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Dr. Josh Friedman:

In my practice, I’m very aware of how foods contribute to mental health symptoms. I’m very aware of inflammatory foods and helping people figure out which foods are inflaming them and which might be inflaming their brains. I’m very aware of this issue of blood sugar stability and the fact that many people with mental health conditions have blood sugar that goes up and down, leading to depressive symptoms, anxiety symptoms, brain fog, all kinds of things.

 

Kirkland Newman:

Welcome to The MindHealth360 Show. I’m Kirkland Newman. If you, your loved ones, or clients suffer from mental health issues such as depression, anxiety, insomnia, poor memory, poor attention, mood swings, exhaustion, et cetera, I interview the leading integrative mental health practitioners from around the world to help you understand the root causes of these symptoms, many of which may surprise you, and suggest solutions to help you heal. If you like this interview, please do subscribe and forward to others who might find it helpful. If you want further information, please go to www.mindhealth360.com or find us on social media.

 

Kirkland Newman:

Josh Friedman, welcome to The MindHealth360 Show. Really happy to have you.

 

Dr. Josh Friedman:

So glad to be here.

 

Kirkland Newman:

Josh, I’m so excited because you’re my first psychotherapist who is into integrative mental health. So I’m really excited to talk to you because I think you combine the best of psychology, psychotherapy, and then the biochemical approach. So I’m really happy to talk to you. I just will give a little bit of background about your bio and then I’ll put the rest in the show notes.

 

Kirkland Newman:

Dr. Friedman earned his doctorate in psychology from New York University and received post-doctoral training in psychoanalysis for the Training and Research Institute for Self Psychology in New York City. You worked as an eating disorder psychotherapist at the esteemed Renfrew Center of New York. We know that eating disorders is quite a tricky area. You’re on the faculty of the Mount Sinai School of Medicine. For more than 10 years, you’ve worked as a psychologist with adults, couples, and families. Your practice has evolved and it’s become very clear to you that something was missing from traditional psychotherapeutic approaches. Curiosity and a chance meeting, which hopefully you’ll tell us about, led you to discover the world of nutritional psychology, which teaches many psychological issues are caused or made worse by underlying biochemical nutritional deficiencies. Further exploration led you to the practice of yoga with its emphasis on breathing, meditation, and movement for emotional centering. You’re married to a lovely yoga teacher, who’s fantastic. To enhance your effectiveness in helping patients to heal and grow, you became certified as a holistic health counselor at the Institute for Integrative Nutrition in New York. To go deeper into the hidden physical causes of mental health symptoms, you’ve studied with nutritional mental health leaders such as Dr. William Walsh and Julia Ross. Additionally, you’ve become a functional diagnostic nutrition practitioner and you’re close to becoming a certified functional medicine practitioner through the Functional Medicine University.

 

Kirkland Newman:

You have a practice in Omaha, Nebraska which offers integrative psychotherapy services and combines the healing power of insight-oriented psychotherapy with education about lifestyle and nutritional tools that have shown scientific efficacy in improving mental health symptoms and you have a telehealth business called Alternative Mental Health Solutions. Basically, you are just an incredibly accomplished doctor in many, many ways. What I’d love to do is to find out a little bit from you personally about your journey. What made you gravitate towards the biochemistry having done the more traditional psychology and psychotherapeutic training?

 

Dr. Josh Friedman:

It goes back to that chance meeting. I did seven years of grad school in psychology with a focus on psychoanalysis, which was amazing. It was about the healing power of the relationship, it was about understanding past dynamics and trauma. I ended up learning just how to be with patients in the healing way. Right as I was ending grad school, my wife at the time was having some hormonal problems. She met with someone that was called a biochemical nutritionist. That was the first time I had heard that term. It was a chiropractor trained in nutrition, pre-functional medicine. He did some diagnostic testing. At the time, I thought it was pretty outside the box that was mainstream. Over time, with dietary changes, some supplementation, her moods just settled. And her moods had been very labile and up and down. I was like, “This is something.” She was a writer and was going to write a book about this guy and his practice. We went out to dinner with him and he said something to me that changed everything. He said, “Do you know why your anorexic patients don’t get better?” And I said, “Trauma. Because they have anorexia.” I didn’t have a good answer. He said, “Because they’re protein malnourished.” And I said, “Protein malnourished.” He said, “You know about serotonin, right?” And I said, “Yeah.” He said, “You’ve been told that eating disorders are somehow linked to serotonin.” I was like, “Yeah.” He said, “Do you know where serotonin comes from?” And I said, “No.” He said, “The only thing in the world that can become serotonin is an amino acid, which is a breakdown product of protein called tryptophan. If you don’t eat protein and you don’t break protein down, you can’t make serotonin.” That one phrase, I heard that. There were lots of things I didn’t hear because my lens didn’t permit me to hear it, but I heard that. And he said, “Let me give you a book that’ll explain all of this a little bit more.” So he handed me the book by Julia Ross called The Mood Cure.

