Bipolar II, Botox For TMJ & The Viral Tongue Trend For Your Nervous System | Ask Me Anything

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Three AMA questions this episode. One of them sparked a ten-minute conversation about ribbon dancing as nervous system medicine. We'll get to that.

The first was from Nina, who asked about bipolar II from a functional medicine perspective. This is one of our top telehealth patient populations, and it's also one of the most underdiagnosed and misdiagnosed conditions in mental health. The conventional framework gives you a label, matches it to a pharmaceutical, and calls that treatment. What we find clinically is that the picture underneath is completely different from person to person — someone can have excess dopamine and someone else can have a deficiency, and both can look like bipolar II. We look at the COMT gene variant (the slow vs. fast dopamine metabolizer question), the MTHFR and homocysteine piece, the ACE score (childhood trauma is a massive driver — an ACE score of four or five exponentially raises risk), and then the environmental variables: mold, specifically ochratoxin A from aspergillus, directly impacts the COMT pathway and the entire dopamine-norepinephrine-epinephrine picture. We also look at organic acids testing and consistently find mitochondrial dysfunction in brain health cases. Fifty percent of dopamine is made and stored in the gut. That alone tells you the gut is not optional in this conversation.

Supplement-wise, we talked about lithium orotate — the supplement form of a micronutrient that is neuroprotective and helps modulate neurotransmitters including GABA, very different from pharmaceutical lithium doses — and saffron, which has been shown in some blinded studies to be more effective than SSRIs with zero side effects, and is one of the few things you can use concurrently while tapering medication.

The second was from Colette, who had tried masseter Botox for TMJ jaw pain, found it incredible, and wanted to know if it was okay to keep doing. The short answer from Dr. Cole is: pragmatic yes for short-term relief if you're a good candidate, with real caveats around cumulative immunomodulating effects over years and decades. Andrea's position is more skeptical. Emily added a detail from her 6-year-old daughter's teeth grinding that reframed the whole thing — a holistic dentist told her that grinding happens when the body isn't getting enough oxygen and goes into sympathetic fight-or-flight. Not a jaw problem. An airway problem.

The third was from Tessa, who asked about the viral trend of sticking your tongue out for 40 seconds, taking a 60-second break, and repeating three times to lower cortisol. Dr. Cole couldn't find the original study. But the mechanism is real — it's essentially a form of indirect vagal nerve stimulation, used in somatic bodywork and in the Simhasana lion pose in yoga for thousands of years, because the jaw and tongue hold enormous amounts of stored tension and trauma. The fascia of the jaw keeps the score in the same way the hip joints do. Nobody said the ribbon dancing out loud but Andrea has bought a set of 20 for the office, and they have used them at lunch, so.

A few of my favorite things we cover in this episode: 

• Bipolar II is widely underdiagnosed AND widely misdiagnosed — and the real number is likely far higher than the estimated 1 in 200
• The COMT gene variant: slow vs. fast dopamine metabolizers — why two people with the same bipolar diagnosis can have opposite dopamine pictures underneath
• 50% of dopamine is made and stored in the gut — which is why gut health is non-negotiable in any bipolar protocol
• ACE scores of 4 or 5 create an exponential increase in risk for bipolar and other mental health, autoimmune, and inflammatory conditions — the interplay between nature and nurture
• Mold toxicity (specifically ochratoxin A from aspergillus) directly impacts the COMT pathway — dopamine, norepinephrine, and epinephrine all affected
• Mitochondrial dysfunction showing up on organic acids testing in nearly every brain health case — often tied to environmental toxin exposure
• Lithium orotate (supplement form) as a natural neuroprotective micronutrient — vs. pharmaceutical lithium, and genetic testing to determine candidacy
• Saffron: shown in some studies to be more effective than SSRIs, and one of the few things you can use while tapering — helps reduce the brain zaps during the weaning process
• Botox for TMJ: pragmatically okay for short-term relief if you're a good candidate — with caveats. Dr. Cole: "low-risk Russian roulette" that's cumulative and immunomodulating over time
• Emily's 6-year-old daughter grinds her teeth so loud they can hear it from their bedroom — holistic dentist: teeth grinding = body not getting enough oxygen = fight-or-flight, not a jaw problem
• Night guards and microplastics: grinding plastic into your mouth every night for years. Dr. Cole: "The dentist says protect the teeth. I'm thinking microplastics are a problem."
• The viral tongue-out cortisol trend: no reputable RCT found — but the mechanism is real. It's essentially indirect vagal nerve stimulation, with parallels to Simhasana (lion pose) in yoga and somatic jaw work practiced for thousands of years
• The fascia of the jaw holds tension and trauma the same way the hip joints do — which is why somatic therapists pull the tongue in bodywork
• Andrea buys ribbon wands for the office — the team's lunch break vagal nerve stimulation ritual nobody expected
• Free vagal nerve tools ranked: humming (Emily's pick), gargling (Andrea's pick), lion pose (Dr. Cole's pick), sun-gazing to induce eye watering, arm-swinging across the midline, ribbon dancing

Products Mentioned:  

• Heal Your Cells by Dr. Will Cole & Dr. Josh Axe
• drwillcole.com/shop — supplement protocols (brain health, gut, hormone, nervous system stacks)
• Brooke Siem episode (companion episode for the bipolar question)
• Dr. Joe Damiani episode (companion episode for the TMJ/Botox question)

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Happy listening, and we hope you learned a little bit more on the art of being well!

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In Health,

Dr. Will Cole