Tag Archives: Neurological Disorders

Anxiety or Depression? Test the levels of your neurotransmitters to guide therapy.

Depression

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Happy New Year!  A new era began at the Vreeland Clinic on January 1st this year.  Dr. Carrie and I would like to thank all of our friends and family for their well wishes.  We looked forward to continuing to serve the community for years to come!

Today I’d like to touch on something that has revolutionized the way I practice.

People come to me for many reasons.  Some people come to my clinic for weight loss or to get more energy.  Others for help with a chronic condition that hasn’t responded to traditional care.  Still others come to see me for a wide range of neurologic conditions.  These include things like Parkinson’s disease, multiple sclerosis, depression or anxiety.  It is the last two that I’d like to focus on today.

Anxiety and depression are extremely common in America.  Millions of Americans suffer from anxiety, depression or both.  These conditions may have many etiologies but one theory is a chemical imbalance in the brain.

Just what is this chemical imbalance?  When someone states that they have a chemical imbalance they are referring to an imbalance in the neurotransmitter system of the brain.  These neurotransmitters are really just proteins that each nerve in the brain uses to communicate with its neighbors.  Sometimes people can have too little of a certain neurotransmitter or too much of another.  This is problematic because it alters the way the brain functions.  It may cause anxiety and/or depression.

The pharmaceutical industry has figured that out and makes a large class of drugs that alters neurotransmitter function in the brain.  These are drugs like Prozac, Zoloft, Wellbutrin and Lorazepam to name a few.

Neurotransmitters are broken down into two categories – they are either excitatory or inhibitory.  That means they either tell the brain to go or tell the brain to stop.  The complexities of the neurotransmitter system are extensive and there is much more to it than “go” and “stop” but that basic principle holds true in most cases.

Examples of neurotransmitters include serotonin, GABA, epinephrine, norepinephrine, glutamate and dopamine.  Serotonin and GABA are inhibitory while epinephrine, norepinephrine, glutamate and dopamine are excitatory.

If you have anxiety and depression often times an imbalance exists in the levels of these neurotransmitters.

For example, high levels of glutamate may cause anxiety or seizures.  Low levels of GABA may cause anxiety.  Low levels of serotonin may cause depression.  Same goes for norepinephrine.

So how do you tell which neurotransmitters are low or which are too high?

Measuring Neurotransmitters

Measuring your neurotransmitters with a urine test is the best way to estimate your levels of neurotransmitters.  We do this routinely in our office for many patients.  It is incredibly insightful and directs our care for patients with anxiety, depression and many other conditions.

The measurement of neurotransmitters in the urine has been around for many years.  I’ve read studies dating to the 1960′s of scientists using similar methods to evaluate neurotransmitter levels.

Until relatively recently, perhaps the last 10-15 years, it has not been used frequently in clinical practice.  Now, through specialized laboratories, it is available to the general public and it is very affordable.

The knock on urinary neurotransmitter testing is that it does not correlate with brain levels of these hormones because the urine test is in fact testing whole body levels of neurotransmitters.

The very neurotransmitters that exist in our brain to make us happy exist outside the brain to serve the body in other ways.  So, yes, it is true that checking urinary neurotransmitter levels is technically a check of the entire body’s store of neurotransmitters.  But, through hundreds of thousands of tests these specialized labs have shown with high correlation that when neurotransmitter levels are abnormal certain psychiatric and neurological conditions are much more common.

Clinically, I have seen an almost one to one correlation in my patients with certain conditions an alteration in their neurotransmitter system.

The lab that I use will test all of the basic neurotransmitters plus a slew of metabolites of these neurotransmitters.  It provides a wonderful window into the neurological system.

If I find that serotonin is low, I supplement with something called 5-HTP.  If dopamine is low, I like to use L-tyrosine or an herb called mucuna pruriens.  The list can go on and on.

Once someone has been on a program for 6-8 weeks we recheck their neurotransmitter profile to gauge our therapy and adjust it if necessary.  We find that once a person’s profile returns to normal, their symptoms resolve.

If you have anxiety or depression, consider seeking out someone who does this kind of testing to improve your outcomes.  The brain is incredibly complex.  It never hurts to have a little extra information to guide your therapy.

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Reducing Your Risk of Alzheimer’s Disease Naturally

PET scan of a human brain with Alzheimer's disease

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As of next year the first of the baby boomers will reach 65 years old and by 2029 all of them will be at least 65.  This is significant because as we age certain diseases become more and more prominent.  One of them is Alzheimer’s disease.  This disease robs people of the faculties much too soon and causes heartache and financial hardship for families across the US.

Just How Big Is The Problem?

About 24 million people worldwide are known to be affected with dementia. This number is expected to balloon to 84 million by the year 2040.  These numbers include all forms of dementia, but up to 80% of dementia is caused by Alzheimer’s disease (AD).  In the US alone 5.3 million American’s have Alzheimer’s Disease and 96% of them are over the age of 65.  In just five years the number of Americans with Alzheimer’s will jump to 7.7 million and by 2050 the number is projected to more than double to 16 million.  The numbers truly are staggering.  As a matter of fact, AD has recently passed diabetes, yes diabetes, as the 6th most common cause of death in the US.  As our population continues to grow older because people are living longer, the problem is likely to get worse.  Current statistics show that just over 50% of people who are over 85 will go on to develop AD.

