Andrew: I’m really good, thank you. But I’ve gotta thank you, especially, because we’re recording on a Monday in Australia, which means it’s Sunday evening in the U.S. So, thank you so much for giving up your time to join us. Perhaps we can start off with just a little bit of your background and your interest, your keen interest in mental health, please.

Dr. Coetzee: Yeah. So, I was born and raised in South Africa, and I finished my bachelor’s degree there. And I had two majors, actually. I specialized in criminology and psychology, and I had a real interest in criminal psychology, you know, at that particular point. Then, after military service, I, you know, decided to come to the United States of America. And I applied for a position at Fair Oaks Hospital, in Summit, New Jersey, where I started working in the area of drug and alcohol counseling. And in that particular arena, I was working with codependency counseling, suicide intervention counseling, you know, as well as, obviously, working with the drug addicts themselves. And that systemically evolved, clearly, in the whole mental side, because it was a direct affiliation to working with people with addiction problems.

Then, at that particular point, I was also just… I just completed my master’s degree, because I was doing, you know, my internship after I’d done my master’s, because I came to the U.S. to study for that. And there was a medical doctor there. His name was Doctor Mark Gold. And I wanted to go and do my PhD in psychology. And he was like, “You know, you might want to investigate this nutritional application and integration with mental health, because nobody is really focusing on that, and it’s really something that he felt at that point was a pretty interesting area to go and investigate. So I was very keenly interested in that. And at the same time, my mom got ill, so I got really drawn to this whole natural approach, and started to dig into alternatives, and one thing led to the other, and started to formulate some ideas on the overlap between psychology and nutritional health. And that just evolved and evolved. So, finally, I ended up in the area of psychology. I went down the clinical path, worked with a lot of, you know, metabolic issues, and then worked with athletes. So, sports psychology, at the end, was the point of my psychological association still, but, you know, most of my clinical work has been done, you know, on a more clinical level. But I do work with anxiety and depression and gastrointestinal health and metabolic issues.

Andrew: Just as a side note, Oscar, the Rat Park study, you would have obviously been exposed to that study early on. What weight do you give the need for social interaction, happiness, and meaning in people’s lives, as a means to either prevent drug addiction, or get off drug addiction once they are drug addicted?

Dr. Coetzee: I think it plays a massive role. You know, I definitely believe that our environment, you know, is a major trigger in the outcomes of our behaviors. But you see, this is where my whole philosophy and theory comes in. You see, I believe that what I call psychonutrigenomics, right, which is the psychological view on the integrative part of genomics and nutrition and psychology. For me, it’s a three-pronged bar stool, and every one of those pieces plays a major role. So, I am absolutely in the belief of foundational, good social environment, and motivating parents, and structure, you know, to prevent these kinds of things from happening. But, you could sometimes have that in a person, and then they still end up being a drug addict. So, maybe their component was there was a dopaminergic conversion issue, and anything with dopamine surges drove them more to, you know, to that addictive behavior.

The nutritional component is the third leg on the bar stool, right. So, that’s the one that I feel exaggerates the psychosocial, as well as the genetic or the genomic component. So, for me, I don’t like just working on the psychology thing in one entity. I like to work with a therapist, as well as maybe a psychiatrist, if that’s needed, a nutritionist, and then maybe a life coach, you know, at the same time. If you want to really get to the bottom of mental health, I think it’s a multifaceted discipline, you know, at this point.

Andrew: Yeah. Yeah. Back to the, sort of, question frame, if you like. But current stats, what are we looking at here, particularly after COVID? I mean, it must have been, you must have just had this massive surge in, it’s almost like a PTSD.

Dr. Coetzee: Definitely. I think there’s been an incline in anxiety and depression over the last couple of years now. You know, if we’re looking at current stats worldwide by the World Health Organization, I think we’re looking at about 23% of the population in a state of depression, and about 25% people in a state of anxiety. Now, COVID clearly threw a big spanner into the works. But I don’t think it’s just there. I think that was kind of the straw that broke the camel’s back, you know, and that isolation state. But I think we had set ourselves up, by virtue of our diets and lifestyles, and, you know, this consistent exposure to a fast-paced life and dopaminergic over-surging, for such a long period of time, that’s all we needed, you know, to finally break the camel’s back with that piece of straw. And, you know, that’s where I think we’re at, you know, at the present time. But the one thing that’s really shocking to me, and scary to me, is, generally speaking, it was the older population that used to end up with the worst depression, right, because you’re losing your friends and your loved ones, and, you know, you’re not working anymore. You don’t feel like you’re, you know, adding anything to the population.

