May 5, 2025 • 51 mins
Building on the science of the gut-brain axis, this episode focuses on actionable strategies pharmacists can use to counsel patients on mental health, gut-related medication effects, and evidence-based lifestyle interventions. From tailored counseling tips to supplement and nutrition guidance, pharmacists will learn how to support patients managing both GI and mental health symptoms. Tune in to discover how small conversations can lead to big health improvements in both gut and brain function.
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact
GUEST
Lara Zakaria, PharmD, MS, CNS, CDN, IFMCP
Owner, Founder
Foodie Farmacist LLC
Pharmacist Members, REDEEM YOUR CPE HERE!
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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify evidence-based strategies pharmacists can use to support patients with gastrointestinal issues linked to mental health conditions.
2. Explain how lifestyle, diet, and complementary supplements influence the gut-brain connection to support patient care.
0.05 CEU/0.5 Hr
UAN: 0107-0000-24-154-H01-P
Initial release date: 5/5/2025
Expiration date: 5/5/2026
Additional CPE details can be found here.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Josh Kinsey.
Hey, ce Impact subscribers,welcome back to part two of our
series on the gut-brainconnection.
I'm your host, josh Kinsey, andI'm excited to jump back into
the conversation with LauraZacharia as we continue
exploring the powerful linkbetween the gut and the brain.
Speaker 2 (00:20):
Laura Zacharia.
Yeah, I think I'm going to putit into three categories for us,
right?
We're going to talk about theeducation and the counseling
opportunities and the littlegems, little pearls that we can
drop for our patients to helpthem become a little bit more
aware and start making theseconnections.
Category number two is going tobe counseling points on those
common medications that wetalked about and opportunities
(00:41):
to weave in some guidance talkedabout and opportunities to
weave in some guidance.
And category three is gonna bewhat are the other tools in our
toolkit when it comes tosupplement recommendations,
lifestyle recommendations ordietary recommendations that we
might be able to leverage andwhen that patient has the
education and the awareness andthe willingness to make those
changes, we can also interceptwith those options as well.
(01:04):
We know a lot of patients.
They're more interested in aholistic approach, right?
We know that most of them theywant somebody that they can go
to, that they can trust, thatcan give them recommendations
when it comes to diet lifestyle,that can think outside the box,
that understands how theirmedications are impacting them,
understands how to get the mostout of their medication and
(01:25):
understands how to skirt some ofthe problems, the side effects,
that come along with thosemedications.
So, what we're advocating for isactually the opportunity to be
that standout pharmacist orpharmacy that can be their go-to
, that can be that resource forthem, and I don't know.
That's kind of why I became apharmacist, right.
So here we go.
Speaker 1 (01:45):
That's the root cause of it, yeah.
Speaker 2 (01:46):
Kind of yeah, it's kind of exactly.
I don't know, it's up my alley.
I feel like this is whatpharmacy is all about, so being
that problem solver, being thatgo-to community resource for
patients to maximize theirhealth right.
Speaker 1 (01:59):
Absolutely.
Speaker 2 (02:00):
So number one, counseling points.
So we touched a little bit onthis, but I think worth
repeating again that we want tomake sure that when we're
counseling particularly ifsomebody comes to you because
they are taking an SSRI,considering starting an SSRI,
concerned about their SSRI notgetting the results they want
from their antidepressant rightthat we ask the right questions.
(02:21):
So number one I want you to bethinking about is do they
experience any GI symptoms?
And this might have to beintroduced a little bit to them
because they may not be makingthat connection between their GI
symptoms and their mentalhealth.
And there's a statisticsomewhere about the incidence of
(02:42):
depression and anxiety in folkswho have IBS, and it's about
80% of patients who present witha diagnosis of IBS whether it
be constipation dominant, mixed,or diarrhea dominant about 80%
also have either depression,anxiety or both.
So it's on us to make sure thatthey understand that there is a
(03:04):
relationship between those twothings, right, and to start
paying a little bit moreattention to their body.
If symptoms get worse when theother symptom gets worse, so
their depression gets worse,does their GI symptoms get worse
, and vice versa, right.
So I think that's a greatcounseling point and a great
opportunity to introduce alittle bit of awareness to your
(03:24):
patient and help them start tosee if maybe some of the side
effects they're experiencing totheir gut might be interfering
with their progress in terms oftheir mental health right and
that could be from the SSRIitself, or it can be from
another medication they might betaking.
So, going back to asking them alittle bit more about what else
(03:44):
are you taking?
How do you, you know?
Do you experience headaches andhow do you handle them?
Do you have irregular cycles orirregular periods, and how do
you manage that?
Speaker 1 (03:53):
Right, do you have?
Speaker 2 (03:54):
painful PMS symptoms Right?
Are you taking an oralcontraceptive?
What's your blood work?
What has past blood work saidabout the health of your liver?
Has that other you know?
Have you ever had issues withyour thyroid?
Have you ever had issues withyour insulin?
Do you experience insulinresistance?
Speaker 1 (04:11):
Do you?
Speaker 2 (04:11):
have pain, joint pain .
Speaker 1 (04:14):
Sure.
Speaker 2 (04:14):
Right, because joint pain is a marker of inflammation
or causes more inflammation.
Inflammation is also a driverof depression, anxiety and GI
issues and vice versa.
It's also sort of playing inthat same pool and changing the
microbiome, changing our immuneresponse and altering some of
our hormonal signaling too.
So all of these questions canstart to.
(04:35):
You're not necessarily eventrying to get to a solution yet,
but even just starting toexplore and help them start to
see the relationship and makethe connections.
Pain, joint pain in particular,is a very common manifestation
of depression, right, and theymight notice when their
depression gets worse, theirpain gets worse and kind of
almost reinforcing.
It's not in their head and thatit's a little bit of the
(04:59):
chicken or the egg.
The two are driving each other,and so that might be a way for
them to really check in withtheir body and see how their
depression is showing upphysically and not just
psychologically.
Speaker 1 (05:08):
Yeah, laura, I'm going to stop right here for one
second, so we're at 30 minutes,but I feel like you still have
a lot to give.
Speaker 2 (05:17):
Yeah, I could probably do it in like 10 to
kind of wrap up those threepoints.
Speaker 1 (05:21):
Well, what I'm thinking is if you do it in like
10 and then maybe we have fiveminutes of like a debrief and
whatever yeah and I'm just goingto make this two episodes.
And right from you, right whenyou started saying I have three
points to share, was that almostlike the 23 or 24?
Minutes, so maybe that's likeone, I'll just make it like,
I'll be like and come back forthe next episode as long as you
(05:41):
feel like it's good stuff so myonly question was are you okay
to continue?
Speaker 2 (05:48):
Yeah, I have time yeah.
Speaker 1 (05:55):
I always buffer myself.
I know, okay, okay, well, let'sjust do that.
No, this is great and it'sactually super helpful to just
to get another episode out of it.
Speaker 2 (05:59):
Great, I'm happy to you know what I was doing you a
favor, Josh.
Speaker 1 (06:02):
Yeah, no, seriously, you are.
Yes, very much.
Okay.
I'm just going to tell myperson to um.
I'm just going to tell Allie toum cut out a little bit of that
in the center, okay.
So let's start um.
Let me just go back tosomething on my lips.
Yeah, okay, so we were at um.
What was your?
What was your second bucket?
Speaker 2 (06:30):
So the second bucket I was going to talk about uh, I
said medications and thenlifestyle stuff.
Speaker 1 (06:32):
Um so bucket number one is counseling tips bucket
number two are things that wecan do when it comes to their
medications.
Okay, I'm just gonna say circleback to bucket.
Number two is that okay?
Speaker 2 (06:37):
yeah, go for it.
Speaker 1 (06:38):
Okay, all right, laura, that was great, that's so
good.
So now let's kind of circleback to the bucket number two
that you mentioned before.
Some more of those.
You know super great tips forpharmacists, so I'll let you
have the stage again, becauseyou're just giving us so much
good info, so have at it.
Speaker 2 (06:54):
Thank you.
So we talked a little bit inbucket one about kind of
creating awareness, starting theconversation, starting to build
that rapport with your patient.
Speaker 1 (07:03):
Right Asking the right questions.
Speaker 2 (07:05):
Asking the right questions.
Now, bucket number two mayhappen in the same conversation
as those counseling points innumber one, or they might
require a few contact pointswith your patient, depending on
where they are, because,remember, when it comes to
depression and anxiety, they'renot always ready to jump right
in with a change right.
It might feel overwhelming,they might not feel motivated in
that moment, they might feellike they're a little lost or
(07:28):
they just want to do their ownresearch or, frankly, they just
want to wait on it a little bit.
So it's really important to keep, or they may not be ready to
talk about it or want to talkabout it exactly yeah, there's
still a big stigma when it comesto mental health and I'm
finding that, although we'vecome a long way, there's still a
significant stigma and I findthat patients, even when they
(07:51):
start medication, they're oftenreluctant or there's a shame
around it.
So just being able to talk aboutit in a way that doesn't shame
them and that never makes themfeel like the fact that they
decided to start this, they'regiving up or even framing their
human or it makes them changingwho they are, or anything Right,
right right, exactly, exactly,and so, even when you're
(08:14):
offering other solutions oryou're offering complimentary
solutions, it's really importantthat we're sensitive in the way
that we're presenting it, notthat it's a failing or it's a
repercussion of the decisionthat they made to take or not
take medication, but that ratherit's just more options for them
to make an informed decisionabout their health and to
empower them, and I think that'sa really, really important
(08:36):
counseling point yeah, I lovethat, yeah, so as we're
transitioning, then, andthinking about the medications.
we're going to start with theobvious thing, and that is the
SSRI itself.
Let's say they're taking anSSRI and they're not feeling
like it's working optimally.
You're going to do all thebasics in terms of making sure
that the timing is correct, thatthey are taking it consistently
(08:59):
, that the dosage is appropriateright, Making sure that it's at
the correct dose.
Sometimes there's amiscommunication they may get
started on a starter dose butthey've never gotten to their
optimal dose, right?
So, just making sure all thosethings are in place, that they
have the most appropriate SSRIclass for their condition and
that they're also gettingcognitive behavioral therapy or
(09:20):
some access to some form oftherapy whether it be talk
therapy, somatic therapy, etcetera to complement that SSRI.
I think to think that the SSRIis going to be this magic bullet
that does all the work.
It's really more like a crutchthat's going to get them to the
point where they're ready to dothe additional work that they
need to do, and it's reallyimportant to remember that that
(09:41):
is part of the guideline andthat is part of the counseling
recommendation when it comes tousing SSRIs.
And this is your chance to jumpin and say okay, I actually, if
you've been taking this now fortwo months, you're not
experiencing benefits.
I don't see a reason why it'snot working to make that
recommendation to say, let'scall your doctor and talk about
an alternative medication or asecondary medication to address
(10:04):
xyz symptoms.
Remember, that is your job astheir advocate, as their
pharmacist, so keep that in mind.
Okay, number two uh, if you havethat conversation with them and
it turns out that they've beentaking a ppi for a really long
time or that they experience giissues.
They happen to have either IBSor GERD or some other GI issue.
(10:26):
I think this is the opportunityfor us to start to address that
, so addressing and screeningwhether the PPI itself or the
long-term use of that PPI isappropriate in that patient.
There are situations wherelong-term PPI use is indicated.
I'm not going to get into those.
But if it turns out thatthey're using it because they
(10:49):
have not been either fullyevaluated or they have been sort
of using it as a crutch orunaware of the fact that it's
not intended for long-term useand that there are repercussions
on our microbiome balance, onour pH, on our ability to absorb
certain nutrients, and thatthere are long-term
ramifications and neurologicalramifications associated from
long term use of PPI, this isyour opportunity to gently
(11:12):
educate them on that and in myexperience a lot of people with
depression and anxiety tend toalso have GI issues.
Again, it's that gut feeling.
They're feeling it in their gutand that very often they're not
making that connection betweenthose two and they're not aware
that there's alternatives.
(11:32):
So I'll cover the alternativesin the lifestyle diet piece but,
having that conversationdeliberately about the use of
PPIs, coming up with a plan or aprotocol or strategy to get
them off.
The PPIs might be appropriateat this point.
Speaker 1 (11:46):
Yeah.
Speaker 2 (11:47):
Number three NSAID use.
This one is a big one because Ifind that a lot of people again
they have depression they'reusing a lot of NSAIDs.
Maybe they have hormonal issuesbecause, again, your hormones,
your sex hormones, particularlyfor women, if you're
experiencing pms, pmdd symptoms,etc.
You're very often relying onnsets in order to get through
(12:10):
the day.
Frankly, yeah, there's also atrend now I'm seeing this a lot
on social media where women areresorting to using pepsid
because pepsid has a a.
