Podcast Transcript

Episode 64: Healing the Brain: Harnessing Biomarkers in Eating Disorder Treatment & Suicide Prevention with Dr. James Greenblatt, MD

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Sam: Hey, I’m Sam.

Ashley: Hi, I’m Ashley, and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.

Sam: We believe that all bodies and all foods are welcome. We would love for you to join us on this journey. Let’s learn together.

Eating disorders are one of the deadliest psychiatric conditions in the DSM-5, and those who struggle with an eating disorder are at elevated risk for suicidality. It’s estimated that nearly half of people with eating disorders report suicidal ideation, and more than 50% of anorexia fatalities are not the result of medical complications or starvation. They’re actually the result of death by suicide. As mental health and medical providers serving our clients, it’s our responsibility to know the risk factors for suicidality, to evaluate the level of risk, to increase safety, and ultimately promote continued recovery. But what if we’re overlooking some of the biggest risk factors for suicide? What if we’re not even aware that there are a number of biomarkers we can actually measure, deficiencies we can detect in our biology that may be significantly contributing to depression and suicidality. And what if targeting and correcting these issues actually helps our clients’ brains function optimally and reduces their risk? Well, today’s guest is someone who’s leading the way in answering these very questions. Dr. James Greenblatt is a nationally recognized leader in the field of functional and integrative psychiatry. Since 1988, he has been at the forefront of transforming mental health care, pioneering evidence-based approaches that emphasize personalized treatment to address the root causes of mental illness. A distinguished expert, educator, and bestselling author, Dr. Greenblatt has shared his insights globally, lecturing on the scientific foundations of nutritional interventions in psychiatric care. With over three decades of clinical practice and research, Dr. Greenblatt has become a prominent voice advocating for the integration of personalized medicine and mental health treatment. He’s the founder and medical director of Psychiatry Redefined, a leading continuing education platform that offers comprehensive training, fellowships, and courses in functional and integrative mental health care. Dr. Greenblatt’s commitment to advancing the field is further evidenced by his authorship of eight bestselling books, including, Finally Focused, The Breakthrough Natural Treatment Plan for ADHD. His forthcoming book, Finally Happy, which focuses on depression, is set to be released in 2026. In today’s episode, Dr. Greenblatt sheds light on the often overlooked connection between the malnourished brain, eating disorders, and suicidality. We’ll be diving into how traditional treatments have so much room to improve and what we can start doing differently to support and protect our clients on a biological level. Stay tuned, this episode is packed with insights that could change the way we think about both the assessment and treatment  of eating disorders and their co-occurring conditions.

Welcome back!  This is All Bodies, All Foods. I’m Sam and I’m here with my co-host Ashley. And we’re so excited to record this episode today with Dr. Greenblatt. Welcome to the show.

Dr. Greenblatt: Thank you. It’s great to be with you.

Sam: So I wanted to let you know, I attended your webinar. You had a webinar a while back. It was titled Malnourished Minds, Exploring Suicide and Anorexia, and I learned so much from this webinar. I was so impressed. And I thought to myself, we have to invite Dr. Greenblatt on the show because I really feel like you have taken, I mean, to me, a very fresh perspective- how to address suicide and suicide prevention and eating disorders.  And I was kind of looking into your work and I know some of our listeners might be wondering what exactly is functional and integrative psychiatry? How does it differ from traditional psychiatry and what led you to it specifically working with eating disorders?

