Episode 69: Can Ketamine Cure Depression?

Infusions - also known as IV therapy - have sprung up all around the country as the answer to nearly every health problem that ails us. But are they the promising solution they’re made out to be? And do they work by changing the composition of the microbiome? 

On this “Straight From The Gut” episode, Andrea and Afif chat with Dr. Roxana Namavar about her use of IV infusions, including using ketamine for complex cases of depression. 

Dr. Roxanna Namavar is the founder of Pretty Healthy, a functional medicine clinic in New York City that specializes in infusion therapy. Her focus is on integrative health, mental wellness and anti-aging - specifically, how we can use customized medicine to find the root cause of mental health conditions and reverse the clock to bring patients onto a healing path.

On the show, Dr. Namavar gives an overview on exactly what infusions are and how they’re used in practice - plus what to look out for if you’re considering giving them a spin.  

Questions? Ideas? Email us at themicrobiomereport@biohmhealth.com or reach out on Instagram @DreEats or @BIOHMHealth. 

Mentioned On This Show:

• BIOHM’s website (Promo Code: POD15)
• Episode 17: Infusion Therapy and The Gut-Brain Axis 
• A Neuroscientist Reviews Michael Pollan's How to Change Your Mind 
• Reimagine your doctor — Pretty Healthy NYC

On this show you’ll learn: 

• What an infusion is in its simplest form (4:18) 
• How the body deals with high levels of vitamins (6:56) 
• 2 specific infusion types (10:31) 
• NAD infusions (16:28) 
• What ketamine is, its risks, and its place in treating different disorders (19:25)  
• How ketamine is different than other psychedelic therapies (26:59)
• How quickly a patient can see results  (29:56) 

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Transcript: 

Andrea Wien: Welcome to the Microbiome Report powered by BIOHM Health. I'm your host, Andrea Wien and today we're doing a straight from the gut episode with Afif Ghannoum, CEO of BIOHM and Dr. Roxana Namavar. We are talking all things infusions, also known as IV therapy. Now, we've had Dr. Namavar on the show before to talk about infusions, but she's been doing something really interesting with ketamine in IVs for severe depression and having really interesting results. So we talk to her about what she's been doing in the world of infusions as it relates to COVID and immunity, give a little bit of background on what infusions are and why they're so helpful and then we've jumped into the work that she's doing with ketamine.

It's just a really groundbreaking field that is so new, and we have had our eye on it for awhile. So it's very exciting to be able to talk to someone who is getting results in her practice. We also talk about testosterone and how testosterone is built off the backbone of cholesterol and how stress can lead to low testosterone. This is a conversation that we've had a lot of questions about, and we have linked to some resources in the show notes at Biohmhealth.com/pages/podcast. So we jumped around a little bit, but this episode is packed with information. So hope you enjoy it. Afif, Dr. Namavar, welcome to the show.

Afif Ghannoum: How's it going?

Andrea Wien: It's going really well. Yeah, things are good. We're rounding into spring. So this is exciting news.

Dr. Roxana Namavar: Finally.

Andrea Wien: Finally. Well, Dr. Namavar, I know last time we spoke we chatted a lot about infusions and immunity which I don't think we knew at the time how telling that would be and how many people would be talking about that now, but we would love to just get an update on what you have going on and dig into some of the work that you're doing now.

Dr. Roxana Namavar: Sure. I think that for everybody the last year and a little bit more has been very bizarre. I think one of the things that dealing with this pandemic I really seen it happen with patients is that normally we have the opportunity to, we get an infection or we feel sick or whatever, we go to the doctor, they give us a pill and we get better, right? And there's a general trust at least in this country in the medical system in being able to fix an issue. And what I think has been really interesting and sad, but also very interesting over the last year and a little bit more dealing with COVID is that the general medical population did not have an answer. And that became very unnerving on both sides for patients and for healthcare provider opposites [inaudible 00:02:46]

And that from what I've seen has sparked a real interest in immunity. How do I make my body strong? What power do I have here? How do I understand my body a little bit better and what can I to support it in ways that are not going to the doctor and taking a pill? I can put together a protocol based on studies that were done basic science and then studies that were done sort of outside of this country to try to help support patients immune systems.