We know it's not anantihistamine, but it has an
antihistamine effect becauseit's a non-selective history,
histamine block and there's arelationship between excess
histamine production and excessestrogen production, and that
(12:33):
causes more PMS or morepronounced PMDD symptoms.
So they're finding that using aPepsid is a way for them to
manage that.
Again, similar to PPIs, it'snot intended for long-term use.
Some women only use it duringthe days leading up to their
period.
Some women are using it allcycle long.
Some women also have GERD, sothey're using it for their GERD
and they're finding it as like atwo-for-one deal.
(12:54):
So, again, an opportunity totalk a little bit more about
things that they may not thinkare related to their mental
health, but are very much adriver not only of their mental
health, but of the decisionsthey're making around
over-the-counter medicationsthat might be having an impact
on their gut health.
That's then having an impact ontheir mental health.
Speaker 1 (13:14):
Yeah, yeah, wow.
And you think about all thetime.
You hear someone say thatsituation made me sick to my
stomach, and so if you thinkabout what that connection is,
it's the anxiety or the fear ofwhatever was happening and they
literally get sick to my stomach.
Or, and so if you think aboutwhat that connection is, it's
the anxiety or the fear ofwhatever was happening, and they
literally get sick to theirstomach because of that
connection.
And you know whatever washappening, they get diarrhea or
they get nauseous or whatever.
(13:35):
Yeah, so yeah exactly or or.
That gird that reflex feelingthat you got when you're really
stressed out about something.
Speaker 2 (13:42):
I have found, found in my experience.
I cannot successfully getsomebody off a PPI or get them
successfully managing their GERDuntil I get their anxiety under
control, and vice versa.
Speaker 1 (13:53):
I feel very seen right now, laura, I got you,
josh, I got you.
I've been on a PPI for a verylong time and I just, every time
I try to go off of it.
I think also the anxiety ofgoing off of it and what would
happen.
Speaker 2 (14:07):
Yes, probably makes it worse and and also the gird
is sort of a symptom of theanxiety right, that's what I
mean.
It's just, it's just feedingitself, and then you think about
the reflux you're going to getwhen you stop the ppi, and that
gives you anxiety.
And then exactly.
Speaker 1 (14:22):
So then I just stay on it.
Yeah, and I have for almost adecade Exactly.
Speaker 2 (14:26):
And so we are talking to you, josh, we are talking to
you.
Speaker 1 (14:30):
This whole conversation is mine.
Yeah, absolutely.
Speaker 2 (14:33):
And this is why I think it's so.
It just goes to show thishappens to the best of us, this
happens to so many people, right?
So it's very important for usto keep in mind that there's a
lot of people that are gettingdiagnosed for depression and
anxiety, but there's even morepeople that don't have that
diagnosis, that aren't evenaware.
(14:54):
So I keep talking about thepeople that are coming to you
and are telling you and or youknow from their prescriptions
that they're suffering withdepression or anxiety.
But what about all the peoplethat maybe it's just a little
surface level, maybe it's notsignificant enough to be
considered diagnostically, right?
Speaker 1 (15:11):
Or maybe they're just dealing.
They're exactly.
Speaker 2 (15:14):
They're embarrassed to talk about it or they think
that they need to just getthrough it power through it.
Whatever exactly hold it in,tough up.
You know, toughen it up right.
There's all these people.
So what an opportunity to thenhave a conversation about the
folks that are telling you thatthey're always in pain, that
they're taking a lot of NSAIDs.
They're telling you that youknow they've been on a PPI for a
(15:37):
decade and they're afraid toget off of it because their GERD
comes back.
What an interesting opportunityto talk to them about their
mental health and what are thestrategies that they're using to
manage their stress and whatare the tools or the resources
or the community that they havein order to help manage that
stress as well.
Speaker 1 (15:53):
Yeah, yeah, super helpful, super helpful, all
right.
So you talked about a thirdbucket and you tease this with
that.
So let's talk about what.
What is another opportunity forus as pharmacists?
So what, what places in that?
Speaker 2 (16:06):
bucket.
So the third bucket happens tobe my favorite bucket.
Because, to me, this is where wereally have the opportunity to
shine and to really show ourpatients something that they
either may not be aware of ormight be intimidated by, and
that is the lifestyle piece.
This is where we also can talkabout diet with them, we can
talk about habits with them, andwe can talk about supplements
(16:29):
and alternative medicine withthem, and to me, this is what
really sets up part of greatpharmacists that has all the
right counseling points, thatcould talk about drug
interactions and that can reallylike make sure that their
patients are safe from a drugsafety perspective, from an
awesome pharmacist that not onlycan hold space for all those
things and then take it to thenext level and give them
(16:52):
additional, complimentary, safeand effective advice.
So this is why this is myfavorite bucket, because to me
this is really empowering, notto just us as pharmacists, but
to our patients as well, thatnow can see you as this like
awesome resource.
Speaker 1 (17:05):
On their healthcare team Right yeah.
Speaker 2 (17:08):
So now number one um, we're going to start with diet,
because the foundational dietcannot be ignored.
That said, people withdepression and anxiety aren't
always really super motivated tobe eating healthy.
We talked a little bit aboutfolks that might be on a GLP one
agonist, that might also beexperiencing like I don't really
care what I eat right nowbecause I'm losing weight, I
feel okay.
My doctor says my numbers lookgood.
(17:29):
I'm not really motivated to eathealthier.
Why should I be eatinghealthier?
So, this is where we starttalking about nutrient density,
we start educating about theimportance of feeding the
microbiome with fiber and withpolyphenols, and I always talk
to my patients from theframework of eat the rainbow,
eating colorful variety andreally, rather than sitting
(17:51):
there and focusing on how manycalories did you take in, how
many grams of protein did youhave?
How did you do in terms ofgetting in enough XYZ nutrient?
That's a little pedantic formost patients, right?
Most of them are busy people.
They're not.
Speaker 1 (18:08):
I'm a nerd, I like that stuff, but they may not be
into it.
So to me Well, and it alsomight be off, putting in a sense
of like I don't have time forthat, I don't want to measure my
food, or you want me to likestart, like putting it in an app
.
Speaker 2 (18:17):
I'm not doing any of that, right?
But when you start talkingabout qualitative things, so the
two kind of go-tos that I havedepending on the person I'm
talking to is I have them.
Either I talk about colorfulfood and how to build a plate
that's colorful and then supportit with some protein, and that
usually gets us talking abouteating a variety of fruits and
vegetables.
It gets us talking aboutincreasing their fiber intake,
(18:39):
and then I go pair that with aprotein, and then I just educate
them on what a protein lookslike, on what their typical
habit, what they like, you know,and to me it's very much
agnostic, right, because itdoesn't matter what cultural
background they come from, itdoesn't matter what their
philosophy around, you know,their carnivore, vegan or
whatever like it's.
There's something that I cantalk about that is relevant to
(19:00):
their, to, to their philosophyaround, and what I'm talking
about essentially is theliterature that talks about the
more variety that we have interms of our diet, the more
color, the more phytonutrients,polyphenols, et cetera that we
introduce into the diet that'ssignified by those variety of
colors the better we feed themicrobiome.
(19:22):
Remember how I talked about thedifferent neighborhoods and the
different little bugs that livein the different neighborhoods
and how much of them we needrelative to each other.
That variety of color is one ofthe best ways to predict the
variety and the volume of thosehealthy, good, commensal, good
bacteria right, so we feedeverybody in the neighborhood
(19:42):
with multiple colors.
It's like a food program forthose, the microbiome right so
exactly, and the more diversityof color, the more diversity of
microbiome.
Super simple concept it's veryvisually appealing it.
The prettier your plate, thebetter.
I used to.
Um, I used to have a tool formy kids patients, where I would
have them fill in a rainbow and,like every meal they would like
(20:04):
fill in the color of therainbow and their goal at the
end of the day was to have thewhole rainbow colored.
And the kids would get superexcited and they'd be like I
gotta find a blue food, mom, Igotta find like, a purple food,
and so you get super excitedabout it.
And then I realized the parentswere really stoked on it.
So I started doing the samething with parents I just made
it a little bit more adult.
So rather than coloring in arainbow, I started just telling
(20:26):
them to start to pay attention.
I gave them a tracker to payattention to the amount of color
that they're having.
Speaker 1 (20:30):
Hey, don't look to color too.
They really do yeah exactlyExactly.
Speaker 2 (20:36):
So I just take, take the same and honestly, sometimes
I'm like do you want thecoloring version?
Cause I totally can give thatto you if you want to download
that and color it in yourself sothat a hundred percent and it
serves as a um cause.
Coloring is also supposed to bea great like stress reliever,
so two for one deal right.
And really visual, takes us awayfrom the calorie counting and
(20:57):
the worrying about am I gettingenough?
X, y, z?
And yeah, sure I want to makesure you're getting enough
protein, because protein issuper important for the
production of thoseneurotransmitters as well,
particularly complete proteinthat have enough of tryptophan
and tyrosine and phenylalanineand iron sources and foods that
contain zinc and things like Bvitamins.
These are all really importantbecause those help shape and
(21:20):
make those neurotransmittersthat we need and help balance
our blood sugar at the same time, which also can impact our
mental health status.
But at the end of the day,again, lowest hanging fruit pun
intended is to make sure thatthey're just aiming for colorful
variety and pairing it with aprotein and as they're feeling
better and more motivated, wecan have deeper conversations.
Speaker 1 (21:40):
Yeah, and you know, laura, I think that you know
this is no tea, no shade, butfor the majority of our
listeners they're they'reprobably not trained dietitians
like you are also a pharmacist,so you know, I think,
understanding that you don'thave to be it's.
You know the the informationyou can share is is minimal, as
(22:02):
minimal as keep it colorful,make sure it's got a protein in
there too, and then when they,if they master that and they say
I have colorful plates and Iwant to learn more, then connect
them with a nutritionist, witha dietician.
You know, have someone on yourteam that either is that, or
have a person that you partnerwith in your store that you say,
(22:23):
okay, I've got a patient whothey're ready to to make some
changes and some decisions.
Speaker 2 (22:27):
And it doesn't have to be that complex.
You can simply up-level that tothe Mediterranean diet.
So if you're comfortabletalking about the Mediterranean
diet, that's actually also hadbeen proven to be just as
effective as medicationintervention in improving mental
health scores.
Speaker 1 (22:46):
So the.
Speaker 2 (22:46):
Mediterranean diet.
There's actually a trial from afew years back called the SMILE
study that actually had a groupof participants as a RCT trial.
So there was a group that hadthe interventions alone and the
group that had it with theMediterranean diet, and it was
modified specifically for thistrial, and the group that had
(23:06):
the Mediterranean dietintervention outperformed the
other group leaps and bounds.
So it's really like it is atruly effective strategy, but
again, that might not be wherethey're at today.
Speaker 1 (23:18):
Right, right, I mean, they may not be ready to talk
about exactly what I should beeating, but to give it from a
from a, you know, high levelview.
Just say keep it colorful, adda protein.
Here's what colorful means.
And you know, I feel like,after listening to what we just
talked about, any pharmacist cando that, you know, like that's
(23:39):
super easy to do.
And if you don't feelcomfortable going to the next
step or having the nextconversation, do have a
partnership already formed towhere you can send them to a
dietitian and a nutritionist oryou know whatever.
I mean, offer your office spaceto a nutritionist to come in
twice a week and meet withpatients exactly, exactly
(23:59):
there's opportunities there foryou to continue to build a
service for your patients andagain you still look like the
winner as the pharmacist,because you made that initial
connection and then you passedthem off to get more information
.
Speaker 2 (24:12):
Absolutely, and I'm going to plant a seed here.
I'm going to come back to itwhen I talk about supplements,
but if they're not willing tomake the dietary changes, there
are supplements and ways that wecan kind of like bypass that
initial hesitation.
Speaker 1 (24:25):
And.
Speaker 2 (24:26):
I'm going to come back to that, so keep in mind
even have the conversation,because I'm always a believer in
having that foundationalconversation with them, because
you cannot outrun an unhealthydiet.
There's been studies that alsoprove that diets are high in
ultra processed foods, high inhigh carbohydrate, low fiber
diets, low protein diets allcontribute to depression and
(24:46):
anxiety as well.
So we don't want to ignore thatresearch because we're leading
with evidence here, butsometimes they're not ready for
that.
Speaker 1 (24:54):
They just don't have the motivation or the capacity.
I mean, maybe they're stillreeling with the idea that I'm
suffering from depression andanxiety or I'm going through
this or whatever.
I had a patient.
Speaker 2 (25:06):
part of her anxiety was feeling like she was never
good enough and she never mether parents' expectations or her
husband's expectations.