Dr. Greenblatt: Sure, no really important question, and I’m glad that you both listened and learned from the webinar. It’s not new. I think I’ve been trying to scream this information for about 20 years, but it’s beginning to sink in because research is supporting everything that we’ve been trying to say. So the distinction between functional medicine and integrative medicine, I think is really important. So integrative medicine, you know, for about 20 years now, our academic institutions have embraced things like mindfulness and yoga and acupuncture.  And we can write prescriptions now for sleep, hygiene for our patients, and we actually have training programs. You can get a fellowship in lifestyle medicine. So those are all the category, what I  use for integrative medicine, right? It’s these kind of what I would say softer sciences,  but they’re all incredibly helpful,  but medicine has embraced it. Harvard, Stanford, I mean, they all have programs in mindfulness and those integrative medicine techniques. Functional psychiatry and the webinar that you heard, particularly looking at biomarkers to look at suicide, functional medicine  is  what we call root cause analysis, looking at objective biological markers to help predict risk,  as well as, to predict underlying contributing factors for symptoms of eating disorders and or other major psychiatric illness. So there is a distinction, and when I talk about those two words, I always say we need both. We need integrative and functional medicine, particularly integrated into our treatment of eating disorders.

Sam: So when you say biomarkers for our listeners out there, what exactly does that mean?

Dr. Greenblatt: It’s that simple blood test or hair test or urine test or stool test is looking for something going on in your body at that time. Are you deficient in vitamin D? Everyone’s heard about testing for vitamin D. That’s a tremendously powerful biomarker for the field of psychiatry.  Or do you have excess of a heavy metal like lead or copper? So these are objective tests where we look at, we can tell that individual, these are steps that you can take to treat these kind of dysfunctional biomarkers.

Sam: See, I’m so happy we’re having this episode. I was just talking to Ashley about how I really feel like this season is all about individualizing treatment.  And you are such a valuable addition to this season because this is really about, you know, testing every person, every person is different and really having these very unique biomarkers that differ between people and targeting them, you know, to test someone and figure out what’s going on, what’s missing and making that part of the treatment plan.

Dr. Greenblatt: No, absolutely. There’s two slides I start with and any of my teachings or anyone comes to our program and one is they can’t use the word ‘alternative medicine’. Because the thing that we’re talking about is alternative, just good medicine. And the other one is this concept of biochemical individuality, this personalized math because everyone is just so different genetically.  As clinicians, we take a pretty good history and understand that unique story of their life and their trauma, but we’re not taking a good biological history of their uniqueness. And that’s what functional medicine is.

Ashley: Dr. Greenblatt, can I ask a question about that too?  So can someone, so you mentioned like testing for these biomarkers.  If someone goes to a traditional psychiatrist, can those testings be done?

Dr. Greenblatt: Yeah, really important to understand there are a number of biomarkers that can be done by your PCP, or your psychiatrist. We talked about vitamin D, we can talk about vitamin B12 and folate and zinc and magnesium. There’s a whole list that is never addressed in an eating disorder patient and or a psychiatric patient. And then as you’re alluding to, there are what we call functional medicine tests that aren’t typically covered by routine labs and the cost would be out of pocket typically.  But we could make a major dent in our treatment of mental health challenges by just some of these routine labs if they were done and understood better by our clinicians.

Ashley: Yeah.  OK. Thank you. Thank you for answering that. So I have a question.  You provided some alarming statistics in your training about anorexia.  You said up to 50% of anorexia nervosa patients relapse within one year of conventional treatment and more than 50% of anorexia nervosa fatalities are not the result of medical complications or starvation.  They’re actually the result of suicide. I’m curious what you think is missing from the traditional models for eating disorders, and from your perspective, how can our field evolve and improve here?

Dr. Greenblatt: Well, what’s missing from our treatment is probably an eight hour discussion. So I won’t go there, but we’re going to touch on some of the important factors. And I mean, I came into the sort of world by accident. You know, I was a traditional inpatient adolescent psychiatry, kids coming in for suicide attempts. But I never experienced a suicide. I never sat with a family. And then in 2003, I was in a community hospital. I had an eating disorder unit, and I started in the eating disorder world at that time, about 2000. In 2003, we opened Walden. And the number of families that I sat across whose kids completed suicide just overwhelmed me. And then when you dig into the statistics, you realize, wait a minute, this disorder that many people pass off as, you know, just eat, is the highest mortality rate, but the highest risk of suicide. You know, at Walden, we stopped having, we used to have a year memorial service for kids and adults that died. We stopped it because we’re too many people. It was just too many over many, many years. So, and we just forget it. But these kids are dying and our current treatment models are obviously helpful, but not always sufficient. And this suicide risk, kind of, when I first experienced it, I had no idea when I started, it just got me into this, well, wait a minute, what is the most prominent part of our patients with anorexia? And that is malnutrition.  And then I started spending the last 25 years looking at that connection between malnutrition and suicide risk.