And as you know, a lot of times by the time the patient is interested in functional medicine with more chronic illness, there is issues with kind of absorption with gut functioning with maximizing gut health. So that was obviously of course brought up in this protocol. But a lot of what we do in my office is different types of infusions because often minus previous pandemic often by the time the patient's in my office, we have that imbalanced absorption is probably off a little bit to say the least, and we have to deal with it maximizing gut health and also replenish any nutrient deficiencies that are a result of that that could be causing any number of symptoms. whether it's a mood disorder, all the way to-

Afif Ghannoum: So, let's break it down, when we talk about infusions for like, we obviously the three of us understand what that means, but what does that in its most basic notion mean?

Dr. Roxana Namavar: So an infusion is something that we would start an intravenous line, which is an IV and we would take whatever component, whether it would be, if you go to rehydrate in an emergency or whatever, it's just sort of water that your body can afford and we'll put that directly into the vein so that we skip any need for your gut to be functioning.

Afif Ghannoum: Got it. So it's like the quickest way, it's like you hear people that if they've ended up in the hospital with dehydration from alcohol, they'll give them an IV line and give them sailing water just to get it in as fast as possible. So on the vitamin side, that is the idea or is the science that by doing an infusion, the absorption is a lot quicker into the blood, is that how it works?

Dr. Roxana Namavar: The absorption is a lot quicker now and you can also do a lot higher dosages. So there are certain vitamins that are limited for example, the dosage of vitamin C that can be absorbed through your gut without upsetting your gut is much lower than what can be safely infused.

Afif Ghannoum: Got it. So someone comes to you and they want to have sort of a quick immunity boost infusion wise. What does that look like? Obviously vitamin C, but what else would be going into an infusion and how long does it take?

Dr. Roxana Namavar: It depends on the infusion. There's lots of different types of infusions that we do. Normally without a pandemic, we will do a lot of specific lab work and then replenish the patient depending on what they need. So I believe that medicine really should be personalized. So if I will look at somebody's labs and say, and notice that their zinc is low, or their vitamin C is off or a certain B vitamin is missing, we can utilize infusions to replenish that quickly. And that usually has a faster acting effect on whatever, let's say they came in complaining of fatigue that usually ends up faster acting effects than taking oral vitamins.

Andrea Wien: So you Mentioned vitamin C, for example, being at a higher dosage. Does the body still excrete what it doesn't need after it's done in an infusion or is it actually being able to utilize more of it? Does that make sense? Like I know from the gut perspective, like we talk about vitamin C flush, which is what you're alluding to that you can only give someone so much vitamin C before they just start excreting it. So, in the blood then, how does that work? The body it kind of just circumvents that?

Dr. Roxana Namavar: Well, it circumvents your gut, your body will then absorb the higher dosage of whatever it is, vitamin C that we're talking about in this case. and it will then you have yourself now have access to a higher dosage.

Andrea Wien: I see.

Dr. Roxana Namavar: So whatever you don't need, you will still excrete, but your body will have access to a higher dosage.

Andrea Wien: Got it. And then in something like glutathione, which we know is just not well absorbed and utilized when taking it in supplement form, does this circumvent that as well so your body suddenly is able to utilize a lot more than it would be if you took it in like a liposomal form, let's say.

Dr. Roxana Namavar: Yes. The studies on liposomal glutathione really show almost no or very little absorption orally. So one of the things that we do to a lot of-

Afif Ghannoum: And then what does that do? I've heard of that, but I don't actually know what that does.

Dr. Roxana Namavar: Glutathione?

Afif Ghannoum: Yeah.

Dr. Roxana Namavar: Glutathione is sort of one of the main antioxidants in your system. So it's sort of, you can think of it as kind of like a garbage truck pulling out access inflammation, or if you were to have a virus that your body has fought off and then it needs to really detoxify, if your liver is slow, it helps to sort of move things out of your system. So giving it intravenously, you can absorb more, more quickly and it helps your system kind of detoxify and then that in turn will help your cells function better, help with mitochondrial health. One thing that a lot of people like about glutathione is it kind of gives you like a nice little skin glow so that also can be helpful for vanity.

Andrea Wien: One question I have about that too. So when we talk a lot about detox and liver detox and gut and everything like that, one of the things we want intact is good barrier function. So no leaky gut, right? So people are like eliminating daily, making sure that those toxins aren't being re-circulated in a case of a glutathione infusion, is that not as big of a concern because it's technically helping, I don't know, I'll just leave the question at that. Is it not as big of a concern?

