Orthomolecular Treatment of Mood and Behavior Disorders (PART FOUR): B6 and Zinc Deficient Kids, Hypoglycemic Kids, EFA Deficient Kids, and Protein-Deficient Kids
[Parts Five of this series will cover Kids with Food Sensitivities, and Vitamin B3 and C Deficiency.]
B6 AND ZINC DEFICIENT KIDS
Zinc and vitamin B6 (pyridoxine) are involved at a basic biochemical level in the manufacture of protein complexes, including neurotransmitters, out of simple amino acid building blocks.52,53 Zinc is needed for the transcription of DNA to messenger RNA, and B6 is needed for the transamination step that decodes the message and assembles an amino acid chain (i.e. a protein). B6 and zinc deficiency are clearly associated with mood and behaviour disorders in kids and adults, and optimal doses of B6 and zinc are required to treat these conditions.54,55
Zinc is important to several biochemical pathways as over 200 enzymes are zinc dependant. Zinc and iron are the most concentrated metals in the human brain. Insufficient levels of zinc are associated with depression, dementia, mental retardation, learning disabilities, lethargy, and apathy.56 Zinc is essential for the synthesis of serotonin and melatonin.57 It is crucial to brain development as it plays a major role in protein synthesis.56,57 In the brain, zinc lowers excitability by moderating NMDA receptor release of excitatory glutamate. Zinc is involved in the synthesis of inhibitory GABA by the modulation of glutamate decarboxylase activity. Among the zinc-dependant proteins we see metallothionein which is essential for heavy metal regulation and zinc bioavailability. The synthesis of Zn-thionein and CuZnSOD are essential to averting oxidative damage.57 Zinc protects against fatty acid peroxidation which destroys neuron structure and function. Zinc is involved in neuronal plasma membrane structure and functioning and might play a key role in blood-brain-barrier integrity.58
Zinc has a role in biogenic amine storage in synaptic vesicles and axonal transport. The biogenic amine histamine regulates nucleus accumbens activity which is responsible for filtering sensory information and communicating with the amygdala, ventral tegmentum, and hypothalamus. Zinc is involved in limbic system metabolism which regulates emotions. Hormonal metabolism of the hypophysis and hypothalamus are dependent on zinc as well.
B6 is involved in the decarboxylation of tyrosine, tryptophan, and histadine into the neurotransmitters nor-epinephrine, serotonin, and histamine.55 It is a cofactor in homocysteine re-methylation.59 B6 has been found useful in memory acquisition, with just a 20mg dose.60 B6 is essential for the synthesis of antioxidants such as metallothionein, glutathione, and CoQ10 which help to prevent neuronal oxidative stress. B6 (and zinc) are involved in the synthesis of glutamic acid decarboxylase (GAD) which blocks excitotoxicity and associated secondary oxidative damage. B6 is essential for glutathione peroxidase and glutathione reductase which help prevent mitochondrial decay.
Previous investigators have described B6 and zinc depletion in the context of pyrolluria. Kids with learning and behaviour disorders often have pyrolluria but this disorder cuts across all diagnostic groups. It is more common in kids with heavy metals, chronic infection, and early childhood trauma. Kids with pyrolluria often have pale skin, poor stress tolerance and poor dream recall. In this metabolic syndrome, B6 and zinc interact with 2,4-dimethyl-3-ethylpyrrole which is readily excreted.61-65
Hypoglycemia is the term that describes low sugar (glucose) in the blood. Low blood sugar is detrimental to kids because they have a huge demand for energy to maintain development. Kids meet this demand by maintaining a faster metabolic rate but it is the brain that demands the most substantial amount of glucose. The brain’s demand for glucose is so immense that about 80% of our total blood volume circulates to the brain, an organ that represents only 2% of our body weight. The brain has special gluco-sensing neurons that regulate glucose availability as a fail-safe mechanism.66 The brain has a great demand for sugar and doesn’t like to be starved for long. Neurons function poorly in sugar deficient states. The hypoglycemic state occurs often after a sharp rise of simple sugars in the blood followed by a sharp decline which robs neurons of their main energy source; the sharper the decline, the greater the effect on brain cells. Irritability, poor memory, “late afternoon blues”, poor concentration, tiredness, cold hands, muscle cramping, and “feeling better when arguing/fighting” are typical hypoglycemic symptoms.61
Dominance of simple sugar consumption is encouraged by agricultural methods that we have adopted over the past half century. The mono-cropping of grains and the resultant ‘saccharine diseases’ have led to serious problems in kids and the general population, problems that include depression and carbohydrate neuroses.67
Diabetic or pre-diabetic kids with high blood sugar (hyperglycemia) also exhibit hypoglycemic symptoms. Mood and behaviour disorder kids with hyperglycemia, much like diabetics, experience hypoglycemic mental changes because sugar’s access into brain cells and elsewhere in the body is significantly diminished. Brain neurons starved for energy behave differently resulting in mood and cognitive dysfunction.68,69 It is not clear if dysglycemia has a causative role in mood or behaviour disorders, but it is reasonably deemed an aggravating factor.
