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Re: The gut, and mental illness (long) » McPac

Posted by Larry Hoover on April 22, 2003, at 10:45:26

In reply to Larry, Re: Interesting Read!!!, posted by McPac on April 21, 2003, at 21:09:11

> Lar, I don't have the website info for the article.

It was the first hit on a Google search....I didn't stop to think.

>I was hoping that you would see it simply because I wondered what your thoughts would be on the recommendations. Remember when I asked you a week or so ago if you took Probiotics? I was just trying to see if you were aware of candida, parasites, leaky gut syndrome....those types of things....things that are never discussed here on this board.

I'd be happy to give my thoughts on the gut and mental illness.

As I mentioned earlier, some years ago, I had an extensive correspondence going with Allen. He opened my eyes, so to speak. I had long believed that one of the contributing factors to my own disease was what I thought of as a "subclinical malabsorption syndrome". Subclinical in that it wasn't so very obvious that medical professionals had identified it as such, but nevertheless, significantly affecting my nutritional status. (Aside: The word disease comes to us from the Old French, diseasu, meaning not at peace. I can't think of a better description for my illness.)Allen wrote massive articles documenting his history and his interventions, but I lost them in a hard-drive crash a few years back (I think). It's possible they're in my archives, and I'll look for them later. Allen was massively afflicted with bipolar disorder, and had come to the brink of suicide, when he decided to try something radical. He really had little to lose at that point. He began taking massive doses of specific amino acids and vitamins, and his mood stabilized for the first time in his life. He was a rapid-cycler, so it didn't take long for him to feel the effects. The last I recall hearing from him, he had been stable for over one year, and was continuing to refine his personal protocol. He gave me some tips, and some places to look, and I began my own journey of introspective treatment. I started doing experiments with n=1 (i.e. with one subject), and took steps towards mood stability and optimized function.

I'll give my thoughts on the factors Allen has identified:

1. "Any hidden food allergy or allergies."

I agree with Allen that this issue is totally trivialized or ignored by doctors and patients alike. Many of the diets that people find success with are actually elimination diets. Atkins sets out to reduce or virtually eliminate carbs. But that coincidentally eliminates gluten. Gluten is the bad boy in celiac sprue, and if you look at the data, about 2/3 of all people with celiac disorder have depression. Go figure. When I look at diets, I think about these coincidental correlations. The thing about coincidental correlation is you can't determine which variable is the coincidental one; is carbohydrate intake the coicidental variable, or gluten? It might help to know, from a planning perspective, but the only thing that really matters is, "Does it work?" It takes weeks for the gut to heal from major exposure to some of the triggers, like gluten or lactose, so you really have to show some determination to sort this one out.

2. "A yeast condition known as candida."

Again, I'm drawn to the coincidental correlation issue. Measures used to control candida also control for sugar intake and yeast intake. The latter is likely to also control for gluten. Whether candidiasis is a clinical entity or not is debatable, but the effect of dietary control measures is not.

3. "A chronic and/or recurrent lack of digestive enzymes. Digestive enzymes are nearly always lacking in persons that are bipolar, as their production draws on the same pool of available amino acids and minerals that neurotransmitters do. It is nearly a given that if a person lacks in an adequate supply of neurotransmitters, that they lack digestive enzymes as well. This crucial biochemical issue needs to be addressed in any person with any psychiatric diagnosis whatsoever. Worthy of note is that some digestive enzyme preparations that are sold are simply not potent enough to be adequately therapeutic in which to treat bipolar."

This is a biggie, in my own thinking. Allen has well described the issue, so I left his words intact. I would add, however, that bromelain is quite effective and readily available. Further discussion on the subject in the next section.

4. "A lack of the ability to produce enough stomach acid."

Major issue. Reflux. Heartburn. GERD. All the Maalox/Nexxium in the world won't fix the problem....because they are not symptoms of excess acid, but instead, mis-timed acid. Medical management, as it currently stands, either blocks acid release (proton-pump inhibition or H2 blockade), or neutralizes it (Tums, Maalox, et al). The effect is iatrogenic (doctor-caused) hypochlorhydria (low stomach acid) or achlorhydria (absent stomach acid). Doctors would have you believe that these situations are benign, but I must vehemently disagree. You look at the literature, and you'll find correlates between these two low acid conditions and a host of pathologies. Here's *my* story.

