|Review of Dr. Bransfield's Article - Part One (of Three)|
In Chapters 7 and 8 of The Lyme Disease Solution I discussed at some length effective methods for Lyme patients to deal with neurological and psychological symptoms. When these symptoms are present, the presence of three major possible causes requires consideration: (1) incompletely treated, active infection, (2) oxidative stress (excess free radicals), and (3) chronic inflammation. Any or all of these three problems may be key in dealing with these symptoms in Lyme disease. A recent excellent article by Dr. Bransfield published late last year sheds additional light on the subject.
One of the most trusted names in Lyme medicine is that of Robert Bransfield, MD. For those who don't know who he is, Dr. Bransfield is a practicing psychiatrist from New Jersey who is also a long-time member of International Lyme and Associated Diseases Society (ILADS). He is a recognized expert in the psychiatric and neurological manifestations of Lyme disease.
Dr. Bransfield published a very important article in December, 2007, in Psychiatric Times (www.psychiatrictimes.com) entitled "Lyme Disease, Comorbid Tick-Borne Diseases, and Neuropsychiatric Disorders". In this article, written primarily for practicing psychiatrists, he effectively presents the medical aspects of Lyme as it affects the brain with resulting neurological and psychiatric manifestations. If you are a Lyme patient and have been seeing a psychiatrist or psychologist (or have seen one in the past), getting a copy of this article to your doctor is a MUST. In this issue of the Newsletter and in the next 2 issues (May and June, 2008), I will discuss several key features of his excellent article.
He begins by discussing the fact that Lyme has taken the place of its cousin, syphilis, as the "new great imitator". But Lyme represents much more a challenge because it is more difficult to diagnose properly and more difficult to eliminate. Combining these two factors with the confusion that is often generated by the presence of co-infections, it makes Lyme medicine the "ultimate" challenge for the average medical practitioner. Frequent symptoms listed by Dr. Bransfield include: fatigue, cognitive impairments, depression, anxiety, irritability, headache, and a multitude of other symptoms. Often fibromyalgia, chronic fatigue syndrome, or multiple sclerosis (MS) has been diagnosed.
Dr. Bransfield suggests that Lyme disease be considered in patients who have no history of previous psychiatric, psychosomatic, or hypochondriacal problems who develop increasing number of somatic (body symptoms), cognitive (mental functioning), neurological, and psychiatric symptoms. Most of the time, he states, a patient will have seen multiple specialists by the time he or she gets to the psychiatrist. Very often he or she will be on tranquilizers and antidepressant medications. Generally, a patient is sent to the psychiatrist for one of three reasons: (1) the symptoms of a patient are unexplainable medically and therefore the referring doctor suspects a psychosomatic or "somatoform" disorder, (2) the mental symptoms are too complex and require psychiatric assessment, or (3) a psychiatrist is needed in order to help manage psychiatric treatments or medications.
From my own clinical observation, psychiatric manifestations of the tick-borne illnesses are extremely common, and all of the chronic tick-borne infections can cause these manifestations. Anxiety and depression seem to be the main issues that Lyme practitioners most frequently face. Because of the frequency of these problems, the rate of severe psychiatric complications, such as suicide, is very high among tick-borne infection sufferers. Lyme patients (and their families) often describe unusual amounts of "irritability", often described as having a "short fuse". Lyme rage, commonly caused by Bartonella or Lyme, can be a significant cause of violence. Severe anxiety in a person with no history of psychiatric problems or in a person where the anxiety is far out of proportion to the life circumstances should be a major clue to the presence of a tick-borne illness. As Dr. Bransfield says, any psychiatric symptom with associated constitutional symptoms (such as arthritis, muscle pain, fatigue, brain fog, etc.) should be thoroughly investigated for Lyme or other tick-borne illness, or be referred to a qualified Lyme practitioner (preferably an ILADS member) for proper evaluation.