But if you look at the current data, the younger children, between the ages of maybe 14 to 28, is really where the depression is surging now. And the sad part of that is also the increase in the suicide ideation and the suicidal tendencies that come with that. And that’s a big concern for me because I feel that there isn’t enough research and literature done on, you know, the use of these medications on young kids, and that could end up, you know, in some issues. I know that there’s a place for them. But I just feel that there needs to be more work done in that area. But I do also feel it’s because we are getting away from social interaction, you know, and the kids were doing that already on tablets and cell phones prior, as we all do. But this is the first generation where we’re really going into no physical eye contact anymore, on a consistent level. And then if you throw COVID in, where you have no presence with other people, other than a social media, I think it’s just an avenue of disaster, you know, and that’s where we’re at.

Andrew: Yeah, and the funny thing is, like, what we learned to accept during lockdown, you know, this global lockdown that we experienced, was that we would communicate like you and I are doing, at a distance, but not face-to-face. And it’s really interesting how society seems to have embraced or accepted that, let’s say hybrid, that hybrid existence. But what I find really interesting is there is nothing like that person-to-person contact. However you want to explain it, whether you want to explain it in a feeling of being a part of something, like a species, like any animal, or whether there’s some other factor in there, it’s just really interesting how we’ve come to accept it, it seems to be okay, but it’s not the same as person-to-person communication.

Dr. Coetzee: It isn’t. And you’re 100% correct. We are pack animals, right? I mean, we want to be part of a social pack. We want to be respected, and admired, and loved, you know, by other humans, right? It’s great to have a dog or a cat, and they’re unconditional, but we want to be accepted by our own species, without a doubt. But I just also feel that, you know, we’ve just gone down a path where, you know, like you say, the social interaction has become the norm, right, you know, with Zoom and the way we communicate. Now, it makes sense for us, you know, in different continents, to be able to do that, but if you buy into any of the anecdotal data that’s out there at the current time, is, like, let’s say you and I are on a room. Let’s say I come out to Australia in February, and I do these talks, and we’re in a room together. We’re actually affecting each other’s microbiomes. Like, we are actually helping to generate and express each other’s microbiomes differently, and if you buy into the microbiome connection to mental health, then, well, there you go, right? I mean, we’re missing out on that part already, and that’s just one little, small section of what we’re really talking about.

Andrew: You also mentioned earlier psychoneurogenomics. We need to dive into this. Big word. Can you break it apart for us?

Dr. Coetzee: Yeah. So, the word is psychonutrigenomics. So, psycho, for psychology, nutri, for the nutritional component, and then genomics for the whole genome, right? Everything that plays a role. It’s not just the genetic individual SNP or gene, it’s the whole interaction of it all. So, the psycho, for me, and that word, would be therapy, support, social endeavors, respect, careers. You know, all the things that drive us to make us feel happy in relationships. The “nutri,” or the nutritional component, is the most overlooked one. Right? We are not going to a psychiatrist and they’re telling us, “Listen, you know, before we dig into an SSRI, how about we just check your vitamin D, your blood sugar, and your iron status, just to make sure that that’s not an underlying cause of your anxiety or depression?” That’s not done. So, that part is the least investigated. And then the genome, there’s a lot going on, right? I mean, there are people that, looking at several genes and SNPs that have a direct correlation to addiction and things to that effect. But if you combine all those three things, through functional testing, really working with a psychiatrist or a psychologist at the same time, so that patient gives in to that interaction between the professionals, that’s when you really have the success. That’s the most success I’ve had with clients and patients, is when I’ve worked with them, with the other doctors, that are also experts in their area, because anxiety and depression is not a one-size-fits-all, and “Oh, this is the cause of Mary or Joe being anxious,” right? I mean, it’s multifactorial.

Andrew: Do you tend to adjust dietary interventions, then, depending on SNPs that you see? And I’m not just talking about the common ones that we think about, like DAO or COMT or things like that. I’m not just thinking about that, but do you look further, and look at, like, you know, the thrill-seeker gene, or the warrior gene, and things like that? And does that…?

Dr. Coetzee: Yeah, you wanna look at… Yeah. I’m sorry for jumping in there. You definitely want to look at that warrior, being the fighter, or the worrier, being the stressed one, right? The warrior versus the worrier, that’s a really interesting one to always look at. But there’s a couple of other genes that you need to look at as well. You know, you definitely look at, you wanna look at some of the genetics involved with dopamine conversion, right? And serotonin conversions, THP1, and DDC, and, you know, like you say, that COMT, with the catecholamine, ties into that whole conversion from dopamine, but, you know, whenever you’re working with addictive personalities, or anxiety and depression, and people that go in overdrive, you know, that’s generally one of the major ones you want to look at. And the unfortunate reality of that is that there are so many foods that artificially drive dopamine surges, right? So, you get this temporary sensation of euphoria and feeling good, and then you go into this massive crash afterwards.

