Download Dan Kalish 4.22.16 Neurotransmitter Assessment and Treatment

Neurotransmitter Assessment and Treatment
Dr. Daniel Kalish
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INTRODUCTION
•
24 years of patient experience,
with over thousands of patients
world wide
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Trained over 1,000 practitioners in
The Kalish Method of functional
medicine
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2 years monastic training in Japan
and Thailand
WHY MENTORING & TEACHING
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Was trained by naturopaths, DC’s and MD’s and have integrated
this information for ease of use by today’s clinicians
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Working to pass on my clinical training to the next generation of
functional medicine doctors
LEARNING OBJECTIVES
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Understanding neurotransmitters and neurotransmission
How production of neurotransmitters can be determined with Organic
Acids testing
How to detect if inflammatory conditions are creating neurotransmitter
related conditions
Treatment options for correcting neurotransmitter imbalances
CORRECT BODY SYSTEMS IN ORDER THAT PROBLEMS OCCUR
Neuroendocrine
System
• Amino acid
replacement
• NT support
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Healing diet
Exercise
Sleep
Meditation
Detox
GI System
• Treat leaky gut
• Probiotics
• Enzymes
• Support liver cells
• Further improve detox
HEALING THE BRAIN
Neuroendocrine
System
Dysfunction
Three Types of Brain Issues
• Deficiency
• Neuron Damage
• Genetics
Decreased immune response
GI System:
GI pathogen acquired,
food intolerances,
leaky gut
Detoxification
System
TOXINS
SYNTHESIS & STORAGE OF NEUROTRANSMITTERS
INACTIVATION OF NEUROTRANSMITTERS
ORGANIC ACIDS TEST
• Evaluates neurotransmitters relating to: energy levels, response to stress,
mood, sleep patterns and weight regulation
• Just like we determine the efficiency of a car’s engine by measuring the
exhaust, we measure the function of these neurotransmitters by measuring
their metabolites, or breakdown products, in urine
• Baseline testing of actual neurotransmitters in urine reflects kidney production
and is not directly related to brain production
ORGANIC ACIDS TEST
The Stress Neurotransmitters: Norepinephrine, Epinephrine, and Dopamine
When we encounter a stressor, our body produces norepinephrine and
epinephrine that stimulate our “fight or flight” or stress response. The by-product in
urine is vanilmandelate (VMA). Dopamine is also involved in the stress response
as well as in memory, movement and mood, and its by-product is homovanillate
(HVA).
PRODUCTION RELATED MARKERS
NEUROTRANSMITTER METABOLISM
MARKERS: VANILMANDELATE
product of both epinephrine and nor
Low Vanilmandelate: VMA is a breakdown
epinephrine. Low levels may indicate that these products are no longer being
made.
Can be caused by:
• Sluggish MAO/COMT fx
from polymorphisms
• Stress
• Low protein consumption
• Poor protein absorption
Symptoms: fatigue, anxiety,
sleep disturbances and
depression
NEUROTRANSMITTER METABOLISM
MARKERS: VANILMANDELATE
High Vanilmandelate: VMA is a breakdown product of both epinephrine and
norepinephrine. High levels indicate a high turnover and over activation of the
nervous system. Phenylalanine and tyrosine are the precursors. Can be caused by:
• Internal stressors
• External stressors Symptoms: headaches,
anxiety, sleep
disturbances, muscle
aches, GI disturbances,
high blood pressure
NEUROTRANSMITTER AND METABOLISM MARKERS
NEUROTRANSMITTER METABOLISM MARKERS:
HOMOVANILLATE
Low Homovanillate: is a breakdown product of dopamine, our excitatory
neurotransmitter, amino acid precursors are phenylalanine and tyrosine
Can be caused by:
• Sluggish MAO/COMT function due to
Polymorphisms or simply decreased fx
• Long term antidepressant usage
• Amino acid deficiency
• Adrenal/HPA axis issues
• Poor absorption / missing co-factors
Symptoms: profound fatigue or physical exhaustion, difficulty concentrating,
compulsive behaviors, loss of satisfaction, addictions, cravings, need for
sensation seeking behaviors, food compulsions and has also been linked to
Restless Leg Syndrome and ADHD
NEUROTRANSMITTER METABOLISM
MARKERS: HOMOVANILLATE
High Homovanillate: The breakdown of dopamine
