by David Gersten, M.D. • January 2010

Brain Health

As a new year arrives, we take time to reflect on our lives and consider what we’d like to improve. At the level of the physical body, everything we do, every positive change we make, ultimately affects the brain. We can change our diets and heal our digestive tract, but without a healthy brain, healthy organs don’t mean very much.

Our brain is responsible for thinking, feeling, perceiving, visualizing, memory, creating, problem solving, behavior, movement of muscles, and coordination. The brain houses the mind and consciousness in ways yet to be understood. The autonomic nervous system (ANS), which originates in the brain, has the job of keeping all of our vital functions in balance. The ANS helps regulate blood pressure, heart rate, breathing, various functions of the digestive tract, body temperature, sexual activity, and much more. The brain does what it does through a variety of chemicals called “neurotransmitters.”

There are 3 main ways of looking at brain abnormalities:

1. Damage to any part of the brain will cause problems, depending on which part of the brain is affected. The most basic functioning of the brain involves neurotransmitters, blood flow to the brain, oxygen, and glucose (which is the brain’s only source of food and energy). Major brain damage can be caused by a stroke, which is the brain’s heart attack, in which blood flow to the brain is blocked. Other kinds of major brain damage occur in trauma and tumors.
2. Much less severe than brain damage are structural problems of nerve cells, most of which can be repaired.
3. Neurotransmitter abnormalities. The main ones are serotonin, dopamine, norepinephrine, GABA, and acetylcholine. This article focuses primarily on neurotransmitter abnormalities, and how to repair them.

Anatomy of a Neuron

In order to understand the brain, we need a basic understanding of nerve cells, or neurons, and the synapse, which is the space between two neurons. In the graphic above, neurotransmitters (and the information they carry) are moving from neuron 1 to neuron 2. Here’s a brief explanation of the parts of a nerve:

1. Axon. This is the end of a nerve, nerve 1 in this case.

2. Myelin sheath. It’s not in this drawing, but axons are rather long, and covered with a special substance called the Myelin sheath (made up of a compounds called phospholipids). Electrical impulses are carried down axons, by the myelin sheath.

3. Dendrite is the beginning of neuron 2.

4. Synapse is the space between two neurons.

5. Neurotransmitters, the black, round circles, are contained in small vesicles at the end of a neuron. These neurotransmitters move into the synapse.

6. Receptor. The wide cell membrane of neuron 2 is covered with receptors. When neurotransmitters are released from the axon of neuron 1, they slip into the synapse. When they make contact with the receptor on the dendrite of neuron 2, chemical reactions begin in neuron 2.

7. Electrical impulse. When the chemical reaction triggered in neuron 2 reaches its axon, the chemical reaction is converted into an electrical impulse, which zooms down the axon and its myelin sheath.

Utimately, when an electrical impulse reaches the end of the axon, it causes the release of neurotransmitters into the synapse.

For millions of years, our bodies have done an excellent job of extracting nutrients from the food we eat, and allowing the right nutrients into the brain. Those nutrients, almost all of which are amino acids, then turn into neurotransmitters. Starting 60 years ago, scientists began developing medications that could alter the levels of various neurotransmitters. We now live in an age in which we have been led to believe that every uncomfortable mental state can and should be treated with a drug. In the last seven years, in my work as a psychiatrist, I have not written a new order for anti-depressants. Not one. We have enough nutritional tools and mental fitness techniques to heal brain chemistry naturally.

Healing Brain Chemistry

Let’s look at a number of neurotransmitters, discussing what they do, what deficiencies look and feel like — and how we can naturally raise the levels of deficient neurotransmitters.

Serotonin

Serotonin is known for its role in mood disorders, like depression, and in sleep. Remember, for each neurotransmitter we discuss, you’re looking at the little black circles in the synapse. Those are the neurotransmitters.

Many depressed people have deficient levels of brain serotonin. People who are blue or down also can have deficient serotonin. Deficiencies also cause insomnia. There can be some cognitive difficulties caused by low serotonin.

Most of us do not require Paxil or Zoloft to increase serotonin. We just need to know what nutrient builds serotonin. The main nutrient is the amino acid, tryptophan. It gets converted in the brain into serotonin. Tryptophan should be taken without food and should not be taken with other amino acids. Tryptophan gets across the blood-brain barrier (and into the brain) quite easily. In the presence of the active form of Vitamin B6, called P-5-P, tryptophan first turns into 5-HTP (5 hydroxy-tryptophan). 5-HTP then converts into serotonin. 5-HTP, while widely used, does not cross into the brain nearly as easily and predictably as does tryptophan.

Norepinephrine

Norepinephrine (NE) is best understood by what happens when we are deficient in it. NE deficiencies lead to depression, impaired memory and concentration, a wide variety of cognitive/thinking problems, irritability, worry, and insomnia.

NE deficiency leaves people feeling mentally drained.

If you’re depressed and have problems with memory and concentration, it is likely that you are deficient in NE and not serotonin.

The amino acid tyrosine is the nutrient that makes two important neurotransmitters, namely NE and dopamine. Just as tryptophan requires P-5-P (active form of Vitamin B-6), so does the conversion of tyrosine into NE.

Dopamine

Dopamine is one of our “feel-good” neurotransmitters. The dopamine receptor site is where cocaine and amphetamines work. It is also where chocolate works in the brain, and is involved in the biochemistry of sexual orgasm. Now you know why there is such a strong romantic link with chocolate. Dopamine deficiency is also associated with obesity and fatigue. Tyrosine is the nutrient that makes dopamine (in the presence of P-5-P).