Dr. Roxana Namavar: Well, the body is a sort of a sentencing feeling vessel that all works together, but I think we would have to separate what's going on in your gut and what is being infused. Now what's being infused to sort of bypass the gut absorption. So it doesn't mean that now all of a sudden you don't have leaky gut. We would still have to deal with gut health and do the appropriate testing, you guys do this testing and so we get information on what is working and isn't working, is there a leaky gut? How is our food being absorbed, how our nutrients being absorbed orally, that's important because most people can't just have an infusion every day, right? But what the glutathione does is it sort of can it helps to detoxify. It helps cell work work better.

And when that happens, the patient tends to have less inflammation, tends to feel better, tends to be able to be more of a participant in their own health and what they have control of which would be to deal with leaky gut, which would be able to notice if there is bloating, if there is gastrointestinal discomfort and really start to work on rebalancing, your one's gut house to you help heal the leakiness. If we have less inflammation in the body, we would assume that the leakiness would also decrease, the gut leakiness would also decrease.

Afif Ghannoum: So leaning into this infusions discussion, because this is actually pretty interesting and I've heard a lot of things now, along these lines, I have two infusions I want to get your thoughts on. Well, let's start with the third one first. I heard a stat the other day that under 30 year old men have the testosterone levels of a 70 year old in the 1970s. Have you heard something similar to that? Like the male testosterone levels are just way down comparatively.

Dr. Roxana Namavar: Yeah, that seems to be the trend. I think that that could be due to any number of things. What I do notice in my patients is that testosterone is one of the... If I have a male, well, any type of patient, actually both male and female patients are whatever gender we identify with, I do do a basic hormonal panel so we have a baseline. I think it's a little bit hard to say when it comes specifically to testosterone in males because I don't think that a lot of people historically have had their testosterone check until they are a later in life or have symptoms of low testosterone which ends up in my office a lot, this depression or fatigue, or-

Afif Ghannoum: Interesting and that is less of an infusion therapy and more of just like ongoing testosterone therapy, is that-

Dr. Roxana Namavar: Yes and no. So, obviously gut health affects your hormones as does cortisol function as does the weight and the way that that interplays with cellular health. So you can have something like a nutrient deficiency that will become so pronounced that it affects your hormone levels and it can do that any number of ways, including affecting cortisol which is one of our main stress hormones. And if cortisol is just this, let's keep it simple, I'll say out of whack, that will push all of your hormone creation to make more of the stress hormone and away from the sex hormones, one of them being testosterone.

Afif Ghannoum: Interesting. So, your point is just to simplify it, higher stress could be linked to lower levels of testosterone.

Dr. Roxana Namavar: Higher stress is linked to lower levels of testosterone. [crosstalk 00:12:51] So if you look at just the basics there, the precursor to our sex hormones is cholesterol, right? So we don't want cholesterol to be too too low because that will make us fatigue. And there's different pathways so your body we'll make the stress hormone cortisol or go to make the stress hormones and the sex hormones, excuse me. And so if we have too much stress, we're going to have more cortisol versus the sex hormone. So one of the things I think that we just looking at low testosterone and saying, okay, let's supplement the testosterone is sort of doing the patients a little bit of a disservice because we have to also understand why is this happening? Is there a nutrient deficiency? Is it that cortisol is out of whack, is our cholesterol too higher, too low, what's going on within those pathways?

Afif Ghannoum: This goes back to the whole idea of integrative medicine, to your point like if someone comes in with, we'll stay on the theme of testosterone, where testosterone levels are low, typically, the initial thought would be to, oh, well, let's just supplement that with testosterone shots. But your point is like, listen, maybe it's better to actually look at, okay, well what could be causing those lower levels and actually get to the apart that's really fascinating.

Andrea Wien: And if too it's not stress like in terms of your work, COVID or anything like that. It could also be stress on the body. So you're eating a food all the time that your body doesn't agree with. You have an intolerance that you don't know about, toxins in the environment, like all of those things can also contribute. So it's not just stress in the way that we think of like, I'm stressed out.