 

Dr. Josh Friedman:

Julia Ross, who I hadn’t heard of, of course, Julia Ross was a master’s level therapist in California working with addictions, eating disorders, and trauma. She was bumping her head against the wall with these clients and realised there has to be something more. So she started looking into this field called amino acid therapy. So it’s giving targeted amino acids like tryptophan and tyrosine and GABA and some others. They are the building blocks of the mood centers of the brain, of the neurotransmitters. She turned to a man named Kenneth Blum. Kenneth Blum was a fringy researcher that was looking at the use of amino acids for the treatment of addictions. He wasn’t having very good luck to find clinicians who were willing to use these tools in clinical practice to do research, and he found Julia Ross. So Julia Ross created this book, it came out, I think, in the ’90s, that lays out a nutritional medicine approach, food-based approach, supplement-based approach to mental health condition. So I felt like I had both x-ray glasses and sort of the Bible. I felt like everything was in this book that I needed to know. I brought it back to Renfrew, where I was working at the time, and I was like, “I met this amazing person. I know some things now I didn’t know before.”

 

Dr. Josh Friedman:

The therapy at Renfrew was amazing. It was an integrative treatment program. There were great psychiatrists and dieticians and dance therapists and yoga therapists. We did wonderful groups. But they weren’t interested, they had no interest whatsoever. So I said it again, “Do you know why our eating disorder patients aren’t getting better?” I told them the whole story about amino acids and protein deficiency and poor digestion and they said… blank stares. And these are super educated, skilled psychiatrists with 20 years experience working with eating disorders, open-minded clinicians. That day I got something, I got like, “Oh, we can be blinded by our training.” And of course, I had my own earlier history with mental health issues from high school for many years through grad school. So I started using some of the amino acids and essential fatty acids and I noticed improvements in my anxiety and my depression. It’s this confluence of things that set this up for me.

 

Dr. Josh Friedman:

My daughter was born with a very serious birth defect that led to massive complications and a long medical journey. We had some money. We were living in New York and we started visiting many, many, many different alternative medicine practitioners. So our little infant had acupuncture and she went to see a holistic pediatrician named Larry Palevsky. Then we went to see Dr. Leo Galland. I started traveling through these functional medicine, integrated medicine circles without actually realising I was doing it because we were looking to save our kid’s life. So it all found a place in me. My daughter’s now going to college. For 20 years, little by little by little, I’ve been growing my knowledge base. As you know, it’s an incredibly complex field. It’s especially complex if you’re coming to it as a poet rather than a scientist. So I was a therapist interested in the poetics of healing, interested in relatedness, interested in spirituality, interested in breathwork and movement. Learning biochemistry has been a heavy lift. But I’ve stayed with it, little by little by little. You learn a piece and then you work with people with it.

 

Dr. Josh Friedman:

So in my practice, I’m very aware of how foods contribute to mental health symptoms. I’m very aware of inflammatory foods and helping people figure out which foods are inflaming them and which might be inflaming their brains. I’m very aware of this issue of blood sugar stability and the fact that many people with mental health conditions have blood sugar that goes up and down leading to depressive symptoms, anxiety symptoms, brain fog, all kinds of things. So I would tell people that I mostly focus on low-hanging fruits. And there’s a lot that can be done. Especially, functional medicine is the science of going down rabbit holes. There are people interested in mould mycotoxins, super important of course. Debilitating, horrible, can lead to terrible symptoms. But it’s like a very small arcane field. And then heavy metal toxicity. There are lots of things to learn and to learn all of those becomes very difficult. So I tend to think of myself as a first responder. I have pretty broad training. I have a lot of training in psychoanalysis, I have training in some trauma therapy in EMDR, I do energy tapping. I’ve lived with a very accomplished yoga teacher for many years and have done yoga teacher training. So I know hundreds of tools to introduce yoga tools, breathwork tools, meditation tools, visualisation tools. But I think I’m good at looking at the different levels at which people are affected and saying, “Hey, here’s what I think might be going on. Let’s start with the basic stuff. Let’s start with giving up foods that are known to be inflammatory.” And meeting people where they’re at. If you tell someone they have to do a very sophisticated elimination diet and they start to freeze, I use my therapeutic skills and I say, “Let’s back that up. How would you feel about giving up gluten for two weeks and just seeing what happens?” That’s probably a longer answer than you were hoping for.

 

Kirkland Newman:

Oh, it’s brilliant. It gives me a fantastic overview. I think that’s fascinating because that’s one of the reasons I really wanted to talk to you, because I think you have such a privileged overview that so few people have. As you say, I think part of the problem is that mental health, even in the functional medicine realm, tends to be siloed to an extent. So people either are experts in mould and mycotoxins or they’re experts in nutrition or they’re experts in psychotherapy or trauma. But really, pulling it all together is super important, because at the end of the day, what we do is personalised medicine. So you have the patient opposite you and then you respond, and you have this amazing toolbox of ways to respond to them. Whether they’re biochemical or whether they’re psychological or therapeutic, you have all these tools to help people’s mental health. So what I’d love to ask you, Josh, is, when somebody comes in to see you, do you do an intake and then say, “Okay, based on their symptoms, they need psychotherapy or they might need nutrition help.”? I mean, how do you decide and then customise what you think people need? What’s your process?