More than any other neurotransmitter, dopamine needs to be within a specific range. Too little of it, and you won’t feel good. Too much dopamine will make some people fearful when there is absolutely no reason at all to be fearful. When dopamine is extremely elevated, people become paranoid.

Very high levels of dopamine are part of schizophrenia. How do you know for sure if you have too much dopamine? Lab testing is required.

Nutrients that support the production of dopamine include zinc, DHEA, and green tea extract.

GABA

GABA is our calming, relaxing neurotransmitter. When it is deficient, we feel anxiety. In alcoholism, nearly all neurotransmitters are deficient, but GABA deficiency is the most critical brain problem in alcoholism. Drugs like Xanax, Valium, Ativan and Klonopin act at the GABA receptor site.

There are two main ways to increase GABA. You can supplement with GABA directly. For some people GABA gets into the brain rather easily, but in other people GABA has a hard time crossing the blood brain barrier. There is no way of knowing if GABA gets into your brain easily, without trying it. GABA is safe up to about 4 grams a day. More is not better with GABA. If you take 7 or 8 grams a day, it can throw you into anxiety and panic.

In addition to using GABA to replace deficient GABA, I recommend the amino acid glutamine. Glutamine gets into the brain easily and is then converted into GABA. So glutamine and GABA are the most important ways of building GABA. Other nutrients that support GABA chemistry includes inositol (one of the B vitamins) and passion flower.

Acetylcholine

Acetylcholine (ACH) in the brain is required for learning and memory, so people with an ACH deficiency have memory problems. In addition, with moderate to severe ACH deficiency, people feel as if someone pulled the plug on their brain. They feel massive mental exhaustion.

ACH levels in the brain can be increased by the nutrients phosphatidylcholine, phosphatidylserine, and CDP-choline. Nutrients that assist ACH production include omega-3 fatty acids (fish oil), ginkgo biloba, and pregnenolone. ACH deficiency has been identified in Alzheimer’s disease.

These descriptions of the main neurotransmitters should give you a good idea if you have are deficient in a particular neurotransmitter. However, there are several lab tests that are useful in diagnosing brain chemistry:

1. Amino acid analysis. Most neurotransmitters are made out of amino acids, so by testing for amino acids, we can determine if the brain is getting enough of the right nutrients.

2. Organic Acids. At Genova Labs in North Carolina, this test is called Metabolic Analysis Profile (MAP). Organic acids are the breakdown products of various reactions. For example, when serotonin breaks down, it becomes 5-HIAA (5-hyrodxy-indolacetic acid). If the MAP shows low levels of 5-HIAA in the urine, there is not enough serotonin in the brain.

3. Testing blood platelets. Vitamin Diagnostic Lab in New Jersey, after years of research, came to the conclusion that the levels of neurotransmitters in platelets in our blood corresponds to the brain levels of those neurotransmitters. This test is the only way I know of to test for acetylcholine.

Essential Fatty Acids

While the incredible speed of neuron-to-neuron communication relies on an adequate supply of neurotransmitters and the nutrients that build those neurotransmitters, numerous other nutrients play a supportive role in brain function.

The brain, by weight, is 40% fat, or fatty acids. The balance of omega-6 and omega-3 fatty acids is critical to brain health. In the brain a 1:1 ratio of omega-3 and 6 fatty acids is ideal. However, western diets tend to have 20 times more omega-6 fatty acids (from meat and dairy) than omega-3. The main omega-3 fatty acids for the brain are EPA and DHA. Depletion of DHA leads to a decline in structure and function of neurons. By increasing our DHA, we enhance communication between brain cells. Some researchers believe that fatty acid imbalances may lead to hyperactivity and schizophrenia.

Omega-3s have been shown to help people with depression. A 2007 study in Norway showed that nearly 22,000 people with depressive disorders who took daily doses of cod liver oil, which is high in omega-3s, experienced less depression.

Fish oil provides both EPA and DHA. It is not clear exactly how fatty acids improve brain function, brain speed, and mood. One consideration is this. Every cell membrane, including neurons, is made up of a balance of omega-3 and 6 fatty acids. Fatty acid imbalances, especially too much omega-6 and too little omega-3 fatty acids, impair the function of brain cells. The myelin sheath, the cells that cover the axon and allow for the transmission of electrical impulses, is 75% fatty acids and 25% protein. Fish oil helps keep the myelin sheath healthy.

Supporting Nutrients

The most important biological issues in understanding why you feel the way you feel are: 1) which neurotransmitters are deficient? 2) What is the balance of fatty acids? Other important nutrients for brain health are:

1. Vitamin C. It is required by the brain to make neurotransmitters.

2. Vitamin B-12. It’s vital for maintaining healthy myelin.

3. Folic acid deficiency interferes with neurotransmitter function.

4. Vitamin B-6 in the form of P-5-P is required for the production of numerous neurotransmitters.

5. Iron is required for healthy brain tissue and for normal neurotransmitter function. Diminished iron can make people irritable and mentally sluggish.

6. Calcium is especially important for the growing brains of children. Low calcium levels in children are associated with ADD/ADHD, including problems with behavior and learning.

Brain health depends on numerous factors, including the nutrients that make up brain cells and neurotransmitters. If you are able to identify your neurotransmitter problems (if you have one), try the supplements you’ve read here, and you should be on your way to the best brain you can have.

David Gersten, M.D. practices Nutritional Medicine and Integrative Psychiatry out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-line pages about holistic health, amino acids, and nutritional therapy at www.aminoacidpower.com and www.imagerynet.com.