The Rush to Change

We are in the change business. So when a child comes to us because of difficult behaviors our first thought is what can we do to change him or her? Jeffrey assaults people when he doesn’t get his way. Latasha cuts herself so badly she sometimes needs to go to the ER. How can we stop these things? That’s why people pay us the big bucks after all.

And there is plenty of external pressure for change- at every review someone is asking why that child hasn’t changed yet. Her parents, too, have suffered enough and want to see something different soon.

Then there is the internal pressure. Our lives would be a lot easier if these kids would stop doing these crazy things. And we judge ourselves- do we really know what we are doing? When Jeffrey hit his teacher yesterday is it because I am not a good enough therapist? I feel guilty about the pain the teacher suffered. We can start to blame each other- isn’t it the therapists’ job to take an angry child to her office and bring her back calm and happy?

And when we feel compassion for the child, we start to feel even more urgent about change. Jeffrey’s life would be so much easier if he could control his anger. He is in danger of being kicked out of this place, as he has been out of his last six places. It is so painful to see the blood stream down Latasha’s arm.

In this urgency for change we ourselves feel powerless, vulnerable and incompetent. We feel much like the kids we serve. So like them, we turn to something that we think will give us more power and control. We often think first about punishment. Surely if we restrict Jeffrey long enough he will learn that his life goes better if he does not hit people. Or, being more enlightened, we think about rewards. Maybe if we promise Latasha that we will take her out to lunch if she can go a week without cutting…

It would be actually astonishing if Jeffrey didn’t already know that his life would go better if he controls his anger. Look at all the bad things that have happened to him already- he is on probation, he has been kicked out of six placements, and he is in residential- just to name a few.

When Latasha is calm she fervently wants to stop cutting, and she hates her scars. She does not need more motivation. She needs more skills.

I would suggest that this very urgency we feel to change the kids gets in the way of effective treatment. It makes it harder for us to stop and think about what is going on. How do we understand this behavior? What is actually happening when Jeffrey hits someone? What leads up to Latasha’s cutting? What problem are they trying to solve? How does this behavior help them in the moment?

We need to take time to explore, observe, think and consider. We need time to help the child feel safe enough to share their experience with us. They will be able to do this when they form strong relationships. In collaboration with the child we will discover the meaning and function of the behavior.

Then, we must consider what skills the child would need in order to choose a different behavior, a new way to meet his needs. It will take time for the child to learn these skills.

Jeffrey formed a close relationship with his teammate (primary child care worker). After a while Jeffrey shared how scared he was that he is such a bad kid that no one will ever take care of him or meet his needs. He said has learned that force is the only way you get anything you want. Staff started looking for the first signs that Jeffrey was agitated and asking if he needed anything. In small steps Jeffrey learned to trust them enough to ask for help. It was important that at the same time Jeffrey discovered a skill at cooking, and became the star chef of the school café. He got a lot of praise and recognition for this and was generally feeling better and calmer.

Latasha connected with her therapist slowly. They began looking at the patterns that led up to cutting. After a while, several factors were identified: not getting enough sleep, fighting among the girls on the unit, and not hearing from her mother. They worked out many strategies, including a crisis kit. Medication helped with her disturbed sleep. Latasha found soothing music, a piece of fur to rub, and a honey candy soothing. This did not always work and she continued to cut for a long time, but the self harm decreased in frequency and severity. She started telling staff when she felt vulnerable.

Note that these children did not change quickly. They did not change because of punishment. But with time, safety and relationships they did change.

And then the staff felt the true power of changing the life of a child.

read more...

Fighting the Insensitivity of Others

Treatment #10

Of all the things we have to deal with internally fighting this hideous disease, to me, the things that we fight externally are sometimes more debilitating. 

This week I came face to face with one of the biggest enemies to recovery, the ignorance and insensitivity of other people. In my case, this shocking reminder of just how alone I really am in this battle came in the form of reminders from the two groups in my life where I least expected it - the medical professionals treating me, and from certain family members who really do love me. 

Let me dispatch both quickly, so that I don't re-attenuate my anger and dissapointment, and allow them to adversely affect my healing any more.

When it comes to family, (in this case some blood relatives who live a distance away and who communicate to me through text messages,)  I forget that they just don't understand what I'm going through. Even though I've tried to explain it, and have asked them to read this blog along with  the comments and struggles of others on blogs like this, they seem to think all I need is a pep talk. 

There is a terrible story that has gone around for years where someone is trying to cheer up Mary Todd after the most horrendous thing happened in her life. A direct relative of hers told me this story so I feel at liberty to quote it here. The punch line was, as this "well meaning" yet ignorant person tried to console her, he said, "Well, apart from that, how did you like the play Mrs. Lincoln?" 

Sometimes I think my relatives have about as much sense when it comes to this horrendous thing in my life. 

I remember reading in a British publication a leading M.E. doctor saying "if my patient's families would understand that for most sufferers of M.E., both the symptoms and the reactions to the viruses raging in their bodies are worse than that which an AIDS patient experiences, they might get a clue."  I hate to quote that statement to my family, although I believe it to be true, because I try not to freak them out. 

On Ampligen, as others have documented, my symptoms  get worse before I get better. So this past week has been extremely difficult, with extreme flu-like symptoms, body aches, emotional roller coasters, migraines, stomach turbulence, and more. I don't know about you, but when I feel like that, simple motivational phrases and "positive thinking" is not going to do it for me. It's like passing a soldier bleeding on the side of a bombed out building in Iraq and telling him to "Cheer up! Think positive! The Army loves you." 

Then there are my Doctors here in the USA.  This week I also discovered what I had been reading about for years, but by reason of living outside the states, hadn't experienced first hand - the overworked, under-staffed,  barely competent office that is called a physician's "practice" or medical center here in this country. I won't use this space to express my amazement at the denegration of this industry. I'll just say to my fellow patients, in my view, you probably know more about this disease than they do. You probably are better suited to know what you need, through research and forums like this one, and listening to other patients, than you are trusting your physician to know what is best for you, and thinking he or she is "plugged in."  

It may not be their faults, personally, but in my opinion, they have neither the time nor finances to invest in maintaining their "edge" against this disease. They are so strapped for time and resources that they do not have room for reading basic journal reviews, dialogueing with other physicians,  or probing new solutions that other physicians are trying worldwide, They certainly don't spend any time doing the research that you and I do - and that to me is frightening. 

I won't even go into the way the office is "run", the lack of administrative cohesion, or the abject lack of professionalism from some of the office staff because Doctors are forced to hire essentially minimum hourly wage workers "off the street." One nurse told me that she was never even interviewed by the nursing service in person! Ever! They hired her by paperwork only. 

Other patients have warned me not to get distracted by these obvious problems, that really tend to scare you, so I try to just focus on my health, and just getting my Ampligen twice a week. But I will say, it still shocks me that no one in that office who swore the hippocratic oath, ever volunteers anything about my treatment, about what to expect, about the symptoms of my disease being attenuated by Ampligen and side effects I should anticipate.

It was through forums like this one and other patients that I found out I should probably try taking a saline infusion after the Ampligen. It was from another Doctor in town who has seen other Ampligen patients that I was told about getting magnesium in my saline, in order to help with the muscle pain. It was through another Doctor in L.A. that I learned that any immuno-modulator like Ampligen or Interferon messes with the serotonin in the brain.

When I experienced the depression trough that I posted about last week, and expressed that to my Doctor, his reaction was to take notes and say "mmm hmmm." No explantion, no recommendations, no comment whatsoever! 