So, the way that I think… So, let’s say a person comes to a clinician with trauma. Sexual trauma, life, bad stuff has happened to that person. The nutritional evaluation is not the most important component, right, in that that… That, you need to go into a deep therapy, and the nutritional component can help. But that’s not phase one. What I’m talking about is the group of people that we all know about, this, they have a job, they have a relationship, they’re not totally unhappy, but they’re not happy. And they don’t understand why they’re not happy, and they don’t understand why they’re a little depressed, and why they’re always anxious. They just can’t put their finger on it. That’s the person where you wanna go in with a nutritional component of that three-prong bar stool first. That’s the “nutri,” right? That’s the one that you wanna go check out, what are the underlining things that could play a role there? And there are several, right? I mean, you can look at anemia, can mimic anxiety and depression. Hypoglycemia can do that. Vitamin D deficiency can do that. Vitamin B3 deficiency, vitamin B6 deficiency, B12 deficiency. I can go on and on and on. And you need to cover those bases before you go to phase two, because you could actually hit the nail on the head. And the interesting thing about this, sometimes, is, it’s not that magic ingredient. It’s the combination of all of them that then makes that shift.

So, it might be a little B6, a little D, a little of amino acid conversion, and you give them some nutraceutical to help convert that SNP, you know, or express their gene slightly differently, like, that you were mentioning. And then you have the results. You know, it’s this whole, SSRI, or MAO, or, I’m gonna give you just a calming nutraceutical, is not really where you wanna go here, because everybody has to have this kind of table filled out, and figured out, hey, you know, these are the things that accumulate to optimal mental health. Let’s make sure that they’re all in place.

Andrew: That was actually a really good answer. I was thinking earlier, you know, do we just barge our way in with something like 5-HTP, for the precursor for serotonin, or do we really need to set the table, as you said? And I think you’ve just answered that, so thank you for that. Can I ask, with regards to anemia, I’m seeing a huge issue of poorly-managed anemias, where people are just bolting in way too much iron, not giving any credence to any other nutritional factors. And, you know, TIBC, ferritin saturation, they’re just, they’re, constantly remain low. Can you take us through how you would address that issue of anemia, please? This is a lecture in itself, I know, sorry, but could you take us through a few hints and tips?

Dr. Coetzee: Yeah, for sure. Yeah. I’m with you there. I think, you know, to determine anemia, you’ve gotta look at some of the markers that you mentioned there. But a very overlooked thing is a condition called anemia of chronic disease, right? So, anemia of chronic disease is where people might sometimes show that they have lower iron because the iron is sequestered into storing, and they might have all the symptoms of an anemic person, but the ferritin and the liver enzymes might be a little bit higher, because the iron is sequestered, right, into storing capacity. So, you gotta be very careful when you start doing that. And what I’ve learned is that there is never one nutraceutical that is going to cover all the bases, because remember, you have iron deficiency anemia, you have sideroblastic anemia, you have megaloblastic anemia, right? So, you have variations of anemia that most people don’t focus on. But for me, what I want to definitely rule out is a bacterial infection or something going on that is sequestering that iron away, and that’s why that person isn’t absorbing it.

Or alternatively, you know, what does that person’s intestines look like? You know, how’s the villi? Because the, look, the villi, the duodenum, is very much looking for iron, right. We don’t make it. We have to get it from outside sources, so these babies are looking for that little nutrient to come into our bloodstream. But, you know, what’s the reason for the compromised duodenum? Right? So, there’s another kind of a theory that I created to my students, and I call it absorption syndrome, right? So, duodenal, compromised duodenal absorption system. Sorry, let me rephrase that. Compromised duodenal absorption syndrome. Right? So, that is a multi… There’s no such thing in the medical dictionary at this point. This is all about the functionality of it. But things that cause you not to absorb the most important nutrients, like iron. So, what would that be? Stress, glyphosate, proton pump inhibitors. Anything that messes with that pH differentiation coming from the stomach all the way down into the intestinal lining. You know, all those things affect us. Certain medications. So, when we are sometimes anemic and we don’t get a response from the iron that we’re taking, and let’s say it’s not an anemia of chronic disease, then maybe you wanna go down the road and say, “Okay, well, let’s go fix the duodenum,” because if you’re deficient in iron, you’re probably gonna be deficient in some of the other massive amounts of vitamins that get absorbed in that small area of the duodenum, you know, for the individual.

