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Brain Health: A
Functional ApproachMichael Montico, MD
Holland Biomedical ClinicMarch 24, 2012
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Current State of Health Care
Expensive
Ineffective
Dangerous Interdependence
Unsustainable
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What is wrong with medicine
One size fits all
Doctor centered
Drug centered Treat the symptoms not the problem
Evidence based medicine
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Treating Pneumonia
Signs/symptoms
Cough
Fever
Body Aches
Disease
Chest X-ray
Sputum culture
Antibiotics
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Redefining Medicine
New paradigm
Function vs.. Pathology
Physiologic systems vs. Diseases New measuring stick Optimal Health
Continuum
Optimal function Disease state
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Functional Medicine
Biochemical individuality
Genetic predisposition
Environmental stressors Patient centered approach
Indentify the imbalances that cause the
disease
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Functional Medicine: Imbalances
Digestion, absorption, barrier integrity
Methylation/Detoxification
Immune dysregulation/Inflammation Hormone/Neurotransmitter regulation
Psychological/Spiritual equilibrium
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Traditional Approach
Name it
Blame it
Tame it
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What is Functional Medicine
Science-based, personalized healthcareapproach that assesses and treatsunderlying causes of illness through
individually tailored therapies to restorehealth and improve function.
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Functional Approach
Get rid of what is hurting them!
Give them more of what they need!
Break the vicious cycles!
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Brain Disease
Not inevitable
Minimize cell damage
Brain aging not detiorating, constantlyadapting
Lifestyle factors affect cognitive aging
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Brain Basics
Organ
Network of neurons
Brain cells communication Synapse
Neurotransmitters
Receptors
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Methylation
Biochemical balance
Methyl groups: CH3
Methylation affects: Serotonin
Melatonin
Creatine
Gene expression
Detoxification
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SAM
SAH
Homocysteine
THF
CBS
B12BHMT
Choline
Betaine
Methylation Cycle/Oxidative Stress
TranssulfurationPathway
THF: tetrahydrofolateCystathionine
Cysteine
Glutathione
Methionine
AK
ADA
Inosine
AMP
B6
Methylation of DNA, RNA,Proteins, Catecholamines,Phospholipids, Creatine
Enzymes
MS
5-CH3THFAdenosine
GSSG
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Impaired Detoxification
Oxidative stress
Methylation/sulfation abnormalities
Environmental toxins Increased inflammation
Dysfunctional mitochondria
Brain cell damage death
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Homocysteine
High levels of homocysteine:
Methylation imbalance
Detoxification issues
Increased risk of heart disease
Mental health issues
Genetics
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Oxidative Stress
Brain is over 50% fat
Trans fats/damaged fats cause problems
Oxidative stress = fire Antioxidants:
Vitamin C
Selenium Glutathione
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Bad for the Brain
Oxidants
Smoking
Alcohol
Sugar
Stimulants
Stress
Toxins
Allergens
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Vicious Cycles
Gut inflammation
Abnormal intestinal permeability
Food sensitivitiesMalabsorption
Dysfunctionalenzymes
AbnormalMethylationbiochemistry
Increasedoxidative
stress
Environmentaltoxins
Impaireddetoxification
Increaseddamage from
toxins
TH1 to TH2shift
Increasedautoimmunityand aller
Chronic viraland fungalinfections
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Memory Problems with Aging
Age related memory decline
Digestion issues with age
Circulation changes: gut to brain Brain aging: neurons/synapses decrease
with age
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The Human Brain
Reptilian Brain
Instinctual
Survival
Regulates autonomic functions
Limbic System
Neocortex
Prefrontal cortex
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Limbic System
Brain of instinct and emotion Amygdala
Hypothalamus
Hippocampus Decoding signals
Fear
Feeding Fighting
Fornication
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Limbic System cont.