Thankfully, from another PhD friend on another M.E. forum,  I had some explanation that made sense. This super guy told me: 

"Cytokines, like the interferon production stimulated by Ampligen, act directly in the brain to cause symptoms of sick behavior. Apparently the body's plan is to get us to withdraw via feelings of anxiety and depression until the infection is dealt with. Unfortunately, for those of us with chronic infections, the anxiety and depression persist. When we take Ampligen, TF or other immune boosters/modulators, we go through a fresh round of intensified psychological correlates of the immune activation."

And from Dantzer and Kelley, 2006:

Cytokines “act in the brain to induce common symptoms of sickness, such as loss of appetite, sleepiness, withdrawal from normal social activities, fever, aching joints and fatigue…The fact that cytokines act in the brain to induce physiological adaptations that promote survival has led to the hypothesis that inappropriate, prolonged activation of the innate immune system may be involved in a number of pathological disturbances in the brain, ranging from Alzheimer’s disease to stroke…Indeed, the newest findings of cytokine actions in the brain offer some of the first clues about the pathophysiology of certain mental health disorders, including depression.”

Thank God for the Internet, and online Forum friends like him, for helping me understand what was going on in my body! Or for at least giving me a clue. 

Wouldn't it have been great for my Doctor to share a little tidbit like this with me? Forget the fact that he is my physician, wouldn't it be something a friend would want to share with me? 

So last week was, in a sense, my "Ford's Theater Revelation." I now know that people are insensitive about me and my affliction. OK, I get it.  I am here in this country for one thing, and one thing only- getting that amazing medicine called Ampligen in my veins twice a week. I am not expecting the physicians in the office to monitor me, inquire about me, or even care about my symptoms. I do not expect them to tell me in advance what I am about to experience, or offer counsel. I am thankful that my nurse, Gwen, is a sweetheart, and is a professional, and makes my treatments pleasant. 

I know that Ampligen is working, and I thank God for Hemispherx and the fact that this medicine exists.  That the FDA, the American medical system, the malpractice insurance rates, the inferior staffs, and the overworked, numb doctors and all the rest make the patient's journey such a challenge today, is a shame. That some of my closest relatives think that when I am down, sick and depressed because of chemicals raging, all I need is to read a motivational phrase from Dale Carnegie,  is not ideal. 

But now I know not to expect more from these folks. Like the guy in Ford's theater with Mary Todd, they haven't been through anything like this before, are at a loss for words, and really don't know what to say. I can accept that. 

But excuse me if to either groups, I choose sometimes not to take your calls. You don't understand, and sometimes there is nothing I can say to make you understand.

read more...

Beauty Review: LypSyl Lip Balm LypMoisturizer (Original Formula)

As you know I am always on the look out for a product to heal my dry flaking lips. This time I was testing LypSyl Balm . I’ve heard some good stuff about their products and how natural and moisturizing they were and how some celebs were using LypSyl, so I was curious to try it. LypSyl is available in several variations: for example LypMoisturizerHoney Berry and SPF 15, LypMedicationwith

read more...

Do Tyrosine Supplements for ADHD Actually Work? (part 8)

Blogger's note: If you are interested in taking tyrosine as a supplement for ADHD or related disorders, the above diagram is a summary of the key nutrients which interact or play a role in tyrosine metabolism. In this blogger's opinion, we want to avoid deficiencies (or, in some cases, excesses) of any of these nutrients. If you are in a rush and do not want to read this whole posting, this table may be a good starting point. I have listed a number of links at the bottom to other sites as far as recommended daily intakes are concerned for the majority of these nutrients. This list is by no means extensive, but this will hopefully highlight the major impact factors in maximizing the benefits of tyrosine supplementation as an ADHD treatment strategy.

(If the above diagram is not easily visible, most browsers will allow you to left-click the image to get a blow-up version, or you should be able to right-click the image with your mouse and view the image in a new window).

We have spent the past seven postings on the pathway of tyrosine metabolism and the implications of supplementing with this amino acid nutrient (and its derivatives for ADHD). But does it actually work?

For the last seven postings, we have been examining the following metabolic pathway of tyrosine. Included are the major enzymes and key nutrients responsible for this process to occur efficiently:



Here's a brief review of the evidence for (and against) tyrosine supplementation. Much has been covered in the previous 7 blog posts, but some is new. Links to the studies (or summaries of the studies if the full article is not available) are provided in most cases.

Potential advantages of tyrosine supplementation for ADHD:

• Tyrosine is a precursor to common neurotransmitters believed to be involved in ADHD (neurotransmitters are chemicals involved in various signaling or messaging processes in the nervous system) dopamine, norepinephrine and epinephrine (adrenaline). Imbalances (typically shortages) in the regions or "gaps" between neuronal cells of these chemicals often occur in ADHD and related disorders, so the idea with tyrosine is that it can theoretically boost levels of these deficiencies and potentially help correct this imbalance.
  
  
• Tyrosine can readily cross the blood brain barrier. This barrier has been discussed extensively elsewhere, but, in summary, the blood brain barrier is responsible for the passage of nutrients and metabolic products in and out of the brain (and also helps keep harmful agents out of the brain). L-DOPA, a derivative of tyrosine, and the first major product of tyrosine metabolism in most cases, is also able to make it across the blood brain barrier. Most of the major products beyond this point cannot, making tyrosine (or L-DOPA) potential supplementation agents which can be taken orally.



• As a "natural" and common amino acid, tyrosine is something the body already is accustomed to metabolizing through the diet. Note that tyrosine shares several enzymes and transporters with other amino acids and nutrients.



• Numerous anecdotal reports have found tyrosine to be useful for comorbid (co-existing) disorders to ADHD, such as depression. Given the high frequency of comorbid disorders associated with ADHD, tyrosine's versatility may potentially give us some "2-for-1" deals with regards to helping treat multiple symptoms or disorders at once.



• Tyrosine is a good starting point for nutrient-based treatments in metabolic disorders involving the amino acid phenylalanine (such as phenylketonuria). Phenylalaline is converted to tyrosine in a fashion similar to how tyrosine is converted to L-DOPa, via an enzyme-based chemical modification called hydroxylation (in which an "OH" chemical group is added to the molecule).



• Numerous anecdotal reports involving tyrosine supplementation for ADHD symptoms have indicated positive results (at least initially, we will see, however, that many of these benefits are often short-lived).



• Many physicians have (and continue to) prescribe tyrosine for ADHD and related disorders, and, in many anecdotal cases, the individuals taking the tyrosine have seen marked improvement in a matter of days regarding ADHD symptoms (focus, impulse control, decrease in hyperactivity, etc.)



• Tyrosine may be used in conjunction with medications for ADHD and other related disorders. In other words, it may boost their effects (although this may be a double-edged sword, as some of these drugs are potent, so co-supplementation with tyrosine can possibly increase their side-effects and risks by several orders of magnitude in some cases). In this blogger's opinion, this may be the strongest potential use of tyrosine (as opposed to supplementation on it's own, which may often be short-lived). I personally believe that we often grossly underestimate the effects of supplements on medications, tyrosine's effects on stimulants (and other drugs targeting various types of dopamine-related pathways) are no exception.



• Tyrosine supplements are typically easily metabolized and cleared from the body, lessening potential side effects from residual metabolites (which is the case for several drugs).



• The enzymes responsible for tyrosine metabolism are often dependent on vitamin and mineral nutrients, and can be much more effective if adequate levels of these nutrients are supplied. I have provided a table of some of these key nutrients in a table at the bottom (and top) of this posting.
  

