• 25 Sep, 2024
• Dr. Andriy V Samokhvalov

Concurrent Disorders, Integrative Care and The Link Between Nutrition & Mental Health: Dr. Samokhvalov on Holistic Healthcare

Magazica: Today, dear readers, we have the honor of speaking with Dr. Andriy V. Samokhvalov, the esteemed Medical Director at Homewood Health Center in Guelph, Ontario, Canada. With a wealth of experience in health sciences and a deep commitment to improving mental and physical well-being, Dr. Samokhvalov is a leading voice in the field. His insights and expertise are invaluable to our readers and listeners who seek practical advice and strategies for a healthier life. Welcome to Magazica.

Dr. Andriy V. Samokhvalov: Thank you so much for such a wonderful introduction. It’s a great pleasure to be here.

Magazica: Just to begin with, Dr. Sam, what is meant by concurrent disorders? I’ve seen the latest video of yours, and just to have context for the upcoming discussions, what inspired you to specialize in it?

Dr. Andriy V. Samokhvalov: This is a great question. In simple terms, concurrent disorders are literally disorders that occur together. In medicine and psychiatry, we often see multiple comorbidities, meaning a person can have multiple conditions. The term “concurrent disorders” usually refers to having general mental health issues, such as depression or anxiety disorder, along with some form of addiction. Depending on the context and location, the term might also mean a combination of different types of mental illnesses.

What inspired me to specialize in this field is the adage that we are supposed to treat the patient, not the disease. In our highly specialized care system, we often treat specific conditions, but most of my patients have at least two or three comorbidities. When I worked at CAMH, concurrent disorders became my passion and field of expertise. We learned that treating these conditions is challenging but necessary to address everything the patient has to be more effective. We developed integrated care pathways and a project called the Da Vinci Project, which stands for Depression and Alcoholism Validation of an Integrated Care Initiative. This approach had a tremendous and profound effect on our patients and reinforced my passion for providing care this way.

Magazica: Fantastic. Two concepts stood out to me from your discussion: addiction and integrative care. Let’s start with the latter. What are some key benefits of integrating care for individuals with concurrent disorders? Can you share some success stories, obviously without revealing any confidential information?

Dr. Andriy V. Samokhvalov: I would be delighted to. The idea of integrated care considers that every individual is more than just someone with a condition. There are physical, emotional, psychological, and psychosocial levels of functioning. Conditions often develop synergistically in a negative way. For example, if someone is depressed, they are more likely to develop addictions, and vice versa. If we don’t address all aspects of a person’s health, treatment is less effective, and people tend to relapse or not take their medications properly.

Magazica: From a layman’s perspective, concurrent disorders seem like a puzzle with many pieces. You can’t address just one piece; you have to address the whole puzzle with a holistic, client-centric, coordinated approach.

Dr. Andriy V. Samokhvalov: The main message would be that it is extremely important to address every single aspect of a person’s life. Even the divide between addictions and mental health is quite artificial. In our classification, addictions or substance use disorders, and even behavioral addictions like gambling or video game addiction, are considered mental illnesses on their own.

To answer your question directly, they are closely interlinked. When we talk about addictions, we are talking about certain pathways in our brain that are usually hijacked by either substances or behaviors. These pathways are responsible for reward-seeking and the ability to experience pleasure. When this aspect of someone’s life is hijacked, it affects their ability to experience happiness, purpose, and gratification.

For example, someone addicted to a substance will spend a lot of time acquiring, using, and recovering from the substance, which affects their ability to enjoy basic life tasks. This can lead to a profound sense of dissatisfaction and lack of motivation, resulting in multiple societal or psychosocial issues, which in turn can prolong the course of depression.

If a person is depressed and also has an alcohol use disorder, for example, treating only the depression without addressing the addiction is less effective. Drinking affects nutrition, exercise, and sleep, which are vital functions. If the person continues drinking, it negatively influences the course of depression. We’ve had cases where people received multiple treatments for depression, but their addiction was not addressed, leading to unnecessary suffering.

Incorporating treatment for substance use disorder into our protocol results in markedly better outcomes. We’ve had many cases where relatively intense and short interventions helped with both conditions, leading to sustainable results. People are happier, and as providers, we are also happy because seeing our patients do better is the best thank you we could ever receive.

Magazica: Fascinating. Throughout your answer, you basically addressed my next question about the integrative approaches you use. I remember a line from a doctor in the UK many years ago, which I’ll share at the end of our discussion.

Let’s move on to another important topic you’re working on: nutrition. We’ll have a separate podcast on this, but for today, how does nutrition impact mental health? What is the link between mental health and nutrition according to your expertise?

Dr. Andriy V. Samokhvalov: I’m very happy you’re asking this question and that you mentioned we might need a separate podcast for it. The connection between nutrition and mental health is hugely complex and multifaceted.

