Interview With Dr. Kelly Brogan

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Hilda Labrada Gore: Today’s guest is Dr. Kelly Brogan. She is the author of the New York Times bestselling book, A Mind of Your Own and co-editor of the landmark book Integrative Therapies for Depression. More and more people are realizing there is something to the psychological issues that we’re seeing and how we can approach them with nutrition and alternative methods. But I want to start with you, Kelly, tell us your story. How did you get into this field of treating depression in a different way?

Dr. Kelly Brogan: I come from a very conventional family—very much believers in the authority of the medical model, and I myself was a huge proponent of the pill-based cure. And, as is the case for so many physicians who ultimately turn their back on conventional medicine, the portal for me was my own diagnosis, my first health problem.

Before then, I never knew what it was like to walk in the shoes of a patient. And so up to that point, the pharmaceutical model seemed to make a lot of sense to me. It seemed like it was reasonably science-based and that there was a linear progression from diagnosis to treatment and to a better experience of life. But when I was confronted with that model, I chose to opt out. It was through my postpartum diagnosis of Hashimoto’s thyroiditis that I discovered naturopathy and realized that lifestyle matters. I watched my own pretty horrifying lab results move very seamlessly into the normal range when all that I was doing was changing the way I was living—examining my habits—and I felt like a totally different person. So that was my big “ah-ha.”

HLG: And when did you decide to explore possibilities with depression in particular?

KB: Since my point of entry was the immune system—an autoimmune condition that happens to have its primary impact on the endocrine system—I began to come upon a whole new body of literature called “psychoneuroimmunology.” This is speaking to the fact that all of these different disciplines that we heretofore imagined were totally separate and distinct—requiring different specialists—are actually linked in a web-like manner, so that the gut, immune system, hormones and brain-based neurochemistry are all in dialogue. The idea of having given specialists addressing this brain problem began to seem more and more suspect to me. I started to research. I hit the books because of my own health experience. I went back to PubMed and I said, “Listen, no one ever told me that modifying my diet would result in remission of an autoimmune condition. So what else didn’t they tell me?” I spent years nearly obsessively reading the primary literature. I was learning everything I could about different pharmaceutical products and undisclosed risks, learning about the science-based evidence for natural healing and learning about this sort of new frontier in thinking about biology that invokes these radical concepts like epigenetics and biochemical individuality and the role of our inner ecology or microbiomes.

And it turned out that there were decades of literature on this, and I had never heard of it! I thought that was so interesting until I discovered a convenient statistic, which is that it takes seventeen years on average for primary science to trickle into clinical translation, that is, to make it to your doctor’s office. In other words, our standard of care is outdated by the time we even get to our doctor’s appointment. I began trying to distill and curate this information for people to use on their own, and then I read a book that changed my life. A colleague gave it to me and she said, “Kelly, what do you think about this? You prescribe a lot of these meds.” The book is called Anatomy of an Epidemic by investigative journalist Robert Whitaker. I had just had my healing experience when encountering this inspiring science, and it ignited in me a lot of curiosity about everything I hadn’t been told. And here lands in my lap a book that drives a nail in the coffin of psychiatric prescribing because Whitaker simply poses a question: “How is it that a psychiatric illness like major depression is ever-escalating? It’s the number one cause of disability worldwide, according to the WHO [World Health Organization]. How is that the case, if we also have ever-escalating access to treatment? We have more people taking psychotropics today than ever before in human history. Shouldn’t that be resulting in diminished disability rates? Why are they escalating in tandem?” That seems like a relatively innocent question, but then Whitaker goes on to provide reams of non-industry-funded data to support the very provocative suggestion that medication is actually driving epidemics of disabling mental illness. When I finished that book, I remember crying on the subway in Manhattan. Literally, tears were coming down my face, because I had just watched my entire training go down the drain. I never started a patient on a prescription again. This was almost a decade ago.

HLG: Whitaker was saying that the very act of getting people on psychotropics is causing the epidemic to spread more. But aren’t we seeing more and more depression and treating it?

KB: Both are true. In my experience, people have symptoms and they appear differently. So, her cancer, his diabetes, her bipolar disorder—these are a very meaningful response to imbalance on a physiologic level. We call that imbalance “inflammation.” We have all of these diseases of modern civilization that are literally taking down our gross domestic product (GDP), dollar by dollar. And we are theorizing about them as being distinct disease entities, but really they are just slight variations on a theme. We are living out of sync with our inbuilt genetic expectations. In the research, it’s called “evolutionary mismatch.” I know that’s probably a familiar concept to the Weston A. Price Foundation community, which is aware that we’ve wandered off the path in a serious way in the way that we wake up, eat, think, expose ourselves to sunlight, move, sleep and relate. As a result, there is a very real signal of distress. It is meaningful. I call it an “invitation.” But what happens, at least in the realm of psychiatry, is that we assume that these are actual disease entities rather than largely non-specific expressions of distress, disturbed homeostasis, inflammation and imbalance. And of course, on a spiritual level they’re highly specific, but on a biological level, it’s just an expression of a lack of being “in sync.”