Disadvantages to tyrosine supplementation for ADHD:

• Beneficial responses of tyrosine for ADHD treatment are often short lived (and usually disappear within 2 to 4 weeks, as the body appears to "adapt" or tolerate the higher levels of tyrosine supplementation.



• In most cases, the imbalances of dopamine and norepinephrine are believed to be due as much to the transporters (or agents which shuttle these chemical in and out of the neuronal cells) or receptors (places on the cells where the dopamine or norepinephrine bind). Most ADHD medications (including the stimulants) typically work by blocking, modifying or reversing the modes of action of these transporters in an attempt to restore a proper "inside" vs. "outside" chemical balance. Interestingly, genetics appears to play a role as to the extent of how a certain transporter or receptor functions, and genes may even affect dosage requirements for certain ADHD medications (such as Adderall, or Strattera). In other words, blasting the body with high levels of tyrosine in hopes of using it as a precursor does not necessarily remediate these transporter issues.



• Localization is a problem. Imbalances of dopamine and norepinephrine in ADHD are often seen only in a handful of specific brain regions, so flooding the whole system with tyrosine may not be conducive to zeroing in on these target brain regions. Interestingly, however, the synthesis of monoamine neurotransmitters such as dopamine and norepinephrine may not be tied down entirely to specific brain regions, as there may be some flexibility as to where these chemicals are generated based on the demands (and failures) of other parts of the brain and central nervous system.
  
  
• While side effects may potentially be lower, tyrosine (or L-DOPA) does have some metabolites which can be harmful at high levels. The pro-inflammatory agent homocysteine is one such example, and has been discussed at length in a previous tyrosine for ADHD blog post.



• While anecdotal reports on the benefits of tyrosine supplementation for ADHD treatment abound, the actual number of published studies showing positive results for tyrosine (especially in the last 10-20 years) is surprisingly low.



• As mentioned earlier, tyrosine can "compete" with other amino acids such as tryptophan, valine, leucine and isoleucine for entry into the brain, because they share a similar system of transporters. In fact, there are a number of parallels between the tyrosine to dopamine/norepinephrine pathway and the tryptophan to serotonin pathway, in that they share similar enzymatic processes. In other words, it is possible to create imbalances or reduce the effectiveness of one amino acid (and its desired products of metabolism) if the presence of a competing amino acid is too high. This interference is often seen especially in the tyrosine/tryptophan and can potentially promote imbalances in the serotonin to dopamine ratios.



• Genetic disorders (which are relatively uncommon) or nutrient deficiencies can hamper the efficiency of several enzymes required for tyrosine metabolism. Even being short in one nutrient can cause problems. Given the nutritional status of many with ADHD, this may be a grave problem. As a result, there are numerous opportunities for the tyrosine supplement to be compromised.
  

Ways to improve the effectiveness of tyrosine supplementation for ADHD:

As a blogger on the subject, I always try to remain neutral (many times, however, this can be extremely difficult). When researching the stories and studies on tyrosine supplementation for ADHD, the one thing that continuously caught my attention was the degree of discord between the studies on tyrosine supplementation for ADHD (most of which showed no significant improvement) and the number of clinicians who prescribed it (and individuals who reported benefits from tyrosine). Again, this disagreement may be due to a number of things (differences between study conditions and the treated individuals, co-treatment with ADHD medications, the placebo effect, immediate vs. long-term effects, etc.), so we need to be very careful when making a comparison.

Having said all of this, and weighing everything I've read and researched, I admit (as a blogger) to being skeptical about the overall effectiveness of the whole tyrosine supplementation thing for ADHD. There just don't seem to be enough positive studies grounded in long-term improvements which tyrosine. Nevertheless, the number of positive reports on tyrosine from individuals are too great to ignore in most cases, so an outright condemnation of tyrosine for ADHD is by no means warranted.

It is important to note that none of the studies I've seen (both those supporting or refuting the idea of tyrosine for ADHD) have paid much attention into controlling for the co-factors of the enzymes responsible for metabolizing tyrosine. Just as a reminder, co-factors are essentially vitamins, minerals and other nutrients which are used to help enzymes function properly (or at least more efficiently).

So if we do decide to begin a tyrosine supplementation program, we should make sure we have adequate levels of the following nutrients (I have listed the major nutrients, and where it helps in the tyrosine metabolic processes. It is important to note that this list is not 100% complete, there are several other nutrients which play a role indirectly in the process, but I am just highlighting the major ones I've come across in the studies I've seen on the metabolic pathways of tyrosine to dopamine, norepinephrine and epinephrine):

Here are some links to recommended daily levels of the following nutrients and "cofactors" which can potentially affect the outcome of tyrosine supplementation for ADHD:

• Iron
• Zinc
• Magnesium
• Copper
• Vitamin B6
• Vitamin B12
• Folic Acid
• Vitamin C
• (no official doses have been set for S-Adenosyl Methionine or SAMe, as this can be produced in the body, a ballpark supplemental dose for SAMe is around 100-200 mg twice a day, but of course varies per individual)

A quick summary of this blogger's overall thoughts and advice on tyrosine supplementation for ADHD:

• There are (surprisingly) few well-controlled clinical studies which show tyrosine to be an effective long-term strategy for treating ADHD. In spite of this, tyrosine supplements are often prescribed by a number of physicians (seemingly in a disproportionate manner when compared to other agents with more promising clinical studies). This disparity is at least noteworthy.



• For those (few) studies who do tout the benefits of tyrosine supplements for ADHD, the symptom improvements are often short-lived (often only a few short weeks).



• However, this blogger personally believes that many of the studies may have shown minimal effects due (at least in part) to the fact that many of the other nutritional "puzzle pieces" (such as those given in the tables above) were either neglected or not necessarily in place. These vitamin and mineral-based cofactors can play a huge role in the metabolic conversion of tyrosine to its desired products, and has been discussed at length in the seven previous blog posts on tyrosine and ADHD. Had these studies incorporated some of these co-treatment strategies, some of the results might possibly have been different.



• Please note that while "natural", tyrosine supplementation is not always benign. Health risks, such as amino acid imbalances (due to the competitive nature of several amino acids with tyrosine to get into the brain), cardiovascular issues and even some types of cancers (which are often more associated with a derivative of tyrosine, L-DOPA, however) are very real. Additionally, biochemical side effects of tyrosine metabolism also exist, and can be magnified greatly if rampant tyrosine supplementation is undertaken. The pro-inflammatory agent homocysteine is one such example. However, nutrient-based treatments via B vitamins can often offset a potential homocysteine buildup.



• The dosages for tyrosine supplementation can vary widely ranging from as low as 100 milligrams all the way up to 5000 milligrams (or more, toxicity often begins to set in around 10,000 mg, but this of course widely varies by individual). 2-3 supplements of 500-1000 mg/day is typical in a number of cases (lower doses are almost always a must for children), but dosing should always be under the guidance of a physician.



• Most of the tyrosine supplemental strategies hinge or ride on the theory that ADHD is a dopamine or norepinephrine deficiency issue. However, much of the evidence on the disorder seems to indicate that the transport of these chemical neurotransmitters across neuronal cell membranes and an imbalance of the "inside-the-cell" vs. "outside-the-cell-in-the-gaps-between-neuronal-cell" concentrations of these agents is the real culprit. In other words, flooding the body with tyrosine in hopes that it will generate more dopamine and norepinephrine will not necessarily address this basis of imbalance.



• This blogger personally believes that tyrosine supplementation may be of much greater benefit if used in conjunction with a medication (often a stimulant or other dopamine "releasing" agent). Please note that these supplement-drug interactions may be extremely potent, so please only do this under the supervision of a physician.

