Functional Medicine For Mental Health and Wellbeing In Children and Adults

Episode Transcript

Dr. Nicole Beurkens: 

Hi everyone, welcome to the show. I am Dr. Nicole and today, I have the pleasure of talking with my good friend and integrative psychologist colleague, Dr. Josh Friedman. Josh and I are among a relatively small but growing group of psychologists who incorporate nutrition and other physiological types of approaches into our work with patients, in addition to what people traditionally think of as mental health treatment — more of the counseling and those types of things. So I asked him to come on the show today to talk about his journey, as a professional, of discovering what patients with mental health symptoms really need in order to improve, because I think this is actually an important perspective for patients, parents — to understand.

Maybe as an adult, you’re struggling with some of these symptoms yourself, things like anxiety, maybe depression or mood issues, those types of things. Or many of you have kids with these types of mental health symptoms and issues. And so it’s really my hope that you come away from this conversation today with some new ideas about what to look for when seeking mental health treatment, and really, all of the options that are available to you for addressing these issues beyond what may have just been already recommended, which is typically counseling and maybe some medication. So before we get into all that, let me tell you a little bit more about our guest.

Dr. Josh Friedman earned his doctorate in psychology from New York University and did post-doctoral training in psychoanalysis from the Training and Research Institute for Self Psychology in New York City. After working in the field for a few years, it became clear that something was missing from traditional mental health treatment. Curiosity and a chance meeting led him to discover the world of nutritional psychology, which teaches that many psychological issues are caused or made worse by underlined biochemical or nutritional deficiencies. Along the way, he became certified as a yoga teacher, incorporating an emphasis on breathing, meditation, and movement into his work and he is certified as a holistic health counselor at the Institute for Integrative Nutrition and has a diploma of comprehensive nutrition from Huntington College of Health Sciences.

Josh is also a functional diagnostic nutrition practitioner and has taken many other trainings in integrative mental health. For the last 15 years, he’s had a private practice in Omaha, Nebraska called Integrative Psychotherapy of Omaha, where he combines psychotherapy with nutritional guidance, targeted supplements, yoga stress management tools and the use of specific functional medicine tests to help people identify and correct the root cause of their symptoms. And in 2015, he started Alternative Mental Health Solutions, a web-based functional medicine coaching business to provide these powerful solutions to a worldwide audience.

Josh, welcome to the show, so great to have you!

Dr. Josh Friedman:

Thank you so much, Nicole.

Dr. Nicole Beurkens: 

Alright, so I want to dive into this because you and I have spent so many hours over the years talking about all this and how much our journeys as psychologists really are similar in terms of the kinds of work that we do with people. Your bio really talks about that journey in a big-picture way of being trained in a traditional psychology doctoral kind of program, being trained in psychoanalysis and then getting into practice and discovering that there was so much more than that. I’d love for you to talk more about how you came to recognize and incorporate these kinds of — what really are considered non-traditional modalities, at least in the field of mental health into your work and if there are any patient stories that stand out in your mind that kind of led to that. Let’s talk about that too. 

Dr. Josh Friedman:

So the first thing that happened — I went to NYU and I got really excellent psychological training and the focus was on the mind and the focus was a little bit on the body but not very much. And then I got into practice and usually we did therapy and then if someone was still struggling, we referred them to a psychiatrist for medication and I sort of came up in the heyday of psychiatry — so I was trained as a psychologist in the 80s at the time that Prozac came out to the scene and everyone, all of my professors, all the training institutions I thought that that would be a huge game-changer.

And so what my experience ended up being was: People would get on to medications, so they would make some progress in therapy, they would get on to medications and maybe 30% of them would do dramatically better with anxiety, with depression, with fears — 60% of them would have very little response and 10% or 20% would have horrific side effects. Sometimes getting more agitated, more depressed, sexual side effects. And I started to wonder, was there something better out there? So, I started asking around and this was before the internet, and I discovered a book that sort of changed my whole life, or my whole professional life. It was a book by Julia Ross, called ‘The Mood Cure’. 

