Answers to Anorexia—Personalized Care for a Brain-Based Illness

Episode Transcript

Dr. Nicole Beurkens: 

Hi, everyone, welcome to the show. I’m Dr. Nicole, and today’s episode is going to focus on a really important topic and that is anorexia, and even more broadly, eating disorder issues in children, teens and young adults. And we are going to be talking about integrative and even proactive approaches to treatment of these serious conditions. Anorexia is an eating disorder that most often starts in adolescence, but we are seeing an increasing number of preteen and even younger kids exhibiting early warning signs and symptoms. It’s no longer just something that we are seeing in older teens and adults, and it can be a really scary and life-threatening disorder for parents to deal with, for the individuals themselves who are affected, and even all of us as professionals who are treating people with these issues. We have not had a very good track record of understanding what is really going on for patients with this condition, and treatment has left a lot to be desired. So, one of the pioneers in really looking at what we need to be doing to more effectively understand and treat this issue is integrative psychiatrist, Dr. James Greenblatt. He has been on the show previously quite a while ago to talk about integrative approaches to anxiety and ADHD, but we are really lucky to have him back today to talk with us about this topic. So whether you have a loved one who has been diagnosed with anorexia nervosa, or you are wanting to be proactive and understand how you can address these types of concerns if they happen, this episode is going to be so valuable to you. Let me tell you a little bit more about Dr. Greenblatt before we dive in.

He is a pioneer in the field of functional integrative medicine, board certified child and adult psychiatrist, and has treated patients since 1988. He received his medical degree and did his psychiatry residency at George Washington University and completed a Fellowship in Child and Adolescent Psychiatry at Johns Hopkins Medical School. He currently serves as the Chief Medical Officer at Walden Behavioral Care and an assistant Clinical Professor of Psychiatry at Tufts University School of Medicine and Dartmouth College. Dr. Greenblatt has lectured internationally on the scientific evidence for nutritional interventions in psychiatry and mental illness. He is the author of seven books, and his latest book Answers To Anorexia is released right now, and we are excited about that. I’m going to tell you all about that. He is also the founder of Psychiatry Redefined, which is a really innovative educational platform dedicated to the transformation of psychiatry, and they offer online courses, webinars and even fellowships for professionals. Dr. Greenblatt, thank you so much for taking the time to be with us today.

 Dr. James Greenblatt: 

I really appreciate the opportunity, Nicole. It’s nice to see you again.

Dr. Nicole Beurkens: 

So I would love to just dive right in, and I want to focus on why you felt like this book was needed so much right now. I know it’s the culmination of your entire career of work, but let’s start with how you came to write this book and why you feel like now is the time for it to be released.

Dr. James Greenblatt: 

I have been practicing psychiatry for over 30 years, about 22 of those years devoted to the treatment of eating disorders, at a hospital level of care, where I see the tragedies of those with life threatening illnesses and some die. And what I have kind of witnessed over the 20 years, which is now getting some press, is that our current model of treatment for anorexia nervosa, the most life-threatening psychiatric illness, has not budged or changed, and as you said in the introduction, is tragically deficient. So I do believe early intervention and there is a treatment model that can be helpful, and our medical community has really just ignored and neglected this illness.

Dr. Nicole Beurkens: 

It’s so true. And are you seeing the same trend that I’m seeing clinically that there are more kids even at younger ages that we are seeing, if not with full-blown symptoms, at least some of the red flags of this? I’m seeing more, and my colleagues here at my clinic are seeing more of this in younger ages than ever before.

Dr. James Greenblatt: 

Absolutely. At our hospital it goes to age 10,12 and we have had to get waivers from the state to admit 10-year-olds to a hospital for anorexia. So I have seen 8, 10, 12 year-olds suffering, and we have them across all ages, genders, and races. It’s really tragic.

Dr. Nicole Beurkens: 

So I want to move into giving people a clear understanding of what this diagnosis is. What are we talking about? Most people have heard the term “anorexia nervosa”. People may have all kinds of ideas of what that is or what that means, but I want you to really give us a bit of education now about what is this disorder? What are the symptoms? What are we talking about when we say anorexia?

