Identifying Early Signs of Neurodegeneration

Datis Kharrazian, DHSc, DC, MS, MNeuroSci, FACN, CNS

Based on an interview with Nancy Faass, MSW, MPH

Health care providers are currently seeing an explosion in the incidence of gluten ataxia, early dementia, Parkinson’s, and aberrant brain function with no clear diagnosis. It is vitally important that we identify symptoms of neurodegeneration at the earliest possible stage while there is still time to address them.

In integrative practice, treatment of the brain has generally emphasized “fix the metabolism and give high-quality supplements,” assuming that alone will improve brain health. However, simply giving nutritional supplements cannot repair brain degeneration, because nutrients do not cause neurons to connect. By way of example, if a patient’s arm is in a cast and the muscles atrophy, the patient will not be able to regain the strength or size of those muscles just by taking supplements; they must use the arm. Similarly, nutritional supplementation as the sole intervention has limited effect on neuroplasticity. When the brain begins to degenerate, our patients must engage in activities that make a difference in brain health.

Functional Diagnostics

The clinical examination starts the minute the appointment begins. If a patient is chronically late, for example, that is clinically diagnostic and raises a number of relevant questions:

• Why were they late?
• Did they get lost? Do they get lost all the time?
• Are they so bad with directions that someone had to drive them to the appointment?
• How long did it take them for them to fill out the new-patient forms? Did it take them three times as long as the average patient?
• How is their handwriting? Is it barely legible? Has it been declining?
• Were they able to remember important details when you took their history?
• Was their thinking disorganized? Did they constantly get lost in the timeline or backtrack?

Most people assume that these signs and symptoms are a natural part of aging. It is our task to help them realize that they should take these symptoms seriously and make the commitment to reverse brain aging.

Brain-Based Fatigue or Metabolic Fatigue? It is vital to differentiate brain-based fatigue from metabolic fatigue. Fatigue that originates in the brain results from tasks that require cognitive processing such as driving, working at the computer, or holding a focused conversation. Has the patient’s attention span been impacted? Do they need coffee to stay alert? Were they exhausted by the trip to the office or the effort required to provide their medical history? These are all signs of early neurodegeneration.

Metabolic fatigue, on the other hand, is suspected when patients feel as if they cannot get out of bed and are tired all day. Practitioners tend to blame such symptoms on food sensitivities, overburdened adrenals, or impaired endocrine function, such as an underactive thyroid. However, loss of brain endurance should raise questions about cognitive functioning, indicating the need for a focused evaluation.

Ruling Out Disease

In assessing patients with neurodegeneration, the next step is to rule out the two primary neurodegenerative disorders, dementia and Parkinson’s. If the patient does not have either of these pathologies, then we assess overall brain health. While they may not have symptoms of disease, they may still be subject to increased risk of neurological degeneration. Perhaps they cannot speak as clearly, or their coordination or balance is off. These are indicators of generalized brain degeneration rather than a specific disease pattern.

Dementia. Once we identify brain fatigue, we want to understand which areas of the brain have lost functioning. I use a questionnaire that I developed for Apex Energetics, which asks questions such as:

• Do you have loss of memory?
• Do you have difficulty finding words?
• Do you forget your keys all the time or where you put your phone?
• Do you forget phone numbers that you used to be able to remember?

These are also signs of early dementia. Most people are shocked to learn that many of these common symptoms are stage 3 on the dementia scale of the American Alzheimer’s Association. Unfortunately, the impact of dementia on a person’s life is not truly apparent until they reach stage 4. It is important to take trivial memory issues seriously and intervene if a patient’s symptoms are worsening.

Parkinson’s Disease. Patients with Parkinson’s exhibit distinctive symptoms. They typically seem disinterested and are not very interactive. They present with a masked face, have a tendency to stare and blink very little, appearing expressionless. They are not being rude. In reality, they have lost facial tone and muscle activity due to neurological changes that are early signs of Parkinson’s.

Although we associate tremors with Parkinson’s, tremors occur only in the last stages of Parkinson’s, once atrophy has occurred. Early indicators of motor impairment include walking slowly or shuffling, lack of arm swing when walking, or swinging just one arm. These patients also tend to lose good bowel function. Joint stiffness is frequently a chief complaint in Parkinson’s. Patients have shoulder or hip problems that no one is able to fix and that tend to worsen. Chiropractic care or massage for a hip or shoulder condition brings only temporary relief as the problem returns immediately, another indicator of Parkinson’s disease.