I was first diagnosed with chronic reflux over twenty years ago. I got all the standard treatments of the day (e.g. cimetidine), and still found myself carrying around Maalox wherever I went. I was put on omeprazole (Prilosec) when it was an experimental drug. I took part in the clinical trials for Nexxium (another one of those cash-grabs which releases on enantiomer of a racemate, as if it was a new drug). I knew I was in the treatment arm of the Nexxium trial, because the protocol called for the use of the drug p.r.n. (as needed), and I could immediately and predictably observe the effect. I still could not go anywhere without my Maalox, which I swigged sometimes many times a day. Over time, I began to notice that other things in my life were beginning to be more chronic (e.g. irritable bowel syndrome, mood swings), and I started to consider the negative impacts of iatrogenic hypochlorhydria, and the pathology we call GERD. I'll give you a synopsis.

I first considered digestive processes dependent upon stomach acid. Why is the stomach acid? Well, it's a pretty good barrier against infection, so blocking stomach acid isn't a good idea from that perspective. But, certain processes stood out: a) digestion of proteins; b) release of vitamin B-12. In the presence of protein, your stomach releases a compound known as pepsinogen. If the pH of the stomach is low enough (that's highly acid), pepsinogen is activated to pepsin, and cleavage of the peptides in protein proceeds effectively. Without acid, nothing happens. And, in the absence of acid, the B-12 in meat remains tightly bound, and is not available for absorption. Bacteria may release it later, but only after the meal has passed by that part of the gut that is dedicated to take it up.

I then turned my attention to the signal to release acid. It turns out that there's a signalling compound called gastrin that says "dump in acid". Looking at that more closely, I found that GERD sufferers release gastrin late. That results in a stratified acid profile in the stomach; that is to say, layers of differing acidity, with virtually none at the bottom, and high acid at the top, closest to the esophagus. The high acid there releases a lot of gas, and reflux is virtually a certainty. And, it turns out that B-12 is essential both for gastrin signalling and for acid production....in other words, B-12 deficiency contributes to B-12 deficiency. I'm going to fast-forward now (I could write a book, ya know?).

So what to do about it? I came to believe that four supplements would have a significant impact: B-12, betaine, bromelain, and magnesium. B-12 is a cofactor in both acid formation and signalling. Betaine (as the hydrochloride) is often suggested as an acid replacement, but I think that's another coincidental correlation. The amount of hydrochloride present is trivial, whereas the betaine is essential in a process that ultimately ends in proper regulation of acid release. Bromelain is a peptidase enzyme. It digests protein, even under the high acid condition of the stomach. Moreover, it has other anti-inflammatory propterties as well. And magnesium is a co-factor of a lot of enzyme processes.

So, what was the outcome of my supplement trials? Within two weeks I stopped using omeprazole. I have not had GERD since (over a year now). My irritable bowel has been substantially stable, and I continue to gain strength and stability in other parameters of my disease.

5. "Improper bowel flora."

The bacteria which proliferate in the gut are those which obtain nourishment there. I see "improper bowel flora (actually fauna)" as a marker of improper diet and disrupted digestion. Restoring the supply of nutrients and regulation of digestion will result in a shift in bacterial populations. That said, taking probiotics cannot hurt, and may well help the process along. I have yet to see convincing evidence of efficacy, except in the case of subjects who have been treated with massive doses of systemic antibiotics (like me, right now, for the pneumonia). I will certainly take probiotics after I'm off the antibiotics.

6. "A lack of various nutrients"

I think you know where I stand on that.

7. "The possibility of parasites."

Actually, I've seen some evidence that certain disorders can be treated by infecting patients with parasites. I think there are a lot of individual characteristics to consider on this issue.

8. A flawed "appetite mechanism" and/or "thirst mechanism".

I think this one is encompassed wholly by previous considerations.

Just my Canadian 2 cents (about 1.4 cents U.S.).

Lar

 

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poster:Larry Hoover thread:221042
URL: http://www.dr-bob.org/babble/20030417/msgs/221445.html