Dr. James Greenblatt: 

It’s listed as one of the eating disorders, as a psychiatric diagnosis. And we do use the term as a colloquial or slang, but as a psychiatric diagnosis, it is weight loss, restrictive eating, and the most significant, I think important for parents to understand, is the concept of distorted body image. Individuals who are either normal weight or underweight, but they articulate and share and believe, and their brain believes that they are overweight, if not obese. So it’s really that distorted body image along with that restrictive eating, that are kind of hallmarks that cause anorexia nervosa, because what happens is the brain plays tricks on the body, and there is complete distortion of reality.

Dr. Nicole Beurkens: 

I think that is one of the most challenging things for people not affected by this condition to understand, especially parents or even people treating it, which is how someone can have such a distorted image, right? Like we look at it, we can look at a person and say, clearly, you are very underweight. Clearly you are not obese or overweight, and it can be difficult for people to understand that that is really the perception and the reality of the individual experiencing it, right?

Dr. James Greenblatt: 

Yes, and the good news in the field is it took 25 years, but scientists now can articulate that this is a brain-based illness, that the anatomical changes in the brain, the neurophysiological changes are different in those with anorexia. So the scientific community has proven it. That information has not been translated into clinical care.

Dr. Nicole Beurkens: 

Right, because we are going to talk about the effectiveness of treatments, but typically what’s been done is just trying to work with this from a cognitive or emotional level, like getting people to see themselves differently, or those kinds of things. And really, when we are not understanding that there is an important neurological and biological basis for this, we really miss the mark.

Dr. James Greenblatt: 

Yeah, I think the most important part of understanding this brain-based description translates to more empathy in treating your child, and if you are a clinician, your patients, because it is not under their control. The changes that take place in the brain are profound, and that kind of creates a more empathic collaborative treatment model.
Dr. Nicole Beurkens: 

I think it even helps the affected individuals, kids and adults to have more empathy for themselves. I have worked with so many young people who have so much guilt and blame and shame around this and feel like, “Obviously, I’m doing something wrong”, or “I can’t get better.” And I think this model of really understanding what this disease process is, what is going on in the brain, really helps even patients themselves to have more empathy and compassion for what they are dealing with, that it isn’t some personal failing.

Dr. James Greenblatt: 

Absolutely, because part of the model is an individual appreciating and understanding that. Absolutely important.

Dr. Nicole Beurkens: 

So you talked about some of the diagnostic symptoms of things like weight loss, restrictive eating, and having a distorted image. For parents who are saying, “My child, I have not felt like it’s to the level where I need to bring them in to see someone, but I see some things in my child’s behavior on food. I’m just sort of wondering if there’s some of this going on.” Can you share what may be some of the early red flags are, or some of the things that before we are in a full-blown disordered state. Some of the things that are happening so that parents can be proactive about watching for that?

Dr. James Greenblatt: 

Sure. That is really important. I think the most important information I can share with parents, and sometimes this is hard to accept, that there is a very high genetic component, so heritability is important, so somebody in the family, it could be a parent or an aunt or an uncle, has an eating disorder, particularly anorexia nervosa, that should be a red flag. So that makes your child, might be just having a picky eating at higher risk. So appreciating the genetics. And then this might upset some of your listeners, but one of the most dramatic, well-proven risk factors is going on a vegan/vegetarian diet in puberty, certainly pre-puberty. So I think that any change in diet is usually the onset, so it could just be avoiding fat. But what we have seen in the literature has clearly proven that a vegan diet in adolescence with that genetic vulnerability is a very high risk for an onset of an eating disorder — I see it every day, as well as poorer outcomes and then higher relapse rate.

Dr. Nicole Beurkens: 

Well, you are not going to upset most of my listeners for that. I’m pretty forthright about the fact that I see vegan diets in particular, and vegetarian diets more broadly, especially when they are not done properly, being a huge problem all the way across the board in brain function and mental health for kids and adolescents. I’m glad to know that there’s such good research on that, specifically related to the anorexia piece, because I just see it across the board in my clinic, is that being a big factor, particularly for preteens and teens, so I’m glad you brought it up.

