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Mental Health & Nutritional Factors: Objective Laboratory Testing

Wednesday, November 14, 2018  
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Mental Health and Nutritional Factors

Objective Laboratory Testing
By Julia Malkowski ND, DC and Lauren Marcoullier ND, DC

With one in four people currently afflicted, mental health disorders are becoming the leading cause of disability worldwide, and by 2020 depressive disorders are expected to rank second as the leading cause of global disease burden. This rise in mental illness has been linked to rapid urbanization and modernization, as many people are adapting to a “Western” lifestyle, due in large part from easy access to calorie-dense, nutrient-deficient food. As a result, chronic low-grade inflammation has been implicated in the pathogenesis of mental illness with diet being a modifiable risk factor. One of the ways to combat these adverse effects are nutritional cofactors such as vitamin D, E, magnesium, folate, essential fatty acids, B-vitamins, and probiotics, which have been shown to exert anti-inflammatory properties and act on specific biochemical pathways pertaining to mental health. In this article we will discuss the role of specific nutrients in mental health and appropriate lab testing for patients struggling with mental illness to help further guide treatment.

Vitamin D:
Prolonged deficiency in Vitamin D has been linked to depression and associated with an increased risk of neurodegenerative disease, cognitive decline and chronic inflammatory conditions. Vitamin D is required for the enzyme that converts tryptophan to 5-HTP—the precursor to serotonin—known commonly as the ”happy” neurotransmitter due to its euphoric effects. A Vitamin D test allows for quantifiable data: we provide testing for D as serum or dried blood spot. Measuring D2 and D3 provides a comprehensive assessment of Vitamin D metabolism.

Fatty Acids:
Fatty acid deficiency has been associated with poor memory, learning difficulties, and depression. Omega-6 and omega-3 fatty acids are synthesized from the essential fatty acids linoleic acid (LA) and alpha-linolenic acid (ALA), respectively, and dietary habits and inherent metabolic pathways affect the ratio of omega-6 to omega-3. The typical modernized diet is higher in omega-6 fatty acids. When ingested in higher amounts compared to omega-3 fatty acids, Omega-6 creates a pro-inflammatory state. Both fatty acids are critical to protecting cell membranes, but the anti-inflammatory properties of omega-3 have proven to be a beneficial adjunct in treating mental illness. Omega-3 fatty acids include Eicosapentaenoic acid, or EPA, and Docosahexaenoic, or DHA; the former having been associated with increased serotonin release, while the latter is associated with increased serotonin receptor action. Our RBC Fatty Acid test provides a complete evaluation of Omegas 3 and 6.

Vitamin E:
Mood disorders have been associated with inflammation, oxidative stress and decreased anti-oxidant status. While decreased serum alpha-tocopherol (or Vitamin E) may not yet be established as an independent cause of depression, it plays an integral role in decreasing inflammation and inhibiting the peroxidation of polyunsaturated fatty acids. Our Fat Soluble Vitamin Test provied quantitative values of both alpha and gamma tocopherol.

Magnesium is an important mineral utilized in over 300 different biochemical reactions and has become one of the leading nutrient deficiencies in a westernized diet. It is an essential nutrient cofactor for all methyltranferase enzymes, influencing gene expression, metabolism of catecholamines, break-down of histamine, and choline production. Magnesium deficiency has independently been associated with depression and supplementation has been shown to improve mood and alleviate symptoms of fatigue, muscle soreness, headache and irritability. A Red Blood Cell Elements tests is recommended to assess the status of essential elements that confer important intracellular functions. Other essential elements included in the test are zinc, copper, potassium, selenium, manganese and molybdenum.

Folate is an essential vitamin found primarily in green leafy vegetables and its deficiency in diets has been linked to psychiatric disorders. Aberrant folate metabolism can affect DNA/RNA and neurotransmitter metabolism. Folate is a critical component in the MTHFR (methylene tetrahydrofolate reductase) enzyme that helps catalyze the reconversion of homocysteine to methionine via the methionine synthase pathway. Whether due to a genetic polymorphism, poor diet, or liver health, a folate deficiency can indirectly affect methylation. Traditionally folate status has been assessed by RBC total folate, but that does not portray the levels of specific reduced folate derivatives. The Doctor’s Data Plasma Folate Metabolism test reports the individual levels of the primary forms of folate, including the undesirable unmetabolized synthetic folic acid, in plasma and can be used to assess folate status. In addition, a DNA Methylation Profile provides a functional assessment of common single nucleotide polymorphisms (SNPs) such as MTHFR, MTR, MS, CBS, and COMT, which can have reduced activity if a SNP is present. Doctor’s Data has developed a unique evaluation of the methylation pathway and the phenotypic expression of common SNPs. The DDI Methylation Profile provides a functional assessment of methylation status via levels of homocysteine, SAM, SAH, adenosine and other biomarkers to help evaluate possible nutrient deficiencies, as well as the methylation index.

