Dr Ralph Ryback


Philosophy: Without health we have little. - from my blog “The Truisms Of Wellness” in Psychology Today.

Each of us in our own microscopic way, reflects our blending and almost merger with our environment in the development of our modern species which is thought to have trudged out of the plains of Africa 50,000 years ago. Their biological and psychological selves experienced many environmental changes including agricultural, industrial, digital, climate, artificial intelligence, etc. Each continues to cause psychological and physical stress expressed in us biochemically.

The delicate balance between stress and our biochemistry is reflected in a constant struggle to maintain a balance between oxidative damage from the formation of free radicals including a subset called reactive oxygen species(ROS) which contain oxygen. Free radicals including ROS are produced by the our normal biological and metabolic processes as well as by exposure to pollutants, radiations, cigarette smoke, etc. When ROS excessively increase or antioxidants are diminished, oxidative damage accumulates resulting in disruption of normal physiology, including damage to DNA, lipids, and proteins with the expression of overt disease. Lifelong damage by ROS, especially to our energy producing mitochondria is part of aging. When our cellular repair process called autophagy and our antioxidant defenses can no longer keep up with the assault of excessive ROS, aging accelerates and death occurs prematurely. Antioxidants from berries, prunes, cherries, broccoli, dark, leafy greens, olives, pinto and red beans, etc. can donate an electron making free radicals less reactive, more stable, and reducing ROS.

Sleep is a necessary part of the repair processes and that is why I call sleep the center of sanity both physically and mentally. During deep sleep, reparative processes take place, including autophagy, and involving the release of growth hormone. The stress system or the hypothalamic – pituitary-adrenal axis is also involved in sleep and mood regulation.

Free radicals are mainly produced by our cellular mitochondria in making ATP energy during the metabolism of what we eat. The over consumption of food can have toxic qualities, particularly with saturated and trans fats, processed foods, sugars, additives, preservatives, etc.. The State Of The US study, 1990-2016, verified that dietary factors are the number one risk factor for death and disease. We are familiar with the concept that overloading a motor will burn it out. We shut it off, to cool it down as a way of preventing this. However, a time to recover or “cool down” also applies to us.

Fasting is the closest we get to a state where repair and restoration or autophagy can take place. FASTING, KETONES, but not the ketogenic diet, as well as POLYPHENOLS found in resveratrol, quercetin, curcumin, olives, extra-virgin olive oil, green tea, lemons, cocoa, carib, apple cider vinegar, tree nuts, oregano, cloves, black chokeberries, blueberries, red and black beans, etc., and EXERCISE, are four components that have been shown to prolong life. When we fast for more than 12 hours, our body begins to shut down metabolically, allowing essential cellular cleanup and recycling of chemicals and amino acids to occur.

Obesity can cause morbidity and mortality, but it is more than simply eating more than what you burn . Rather, our energy producing cellular mitochondria can affect our weight by limiting the amount of nutrients actually metabolized called uncoupling. This is a protective mechanism to keep our millions of mitochondrial engines from overheating, working optimally, and not dying. Not surprisingly, the four components noted above all support mitochondrial uncoupling thus actually affecting our weight and our health. Moreover, some people may be genetically and thus biochemically predisposed to gain weight because of for example, differences in the way they secrete and release insulin, how fast or slow their stomachs empty, etc. This may be in part why some of the newer semiglutide related weight loss medication’s work.

These newer medications have to be part of a total package for optimal outcome. For example, soluble psyllium husk, or oats have been found, as well as non-soluble fiber, to increase the speed of food transient and decreases appetite. Consuming resistant starch found in certain types of corn, green bananas and barley can increase feelings off fullness, and decrease glucose and insulin levels after a meal as well as the next meal. This benefits in part result from favorably affecting the colonization of the intestinal tract, as well as flattening the glucose curve, subsequent to its ingestion. In turn, this helps diminish glucose binding to proteins and fats in her body called glycation which causes subsequent damage to our organs and blood vessels. I discuss this process in more detail in my book, entitled “Gut and Soul”.

