Top takeaways from the Integrative Practitioner Digital Summit on brain health

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By Avery St. Onge

Integrative Practitioner hosted its first Digital Summit of the year on April 12. The free event focused on the topic of brain health and included live and interactive sessions, as well as on-demand content covering areas such as mindfulness, dysbiosis, and herbs for mental health.

It you were unable to attend the event, we’ve compiled a round-up of top takeaways from the live presentations that you can apply to your patient practice. You can also watch the content on demand here.

How to Implement Mindfulness to Patient Care and Self-Care

The first live session was led by Bojana Jankovic Weatherly, MD, FACP, MSc, IFMCP, a physician in New York, double board certified in internal and integrative medicine, a fellow of American College of Physicians and certified in Functional Medicine by the Institute of Functional Medicine. Weatherly discussed why mindfulness is important in clinical settings and simple ways to incorporate the practice not just into patient care, but also practitioner self-care.

Weatherly defined mindfulness as a form of awareness that requires sustained attention in the present moment with a lack of judgment. She explained the benefits that mindfulness brings to the patient-practitioner relationship, patient outcomes, and physician burnout. Weatherly said that while results may not be instantaneous, in the long-run, evidence suggests that mindfulness meditation reduces stress which is associated with negative health outcomes and chronic disease.

In addition to improve patient health outcomes, Weatherly explained that when properly practiced, mindfulness can enhance patient-practitioner communication leading patients to have:

• Increased comprehension of diagnosis and treatment options
• Improved adherence to treatment
• A better sense of control
• Increased satisfaction

Weatherly cautioned practitioners to be aware of whether their patients have experienced trauma because meditation can sometimes be a trigger for post-traumatic stress disorder (PTSD). In that case, she suggested the patient work with a qualified therapist who can assess whether the patient is ready to practice meditation and if so, properly lead them through it.

In the presentation, Weatherly also addressed burn out among practitioners. With the majority of physicians reporting feelings of burnout, and suicide rates among physicians twice that of the general population, Weatherly said it is essential that structural problems within the field are addressed for a more sustainable future. In the meantime, mindfulness can help alleviate stress and feelings of burnout among healthcare professionals as it has been shown to improve anxiety, depression, and pain.

Weatherly described two types of meditation including: focused attention, which requires focus on breath, a body part, mantra, or visualization, and open monitoring, where a subject keeps their attention open and is aware of all aspects of their experiences, also known as mindfulness meditation.

While meditating, qualities of acceptance, non-judgment, and non-striving are important to enlist, according to Weatherly.

“With meditation there’s a non-striving element of trusting, being in the moment, and being consistent,” said Weatherly. “We should not be discouraged if we have thoughts while meditating. We can’t suppress them. We must acknowledge them and then let them pass.”

To finish her session, Weatherly listed several keys for success including:

• Gain perspective: practice being the observer
• Allow yourself to pause
• Journal
• Utilize apps, guided meditations, and groups
• Design a routine
• Meditate in the morning, if possible
• Create realistic goals
• Practice in a quiet space with no interruptions

“The results with show eventually,” said Weatherly. “With meditation there’s a non-striving element of trusting, being in the moment, and being consistent.”

Mood by Microbe: Dysbiosis The New Unifying Theory of Mental Illness and Diseases of Civilization

The second live session was presented by David Scheiderer, MD, MBA, DFAPA. Scheiderer, chief medical officer and director of education at Integrative Psychiatry, in Sarasota, Fla. and the president of Tiberius Enterprises, Inc. in Roanoke, Va., focused on dysbiosis and its relation to chronic, systemic, inflammation or meta-inflammation.

According to Scheiderer, meta-inflammation can lead to perturbations in psycho-neuro-immunological parameters such as neurotransmitters, hormones, growth factors, and immune reactivity, leading to what he calls “diseases of civilization” which are disorders that correlate to the Western lifestyle.  

Scheiderer defined dysbiosis as “an alteration in the microbiome caused by a change in the composition of the microbiota, a change in microbial metabolic activity, and/or a shift in local distribution of communities of microbes.”