Dr. Roxana Namavar: Yeah. I think of our body and one of the things I tell my patients is that we are sensing feeling vessels. So anything that you put in your body, anything you're exposed to causes a biochemical response and your body can perceive any number of things at stress. One of the things that I will say to my patients to kind of simplify it as to say 1000 years ago, the stress we had was feeding our families and if we're being chased by a lion, your body responds with the cortisol and adrenaline peak, this biochemical reaction where your heart and blood pumps more quickly, your blood pressure goes up, you become hyper alert and you do that as a protective mechanism, but that usually recovers quickly because you either are eaten by the lion or you get away and your body has time to recover.

But the stress that we have most of the time now is not that. So our body is learning now that stress can be toxins. It can be chronic inflammation from leaky gut, it can be just this chronic stress that we do think of from the everyday grind of working every day from living with the pandemic or uncertainty or any number of things that are perceived as well.

Andrea Wien: And are more interested in hearing about this whole like hormone pathway because I know we have some people that might want to dig a little deeper, it's called the Pregnanolone, I always mess that up, but we can link to that in the show notes and it will actually break down. I'll put like a cool little infographic in there that'll break down how cholesterol turns into cortisol or testosterone or all these different things and where those pathways get messed up along the way.

Afif Ghannoum: Super interesting on testosterone. My second infusion question, some of these things when it disturbs you like I need to figure this out, what are your thoughts on NAD infusion?

Dr. Roxana Namavar: Oh my God, I love NAD infusion to be honest, personally-

Andrea Wien: Over glutathione?

Dr. Roxana Namavar: I think it depends on my body personally-

Afif Ghannoum: Can you break down what NAD is so everybody is aware of it.

Dr. Roxana Namavar: To make it simple, I would sort of say it's like the energy molecule so it helps with... It's a coenzyme that central to metabolism. So it's basically helps our mitochondria function and is necessary for our mitochondria to function. So NAD is utilized in a lot of different ways. I think we can talk about it from an infusion perspective and NAD infusions can be given in a lot of different ways. My body really likes NAD infusion. So if I give myself a 90 minute NAD infusion, for example, I feel more energy, more mental clarity, more overall awareness, alertness and my body feels let's call it cleaner.

Andrea Wien: Is it a longer reaching thing? Are people coming back for that weekly? Like what is the timeframe look like for that?

Dr. Roxana Namavar: It depends on the patient. NAD is sometimes utilize in drug rehabilitation. I've it for mood disorders. It seems to really help with that dopamine pathway that helps you feel sort of alert, connected, engaged, and helps with sort of let's call it cravings whether you want to call it drug cravings, that type of thing, has a lot of different properties so it just depends on what we're targeting. So it can be given in a short infusion once a week, it can be given in higher dose protocols, like every single day for two weeks if we want to do for a longer period of time, it just depends on what we're targeting.

Afif Ghannoum: And the science along NAD is pretty solid. I've seen some pretty interesting studies, but always interesting getting perspectives from someone like yourself. Like you feel the science is pretty strong on NAD.

Dr. Roxana Namavar: Yeah. And what I tend to treat is more mood disorders and then there's use a lot of Parkinson's like neurodegenerative disorders. That's what I end up seeing a lot of in regards to the patients wanting to try an NAD. In general, I don't do NAD infusion that's less than 90 minutes. So it could be time limited. I think that's the biggest issue.

Afif Ghannoum: Got it. All right. So the most interesting infusion that I want to get your thoughts on, I know you actually do this is using ketamine for, I I've seen it in depression, I don't know if there's other like mood disorders, but can you from like the sort of 10,000 foot level, walk us through like what ketamine is like I've always heard of it is like a horse tranquilizer or something that obviously we've heard, especially growing up that it's also been used recreationally, but there's a lot of very strong science emerging around ketamine's impact and use towards treating. This is like my term, like stubborn depression, there's a term for that that I'm forgetting, but like basically like hard to treat depression. So when you had told me, oh yeah, I'm actually doing this, would love to hear your thoughts on this and then we can obviously go from there on on some of these other emerging classes like the silicidens of the world, but we'd love to hear your thoughts on one, understanding how it works and two, what you're seeing with your patients.

Dr. Roxana Namavar: So ketamine got started sort of as an anesthetic agent in the 1960s. It's a very well let's call it relatively safe drug. and it used pharmaceutical grade and use under the auspices of a physician. And there's more information coming out on ketamine being utilized as an antidepressant agent, as an infusion and then also as a nasal spray form. Ketamine, it can be abused. I don't have personal experience with illicit drugs, the street name is special k and it sort of-

Andrea Wien: Jump into because you did say relatively safe and I want to make sure that everyone knows that it is under the physician because I did have a friend die from ketamine. So I just want to make sure that when we say, sometimes we say relatively safe when we're talking about like vitamin C, right? So anyone listening to this, like it's not something that you're going to find on the street and then experiment with your depression. So just want to make that very clear.

