Episode # 65 Aruna Tummala, MD - The 3 Root Causes of Mental Health Illness.

Episode 65:

The 3 Root Causes of Mental Health Illness with Aruna Tummala, MD & Evan Hirsch,

MD

Evan H. Hirsch, MD 00:07

Hey everybody, welcome back to the energy MD podcast. So happy that you're here

today because today we're going to be talking about psychiatry, holistic psychiatry, as

well as some of the controversies that exist in the community and some important

things to be thinking about when it comes to mental health illness. So I'm really excited

to speak today with my guest who is a Runa Tamala. So she is a board certified adult

geriatric psychiatrist and holistic doctor. She studied Functional Medicine and Ayurveda,

and is the founder of synergy health in New Berlin, Wisconsin. She is a hyperbaric

oxygen therapy certified doctor, and treats and reverses the root causes of mental

illness with diet supplements, Ira, the body and detox therapies, hyperbaric oxygen,

psychotherapy and careful use of psychiatric medicines. By reducing the reliance on

psychiatric medicines, she reduces the severity and occurrence of side effects while

empowering her patients. Dr. Tamala has presented on the topics of mental illness, IR

Veda and integrative approaches to the mental illness to academic audiences, both in

the United States and abroad. Dr. Tamala thank you so much for joining me today.

Aruna Tummala, MD 01:24

Thank you, Evan. And please call me Aruna.

Evan H. Hirsch, MD 01:27

Runa. Very good. So let's talk a little bit about this, this branch or this a different

paradigm associated with psychiatry. It sounds like you call it holistic psychiatry, or

integrative or functional psychiatry. What is your preferred term? And what is it?

Aruna Tummala, MD 01:45

I? That's very, very interesting question. At first, I used to call myself as an integrative

psychiatrist, because I was actually under the impression that the term holistic was

somewhat stigmatized and demonized. But in actually looking at what I do, it is really

about viewing the person as a whole entity, mind, body and spirit system together. And

so I've actually warmed up to the idea of calling myself a holistic psychiatrist. So I do

think that that is, that is the term that I think is most applicable. It's holism. And in terms

of the approach that a practitioner brings to the patient, it is also holism, in the sense

that we are looking at multiple different causes for pathology to exist. So it's a 360

degree view.

Evan H. Hirsch, MD 02:36

So it sounds like that differs from conventional psychiatry, in the sense that, you know,

medications are only a small part of your practice. And for conventional psychiatrists,

they are most of their practices that correct?

Aruna Tummala, MD 02:49

That is correct. Unfortunately, I do think mainstream psychiatry, like with rest of

mainstream medicine has lost its way it's really become very much focused on

pharmaceutical interventions. But I mean, but we all know, I mean, as we learn medicine,

and then psychiatry, and psychopharmacology, we know that these medications, at best

they act as band aids, there is I mean, the very hypothesis, the foundational hypothesis

of chemical imbalance, more and more recent studies are showing that there is no merit

to that there is no chemical imbalance. But we have increasingly we are seeing the rates

of anxiety, depression are skyrocketing in every age cohort that we are looking at. So

there is no chemical imbalance, but people are becoming sicker and sicker, including

our children and adolescence. What is the underlying costs? And that is the important

question that we need to look at. But unfortunately, my mainstream colleagues are not

willing to do that.

Evan H. Hirsch, MD 03:50

So let's go there. So what are the causes that you're looking at that you see in mental

health illness?

Aruna Tummala, MD 03:58

So, and I did put this down in my book, but in to put it very, very simplistically, I think of

all diseases, including mental illness as having three primary root causes, and a final

common pathway that leads to the manifestation of symptoms of disease. And these

three primary root causes are diet, trauma, and toxins. So diet, and of course, you know,

it's not that I don't look at the genetics, that's a big thing of a big part of what I do

especially MTHFR, Gene methylation gene polymorphisms, but also other newer

polymorphisms that researchers are finding have that have a connection to mental

health and wellness, but excluding the genetic component, what we see what I see

consistently is that it is a standard American diet which is woefully lacking in nutrients

and filled with artificial Frankin foods and ingredients that that belong to a lab not to our

bodies, then the trauma and under trauma, it's not only, you know, things like head

injuries that noticeably cause a clear onset of damage to the brain and the mind, but

also psychological trauma. And this can be even subtle forms of trauma where a child if

the child is being raised by parents who are stressed out, for whatever reason, and not

able to pay attention to the child, and especially be able to provide the pathway for

developing an authentic sense of self, that itself is traumatic. And this is not about

blaming parents, I have two kids, myself, and part of my motherhood is spent feeling

guilty about the things that you did not do or should have done. It's not about that it is

about recognizing where we are where the pathways for these illnesses are developing.

