Nutrient Power

Each of these clinical steps is essential to treatment success. This therapy approach is complex and requires supervision by an experienced medical professional. Nutrient overloads or deficiencies can have a powerful effect on brain functioning and improper treatment can cause great harm. In other words: Don’t try this at home! Find a doctor experienced in nutrient therapy!

In 1989, our clinical protocols were modeled after the system developed by Dr. Carl Pfeiffer at the Princeton Brain Bio Center in Skillman, New Jersey. Since that time, advances in brain science and biochemistry have produced numerous new treatment approaches. In most cases, we performed outcome studies to measure treatment effectiveness prior to incorporation into our clinical protocols. This activity yielded several disappointments as well as many successes. For example, we confidently began supplementing low-histamine patients with histidine, the amino acid that converts to histamine in the body. Unfortunately, this often produced dramatic worsening, and the procedure was discontinued after discovering that histidine supplements caused severe zinc deficiency in these patients.

In another misadventure, we began treating manganese-deficient Tourette syndrome patients with manganese supplements. This resulted in lower dopamine activity and made symptoms worse. An example of a successful trial involved use of SAMe for undermethylated depressed patients in 1991. It didn’t take long to learn that SAMe produced more rapid improvements than any previous methylation approach. Brain biochemistry is very complex, and each new therapy or clinical procedure must be put to the test. This evaluation approach has brought great improvements in reported outcomes since 1990, and future advances will be achieved as additional mysteries of brain biochemistry are resolved.

Successful nutrient therapy requires in-depth knowledge of the patient, and an extensive medical history is essential. Lab chemistries provide only 50% of the information needed for accurate diagnosis. Each biochemical imbalance is associated with a distinctive collection of physical characteristics and behavioral traits, and it is often possible to predict the lab findings before testing. The ideal situation occurs when symptoms and traits dovetail with the blood and urine chemistries. Table 10-1 presents a partial list of medical history factors that can assist in diagnosis.

Table 10-1.
Medical History Factors

Problems during pregnancy	Problems during birth
Early health issues	Food sensitivities
Developmental milestones	Growth history
Seasonal allergies	Chemical sensitivities
Illnesses	Injuries
Academic strengths and weaknesses	Academic level
Family unit	Occupation
Medical diagnoses and treatments	Response to medications
Immune function	Behavior control
OCD tendencies	Sleep issues
Substance abuse issues	Pain threshold
Family history of illnesses	Socialization issues
Competitiveness	Diet

Some patients become discouraged if they have a close relative with the same mental disorder. They assume their condition may be inevitable and untreatable since it appears genetic in nature. Over the years, I’ve learned the exact opposite is true: the best treatment candidates are those with a family history of the same disorder. An inherited mental illness usually involves abnormal brain chemistry, and chemistry can be adjusted. The prospects are poorer for patients who experienced a difficult birth or a severe head injury.

In our early clinical experience, we were surprised to learn that more than 30% of violent children receiving our services had been adopted, and this population generally had better outcomes than other children with behavioral disorders. We believe a high percentage of the adoptees inherited abnormal brain chemistry from dysfunctional birth parents but were adopted by caring and capable persons who sought solutions when problems developed. Typically, the adoptees had a striking combination of terrible chemistry and an excellent family environment. Most of these families reported a complete elimination of violent episodes following nutrient therapy.

Telltale Clues of a Chemical Imbalance

The primary nutrient imbalances that impact mental health are usually accompanied by a distinctive set of symptoms and traits. This information can be valuable in forming a correct diagnosis, especially when chemistry findings are inconclusive. General syndromes associated with these imbalances are summarized below. The presence of more than 30% of these symptoms and traits is considered a positive indication of the imbalance.

Zinc deficiency: Poor growth through puberty with significant growth after age 16, white spots on fingernails, frequent infections, tendency for sunburn, preference for spicy foods, irritability, poor stress control, anger, poor wound healing, poor muscle development, premature graying of hair, abnormal or absent menstrual periods, stretch marks on skin.

