System II:
Nutrition: Metabolism of Essential
Fats and Oils, especially the omega-3 class
The Science:
Mild to moderate
deficiency of essential oils is surprisingly common. This is especially so
for the omega-3 oils (fish/flax/algae). Omega-3 oils are especially likely
to be low among people with depression, autism, attention deficit disorder,
schizophrenia, and also among those with heart disease, diabetes, and some
forms of cancer.
Fortunately, lab science has progressed to where it is now practical to
measure whether a person's essential oils are deficient.
Three recent double-blind studies, including one from Harvard Medical
School, show that omega-3 supplements are effective treatments for
depression. Double-blind studies also show benefit for Crohn's Disease,
rheumatoid arthritis, heart disease prevention and some forms of cancer.
What We Might Do: Our dietary history questionnaire provides a reasonable estimate of your
essential fatty acid intake. A red blood cell fatty acid analysis can
measure this directly.
When appropriate, we would recommend supplementation. The best dose will vary
for each individual and each setting.
CAUTION:
There is no free lunch. As valuable as fish oil is proving to be,
it's not totally without hazards. For example, in a manner similar to
aspirin, high doses of fish oil acts to thin the blood. This is
valuable if you need to prevent blood clots, but not if you already have an
increased tendency to bleed. For instance, if you take Coumadin
or anti-inflammatory medicines, have an ulcer, or are making plans for
surgery.
System III:
Building brain neurochemicals one carbon atom at a time: the
methylation pathways and depression, including SAMe, folic acid, and vitamin B12
Brain Biochemistry
The Science: The brain builds vital chemicals by adding
carbon atoms or methyl groups to change the shape and form of other
molecules. The brains main methylation work-horse is a special
molecule, S-Adenyl methione (SAMe)
SAMe, as a supplement, is an effective anti-depressant
with more than a dozen successful double-blind trials. The body also makes SAMe on its own, but optimal production requires generous amounts of folic
acid and vitamin B 12, as well as trimethyl glycine (TMG), the amino acids
serine and methionine, and also omega-3 fish oil.
Weak methylation increases risk for depression and
anxiety. Weak methylation also causes elevation of the blood level of
the amino acid homocysteine. High homocysteine worsens heart disease risk. Weak methylation also reduces ability to repair damage to DNA. This
increases risk of cancer.
Probably the most frequent obstacles to methylation occur
with suboptimal intake of vitamin B12 and/or folic acid. Clinical
studies have shown that under certain circumstances adding vitamin B12
and/or folic acid helps relieve depression.
What We Might Do:
We can measure the efficiency of key enzymes that depend for their action on
folic acid and B12. Such functional assays provide better information
than does just measuring the level of each vitamin in
the blood.
We seek to identify and reverse factors that block the
effectiveness of your vitamins. For example, as many as 25% of Americans
have a genetic variant that increases their need for folic acid. Birth
control pills and other medicines also inhibit folic acid.
Acid-blocking drugs (e.g. Prilosec), chronic low grade gastritis, which is
very common in older people, and strict vegetarian diets all act to reduce
our ability to obtain B12.
We recommend vitamin supplements in doses that are
appropriate. We might also recommend supplementing SAMe, but with special
care for its potential hazards. Like most effective anti-depressants,
including Prozac and SAMe can sometimes trigger conversion from depression
into mania among people who have a tendency toward bipolar disorder.
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System IV Nutrition:
Amino
Acid imbalances that alter brain neurotransmitters, which affects
vulnerability for depression, anxiety and stress
The Science: Amino Acids are the raw material from which
the brain forms key neurochemicals.
Serotonin, for example, is an important brain chemical. Serotonin deficiency is believed to contribute to anxiety, depression, PMS,
insomnia, carbohydrate craving and a host of other ills. Adding Prozac
is one way to increase Serotonin. Adding tryptophan, the starting
molecule for serotonin, is another way to accomplish this. Tryptophan
is available only with a doctor's prescription. 5-hydroxy tryptophan
(5HTP), an over-the-counter derivative of tryptophan, is available in most
health food stores.