And a big contribution to, for me to include trauma as one of the root causes is actually

the ACE study, which was done in the 70s, the adverse childhood events study by

Vincent Felitti. And, and his group of researchers, and what they have found that even

psychological trauma, so you don't need to touch the child in any manner, just

consistent psychological trauma, one of stress, you know, scarcity, unpredictability,

these kinds of things can actually impact this child's health outcomes, physical and

mental illness outcomes, even contributing to early death. So, so that that is why I

realized that trauma really plays a big role. And the third big factor for us in I used to

think that this was only in the Western world. But recently I was in India, and I was

bombarded with so many artificial fragrances wherever I went. And it's not only on

Billboard's five times the for the fragrance in this particular laundry detergent, you know,

it's there, it's all being brandished everywhere. Why because in the Western world, we are

becoming aware of the toxic effects of palates, and all of these artificial synthetic

fragrances. So now these companies are taking their poison to other developing

countries in the world and underdeveloped countries. So it was very sad for me to see,

but toxicity is a big factor. And the way these three things, whether it is the bad diet, or

the trauma, and toxicity, one of the first damages that they cause is to our gut line. We

have seen how, you know, inflammatory diets directly disrupt our gut lining resulting in

leaky gut, psychological trauma, creating a hyper cortisol state also does the same

thing. And toxins, whether it is toxins that we are inhaling, or whether we are ingesting,

whether it's you know, pesticides, too much salt and too much sugar that we find in

processed and junk food, as well as the artificial chemicals that are added to preserve

food. I think sodium bisulfite is one of them. It's a preservative of benzoate. I think I

forget the names of these things, you know, but even these preservatives that are used,

they have been shown to consistently disrupt our gut lining. And so so the gut lining

when that gets disrupted now, the gut lining is the barrier between the true interior and

the exterior. And right beneath the gut lining, we have 90% of our immune system. Why

is it placed this way, because before anything passes through the gut lining into our true

interior, our defenders, our immune system are right there. To see whether it's a friend or

a foe, but with a disrupted gut lining, everything is passing through triggering our

immune system, and inflammation sensing. And this inflammation, add in the beginning

will manifest in the GI system. But when it continues, and it is not addressed, it's not just

about suppressing the inflammation, we have to remove the causes for this

inflammation. But if that doesn't happen over time, it reaches various organs in the

body. And when it reaches the brain, we call it as mental illness or neurological illness.

So this is so what I'm talking to you about really is the Ayurvedic pathway to diseases.

So it's the entire way that they have described this process very, in much much detail. So

I've just kind of this is this is what they describe, and this is what I happen to see over

and over again with all of my patients. And so the final common pathway is

inflammation and inflammation reaching different end organs and causing damage

destruction and impairment and physic physiology in that endorphin. And so it follows

in treatment that if we address these three root causes, remove inflammation, then we

should see improvement. And that is what we see in our patients here. So

Evan H. Hirsch, MD 09:57

wonderful. Can you tell us a little bit about it? VEDA for those who do not know what it

is.

Aruna Tummala, MD 10:03

So I Aveda is India's medical tradition with a medical system. It is a very, very old

medical tradition. The oldest texts are, I think 5000 years old. So it's very comparable to,

to traditional Chinese medicine, both these disciplines of medical thinking developed

probably parallel at about the same time and there was a lot of exchange of ideas from

one to the other. So in an in like in both these medical traditions, the basic premise is

that all matter is not material, but it is made up of energy. So most of the times we are

actually talking about the energy constitution, the imbalances in the energy constitution.

And because everything is made up of energy, we then use the food or the earth, that

can complement really treat the energy energetic imbalance that we have in our body.

So this is kind of the very basic understanding of how I read that works. But it is, I mean,

many people don't know about this, it was a complete medical system. And back in the

day, like two 3000 years ago, in the textbooks, we have identified that they had very

clearly eight disciplines, internal medicine, surgery, EMT, pediatrics, obstetrics and

gynecology, rejuvenation, and anti aging medicine, toxicology, and, and psychiatry. And

basically, the way the term for psychiatry actually refers to it as energy medicine, like

diseases of the energetic system of the body. So in other words, from the way I mean,

when I read these books, the way I understand is that they're talking about the software

of our body, which is the mind and the brain. And the gut is the hardware mind is our

software. So that's the term that they use for psychiatry. So these were the eight

disciplines, and in the surgery, surgical textbook of our VEDA, very beautiful descriptions

of instruments, which are very comparable to modern surgical instruments. But they