Similarly, we need to avoid eating excessive protein, sugar, and processed starch increases insulin growth like factor one (IGF-1) and the mammalian target of rapamycin (mTOR) who's elevation are associated with shorter lifespan, and early onset of chronic illness, in all animal and human studies. IGF-1 usually promotes normal growth of bone and tissues. But diets with high levels of IGF-1, increase the risk of prostate, breast, colorectal, and thyroid cancers. Bodybuilders often utilize IGF-1 to enhance muscle growth and decrease body fat, but generally die younger than their peers. This is also true of large dogs who have higher levels of IGF – 1 and shorter lives compared to smaller dogs, who have lower levels of IGF –1 and live longer. MTOR increases proteins synthesis and the size of muscle fiber. MTOR levels rise with increase consumption of branched-chain amino acids, such as leucine, isoleucine and valine, which are highly concentrated in red meat, such as beef. Both IGF-1 and mTOR are beneficial when we are young and growing. However, they both inhibit autophagy, or the reparative, recycling, cleanup mechanisms of our cells. Thus as we age where maintenance and repair are more important than growth, there is an increase in chronic illnesses and cancer. This can be ameliorated by eating a more plant-based diet, with less animal proteins, sugar, starch and other processed and especially ultra processed foods.

Cognitive decline with age in some individuals affects reason, memory, and other brain functions with the most extreme being Alzheimer's dementia. Approximately 20% of the US population are seniors, with the largest percentage being baby boomers who control almost 50% of the total US wealth. Senior moments are not dementia, but rather reflect slower retrieval of existing information in our brain's computer. Google, Facebook, and Amazon are valuable because of their databases. As we get older, we acquire a larger database which in of itself, like a computer, slows processing and retrieval. Nevertheless, it would seem favorable to have a person with a larger database making your decisions. Despite an industry that has jumped to the fore with mindset, brain age, brain, trainer, crossword puzzles, etc., there is not a great deal of evidence that mental exercises slow decline. The period of greatest creativity for money is between 50 and 75 years of age. How can we reconcile this? It has been shown that novelty and especially attention are necessary prerequisites for the brain rewiring itself or what is called plasticity.

Are you paying attention? Plasticity is absolutely necessary for the acquisition of skills. This is why most brain games eventually fail because they become routine or hardwired instead of flexible demands needed to think outside of the box. Moreover, with age, and without illness, the brain cells that we have actually become more efficient, and we usually acquire a larger database as noted in our repertoire. More than 70% of your brain is dedicated to your body's muscles and their integration, including those of the heart, diaphragm, stomach, and intestinal tract. A 2003 review of 18 studies found aerobics and strength training maintained memory, planning, multitasking or executive functioning at a high level. My experience running a weightlessness study for NASA's Man Orbiting Laboratory while at the school of Aerospace Medicine 60 years ago, supports these studies. In the weightless studies to simulate a no gravity state, young airmen ages 18 to 21 were put on complete absolute bed rest for eight weeks. They had TVs, a novelty in those days, and regular daytime visits by young female air women. They were carried to the bathrooms. By the fourth week, their mental acuity including memory, and mood decreased, which became more evident and severe by week eight. These effects could be stopped and reversed by exercise. Pertinently, the benevolent asylums of the 19th century regularly used exercise, even forced exercise as a treatment for depression. More recently, high intensity interval training has been shown to increase mitochondrial, proliferation and functioning, especially in individuals older than 60 years of age. Weight training and resistant exercises increases muscle mass, which is directly related to longevity.