During the 1970's, tryptophan was used to treat depression,
but with only so-so success. However, those studies did not measure blood or
urine amino acid levels to see who was actually low on tryptophan. Our
experience is that only 15-25% of people with depression have the low tryptophan pattern. We confine tryptophan supplementation to those whose
tryptophan ratios are low. This seems to provide much better results.
About 15 years ago, a manufacturing error in one large
batch of tryptophan made many people severely ill. At that time, the
FDA removed tryptophan from the market. There have not been further problems since tryptophan was reintroduced as a prescription drug.
What We Might Do: Measure blood or urine amino acid
levels. Recommend specific amino acid supplements.
Be cautious about potential amino acid interactions with
drugs and herbs. For example, except with special cautions, tryptophan
should not be combined with Prozac-like drugs or with the herbal remedy St.
John's Wort. (Nor should Prozac and St. John's Wort be combined with each
other.)
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System V:
Hormone Imbalances influence depression,
anxiety, and stress: Thyroid,
estrogen, testosterone, DHEA, prolactin, growth hormone
THYROID: Does it ever make sense to take extra
thyroid if your standard blood thyroid tests are normal? This has been
a controversial issue for at least 50 years. However, recent research shows
that in the right setting the answer can be yes. Most mainstream
psychiatrists now agree that a small dose of added thyroid can help
depression, even if standard thyroid blood tests are normal.
Who is likely to benefit from added thyroid? One can
infer this from the medical history and physical. We can also measure
standard thyroid blood tests as well as more sophisticated versions such as
"free T3" and "reverse T3" thyroid hormone levels.
What We Might Do: Take a careful thyroid-related history. Monitor AM axillary temperature. Measure standard and special thyroid
tests. Consider supplementing with low doses of natural (Armour pork)
thyroid or with synthetic T3 (Cytomel).
See
Hypothyroid and Fibromyalgia.
FEMALE AND MALE SEX HORMONES: During perimenopause
estrogen levels fluctuate wildly. A steady dose of estrogen supplements can
have a stabilizing effect. When women are
depressed during perimenopause, adding estrogen is very likely to help.
In contrast, during menopause itself, women
who become depressed do not usually improve by being treated with estrogen.
Correcting low testosterone levels can help mood in some and this is true
for both men and women.
What We Might Do: Measure key thryoid, adrenial or
sex hormones. Consider the pros and cons of a short trial of treatment.
DHEA, PROLACTIN, GROWTH HORMONE:
Abnormal levels of these hormones can adversely affect
mood. Consider measuring these hormones and the pros and cons of
treatment.
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System VI:
Respiratory Bio-rhythms and
Stress-Management Techniques: Proper
breathing induces the relaxation response. "Disordered" breathing worsens
distress
The Science: Both physical and mental distress tend
to push the rhythm of breathing into a disordered pattern of shallow, rapid
breathing from the chest instead of slow, deep breathing using the diaphragm and
muscles of the abdomen. This chest hyperventilation makes people feel
stressed and not in control. Slow, abdominal breathing induces feelings of
calmness and confidence.
Most people are not aware of their breathing
pattern.
Many even feel that they are breathing too little, rather than too much. Sighing, feeling breathless, or feeling unable to take a full, deep
satisfying breath-- these are all tip-offs that breathing rhythms might be
off.
Disordered breathing disrupts the carbon dioxide
balance in the blood. This disturbs the flow of blood to various parts of
the body. Among the symptoms that can result: mental fog, dizziness, chest
pain, numb lips, tingling fingers, muscle aches, and weakness. These
all foster a sense of feeling out of control.
Disordered breathing worsens many symptoms. More
symptoms, worse breathing. Worse breathing, more symptoms. Reversing
this process is crucial--and not too difficult, once we recognize the
problem.
What We Might Do: We evaluate breathing rhythms and
teach people how to restore the normal pattern. We can usually retrain in
just two or three sessions. This almost always improves well-being and the
feeling of self-control.
In addition to proper breathing, we teach several advanced
bio-behavioral skills. One of these, Freeze Frame, entrains the
natural biorhythms of the heart. This triggers the brain's relaxation
response within just one minute. The beauty of Freeze Frame is that
you can do it while you work or talk without anyone around you realizing
that you are relaxing.