Julia is a pioneer in this new field that’s now called ‘Nutritional Psychology’, and she started helping people, mostly sort of treatment-resistant, people with substance abuse problems and eating disorders that mental health didn’t have a very good handle on. And she started helping people make very simple diet changes, sort of moving towards a paleo — what we would call now a whole foods diet, cutting down on junk food and then using targeted, very specific nutraceuticals: Amino acids, essential fatty acids, minerals, vitamins to help people address mood issues.

And so, I contacted her and started to do a little phone training and then went out to a workshop and was just sort of blown away by the power of these very simple tools that you could get at a health food store. These are tools and many people have heard of them, but maybe don’t know how to use them. Things like tryptophan, 5-Htp, tyrosine, GABA. And so, I just started doing sort of basic evaluations with people and helping people do a little bit of exercise, make some very simple diet changes and starting to see dramatic improvements in patients that were pretty stuck. So I mean I can think of early on — and so this is about 15 or 20 years ago now. Sort of before these buzzwords like paleo, ketogenic and functional medicine were even around.

And so there were people that were anxious and depressed and if you gave them a little magnesium and took out gluten from their diet, maybe dairy, they would just get dramatically better. And so, that was really interesting to me and at the time, and in one of the really interesting parts — I was working at the time at this place called the Renfrew Center in New York and it is kind of a well-known eating disorder center. I sort of brought this information to them and said, “Hey, I’m learning all this new stuff.” And they had these amazing integrative teams of psychologists and nutritionists and medical doctors who were very skilled at what they did, but almost none of them were interested to learn more about the amino acids or any of the things I was learning. And so I sort of floated around for a while and I didn’t really know who to talk to about this stuff. And so little by little, over the years, Julia Ross introduced me to some people and then maybe 8 years later, I discovered Integrated Medicine for Mental Health, where you and I met, which is a really amazing gathering of integrative mental health practitioners, many on the medical side, so doctors and nurse practitioners, acupuncturists, chiropractors and then a growing group of psychologists and psychotherapists. And so out of that, I feel like I’ve now found a community. 

Dr. Nicole Beurkens: 

Yeah, it’s so interesting. Your story in many ways mirrors mine, although we work with different populations. You primarily work with adults, I primarily work with children and teens, but that same thing of coming out of really strong psychology training and thinking, “Okay, I’ve got these tools now, I know how to do good assessments and diagnostics, I know how to do good counseling and psychotherapy work with kids and with families and then you get into the real world of practicing with people and you go, Oh, not everybody gets significantly better with these things.”

Dr. Josh Friedman:

That’s right.

Dr. Nicole Beurkens: 

Yeah, and I think that same piece of what the world of therapists at least, we’re talking about psychologists because that’s the training you and I had, but throw social workers and counselors into the mix too, the training really is very much like you described — we’re taught to do these more mind-based, psychotherapy-based interventions and then if we’re not making good progress with that, then we refer them to their primary care physician or to a psychiatrist to get medication. And you know, we’re told that that’s what’s going to be helpful for people and then you keep meeting with people and you keep working with them, but for me — I distinctly remember a point in time around a couple of cases I was working with where I thought: “These people are not getting better. In fact, I think these kids are actually getting worse! The more medications they are put on, the more problems we’re having!” And that really as my awakening, similar to yours — and going, “Okay, wait. Maybe there is more here beyond what I’ve been taught.”

Dr. Josh Friedman:

Right. So in my experience, often people will get on one medicine and they won’t do well, and then the second medicine and won’t do well. And I’ve almost never seen someone on 3, 4, 5, 6 medicines that are going to get any better. The really hard part is — because there are very few clinicians that know about sort of alternative treatments, their people are told that this is the best that they can do and to me, that is the greatest tragedy, actually. So my whole thing is: I want to touch as many people as I can, but I want as many people to know that there are alternatives, that if you have a child, or you’ve been hospitalized, you’ve been to multiple physicians or multiple psychiatrists and you’re told that there is nothing that can be done — I think that’s actually not true. Can I tell a story?