Medicine is often focused on treating symptoms instead of root causes. Inflammation occurring at the cellular level may help us understand the relationships and similarities between depression, anxiety, cardiovascular disease, cancer, diabetes, arthritis, etc.. Our cell walls are double or bi layered made up of water, protein, fats, including cholesterol and omega-3, fatty acids, etc. With pumps and channels creating an electrical gradient, which is essential for life and utilizes 75% of all the energy we consume. Our immune system is intimately and precisely familiar with all of this at birth. If any of these intricate arrangements change, an inflammatory response begins and can progress if the immune system decides it is a foreign substance or antigen and attacks. Inflammation can also result from germs like viruses, bacteria, or fungi, external injuries, other foreign objects like a wood splinter, allergens, chemicals, radiation, etc. Our immune protects, but inflammation is essentially an overreaction of our immune system. If it becomes chronic it can damage healthy organs, tissues and cells. It can result in tissue death, internal scarring, and even damage the DNA in our cells. If you put coal tar on your skin, it will become inflamed. If you continue to do so for several weeks, the skin cells undergo change, and eventually become cancerous. If an individual is predisposed genetically to psoriasis, depression, anxiety, rheumatoid or psoriatic arthritis, and they are stressed, psychologically, or physically as in exposure to cold temperatures, their illness will be expressed. In arthritis, for example the actual biochemical cellular composition of the lining of our joints change. One of the oldest anti-inflammatory treatments is the use of steroids.

Antidepressants surprisingly have anti-inflammatory effects. Chronic sugar blood spikes , the pure white poison, causes inflammatory damage to the lining of our blood vessels called atherosclerosis. Large amounts of blood spiking sugar are essentially foreign substances since we didn't evolve consuming more than 80 pounds of sugar per year. This interaction of sugar with the fat molecules and protein molecules in our blood vessels is called glycation. This is random binding of excessive sugar molecules to the fat and protein of the cells lining our blood vessels and other tissues and organs. Ironically, the hemoglobin A1c is actually used as a measure of how many sugar molecules are attached to our hemoglobin, and used a measure for the severity of diabetes. Depression and anxiety are inflammatory processes and both signals of stress, and stressors in and of themselves. Depression and anxiety in heart disease patients raises the risk of deterioration and death, or the likelihood of having a heart attack. In one ten year study of 740 healthy men, overall anxiety independently and strongly predicted the incidence of myocardial infarction, even after controlling for age, education, blood pressure, weight, marital status, smoking, drinking, caloric, intake, cholesterol, and glucose. More remarkable was that the incidence of myocardial infarction and anxiety were directly related. Stress is often discussed as this job is killing me is actually related to the release of pro-inflammatory cytokines, including tumor necrosis factor – alpha, interleukin one, and six, etc. while most antidepressants have the opposite effect.

As we age the molecular arrangements of our cell walls and cellular proteins change slightly with an increasing incidence of cancer, hypertension, immune and metabolic disorders, such as diabetes, dementia, etc.. In Alzheimer's, a protein called tau, becomes changed because of hyper phosphorylation. Tau can no longer form microtubules that act as the subways, tunnels or highways in our nerves and other cells. This leads to the breakdown of communication inside and between cells with nerve cell death, accompanied by toxic inflammatory amyloid beta accumulation, neurofibrillary tangles, or the pathological sinequanon of Alzheimer's. These changes can be viewed in part as a failure of cellular cleanup and restoration called autophagy. Because medicine hasn't helped prevent or alleviate many chronic diseases or problems, many people have turned to the use of supplements, or the addition of vitamins, minerals, etc. to their normal diet, in the hope that they will improve their well-being.

Unfortunately, many diets are abnormally loaded with processed and ultra processed chemically engineered foods. Our bodies have not evolved on supplements, but on the whole organic foods that Hippocrates was talking about when he said let food be our medicine, and medicine be our food. Our body is not prepared to assimilate most supplements in a complete and healthy manner. Ironically, if vitamin E is taken as a supplement of more than 200 International units per day it is associated with a higher incidence of stroke, possibly related to easier bleeding. Yet, if you would take 400 international units of vitamin E on an empty stomach less than 60 international units are absorbed, because fat is necessary to improve absorption. That fat is present in the original food such as in wheat germ, sunflower seeds, almonds, avocados, etc. This is also true of fat soluble vitamin D3, which should always be taken with olive ,avocado, or MCT oil to improve absorption. Taking a half tablespoon of olive oil daily with your vitamin D, also decreases the likelihood of developing dementia by 28%.