 

Dr. Josh Friedman:

It’s interesting because I have several businesses and I have referrals that come in different ways. Some people will come in as a psychotherapy referral. My intake is very integrative. So it’s asking both about trauma and it’s asking about history, what’s your psychological history? But it’s also very targeted to specific questions about underlying biochemical issues. The first thing I assess is, what do they say about the intake? What are they curious about about the intake? I want to meet people right where they’re at. There are people that come to see me for talk therapy that I’ll never mention nutrition to at all. It may not be because they don’t need it, because I think actually, I mean, the standard American diet or the standard diet that we eat in the Western countries is ill-equipped for balanced brains and bodies. So I think anyone that comes to see us needs it, everyone needs a tweak. So I start where people are at. So if I have a psychotherapy patient and they’re pretty clear they’re not interested in nutrition, they’re not interested in supplements, I will notice things and just pocket them for later. And sometimes later comes.

 

Dr. Josh Friedman:

A typical scenario would be someone who comes, I might see them for a couple of months, focusing on the relationship like building the rapport, creating in psychoanalysis what they call the holding environment, which is the frame by which we contain the relationship there. Then I might say, “I noticed this, this, and this symptoms. I’ve noticed that you’re having problems sleeping, you’re agitated, especially at night, you have a hard time settling, you have racing thoughts. I have a subspecialty in nutritional mental health. Would you be interested in hearing about some things that might be helpful?” So that person I just described, I will often know from the first moment I meet them because there’re very distinct patterns of amino acid deficiencies or neurotransmitter deficiencies. I would say that person has blood sugar issues, low serotonin, and I would say, “If I gave you a couple of supplements, what would that feel like? Would you be interested? If I suggested some dietary changes or keeping a food diary, would you be interested?” If they say, “Yeah, I want to do anything that would be helpful,” I’m like, “Great,” and I’ll start them off. “How quickly do you want to do?” I’ll say, “Are you the kind of person that wants to read the book or do you want to watch a three-minute video summary of the book? How much can you digest?” Since I’ve worked with eating disorders a lot, I think about digestion a lot, both about how we digest food, but more how do you digest ideas? How do you digest relationships? How does change work with you and move through you? But I am thinking a lot about the difference when I see someone in that first meeting or two, where are the imbalances? Where do I think the imbalances are? I’ve been trained in two different neurofeedback systems too. So are the imbalances electrical? Are there electrical imbalances going on in this person? Are they stuck in trauma, like a trauma loop? Are there problems with their digestion? Is there something biochemical? Then the question is, okay, how do you move with that? Assume I have a hypothesis that there’s digestive problems, there’s bloating, there’s constipation, diarrhoea, they’re sensitive to many foods, the question is, do we address that symptomatically using a target supplement?

 

Dr. Josh Friedman:

Let’s say a spore-based probiotic and some digestive enzymes, some support, or then do we move to some testing? So then it’s assessing, when do they have the means? Are they interested in digging a little deeper? Do they want to order a GI-MAPs test or something? And I explain doing a lot of education and I never push things along. I say, “I think this might be good now. Let’s try it on. How about I give you a link that describes what this is and I want you to come back to me because we’re partnering here. This is a partnership. The model is no longer me fixing you. You are not helpless. It’s the ideas empowering you to take ownership of your healthcare, of your mental healthcare.” Does that answer your question? Yeah.

 

Kirkland Newman:

Absolutely. Yeah, that’s absolutely brilliant. In terms of what you see the most of, so when people come to you with their issues, whether it’s anxiety or depression or they’re having problems in their life, do you feel that there are any patterns in terms of what might be causing these issues? We talk about the fact that, well, we don’t really know what causes depression or anxiety, but as a practitioner, given your breadth of experience and rules, are there things that come up that you would say, “Okay, the most frequent causes of people’s mental health issues are X or Y.”?

 

Dr. Josh Friedman:

Yeah. From my experience, and there’s different levels to that question, I think, I think there’s a huge epidemic. And this is where I focus. I see things a lot through Julia Ross’s amino acid work. I think that adrenal exhaust, adrenal imbalances, and serotonin deficiencies are huge. I think by far, the most common is seeing people that are wired but tired and overly stressed, and seeing people that are both anxious and depressed and they have a particular edgy or anxious depression. I think underlying that is how overworked and stressed out we are as humans. I think we’ve lost the ability to live in sync with our natural rhythms, with the natural rhythms of the Earth, and I think that we have been trained to not listen to our own needs in so many ways. I think the result ends up with people being incredibly imbalanced. You’ve heard of Ayurveda, the sister science to yoga. What they say is that the first time of illness is a break from nature. It makes a lot of sense right now that where we are right now culturally in the world, in the West especially, is a movement towards nature and a movement towards native cultures and plant medicines and connection to the sea and the forests. Because I think we all know in our hearts that we are completely and totally disconnected with our true selves. So I think it is a psycho-spiritual crisis we find ourselves in. Of course, serotonin imbalances, adrenal imbalances, digestive imbalances are all way upstream.

