IBS, Anxiety & Depression: The Link Between Hormone Imbalance and Gut Microbiome

In this episode of Hormones & Hope, Dr. Chhaya Makhija sits down with Dr. Melissa Mondala, Family & Integrative Medicine Specialist, for a powerful conversation about the connection between lifestyle, gut health, and emotional well-being.

Drawing from both personal experience and years of clinical practice, Dr. Mondala explains how the gut and brain work together, why nutrition and exercise are essential for mental health, and how sleep, stress management, and social connection can help build emotional resilience. She also shares practical tips for making healthy habits stick, overcoming setbacks, and creating routines that work in real life—not just for a few weeks, but for the long term

Whether you're supporting your own mental health or helping someone you love, this episode offers hope, practical guidance, and a reminder that meaningful change often starts with simple daily choices.

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Dr. Melissa Mondala, MD is a double board-certified physician in Family Medicine and Lifestyle Medicine, with advanced fellowships in training in integrative psychiatry and integrative medicine.

Dr. Mondala is the President and co-founder of Dr. Lifestyle Clinic in Newport Beach — the first Lifestyle and Integrative Direct Primary Care and Rheumatology clinic The clinic has been recognized as a Public Health Site of Excellence and she is a best-selling author of Embody Lifestyle Medicine and well sought out speaker.

Disclaimer: This podcast is for educational, informational, and entertainment purposes only. It’s not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personalized guidance.

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Transcript

SPEAKER_00 0:00

Number one, seeking help for anxiety or depression is a sign of strength, not weakness. Is it a myth or a fact?

SPEAKER_01 0:07

So it's a sign of strength and it's totally a fact because this is where we have self-awareness, and that's number one.

SPEAKER_00 0:14

True or false, not everyone with anxiety or depression requires medication.

SPEAKER_01 0:20

True. We can use lifestyle. Actually, 50% of people can improve their moderate or severe depression anxiety with lifestyle.

SPEAKER_00 0:29

Number three, uh, is this a myth or a fact? Sleep is one of the most powerful mental health interventions we have. Very, very important. True. Number four, chronic stress can affect both physical and mental health.

SPEAKER_01 0:45

Very important people often underrecognize this. We need to start with stress management. True.

SPEAKER_00 0:51

Number five, is this a matter of fact? Family relationships and social connections significantly influence our emotional well-being. Welcome to Hormones and Hope, a podcast where we bridge science and wellness to help transform your health. I'm your host, Dr. Chaya Makija, or you can call me Dr. Chaya, a triple board certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care. Each week we dive into the powerful intersection of clinical medicine and real-life lifestyle strategies to help you feel stronger, live longer, and show up as your most vibrant self inside and out. So let's get empowered. So who's here worried about anxiety or a flight and fight response or just the stresses which cause you to have no motivation or feel like life is just a big burden? I'm here today with Dr. Mandala, who's going to change your perspective completely. She has amazing professional accolades. I had to figure out where she's at in her stage of expertise, just because I've known her for a long time. But with her upgrades and her specializations, I had to make sure that we have her on our platform. So Dr. Melissa Mundala is a double boat certified physician in both family medicine and lifestyle medicine. And that's how I got to know about her, was somewhere around, I think, 2021, when she was at one of the lifestyle medicine conferences in Palm Springs, California. The other way I know her is her amazing practice. So she's the first direct care specialist who's founded a direct care practice in Orange County, resides in Newport Beach, and she's a co-founder. And if you've tuned into our previous episodes with Dr. Micay, who's an integrative rheumatologist, and he gave us amazing perks about lifestyle, about supplements, about how to use functional labs versus how to use your specialty in terms of evidence-based science. So welcome, Dr. Mandala. I am uh thrilled to have you here on our podcast, Hormones and Hope. But before we jump in into the nuances today, I really wanted you to share about your expertise, your passion, your multiple hats, like fellowship in integrative psychiatry and integrative medicine, in lifestyle medicine, and what's been the journey like for so many years as a specialist physician.

