Brain Health and Function

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Brain function and health is an issue important to a large number of patients today, both those that suffer from a diagnosed pathology such as Parkinson's disease, ADHD, or Mild Cognitive Impairment, a precursor to Alzheimer's dementia, and those who experience a variety of disorders and symptoms related to brain health and function, such as insomnia, poor short term memory, depressive disorders, anxiety disorders, bipolar disorders, benign essential tremors, and a variety of sleep disorders, such as apnea, bruxism, or restless leg syndrome. Even more severe psychological disorders, such as deficit schizophrenia, are related to neurodegeneration in areas of the brain such as the insula, related to specific oxidant stress and inflammatory imbalance. Restoring brain health and function after trauma or stroke is an important consideration for many as well. Many endocrine disorders are also related to brain health and dysfunction, as the heart of hormonal regulation lies in the hypothalamus and pituitary complex near the top of the brainstem. Of course, any neurological disorder signals the need for restorative treatment, and Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) offers and array of protocols to achieve such restoration of healthy homeostasis.

A wide variety of health problems point to the need to address the health and function of the central nervous system and the brain. While many advertisements now claim that one specific nutrient supplement or herb is the miracle product that we are all looking for, to improve memory and cognitive function, or to reverse degeneration of the central nervous system, this is not true. The health and function of the brain, brainstem and spinal cord (CNS) is a complicated issue, and a health professional, such as a knowledgeable Licensed Acupuncturist and herbalist, may be able to provide the individualized assessment and protocol to help you restore neurological health and function intelligently. A little knowledge of physiology and what current research tells us helps the patient to take an intelligent proactive role in working with a Complementary and Integrative Medicine (CIM) physician to achieve their goals.

The brain and spinal cord are the most important organs in our bodies, centrally controlling most of the functions of the other organs, and coordinating our sense of emotional well being, memory and cognition. Cognition, our process of awareness, understanding, sensing, perceiving, intuiting, reasoning, imagining, judging and relating, is all important to our quality of life, and we take it for granted, despite its complexity, or perhaps because of it. Since so many diseases and dysfunction in our life are related to the brain and central nervous system, an enormous amount of scientific study is being conducted to find treatment protocols related to brain function and health in Complementary and Integrative Medicine (CIM/TCM). The amount of information is overwhelming, and to utilize this mountain of information, the patient should take a proactive role with a Complementary Medicine physician, such as a knowledgeable Licensed Acupuncturist and herbalist, to choose the best individualized protocol, understand it, and stick with it in a step-by-step process.

There are a number of important considerations to consider in restoration of health and function to the central nervous system (CNS). Neurogenesis, or the constant creation of new brain cells and support glia, is now thought to be the integral aspect of most treatment success with mood disorders, recovery from stroke, and of course neurodegenerative disorders such as Parkinsonism and Alzhemimer's Disease. Neurogenesis in the hippocampus is of particular concern, since this horseshoe shaped section of the brain surrounding the brainstem and joined with the amygdala is most important for functional memory, cognition and emotional balance. Balance and bioavailability of neurotransmitters, efficient clearing of oxidative stress and neurotoxicity are the chief concerns in preventing and reversing neurodegeneration. Circulation and nutrient supply are vital to these goals, as is the health of the immune system and the Adrenal-Hypothalamic Axis. Stimulation of new growth and connectivity are principle concerns as well, and there is not single drug or herb that achieves all of these goals. A broad holistic approach is needed, and each individual needs to focus on specific areas and goals to correct individual deficiencies and concerns. To achieve specific goals related to an individual health profile, the first step should be to gain some basic understanding of the physiology and anatomy of the brain, and then examine the research related to achieving your goals in restorative medicine. A combination of short frequent courses of acupuncture with a prolonged step-by-step approach with herbal and nutrient medicine can be combined with individualized diet and lifestyle habits, such as aerobic exercise and stress reduction to achieve the outcomes needed to prevent or restore degeneration of the brain.