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System VII:
Nutritional
Deficiencies and Food Sensitivities as They Affect Depression, Anxiety,
and Stress Management
Nutritional Deficiencies:
The Science: Almost
every molecule in our body starts out as a food, including the coenzymes or
cofactors that turn on the enzymes which guide our metabolism. Almost
all of the required coenzymes are basic vitamins and minerals. Two examples of nutritional
therapies: Magnesium and Inositol.
Magnesium serves a vast range
of biochemical reactions. Many Americans have less than optimal magnesium. Low magnesium increases vulnerability to stress, anxiety, headache, heart
palpitations, muscle irritability, asthma, and also sensitivity to loud
noises, bright lights and noxious smells.
However, stress, chronic pain, diabetes and
other illnesses all act on our kidneys to increase magnesium loss through
the urine. As with disordered breathing, there is often a low-magnesium
vicious cycle that is important to reverse.
What We Might Do: By history or
direct testing, we evaluate for low magnesium. We usually recommend oral
magnesium supplements. For difficult problems, intravenous magnesium might
be preferred.
Inositol, a food derived biochemical, acts
as a messenger within nerve cells. At least four double blind studies have
shown that high dose inositol improves both anxiety and depression. Like
other anti-depressants, Inositol can (infrequently) convert depression to
manic phase. Side-effects are uncommon, except that some people have G.I.
upset. Few drug interactions have been reported; however, Inositol
might counter act the treatment effects of Lithium.
What We Might
Do: There is no commercially available lab test to measure Inositol.
Therefore, if the history is suggestive, we might offer a therapeutic trial. Food sensitivities can be obstacles to healing
and they are probably much
more common than we had previously thought. Two examples are Celiac
disease/wheat gluten and low blood sugar/hypoglycemia. Celiac/Wheat
Gluten: Celiac disease had been thought of as a relatively rare condition in
which gliadin, a protein component of wheat gluten, causes
immunological damage. Diarrhea was believed to be the first and most
important symptom.
In contrast, recent research
shows that sensitivity to gliadin is fairly common, affecting 2% or so of
the population, and a much higher proportion among people who are ill. This
sensitivity can damage the brain, heart and other organs, even when there
are no G.I. symptoms at all.
What We Might Do:
Screen with a blood test to detect gluten sensitivity. Or, do a full
elimination diet to look for a broader range of food sensitivities.
Low Blood Sugar/Hypoglycemia: Despite
persisting skepticism among some physicians, there is strong evidence that
too much sugar and simple carbohydrate can cause mood swings and other
symptoms. Ironically, the immediate cause of symptoms is not low blood
sugar per se, but the over-reaction of hormones that the body calls on
to prevent blood sugar from falling too low. These include adrenalin,
insulin and cortisone. These hormone surges increase vulnerability for mood
instability, anxiety and/or depression.
What We Might Do: We can often
judge from your history whether hypoglycemia is likely.
Often, we try a few weeks of an anti-hypoglycemia to see if you improve. Proper exercise and stress management are also useful. The traditional 5
hour glucose tolerance test, however, is not usually worth doing.
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System VIII:
Integrative Medicine:
Brain, Gut and Liver Connections
Indirectly
Affect Depression, Anxiety and Stress Management
The Science: The gut is an active, not
a passive,
organ. It communicates intimately with the brain, the immune system and
other organ systems. For example, many of the hormones made in the gut also
act on the brain as key neurotransmitters. Serotonin is one example.
The
microorganisms that live within the gut play a critical role as supports for
the immune system. Imbalances and overgrowths of gut bacteria and
yeast can damage the gut's lining allowing toxic products to enter. Known as
the "leaky gut syndrome" this can affect distant parts of the body.
The liver acts as the body's main waste disposal
and recycling plant. The liver has specific biochemical pathways for
processing metabolic by-products, hormones, foreign chemicals and
medication. Many of us have weaknesses within one or more of these detox pathways. That
is one reason why people might react adversely to
medicines or to environmental chemicals.
Identifying and supporting weak detox pathways can aid the
healing process.