The mistake is when we don’t have the nuance, when we don’t have the sophisticated clinical inquiry, when we don’t know how to approach these complex problems, and instead we fit them into a convenient template of psychiatric labeling. Most of you likely know that psychiatry doesn’t involve any testing at all—there’s no blood testing, there’s no EEG testing, there’s no cerebrospinal fluid levels, there’s no neurochemistry assessment. There’s nothing. It’s an impressionistic conversation that often leads to a person being assigned a label for life. That label has a tremendous impact on your sense of self, your personal identity and the lens through which you experience your own life and associated limitations. The problem arises when practitioners just trample over the whole clinical presentation and say, “this is what’s going on,” with some hand-waving around “neurochemical imbalances” and some sort of question of “genetic susceptibility,” and then put people on prescriptions and pharmaceutical management in perpetuity. Instead, we should be saying, “Something is wrong on this planet. People are struggling in pretty serious ways. What is that about? Why?” We need to ask the question “why.”

HLG: Is this why you say in your book that depression is not a disease? Because you’re implying that the label is inappropriate.

KB: I do feel that way. I think of it like a fever because we look at a fever and we don’t really know from the fever itself what’s driving it or what to do about it. We have to investigate that. In that way, it’s a symptom. It’s a collection of symptoms, which is called a “syndrome,” but by no means is any diagnosis in psychiatry—from schizophrenia to OCD [obsessive-compulsive disorder] to bipolar disorder to ADHD [attention-deficit/hyperactivity disorder]—actually a verified scientific biological entity. This is where psychiatry deviates from other branches of medicine. When we say, “What’s diabetes?” we don’t say, “It’s when you’re really thirsty and you have to pee a lot and take insulin.” We say “It’s a sort of an imbalance in insulin management of blood sugar levels, and this is the physiology, and this is what we best understand is the way to intervene.” (Not that I think diabetes is not amenable to lifestyle interventions, but nonetheless there is a physiologic mechanism that we have elucidated that is the sort of biology that is verifiable from patient to patient.)

In psychiatry, we say, “what is depression?” and we say, “Oh, well, it looks like this. And here’s what you do about it.” There is absolutely no mechanistic understanding of what it is. And that is a big “ah-ha” for me because when I looked through about sixty years of research assuming that depression had something to do with the serotonin imbalance, I was shocked to learn that there’s literally not a shred of valid evidence to support that. To the extent that over the past twenty years, the whole notion of what’s called the “monoamine hypothesis” has been completely abandoned, in lieu of what’s called the “cytokine theory,” which is what we were just talking about—this inflammatory model.

HLG: You just used a couple of terms that went over my head, but I get the gist of what you’re saying. Tell me if this is right. There isn’t scientific proof that demonstrates where depression is stemming from. But according to your investigations, there is a link that may become better known by the public at some point that the gut microbes and inflammation have a lot to do with our mental health.

KB: Yes, certainly not all the time. Let’s take the example of your toe hurting. It could be that a hammer dropped on it. It could be that a string is tied around it too tight. It could be an infection in the toenail. Everyone’s experience of these symptoms requires personalization. Depression can have many, many drivers ranging from nutrient deficiencies, like a B12 deficiency from a poor diet or taking an acid-blocking drug for a long time, all the way to an endocrine disruption, like hypothyroidism, or a psychospiritual emergence.

It’s an amazing detail that in our current iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in psychiatry, which is this growing book of labels of what is not “normal,” the bereavement clause was lifted, so that if you are exhibiting symptoms of depression for more than two weeks after the loss of a loved one, you could be a candidate for medication-based treatment. The implication being that something is wrong with you when you experience that kind of grief that is protracted beyond two weeks. The range of what we are labeling as a disease encompasses so many important factors of wise response on the part of the body, mind and soul that we need to begin to dive into your story personally.

HLG: What are some things we can do to mitigate these factors that are leading us to problems with our gut microbes and inflammation?