Dr. Nicole Beurkens: 

Please do!

Dr. Josh Friedman:

This is maybe about 5 years ago. There was a guy who had been an alcoholic, he had relapsed multiple times, he had fallen into a deep depression, the deepest depression he was in his 30s, he was hospitalized, he was put on multiple medications and he was just sort of getting worse and worse and worse. He came out, he relapsed again, he went back into the hospital. He somehow found me — I think he was from Texas. He came up to see me. When I got into this, when we got into this, there wasn’t sort of a standard training. You sort of had to ad-hoc it, learn a piece at a time. So by the time this guy saw me, I had been introduced to some basic functional medicine tests. I think at the time, I knew about 3 tests.

So one was called an organic acids test, and this is a urine test that looks at multi-systems of the body to look for imbalances. I gave him a food allergy test. This was not like the standard food allergy test you would get at your allergist or the standard doctor — those are anaphylactic IGE tests. This is looking at delayed food sensitivities that are often connected to mental health symptoms. So some basic tests that might have cost him $500 or $600. He was very depressed, he would have done anything. And so what turned up is what, sort of, you want to turn up. It was 3 or 4 very specific things. So, one was low levels of serotonin. Second, was a very severe food reaction to dairy, and a third was very low levels of lithium. We also gave him a hair mineral analysis. So really, the intervention was supporting serotonin with, I think it was 5-Htp, some zinc, some magnesium, some B6 — that’s 4 supplements. Some nutritional lithium — which we all think of lithium as a psychiatric drug, but it’s actually on the periodic table and is a mineral that’s often connected to suicidal depression, which this man had.

And he went off of dairy, and the dairy was interesting because he was a bodybuilder. Because he was a bodybuilder, his coach had him do 4 whey protein shakes a day. Whey protein is a dairy protein. So he did those, he did this protocol — 5 or 6 supplements, he got off dairy, and he calls me back in 3 weeks and he says, not only is he not depressed, he feels better than he has ever felt in his whole life. And then we talked a couple more times, he referred some family members, he’s doing great and then he gets back in touch with me, I lose contact with him, 2 years later — and he says he has never had another depressive episode again.

I think that’s the kind of potential. It doesn’t always work out that well — that’s like the home run. But when that happens, and the things we identified, I think that very few clinicians are not trained in the integrative model where they would have even thought about those things, but this is the man that would be put on, probably very strong medications, probably antipsychotics, would have gotten sort of trapped in a chronic depression. And so I think that to me, that took the power of all of this to the next step, I was like “Wow!”. And of course, when I was doing this at first, my expectations were pretty low. So I would read about these amazing things in the books and talk to people, and I was like — “That’s not really going to happen. It’s not going to happen that way.” Then it would happen that way!

Not always, but the people that were coming to me are people that we would call ‘treatment-resistant’. People that have tried medications, people that have hopefully been in psychotherapy, they’ve tried multiple modalities and they’re saying, “Hey, this isn’t working.” And so we’re focusing on whatever that percentage of people is, and in my experience, it’s a huge number of people that are at least only getting partial help from what we have to offer. And so it’s very gratifying to be someone who can offer more and it took me a long time to sort of put myself out there, because I thought, “Oh, there are all these experts, and they wrote the books.” And blah, blah, blah — and then I realized, you know, there is so much I can offer people, doing very simple things.

And so gradually, I didn’t sort of intend — you know you read that bio and it’s like, oh my! Sounds like someone who has done a lot of things. I just followed the data in a way. You hear a good scientist — I wasn’t a good scientist, but I was like, “Oh, I think hormones are involved. I think I want to learn about hormones.” And not I’m looking into mold, mycotoxins and environmental toxins, which are a huge deal right now. But for any clinicians out there, if there are any, stepping into this once, it’s a journey. And even now, there aren’t really unified treatment programs. But choose one thing to learn, master that, then learn the next thing. So it’s been kind of an interesting journey, actually. Now you and I are close to the same age, I think, I’m about to turn 50 this week. And I was like, “Wow! I graduated from graduate school more than 20 years ago and I never would have expected the path to go the way it did.” It’s weird, it’s just really — it’s been interesting and fascinating and special and it’s really good to be walking the path with people like you. Super cool.

