Hypermobility—having joints that bend further than normal—is a surprisingly common trait in those with brain symptoms.

RCCX is a gene module (a cluster of four genes that are inherited together).  Normally, our genes are not inherited together like this.  This is a big deal because three of the genes are powerhouses when it comes to our health.

(1) TNXB - variants can cause hyper-mobility (from none to Ehlers Danlos). Our connective tissue isn’t just about our joints, its also about the things like permeability of our gut blood barrier and blood brain barrier, and even how vulnerable we are to upper cervical instability (which can put tension on the vagus nerve)

(2) CYP21A2 - (the most important of the three when it comes to psychiatric conditions) codes for an enzyme, 21-hydroxylase - a pivotal enzyme in hormonal pathways. When this enzyme is impaired (due to a mutation), there can be problems keeping up with the demands for cortisol, resulting in mast cell activation and secondary brain inflammation.

(3) C4 - codes for complement C4 - a protein involved in the immune response (and autoimmunity)

TNXB and CYP21A2 have high rate of mutations.
​
According to Dr. Sharron Meglathery’s RCCX theory - this cluster of genes appears to be at the foundation of many psychiatric conditions and complex chronic health conditions, such as mast cell activation syndrome (MCAS), chronic fatigue syndrome, chronic inflammatory response syndrome (CIRS), and postural orthostatic tachycardia syndrome (POTS). There are also common traits that appear related CYP21A2, fitting with HSP/Highly Sensitive Person. This is likely due to hormonal affects on the brain (especially the amygdala) in utero, . Symptoms and traits also align with pyrrole disorder. Interestingly, CYP21A2 contains a pyrrole structure.

In an upcoming newsletter, I’ll discuss how early adversity and trauma can impact our physiology and biochemistry, and what can be done to promote healing and decrease potential health risks.

Researchers use Adverse Childhood Experiences (ACEs) scores from large populations to look at health risks later in life. (These are less useful at an individual level, but still informative)

ACE’s include experiences such as:

• Abuse- emotional, physical, sexual
• Neglect - emotional, physical
• Household -  a household member with substances use, mental illness, suicidal thinking or behavior; divorce  or separation; incarceration; domestic violence
• Other - systemic racism (an often overlooked trauma), bullying, community violence, exposure to war, natural disaster, witnessing an act of terrorism, poverty  (I would add: loss of a parent, parent with a serious illness, serious childhood illness and medical trauma)

The higher the ACE’s scores in large populations, the greater the risk of cardiovascular disease, diabetes, cancer, depression, anxiety and suicidality.

Not all childhood adversity and abuse, however, is captured by ACE. In this reel, I discuss what covert abuse looks like.

​It is well known that early trauma and attachment disruption increase the likelihood of psychiatric and other chronic health conditions throughout the lifespan. Much of this relates to the chronic and persistent stress response that can occur when someone’s need for safety hasen’t been met while their neurophysiological pathways were being laid.

In this reel, I discuss some of the biochemical “downstream” effects of this chronic high stress response. The good news is that we have tools, including targeted nutrient protocols, to address these imbalances. This can make it much easier for someone to regain or even learn for the first time what it means to feel safe. I also share my experience using nutrient protocols in children with severe early trauma and attachment disruption.

There are many children out there whose cognitive, emotional and social development is impacted by candida overgrowth in the GI tract. This treatable, often overlooked condition, in my experience, is one of the more common contributing factor when it comes to inattention, restlessness, anxiety, irritability, insomnia, and OCD symptoms in children. “Drunken laughter,” seen especially in younger children, is due to “autointoxication” from fermentation in the gut. Some children will routinely rev up or have bouts of over the top silliness in the evening. Carb craving can be particularly severe - so severe, I’ve had some parents bring their children for treatment after having put locks on the refrigerator.

In this reel, I also discuss other symptoms, treatment and typical treatment response.

​EMF, or electromagnetic fields, can impact brain symptoms in a number of ways. It can create a subtle and, for some, a not-so-subtle stress response in the body and brain. When we are under physiologic stress, we can have an increase in cortisol, an increase in stress neurotransmitters, inflammation, limbic system (think lizard brain) dysfunction, a depletion of our antioxidants, and disruption of our innate electricity, all contributing to brain symptoms. In this reel, I discuss the EMF meters that I use, and which have helped me assess and lower my own exposure.