The causes of dysbiosis can vary, according to Scheiderer. Causes he listed included:

• Infection, trauma, interpersonal rejection, anger
• Host genetics (NOD2, IL23R, ATG16L, IGRM)
• Lifestyle (diet, sleep, exercise)
• Early colonization (multiple sclerosis, hospitalization, maternal diet/stress)
• Medical practices (antibiotics, vaccinations, hygiene, sanitation)

Effects of Dysbiosis, according to Scheiderer include:

• Localized gut inflammation
• Systemic inflammation
• Oxidative stress
• Nitrosative stress
• Altered synthesis of neurotransmitters
• Intestinal permeability
• Chronic infections
• Impaired detoxification
• Impaired nutrient synthesis and absorption
• Impaired enzyme activity
• Autoimmunity

Dysbiosis of the gut microbiota is associated with a multitude of disorders, Scheiderer explained. These include:

• Neurodegenerative disorders
• Cardiovascular disease
• Intestinal disorders
• Psychiatric and mood disorders
• Metabolic disorders
• Pregnancy-related conditions

According to Scheiderer, evidence suggests that depression is linked to alterations of the gut microbiome. In turn, he said, restoring the gut microbiome can help alleviate symptoms of depression. To support the gut barrier, Scheiderer suggested dietary changes such as:

• Reducing sugar intake
• Avoiding the energy-dense Western diet
• Increasing intake of prebiotics/fiber
• Increasing intake of glutamine

Scheiderer also said select strains of probiotics, probiotic cocktails, and a combination of probiotics and prebiotics can help restore the gut barrier. Some of Scheiderer preferred strains included:

• Lactobacillus casei W56
• Lactobacillus acidophilus W22
• Lactobacillus paracasei W20
• Bifidobacterium lactis W51

In addition, he suggested short chain fatty-acids, metformin, and quercetin can benefit the gut microbiome and improve patient outcomes for depressed patients.

Herbs and Nutraceuticals for Stress, Mood, and Sleep

The Digital Summit’s final live session was led by Tereza Hubkova, MD, ABIM, ABIHM. Hubkova, medical director at the AdventHealth Whole Health Institute in Overland Park, Kan., discussed various herbs that can be used to help patients improve their mental health and sleep quality. 

Hubkova began the presentation by explaining that large portions of the population struggle with depression, anxiety, stress, and insomnia. These mood disorders, Hubkova said, are interconnected. Pharmaceuticals to treat these conditions not only have numerous side effects, but according to Hubkova, certain drugs for mood disorders such as antidepressants don’t work for many patients. In contrast, herbal psychopharmacology can target several symptoms within a mood disorder, they have few side effects, and generally are more inexpensive, according to Hubkova. In addition, she said they have been used for a much longer period of time than pharmaceuticals, indicating that they are safer.

Hubkova then listed an array of different herbs that can help with sleep, depression, and anxiety, among them were:

• Ashwagandha: Helps reduce anxiety and improve sleep.
• Holy Basil: Improves generalized anxiety, decreases forgetfulness, increases energy
• Nervines: Aids with sleep and anxiety
• John’s Wort: Assists with mild to moderate depression
• Passionflower: Supports sleep, helps with generalized anxiety
• Lemon balm: Modulates mood and cognitive function
• Turmeric: Boosts mood

Hubkova cautioned practitioners to pay attention to how other drugs interact with herbs because some herbs such as St. John’s wort have negative effects when combined with certain pharmaceuticals.

Knowing of only a few herbs that can help with mood disorders, Hubkova said, can drastically expand treatment options for patients struggling with mental health and sleep. Generally, she argued, they have fewer side effects than drugs and they can even be home grown.

“It’s a no brainer for me to first use herbs for sleeping problems, depression, and anxiety before using pharmaceuticals,” Hubkova said.

To view these presentations and the other sessions from our Digital Summit on brain health, be sure to check our website to access all the on-demand content from that day.