 

Dr. Josh Friedman:

The basic trauma is this break from our own nature, a break from being rooted on this Earth. And over generations now, we get farther and farther away. We’re living in these artificial environments in almost every way. That’s a basic truth, such a deep, basic truth. There’s this beautiful book. There’s a book called… It’s by Shambhala Press, My Name is Chellis and I’m in Recovery from Western Civilization. It’s this woman who tells this story about comparing her own experience of child sexual abuse to how we as people got divorced from the land over time. She thinks that the beginning of health crisis, mental health crisis, was the beginning of farming. So when people were pneumatic, there were no possessions. I mean, people, tribes traveled together with no possessions. It’s only when you could stay put that there was accumulation of wealth, so there were the haves and the have-nots, the kinds of foods we were eating. But she brings everything back to this being divorced from our animal nature. It’s a book from, I think, the ’80s, ’70s or ’80s. I read it on vacation a couple years ago. I read it to my wife and we were like, “This is exactly what’s happening right now, like 50 years later.”

 

Kirkland Newman:

It’s so interesting because when you talk about being divorced from nature and being divorced from the land, and we’re also divorced from our circadian rhythms because of the fact we’re constantly on technology and we have light bulbs, et cetera, but we’re also divorced from our bodies. One of the key tenets of trauma is dissociation from our bodies, and so we no longer inhabit our bodies. Whether it’s because of our lifestyles or whether it’s because we’ve had trauma, there’s a real disconnect between ourselves, our circadian rhythms, our natural environments, and our bodies. Then the downstream effect of that is the adrenal burnout and the lack of serotonin. In some ways, those are biochemical reactions to the stressors and the traumas that we experience through our lifestyle and through our circumstances. I mean, how do you address that as a therapist, but also as somebody who works with the biochemistry in these cases of adrenal burnout and these cases of serotonin deficiency and these cases of disconnect from circadian rhythms? I mean, what are your go-to ways of dealing with this to try and get people better? And do people get better? Are you able to improve people?

 

Dr. Josh Friedman:

Hopefully. It’s interesting. My first training is in psychoanalysis. Psychoanalysis really focuses on regulation, co-regulation. The first skill I have as a healer person is attunement. And of course, as we know about the attachment theory, this idea that we are always tuning into one another and we are always regulating one another. So I think that my starting point is to be present and is to help people be present. My interest is in psychoanalysis and also this idea of healing through yoga. My wife was my teacher before she became my wife. The kind of yoga she’s teaching is what’s called Ashram style Hatha yoga. And she’s teaching this when I’m getting into it in the middle of very athletic movement style yogas that promote dissociation, I think, in some ways. I mean, they get you high, but it’s not about moment to moment embodiment. So helping people just know this through yoga practices, through being able to do breathing practices, breathing practice for two or three minutes, and see where they get.

 

Dr. Josh Friedman:

And also, most of my work is in the context of psychotherapy. The psychotherapy I do is working with people for multiple years often. I mean, my therapist saved my life and I worked with him for 12 years three times a week. Through the consistency of that, through being regulated by him, and by being regulated by him learning to regulate and name the experiences I was having, was incredibly helpful. There’s this really brilliant story. There’s a famous psychoanalyst who presents this. His name is James Fosshage. He’s worked with this woman for 10 years, and as they’re wrapping up treatment… She had started out being very fragmented, dissociated, parasuicidal all the time, and through the analysis over many years found herself, found her body, found her being, and was able to be in the world in a much safer, more productive way. Out of his ego, he says, “What did I say that was really important to you? What about our work was incredibly important to you? Were there any insights? Were there any interpretations that really landed, that changed things for you?” Her answer is perfect and tells this whole story. “Jim, I don’t remember one thing you said. All I remember is the lilt of your voice.” What it was for her was him telling her bedtime stories and it wasn’t about language. It was heart to heart. I mean it, the mind is part of it because the mind is helping to make sense of the narrative. But I think there’s so much about this stuff that we really don’t know. But it’s about heart syncing. It’s about tools.

 

Dr. Josh Friedman:

So this is kind of cool. I did this program called the Institute For Integrative Nutrition. This guy, Joshua Rosenthal, is quite a brilliant teacher. He does this exercise where he has people bringing their favourite supplement, their supplement that they can’t live without. And it’s a huge thing, thousands of people there. He has people come up on stage and he has them say why they love their supplements, what this supplement is, whatever it is, like rhodiola, tryptophan, whatever it is. Then he opens them up and he dumps them in the garbage and these people have a big reaction. He goes through this whole process with them, and at the end of it, he says, “There’s only one important supplement. There is only one important vitamin, and it’s vitamin L.” Everyone’s like, “Vitamin L? I haven’t heard that.” They’re writing it down, and he says, “The only thing in the end that’s important is love.”

 

Dr. Josh Friedman:

My wife works for this integrative doctor, Dean Ornish. He’s really one of the first integrated docs that’s healing people from heart disease without drugs and surgery using a very simple lifestyle program. This very simple lifestyle program involves yoga, easy movements, diets, and then sharing your feelings. This program that he’s developed comes right out of living international with a yoga guru. They take community living and then they bring it into people who are totally disassociated from their bodies, that aren’t in community, that don’t know how to feed themselves. So he tells the story. He’s invited by the US military… Of course, lots of problems with heart disease in the military, lots of stress. He’s invited to address, I think, 1,000 4-star generals. And they say, “Speak on whatever you want to these generals.” These people run the military. He spends an hour talking about love, the power of love to heal, and that love is really ultimately what it’s about. I think the interesting thing is we all in functional medicine, in trauma work, our minds are so seduced by the latest and greatest tool. Polyvagal theory, somatic experiencing for therapy people, mycotoxins, heavy metals, stealth infections, whatever the latest, that if you master this, then you’re going to be able to help people. I think the thing we forget is that if you are not present with people, if people don’t feel safe with you, then it’s impossible for them to heal.