The FDA agrees cold water fish oil containing EPA and DHA are good for the heart and the brain.. It is a molecularly distilled natural product therefore without mercury, or other pollutants, which decreases the risk of poor memory in healthy men and in mice. Even when given to older mice, beta amyloid, accumulation, and oxidative brain-damaged decrease along with improved cognitive function. I'm never sure what the mouse knows. However, the Framingham Heart nine years study of 899 people averaging 76 years found that those in the top 25% of DHA blood levels, and who were averaging three servings of fish per week, had a 47% decrease in the development of poor memory. Yes, you can teach an old dog new tricks if you feed him fish regularly or give him optimally at least 2000 mg daily of omega-3 DHA and EPA. This was also found to be more beneficial for heart health.

Many of these issues, including the importance of emotions in food assimilation, are discussed in my forthcoming book entitled "GUT AND SOUL - Answers to the American Diet and male death and fertility crisis derived from history, science, and French food culture”. There I describe a science data based nutraceutical approach to reduce the risk of prostate cancer in my Prostate Promoter now on sale on Amazon. The most commonly used prostate supplement is sal palmetto which has demonstrated no benefit in two double blind placebo controlled studies, the gold standard in medical research, in patients with prostatitis and benign prostatic hypertrophy. That is, there was no difference in the sal palmetto group from the placebo group. There is No evidence at all that saw palmetto is beneficial in reducing the risk of prostate cancer, which is the most common cancer in men . Saw Palmetto is in the formula because of its anti inflammatory effects and its positive interaction with lycopene. The formula contains black pepper and bromelain to increase the absorption of turmeric and quercetin, respectively. The latter two and all of the other ingredients have data demonstrating a decrease in the risk of prostate cancer and/or inhibiting the actual cancer pathways. I can not and I am not claiming to treat or prevent prostate cancer. That would necessitate extremely costly double blind placebo controlled studies. I have been taking 10 of these ingredients for more than 35 years. This Prostate Promoter was precipitated by the prostate cancer death of a close friend and colleague, as well as my internist commenting twice during my prostate examinations, “Your prostate doesn’t know how old you are”.

Another issue I discuss in greater detail in my book, is the increasing pervasive use of the new weight loss medications such as Ozempic and Wegovy which activate the glucagonlike peptide-1 (GLP-1) receptors , Mounjaro which affects both the GLP-1 and GIP receptors , and others. Food metabolism and assimilation is interrelated with numerous other systems in all living creatures. Thus stimulation of these receptors is not just limited to those directly involving food. There are clear differences metabolically in the manner, genetically, environmentally or epigenetically guided, in which we utilize and assimilate food. Each individual will gain or lose weight differently eating the same diet which is why some overweight/obese people can't lose weight no matter how hard they try. The new medications decrease hunger/sugar cravings, reduce appetite, lower body weight, improve insulin sensitivity and release, and slow stomach emptying creating a sense of more fullness among other effects. This may help create a more “normal” metabolic/ physiologic pattern for many people. The new weight loss medications are especially useful for people with a BMI of 35 or more and/or a waist-hip ratio of 1 or more. People who are not actually overweight, but who are interested in “cosmetic” weight loss, may experience more side effects. There are many GLP-1 receptors in our body including those involving the amygdala in the brain involved in mood, anxiety, and emotional memory. Some of my non obese patients using GLP-1 medications excessively, or obese or non obese patients withdrawing from them have reported severe anxiety which basic research has documented. This withdrawal induced anxiety may make it more difficult to stop these medications. A secretary who mistakenly took 5+ times the dose of semaglutide or Wegovy vomited for 3 days, was hospitalized, and found it almost impossible to eat for the following 6 weeks.