Dr. James Greenblatt: 

It is. I run parent groups, and one parent will talk about, “My child went on a vegan diet”, and then every 10 other parents will share the same story. When I first started years ago, and some of the research was like 6 to 12 months after a vegan diet, and now I’m seeing it 3 to 4 months, the restricting of those foods are particularly high in nutrients, zinc and vitamin B12, which is critical for puberty, and in my work, one of the core deficiencies in anorexia nervosa.

Dr. Nicole Beurkens: 

Yeah, absolutely, and we will get more into that in terms of the nutritional piece of it. I want to shift and talk about what I mentioned in the opening, and you reiterated this, around the fact that the way that we have historically approached treatment for anorexia specifically, I would argue eating disorders and those kinds of challenges more broadly, has been pretty ineffective, profoundly so in some cases. So, I would love to have you share what has been historically sort of the commonly applied treatment and why do you feel like those have been so ineffective?

Dr. James Greenblatt: 

Oh, there are just so many reasons, but let’s start with just training physicians, psychiatrists, practitioners, pediatricians who are not trained in eating disorders and nutrition. So there’s very little training. And the model across the country and actually across the globe, it’s not dissimilar in other countries, pretty much varies from treatment center to treatment center. In much of psychiatry, we have medications that are approved. For anorexia nervosa, there are no approved medications. So every doctor just makes an educated guess, and guess what? They vary tremendously as to what medicine they believe, and nothing is proven to be helpful. So there’s no medical model that has been proven. And even the therapies, some of the therapies that are effective for binge eating and other eating disorders have just not been consistently shown to help with anorexia nervosa, because — at least my thesis, is it’s a brain-based illness due to malnutrition, and without that nutritional repletion, therapy is often ineffective.

Dr. Nicole Beurkens: 

I have seen that in my doctoral training as a clinical psychologist. Certainly, we covered eating disorders, covered anorexia, about as much as you cover anything else in your doctoral training. And unless you really specialize in that afterwards, people don’t really have a lot of training in it. And the model is really around, again, some of those broad-based psychological kinds of treatments using maybe cognitive behavioral therapy or some family approaches or mindfulness and looking at anxiety. I mean, a lot of it really comes down to treating the comorbidities of it: The anxiety, the depression, those kinds of things, and really, there is very little training with it. And as you said, it can differ so much in approach. I have even seen that in my work with patients coming out of inpatient treatment centers. A wide variation in what has been done in inpatient kinds of settings. And then they sort of stabilize them enough to release them with no ongoing care, and I find that people relapse so quickly and I’m wondering if you see that as well.

Dr. James Greenblatt: 

Absolutely. The relapse rates are incredibly high because of our ineffective treatments, and it’s just overwhelming for families. I mean, what other illness in medicine, would they have to get treatment four hours away for a hospital, and then six hours away for residential, and no treatment in their community? I mean that is not how we treat diabetes, asthma or any other illness. So it’s overwhelming for families. Insurance companies limit treatment, again, for a life-threatening illness with the highest risk for suicide, actually.

Dr. Nicole Beurkens: 

I want to touch on that. I have heard you speak for years now about this, that anorexia has the highest suicide risk of any psychiatric illness. Can you talk a little bit about why that is?

Dr. James Greenblatt: 

I think we don’t have the research to say why. I have my theories, and one of the relationships that we have found through many years of research is low levels of the essential fats in the body, in the brain, that is in fish oil, EPA, and DHA is associated with a higher risk of suicide. Many of these studies were done in the military, but we have studies across the globe for about 20 years, looking at these low levels of these essential fats increasing the risk for suicide. And what are the foods that our patients with anorexia restrict? They are restricting fats, they are profoundly deficient, and I believe that is one of the key relationships to increasing the suicide risk.

Dr. Nicole Beurkens: 

I also have to believe — I mean, again, this is just anecdotal. This is just my hypothesis, working with individuals and families: When you have an illness that no one seems to know what to do with, you continue to suffer, you continue to just feel like there is no hope for this, no one knows what to do, this isn’t getting better, and these people are really living with a profound amount of distress and pain on an emotional level, on just a practical life level, and I have to believe that is a piece of it too, around not only comorbid depression and those kinds of things, but around even suicidality.