were mostly made of copper because it is naturally antibacterial. They used a lot of

plant anesthetics and different kinds of techniques to, to numb the area, and the

procedures and even including orthopedic procedures, cataract extraction, tumor

excision, they're all very comparable to modern surgical techs. So it's, it's really

fascinating, and they have talked about the microbiome 2000 years ago without the aid

of a microscope. So, so they knew our ancient people knew a lot more about the world,

the nature and the functioning of our bodies, than what we are able to grasp and

understand even today. And I whether brings with it, this knowledge about the use of

herbs, and even metals, like you know, and you know, in rheumatology, we do use gold

and silver salts. So even an iron whether there are some formulations that use some of

these metals, iron, of course, you know is used for different kinds of iron deficiency

anemias and, you know, different things like that. But the herbal pharmacology is very

extensive. And the way we approach any disease in our Veda is not by its name,

although there are different I mean, diabetes has a name and you know, there are many

names that are comparable to modern diseases. But the approach in Iowa is always to

look at where is the breakdown in physiology, and the attempt is to restore that

physiological functioning. And one of the basic foundational tenets is that all disease

begins in the gut. And so it's with the the hypothesis that I presented with the gut lining

disruption and the inflammation that results as a result of the gut lining disruption. That

is one of the Pathak mnemonic, foundational causes of all disease according to

Ayurveda. So, and the second one they talk about, actually, in fact, even before they talk

about the breakdown in the gut lining, the foundational cause for any disease, it will be

the asserts is loss of self worth. So that mean for me that they're they're talking about

trauma there because that's what happens when we are traumatized, especially in

children, we lose we forget our own value, there is an element of spirituality that brings

in and like in in the Vedic texts, when they talk about loss of self worth, they are talking

about falling from grace basically like you know, we have forgotten who we are our

innate nature or the holism or connection to the, to the universe and to everything in

nature. When we forget that, then we act in behave our behaviors reflect that loss of

connection. That is why we Whether it is we are choosing to use drugs and alcohol,

knowing that they're bad for us or not exercising or consuming media that is that we

know is making us agitated or depressed. We do all of those things, because inherently

we don't value ourselves, because we have forgotten how valuable we all are simply, you

know, the fact that your life form itself assigns value and worth to us and but when we

forget that we've gone down this path of actually creating these diseases for ourselves.

So there's a lot of personal responsibility that is also emphasized here.

Evan H. Hirsch, MD 15:40

So how do you remedy that loss of self worth

Aruna Tummala, MD 15:45

is me the pathway to that is through meditation, but the actual technique, I mean, the

way to remedy that is by getting to know oneself, it is through introspection and going

inward, which is what happens when we meditate and becoming, developing that

participant observer attitude within oneself. So and that also can only happen once we

dedicate, even if it is 510 minutes of our busy days, to going inward, meditating,

centering on centering our breath and our physiology, and simply closing our eyes and

going inward. And when we do that, we slowly begin to awaken our soul. And then when

the soul is awake, then the soul becomes really observant about what we are thinking,

how we are behaving. And it's Jiminy Cricket. In other words, we need to waken up our

inner Jiminy Cricket. So,

Evan H. Hirsch, MD 16:45

so just five minutes a day to get started and paying attention to the breath in and out,

Aruna Tummala, MD 16:53

in and out. Yes, yeah. So actually, in fact, there is an exercise that I teach my patients

and this is I found this in a car tools book The Power of Now. So this is a very easy way

to one recognize that we all have an inner entity that is separate from our mind, which is

which I call the soul. But you know, people can call it whatever they want. But there is we

are not just our body and our mind, there is something else. It is that that deepest part

of our subconscious, which in times of intense crisis, we will hear it, we will become

aware of it, when we are in that state when our life depends on it, or in whatever way we

do become aware of it. But the practice of meditation and introspection, makes it so

that we are more in touch with this inner entity within ourselves. So this exercise in this

book power of now is very simple. So you close your eyes, and you focus on your breath.

And then you ask yourself, I wonder what my next thought will be. And you simply wait

for the next thought to come. To as soon as a thought comes into your mind, and you

see the thought. So right there, you can see that there is an interviewer that is able to

quote unquote, see the thought. So our goal in meditation is to go and align more with

this inner conscience are so. So creating the distance between the mind and the soul

will slowly help us realize that what the mind is doing mind is all about conflict. Right to

do or not to do to be or not to be. That's what the mind creates. And it never is able to

give us a clear solution solutions only come from our inner conscience. A clear answer

comes only from the inner conscience. But the noise that the mind creates for most of

us, we are so hyper focused with our mental activity. We think that that is the way to be.