Mental Health Conditions With Strong Associations With Specific Nutrient Imbalances

It is becoming increasingly clear that optimal brain health depends on balanced nutrient levels. But how exactly do nutrients influence neurotransmitter activity?

It might seem intuitive to assume that specific nutrient levels would directly lead to specific symptoms or diagnoses. However, what clinical data more often reveals are biotypes—patterns in which a single condition is associated with a small group of nutrient imbalances. For example, depression biotypes identified by the Walsh Research Institute include undermethylation, overmethylation, pyrrole disorder, copper overload, and metal toxicity.

Conversely, a single nutrient imbalance can manifest in a wide range of psychiatric symptoms. Copper overload, for instance, may contribute to ADHD in one individual, while in another it may be linked to panic, insomnia, or even rage and behavioral dysregulation. That said, certain mental health conditions do show strong correlations with specific nutrient imbalances. In this article, I will cover:

• 5 Ways Nutrients Impact Neurotransmitter Functioning
• Psychiatric Conditions That Strongly Predict Specific Nutrient Imbalances

​
The data referenced here is based on findings from the Walsh Research Institute.

Nutrient Imbalances Can Be Due to Excess or Deficiency
​
The term nutrient imbalance is used intentionally, as it encompasses both deficiencies and excesses. Elevated levels of certain nutrients can be just as impactful on brain function as low levels.
This reflects the biochemical individuality of each person—nutritional needs are not universal. For example, while some individuals benefit from folate supplementation, others with elevated folate levels may experience worsening depression or anxiety. Similarly, individuals with copper overload may see symptom exacerbation with copper supplementation, whereas others may require additional copper for optimal functioning.

​What Causes Nutrient Imbalances

Although dietary intake plays a role, nutrient imbalances are not solely determined by what we consume. Genetic predispositions can significantly influence nutrient status. Additionally, imbalances may develop as a result of high oxidative stress.

Oxidative stress occurs when the body is exposed to excessive physiological burden, depleting antioxidant reserves and increasing vulnerability to DNA damage, inflammation, and cellular dysfunction. Indicators of oxidative stress include copper-zinc imbalances and elevated pyrroles, which are associated with relatively low zinc and vitamin B6 levels.

In many cases, nutrient imbalances arise from multiple contributing factors. For example, a woman experiencing anxiety related to elevated copper levels may have:

• A genetic predisposition (e.g., family history of postpartum depression, ADHD, or mood dysregulation)
• Dietary contributors (such as high chocolate intake, which is rich in copper)
• Supplement use (multivitamins containing copper)
• Hormonal influences (e.g., oral contraceptives increasing estrogen, which can elevate copper levels)
• Increased oxidative stress

​5 Ways Nutrients Can Impact Neurotransmitter Functioning

Nutrients frequently act as co-factors, enabling enzymes to carry out essential biochemical processes. Key mechanisms include:

• Neurotransmitter production
  Certain nutrients are required to synthesize neurotransmitters. For example, vitamin B6 is essential for the production of serotonin, dopamine, and GABA. Low B6 levels, as seen in pyrrole disorder, can contribute to a broad spectrum of symptoms.
• Conversion between neurotransmitters
  Nutrients also facilitate the transformation of one neurotransmitter into another. Copper is required to convert dopamine into norepinephrine (adrenaline). Elevated copper levels may therefore contribute to relatively low dopamine and high norepinephrine states, a pattern commonly observed in ADHD.
• Breakdown of neurotransmitters
  Enzymes responsible for neurotransmitter degradation also depend on nutrients. Monoamine oxidase A (MAOA), for example, requires vitamin B2 to break down serotonin, dopamine, and norepinephrine. Impaired breakdown can result in overstimulation, activation, and anxiety.
• Receptor regulation
  Neurotransmitter receptors determine how signals are transmitted within the nervous system. Zinc and magnesium help regulate the NMDA receptor. Dysregulation may lead to excessive neural activity, presenting as rumination, obsessive thoughts (as in OCD), cravings (as in addiction), or even delusional thinking (as in psychosis).
• Gene expression for serotonin reuptake receptors
  Nutrients can influence gene expression. Folate increases the expression of genes responsible for serotonin reuptake receptors, leading to increased reabsorption of serotonin and reduced availability in the synaptic space. This may worsen symptoms in individuals with already low serotonin levels. In contrast, SAMe has an opposing effect and may function similarly to an SSRI.