Dr. James Greenblatt:   17:26

Absolutely. In addition to that, kind of perceptual distortions about being forced to eat. Some people would choose to die because they can’t tolerate that. And others have, just as you are articulating, have tried to get help in treatment programs across the country. Parents have mortgaged their home, and at some point, it becomes overwhelming that if they do get better, they relapse, and they just can’t continue that fight.

Dr. Nicole Beurkens: 

Yeah, I think it’s important for us to be honest about the life-threatening nature of this for many people, and to understand the great need for more innovative approaches to looking at this. And I know that is really what you have been doing for so many years now. And so, I want to move our conversation now into what it is that you are finding are the missing pieces. What are the things that we should be assessing or doing from a treatment standpoint for these people, that has been missed previously?

Dr. James Greenblatt: 

Both from a treatment standpoint, as well as a prevention model, I believe the missing link has been our complete ignorance, for lack of better word, about malnutrition and again, the genetic vulnerability. That has to be kind of the first red flag. A change in diet is the second red flag, and the third one is chronic malnutrition. What happens if you are restricting calories, and particularly vitamins and minerals, particularly during puberty, when your body needs more vitamins and minerals to get through those hormonal changes, and the brain starts to starve. We know all of the nutritional deficiencies of major nutrients affect brain function and actually affect brain distortion. We can mimic schizophrenia by depriving someone of vitamin B3, and that happened in the 1900’s with pellagra, and people become delusional. So there is such a simple relationship between malnutrition and this illness. It’s just frustrating that it just hasn’t been incorporated into treatment models.

Dr. Nicole Beurkens: 

Absolutely. And I want to dive into what your experience has been around some of the specific nutrients with that, but something that came into my mind as you were just saying that, is how so much of particularly the inpatient hospital treatment model center around forced feeding and getting calories into a person in order to sort of physically stabilize them for discharge. But when you look at what they are forcing these people to eat, yes, it’s calories, but it is still so devoid of good nutrient building blocks that these people need that okay, we get calories in them for four to six weeks or whatever in an inpatient environment, but we still have not given their brains the vital nutritional information and building blocks that they need to really get better.

Dr. James Greenblatt: 

It’s tragic, it’s absolutely tragic. I talk a lot about the term “It’s not about the weight” because yeah, calories can change the scale, but without that nutritional repletion, the brain is not repleted.

Dr. Nicole Beurkens: 

So what are — both in your experience and in the research, what are some of the key nutrients that we are talking about here that have been linked to either the symptoms that we see in this, or to helping them get better? You mentioned the omega 3 fatty acids as being really important. What are some of the specific vitamins and minerals that you find are important to be thinking about?

Dr. James Greenblatt: 

I think the most important in my experience is probably the mineral zinc, because you have a higher need during puberty as well as pregnancy, and if we take an animal and deprive them of zinc, or we have human studies of individuals that were kind of naturally zinc deficient, the symptoms look like anorexia nervosa. You lose your appetite, you lose your taste, you have poor digestion, depression, and sleep problems. So zinc, that mineral I think, is the most important. Also, the B vitamins are also important, and essentially, provide the building blocks just like the fatty acids, also the amino acids, because they are not getting these essential nutrients that you and I would get from digesting our food, if they are not having that intake. They are called “essential” because our body can make it, and over time, those deficiencies affect digestion, mental health, as well as those perceptual distortions.

Dr. Nicole Beurkens: 

Yeah. I think that it’s really important as you are talking about this particularly being issue with people who go on a vegan or a vegetarian diet, because a lot of the main place that we can most easily get these minerals and the vitamins and the fatty acids that you are talking about, and the amino acids, are through animal proteins, which by and large people who end up with any kind of disordered eating issue, whether it’s anorexia or something else, good quality animal proteins and proteins in general are not the things that they are eating anyway, even if they are not on a vegetarian or vegan diet. We are talking about the stuff they are eating tends to be a lot of starches or sugars or things that don’t have those quality proteins and nutrients.