Andrew: Can I ask… I know we’re sort of going down the nutrition avenue, but, just pulling back a bit. When we’re talking about people who suffer from anxiety, let’s say, and they’re just chained. They’re shackled. They can’t… They’re very fearful of going outside of their small, little enclave, to even try things new. How do you get these patients to be brave? To try things new, because it seems like they go round and round in their head, and it seems like there’s ever-decreasing circle of safety that they go into, which causes more anxiety because they don’t do anything.

Dr. Coetzee: Yeah. I mean, I think the way to answer that is, like, comparing that to a person that doesn’t have a diversified microbiome. This is nothing to do with that directly, right? I mean, if you only eat one or two foods, you’re only going to have so many substrates and so many species of bacteria that then benefit from that, right? You need the diversity. But, to take a step back into what you just mentioned, to me, if you look at that patient that is in that little bubble, right, and they can’t seem to break out of that bubble, I feel that a lot of patients have been given the run-around in the wrong direction. You know, they’re made to believe that there’s something wrong with them, because they have anxiety or depression, so they become fearful of expressing that to the outside world because it’s a sign of weakness. You know, and even though it’s now obviously spilt over, you know, we don’t really look at it that way, but a lot of people still do, right? I mean, our shame. You know, “Joe can’t handle stress, so, you know, he’s, you know, don’t put too much stress on him.” And I think it’s because the clinical world treats depression and anxiety as a disease, instead of treating it as a insufficiency, you know.

So, and again, this is the category of anxiety and depression that has more of the bar stool effect in the nutri and the genomic part, right, not the psycho part, if there wasn’t trauma. But I will tell you that most of the patients that come into my office actually sit down and feel relieved because I actually believe them. Right? We’re actually listening to them. We’re actually paying attention to what they have to say, and then we tell them, “Listen, you know, there isn’t something wrong with you.” “Yeah, but I’ve been tested for all sorts of things and I am scoring so many points on my generalized anxiety score test, or my Beck’s inventory,” or whatever. And I say to them, “Well, I get that, but that is the end result, right?” What is driving that result? What is driving that score, right? I mean, what if I tell you that if I can show you that you have a vitamin D deficiency, that might improve the score if we improve that? Or if you you’re hypoglycemic, so you tend to feel like you’re having a panic attack when you might not. And then if we fix the blood glucose problem, then that might improve. That’s when they really start listening.

But, you see, that’s the point where functional testing comes in, right. So, we need to quantify what we’re saying to these people, because they’ve already been given the run-around, where they have doubt in themselves, but also the clinicians, because it’s, “Hey, let’s try this drug. Let’s try this approach. Let’s try…” So, it’s all experimental. So, these people are kind of tired of the experiment that they’ve been put under to kind of determine what we need to do to make them feel better short-term. And it’s never long-term, because neurotransmitters is not like changing a tire on a car, right? I mean, there’s a lot of things that are involved with the firing of those synapses and the communication in the brain, and it’s all interrelated, right. I mean, you know, thyroid health, anemia status, blood sugar status, malabsorptive status, these are all things that could cause anxiety and depression, and nobody is talking about it.

Andrew: Yeah. So, thyroid’s an interesting one. And again, there’s another lecture, but is it something that you do as a standard investigation? And do you look at antibodies? Or do you just look at TH…sorry, T4 and T3, 3T3. Do you always look for the antibodies, and does that give you a clue to maybe a malabsorption syndrome?

Dr. Coetzee: Yeah, that’s a very good point. Look, I’m sure that Australia has certain provinces that are very similar to America, where, with certain licensure, you can’t do all the tests. Now, thank goodness my relationship with physicians have improved dramatically, and I teach at medical schools, so that never hurts. So I don’t really have a problem getting blood work called if I tell a physician, “Hey, I’d like to do this.” So, yes. I want to get at least a ferritin score. I want to get at minimum at TSH, hopefully a T4 and a T3 right? That will be very helpful. Antibodies, yes, it’s helpful, but it doesn’t necessarily always interplay to the direct anxiety and depression thing, [inaudible 00:24:04] more the autoimmunity thing that we need to talk about, right. What else do I do? Blood sugar. I love to have hemoglobin A1C, right. I like to look at liver enzymes. I like to look at pretty much an overall investigation of the white blood cells, because I need to see if there’s an inflammatory reaction, or something going on. You know, CRP, it’s… homocysteine, they all have a correlation to anxiety and depression.

