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The Neurobiology of Libido

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The Neurobiology of Libido with Vanita Dahia

A lack, or loss of libido is a common health concern affecting one in four men and up to 40% of women. Many health professionals may not feel comfortable discussing this area of sexual wellbeing or dismiss it as a purely psychosomatic condition. But the fact is, sexual difficulties affect a person's quality of life.

Vanita Dahia shares with us today how integrative, personalised medicine is in a unique position to help patients bring stability to the neurological and endocrine functions that govern the chemical signals that facilitate sexual arousal.

Vanita has over three decades of experience as a pharmacist, naturopath, nutritionist and herbalist. She is also the author of the book Alchemy of the Mind, a book that expertly captures the power vitamins, minerals, amino acids and herbs can play in balancing mood, including libido. 

Covered in this episode:

[00:31] Introducing Vanita Dahia
[02:18] Today's topic: Libido
[04:06] Males vs. Females
[08:13] Waning libido
[10:04] The science of sex and love
[12:07] Antidepressants and libido
[14:40] The influence of prolactin
[16:03] The value of Vitex 
[18:51] Cofactors and precursors
[21:43] Vanita's Book: Alchemy of the Mind
[23:46] Oxytocin: 'the cuddle hormone'
[30:50] The many layers to libido
[35:01] Methods of assessment/ labs
[39:27] Genetic SNPs
[45:32] Where to access resources and training?
[48:57] Safety of herbal/ nutrient applications
[51:14] Final thanks to Vanita

Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining me on the line today from Melbourne, Australia, is Vanita Dahia. Who's an integrative medicine clinical consultant pharmacist, naturopath, and clinical nutritionist. Board-certified fellow in antiaging and regenerative medicine, providing clinical training programs and educational initiatives to doctors and allied health practitioners. 

Vanita is a functional pathology clinical consultant and health services manager, providing in-depth technical and clinical consultancy and expert technical training incorporating assessment, interpretation, and prescriptive guidelines to doctors and allied healthcare practitioners internationally. 

Vanita is a medical authority, an extraordinary mentor to her peers and patients alike. And as a presenter to her peers and community at large, she's engaging articulate humorous and insightful. I've known Vanita for many years. Many, many years. Today, we're going to be talking with Vanita about the science of love, lust, and sex. So Vanita, I'd like to warmly welcome you to FX Medicine. 
Vanita: Thank you, Andrew. Thank you so much. This is quite a hot topic because it actually guides us through life, particularly with very powerful politicians out there. They often become unstuck when they are exposed to promiscuous activities. 
Andrew: I don't think there would be many people in the world who aren't governed or guided by their libido in some way, shape, or form throughout their lives. 
Vanita: Absolutely. Well, you know, if think about it, most of our life energy is actually spent in either pursuing or avoiding sex. 
Andrew: Now, why would we be avoiding? So, let's go into libido.

Why… It's a big topic, particularly as we age. But I've also noticed amongst friends and colleagues and when we have discussions about this. That it seems to affect men and women at different stages in their life, sometimes discordantly. Why is this so? What's happening? 
Vanita: Well, the two major players when we're talking about libido, is really, from a chemical perspective, libido is all about sex hormones and about neurotransmitters. 

And anything that blocks the production of neurotransmitters or sex hormones is going to affect libido or sex drive. Now obviously, as we age, our hormones decline with age. And the hormones fluctuate throughout one cycle, whether it's menopause or PMS or perimenopause, etc. But major simple factors, just something as simple as diet, plays such a vital role in the manufacture of neurochemical as well as sex hormones. 

After all, diet or our protein, is the precursor to manufacture of our neurotransmitters. And they play such a vital role, they play with the hormones. And then the other thing too, is something as simple as exercise. We don't do enough exercise. A lot of us either do too much or too little of it. And exercise is necessary to oxygenate the system. It's necessary to get the blood flowing, get the endorphins flowing, etc., and people who have high levels oxygenation in their system will have a higher drive, energy drive, and that'll play a role in libido as well. 
Andrew: I've often said that men don't get enough exercise and two of the exercises they should be doing more of is, bending over and stacking the dishwasher, and reaching up and hanging up the shirts. And that will affect the biochemistry of the female. 
Vanita: Absolutely. That'll get some of the oxytocin flowing, knowing full well that the men can get involved in domestics as well. 
Andrew: I can just hear my wife when she listens to this podcast saying, "Yeah. Start walkin' your talk, son." 