Sam: Wow. And I just want to clarify, when we’re talking about malnourishment and the malnourished brain, this really isn’t just about people with anorexia, right?

Dr. Greenblatt: Absolutely. I mean, it has very little to do with weight because some of our adolescents, normal weight, overweight doesn’t really matter what the weight is, but malnutrition is based on the amount of micronutrients that someone is eating in their diet. But more importantly, there’s such a powerful genetic vulnerability. So you and I can be eating the same diet, whether it’s vegan or keto, and our kind of micronutrient levels could be very different.  So there’s so many other factors related to digestion, absorption, and just our genetic needs.

Sam: Yes. I think that’s such an important point for our audience because I think there is this misconception that you can only be malnourished if you’re quote unquote underweight. And we always talk on this podcast about the fact that you can be malnourished at any weight, and there’s a variety of eating disorders that will result in malnourishment.  And so I do think this episode is going to apply to so many people in our audience.  You brought up DNA, and you’re bringing me to my next question here.  In your functional medicine model for suicide prevention, you talk about the role of DNA. So let’s start there. Let’s talk genetics. What is the role of DNA, eating disorders, and suicide risk.

Dr. Greenblatt: Well, I mean, we know and the research is now quite clear and established and everyone’s sharing  that the genetic liability to eating disorders is very, very high. And we also have the research supporting the genetic vulnerability to suicide risk is also very high. So we don’t understand what specific genes or what that is. But, the good news about being old and doing this long enough, thousands of histories, just go back two or three generations. There’s usually a pattern of multiple suicides or suicide attempts. So the teaching point is helping clinicians understand you can’t just ask the parents any family history of suicide. You need aunts and uncles and grandparents. And you often see this pretty profound family history of suicide attempts. And the example that we all use is Hemingway’s family, I think, 8 suicides. oftentimes it’s linked to family histories with bipolar, sometimes it’s not. But you have to take that three generation family history to understand risk.

Ashley: Yeah. I was telling Sam that this morning, Dr. Greenblatt, I actually attended a CE on, it was called Hidden Suicides. And so he, the presenter actually shared Hemingway’s family dynamics and how  Hemingway even used the same weapon that his father used to complete suicide as well.  So there are definitely risk factors. There are definitely, like you’re saying, you know, taking a history of familial experiences, what has happened in several generations back.  So moving on to medication, what do we need to know about psychiatric medication and suicidality?

Dr. Greenblatt: Well, for focus on eating disorders, it was one of the most dramatic moments in my career. I mean, I would probably say that the suicide emotional trauma for me was probably number one. But the second one was when the antidepressants came out, there was no warning. And then a number of years later in 2004, the FDA put a black box warning saying, “suicide risk” for these antidepressants.  And I was treating, for years, kids with depression and I never saw suicidal ideation on antidepressants. I walked into an eating disorder job full-time, all day long interviewing patients with eating disorders.  And I kept getting told the same story. “I was put on this medication and I had intrusive thoughts of wanting to kill myself.”  They stopped the medications and those thoughts went away.  So I’m quite convinced and a lot of my colleagues ignore it, but we still have a black box warning that the  SSRIs in particular  increases risk for suicidal thoughts. In my experience, without any research to document it, many of my colleagues have found it, that those malnourished individuals had a higher risk of this suicidal ideation with antidepressants. 

Sam: Wow. So there’s something about the coupling of the malnourishment and the SSRIs? 

Dr. Greenblatt: That is my theory. Yeah. But absolutely. Because I’ve seen it so much with patients with disordered eating. And as you said, Sam, regardless of weight, they are  malnourished.  And occasionally you’ll see it with other individuals, but I’m quite convinced that it has to do with malnutrition.