 

Dr. Josh Friedman:

The thing I’ve learned lately, which you probably know about, which to me is the most interesting idea, is this idea of the cell danger response. I think you may have written about it. To me, the cell danger response… The mitochondria that we’ve known, that these are the powerhouse of the cells involved with lots of mental health conditions, chronic fatigue, fibromyalgia, this sort of thing, but that the mitochondria can be in one of two modes. It can be in energy-producing mode, which is good, which we want, or it can be in danger sensing. So if you’re under stress… And stress could be trauma from childhood, the ACEs, it could be heavy metals, it could be bacterial overgrowth, it could be anything, could be physiological stress, your mitochondria shift into defense mode. No amount of supplements, nothing…. This is the bridge. This is the bridge between the psychology and the physiology. Having a cell danger response means cells are shut down, we’re not healing. I mean, the only thing that can get you out of that state is stress reduction. The magic is, what is the thing that we need? We need to not make the assumption that stress is psychological. It may very well be. It probably is in part. But the idea is teasing out what is the stressful thing that’s causing the body to shut down, that’s causing the body to go into a dorsal response in polyvagal theory or fight, flight? What is that? In some ways, it’s the curiosity of the intelligence and the openness, but to have a model to think through what’s in front of you. If someone has something physiological going on and they’re presenting with mental health symptoms and they go see a therapist, whatever the therapy is might be helpful, but it’s not going to give you a total solution here, right?

 

Kirkland Newman:

Totally.

 

Dr. Josh Friedman:

And if you go see a functional medicine person and they do all of this very expensive elaborate testing and they find 20 things that are wrong and they throw 85 supplements at you and the person is stuck in cell danger response because their childhood trauma loops are keeping them stuck, that person won’t get better in a way. Yeah.

 

Kirkland Newman:

I think that’s the real beauty and complexity of really good integrative mental health therapy, is just being able to identify what it is that’s dysregulating the system, that’s making the system out of balance, and you become a medical detective, and whether it’s childhood trauma-

 

Dr. Josh Friedman:

That’s right.

 

Kirkland Newman:

-or whether it’s mould or whether it’s a heavy metal or whether it’s just chronic ongoing stress, whatever it is that’s putting your system out of homeostasis, out of balance, because our bodies are incredibly good at healing. I mean, there’s so many things that I want to respond to because you’ve said so many rich things. But you talk about the relationship with the therapist, and if you go back to polyvagal theory, social engagement, which is the ventral vagal system, is so important in terms of managing stress. It’s the time when we rest and digest when we’re in this ventral vagal state. And social engagement, so the relationship with your loved ones, but also with your therapist, is really important. But it’s always tricky because you have to deal with all the 360 degree things that are impacting this lack of balance in your system. The other thing I wanted to ask you in terms of therapy, because there’s a huge movement now more toward somatic therapies. So the fact that we store stress and trauma and memories in our body and our cellular memories and that actually cognitive therapies, talking therapies, are less effective at going to the root of these issues. Now, it’s very interesting because you’ve done psychoanalytic work, which is very cognitive, but you’ve also done somatic work. The interesting thing is that a lot of clinical guidelines, especially in the UK, advocate CBT, cognitive behavioral therapy, as being the be-all and end-all in terms of therapies. But we know that cognitive therapies aren’t always that effective when it comes to chronic stress, trauma, et cetera. So what’s your view on that? Do you think that just the relationship with a therapist, even if it’s based on talking, is enough? Or do you find that these somatic therapies are more effective?

 

Dr. Josh Friedman:

I think that somatic therapies are definitely the future for sure. I think that talking therapies, specifically therapies that just focus on cognitions, in 20 years, we won’t be talking about CBT. We may be talking about an integrative new therapy that combines. The bridge from CBT to truly somatic therapies is dialectical behaviour therapy. Dialectical behaviour therapy, a therapy designed for borderline personality disorder, takes elements of mindfulness, takes elements of embodiment and Buddhism, and creates a skills-based approach to deal with dysregulation. But I don’t think that therapy probably goes far enough. Finding the body is what therapy has needed for a long time. Not in the body, finding the nervous system and understanding maps of the nervous system. So in there are different maps. Polyvagal theory focusing on the polyvagal nerve is one well-known map at this point. But the interesting thing is, if you look at yoga, let’s say, they’ve been talking about maps of the body connected to maps of the mind for 5,000 years. So again, it’s rediscovering the old. There’s this idea in yoga of the five different bodies, which are called the five different koshas. You make your way through the physical body and then the energy body and so on and so on, until you get to your true self. In some ways, these are maps of how do we move through suffering? How do we move through places where we’re stuck? There’s a 30-year old therapy called Phoenix Rising that combines somatics with yoga and assuming particular yoga postures and being embodied in them and really listening to the shifting movements within your body.

