Tag Archives: functional neurology

Your 4 year old needs Ritalin Part II

Ritalin Methylphenidat

Yesterday I wrote about how the American Academy of Pediatrics has changed the guidelines about how young (and old) a child could be diagnosed with ADHD. The new guidelines say that a child as young as 4 and as old as 18 may now be diagnosed with ADHD.

They went on to say that Ritalin and other drugs are good choices for treatment even for the youngest patients. To me this sounds like a terrible idea.

So what are some effective alternatives?

First and foremost, we must look at a child’s diet.  A healthy diet is a big key to helping a child regulate his brain function.  The problem in ADHD is that circuits in the brain that are responsible for attention, focus and other executive functions are under active.  That is precisely why most of the medications that exist are stimulants.  These stimulants speed up the processing in these brain regions and allow the child to function more normally.  The problem is that they carry serious side effect profiles, some of them very dangerous.

So where, exactly, does diet fit into this? Good question. First, each and every child must begin the day with breakfast. Food provides the fuel that the brain uses to do its job!  If there isn’t enough of the right kind of fuel, the child’s brain cannot function as well as it should.

And what is the right kind of food? Each child should begin the day with a source of protein and a little healthy sugar in the form of fruit.  This will provide ample amounts of fuel so your child can make it until his next meal at lunch.  Do not allow a child to eat sugary cereals or pop tarts or to skip breakfast.  Those types of fuel (or lack thereof) only set the child up for a crash in blood sugar which deprives the brain of the vital energy it needs.

The rest of the day should be roughly the same.  Be sure that your child eats protein and a fruit or vegetable every time he eats. Steer them away from sugary snacks and drinks.  They have a negative impact on brain function.

Balancing Neurotransmitters

A natural program to balance neurotransmitters in the brain is important. Neurotransmitters are specialized proteins that each nerve in the brain uses to communicate with its neighbors. The balance of them is important.  In ADHD the focus has been on the neurotransmitters called dopamine and norepineprhine.  Others, however, may play a role and include GABA, glutamate, PEA and serotonin to name a few.

The levels of these neurotransmitters in the brain is important.  Levels that are too high or too low can cause the brain to function less than optimally.  In my office we measure these neurotransmitters in a urine test and have found them very helpful clinically.  If we find levels that are low, we can supplement to raise them.  For example, dopamine is raised by increasing dietary levels of tyrosine (or its derivatives) and serotonin is raised by increasing dietary levels of tryptophan (or its derivatives).  The process is relatively simple, but it is very effective. Through this process we are able to rebalance the neurotransmitter system and see improvements in behavior and attention.

Reprogram the brain

This sounds very much like something out of a science fiction movie, but it is all based in neurology.  In ADHD the brain is wired incorrectly.  The circuits that we want to work are not efficient enough to produce balanced brain function.  To change this we must provide a program of neurologic rehabilitation.  It can be done many ways, but in our office we use a combination of home exercises that include eye exercises, balance exercises, light and sound therapy and proprioceptive feedback with an in-offfice therapy called interactive metronome or IM.

IM was developed in the early 1990s and is used to help children with learning and developmental disorders as well as adult neuro rehabilitation patients. IM is a neuro-motor assessment & treatment tool used in therapy to improve the neurological processes of motor planning and sequencing.

The IM program provides a structured, goal-oriented process that challenges the patient to synchronize a range of hand and foot exercises to a precise computer-generated reference tone heard through headphones. The patient attempts to match the rhythmic beat with repetitive motor actions. A patented auditory-visual guidance system provides immediate feedback measured in milliseconds, and a score is provided.

Over the course of the treatment, patients learn to:

  • Focus and attend for longer periods of time
  • Increase physical endurance and stamina
  • Filter out internal and external distractions
  • Improve ability to monitor mental and physical actions as they are occurring
  • Progressively improve coordinated performance.

I’ve used this program with many children and adults in my office and it works exceptionally well.  It is a great option for patients who have been diagnosed with ADHD and other learning disorders.

There are many options for parents with children with ADHD.  Medications are of course one of them, but there is no permanent benefit to taking them.  As a matter of fact, 50% of children who take medications will still need them as adults.  Rewiring the brain, dietary changes and rebalancing neurotransmitters has lasting and permanent effects.  In my opinion, it’s the best way to go.

Advertisements

Leave a comment

Filed under Brain Health

What’s that sound?

This is a transaxial slice of the brain of a 5...

Image via Wikipedia

Tinnitus, or ringing in the ears, is an exceptionally common problem.  As many as 2 million Americans experience this on a daily basis.  It can range from very minor to annoying to debilitating.

Tinnitus is often associated with hearing loss.  Prolonged exposure to loud noises is the most common cause of hearing loss.  It is this loss of hearing that is actually causing the tinnitus.  Say what? Hearing loss actually causes people to hear sounds that don’t really exist? Yes!

People often describe tinnitus as ringing in the ears.  However, the list of sounds that are considered tinnitus is very long.  Other sounds that people might perceive include ticking, clicking, whooshing and buzzing to name a few.

Recent research, published online in the journal Proceedings of the National Academy of Sciences, suggest several new approaches to treatment, including retraining the brain, and new avenues for developing drugs to suppress the ringing.