In other words, tyrosine supplementation for ADHD treatments is theoretically viable, and has had numerous success stories. Maintaining adequate intake of the nutrient cofactors listed in the tables above helps supply the body's enzymes with the tools they need to metabolize tyrosine most effectively. When dietary intake of these nutrients is sufficient, and tyrosine is wisely used in conjunction with proper pharmaceutical agents, this blogger personally believes that there may be great tangible benefits with regards to ADHD symptoms and treatment.

read more...

Ampligen, Serotonin and Anhedonia

"Depression is melancholy minus its charms." Susan Sontag

Treatment #9

 This past weekend was rough. After having 8 treatments of Ampligen over the past 4 weeks go so smoothly, I wasn't prepared for the surprise dark cloud that rolled over my horizon beginning Friday evening. Some would call it depression,  and I'm OK with that. But upon further research, I think the more appropriate term is "anhedonia." Let me explain. 

Starting late this past Friday afternoon, I began to sense an overall mental malaise come over me - a generalized anesthetizing lack of emotional feelings. This “vacuum” of emotions continued into Saturday, to the degree that I was no longer enjoying watching the Olympics on TV, was no longer interested in eating, and surprisingly for me, no longer even interested in sex. This was especially disconcerting due to the fact that my wife had just flown in from our home country, after having been away for the past 20 days. And what’s more, she looked great. I mean, really great, if you get my drift. 

Although my mind could process this fact empirically, neither my heart, nor my body would have any of it. It was as if something in my brain was “unplugged”, and nothing was reaching my heart. I had no appetite for anything, and ended up just laying on the couch, mindlessly clicking the TV, noticing that the only thing I could actually feel was a headache. And that made me frustrated, and that prompted my old friend, the “F-word” to come roaring back.

Of course, my wife responded appropriately, basically telling me that cursing at her was neither charming, or a good way to get romance. Well, you get how the weekend went, right? 

In a desperate attempt to figure out what the heck was going on with my brain chemistry or my body, I did what we’ve all learned to do in our situation, and went to the Internet for research. What I found jumped off the page at me on scores of reports.

It turns out that, when you read the journals and reports of other Ampligen patients, some from the 1990 original trials, and others in 1999 and beyond, you find this “emotional trough” hit many of them. Even more striking to me, upon reading these reports, was that almost to the person, this “cloud” of “blah” occurred almost exactly one month after beginning the Ampligen!

Friday marked the end of my first month. Ding!

I went on to do more research, and discovered that this is not a new thing for other immunomodulatory drugs. For example, if you search “interferon alpha” a standard anti-viral drug used to fight Hepatitis C and some cancers, you will see most of the reports citing this “depression” “irritability” and “anhedonia” that hits interferon patients- again, after the first month of treatment. The reason the drug does this, these Journal reports describe, is that the drug basically messes with the serotonin levels in the brain.

Because of the immune modulating properties of Ampligen, that I believe probably have affected my serotonin levels, what I felt this past weekend was likely best described as Anhedonia- which the medical dictionary defines as: “an inability to experience pleasure from normally pleasurable life events such as eating, exercise, social interaction or sexual activities.”

Whatever you want to call it, it was no fun. But surprisingly, as quickly as it arrived, like a Mid-Western downpour, the storm clouds pretty much blew away today. I received my usual infusion of Ampligen this morning, and as is typical after,  I feel some mild flu-like symptoms. But I do have an appetite again, had an animated conversation with my wife on the ride home, and am "feeling" things again. But I have to admit, I’m still sort of on guard. The speed with which the darkness came over me, and the lack of warning from either my doctor, or anything I had read to date, sort of shocked me.

I’m still not feeling very charming today, but we’ll see how the evening unfolds.

Your comments and questions as always are very valuable to me. Thanks!

read more...

Beauty Talk: Flipside of Retinoids

Image: www.marieclaire.comAfter the post I made on Retinoids’ use in skin treatments some time ago I came across an article in Marie Claire Magazine covering pros and cons of this well-known anti-aging treatment. I had to make a follow up post and talk about the flipside to Retinoids. According to some skin experts, Retinoids can actually be damaging to the skin. First of all Retinoids can

read more...

Congratulations. You Feel Like Crap!

Treatment #8

Today is my first month's anniversary with Ampligen, and my body celebrated by manifesting all the signs that it was working - feeling like I had the flu. I say that only half in jest, because my Doctor confirmed last night that,  after seeing patients on this drug for the past 20 years, it is a validation -  if you don't show flu-like symptoms in the early stages, something is amiss. "Congratulations!" he beamed. "That's good news. The drug is working." So with my eyes fuzzy, my head hurting, my bones aching and my stomach a little quesy, I forced a smile and said,  "All right! I'm so glad I feel like crap right now!" 

I guess it's sort of like exercise. I remember in College long before I got sick, after doing my first weight-lifting workout as a skinny adolescent, and waking up the next day with everything hurting.  I' was so shocked! I mean I could understand my biceps and glutes hurting, because we had done those exercises. But that day my elbows, and my ears, and even my ankles ached! My trainer just smiled and said the famous gym-phrase "If it ain't hurtin, it ain't workin!" and went on to add that the muscles all over my body had to adapt to these new stressors, in order to build back stronger. He actually liked it that I felt so horrible the next day.  That I had to walk around campus like a 90 year old man all week, saying "ouch" with every step just made him more pleased.

Such is the world of Ampligen. It may seems incongruous, but the genuine grin on my Doctor's face last night when he heard I felt like crap was not because he was a masochist...it was very appropriate here. Other patients have told me the same thing, that "flu-like symptoms" after infusion is a good sign. But there are other good signs that I've started to notice.

Good sign #1- I'm dreaming again! 

I can't tell you how long it has been since I've awakened from a night's sleep with the memory of a dream I'd had. Now I have memories of 3, 4, even 5 deeply profound dreams, almost every night. Especially on the night after I get the drug infused. Most are quite entertaining. Last night I was on a Navy Aircraft Carrier, and had what seemed to me to be about 3 day's worth of adventures with the Navy Seals! In recent dreams I have had hilarious arguments with movie actor Randy Quaid, (why I have no idea!), have revisited long-forgotten events from when I was only 3 years old in dreams, and have been to Russia. Pretty wild, no?

I used to dread the nights, for all the sleep problems I'd had. Now going to bed for me is actually as good as going to the movies.

Good Sign #2 - My employees are engaging me again!

Because my business can be done over the phone and internet, from all parts of the world, my moving to the USA to come here to this clinic really didn't change the way I did my job. But one thing already has changed.  The way my staff and I are relating, and working on more projects together again.  I'll confess, even though I tried to be a good leader, the sicker I got over the past few years, the less I was able to do, well. So two things resulted. I ended up doing less, and they began to involve me less; by necessity!

Let's face it, loving people do loving things, and when my team knew I had a headache, didn't sleep for 3 days, or could hardly form cogent sentences, they tried to leave me alone. I appreciated them for that, but over the past few weeks, that has changed. Sure, I still do most of my work horizontally, lying in my bed with my laptop. But now my brain seems to be able to handle more. I haven't arrived yet, that's for sure. But I can tell you that I am probably 20% more productive than I was 3 months ago.

Good Sign #3- My appetite is back!