Afif Ghannoum: Yeah. Just for proper context, you mean relatively, I think as we're discussing relatively safe in the context of just what you said under the-

Dr. Roxana Namavar: [inaudible 00:21:28] of a physician who knows what they're doing. What relatively safe I mean in general when you're giving a ketamine infusion at the dosages that you do for mood disorders, I haven't had a case where there's been any issue. If you have a patient that has high blood pressure at baseline, ketamine can raise your blood pressure, but it's not something that we're worried about, causing respiratory depression and all of a sudden having a patient in the office that is was not breathing for example. So when, I mean relatively safe, I mean it, from a medical perspective, it's not something you want to go and try on the street for depression. Ketamine is something that can be abused obviously in that way, it did come out in the version of a nasal spray. I haven't seen that work in a way that I would want to really recommend that over an infusion at any points. There's good studies on ketamine, we're still working out exactly how it works just like we are with a lot of medications that shift mood and perception and cognition.

Afif Ghannoum: In your background, and I think this is really important. So let's take a step back, especially Andrea and I see a lot of these trends emerging, where people are doing a lot of things that for lack of a better term are promising at best, but it experimental and a lot of people will take leaps. One of the things that is intriguing to me is you're actually a psychiatrist by background, isn't that correct?

Dr. Roxana Namavar: Correct. I'm both [inaudible 00:23:04] psychiatry and then [inaudible 00:23:04]

Afif Ghannoum: I think that a very important because especially with ketamine specifically, I've heard that there are a lot of actually clinics popping up all over the country and you basically kind of need, I think at the most NAD involved. But what I've heard is that it's very compelling case studies are emerging, clinicals are emerging, but that, it's very important that it's utilized under the care of not just the physician, but someone who actually has expertise in this area because not just on the safety side, but also on the reaction to it.

So I think that's really important is just because something is offered in a quote unquote clinic, you really need to do your due diligence as a consumer and a patient to make sure whoever is actually offering this is qualified to do so. And it's not just like medspa adjacent because I've literally heard people that are like, oh yeah, like I know a guy who owns a number of medical spas and he's like, oh yeah, we're looking at ketamine, I kind of raised my eyebrows like that's not a soft surface. Do you know what I mean? So I think that's really important.

Dr. Roxana Namavar: It's not like getting ice cream, no.

Afif Ghannoum: Like even something that's like, it's medical like Botox, I guess it's medical, but it's not the same level of seriousness when it comes to these things. So I think that's really important because that these things are super exciting. And I know, especially for people dealing with depression, like people want to try things that may help them. But it's really important to make sure that if you're going to try something like this, that you're getting it from a reputable placement. And frankly that goes for any of these things, like even infusions. I was visiting another supplement company who will remain nameless and really nice people. And they literally like, do you guys, I was with my dad, I'll never forget my dad's reaction to this because they were like, do you want to get infusion of what? Oh, vitamins. And it was some lady in scrubs and we're like, is she a doctor or a nurse? No, like, this is kind of like, she does this, no, this is like a needle going in your body. Like people are so casual now about some of these things.

Dr. Roxana Namavar: It's a little bit scary because you also want to know that the vitamins, for example, in my office, we get these made by a reputable compound pharmacy, like the day off for the day that we give them to the patient. So that's a very different experience than having it be sitting on a shelf for months, for example. And what's the form of the vitamins can your body process, that what's the dosage? Where are they coming from? All of those things are important as is that the same for ketamine because there are certain places that you can get ketamine as a physician that has a lot of preservatives in it that I've actually seen those preservatives show up on functional medicine testing months and months later. So your body has to also be able to process whatever you're giving it.

Again, the ketamine that we use in the offices, we do get it compounded without any preservatives for that reason. But also just making sure that ketamine is actually the right medication for whatever symptoms we're dealing with, because you can also have other negative effects that is a dissociative, it can make the patient more anxious if it's chosen for the right patient, you can have great whack benefits from ketamine infusions. But if you really shouldn't be sort of just picked by the patient off the shelf because let's see what happens, I want to get high or maybe I'm depressed and maybe this will work. You really should have a good psychiatric evaluation before it's utilized for mood.