Sam: That’s so interesting. I’m just curious, I mean, what would your guidance be for psychiatrists out there who, I mean oftentimes antidepressants are part of the treatment plan and they do help. It seems like they do help many people struggling with eating disorders. I’m just curious, what would your guidance be around that to help reduce harm?

Dr. Greenblatt: Well a number of things. There are a couple genes that we know that increase risk. So genetic testing is part of our functional medicine workup. Remember we talked about all those biomarkers? Of looking at genetic tests, there a couple biomarkers that say, you know, possible side effects with SSRIs. So that genetic test would be helpful. And then also everything I’ve been screaming about, making sure that nutritional repletion and not just calories, that micronutrients are part of the treatment plan, particularly if you’re utilizing antidepressants.

Ashley: So really making sure a client is at an appropriate level in their nutrition intake and kind of like proper health functioning before they can be put on an SSRI.

Dr. Greenblatt: Correct. I mean, the SSRIs is a little complicated when we talk about anorexia. We have no research to demonstrate that it’s been helpful. We know, it’s not helpful for the anorexia, but it is a reflex that people get put on quickly. And for some, it can be helpful. So my model would be to not start an SSRI on an underweight patient with anorexia, to wait until they’re repleted a bit with micronutrients, do the genetic testing, and then be able to kind of personalize the medication choices based on those parameters.

Sam: Yeah.  That makes a lot of sense.  Again, this is sort of bringing me to my next question.  You know, in many treatment plans, a lot of it can be about let’s restore weight here. But you talk about there being a big difference between just restoring weight and targeting and repleting the malnourished brain. These are two different things.  So I was hoping we can talk about, first of all, how exactly does malnourishment affect the brain and why isn’t it enough to just restore weight?

Dr. Greenblatt: Yeah, which is the essence of everything that we’re talking about today. So you go to a treatment program or you’re in treatment and whether it’s an NG tube or Boost or whatever, the whole goal is caloric intake to restore a number on a scale.  And you get to that number and everyone says, “great”, the insurance companies, the parents, the patient,  and  life goes on.  But that caloric intake is not sufficient, in my experience, most of the time, to provide the nutritional deficiencies that someone might have had for many, years. If we take a 32-year-old individual, male or female, that’s been struggling with disordered eating since they were 12, they might get to this magic number of 100% ideal body weight, but they have not repleted these micronutrients. The one that is most distressing to me that has a lot of implications for mental illness is fat, right? So the essential omega-3 fatty acids. We’ve all heard about fish oil, eat your fish, how healthy it is for brain function. And that’s great. So many of our patients have avoided fat for three, four, five, or 10 years. So they’re still profoundly deficient in omega-3 fatty acids, which affect depression risk, anxiety risk, and suicide risk. So that is the goal, to make sure we restore these micronutrients, and there’s an expression we say it takes three months to change your oil. So by even taking omega-3 fatty acids, it takes three months for your brain to kind of replace those micronutrients. 

Sam: Wow. And someone might be in a treatment center for say a month and that’s really not even enough time for the brain and body to absorb those omega-3s.

Dr. Greenblatt: And then many of our treatment centers don’t provide. When I started this, I remember giving a lecture, nobody even heard about it, nobody provided it. And then a few years later, about 10 years ago, someone did talk in the audience about, “yeah, we provide omega-3s for our treatment center,” but it is the minority. So the micronutrients aren’t integrated into our care.  Many residential and inpatient programs have individuals stop their supplements when they get into treatment.

Ashley: What are some other micronutrients other than omega-3 fatty acids that might need to be restored in someone?

Dr. Greenblatt: Well, if there are almost 100 minerals and 10 vitamins, so there are hundreds of micronutrients. But the big ones for me, with disordered eating would be the micronutrient zinc the B vitamins, and omega-3s, and magnesium. Those four, I recommend everyone replete on day one for at least 60 days, and then the testing helps us fine tune that model  as to what individual that we didn’t know that they had a very deficient level of vitamin D that was interfering with their mood or their recovery.