SPEAKER_01 3:24

Thank you so much, Dr. Shy. It's so great to see you again. I know we met in person and it was just so nice because we know that we are passionate about all things lifestyle medicine, food is medicine, and that's the foundation. And really, that's what my first interest was. You know, I love nutrition. I I really validated it because I myself had irritable bowel syndrome at a very young age. I had reflux acne in my early teens and elementary years, where my my own parents did not know what to do with me. They didn't really believe me. They're like, why are you always crawling on the floor? You're in pain. You can't eat my food. You can't eat the food I cook you. It's like so they think it's healthy, it's so full of flavor, but they're spicy, oily. Even the the meaty foods were giving me so much bloating, so much loose stools. I didn't know what to do. And so I thought food would cure it. So when I went in my teens in my high school, I was a cheerleader. I was very active, competing with all the football, basketball players on food. Like, okay, I'm gonna eat more food, I'm gonna eat all the junk food, the hot dogs, the pizzas, eat it all, and maybe that will make me feel good and give me the confidence. But actually, it was a downward spike. It really made me feel worse. My acne got worse. I felt like you know, I had this big ball in my stomach, I was uncomfortable, and I didn't know why I was feeling like that. And of course, as a teen, you know, it uh it affects your you know your mood, your energy, you don't have as much confidence and anxiety kicks in. And I didn't know at that at the time, you know, you and uh and as a woman, sometimes we don't really know what's happening in our hormones either. You know, you have puberty, then you have the PMS, the and you just don't realize, wow, this food is causing me to have all these mood swings. So, you know, when I went in my college and my medical career, I still had all these symptoms. I still kept eating worse and worse. I didn't think exercise was helping me. I didn't really, you know, I was active, but I didn't know what the value of exercise was. And so I was a psychology major because I love mental health. I love the studying behavior, why we do things. I studied the doctor-patient relationship, and then I pursued family medicine. And, you know, family medicine's awesome because of course you see all ages, you see how the body works, how everything's connected. And it was still to me incomplete because I really want to know why people had the anxiety, depression. And 50% of people who come to primary care offices already have depression, anxiety, and they're underscreened and under treated. And so I pursued lifestyle medicine first. And we all know that food is medicine, exercise, sleep, stress management, reducing toxins. This is what I needed because medicine was to me a dead end. It's almost like a revolving door. You don't really find the root cause, or yes, the medications can serve as an option, but there's so much depth of, you know, the iceberg that people can do. And with me, I realized when I started to change my eating patterns to more plant-based eating, I started to run, which I hated, but I began to love it. Um really improved my mood, took away my acne, reset my microbiome, and I didn't have to suffer anymore. And so when I saw that difference in my lifestyle, I brought my husband on board, as we all know. He reversed his gout, pseudo-gout, and angualizing spondilitis. But I I started in with every single patient from the primary care setting to the urgent care setting to the lifestyle setting where I at Loma Linda I was core faculty for lifestyle medicine fellowship. And then I also trained residents there. And I was the assistant director of the inpatient side. So on the inpatient side, we saw P and R patients who just suffered from stroke heart attacks. You know, they were in a place of life or death situation, and then also going into the right when people came out of the ICU from DKA. As we know, Dr. Shaya sees those patients. And so they have an opportunity to really change their life. So whatever setting they were in, we have such a powerful opportunity, wherever journey we are on, to have that question, why and what can I do? And so that's what I love doing in my clinic. And so I've incorporated lifestyle medicine, integrative mental health, integrative psychiatry specifically, integrative medicine and my primary care, all of that in one. And I really love serving all ages, all of all sorts. And of course, the autoimmunity comes in just because it's so interplayed with the gut-brain immune connection.

SPEAKER_00 8:12

So well said. And um, I love the story. So it reminds me last week I was in the Bay Office for the entire week and we had a few talks. And I had, I would say, at least four or five young females who were in Silicon Valley working hard, all in their just uh early 30s or late 20s. And five of them actually asked me about IBS. They quoted as IBD. I was like, no, that's not IBD, that's probably IBS, like inflammatory bowel disease versus irritable bowel syndrome. So I have their emails. I asked them to follow us on uh the podcast because around the same time you said yes to be a guest on our podcast. So definitely IBS is so common in girls and women. This specific span, I would say, especially during that uh early phase of life, like you mentioned, till I, you know, the more common incidences or until age 60, and then something changes if you've uh implemented it. I would also want to know as we get into the deep dive, Dr. Mondala, that you said you implemented these changes, but also, you know, what makes it sustainable, and it's not 24-hour changes and suddenly the gut microbiome will change, but how you've implemented those and how you can share those implement strategies in our deep dive. So there's gonna be a lot of wealth that you're gonna learn today or get gain from you. Definitely excited. Okay. Can you tell us more about your book? Because I think that's a a great way for someone to learn in depth before we get into the QA's.