Even people without M.E. will tell you, when you are sick, when your body aches, when you are depressed and you don't sleep, you often just don't feel like eating. Because my challenge was complicated by intestinal parasites I picked up in the tropics, I was taking anti-parasite medicine that also contributed to the lack of appetite. My wife would cook the most amazing meals, and I'd just stare at the plate. By the time I arrived here 2 months ago, I was like 30 pounds underweight. But that all changed a month ago. For the past 4 weeks, actually beginning with my very first infusion, there's been a new sound coming from my belly...hunger pains! Plus a desire for food! And I have gained 5 pounds back already.

Good sign #4- I have slightly more physical energy! 

This one is easy to measure, because when I arrived in this country at the Miami International Airport over 2 months ago, I could hardly walk for more than a couple minutes. That is one wicked airport for sick people, I'm telling you. I guess there is some Spanish law brought from Cuba that prohibits moving sidewalks in MIA, so to walk from the plane, through customs, to our bags, required me to stop and rest about every 3 minutes. This morning, I spent 25 minutes in the gym, doing light exercise, resting about every 8 minutes or so, but completing my little routine. To Arnold Schwarzenegger that may be child's play. But to me it's significant. I am seeing my physical energy slowly return! No, I still couldn't spend a day at Disneyworld, that would be way too much. But I bet I could make it through Miami Airport a lot faster today!

CORRECTION: In a previous post I misstated the cost of Ampligen. The correct number in the "cost recovery program" for the drug itself is $1200/month, which represents 8 infusions given two times a week for a month. My rough estimate of planning for an investment of $50,000 may be a little high, but includes the additional doctors fees, and equally important, the cost to live here. My 1-bedroom apartment alone runs around $2000/month, so with transportation and the like, you can see how the numbers add up. In accounting terms, it's not the drug itself that is the major expense, but the relocating and living in new place in order to get the drug that adds up. Hope that clarifies it.

As always, questions and comments are what keeps me posting. Thanks!

read more...

Do Tyrosine Supplements for ADHD Actually Work? (part 7)

Homocysteine Buildup: The (Potential) Dark Side of Tyrosine and L-DOPA Supplementation for ADHD

Throughout the last six posts on this blog, all of which were concerned with tyrosine supplementation strategies for ADHD, we alluded to the fact that introducing high levels of tyrosine into the body can precipitate a number of other biochemical processes besides the conversion to dopamine and norepinephrine in the brain of the ADHD patient. For reference, I have included the diagram we've been following for the past six blog posts on ADHD and supplementing with tyrosine (you can click on the diagram below and get a larger picture in most browsers):

As we can see, there are a number of enzymes, processes and intermediate steps involved in just this one pathway of tyrosine. Please note that other nutrients, such as ascorbic acid (a.k.a. vitamin C, which has a number of connections to ADHD) and S-Adenosyl methionine (also known as SAM or SAMe, which has also been discussed in greater detail in relation to ADHD elsewhere) are required in this process.

Also, a number of enzymes are required to make this process go.

Here is a quick summary of some of the enzymes used and some of the key vitamins and minerals required (either directly or indirectly) to optimize this enzyme's function:

Tyrosine Hydroxylase: (iron, vitamin C, magnesium, zinc, copper, folic acid or folate, niacin). This is perhaps the most important step of the process, in that it is the slowest or "rate-limiting" step. Because of this, we want to make sure all necessary nutrient "co-factors" (helpers) are in place to help move along this "slow" step as fast as possible)

Dopa Decarboxylase: (vitamin B6, zinc. Also note that excessive levels of some other amino acids, such as leucine, isoleucine, valine, and, especially, tryptophan can compromise this step of tyrosine metabolism. Furthermore, buildup of one of the products of tryptophan metabolism, serotonin, can inhibit or begin to shut down the activity of this Dopa Decarboxylase enzyme and compromise our tyrosine-to-dopamine conversion pathway. This spells bad news if we want to attempt to regulate these dopamine levels in an ADHD brain)

Dopamine Beta Hydroxylase: (vitamin C, but also requires additional antioxidants to "recycle" the used vitamin C)

Phenylethanolamine N-methyltransferase: (S-Adenosyl-methionine or SAMe)

Keep in mind that this list is not extensive. However, the vitamins and minerals are some of the key players in the conversion processes of tyrosine metabolism.

Other Pathways of Tyrosine Metabolism and the Generation of Homocysteine

This is extremely important. A lot of times we get lulled into believing that just because we're using a natural or dietary-based treatment strategy instead of potentially harmful medications, we are immune to negative and/or dangerous side effects typically associated with drugs. However, as a blogger, I urge everyone to reject this idea as quickly as possible. While the side effects as a whole may be a bit more benign or have more room for error for nutrient-based ADHD treatments, going overboard can be just as harmful.

Minerals such as iron, copper and chromium all can be extremely toxic at high levels, and overdosing on certain vitamins (especially the fat soluble ones such as vitamins A and E, which are more difficult to flush out of the system than the water soluble ones), can also be harmful (or even fatal). Even the water-soluble B vitamins can cause problems if overdone (there is a high degree of interaction among most of these, and there is a relatively delicate balance between their levels. Over-supplementing on one, therefore, can greatly compromise the others).

Amino acid supplementation can also be tricky. We mentioned in an earlier posting that chemically similar amino acids often "compete" with each other in areas such as entry into the brain and competition for the same enzymes. As a result, if we go overboard with supplementing on one type of amino acid (such as tyrosine, in the case of ADHD treatment), we need to examine some of the possible repercussions of disturbing the balance of the other amino acids and the products of their metabolism.

Additionally, we need to be aware of other biochemical pathways in the body in which tyrosine is involved. While it may be true that supplementing with tyrosine can boost levels of dopamine and norepinephrine (although the extent of this is debatable, and will be discussed in our final "wrap-up" post), boosting tyrosine intake can result in higher levels some potentially harmful agents such as the compound homocysteine. For this, we will begin by examining the last step of the tyrosine metabolic process (this was covered in the last post in more detail):

Here we see that tyrosine-derived norepinephrine can be converted to epinephrine (adrenaline) in a process which utilizes the enzyme (phenylethanolamine N-methyltransferasePNMT). Even without a chemistry background, we can still see the chemical transformation process above. A methyl (CH3) group was added to the Nitrogen (N) on the right side of the norepinephrine molecule to form norepinephrine. But where does this methyl group come from?

As mentioned in the last post on ADHD and tyrosine, the compound S-Adenosyl Methionine or SAMe, is a very important nutrient in a number of biochemical processes, in that it is able to "donate" (give-up) a CH3 methyl group. This is a relatively rare property among nutrients, and we are just beginning to scratch the surface with regards to the role of this nutrient in treating neurological and psychological disorders such as depression, ADHD and the like.

However, when SAMe does donate it's CH3 methyl group, as in the case above, we are left with homocysteine (please note that there are a few additional steps to go from SAMe to homocysteine, it is not a 1-step conversion process. For simplicity, however, we will not go into these in any further detail. Nevertheless, homocysteine is a major end product of SAMe-related CH3 donor reactions, such as the one given above).

In other words, higher tyrosine (or L-DOPA) levels can make their way to this step of the metabolic process and begin to deplete SAMe levels and lead to high levels of homocysteine. High levels of homocysteine are known as hyperhomocysteinemia, is commonly seen in Parkinson's patients, who often take large amounts of L-DOPA (the second step of tyrosine metabolism in our first diagram in this blog post). Numerous studies have shown that long-term treatment with L-DOPA leads to elevated homocysteine levels in the blood of Parkinson's patients.