It is said that ‘hypoglycemia is 100% treatable in compliant patients’. This emphasizes the need to address diet. Developing children or adolescents with sugar imbalances require three solid meals of 40% protein a day, and sometimes additional protein-containing snacks. Kids need to concentrate on ‘complex’ versus ‘fast’ carbohydrates (e.g. avoiding junk food and sugar and eating snacks containing protein). When kids increase protein in their diet, they release sugar to the brain at a steady rate and sugar cravings diminish greatly. Sugar imbalance treatment may include chromium (drives sugar into cells), zinc (involved in insulin production), or adrenal gland (sugar regulation) support.
ESSENTIAL FATTY ACID (EFA) DEFICIENT KIDS
Kids with ADHD, behavior disorders, depression, or anxiety benefit from EFA supplementation but these essential fats are not readily found in the American diet.70 EFA’s, including omega-3 (DHA & EPA) and omega-6, are good fats, not saturated with hydrogen. 60% of the dry weight of the brain is fat. EFA’s are important components of nerve cell walls and are involved in neurotransmitter electrical activity and post-receptor phospholipid mediated signal transduction. Good fats are flexible and have the ability to position protein receptors well in the fat soluble brain cell membranes. In the clinical treatment of mood and behavior disorders, DHA and EPA are recognized as the most useful essential fats 71-73 DHA is understood to be more useful in developing children and adolescents. For the human body to assimilate plant based (flax, borage, etc.) essential fats, delta-6-desaturase enzymatic conversion is required. By contrast, animal based DHA or EPA, typically from the muscle of cold water fish, does not require enzymatic conversion and therefore provides a direct source of DHA and EPA.
Cold water fish with teeth have a fat profile that is suitable for kids. Salmon, tuna, mackerel, herring, cod, and trout provide the highest omega-3 profile. Other high EFA sources include scallops, shrimp, flaxseeds, walnuts, winter squash, and kidney beans. Larger fish species and shellfish are a potential source of mercury so this needs to be avoided, especially in cases with heavy metal overload.
PROTEIN DEFICIENT KIDS
Protein nutriture is very important for kids with mood and behaviour disorders and, for overall general mental well-being. Neurotransmitter production is dependent on the amino acid protein building blocks supplied from the diet. The catecholamines dopamine, norepinephrine, and epinephrine are derived from phenylalanine and tyrosine. Catecholamines are involved in executive brain functions and motivation. Serotonin, the ‘feel good’ neurotransmitter, is derived from the amino acid tryptophan. I have seen many mood and behaviour disorder kids that respond well when they start increasing their protein intake with meals, especially breakfast. A diet that has 40% protein, 40% carbohydrate, and 20% fat is ideal for many kids.
Many mood and behaviour disorder kids do not eat three meals a day and their diet is invariably carbohydrate dominant. Carbohydrate dominant North American diets release glucose to the bloodstream quickly. Such patients do well to avoid high glycemic load foods including junk food, white sugar, white rice, and white bread. If they have poor appetite, this can lead to inadequate nutriture. Poor appetite is often associated with zinc or iron loss.
Fat nutriture is also important in kids with mood and behaviour disorders and diets with adequate animal protein often are not fat deficient. Vegetable derived fats (olive oil, etc.) are also a significant source of fat. Without adequate fat intake, kids will not be able to make hormones that regulate sugar, thyroid metabolism, adrenal metabolism, etc.
Intact gastrointestinal health is a prerequisite for improved outcome in kids with mood and behaviour dysfunction. Inadequate nutriture can be caused by digestive system problems, mal-absorption, and low thyroid function. I constantly see digestive system conditions in kids with mood and behaviour disorders; symptoms include constipation, spastic obstipation, bloating, cramping, abdominal discomfort, IBS, and GERD. Compromised gastrointestinal function leads to the mal-absorption of nutrients. The lack of stomach acid can reduce intrinsic factor and B12 utilization; B12 is essential for methylation and neurotransmitter formation. Poor bowel transit/movement locks toxins in, taxes the immune system, and reduces the absorptive area.
Other factors contributing to poor bowel transit include low thyroid function, magnesium deficiency, and inadequate water intake. Adequate water intake is essential for kids because bowel elimination depends on bowel contents remaining hydrated and water is essential to keep toxins moving.