But in fact that that is what causes many of our neurosis. So I've had patients with OCD,

once they start doing this, they can actually go into their inner soul alignment and see

the obsessions happening in their mind. But now they don't have to engage with it. So

it's a very, it's a very curious experience. It's a very whimsical experience that some of

my patients actually describe. But once they get it, it's you can actually see the OCD

melting away. But I will also say to be able to get to that level. Yes, you need to spend

those five minutes and practice. But if you're inflamed if you're having leaky gut, if you're

nutritionally depleted, it's not going to be that easy. Just like you know, hangry, when

you're hungry, you get angry. So when you're nutritionally sated, then you tend to be

more calm, in the same manner, for any form of psychotherapy or inner work to happen,

we need to first take care of our physical body, this is the first level that needs to come

into balance doesn't mean that you don't steal, don't spend those five minutes because

that is also a way that you are sending a message to your nervous system, and to your

mind that I am valuable to me. Because as adults, the only way to find self worth is with

these acts of value that we do for ourselves. So,

Evan H. Hirsch, MD 20:46

so good, thank you for leading us through that I highly recommend that people start

doing that. And it's so important, I'm so glad you brought that up that it is a it is a

complement to all of this, you know, we have to be Mind Body Spirit emotions, in order

to be able to have had true success. So let's go back to the diet for a second. So what

do you recommend, generally for a healthy diet from a mental health perspective? Does

it have to do with the doshas? Or is there one that's better than others? What is your

been your experience?

Aruna Tummala, MD 21:27

So for most people that coming to the practice, at least from my experience, what we

have seen the most common dosha imbalance, dosha is one of the three energy types

that we identify in our Veda is the Pitta dosha, which is to do with inflammation. So

there are two we are seeing that almost everyone is coming in with inflammation. So

one of the first things that we do is put them on a PETA balancing diet, which is the anti

inflammatory diet. So this anti inflammatory diet, it's and it's again, very similar to many

functional medicine recommendations, it's no dairy, no gluten, no corn, no soy and no x.

So these are the five things I do recommend that people eliminate for the first six weeks

at least very religious about that. And, but that is just eliminating these foods is only

stopping the attack, we still need to pay attention to what can repair the gut lining. And

that can differ a little bit to each individual person and their presentation. But some of

the common egg so what what I mean by that is that sometimes I'm giving people

probiotics right at the beginning, because that's what seems to be what is needed, or

giving people you know, a fish oil, or I might recommend a free form amino acids or you

know, there are different things, but the common things that seem to be required for

everyone is actually bone broth, collagen powders too, but I'd like to recommend Whole

Foods. So because yeah, collagen is an aspect isn't is one of the components of the

bone broth, but the bone broth has not only the collagen, which is part of the the protein

component, but it also has healthy fats in it. And it'll also have the fat soluble vitamins in

it. So nature packages at best, if you're able to get either if you're able to make your own

bone broth, we have a recipe for that in on my website. So that's great. Otherwise,

nowadays you're you know, we are able to get many commercially available

formulations which are, you know, pretty decent. But the the foundation for any diet

change is that it has to be organic, it has to be whole cook at home, use clean

ingredients. Make sure that you're not using nonstick cookware, you know, avoid toxins

as much as possible. Use healthy fats and what I mean by healthy fats is extra virgin

olive oil, clarified butter or butter and sesame oil, peanut oil, organic peanut oil as well. If

a person does not have allergies to peanuts, so these are the different fat and large

immune if you you can cook in lard bacon is good, provided it is organic and grass fed.

And whenever we are consuming a high calorie food, we really need to limit the quantity

and for that if you're in tune with ourselves. If you're sitting in front of the TV and you

know eating bacon or ice cream, even ice cream is rich and fat, but you got to finish it up

without realizing how much you eat. But if you're mindful and present with it and paying

attention to your sense of taste and the satiety, then you're going to eat what is good for

you what is right for you. So these are some of the basic guidelines that we provide in

terms of diet. And this some people require more fine tuning according to the doshas,

but for most people, this seems to be more than enough. So these are some of the

foundational changes.

Evan H. Hirsch, MD 25:08

When you mentioned amino acids, in what situations do you find that people require

amino acids?

Aruna Tummala, MD 25:17

Amino acids, when I suspect that is one number one, when they're very depressed or

very anxious, I've seen that giving them a one month course of free form amino acid

seems to help. Because again, it's depression and anxiety can also be seen as a severe

deficiency of these protein building blocks, which are very necessary for making the

neurotransmitters. I, if I suspect digestive problems in the sense that it clinically and

through the interview, if I'm picking up on the fact that they're not making enough

digestive enzymes to break down the foods that they're eating, that would be another

time that I would consider doing freeform amino acids. And sometimes when people

are struggling to come to taper off of their medications, that's another time that I would

use freeform amino acids.