Concerns that commonly prescribed medications may be slowly impairing brain function and memory

While there is a general belief that problems with short-term memory and cognitive function are purely a result of aging, research in recent years has shown that some commonly prescribed medications contribute to cognitive decline and short-term memory problems with chronic use. Warnings were issued in 2012 that the habit of prescribing a host of medications to the elderly needs to be reversed, as considerable worsening of neurocognitive degeneration occurs with the prescription of a variety of drugs. Benzodiazepines prescribed for anxiety and insomnia, cholesterol-lowering statin drugs, antiseizure drugs now prescribed widely for a variety of mood disorders, neuropathic pain, and migraines, antidepressants, sleeping aids, antihistamines, narcotic pain medication, beta-adrenergic inhibiting hypertension drugs, medications to treat incontinence and urinary urgency, and medications to treat Parkinson's disease are all now implicated in neurocognitive dysfunction. Of chief concern are the GABA-modulating drugs, benzodiazepines, anti-seizure medications, and sedative-hypnotic drugs. A serious attention to this health risk has not been seen in standard medicine.

Benzodiazepines come with a variety of adverse effects, and are addictive, with an alarming rebound effect experienced by a high percentage of users. Extrapyramidal side effects have long been a discouragement for use, but it seems that each time the alarm of benzodiazepine prescription subsides, medical doctors again widely prescribe these medications. By dampening neural activity in key sections of the brain transfer of events from the short-term memory to the long-term recall is hampered. Benzodiazepines have long been used in anesthesia to decrease the chance that the patient will recall unpleasant aspects of a surgery or procedure. In 2014, a study published in the esteemed British Medical Journal, (BMJ) showed that benzodiazepine use may promote the development of Alzheimer's disease, and this multicenter study in France and Canada showed that cumulative dosing of benzodiazepines was clearly linked to higher risks of developing Alzheimer's disease. Concurrent use of common medications are shown to enhance this risk. In 2009, a study published in the medical journal Pharmacotherapy found that 3 of 4 people taking statin drugs for cholesterol reduction experience cognitive effects with chronic use that are probably related to the drug, and that 90 percent of users reported improvements in cognition after stopping the use. Antiseizure and anti-psychotic medications, often prescribed now with pleasant names, such as Lyrica and Abilify, act by blocking signals in the brain and may have a dramatic effect over time on memory and cognitive function. Tricyclic antidepressants went out of favor due to adverse effects, and studies have shown that between 35 and 50 percent of patients taking these antidepressants long-term experience some degree of memory impairment and difficulty concentrating.

Synthetic opioid medications often work not by directly increasing opioid neurotransmitters, but by mediating these chemical messengers. This indirect opioid effect often impairs the emotional memory of pain as well as transmission of pain signals to areas of the brain involved in memory and cognition. Over time, memory and cognitive function are dulled by these opioid pain medications. On the other hand, acupuncture stimulation has long been proven to stimulate natural endogenous opioid neurotransmitters, such as endorphins and dynorphins, to modulate pain perception in a healthy manner. Commonly prescribed hypertension medications called Beta-blockers (usually ending with the suffix -olol) inhibit adrenal neurotransmitters and affect epinephrine and norepinephrine in the brain, which are intimately involved with neural function, cognition and memory. Sedative-hypnotics for sleep are now heavily prescribed, due to the adverse effects of other sleep medications, but these newer drugs, such as Ambien, Sonata and Lunesta, act on many of the same pathways as benzodiazepines, and may cause more cognitive dysfunction and memory problems over time than even the benzos. Antihistamines and anticholinergics are often prescribed for a variety of reasons, and inhibit the chief neurotransmitter acetylcholine. While this may calm some dysfunction and relieve allergic symptoms and acid regurgitation, chronic use of these drugs is problematic, impairing acetylcholine activity in the brain in areas devoted to memory and cognition. Atypical antipsychotic medications have tripled in prescription in the United States, often prescribed off-label (non-FDA approved diseases and symptoms), and often to control behavior in the elderly, with clear proof of cognitive decline resulting in many cases.