Copper overload: Hyperactivity, academic underachievement, skin sensitivity to metals and rough fabrics, estrogen intolerance, emotional meltdowns, ringing in ears, sensitivity to food dyes, high anxiety, sleep problems, adverse reaction to nutritional supplements containing copper, abnormal menstrual periods.

Undermethylation: Obsessive-compulsive tendencies, seasonal allergies, strong-willed, competitive in games and sports, ritualistic behaviors, high libido, poor pain tolerance, addictive tendencies, sparse arm/leg/chest hair, history of perfectionism, chronic depression, high fluidity (tears, saliva), phobias.

Overmethylation: High anxiety; dry eyes and mouth; hirsutism; noncompetitive; low libido; talkative; low motivation in early school years; obsessions without compulsive actions; sleep disorder; food and chemical sensitivities; estrogen intolerance; absence of seasonal allergies; postpartum depression; antihistamine intolerance; adverse reaction to SSRI antidepressants, methionine, and SAMe.

Pyrrole disorder: Poor stress control, poor short-term memory, reading disorder, sensitivity to noise and bright lights, little or no dream recall, spleen area pain, poor growth, many fears, dry skin, underachievement, tendency to skip breakfast, frequent infections, extreme mood swings, severe inner tension, abnormal fat distribution, affinity for spicy or salty foods, high anxiety, delayed puberty, abnormal EEG.

Toxic metal overload: Abdominal discomfort, poor appetite, increased irritability and temper, decline in academics, metallic taste in mouth, bad breath, change in personality.

Although the above information is helpful in forming a diagnosis, it should be considered inconclusive in the absence of blood and urine testing. The combination of a good medical history and reliable lab testing is essential to accurate diagnosis.

There are a multitude of lab assays that can provide valid evidence of disordered brain chemistry. However, if patients had every available test, they wouldn’t have a drop of blood left and probably no money either. Clearly, it is necessary to make priorities in lab testing. My approach has been to establish a basic test portfolio that enables accurate diagnosis for most patients, with additional assays performed in complex cases. There are several labs in the USA and elsewhere that capably perform these tests. If possible, samples should be submitted to labs with CLIA certification to maximize the chances of high proficiency. Some of useful laboratory tests are described below:

Whole blood histamine: This is a useful test for evaluating methylation status. Histamine and methyl groups are present in measurable levels throughout the body, and an inverse relationship exists between them. Histamine is metabolized (destroyed) by methylation, and this is a primary mechanism for regulating histamine concentrations. Elevated blood histamine indicates undermethylation, and low histamine is evidence of overmethylation. Antihistamine treatments can artificially lower blood histamine and should be avoided for several days prior to sampling. Laboratory assays for SAMe/SAH ratio are more decisive, but they are not widely available in commercial laboratories.

Plasma zinc: There are about 10 different approaches for measuring zinc status, and plasma testing has consistently been regarded by zinc experts as the best way to obtain reliable and meaningful results. The zinc concentration in blood serum is nearly identical, but this approach involves a greater likelihood of contamination during sampling. Some doctors prefer to assay packed cells, which gives an indication of the zinc level within blood cells rather than in blood fluids. Testing of both plasma and blood cells provides additional information that is sometimes useful in diagnosis.

Serum copper: This is a routine and highly reliable assay that is available in many parts of the world. Copper has special significance in mental health due to its role in metabolism of dopamine and synthesis of norepinephrine (see Chapter 3). Elevated serum copper can alter the synaptic activity of these important neurotransmitters.

Urine pyrroles: This chemical assay is available in laboratories in the USA, Europe, and Australia and is gaining in popularity. This test serves two purposes:

Identification of pyrrole disorder, a medical condition associated with extreme deficiencies of B-6 and zinc

Pyrrole disorder typically involves high anxiety, poor behavioral control, a reading disorder, impaired immune function, and other troubling symptoms. Severe pyrrole levels have been observed in persons diagnosed with violent behaviors, depression, schizophrenia, and other serious mental disorders. Elevated pyrroles can also result from excessive oxidative stress levels in persons who do not have the classic symptoms and traits of pyrrole disorder.