But I've got to ask first, my wife and I have had a lot of discussions on this regarding our friends and indeed our relationship, particularly in the early days. That there was this discordance, there was this disconnect sometimes when one of the couple had a high libido and the other one had a low libido. And this might have changed with regards to pregnancy. We've spoken to a lot of women with regards to what happens around the time of their periods, I've said after pregnancy, childrearing. But then on the reverse end with the male, there's certain times when a male's libido is high. And then I've spoken to other colleagues for instance, when the male is more interested in footy and fishing, and the woman has to really go all out to try and incite some interest if you like. So why is there this discordance, this disconnect between the male and the female? 
Vanita: Well, when a woman goes through any changes in their life… this is all about hormones. So progesterones and estrogens change throughout one's cycle. 

Now, in a cycle itself, a woman's progesterone will peak in the luteal phase and estrogen will peak in ovulation and just before a period. So when there is an imbalance of both progesterone and estrogen, they create changes like progesterone deficiency or estrogen dominance. That happens in a female. But in a male, you'll happen to see that your androgens, particularly as a man ages, androgens shift. They shift into becoming estrogen-dominant. In other words, they get the potbelly, they get the receding hairline, their muscles become flaccid. But there are drivers that actually send these signals out to the system. 
Something as simple as stress, everybody is exposed to stress. When we're very stressed, your catecholamines are released. Obviously, upregulation of cortisol stimulates catecholamine release. And the catecholamine, this is the adrenaline rush, your fight, flight, freeze response. Now we know that sex is really a parasympathetic dominant activity. 

But when the body is under a lot of stress, what actually happens is that the adrenaline and noradrenaline gets pushed up, creating anxiety, stimulating a metabolism. It then starts to mop up all the glucose in the body and it then creates a feeling of, I guess, what you could call, brain starvation. And so the brain looks for…and this is part and parcel of insulin up and downregulation, and the same applies to serotonin. As insulin goes up, serotonin goes up and vice versa. 
So we know that your sympathetic and your parasympathetic systems… Look, your central nervous system is the global control of both the sympathetic and parasympathetic nervous system. Right? And we know that we need the sympathetic nervous system to drive the ejaculation. We need the parasympathetic nervous system to stimulate erection. We also know that when you eat, your parasympathetic system goes up. That doesn't mean that you get an erection. Your nervous system plays a role for sure but it's not the only factor. 
Andrew: There are so many pictures going through my mind right now, Vanita. 

But what about libido waning as life goes on? Surely, there's got to be peaks and troughs. But in general, one would like to think there's an elegant 'exit stage left'. But there seems to be this real issue in modern day society of a waning libido. 
Vanita: There seems to be a waning libido because of the fact that we are so much more attuned to neurological imbalances. The nervous system talks to the sex hormones. So it's not only about, you know, we're talking about sex as a...It's a natural thing, really. 

Andrew: Absolutely.

Vanita: It's nature's trick to reproduce. And we actually have, well, we live our lives in duality and that's what sex is all about. We have light and dark. We have male and female. We have yin and yang. And that duality is what we call…when the duality meets, we call that sex. 
Now in the young, our intelligence is actually hijacked by hormones and we call that physical sex. And as we age, our intelligence is hijacked by emotion and that's what we call love. But as we get older, much older, then we seek other levels of awareness. And that could be seeking the meaning of life or the divine, etc. 

So really when we identifying with sex, we are identifying…it's a natural thing. So we identify…we need to stop decorating it and feel inadequate about it. Because the moment you need to add decorations like emotion, then sex doesn't become a natural thing. 
Andrew: But I do like your description there. About sex versus love. And then even the follow-on from there to companionship. There's sort of emotional play. That was really elegant, that was really nice. You've mentioned the hormones talk to the neurotransmitters and vice versa. Is sex and libido not all about hormones? What's the science behind love and sex? 
Vanita: Well, let's have a look at some of the science behind falling in love. When you fall in love, there's an excitation. There's lust, there's obsessive thoughts, there's an addiction that dominates. And all it involves is release of certain neurochemicals. It's a flood of endorphins. When you fall in love, a flood of endorphins and neurochemicals such as oxytocin, vasopressin, and dopamine are released. 

Like, when you kiss, your neurotransmitters like phenylethylamine, this is the stuff that goes up when we eat chocolate, we feel nice and relaxed. Your endorphins, dopamine, they're released from the brain's cortex. So the nerve endings in your lips become more sensitive and they fire signals back to the brain's cortex to release these hormones. 