First, everyone needs certain nutrients and energy to lead a good life, be happy, and function well. This includes proteins, micronutrients, vitamins, and minerals. There is a direct link between body image and eating disorders or disordered eating patterns, which are unfortunately common. Modern societal norms and social media can create unrealistic demands on how people should look, function, and eat.

Nutrition and weight play a huge role in physical health, which is strongly correlated with mental health. When I mention weight, I don’t just mean being overweight; significant deviations from a standard normal weight, including being underweight, are also concerning. Anorexia nervosa, for example, is a mental health condition with the highest mortality rate in psychiatry.

Returning to the link between physical and mental health, there is a strong connection to gut function and the microbiome. Different dietary approaches, such as vegan, vegetarian, and plant-based nutrition, have shown positive effects on mental health. Conversely, the standard Western diet is often unhealthy. There has also been a resurgence of interest in carnivore diets, animal-based nutrition, and ketogenic diets for mental health. These approaches are not new; for example, a clinical trial on a ketogenic diet for schizophrenia was published in 1965.

There is a strong link between gut function and the microbiome. Various dietary approaches affect mental health. For example, vegan and vegetarian diets have shown positive effects on mental health, likely because the standard Western diet is often unhealthy. There has also been a resurgence of interest in carnivore diets, animal-based nutrition, and ketogenic diets for mental health. These approaches are not new; for instance, a clinical trial on a ketogenic diet for schizophrenia was published in 1965.

The ketogenic diet was developed in the 1920s to treat epilepsy and showed good results. Epilepsy is somewhere between physical and mental health, as it affects central nervous system function. Over the century, the ketogenic diet has been shown to help with various conditions and tends to normalize mental health. While I’m not promoting the ketogenic diet, it illustrates that nutrition is crucial for maintaining and promoting mental health. It is linked to body image, physical functioning, and translates into mental health, cognitive function, emotional stability, mood, and anxiety.

Addressing nutrition is essential in our work with every patient. Physicians study endocrinology, biochemistry, and nutrition in medical school, and every guideline for treating depression, anxiety, or schizophrenia includes lifestyle modification and nutrition. However, there seems to be a gap between guidelines and actual practice. In our modern era of highly specialized medicine, we must bridge this gap and ensure nutrition is part of our patient care.

Physicians often don’t have time to discuss these things, which is another reason to focus on integrated care approaches. We need to integrate pharmacotherapy, psychotherapy, and lifestyle modifications. I’m a big proponent of this and try to talk to all my patients about basic things. For example, I recently spoke with a patient with severe ADHD and concurrent disorders. I made simple suggestions about planning the day, scheduling sleep, and nutrition. These basic suggestions had a profound impact, allowing the patient to reduce medications and feel much better.

These simple yet important recommendations often don’t require a doctor to implement. This highlights the role of integrated or interdisciplinary teams, including naturopathic doctors, nutritionists, recreational therapists, occupational therapists, and social workers. They can make significant contributions without needing an MD title, profoundly impacting a person’s life.

Magazica: Just by listening to that, I want to confirm to my readers and viewers that before starting this conversation officially, Dr. Sam and I discussed having more episodes on various aspects of this topic. The more I listen, the more I realize the need for it. We are just scratching the surface today. Each direction you speak about needs to be explored in much greater depth.

For now, based on our conversation about the connection between mental health and nutrition, what basic dietary recommendations do you have for individuals looking to improve their mental well-being? I understand it is customized and personalized, but what general advice can you offer?

Dr. Andriy V. Samokhvalov: I do have very basic recommendations, and I’m grateful you mentioned it’s highly individualized. My approach is very simple. I believe the main purpose of nutrition is to provide adequate amounts of energy and building blocks for proper body functioning. We have macronutrients and micronutrients. Macronutrients include protein, carbohydrates, and fat.

Protein is essential as our bodies constantly rejuvenate and rebuild proteins. The standard recommendation is consuming 0.8 grams of protein per kilogram of body weight. Carbohydrates, though often vilified, are necessary. Even those on low-carb diets need some carbohydrates, as certain parts of our body, like the brain, require glucose. The brain typically needs about 120 grams of glucose per day, but this can decrease to 50-70 grams on a low-carb diet.

Fat is another macronutrient, and while carbohydrates are often criticized, they are crucial for energy, especially during exercise. For example, athletes need to consume carbohydrates to avoid hitting the wall during intense physical activity. Marathon runners often practice carb loading to maintain energy levels and prevent a significant drop in mood. They start having muscle cramps and cry. Many people think they’re just upset, but it’s more than that. This highlights the link between nutrition, mental health, and cognitive functioning.