Dr. Bransfield discusses a case of "atypical depression" - a patient treated with 51 different psychiatric medications over an 8 year period of time without help. Because of a negative medical workup, it was felt by her treating physicians that physical reasons could not be the cause of her symptoms. Finally the patient was properly assessed by a knowledgeable Lyme physician and was found to have a positive Lyme Western Blot, a low CD57 count, and evidence of four other tick-borne diseases. The patient also had a SPECT study of the brain which was grossly abnormal. After several months of therapy, including intravenous ceftriaxone, the patient's depression permanently resolved and her SPECT was markedly improved (though not completely normal).
SPECT scanning can be extremely useful in cases like the one described by Dr. Bransfield. It is important to remember, however, that all abnormal SPECT scans are not necessarily caused by Lyme. In fact, depression itself is known to cause abnormalities on SPECT scans. On his BrainPlace web site, psychiatrist Daniel Amen, MD, states: "Decreased prefrontal cortex activity at rest, especially on the left side is a consistent SPECT finding in depression." For this reason is important that brain SPECT scans be interpreted by readers experienced in evaluating patients with Lyme disease, such as those at Columbia University in New York. As was the case with Dr. Bransfield's patient, SPECT scans can be used to follow the progress of Lyme treatment. Remember, however, those findings may lag behind the clinical improvement. That is to say, a patient may improve clinically before the SPECT shows improvement.
Next month (May '08): Other Assessment Tools for Lyme Psychiatric and Neurological Symptoms, Chronic Infections, and Inflammatory Mechanisms of Neurological Damage
Following month (June '08): Treatment Recommendations for Lyme Psychiatric and Neurological Symptoms
Pyroluria (Pyrroluria) - A Possibility to Consider in Psychiatric Lyme
In The Lyme Disease Solution I made mention of a condition called "pyroluria". There was not enough room in the book to cover this somewhat controversial condition. For that reason I wanted to deal with this topic on my web site. In this issue of the Newsletter I would like discuss this intriguing and very treatable condition that may sometimes coexist with Lyme disease or with Bartonella.
What is pyroluria and how is this related to brain function? Though well described in the medical literature by Pfeiffer and Hoffer, this disorder has not been received wide acceptance in the medical community for reasons that are not clear. (Sound familiar?) In some people (particularly females) and some families, during periods of high stress a specific biochemical called "kryptopyrrole" is produced by the body in excess and excreted in the urine. While this substance, 2,4-dimethyl-3-ethylpyrrole, is itself harmless, it may cause a major problem. It interacts with vitamin B6, zinc, and manganese by binding them, leaving these nutrients deficient in the body. The result is that these individuals have problems forming several vital body substances including: serotonin, dopamine, GABA, norepinephrine, and glycine. In addition, vitamin B6 is needed for proper brain detoxification. Zinc is essential in nerve development, intellectual function, serotonin formation, the regulation of mood, support of the immune system, and the prevention of oxidative damage (antioxidant function).
What are the signs and symptoms of pyroluria? The early symptoms often begin during the teen years with behavioral problems. These may include: very poor tolerance of physical and/or emotional stress, mood swings, depression, noise or light sensitivity, and skin sensitivity.
Adult symptoms can range from severe depression to schizophrenia. Most commonly the symptoms that are seen consist of severe inner tension, ongoing anxiety, excessive and inappropriate fearfulness, and sometimes anger outbursts. They may have pale "China doll" skin that is sensitive and easily burns. Eyes may be sensitive to light and ears to sound. Knee pain may occur for unclear reasons. White flecks/marks may occur on the nails and stretch marks (straie) on the skin - both of which may arise due to zinc deficiency. These patients may tire easily, tend to be anemic, and often have poor dream recall due to vitamin B6 deficiency state. Abdominal symptoms may occur with abdominal pain when stressed and side stitches with exercise. All symptoms get worse when the individual is under stress or has a chronic debilitating illness (such as a chronic infection like Lyme). A significant clue to the existence of pyroluria is the tendency for a patient to note that in the past alcohol usage was a reliable way to reduce the anxiety and to help them to feel more sociable and temporarily more "normal".