A lot of concern has now been voiced that the alarming growth in neurocognitive dysfunction in the United States is partially attributed to overuse of medications, especially with the elderly in nursing facilities. Younger patients are also experiencing a significant rise in ADHD and short-term memory problems, and while there are a number of known causes and contributors to this rise, increased prescription of the above drugs may be a significant contributor. Some atypical antipsychotics are shown to result in tardive dyskinesia (bruxism and movement disorders) in 3 percent of patients in clinical trials, as well as Parkinsonism syndromes, and study in 2013 at Southern Illinois University in Carbondale, Illinois, U.S.A. found that these atypical antipsychotics, contrary to popular belief, do not promote recovery of degenerative areas of white matter in the brain, but merely relieve symptoms via unknown mechanisms, often with inhibition of the dopamine metabolism and receptor functions (PMID: 21747763). Many of these drugs are prescribed to treat mood and emotional disorders, and we have been led to believe that they target key centers in the brain and key neurotransmitters that are directly related to mood and emotion. In 2015, research from Dr. Lisa Feldman Barrett, of the Interdisciplinary Affective Science Laboratory at Northeastern University, showed that our accepted beliefs that there are emotional centers in the brain that are responsible for our emotions are wrong, and that mapping and study of many thousands of subjects shows that there are no specific areas of the brain, or specific neurotransmitters and receptors, that are directly linked to specific emotional responses. Her studies have found that the human emotional responses are complex and holistic, utilizing biochemical and neurohormonal metabolism throughout the body, and very much individualized, both to different humans, and to different fields of circumstances. To truly restore emotional and mood balance, a more holistic approach must be found. The solution to this problem of common prescription drugs causing adverse effects on brain function over time would be to use these drugs for a shorter period of time then they are needed, utilizing Complementary and Integrative Medicine (CIM) to correct the underlying health problems so that the drugs can be discontinued in time. Integration of Complementary Medicine is an important goal of responsible healthcare in the future, and should be seriously considered in standard medicine to achieve restoration of brain health, function and regrowth.

In 2015, a large retrospective study of the use of antidepressant medications during pregnancy by medical centers in Canada found that this practice significantly increased the risk of developing autism or and autism spectrum disorder by age six. Nearly one percent of the 150,000 babies studied were diagnosed with autism overall, and when mothers were taking antidepressant medications during the second and third trimester, the risk of the child developing autism was increased 87 percent. The lead author the study, Dr. Anick Berard of the University of Montreal made clear that she was not advocating ignoring treatment of depression during pregnancy, but that clearly a more holistic approach with treatments that posed no risk were needed. Of the 2,532 infants exposed to antidepressant medications during the second or third trimester, 1.2 percent were later diagnosed with autism. Now, this is surely to be downplayed as a small percentage, but with something as debilitating as autism, 1.2 percent is a very large number of people. If an herbal medicine was associated with such risk the outcry would be tremendous, and of course we are well aware of the indirect evidence of mercury in the multifactorial etiology of autism still causing an incredible alarm, but with medication, we are only going to see statements denying proof of a direct causative relationship in the disease, and thus a broad ignoring of the problem.

Traumatic Brain Injury, Concussion, Post-Concussion Syndrome and PTSD

An enormous amount of attention and research has focused on brain and spinal cord dysfunction related to trauma, especially in sports and the military. A July 5, 2015 article in the New York Times, entitled Concussion Inc., Chasing a Remedy, outlined the failures to find an effective treatment protocol, the problems with just prescribing psychotropic drugs with long-term adverse health effects, and finally the research into Complementary and Integrative Medicine by the military as they are frustrated with the lack of progress in treating the many soldiers who experienced traumatic brain injury in Afghanistan and Iraq from IED explosions. As hundreds of millions of dollars became available for research and development of treatments for brain injury and dysfunction, with the U.S. Defense Department alone having spent more than $800 million, and the NFL devoting a sizable sum as well in response to massive medical claims and many players choosing to retire for fear of brain dysfunction, experts described a "feeding frenzy" in research, but a disappointing hodgepodge of poor quality studies seeking to hype an array of treatments that we are finding are not proven to work. A 2013 Veterans Affairs review did note, though, that this research proved that it was impossible to truly separate the long-term impacts of mild traumatic brain injury (MTBI) from PTSD, and that the study of these problems has shown that few tangible results have emerged from this enormous sum of money spent on research.