 

Dr. Josh Friedman:

But yeah, there’s no doubt to me that unless the nervous system is regulated, no one’s mind can be regulated. My sense is probably we’re very much at the beginning of nervous system regulation tools. Polyvagal theory is 30 or 40 years old probably. It’s really interesting to me being in the field. It’s only within the last 10 years that there’s widespread interest in polyvagal theory. Now everyone wants to study polyvagal theory or somatic experiencing. That’s very much the future.

 

Kirkland Newman:

Yeah. I think you’re right. What’s really interesting about the whole nervous system is that if you look at it from a functional medicine approach, we always think of things that dysregulate our nervous system as being psychological mainly. But I think you pointed out very well that some of them could be biochemical. So you could have had a very happy childhood and everything’s fine, but then you’re in a very mouldy house for a long time and then your body perceives that mould as mycotoxins, as stressors, and they are quite traumatic and they create inflammation in your various organs, in your pituitary, et cetera. Heavy metals, the same. Now, there’s also a theory that if your nervous system is well regulated from the start, you’ll be less susceptible to things like toxins and infections. So it’s a bit of a vicious circle. I know, for instance, I have all these weird infections like Lyme and Epstein-Barr and all these viruses now. Those are stressors and they’re stressing out my system and my nervous system, but also, I equally probably got them because I was susceptible through stress.

 

Dr. Josh Friedman:

Right. Right. If your nervous system is not regulated, you don’t have a healthy host.

 

Kirkland Newman:

Exactly.

 

Dr. Josh Friedman:

If your nervous system is not regulated, your gut floor is going to be off.

 

Kirkland Newman:

Exactly.

 

Dr. Josh Friedman:

Yeah. I think that’s exactly right. So the thing is, from a therapist perspective, how do you create awareness amongst therapists to even have the beginning ability to ask questions? Might this be something? Might this regulation be caused by something other than trauma?

 

Kirkland Newman:

Exactly.

 

Dr. Josh Friedman:

Because I think we’re good at doing that work up and thinking about, what are the ACEs scores? What are the adverse childhood events that happened to this person that lead to this? But I think it’s pretty rare for someone who’s skilled in the psychotherapeutic world to have really any idea of the real impact, cellularly, the real impact that can have on a person. I mean, I think we’re trained to think about stress. Even globally, oh yeah, stress can lead to illness. It’s such a high-level way that we think about it that we don’t really drop in to understand what that means. So when I learned about this cell danger response, I was like, “That’s it. It’s right there. Literally, every cell of your body is affected by some kind of stressor.” And when someone gets sick, they can get sick with everything. They’re prone to getting the opportunistic infections like Candida and Epstein-Barr. The same people that get Lyme disease or the co-infections also get heavy metals, also are susceptible to mould. That can’t be just that it was a genetic lottery that left them vulnerable to all these things. It has everything to do with susceptibility to stress that leads to weakness in the immune system, weakness in digestion, weakness in the nervous system. For most therapists, it’s easier if you don’t think about it in some ways. I heard this great interview on the Mould Summit with Wendy Myers who’s this great functional medicine doctor specialising in autoimmunity. She said she started seeing cases of mould in her practice but she pretended that they weren’t there at the beginning. Because it meant if you know it’s there, it means you have to learn what to do about it. I mean, this was many years ago. There’s this thing in us, we want to feel like we’re good at what we do. And the more we let ourselves know, the more we have to sit with uncertainty. The more we have to be willing to say, “Oh, there’s this thing I don’t know… ” In my presentations, I have a little New Yorker cartoon and it says, “My interest in being informed is at odds with my interest in staying sane.” In this world, it’s incredibly complicated. I find myself constantly shutting down to new ideas because it means that, “Oh God, I have to learn that now.” It’s both exciting, but it’s overwhelming to be aware.

 

Dr. Josh Friedman:

I think the other thing is as a practitioner to know your limits, to know your lane. I’m a little ADD and highly interested in things. So it’s quite easy for me to hear about something and then want to go learn it and invest $20,000 in something that takes me off course. I’m not sure I’m wise yet, but one of the wise things I’ve done is I’ve asked my wife to be my super ego. So I tell her, “I want to go buy this $25,000 neurofeedback system, should I do it?” And she’ll ask me a set of questions to see, is this part of your dharma? Is this part of your path? Because you can’t do everything. Integrative means you rely on other people too. You’re not a one-man band. It’s okay to know the best neurofeedback practitioner in town. I’m not a functional medicine doctor, and I grieve over that a little bit, but then it’s like, “Oh, I get to do what I do, and if I see an uber-complex case, it’s not my lane.” I’m giving them a huge gift if I send them to Dr. Neil Nathan or if I send them to someone like Wendy Myers. That’s so important to know, where’s your limit? What’s yours to do in this world? Because we can’t do anything. And it’s not about you or me, it’s not about my ego. We’re here to be the healthiest, to live in line with our dharma, to live in line with what we’re supposed to do here, and to help others.

 

Kirkland Newman:

Completely.