Why One Diagnosis Is Not Always Linked to One Imbalance
​

• Psychiatric diagnoses often have multifactorial origins. A diagnosis such as depression describes a cluster of symptoms, but does not identify the underlying cause. For example, depressive symptoms may be associated with: copper imbalance, methylation abnormalities, elevated pyrroles, candida overgrowth, upper cervical misalignment, mast cell activation, mold toxicity, heavy metal toxicity, hormonal imbalances, or a combination of these factors
• In many cases, multiple contributors coexist. It is not uncommon to see patterns such as mold or candida contributing to elevated pyrroles, which lower zinc levels, leading to increased copper—and potentially coexisting with undermethylation.
• A single root cause can manifest across different diagnoses. For instance, high copper may present as depression, anxiety, or ADHD. Undermethylation may be associated with OCD, depression, or schizophrenia. Multiple diagnoses—referred to as comorbidities—are more the rule than the exception in psychiatry.

​Data From Walsh Research Institute

​The presence of a mental health condition alone increases the likelihood of a methylation imbalance, most commonly undermethylation.

Over 40 years of research involving more than 30,000 individuals, the Walsh Research Institute found:

• 70% of individuals with mental health conditions exhibit a methylation imbalance (undermethylation or overmethylation)
• In comparison, approximately 30% of the general population show a methylation imbalance

​
Additional findings include:

• History of Postpartum Depression – 95% have copper overload
• ADHD – 68% have a copper-zinc imbalance
• Autism Spectrum Disorder – 98% undermethylation, 98% low zinc
• Antisocial Personality Disorder – 95% undermethylation, 95% pyrrole disorder, 95% low zinc
• Oppositional Defiant Disorder – 85% undermethylation
• Schizoaffective Disorder – 90% undermethylation
• Anorexia – 82% undermethylation
• Schizophrenia – 70% undermethylation
• Violent Behavior – 78% elevated copper

​Evaluation & Laboratory Testing Remain Essential

​While these associations are compelling, none are absolute. Nutrient imbalances rarely exist in isolation, making comprehensive clinical evaluation and laboratory testing essential. For example, even when zinc deficiency is strongly suspected, supplementation should not begin without assessing zinc and copper levels. Rapid zinc supplementation can mobilize stored copper, potentially worsening symptoms. Conversely, if copper levels are already low, zinc may further deplete them.

There are also situations where one imbalance cannot be effectively addressed without first treating another underlying issue. For instance, some individuals may not tolerate treatment for undermethylation until conditions such as candida overgrowth or mold exposure are managed.

There is a vast amount of additional data from the Walsh Research Institute, and future discussions will explore biotypes of depression, ADHD, and schizophrenia in greater depth.

As always, your comments and questions are welcome.

Until next time,
Courtney

The brain is a great barometer of oxidative stress. Psychiatric conditions, just as other chronic health conditions suggest high oxidative stress. The more severe the condition, the higher the oxidative stress. In this reel, after briefly explaining oxidative stress, I discuss the three components of lowering oxidative stress:

1) antioxidant support
2) lower exposures
3) support organs of detoxification
​
There is not a one size fits all approach.. What is helpful to one person could be harmful to another. This is why antioxidant support and supporting detoxification should be done in a treatment relationship with someone knowledgeable.

​In my experience as a holistic child and adult psychiatrist, I consider a number of factors when evaluating and treating brain related symptoms including genetic vulnerability, attachment experience, trauma, nutrient imbalances that impact neurotransmitter functioning, “oxidative stress,” toxicity, gut microbiome issues and other sources of inflammation, hormonal imbalances, and even structural issues of the head and neck. One root cause isn’t associated with one symptom or condition.
Despite this, there are certain nutrient imbalances that occur so commonly in certain psychiatric conditions that they can almost be predicted . In this reel, I discuss those conditions. Those of us trained through the Walsh Research Institute, assess for these imbalances using lab testing (along with looking at symptoms and traits) and then treat using use specific nutrient protocols.