Ashley: Have you seen the images of the brains that have gone from like, quote unquote, healthy to like the malnourished brain where the  ventricle space increases and the gray matter decreases?  And is that what you’re talking about? Give that three months and that stuff comes back with the micronutrients, your brain.  So essentially as that ventricle space increases, then there’s not the gray matter where our neurons can fire and wire together and kind of connect. And so we see a lot of rigidity, right?  So when somebody is focused on repleting their micronutrients, that’s when their brain can optimally perform and the neurons can fire and wire together.

Dr. Greenblatt: Yeah, one example I use a lot is if we think of the brain as only three pounds, right? I think 2% of our body weight, but utilizing 25%, one quarter of our, what’s called metabolic energy. I mean, the brain is such a metabolically active organ that, and for anything to happen to make neurotransmitters or to think or to feel or to act, it takes vitamin and mineral cofactors. So by being malnourished, it’s going to affect the brain before other physical symptoms. And we see this in our eating sort of patients all the time. So absolutely.

Sam: I have a couple of questions. So something that’s coming to mind for me, I remember listening to Christy Harrison, she was a keynote speaker for us at the Renfrew Conference, and she talks a lot about wellness culture and how there are so many supplements out there, and how many of them aren’t regulated.  And I’m curious what your thoughts are on navigating this wellness space where there are so many supplements available.  And again, how do we reduce risk, making sure that we are actually repleting what’s missing in a way that’s actually effective?

Dr. Greenblatt: Sure, I mean, if we think of the term Orthorexia in some of our patients, obsessed with healthy eating, they’re also obsessed with supplements and, you know, patients walk in with bags of, you know, literally a hundred supplements that they’re taking.  And you’re absolutely right, the industry is not regulated.  And there are some supplements you probably don’t want to go to local drug store and get because you don’t really know what’s in it.  But we’re talking about a life threatening illness, anorexia nervosa, an illness of malnutrition. Nutritional supplements, I believe, are essential, and so we’re not talking about mega dosing, and we’re not talking about taking 20 supplements. We’re talking about taking a few supplements that are clearly deficient and then testing to personalize what supplements that person might need. 

Sam: And so all of these deficiencies, whether it’s zinc, magnesium, omega-3s, there are actually tests that can measure it in each person?

Dr. Greenblatt: There is for almost everything but magnesium, an accurate test, because magnesium is just stored in our bones and tissues, it’s hard to test for. So there are tests. Some of it, as you mentioned, might not be covered by insurance, but many are. But absolutely, we can fine tune the path to what nutritional supplements can be helpful for that individual.

Sam: Amazing, amazing. And so when someone finally is able to get the micronutrients they need and that repletion, what can they expect as far as improvements?

Dr. Greenblatt: Well, with the patients that we’re discussing, it’s not one thing. I don’t think there’s any mental health challenge that we can just say, “do this,” whether it’s  a form of therapy or a drug or a micronutrient. But what I share with patients who initially don’t necessarily want to get better, because get better means gaining weight, I share with them the power of these micronutrients to help with what many of my patients are struggling with most, which would be digestion, anxiety, and sleep. So that’s what I target, and I explain to them how zinc is critical for your digestive system to work. You can’t make digestive enzymes without zinc.  You can’t make melatonin to help you sleep without zinc.  And so that is kind of the path that I take in terms of helping individuals with what they’re more than willing to support, their digestive system, the bloating, the sleep, the anxiety, and never discuss weight restoration as a path. I want their bodies to feel better and their brains to think a little more clearly to be able to make some right choices, and I’m quite convinced micronutrient therapy is a part of it. I haven’t thrown away my prescription pad. I still use medications and I still refer to my psychotherapist colleagues.

Sam: The education is so important. I think there are so many people who don’t know, just as an example, you know, that’s all the roles that zinc plays in our bodies and in our brains and how it impacts so many functions. And that’s not psycho-ed that I think most people get in mental health treatment.

