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.
Click here for more information about diet and depression.
Click here for more information about stress management techniques
and treatments
back to top of page
System III:
Building brain
neurochemicals one carbon atom at a time: the methylation
pathways, 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 molecules. The brain's 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.
Click here for more information about diet and depression.
back to
top of page
System IV Nutrition: Amino
Acid imbalances that alter brain neurotransmitters
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.)
back to top of page
System V:
Hormone Imbalances: 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).
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.
back to top of page
System VI:
Respiratory Bio-rhythms:
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.
Click here for more information about stress management techniques
and treatments.
back to top of page
System VII:
Nutritional Deficiencies and Food Sensitivities
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. (See our
hypoglycemia symptoms,
hypoglycemia treatments pages)
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.
back to top of page
System VIII:
Integrative Medicine:
Brain, Gut and Liver
Connections
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.
back to top of page
System IX:
Sleep Medicine 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.
back to top of page
System X:
Metabolism Nutrition:
How
Mitochondria produce energy for the brain
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.
back to top of page
System XI:
EXERCISE, the best medicine, 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.
back to top of page
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.
back to top of page