What We Might Do: We have a broad range of
laboratory tests for evaluating gut and liver. These include:
- The Comprehensive Digestive Stool Analysis evaluates
digestive enzymes, malabsorption, bacteria, yeast, and parasites.
- The leaky gut test measures how well the
gut selects which molecules to admit and which to keep out.
- The bacterial overgrowth breath test detects the
presence of excessive bacteria in the gut.
- A liver detoxification challenge test monitors the
strength and weakness of specific liver detox pathways.
Unfortunately, standard liver function tests do not tell
us much about the liver's detox pathways.
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System
IX:
Sleep
Medicine: Depression, Anxiety and Stress Can Be Helped by
the Healing Powers of Sleep
The Science: Both
physical and mental distress undermines the healing power of sleep. Specific
sleep disorders such as sleep apnea and Periodic Leg Movement Disorder (PLMD)
also damage sleep. Repairing sleep quality strengthens the body's
healing systems overall.
What We May Do: We take
a careful history to evaluate sleep patterns. We may ask you to have a
friend observe you while asleep. A few people require an overnight sleep
study.
Many
behavioral, nutritional, herbal and pharmacological options are available. It may be difficult to predict in advance which will do best, but
persistence and trial and error carries very low risk and is often
effective.
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The
Science:
The
body's chemistry requires continuous energy every minute of our lives. We store this energy primarily within a small molecule called ATP.
Mitochondria, tiny organs within cells, are where we make this ATP.
The active brain requires a major share of this energy. Several
neurological and metabolic diseases reflect damage to the mitochondria and
their energy production.
Production of biochemical energy requires collaboration among a broad team of nutrients including
Vitamins C, E and A, glutathione, Co-enzyme Q, L-Carnitine, lipoic acid,
Riboflavin, and NADH (ENADA). Deficits in any of these can affect
total energy output.
What We Might Do:
We
usually cannot measure the specific function of mitochondria, so we might
cast a broad nutritional net to cover many of the elements that might need
support.
Please see our discussion of chronic fatigue and
fibromyalgia for more on
improving mitochondrial energy.
System XI: EXERCISE, the Best Medicine
for
Depression, Anxiety and Stress, if Done Just Right
Both too much and too little exercise can make mood disorders
worse. In contrast, exercise that is tailored to each individual's
abilities and needs almost always helps mood. We base our exercise advice on
the Goldilocks Principle. Do the right amount, not too little and not too
much.
Recent research suggests that CFS/FMS has different
effects on aerobic versus anaerobic metabolism. Aerobic capacity (e.g. for
sustained walking) is often moderately to severely reduced. However,
anaerobic capacity (e.g. brief heavy-lifting) is usually fairly well
preserved.
What We Might Do: We take a careful exercise history and
tailor your starting program to your individual needs, abilities and
interests. Often, we start at much lower intensities than you might
expect. We then build slowly, but steadily, with the pace based on
your tolerance. We help design separate programs for aerobic and
anaerobic work. Beneficial effects on mood may require several months, but
this approach to exercise is one of the most dependable of all therapies.
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System XII: Positive
Psychology: How To Feel In Control
while coping with Illness
Coping with chronic illness can be very difficult. Positive change comes easier when you feel in control and optimistic. Traditional talk therapy works toward this goal, and we support its use.
However, we also offer additional techniques that much
psychotherapy tends to overlook.
Behavioral Medicine/Relaxation is not so much
psychotherapy as training to use a set of skills. Like learning to ride a
bicycle, it's awkward at first, but quickly becomes second nature. Mastering
behavioral/relaxation skills improves control over your physical and mental
response to stress. This helps you keep your emotional balance.
We offer a selection of behavioral tools including slow
diaphragmatic breathing, guided visual imagery, and deep muscle relaxation.
We also teach advance skills, one of which, called Freeze-Frame, has these
great advantages. It reduces stress reactions within one minute and you can
do it while you carry on with activities. No one around you need know that
you are relaxing.
Cognitive behavioral therapy (CBT) is another educational
skill. CBT helps you reframe issues and problems in ways that escape the
trap of negative thinking, and also helps recognize opportunities for
healthy change. Our basic CBT training requires only a few sessions.
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