How is pyroluria diagnosed? The classic method for diagnosing pyroluria is by testing the urine for the presence of excess amounts of kryptopyrroles. The laboratories mentioned in the Resource section of my book can do this simple urine test. Another useful test is a blood test done by SpectraCell Labs which looks for functional deficiencies of vitamins and minerals in the blood. When a person has suggestive symptoms, and the SpectraCell test shows deficiency of zinc or vitamin B6, the test should be followed up with a urine test for kryptopyrroles in my opinion.
How is pyroluria treated? In addition to using supplemental doses of zinc, vitamin B6, and manganese, the following natural products (all discussed in The Lyme Disease Solution)are extremely useful in managing the anxiety symptoms of pyroluria: GABA, inositol, and tryptophan. It may take several months for complete recovery, but the person will improve. Relapse will occur within 2 weeks if one goes off the program.
It is my opinion that the many Lyme and especially Bartonella patients should be evaluated for pyroluria. This is especially true if there is a personal or family history of chronic alcohol use for anxiety control or of mental illnesses such as severe depression, anxiety, or schizophrenia.
Glutathione - A Missing Link to Recovery
If you have read The Lyme Disease Solution you undoubtedly realize that I consider glutathione (GSH) to be one of the most important healing modalities for Lyme and other tick-borne illnesses. It is the most important antioxidant produced by the body. GSH is critical for brain health, liver health, and the health of virtually every cell of the body. I refer you back to the book for details on all of the wonderful things that GSH does. In this edition of the Newsletter, I want to discuss methods of raising the levels in the body of GSH.
As a brief review, GSH is manufactured in the body from three materials: glycine, glutamate, and cysteine. Required also are vitamins B2, B6, B12, folic acid, and selenium. A partial list of things that deplete GSH include smoking, alcohol use, HIV infection, misuse of acetaminophen, diabetes, and cancer. Foods (such as avocado, asparagus, walnuts, and others) contain some GSH but it is not significantly absorbed from the gastrointestinal tract and therefore is probably utilized for gut support purposes by the body. As a potent intracellular antioxidant, its depletion is a component of every chronic disease or inflammatory condition. Of course the most chronic of all circumstances is the process of aging.
How do you raise body levels of glutathione? Fortunately, there are a number of ways to improve GSH levels in the body. In addition to reducing those things that deplete the body of GSH, the most reliable way is to directly infuse GSH by the intravenous route. It can done easily and safely in a physician's office. The usual dosage is 500-2000 mg. two to three times a week. The down side of this method is the fact that most doctors (even LLMDs) don't do the IV infusions and the high cost (ranges from $50 to $150 per treatment).
Other methods of increasing GSH levels include: topical GSH (via glutathione patches), GSH inhalation (via nebulizer), and intramuscular GSH injection. There are also several items that increase the body's production of GSH and they include: undenatured whey protein, N-acetyl cysteine, alpha lipoic acid, vitamin C, L-glutamine, and certain herbs such as curcumin. Perhaps the most intriguing and cost effective method that I have been using in recent months is a product called "acetyl-glutathione".
Acetyl-glutathione is a compound that actually occurs normally in a human body. It is an analog to the more potent antioxidant, reduced glutathione (the type used intravenously). Reduced glutathione is acted upon by "peptidase" enzymes almost immediately in the blood and tissues, and thus it loses its ability to enter cells and act intracellularly. This happens in a very short period of time and thus IV glutathione, while having a remarkable impact on metabolism, is relatively short-lived. (Inhalation of glutathione, as mentioned above, has shown promise in chronic lung diseases and it is believed that inhalation GSH treatment along with oral acetyl-glutathione supplementation appears to work much better than inhalation alone.)
Acetyl-glutathione has a major advantage over other forms of GSH supplementation. At the tissue level it is very easily assimilated intracellularly and then allowed to perform its powerful antioxidant and metabolic regulatory effects without prior decomposition by peptidases. It has been found that acetyl-glutathione is absorbed orally and is transported to all tissues of the body with remarkable anti-aging effects, anti-viral effects and in some studies an effect on some cancers.