Phenylethylamine is actually released not only when you eat chocolate but it actually acts as the releasing agent of noradrenaline and dopamine. So that gives you…the dopamine is so important. When we use antidepressants like SSRIs, often they say their libido is stunted or blunted. And the reason being is, that we're often barking up the wrong tree. Patients who are serotonin deficient need the SSRIs, but a lot of patients have this lack of dopamine, they actually feel rather...They have symptoms of low dopamine, lack of satisfaction, lack of motivation, and they translate that as depression. 
Andrew: Now, I'm just going off on a tangent here. Off from sex, but with regards to depression. And I'm wondering about the facility then of the newer class of antidepressants, the SNRIs. So, do they sort of tend to have a less impact on lowering libido? 
Vanita: They would have the same level of side-effect profiles as an SSRI, but they may be slightly different, in different degrees. 

It is important that we need to recognize that these neurotransmitters, just like hormones, work in harmony, like an orchestra. The moment you put progesterone into the soup of sex hormones, you're going to alter all the other hormones as well. So it's important when you're using an SSRI or SNRI, you're supporting two particular pathways. Often, you need to support all of the pathways. We're not looking at GABA, noradrenaline, adrenaline, etc., and they all need to be in balance. 
Because these neurotransmitters play such a vital role in talking to other hormones, for example, progesterone. As we age, progesterone depletes. And as progesterone depletes, we have symptoms...look, progesterone we know it's used in dysmenorrhea, it's used in irregular cycle, it's associated with infertility, etc. 

But the way it talks to neurotransmitters, if we have a low progesterone, particularly as we age…progesterone is a GABA stimulator. It stimulates GABA-A receptors. So, as we have a low progesterone, you will see low GABA, and that leads to anxiety. As you have a low progesterone, you will see low serotonin and this relates to low mood. As you have a low progesterone, you will have low dopamine and this is associated with your breast tenderness and fluid retention. And it also lowers your beta-endorphins and this allows for cravings. This is why women premenopausally or premenstrually go through cravings. They need to have their sugar and their salt fix. And they also have an increased crying sensitivity during that time. So your hormones play a direct role with your neurotransmitters. 
Andrew: Can I ask a question, and this may be again off topic again. Forgive my mind but I just keep coming up with these sort of clinical situations. So you mentioned there about when you've got low progesterone, that you have lower dopamine, does that automatically mean high prolactin in low progesterone states? 
Vanita: There is a direct correlation between prolactin. As you well know, elevated levels of prolactin, are associated with decreased sexual interest, arousal, and orgasm. 

And so, in women, high prolactin is associated with infertility. There's an inverse relationship between prolactin and dopamine. So the higher the prolactin, the lower the dopamine. The lower the satisfaction. Because dopamine inhibits the release of prolactin. 

And where does herbs, like progesterogenic herbs fit in? Vitex is an example. It actually stimulates that particular pathway by inhibiting prolactin release and improving dopamine levels. So this is why when somebody is taking progesterone, bioidentical progesterone or even a herb like Vitex, it will stimulate that dopaminergic pathway. Not only does it do that, but it also stimulates GABA pathways as well. 
Andrew: What's the current experience, if you like, of Vitex in low dose versus high dose? I seem to recall some older papers talking about a biphasic response, if you like, from low versus high dose. That one increased progesterone and one dose inhibited progesterone. Is that correct, or have we moved on from that? 
Vanita: I cannot quote the study that you're referring to, but there is definitely a correlation between dose dependency. 

Andrew: Okay. 

Vanita: It's actually quite interesting, whilst you're talking on the topic of Vitex. They've done a study, Atmaca in Psychopharmacology in 2003. They did a study comparing fluoxetine, which is an SSRI, with Vitex. They looked at your Hamilton Depression Scale, they looked at the Penn Daily Symptoms, etc. And they found that Vitex compared significantly with your fluoxetine. 

Andrew: Wow.

Vanita: It actually showed that the Hamilton Depression Scores were almost on par. And your Vitex showed greater improvement in physical symptoms. So that will be associated predominantly with dysmenorrhea and that's where this study was actually done. But Vitex doesn't work on its own, it works with B6, it works with your adrenal herbs, etc. It works really well... 
Andrew: So, that was my next point. What that why, I think at one stage somebody was investigating Vitex combined with St. John's wort, is that right? For menopausal symptoms? Is that it?  
Vanita: They generally tend not to use St. John's Wort because it's supporting serotonin pathways and not everybody needs serotonin support. 

Generally, most commercially available progesterogenic support, complex progesterogenic support, would contain Vitex together with an adrenal support, something like Withania or Rhodiola. And obviously, your cofactors, B6 is necessary in all avenues. 