Elevated homocysteine levels have been linked from everything from cancer to diabetes to autoimmune disorders to stroke (however, please note that these results are far from unanimous, there are a number of studies showing the contrary for each of the diseases listed. Furthermore, there is still some debate as to whether the high levels of homocysteine are a causal factor for these disorders or just another side effect or symptom of these disorders. Nevertheless, the near-ubiquitous presence of high homocysteine levels in so many diseases across the board should at least suggest that homocysteine-lowering efforts are of great potential benefit, at least in this blogger's opinion).

With regards to ADHD, the actual role of homocysteine is, admittedly, much more murky. While the mechanisms and overall physiology of an ADHD brain vs. a Parkinson's brain show acute differences (In ADHD, chemical imbalances between the "inside" and "outside" regions of a neuron exist, which can be chemically modified via medications which target the proteins which shuttle this neuro-transmitting agents in and out of the cells. In Parkinson's, however, the imbalances are caused by cell death and neuronal degeneration, requiring overall higher levels of neurotransmitters like dopamine need to be supplied via chemical precursor agents like L-DOPA), the fact that the two disorders both share similar treatment methods should (in this blogger's opinion) at least sound a warning bell that some of the negative effects for one might also be prevalent in the other.

Surprisingly, there are very few studies (at least to the best of this blogger's knowledge) on homocysteine levels in the ADHD population, so it is difficult to get a good read on the subject. Nevertheless, given some of the points made earlier on tyrosine or L-DOPA supplementation or treatment and homocysteine buildup, we should at least examine some of the ways to reduce high homocysteine levels. Fortunately (at least in most cases), homocysteine-lowering efforts often respond very well to vitamin and mineral based treatments via supplementation or food fortification. At the center of this are the some of the well-known B vitamins.

B vitamin-based nutritional "weapons" which can combat potentially high homocysteine levels arising from tyrosine or L-DOPA supplementation:

• Vitamin B6 (whose "active" form is known as pyridoxal phosphate. For simplicity, we will just be referring to this compound by its common vitamin name, vitamin B6)
• Cobalamin (a version of vitamin B12)
• Folate (a derivative of Folic Acid or Vitamin B9. For simplicity, as in the diagram below, we will just refer to this modified form of folate as "folic acid", but please note that there is a modest chemical difference here)
  

While the above diagram may look extremely complicated and "busy", please try not to get distracted. The first four "steps" at the top (the arrows simply refer to a metabolic pathway by showing the gradual transformation of one tyrosine-based compound to the next. We have discussed each of these steps in great detail in the previous postings) have already been covered extensively.

The last step, the conversion of norepinephrine to epinephrine was discussed in the last posting on ADHD and tyrosine. The curved arrow simply refers to the fact that the norepinephrine to epinephrine conversion requires another nutrient-based compound SAMe. The norepinephrine essentially "steals" a methyl (CH3) group from SAMe, leaving SAMe to transform into another compound S-Adenosylhomocysteine (which then proceeds to our "dreaded" homocysteine). To put it another way, in order to make the norepinephrine to epinephrine conversion, the valuable nutrient SAMe must be "sacrificed" to a more potentially harmful compound homocysteine.

If this SAMe to homocysteine conversion process is not kept in check, we run the potential risk of homocysteine buildup. However, based on the diagram above (look at the far right side of the diagram for this part), there are 2 different ways to "dump off" high levels of homocysteine by converting it to other more benign compounds. However, each of these two "paths" requires at least one type of B vitamin.

Path #1: conversion of homocysteine to the amino acid cysteine: This is actually a multi-step process, but for the sake of brevity and simplicity, I have left out some of the middle steps. The two major points of note here as follows:

1. This process requires a specific enzyme called cystathione beta-synthase (don't worry about remembering this enzyme, just remember that this enzyme requires a form of vitamin B6 as a cofactor or "helper to function). Thus, to optimize this vitamin B6-based conversion process, we want to make sure that we don't have any deficiencies of this vitamin. Please note that we already mentioned the need for vitamin B6 in another step of the tyrosine supplementation process for ADHD, the conversion of L-DOPA to dopamine. Thus, it is doubly important that we don't come up short on this vitamin.
   
   A rough summary of recommended dosage levels for B6 will be given at the end of this post (Blogger's note: not to go into too much detail here, but this homocysteine to cysteine conversion process is also dependent on another amino acid called serine. I have not included serine as an essential nutrient because serine deficiencies are rare. However, there are some genetic disorders in which serine synthesis is compromised. Seizures and related symptoms are common among those with this genetic defect on serine metabolism).
   
   
2. The conversion of homocysteine to cysteine is (largely) irreversible. This is good news if we want to "dump off" homocysteine levels and not have to worry about the process chemically finding its way back to homocysteine (at least not through this pathway).

Path #2: the conversion of homocysteine to the amino acid methionine: While path #1 is dependent on one type of B vitamin (B6), this pathway is dependent on 2 different B's: a form of vitamin B12 and a derivative of folic acid (vitamin B9). Without going into too much detail, this process requires a methyl (CH3) "donor" (which, in this case, is the modified form of folic acid here. This is very similar to like way the nutrient SAMe acts in helping the conversion from norepinephrine to epinephrine as mentioned earlier).

Please note that, unlike the last case, this process is chemically reversible (which means that the process can go backwards and regenerate homocysteine to a certain extent). This process also requires a special enzyme called homocysteine methyltransferase. Again, don't worry too much about this enzyme, just note that it requires a form of vitamin B12 to function.

To summarize: if we want to keep the "cycle" going to avoid homocysteine buildup by converting homocysteine to methionine, we need 2 different B vitamins: The folic acid as the chemical modifier, and vitamin B12 to help the enzyme involved in the process to function properly.

Perhaps not surprisingly, taking B12 (also known as cobalamin) and a form of folic acid (folate) together has shown to be advantageous in a number of cases. Combinations of folate and cobalamin have also shown to be useful in reducing homocysteine levels in those treated with L-DOPA.

A quick summary on using B vitamins to reduce potential homocysteine buildup from tyrosine (or L-DOPA) supplementation:

• Homocysteine can be an inflammatory compound that is produced indirectly as a result of tyrosine metabolism. High levels of this compound have been linked to a wide number of diseases and health risks.
  
  
• Vitamin B6 can be used to help "shunt" homocysteine to a common (and typically less-harmful) amino acid known as cysteine. This process is (essentially) irreversible. B6 is also a requirement for an earlier step of the tyrosine or L-DOPA metabolic process, the conversion of L-DOPA to dopamine.
  
  
• Vitamin B12 and folic acid can both assist in the conversion of homocysteine to another amino acid, methionine. Unlike the cysteine conversion process above, this process is reversible, meaning that it is possible to "work" backwards towards homocysteine in a bi-directional pathway.
  
  
• Because of the importance of these 3 B vitamin-derived factors in the prevention of homocysteine buildup, it is imperative that we try to avoid shortages of these agents at all costs (but be careful about over-supplementing, B vitamins work best in specific ratios, and overdosing on one can compromise the functions of the other, as we have noted in previous posts on ADHD and nutrient deficiencies).
  
  
• Here are some good sites which list the suggested daily amounts for folic acid (folate), vitamin B6 and vitamin B12. Going slightly higher is often fine (as these agents have relatively high "ceilings" between recommended amounts and toxicity levels), but try to keep the ratio of these different B vitamins as close to the same as in the recommended amounts as possible. Again, please make sure your physician is in the know if you choose to supplement with anything significantly above the recommened levels.

This is our second-to-last post on ADHD and tyrosine. The last one on tyrosine supplementation strategies for ADHD will give a recap of all the key enzymes, nutrients, and chemical intermediates we've covered throughout the past seven postings. It will also provide a summary of what the main studies on exactly how effective tyrosine supplements really are based on clinical studies. Finally, we will briefly mention how tyrosine may be able to augment the effects of common ADHD stimulant medications.

read more...