Processes info from environment
Relies on emotion/instinct
Memory storage
Damaged in brain dz
Free radicals
Oxidative stress
Hippocampus damaged Memory affected
Emotions blunted
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Neocortex
Higher-order thinking
Interprets our environment
Creates messages Functions:
Logic
Planning
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Prefrontal Cortex
Higher brain function
Reasoning
Invention
Creative thinking
When brain functions well
Develop intelligence
Creative
We thrive
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Mitochondria
Powerhouses
Cell regulation
Provide fuel to build cells: ATP Create reactive oxygen species (ROS)
Free radicals - apoptosis
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Free Radicals
Apoptosiscell death
Necessary process avoid cancer
System is flawed when mitochondriabecome impaired
Free radical >>> oxidative stress
Damaged tissue >>> aging
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Stress
Amount of resistance a material offers tobeing reshaped
Structure of a building
Psychological stress
Stress bucket
No longer resist the forces collapse!
Cant cope
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Acute Stress
Short lived
Encountered in new learning environment
Creates imprint Causes positive hormonal changes
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Chronic Stress
Long lasting
HPA axis
Hypothalamus
Pituitary
Adrenal glands
Hormones
Cortisol
Adrenaline
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Acute vs. Chronic
Acute stress: Appropriate hormone release
Ready energy
Appropriate action fight or flight Chronic stress:
Adrenal stuck on
Increased affect of free radicals Damaged mitochondria
Cell death >>> brain damage
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Stress = Brain Dysfunction
Higher brain function stops
Primitive brain takes over:
Cant learn
Avoid pain
Take risks
Adrenal fatigue exhaustion
Im in a rut wiring of neural networks
Structure of building
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Our Thermostat
Hippocampus regulates adrenal glands Healthy brain normal cortisol levels
Damaged brain triggers excessive cortisol
Hippocampal set point Determines amount of cortisol released
Trauma/stressturns down thermostat
Positive experienceturns up thermostat Genetic factors involved
Life experiences reset sensitivity
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Neuroplasticity
Brains ability to create new networks
Neuroplasticity = adaptability
Attention + focus = new neuralconnections
Stop feeding the negative circuits and
start feeding the new ones!
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Balancing our Brains
Shifting from the emotional brain:
1. Take away what harms toxins, allergens,negative emotions
2. Give what heals fix the physiology
3. Build new positive neural networks
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Neurogenesis
Ability of the brain to grow new neurons
The brains own . stem cell therapy
BDNF brain derived neurotrophic factor Protects neurons
Stimulates creation of new neurons
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Activating BDNF
Physical Exercise
Reduced calorie intake: Sugar
Obesity Fasting
Intellectual stimulation
Brain supplements Omega 3s
Curcumin (Nrf2 pathway)
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Benefits of Fasting
Reduces free radicals
Reduces inflammation
Enhances mitochondrial function Increased BDNF production
Reduces apoptosis
Activates the Nrf2 pathway
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The Brain and Nutrition
Cell communication: fats
Neurotransmitters: amino acids/proteins
Energy: carbohydrates Work
Vitamins
Minerals Energy
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Carbohydrates
Glucose is brain fuel
Carbohydrates are not created equally Complex carbohydrates
Refined carbohydrates Glycemic index
Blood glucose stability
What about fruit??? Fiber
Vitamins
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Carbohydrates cont.
No sugar substitutes
Avoid processed carbs
Eat whole grains: rice, oats, quinoa Fruits: apples, pears, berries
Stop eating sugar!
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Fats
60% of brains mass
Essential fats: thru the diet
Omega 3s: EPA/DHA
Omega 6s: GLA
Cell communication
Synapses
Myelin sheath insulates the nerve cell
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Omega 3s
Unsaturated fats
Damaged by cooking
Functions of Omega 3s Relax blood vessels
Anti-inflammatory
Balance blood sugar
Regulate neurotransmitters
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Fats cont.
