tastes good. When I tried yours, I was like — I guess in a nice way, we could describe a lot of them as earthy, right? But the taste of yours and even the texture of it, because yours is in oil and there are ones in capsules or whatever — is there a reason that you find that you like to use the oil? Do you recommend that oil as compared to a capsule product?

Dr. Hyla Cass:

Well, I actually supply both. The capsule takes longer to become effective because it has to go through your digestive system, you lose some of it through the first pass to the liver or some of it is broken down, but then what’s left lasts longer. So I recommend that people take that at night so it will help them to stay asleep. They take a tincture, the oil — tincture is really in alcohol, so I don’t know why they call CBD tinctures, but we do. Anyway, so you take the oil product and that will work right away. As I mentioned with that young man I was seeing, it just seemed like there he was: He suddenly went from highly anxious to, “Oh, I’m feeling great!”

So you use it at bedtime, and that will bring you down from anxiety, calm you down, relax you so that you can fall asleep. And then the capsule will sustain you throughout the night. Even if you wake up, you can always take another drop of it. 

Dr. Nicole Beurkens:

A drop of it to work more quickly. Yeah, I think that’s a helpful distinction for people to understand how the different formulas work. One of the things that I think you work on with people that is so valuable, that most psychiatrists aren’t is how they help themselves wean off of or reduce their psychiatric medication use because it’s such a challenge for people and I hear this from patients and from parents all the time. It’s like, there isn’t a lot of information out there and not a lot of even medical practitioners who know how to help people with what can be, sometimes, a really tough journey of getting themselves off of medications that either aren’t working well for them or are causing side effects, or they have found things that work better. What do you find are some helpful things to keep in mind for that? I assume using nutrients, good principles of nutrition, gut health, all of those things are important in that process, right? 

 

Dr. Hyla Cass:

Right. And then depending on what the medication is, taking nutritional supplements that help support that particular system. So if they’re coming off an anti-depressants like an SSRI, I would give, say 5HTP, but also take that 6 hours away from the medication because of the kind of rare, but risk of what’s called serotonin syndrome, just too much serotonin. Or if somebody’s on a stimulant, you would make sure that you are supporting the dopamine system with, say, Tyrosine. Or I have a product called Focus, it has Tyrosine and Phenylalanine. But you can use plain Tyrosine, as well as the B vitamins. And a full complement, have a good multi because we need the cofactors who make those neurotransmitters. It’s not just the amino acids, but it needs its helpers, the B vitamins, magnesium, zinc, and so on, and often, by the way, kids are low on zinc, especially when they’ve had a growth spurt in puberty. So it’s very important to measure zinc levels and give zinc. So that’s a topic for another time. 

Dr. Nicole Beurkens:

But I think it is helpful because some people really do struggle with coming off of these or weaning them or making changes to them, and there’s not a lot of support out there. So for parents to understand that there are very tangible, helpful things that can be done by using nutrition, both through food and through targeted nutrient protocols that can really ease the way with that and help make that process easier, I think that’s so important for people to understand. 

Dr. Hyla Cass:

Yeah. And then you wean slowly. I think the problem in the community is that when someone wants to go off the medication — I’ve had doctors say, “I put people on medication, I don’t take them off.” You’re on it for life. It’s like insulin for a diabetic. A child? I can’t even go there. So you wean slowly. You say, it’s a rule of thumb, about 10% every two weeks. There are different ways of doing that. Sometimes you need to go to a compounding pharmacy, or if it’s a capsule, I have them mix it up with sterile water in a syringe and then take a measured amount everyday. You know, I don’t think you can do this at home. You need a doctor’s supervision. Your own prescribing doc has to be willing to do this, which is unusual. And hopefully, there can be more and more of them coming online, because we desperately need more functional medicine, integrative psychiatrists. 

Dr. Nicole Beurkens:

Absolutely. We need more people like you who can help with navigating this, number one, in a way to really get to the root of things, but also to help with this process of coming off, because so many parents say to me, if I had known what the reality of this was going to be like back when we were handed that prescription, I never would have done it. But they don’t know. 

Dr. Hyla Cass:

They don’t tell you. 

Dr. Nicole Beurkens:

That’s right. 

Dr. Hyla Cass:

And they don’t tell you the misery. I can’t even tell you. The emails I get from people who have been put on Benzodiazepines and were never told they were addictive. Never. Their lives are ruined. So I try to help as much as I can with shoring up their system using some of the precursors. GABBA enhancers, serotonin enhancers, essential fatty acids and, of course, CBD. Just doing a very gradual — even when you get to the left, like 1mg of Klonopin they think, “Well that’s nothing”. But it’s terrible getting off it for many people. Some people can do it, actually. But when they have low reservoirs of the precursors, then they’re in trouble. 

So that’s what I do: give them the precursors, take CBD, then they can bold up their systems as they are reducing very, very gradually by a very tiny amount of, say, benzo, like Klonopin.

Dr. Nicole Beurkens:

I think it just gives hope to people out there who have really struggled with this or are struggling with this issue with their kids to know that there are options, there are things to explore, there are practitioners who can help them to do this. We’ve covered so many great and important things and I really appreciate the conversation. I want to make sure that people know where they can get more information about you. You’ve got a great website, you’ve got great books, great things available, products — where’s the best place for people to find the things that you are providing?

Dr. Hyla Cass:

I’d say just go to my website, cassmd.com. I also have a professional Facebook page. So that’s listed on my website. So people can write their comments and I post pretty regularly, and I invite people to go there. That’s where I have my correspondence with people. 

Dr. Nicole Beurkens:

Yeah, and we’ll make sure that all the links for those things are with the show notes. Your books are available on Amazon, I know as well as other places too, right? 

Dr. Hyla Cass:

Yeah. 

Dr. Nicole Beurkens:

Yeah, and those are really great additional resources that I highly encourage listeners to access to just delve into different specific aspects of the kinds of things that we have covered today. I really appreciate you being here, spending the time with us. I know that this conversation was very valuable to our listeners, so thank you so much. 

Dr. Hyla Cass:

Oh, it was such a pleasure, Nicole. You’re making such an important contribution with your work, both in the office and with this podcast, so thank you!

Dr. Nicole Beurkens:

Thank you, I appreciate that. And thanks to all of you for being here with us and listening, we will catch you next week for our next episode of The Better Behavior Show.