Beauty Shopping: Avene Cleanance and Collistar Super-Concentrated Anticellulite Night Treatment

Shopping again!Rather than being loyal to my usual Estee Lauder Verite Cleanser I decided to try Avene’s Cleanance soapless gel cleanser. The fact that it was for oily, blemish-prone sensitive skin got my attention. I was not 100% sure as my skin is not that oily but in the recent months I had some annoying break outs. So I decided to give it a try.I have been dreaming of trying Dior’s Svelte for

read more...

My Peter Falk View of Ampligen

Treatment #7

I don't want to say that getting a needle stuck in your arm is getting routine, but a nice short summary of this morning's Ampligen infusion would simply be "speed." Because I have now tolerated the full dose twice last week, nurse Gwen ramped up the rate of my drip today and got the whole 400ml into my veins in less than 35 minutes. Including taking my vital signs, charting my progress, and the rest, the entire process took no more than an hour this morning! And it felt no different than when it was going in slower last week, thank God.

Many have asked about the financial aspects of my decision to come to this country to start the Ampligen treatment, so I'll jump to that now.

Are you the kind of person who likes to yank a band-aid off quickly, and get the pain over with? If so you won't be quite as shocked with what I'm about to tell you. This decision cost me big time. I won't go into the intangible costs to family, business, and one's psyche, because the money alone is enough to drive you to your knees and ask "Are you sure, God?" There is a page on Wellsphere that talks about the "Ampligen Cost Recovery Program" and features some of the Doctors in the USA and Europe that offer it, but let me cut to the chase. I calculated that I would need $50,000 to come here and live for 6 months, pay for the Ampligen itself, as well as the clinic fees.

Gives new meaning to the term "recovery", no? You may be saying to yourself, "Well, I don't have a spare $50K lying around!" And neither did I. But over the past 5 years, the more I deteriorated in measurable, noticeable ways (see my previous posts)  the more I began to have a subtle change in my mindset. A change that got me to the place where the money, while outrageous, was still something I could get over. Or, better said, something I could figure out.

In a word, the sicker I got, the more I started thinking about survival. In a 5 year period I had gone from being frustrated with my decreasing, reduced lifestyle, to actually being concerned about my life in general.  

You know we are all great at coping and convincing ourselves that we can get along with all these horrible symptoms, and I was probably the "king" of denial in that regard.  And because I had jobs and people I was responsible for, and no bank account with $50,000 just sitting there, for 5 years I basically just, well, gutted it out. Thinking all the while that a half-assed me was OK. That me in pain, working part time, was alright.

But then one day, these subtle nudges came to a head, and I realized the truth. I was seriously going downhill. I wasn't even able to work part-time very well at all. It was during a Christmas celebration in 2008, when I couldn't even sing one Christmas carol, so excruciating was the pain in my head, that I snapped. On that day, something clicked. I decided that my life was at stake, and that in survival mode, you do anything and everything to live. Including giving up dreams,  moving 10,000 kilometers away, and even selling things or taking out a loan if I had to.

On our ride back to our apartment after the event, still in agony, I cursed, screamed, and pounded the dashboard. I cried and said to my wife, "I'm not sure I can do this anymore!" Steady, solid woman that she is, she calmly said, "well let's pray, and then let's figure out what to do so you can." 

There is a great line in the classic 1979 movie "The In-Laws" where Peter Falk, a CIA guy, is explaining his job to Alan Arkin. "Yes, being a spy is dangerous" he says, "but the CIA has a great benefits program. Of course, the secret to the benefits plan is not dying."

The change in my mindset that Christmas day allowed me to actually consider radically upturning and changing not only my life, but that of my family and friends as well. It was a mindset that went from "surviving this sick life" to "fighting for my life." And at that moment, to be honest, the money didn't seem so important. You see, as Peter Falk pointed out, if you're dead, it just doesn't matter.

Once I had my "head-game" fixed, it was relatively easy. I recalled, like most people my age, that I had done these crazy financially "unsound" types of things before...when I started more than one business from scratch; when I left home at age 17 to follow my career dreams as a youth; when I worked three jobs to pay for my daughter's education. I had sacrificed before, and it always worked out. Besides, I figured if I was healthy, I could make that $50K back in about a year, if I stayed in the USA. "But the key was not dying."

Do I think the medical system in the USA and other countries is whacked out? Yes. Would I feel comfortable telling anyone that a bottle of Ampligen costs $1200 a pop? No. Most wouldn't understand. Although the fact is, in comparison to HIV and AIDS medication it's cheap.

But do I gladly pay this money, until such time as it is officially approved, and do I thank God for Hemispherx and Dr. Carter and this amazing drug?  Absolutely. Like the CIA, it's not perfect. But once you decide about the "not dying" part,  the benefits are great.

read more...

Healing the Generations Conference

I want to highly recommend the second annual Healing the Generations conference at Foxwoods on March 25 and 26th. Last year’s conference was wonderful and this year looks to be even better. I am presenting on Trauma Informed Foster Care, Helping Survivor Parents and What We Know about the Brain and What We Should Do. My colleague Steve Brown is presenting on teaching Healthy Sexuality to High Risk Kids, and on our statewide initiative to use Risking Connection to train the staff of Extended Day Programs. This presentation, in conjunction with Marilyn Cloud from DCF, will include exciting new research demonstrating the effectiveness of the training. I hope to see you at the conference, and be sure and come up and say hello!


The Clifford W. Beers Guidance Clinic, Inc. Presents

Healing the Generations:

Second Annual Family Violence and Child Trauma Conference

Keynote Speaker: Dr. Alicia F. Lieberman, PhD

Dr. Lieberman has spent her career trying to prevent and undo the emotional damage inflicted on people at very young ages. "Young children, even babies, remember traumatic events in their bodies with increases in stress hormones such as cortisol--the event makes a distinct impression on them." Investments made in the first three years of life have the best predictive role in creating positive change in a person's life, so the infancy years are crucial in shaping not only individuals, but society as a whole.
Dr. Lieberman's keynote and workshop will describe the impact of chronic adversity on parents' attitudes and child-rearing practices, illustrating the transmission of emotional difficulties and relational conflicts from one generation to the next. It will also describe how parents can surmount difficult child experiences to transmit a message of love and hope to their children.

Spotlight on Workshop Presenter:

Michael Mack

Haunted by memories of childhood clergy sexual abuse, Michael Mack wondered for decades if one day he might meet his abuser for a conversation. In 2008 he had that chance. Although Mack had anticipated countless scenarios, what happened was beyond anything he had ever imagined. He will deliver a theatrical monologue about the healing power of personal storytelling. He uses monologue "because when we can talk to ourselves consciously, we can experience healing more deeply."

Michael Mack is a poet, playwright, and solo performer best known for his one-man verse play "Hearing Voices (Speaking in Tongues)" about his mother's life with schizophrenia. Mack has performed Off-Off-Broadway, at the US Library of Congress, at Yale University, and for faculty and students of the Harvard Medical School.

For full conference agenda visit:

www.cliffordbeers.org

Up to 12 CEUs will be available through the Women's Consortium for MFT, LPC, LCSW, NASW and CCB.

Contact Info:

Jane Hendrickson at (203) 772-1270 ext 246 or jhendrickson@cliffordbeers.org

read more...

Does Tyrosine Supplementation for ADHD Actually Work? (Part 6)

Can we use tyrosine as an effective supplement to treat ADHD symptoms?