KB: I was able to translate my own healing experience of recovery and remission into something that I could pass on to those struggling with psychiatric symptoms or even with just feeling overwhelmed, so symptoms ranging from malaise all the way to what would be considered major mental illness. Even though that list of potential drivers is a big list, what’s interesting is that on a bodily level, social or spiritual distress can show up the same way as gut-based disturbance in terms of inflammatory signaling, so the body doesn’t discriminate—because we are holistic organisms and it all matters. The lowest-hanging fruit is probably not some dark-night-of-the-soul journey to examine all the skeletons in your spiritual closet. The lowest-hanging fruit is going to be to heal your body—and that explains my bias. Even though I have many friends who are shamans and energy healers and walk different paths in the way they support people, my bias is that if we start with physical healing often you don’t need to dedicate more than an intensive month to that effort before you can get clear enough to know what your baseline symptoms are. Are you an irritable person who has insomnia and cloudy thinking? Maybe you’re not. Maybe it is just blood sugar disturbance.

The dietary recommendations I make are in line with what is familiar to WAPF, which is basically to control for inflammatory processed foods, to increase nutrient density and to begin to relate to food in a new way. See food as something that connects you to the natural world—to a greater ecology and to a lineage. Begin to restore a sacred dynamic to your diet.

I had the privilege of working with and being mentored by Dr. Nicholas Gonzalez in the last year of his life. In my opinion, he was the most important figure in modern medicine. I believe that he was able to bring a faith in the potential for healing that was so radical that I’m not sure anyone could stand with him. He had hundreds of cases of complete, long-lasting remission from terminal cancer, hospice-bound patients who were left basically for dead who are alive thirty years later. He also saw neurodegenerative conditions resolve, or something like Hashimoto’s or even symptomatic bipolar disorder. His approach was predicated on detox and personalized nutrition. He used the idea that there isn’t one diet for all; there are variations of diet ranging from fatty red meat twice a day to no red meat ever. Plus, he personalized mostly glandular supplementation.

The time when I met him in my clinical career felt divinely ordained because I was at the point where I was seeing these outcomes over and over again in my practice with a red-meat-inclusive diet. As a former ethical vegetarian, I could not explain how this could be possible. As a big Weston Price fan, I also knew that there can’t be just one diet—how could there be one template? That didn’t make logical sense to me, let alone clinical sense. In my work with Nick, I was able to understand that the patients who are diagnosed with multiple chemical sensitivity, autoimmunity, depression, hypothyroidism and ADHD are what we would call parasympathetic-dominant. Dr. Gonzalez came from a long lineage of great thinkers, including Pottenger and others, who saw that these conditions are parasympathetic-dominant and will only get better when they include red meat in their diet. I don’t see the other side of the spectrum typically—those with diagnoses of heart disease or type 1 diabetes, or the neurosurgeon who gets by on a candy bar all day.

My patients struggle with what’s called reactive hyperglycemia—their blood sugar goes all over the place, they’re hungry and irritable all the time. They can’t go two hours without eating a meal. These are very different templates that require different interventions. The good news is that if you clear the slate of addictive foods such as processed grains and processed sugar, if you look at controlling for other inflammatory variables like vegetable oils and you include food in its whole form, you begin to want to eat the diet that will heal you. Nick always told me that, and it was my personal experience seeing it over and over again, that you know exactly what you’re supposed to eat. But when you are yanked around by coffee and alcohol all day, native perceptual skills are totally clouded over by the addictive nature of some foods. When you get rid of those, you begin to get clear enough to understand what your baseline is. Then navigating it becomes intuitive in a way you probably never thought possible.

HLG: I’m glad that you said that our bodies can be more in tune with the foods that are going to heal us. I was thinking that for some people, it might seem simpler to take the medicine the psychiatrist prescribes, because pill-popping is simpler in some ways, especially to the person who’s not in tune with their body.

KB: It may seem that way. I think though, that the reason I had a two-year wait list before I started my online program and put out a book with my exact approach and protocol in it, is actually because the standard medical model is not working. It’s actually leaving people feeling like they may be stabilized somewhat on their prescription, but actually that if they look back, they’ve been continuously and episodically sick. I have many patients who’ve been medicated to the gills and have been suicidal almost the entire time. People struggle with side effects, ranging from sexual dysfunction to liver failure and even behavioral changes that are totally shocking and heinous.

But perhaps the most common driver of psychiatric medication discontinuation is that people begin to feel like they want to know who they are. They want to know who they are off these medications and when they try to stop them on their own it can be difficult. The withdrawal from these meds is very difficult. It’s what I devote my entire practice to—an online platform to support people in coming off these medications. There’s an idea within psychiatry that a person cannot discontinue medication—it’s dangerous—so you have to take them for life. But the truth is that the long-term data contradict that assertion. It’s a very paternalistic assertion on the part of many psychiatrists because the data don’t support that idea. The data in Whitaker’s book suggest, in no uncertain terms, that the longer you’re on medication, the more risk of disability you have.