So she refuses to cook, becausecooking is a trigger for her,
because she's always worriedshe's going to mess it up Like
that something's going to gowrong and she's going to mess it
up.
That's a real trauma, right?
So?
Speaker 1 (25:24):
I'm not going to.
Speaker 2 (25:26):
It's a vicious cycle, because then if she does mess
it up or somebody gives hercritique or she doesn't like it,
that's going to just make herless likely to try again.
So until that's addressed atits root, me telling her just
try, let's see what happens nobig deal, is dismissive and,
frankly, is not trauma informed.
So, yes, we do always want tomeet the patients where they're
(25:48):
at.
Sometimes they're ready for it.
We want to give them the lowestpossible low hanging fruit
option.
Speaker 1 (25:54):
There are.
Speaker 2 (25:54):
there's so much that we can frankly explore in this
conversation in terms of likethe nutrient density and why
Mediterranean diet works and allthose things, but we need to
also keep in mind that noteverybody is ready for that.
So let's start there, and thenI think of the supplements as a
way to bypass that, to get theimpact, get them feeling better,
get them past that, and then wecan start having more
(26:17):
meaningful conversations arounddiet and lifestyle.
Speaker 1 (26:19):
Yeah, so diet is the first level, the cornerstone.
So what would you say is thenext step?
Speaker 2 (26:25):
Two is going to be lifestyle.
There's again I'm trying tosimplify this conversation, so
keep that in mind.
So anybody out there who's likeshe forgot to talk about, keep
this in mind.
I'm trying to simplify itbecause there's environmental
factors, there's going to bestressors that that patient
can't get to.
Socioeconomic factors right,there's a lot of layers to this,
right, trauma, like we talkedabout in that example.
(26:47):
But just honing down on movement, sleep and stress management
right, those are reallyessential.
What it looks like for thatindividual is going to look a
little bit different, butessentially, getting them into a
routine that gets them on aregular rhythm throughout the
day, that addresses theircircadian rhythm, that we're
ensuring that they are waking upat a regular time, going to bed
(27:09):
at a regular time and thattheir cortisol and their
melatonin are offsetting eachother.
Excessive blue light exposureat night not only impacts our
cortisol response and impactsour melatonin production.
Overnight impacts our sleepquality, is also going to impact
our mood the next day, not justbecause you didn't sleep well
(27:29):
and you're cranky, but you'realso going to experience altered
mood as a result and the shiftin those chemicals.
Right?
Speaker 1 (27:36):
And when you say blue light, I'm assuming you mean
looking at your phone or youriPad before bed.
Speaker 2 (27:40):
Yeah, I'm not going to make a lot of friends saying
this, but scrolling on yourphone, scrolling through the
phone right before you're tryingto fall asleep, falling asleep
to the TV, having too manylights on at night even all of
that is stimulating blue light.
Blue light sends signals to thebrain that this is daytime and
it's very confusing to the brain.
You know what you can do.
(28:00):
You can listen to a podcast.
So there's that A littlealternative.
A little podcast, an audio book, those are all fine.
Speaker 1 (28:09):
Well, I hope we don't put them to sleep though.
Laura, I hope we don't put themto sleep.
That's a very excellent point.
Speaker 2 (28:15):
But that's really important Then countering it
with blue light in the morning.
So part one is limiting bluelight exposure, at least one to
two hours before bedtime.
I would say the longer thebetter.
And part two is getting bluelight exposure in the morning.
That means getting eyes onsunlight don't stare at the sun,
but getting eyes on sunlight sothat you are getting the blue
(28:37):
light to the brain and you'resaying hey, brain, this is what
real blue light exposure lookslike.
Wake up, let's get thingsmoving, because we want cortisol
to gradually rise.
So it starts around 5, 4, 5 am.
It gradually rises.
It hitsa peak at late morningand then it's supposed to dip
low enough around 4 pm wheremelatonin is like okay, cool,
(28:57):
let me come out I'm going totake over.
Yeah, exactly, and so those,those are largely dictated by
blue light and then red lightexposure.
And so another thing you coulddo is potentially that's another
thing that you could do ispotentially use red light
exposure.
So there's like red light bulbsthat you can use and there's
(29:19):
actually light machines thatfolks can use, where it will
automatically change the lightin the room and they can use a
blue light in the morning and ared light at night and that
could help to reset theircircadian rhythm.
That is going to go a long wayin improving not only their
sleep quality, but that is aform of stress response and
stress support.
Obviously, there's other thingsyou could do.
(29:41):
There's talk therapy, which isobviously kind of the gold
standard when it comes tosupporting patients who are on
SSRI, but there are also otherstress management techniques
that you can talk to yourpatients about Simple box
breathing techniques, forexample, taking a walk outside.
I like to combine the morninglight exposure with an
opportunity to take a walkoutside and to get some exercise
to get a little bit of movementand if you have the luxury to
(30:04):
be able to get into nature, soif they live near a park or an
area that's grassy or has trees.
The actual exposure to naturehas also been shown to reduce
stress and to improve stressresponse as well, and is a great
way to manage mood.
Speaker 1 (30:19):
Yeah, yeah, wow.
It's also a great way to getsome pollen in the spring.
Speaker 2 (30:25):
Absolutely Very good point.
Speaker 1 (30:28):
Good or bad, but very good point.
No, I love that and I love.
I love the idea of you knowagain, hopefully, as pharmacists
, we're trying to give theinformation in those bite-sized
formats again, because ourpatients are not always ready to
be overloaded with everything.
But I love the idea of hey, youcan kill two birds with one
stone.
I would hate that saying and Ithink that's the best one.
Speaker 2 (30:51):
It's a little violent to birds.
Speaker 1 (30:53):
Maybe I should come up with another one, anyway, um,
anyway, addressing two thingswith one, by getting the
cortisol and by also moving, andso I love the idea of doing
that.
You know, brisk, walk in themorning or exercise in the
morning outside, especially, youknow, as we get um better
weather, but um, that's a greattakeaway.
(31:14):
That's a great takeaway rightthere is that, if you can get
them to avoid, light at night towake up in the morning, get
outside and take a walk.
Speaker 2 (31:18):
You've addressed sleep, you've addressed stress
and you've addressed movementyeah, that's great.
Speaker 1 (31:23):
Yeah, easy peasy, okay, easy peasy.
Speaker 2 (31:26):
So that allows us to now move into complementary
support.
So there's so many nutritionalfactors that impact our mental
health, so keep in mind we'regoing to kind of go through them
.
You don't need to do all ofthem all at once.
Use your instinct and yourunderstanding of the situation
(31:46):
to sort of make thatrecommendation.
But no, you have a ton ofoptions on your proverbial shelf
or on your bookcase or in yourtoolkit that you can pull out
and use to support your patients, and sometimes that's going to
be conditional and sometimesit's just going to be like
you're going to come up with aprotocol that you see works.
And that is where, you know,the fun of clinical practice
comes in.
So I'm going to go back andaddress what happens.
(32:08):
When you've got someone who'snot willing to make the dietary
changes foundational dietarychanges.
What do we do?
And I would recommend a medicalfood that has a good amount of
protein in it, that might evenhave some polyphenols in it or
some anti-inflammatoryingredients in it, and there are
some that also have a prettydecent amount of basic nutrients
(32:30):
vitamins, minerals that can bereally useful.
So a good example of that, onethat I actually use often, is a
product called MitoCore fromOrtho Molecular, and I use that
one because it was studiedspecifically for people who have
chronic fatigue.
Chronic fatigue's hallmark isinflammation uh, you know,
(32:55):
fatigue, difficultyconcentrating.
They mimic a lot of the symptomsthat you'll see in folks that
have depression and anxiety, andthe takeaway here the
ingredients are really going tobe helpful, especially if you're
using the protein form isyou're going to get a protein in
them.
They can make it quickly into ashake, so it's super easy.
They can either make a fancysmoothie or they can just mix it
with water if they want, andthen they're going to get things
like magnesium, b vitamins,zinc, um, all the major you know
(33:17):
the main nutrients that theyneed to power their mitochondria
powder, the neurons, and it'sgot a few antioxidants
resveratrol, egcg, etc.
So I say that because there's afew different formulas that you
can look at, things like ag1,which is like that greens powder
formula.
There's a bunch of differentgreens products.
There's things like whey proteinthat you can use and you can
(33:39):
combine them and, depending onthe patient, what they're
willing to do you might findyour favorite combination to
recommend or a one go-to option,but that's essentially what you
want to look for.
You want to look for protein toget their day started.
You want to look for somepolyphenols, antioxidants, and
then you want to look for a good, balanced multi-nutrient that's
(33:59):
going to be well absorbed,because not all multi-nutrients
like most of ourover-the-counter common you know
, common multivitamins don'tabsorb very well.
They're actually also don'thave a high enough concentration
of most of the nutrients thatwe're looking for.
So, keep that in mind.
They tell you oh, I'm alreadytaking a centrum or one a day,
(34:20):
Just make sure that they areeating adequately enough that
they don't need a more robustmultinutrient.
So that's my one go-to Like.
If they do nothing else andthey can at least do that, I can
get them on a baseline.
That's usually a great startingpoint From there.
Fish oil, or thinking aboutinflammation.
So fish oil is one of the moststudied interventions when it
(34:41):
comes to depression inparticular.
But fish oil omega-3s can bereally helpful for improving
inflammation and thereforeimproving mental health.
Fish oil can also change themicrobiome.
It can have a positive effecton the microbiome as well.
This is actually more recentresearch.
So a high-quality fish oil canbe a really great intervention
(35:04):
intervention.
This is where I'm prettystaunch about a high quality,
because if there's contaminants,heavy metals, if it is been
processed in a way that altersthe quality of the fat and
denatures it, or if it is intransport it's getting
overheated, et cetera that'sgoing to have a very.
(35:25):
Not only it's not just going toneutralize that fish oil, it's
going to have a very.
Not only it's, it's not justgoing to neutralize that fish
oil, it's going to actually makeit more inflammatory.
Speaker 1 (35:30):
So I'm very like.
Speaker 2 (35:32):
this is the area where I'm like, if they're going
to splurge on anything, this iswhat I want them to splurge on.
Everything else, I keep kind ofusually find a low cost
alternative, but this is the onethat I'm pretty bull on.
Like we have to have a highquality fish oil, so that's one
one kind of like pearl to tokind of keep in mind.
And if you're noticing somebodyis taking a fish oil and
they're not getting the benefits.
Speaker 1 (35:53):
Explore whether or not it's a high quality fish oil
Exactly If they're getting fishburps from it you should never
get fish burps from it.
Speaker 2 (36:00):
That's a low quality fish oil right there.
Speaker 1 (36:02):
Yeah, yeah, that's good feedback.
Speaker 2 (36:08):
Yeah, the third intervention, which is, I feel
like, pretty baseline, ismagnesium.
Magnesium is a great go-to.
Honestly, most of us aredeficient in magnesium.
Most of us can actually use alittle bit more magnesium.
Depending on the form ofmagnesium, we could see
different benefits.
So I usually recommend amagnesium glycinate or a
magnesium threonate.
When it comes to depression,anxiety, glycinate could be a
little bit more relaxing.
(36:28):
3 and 8 has better absorptionneurologically, so you have a
more direct brain effect whichcan be relaxing, can also
support sleep, can also supportanxiety, et cetera.
So either of those 3 and 8tends to be a little bit more
expensive, so glycinate tends tobe a little bit more affordable
and I can kind of play with thedosage and see what's working
(36:49):
for them.
And that, to me, is animportant baseline intervention
for most people, especially,though, if they're experiencing
insulin resistance.
They're pre-diabetic, diabetic,they're on that cardiovascular
risk spectrum.
Super important intervention.
And I find it very useful againif they're experiencing sleep
disturbances, either because oftheir mental health or vice
(37:11):
versa.
Speaker 1 (37:12):
Yeah.
Speaker 2 (37:13):
The next one is vitamin D.
There is a very strongconnection between low vitamin D
and increased risk ofdepression, in particular, and,
to a smaller extent, to anxiety.
So making sure that we'remaintaining adequate vitamin D
levels.
It's not the main reason thatwe experience seasonal affective
(37:33):
disorder, but is a contributorto seasonal affective disorder.
So making sure that they haveadequate levels I call adequate
over 40 on their blood work.
So making sure that we'rechecking their blood work and
seeing where it's at and thendosing them appropriately to
ensure they get hot.
they get, uh, optimize theirvitamin d levels okay magnesium
helps to optimize that vitamin dlevel, by the way.
(37:55):
So we go back to magnesium andI usually pair uh vitamin d3
with k2 for better absorptionand utilization and conversion
of that vitamin d.
Okay, okay that's a lot.
That's a lot.
I've got one more for you.
