I’m very excited for today’s show, to have one of my favorite doctors on, talking about hormones and mood. So if you’re struggling with mood swings, depression, anxiety – anything like that – stay tuned because it might be related to hormones.
Evelyne Lambrecht: So on today’s show, I met Corey at the National Association of Nutrition Professionals conference dinner a few months ago, and we instantly became friends. He has become one of my go-to doctors for medical questions because he is just so darn smart. I’m really happy to have him on today’s show.
Dr. Schuler is both a locally and nationally recognized expert in the field of natural health and metabolism. He is a frequently sought out expert, teaching to physicians and other healthcare providers, often interviewed for radio and magazines, and consulted by leaders in the industry. Dr. Schuler is a chiropractor, board certified nutrition specialist and functional medicine practitioner with a profound curiosity about why one medicine cures one person with a condition but not another person with the very same condition. For his patients, he brings experience from all facets of natural medicine, including advanced nutritional laboratory analysis to connect the patient to the proper course of care. He is the clinic director of the Metabolic Treatment Center in Bloomington, MN and the Director of Education for Natural Health International.”
So Dr. Corey, welcome to the show!
Dr. Schuler: Thanks for having me, Evelyne.
Evelyne: Of course, you’re welcome. How are you today?
Dr. Schuler: Good. Thank you for the glorious introduction. I feel like I should be walking on water. It’s great.
Evelyne: Well, you do have a lot of credentials and experience. So tell us a little more about yourself and how you got so interested in this topic, specifically.
Dr. Schuler: Well this topic specifically gets right to the heart of quality of life. A lot of practitioners tend to focus on a set of conditions or a set of procedures, and I even kind of tried doing that – working on a special condition here and there – but what I found was that there are certain things that cut across all these different conditions. And for women, when they weren’t feeling like themselves, when they weren’t feeling good about themselves, everything else, their health and quality of life, suffered and deteriorated. And so I have a broad base of knowledge. I’m not a true specialist. I’m not a trained endocrinologist, or a psychiatrist, or even a family doctor. What I am is someone who knows a little about everything, so what fits best for that is moods and hormones and metabolism – this all fits really well together and cuts through and gets at the quality of life issues that I’m most concerned with.
Evelyne: So today we’re talking about mood disorders, mood issues, mood problems. Can we broadly define that and talk about some of the causes of those?
Dr. Schuler: Usually when I talk about mood, I say things like depression and anxiety and irritability. And irritability strikes a chord more with people than things like depression and anxiety. I just say those because we all can at least somewhat relate to them. But when I talk about mood, it’s not about clinically depressed people; it’s not people who have to go to the hospital because they are very depressed and can’t function. It’s low-grade mood issues, those low-grade anxiety and depression issues, like when you get home from work and your hands shake and you think, “I’m frustrated and I can’t function when I get home or there’s something that sets me off.” It’s just transient, short-term. But it comes up frequently enough where that’s a challenge.
Oftentimes those conversations aren’t even had with people’s primary care doctors or even their integrative medicine practitioners. It’s just sort of like, “This is normal. I’m not going to address it.”
So for one, I think that it’s not talked about. It’s a little bit taboo to talk about how we feel when we don’t feel the way we should and how often we don’t feel that way. The cause has been primarily thought to be a “neurotransmitter” thing. We’ll get a little deeper into that. But I think it’s a mistake to categorize mood challenges – things like mild depression, anxiety, or irritability – as just a neurotransmitter issue.
Evelyne: So for these issues that we’re talking about, standard treatment would probably include antidepressants and therapy. But you say that they’re caused by hormone imbalances. But many doctors probably prescribe Prozac or Xanax or Ambien for issues that could be related to hormones so let’s get into it a little more. Which specific hormones are you talking about and how do they cause changes in mood?
Dr. Schuler: Sure. Let’s take a step back. Intuitively, you know that exacerbation of mood happens during major hormonal shifts. PMS is a prime example of that, where we have things like cravings. A craving is essentially a mild mood disturbance. People who are pregnant have huge changes in mood, and of course major changes in hormones.