Andrea Wien: So I love the work of Michael Pollan and he wrote a book recently, How to Change Your Mind and it's a lot of what we're talking about in terms of different psychedelic therapies and how a lot of this research has been done in the past, right? A lot of this was already done in the 50s and then it kind of all went underground and now it's re-emerging, but in those situations for depression, like something like siliciden or getting you out of the headspace and kind of creating new neural pathways to help you think about things in different ways, how is that different than what ketamine is doing? Or is it working on similar pathways? What does that look like?

Dr. Roxana Namavar: I think that's a really biologically complicated question. I think that there's a lot more research to do on things that are not currently FDA approved for use. I think ketamine is interesting because it's already approved. So physicians that are licensed can have the ability to take drugs that are approved for usage and use them for other purposes, for example, Botox is approved in certain areas on the face that you can utilize it elsewhere, even though it's not technically approved for-

Andrea Wien: My sister just did it for migraines and it completely worked. It's crazy.

Dr. Roxana Namavar: And that's approved for migraines now, but there's certain areas on the face that it isn't approved for usage and physicians and other injectors will utilize it in those areas with great results and sometimes not so great results. So I think the difference between when we're talking about, we're not totally sure all of the things that ketamine does, we do know that it does help through certain pathways promote new neuronal growth we think, kind of like exercise does. And I think that we'll find also that with more of this research coming out about an interest in things like siliciden we will get more and more information about that.

I think it does look promising there was a lot of research being done again, as you said a while ago on these things. And then there's international review boards and things that are put in place in academic centers that would come in and find certain risk and say, okay, like, we're going to stop this. I know it used to be commonplace for psychiatrists during their residency to be given some sort of psychoactive drug and then do psychotherapy as like an experiential way of getting in touch with their own psyche, that obviously never happened to me when I was in residency and has not happened for a long time, but I know seasoned psychiatrist who did do that.

Andrea Wien: Anecdotally in your practice, when you're doing ketamine therapy on someone and this kind of goes back to my previous question when we talking about just the NAD infusions and those things, are you seeing, is it instantaneous results? Are patients coming back to you multiple times? Are they reporting two weeks of, Like what does the result look like?

Dr. Roxana Namavar:

It depends on the patient. So ketamine sort of prompt us to read our own brain cells that are involved in mood, we think, and the effects would have happened as ketamine is coming out of your system we think. So it depends on the patient. I've had patients come in for one ketamine infusion and call me the next day and say, I'm a new person and that just stays. And it sort of resets things. I have other patients who need to do a whole series of, let's say it depends on the patient, but usually, six infusions within a short amount of time, and that will pull them out of her really severe depression. And then sometimes they're fine and they don't have to do it again, sometimes we redo it in six months, sometimes we have to do maintenance infusions every so often to kind of pull up their mood again. I've seen, I have utilized ketamine and gotten patients off of long-term antidepressants. So somebody has been on an antidepressant or trying to find the right antidepressant for years, and then we utilize ketamine and then they've been able to get off of oral medications.

Andrea Wien: So interesting. Do we know anything about effects on the microbiome? Because obviously we know there's such a strong component between gut health and brain health and the tie between depression and gut health just seems to be getting stronger and stronger. So my thought then is okay if we know that that is such a solid pathway, is there some change that's happening in the microbiome when we're doing this?

Dr. Roxana Namavar: I don't think that that's been measured. I think that's a good study for you guys. I know that ketamine has activities on BDNF which helps with the normal growth and functioning and sort of regrowing neuronal pathways. And there is research that shows that that BNF is increased by oral Bactrim and lactose a certain lack of [facila 00:31:47] strains in the intestinal tract will increase BDNF in the brain as well, as well as certain prebiotics. So I think there's a lot of research to do there.

Afif Ghannoum: So just doing a quick search, there are some interesting studies, but again, as with a lot of these areas, it's still early, but they basically gave mice ketamine and what they found was that the ketamine actually adjusted the sort of good organisms in the microbiome and suppressed the opportunistic organisms. So they were actually able to modulate the state of the microbiome again, early days, but it just goes back to how complex all these interactions are.