Speaker 1 (38:10):
This is so good One more for you guys.
Speaker 2 (38:13):
The last one I'm going to mention is probiotic.
Okay, there's a ton ofdifferent probiotics on the
market.
There is some evidence thatsuggests that the use of
probiotics can help to improvemental health is specifically,
anxiety and depression scorestend to improve.
However, it is more stronglyassociated with certain strains
(38:35):
of probiotics.
So where you might see ageneral probiotic, one that has
multiple strains, do okay withsome people, especially if they
have a pretty significantdysbiosis if you really need a
targeted approach, then you needto be more strain specific in
how you prescribe that probiotic.
So the species that's mostassociated with particularly
(38:57):
depression is Bifidobacterlongum 1714.
That specific strain ofbacteria has been shown to be
really effective or reallyhelpful for improving depression
and even sleep disturbancesassociated with mental health
status.
There's a particular productthat I know has this in
(39:17):
combination with saffron, and Iwant to highlight this for two
reasons.
Number one we have nightmaresabout St John's wort, because I
remember being warned so muchabout all the drug interactions
with St John's wort, because Iremember being warned so much
about all the drug interactionswith St John's wort right.
We all remember it's absolutelyno-no to give St John wort with
anybody who's on an SSRI, so weall know that.
However, what St John's wortalso does is it acts as a
(39:39):
natural SSRI.
So although in a person who ison an SSRI, or maybe on multiple
medications, that may not be anoption, st John's wort is a
great option in those cases.
One with less drug interactionsand less risky is saffron.
And saffron as an extract hasbeen shown to be as effective as
not necessarily new generationSSRIs but old antidepressants,
(40:03):
so things like trazodil andritazapine et cetera has some
really good benefits in terms ofmood regulation.
And there's a particularproduct that combines the
bifidobacterium longum with asaffron that has been shown to
target specifically serotoninproduction in the gut.
First warning if they are anSSRI, be mindful of that
interaction.
(40:23):
Second warning is not everybodynecessarily does well with that
on its own, but I have founddifferent combinations of those
probiotics to be helpful, butthe most effective in my
experience has been the straight, specific probiotics.
Speaker 1 (40:38):
Sure, sure, wow.
Well, this is so good.
I want to try to debrief alittle bit and just make sure
that I know our listeners areprobably well, probably about
halfway through.
They decided to pull out a penand paper and take notes because
you were giving so much goodstuff, but some of them may be
in a position.
(40:58):
I hope if you're driving,you're not taking a pen and
paper.
Please don't take notes ifyou're driving yeah please don't
do that, just listen to theepisode again.
But I want to try to debriefand kind of do like a summary.
If you don't, yeah, let's do it.
So basically, just kind ofstarting over, and this being a
two-part episode series, thefirst part, where we really kind
(41:20):
of dug into the gut and thebrain talk, they talk, they
chit-chat all the time.
There's multiple pathways inwhich they discuss things.
They affect the two of themtogether affect our mood, our
cognition, neurological healthin general.
There are a lot of.
We also broke down microbiomein the first episode and so we
talked about exactly what thatis, the multiple neighborhoods
(41:44):
that are involved in thatprocess, and then we talked a
little bit about some of themedications that commonly are
kind of interacting with thatand things to kind of be on the
lookout for.
And then you gave us thesethree buckets at the end of the
first episode, which we teasedand made you come back and
(42:04):
listen to the second episode andso just quickly remind us of
just the overview of those threebuckets and just like the quick
take home from each as justlike a summary.
Speaker 2 (42:15):
Yes.
So I'm going to start with yeah, let's, let's, let's try.
Speaker 1 (42:20):
Let's see if we put them in order, right.
Speaker 2 (42:22):
I remember, because this is how my, this is how I
organize things.
I think, about them, fromwhat's the most kind of high
level awareness buildingtechnique for our patients down
to what's going to be a quick,easy consultation point
regarding their medication.
And then three gets into whattypically is a little bit harder
(42:42):
, longer for protractedconversation which is going to
be diet and lifestyle.
Speaker 1 (42:45):
Yeah, and a little bit more of you're really
changing something.
So yeah, exactly.
Speaker 2 (42:50):
It takes a little bit more behavior change and a
little bit more coaching aroundthat and that might open up
opportunities for referrals toother clinicians that might be
doing that deeper work.
Speaker 1 (42:58):
And, quite frankly, it takes a little more of them
feeling comfortable with you andgrowing a relationship and
being communicative.
Speaker 2 (43:07):
Yeah, so building that rapport in that way.
So if you kind of follow thatroadmap, you're also building
that rapport and strengtheningthat communication building
trust.
So box one yeah, bucket one arethose counseling opportunities
where they either come to youbecause they're having
depression symptoms orconsidering starting an SSRI,
(43:28):
they're on SSRI or they havequestions about their SSRI.
Flip side of that is that theyhave GI issues and they have
questions about their GI health,the symptoms they're
experiencing, or medication thatthey're taking and its impact
on their gut.
Speaker 1 (43:41):
So either we're thinking about starting it.
It's not working I don't seethe effect or I'm having a
terrible side effect, or I'mhaving an annoying side effect.
Speaker 2 (43:49):
Or you're filling it and you're saying do you have
any questions?
And you go.
I'm curious are youexperiencing any of these
symptoms?
Or I happen to see that you'repicking up a medication, an
over-the-counter NSAID right, oryou also have this other
medication.
You have this oralcontraceptive.
Are you aware, are youinterested in learning more
(44:10):
about this interaction?
Speaker 1 (44:11):
Are you interested?
in learning more about thisconnection and you know,
sometimes it is important tomake the connection for them.
Like you said earlier, I'veused the example.
I'm currently going throughsome uh vein procedures and when
I first went I didn't think itwas that big of a deal and the
doctor said, are youexperiencing this?
And I was like, well, yes, I am, and it's because of this.
And so it's important sometimesto make the connection for them
(44:34):
, because then it it is a biggerimpact and you're going to be
able to really impartinformation and it's not their
job to make the connection.
Right, right.
Speaker 2 (44:43):
It's our job to help them see those connections and
when they are saying, oh my God,I feel crazy because X, y, z is
happening.
But when I looked online, thiswasn't a side effect of this
medication and you can sayyou're not crazy, here's the
explanation.
But I feel like such.
I feel feel like like so coolwhen I can, like me, help them
see that connection.
(45:03):
They think I'm so smart and nowI've got their attention and I
can educate them about how tolike take it to the next level
yep, and you're building thatrapport and it's getting
stronger and stronger exactly,exactly, exactly.
So that opens up the opportunityin stage two, when they're
feeling a little bit more openand ready to have that
conversation, they might becoming more proactively with
(45:24):
questions.
Or now that you've built thatrapport and you're on that same
page that they go hey, um, Iread the article that you sent
me, or I, you know, listen tothat podcast that you
recommended on this topic, orwhatever it is and they go hey,
um, I would love to know ifthere's something I could be
doing or I should be thinkingabout because of this medication
.
Or they're asking you and youcan start to say okay, here are
(45:47):
some of the side effects or theimpacts of this other medication
that you may not realize isimpacting this, or some of the
symptoms from this otherdiagnosis that you don't realize
is connected to this.
Because, look, in ourallopathic training we do a
really, really good job ofbreaking things down and putting
them into buckets right.
We have hyper specialties, likeI always have a friend, I have
(46:08):
a colleague who is anephrologist.
Like, think about, like theyare a specialist in, like one of
the tiniest parts of an organ.
That's already a specialty youknow what?
I mean, like think about thesort of depth of knowledge that
they have on just one piece ofthe body.
We're really good at that andcompartmentalizing and
understanding how things work ata cellular level.
(46:30):
What we're not, as good at and Ithink where we're potentially
there's a gap in and ourpatients are suffering.
The consequence is in makingthat whole connection and
helping them understand thatthere are relationships between.
These are not silos.
Your body doesn't go well,that's a heart thing.
I have nothing to do with that.
I'm the gut over here right.
Like that's not a thing, right?
(46:52):
It's all connected and I thinkit's our job to help them
understand those connections.
And again, that really is goingto help set you apart as that
expert and I think, aspharmacists, we are already kind
of positioned as that wholeperson care clinician, because
we have to know a little bitabout everything I don't care if
you're an ER pharmacist.
I don't care if you have aspecial you still have to know a
(47:15):
little bit about everything,because you can't like be
filling a prescription for likea GI med and somebody's like
here's your antidepressant.
You're like I can't fill that.
That's not on my.
I only do GI right you have toknow a little bit about
everything.
So I think that helps us makethose connections and I think we
can use that then to helpsupport our patients.
And that brings me to bucketnumber three is when they are
(47:38):
ready to actually take steps andthey're looking for something
that they can do.
Um number one, you know, gaugetheir interest in changing their
diet.
I think, first and foremost,I'm biased.
I'm a nutritionist, so Ibelieve that diet kind of leads
in that but it might not be diet.
It may not be big changes.
It might be just talking abouteating the rainbow or talking
about you know, are you gettingadequate amounts of protein?
(47:59):
What's your appetite even looklike and what are you ready to
eat today?
What are you willing to do?
And maybe what they're willingto do is have a shake in the
morning and that's all they'reready for and that's okay, and
that's totally okay, that's anawesome first step because you
know what they weren't gettingyesterday 30 grams of protein in
the morning right.
So start where you can,no-transcript.
(48:47):
If you just go get the mail andcome back, that counts, totally
counts.
Speaker 1 (48:52):
What it'll eventually do is it'll extend and then
they'll walk around theneighborhood.
Speaker 2 (48:57):
Yeah, it's like oh, I put my sneakers on, I guess
I'll go walk down the block, andthen they get down the block.
I'm like I guess I could go alittle bit longer.
Speaker 1 (49:04):
It's such a nice day yeah.
Speaker 2 (49:06):
And so hopefully that that that builds and that grows
and as they get more, as theystart to feel better, they get
more motivated and that drivesthat behavior change and really
reinforces that.
And then from there you can addsupplements, right, like you're
already talking about.
You know, we're talking aboutvitamin D.
That's a pretty kind of lowhanging fruit, fish oil, multi
(49:28):
nutrients, combining a multinutrient with a protein shake,
making it really comprehensivein one shot.
Thinking about sources ofantioxidants, high quality
nutritional support, like a goodlike you know, even a greens
formula.
That's going to do it all inone shot.
That's going to be that we'regoing to hopefully get better
(49:48):
absorption out of.
And then we can also supportthem with magnesium and a
probiotic.
Ideally I would suggest a strainspecific probiotic, but again,
probiotics in my opinion arecost prohibitive for many.
A really good one often is veryexpensive.
Same with fish oil.
So if I had to choose and I canget them to eat fiber or eat
polyphenols or take aantioxidant formula, then I
(50:11):
might opt for the fish oil andthen maybe just feed their
microbiome.
But that's a decision you'regoing to have to make depending
on their symptoms, their budgetand what they're drawn to, one
versus.
there there's a lot ofconversations on social media
about microbiome and probioticsso they might be more motivated
to take that.
Speaker 1 (50:31):
So it really depends, or I'm willing to splurge on
that because I've heard it'sreally effective.
Speaker 2 (50:35):
Exactly, exactly.
So let's take advantage of themarketing and sort of just
follow their lead.
Speaker 1 (50:40):
Exactly, exactly.
So let's take advantage of themarketing and sort of just
follow their lead, yeah, yeah.
Well, laura, this has been soinsightful and I really
appreciate you giving your timefor two very informative
episodes.
So what's the game changer forthis episode?
We always like to leave ourlearners and our listeners with
a take home point, a summary.
So what do you feel like is theoverall game changer for
(51:02):
today's episode?
Speaker 2 (51:04):
So the game changer for me is being the healthcare
professional on their team thatis willing to have a
conversation with them thathelps them connect the dots
about whether it be the gutbrain connection, about the
connection to diet, about theoptions that they have in terms
(51:24):
of how impactful a habit changeor dietary change or even a
supplement or nutraceutical canhave on their health, and really
just being their advocate,being that person that they can
trust to go to and have thatconversation with, where they
feel safe, they don't feeljudged and they know that you
are going to steer them in theright direction, you're going to
use evidence-based thinking todrive that and that they can
(51:49):
trust that they can come back toyou and say, hey, this worked
or this didn't work or what elsecan we do next?
Speaker 1 (51:54):
Yeah, yeah, so good.
Well, laura, thanks again.
It's been so great to have you,and we've worked on a few
projects together here and there, but we've never had a chance
to see each other face to faceuntil today on the episode.
So it's been great to get toknow you and talk with you.
So thanks again for taking timeout of your schedule.
We really appreciate it.
