GLUTEN

Gluten, a dietary protein found in barley, wheat and rye, is a potent trigger of neurological function and neurological autoimmunity. Over the last 50 years the number of people sensitive to gluten has risen sharply. No wonder, as the gluten content of our grain was essentially 0 around 1900 until the 50s when, secondary to genetic manipulation, the gluten content of the above mentioned grains is greater than 40%. Deamidation (a process used to make gluten more water soluble), has been shown to cause a severe inflammatory process.

The criteria for diagnosing celiac disease (congenital) or gluten sensitivity HLA-DQ2 and HLA-DQ8 are outdated. People without the 2 mentioned criteria can still have severe gluten sensitivity affecting the gut, brain, thyroid joints and skin.

There are 2 main mechanisms that appear to cause gluten to impact the nervous system. 1. Eating gluten can create an autoimmune reaction against nervous tissue (or thyroid, i.e. Hashimotos). 2. Immune reactions to gluten can break down the blood brain barrier leading to "leaky brain" versus "leaky gut."

Going gluten free alone, unfortunately, may not always address some of the symptoms as there are some proteins in food that can cross react with gluten.

If you are gluten sensitive (every one is, albeit silent in some cases). If you are exposed or plan on being exposed to gluten there are certain supplements (I prefer Glutenza) that can break down gluten. Prior to eating pasta for instance.

The following is a complete gluten antibody screen that should be run. (WOW)

alpha gliadin

omega gliadin

gamma gliadin

deaminated gliadin

wheat germ agglutinin

gluteomorphin

prodynorphin

TG2

TG3

TG6

WEIGHT

Our country is obsessed with weight and weight loss. No surprise as over 50% of the country has a BMI (body mass index over 30) BMIs can be misleading, however, as tall, heavily muscled men can have BMIs in the 40 range. There are at least 50 weight loss programs not including the HCG diet (at one point I worked with around 90 HCG patients). The components of an "effective" obesity management program include diet and physical activity (together) followed by behavior modificatio, then anti-obesity medications and lastly surgery. Before addressing weight loss, and having addressed lifestyle, other contributors of weight gain need to be addressed including estrogen dominance and stress related i.e. elevations in cortisol both of which cause abdominal obesity, hypothyroidism, genetics propensity, imbalances in the 2 hormones that directly impact fat deposition and hunger (gherlin/increases hunger and fat deposition, and leptin/decreases hunger and fat deposition), and the gut microbiome, specifically akkermansia which is critical for addressing metabolic syndrome. When looking at lifestyle the various components of appetite must be taken into consideration: Hunger (the drive to consume), Satiety or the end state of satisfaction, fullness (the physical feeling experienced in the gut, cravings, satiation or negative feedback leading to meal termination, and sensory pleasure elicited by contact with food. Until recently, I was unable to find a probiotic with akkermensia, however, a company started marketing one. Also, until recently, there was nothing on the market to depress gherlin until a company called integrated peptides came out with an oral peptide specifically for weight loss. Other than commitment, why is it so hard to loss weight? In my experience most weight loss programs fail due to lack of consistency and commitment. The simple answer is tug of war between trying to lose weight via decreasing calories and increasing activity and weight gain due to a decrease in metabolism and an increase in hunger hormones like gherlin. The complex answer is the interplay between food, neurotransmitters, the vagus nerve, inflammatory markers, etc. and the hypothalamus, (the center that drives most endocrine function).

Why do we care about losing weight? The answer should be obvious, health. Obesity leads to sleep disorders, inability to be active and impaired mental health, promotes insulin resistance and beta cell (pancreas) decompensation leading to type 2 diabetes which then results in medication induced weight gain, neuropathy and decreased activity, hypoglycemia and stimulation of food intake. "Vicious circle". This is just the beginning. The burden of excess fat results in knee arthritis, obstructive sleep apnea, GERD, urinary incontinence, high blood pressure, angiogenesis (encourages cancer growth), immune function effects inflammation in general and reproduction (PCOS and fertility)

What are the benefits of weight loss for diabetics? A 10% weight loss (abdominal fat and waist circumference) improves the lipid profile, improves insulin sensitivity and blood glucose as well as decreasing inflammatory markers. A study looking at diabetes remission as per achieving and HbA1c of less than 6.5% revealed that a 15 kg (2.2pounds to a KG) loss resulted in over a 70% change, 10-15kg loss/57%, 5-10kg loss/34% and 0-5kg loss 7%.