It's quite interesting because Vitex stimulates your dopaminergic pathway as well as the beta-endorphin pathway. A herb like Withania, it stimulates GABA as well as the serotonin pathways. And B6 is the cofactor required at every level. You know, glutamate to GABA, tryptophan to serotonin, tyrosine to dopamine. B6 is needed everywhere. 
Andrew: Well, it is. I've often said when you're doing everything right "by the book" and you're missing one piece of the jigsaw, if you had simply add a very cheap, zinc, B6, magnesium supplement, just seems to be that last piece of the jigsaw to fit into place. To make everything work. And that's these hydroxylases and dehydrogenases, these enzymes. 
Vanita: That's so true. And this is where the concept of methylation comes into play. We often find that patients who tend to be rather stressed, have neurological issues, and invariably will have libido issues. And so, we need to have a clear understanding of where these cofactors play such a vital, vital role in these areas. 

You'll find that your hormones, it's funny how these hormones play with neurotransmitters. Progesterone, as an example, will suppress the excitatory glutamate level, and it enhances GABA. We know that progesterone acts like alcohol, it stimulates GABA. Right? When a woman gets pregnant, her progesterone is increased at least tenfold. Production is increased tenfold. And this is why she's feeling so nice and relaxed because the body naturally produces more GABA. 

But estrogens work totally oppositely. So what they do, estrogens not only stimulate glutamate neurotransmission. So they stimulate glutamate, but… and it does this at the NMDA receptors. And that's why estrogens are quite helpful in learning, and memory, and concentration. Because they're improving the synaptic plasticity. 
Andrew: Estrogens improve? 
Vanita: Yes. Yes. Estrogens do that. Not all estrogens, it's estradiol that does that quite effectively. 

Now, estrogen also promotes the dopamine release. And that might be mediated by your inhibitory effects of your estrogen release. Because dopamine terminals, they're influenced by GABA. So estrogen can actually improve your cognition and mood through modulation of your neurotransmitters, particularly serotonin. 

Andrew: Ahh. 

Vanita: See how they play with each other? It's fantastic how they play with each other. 
Andrew: Yeah. 
Vanita: So estrogens great. Because they increase the level of serotonin but they also decrease your 5-HTP, 5-hydroxytryptophan reuptake. So it allows for more 5-HTP to remain longer in the synaptic cleft. So it allows for the prolonged effect of estrogen in the synaptic cleft. So, you know, the two work opposite to each other, so it's important to make sure that we're balancing those two. 
Andrew: I can see here that there's more than just a seesaw going on. There's swings and roundabouts. Like, you've really got to know what you're talking about. 

And one thing that I didn't mention when I introduced you, Vanita. Is your new book called, Alchemy of the Mind. Now, I haven't studied this. I've read it or, let's say, given it a cursory glance. And it's an extremely well set out book. So I've got to say, if people are really interested in learning about these interplays between the hormones, get your book and start really doing some learning. 
Vanita: Yes. Thank you. It's a really great synopsis. The Alchemy of the Mind is really aimed at assisting the reader. Whether the reader is a patient or practitioner, in understanding the metabolic block, the neurochemistries. 

Often we see that, you know, mental health is just not about neurochemicals. It's all about, we need to balance the stress hormones, the sex hormones, and the neurotransmitters together. We need to actually validate all the variants that walk through our door when we're looking at ourselves clinically, our libido clinically. We need to establish all the various clinical triggers, find those clusters of symptoms. Is it the gut? Is it the toxic exposure that is causing some of my mental health concerns? So find those clusters of symptoms. 

We can't compartmentalize the body any longer. We actually are working towards an integrative approach and we need to combine all those modalities. And this is what the book's aiming at doing. It's splitting the arms of the mind and understanding how the gut affects the mind, how adrenals affect the mind, the thyroids affects the mind, etc. 
Andrew: Yeah. Now when you were talking earlier about that sort of addictive phase of love, you mentioned a very topical hormone, oxytocin. And there was some early research about delivering oxytocin, it was basically called the 'cuddle hormone'. But then, there was some research that was saying "I'm not so sure." Where are we at with the research with oxytocin now? 
Vanita: Look, we know that women produce a lot of oxytocin, particularly postpartum. And it's released in large amounts particularly during labor and after stimulation of the nipples. And this is really a facilitator for childbirth and breastfeeding. And it's released by the posterior lobe in the pituitary. 