The last macronutrient is fat, which is often vilified but extremely important. Fat plays a role in endocrine functioning, and our bodies need cholesterol for various functions, including making sex hormones. There are different types of fats, such as saturated, unsaturated, monounsaturated, and polyunsaturated fats. Omega-3 and Omega-6 fatty acids are essential, almost like vitamins. I always recommend my patients take Omega-3 supplements unless they get enough from food.

Micronutrients, including vitamins and minerals, are essential for proper body functioning. Many people, especially in Canada, are deficient in vitamin D due to lack of sunlight exposure. This can lead to suboptimal cognitive and emotional function. I recommend designing a diet that includes all necessary macro and micronutrients in the most natural way possible. I discuss these topics in detail in my book, “The Rational Diet,” which focuses on weight loss and designing a diet that meets individual requirements.

Magazica: Having an educated and expert approach is crucial. That’s why we request our leading industry experts to share their knowledge and experiences with our readers and viewers. We are scratching the surface today, but we will have deeper conversations in upcoming podcasts.

Two questions remain before we wrap up. As a medical director, what advice would you give to someone considering a career in the medical field, particularly in your area of expertise with concurrent disorders? You can address this in a specialized manner for future experts in concurrent disorders and in a generalized manner for aspiring medical professionals.

My first piece of advice is to be humble and prepared to be humbled. There will be many situations where you won’t know all the answers, and that’s part of the territory. It’s easy to fall into the vanity trap when people call you “doctor” and seek your advice, but humility is essential. Always keep track of your limitations and stay humble.

The second piece of advice is to be open to new information and opinions. There are many misconceptions on social media about health, and one reason I started a YouTube channel was to dispel them. Sometimes, even sensationalistic claims are based on a grain of truth. It’s important to be open-minded, especially when patients bring up information they’ve seen online. Respect their perspective and try to understand where they’re coming from. Sometimes, you can find valuable insights by doing a bit of research.

For example, many serious bodybuilders take creatine supplements. Recent research shows that creatine can also boost mental health and cognitive function by providing energy for the brain.

The third piece of advice is to understand things profoundly, using first principles. Medicine is an evolving field, and it’s crucial to understand your patients and the underlying physiology of their conditions. This understanding allows you to use medications and therapeutic approaches in innovative ways. In my clinical practice, I’ve had moments where we ran out of certain medications, and I suggested alternatives based on a deep understanding of physiology. Initially, people were skeptical, but they often realized it made sense.

Sometimes, using something not necessarily intended for a specific purpose can yield better results than the intended solution, especially when the intended solution is unavailable.

Magazica: Fascinating. Be humble, open to new information and ideas, and understand things in a profound way. Fantastic advice that applies to many professions, including mine.

Our last question is about the future. You mentioned your field is continuously evolving. What do you see coming in your field, and where do you see yourself in it? What is your future mission and vision?

Dr. Andriy V. Samokhvalov: That’s an amazing question. I’m not a fortune teller, but I see a few deficiencies in every system. I hope for a much better understanding of how the brain works and how somatic health interacts with mental health. We’re exploring genetics, using AI to find patterns, and developing telepsychiatry and new medications. Adjusting pharmacotherapy based on genetics has clear benefits and challenges. I hope that in the next 10-30 years, our understanding will become much more comprehensive.

There are many pieces of the puzzle being researched, and I hope that with AI’s help, we’ll achieve an amazing conceptualization of human physiology, brain structures, genetics, epigenetics, and the environment. Advances in technology will allow us to tailor this understanding to each person, understanding not only how the brain works in general but specifically how an individual’s brain works. This will involve the interaction between healthcare professionals and computerized systems.

My dream is to tailor interventions to each specific person really well. This concept of integrated care is foundational for all medical and clinical research. However, it will be a bumpy road with many challenges.

As for where I see myself, I hope to be part of this process, advocating for integrative approaches and new therapies. I received my medical education in one place and then came to Canada, where I had to redo my education to get licensed. This experience allowed me to see the developments in medicine over time and across different practices. I want to advocate for holistic, integrated approaches tailored to each person, with a strong human touch.

Magazica: Sometimes the journey itself is the destination. We’ve had a wonderful session, covering concurrent disorders, addiction, integrated care, behavioral addiction, and the interconnection between nutrition and mental health. We’ve also discussed advice for aspiring medical professionals.

I remember a doctor treating my father once said, “A human being is not a body with a mind; a human being is a mind with a body.” This resonates with everything you’ve shared about mental health and nutrition. It was so enlightening to listen to you. Our team at Magazica is grateful for your precious time with us.

Dr. Andriy V. Samokhvalov: The feeling is mutual. I really appreciate being invited and having a platform to speak about my passion.

Magazica: This is not the last time you’ll be joining us. We will invite you again. Thank you very much.

Dr. Andriy V. Samokhvalov: Thank you.

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Keywords: Concurrent Disorders; Integrative Care; Addiction; Mental Health; Nutrition