Dr. Nicole Beurkens: 

Yeah, we need a community and that’s the thing, is that there are so few of us doing this type of work but I think what it speaks to, as I hear you talk about that amazing patient story, and just the evolution of your practice and your learning — you are a practitioner who is so committed to helping the people who come to you and people like you and like me look outside of those labels of ‘treatment-resistant’ and say, “Wait a second. What can be done to help these people?” ‘Treatment-resistant’ simply means that what someone has already done with them hasn’t worked. That doesn’t mean that these are people who can’t be helped.

And I love what you said about that, of wanting to bring education and hope to patients, especially those who have been on the merry-go-round of mental health treatment for themselves or their children for a long time, who have been dubbed ‘treatment-resistant’, or have been told — Parents, I see many parents who have been told, when their kids are at a fairly young age, 5 years old, 8 years old, 12 years old — “This is as good as it gets.” or “We’ve done everything, there’s nothing more. Your child is the most complex case we’ve ever seen, there’s nothing that can help them.” And I’m going, “What a terrible thing to say to somebody with an 8-year-old child!” 

Dr. Josh Friedman:

Yeah, and completely untrue. 

Dr. Nicole Beurkens: 

Right.

Dr. Josh Friedman:

The fact is, people can only do as much as they know how to do and we as a field can only do as much as we know how to do. The whole thing with things like the effects of mycotoxins, of mold on human brains, especially children’s brains — this is new information over the last 5 years. That information on the effects — It’s huge, it’s affecting hundreds of thousands of people for sure and there’s only probably 500 doctors in America right now that would even recognize that as a rule out, if your kid came in with very severe conduct problems. So that fact alone is remarkable.

So sometimes, people will come to me — I had a man come to me pretty recently who was a pastor. A young guy, who was severely suicidal and depressed. He had left his home where he has 5 kids and went to his parents’ summer house, and when he left the home for a month, thinking that he just was stressed out and he couldn’t deal with the kids, he got dramatically better. And so what I said to him was, “I think you might have mold in your home.” And he said, “Why isn’t anyone else getting sick?” I said, “I think other people in your home may not have the genetics that would make them susceptible to the mold.” They test for mold in the house and mold in his body. He has huge loads in his body and huge loads in the house. They ripped the walls out, they found it.

And he’s not someone that I could treat because I don’t have the expertise because very few people do, but I made a referral to a doctor. They were actually already engaged at the Amen clinic, and so I said, “Tell the doctor that you have mold.” They did and he’s getting treatment for that. But even though I couldn’t treat that at this point, I felt really grateful for having innate curiosity. I said to him, it wasn’t meant to be arrogant, but I said, “God must be looking out for you.” And I don’t believe in God, but I know he did. “God must be looking out for you because you were brought to me, and even though I can’t treat this, I could identify it. And it would have taken you many, many, many years to get to someone that finally would have asked the right questions.” And I think in some ways it’s about being curious and being humble. I think there are answers to almost every problem. I don’t think there probably is this term ‘treatment-resistant’. I think we just don’t know the right questions to ask when faced with a person and we can’t unravel their case.

So mold is what’s happening now. There’s going to be other stuff — EMFs for sure, but there are all these influences, the brain is so sensitive, the nervous system is so sensitive. Finding the right clinician is so important. Sometimes when I have clients that decide that they have ‘treatment-resistant depression/anxiety/OCD/conduct disorder’ whatever the label is, and they end up going to the Mayo Clinic or something. So we’re in the midwest, the Mayo Clinic has the reputation of being the best diagnostic hospital in this area, probably the country, and sometimes the Mayo Clinic does something amazing — sometimes they discover an autoimmune process that is really interesting, but more often than not, you meet doctors who are the best in the traditional paradigm.

