My colleague Carl Germano, RD, CNS, LDN, has just co-authored with neurologist Jay Lombard, MD, an essential book entitled "The Brain Wellness Plan." I believe that this is the first book to elucidate that brain diseases require treatment of the immune system and intestinal tract as well as the brain itself. Their book describes the latest developments in brain research and provides a comprehensive plan for building brain health to prevent and treat brain diseases such as depression, Alzheimer's Disease, Chronic Fatigue Syndrome, Attention Deficit Disorder, Multiple Sclerosis, Parkinson's Disease and Amyotrophic Lateral Sclerosis.
Carl Germano is a registered and certified clinical nutritionist and has nineteen years of experience in clinical nutrition and nutritional product development. He is an adjunct professor in nutrition at New York Chiropractic College, and is the Director of Product Development and Technical Services for Solgar Vitamin & Herb Company. Their book gives us much food for thought, and we don't have the space to cover all of the interesting topics in this column, so let's start with the basics and then cover some of the major points.
When people usually think of the brain and brain disease, they usually do not associate it with the immune system. You emphasize this link in your book - please explain the connection for our readers.
The growth and development of the brain is dependant on proper immune function. Conversely, the premature demise of brain cells are linked to immune system collapse. There exists a complex communication pathway that connects your brain with your endocrine, cardiovascular and immune system via neurotransmitters (chemical messengers produced in the brain) and immunotransmitters (chemical messengers produced from the immune system). Neurotransmitters are not limited to transmitting information between neurons in the brain. For example: the neurotransmitters norepinephrine and serotonin have receptors on various components of the immune system and therefore able to influence the immune response in specific ways. Additionally, immunotransmitters are not limited to transmitting information throughout the immune system. For example: in certain areas of the brain, neurons have receptors for immunotransmitters (cytokines). They can profoundly alter the way important neurotransmitters are released or inhibited.
OK, let's chat about the neurotransmitters a little. Please describe the major neurotransmitters and brain messengers and their roles.
What are the major immune messengers and what are their roles?
Cytokines are to the immune system as what neurotransmitters are to the brain. They are crafted to deliver warnings to speed up or slow down the immune system's response. Three of the most important cytokines are interleukins, tumor necrosis factor and interferon.
As much as neurotransmitters and immunotransmitters are vital to the brain-immune connection, you refer to them in your book as potential destructive components to the brain. Would you please elaborate on this?
With respect to cytokines, they may play major roles in causing or promoting neurological disease. Certain cytokines are "offensive" to the immune system and the brain. For example: certain cytokines are capable of producing fatigue, slowed thinking and depression such as gamma interferon interfering with serotonin production. This is the reason for the depression seen in chronic fatigue syndrome and multiple sclerosis.
With regards to nitric oxide, we know that excess production can cause the production of peroxynitrite, the most toxic free radical to the body, especially the brain! Peroxynitrite can damage proteins and deplete vitamin C, CoQ10 and glutathione. Interestingly, initiated by an infection, toxin or part of the aging process, the immune system cytokines activate macrophages (WBC) which increase the production of nitric oxide.
Therefore, immune response can actually play a role in the further development of neurological disease.
That is correct and one of the messages we emphasize in the book - your immune system can save you and also kill you in the process. It all depends upon how well equipped you are with regards to your body's defense systems - primarily antioxidant defense.
Regarding your antioxidant defenses, what are the neurological consequences of free radicals in brain diseases?
Free radicals have an affinity for the lipid membranes of the brain's neurons causing them to oxidize (lipid peroxidation/rancidity). Lipid peroxidation appears to be the final common pathway for many neurological diseases. For example: In Alzheimer's, cell membranes of the hippocampus (memory region) are primary targets of free radicals. In Parkinson's disease, the substantia nigra (produces dopamine) suffers most of the damage from free radicals.
This leads us to the importance of antioxidant nutrients.
Since the brain is primarily fat, preventing lipid peroxidation is critical since the brain is vulnerable to free radical attack. Additionally, during any challenge to the immune system, increased amounts of antioxidants are required to scavenge the free radicals naturally produced by the immune system's cells during "warfare" initiated by disease, toxins, infections, stress and aging.