Speaker 2 (52:12):
Thanks, I appreciate you, josh, appreciate this
opportunity and, for those ofyou stuck through both episodes,
thank you so much for listening.
Speaker 1 (52:19):
Yeah, I mean it's.
Clearly you can tell thatyou're passionate about the
topic and very well, well versed, so thank you.
If you're a CE plan subscriber,be sure to claim your CE credit
for this week's episode of GameChangers by logging in at
CEimpactcom and, as always, havea great week and keep learning.
I can't wait to dig intoanother game-changing topic with
(52:41):
you all again next week.
Josh Kinsey.
Hey, ce Impact subscribers,welcome back to part two of our
series on the gut-brainconnection.
I'm your host, josh Kinsey, andI'm excited to jump back into
the conversation with LauraZacharia as we continue
exploring the powerful linkbetween the gut and the brain.
Speaker 2 (00:20):
Laura Zacharia.
Yeah, I think I'm going to putit into three categories for us,
right?
We're going to talk about theeducation and the counseling
opportunities and the littlegems, little pearls that we can
drop for our patients to helpthem become a little bit more
aware and start making theseconnections.
Category number two is going tobe counseling points on those
common medications that wetalked about and opportunities
(00:41):
to weave in some guidance talkedabout and opportunities to
weave in some guidance.
And category three is gonna bewhat are the other tools in our
toolkit when it comes tosupplement recommendations,
lifestyle recommendations ordietary recommendations that we
might be able to leverage andwhen that patient has the
education and the awareness andthe willingness to make those
changes, we can also interceptwith those options as well.
(01:04):
We know a lot of patients.
They're more interested in aholistic approach, right?
We know that most of them theywant somebody that they can go
to, that they can trust, thatcan give them recommendations
when it comes to diet lifestyle,that can think outside the box,
that understands how theirmedications are impacting them,
understands how to get the mostout of their medication and
(01:25):
understands how to skirt some ofthe problems, the side effects,
that come along with thosemedications.
So, what we're advocating for isactually the opportunity to be
that standout pharmacist orpharmacy that can be their go-to
, that can be that resource forthem, and I don't know.
That's kind of why I became apharmacist, right.
So here we go.
Speaker 1 (01:45):
That's the root cause of it, yeah.
Speaker 2 (01:46):
Kind of yeah, it's kind of exactly.
I don't know, it's up my alley.
I feel like this is whatpharmacy is all about, so being
that problem solver, being thatgo-to community resource for
patients to maximize theirhealth right.
Speaker 1 (01:59):
Absolutely.
Speaker 2 (02:00):
So number one, counseling points.
So we touched a little bit onthis, but I think worth
repeating again that we want tomake sure that when we're
counseling particularly ifsomebody comes to you because
they are taking an SSRI,considering starting an SSRI,
concerned about their SSRI notgetting the results they want
from their antidepressant rightthat we ask the right questions.
(02:21):
So number one I want you to bethinking about is do they
experience any GI symptoms?
And this might have to beintroduced a little bit to them
because they may not be makingthat connection between their GI
symptoms and their mentalhealth.
And there's a statisticsomewhere about the incidence of
(02:42):
depression and anxiety in folkswho have IBS, and it's about
80% of patients who present witha diagnosis of IBS whether it
be constipation dominant, mixed,or diarrhea dominant about 80%
also have either depression,anxiety or both.
So it's on us to make sure thatthey understand that there is a
(03:04):
relationship between those twothings, right, and to start
paying a little bit moreattention to their body.
If symptoms get worse when theother symptom gets worse, so
their depression gets worse,does their GI symptoms get worse
, and vice versa, right.
So I think that's a greatcounseling point and a great
opportunity to introduce alittle bit of awareness to your
(03:24):
patient and help them start tosee if maybe some of the side
effects they're experiencing totheir gut might be interfering
with their progress in terms oftheir mental health right and
that could be from the SSRIitself, or it can be from
another medication they might betaking.
So, going back to asking them alittle bit more about what else
(03:44):
are you taking?
How do you, you know?
Do you experience headaches andhow do you handle them?
Do you have irregular cycles orirregular periods, and how do
you manage that?
Speaker 1 (03:53):
Right, do you have?
Speaker 2 (03:54):
painful PMS symptoms Right?
Are you taking an oralcontraceptive?
What's your blood work?
What has past blood work saidabout the health of your liver?
Has that other you know?
Have you ever had issues withyour thyroid?
Have you ever had issues withyour insulin?
Do you experience insulinresistance?
Speaker 1 (04:11):
Do you?
Speaker 2 (04:11):
have pain, joint pain .
Speaker 1 (04:14):
Sure.
Speaker 2 (04:14):
Right, because joint pain is a marker of inflammation
or causes more inflammation.
Inflammation is also a driverof depression, anxiety and GI
issues and vice versa.
It's also sort of playing inthat same pool and changing the
microbiome, changing our immuneresponse and altering some of
our hormonal signaling too.
So all of these questions canstart to.
(04:35):
You're not necessarily eventrying to get to a solution yet,
but even just starting toexplore and help them start to
see the relationship and makethe connections.
Pain, joint pain in particular,is a very common manifestation
of depression, right, and theymight notice when their
depression gets worse, theirpain gets worse and kind of
almost reinforcing.
It's not in their head and thatit's a little bit of the
(04:59):
chicken or the egg.
The two are driving each other,and so that might be a way for
them to really check in withtheir body and see how their
depression is showing upphysically and not just
psychologically.
Speaker 1 (05:08):
Yeah, laura, I'm going to stop right here for one
second, so we're at 30 minutes,but I feel like you still have
a lot to give.
Speaker 2 (05:17):
Yeah, I could probably do it in like 10 to
kind of wrap up those threepoints.
Speaker 1 (05:21):
Well, what I'm thinking is if you do it in like
10 and then maybe we have fiveminutes of like a debrief and
whatever yeah and I'm just goingto make this two episodes.
And right from you, right whenyou started saying I have three
points to share, was that almostlike the 23 or 24?
Minutes, so maybe that's likeone, I'll just make it like,
I'll be like and come back forthe next episode as long as you
(05:41):
feel like it's good stuff so myonly question was are you okay
to continue?
Speaker 2 (05:48):
Yeah, I have time yeah.
Speaker 1 (05:55):
I always buffer myself.
I know, okay, okay, well, let'sjust do that.
No, this is great and it'sactually super helpful to just
to get another episode out of it.
Speaker 2 (05:59):
Great, I'm happy to you know what I was doing you a
favor, Josh.
Speaker 1 (06:02):
Yeah, no, seriously, you are.
Yes, very much.
Okay.
I'm just going to tell myperson to um.
I'm just going to tell Allie toum cut out a little bit of that
in the center, okay.
So let's start um.
Let me just go back tosomething on my lips.
Yeah, okay, so we were at um.
What was your?
What was your second bucket?
Speaker 2 (06:30):
So the second bucket I was going to talk about uh, I
said medications and thenlifestyle stuff.
Speaker 1 (06:32):
Um so bucket number one is counseling tips bucket
number two are things that wecan do when it comes to their
medications.
Okay, I'm just gonna say circleback to bucket.
Number two is that okay?
Speaker 2 (06:37):
yeah, go for it.
Speaker 1 (06:38):
Okay, all right, laura, that was great, that's so
good.
So now let's kind of circleback to the bucket number two
that you mentioned before.
Some more of those.
You know super great tips forpharmacists, so I'll let you
have the stage again, becauseyou're just giving us so much
good info, so have at it.
Speaker 2 (06:54):
Thank you.
So we talked a little bit inbucket one about kind of
creating awareness, starting theconversation, starting to build
that rapport with your patient.
Speaker 1 (07:03):
Right Asking the right questions.
Speaker 2 (07:05):
Asking the right questions.
Now, bucket number two mayhappen in the same conversation
as those counseling points innumber one, or they might
require a few contact pointswith your patient, depending on
where they are, because,remember, when it comes to
depression and anxiety, they'renot always ready to jump right
in with a change right.
It might feel overwhelming,they might not feel motivated in
that moment, they might feellike they're a little lost or
(07:28):
they just want to do their ownresearch or, frankly, they just
want to wait on it a little bit.
So it's really important to keep, or they may not be ready to
talk about it or want to talkabout it exactly yeah, there's
still a big stigma when it comesto mental health and I'm
finding that, although we'vecome a long way, there's still a
significant stigma and I findthat patients, even when they
(07:51):
start medication, they're oftenreluctant or there's a shame
around it.
So just being able to talk aboutit in a way that doesn't shame
them and that never makes themfeel like the fact that they
decided to start this, they'regiving up or even framing their
human or it makes them changingwho they are, or anything Right,
right right, exactly, exactly,and so, even when you're
(08:14):
offering other solutions oryou're offering complimentary
solutions, it's really importantthat we're sensitive in the way
that we're presenting it, notthat it's a failing or it's a
repercussion of the decisionthat they made to take or not
take medication, but that ratherit's just more options for them
to make an informed decisionabout their health and to
empower them, and I think that'sa really, really important
(08:36):
counseling point yeah, I lovethat, yeah, so as we're
transitioning, then, andthinking about the medications.
we're going to start with theobvious thing, and that is the
SSRI itself.
Let's say they're taking anSSRI and they're not feeling
like it's working optimally.
You're going to do all thebasics in terms of making sure
that the timing is correct, thatthey are taking it consistently
(08:59):
, that the dosage is appropriateright, Making sure that it's at
the correct dose.
Sometimes there's amiscommunication they may get
started on a starter dose butthey've never gotten to their
optimal dose, right?
So, just making sure all thosethings are in place, that they
have the most appropriate SSRIclass for their condition and
that they're also gettingcognitive behavioral therapy or
(09:20):
some access to some form oftherapy whether it be talk
therapy, somatic therapy, etcetera to complement that SSRI.
I think to think that the SSRIis going to be this magic bullet
that does all the work.
It's really more like a crutchthat's going to get them to the
point where they're ready to dothe additional work that they
need to do, and it's reallyimportant to remember that that
(09:41):
is part of the guideline andthat is part of the counseling
recommendation when it comes tousing SSRIs.
And this is your chance to jumpin and say okay, I actually, if
you've been taking this now fortwo months, you're not
experiencing benefits.
I don't see a reason why it'snot working to make that
recommendation to say, let'scall your doctor and talk about
an alternative medication or asecondary medication to address
(10:04):
xyz symptoms.
Remember, that is your job astheir advocate, as their
pharmacist, so keep that in mind.
Okay, number two uh, if you havethat conversation with them and
it turns out that they've beentaking a ppi for a really long
time or that they experience giissues.
They happen to have either IBSor GERD or some other GI issue.
(10:26):
I think this is the opportunityfor us to start to address that
, so addressing and screeningwhether the PPI itself or the
long-term use of that PPI isappropriate in that patient.
There are situations wherelong-term PPI use is indicated.
I'm not going to get into those.
But if it turns out thatthey're using it because they
(10:49):
have not been either fullyevaluated or they have been sort
of using it as a crutch orunaware of the fact that it's
not intended for long-term useand that there are repercussions
on our microbiome balance, onour pH, on our ability to absorb
certain nutrients, and thatthere are long-term
ramifications and neurologicalramifications associated from
long term use of PPI, this isyour opportunity to gently
(11:12):
educate them on that and in myexperience a lot of people with
depression and anxiety tend toalso have GI issues.
Again, it's that gut feeling.
They're feeling it in their gutand that very often they're not
making that connection betweenthose two and they're not aware
that there's alternatives.
(11:32):
So I'll cover the alternativesin the lifestyle diet piece but,
having that conversationdeliberately about the use of
PPIs, coming up with a plan or aprotocol or strategy to get
them off.
The PPIs might be appropriateat this point.
Speaker 1 (11:46):
Yeah.
Speaker 2 (11:47):
Number three NSAID use.
This one is a big one because Ifind that a lot of people again
they have depression they'reusing a lot of NSAIDs.
Maybe they have hormonal issuesbecause, again, your hormones,
your sex hormones, particularlyfor women, if you're
experiencing pms, pmdd symptoms,etc.
You're very often relying onnsets in order to get through
(12:10):
the day.
Frankly, yeah, there's also atrend now I'm seeing this a lot
on social media where women areresorting to using pepsid
because pepsid has a a.
We know it's not anantihistamine, but it has an
antihistamine effect becauseit's a non-selective history,
histamine block and there's arelationship between excess
histamine production and excessestrogen production, and that
(12:33):
causes more PMS or morepronounced PMDD symptoms.
So they're finding that using aPepsid is a way for them to
manage that.
Again, similar to PPIs, it'snot intended for long-term use.
Some women only use it duringthe days leading up to their
period.
Some women are using it allcycle long.