Dr. James Greenblatt: 

Yeah, and even the treatment programs across the country, again, across the globe, are not necessarily providing nutrient-dense food, or understanding that with a deficiency over time, someone will likely need additional supplementation to come back from some of these nutritional deficiencies.

Dr. Nicole Beurkens: 

I want to touch on that for a minute just to see your sense of this with having treated so many patients over the years with these issues. Sometimes medical professionals will say, “Well, okay, fine, we will run tests for some of these nutrient levels. But look, they are all in the normal range or they are all close to it. It’s fine. We don’t need to worry about these minerals or these vitamins.” In my experience, what a lab test shows may not be correlated to clinically what would be beneficial for improvement. So I’m wondering what your stance is on that.

Dr. James Greenblatt: 

Yeah, it’s really important. I think most of my career is based on looking at objective tests for depression, anxiety and ADHD, and personalizing a nutritional program, in addition, if medications are needed. For anorexia nervosa, I don’t think there’s any testing that is needed, understanding that the malnutrition is profound. And so many of our tests — I will just give one example. Let’s take magnesium. It’s the most common deficiency, I think, in the United States, certainly for those with anxiety and mental health issues. But we don’t have a good blood test because most of the magnesium is in our bones and in our cells. So if a doctor just does a blood test, they might tell you magnesium level is fine. But that is meaningless because 99% of the magnesium is not detectable by a blood test. But if you are anxious and not sleeping and are constipated, those are all signs of magnesium deficiency. So I don’t think expensive, elaborate blood testing is necessary in understanding a child or young adult with anorexia nervosa is deficient in zinc, B vitamins, fatty acids, and amino acids.

Dr. Nicole Beurkens: 

Yeah, so true. So we need to focus on, as soon as possible, as soon as we see these things starting, looking at incorporating these nutrients, looking at these pieces, in addition obviously, to good family support and psychotherapy and other things that may be needed. But for parents who are listening to this and who are saying, “Wow, this is our story, we have had our child in all of these different settings. This is something we are really struggling with”, and so they are thinking, “Okay, this makes sense. I get this. We have not looked at any of this.” Where do they start? What are the options for people to be able to get the type of support that you are talking about and the type of treatment that you are talking about?

Dr. James Greenblatt: 

I think it’s challenging for parents. I think that probably the fields of functional medicine or integrative medicine are both across multiple disciplines, so dietitians, therapists, and doctors who are trained in functional integrative medicine would be comfortable talking about zinc and omega fatty acids and B vitamins. So that doesn’t mean that has to be the entire treatment team, but getting that consultation on nutritional augmentation could be really critical, particularly for the younger kids.

Dr. Nicole Beurkens: 

Yeah, I think so too. And as you said earlier, the sooner that we can start to intervene and support with some of these things, the better to try to prevent full blown illness. And you see that right? I mean, if we can intervene and start doing some of these things earlier, we can prevent kids and young people from ending up in full-blown life-threatening episodes.

Dr. James Greenblatt: 

The progression is real. The child goes on a diet. He says, “I’m coming home”, comes home from camp or a meeting and says, “I’m not eating meat.” And maybe they are triggered by the pediatrician or the school with these BMI report cards, and somebody was slightly overweight and they said, “You need to lose 10 pounds”, and then they just can’t stop. So there are so many factors that parents can look at to help and get help quickly. But certainly, again, if there’s a genetic family history, making sure there’s adequate nutrient-dense foods, multivitamins with adequate zinc, and maybe early interventions with therapy and a dietitian.

Dr. Nicole Beurkens: 

Yeah, and I’m glad you brought up using supplements because certainly, food is the preferred way of giving people’s brains and bodies what they need nutritionally, but the reality is for people with these kinds of issues, and really the vast majority of patients that I see with any type of neurodevelopmental or mental health issue, yes, we want to focus on the food, but targeted supplementation, targeted nutrients and different formulas for that can be absolutely necessary and important to turn that around. So we are not just talking about changing the diet in terms of food intake, we are also talking about understanding that we can use therapeutic nutrients, we can use supplementation to help.

Dr. James Greenblatt: 

And the earlier that kind of intervention, the easier it is. Once men and women go into that black hole with the perceptual distortions, it is just so difficult sometimes for them to take the supplements. It can be challenging. So it’s the earliest moment that we can begin to help parents understand the role of nutrition, the easier the treatment will be.