SPEAKER_01 9:47

Thank you so much. Yes, I'm an author of Embody Lifestyle Medicine, and embodiment is really if you look at the definition, is to be transformed, to be really it's when you're aligned, where where you're you have a new sense of purpose, hope. And that happened to me, and that's why I chose the title. And I see that in my patients and in my community, where everything just becomes part of you. You know, it's no longer like a conscious decision. It's just what you do because you believe in it. You know it's part of you, you practice it. And so this book focuses on not just how providers can start a direct lifestyle practice, you know, the ins and outs, the business side. But my patients read it too. They love to hear these stories and get inspiration of how I've helped patients and how they can carry out these healthy lifestyle changes. First, of course, knowing the science is the first step. And the that implementation, as we talked about, how do we actually change behaviors? How do we keep it sustainable? And how do we uh keep it in our family, right? Because we had to change our family values, practices, the shopping experience, the even the going to eating out. What does that look like? So from beginning to end, knowing how to be equipped and how it really is an intersection of all that we do and it can be done in a very positive, comfortable way. Yes, it may be adventure, but how to roll with resistance and how to be present with that because it is a lifelong journey, and that's the beautiful thing because our health requires that attention. It is really needs that that care as if it was our, you know, our baby, because we can't have it at the end of our checklist. It needs to be first place. So just re it's a mindset book, that's what I like to call it, on top of a how-to book. I'm really glad, thankful. Um, it's best-selling. You can find it on Amazon, so you can check it out. A lot of people have loved it, and you can share it with your friends and family. Thank you. Absolutely.

SPEAKER_00 11:55

So embody lifestyle medicine. Very lovely. So, Dr. Mandala, we're gonna start with rapid fire questions. We have a few for you, one-liner or just maybe a sentence, and then uh we get to learn more from you. You ready? Yes, awesome. Okay. Number one seeking help for anxiety or depression is a sign of strength, not weakness. Is it a myth or a fact?

SPEAKER_01 12:18

So it's a sign of strength and it's totally a fact because this is where we have self-awareness, and that's number one.

SPEAKER_00 12:26

Thank you. True or false, not everyone with anxiety or depression requires medication. True.

SPEAKER_01 12:33

We can use lifestyle. Actually, 50% of people can improve their moderate or severe depression anxiety with lifestyle.

SPEAKER_00 12:42

50% people, number three, is this a myth or a fact? Sleep is one of the most powerful mental health interventions we have. Very, very important. True. Thank you. Number four, chronic stress can affect both physical and mental health. Very important people often uh underrecognize this. We need to start with stress management. True. Number five, is this a matter of fact? Family relationships and social connections significantly influence our emotional well-being.

SPEAKER_01 13:14

100%. Most psychiatrists and psychologists sometimes don't talk about emotions, but that's where we have a lot of things to unravel.

SPEAKER_00 13:22

Mm-hmm. And I feel like every clinician should be capable to have those discussions. Thank you. Number six, true or false, lifestyle intervention such as exercise, nutrition, mindfulness, have evidence supporting a great role in mental health.

SPEAKER_01 13:38

Yeah, that's the number one well-studied uh factor for mental health is exercise. So true.

SPEAKER_00 13:44

And uh just one sentence based on your expertise. What is one overlooked habit that contributes to emotional resilience? You're not gonna like this, but it's alcohol use.

SPEAKER_01 14:00

Yes. So most people think that alcohol is sedating and it calms their nervous system because there's a GABA release, but there is an anxiety rebound that happens and early awakenings at two or three in the morning. So overall it makes their anxiety worse and it becomes a bad habit. So I definitely discourage people with anxiety to have any alcohol use.

SPEAKER_00 14:23

Yes. All right, 100% on it. Thank you. So, Dr. Mandala, now we get into learning more about you and you know your expertise for uh anxiety and depression specifically, and just our mental health, you know, well-being. So before we dive into, you've explained at the background, you gave us uh, you know, your uh holistic approach with all the evidence-based facts, as well as that human touch, the clinician touch, the art of medicine. If you can just break down, you know, for our audience the number of years and the the hard work in terms of you know your education before we get into the clinical realm of it. So medical school, your residency, lifestyle medicine, family psychiatry, integrative psychiatry, integrative medicine. What's been the journey of the education? Because we really trust that clinical expertise, and I would love the audience to know about the journey too.

