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One of my son's favorite cartoons, when he was young (mine also), was Pinky and the Brain. Of course Steven Spielberg was the executive producer, so it shouldn't be any great surprise that this cartoon was complex and contained a large amount of humor geared toward the adults watching with their children. Pinky and Brain are genetically enhanced laboratory mice who live in the Acme Labs research facility. Brain is self-centered and always attempting to take over the world, whereas Pinky is good-natured but feeble-minded. In each episode, Brain devises a new plan to take over the world that ultimately ends in failure.
In terms of mental illness, many of our patients are similar to either Pinky or Brain or sometimes both. What I will attempt to elaborate on in this article is the steps we can follow to truly individualize our treatment plan for the patients who walk into our offices. It doesn't matter if they are depressed/schizophrenic/anxious. We need to evaluate some basic parameters in their bodies which, upon correction, tend to have some powerful biochemical effects on their brains at the level of the synaptic cleft, which is where true change has to occur if they don't just want to take some type of drug for the rest of their lives.
I would like to focus on these areas that I have found to be the most clinically relevant and able to effect the most vibrant change in my patients: food intolerances, leaky gut > leaky brain, stress/Earthing, increased/decreased reuptake of neurotransmitters at the synaptic cleft, toxic metal overload, and hypothyroidism. To avoid an overly long article, which I also never like, I will focus just on the first three here and hopefully the other three in a later article.
This is not going to be so much a research article as it will be a guide geared to ascertaining which of the above variables you need to look at first to maximize your clinical outcomes. It's as if you and your patients are in a giant game show and you need to figure out behind which door is the prize or behind which of the above doors lies the clinical choice/key that will begin to unlock the blockages in their bodies to allow their mental illness to improve.
A great example of this individualization of treatment comes from my good naturopathic friend Wade Boyle, who used to give a speech every year at the annual naturopathic convention. He would title it: "What Works and What Doesn't." He would then proceed to hold court on what he had found to work and what didn't and why. They never scheduled anyone opposite him, because everyone would come to his talk. One great gem from Wade was how to distinguish the use of valerian from hops in the treatment of insomnia. He found in the old Eclectic literature that hops worked better if the carotid pulse was stronger than the radial pulse and vice versa for valerian. Great clinical anecdotes from my brother!
We must then approach this patient with a chronic mental illness from a new paradigm. Just focusing narrowly on one and maybe two variables is perfect for a person who has just fallen off their bike and fractured their distal radius or for a person with a 104º fever and acute bacterial pneumonia. The fall on the bike tends to affect us all in the same manner. Why a person has a complex mental illness will not be dealt with using the simple linear relationship above.
Chronic illness is complex because it is the interaction of our own uniquely biochemical bodies, the traumas they have been exposed to in this life, and the degree to which we are aware of all that has happened to our bodies. How sensitive some patients are over others determines whether they will develop an easily treatable illness or a complex, chronic condition that will stump most caregivers. This is our task as true caregivers of the 21st century: determine the one or two clinical factors that need immediate attention to begin the healing our mentally ill patients' minds to the point where they will no longer need drugs to allow them to function in our dysfunctional society. After we have unlocked these first couple of doors, then our detective work can hopefully continue and lead us to other areas of their lives that have physical/emotional/mental blocks.
Door #1: Food
So, without further adieu, let's examine my first three roadblocks to optimal mental health. Behind magic door #1 lies: food. How important is food, you may wish to know, and why would you list it atop your roadblocks? I taught various classes at American College of Traditional Chinese Medicine in lovely San Francisco for 6 years. One of them was Western nutrition. I would start the class asking my Chinese medicine students how many times a year they visited a medical doctor. Most laughed at the thought, as they were in acupuncture school. A few raised their hands because they had semiserious illnesses that required skilled Western medical intervention. Then I asked them how many times a year they received acupuncture. Surprisingly, as they were studying Chinese medicine, 1 to 2 times a month! Then I asked them, how many times a year did they eat? Most acupuncture students didn't take science and math courses like medical students did for their prerequisites. I helped them out: I went with what I would consider a typical American who would eat 3 main meals and 2 snacks, so 365 × 5 = 1825 ×/year. Now maybe you are beginning to see why I put food as #1. Just think of the damage that is happening in a body that consumes what is sold in supermarkets, fast food stores, and most restaurants 1825 times a year. That thought terrifies me!
Bruce Ames is a professor emeritus of biochemistry and molecular biology, University of California, Berkeley. He is also the originator of the triage theory. This theory states that our bodies, if they do not receive the daily needed amount of a nutrient, will triage what they receive of that nutrient to the areas that need it functioning in the present. The future is of no concern in that scenario.