Serum ceruloplasmin: In healthy individuals, about 80 to 95% of serum copper is bound to ceruloplasmin, with the remaining 5-20% present as loosely bound atoms or unbound free radicals. Patients with more than 25% of their copper not bound to ceruloplasmin have a metal metabolism disorder involving elevated oxidative stress. This condition is common in autism, postpartum depression, ADHD, and certain forms of psychosis.

Thyroid panel: A surprisingly high number of patients with chemical imbalances also exhibit hypothyroidism. Normalizing thyroid levels is essential to treatment success for these persons. In rare cases, hypothyroidism alone can cause clinical depression or psychosis.

Liver enzymes: The presence of elevated liver enzymes suggests this organ is under significant stress, and nutrient therapy should be modified to avoid aggravating the condition. Liver enzyme elevations are a common side effect of psychiatric medications. In any case, high dosages of niacinamide and fat-soluble vitamins such as A, D, and E should be avoided for these patients.

Most mental illnesses involve abnormal synaptic activity of one or more brain neurotransmitters, and treatment design should reflect this reality. For example, undermethylated patients generally have depressed serotonin activity, and treatment should provide nutrients that elevate serotonin activity and avoid those that depress it. Table 10-2 shows the impact of specific nutrients for some of the primary neurotransmitters.

Open communication with families is a high priority, especially during the first few months of treatment. Common issues include compliance difficulties, temporary adverse side effects, psychiatric medications, and a more healthful, therapeutic diet. Many of these problems can be resolved without involving a physician. My favorite approach is for each patient to have a primary care nurse who can provide practical suggestions to cope with such difficulties. If a complex medical issue is involved, the nurse can bring the doctor into the discussion. Another requirement for effective aftercare is regular checkups with the doctor. Patients with ADHD, BD, or mental illness should be retested after three to six months to enable fine-tuning of dosages, with follow-up about once annually thereafter. In my experience, children with autism should be evaluated every six months until age six.

Table 10-2.
Neurotransmitter-Nutrient Relationships

	Increased Activity	Decreased Activity
Serotonin	Methionine, SAMe, 5-HTP, tryptophan, inositol, Ca, Mg, vitamins B-2, B-6, D	Folic acid, DMAE, choline, vitamin B-5, niacinamide, CoA
Dopamine	Tyrosine, phenylalanine, vitamins B-1, B-6, SAMe, methionine	Folic acid, vitamins B-5, C, choline, DMAE, niacinamide, Mn, GABA, CoA
Norepinephrine	Tyrosine, phenylalanine, copper, vitamins B-6, C	GABA, folic acid, DMAE, niacinamide, Mg, CoA, zinc, vitamin B-5, choline
NMDA	Glutamine, glutathione, glycine, D-Cycloserine, sarcosine, D-Serine, Se	Low glycine level, low glutathione level, high oxidative stress
GABA	Pyridoxyl-5-Phosphate, zinc	Aspartic acid

Poor compliance is the most frequent cause of treatment failure. To facilitate compliance, doctors should make treatments as simple as possible by minimizing the number of capsules needed and the frequency of dosing. Nutrient therapy requires the patient to swallow capsules, tablets, or powders containing the prescribed nutrients. Most children under the age of 6 have difficulty with capsules or tablets, but they can ingest powders stirred into juice or other acceptable fluids. Most children are able to swallow capsules and tablets after age six, but there are many exceptions. A compounding pharmacy can usually reduce the number of capsules by a factor of two to three, which can make all the difference for patients with compliance issues. Several key nutrients have a very unpleasant taste, and many pharmacies offer innocuous additives (such as vanillin) that can mask the unpleasant taste.