SPEAKER_01 15:19

Thank you so much. Yes, it's no easy task. Obviously, you know, already getting into medical school is um a high standard, and you there takes a certain academic rigor and sacrifice, and to be up to date with the science and research is really an extra step. And to take these extra fellowships um is a big feat. And so there's four year four years in medical school, three years of family medicine, and then I did one year of uh lifestyle medicine fellowship at Loma Linda, where you know, I get a study with the blue zoners and see it the full scope of lifestyle medicine from tobacco cessation programs to diabetes um programs to even seeing reversal in two weeks, um, one week. So many factors. And so that was a deep immersion experience, which I really appreciate. And then I did actually do um uh UCI, um primary care psychiatry, that was another year, and then integrated medicine at two years. So and then I also um did uh health and wellness coaching another year. I I I sometimes you just leave lose track because I love to learn because I think it's so valuable to be in the evolution, uh, because medicine is already outdated, to be honest. You know, by the time we practice, the medicines are there, but the the extra intersections, as I talked about earlier, is ever so growing. And what patients are asking and needing is really where we need to be. And so if you think about it, four years, oh, let's see, three years, I think I counted like 11 or 12 years. Like, you know, this is fun, like a fun exercise, you know, four or three, then eight, then ten, at least twelve. So, and I always say ever growing because I'm always getting more, and more is, you know, good. Like I love to learn more about, you know, I already do hormones in women's health, but there's just so much that we can learn. And we it's important to uh stay above it because you know, pharmaceutical companies will be there to uh release all the medication updates on ads, right? And then if if the clinicians don't know, then that's where the gap is. And so, and then health technology, right? Uh and AI and all these supplements that you see at the health store, there's hundreds out there, but we need to know the evidence behind it. So that's why I go and um dive deeper. And so it's a lot of fun.

SPEAKER_00 17:57

Thank you. Yes, that's that's been a long journey, but a never-ending journey. So thanks for teaching our uh community, patients, and of course, today our audience. So I wanted to start with, you know, breaking it down, especially uh the mental health anxiety and depression, but also tie in with your story that you shared about IBS and how it kicked in the anxiety and how foods or different types of lifestyle interventions, including the mindset, has helped you. And I'm pretty sure several of your patients, and I've seen that personally in our patient population too. But if you can break down for us, so say there is this young adult, and for me, young adult is anyone less than 60, by the way. So anyone who is uh an adult, 18-year-old, uh, to that age, uh mid-adult phase, and they're unable to decide or figure out that, you know, I feel overwhelmed or anxious, or it's the work, or it's the job, or it's family, the way to deal with daily stressors of life, right? Are there certain evidence-based techniques or uh strategies in terms of first the person identifying that, you know, I'm dealing with this, and then when do they figure out or how do you explain them about seeking professional expertise? And then the third step would be how are you implementing certain lifestyle interventions in your patients once you understand or gather all the information of where is this anxiety or overwhelm sense or the sense of burnout coming. So, first is just in general, if someone's listening to you today, how do they identify that is this something just me, my personality, my behavior, versus I need to seek professional help?