Now we know that oxytocin is, it has been quite fashionable within compounding pharmacy as a nasal spray to stimulate that 'cuddle hormone' effect. So as men become, or rather as we age, women have produced a lot more oxytocin than men. And that's possibly because men have difficulty. They are testosterone dominant. And that's probably why women have problems maintaining or having an orgasm. This is all part and parcel of the same mechanism. 

So when you see a woman with oxytocin, that's the cuddle hormone. Right? Men can have a climax so fast, whereas women have a lot of difficulty with orgasms. So orgasms in a female, are very, very clinically beneficial for a female both physically and psychologically. Because they ease menstrual cramps and they alleviate stress. 
And one of the things that is not related to hormones nor neurotransmitters is nitric oxide. Nitric oxide is, we relate that as a vasodilator and is used particularly in our cardiovascular issues. So, nitric oxide is necessary for penile erections. Because the mechanism behind that, it actually converts guanylate cyclase which is GTP to cyclic GMP. And it produces an increased blood flow to the penis. The same mechanism is used in a drug called sildenafil. Which is used for erectile dysfunction along with the Viagra. Because it inhibits the metabolism of cyclic GMP and by doing so, it prolongs the effect of the erection. 
So, if you're looking at serotonin. Serotonin constricts the smooth muscle. Adrenaline increases the heart rate. So, in women, adrenaline also increases vaginal pulse amplitude as well. 

Andrew: Right, okay.

Vanita: So, therefore, if you have somebody who's really stressed, noradrenaline and adrenaline, they will increase arousal. So this happens… there's a play of all of these neurotransmitters during a sexual event. 

So in males, your testosterone influences your sexual interest and behavior but it has very little impact. The estrogens have very little impact on the sexual desire. 

Andrew: Right.

Vanita: So when you have estrogen deficiency as one ages particularly, you might have decreasing genital or vaginal lubrication, or vaginal atrophy. And that can also play a role in the level of orgasm. 
So, you know how you spoke about oxytocin? We know oxytocin is produced by dopamine. And it's increased on sexual arousal. But in men, that whole bonding effect is quite muted. Because the male has much higher levels of testosterone. So they don't have that emotional attachment. They do the deed and they go. Whereas women would need to have that emotional attachment because their oxytocin levels are still rising. Men's oxytocin doesn't. So women, probably after sexual activity, will want the cuddle effect and probably have a long chat, whereas men will just say, "Look, go away." 
Andrew: What is it? Men just need a time and a place? What about that research that showed that oxytocin was involved in trust? Is that part of the sexual desire and you know, sort of need for a woman to trust the sexual partner? 
Vanita: It's very interesting. A while ago, I had read a paper on what we call neuro-bunk. And these neurotransmitters and hormones, they have an effect of stimulating and inhibiting and it's dose dependent. Just as much as you were talking about Vitex and just as much as we're talking about cortisol. At a low level, cortisol could be associated with adrenal fatigue, third stage adrenal dysfunction. At a higher level, cortisol could be considered to be high adrenaline output and that's stimulatory. Physically and physiologically, the patient may be feeling exactly the same. 

So the same applies to oxytocin. When you're having oxytocin at a lower or a higher level, it might play a role not only in cuddle and addictions etc. But can also play a role in… and this is where adverse addictive aspects or negative emotions. So this is where major corporations would use this level of testing. They might use PET scans. They might use qEEGs, or hormonal measures to identify why a consumer would consume a particular marketable product, this is not. And so that's marketing, using neurochemistry as a marketing, neuro-bunk. 

So back to the same question. Your question was, oxytocin, good or bad? It can be good or bad depending entirely on the setting. 
Andrew: But should we be mucking with it? That's I guess the overall question, and I think part of that is that corporations sort of think about…this will give you the be-all and end-all answer to how you achieve orgasm and how you enjoy sex. 

When I think, the enjoyment of sex is so much more dependent on men getting off your butt and doing some things around the house and being of use, of function to the family unit, or the female at least. And there are so many other issues that are involved with the woman, you know, needing to feel secure, not having to have stressors in her life from totally disparate things. To be able to concentrate on the act of making love or having sex. 
Vanita: Andrew, what you're saying here is should we bark up one tree only or should we look at all of them in its entirety? When we have a lack of libido or an impaired sexual function, you do need to look at the clinical triggers. You cannot identify oxytocin as the major clinical trigger only. It may be of use but you cannot do it independently of identifying your hormonal dysregulation because they play a vital role. If your testosterone, DHEA are out of balance, you're going to have a poor libido. And particularly if your progesterone is depleted and you have estrogen dominance, that's going to play a role in libido. 