While I am not an advocate of anti obesity meds, I need to address the purpose of anti-obesity medications. To impact the appetite dysregulation of the disease, supports adherence to lifestyle interventions by helping patients adhere to a lower calorie diet and changing their relationship with food and to facilitate weight loss and improvements in health. They are usually indicated for patients with a BMI greater than 30. I feel I should touch on the latest weight loss drug craze. These are the GLP-1 RAs, the most popular being semaglutide which is given SQ weekly (although there is an oral form) Weight loss of 20% or more can be achieved over weeks to months. The downside to this class of drugs are two fold, an extensive side effect profile (I strongly recommend to all my patients that prior to starting any drug to review the side effects), and the expense which could run to hundreds and even thousands of dollars, with the understanding that all these drugs must be continued. If stopped (as show with studies with semaglutide) there is a progressive weight gain.

As a last ditch effort there are bariatric surgical procedures. The 3 most common are a sleeve gastrectomy, a Rous-en-y gastric bypass and a duodenal switch. Obviously any surgery has its downside as does these 3. Other than surgical complications the biggest concern is nutritional deficiencies. Depending on the procedure they may include iron, thiamine, calcium B12 folic acid and protein.

At the end of the day, everything, other than committing to a weight loss lifestyle, in my opinion and experience, is doomed to failure.

DEPRESSION

Depression is a disabling illness that can result in chronic despair and a feeling of hopelessness. It is currently ranked by the World Health Organization as the leading cause of global disability and may affect up to 300,000,000 (probably double that now) people worldwide, an increase of more than 18% from 2005 to 2015. The global cost is approximately 210.5 billion annually. There is a life time prevalence rate of around 19% and on the rise. In the US, as elsewhere, depression episodes are increasing, especially in the adolescent population. Between the years 2017 and 2018, rates of adolescent depression increased by approximately 60% involving primarily teen and pre-teen girls. Those who have experienced depression can relate to the devastating impact on body, mind and spirit. So how is depression treated? The psychiatric field has failed miserably. As with most allopathic specialties, "symptom-drug", however most specialties, i.e. infectious disease have lab work to work with. Psychiatrists, after interviewing you (no testing) pick from the DSM (the diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric association. After matching your reported symptoms with the criteria in the manual they arrive at a "diagnosis" and formulate a plan. The plan inevitably includes drugs. They subjectively pick a drug that they think may benefit (and in fact, may benefit for short periods of time). Frequently, the first drug does not work and the patient is placed on a second drug then a third, etc. I had a patient on 5 psychotropics. Rarely, does the psychiatrist drop the drugs that are not working, maintaining the side effect profiles. What are the alternatives? Treating depression, even from a functional medicine perspective is still not easy, however, identifying the "why" is imperative. Allopathy, including psychiatry, is not interested in the why. When approaching the why for depression, a functional medicine/alternative clinician goes down the following list:

1. Has there been a life altering event, i.e. death, etc. that can be addressed with mourning counseling?

2. Is there a genetic component? Unfortunately genetics does play significant role in most every pathology including depression. Depression can be genetically linked to up to 50% of the time. A percentage I observed when I was doing genetics. (there are genetic tests that can identify genetic propensity (methylation etc.)

3. Vitamin deficiencies (can impact emotions)

4. Toxic metals (can cause a lot of neurological issues)

5. Hormonal imbalances (sex hormones/men and women play a significant role in how one feels both physically and emotionally. A healthy thyroid is also essential for both physical and emotional well being.

6. Amino acid and fatty acid imbalances (many amino acids are precursors to neurotransmitters, phenylalanine and tyrosine for example.

7. Low or high levels of certain minerals

8. The gut. SIBOdysbosis can have a dramatic impact on both physical and emotional well being. Some of our neurotransmitters are made in the gut (serotonin, dopamine, gaba, etc.)

9. Imbalances in digestive enzymes

10. Parasites

Once all of these tests have been completed an integrative clinician can accurately assess the "why" and come up with an individualized intervention including supplements like CBD/PEA, SAMe with magnesium, etc. This is a way of looking at an individual as a whole person with unique biochemistry and nutritional needs that when balanced allow health and vitality.