Evan H. Hirsch, MD 26:16

So you mentioned amino acids is precursors to neurotransmitters. So that's a great

transition to talk about the serotonin hypothesis and the neurotransmitter hypothesis for

psychiatric illness. Can you tell us a little bit about what are some of the latest updates

that have happened over the last year or so?

Aruna Tummala, MD 26:35

Sure. So the one of the basic hypothesis in psychiatry with terms of the cause of

psychiatric illness was the so called the chemical imbalance theory, which basically

means that there are certain neurotransmitters or chemicals in the brain. And each of

these chemicals when they are in a state of imbalance, then they manifest certain

diseases. For instance, if it's a serotonin imbalance, or norepinephrine imbalance, we

may see symptoms of depression or anxiety. If it is a dopamine imbalance, we see

psychosis like schizophrenia or bipolar disorder, or if it is broader imbalance of nerve

stability imbalances, then we may call it as a mood disorder like bipolar disorder. But

what and then of course, based on these hypothesis, we had all these different classes

of medications like benzodiazepines, anti psychotics, and antidepressants. And the

whole promise was that they were going to cure psychiatry for good. But that has not

happened. And so when we go back and see look at actually all these studies, even

looking at animal studies and preclinical studies where they've actually looked at

serotonin metabolites, dopamine metabolites and patients experiencing these different

illnesses, no consistent hypothesis has come out. What I mean by that is that

sometimes yes, we do find low serotonin in patients that are depressed, but equal

number of times you're finding that there is high serotonin in the city in another group of

people that are depressed. Same thing with psychosis, we are seeing some patients

having very low dopamine levels and other patients having very high dopamine levels.

And even in terms of treatment, what we see is that in the beginning, whether it's an

antidepressant or an anti anxiety, anti psychotic patients seem to respond, meaning that

oh, this antidepressant is increasing serotonin levels, and then their their depression is

going away. But when you continue that treatment within a year or two, we are seeing

that the original symptoms of depression coming back. What's going on? We're giving

you enough serotonin. Why Why on earth? Are you still depressed? We call it the

pooping out. And that's when Oh, this medication is not working for you. Let's try

something else. In this vacuum all happens at that time. And we see the same thing

with anti psychotics. In fact, with anti psychotics, we see, syndromes like you know, anti

psychotics traditionally reduced dopamine levels, and they seem to reduce agitation and

hallucinations and delusions. But when you continue this anti psychotic, not only do we

see sometimes a reemergence of the psychosis, but at other times we see syndromes

like tardive dyskinesia, which is a very, very difficult side effect to cope with. It's these

abnormal involuntary movements that can happen in the facial muscles in your upper

extremities and your lower extremities. It is very stigmatizing for patients. It interferes

with their quality of life with their everyday functioning. And one of the leading

hypothesis for tardive dyskinesia is actually dopamine imbalance that is created by the

antipsychotics. So before the advent of these medications, we rarely saw these kinds of

types of phenomena. And it can happen even with antidepressants as well. So with all of

this happening, And when you take a step back and say, Hey, what's going on? This

should not have happened. Why is this happening? And of course, you know, wonderful

physician researchers like Peter Gosha and Joanna Moncrief. And her colleagues are

team. These two people and many others too. But these two come to my mind.

Currently, they have not only documented their thoughts, they've actually done some

credible research, which is mainly meta analysis looking at pulling together all the

studies for a given question and looking at what is the evidence that can be that can

come out of this meta analysis. And in doing these kinds of studies, what we're finding

is that there is no chemical imbalance that stands out as a definitive theory. In fact,

Joanna Moncrief, I think she, her study was published in July of 2022. I, I believe it was a

New England Journal of Medicine. Don't quote me on that. But if you type in Joanna

Moncrief and depression hypothesis, serotonin hypothesis, we'll be able to get that

study. But basically, she did a huge meta analysis looking at almost all the studies that

exist that links the idea of serotonin as a cause for depression. And basically they do

not find anything. And so they have rightly questioned the whole chemical imbalance

hypothesis.

Evan H. Hirsch, MD 31:27

thing. So does that mean that that no SSRIs, or any of the other antidepressants out

there will work?