If your stress levels are elevated, obviously, as you well know, elevations of stress will stimulate the pregnenolone-steal pathway and drive down your DHEA. And that in itself plays a major role not only in libido but all other functions as well. That will drive down your neurotransmission pathways. And as we've expressed, all the neurotransmitters talk to the hormones. So we therefore sensibly identify. One way to identify your clinical trigger is measure hormonal dysregulation, if there is any, and correct that. 

That can be corrected either through pharmaceutical hormone replacement therapy, bioidentical hormone therapy, which in Australia is prescription-only and it's tailored for the individual and it's compounded in a compounding pharmacy. Or herbs, herbs and nutrients play such a vital role in stimulating and balancing hormones. That is one component. 

The second component is addressing adrenal function. Everything is driven by your adrenals, so we do need to support adrenal function. Measure the cortisol. Cortisol is released by diurnally, so measure the diurnal rhythms. And cortisol plays a direct role with HPA axis. Is intimately related to the HPT axis, which is thyroid. So if you've got a bunged-up adrenal, you're likely to have a thyroid that doesn't work properly. So that's the first key and then in conjunction with that, measure neurotransmitters. 

Now neurotransmitters can be measured quite easily. Could be measured in urine sample and it can be even measuring your inhibitory and excitatory neurotransmitters. And in conjunction with that, you might want to measure histamine and your amino acids, etc., so that you can examine the play of the excitatory and inhibitory neurotransmitters. Balance them up. And having an understanding of the correlation between your herbs as well as your neurotransmitters, correct that. And last resort, if need be, then you could use something like oxytocin. 
Andrew: I've covered the urinary assessment of neurotransmitters with your colleague, Beth Bundy, favourite friend of mine. We've spoken a little bit about the controversy of this with regards to, I guess, acceptance with mainstream medicine. Given that there's no real way of measuring exactly what's happening at the synaptic level or even in the CNS unless you want to do a lumbar puncture which isn't going to meet any sort of criteria for intervention, given that it's a serious intervention to undertake. 
Vanita: Yeah, pretty serious. Yes. 
Andrew: Yes. So is there facility, or is there any research showing that when you do urinary measurement of neurotransmitter metabolites, that they are concordant with an improvement or a deleterious trend towards either depression or recovering from depression, or anxiety, or other sort of, mood disorders? Is there any correlation, given that it's not a proven thing, causality might be a long way off, but is there any correlation to draw from this? 
Vanita: There is a growing body of evidence and we have access to a white paper that validates the use of urinary assessments of neurotransmission pathways and how they correlate to brain chemistry, and I'm happy to share that with our listeners. So that's a white paper and that's very well researched and referenced. 

In relation to the evidence behind the validity of neurotransmission pathways. I know from a clinical perspective, I look at neurotransmission pathways and I correct them naturally using amino acids and the various precursors of the neurotransmitters. And within weeks, my patients tend to improve dramatically. 
Andrew: And this is using objective assessments like HAM-D, HAM-A?  
Vanita: Objective. That's right. Yes. But you can also reassess them and remeasure them and so you can see how your neurotransmission pathways have improved over the period of time. So you can use your pathology to monitor the assessments. 

You can go the next step up, and what has not been done is there is not enough evidence showing changes in circadian rhythm. These are energetic mediums as well as qEEG, quantitative electroencephalograms or PET scans, etc. There is no direct, that I know of, there may be some out in the making, that I know of, that correlates PET scans and changes in neurochemistry with that of the electroencephalograms. And I guess that will open up an area as the area of neuroscience, neuroplasticity, and neurochemistry, is a growing and a burgeoning science. People are so aware of everything to do with the brain these days. And there's never been a time that I know of, that has been so rampant in terms of awareness in this area. 

Possibly because the media now, and there are many organizations that acknowledge and support mental health issues. They're becoming a major issue, particularly in western society. Doesn't happen so much in third world countries but it definitely happens a lot in the Western society. So as a result of that, there's a burgeoning interest in that area and I dare say that this level of assessment and validation needs to be done. 
Andrew: I think this would be the perfect opportunity for a place like Swinburne University's Centre for Human Psychopharmacology to really be able to do some research. Or somebody to fund some research into looking at this. It would be awesome to see that sort of correlation be proven or indeed disproven. See if there is an effect there. 
Vanita: That's true. As a matter of fact, at this stage now, just new to our books at the moment is…I've just come across a genetic test that is able to identify a gene mutation associated with mental health disturbances and its correlation to prioritizing of specific classes of antidepressants, pharmacological antidepressants, or antipsychotics, or anxiolytics, etc. 