What would you consider to be the most important antioxidants useful in brain diseases?
One would require a complete array of the fat and water soluble antioxidants with special emphasis on: Tocopherols, tocotrienols, carotenoids and polyphenols (fruit polyphenols, green tea, grape & pine bark extracts). Glutathione modulators such as lipoic acid, n-acetyl-cysteine (NAC), vitamin C, s-adenosyl methionine (SAM). SOD inducers such as zinc, copper and manganese (those with Parkinson's should avoid manganese). Additionally, the use of standardized ginkgo biloba is recommended for its antioxidant activity and role in brain health.
I'm glad that you mentioned a complete array of antioxidants. By the way, I forget, but doesn't ginkgo biloba help memory? Let's talk about memory for a moment. Which nutrients help memory and what mechanisms are involved?
The primary nutrients used to support memory and cognitive development are:
You cautioned Parkinson's Disease patients not to take manganese. I'm sure they are wondering why. Please explain why not?
In the 1995 issue of Toxicology, University of Arizona College of Medicine researchers reviewed the role of several metals such as iron and manganese in Parkinson's disease. According to the report, these metals may play an important part in breaking down dopamine and producing free radicals in PD patients.
Multiple Sclerosis is a disease in which the myelin sheath that wraps the axons of many nerves in the body is damaged. What causes this damage?
Normal immunological reactions in the body become damaging because immune cells target the body's own cellular structures. In other words, the immune system loses its capacity to recognize its own body. Scientists believe that the previous exposure to certain viruses such as herpes and EBV causes the immune system to create antibodies to that virus. When the virus is no longer active, something prompts the immune system to create antibodies to the body's own brain myelin - which has molecular components bearing an uncanny resemblance to that virus.
What nutrients may help prevent this disease?
A controlled low fat diet based upon the diet created by Dr. Roy Swank. This diet emphasizes avoidance of saturated fat and incorporation of more polyunsaturated fats is essential. Today, investigators are demonstrating success with modified versions of the Swank diet with particular emphasis on the omega 3 polyunsaturates especially DHA and essential fatty acids. Essentially, decreasing your fat intake to no more than 5 - 10 grams and increasing the omega 3, GLA and essential fats to 50 grams daily would follow the guidelines currently recommended.
The following nutrients are essential in treating the disease:
How about Parkinson's Disease: What do we know about its cause?
Essentially, scientists believe that genetically impaired cellular detoxification mechanisms are the key reason why individuals are at risk for PD. Additionally, exposure to environmental toxins has a significant role to play as their exposure increases the demands for detoxification by the body. Today, we now know that certain drugs that are molecularly similar to MPTP can cause increased mitochondrial damage and eventual neuron death - especially in the area of the substantia nigra which produces dopamine.
Since Parkinson's Disease patients have a shortage of dopamine in the brain, should a Parkinson's Disease patient be concerned about proteins in the diet and the competition of amino acids in the transport across the brain blood barrier?
Definitely, we adjust the diet to supply very little protein in the day to allow for entry of dopamine, without competition, into the brain. The remainder of protein is given at the end of the day. Additionally, we recommend incorporation of more broad beans such as fava beans since they contain naturally occurring dopa.
Well we could chat about several more brain diseases, but we would be re-writing your book. What advice can we leave our readers with? What is your take-home message?
Science has gained extraordinary insights into how supplements and diet not only successfully address the symptoms and root cause of disease but also enhance our health by altering the very biochemistries of our systems. Additionally, modern medicine has now begun to recognize and contribute to the complimentary approach to preventing and treating illness. We have, for the first time, united both modalities in this book to provide the reader with a full complimentary arsenal of agents to address brain diseases. How we heal ourselves depends on how we educate ourselves on the causes and most effective methods of combating disease. The Brain Wellness Plan will show you how to make the informed choices you need, based upon a better understanding of the human brain and its relationship to the entire body - especially the immune system. My last word of advice is simple, if your healthcare practitioner fails to incorporate well documented nutritional agents to assist in prevention or rehabilitation - its time to get a new practitioner since they are doing more harm than good!