Dr. Nicole Beurkens: 

And I think that really applies to this whole realm of symptoms and disorders. I mean, we are focusing specifically on anorexia, but really, there’s a wide range of disordered eating patterns and issues that we are seeing in kids and young adults these days. You mentioned binge eating, we have bulimia. We have got things that maybe don’t rise to the level of diagnosis, but clearly are dysfunctional and have an impact on people, and this nutrition piece and understanding the importance of nutrient-dense foods and giving kids and young people what they need for these nutritional building blocks, this really applies across the board, doesn’t it?

Dr. James Greenblatt: 

Yes. We see it across all the kinds of major mental health issues we are seeing in kids that are growing. Depression, anxiety, even, cutting, self-injury, and suicide risk. And the role of nutrition is appreciated now in cardiology and so many other medical specialties, but for mental health, it really has not been embraced in the way it should be, certainly with the diets that many of our teens are eating, and certainly in lower socioeconomic communities, where the only food available is often nutrient-deficient foods.

Dr. Nicole Beurkens: 

I think one of the things that I have always appreciated about your message and really your passion around this is talking about the importance of nutrition across the entire spectrum of psychiatric illness and diagnoses, because I think there are more people willing to say that, “Okay, yes, food and nutrition, it makes a difference for people’s mood and their mental wellness in general and their stress.” But there still is this barrier, I think, both in the general population, as well as in the fields of medicine and mental health, of really acknowledging the profound importance of nutrition for even the most severe psychiatric kinds of issues that we deal with. I had a journalist just the other day contact me. She was writing a piece for a major publication on mental health in general, particularly anxiety and depression, and she said, “I want to talk to you about home remedies for this.” And I said, “Well, home remedies? What do you mean by that?” She was like, “Well things like diet changes, little things that people can do to help themselves.” And I was like, “Well, first of all, we are going to need to recenter this conversation about the fact that nutrition is not a cute little home remedy. This is a research-based entire field of research and study around how we can impact the brain.” But to me, that stuck with me, because this is still how a lot of the general public and even practitioners think about it, right?

Dr. James Greenblatt: 

Yeah. I think for the medical community, if it’s not a pill, it doesn’t fit our model. And I think for the public, it just can’t be that powerful, because it’s just food. It’s just diet, and we really minimize that role.

Dr. Nicole Beurkens: 

And I think that is why it’s so important that you continue to educate and write and talk about this, that food and nutrients and nutrition play a role, as you said, in psychosis, in this condition of anorexia that has the highest suicide risk. We are not just talking about, oh, this cute little thing of, “We should eat better so we feel better.” We are talking about nutrition as being profoundly important in even some of these most severe clinical presentations.

Dr. James Greenblatt: 

Absolutely true, we see it across all diagnoses. I think the hard next step for both clinicians and parents is — it doesn’t mean that every child with anorexia is deficient in X vitamin .There’s very complicated, again, that genetic vulnerability with that individual. We see things like celiac disease, very commonly misdiagnosed, that triggers anorexia nervosa. If you don’t diagnose celiac disease, you are not going to be able to treat anorexia. PANDAS, other immune disorders. So there are so many variables that have to be looked at for each individual — but the nutritional deficiencies and the genetics of nutritional deficiencies for one person might be deficient in vitamin B12, and then a vegan diet kind of pushes them into a depression. Another person might do fine on a vegetarian diet.

Dr. Nicole Beurkens: 

Yeah, understanding of the bio-individuality of that. And I think you raise an important point here, even beyond the discussion of nutrition, that when your child is struggling with symptoms or has a diagnosis you have been sort of hitting a wall with figuring out what to do, that we need to stay curious and keep asking good questions. Like you raised a couple of things there that I think are important like it could be undiagnosed, untreated celiac, it could be ongoing chronic infectious issues like PANS and PANDAS, it could be a lot of these things. And I think for parents to continue to ask questions, to try to dig deeper into what’s really going on and not just accept that, “Well, this is just something we can’t understand, and this is the best that we can do”, but to keep looking, because as you point out, there are a lot of things that could be going on.