Can be caused by:
• internal stressors
• external stressors
NEUROTRANSMITTER AND METABOLISM MARKERS
NEUROTRANSMITTER METABOLISM
MARKERS: HYDROXYINDOLEACETATE
High 5-Hydroxyindoleacetate: is a breakdown product of serotonin a
calming neurotransmitter, controls mood, behavior, appetite, sleep and bowel
contractions. If 5-HIA is high it indicates higher than normal turnover of
serotonin with potential depletion of tryptophan. Can be caused by:
• SSRI usage
• Stress
• Sluggish MAO function
NEUROTRANSMITTER METABOLISM
MARKERS: HYDROXYINDOLEACETATE
Low Hydroxyindoleacetate: is a breakdown
product of serotonin. Low levels
may indicate inadequate production of serotonin. Can be caused by:
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Adrenal exhaustion
Antidepressant usage
Amino acid deficiency
Poor absorption and/or missing cofactors
Symptoms: depression, anxiety, panic attacks, insomnia, digestive imbalances,
constipation and chronic pain
NEUROTRANSMITTER METABOLISM MARKERS INFLAMMATION RELATED MARKERS
NEUROTRANSMITTER METABOLISM
MARKERS: KYNURENATE
High Kynurenate- abnormal levels can have direct effect on brain
function in addition for showing a need for vitamin B6
Can be caused by:
• Inflammatory diseases
• Pathogen defense
• B6 deficiency
NEUROTRANSMITTER METABOLISM
MARKERS: QUINOLINATE
High Quinolinate: When levels are high it can make you feel flulike due
to its neurotoxic effects, achey, tired…
Can be caused by:
• Inflammatory process induced by immune system
• Increased oxidative stress
• Viral, parasitic, fungal or bacterial infection
• Gastrointestinal fungal or bacterial overgrowth
• Autoimmune disorders
• IBS
Symptoms: Insomnia,
irritability and nervousness
NEUROTRANSMITTER METABOLISM
MARKERS: PICOLINATE
High Picolinate:
Can be caused by:
• Chronic inflammation
• High protein intake
Low Picolinate:
Can be caused by:
• Excessively high fish oil
intake
SECOND TIER OF OAT- MICRONUTRIENTS
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Organic acids test shows micronutrient depletion and can reveal
micronutrient deficiencies:
• Depleting B6/B12/Folate leading to methylation problems
• Depleting sulfur amino acids leading to liver detox phase 2 as well as
catecholamine imbalances
• Depleting antioxidants leading to oxidative stress being placed on
DNA, energy production
• Depleting of good bacteria and imbalance of flora in GI tract
• Depleting of carnitine, CoQ10, free form amino acids, B vitamins and
other Krebs cycle intermediaries
NEUROTRANSMITTER METABOLISM/ PRODUCTION AND SULFUR
TYROSINE
Tyrosine is a non-essential amino acid synthesized in the body from the
essential amino acid phenylalanine. Tyrosine is the precursor amino acid from
which the body makes dopamine, which is converted to norepinephrine and then
epinephrine.
Tyrosine Supports:
• Fat loss
• Supports brain dopamine production
• Supports dopamine production by the
adrenal gland
• Improves stamina for exercise
• Precursor to thyroid hormones
• Precursor to melanin
L-DOPA
Increases the body’s natural production of dopamine
L-Dopa Supports:
• Neurological conditions affecting
movement/ balance
• Behavioral disorders
• Sleep disorders
• Mood disorders
• Cognition issues
• Lack of motivation
• Low prolactin production
5-HYDROXYTRYPTOPHAN (5-HTP)
Made from the amino acid L-tryptophan with the help of vitamin B6, is a precursor to
serotonin production.
5-HTP Supports:
• Excessive appetite
• Binge eating
• Carbohydrate cravings
• Obesity
• Headaches
• Migraines
• Insomnia
• Depression
• Bipolar disorder
VITAMIN B6
Water soluble vitamin found in meat, vegetables and grain products
Vitamin B6 Supports:
• Normal energy-yielding metabolism
• The production of neurotransmitters
• Support the production of red blood cells
and immune cells
• Regulation of hormonal activity
• Healthy nervous system
B6 VITAMIN MARKER: XANTHURENATE
High Xanthurenate- may indicate tryptophan catabolism and is a functional
marker for B6 deficiency. Product of tryptophan catabolism.
Can be caused by many things including:
• Excessively high protein diet or tryptophan • Oral contraceptives
• Antihypertensives
supplementation
• Bronchodilators
• B6 deficiency
• Smoking
Commonly seen in individuals who have villous atrophy and/or gut damage.
B6 is also a major co-factor in serotonin production.