And if you’re going to meet doctors who are the best in the traditional paradigm, they’re going to ask the same questions, only better. They’re going to use the same treatment tools but only better than other doctors. We need a set of doctors that are going to ask totally different questions, and I think that is — probably many of your listeners have heard of functional medicine and I like the definition of functional medicine, it is the medicine of why? Why is this happening physiologically? And if you expand that — why is this happening spiritually? Why is this happening psychologically? What we have to bring to this new inquiry, is why? Let’s not be so sure about things. Let’s be open and permissive and just keep on asking questions like, “Where are people stuck? Is it trauma?”

So on one of my websites, I talk about — if you come to work with us — us is me, I’m only a one-man show, but the idea is we’re going to try to address the problems at the level they are created. So there are people who have psychological issues. Trauma is a real profound thing. Having trauma resolution at work for someone who has acute childhood trauma is it changes everything. It changes physical health. If it’s a physical problem, let’s dig deep and figure out why. And the thing I’ve grappled with is — I can’t do everything, so I’m just trying to do my piece in concert with an army of curious, intelligent, compassionate helpers.

And there are millions, there are so many of them in different fields. I practice humbleness and I try to say “I don’t know” as much as I can, when it’s the right thing to say — or “I’m curious and I’ll find out, we’ll do this together”. We’re in a collaboration to try to figure this out. So I do think it’s a revolution and I think we as mental health providers have something really important to bring to the table, which is: How do you support and hold someone in a relationship? Because everyone that comes to see us is scared, scared for their kids, they’re scared for themselves, they’ve been told that there are no answers, they’re told that they’re going to have a lifetime of this.

I wonder if you’ve had this experience. One of the first times that I went to an integrative medicine for mental health conference, I heard a mom of an autistic kid stand up and say, “My kid had profound autism and now they are in college.” To me, when I heard that — and of course you learn that autism — you can only make it better around the edges with behavioral treatments and what not, but there are physiological underpinnings for lots of very physiologically stuck situations. PANDAS OCD — very profound OCD, to me it’s amazing. I’m not a researcher and I’m not a doctor but I’m curious and I know how to hold space and I know how to ask questions and that’s been my goal, just to humbly help people along. 

Sometimes I’ll work with people who are seeing functional medicine doctors and they are so grateful to have someone to walk the journey with them that understands what they’re going through and understands what their doctor is doing and doesn’t undermine — “Why aren’t you seeing a psychiatrist, why are you doing this? That’s not going to work.” And it’s blatantly not true, obviously.

Dr. Nicole Beurkens: 

And that’s really the paradigm shift and that’s why I wanted to have this conversation with you today, because I want listeners to really start to think outside the box of what they’ve been told about their diagnosis, their child’s diagnosis, what the treatment options are, because the type of treatment that you and I use, this integrative model in mental health is not the norm yet. Hopefully, that’s where we’re headed but it’s not the norm, and so most people are not seeing practitioners like you or like me and what I think this conversation helps to do is expand people’s minds about how to be curious as a patient, and how to start asking questions to find providers who are going to look outside that box.

Especially if you are a parent or an adult who has been, like I said, on this merry-go-round of medication after medication or you’ve done all the different counseling, you’ve been doing the same things and you’re being told “this is as good as it gets” or “this is all there is” — to start to get curious about that and say, “Well, wait a second, what other things could be out there? What might be going on?” Just because this is what we’ve been told by the practitioners that we’ve seen, doesn’t mean this is all there is. Josh and I are talking about this curiosity on our end, as a clinician, of saying, “Hmm, this person is not getting better, what can we do?” I want you all on the patient end of things, for yourselves and your kids to get curios and say, “You know? I think I’m not going to accept that this is all there is. I want to explore more of what might be going on. I want to learn more. I want to find a clinician who is going to ask these questions with me and who is going to look outside the box and see me or my child as someone with greater potential, as someone who can get better if we find the right underlying issues, if we find the right kinds of treatment modalities.”