Gluten Ataxia. Another neurodegenerative disorder that is important to mention is gluten-based ataxia, which is growing in prevalence due to cross reactivity to modern wheat and certain other foods. Symptoms usually involve dizziness, balance problems, or instability. Patients with ataxia tend to get carsick or seasick fairly quickly, and they can become nauseous if there is too much movement in their visual field.

During the exam, observe them walking. Can they walk in a straight line with their arms at their sides and with their eyes closed for more than three steps? If they cannot, that is a clinical sign of ataxia. Ataxia that is not related to head trauma or degenerative disease of the brain is described as sporadic idiopathic ataxia. The most common cause of this phenomenon is gluten sensitivity. These individuals need to be checked for both gluten sensitivity and neurological antibodies to cerebellar, GAD, and other markers, for proper diagnosis.

Identifying Causal Factors

Generally speaking, the initial goal in brain treatment is to identify the mechanisms that are involved. Are any of the following disorders factors in the patient’s deteriorating brain health:

• Blood sugar imbalance (hypoglycemia, insulin resistance, or diabetes)
• Poor circulation and insufficient blood flow and oxygen delivery to the brain
• Brain inflammation
• Gut-brain axis dysfunction such as leaky gut
• A breached blood-brain barrier
• Neurological autoimmunity
• Insufficient basic nutrients and fatty acids
• Hormone imbalance
• Imbalanced neurochemistry
• Toxic exposure
• Chronic, debilitating stress
• A history of traumatic brain injury that is now starting to catch up with the patient

These are the factors that most commonly initiate neurodegeneration. For example, people with cold hands and feet typically have poor circulation and insufficient blood flow to the brain. When these individuals exercise or drink coffee, their brain function improves dramatically. Strategies to improve brain circulation include the use of botanicals, increased physical activity, and mental exercises to increase nerve connectivity. This type of approach makes it possible to intervene quite specifically with different mechanisms to slow brain degeneration.

Functional Assessment

In my practice I use a form that I developed for Apex Energetics, the Brain Function Assessment Form (BFAF), which is also available in a course I developed called Mastering Brain Chemistry. The assessment lists major symptoms specific to different areas of the brain, which helps to identify the locus of neurodegeneration. With this information, the clinician can intervene to increase activity in the area of the brain implicated, which is a basic rehabilitation concept.

© 2015 Datis Kharrazian, DHSc, MS, MNeuroSci. Why Isn’t My Brain Working? www.BrainHealthBook.com

Screening Tools. Simple screening exercises can be surprisinglyuseful in diagnostics:

• To screen patients (or yourself) quickly for brain function, give them five random words or a phone number to remember. Engage in conversation for a period of time so they are distracted. Then see if they can recall the exact words or the phone number. If they cannot, that is an early sign of dementia.
• Another exercise involves bringing the thumb and forefingers of each hand together very quickly, as fast as they can. If they are doing it slowly, that is an early clinical sign of Parkinson’s.
• As mentioned, have the patient close their eyes and try to walk in a straight line. If they cannot take more than three steps, that could be one of the early signs of cerebellar ataxia or cerebellar degenerative disease, such as gluten intolerance, which is very common.

Obviously, a more comprehensive evaluation is needed to confirm a diagnosis, but these types of exercises serve to raise a red flag.

Hands-On Experience. Every year I teach a brain dissection course at Bastyr University. Students palpate brain tissue to identify degenerative changes and correlate them with the patient’s health history. In some cases there is evidence of general overall brain degeneration; in other cases, there is brain degeneration in only one area. Surprisingly, it is rare for us to examine a brain that does not show any signs of degeneration. There is always degeneration; it is simply a matter of where and how much. The risk of dementia is now a battle that we all face, but one that most people ignore.

Advances in Lab Testing

Blood-Brain Barrier Integrity. An intact blood-brain barrier is another important aspect of brain health. We know that traumatic brain injury breaks down this barrier. Other factors that cause breaching of the blood-brain barrier include celiac disease, chronic gut inflammation, leaky gut syndrome, elevated homocysteine, and alcohol addiction. These disorders also increase one’s susceptibility to inflammatory autoimmune reactions. Consequently, anyone with brain impairment should have their markers tested to determine whether their blood-brain barrier is intact.