Aruna Tummala, MD 31:38

That is my understanding. And that is also my observation with my patients. Like even

today, the new patient that I saw, she is 21 years old. childhood onset of anxiety and

OCD, has been on various medications, develops a lot of side effects with them, and

none of them have helped him. And she's somebody that was born with acid reflux, like,

right as a baby, she had severe acid reflux and projectile vomiting. So right there, we see

the gut brain connection, and and she still continues to have acid reflux. She has severe

constipation. So none of them in these symptoms that are so glaring, they're not put

together. And she looks very pale, I suspect that she has I mean, I have a bunch of

bloodwork recommended for her. I would suspect that she's nutritionally depleted,

probably having iron deficiency, probably carnitine deficiency as well. And, and with the

constipation, she's reabsorbing the toxins, and standard, a woman, young woman in

today's world with makeup that she's using, she's getting a regular dose of toxins. So,

and she works for her dad's construction company as she cleans up the condos that

they all scan not using clean cleaning agents. So there's, again, another load of toxins.

So these are mold. Yes, yeah. So I do have my do testing to all of this stuff. I didn't think

of mold when she was thank you for bringing that to my attention. But that is part of my

standard protocol, is that I do mold testing for all my patients. Because it is so common.

And then the toxins to you know, almost everybody comes back positive for glyphosate

in the urine. And Aspergillus, this is the two things that I see without fail the testing that

I do so. So then we address that. And we do see recovery in symptoms. Excellent. And

Evan H. Hirsch, MD 33:47

so, so what's happening when somebody you know, people might be listening to this

and saying, oh, but my Prozac is really helping me. Is that placebo? Or is it you? You

know, maybe there is some sort of? Yeah, so what do you think is happening there?

Aruna Tummala, MD 34:04

According to Irving Kirsch, he's a therapist who has done a lot of work in this area of

antidepressant and the placebo effect. So if you look at his studies, then you will think

that this is nothing but the placebo effect. But, again, so if I mean, let's look at the

concept of medicine, what is a medicine supposed to do? We become sick, we take a

medicine, we get better than we stop it. Does it happen with Prozac? Does it happen

with any antidepressant? In fact, if they stop it without addressing the root causes? At

the bare minimum, they'll have a relapse of their original illness. But most importantly,

many of these patients actually go through pretty bad withdrawal. In fact, coming off of

Prozac is when I've seen many patients develop tardive dyskinesia because all of these

medical Asians are messing up with our neuro architecture, and our new chemistry. So if

you really apply the concept of medicine, that's how it should be. So even for patients

that are coming into my practice, you know, you know not, you know, I'm not a magician,

it's not like 100, I don't have 100% success rate. And I tell people, it's not because of their

fault. It's, you know, I don't do Lyme disease testing that's outside my wheelhouse.

Maybe it has to do with Lyme disease. Now, that is one thing that I know, I don't know.

But what about the unknown unknowns that I have. So I always tell patients that if I'm

not able to help you, in three to four months time, if you're not seeing benefits, then it's

time for you to find somebody else. But we should try everything that I'm offering. Try it

with good intention, diligence, and attention. And if it doesn't work, then you should

explore other avenues because I know this much. And this seems to help majority of

patients that come into, into practice with me. But there are things that even I don't

know. And for that, you know, I do have a network of physicians that if I suspect line, or

if somebody is not responding to what I'm doing, then I do refer them out to other

providers in the area. But I want to say that for 90 to 93% of patients that come in, when

we address the dire trauma, toxins, and that can take like the toxicity, I do a very

extensive mold, environmental toxin panel, the whole organic acid testing, all of that. So

that gives me wonderful information about how to intervene, where to intervene. Plus I

do methylation gene analysis. So that also gives me a lot of information. And we focus,

it's rinse and repeat, we add the good diet, we will detox we provide the vitamins, and

then people get better than the seem to have a little bit of a downside. Again, rinse and

repeat. And we do this over and over again, along with people learning how to be kind to

themselves and working on their self worth. So this process keeps on happening over

and over again. Until they cross onto the other side. So that's that's the hope for

everyone.

Evan H. Hirsch, MD 37:23

Yeah, that's excellent. I love the fact that you know, your wheelhouse, you know what

you're good at. And, you know, sometimes that there are times where you can't help

somebody, there's a cause out there. I mean, we're looking at 39 different causes. And

there are times when we can't help somebody, there's something that we don't know, or,

you know, like, I tell people that you know, we know about this much in a stadium of

100,000 people, right, you know, like, we just don't know a lot when it comes to medicine,

even though we're practicing functional medicine, we're understanding a lot more than

conventional medicine. So I appreciate the vulnerability. Thank you. So So let's talk a

little bit about infections other than Lyme. What other infections Do you see that are

playing a role? You talked about stool, or you talked about some of the gut issues that

people see, do you see infections on stool testing? Are you working on any of those

right now.