​Deficiencies of certain nutrients can impact brain health, but so can specific nutrient overloads, which we can come by genetically or acquire from high “oxidative stress.” In this reel, I discuss five ways that specific nutrients can impact neurotransmitter functioning. Because of our biochemical diversity, we don’t all have the same needs when it comes to supplementation. Some of us, for example, can benefit from folate, but for others, it could worsen depression and anxiety. Many people I see have copper overload and have worsening of symptoms with copper supplementation, but there are some people who have relatively low copper.

​Mast cell activation causes high immune reactivity to a range of triggers, resulting in a range of physical symptoms. Though mast cells are not in the brain, they communicate with inflammatory cells in the brain and can play a role in brain-related symptoms, including intermittent brain fog, panic, hopelessness, fatigue and for some psychosis. Those who’ve struggled with this treatable condition often see many specialists before finding their answers and getting to the root causes.

They say it takes at least twenty years for medical research to make its way into medical schools and clinical settings. Oxidative stress - the depletion of our inherent antioxidants, has been found in a number of studies, to be especially high in those with autism. Though not addressed in conventional psychiatry at this time in history, we do have a number of ways to lower oxidative stress. Reasons this should be considered part of a more comprehensive treatment plan, is because doing so can decrease the likelihood of comorbid symptoms and conditions, decrease the need for psychotropic medication and prevent the accumulation of other health conditions down the road.

​COMT and MAOA are genes that code for enzymes that help with breakdown of catecholamines - our stress neurotransmitters, dopamine and norepinephrine. Particular variants on these genes can result in a slowing in the clearance of these neurotransmitters. When someone is under emotional or physiologic stress, this can look like insomnia, restlessness, high anxiety hyperfocus, obsessional thinking, and for some paranoia and psychosis. Treatment involves addressing the “stressor,” to decrease the catecholamines being generated, but can also involve nutrient and dietary interventions to help clear catecholamines. Such variants are why some people will become very “activated” when under stress.

​One of the most common nutrient imbalances in children (and adults) with brain-related symptoms is undermethylation - a methyl-folate imbalance. The Walsh Research Institute found that 85% of children diagnosed with oppositional defiant disorder and 98% of those with autism spectrum disorder were undermethylated. Other common symptoms in children (most children don’t have all of the symptoms) include perfectionism, obsessive compulsive traits, including (skin picking and nail biting), and/or phobias. As with adults, we address this nutrient imbalance using targeted nutrients and dietary recommendations.

"Left Brained," Undermethylation & Attachment.
​ In this reel, I discuss reasons we can have over-functioning of our left hemisphere and under-functioning of our right hemisphere.

Research, Support & Resources for Parents

As concerns around children, teens, social media, and screen use continue to grow, including the recent lawsuit against Meta and YouTube/Google, I wanted to bring together some of the current research on how technology may affect child development, emotional well-being, and mental health.

More importantly, this episode is meant to offer support, practical perspective, and helpful resources for parents who are trying to navigate technology in a more intentional way at home.

In this episode, I discuss:

• The recent and expected wave of lawsuits involving social media platforms
• Research into:
  • Infants and toddlers and screen time
  • Online learning in schools
  • Amount of time online in teens pre and post COVID
  • Chat/bots and generative AI
  • Children’s exposure to pornography
• EMF, which has a greater impact on children than adults
• Support and resources for parents
• The importance of aligning with children and teens around shared goals

​Referenced Resources

Boston Children’s Digital Wellness Lab

• The 5 M’s of Digital Wellness
• Family Digital Wellness Guide

​
Assessing and Lowering EMF Exposure
EMF and the Brain

​As always, I welcome your thoughts and questions.
​
Until next time,
Courtney

In this brief episode, I explore the connection between aging and oxidative stress. Oxidative stress plays a major role in accelerating the aging process, contributing to chronic illnesses, including conditions that affect the brain, and draining our energy, mental clarity, and overall quality of life.

Our left brain often tries to manage and control the body and the natural processes of life. Meanwhile, the right brain encourages us to stay present and connected to our embodied, finite time on this planet. Rather than obsessing over the idea of "anti-aging," it may be more helpful to think about how we can reduce oxidative stress-and to do so without creating additional pressure or tension.