One U.S. military study did find, though, that a simple nutrient medicine, N-acetyl cysteine (NAC), showed significant benefits in a randomized controlled study of soldiers who had sustained a concussion or MTBI in Iraq. Of course, this study was quickly derided in standard medicine, despite the rigorous quality of military research, but some experts, such as Dr. David W. Dodick of the Mayo Clinic, found the study results compelling. Dr. Dodick was quoted in the New York Times article: "Every coach and parent could be carrying this on the sidelines (in the near future)." Studies of hyperbaric oxygen therapy have also been touted in a few studies, but a definitive study sponsored by the U.S. military, involving Dr. Carl Castro, a professor at the University of Southern California, and a retired military colonel, and Dr. Lindell K. Weaver, a hyperbaric expert at the LDS Hospital in Salt Lake City, Utah, found that those receiving real hyperbaric oxygen therapy, and those receiving a sham treatment showed the same results. The debate did not end there, though, with enormous lobbying for this expensive procedure in Congress resulting in amendments to budget bills that required a military review of these studies, and bills introduced that would require the Veterans Affairs Administration to pay for hyperbaric oxygen therapy even if it was not evidence-based. One sponsor of such legislation, Representative Walter B. Jones Jr. of North Carolina was quoted as saying: "No one has committed suicide from the treatment with oxygen." This statement purportedly referred to the sometimes devastating effects of anti-psychotic medications commonly used to treat MTBI and post-concussion syndromes, and supported hyperbaric oxygen therapy even if it only works by a placebo effect. Of course, this is the opposite sentiment voiced strongly to deny support for acupuncture over the last four decades. The acupuncture profession apparently didn't have a moneyed lobby.

What is missing in this debate is the fact that preliminary studies in the field by the U.S. military have already confirmed the proven efficacy of N-acetyl cysteine and even acupuncture in this realm of restorative medicine, and that we shouldn't then just assume that N-acetyl cysteine (NAC) is the treatment. Integration of synergistic protocols such as NAC within a more holistic treatment regimen is obviously needed. Such inexpensive and safe therapeutic tools are meant to be just part of the holistic protocol, not a substitute for a pharmaceutical intervention. Hopefully, this study will spur more serious study of a variety of herbal and nutrient medicines that have already shown themselves to be effective in a variety of ways. For instance, a chemical found in a number of Chinese herbs, and in minute quantities in some foods, resveratrol, usually derived from Polygonum cuspidatum (Hu zhang), was found in 2014, at Taipei University, in Taiwan, to be able to increase cell survival after traumatic brain injury by suppressing the GSK/3beta pathway of mitochondrial dysfunction and cell apoptosis (PMID: 24675465). As research progresses, a number of biochemical pathways will be revealed that may be addressed with herbal and nutrient chemistry. The sum of these mechanisms will create a workable holistic strategy, although the present system of medical research does not really fit a model of a combination of therapies in a larger holistic protocol in study design with randomized controlled human clinical trials. This will need to change. In 2014, a large multi-center randomized controlled human clinical trial of integrated treatment protocols for patients with persistent cognitive impairment after traumatic brain injury in an earthquake in China found that the addition of acupuncture to a protocol of hyperbaric oxygen and cognitive rehabilitation training produced significantly better results than the combination of hyperbaric oxygen and rehabilitative cognitive therapy alone (PMID: 24796041). A retrospective study in Taiwan, by Taipei University, I-Shou University, and China Medical University Schools of Medicine, using the Taiwan National Health Insurance Research Database, reviewed records of about 37,000 patients after traumatic brain injury, and found that those who had received acupuncture treatment showed a decreased risk of future stroke between 6 and 14 years after the brain trauma (PMID: 24586597). Integrating an holistic protocol of acupuncture with herbal and nutrient medicine, a completely safe and inexpensive treatment protocol, into the restorative and preventive treatment for such patients seems entirely sensible. With such evidence mounting, patients now just need to wait for Medical Doctors to actually get past their competitive bias and start referring patients to such care.