I love the focus that you’re talking about, Josh, on retaining that hope and that one of the biggest things we can do in clinical practice is to keep hope alive for people — That even if we don’t have the right answers right now, that we can keep looking and that there is never a point — I have yet to feel with any patient I’ve seen in over 20 years that gosh, there just really is nothing left to look into. We’ve had nothing but dead-ends here and there’s no possibility that you can get better. I have yet to encounter that with a patient.

Dr. Josh Friedman:

Yeah, I agree with that. And I’ve definitely run into people I can’t help, but I always know there’s hope out there. And I know — I have a daughter who’s a multi-organ transplant survivor and what I know about that is she’s alive and well and 10 years before she had an intestine transplant, they weren’t doing that. So medical science — had she been born 10 years before, she wouldn’t have survived and now she’s this amazing 16 year old, driving the car and everything. It’s just amazing. To me, that’s a very concrete example of just hope.

It’s like there are lots of smart people out there really trying to create a new paradigm. Nicole and I are just a part of this really cool movement. One of the things is: Where do you look? integrativemedicineformentalhealth.com has a list of people that are open to integrative treatments. I did some training with kind of a well-known biochemist that treats mental health issues named Bill Walsh and he has a very specific set of tests that he runs and treatment protocols. He has an institute called The Walsh Institute. There are mostly physicians in that group, there are a few psychologists and they’re spread out throughout the world. There is also another resource called alternativementalhealth.com, which is Dan Stradford’s organization, they have a pretty good database of clinicians, but there are clinicians — and usually sometimes Facebook, I mean Facebook is good for some things and not good for other things, away from politics, but there are parent groups on Facebook. There are parents that have been through this with their kids. 

Parents, in my experience, having been a professional but also in the world with my daughter in a chronic medical situation — the people that are often most knowledgeable about these sorts of things are parents. Professionals have to do a whole lot of unlearning to create space in their psyches to take on this new information, so they’re often slow learners. Learning a first language is way easier than learning a second language, especially in adulthood. So I found parents are a really excellent resource. Can I say what my —

Dr. Nicole Beurkens: 

Yeah, please do. I was going to say thank you for sharing those resources. I want to make sure that you share where people can find you online as well because you’ve got a lot of fantastic articles and resources.

Dr. Josh Friedman:

So I have a website. I have a couple of websites, but I have a blog site where I post my own articles and there is more information about me and my practice. It’s moodhealing.com and I also have a pretty active Facebook group where I post lots of articles and things that are funny and things on nutrition and integrative mental health and yoga, which is another huge interest of mine, and you can find it through my link.

Dr. Nicole Beurkens: 

Yeah, if they go to moodhealing.com 

Dr. Josh Friedman:

Yeah, moodhealing.com, that’s alternative mental health solution. 

Dr. Nicole Beurkens: 

And what’s the website for your practice?

Dr. Josh Friedman:

I have a local one in Omaha, it’s called omahamind.com

Dr. Nicole Beurkens: 

Okay, wonderful. And those will be in the show notes too for people to access so they can follow along with what you’re doing, your Facebook page is fantastic as are the websites, I hope people will check that out. Josh, we could talk about this for hours, but this has been so helpful and so wonderful in terms of opening people’s minds to the options that are out there and the types of clinicians that are there, so I really appreciate you taking the time to talk to us today, thank you for being here. 

Dr. Josh Friedman:

Can I say one more thing? I think someone — a therapeutic person, like a therapist that understands these things like Nicole or I can be really helpful in thinking through a treatment plan. It might not even include us as clinicians, but thinking — is this a biofeedback situation? Is this a detox situation? Is this a neurofeedback — would yoga and stress management be a part of it here? Because I think one of the hardest things is to know which direction to go. There are lots of good clinicians but thinking intelligently about a treatment plan can make a lot of sense.

Dr. Nicole Beurkens: 

Wonderful, excellent, excellent advice. Could not agree with you more. So thank you, Josh, for being with us today.

Dr. Josh Friedman:

Thank you so much, Nicole.

Dr. Nicole Beurkens: 

Thank you to all of you for listening, that’s it for this episode — we will see you next time on The Better Behavior Show!