Dr. James Greenblatt: 

Yeah, I think having that medical kind of model is really important. Understanding the illness, as a brain-based illness will just kind of help parents pursue some of these medical diagnoses that can be confused, or occur with an eating disorder.

Dr. Nicole Beurkens: 

This has been such a helpful conversation. You have given so many people a new reason to be hopeful about what could happen for their kid’s improvements that could be made. I’m curious, I’m going to have you talk about where people can get the book, but I just would love, in wrapping this up — As we look at the big picture of mental health today, just population-wide, but particularly for kids, teens, young adults, what do you think we are missing? What should we really be thinking about? Because there’s more talk than ever before, in the media and everywhere else about this epidemic of mental health issues. The pandemic has made everything worse. So many people are just not in a good place. So what sort of message do you think is important for people to hear about that?

Dr. James Greenblatt: 

I think there are so many levels that as a profession, mental health community, and as a society that we need to kind of improve. The good news, as you said, is more people are talking about mental health issues. I think that most of my career is focused on understanding nutrition and how that has been neglected. The other piece is we now have some decent genetic tests to be able to kind of help predict which medicines might be helpful. So it’s really kind of understanding that personalized model. That is critically important. And the other part is the psychotherapy: Having our children or adolescents feel like they are valued and they are heard and they are listened to. That should come from the family, that level of support, but oftentimes, we need to go outside the family. I think there are just so many levels. Things are getting better, that we are talking about it. But there are certain communities that have no access to care. There are people that need to wait three or four months for a child psychiatrist in crisis, and it is really tragic.

Dr. Nicole Beurkens: 

Agreed. And I know that is really the driving force behind your mission in educating practitioners in the field of psychiatry, medicine more generally, even in the more, broad field of mental health around ways that we can be stepping up and better meeting the needs of kids, of adults, of people with this, and your new book is certainly part of that initiative, around helping people understand more about anorexia and treatment and nutrition. So, tell us the title of the book and where people can find it.

Dr. James Greenblatt: 

The book is called Answers to Anorexia, and it’s an overview of the lack of a current effective model and a proposal around a kind of nutritional repletion model, and it’s available on Amazon, and our website is just my name, jamesgreenblattmd.com.

Dr. Nicole Beurkens: 

Great, and for our practitioners who are listening who are really interested in learning more about these types of approaches and about what you do, you have a specific website with your training courses and things, correct?

Dr. James Greenblatt: 

Yes, psychiatryredefined.org is an educational platform for clinicians, therapists, nurse practitioners and psychiatrists. We have hundreds of hours of content on what I call functional medicine for mental health, functional psychiatry, where they can learn the model of kind of digging deeper. There’s no other field in medicine where we have no objective tests. We don’t do blood tests in psychiatry, we don’t examine the brain in psychiatry, we just make educated guesses and that hasn’t been effective enough.

Dr. Nicole Beurkens: 

And I just will put in a plug for that. I have taken many of your courses over the years, have heard you speak many times. The courses, the events, the things that Dr. Greenblatt has on that website, I just want to encourage any of you who are practitioners who are listening to really take advantage of those, and all of you who are not practitioners listening, parents and others, for you to know about this and encourage the practitioners that you are working with or colleagues or whoever to know that these resources are out there. I do believe, or at least I want to believe, that there are so many of our colleagues in medicine, in mental health who want to be able to do better for their patients, who want to understand this. And so the resources and the courses and things that you provide are such a great way to do that. So spread the word about those, and thank you for taking the time to really put all those together and make them available to people. I think it’s really an important part of your legacy, and as someone in the field, I’m really appreciative of it.

Dr. James Greenblatt: 

Thank you Nicole, I appreciate that.

Dr. Nicole Beurkens: 

So go out and get the book. You will find it very helpful. Spread the word. And Dr. Greenblatt, thank you as always for taking time to be with us today. We really appreciate it.

Dr. James Greenblatt: 

Thank you. Have a great day.

Dr. Nicole Beurkens: 

And thanks to all of you, as always, for listening. We will catch you back here next time.