Some women also have GERD, sothey're using it for their GERD
and they're finding it as like atwo-for-one deal.
(12:54):
So, again, an opportunity totalk a little bit more about
things that they may not thinkare related to their mental
health, but are very much adriver not only of their mental
health, but of the decisionsthey're making around
over-the-counter medicationsthat might be having an impact
on their gut health.
That's then having an impact ontheir mental health.
Speaker 1 (13:14):
Yeah, yeah, wow.
And you think about all thetime.
You hear someone say thatsituation made me sick to my
stomach, and so if you thinkabout what that connection is,
it's the anxiety or the fear ofwhatever was happening and they
literally get sick to my stomach.
Or, and so if you think aboutwhat that connection is, it's
the anxiety or the fear ofwhatever was happening, and they
literally get sick to theirstomach because of that
connection.
And you know whatever washappening, they get diarrhea or
they get nauseous or whatever.
(13:35):
Yeah, so yeah exactly or or.
That gird that reflex feelingthat you got when you're really
stressed out about something.
Speaker 2 (13:42):
I have found, found in my experience.
I cannot successfully getsomebody off a PPI or get them
successfully managing their GERDuntil I get their anxiety under
control, and vice versa.
Speaker 1 (13:53):
I feel very seen right now, laura, I got you,
josh, I got you.
I've been on a PPI for a verylong time and I just, every time
I try to go off of it.
I think also the anxiety ofgoing off of it and what would
happen.
Speaker 2 (14:07):
Yes, probably makes it worse and and also the gird
is sort of a symptom of theanxiety right, that's what I
mean.
It's just, it's just feedingitself, and then you think about
the reflux you're going to getwhen you stop the ppi, and that
gives you anxiety.
And then exactly.
Speaker 1 (14:22):
So then I just stay on it.
Yeah, and I have for almost adecade Exactly.
Speaker 2 (14:26):
And so we are talking to you, josh, we are talking to
you.
Speaker 1 (14:30):
This whole conversation is mine.
Yeah, absolutely.
Speaker 2 (14:33):
And this is why I think it's so.
It just goes to show thishappens to the best of us, this
happens to so many people, right?
So it's very important for usto keep in mind that there's a
lot of people that are gettingdiagnosed for depression and
anxiety, but there's even morepeople that don't have that
diagnosis, that aren't evenaware.
(14:54):
So I keep talking about thepeople that are coming to you
and are telling you and or youknow from their prescriptions
that they're suffering withdepression or anxiety.
But what about all the peoplethat maybe it's just a little
surface level, maybe it's notsignificant enough to be
considered diagnostically, right?
Speaker 1 (15:11):
Or maybe they're just dealing.
They're exactly.
Speaker 2 (15:14):
They're embarrassed to talk about it or they think
that they need to just getthrough it power through it.
Whatever exactly hold it in,tough up.
You know, toughen it up right.
There's all these people.
So what an opportunity to thenhave a conversation about the
folks that are telling you thatthey're always in pain, that
they're taking a lot of NSAIDs.
They're telling you that youknow they've been on a PPI for a
(15:37):
decade and they're afraid toget off of it because their GERD
comes back.
What an interesting opportunityto talk to them about their
mental health and what are thestrategies that they're using to
manage their stress and whatare the tools or the resources
or the community that they havein order to help manage that
stress as well.
Speaker 1 (15:53):
Yeah, yeah, super helpful, super helpful, all
right.
So you talked about a thirdbucket and you tease this with
that.
So let's talk about what.
What is another opportunity forus as pharmacists?
So what, what places in that?
Speaker 2 (16:06):
bucket.
So the third bucket happens tobe my favorite bucket.
Because, to me, this is where wereally have the opportunity to
shine and to really show ourpatients something that they
either may not be aware of ormight be intimidated by, and
that is the lifestyle piece.
This is where we also can talkabout diet with them, we can
talk about habits with them, andwe can talk about supplements
(16:29):
and alternative medicine withthem, and to me, this is what
really sets up part of greatpharmacists that has all the
right counseling points, thatcould talk about drug
interactions and that can reallylike make sure that their
patients are safe from a drugsafety perspective, from an
awesome pharmacist that not onlycan hold space for all those
things and then take it to thenext level and give them
(16:52):
additional, complimentary, safeand effective advice.
So this is why this is myfavorite bucket, because to me
this is really empowering, notto just us as pharmacists, but
to our patients as well, thatnow can see you as this like
awesome resource.
Speaker 1 (17:05):
On their healthcare team Right yeah.
Speaker 2 (17:08):
So now number one um, we're going to start with diet,
because the foundational dietcannot be ignored.
That said, people withdepression and anxiety aren't
always really super motivated tobe eating healthy.
We talked a little bit aboutfolks that might be on a GLP one
agonist, that might also beexperiencing like I don't really
care what I eat right nowbecause I'm losing weight, I
feel okay.
My doctor says my numbers lookgood.
(17:29):
I'm not really motivated to eathealthier.
Why should I be eatinghealthier?
So, this is where we starttalking about nutrient density,
we start educating about theimportance of feeding the
microbiome with fiber and withpolyphenols, and I always talk
to my patients from theframework of eat the rainbow,
eating colorful variety andreally, rather than sitting
(17:51):
there and focusing on how manycalories did you take in, how
many grams of protein did youhave?
How did you do in terms ofgetting in enough XYZ nutrient?
That's a little pedantic formost patients, right?
Most of them are busy people.
They're not.
Speaker 1 (18:08):
I'm a nerd, I like that stuff, but they may not be
into it.
So to me Well, and it alsomight be off, putting in a sense
of like I don't have time forthat, I don't want to measure my
food, or you want me to likestart, like putting it in an app
.
Speaker 2 (18:17):
I'm not doing any of that, right?
But when you start talkingabout qualitative things, so the
two kind of go-tos that I havedepending on the person I'm
talking to is I have them.
Either I talk about colorfulfood and how to build a plate
that's colorful and then supportit with some protein, and that
usually gets us talking abouteating a variety of fruits and
vegetables.
It gets us talking aboutincreasing their fiber intake,
(18:39):
and then I go pair that with aprotein, and then I just educate
them on what a protein lookslike, on what their typical
habit, what they like, you know,and to me it's very much
agnostic, right, because itdoesn't matter what cultural
background they come from, itdoesn't matter what their
philosophy around, you know,their carnivore, vegan or
whatever like it's.
There's something that I cantalk about that is relevant to
(19:00):
their, to, to their philosophyaround, and what I'm talking
about essentially is theliterature that talks about the
more variety that we have interms of our diet, the more
color, the more phytonutrients,polyphenols, et cetera that we
introduce into the diet that'ssignified by those variety of
colors the better we feed themicrobiome.
(19:22):
Remember how I talked about thedifferent neighborhoods and the
different little bugs that livein the different neighborhoods
and how much of them we needrelative to each other.
That variety of color is one ofthe best ways to predict the
variety and the volume of thosehealthy, good, commensal, good
bacteria right, so we feedeverybody in the neighborhood
(19:42):
with multiple colors.
It's like a food program forthose, the microbiome right so
exactly, and the more diversityof color, the more diversity of
microbiome.
Super simple concept it's veryvisually appealing it.
The prettier your plate, thebetter.
I used to.
Um, I used to have a tool formy kids patients, where I would
have them fill in a rainbow and,like every meal they would like
(20:04):
fill in the color of therainbow and their goal at the
end of the day was to have thewhole rainbow colored.
And the kids would get superexcited and they'd be like I
gotta find a blue food, mom, Igotta find like, a purple food,
and so you get super excitedabout it.
And then I realized the parentswere really stoked on it.
So I started doing the samething with parents I just made
it a little bit more adult.
So rather than coloring in arainbow, I started just telling
(20:26):
them to start to pay attention.
I gave them a tracker to payattention to the amount of color
that they're having.
Speaker 1 (20:30):
Hey, don't look to color too.
They really do yeah exactlyExactly.
Speaker 2 (20:36):
So I just take, take the same and honestly, sometimes
I'm like do you want thecoloring version?
Cause I totally can give thatto you if you want to download
that and color it in yourself sothat a hundred percent and it
serves as a um cause.
Coloring is also supposed to bea great like stress reliever,
so two for one deal right.
And really visual, takes us awayfrom the calorie counting and
(20:57):
the worrying about am I gettingenough?
X, y, z?
And yeah, sure I want to makesure you're getting enough
protein, because protein issuper important for the
production of thoseneurotransmitters as well,
particularly complete proteinthat have enough of tryptophan
and tyrosine and phenylalanineand iron sources and foods that
contain zinc and things like Bvitamins.
These are all really importantbecause those help shape and
(21:20):
make those neurotransmittersthat we need and help balance
our blood sugar at the same time, which also can impact our
mental health status.
But at the end of the day,again, lowest hanging fruit pun
intended is to make sure thatthey're just aiming for colorful
variety and pairing it with aprotein and as they're feeling
better and more motivated, wecan have deeper conversations.
Speaker 1 (21:40):
Yeah, and you know, laura, I think that you know
this is no tea, no shade, butfor the majority of our
listeners they're they'reprobably not trained dietitians
like you are also a pharmacist,so you know, I think,
understanding that you don'thave to be it's.
You know the the informationyou can share is is minimal, as
(22:02):
minimal as keep it colorful,make sure it's got a protein in
there too, and then when they,if they master that and they say
I have colorful plates and Iwant to learn more, then connect
them with a nutritionist, witha dietician.
You know, have someone on yourteam that either is that, or
have a person that you partnerwith in your store that you say,
(22:23):
okay, I've got a patient whothey're ready to to make some
changes and some decisions.
Speaker 2 (22:27):
And it doesn't have to be that complex.
You can simply up-level that tothe Mediterranean diet.
So if you're comfortabletalking about the Mediterranean
diet, that's actually also hadbeen proven to be just as
effective as medicationintervention in improving mental
health scores.
Speaker 1 (22:46):
So the.
Speaker 2 (22:46):
Mediterranean diet.
There's actually a trial from afew years back called the SMILE
study that actually had a groupof participants as a RCT trial.
So there was a group that hadthe interventions alone and the
group that had it with theMediterranean diet, and it was
modified specifically for thistrial, and the group that had
(23:06):
the Mediterranean dietintervention outperformed the
other group leaps and bounds.
So it's really like it is atruly effective strategy, but
again, that might not be wherethey're at today.
Speaker 1 (23:18):
Right, right, I mean, they may not be ready to talk
about exactly what I should beeating, but to give it from a
from a, you know, high levelview.
Just say keep it colorful, adda protein.
Here's what colorful means.
And you know, I feel like,after listening to what we just
talked about, any pharmacist cando that, you know, like that's
(23:39):
super easy to do.
And if you don't feelcomfortable going to the next
step or having the nextconversation, do have a
partnership already formed towhere you can send them to a
dietitian and a nutritionist oryou know whatever.
I mean, offer your office spaceto a nutritionist to come in
twice a week and meet withpatients exactly, exactly
(23:59):
there's opportunities there foryou to continue to build a
service for your patients andagain you still look like the
winner as the pharmacist,because you made that initial
connection and then you passedthem off to get more information
.
Speaker 2 (24:12):
Absolutely, and I'm going to plant a seed here.
I'm going to come back to itwhen I talk about supplements,
but if they're not willing tomake the dietary changes, there
are supplements and ways that wecan kind of like bypass that
initial hesitation.
Speaker 1 (24:25):
And.
Speaker 2 (24:26):
I'm going to come back to that, so keep in mind
even have the conversation,because I'm always a believer in
having that foundationalconversation with them, because
you cannot outrun an unhealthydiet.
There's been studies that alsoprove that diets are high in
ultra processed foods, high inhigh carbohydrate, low fiber
diets, low protein diets allcontribute to depression and
(24:46):
anxiety as well.
So we don't want to ignore thatresearch because we're leading
with evidence here, butsometimes they're not ready for
that.
Speaker 1 (24:54):
They just don't have the motivation or the capacity.
I mean, maybe they're stillreeling with the idea that I'm
suffering from depression andanxiety or I'm going through
this or whatever.
I had a patient.
Speaker 2 (25:06):
part of her anxiety was feeling like she was never
good enough and she never mether parents' expectations or her
husband's expectations.
So she refuses to cook, becausecooking is a trigger for her,
because she's always worriedshe's going to mess it up Like
that something's going to gowrong and she's going to mess it
up.
That's a real trauma, right?
So?
Speaker 1 (25:24):
I'm not going to.
Speaker 2 (25:26):
It's a vicious cycle, because then if she does mess
it up or somebody gives hercritique or she doesn't like it,
that's going to just make herless likely to try again.
So until that's addressed atits root, me telling her just
try, let's see what happens nobig deal, is dismissive and,
frankly, is not trauma informed.