52. Bourre JM: Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. J Nutr Health Aging, 2006 Sep-Oct; 10(5): 377-385.
53. Cuajungco MP, Lees GJ: Zinc metabolism in the brain: relevance to human neurodegenerative disorders. Neurobiol Dis, 1997; 4(3-4): 137-169.
54. Sahley, BJ. Nutrition and Mental Illness. MMRC Health Educator Reports, 2006: 1-2.
55. Marz RB: Medical Nutrition from Marz. Portland, OR. Omni-Press. 1997.
56. Pfeiffer CC, Braverman ER: Zinc, the brain and behavior. Biol Psychiatry, 1982; 17(4): 513-532.
57. Johnson S: Micronutrient accumulation and depletion in schizophrenia, epilepsy, autism and Parkinson’s disease? Med Hypotheses, 2001; 56(5): 641-645.
58. Noseworthy MD, Bray TM: Zinc deficiency exacerbates loss in blood-brain barrier integrity induced by hyperoxia measured by dynamic MRI. Proc Soc Exp Biol Med, 2000; 223(2): 175-182.
59. Levine J, Stahl Z, Sela BA, et al: Homocysteine-reducing strategies improve symptoms in chronic schizophrenic patients with hyperhomocysteinemia. Biol Psychiatry, 2006; 60 (3): 265-269.
60. Deijen JB, van der Beek EJ, Orlebeke JF, et al: Vitamin B-6 supplementation in elderly men: effects on mood, memory, performance and mental effort. Psychopharmacology (Berl), 1992; 109(4): 489-496.
61. Wenzel K-G: Orthomolecular Treatment for Mental Health: The Roles of Hypoglycemia, Pyrroluria and Histamine Disturbances. 2000 Apr. Nutritional Medicine Today 29th Annual Conference. Vancouver, BC.
62. Jackson JA, Riordan HD, Neathery S, et al: Case from the Center: Urinary Pyrrole in Health and Disease. J Orthomol Med, 1997; 12(2): 96-98.
63. Edelman E: Natural Healing for Schizophrenia: A Compendium of Nutritional Methods. Eugene, OR. Borage Books. 1996.
64. Pfeiffer CC: Mental and Elemental Nutrients. New Canaan, CN. Keats Publishing. 1975.
65. Sohler A, Beck R, Noval JJ: Mauve factor re-identified as 2,4-dimethyl-3-ethylpyrrole and its sedative effect on the CNS. Nature, 1970; 228(278): 1318-1320.
66. Rao J, Oz G, Seaquist ER: Regulation of cerebral glucose metabolism. Minerva Endocrinol, 2006 Jun; 31(2): 149-158.
67. Hoffer A: Orthomolecular Medicine for Physicians. New Canaan, CT. Keats Publishing. 1989.
68. Cox D, Gonder-Frederick L, McCall A, et al: The effects of glucose fluctuation on cognitive function and QOL: the functional costs of hypoglycaemia and hyperglycaemia among adults with type 1 or type 2 diabetes. Int J Clin Pract Suppl, 2002 Jul; 129: 20-26.
69. Mitrakou A, Ryan C, Veneman T, et al: Hierarchy of glycemic thresholds for counter regulatory hormone secretion, symptoms, and cerebral dysfunction. Am J Physiol, 1991 Jan; 260(1 Pt 1): E67-E74.
70. Greenwood CE, Young SN: Dietary fat intake and the brain: a developing frontier in biological psychiatry. J Psychiatry Neurosci, 2001 May; 26(3): 182–184.
71. McNamara RK, Carlson SE: Role of omega-3 fatty acids in brain development and function: potential implications for the pathogenesis and prevention of psychopathology. Prostaglandins Leukot Essent Fatty Acids, 2006 Oct-Nov; 75(4-5): 329-349.
72. Kidd PM: Bipolar disorder and cell membrane dysfunction. Progress toward integrative management. Altern Med Rev, 2004 Jun; 9(2): 107-135.
73. Ranjekar PK, Hinge A, Hegde MV, et al: Decreased antioxidant enzymes and membrane essential polyunsaturated fatty acids in schizophrenic and bipolar mood disorder patients. Psychiatry Res, 2003 Dec 1; 121(2): 109-122.
MindCheck is the Weekly Wednesday Kids Mental Health series with Dr. Ray Pataracchia, N.D. MindCheck provides in depth information on the orthomolecular approach to coping with mood and/or behavior disorders. The MindCheck Health Series is endorsed by the Mindful Network - ‘A Better Future for Children’s Mental Health’.