Typically, patients are asked to take some nutrients with breakfast and others with the evening meal. Vitamin B-6 is a component of most treatments and can make sleep difficult if taken late in the day. For patients who are intolerant of morning nutrients, we recommend vitamin B-6 be taken prior to 3:30 pm. About 25% of patients taking zinc in the morning (or without food) report nausea or stomach pain. For this reason, zinc is usually given with the evening meal. Absorption efficiency drops somewhat for certain nutrients if taken at mealtime. The doctor can adjust for this effect by prescribing small increases in dosage.

Many persons with pyrrole disorder report little or no appetite in the morning and avoid breakfast entirely. For these patients, we recommend the morning nutrients be taken with the first substantial meal.

More than 50% of patients exhibit a dominant chemical imbalance that is the cause of their illness. In these cases, treatment should concentrate on that imbalance and avoid adjustments of other biochemical factors or special diets until significant progress is achieved. An exception is made for patients with autism who require multiple therapies and are sensitive to dietary casein and gluten.

Some first-time patients report awful diets that require major improvements. I recall a bipolar patient who reported his diet in the past 30 days consisted of tortilla chips and cola from vending machines. In my experience, better outcomes are achieved if the primary imbalance is corrected before dietary intervention begins. Many patients are unable to make a major change in lifestyle before the major imbalance is corrected. A nutritional practitioner needs to grit his/her teeth and avoid major dietary changes until treatment progress is achieved. In an exception, ADHD children should limit sweets and restrict food dyes at the outset. Another exception involves children diagnosed with ASD who need special diets from the initial stages of treatment.

Many children and teenagers diagnosed with ADHD or BD have little or no interest in medical interventions and plan to sabotage treatment. An effective approach is to spend considerable time alone with them to identify a treatment benefit they might want. If a child is below average in height, the conversation might center on the fact that zinc deficiency can stunt growth. Children involved in sports might become motivated upon learning that world-class athletes have reported benefits from our nutrient therapy. We rejoice if an oppositional teenage girl presents with acne since that attitude may change after discovering that treatment clears the complexion. Violent children sometimes cooperate when told our objective is to put them in complete control of their actions. Some oppositional-defiant patients will agree to a treatment trial of a few months if, after this time, THEY are allowed to decide if life is better and whether to continue. In nearly every case, oppositional-defiant children will find a way to sabotage compliance unless they believe they can benefit in some way.

Many practitioners prefer to obtain medical history information from family members in the absence of the patient, who may be angry and disruptive. However, after collecting medical histories for 2,000 schizophrenics, I’ve learned the great value in meeting directly with the patient and getting as much information from him/her as possible. Many patients are paranoid and imagine that private discussions with parents involve plans for institutionalization or lobotomy. It’s best to invite full participation by the patient, which builds teamwork, confidence, and improves the likelihood of treatment compliance.

Many ADHD and BD patients report ongoing treatment with an amphetamine medication during the initial evaluation. Outcome studies have shown best results are attained if the medication is continued during the first three to six months of nutrient therapy. After that time, we suggest the family ask the psychiatrist to gradually reduce doses until an optimum condition is reached. About 80% of these families report medication can be reduced to zero without symptoms returning. The remaining 20% of families report that some benefits are lost when the amphetamine is eliminated. In this event, the drug dosage has usually been reduced (with lessened side effects), and we recommend continuation of both therapies.

After many failed attempts, I learned that patients currently abusing cocaine, heroin, and other illegal drugs have a zero treatment success rate from nutrient therapy. However, significant progress is possible if the patient has abstained from the drug for at least six weeks. Marijuana is an exception, with many cases of treatment success even if this drug abuse is continued. Also, new research189 strongly indicates that N-acetylcysteine (NAC) reduces cocaine cravings and can assist in treatment of addicted patients.