So, yes, we do always want tomeet the patients where they're
(25:48):
at.
Sometimes they're ready for it.
We want to give them the lowestpossible low hanging fruit
option.
Speaker 1 (25:54):
There are.
Speaker 2 (25:54):
there's so much that we can frankly explore in this
conversation in terms of likethe nutrient density and why
Mediterranean diet works and allthose things, but we need to
also keep in mind that noteverybody is ready for that.
So let's start there, and thenI think of the supplements as a
way to bypass that, to get theimpact, get them feeling better,
get them past that, and then wecan start having more
(26:17):
meaningful conversations arounddiet and lifestyle.
Speaker 1 (26:19):
Yeah, so diet is the first level, the cornerstone.
So what would you say is thenext step?
Speaker 2 (26:25):
Two is going to be lifestyle.
There's again I'm trying tosimplify this conversation, so
keep that in mind.
So anybody out there who's likeshe forgot to talk about, keep
this in mind.
I'm trying to simplify itbecause there's environmental
factors, there's going to bestressors that that patient
can't get to.
Socioeconomic factors right,there's a lot of layers to this,
right, trauma, like we talkedabout in that example.
(26:47):
But just honing down on movement, sleep and stress management
right, those are reallyessential.
What it looks like for thatindividual is going to look a
little bit different, butessentially, getting them into a
routine that gets them on aregular rhythm throughout the
day, that addresses theircircadian rhythm, that we're
ensuring that they are waking upat a regular time, going to bed
(27:09):
at a regular time and thattheir cortisol and their
melatonin are offsetting eachother.
Excessive blue light exposureat night not only impacts our
cortisol response and impactsour melatonin production.
Overnight impacts our sleepquality, is also going to impact
our mood the next day, not justbecause you didn't sleep well
(27:29):
and you're cranky, but you'realso going to experience altered
mood as a result and the shiftin those chemicals.
Right?
Speaker 1 (27:36):
And when you say blue light, I'm assuming you mean
looking at your phone or youriPad before bed.
Speaker 2 (27:40):
Yeah, I'm not going to make a lot of friends saying
this, but scrolling on yourphone, scrolling through the
phone right before you're tryingto fall asleep, falling asleep
to the TV, having too manylights on at night even all of
that is stimulating blue light.
Blue light sends signals to thebrain that this is daytime and
it's very confusing to the brain.
You know what you can do.
(28:00):
You can listen to a podcast.
So there's that A littlealternative.
A little podcast, an audio book, those are all fine.
Speaker 1 (28:09):
Well, I hope we don't put them to sleep though.
Laura, I hope we don't put themto sleep.
That's a very excellent point.
Speaker 2 (28:15):
But that's really important Then countering it
with blue light in the morning.
So part one is limiting bluelight exposure, at least one to
two hours before bedtime.
I would say the longer thebetter.
And part two is getting bluelight exposure in the morning.
That means getting eyes onsunlight don't stare at the sun,
but getting eyes on sunlight sothat you are getting the blue
(28:37):
light to the brain and you'resaying hey, brain, this is what
real blue light exposure lookslike.
Wake up, let's get thingsmoving, because we want cortisol
to gradually rise.
So it starts around 5, 4, 5 am.
It gradually rises.
It hitsa peak at late morningand then it's supposed to dip
low enough around 4 pm wheremelatonin is like okay, cool,
(28:57):
let me come out I'm going totake over.
Yeah, exactly, and so those,those are largely dictated by
blue light and then red lightexposure.
And so another thing you coulddo is potentially that's another
thing that you could do ispotentially use red light
exposure.
So there's like red light bulbsthat you can use and there's
(29:19):
actually light machines thatfolks can use, where it will
automatically change the lightin the room and they can use a
blue light in the morning and ared light at night and that
could help to reset theircircadian rhythm.
That is going to go a long wayin improving not only their
sleep quality, but that is aform of stress response and
stress support.
Obviously, there's other thingsyou could do.
(29:41):
There's talk therapy, which isobviously kind of the gold
standard when it comes tosupporting patients who are on
SSRI, but there are also otherstress management techniques
that you can talk to yourpatients about Simple box
breathing techniques, forexample, taking a walk outside.
I like to combine the morninglight exposure with an
opportunity to take a walkoutside and to get some exercise
to get a little bit of movementand if you have the luxury to
(30:04):
be able to get into nature, soif they live near a park or an
area that's grassy or has trees.
The actual exposure to naturehas also been shown to reduce
stress and to improve stressresponse as well, and is a great
way to manage mood.
Speaker 1 (30:19):
Yeah, yeah, wow.
It's also a great way to getsome pollen in the spring.
Speaker 2 (30:25):
Absolutely Very good point.
Speaker 1 (30:28):
Good or bad, but very good point.
No, I love that and I love.
I love the idea of you knowagain, hopefully, as pharmacists
, we're trying to give theinformation in those bite-sized
formats again, because ourpatients are not always ready to
be overloaded with everything.
But I love the idea of hey, youcan kill two birds with one
stone.
I would hate that saying and Ithink that's the best one.
Speaker 2 (30:51):
It's a little violent to birds.
Speaker 1 (30:53):
Maybe I should come up with another one, anyway, um,
anyway, addressing two thingswith one, by getting the
cortisol and by also moving, andso I love the idea of doing
that.
You know, brisk, walk in themorning or exercise in the
morning outside, especially, youknow, as we get um better
weather, but um, that's a greattakeaway.
(31:14):
That's a great takeaway rightthere is that, if you can get
them to avoid, light at night towake up in the morning, get
outside and take a walk.
Speaker 2 (31:18):
You've addressed sleep, you've addressed stress
and you've addressed movementyeah, that's great.
Speaker 1 (31:23):
Yeah, easy peasy, okay, easy peasy.
Speaker 2 (31:26):
So that allows us to now move into complementary
support.
So there's so many nutritionalfactors that impact our mental
health, so keep in mind we'regoing to kind of go through them
.
You don't need to do all ofthem all at once.
Use your instinct and yourunderstanding of the situation
(31:46):
to sort of make thatrecommendation.
But no, you have a ton ofoptions on your proverbial shelf
or on your bookcase or in yourtoolkit that you can pull out
and use to support your patients, and sometimes that's going to
be conditional and sometimesit's just going to be like
you're going to come up with aprotocol that you see works.
And that is where, you know,the fun of clinical practice
comes in.
So I'm going to go back andaddress what happens.
(32:08):
When you've got someone who'snot willing to make the dietary
changes foundational dietarychanges.
What do we do?
And I would recommend a medicalfood that has a good amount of
protein in it, that might evenhave some polyphenols in it or
some anti-inflammatoryingredients in it, and there are
some that also have a prettydecent amount of basic nutrients
(32:30):
vitamins, minerals that can bereally useful.
So a good example of that, onethat I actually use often, is a
product called MitoCore fromOrtho Molecular, and I use that
one because it was studiedspecifically for people who have
chronic fatigue.
Chronic fatigue's hallmark isinflammation uh, you know,
(32:55):
fatigue, difficultyconcentrating.
They mimic a lot of the symptomsthat you'll see in folks that
have depression and anxiety, andthe takeaway here the
ingredients are really going tobe helpful, especially if you're
using the protein form isyou're going to get a protein in
them.
They can make it quickly into ashake, so it's super easy.
They can either make a fancysmoothie or they can just mix it
with water if they want, andthen they're going to get things
like magnesium, b vitamins,zinc, um, all the major you know
(33:17):
the main nutrients that theyneed to power their mitochondria
powder, the neurons, and it'sgot a few antioxidants
resveratrol, egcg, etc.
So I say that because there's afew different formulas that you
can look at, things like ag1,which is like that greens powder
formula.
There's a bunch of differentgreens products.
There's things like whey proteinthat you can use and you can
(33:39):
combine them and, depending onthe patient, what they're
willing to do you might findyour favorite combination to
recommend or a one go-to option,but that's essentially what you
want to look for.
You want to look for protein toget their day started.
You want to look for somepolyphenols, antioxidants, and
then you want to look for a good, balanced multi-nutrient that's
(33:59):
going to be well absorbed,because not all multi-nutrients
like most of ourover-the-counter common you know
, common multivitamins don'tabsorb very well.
They're actually also don'thave a high enough concentration
of most of the nutrients thatwe're looking for.
So, keep that in mind.
They tell you oh, I'm alreadytaking a centrum or one a day,
(34:20):
Just make sure that they areeating adequately enough that
they don't need a more robustmultinutrient.
So that's my one go-to Like.
If they do nothing else andthey can at least do that, I can
get them on a baseline.
That's usually a great startingpoint From there.
Fish oil, or thinking aboutinflammation.
So fish oil is one of the moststudied interventions when it
(34:41):
comes to depression inparticular.
But fish oil omega-3s can bereally helpful for improving
inflammation and thereforeimproving mental health.
Fish oil can also change themicrobiome.
It can have a positive effecton the microbiome as well.
This is actually more recentresearch.
So a high-quality fish oil canbe a really great intervention
(35:04):
intervention.
This is where I'm prettystaunch about a high quality,
because if there's contaminants,heavy metals, if it is been
processed in a way that altersthe quality of the fat and
denatures it, or if it is intransport it's getting
overheated, et cetera that'sgoing to have a very.
(35:25):
Not only it's not just going toneutralize that fish oil, it's
going to have a very.
Not only it's, it's not justgoing to neutralize that fish
oil, it's going to actually makeit more inflammatory.
Speaker 1 (35:30):
So I'm very like.
Speaker 2 (35:32):
this is the area where I'm like, if they're going
to splurge on anything, this iswhat I want them to splurge on.
Everything else, I keep kind ofusually find a low cost
alternative, but this is the onethat I'm pretty bull on.
Like we have to have a highquality fish oil, so that's one
one kind of like pearl to tokind of keep in mind.
And if you're noticing somebodyis taking a fish oil and
they're not getting the benefits.
Speaker 1 (35:53):
Explore whether or not it's a high quality fish oil
Exactly If they're getting fishburps from it you should never
get fish burps from it.
Speaker 2 (36:00):
That's a low quality fish oil right there.
Speaker 1 (36:02):
Yeah, yeah, that's good feedback.
Speaker 2 (36:08):
Yeah, the third intervention, which is, I feel
like, pretty baseline, ismagnesium.
Magnesium is a great go-to.
Honestly, most of us aredeficient in magnesium.
Most of us can actually use alittle bit more magnesium.
Depending on the form ofmagnesium, we could see
different benefits.
So I usually recommend amagnesium glycinate or a
magnesium threonate.
When it comes to depression,anxiety, glycinate could be a
little bit more relaxing.
(36:28):
3 and 8 has better absorptionneurologically, so you have a
more direct brain effect whichcan be relaxing, can also
support sleep, can also supportanxiety, et cetera.
So either of those 3 and 8tends to be a little bit more
expensive, so glycinate tends tobe a little bit more affordable
and I can kind of play with thedosage and see what's working
(36:49):
for them.
And that, to me, is animportant baseline intervention
for most people, especially,though, if they're experiencing
insulin resistance.
They're pre-diabetic, diabetic,they're on that cardiovascular
risk spectrum.
Super important intervention.
And I find it very useful againif they're experiencing sleep
disturbances, either because oftheir mental health or vice
(37:11):
versa.
Speaker 1 (37:12):
Yeah.
Speaker 2 (37:13):
The next one is vitamin D.
There is a very strongconnection between low vitamin D
and increased risk ofdepression, in particular, and,
to a smaller extent, to anxiety.
So making sure that we'remaintaining adequate vitamin D
levels.
It's not the main reason thatwe experience seasonal affective
(37:33):
disorder, but is a contributorto seasonal affective disorder.
So making sure that they haveadequate levels I call adequate
over 40 on their blood work.
So making sure that we'rechecking their blood work and
seeing where it's at and thendosing them appropriately to
ensure they get hot.
they get, uh, optimize theirvitamin d levels okay magnesium
helps to optimize that vitamin dlevel, by the way.
(37:55):
So we go back to magnesium andI usually pair uh vitamin d3
with k2 for better absorptionand utilization and conversion
of that vitamin d.
Okay, okay that's a lot.
That's a lot.
I've got one more for you.
Speaker 1 (38:10):
This is so good One more for you guys.
Speaker 2 (38:13):
The last one I'm going to mention is probiotic.
Okay, there's a ton ofdifferent probiotics on the
market.
There is some evidence thatsuggests that the use of
probiotics can help to improvemental health is specifically,
anxiety and depression scorestend to improve.
However, it is more stronglyassociated with certain strains
(38:35):
of probiotics.