In this episode, I reflect on:

• The modern double bind around aging
• A simple explanation of what oxidative stress actually is
• Common signs and health conditions linked to oxidative stress
• Why some people are more vulnerable to oxidative stress than others
• Key causes that contribute to oxidative stress
• General approaches that may help lower oxidative stress (with deeper discussion in future episodes)
• Why it is important to reduce oxidative stress in a calm and sustainable way-so the effort itself does not create more stress and worsen the problem

​
In upcoming episodes, I will go deeper into ways to limit harmful exposures and support the body's antioxidant and detoxification systems.

​As always, I welcome your thoughts and questions.
​
Until next time,
Courtney

In this episode of the Holistic Psychiatry podcast, I discuss panic attacks, exploring their physiological, neurological, and emotional underpinnings. I discuss the heightened sensitivity of the brain’s alarm system, the role of neurotransmitters, hormonal influences, and the impact of inflammation and biotoxins. I’ll emphasize the importance of being curious about the nature of panic attacks..

Takeaways
​

• Panic attacks occur when the brain’s alarm system is overly sensitive.
• Physical symptoms of panic attacks can be debilitating and terrifying.
• Underlying physiological factors contribute to vulnerability to panic attacks.
• Neurotransmitters like norepinephrine and GABA play crucial roles in panic disorders.
• Hormonal imbalances, especially in women, can increase the likelihood of panic attacks.
• Mast cells are involved in the immune response and can trigger panic symptoms.
• Biotoxins, particularly from mold, can significantly impact mental health.
• Limbic system dysfunction can lead to heightened anxiety and panic.
• The autonomic nervous system regulates our fight or flight response.
• Emotional stressors, trauma and stressors can contribute to panic attacks

Chapters
00:00 Understanding Panic Attacks
03:07 Physiological Factors Behind Panic Attacks
06:00 Neurotransmitters and Panic Disorder
08:52 The Role of Hormones in Panic Attacks
12:07 Inflammation and Panic Attacks
14:53 Mast Cells and Panic Responses
18:06 Biotoxins and Their Impact on Panic
21:00 Limbic System Dysfunction and Panic
24:11 The Autonomic Nervous System’s Role
26:45 Emotional Stressors and Panic Attacks


​As always, I welcome your thoughts and questions.
​
Until next time,
Courtney

It could be a lyric that aligns with something on my mind. The other day I heard Elton John sing the lyric about the howling old owl in the woods from Goodbye Yellow Brick Road. Though I've heard the line many times before, this time was different.

Recently, each night when I take my dog out, I hear the haunting sound of a great horned owl in the woods behind my house. But what do I do with that synchronicity? Is it the owl itself, a symbol of wisdom, intuition, mystery, and the ability to see beyond illusion, that I should be listening to?

Maybe it's the lyric Bernie Taupin wrote for Elton, about a desire to leave the superficial, ego-driven world behind and return to a more grounded life, a more authentic self. Bernie was ready to leave the yellow brick road of striving for success. He wanted to go back to his plow and back to the howling old owl in the woods.

Maybe it's both the haunting sound of the owl and the longing to return home. Maybe the owl's saying, leave me alone already and just honor the mystery. Maybe Bernie is telling me he'd love my simple, quiet life in rural Kentucky, a life that at times doesn't feel full enough.

A couple of days ago, while doing qigong, these are meditative movements similar to tai chi, I wondered if there is a place nearby where people gather and move in these gentle and unusual ways. The first place that came to mind was the Abbey of Gethsemane, which is not far from here.

Finding a group of monks, at least Trappist monks, doing qigong would be quite unlikely, maybe if Merton were still around.
Gethsemani was made famous by Thomas Merton an influential spiritual writer and Trappist monk who lived at the monastery for twenty-seven years. Four of those years he spent mainly in his hermitage, a secluded cabin in the woods.

To quote Merton, not all of us are called to be hermits, but all of us need enough silence and solitude in our lives to enable the deeper voice of our own self to be heard at least occasionally.

Before entering the Abbey, at 26, Merton was worldly, raucous, and rebellious. Like Bernie and many of us, he struggled with the tension between a simple, humble life and a desire to engage with and influence the outside world.

While at Gethsemane, Merton wrote over 70 books about contemplation, prayer, Eastern religions, interfaith dialogue, and social justice, including his famous autobiography, Seven Story Mountain.