Eat nuts/seeds
Eat fish
Use oil on food (after cooking) Take fish oil
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Phospholipids
Cell membranes
Myelin sheaths: insulators
Neurotransmitters
Methylation
Homocysteine
Source: Eggs
Fish
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Proteins
Amino acids: building blocks
Neurotransmitters made of amino acids
Adrenalin/dopamine feel good
GABA calming
Serotoningood mood
Acetycholine memory/communication
Essential amino acids
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Eat Protein
Grains: quinoa, brown rice
Beans
Nuts/seeds
Fish
Poultry
Eggs
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Brain Nutrients
Vitamin B 12 methylation
Folic Acid 100mcg
B6 (P5P) 50mg
B vitamins 25mg
Vitamin C 500mg
Magnesium 250-500mg
Zinc 10-20mg
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Defining HBOT
A treatment in which a patient breathesoxygen while inside a pressurizedtreatment chamber @ a pressure that is
greater than the atmospheric pressure atsea level
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O2 and Respiration
Human respiratory system: designed tosupply O2 to tissues
Oxygen travels:
Lungs
Blood
Circulation
Delivery of O2 >>> Tissues
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Oxygen and Energy
Respiratory system series ofcompartments linked by circulation
O2 transferred from gas >>> cells
In cell O2 consumed by mitochondria
Powerhouse of the cell makes energy!
Energy = work!!!
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Oxygen Transport
O2 travels from lung >>> vessel
RBC carries O2 via hemoglobin (Hgb)
Blood has large carrying capacity
Good circulation + adequate Hgb = goodoxygenation
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Oxygen Transport cont
Blood transports O2 via
Hgb
Plasma
Hgb saturated
How do we increase O2 content???
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Oxygen and Plasma
Increase O2 content via increasing O2dissolved in PLASMA!!!
Amount of O2 in plasma ~ O2 partial
pressure
Increase pressure = increased O2 in thetissues
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O2 Transport and HBOT
At atmospheric pressure oxygen transportlimited by oxygen binding capacity ofhemoglobin (hgb is already saturated)
Plasma carries oxygen to areas thatRBCs can not reach!!!
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HBOT and the Brain
Increases cerebral glucose levels
Improves neuron function
Recovers neurons injured by:
Ischemia
Hypoxia
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Oxidative Stress
Electrons passed along ETC to create nrg
Electrons leak >>> free radicals
(Reactive O2 species ROS)
Free radicals can lead to damage of:
Lipids
Proteins
Mito DNA
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Oxidative Stress cont
Occurs when ROS cant be quenched
Increased in most chronic diseases
Oxidative stress leads to mitochondrial
dysfunction
Effects of HBOT on
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Effects of HBOT onMitochondria
Increase function of normal mitochondria
Mitochondria:
Weaker apoptosis
Stronger multiply
Aging result of accumulatedmitochondrial damage from ROS
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Mechanism of HBOT in ASD
1. O2 causing angioneogenesis
2. Increased blood flow independent of newblood vessel formation
3. Decrease in inflammatory markers
4. Up-regulation of key antioxidant enzymes
5. Increasing O2 to mitochondria6. Increase production of new mitochondria
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Mechanisms of HBOT cont.
7. Improvements in immune system function
8. Decreasing bacterial load in the GIsystem
9. Decreasing yeast load in the GI system
10.Decreasing viral load in the GI system
11.Increased production of stem cells
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HBOT and ASD
Problem Autism Finding HBOT Effect
Cerebral perfusion Reduced Increased
Inflammation Increased Reduced
Immune function Reduced Increased
Oxidative stress Increased Reduced
Mitochondrial function Reduced Increased
Neurotransmitterabnormalities
Increased Reduced
Dysbiosis Increased Reduced
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Effects of HBOT in TBI
1. Reduce cerebral edema
2. Stabilized the blood brain barrier
3. Decrease intracranial pressure
4. Improve aerobic metabolism
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The Injured Brain
Injured brain needs more:
Blood flow
Oxygen
Injured brain has cerebral edema
causing:
Less blood flow
Less oxygen
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Effects of HBOT in TBI
Increase blood flow
Increase oxygenation to tissues
Increase O2 utilization efficiency s/pHBOT
Improve mitochondrial function/recovery
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Off label uses of HBOT
Traumatic brain injury
Inflammatory boweldisease
Cerebral Palsy Ischemic stroke
Myocardial infarction
Autism
Parkinsons Disease
Multiple Sclerosis
Osteoarthritis
Cancer
Lyme Disease
Dementia
CFS/Fibromyalgia