So research in this area definitely needs to be done. Particularly in relation to qEEG assessments together with neurotransmission pathways and see how that correlates. 
Andrew: Absolutely Vanita. Indeed, I remember an old psychology lecturer. Robin Holden, if you're out there, thank you so much for your teachings when I was doing nursing. 

But I'll always remember a line that she said and that was, "It is only a matter of time, probably only decades before it is proven that all mental health disorders are revealed to be of a biochemical nature." And I guess now we sort of think, "oh duh". But back then, it wasn't so proven if you like, and I just think if so much more can be done to help people respond to a medicine in a more precise manner. For instance, at the moment, you're basically flipping a coin to see if somebody will respond to an antidepressant. And there is some skill in the psychiatrist prescribing that to say "Yes, this sort of symptom picture, you're probably more likely to do better on that sort of medicine." But it's still a toss of a coin in some manner, it's not a guaranteed. And it would be really interesting to see some more work on genetics to say, "Well, look these people with that genetic snip are more likely to respond to this. Or conversely, they're more likely to be resistant to that sort of medication." It's such an important part to be able to personalise medicine. 

So I guess, my next question is, do you find that people with certain genetic snips, I guess some are given things like COMT, would respond or indeed have more of an issue with libido if they have a certain snip in an area like COMT or methylation or stuff like that? 
Vanita: I guess the contcept…as you just spoke about neurotransmission pathways, I guess the concept of genetic mutations, COMT or MTHFR. All of these markers will play a role in inflammatory markers. So inflammation, interleukin-6, TNF-alpha, etc., These are inflammation markers that will also play a role in inflammation as a whole. And inflammation, as we well know, is associated with acidity. Acidity is associated with changes in the microbiome. And the microbiome is necessary. Without probiotics in our gut and without fermented foods in our gut, we can't make neurotransmitters. We can't make GABA, as an example. Fermented foods make GABA. 
So just in relation to methylation cofactors and methylation defects. That's one the works of Dr Carl Pfeiffer and Bill Walsh from the MINDD Institute. These are really very well-published authors in the area of nutrient deficiencies. The power of nutrients within, and here we are relating specifically to zinc-copper ratios. Identifying medicaments or toxic medicaments such as pyrroles in the urine to correlate deficiencies of specific nutrients, which relate to specific diseases such as schizophrenia, etc. So when we're opening up the can of worms with neurotransmission pathways, libido, and hormones, we do need to understand where the metabolic blocks are. 
We've just opened up, I guess, one area of neurotransmission pathways. But they also correlate and are driven with nutrients such as zinc, copper, histamine, etc. And the concept of over and undermethylation, this is where your COMT gene comes in. This is where MTHFR comes in. And this is where your SAMe and your folate cycles come in. They all play a role in inflammatory conditions. And if you have inflammation, you will have pain. You might have a whole host of symptoms that are associated with degeneration of your physiology. And under any circumstances, libido will wane automatically. 

Andrew: Yeah. 
Vanita: So we do need to be mindful of those physiological defects, I guess we could call them, and rectify them. And they can be easily measurable, and they can be easily corrected. And there's enough evidence, particularly from the MINDD Institute. Enough evidence to show that specific nutrients can play such a vital role in rectifying…something as simple as vitamin B6 and zinc can rectify neurotransmission pathways to the point where a patient's life is normalised. The libido then starts to kick in. 
Andrew: Vanita, I've got to ask, this sort of stuff seems just so second nature to you. You've been a community pharmacist for many years in the past. You've specialised in compounding. You are intimately involved with functional pathology testing. And so you actually see the results of intervention. 

But I've got to ask you, when did it click for you? Because this seems like to me, there is not just a triangle. There's triangle upon a triangle upon a triangle upon a triangle. So that you end up, as if you did one of those weaving things with wrapping wool around nails. You end up with this really complex interwoven structure. I guess where I'm going here is, I primarily want practitioners to be safe and to get successful interventions for their patients. So where should they start and I guess what resources would you say that are mandatory for them to undertake before they start intervening in these sort of interventions that you've spoken about? 
Vanita: Okay. So the first question you asked is, when did it click for me? I guess I think it is important to let you know that many, many years ago, I used a specific combination of amino acids for somebody who was really, really anxious and panicky. She was virtually having a heart attack within my compounding pharmacy at the time. And within minutes, she calmed down. 
Andrew: Wow, minutes? 
Vanita: Within minutes, yes, she calmed down. And that's when I realised that I needed to understand a lot more. So my pet love is amino acids. I love working with amino acids because I know how to upregulate to prevent the calcium excess and how to stimulate various neurotransmission pathways. 
So the next question is, where does the listener go out and seek the information? One of the resources that is a really basic guide, would be the book that I've just written called Alchemy of the Mind. 