As a chiropractic neurologist the above statement about retraining the brain got my attention.  This is something that is near and dear to the heart of all chiropractic neurologists.  We use techniques that retrain the brain every day.  We use these techniques to help people with a wide variety of conditions ranging from anxiety to muscular imbalances and pain.

Traditionally, patients with tinnitus are told the problem stems from damaged hair cells inside of the ear.  They are told it is these hair cells that are sending the wrong signals into the brain which interprets them as noise. Turns out, this is not true.

Because each hair cell is tuned to a different frequency, damaged or lost cells leave a gap in hearing, typically a specific frequency and anything higher in pitch.  It is this gap which causes problems for the brain.

Chiropractic neurologists have been saying for a very long time that ringing in the ears is actually brain based.  This new research supports this assertion. Below is information from coauthor of the recent study Shaowen Bao, adjunct assistant professor in the Helen Wills Neuroscience Institute at UC Berkeley

Experiments in the past few years have shown that the ringing doesn’t originate in the inner ear, though, but rather in regions of the brain — including the auditory cortex — that receives input from the ear.

Bao’s experiments in rats with induced hearing loss explain why the neurons in the auditory cortex generate these phantom perceptions. They showed that neurons that have lost sensory input from the ear become more excitable and fire spontaneously, primarily because these nerves have “homeostatic” mechanisms to keep their overall firing rate constant no matter what.

“With the loss of hearing, you have phantom sounds,” said Bao, who himself has tinnitus. In this respect, tinnitus resembles phantom limb pain experienced by many amputees. (From sciencedaily.com)

The neurons that have lost sensory input in the brain are the neurons that are responsible for the perceived noise that people hear.  These neurons have undergone a process called transneural degeneration.  To stabilize these neurons they need more input.  But because they cannot receive it from the hair cells in the ear that are damaged, other areas of the auditory cortex must take over.  This retraining of the brain takes time, but if performed diligently, the results can be phenomenal.

We know this is a possibility because the brain is plastic.  That is, it changes in response to the stress and environmental input it receives. When a finger is amputated, for example, the region of the brain receiving input from that finger may start handling input from neighboring fingers.

Drug therapy is aimed at increasing the levels of the neurotransmitter GABA in the brain.  GABA is the primary inhibitory neurotransmitter.  In order to slow down the firing rate of these over excited cells, we must increase the levels of this inhibitory neurotransmitter.  The good news is there are lots of natural therapies that work to raise GABA levels or drive GABA receptors in the brain.

One way is to use the amino acid taurine.  I use it frequently.  Another is a product called phenibut (Phen-i-bute).  It is a natural GABA derivative that crosses the blood brain barrier and binds to GABA receptors.  I also use this frequently in my practice. These supplements, however, I believe are temporary solutions.  The permanent solution is to retrain the brain.

Tinnitus is a complicated and elusive condition, but we appear to be headed in the right direction in terms of research.  Always remember, the brain holds the key!

4 Comments

Filed under Brain Health

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

Depression

Image via Wikipedia

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.

10 Comments

Filed under Brain Health

How to get better brain function!

In the study of neurology, there are many theories and formulas that can be applied in order to better help our understanding of how we as humans experience the world around us.  Scientists, researchers and other doctors break them down, analyze them and apply them to different areas of the brain, mostly for academic value.  That is extremely valuable, especially for me as a functional neurologist.  While helpful for me, this is usually not the case for many of you.  One of the most common questions I get is “How can I better understand the way my brain functions so I can feel better?”

There is one principle that applies to the entire brain that is very easy to understand and is indispensable for me when considering my treatments.  It is also very simple; input equals output.  That’s it.  And it really is as simple as it sounds.

Our brains are completely dependent upon the input coming in from all around us to generate its output.  Let me give you a simple example of correct input resulting in correct output and then just the opposite.  Picture yourself at a restaurant and you are ordering a wonderful organic, grass-fed New York strip steak.  When you place your order the waiter asks, “How would you like that done?”  You reply, “Medium, please.”  You responded appropriately because the input (the waiter’s question) was interpreted by your brain correctly and it quickly formed the correct output (your response to his question).  But what if the scenario unfolded as follows; the waiter asks the same question, but you hear, “Would you like a bun?”  You might reply, “No thank you,” but of course the waiter would look at you funny because that is not the answer to his question.  The problem in the second scenario is that the input was interpreted incorrectly, so your brain had no choice but to formulate incorrect output.

This is a very simple set of circumstances, but in fact, this is happening millions of times per day in our own brains.  And input comes from everywhere!  Input comes from the outside world in the form of hearing, sight, touch, taste and smell among others.  This is called external input.  Input is also internally generated.  This input comes from within the brain from other circuits that communicate with each other to maintain the high output of the human brain.

Both internally and externally generated input is critical.  In functional neurology, we use a combination of these two inputs to change the way the brain fires.  First we establish where the problem is.  A person might say they have headaches, high blood pressure or depression, all of which could be from aberrant output of the brain.  The symptoms are being caused from this aberrant output, but as illustrated earlier, the brain is actually just responding or interpreting the input it is receiving incorrectly.  Once we discover the part of the brain that is not working correctly, we recommend specific exercises to retrain the brain.

It is through these corrective exercises that we are able to change the input, which changes the output and reduces the symptoms of many conditions.  It is a cutting edge treatment for many conditions and is gaining momentum as research mounts on brain function.

2 Comments

Filed under Brain Health