SPEAKER_01 19:40

Great question. I love the the depth of this question because uh the first thing is just being aware, which I talked about in the beginning, is if one if you're not being so motivated, if this is depression site, you're lacking motivation, you're either sleeping in too much to have teenagers who wouldn't sleep until 12, 1 or 3, they lack motivation, and that's atypical depression sometimes. And then there's who cannot sleep at all and they're sleeping three or four hours, and then there's those who are in a point where they just feel hopeless. They feel like there's a dark cloud all the time. They can't get feel the sense of hope, no positivity. And they're even a place where they're not eating. Some team people just have the lack of appetite, or they're overeating, right? That they're just cramming down their emotions, and that's how they negatively cope with their their worlds or their work or their social life, and they're just under or overeating, and to the point where it uh impacts their function, right? They're not able to go socialize. They're that's one of the first quiet steps. They maybe they're like, well, it's maybe my person their personality, or maybe they're just tired. And but really they start to socially withdraw, they're feeling burnout emotionally, not just physically, and they're not attending their favorite things, they're not even going out to eat with their friends, and it becomes a pattern, and it can happen drastically, you know, in the pattern of two weeks, because they either have grief or because they lost a loved one that started to just evolve, or they have work transition, life transition. And of course, but this can last for weeks, months, and years under treated, because I like to say people are really good at masking it. It's because of the neuroinflammation. Sometimes we have inflammation in our brain, but we also have inflammation in our gut. So some with IBS, they're gonna start feeling the emotional distress, you know, the butterflies in the stomach, they might feel a little sweaty, they might feel some palpitations and having the loose tools that evolve. But usually if there's a fight or fight situation, it's happening in an unpredictable manner and it's uncontrollable. They have anxious thoughts, they're catastrophizing, they think one small Is going to be the end of the world, or they overgeneralize it where this small thing is in every part of their life and they feel paralyzed. So that's the it's the flight, fight, or freeze aspect. Um and so it's very easy for one to feel lost and spiral. And anxiety and depression go usually go hand in hand. That's what they say. Sometimes they call it where when anxiety is uncontrolled, it goes into depression. And then sometimes when people have PTSD or some type of trauma, it looks like depression. They might not have PTSD itself. Other times, people with ADHD, they what it may look like is anxiety at times, but they didn't have the ADHD treated, or vice versa. So it can, there's a lot of overlap that can happen. So being at really a great having assessments by a professional, um, a mental health professional who can start the screening process. Sometimes it can take, you know, 10 minutes, half an hour, but then there's also long testing that can happen. But I think the fact that you can talk to a provider first, if you're losing focus, you're lacking energy, you are having physical symptoms along with mental health symptoms. Because remember, there's a lot of gray zone that can happen and you don't want to wait till it's too late for patients who have suicide ideations. So they don't want to live or be alive. And it's not like they want to cut themselves or harm themselves. It can be very quiet. It can just be like, I don't want to exist or life's too hard. Just I want to disappear. And so you want to be, you want to really lean into those thoughts. And if you journal about it and you see that these patterns aren't going away, you want to get help. And how can you cope, right? So, what are the things you can do? Nutrition is key. I know when I had my earbowel syndrome, you know, sometimes people have that the physical conditions that they just don't want to be alive. Sometimes they just don't even want to they avoid everything because of their physical symptoms. So you want to determine do we want to treat the physical or the emotional side or the mental health side. So there's a lot of complexities, but the beauty about nutrition is that it treats head to toe, right? The brain is not separate from the body. And the neurotransmitters in the gut is actually high, meaning it's 90% of our serotonin is there, 40 to 60% of our dopamine is there, a lot of our immune system is there. So we need to regulate all that's happening and the stress that we're um faced every single day. So I got got rid of all my junk food, right? The chips, the popcorn, these the spicy foods, the f the oily animal products, fried foods. I was on hooked on hot dogs, like I will no joke, and pizza. Um so I had to change and have whole foods. Like I wow, I I didn't salad is so good. I didn't even realize, you know, fresh and like beans and lentils, like introducing new ingredients was really nice. And of and then I I made it in a way that was uh close to my upbringing, which I'm Filipina, and so I just made it more plant-based or veganized it in a way. And so that was the first step of my healing. And I had to go all in, to be honest, because if you dance around, you're not gonna feel relief. And so, of course, you you can once you start feeling like you your microbiome can change within two weeks to one month. So it's not like forever for you to feel a difference, but if you um at least try, I say 30 days, even 90 days, being consistent, that can be a world of difference. And then incorporating movement, especially with IBS, mental health, 50% of exercise helps with mental health, but also it's equivalent to an antidepressant or anti-anxiety medication. So imagine Prozac, amitriptyline, any of those medications has been really well studied. And when we think about it's about 30 days also for mental health conditions to improve. So it's so powerful. And when you think about the science, I say number needed to treat is only two as well. So when you start doing the nutritional interventions, it's so powerful. And if for exercise, it's dose-dependent, meaning the more you walk, the more you pick your favorite, spin, rowing, weight training, whatever it is, it's gonna just be exponential. And imagine exercise or medications has a cap, right? This is only gonna work for so long for and they say up to only one year, where medications actually have the pharmaceutical therapeutic impact. After one year, it becomes it plateaus, and then a patient as eventually patients become depressed. We call it treatment resistance anxiety or depression. So lifestyle is the huge piece and the missing link. I really believe in really recovery and getting into remission. And so for me, it helped me fight my anxiety and depression. Because I in med school, I remember just feeling so overwhelmed. Not I'm like, am I going through a panic attack? What is this? I can't focus this like this ADHD, what is this? Um, but you know, when I'm able to eat healthy, when I'm able to exercise, 150 minutes is the sports American College of Sports Medicine recommendation. But even 10 minutes or 30 minutes a day, like I said, is very important to keep that in. And when we think about stress reduction, that's really, really key. Because as anyone in America or in any culture, when we're trying to do things, you know, we want to do things well, we have this sense of urgency. And it's this ticking time bomb in our mind and our body, and we're running, running, running rather than being present and slowing down the processes. So our nervous system feels like it's always on, and the parasympathetic, which is our vagus nerve, can't ever fire up and actually turn off these sympathetics. So we need to have breaks, give ourselves permission to take breaks if it's either the breathing techniques, taking a walk, or just mentally saying, you know, giving yourself compassion, saying it's okay to unwind. You don't have to go through your checklists, you don't have to please other people, you don't have to really burn on both ends. There's always tomorrow because your health is worth it and your mental well-being, then you'll build the mental resilience that everyone's talking about. Like people are like, well, you just have to exercise that. Well, you know what? First, you have to learn to rest first before you deal with stress, um, because people are always overflowing their plate. So stress resilience is not really to me as important as understanding what rest and recovery means.