Postpartum, we have postpartum depression. It doesn’t always go to that level all the time, but that definitely is due to a loss of hormones. Then in perimenopause, there’s some mood instability that correlates with hormone instability. And then in menopause, women have things like anxiety and depression that come along with that hormone loss. The other version of that is hysterectomy. One of the major issues with hysterectomy, the surgical procedure, is that women have major changes in their mood. They’ve never experienced depression, but they start experiencing it. They’ve never experienced anxiety, but they start experiencing it. So intuitively, we have this known connection with mood and hormones.
However, medically, we have disconnected that. If we turn the clock way back to when Premarin was prescribed, or conjugated equine estrogens were prescribed for a lot of different things, we found that women would come in and they had osteoporosis or osteopenia – bone health issues – and we’d give them hormone replacement. Women had a higher risk of cardiovascular disease, so we’d give them hormone replacement because we knew how important estrogen was in the body. The thing with depression is that before there was Prozac, we gave people conjugated equine estrogen or Premarin. So doctors have known this for a long time. We all know it intuitively. We’ve known for a long time that there’s this connection.
I’ve said estrogen now a few times but I don’t just mean estrogen. Hormones aren’t seen in a deficiency or excess state all by themselves. It’s never an isolated event. It’s always a series. I think of hormones as a cascade. There are sex hormones of course, and estrogen is included in that. There are a few different versions. There’s progesterone, and then there are things like pregnenolone and DHEA, which are kind of sex hormones, and kind of stress hormones. There are known stress hormones like cortisol. Cortisol definitely impacts mood. And then if we take it one step further, there are the hormones of metabolism like thyroid hormones.
And so I wanted to underpin our entire conversation with a study that I came across relatively recently. It had to do with women, and they were looking at why women have postpartum depression. Do you mind if I talk about that study?
Evelyne: Please do.
Dr. Schuler: It was interesting because it’s really hard to deal with postpartum depression. So once it sets in, it’s hard to get people out of it. If you’re a new mom, you have new responsibilities and you are probably sleep-deprived. So you have to function in a quality of life that’s poor. It’s hard to function. So predicting and knowing who is really at risk for it is key.
So these researchers took 60 women who were all healthy and they evaluated them. They looked at their whole life, what kind of factors they had. And this had been done before, but this study was interesting because they actually took blood samples for things like estrogen, thyroid hormone, and cortisol. And they found that all three of those hormones were really highly correlated with women having postpartum depression. So it hasn’t gotten to the point of standard screening, but what it does show is that there’s such a strong correlation that it might even be predictive of one of the hardest things to treat as far as mood disorders go.
Evelyne: Can you talk about how hormones specifically impact mood? Is it the fluctuations in hormones or what exactly is it?
Dr. Schuler: That’s a great question. Because estrogen is easy to pick on, I’ll talk a little bit about that because that’s what we see especially with women dealing with it. I’m going to use the drugs that you just mentioned, things like Prozac, Paxil, Zoloft. These are a class of drugs known as SSRIs, or Selective Serotonin Reuptake Inhibitors. What those SSRIs do – and here’s some physiology for the audience, just to catch us all up – is that basically a cell releases serotonin, the neurotransmitter, and it has to float across this vacuum of space and has to land on another cell. And all of this has to be orchestrated really well. It has to release well, it has to spend enough time in that vacuum of space, and then it has to dock appropriately. There have to be enough places for it to dock to do this. All of this has to be perfect.
The thing about it is that the drug comes in and keeps an enzyme from allowing that serotonin to be sucked up by the original cell, because that’s what happens: it shoots it out into the vacuum of space, it lands on the cell, and then it gets sort of sucked back into the original cell. So these drugs stop that from happening, and that’s what they do. One function, just like a good drug should do.
However, our naturally occurring estrogen does a lot more than that. It actually influences how those neurotransmitters are released. It supports or has an influence on the reuptake just like the SSRIs do, and it also has an effect on enzyme inactivation. But the other thing that’s really cool about estrogen specifically is it actually increases the number of receptors on the receiver cells for serotonin. And it’s not just serotonin. It also affects things like dopamine and norepinephrine. So it kind of affects all of those neurotransmitter receptors, and not just the one, single targeted function that the drugs do. So it has a broader impact.