So, the more blood work you can get as a clinician, as it pertains to that patient, the better, right? So, if you can have some indication of vitamin D issues, or iron deficiency anemia, or B12 methylmalonic acid, that we can pick up in certain tests, then, you know, you can start getting a picture, “Wow, okay. So, this person seems to be deficient in most of those little nutrients that we get. And the interesting thing about that, it’s not always a deficiency that is required for anxiety. It might be as little as an insufficiency. And that’s where it becomes important to investigate. How deep can you go in the early investigation, because the quicker you hit this problem, and return it to normalcy, the quicker that person is going to have those results.

Andrew: Okay. So, even something like vitamin A, which is often said that we don’t experience that in the Western world, forgive me, a vitamin A deficiency, and yet we know that vitamin A is crucial for neurotransmitter production. Do you ever look at vitamin A? Could it be, as you said, like, a malabsorption-type syndrome, let’s say, created by gluten? Let’s just pick that one, because it’s always the big baddie. But do you look at, forgive me, do you actually assay vitamin A as a means to try to find out if there might be an issue with that production?

Dr. Coetzee: Unfortunately not, but I know exactly where you’re coming from, right? Because that’s one that I would really like to do. Now, if I was to do, let’s say, a micronutrient assessment, looking at it from a leukocyte level, in a test in the U.S., that’s gonna require a phlebotomist. And a lot of people don’t wanna go down that road, right, because then you can look at all the different vitamins and minerals that play a role. But, you know, if you have a very low vitamin D status, right, and you kind of look at that person from a symptomology standpoint, because that’s always something I go and, because I kind of want to look at the symptoms of vitamin A deficiency, and read that to my patient and say, “Okay, how many of these do you portray?” And, “Oh, I’ve got 7 out of the 10 that you just read.” Now, I don’t recall them all off the top of my head, but you know what I’m saying? I’ll have a list. I can say, okay, B vitamin deficiencies. Here are the symptoms of B vitamin deficiencies as they relate to the psychological thing. And that’s what I will be doing in the presentation, in Australia, is I’ll show you the psychological, neurological association to vitamin and mineral deficiencies, the key ones.

So, this is where we need to go, in this world, is we need to design a test that can do all that assessment that we’re talking about, to determine the status of all these nutrients, so we can cover that base, which will include vitamin A. It’ll include vitamin K, E, D, C. I mean, they all play a role somewhere along the line, you know, in this process. So, if you can actually have a proper analysis of all that, and make that the nutritional psychology assessment, then that’s great. And on that point, one of my former students, she created a new division in the U.S. She was a psychologist when she came into my program, and she did a master’s in nutrition. And she’s now created the American Nutritional Psychology division, of which, in 2030, they’re going to launch the first full-on degree in nutritional psychology. So, there’s progress, right? And I know this is a little off topic, but just to tell you kind of where all these brains are heading for the future. But yeah, not vitamin E in my testing, unfortunately, at this point, but absolutely see the value of that.

Andrew: Yeah, yeah. So, let’s go into five hero nutrients that you use, then. If we can just get a semblance of what you might commonly use. I understand this is a piece of string, because every patient’s gonna be different. But what sort of things do you use commonly, that you find have merit?

Dr. Coetzee: Vitamin B6. Really important one. Okay, that a lot of people are looking at, right, because they assume that we’re all so exposed to the amount of B6, somehow people assume that we just have high levels of it. And that is actually one of the most common low markers that I see when I look at metabolomics or organic acid tests, right, by looking at xanthurenic acid and pyridoxic acid. Because vitamin B6 is how we convert tryptophan to serotonin, and then to melatonin, and B6 is what we require our tyrosine to convert to dopamine, and eventually ends up in the catecholamines, right, epinephrine and norepinephrine. So, that’s a really important one. Vitamin D, the obvious one, right? I mean, everybody knows about seasonal affective disorder, and that’s not really something that I’m sure Australians see that much, but here in the northern part of America, there’s a lot of that going on, right? Five months, six months of the year, these people aren’t exposed to sunshine, we see detrimentally low levels of vitamin D.

Now, I personally don’t think it’s only sunshine-related. I think your immune system is using up so many of these vitamin D precursors to make T-regulatory cells, that that’s one of the reasons that the vitamin D is low. Forget about, you know, the lack of sunshine. So, vitamin D, B6. A couple of the amino acids, right. I mean, you wanna look at some of the bacterial strains like Lactobacillus and Bifidobacteria, they play a big role in aromatic amino acid production, or the utilization of that, in the form of tryptophan and tyrosine. So, that would be another one. B3, vitamin B3, is a big player as well, when it comes to that. So, how many is that now, that I’ve just mentioned off the top of my head, that…

Andrew: Keep going.