Dr. Greenblatt: Yeah, absolutely. I mean, the first book on our little pamphlet on zinc and eating disorders was written by Carolyn Costin, who used zinc to help her eating disorder when she struggled early on, so the information has been out there for many, many years, but it’s a little too simple and expensive and just doesn’t quite fit our model of medications and treatment.

Ashley: Well, maybe we need to expand.

Sam: Exactly That’s why we have this podcast. We want to keep spreading awareness about all of these things that have been around for so long, but we need to keep trying to spread that awareness.

Ashley: So Dr. Greenblatt, can you talk a little bit more about the role of sleep? It’s definitely not uncommon for some of our clients to come in with eating disorders and report issues with their quality of sleep, so I’m just curious how sleep dysfunction, eating disorders, and the risk of suicide are all connected.

Dr. Greenblatt: Well, absolutely is the answer. They’re all connected.

Ashley: They’re all connected. Yeah. 

Dr. Greenblatt: The vast majority and the ones that aren’t struggling with sleep are usually taking sleeping medications. We can just draw that line, disordered eating and sleep. We also have significant research on disorders of sleep and suicide risk. And this is our traditional psychiatric community. The latest handbook from the American Psychiatric Association on suicide has an entire chapter with hundreds of reference, how disordered sleep increases suicide risk. And we actually understand the mechanism. I mean, some of the research are individuals that attempted suicide, completed suicide, the amount of sleep they got the month before and the night before is staggering, the lack of sleep. And we know the lack of sleep causes the body to produce all these inflammatory chemicals. And that is one path to increase suicide risk. So we understand the risk, but when we get back to that individual in the emergency room, as we make our list of risk factors, nobody’s taking, they just made a serious suicide attempt. Nobody’s taking that three generation family history. Nobody is asking about sleep. And that is one of the most significant predictors. If that individual, whether 14 or 24, had not slept well for the last 30 days, and they continue not to sleep, and we send them home from the ER, they just have a much higher risk of completing suicide.

Ashley: That is so interesting for me to hear you say just. Because I feel like I don’t know, it wasn’t that long ago, kind of was 20 years ago when I was in college in high school and I always thought, oh, I can do this. I don’t, you know, I can stay up till 2 a.m. and get up at 6 a.m. and just live…

Sam: Or pull an all-nighter.

Ashley: You know, pull the amount of all-nighters I pulled, and I was always so proud of it. And so this information is kind of like rocking my world a little bit right now, how much sleep is actually restorative for us and how much we actually need it. 

Dr. Greenblatt: Yeah. And again, another one of these areas where the research has clearly caught up and it’s now common knowledge as part of wellness culture and important, just not as integrated into our kind of eating disorder treatment model, as much as it should or certainly in our suicide prevention models. 

Sam: So Dr. Greenblatt, how do you help a client who has been struggling with sleep? I know the micronutrients play a role in that. Is there anything else you can do to help support them?

Dr. Greenblatt: Yeah, I mean, for someone struggling with depression and suicide,  my motto would ‘be whatever it takes.’  So that’s where we look at micronutrients, magnesium is probably the most helpful, where people can see a difference in days or weeks.  So we replete zinc, because you need zinc to make melatonin. Magnesium is usually core. But if somebody is not sleeping, I am very comfortable using medications for these brief periods of time to regulate the sleep cycle. Sleep deprivation wreaks havoc on the body and some of us, and Ashley, and you know at some point in our lives we can recover very quickly without problems but if you’re already you know  chronic inflammation due to malnutrition or infection or something else and that sleep deprivation just prolongs and then it becomes a risk factor for  chronic illness and or suicide risk.

Sam: How quickly can we recover from sleep deprivation? I’m like thinking to myself, you know, there have been periods of time where I’ve really struggled to sleep and I’m just wondering like, how long does it take to actually get caught up?