Now, let’s take that away from the biochemistry and the physiology because it’s easy to get lost in that. What that means is that the more serotonin, dopamine, and norepinephrine you have floating around in your body, and the more neurotransmitters that are active and doing their thing, the more you are able to experience things like joy. And it’s not just limited to how you feel in your brain. These neurotransmitters support all these other different functions.
One of the forgotten functions of serotonin is actually about gut motility. And so it’s really impactful, I think, because so many women who have these silent or subtle mood challenges also have things like IBS or ulcerative colitis, and it’s really hard for a practitioner to put a lot of those pieces together because they’re trying to treat five different things now, or two or three different things, when really they may be intimately related by the same circulating signals like serotonin.
Evelyne: And how much of that is related to hormones versus inflammation? I’ve been reading a lot about inflammation in the gut and inflammation in the brain. Does that all kind of work together?
Dr. Schuler: I think it’s almost impossible to delineate that. This is frustrating to some degree, because we want to know what causes things, and then we have to remember that’s a very reductionist way of thinking. We’re not parts. We have parts, but we’re not parts. So it’s nice to be able to remember that it’s all really related.
And you know what? It’s William Davis’ birthday today. He wrote Wheat Belly. So let’s honor William Davis by talking about gluten. Gluten causes inflammation in the gut and that inflammatory cascade and that immune response actually bind up a lot of the hormones from being active. And if they’re not active, then they don’t influence the neurotransmitters. And so I would say that it’s intimately related. But we have to work on both sides of the equation. So if somebody does have a mood challenge, I’m going to be looking at inflammation as well as hormone levels and that entire orchestration of hormone production, metabolism, etc.
Evelyne: When someone comes in to see you and they say they are struggling with some of these issues that we’re talking about, what do you start with? What testing do you do? Do you do questionnaires? What lab tests do you run? Where do you start?
Dr. Schuler: The terrible answer that no one wants to hear is “it depends.” In reality, I want to get a handle on what is really happening. And I was taught – all doctors are taught – that 90% of the diagnosis comes from history. And so while I love testing, seeing the numbers and putting together the biochemistry in my head, what I’ve gotten better about recently is really hearing out the story, really fleshing out the timeline of when things started and how people’s life events overlapped, and all of that. And I do that not just with mood, but if people come in with a GI problem or they have a named thyroid disease or something like that, I still want to know the timeline.
I think functional medicine has done a lot to help practitioners like myself put that into a context. Let’s put together the timeline, let’s understand the triggers for the problem, and what we think caused them or what we noticed caused the problem that we are dealing with. But also what were the mediating factors behind those triggers? And behind that, what were the antecedents or what were the predisposing factors? Was there a little bit of a genetic component or not? So for me, I have to go back through a person’s family history and their personal history, and then when it comes down to it I can eliminate a lot of the excess testing that I think is done by just understanding physiology. We can minimize the testing and then we can create an elegant solution so we can improve the body’s own hormone production.
When I talk about hormones, it is really attractive to jump to the conclusion of, “Let’s measure the hormones and then let’s either try to metabolize them out of the system if they’re too high or replace them if they’re too low.” But I don’t believe that hormones are an insufficiency/deficiency/toxicity kind of thing. I think about it more like, “Is the body producing things at the levels it is supposed to?” Because that is what is supposed to happen. I look back not just on that person’s history, but I also think about and educate my patients on the fact that you are an animal, part animal and part machine. And so if you are running away from a bear in the woods, the last thing that you need to know or the last thing that your body needs to do is reproduce. So your libido doesn’t matter and your body only has a certain amount of energy. It’s going to take that energy that was going to go towards sex drive, and it’s going to shunt it into your circulatory system so you can run away from the bear in the woods. Again, intuitively, that makes sense and I don’t need expensive testing to do that.
I want to take one tiny step back, because I mentioned libido, and the thing about it is that all of these things that support mood – these serotonin reuptake inhibitors – their main side effect is sexual dysfunction. So some women have sexual dysfunction, poor libido, and those problems actually exacerbate their mood condition. So we’re going to make it worse by treating the wrong thing in metabolism.