Dr. Coetzee: iron, B6, B3. So, all the Bs, quite frankly, are really important, and that’s the number-one thing that gets depleted with alcohol use, which is why there’s such a strong association between depression and alcoholism.

Andrew: What a salient point. Can I ask? The Therapeutic Goods Administration in Australia, TGA, is very down on B6 at the moment, and restricting dosages right down, with the warnings accompanying them of sensory damage, peripheral neuropathy, things like that. I’ve never, ever seen these. And although I’ve never, ever used B6 on its own, in massive doses, without complementing with a B complex, I simply have not seen these. Have you ever seen these peripheral neuropathies of high-dose B6?

Dr. Coetzee: I haven’t. I know of one or two cases, in some of my colleagues, that has come up, but that’s generally a person that isn’t testing where they are on that, and then just starting to take B6 because they’re trying to address an issue, and thinking that that’s the smart move. It’s always good to do it in a complex, right, because you want them to be interacting with each other. And when I’m talking about B6 intervention, I’m not talking long-term, right? I’m talking about something that will just kind of get that gear turning, and see if that has a positive influence. So, I would say that that is a little bit of a aggressive overreaction. I’m not saying that there isn’t validation behind the dangers of excess vitamin B6. That’s a fact. I mean, that is a dangerous issue. But like you, I don’t see that a lot clinically. As a matter of fact, I am actually kind of shocked why we have so much of the deficiency, or insufficiency, you know, compared to the excess. Now, if a person has renal issues, or there are liver issues, then I would be more cautious, you know, with any of these things. But if a person has a healthy detoxification system, their liver isn’t overloaded, yeah, I don’t think a short-term use of that is really a problem. But it’s individual, right?

Andrew: Yeah. I think there’s an interesting narrative that goes with these things. A classic one for me is vitamin D deficiency. And there was a recent narrative in Queensland. So, this is the Sunshine State of Australia, right. And the narrative that was put out was that, the way that, forgive me, the way that the narrative sounded was, “You don’t have to worry so much about vitamin D. We’re really doing well, because we’ve only got 12% deficiency in Queensland.” And I went, “Well, hang on. Your message about iron is that we need to be really concerned about iron intake, and that’s 12%. But you don’t have to worry about vitamin D because that’s 12%.” It’s a real interesting, “It’s only 12%,” or “It’s as high as 12%,” real interesting narrative that’s going on. That’s a… How the pendulum swings.

Dr. Coetzee: I just think that with these things, we need to get to a point as a profession where we can delineate between insufficiencies and deficiencies, because we do not want to be working in this competitive, combative zone of disease. We need to get out of that, right, when it comes to mental health, because then they’re gonna tell you, “B6 is dangerous. Don’t use that, and don’t use too much vitamin D,” and, you know, “We only have a 12% deficiency,” but what is the insufficiency status? You know? So, let’s say there’s 12% deficiency. There might be a 43% insufficiency, and that insufficiency is enough for that person not to wanna get up and go to work. Or not being motivated enough, or their immune system might be slightly suppressed because they don’t have enough of those substrates to help them build it, right? So, again, I’m not talking here in any way, shape, or form, “Hey, listen. You know, you have an overt vitamin D deficiency. It’s so obvious that, you know, you need to almost go to a hospital.” I’m talking about matching the symptomology of your patient to their reference range, and start forgetting about the fact that we are working on this optimal thing.

Now, here in the U.S., the reference range is between 30 and 100 is deemed semi-normal for vitamin D, right? So, 32 apparently is the same as 58. Apparently it’s the same as 63, which is just totally absurd, right? That’s the same thing as telling me, “Hey, my car has a quarter tank of gasoline. That’s almost the same as having a three quarter tank of gas, because it’s still driving.” Yeah, right. But I can’t really go very far and very fast on a quarter tank, right, if I maintain a certain speed. And that’s what we’re doing. We’re all running at 75 miles an hour in a 55 zone, with a quarter tank of gas. And then we’re surprised when the performance is lacking when it comes down the stretch. So, you know, I’ve kind of tried to get out of that competitive and combative element, because I’ve lived with it for 25 years of my clinical practice. You know, “You guys are quacks, and this is that.” I’m like, “Yeah. I’ll keep taking your injured and the people that you can’t figure out, and, you know, you can keep calling me what you wanna call me.” But at the end of the day, I’ve kind of shifted my mind now into more of a insufficiency thing, and really working with a topic of optimal health, right? And we’re talking mental health here. So, how do you optimize mental health you have to get those three-prong bar stools to be solid, the same length, on a flat floor. You can’t have a tilt the other way, and if you have an insufficiency, there’s about an inch taken off of that one leg on that bar stool, and now you’re kind of rocking a little bit, right? So, it’s all about measuring and maintaining all three of those things at the same level, and then you have success.