Dr. Greenblatt: Oh, I mean, I think, I think pretty quickly. I mean, I think we can regulate sleep pretty quickly.  I think too many people, you know, just say, “I just can’t sleep. So I’m going to just, you know, that’s who I am,” but there’s so much good research now and there’s so many paths towards kind of regulating sleep. Again, it always goes back to individual needs, not everyone needs eight or nine hours, some people do better on less, but some of our high-risk individuals are really getting three or four hours of sleep for long periods of time.

Sam: Wow.

Ashley: Okay. I have a client who I’m working with and literally right before we got on this podcast, we were discussing circadian rhythm, because he is not sleeping.  And when he does go to sleep, it’s like early in the morning, right, and then will sleep till like noon or something.  Is there a connection in hunger cues and lack of sleep?  As we’re talking about this, yeah, I’m just curious. Is there a connection between, I guess, yeah, a lack of hunger cues, restriction and lack of sleep?

Dr. Greenblatt: There’s certainly a lot of connections between sleep deprivation and  eating, appetite and hunger cues. Usually we see it, I’ve seen more literature on the binge eating side versus the restrictive side.  There’s so many paths towards making what you just said, Ashley, clear to me.  Absolutely. Sleep deprivation and circadian rhythm disruptions wreak havoc on the body.

Ashley: Yeah.

Dr. Greenblatt: Let’s just go back to zinc, because zinc deficiency, no appetite is the most common symptom.  And we see it in our geriatric patients who are depressed. And we see it in our ARFID patients.  Zinc deficiency is the most common path towards not having an appetite.

Ashley: Thank you.

Sam: Wow. This is just fascinating stuff. There was something you had said in your webinar that also really surprised me. I sort of paused and I was taking notes furiously. There’s a link, you said, between cholesterol and suicide risk. Can you say more about those findings?

Dr. Greenblatt: Yeah, this is an extensive scientific literature going back 25 years.

Sam: Where have I been?

Dr. Greenblatt: Well, it’s not literature that’s going to be front page anywhere because our culture is “cholesterol is evil  and we have to lower it.” Right?   That’s the commercials. That’s our entire medical culture. This is, what you’re referring to as something called very low cholesterol. And it’s actually not a significant problem in our patients with anorexia nervosa. Our patients with anorexia or eating disorders usually have normal or high cholesterol. So it’s not a concern there, but it is if we just broaden our discussion to suicide risk, particularly in young adults, it is just a profound biomarker that increases suicide risk. And if you know anything about cholesterol, which we all look at these numbers, 170, 180, and then people panic if it gets over 200. These are individuals that have total cholesterol, oftentimes under 100.

Ashley: Oh, wow.

Dr. Greenblatt: It’s typically anywhere from total of 80 to 120. We don’t understand the cause, but we’re talking about a test that costs pennies. But with significant scientific literature saying that individual, if you find somebody with a cholesterol, usually the literature is under 130, they have a staggering increased risk of suicide. And we’ve actually had post-mortem studies looked at the brains of those that completed suicide. Much lower cholesterol than, you know, age-matched individuals that died for other causes.  And, you know, our psych hospitals don’t test for lipid panels or cholesterol.  And when our psychiatrists see these numbers, they just don’t know what to do with them. And our culture is the lower cholesterol, the better.  Extensive scientific literature, 25 years, hundreds of references that, again, think of that kid in the emergency room. Hasn’t slept in a week. Had a family history of suicide. And then we find a cholesterol of 100. That is someone that should be watched very closely.

Sam: Right, but these are risk factors that aren’t even getting caught.

Dr. Greenblatt: They’re not discussed, they’re not looked at. 

Sam: Well, hopefully that will change. How do we, I mean, how would you address someone  with that low cholesterol? How do you help someone?  Is there a way?

Dr. Greenblatt: Well, awareness is an important part.  These individuals also are at high risk for addiction and other major psychiatric illness. But if we get that individual with that cholesterol of 100, then we share with the treatment team that there’s high risk, parents, and sometimes it’s dietary related, often it’s genetic, so we really can’t. We do encourage cholesterol, meaning eggs. We encourage digestive enzymes to help them break down fat in their food. And there’s also cholesterol supplements. There are supplements for individuals  who have this very low cholesterol that often can be helpful.