Andrea Wien: Well, and it gives me the idea... So the more we're talking about patient outcomes, it lines up with that, right? So if someone is having one infusion and then they're kind of on a good path after that, and don't need to come back in and see her that often, then it's like, well, maybe they're actually following up with some diet and lifestyle that's maintaining that homeostasis in the microbiome versus someone who maybe then goes back to eating standard American diet and then maybe they do have to come back a few more times.

Afif Ghannoum: Totally.

Dr. Roxana Namavar: Yes. I think that's one of the reasons that in my practice, we really won't focus on cellular health and say like, look, either I can deal with depression, we can do the academy and for that, but unless we're really focusing on how well your cells functioning and where do you have power here in maintaining a healthy cellular functioning whether gut got help brain health, the neuroendocrine system, whatever you want to call it, we're not going to have the best results.

Andrea Wien: Right. It's A full package deal and it's not, I think we're so used to bring it back full circle to this conversation of medicine can cure us of taking the pill or getting the diagnosis and suddenly we're fine because doctors know what to do, we can very easily fall into that trap with ketamine therapy or with infusions or with any of these other things that look like a quick fix. We still have to do the work of staying healthy on the other side.

Dr. Roxana Namavar: I think that's one of the biggest lessons that the past year and couple months has really shown patients is that a lot of the power is with the patient and maintaining your own health. Doctors are trained in medical school, hope I don't get myself in trouble for this, but how on really how to think and what we do know about the body, but that doesn't mean that we know everything, right? When a patient comes into my office, I'll do my best to go through everything we possibly can when it comes to cellular health and the most important thing I think that we can do as physicians is really listen, because patients will tell you if you really listen what is going on, what may or may not help if you're really paying attention.

Andrea Wien: Well, if I feel like now we have another stop to make in our journey around the country to see all of these amazing practitioners. We need to go to New York and get some infusions and get all squared away.

Afif Ghannoum: Like a day of it.

Andrea Wien: Well, Dr. Namavar, Thank you so much. We really appreciate having you on. Afif, did you have any other last questions before we wrap up?

Afif Ghannoum: No. I just think again, it's with any of these things, like we were saying in the middle of the discussion, super interesting therapies that are available, but definitely do your due diligence about who's offering it, how long have they been doing it? All those things, I think that's critical.

Andrea Wien: Yeah. Absolutely.

Dr. Roxana Namavar: Is one of the is the most important thing you can do as a patient.

Afif Ghannoum:

My favorite story in this kind of thing is here in Cleveland, we have, well, we used to before COVID had this giant convention center, I don't know if I told you the story, but it was like the Cleveland boat show, some random boat show and they always in these big conventions have maybe 25% of the space or like random vendors. And I will never forget this, but my wife and I were walking and we saw like 20 people lean back in basically beach foldout chairs with trays and glow, sort of like clearly they're getting their teeth whitened. And some guy just running around shoving trays in these people's mouths. And I'm like, you're in the middle of this disgusting convention center, some dude is shoving some random stuff in your mouth and putting a laser and you're in a folder like this seems like, and it was something like two for one teeth whitening at the Cleveland Boat Show.

And I was like, this is not what we should be doing when it comes to these things. So, and it sounds so crazy, but I'm not talking must have been 25 people and this guy could not keep up with it. So don't do infusions at places that are there should [crosstalk 00:36:50] be no BOGOs involved It's like [crosstalk 00:37:03]

Andrea Wien: There are certainly things that you don't want to discount on. And yeah, that's One of them. Well, thank you guys So much. It was great to chat and we'll definitely continue to watch this space obviously. And I do think Michael Pollan did do a great job at looking at some of these therapies and not just for people who have depression or anxiety, but just normal people who want to better their health. So his book is really good. We'll link to it in the show notes. And then obviously Dr. Namavar, we'll link to all of your information there as well. So people can get in touch if they have further questions or want to come in for treatment. So thank you so much for the time.

Dr. Roxana Namavar: Thank you. Take care, stay healthy.

Afif Ghannoum: Right, you too.

Andrea Wien: Bye guys. You've just listened to the microbiome report powered by BIOHM health. Again, I'm your host, Andrea Wien. Don't forget you can save 15% off with the code pod15 on BIOHM's website. And again, BIOHM is spelled B-I-O-H-M. You can also find the show notes at biohmhealth.com/pages/podcast. Until next time, we'll catch you later.

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