When the blood-brain barrier is breached, the brain’s immune cells react, producing antibodies in response. A test for these blood-brain barrier antibodies is now available through Cyrex Laboratories (Array 20), based on the work of Aristo Vojdani, PhD. Through his research, Dr. Vojdani has identified the specific protein sequence that antibodies take when the blood brain barrier is breached.

If this antibody test comes back positive, the next step is to identify the mechanism(s) causing breaching of the blood-brain barrier. Is there a history of a previous head trauma, an ongoing inflammatory condition, gluten sensitivity, or some other dynamic? As a clinician your goal is find the cause(s), and then treat it. After one to two months you will want to repeat the test again to determine whether the levels have changed. This is a clinical strategy similar to that used in the leaky gut model.

Gluten Sensitivity. Another lab test critical for people with neurological symptoms is the gluten-sensitivity panel from Cyrex, Array 3. Most clinicians are not fully aware of the enormous increase in the prevalence of gluten sensitivity and its relationship to neurodegeneration. We are now seeing many, many people with gluten ataxia.

We know that gluten antibodies can cross-react with brain tissue. When this occurs, the immune system is mistaking brain tissue for gluten, because these tissues are similar in structure. When the gluten-sensitive person consumes gluten, the immune system recognizes the gluten as an inflammatory trigger and produces antibodies that attach to gluten proteins. Once the gluten protein is broken down, the reaction stops. However, researchers have found that gluten antibodies can also attach to brain tissue, targeting it for destruction by the immune system. A specific example is the attachment of these antibodies to the protein synapsin in the cerebellum. The literature indicates that we can screen for gluten reactions in the brain by testing for antibodies to the enzyme transglutaminase 6. However, current tests for gluten sensitivity and for celiac disease typically check only transglutaminase 2, which indicates reactions in the gut. Cyrex Labs’ test for gluten sensitivity (Array 3) also measures the brain-associated marker, transglutaminase 6.

Why is it so important to measure transglutaminase 6? The majority of reactions to gluten are neurological, rather than intestinal. In fact, recent research has found that two-thirds of the individuals who have an immune reaction to gluten have no gastrointestinal symptoms. Researchers hypothesize that gluten sensitivity is more of an immunological disease of the brain than a disorder of the intestine. Although gastroenterologists were the first to report gluten reactivity, the majority of gluten reactions take place in the brain.

The theory is that hybridized wheat, which researchers describe as “modern wheat,” causes this reactivity. This is not to be confused with GMO wheat. Compared to native wheat, hybridized wheat is more protein dense, contains approximately 500 times more gluten, and includes proteins that are new to humanity. Research has found that some with these sensitivities patients react to hybridized wheat, but not native wheat. We also know that pesticides bind to the proteins of the wheat, changing the very nature of the proteins.

A study published in 2010 evaluated blood samples from 50,000 air force personnel that had been collected and frozen 50 years previously. These blood bank samples were compared with 10,000 gender-matched, age-controlled samples from air force personnel taken at the time of the study. The results showed a dramatic increase in gluten sensitivity and celiac disease. This finding is not an anomaly. The theory is that the hybridization of wheat and the binding of wheat proteins with pesticides explain the rise in immune reactivity.

Furthermore, gluten immune reactivity can also trigger molecular mimicry in the brain, a condition in which the immune system mistakes brain tissue for gluten, attacking the brain when gluten is consumed. Consequently, modern wheat can also cause massive inflammatory reactions in brain tissue and initiate neurological autoimmunity in some individuals, with devastating consequences.

Autoimmune Reactivity. Currently, the most common impairment in brain function associated with gluten sensitivity is cerebellar ataxia. In some cases, patients with sporadic ataxia and gluten sensitivity show dramatic improvement once they eliminate gluten. However, other patients do not improve, which has motivated additional research. Working in collaboration with Dr. Aristo Vojdani, we performed detailed testing for molecular mimicry in the cerebellum. To further study gluten sensitivity, we obtained monoclonal antibodies for different target sites in the cerebellum, such as GAD 65 and GAD 66. The defining characteristic of a monoclonal antibody is that it will only attach to a single antigen, unless the new protein is almost identical, referred to as molecular mimicry.