Andrew: Absolutely, absolutely. 

Vanita: And that's a good starting point because it's laced with a bunch of checklists as well as lists that will be associated with up or downregulation of every specific pathway. 

But in terms of where a listener might be able to learn more is through FX Medicine podcasts and through your integrative medicine teaching bodies, and there are a number of them out there at the moment. And also having purer understanding of really getting to understanding your labs. Finding those lab variants, finding out what up and downregulates the lab variants and how they actually talk to each other. Learning about hormones is one thing, learning about neurotransmitters is another, but putting them together is the key. 

Andrew: Yep, that's right. 

Vanita: And that's what we would hopefully be able to provide some more teaching material in due course. 
Andrew: Okay. So I guess, the next question here, I guess, is a little bit…I hope it's not too much of a devil's advocate question, but with regards to safety, how safe are the interventions, nutritional, herbal interventions? When do you have to be really cautious and what's their, let's say, a safe window of use? 
Vanita: As a nutritionist, naturopath, or herbalist, you'd be well aware of the materia medica of all your ingredients. 
Andrew: Yes. They should. 
Vanita: They should be. Right? Okay, so it's very important to note that herbs, and vitamins, and nutrients are almost as powerful as pharmacological interventions. And they also have their own materia medica associated with adverse reactions, side effects, etc. They're generally, overall, are much safer than pharmacological interventions. But it is important to understand that there are contraindications. 

So, things like rhodiola, which is a typical herb used for adrenal support. Brilliant for adrenal support. It's contraindicated in bipolar disorder. Licorice, as you well know, again another herb that is really brilliant for adrenal function. Is contraindicated in renal insufficiency, and cardiovascular disease, and so forth and so on. 

So they all have their value and so the practitioners need to use their expertise in identifying the correct dosage and the safety of their supplementation based on their professionalism. 
Andrew: And I think that this sort of ties intimately in with the toxicologist axiom and that is that everything is toxic, it's merely the dose. 
Vanita: It's merely the dose. Too much water…if you drink water all day, that will also be damaging to your body. 
Andrew: Yeah. Vanita, you know, we could podcast, we could seriously talk on this for hours and not even scratch the surface. There's so much to cover here. 

So I would just suggest, get your book, delve further into learning from organisations and associations like for instance, ACNEM, A5M, things like that. IFM overseas. And become an expert in this sort of thing. But I've got to say, I was so impressed with the set out of your book. It was really nice, clear, concise, and well-minded in its approach to what effect you want to get. 

Vanita: Yes, thanks, it was fun.
Andrew: Vanita, thanks so much for joining us on FX Medicine today, it's been great. 
Vanita: Thank you. Thanks so much for having me. 
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.

Addtional Resources

Vanita Dahia
Hamilton Depression Rating Scale
Dr Carl Pfeiffer
Dr Bill Walsh
Mindd Foundation
ACNEM: Australasian College of Nutritional and Environmental Medicine
A5M: The Australasian Academy of Anti-Aging Medicine
IFM: Institute for Functional Medicine

Research Explored in this podcast

Watkins, R.W. Validity of Urinary Neurotransmitter Testing with Clinical Applications of the CSMTM (Communication System Management) Model. 2009. 

Atmaca M, Kumru S, Tezcan E. Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder. Hum Psychopharmacol Clin Exp 2003;18:191–195.

Alchemy of the Mind offers an engaging and informative look into happy and sad brain chemicals. Whether you suffer from stress, anxiety, depression or addictions, just one pill may not always be the solution. Change your brain with targeted nutritional supplementation using the self-help tools found in this book.

Vanita Dahia reveals the Mind-bending power of neurotransmitters in depression and mood. Alchemy of the Mind uncovers the brains’ interconnectedness with sex, gut, stress, toxins and addictions. Your biology is in your biochemistry!

In this book, you will find:

  • the integration of mind, body and brain
  • the play between serotonin, stress and hormones
  • underlying causes of mental health
  • natural options to antidepressant therapy

This is a must read for anyone interested in the science of the mind. 

Special Offer to FX Medicine listeners:

Buy Alchemy of the Mind for $30 inc. shipping
**NB. Australia only

For international purchases visit Vanita's Website | Find e-book and Kindle here



The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.


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