For many years, I had marveled at the resiliency and strength of the bodies of my patients who eat a typical American diet. How could they not fall acutely sick and/or die? Dr. Ames appears to answer this question extremely proficiently. I might also add that Dr. Ames also seems to have discovered the source of chronic disease. As this triaging continues to happen in most Americans (none of the readers of this magazine of course!), the areas of the body not receiving the required nutrients will begin to function sub-optimally, which will eventually lead to actual disease in that area.
Back to that 1825 figure: I use this number because it is a powerful motivating tool. When my patients start to grasp the number of times that they eat per year, they begin to understand the powerful impact that food has on their bodies. Now comes my next metaphor. It requires a large effort to eat food that is optimal for you in our society. You must purchase the food, prepare the food, and not let anybody talk you out of eating this food. This is where I use a line from the song "Equal Rights" by Peter Tosh: "Everybody wants to go to heaven/But nobody wants to die." It takes substantial Yuan qi, intestinal fortitude, or just plain guts to withstand the barrage of edible foodlike substances that American corporations attempt to throw at you.
Now, how do you individualize each person's diet to make their metabolism run as quietly and efficiently as a 1965 Rambler? Everyone has a slightly different idea as to how they can accomplish this Herculean task (plus everyone thinks that their way is the only way!). There are various food allergy tests, radionics testing, and so on. The list is interminable. I personally use little vials whose water contains the electromagnetic signature of whatever food I am muscle testing. To me, it doesn't matter what test you use. I just want them to be able to pass my food test: immediately after you eat a meal, do you feel physically and especially mentally clear? Do you also feel mentally and physically clear 1 hour, 2 hours, 3 hours, and 4 hours after eating? If you can say yes to this statement, then I believe that you are eating in a way that is biochemically feeding the cells of your body so that they are humming like that old ‘65 Rambler I wish I had never sold!
Before I move on to Door #2, below is a handout that I give to patients that further reinforces the power that food has on their bodies and how noncompatible foods can wreak havoc everywhere in their bodies. Also, I will include my Modified Elimination Diet (pdf) that I have people follow for 14 days so that they can see how wonderful they will feel when they remove possible offending foods from their daily consumption. After the 14 days are up, there are multiple ways that you can test to see which foods are contributing to the source of their problems. The crucial key is that most true food allergies are moderated through IgG antibodies via a type IV hypersensitivity reaction. These symptoms can show up anywhere from fairly quickly to 48 hours later. Due to this slight inconvenience, patients must reenter one type of food every 2 days, or they may confuse the issue as to which food they are actually reacting to.
Symptoms and Signs Associated With Food Allergy
||canker sores, celiac disease, chronic diarrhea, ulcers, gastritis, irritable bowel syndrome, malabsorption, bloating, gas, ulcerative colitis, Crohn's disease, constipation
||bed-wetting, chronic bladder infections where the urine shows only white blood cells but no bacteria
||chronic infections, frequent ear infections in kids, chronic nasal drip, chronic environmental allergies, frequent colds/flus
||brain fog, fatigue, anxiety, depression, hyperactivity, inability to concentrate, insomnia, irritability, mental confusion, personality change, seizures, headaches, migraines
||bursitis, joint pain, low back pain, tendonitis
||asthma, chronic bronchitis, chronic sinusitis, itchy nose or throat
||acne, eczema, hives, itching, any skin rash, psoriasis
Door #2: Leaky Gut/Leaky Brain
There are many causes of leaky gut, which I will list below. The most important one, in my estimation, is continued consumption of reactive foods, which leads to continual inflammation in your small intestine, which causes those tight junctions between the simple columnar epithelial cells to loosen up and let antigenic substances into your bloodstream. This then is the initiating factor leading to all the possible downstream side effects from this initial insult.
Causes of leaky gut:
- Diet: alcohol, gluten, casein, processed foods, excess sugar, food allergies
- Meds: corticosteroids, antibiotics, antacids, xenobiotics
- Infections: H. pylori, bacterial overgrowth, yeast overgrowth, intestinal virus, parasitic infection
- Hormonal: decreased thyroid hormone/testosterone/estrogen/progesterone
- Stress: increased cortisol and catecholamines and CRH
- Neurologic: brain trauma, stroke, neurodegeneration
- Metabolic: glycosylated end products, intestinal inflammation, autoimmune conditions
Now, with regard to our present brain conversation, what does leaky gut lead to? Drumroll, and our winner is: leaky brain. Do you mean the brain leaks something? Yes and no. It doesn't leak any CSF out, but inflammatory products from that leaky gut compromise the blood–brain barrier (BBB) and now enter a defenseless brain and begin to activate the immune system of the brain or the microglia. So, your fire in the gut is leading to a fire in the brain. Wasn't that a Steven Seagal movie?