The product that we use in my office is manufactured by the Maplewood Company. You can search online and find it, or you can order it from my office if you cannot find it (410-296-3737). You will also be able to obtain it via a company that I was formerly affiliated with, Nutrition Essentials, beginning next week. Their web address is www.nutritionessentialsinc.com
Avocados Offer a Wealth of Health Benefits
Once looked upon with caution because of its high fat content, the avocado is getting second look, this time, with nods of approval. Yes, the avocado is a fat-rich fruit, with 71 to 88% of its total calories coming from fat - about 20 times the average for other fruits. A medium-sized avocado contains about 30 grams of fat. That's why nutrition experts have long urged us to go easy on avocados, and favoring fruits and vegetables with a lower fat content.
But as researchers have examined this fruit with greater scrutiny, they have found that most of the fat in an avocado is oleic acid, a monounsaturated fat that may help to lower cholesterol levels. In fact, some studies have reported that individuals who consumed a diet high in avocados significantly decreased total and LDL (bad) cholesterol, while increasing health promoting HDL cholesterol. Numerous studies are revealing that a diet high in oleic acid shows other promising health benefits as well.
In addition, avocados contribute nearly 20 vitamins, minerals and beneficial plant compounds that can contribute significantly to the nutrient qualityof your diet. The avocado is well-known for its high vitamin K and carotenoid (vitamin A precursor) content, but also provides significant quantities of vitamin E. It also contains vitamin C and the B vitamins, thiamin, riboflavin, niacin, vitamin B6, biotin, and folate. Avocados are a good source of potassium and copper. The avocado even serves as a source of fiber. Armed with this important health information, health and nutrition experts are now encouraging us to include avocados in our diets on a regular basis.
But the good new continues. Avocados act as a "nutrient booster" by enabling the body to absorb more fat-soluble nutrients, such as alpha and beta carotene and lutein. The avocado is a very concentrated dietary source of lutein. Lutein has been shown to promote eye health and protects against macular degeneration, a leading cause of blindness in the elderly.
Avocados are also rich in glutathione, making them a particularly good choice for anyone dealing with chronic inflammation, such as with Lyme disease, celiac disease, and inflammatory bowel disease. Glutathione functions as an antioxidant to neutralize free radicals that can cause cell damage and lead to disease. In Chapter 5 of The Lyme Disease Solution, avocados are included in Phase I of the Lyme Inflammation Diet (LID).
When choosing a ripe, ready to eat avocado, choose one that is slightly soft, with no dark sunken spots or cracks. A firmer, less mature avocado can be ripened at home in a paper bag or in a basket at room temperature. As the fruit ripens, the skin will turn darker. Once ripe, they can be kept refrigerated for a few days. If you are refrigerating a whole avocado, it is best to keep it whole and not slice it in order to avoid browning that occurs when the flesh is exposed to air.
If you have used a portion of a ripe avocado, it is best to cover and store the remainder in the refrigerator. Sprinkling the exposed surface(s) with lemon juice will help to prevent the browning that can occur when the flesh comes in contact with oxygen in the air.
Avocados can add variety - and provide a nutritional boost to your meal plan.
· For your sandwich, spread ripe avocado on sprouted whole grain bread as a healthy replacement for butter or mayonnaise.
· Add avocado to your favorite dressing recipe to give it an extra richness and beautiful green color.
· Mix chopped avocados, onions, tomatoes, cilantro, lime juice. Add sea salt and cumin for a rich-tasting guacamole. Use as a dip for fresh veggies such as celery, carrots and broccoli. (Appropriate for Phase III of the LID)
· Add diced avocado to your tossed salad.
· For an exceptional salad, combine sliced avocado with fennel, oranges and fresh mint.
A recommended serving size is 2 tablespoons, or roughly one-fifth of a medium-sized avocado. Each serving provides 5 grams of fat (45 calories). In comparison, butter or mayonnaise provides 22 grams of fat and 200 calories in a 2-tablespoon serving.
As an added bonus, for optimal health and beauty, the healthy fats in avocados are ideal skin and hair moisturizers and provide an excellent remedy for dry skin.
To sum it up, avocados will help you feel healthy and look good. What a wonderful fruit!