 

Dr. Josh Friedman:

It doesn’t help others if you step into things that are aren’t yours to do. So the one thing I’ve learned is to say no to more things and go deeper into a few things. I figure learning to be a therapist, learning to be a functional medicine practitioner, and be a yoga teacher, that’s enough for this lifetime, because any one of those is 10 lifetime’s worth of study.

 

Kirkland Newman:

I totally agree.

 

Dr. Josh Friedman:

I’ll never be the best of any of those, but I’m going to be someone who knows enough about… I’m going to be like a librarian. I know how to help people get where they need to go. So I’ll often say to people when I make a good referral, “I’ve just saved you five years of suffering. I’ve saved you five years of trying to figure out where to go.” I just want to say about your websites that you’ve created to help people navigate and educate themselves about how to help themselves is so important. Because I think if there’s so much information coming at people on Facebook, on social media, you don’t know who to trust, you have no idea what you actually need. And to have a guide, a navigational tool, first, like a broad-based one like your… Is it called Mind360? Is that what it’s called?

 

Kirkland Newman:

Yeah. MindHealth360.

 

Dr. Josh Friedman:

Yeah. And then a practitioner that can help you navigate how to think, what’s infrared saunas and how is 5G affecting me? Because the symptoms of all these underlying causes are so similar. It’s like, “Oh, I think I’ve heavy metals. I think I’ve SIBO.” And there’s a million things to think about.

 

Kirkland Newman:

Given all this complexity and given this slightly overwhelming realm of possibilities of things that could be dysregulating our nervous system, dysregulating our homeostasis, what in your experience, if you had one or two go-to therapies that you feel are the most helpful? I don’t know if they’re in your feedback or EFT or EMDR or-

 

Dr. Josh Friedman:

So in my experience, I start with the basics. At the beginning, I used to do much more testing and intervention and stuff. And now it’s just, “Let’s start with the basics.” I typically have people do a diet like the Whole30. “Let’s do a diet experiment where you eliminate foods that are known to be inflammatory and then let’s do a reintroduction.” So diet is huge. If I see someone who I think might have blood sugar issues, “Tell me about the pattern of your symptoms. How long after you eat do you have symptoms?” So if someone says to me, “I have no idea.” I just say, “Okay, let’s just track that.” And they come back the next time and they say, “Every time, four hours after I eat, I have a panic attack.” It’s clear to me. “Okay, let’s eat for blood sugar too.” That’s one thing for sure. “Let’s find some way for you to begin to increase your vagal tone, to increase your embodiment. Here’s five things to think about. Okay, let’s be outside in your circadian rhythms. Be outside for some exercise in the morning, bright sunlight. Turn your screens off by nine o’clock. Do a yoga nidra practice.” To me, these are like, “Before you do anything else, find yourself. Find yourself.”

 

Dr. Josh Friedman:

In my experience, the basics go a long, long way. Then if they’re frank traumatic things, let’s maybe target those with the EMDR. So I do EMDR. What happens if we move some of that through? Why don’t you try tapping between sessions? What do you get? I have people try things on, if they don’t love it, we try to tweak it a little bit. If they’re like, “I hate it,” I follow them. I follow them. Unless we’re doing a gut cleanse or liver support, I try to give people five supplements. “Your mood’s up and down. Let me give you a little lithium. How many times a day can you take a few supplements? How about we find the right dose of 5-HTP? Will give you a little adrenal support and let’s just see how you do.” So I’m regulating them and I’m holding the possibility that a simple solution’s going to be helpful. Because I think when people are being exposed to functional medicine approaches, they think they’re incredibly complex. They think that their systems are incredibly complex and they need to find the root cause.

 

Dr. Josh Friedman:

I think there’s ways in which that’s right and finding the root cause can be a jackpot, but I think it also for some people can be a rabbit hole. And probably it’s also because it’s the place that I feel comfortable, is occupying space with people, being attuned. My wife says I am. I’m trying to own this, that I’m more intuitive than I think. We’re not talking about necessarily moving a barge 180 degrees. What happens if we move something 20 degrees and notice and see what happens? So that approach is similar to somatics. It’s small movements that lead to big outcomes. It’s the noticing, it’s the reporting back, it’s being in relationship as you do it. The funny thing is, people will come to me for psychotherapy and will end up doing nutrition. Invariably, the people that come to me through my website for nutrition will end up doing psychotherapy. I just recently saw someone from Europe, and clearly, a young woman with incredible perfectionism. Stress was a huge part of it. Was trying to get pregnant, of course she couldn’t. Had felt like a failure because she had had to leave one European city to come home. We did some nutrition, but the thing that helped was helping her go easy on herself, helping her be a friend to herself. Noticing when she was critical, would you talk to your friend that way? My wife always says to me if I’m being mean to myself, “Be nice to my friends.” It’d be nice. But I do think simple things are incredibly powerful, and simple interventions. Anyone who’s interested, this idea, Julia Ross’s book… There’s a lot of really good functional medicine books. I think Dr. Hyman’s book is awesome. I forget what it’s called. The UltraMind. It’s pretty functional medicine focused. Julia Ross comes at it not being trained as a functional medicine doctor, but being trained as a psychotherapist, starting with very simple solutions that get increasingly more complex if you don’t get the results that you need. In my experience, which sort of matches her, she says 80% of people get better with diet, with targeted supplements, with some embodiment work, I would add that part, with encouraging people to do movement. Then when that doesn’t work, you move into digging deeper. If you’re in archeology, there’s no point in digging the whole thing up. You’re going to miss a lot of opportunities. You go layer by layer by layer. In my experience, start with the first layer, the simple stuff. One, it’s very easy to do. It doesn’t cost a lot. It doesn’t cost a lot for people to understand their blood sugar, to get some targeted supplements like glutamine. That doesn’t cost a lot. And it doesn’t take a long time. So I’ll usually say, “We’re probably going to work for three months or four months together,” if it’s a nutritional-focused thing. And I’m only going to keep you as long as it’s going to be helpful. So I’m simple in a way. It’s deceivingly simple probably, but the low-hanging fruit tends to be the usual suspects, because I think there’s very common patterns that you see. And the more you do, the more you see the common patterns. But of course, sometimes it is lying and the common patterns aren’t going to fix that. But if you build up people’s resiliency, those things aren’t going to be nearly as bad. If you do interventions to turn off the cell danger response, people are going to be more resilient and adaptable.