AD is also a very expensive problem for the United States.  In 2005, total Medicare spending was $91 billion and the total US cost was $172 billion for AD.  AD patients make up roughly 13% of Medicare enrollees but account for more than 1/3 of its spending.  The problem will only grow as our population ages.

So What Can I Do To Reduce My Risk?

The best way to treat AD is to prevent it in the first place.  There is very good research behind several nutritional supplements that can significantly reduce your risk of developing dementia as you age.

Vitamin E

Here’s what one study found on vitamin E:

“Among MCI-AD patients, the longitudinal decrease in cellular vitamin E was associated with the deterioration in cognitive performance. These results suggest that accumulation of oxidative damage may start in pre-symptomatic phases of AD pathology and that progression to AD might be related to depletion of antioxidant defenses.”

-J Alzheimers Dis. 2010 Aug 6.

So what does that mean.  Basically what this study found was that among patients who has mild cognitive impairment (MCI) or AD, people with the lowest levels of vitamin E had poorest performance on mental testing.  Oxidative damage is the process by which our brain tissue is broken down in AD.  Vitamin E helps fight this process.

Another study concluded:

“In conclusion, high plasma levels of vitamin E are associated with a reduced risk of AD in advanced age. The neuroprotective effect of vitamin E seems to be related to the combination of different forms, rather than to alpha-tocopherol alone.”

-J Alzheimers Dis. 2010;20(4):1029-37.

This is saying that higher levels of vitamin E in the blood were associated with a significant reduction in AD with advanced age.  It also says that when taking vitamin E you should be taking a combination of forms, not a singular type.  When you look at the back of your vitamin E supplement be sure that it says ‘mixed tocopherols.”  That will provide you with the most benefit.

Vitamin D

Vitamin D is the supplement of the hour right now.  It is being studied by everyone and just about everyone has found that it is critically important for overall health.  New research also shows it helps prevent AD.

“Vitamin D insufficiency and deficiency was associated with all-cause dementia, Alzheimer disease, stroke (with and without dementia symptoms), and MRI indicators of cerebrovascular disease. These findings suggest a potential vasculoprotective role of vitamin D.”

-Neurology. 2010 Jan 5;74(1):18-26. Epub 2009 Nov 25

This study is telling us that vitamin D insufficiency and deficiency was associated with higher risk for dementia and AD.  What this means is that even having levels that are slightly decreased (insufficiency) are associated with higher risk.  Keeping vitamin D levels up not only is important for bone health, cancer reduction and fall prevention but also reduces your risk of AD.  Pretty amazing stuff.

Another study on vitamin D found that:

“Clinical data suggest that vitamin D insufficiency is associated with an increased risk of several CNS diseases, including multiple sclerosis, Alzheimer’s and Parkinson’s disease, seasonal affective disorder and schizophrenia.  Overall, imbalances in the calcipherol system appear to cause abnormal function, including premature aging, of the CNS.”

- Psychoneuroendocrinology. 2009 Dec;34 Suppl 1:S278-86

This study is particularly interesting in that it shows that low vitamin D levels are associated with an increased risk of several CNS or central nervous system diseases including AD.  It also concluded that imbalances in the calcipherol, or vitamin D, system causes premature aging of the brain and central nervous system.  Why is this problematic?  Remember, the number one risk factor for AD is aging.  If we can slow this process, particularly in the brain, we can slow the onset of AD.  Vitamin D can do this for you.

Omega-3 Fatty Acids (Fish Oil)

“A plethora of in vitro, animal model, and human data, gathered over the past decade, highlight the important role DHA may play in the development of a variety of neurological and psychiatric disorders, including AD. Cross sectional and prospective cohort data have demonstrated that reduced dietary intake or low brain levels of DHA are associated with accelerated cognitive decline or the development of incipient dementia, including AD.”

-Clin Interv Aging. 2010 Apr 7;5:45-61.

DHA is a particular form of omega-3 fatty acid or fish oil.  This study concluded that low intake of this particular fatty acid or low brain levels of it are associated with cognitive decline and accelerated development of AD.  This is of particular interest because of all of the wonderful other benefits that omega-3′s give us.  You can prevent or reduce the risk of many other diseases simply by supplementing with fish oil.

There was this study as well:

“Plasma DHA was associated with slower decline on BVRT (Benton Visual Retention Test) performances in ApoE-epsilon4 carriers only. EPA and DHA may contribute to delaying decline in visual working memory in ApoE-epsilon4 carriers.”

-Neurobiol Aging. 2010 Jun 4.

This study was done on people who have the gene that is linked to an increased risk of AD.  What it concluded was very exciting.  Basically it found that the higher the omega-3 DHA was in the plasma the slower the decline in memory in people that were genetically predisposed to getting AD.  That’s wonderful news!  Many people think that their genetics are their destiny, but this study showed otherwise.

In Summary

This is just the tip of the iceberg in terms of research that is available on how to combat and reduce your risk of developing AD.  What we did not touch on in this article is that keeping your heart healthy and controlling your blood sugar is of utmost importance.  Do those things and take the supplements listed above and you can significantly reduce your risk of Alzheimer’s disease.

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