The most important aspects of brain metabolism and neurogenesis

When devising the most effective individualized treatment protocol for improving brain function and health, a number of key issues need to be examined and assessed, and priorities need to be established for each individual. The number of ways that we now know to effectively aid brain functionality and improve the health of the brain cells, tissues, circulation and neurotransmission are growing year by year with research, and choosing the right tools from the array of beneficial treatment options is now daunting. This is why each individual must work as a team with a Complementary Medicine physician to choose the most important aspects of brain health to work on. This means that we should gain some understanding of the way that our bodies circulate nutrients and herbal chemicals to the brain, which nutrient and herbal chemicals easily cross the brain-blood barrier and affect the brain, and what aspect of the brain health needs to be focused on. This may include the neurotransmission, with a balance of neurotransmitter bioavailability and receptors, or it may include the health of the energy utilization of brain cells and tissues, especially mitochondrial health. We may also consider neurotoxicity and oxidative stress and damage, and the ability of the brain to repair itself faster than it ages or is damaged from toxicity or oxidative stress - neurogenesis. A step-by-step approach may include treatment of vascular health and the blood brain barrier integrity, cerebral circulation, essential nutrient bioavailability, antioxidant aids, detoxification and chelation, and bioavailability of neurotransmitters and restoration of their receptor balance.

Neurogenesis, or growth of new neurons from neural stem cells, was denied in standard medical science for many decades based purely on a belief, not objective evidence. The concept that the human brain, once developed as an adult, was enclosed in a set space and could not continue to grow, was devised in the nineteenth century, and was largely not challenged in the twentieth century, or when contradicted by scientific proof, this proof was kept out of print. The belief that the human organism contained a set number of brain cells, and once damaged, did not grow replacements, seems on the whole absurd, especially when seeing the remarkable recovery from severe stroke and surgical removal of a large brain tumor, yet was held as a religious belief in science, unquestioned. In the 1960s, to prove that this finite number of brain cells existed, experiments on rhesus monkeys studied the growth of neuron synapses, but the only way to actually obtain proof was to actually cut into the brain, mostly with autopsy studies. In 1965, Joseph Altman and Gopal Das of the Massachusetts Institute of Technology (MIT) refuted these studies by showing that new cells grew in the mammalian brain in the hippocampus and olfactory system. These findings were challenged as surely mistaking glial cells for neurons. There were almost no published studies to resolve this issue until the 1980s, when new neurons in the brains of song birds were found to be associated with new songs, and many studies noted that the weight of mammalian brains increased with learning. By the late 1980s, Elizabeth Gould, studying the effects of hormones on the brain, observed that new neurons appeared to grow in the hippocampus of laboratory animals, but she was largely ignored, until studies in 1996 showed that environmental stress reduced this neurogenesis, and more scientists were enticed to study the effects of stress on the brain. In November of 1998, a study by Peter Erickson and Fred H. Gage was finally published that clearly showed that new neurons were generated in the human hippocampus from stem cell progenitors, and migrated to other parts of the brain. Dr. Gould's research demonstrated that new neurons were produced in the cortex of rhesus monkeys, throughout the cortex, and growth was related to cognitive function. This would seem obvious, considering our understanding of cells and growth, yet was a notion that was fiercely fought for over a century.