SPEAKER_00 28:35

Absolutely. I could just come and give you a hug right now. So I'm sending you a virtual hug for that. Absolutely beautiful. And I've had this as a personal experience with so many of the patients. Now, here is the challenge that I see clinically is you know, someone who's ready, who's identifying, who's become aware, they end up implementing these steps like just you were suggesting, and they'll find that environment. There is this self-inspiration, or call it as motivation. There is a whole subset of population which will be like, you know, I tried it for a week or so and then I fall back. Or they'll do amazingly well for a year and life happens. There is some form of a stressor, which is a big one, they lose that one to two months, and now they feel like everything is back to square one. So in those scenarios, right, so that's where the behavioral modification. How would you advise someone in terms of sustainability? They've seen the results, but it's just the life aspect of it. You know, in our practice, we call it call it as life is life. And that's where the fall back occurs, or that's where the sense of guilt occurs, but it's just about picking up from where you were at and rather than, you know, uh adding to the sense of guilt. So, in terms of sustainability, right? So now comes the social connection or the purpose, the why that you were mentioning. How do you have that as a conversation? If someone's implementing uh the nutritional changes, the exercise, you know, trying and making sure that the physician has assessed them, they're getting all their evaluation done, fixing those conditions or specific discrepancies, be it in, say, thyroid or someone with PCOS or perimenopause, menopause, they're getting that addressed with their clinician. But how do you approach the sustainability or the behavioral modifications or the mindset change that you were talking about early on?

SPEAKER_01 30:23

Absolutely. And I love how you said life is life because it's very, very true, right? It's unpredictable. There's changes in the environment, changes in economy, um, people have a new job, get laid off. So we call this relapse prevention and really finding a way to be equipped and have tools. And stacking can help is like really knowing what are the habits that they had before and what was working well. So we kind of it's good to look at the past and say, what two habits were you doing together that just really was part of your day-to-day or week to week? And can you go back to that routine or schedule? What was the disconnect? Is it because there was, you know, maybe now you have a new dog? Or maybe because there's a a time change literally and you've you that like threw off your whole schedule? Or maybe the fact that you're you started to have um chocolate in the middle of the night because you you were eating um in front of their new soap opera that you that was introduced to you by a friend. Um, so like really going in the weeds of what happened before the relapse and seeing, you know, was it the mind setting or was it really unconscious? Because 90% of our brain is unconscious. Our behaviors, our world, our environment is 90%. So you bringing it to an awareness is gonna be so important. Say, you know, let's go back in time. Um, figure out what may have slipped away, what new thoughts have you had that maybe interrupted and maybe your your confidence or your focus on your health journey. And so that is like a really nice mental exercise to do with people, or even when you journal at home. And then you can identify, okay, yeah, it's not that hard. I just have to go back and make a new intervention there and add restack a new habit. And if you can't change the past, you can't get back to that old routine, then just starting a new routine, either adding on to what you have or being like some people because of their personality or stress, they just say, I need a new start. Let's start over. So it's always asking yourself, being honest with yourself, because a lot of people trick themselves and say, you know, I will wake up at instead of 6 a.m. I will wake up, you know, at 4 a.m. Like who's gonna do that? Um, so but uh keeping it very, very real and honest and then consistently reevaluate. So I love like sometimes I call it lifestyle trackers where you like every day they're writing their, you know, their goals, their habits, and using it for a week or two weeks or using a special app. And that kind of keeps people more conscious. And then of course, having an accountability partner if it's your best friend or your partner to say, let's do this together, or just having them agree with you, right? Because sometimes they're the ones like you might get so mad, you're like, You're sabotage me. And you're not trying to they're not trying to always sabotage you, and you're not trying to sabotage yourself, but just knowing sometimes that negativity can kick up. And we have to know why. And is it the anxiety around it? What is what is the barrier there? So there's a mental emotional barrier that can happen because some people want to be perfect, or because they're traveling and and it's okay to start over because our body will bounce back. And you just do the same thing you did before and it will heal and the numbers will look better.

SPEAKER_00 33:50

Yes, simple, absolutely. The real and honest uh way of adjusting the discipline or the schedule. Sweet. Now, with your background, Dr. Mandala, especially with integrative medicine, you have your lifestyle pillars, and that's like a work in work in progress, basically. Can you give us some tips, some advice, some evidence-based suggestions or recommendations for herbs and supplements? So, what is the difference between an herb and a supplement? And in the realm of mental health or dealing with anxiety depression, any herbs, maybe top three, top five that you would recommend and any supplements that are evidence-based and uh could be potentially considered after discussing with your clinician.