Symptoms may include: high homocysteine, balance issues, fatigue,
anemia, skin disorders, PMS, ADHD, anemia and peripheral neuropathy
Intervention:
Improve digestion and absorption, supplement with B6 and/or B complex
VITAMIN C
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Vitamin C is water soluble and found abundantly in vegetables
Unlike most animals, our body is unable to make its own vitamin C
Vitamin C refers to both ascorbic acid and dehydroascorbic acid (DHA)
A powerful antioxidant, supplying electrons to free radicals
Vitamin C Supports:
• Healthy formation of collagen and elastin
• Activates white blood cells
• Supports metabolism of fats, folic acid and
histamine
• Regulates cholesterol levels
CALCIUM
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Calcium is found in the human body as deposits in bone and teeth
High sources of calcium can be found in milk, leafy green vegetables and
fish like salmon
Calcium Supports:
• Healthy bone development
• Dental health
• Protects cardiac muscle
• Ensures healthy pH levels
• Helps control blood pressure
• Reduces risk of kidney stones
FOLATE vs. FOLIC ACID
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Folate and folic acid are NOT interchangeable
Folic acid is the synthetic form of folate
• Only found in supplements
• Not found in food supply
• Hard to convert folic acid to folate, so it’s easy to get
unmetabolized folic acid -> folate deficiency
FOLATE
METHYLATION CO-FACTORS MARKER: FIGLU
High Formiminoglutamate: Functional marker of folate insufficiency. High marker
usually appears after 90 days of insufficient folate availability. Deficiency can lead to
precursor for many diseases especially coronary heart disease and cancer.
Responsible for repair of DNA and making of red blood cells.
Can be caused by many things including:
• Insufficient dietary intake of leafy greens high in folate
• Insufficient absorption caused by celiac disease or gut damage
• Alcoholism
• Medication interaction
Symptoms may include: severe hair loss, fatigue, insomnia, anemia, swollen or
sore tongue, mouth ulcers, nerve damage (peripheral neuropathy), headaches,
heart palpitations, cognitive issues such as, forgetfulness, brain fog or other
cognitive decline, depression and behavioral disorders
FOLATE
METHYLATION CO-FACTORS MARKER: FIGLU
FIGLU is converted into glutamate by folate. Hi FIGLU in the urine indicates a
functional need for more folate. There is a blood test for folate, but at times it comes
back normal despite a functional need for more folate. In these cases the FIGLU
marker serves as a functional assessment where the blood folate test does not.
Intervention: Folate
SUMMARY
KEY CONCEPTS:
• The organic acids test measures the function of
neurotransmitters by measuring their metabolites or
breakdown products in urine
• Neurotransmitter markers can be split into 2 groups:
production related markers and inflammation related
markers
• The organic acids test shows micronutrient depletion and
can reveal micronutrient deficiencies
CASE STUDY
• History: 45 year old female, Mother to two autistic children, full time care
giver, moved to new state, lost most of support network
• Chief complaints: depression and insomnia
• Triggers: Father died recently in battle with siblings over estate issues.
Very high stress and stress to continue.
• Physical exam: normal
• Treatment: 5-HTP, tyrosine, mucuna, methionine, B complex, gluten
free, blood sugar control diet, parasite protocol and mitochondrial energy
support with magnesium, CoQ10, carnitine and co-factors
• Resolution: first month of treatment significant improvement in mood
and energy levels, able to be more present for children, by month 6 able
to stop supplements and maintain benefits of 80% improvement on
fatigue, energy and mood
FOLLOW UP TEST AFTER 6 MONTHS TREATMENT
CASE STUDY
• History: 39 year old male, computer programmer Silicon Valley, poor
diet, skips meals, protein powders for lunch, long commute works long
hours, long history low grade GI complaints, heartburn, bloating
• Chief complaints: chronic fatigue, memory issues, emotionally worn
down
• Triggers: Stress, work meeting melt downs
• Physical exam: normal, conventional medical labs normal
• Treatment: 5-HTP, tyrosine, NAC, B complex, increased whole foods
diet, H. pylori protocol and meditation exercises and increase in physical
activity of walking 30 minutes daily
• Resolution: Significant benefits accrued from lifestyle changes and
starting to eat regular food for meals, elimination of H. pylori and treating
GI tract also contributed to improvements in fatigue. “Lights on” again
experience with use of high dose amino acids, 5-HTP 600 mg daily in
divided dosages with tyrosine at 4,000 mg daily
FOLLOW UP TEST AFTER 6 MONTHS TREATMENT
THANK YOU!