So what do I do with that? Merton did all of that while living a quiet life right here in my neck of the woods. Hmm.
Sometimes the soul provides a shift in how we think about ourselves and our lives. Sometimes, however, a postcard cuts right through all the analysis and goes straight to the heart.
Yesterday I saw a video of Sara Bareilles and Rufus Wainwright singing She Used To Be Mine. Though I'd heard parts of the song before, I never stopped long enough to listen. Last night, with my reclaimed intention of receptivity, I did.

Instead of landing on some great insight, I found myself in tears. Quickly, I pulled myself out before sliding right back into those tears. Tears that I realized I was grateful could still flow.
When was the last time I cried? And why was I crying? And why were so many people in the audience crying?

The song is about losing oneself and losing the connection to the child we once were. Seemingly a universal loss that can make some of us ache even at the age of 58 when we think we've done such a brilliant job of putting all those parts of ourselves back together.
You hear someone no longer recognizing herself. She still remembers the girl she used to be. She sings with tenderness about that child's imperfection, effort, goodness, and self-reliance. She questions what life would have been like if she could rewrite the ending for that girl.

Sara Bareilles wrote this song for the 2016 Broadway musical Waitress. The lead character sings it at the end of the second act, when she has hit rock bottom. She is lost and struggling to remember who she is.

Through the song, she mourns that loss before she starts to gain footing and starts to reclaim the strength and grit of the child she once was.

This story isn't over. We all have an opportunity to write the next act and to extend unconditional affection for the child that she describes in the song as messy but kind, lonely most of the time, but more she is all of this mixed up and baked in a beautiful pie.
My long-held hope in sharing information online has been to balance the mind and spirit. In recent times, I've leaned into the left-brain science. That's what people tend to read and listen to. That's what people need and can't easily find elsewhere.

I'd forgotten, however, that expressing myself from the heart is something that I need. It is who I am. My own healing and health require much more than scientific information. It would be dishonest to share only that part of the story.

Even as a child, writing was my lifeline. It helped me find my place in the world. It helped me find peace.

That child wouldn't need to make sense of why the owl speaks to me at night, or why Bernie showed up with his plow in hand, or why Merton put down his pen and stepped out into the cabin to greet me in the woods, or even why Sarah, dressed as a waitress, crossed my path while singing a song I'd be sure was written just for me.

But I'm not only that child i'm all grown up and can't help but wonder why these particular energies showed up now, beyond the fact that I created some space for them to do so, what would they have me know? I think to embrace paradox.

And remember that we are all physical beings in this world and we transcend it. We need connection and we need solitude. We are grown up shaped by a lifetime of experience and still vulnerable children filled with wonder and sometimes hurt. We are light and we are shadow.

And as Sarah Bareilles would say, we are all of this mixed up and baked in a beautiful pie.

Wishing you wholeness as you make your way through this new year.

​As always, I welcome your thoughts and questions.
​
Until next time,
​
Courtney

Summary
In this episode, I discuss copper overload, a common yet often overlooked contributor to various mental health issues, including postpartum depression and ADHD.
The referenced data comes from the Walsh Research Institute, which studied nutrient levels in 30,0000 people with brain related symptoms, and found a small handful of nutrient imbalances repeated showing up. Copper overload was the one of those imbalances.
I explain the relationship between copper and zinc, and how elevated copper can impact neurotransmitter functioning. I also address the symptoms of high copper, potential causes for its elevation, methods for assessing copper levels, and treatment strategies to manage copper overload effectively
Takeaways

• Copper overload is prevalent in mental health conditions.
• High copper levels are linked to postpartum depression.
• Copper affects neurotransmitter functioning, specifically dopamine and norepinephrine
• Zinc is essential for regulating copper levels.
• Symptoms of high copper include anxiety, insomnia, depression and rage.
• Dietary sources of copper include shellfish and chocolate.
• Oxidative stress can elevate copper levels.
• Copper and estrogen have a significant relationship.
• Assessment of copper involves specific lab tests.
• Treatment includes nutrient protocols and reducing exposure.

Chapters
00:00 Understanding Copper Overload
10:36 Identifying Symptoms and Conditions Related to Copper
21:10 Assessing and Treating Copper Overload
As always, I welcome any comments and questions, as these help guide the information that I share.