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Cognitive Disorders

I have a patient with long-standing depression, episodes of suicidal thoughts. Chief complaints are morning fatigue, bacterial vaginosis, skin issues, and depression. She believes depression can change even after 24 years. Gluten and dairy free for years. Recent labs indicated anemia. Not sure if it’s B12, B6, folate, or iron. She’s responsive to eating more animal protein, which is good. She doesn’t seem to eat enough in general. Her mom requested OAT lab as they’ve tried everything else, including working with a functional medicine practitioner. I’d like your input on the OAT results below and any other thoughts.

Chris Kresser: Well, before we even get into OAT, anemia is absolutely associated with depression. And so if it’s iron-deficient...

Any thoughts about the Feingold diet, which eliminates artificial colors, flavors, preservatives, and foods high in salicylates for ADHD kids? If patient is already on Paleo and not eating grains or dairy, to eliminate salicylates makes the diet very restrictive and hard for a child to follow. Do you think salicylates are a problem for ADHD kids and worth removing to find out?

Chris Kresser: In some cases we have patients with salicylate intolerance, and they do benefit from reducing salicylates. But I...

The client has a very severe insomnia and anxiety for at least 40 years and no gut symptoms. He has a stool test that came back with insufficiency dysbiosis and a few Blastocystis hominis in his three samples. Would you treat Blasto, or is treating the insufficiency dysbiosis enough?

Dr. Amy Nett: Yeah, great question. He has no gut symptoms, but he does have severe insomnia and anxiety. Yes...

Twenty-four-year-old male presenting with depression for seven to eight years but also lethargy and poor digestion after a trip to India four years ago. Doctor’s Data showed susceptible amounts of beneficial bacteria, five species of commensals and 1+ or 2+. 1+ of candida and Saccharomyces boulardii, but Blasto and giardia in all three stool samples. If Saccharomyces boulardii could be used to treat these parasites, is it possible that they could coexist? Patient opted for a course of Flagyl with S. boulardii. Would this be redundant given he already has it, and would you follow with another month or two of herbal antimicrobial parasitic protocol, SIBO results still pending?

Chris Kresser: I would definitely treat the giardia, and probably the Blasto in this case as well, given the symptoms...

Are there any contraindications that you know of to treat with CBD?

Chris Kresser: I think we kind of addressed that. I’m not aware of specific contraindications in the literature, but I...

Do you have any suggestions on resources, books, therapies, where to start, etc., for people who are emotional eaters?

Laura Schoenfeld: So I don’t necessarily have specific resources for that type of topic. The one resource that I am...

I wondered what your thoughts were on mental activity and caloric need. Are there certain people who use their brain so much, whether in a productive way or perhaps constant worrying and overthinking, that it would influence your recommended calorie targets for them?

Kelsey Marksteiner: That’s a really interesting question. I would say that really the only way that would alter my recommended...

How do you approach suggesting dietary changes with a patient you suspect has body dysmorphic syndrome? Do you refer patients to therapists if you suspect an eating disorder?

Laura Schoenfeld: An eating disorder versus disordered eating—we have to be really careful about definitions here because a clinical eating...

Can you talk about supplementing with B12 and why certain types of B12 cause anxiety in people with certain genetic mutations or SNPs. Which specific SNPs are these? Which specific forms of B12 negatively or positively affect these?

Dr. Amy Nett: So this is talking probably a little bit more about methylation. I think that’s what you mean...

One of the case studies during Week 18 included a recommendation to supplement with zinc and vitamin A if a patient is not eating shellfish or liver, for a patient whose chief complaint was anxiety. Patient reported eating a low-carb Paleo diet. Would we assume the patient is not getting enough zinc from other food sources like meat and eggs? How long and in what amount would you supplement with zinc? Also, what’s the relationship between potentially inadequate vitamin A intake and anxiety?

Chris Kresser: With a standard low-carb Paleo diet with no organ meats, probably zinc will be sufficient, but there are...

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