Aruna Tummala, MD 38:17

So I don't do infections with regard to the I'm not doing stool testing, I do primarily the

the oat which gives an idea about the fungal and bacterial metabolites. So most of the

times again, when there is leaky gut inflammation, I go with the hypothesis that there is

bacterial and fungal dysbiosis SIBO is happening. And then clinically, you know, based

on the this actually their breath, this how their breath smells, we can differentiate

whether it's more fungal or bacterial. I do use all my five senses in the room. So you

know, sometimes I have actually reliably diagnose people with fungal infections, simply

by the by the odor, that they have their body odor, and that has been proven positive with

tests. So those bacterial dysbiosis, fungal dysbiosis these are things that I feel very

comfortable treating. And, and I awfully I'm actually like even with this young woman

today, and with a young gentleman who's 26 years old, came in with the diagnosis of

schizophrenia, but and he's been sick for six years, five to six years, has been to all the

major hospitals and residential programs in this country spent 1000s of dollars. And he

wasn't a crazy regimen of medications, still very symptomatic. And I started working

with him since August 4. And with the approach that we have taken, he became

symptom free as of September 10. Except for anxiety but no delusions, no

hallucinations, none of those overtly psychotic symptoms, and all I'm doing right now is

helping him come off of the The crazy regimen that he was on. And of course, we found

out that he's having national non alcoholic steatohepatitis because of the metabolic

syndrome caused by these medications. To give you an idea he was on 85 milligrams of

olanzapine. 1500 of Depakote. 900 of lithium plus 1000 of metformin and 60 of

propranolol. So I mean, 85 of olanzapine is a criminal dose I really, there is no

justification to put anybody on that kind of a dose. But looking at his so I did send him

off to somebody else because he is a very complex patient and he was getting better.

But I wanted to cover all bases. And we did find that he's having elevated structure. nisin

Titus is an older age. So he did present with OCD earlier on in life, you know, as a middle

schooler, and high schooler. So was it post streptococcal infection, he also has

antibodies to Epstein Barr Virus and mycoplasma in fact, antibodies. So now now we

got all of those tests back. And the question is, do we treat them with antibiotics, I am a

little hesitant about that, because his gut is doing really well. And I've sometimes high

dose probiotics and herbal antibiotics and herbal antifungal seem to do the trick. So

that's my, that's my next level of recommendation for them would be to do a month or

two of the herbal antibiotics and herbal antifungals, while continuing to massage, or

massage the immune system, back to health, that's, that's going to be the foundation of

anybody's recovery process is balancing our immune system. Everything in today's

world is so inflammatory. And we really need to actively seek out anti inflammatory

ways or inputs to, like I said, massage your immune system into a state of balance. So

that's, that's, that's the pathway that we'll be taking. So even with infections, and also

with all these infections, there is always the component of the toxins, whether it is with,

you know, the die off release, or even just active toxins that the bugs can make. So

always having a binding agent or, you know, glutathione, or NSDL, cysteine. These also

become part of the protocol at that point in time.

Evan H. Hirsch, MD 42:29

And I think one of the things that you're also referring to is the fact that people have

multiple causes. It's never just one thing, which I think is always important. You know, as

humans, we want to simplify things. And we would love to have a unifying hypothesis

and just have one diagnosis. But the reality is, is that there are lots of causes, and the

sooner that people get their head around that, and that all of them need to be

addressed, the sooner that they buy in, and the sooner they get better. Would you agree?

Yes. So yeah, so let's talk about COVID, long COVID SPIKE protein illness, I know that

you've delved into this, and you've had success. So can you talk to us a little bit about

what you're seeing in mental health with, with COVID? And long COVID? And and what

your approach is?

Aruna Tummala, MD 43:18

Sure. So COVID, it's not an enigma as people would have you believe, again. So I mean,

to be fair, I was very afraid of COVID In the beginning, why, because when we don't know

what it is, we tend to be afraid. And, but as soon as some studies began to come out, I

started to, you know, look at the some of the studies that influenced my thinking were

coming from Singapore, South Korea, Japan, and even from China. But you know, let's

exclude China, you know, we don't trust everything that comes out of there. But even

from all of these countries, and then here within the United States, Stanford, actually

POB did a seroprevalence study very early in March of 2020. And they found that there

was a majority of COVID patients were actually asymptomatic. So that very dramatically

brought the case fatality rate down to being comparable to that of the flu. And even

though the authors of this study, were trying to get attention and kind of trying to kind of

calm down the hysteria and all of that, it did not people were not paying attention, then

some of the things that were coming out like you know, there is no treatment for this. I

never bought into that because as a holistic physician as a functional medicine

physician, we care more about the balance within us. COVID can come its grandfather

may come but it doesn't matter what about the other person or the other agent. What

matters is how we are how balanced we are. And when in and in our population. We

know that majority of us are chronically inflamed. So any virus is going to destabilize us

any bacterial infection is going to destabilize us, anybody with chronic inflammation. So

thinking along these lines, I began to realize that no, it's not as crazy as that it's not as

bad as that, we need to tell people how they can improve their immune system balance.