Ashley: I didn’t know that.

Sam: This is amazing. I did not know any of this.  Wow. OK. Ooh, we’re learning a lot.

Ashley: Dr. Greenblatt, you have written  a few books,  and I’d like to highlight  a few of those right now.  So you wrote the book, Answers to Anorexia. It’s available and goes through a lot of the material we’ve discussed today.  And you’ve written a book, Finally Focused, which is a book on holistic treatment and approach for ADHD, which is also available.  And you are working on a book, Finally Happy, which I think is going to be published coming out in 2026.  And I’m curious if you could tell us more about this book and what inspired you to write it and how do you hope it helps us?

Dr. Greenblatt: Sure. Well, I mean, all the books are really, as we’ve been talking, a functional medicine approach to mental health challenges. And we call it functional psychiatry. And there’s so many books. You know, I was kind of done with books. I thought I was with answers to anorexia, which is the most important, because these are  as we talked about, these kids are dying and our treatment model [inaudible]. So I thought I was done there, but all these books were coming out on treating depression and they were just like, “eat your avocados and eat a whole food diet, eat a Mediterranean diet.” And I said, well, absolutely, a good diet and good lifestyle is helpful. But in the world of being a psychiatrist treating those with mental illness, it’s just not sufficient.  And I got really frustrated, and I just needed to put on paper what we’re talking about is yes, everyone should eat their healthy food and we know what that is. But if you don’t check for B12 deficiency or vitamin D deficiency or zinc deficiency or see if someone has celiac disease, mean, the list is long, that person struggling with depression is not going to get better with avocados and, you know, wheat toast. So it was just an attempt to help people see that everyone’s different. If we look at this testing, if your doctors can do a deeper dive,  then the healthy diet and healthy lifestyle and that yoga class is going to keep one feeling great.  But I’ve just seen too many people that have spent a fortune trying every lifestyle intervention and we do a simple blood test and depression can change.

Ashley: That’s so helpful for me to hear just, you know, as a therapeutic provider, why am I not then referring out, you know, not referring out, but just like referring to go get a blood test. Let’s see where these are and if you can, you know, elevate them if you need, you know, that’s incredible.

Sam: Dr. Greenblatt, you’re the founder and medical director of Psychiatry Redefined, which is a leading continuing education platform. It offers trainings, fellowships, courses, all in functional and integrative medical health care. Who can sign up? Where can we learn more about this platform?

Dr. Greenblatt: Yes, Psychiatry Redefined is primarily for clinicians.  Most of the content is for prescribers, nurse practitioners, and physicians. And we have a few programs for therapists, but it just helps individuals understand functional psychiatry. So they’re are short courses, and then there’s a year-long fellowship.  And I just launched a consumer version, so it’s called Mind Refined.  And there are only two courses up, and one is anorexia. So one is a course for parents where I go through all these micronutrients  and the other course up for consumers is ADHD.  So that’s Mind Refined, it’s for consumers, patients. It’s written similar to the books for individuals to kind of just appreciate there’s another path. But the Psychiatry Defined  is the training that we just didn’t get in our education. There’s no medical education and medical school, there’s no nutrition education, I’m sorry. And our training programs, whether it’s psychologists, nurse practitioners, we just miss this part of what I think is critical for treating patients.

Sam: It is critical. And I just want to thank you for sharing all this with us today. It’s been such a learning experience.

Dr. Greenblatt: No, my pleasure. It’s great to be with you and I really appreciate the well thought out questions and interest in the topic.

Ashley: Yes, thank you so much Dr. Greenblatt and thank you to all of our listeners who have been with us today. We appreciate it and we will see you next time.

Thank you for listening with us today on All Bodies, All Foods, presented by the Renfrew Center for Eating Disorders. 

Sam: We’re looking forward to you joining us next time as we continue these conversations.

Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by the Renfrew Center for Eating Disorders.

Sam: We’re looking forward to you joining us next time as we continue these conversations.

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