 

Kirkland Newman:

I think that’s key, is building people’s resilience. I think that’s so important. Just one final question, is how do you work with turning off the cell danger response? Do you have a technique to do that that’s effective?

 

Dr. Josh Friedman:

I think all of these techniques.The question is, how do you turn down stress? I think the first thing is, what are the stressors? So if you have a way of thinking about stress… Doing a good clinical interview gives you the information to start thinking about, what direction are we going to go here? What’s the most likely cause? Because clearly, it’s never one thing, as you said. It’s Epstein-Barr and it’s a dysregulated nervous system from messaging, parenting, and it’s a difficult relationship, it’s divorce. It’s a million things. The question is, what are the most potent contributors to it and how do you go from there? So the question is, do you start broadly? So some functional medicine doctors will do $5,000 worth of testing, which I think is a fair place to start. It’s not typically where I would start. I would start with giving self-regulating tools. I would start with having the top 10 list of things that tend to help people feel more empowered and supported. And being in nature, having down time. What do you do for fun? When was the last time you laughed? Let’s get some basic blood work and look at it functionally. Let’s run it through a functional program, or an organic acid test. Those are two things. The blood work, especially cheap because they can get it, 50 bucks, and run through a program that’s a nice thing to do because it then gives you, “Okay, there’s definitely infection here,” or, “It looks like there might be thyroid,” or, “I think it might be the thyroid problems related to adrenal problems.” Or mineral analysis, some broad analysis that just gives you a way to think about… Okay, because you need a game plan. It’s hard to win the game if you don’t have a plan. I think often we don’t have plans, but how do you think, “What do we do first? What do we do second? And what do we do third? How much can this person digest? How much can this person handle?” I’ve seen patients that have been to different people and they leave without any understanding of what they’re doing. It’s like an allopathic model. They’re taking the right supplements, but they don’t really get it. I think so much of it is having the patients align their spirit with the tools. The most important thing is the placebo. We think of placebo being bad. Placebo can cure anything. It’s much more powerful than any medicine, any supplement. If the person believes they’re going to get better, they’re going to get better likely because it’s going to activate their healing response, it’s going to put them out of defense, cell danger, into healing, rest and digest.

 

Kirkland Newman:

Completely. And that’s key. I mean, once you’re in rest and digest, then your body can do the rest. I mean, your body is very good at healing.

 

Dr. Josh Friedman:

Yeah. And your body is the best doctor there is. So if you can take the impediments out, and some are frank impediments and some is the dysregulation, then people are going to heal because bodies do that. That’s what they’re supposed to do.

 

Kirkland Newman:

Exactly. Josh Friedman, Dr. Friedman…

 

Dr. Josh Friedman:

This is great.

 

Kirkland Newman:

It’s been so lovely to talk to you. Your patients are so lucky to have you with your wide toolkit and your wonderful wisdom. So thank you so much.

 

Dr. Josh Friedman:

Thank you. Thank you so much for having me.

 

Kirkland Newman:

It was fantastic. I’m very envious of people who get to actually work with you. I will put all your resources in the show notes. But just very quickly, what is your website for those who are listening?

 

Dr. Josh Friedman:

Mood, M-O-O-D, healing.com.

 

Kirkland Newman:

Moodhealing.com. That’s Dr. Josh Friedman. Josh, thank you-

 

Dr. Josh Friedman:

Thank you so much.

 

Kirkland Newman:

… so much for your time. Have a lovely day.

 

Kirkland Newman:

Thank you so much for listening to The MindHealth360 Show. I hope that we’ve helped you realise that mental health symptoms have root causes that can and need to be addressed in order to sustainably heal and have given you some ideas about steps you, your loved ones, or clients may take to start their healing journey. Please share this interview with anyone you think may find it helpful and don’t forget to subscribe to keep up to date with our latest interviews on integrative mental health.

If you want further information, please go to www.mindhealth360.com or find us on social media. This information is for educational purposes only and is not intended to diagnose or treat any disease or to replace medical advice. Please always consult your healthcare practitioner before discontinuing any medication or implementing any changes in your diet, lifestyle, or supplement program.