Novel research into the gut-brain axis has redefined probiotics as psychobiotics, which exhibit the ability to exert positive psychological effects on the brain. The pro-inflammatory model of mental illness has well been established but the role of the microbiome is now understood as a key player for chronic underlying inflammatory reactions. Gram-positive Bifidobacterium and Lactobacillus species have shown to produce anxiolytic and antidepressant effects in rodent models. In contrast, gram-negative dysbiotic bacteria have been shown to have an adverse effect on mood, in part due to low-grade chronic inflammation caused by the release of lipopolysaccharide side-chains into systemic circulation. In the absence of dysbiotic flora, having decreased amounts of probiotics in the gut has been implicated in depressed mood and anxiety-like symptoms. Independent of the gut microbiota, prebiotic fiber has also been shown to also exert anxiolytic and antidepressant effects through decreased attention and reactivity to negative stimuli. Prebiotic fiber is broken-down and fermented in the colon by beneficial flora, which in turn produce short-chain fatty acids that are critical in microbial-host cross talk and maintaining a healthy gut barrier. Furthermore, intestinal permeability has been associated with low-level inflammatory conditions that can play a role in the pathogenesis of mental disorders. Evaluating the composition and health of the gastrointestinal identifies these important components of the microbiome.

Neurotransmitters/Amino Acids:
Alterations in neurotransmitter (biogenic amines) levels have been implicated in mood, behavioral and psychiatric disorders. The synthesis and degradation of neurobiogenic amines relies on multiple enzymatic processes, many of which require specific nutrient co-factors. Often times it is not an actual issue with the neurotransmitter but rather the enzymes along the biochemical pathways that can either be working too fast or too slow depending on the availability of the nutrient cofactor and genetic variability. MAO (monoamine oxidase) and COMT (catechol-O-methyltransferase) are two important enzymes for the degradation of serotonin, dopamine, norepinephrine, and epinephrine that are susceptible to single nucleotide polymorphisms variability and nutrient deficiencies. COMT requires SAM and magnesium as cofactors, whereas MAO requires FAD. If a neurotransmitter is not broken down due to faulty enzymatic reactions, the action is weakened and the effects become lessened creating symptoms of a deficiency. The enzymes responsible for the conversion of L-DOPA to dopamine and 5-HTP to serotonin both require B6, thus low levels of dopamine or serotonin may actually be due to a B6 deficiency. The Comprehensive Neurobiogenic Amines test provides a thorough evaluation of neurotransmitters and their metabolites to help better understand where along the biochemical pathways aberrant metabolism may be occurring. A Red Blood Cell (RBC) and Whole Blood Elements test provides intra- and extracellular levels of specific nutrients utilized as enzymatic cofactors. Amino acid testing provides a comprehensive assessment of the precursors to neurotransmitters, such as tryptophan, tyrosine and arginine, along with biomarkers for inflammation, oxidative stress, impaired detoxification, altered microflora, and overall nutrient deficiencies that influence psychiatric disorders.

Vitamin deficiencies have been shown to affect mental and physical health, and without these essential building blocks in a well-rounded, clean, and healthy diet, a solid foundation for mental well-being cannot be established. Taking action in testing for nutrient deficiencies and supplementing these essential nutrients along with a healthy diet could help prevent the onset and progression of many mental illnesses. Lab testing provides a targeted approach for treatment options based on an individual’s unique needs and genetic metabolic variations. By identifying and treating the root-cause of mental illness through the use of quantifiable lab testing, practitioners gain the ability to address the complexity of mental health on an individualized basis.

Suggested References:
Alper E., & Ceylan M., (2015) The Gut-Brain Axis: The Missing Link in Depression. Clin Psychopharmacol Neurosci. doi: 10.9758/cpn.2015.13.3.239
Ames, B., & Patrick, R., Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior. 24 Feb 2015
Eby GA & Eby KL. Rapid recovery from major depression using magnesium treatment. Medical Hypothesis. 2006.
Marx, W., Moseley, G., Berk, M., & Jacka, F., Conference on ‘Diet, nutrition and mental health and wellbeing” Plenary Lecture: Mental health as an emerging public health problem. Nutritional Psychiatry: the present state of the evidence. Proceedings of the Nutrition Society. Doi: 10.1017/S00296665117002026
Young, S., Folate and Depression-a neglected problem. J Psychiatrty Neurosic. 2007 Mar; 32(2):80-82

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