Today, we know that many disease states of the brain can be attributed to unhealthy homeostatic mechanisms of generation of new cells and degeneration and cell death, including mood disorders, and that the neural plasticity is quite amazing. The old ideological fight continues, though, and it appears unsafe to suggest that growth of new neurons occurs anywhere in the brain than the hippocampus. To prove the point fully, we would have to cut into the brain, and then later cut into the brain again, in a human, and measure and study these neurons, with positive proof that the new neurons were not just the old ones. In February of 2002, though, Fred Gage and Henrietta van Praag showed that these new neurons in the hippocampus of laboratory animals show signs of normal growth of functional synapses, extending to other parts of the brain. Such finding clearly points to a regenerative medical approach to degenerative disease. Finally, the religious dogma that we cannot stimulate healthy generation of new neurons in the brain is largely ignored, although the repetition that these new neurons only may occur in the hippocampus continues. It is just a shame that this concept of brain cell growth was not accepted earlier, so that we could be utilizing a more holistic protocol with restorative medicine as a standard, instead of the failed allopathic strategies used so far, such as replacement of dopamine in treatment Parkinsonism. In 2003, Zhao et al published studies that clearly showed that neuron repair occurs in the substantia nigra, the key area of neurodegeneration on Parkinsonism. This study showed that dopaminergic neurons constantly died and new ones grew to replace them, albeit at a fairly low rate of about 20 new neurons per day. These new neurons would need to grown new axonal pathways and connections, of course. Such development could be affected by neurotoxicity, oxidant stress, and lack of functional stimulation. Once again, though, to fully prove that new neurons were growing, the old neurons would have to be tagged somehow, which is difficult to achieve in live brains.

Once it it finally accepted that brain cells regrow, which to many seems obvious at this point in time, we will finally be able to accept concepts such as providing the raw materials to aid this growth, the efficacy of stimulation of the area with acupuncture, and the need to include antioxidants and detoxifying therapy into the treatment protocol. We also will see more emphasis and homeostatic balance in inflammatory mechanisms, and may even stop the number of CAT or CT scans of the brain, which obviously damages regeneration and promotes degeneration with excess radiation. We will also see the need to restore metabolic homeostasis and healthy insulin production in the brain, which is involved in cell growth regulation, as well as the need to establish a healthy lipid metabolism and homeostatic balance, to insure that the main type of tissue in the brain, fatty tissue, is as healthy as it can be.

The keys to healthy neurogenesis and neuroplasticity (adaptive responses) in human homeostasis are finally being elucidated, and will provide us with more key information concerning brain health and prevention of neurodegenerative disease. A 2016 study at the Yale University School of Medicine and Child Study Center, in New Haven, Connecticut, U.S.A. revealed that an enzyme called striatal-enriched tyrosine phosphatase, or STEP, is consistently found to be deficient or in excess in many common disorders of the brain. Deficiency of STEP is consistently seen in stress disorders, alcoholism, Huntington's chorea, and after an ischemic stroke, and excess of STEP is consistently seen in Parkinsonism, Alzheimer's disease, schizophrenia and fragile X syndrome (childhood delayed development) (PMID: 27190655). To understand the various reasons for STEP imbalance may be a somewhat complex task, though. A phosphatase protein enzyme controls the rate of removal of phosphates from molecules, usually in relation to control of acidity, as in alkaline phosophatase, or to alter a genetic RNA or DNA. Other phosphatases control the rate of activity of protein hormones and messengers by removing a phosphate from an amino acid complex. This removal of phosphates from proteins is the main way our bodies regulate metabolic processes. Protein tyrosine phosphatases control the rate of cell growth and regeneration, proliferation, differentiation, transformation and synaptic plasticity. There are many types of protein tyrosine phosphatases, and the striatal-enriched tyrosine phosphatase concerns the brain striatum, or subcortical part of the forebrain, often referred to as the corpus striatum, divided into the dorsal and ventral striatum. This part of the central brain coordinates cognition, planning, motivation, reinforcement and reward perception, and is especially rich in glutamate and dopamine receptors, making it the focus in Parkinsonism, addiction, bipolar mood disorders. The neurotransmitter GABA is especially important in this reason to exert control and regulation. STEP is important in regulation of the glutamate NMDA receptor expressions, implicated in the pathology of many neurological diseases, and amyloid-beta proteins, central to brain plaques in Alzheimer's disease, is shown to regulate STEP. The key to maintaining homeostatic balance for this important enzyme may involve an holistic protocol, although assuredly we will see attempts to find drugs to inhibit or promote some aspect of the STEP metabolism. The success of supplements such as L-tyrosine, L-phenylalanine (which converts to tyrosine), and L-glutamine in treating brain dysfunction and neurohormonal disorders may be largely related to the STEP metabolism.