SPEAKER_01 34:34

Great, thank you. And before I start with that, because I always like to go for its food. So for depression anxiety, I always love zinc and magnesium foods. So zinc-rich foods, so that's pumpkin seeds, that's gonna be even sesame seeds and and even um tomatoes, and like and when I think about magnesium-rich foods, you know, that's very, you know, calming, right? So that's gonna be your greens, any leafy green. Um, I like tryptophan and tyrosine-based foods because they are the building blocks for dopamine and neuroepinephrine, so that's gonna be even tofu, um, edamame, but I love cheese seeds, fox seeds, SMEC. So seeds are like so foundational when it comes to mental health. And then when we think about the difference between like nutraceuticals, herbs, supplements, you know, and even there's like powders out there, there's tinctures, there's liquids, so many different things. We we always want to look at, you know, at the labels. We want to, you know, make sure there's no artificial fillers in there and looking for NSF, certain labels to know that it's certified CMP, all these things that really help. And my favorite one for I would say depression is, you know, there's 5 HTP, which is really good, just like the foundation for serotonin rehab inhibitors or what we call SSRIs, uh, the medications, but we also want to make sure you're you have to do this in under supervision because you don't want serotonin syndrome where you feel like you're overdoing your serotonin and you get in the flu. So I wouldn't advise people just to take this on their own. And then SAME is um also uh another one. Magnesium and zinc, there's studies that show people are with depression that ha have severe magnesium and zinc deficiency. That's why I mentioned that. So if you're not getting enough, you can take magnesium bisglycinate or magnesium thironate or then zinc. There's two forms of zinc, just the zinc, any zinc form will help. But um, you know, I think finding the ones over the counter should be okay. And then remember that when it comes to anxiety, there's GABA. So people don't know about this neurotransmitter because there's not many medications for it. People sometimes just give GABA pentin for anxiety or insomnia or even um ADHD. But it's really, I don't like giving GABA pentin because it can be very sedating and it can have increased risk for dementia. So I like just GABA supplement, GABA LD, or even lemon balm is really nice. And when we think about some people can do Valen Root if you take it at night. So that's okay too. There's definitely a bunch, a host of different ones, but I like to say you want to do it with um professional guidance because a lot of times people get like the combination. It'll say the anxiety supplement. And I don't like it when it just says the anxiety sleep, but it has like five or ten ingredients because you don't know what one will react to. I really go slow and gradual and pick one ingredient at a time. And so that's what I really describe the difference between a supplement versus like a nutraceutical um and an herb is very specialized too as well, because these are um medicinal at very small doses. And so, you know, I grow the lay and route out here in chamomile and like you can have the tea form. Like the tea form is so nice as well. So just finding what your preference is and what you can do, and if especially if you're mild or moderate, you can use supplements and lifestyle so well. And so that's the beauty of it.

SPEAKER_00 38:03

How impressive. Yeah. You know the lifestyle pillars that you're sharing, and you know, when you talked about seeds, sorry, just raises my uh endorphins when I hear from other special teams too. Because, you know, we we are living in the world where, you know, especially metabolic health or everyone starts talking about longevity, but it's all about preventing chronic diseases or you know, your risk of uh chronic diseases and complications. And in my realm, it's you know, endocrinology. So it's all those diabetes, hypertension, high cholesterol, obesity, you know, the world of GLP1 become it's become just more out there, like in terms of awareness. For us, it's been there for 20 years, but the honing, like just re-emphasizing the foundations of lifestyle, has become even more important because we are surrounded with a lot of scientific innovations, we are surrounded by a lot of FDE approvals and more options in terms of pharmaceuticals. And I feel like we have to just re-emphasize even more now that how much that lifestyle foundation becomes important, no matter if you're on supplements, no matter if you're on prescriptions coming from your clinician, but this is such foundational. All the foods that you mentioned literally work for gut health, literally work for prevention of chronic diseases, literally work to treat constipation, literally are uh the ingredients that we talk to patients if they're on GLP1 receptor Agnes for a specific medical indication. So I loved all of those in terms of uh emphasizing about you know anxiety, depression, or uh just our mental well-being. This was gold. Thank you.

SPEAKER_01 39:38

Yeah, so much fun. I think there's so much to talk about, and I thank you for these questions.

SPEAKER_00 39:43

No, absolutely. If I had to ask you, like for any individual in terms of prescribing three specific daily habits to start. They're unsure where to start, not aware, but they just they're just ready to start something uh in in terms of implementation, not medications. And these daily habits could be individual or could be incorporated as a family, as a unit. What would those be to improve their emotional well-being? Like just the happiness or the joy of living.