Similarly, alcoholic patients who continue drinking during nutrient therapy rarely improve. Nearly all patients underestimate their alcohol intake, and a general rule is to multiply their reported intake by a factor of three. Complete abstinence for at least six weeks should precede nutrient therapy. Alcohol abuse is known to diminish glutamate activity at NMDA receptors,190-191 and nutrients that enhance NMDA function are an important part of therapy. These include vitamin B-6, zinc, sarcosine, D-serine, and D-cycloserine.

If the biochemical diagnosis is incorrect, an improper nutrient therapy can cause great harm. In some cases, certain sensitive patients can experience significant adverse reactions even if the diagnosis is correct. Adverse reactions may be divided into three types: (a) side effects resulting from rapid biochemical transitions during early treatment, (b) symptoms associated with extreme nutrient sensitivities, and (c) adverse reactions associated with incorrect diagnosis or excessive nutrient dosages.

a. Transitional side effects: Many patients exhibit an overload of copper or a toxic metal prior to treatment. These excess materials depart the body via the bloodstream during early nutrient therapy. If the exit from the body is too rapid, blood levels can escalate and cause unpleasant side effects. Other side effects can occur if excess histamine is released too rapidly from tissues. In all cases of transitional side effects, the solution is to take one’s foot off the accelerator and temporarily reduce treatment dosages.

b. Nutrient sensitivities: There is great individuality with respect to nutrient sensitivities, and doctors should be alert for these rare side effects. Some patients are very sensitive to nutrients that are in deficiency. For example, many children with autism are deficient in cysteine, glutathione, and other sulfur-containing nutrients, but they exhibit extreme negative reactions during modest dosages. Human biochemistry is complex, and there are a multitude of genetic variations between different persons. Occasional unexpected results of nutrient therapy are inevitable.

c. Incorrect therapy: Nutrient therapy should be supervised by a medical professional with experience in this medical approach. An example of improper treatment is excessive zinc dosage that can produce anemia due to reduction in iron stores. Manganese incorrectly given to an undermethylated patient can produce Parkinsonian-like symptoms. Patients with vitamin B-6 sufficiency can develop temporary skin neuropathy and wild troubling dreams after doses of vitamin B-6. Undermethylated patients can develop worsened depression and psychotic symptoms if mistakingly given folic acid. Overmethylated patients may develop worsened anxiety and depression if given methionine or SAMe methylating agents. Treatment with copper can increase the risk of hormonal cancers in high-copper females. Individualized nutrient therapy should never be attempted by inexperienced lay persons.

The optimal nutrient dose for a small child would be insufficient for a large adult sharing the identical chemical imbalance. In addition to weight, a person’s area/volume ratio affects nutritional equivalency. Nutritional scientists use a metabolic weight factor (MWF) that enables more precise dosing for persons of different body weight. MWF is approximately equal to the weight ratio taken to the 0.75 power. In essence, smaller persons require a higher mg/kg dose than larger persons. For example a 26-pound child needs about 25% of the dose for a 160-pound adult for nutritional equivalency, although the child’s weight is only 16% of 160 lbs. Similarly, a 320-pound adult requires less than half the dosage required for a 160-pound person. This system is useful in selecting initial treatment dosages. Follow-up lab testing after a few months of therapy can determine the degree of chemical imbalance and enable fine-tuning of dosages.

About 10% of patients are malabsorbers who process foods and nutritional supplements with low efficiency. These patients need higher nutrient doses to normalize body chemistry. My general rule is to increase dosages by 10%, 20%, or 30% for persons with mild, moderate, or severe malabsorption, respectively.

Patients with a history of zinc deficiency have a tendency to relapse during a prolonged, stressful period. Over the years we have learned that temporary increases of zinc can be very useful in maintaining treatment effectiveness. I recall a patient who increased her zinc dosage before visits from her mother-in-law.

The response to nutrient therapy is relatively slow when compared with that of psychiatric medications. In addition, response times vary greatly for different chemical imbalances. Typical treatment response times (assuming good compliance) are shown below for some of the major biochemical imbalances.