Andrew: One of the things we haven’t mentioned about the nutrients, if you like, that you use, is, you’ve mentioned them a couple of times, probiotics, Lactobacillus and Bifidobacteria, and there are others. How important do you think, A, the gut is, and B, the use or the implementation of probiotics are in helping people with really quite substantial mental health disorders?

Dr. Coetzee: You know, I’m gonna try and make this as scientific as I can, because it’s still, you know, reasonably anecdotal on many levels, right? We don’t know anything about the gut, and what I will share in presentations moving forward will be based on some very, very credible science and data, and some human studies, right? I personally think the enteric nervous system is more powerful than the human brain, right? I mean, that’s just my opinion. I think this microbiome that we are talking about, that is this little thing of 3 pounds in our body, that somehow is affecting this, I think we should look at the microbiome as an accessory organ system. It’s not just this little attachment that is, like, kind of sucking onto us like a whale, and we’re floating around the ocean, and we have these little fish sucking on to us, right. It’s not that. It’s really complicated. And I think the data is really starting to show the massive connection between all these different strains. Now, what all the companies wanna do now is they wanna evolve a strain, right, that they can patent, and then that is the new anti-anxiety and anti-depressive state. Now, there’s very good data on some of these Bifidobacterium strains and anxiety and depression. But what I’ve seen is, if that person’s absorption is very good, or at a very high susceptible level, then these things tend to work extremely well.

The microbiome has expression on our genes, right? It is really the outside of our body, so you can’t find a bigger epigenetic center of information being triggered to the rest of our system. And then, one thing in the microbiome that I think is really strong on the literature right now, which I’ve really dug into, is LPS, right? So, lipopolysaccharides, the gram-negative bacteria, when they go through their natural cell cycle and they die off, they produce a huge amount of LPS. And when there’s permeability in the gut, and that LPS can escape into the bloodstream and then cross into the blood-brain barrier, and they cause a massive inflammatory reaction, that’s where I think a lot of this stuff comes from. So, it’s brain inflammation. So, that’s the other side that you need to work on. I don’t think you can work on proper mental health without having the GI tract intact, just by virtue of the LPS alone. Forget about all the individual strains that go with that. I think you really need to have a healthy microbiome to overcome… And if, you know, it will make total sense, because if we look at the younger population, their diet is more exposed to herbicides and pesticides that we don’t do. It’s a lot less whole foods. There’s a lot less biodiversity in them because they’re only eating a certain amount of food, so they don’t get the same amount of food to their microbiome. Yeah. So, I think there’s a massive, massive connection there, and I’m really looking forward to the next 10 years, to see where all that’s going.

Andrew: We can’t wait to have you out to Australia, and New Zealand, in 2024. So, it’s February, right? February and March, I think you’re coming out, is that right?

Dr. Coetzee: Yeah, yeah. Last two weeks of [crosstalk 00:40:07]

Andrew: Yeah. I’m certainly gonna be there. I’m gonna be writing down my questions from now. I need to ask you, Oscar, about gluten. I’ve interviewed David Perlmutter, who is just against gluten. I’ve interviewed Alessio Fasano, in a brief interview. And he says, “Look, it’s bigger than celiac. It’s less than [inaudible 00:40:28] It’s somewhere in between.” There are certain people, more than celiac, who respond to wheat. But I have to ask, how much do we have to look into either what type of bread? High gluten, low gluten. Other things that are in there, like, you get these people taking non-gluten alternatives that are high in additives, you know, the E numbers and things like that? And then, how much do we have to focus on the terrain in these non-celiac people? How much do we have to focus on the terrain, to possibly be able to heal the gut enough so that it doesn’t react to gluten?