So it's not about energizing your immune system in this situation, because everybody's

already on fire, we actually want to bring that fire down. And I realized that again, it goes

back to the anti inflammatory diet goes back to eliminating toxins and taking vitamins

such as vitamin D, very, very important vitamin and prohormone. Very important for

regulating the immune system. And the other thing that is also just as important is fish

oil. Fish oil is not only for the gut for the brain, but it actually has a calming effect on our

immune system. So it regulates many different aspects of the anti inflammatory

cascade. And it is, you know, on the one hand, we have the arachidonic acid, and then

we have the Omega three pathways. So it really enhances the anti inflammatory

pathways, that's what we want, we want the pro inflammatory to come down, and the

anti inflammatory to go up. So we have very easy cost effective when vitamin D is less

than $1 per day to get 5000, our use of d3. So So So these were the things that I started

to look at. And I did come up with a protocol for acute COVID infections, which we have

used successfully in my practice, then came long haul COVID, which again, anybody that

has been practicing medicine, we know that we see these kinds of post viral syndromes

with any virus. I've treated post flu anosmia before I've treated post flu, chronic fatigue

syndrome before. So none of these things are new to the virus. So I saw all of what was

coming from the mainstream did not make sense to me at all. So I mean, not even going

into any of the conspiracy theories, what I began to see is that, hey, what they're saying

does not match up to my lived experience. That is what I was seeing. So then, but what

is my lived experience? I know how to treat post viral anosmia, I know how to treat post

viral chronic fatigue syndrome. Why not do the same thing because ultimately, our

immune system is the same, it doesn't matter what virus it is. So we started

implementing the same thing. Again, the principles are very much the same thing. anti

inflammatory, bringing the immune system into balance, detoxification, nutritional

supplementation, mitochondrial rejuvenation, when chronic fatigue is happening. And

for detoxification either has a wonderful treatment protocol called Panchakarma. It's a

seven to 10 day detox protocol, which we do in house here. And I'm in the process of

actually trying to see how we can make that possible even in a word for a virtual

audience as well. That's the project for the next three months. But once we, the punch of

karma is absolutely wonderful to balance many different organ systems in our body,

mainly the immune system, and to draw parallels to modern medicine. And again, no

studies have shown this, but the way I understand it is that it reliably removes not only

environmental toxins, but also the toxic chemicals that our body makes, which could be

an over abundance of inflammation molecules immunoglobulins. So in that lens, you

can almost say that it acts like plasmapheresis or like dialysis, it removes all these

impurities from our system, and eliminates them, allowing for our system to thrive in its

natural state. So Panchakarma is absolutely something that we recommend for anyone

experiencing Long Haul COVID. And finally, hyperbaric oxygen therapy, which is

wonderful for mitochondrial rejuvenation, and it is also antibacterial, antifungal, it

releases stem cells. So this is kind of the broad protocol that we have for long called

COVID. Or for many of these chronic syndromes like for even multiple sclerosis, this

would be the same protocol. The individual herbs that we use will differ from person to

person, but the overarching theme of what we're doing is the same. Excellent.

Evan H. Hirsch, MD 49:23

So Runa thank you so much for joining me here today. Where can people go and learn

more about the work you're doing?

Aruna Tummala, MD 49:31

So I my website to synergy health.com. That's T R I N E R G by health.com. My office

number is 262-955-6600. And Erica is my wonderful receptionist. She's really good and

she can help people with what they need. And people can also follow me on Facebook.

It's facebook.com/true Energy health, on Instagram also it's true energy health, Twitter,

it's tryna Gee, I forget that. It's so I mean, my photo is there so people can, you know,

recognize me but Instagram, it's true energy health and I am more active on Instagram. I

do a lot more videos and share my thoughts about different things on Instagram at this

time.

Evan H. Hirsch, MD 50:17

Wonderful I so appreciate the work you're doing and the awareness that you're bringing

to these mental health issues. Thank you so much for joining me today.

Aruna Tummala, MD 50:25

Thank you, Evan, thank you so much for having me.

Evan H. Hirsch, MD 50:29

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amazing day.