SPEAKER_01 40:14

I love that, right? This is the essence of life, right? Because sometimes we are scrolling on their phones, we are looking for the next trend, we are just wanting overstimulated, and we don't know where to begin. And really is coming back to the basics. And, you know, I do a lot of therapy in my own practice, and that inner child work is like, really, you know, what were you uh yeah, who were you as a child? What did you like? What did we know, what kind of play did you like if you have kids or no kids, but you remember yourself as a child, you know. Oh, I remember when I used to bike, or I remember, you know, I loved watermelon, and I can't believe I don't even eat watermelon as much anymore. And there came a time where I had friends where I went to birthdays or I was socializing, or I like had tea time and parties, and like, who am I now, right? And as we adults, right? And we're so inundated with work and responsibilities. And you know, I incorporate this in my practice and in my personal life is like making those times, right? This is so important to have I really think social connection is very undervalued. This is really the healing, right? That's why group therapy works. That's why when you are in, when you pick up the phone call, it makes a huge difference. And that's why texting is not the same as actually being present with somebody. So, like if it's your neighbor or your family member, go shopping together, go grocery shopping together, go take a walk somewhere on the park and have a picnic, right? Make meals together. The more you do life together, I would say is gonna be so important because sometimes we just delegate and you're like, I'm gonna do this, you do that. But and then we forget like the companionship. So, number one prescription I recommend is social connection, making an appointment with somebody that you care about and that you want to spend time with that you have delayed, that you have uh ignored. So number one, and and number two is sleep. We had we didn't talk about it enough because sleep is so important, not just to regulate our ner, you know, our hormones, our sugars, but our blood pressure, but also our nervous system. We need to really honor that because that's when we get the, you know, when we're less likely to be anxious, depressed, or lack of focus. You can easily just in a matter of 24 to 72 hours, someone can look anxious, depressed and with ADHD. So you need to get don't compromise sleep. And number three, I would say cut down the addictions, whatever it is, if it's tobacco, sugar, alcohol, if it's even cannabis, which I help people with, or vaping, or or if it's, you know, some people are addicted to a bad habit on their computers or gambling, whatever it is. I would say now's the time. You deserve it. It's not impossible when you seek support. And we've helped so many people. And I thank you, Dr. Shaya. You you help so many people, families, um, really restart their life and get their miracles. So thank you.

SPEAKER_00 43:23

Yeah, likewise. Thank you so much. I loved what you said. The more you do life together, so number one is social connection, number two is the sleep, restorative sleep, and number three is uh cutting down on addictions. And for sleep for our audience, you know, we have had two uh amazing podcast interviews by two sleep specialists, one from Pennsylvania, one from San Francisco. So you definitely can tune in after this episode by Dr. Mandala. Now, Dr. Mandala, you're based in California. If anyone uh listening today may want to seek expertise from you, or if they know about a family member and they would really want to connect to you, what's the best way to reach out to you if they wanted to get actual appointment?

SPEAKER_01 44:06

Yes, thank you so much. So our clinic is called Dr. Lysal, and you can find us at drlysal.org where I see patients in person or virtually. And I I love seeing patients actually in not only in our clinic, but um virtually too. And I have estate licenses in Colorado, Pennsylvania, Idaho, um, and I think a couple more, it's all on our website. And I have patients too that fly in and see me too. So it's just a beautiful thing. And I'm also all over social media, Dr. Melissa Mandala, and you can see me on Instagram, TikTok, um, YouTube, and I share more recipes, more tips for mental health. And it's really what we are exposed to every day. So if you want to lean in, um, you can give me a follow and subscribe and learn more about what I do.

SPEAKER_00 44:55

Yes. Thank you. So go follow her, get her book if you were really interested into a deep dive. And that was Embody Lifestyle Medicine. It's my joy, it's my pleasure to meet you in person and now interviewing you virtually. You've done amazingly well, and I feel there will be so many more hundreds and thousands of people and uh community that you're helping and reaching out to. Thank you so much and tune in again for our next episode and give us an amazing testimonial review because I'm pretty sure you are enjoying it and you've received an immense amount of wealth from just today's conversation with Dr. Mandala. Thank you. Thanks for hanging out with me on hormones and hope. If you've loved this episode, do me a favor, hit subscribe, share it with someone you care about, and drop a review if you're feeling generous. Want more tools to support your hormones and health? Head over to unified endocrine care.com. We've got free guides, resources, and more waiting for you. Until next time, stay curious, stay kind to your body, and keep your hormones happy.