So where you might see ageneral probiotic, one that has
multiple strains, do okay withsome people, especially if they
have a pretty significantdysbiosis if you really need a
targeted approach, then you needto be more strain specific in
how you prescribe that probiotic.
So the species that's mostassociated with particularly
(38:57):
depression is Bifidobacterlongum 1714.
That specific strain ofbacteria has been shown to be
really effective or reallyhelpful for improving depression
and even sleep disturbancesassociated with mental health
status.
There's a particular productthat I know has this in
(39:17):
combination with saffron, and Iwant to highlight this for two
reasons.
Number one we have nightmaresabout St John's wort, because I
remember being warned so muchabout all the drug interactions
with St John's wort, because Iremember being warned so much
about all the drug interactionswith St John's wort right.
We all remember it's absolutelyno-no to give St John wort with
anybody who's on an SSRI, so weall know that.
However, what St John's wortalso does is it acts as a
(39:39):
natural SSRI.
So although in a person who ison an SSRI, or maybe on multiple
medications, that may not be anoption, st John's wort is a
great option in those cases.
One with less drug interactionsand less risky is saffron.
And saffron as an extract hasbeen shown to be as effective as
not necessarily new generationSSRIs but old antidepressants,
(40:03):
so things like trazodil andritazapine et cetera has some
really good benefits in terms ofmood regulation.
And there's a particularproduct that combines the
bifidobacterium longum with asaffron that has been shown to
target specifically serotoninproduction in the gut.
First warning if they are anSSRI, be mindful of that
interaction.
(40:23):
Second warning is not everybodynecessarily does well with that
on its own, but I have founddifferent combinations of those
probiotics to be helpful, butthe most effective in my
experience has been the straight, specific probiotics.
Speaker 1 (40:38):
Sure, sure, wow.
Well, this is so good.
I want to try to debrief alittle bit and just make sure
that I know our listeners areprobably well, probably about
halfway through.
They decided to pull out a penand paper and take notes because
you were giving so much goodstuff, but some of them may be
in a position.
(40:58):
I hope if you're driving,you're not taking a pen and
paper.
Please don't take notes ifyou're driving yeah please don't
do that, just listen to theepisode again.
But I want to try to debriefand kind of do like a summary.
If you don't, yeah, let's do it.
So basically, just kind ofstarting over, and this being a
two-part episode series, thefirst part, where we really kind
(41:20):
of dug into the gut and thebrain talk, they talk, they
chit-chat all the time.
There's multiple pathways inwhich they discuss things.
They affect the two of themtogether affect our mood, our
cognition, neurological healthin general.
There are a lot of.
We also broke down microbiomein the first episode and so we
talked about exactly what thatis, the multiple neighborhoods
(41:44):
that are involved in thatprocess, and then we talked a
little bit about some of themedications that commonly are
kind of interacting with thatand things to kind of be on the
lookout for.
And then you gave us thesethree buckets at the end of the
first episode, which we teasedand made you come back and
(42:04):
listen to the second episode andso just quickly remind us of
just the overview of those threebuckets and just like the quick
take home from each as justlike a summary.
Speaker 2 (42:15):
Yes.
So I'm going to start with yeah, let's, let's, let's try.
Speaker 1 (42:20):
Let's see if we put them in order, right.
Speaker 2 (42:22):
I remember, because this is how my, this is how I
organize things.
I think, about them, fromwhat's the most kind of high
level awareness buildingtechnique for our patients down
to what's going to be a quick,easy consultation point
regarding their medication.
And then three gets into whattypically is a little bit harder
(42:42):
, longer for protractedconversation which is going to
be diet and lifestyle.
Speaker 1 (42:45):
Yeah, and a little bit more of you're really
changing something.
So yeah, exactly.
Speaker 2 (42:50):
It takes a little bit more behavior change and a
little bit more coaching aroundthat and that might open up
opportunities for referrals toother clinicians that might be
doing that deeper work.
Speaker 1 (42:58):
And, quite frankly, it takes a little more of them
feeling comfortable with you andgrowing a relationship and
being communicative.
Speaker 2 (43:07):
Yeah, so building that rapport in that way.
So if you kind of follow thatroadmap, you're also building
that rapport and strengtheningthat communication building
trust.
So box one yeah, bucket one arethose counseling opportunities
where they either come to youbecause they're having
depression symptoms orconsidering starting an SSRI,
(43:28):
they're on SSRI or they havequestions about their SSRI.
Flip side of that is that theyhave GI issues and they have
questions about their GI health,the symptoms they're
experiencing, or medication thatthey're taking and its impact
on their gut.
Speaker 1 (43:41):
So either we're thinking about starting it.
It's not working I don't seethe effect or I'm having a
terrible side effect, or I'mhaving an annoying side effect.
Speaker 2 (43:49):
Or you're filling it and you're saying do you have
any questions?
And you go.
I'm curious are youexperiencing any of these
symptoms?
Or I happen to see that you'repicking up a medication, an
over-the-counter NSAID right, oryou also have this other
medication.
You have this oralcontraceptive.
Are you aware, are youinterested in learning more
(44:10):
about this interaction?
Speaker 1 (44:11):
Are you interested?
in learning more about thisconnection and you know,
sometimes it is important tomake the connection for them.
Like you said earlier, I'veused the example.
I'm currently going throughsome uh vein procedures and when
I first went I didn't think itwas that big of a deal and the
doctor said, are youexperiencing this?
And I was like, well, yes, I am, and it's because of this.
And so it's important sometimesto make the connection for them
(44:34):
, because then it it is a biggerimpact and you're going to be
able to really impartinformation and it's not their
job to make the connection.
Right, right.
Speaker 2 (44:43):
It's our job to help them see those connections and
when they are saying, oh my God,I feel crazy because X, y, z is
happening.
But when I looked online, thiswasn't a side effect of this
medication and you can sayyou're not crazy, here's the
explanation.
But I feel like such.
I feel feel like like so coolwhen I can, like me, help them
see that connection.
(45:03):
They think I'm so smart and nowI've got their attention and I
can educate them about how tolike take it to the next level
yep, and you're building thatrapport and it's getting
stronger and stronger exactly,exactly, exactly.
So that opens up the opportunityin stage two, when they're
feeling a little bit more openand ready to have that
conversation, they might becoming more proactively with
(45:24):
questions.
Or now that you've built thatrapport and you're on that same
page that they go hey, um, Iread the article that you sent
me, or I, you know, listen tothat podcast that you
recommended on this topic, orwhatever it is and they go hey,
um, I would love to know ifthere's something I could be
doing or I should be thinkingabout because of this medication
.
Or they're asking you and youcan start to say okay, here are
(45:47):
some of the side effects or theimpacts of this other medication
that you may not realize isimpacting this, or some of the
symptoms from this otherdiagnosis that you don't realize
is connected to this.
Because, look, in ourallopathic training we do a
really, really good job ofbreaking things down and putting
them into buckets right.
We have hyper specialties, likeI always have a friend, I have
(46:08):
a colleague who is anephrologist.
Like, think about, like theyare a specialist in, like one of
the tiniest parts of an organ.
That's already a specialty youknow what?
I mean, like think about thesort of depth of knowledge that
they have on just one piece ofthe body.
We're really good at that andcompartmentalizing and
understanding how things work ata cellular level.
(46:30):
What we're not, as good at and Ithink where we're potentially
there's a gap in and ourpatients are suffering.
The consequence is in makingthat whole connection and
helping them understand thatthere are relationships between.
These are not silos.
Your body doesn't go well,that's a heart thing.
I have nothing to do with that.
I'm the gut over here right.
Like that's not a thing, right?
(46:52):
It's all connected and I thinkit's our job to help them
understand those connections.
And again, that really is goingto help set you apart as that
expert and I think, aspharmacists, we are already kind
of positioned as that wholeperson care clinician, because
we have to know a little bitabout everything I don't care if
you're an ER pharmacist.
I don't care if you have aspecial you still have to know a
(47:15):
little bit about everything,because you can't like be
filling a prescription for likea GI med and somebody's like
here's your antidepressant.
You're like I can't fill that.
That's not on my.
I only do GI right you have toknow a little bit about
everything.
So I think that helps us makethose connections and I think we
can use that then to helpsupport our patients.
And that brings me to bucketnumber three is when they are
(47:38):
ready to actually take steps andthey're looking for something
that they can do.
Um number one, you know, gaugetheir interest in changing their
diet.
I think, first and foremost,I'm biased.
I'm a nutritionist, so Ibelieve that diet kind of leads
in that but it might not be diet.
It may not be big changes.
It might be just talking abouteating the rainbow or talking
about you know, are you gettingadequate amounts of protein?
(47:59):
What's your appetite even looklike and what are you ready to
eat today?
What are you willing to do?
And maybe what they're willingto do is have a shake in the
morning and that's all they'reready for and that's okay, and
that's totally okay, that's anawesome first step because you
know what they weren't gettingyesterday 30 grams of protein in
the morning right.
So start where you can,no-transcript.
(48:47):
If you just go get the mail andcome back, that counts, totally
counts.
Speaker 1 (48:52):
What it'll eventually do is it'll extend and then
they'll walk around theneighborhood.
Speaker 2 (48:57):
Yeah, it's like oh, I put my sneakers on, I guess
I'll go walk down the block, andthen they get down the block.
I'm like I guess I could go alittle bit longer.
Speaker 1 (49:04):
It's such a nice day yeah.
Speaker 2 (49:06):
And so hopefully that that that builds and that grows
and as they get more, as theystart to feel better, they get
more motivated and that drivesthat behavior change and really
reinforces that.
And then from there you can addsupplements, right, like you're
already talking about.
You know, we're talking aboutvitamin D.
That's a pretty kind of lowhanging fruit, fish oil, multi
(49:28):
nutrients, combining a multinutrient with a protein shake,
making it really comprehensivein one shot.
Thinking about sources ofantioxidants, high quality
nutritional support, like a goodlike you know, even a greens
formula.
That's going to do it all inone shot.
That's going to be that we'regoing to hopefully get better
(49:48):
absorption out of.
And then we can also supportthem with magnesium and a
probiotic.
Ideally I would suggest a strainspecific probiotic, but again,
probiotics in my opinion arecost prohibitive for many.
A really good one often is veryexpensive.
Same with fish oil.
So if I had to choose and I canget them to eat fiber or eat
polyphenols or take aantioxidant formula, then I
(50:11):
might opt for the fish oil andthen maybe just feed their
microbiome.
But that's a decision you'regoing to have to make depending
on their symptoms, their budgetand what they're drawn to, one
versus.
there there's a lot ofconversations on social media
about microbiome and probioticsso they might be more motivated
to take that.
Speaker 1 (50:31):
So it really depends, or I'm willing to splurge on
that because I've heard it'sreally effective.
Speaker 2 (50:35):
Exactly, exactly.
So let's take advantage of themarketing and sort of just
follow their lead.
Speaker 1 (50:40):
Exactly, exactly.
So let's take advantage of themarketing and sort of just
follow their lead, yeah, yeah.
Well, laura, this has been soinsightful and I really
appreciate you giving your timefor two very informative
episodes.
So what's the game changer forthis episode?
We always like to leave ourlearners and our listeners with
a take home point, a summary.
So what do you feel like is theoverall game changer for
(51:02):
today's episode?
Speaker 2 (51:04):
So the game changer for me is being the healthcare
professional on their team thatis willing to have a
conversation with them thathelps them connect the dots
about whether it be the gutbrain connection, about the
connection to diet, about theoptions that they have in terms
(51:24):
of how impactful a habit changeor dietary change or even a
supplement or nutraceutical canhave on their health, and really
just being their advocate,being that person that they can
trust to go to and have thatconversation with, where they
feel safe, they don't feeljudged and they know that you
are going to steer them in theright direction, you're going to
use evidence-based thinking todrive that and that they can
(51:49):
trust that they can come back toyou and say, hey, this worked
or this didn't work or what elsecan we do next?
Speaker 1 (51:54):
Yeah, yeah, so good.
Well, laura, thanks again.
It's been so great to have you,and we've worked on a few
projects together here and there, but we've never had a chance
to see each other face to faceuntil today on the episode.
So it's been great to get toknow you and talk with you.
So thanks again for taking timeout of your schedule.
We really appreciate it.
Speaker 2 (52:12):
Thanks, I appreciate you, josh, appreciate this
opportunity and, for those ofyou stuck through both episodes,
thank you so much for listening.
Speaker 1 (52:19):
Yeah, I mean it's.
Clearly you can tell thatyou're passionate about the
topic and very well, well versed, so thank you.
If you're a CE plan subscriber,be sure to claim your CE credit
for this week's episode of GameChangers by logging in at
CEimpactcom and, as always, havea great week and keep learning.
I can't wait to dig intoanother game-changing topic with
(52:41):
you all again next week.
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