Next up, what do the microglia do? They destroy plaque, remove dead cells, and can overreact to these inflammatory products that don't normally enter the brain and begin to cause collateral damage and injury to brain neurons and brain degeneration. Does this sound like some of our politicians? How about many of our patients?
So, how do we begin to fix this leaky brain? What I learned in naturopathic school was, go back to the source. Fix the leaky gut! You all should know how to accomplish this task. There are many products for leaky gut, but I think you have to fix the source of the problem to achieve lasting results. This definitely includes removing any food sources that are initiating the process.
An extremely interesting article by Andrew Heyman, MD, appeared in the July 2012 Townsend Letter: "Testosterone, Cortisol, and Insulin." He makes a great point that, interestingly, the adaptogenic herbs used traditionally for the adrenal glands (ginseng, ashwagandha, and rhodiola) actually work primarily in the brain by decreasing neural inflammation and neural excitotoxicity and aid in the repair of neurons and dendrites. This was a eureka moment for me. Chronic overexcitation of the adrenal glands doesn't initially burn out the adrenal glands; it affects the BBB and thus the brain – wow! More on this next.
Cyrex Labs has a new test that allows you to assess the integrity of the BBB or the degree of leaky brain. Its Array 20 gives you a unique tool to investigate the breach of the BBB by stress, trauma, or environmental triggers, even in the absence of apparent concussion or traumatic brain injury.
Before we move on to Door #3, let's look a little deeper at gluten, as this substance is also a prime initiator of leaky gut and hence leaky brain. Also, Lou Gehrig was on the box of Wheaties and was probably a big consumer of wheat products. Did he possibly not die of ALS?
There are two main groups of proteins in gluten, called the gliadins and the glutenins. Upon digestion, the gluten proteins break down into smaller units, called peptides (also, polypeptides or peptide chains) that are made up of strings of amino acids – almost like beads on a string. One particular peptide has been shown to be harmful to celiac patients when instilled directly into the small intestine of several patients. Other peptides may be harmful, including some derived from the glutenin fraction.
When celiac patients talk about "gluten-free" or "gluten-free diets," they are actually talking about food or a diet free of the harmful peptides from wheat, rye, barley, and possibly oats. This means eliminating virtually all foods made from these grains, regardless of whether these foods contain gluten in the very strict sense.
In barley, gliadin is called hordein. In rye it's called secalin. These three proteins, gliadin, hordein, and secalin, are in a category of proteins called prolamins that are present in all the grains of the grass family. The family also includes oats, corn, rice, millet, and others. In oats the prolamin is called avenin. Avenin may cause problems in some people with gluten sensitivities because it contains some of the same problematic amino acids as the prolamins in wheat, rye, and barley, just in lower amounts.
In addition, there is also HLA-DQ, or human leukocyte antigen, which assesses the probability of developing celiac disease rather than actually diagnosing the disease itself because some people have the genes that makes them sensitive to gluten but have not developed detectable evidence of the immune reaction to gluten or have no observable symptoms yet. Here are four possibilities:
A. If positive, gluten exposure can cause phenotypic expressions of celiac disease.
B. Useful if diagnostic confusion like atypical intestinal biopsy.
C. HLA-DQ 1, 2, and 8 are predisposed to celiac, 3–7 are not.
D. HLA-DQ: positive markers 1/2/8 exist in 95% of all celiacs.
Next, many people do not have celiac disease but just non-celiac gluten sensitivity (NCGS), an ongoing immune reaction to gluten in the diet usually detected as an immune response or sensitivity against the gliadin fractions of wheat, barley, rye: gliadin, hordein, and secalin. It is an IgA, IgM, or IgG antibody response to these proteins. Thus, typical allergy skin testing will not elicit positive responses because they are testing for IgE antibodies. Gluten sensitivity also promotes an immune response that increases systemic inflammation and has been associated with a multitude of health conditions in peer-reviewed literature.
Also, there are many nonintestinal manifestations of gluten. Tissue transglutaminase (TG) is an enterocytic enzyme that digests gluten. Antibodies (tTG) can be formed against this enzyme which can destroy enterocytes and initiate leaky gut. There are subtypes of this enzyme that can be tested through Cyrex Labs Array 3. If tTG2 is positive, then it indicates that there is autoimmune damage to the intestinal mucosa. If tTG3 is positive, it indicates NCGS and some sort of skin involvement. If tTG6 is positive, it indicates NCGS and some sort of neurological involvement.
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