The prototypical example of the interwoven nature of food and anxiety/emotions is the anxious crying newborn becoming relaxed and drowsy/sleepy during and after feeding. Food turns off the anxiety. “Failure to thrive” in John Bowlby's study of infant orphans dying, even when offered food during the Battle of Britain in World War II, experienced the stress of abandonment from the death of their parents. This stress seems to have affected the same receptors that GLP-1 activates, particularly since GLP-1 appears to play an undeniable role in stress regulation. In animals GLP-1 increases weight loss and often anxiety.

The GIP receptors, which are additionally activated by Mounjaro, are also found in the adrenal cortex, the main source of cortisol in our body which has mood and sexual effects. Cortisol levels are reported to be related to compulsive sexual behavior. One of my patients became hypersexual and broke out in a rash while taking higher doses of Mounjaro and had to be withdrawn. These side effects can be treated and ameliorated, including the anxiety induced by attempts to withdraw from these medications to maintain a “normal”, but different style of eating that resists weight regain.


1. Insurance coverage. The Mindful Health Foundation staff, including its Medical Director Ralph Ryback M.D., provides the following services which are covered under most insurance plans. Outpatient eating disorder treatment. Outpatient drug and alcohol treatment. Intensive outpatient programs. Day treatment programs. Family therapy. Marriage counseling. Psychological assessment. Group cognitive behavioral therapy. Group dialectical behavioral therapy. Court related assessments. Nutritional therapy. Art therapy. Body image therapy. Dance and movement therapy.

2. Modified concierge psychiatric care provided by Ralph Ryback, MD. This is available for no more than 20 patients per year who have complex psychiatric related problems that have not been ameliorated or resolved by previous treatments or programs under a separate agreement. Dr. Ryback provides a problem oriented holistic functional approach. This involves investigating many different dimensions of the patient in order to find possible underlying contributing causes to the patient's poor functioning/illness. The patient is the record of treatment. This is an extensive joint undertaking with the patient in the search for improved health and function. Dr. Ryback focuses on physical health, wellness, nutrition, and acts as a personal mental health coach sometimes utilizing a modified version of the internal family systems model in a no rush on demand relationship. Services are easily obtained, and provided either in person, or via various forms of Telepsychiatry in a fee for service or contractual manner. Dr. Ryback is most easily accessible for discussion about the services needed by leaving a voicemail at 239- 799-5933 or through an email to rsryback@gmail.com

3. Problems addressed include: Attention disorders. Eating disorders, including night time eating disorders, Mood disorders, Trauma – base disorders. Addiction and substance abuse disorders including Kratom withdrawal, Asperger patients for both adolescents and adults, Traumatic brain injury difficulties, Self mutilation, Psychosis including THC psychosis, Phobias, Prostate cancer nutraceutical approaches to reduce risk and reoccurrence, Senescence, Weight control, Anxiety states, and emotional problems related to the new weight loss GLP-1, GIP, etc. medications.

4. Treatments include all those available through the Mindful Health Foundation, as well as a holistic functional integrative psychiatric and medical incremental approach. This can include include nutraceuticals, propranolol, Suboxone, oxytocin, diet, cognitive behavioral therapy, ketamine, modified internal family systems model, trauma therapy, psychopharmacological medication, etc.. A problem oriented approach involves psychosocial, nutritional, and biochemical assessment to determine which treatment approaches will be optimal together or alone. The patient is always the partner in mutual education, assessment, and decision making at each step of the way toward improvement with each potential treatment and its risks/benefits.

Contact Ralph Ryback
Tel: 239–799-5933

Ralph Ryback, Psychiatrist Naples Florida

He does not believe that does not live according to his belief.
~Sigmund Freud

"A man's life is what his thoughts make of it." - Marcus Aurelius