We then processed 220 foods, extracted the pure protein, and tested those foods to explore the hypothesis that other foods in addition to wheat can cross-react with tissue in the cerebellum. We identified approximately 40 foods that can cross-react with the cerebellum just as gluten does. Not everyone has antibodies to these 40 foods. However, some of this reactivity is quite common. For example, we found that peanuts can bind to cerebellum tissue. If one has a sensitivity to peanuts, antibodies could be elevated by the exposure. The antibodies attach to cerebellum target sites, which can result in cerebellum degeneration. We also found that in sensitive individuals, this type of reactivity can occur with other common foods as well, such as mustard seeds, the primary ingredient in mustard.

This understanding is changing the way we treat these issues clinically. We now perform routine testing for cross-reactive foods for all patients who have neurodegeneration. Just recently a patient was found to react to one of these cross-reactive foods, and when it was removed from the diet, that made a significant difference.

Once someone begins to develop autoimmune symptoms, particularly in the brain, other immune reactions can occur as well. The process involves more than just gluten as a trigger of neurodegenerative changes. Array 10 from Cyrex serves as a comprehensive food allergy test to evaluate patients for cross-reactivity.

Rehabilitation

When practitioners learn and apply these simple strategies, we see life transformations take place. Strategies to modulate the immune system and support brain health include:

• The use of botanicals to increase blood flow to the brain

• Taking flavonoids to reduce neuroinflammation

• Consistently stabilizing blood sugar levels

• Removing food items from the diet that trigger sensitivity

Exercise. The single most important intervention to slow brain degeneration is, quite simply, exercise. A few minutes of physical exercise each day changes the chemistry of the brain profoundly. As little as four minutes of high intensity exercise daily raises the heart rate, dramatically increasing BDNF (brain-derived neurotrophic factor). This is a neurochemical that enables neurons to connect, increasing neuroplasticity. Simply jumping rope or running for ten minutes can have a profound effect, reducing the risk of dementia and saving the brain.

Sleep. Getting adequate sleep can also prevent brain atrophy. This is another very general, practical step we all can take to protect our brains.

Nutrients. Good nutrition and dietary factors create a more optimum environment for plasticity.

Sensory-Based Therapies. To maintain neuroplasticity, one must activate neurons through stimulation. When we recommend yoga, massage, manipulation, or biofeedback, these therapies are effective in part because they activate different receptors in the body, whether those are muscle spindles or Golgi tendons. When these receptors are activated, they fire to neurons in the brain, and as a result, promote neuroplasticity. Thus sensory-based treatments can have a beneficial impact on brain health.

However, to achieve the desired improvement, it is important to match the therapy to the area of function that needs support. It is not uncommon for a patient who has, for example, temporal lobe olfactory degeneration to benefit from aroma therapy. The patient may have a phenomenal outcome and refer friends to aroma therapy. However, if their friends have no functional degeneration in the olfactory region of the brain, the therapy may have no effect.

Mental Stimulation. Ultimately, the most effective therapy is a combination of physical receptor-based treatments (for example, yoga or massage) and other forms of stimulation. At the end of the day it is a matter of being both physically active and stimulating cognitive functions, to be both a scholar and an athlete. In addition to exercise, this could mean reading, performing arts, or painting. The goal is to achieve a receptor effect in the brain that goes beyond the effect of nutritional supplements alone. In the past we thought taking fish oil was enough to improve brain health. It is not.

Addressing Loss of Function. Treatment is a matter of understanding brain function and knowing which therapy activates the areas of the brain that most need intervention. The basic concept is “Whatever you cannot do, do that.” If the patient is bad at math, then have them do math puzzle games. If they are really bad at drawing, then have them draw. If the patient’s handwriting is terrible, they should work on their handwriting. That is the simplest way to teach this strategy without getting too complicated. When the patient’s handwriting is deteriorating, the areas of the brain that exert motor control are degenerating. When they lose the ability to do math, their left frontal cortex is degenerating. When they lose their sense of direction, their parietal temporal lobe is degenerating. When they can no longer walk down a flight of stairs without holding the handrail, the cerebellum is degenerating. This is not a personality issue, it is not a matter of aging, it is neurodegeneration. This is not something we should get used to. We need to take these symptoms seriously.

Insight for Health Care Practitioners

I see practitioners who attend every seminar, constantly studying in order to help their patients, but that is only half of the equation. The other side of that issue is retaining all that information, which depends on brain health. Health care practitioners have to remember they are only as good as their brain function. Once brain function begins to deteriorate, it does not matter how many degrees they have or how much education they have; they are not going to be able to serve their patients.