Pyrrole disorder: Nice improvement in behavior control and calming can be seen during week one, with full effectiveness after one month.

Zinc deficiency: Little improvement is seen during the first two weeks, with gradual improvement thereafter and full effectiveness after 60 days.

Copper overload: There are many reports of mild worsening during the first 10 days, followed by clear improvement during weeks three and four and full effectiveness after three to four months (except in the case of type A blood, which may require 6-12 months for full effectiveness).

Overmethylation: There is increased anxiety during the first two to three weeks, followed by sharp improvement during weeks four to eight and full effectiveness after three to four months.

Undermethylation: Little/no improvement is seen during the first three to four weeks, followed by steady improvement during months two to six.

Toxic metal overload: There is mild worsening during the first 10 days, followed by steady improvement for four to six months. Removal of lead is especially slow (half-life of long-term lead in the body is 22 years). Other metal toxins can be removed relatively quickly.

Factors that often retard progress are malabsorption, type A blood, and hypoglycemia. Patients who have all three factors require great patience since initial progress can be delayed by several months. In addition, treatment response usually is very protracted for treatment of undermethylated schizophrenia and bipolar patients. For these persons, improvement usually begins after 3 to 6 weeks, with 12 months often needed for the full effect.

As with all medical therapies, there are some patients who fail to improve after nutrient therapy. While working with 30,000 patients, I encountered numerous cases in which little or no improvement was reported despite promising biochemistry. Careful analysis of nonresponders has identified the 10 most frequent reasons for treatment failure:

1. Noncompliance: More than 50% of all treatment failures resulted from poor treatment compliance. About 10% of oppositional children and teens refused to comply, and some never took a single capsule. We learned that many children can be adept at sleight of hand and avoid compliance without the parents’ knowledge. We received many reports of flower pots filled with soggy capsules. I believe the honor system is unwise for ADHD or children with behavioral disorders.

2. Growth spurt: Some zinc-deficient patients experience rapid growth during the first few months of treatment and fail to improve until the growth spurt has ended. We use and lose zinc when cells divide, and standard zinc doses are insufficient if rapid growth occurs.

3. Physical injury: Successfully treated patients may experience a temporary relapse after a broken leg or similar injury. If an injury occurs during early treatment, symptoms may worsen for weeks before progress is noted.

4. Illness: Infections and other illnesses can result in biochemical changes that may delay response to treatment.

5. Emotional stress: Several chemical imbalances are heightened during traumatic experiences. I recall an ADHD child who failed to respond after months of good compliance. His mother discovered he was being terrorized daily by a school bully, and his academics improved nicely after the situation was resolved.

6. Type A blood: Outcome studies indicate that persons with type A blood respond very slowly to nutrient therapy. The combination of a metal metabolism disorder and type A blood can require great patience on the part of the family.

7. Malabsorption: Persons who process foods inefficiently usually have a slowed response to nutrient therapy.

8. Anoxia during birth: Patients with a history of oxygen deprivation during birth were found to have an increased probability of treatment failure.

9. Head injuries: Persons with a history of serious head injury have an increased incidence of treatment failure.

10. Substance abuse: Many nonresponding patients eventually were discovered to have been secretly abusing alcohol or illegal drugs during treatment. Serious substance abuse usually nullifies the benefits of nutrient therapy.

For every person who does not respond to nutrient therapy, there are many more who report major improvements and achieve a higher quality of life. The treatment approaches described in this book are relatively safe and free of adverse side effects. As biochemical science progresses, great improvements in treatment effectiveness will be achieved with this modality. I believe we are approaching a new enlightened era in mental health in which therapies will be aimed at normalizing brain function rather than introducing foreign molecules into the brain. Every human being deserves the opportunity to achieve the highest attainable degree of health, safety, function, and happiness, and this approach is the best way to reach this goal. Progress in epigenetics will enable future cures for many mental and developmental disorders, and epigenetics research must become a high national priority.