In general, we have only studied these medications for four to eight weeks, sometimes twelve. They have never been studied apart from a handful of naturalistic observational studies for long-term use, yet we make a lot of assumptions in medicine. One of the assumptions we make is that it’s better to do something pharmaceutically than to do nothing, when actually the data suggest otherwise.

HLG: Kelly, this is a controversial question—would the behavioral changes you mentioned explain why so often those people who kill themselves or others are not stable even though they are on these meds?

KB: Yes, exactly. This became more and more clear to me since I was contacted by somebody named David Carmichael, who’s just a regular old guy. He was prescribed Paxil for work-related stress. Shortly thereafter, he strangled and murdered his eleven-year-old son. He is on a mission to raise awareness about the very real possibility of a kind of intoxication that can happen even with one dose of different psychiatric medications. There’s a fair amount of data on the antidepressant category that can induce what is called akathisia-related impulsivity. This is a clinical entity that we know about. We actually know, based on the scientific literature, that people who go on to commit alarming acts of public violence—which can range from a patient coming in and murdering their doctor to someone shooting up a movie theater—when studied, they actually have a liver enzyme variant that accounts for the fact that they become essentially intoxicated in a way that is not apparent to them. And what’s even creepier is that they look very calm on the outside, but inside they are consumed with delusions and this sense of crawling out of their skin and an impulsive desire to commit acts of violence against themselves or others.

I have another activist whose husband was prescribed Zoloft for insomnia, which is weird to begin with. Five weeks later he hanged himself in their garage. He’d never been depressed a day in his life and certainly not suicidal. This is not a rare occurrence, and it is poorly screened for, if at all. This is one reason I believe all prescribing needs to halt until we have a better understanding, even on a public health level, of what are possible adverse outcomes of even a single prescription of psychotropic medication.

HLG: It seems all of this medication is a stab in the dark. Without testing where the levels are in the body that are affecting the person’s state of mind, then it really is a crap shoot, and it doesn’t sound like the odds are in our favor.

KB: That’s exactly it. Everyone is entitled to do exactly what feels right to them. I believe in freedom of choice and informed consent. I’m not saying that I want to shut down conventional medicine tomorrow. I believe that people will be attracted to exactly the medicine that’s going to work for them at their stage in life. But I also think it’s important for people to know, whether it’s my outcomes or my colleagues, that there is a safer, potentially more effective way that has innumerable side benefits. It is also cheaper.

My passion is to celebrate the very radical outcomes I see. I have four that are being published in peer-reviewed indexed medical journals. I have never even met three of them. So it’s not some magical voodoo I do in my office. It’s a kind of self-healing that is directed through a structure of lifestyle interventions. The outcomes that I have range from people who put their Hashimoto’s or migraines into remission, to people who overcome being psychotically suicidal and self-injurious. I have a schizophrenia case and other severely disabled people who have gone on to reclaim their mental and physical health on levels that are not possible through the conventional model. We’re talking about no side effects and all upside. I believe it deserves some attention.

HLG: Absolutely! As we wrap up today, I want to ask you the question I often ask my guests: If someone would only do one thing to improve their health, what would you recommend that they do?

KB: So it’s funny because I love to write. I also love to research, and I will sometimes spend weeks and weeks on a blog article about a given topical issue. And the most viral contribution I have ever made to the Internet is what I eat for breakfast! It is a smoothie that I made up. It does not require any special protein powders or subscriptions to any kind of products. It’s all kitchen-based stuff, and interestingly, there are actually no greens in it. It’s not a green juice, it’s not a green smoothie even. And that was another weird thing that I discussed with Nick Gonzalez—how can I be getting so much feedback on this smoothie? It’s like a passionate choir of people singing from the audience about how much better they feel. I couldn’t understand. There’s not even kale in it.

The recipe is on my website. But it’s very basic, it’s cacao, ghee, coconut oil, butter, raw egg yolks, coconut water, whatever frozen fruit you happen to like (I like cherries) and collagen (such as you would get in bone broth). The reason I think changing your breakfast is sometimes the first step is because it’s a really easy and early win. If you struggle with blood sugar disturbance, which I think is extremely common, particularly in those who’ve been labeled with depression, ADHD, anxiety, agitation or irritability—or just people who feel cloudy or have brain fog and may be chasing it with coffee all day—the early win can come from a lot of natural fat that serves to stabilize blood sugar. The feedback I get is that with this smoothie you feel full for hours longer than you might otherwise, and you have that slower, steadier burn. And so that would be my first intervention. (kellybroganmd.com/vitalmind/kb-smoothie-video/.)

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Fall 2018.

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