We all lose neurons every year but we can still maintain a high level of function if keep our brains active through physical and mental exercise. If we do not take brain health seriously, and we do not have sufficient neuroplasticity, then we begin to lose physical or cognitive skills, memory, or balance.

Once practitioners become educated about the prevalence of early-onset dementia, they realize how much trouble they could be in. They see that the symptoms they have neglected in themselves could be quite serious. If practitioners do not save their own brains, no one else is going to. When we teach the course we say, “We know you’re here for your patients, but we really want this course to be about you.”

DATIS KHARRAZIAN, DHSc, DC, MS, MNeuroSci, FACN, DACBN, DACNB, CNS

Dr. Kharrazian works as a clinician, researcher, professor, industry consultant, and author striving to incorporate the most up-to-date, evidence-based concepts into clinical practice and to investigate unanswered clinical questions through his research. He serves as associate clinical professor for the Department of Preventive Medicine at Loma Linda University School of Medicine, and adjunct professor at the National University of Health Sciences and at Bastyr University. A faculty member of the Institute for Functional Medicine (IFM), he participates in program development for IFM. He has also served as a trainer and educator in functional medicine and nutrition, having personally trained several thousand health care providers in post-graduate seminars over the last 15 years. Dr. Kharrazian recently completed a post-doctorate clinical research scholar program at Harvard Medical School. He has published scientific papers in the fields of nutrition, autoimmunity, and toxicology, and is involved in research on autoimmune molecular mimicry and environmentally induced immune reactivity. In his private practice he sees patients seeking non-pharmaceutical alternatives to manage chronic conditions through diet, nutrition, and lifestyle applications. His practice has up to a one-year waiting list and is limited to patients suffering from chronic health conditions. As a researcher and clinician, Dr. Kharrazian shares his clinical model in his two best-selling books, Why Do I Still Have Thyroid Symptoms When My Lab Test Are Normal? and Why Isn’t My Brain Working?

RESOURCES

Book. Why Isn’t My Brain Working? This highly readable book is appropriate for both consumers and professionals. A comprehensive resource, the book contains 21 chapters, each focused on a different mechanism that can impact brain degeneration and cause neurological symptoms. The work is 587 pages, with more than a thousand references, and includes case histories, clear explanations, and clinical action steps. A copy of the book’s table of contents and associated resources are available online at www.BrainHealthBook.com and on Amazon.com.

Online Course for Consumers. This course, entitled One-to-One: Save Your Brain—A Six-Week Rescue Plan, will take viewers through the same steps Dr. Kharrazian takes with his patients to begin repairing brain health and function. To get on a waiting list for this online class, visit www.DrKNews.com/one-to-one.

Course on Functional Neurology. A 20-hour course on neurology will be offered this year by the International Association of Functional Neurology and Rehabilitation. The course will cover neurological exams, selection and interpretation of lab work, and the development of individualized plans for brain rehabilitation. Live case histories on video are included, with before and after interviews, and clinical specifics such as lab work. Additional information will be posted on the association’s website at: www.iafnr.org.

Course on Neurochemistry. Apex Seminars offers a course designed by Dr. Kharrazian, Mastering Brain Chemistry, available to licensed health care professionals. The course is approved by the University of Bridgeport and provides CEUs for acupuncturists, chiropractors, naturopaths, nutritionists, and nurses (but not currently CME units). For further information, see: www.ApexSeminars.com.

Laboratory Testing. Cyrex Laboratories, located in Phoenix, AZ, offers a series of test panels for the detection of gluten sensitivity (Array 3), cross reactivity (Array 4), autoimmune mechanisms (Arrays 5, 7, and 8), and blood-brain barrier integrity (Array 20). Descriptions of Cyrex tests and arrays can be found at www.CyrexLabs.com.

Special Thanks. Technical support was provided by Jerry Stine, CNC, of Lifespan Institute, available at 707-399-9171.

Editorial—Nancy Faass, MSW, MPH. A writer and editor in San Francisco, Ms. Faass has worked on the development, writing, and editing of more than 45 books. Director of the Health Writers’ Group, she also works collaboratively on articles, white papers, and writing for the Web and can be reached at info@HealthWritersGroup.com .