Dr. Coetzee: So, Alessio Fasano’s work was indicating the CXCR3 receptor, that has an effect on occludin and zonulin, and makes total sense to me from a scientific standpoint. So, I do believe that when we eat some of those foods that there is a tight junction expression, but that’s not the only thing that affects our tight junctions. Alcohol is the biggest cause of permeability in the country. Forget about gluten. So, if you combine gluten and alcohol, you have a bigger issue. The other part of the problem is that people are always talking about tight junctions. Yeah, but you have buffering agents, right? So, if you have biodiversity, and a good mix of good bacteria, and opportunists, and they’re working cohesively and symbiotically, you know, you have buffering, right? And if you have enough Akkermansia species, and you have enough butyrate, and you have all of that stuff, then I think the body can handle a lot of stuff, right? Not sprayed with excessive amount of pesticides and herbicide. So, there is a mode of that, right, that we need to take into consideration.

And then, finally, you know, when we’re looking at this whole gluten thing, like, you gotta look at the prolamins, right, some of these protein contents in corn, and, you know, some…even people with oats and rice. Like, sometimes when I get people that are extremely sensitive to gluten on a test, I’ll just remove all grains, short-term, and then work with all the other parameters, and then, if you can reintroduce, like, sprouted grains or something like that, you know, you know you’ve won the battle. Do I believe that everybody has to be off grains their whole life? No. Can I see the scientific argument by some people? Yes. But there’s confounders that they’re not mentioning. Okay, so, if we are talking about that, and these people are having these reactions, then let’s assess their entire microbiome, and see what’s out there. Maybe we find that they’re very low in Akkermansia, or Faecalibacterium prausnitzii, or Roseburia species. And those are the people that are highly reactive to gluten. But we don’t know that yet. So, I, look, I buy into all the science of everybody’s opinion. You know, there’s value and some data on every diet out there, that has value. You can look at the carnivore diet, they having strong arguments, the Paleo diet, the vegan diet, the raw diet, you know, everybody has their own claim to fame. I just think, as a species, we were not supposed to be eating non-diverse.

And, you know, maybe it is a good thing to challenge your body a little bit with something with a little bit more fiber, and maybe it’s not always the worst thing in the world to have a little bit of inflammation, to test your immune system, you know, with something coming in. I mean, I’m a very outside-the-box thinker. But I can tell you this, that the thing that I always tell my patients when they come in to me with a GI issue, which is always gonna end up with an anxiety or depression association at some point, I say to them, “Listen, you can only eat six foods right now. I would have won this game if I can have you go out one day and eat what you want and have no reaction. That doesn’t mean that you have to eat that every day. But this whole hypochlorhydria, low stomach acid thing, and PPI use, I mean, I feel that there’s a strong connection between that and anxiety and depression, right? Because I can show you the steps that are affecting, you know, the outcome of those nutrients that we’re missing in the “nutri” part of my psychonutrigenomics thing, that play a role because of the medication.

Andrew: This is gonna be so exciting to have you out, Oscar. Forgive me. I’m gonna be a little bit of fan-waving at the back, so, I just, I can’t thank you enough for taking us through just a snippet. There were so many other things I wanted to cover, and we just haven’t got time, but I really cannot wait to welcome you out to Australia. I think it’s your third time out to Australia. Is that right?

Dr. Coetzee: That’s right. And all associated with Designs for Health, so thanks to them for getting my fiancée and myself out there to that lovely country, and we are… We can’t wait. We’re really pumped to come out, and it’s a topic that is extremely passionate to me. I have a very, very strong connection because of my graduate degrees in psychology and my doctorate degrees in nutrition, so, you know, I’ve really looked at this thing from many, many avenues, and the beauty about it is it’s so young, and we’re only learning more and more about it, but I will share clinical pearls that I’ve used with my patients, that were very successful, you know, with them stepping up. Because look, being 70% less anxious is better than being 30% less anxious. Right? So, there’s modes of improvement. You don’t always have to completely get rid of anxiety for there to be improvement. And that’s the whole optimal health thing. Where are you on that continuum? We’ve gotta get our patients to say, “Hey, look. We’re not gonna give you something that’s gonna make you feel better tomorrow. But, five months from now, that continuum, you’re gonna move more towards that optimal health thing, and that’s where your mental health starts to improve.”

Andrew: Fantastic. Thank you so much for joining us today, and we will certainly look to welcome you to Australia, and New Zealand, in early 2024. Professor Oscar Coetzee, thank you so much for joining us today on “Wellness by Designs.”

Dr. Coetzee: Thank you for having me, and I look forward to seeing you in a couple of weeks, actually. Take care.

Andrew: And thank you, everyone. Remember, all of the show notes and the dates of the seminars that Oscar will be presenting in early 2024 will be up on the website and in the show notes of today’s podcast. Thanks so much for joining us. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”