We have dedicated the last five postings on the role of tyrosine and its metabolism, and how imbalances of this common amino acid may dictate, in part, some of the symptoms related to ADHD.

Just for refreshers, here's a diagram of the overall conversion process and metabolism of tyrosine. We have spoken through the first three steps (and the corresponding enzymes and required chemical nutrients) in the process:

Here's a quick recap on our last 5 discussions on ADHD and tyrosine:

Post #1 on ADHD and tyrosine: We examined the overall theory and background behind the use of tyrosine as an ADHD treatment strategy. We saw how it is a chemical precursor to important neurotransmitters (neuro-signaling chemicals responsible for communication among brain cells and the central nervous system) such as dopamine and norepinephrine. We also introduced the concept of the blood-brain barrier, a biochemical barrier which controls the transport of drugs, nutrients and toxins in and out of the brain.

Post #2 on ADHD and tyrosine: here we analyzed the first step of tyrosine metabolism, in which tyrosine is converted to another compound L-DOPA (a common treatment method for Parkinson's patients). This step heavily involves the enzyme tyrosine hydroxylase. However, in order to optimize function of this conversion process, the tyrosine hydroxylase enzyme requires certain vitamins and minerals to act as "co-factors" or "helpers". These include iron, vitamin C, magnesium, zinc, folic acid (namely folate or vitamin B9) and overall adequate antioxidant levels. Secondary nutrients (necessary for enzymes which lead up to the formation of some of the products used by the tyrosine hydroxylase enzyme) include copper, and (as we'll see later on in the tyrosine metabolic pathway), vitamin B12. Deficiencies in one or more of these nutrients could potentially compromise this enzyme's function. Since this first step is actually the slowest (rate-determining) step of the whole tyrosine metabolism process with regards to converting tyrosine to the neurotransmitters dopamine and norepinephrine, making sure we have adequate resources of these "helper" nutrients is crucial to our success.

Post #3 on ADHD and tyrosine: We can essentially bypass this first step of tyrosine to L-DOPA conversion altogether if we just decided to supplement directly with L-DOPA instead. But is L-DOPA more effective than tyrosine as a treatment method for ADHD, or are there some serious drawbacks to this strategy? This third post evaluates and compares both tyrosine and L-DOPA options and compares both their effectiveness as ADHD treatment agents and their comparative safety issues in several different categories.

Post #4 on ADHD and tyrosine: In this post, we examined the second major step of the conversion process in tyrosine metabolism, the conversion of L-DOPA to dopamine. This step requires use of the enzyme DOPA decarboxylase. Like the tyrosine hydroxylase enzyme in the step before it, DOPA decarboxylase also requires nutrient co-factors to optimally function. The main nutrient requirement of this enzyme, however, is a specific form of vitamin B6, known in this case as pyridoxal phosphate. In addition to requiring adequate vitamin B6 levels to function properly, we also saw that other amino acids (namely tryptophan), can actually interfere and even compete with this process, so the post ended with the recommendation to avoid taking in tryptophan-rich foods (which were listed in this fourth post) at the same time as tyrosine was being supplemented.

in post #5 on ADHD and tyrosine supplementation, we examined the conversion process of dopamine to norepinephrine. It is important to note that this process is NOT universal across the body, or even throughout all regions of the brain and central nervous system, for that matter. However, since both dopamine and norepinephrine both can play major roles with regards to ADHD and the symptoms of the disorder, this enzymatic conversion process is still of importance. The enzyme used here for this step of the tyrosine metabolic pathway is called dopamine beta hydroxylase. Interestingly, the gene coding for this enzyme (which goes by the same name, the dopamine beta hydroxylase gene and is located on the ninth human chromosome), has been implicated as a potential hereditary factor for ADHD. Like the aforementioned tyrosine hydroxylase the dopamine beta hydroxylase enzyme is heavily dependent on ascorbic acid (vitamin C) as a cofactor, and heavy utilization of this enzyme (especially without adequate antioxidant pools in place to help regenerate the vitamin) can use up the body's overall supply of vitamin C.

-----------------------------------------------------------------------------------------------

Moving on to our sixth post in our series on ADHD and tyrosine, however, we need to investigate the next step of the process, the conversion of norepinephrine to epinephrine (adrenaline). Keep in mind that this process is not universal, it is dependent on an enzyme called phenylethanolamine methyltransferase, or PNMT for short. Interestingly, the gene which "codes" for this enzyme, also called PNMT, has been linked to a common behavioral sub-component of ADHD called cognitive impulsivity. The PNMT gene is located on the 17th human chromosome.

In contrast to the other main type of ADHD-styled impulsivity, known as aggressive behavioral impulsivity (which is more characterized by arguing, having a short temper, conflicts with peers and adults, and the like, which is more characteristic of oppositional defiant and conduct disorders, and is seen more in the hyperactive/impulsive or combined ADHD subtypes), cognitive impulsivity often has more academic than behavioral inhibitions.

Symptoms of cognitive impulsivity deal more with things such as having trouble waiting in line, struggling with maintaining a continuous focus on school assignments, inability to complete schoolwork, and being prone to every little distraction (a chirping bird outside, the sound of cars passing by on a nearby road, etc.). Cognitive impulsivity is therefore more reflective of the inattentive subtype of ADHD (which is often more frequently seen in girls, and is often more easy to overlook than the other subtypes of ADHD).

It is interesting to note that differences in parent and teacher evaluations often occur over this type of impulsivity, since this type of behavior is often much more visible in a classroom setting. Therefore, if a large discrepancy occurs between the parent and teacher rating scales, which are usually used to help diagnose and assess ADHD, cognitive impulsivity (and possibly even the factor of the PNMT gene) may, in part, be to blame. (Please take this last statement as a possible explanation for this type of behavior and not as an excuse or a "cop-out" for a child's poor performance in school!)

Returning from our aside on the possible genetic relationship between the Phenylethanolamine N-methyltransferase (PNMT) enzyme function and cognitive impulsive ADHD-like behavior, let's return to the chemical process and nutrient requirements of this enzyme. To us visualize this step of the process, here is a chemical depiction of the norepinephrine to epinephrine conversion:Even if you're not a chemist, do you see how the norepinephrine molecule added a methyl (CH3) group on to the right end of it to get epinephrine? This is the working of the Phenylethanolamine N-Methyltransferase (PNMT) enzyme.

However, the source of this methyl (CH3) group to be added to the molecule needs to come from somewhere. This is where an essential nutrient called S-adenosyl-methionine (as depicted in the diagram above by the downward arrow) comes into play.

S-adenosyl-methionine often goes by other shorter names in the literature and in the grocery aisle, it is often referred to simply as SAMe or just "SAM". We will refer to it as "SAMe" from this point onward.

SAMe is one of the hot new supplements out in the health food aisles these days, and while this blogger personally believes that this nutrient is a bit overhyped, it does offer a number of unique benefits which can possibly cover a whole array of disorders. It is a chemically-modified version of the amino acid methionine. The ability of SAMe to pass on or "donate" a methyl (CH3) group to another molecule (as in the above process where norepinephrine is converted to epinephrine) is a relatively rare property among dietary nutrients, so SAMe does have a number of biochemical implications as a potential supplementation strategy.

As far as psychiatric disorders are concerned, SAMe is a particularly well-known natural supplement for treating depression, and can often have a faster onset than several types of prescription medications (it can also be used in conjunction with antidepressant medications in several cases to augment these medications' effectiveness). SAMe has also been implicated as a potential treatment strategy for other neurological disorders such as Alzheimer's and Parkinson's diseases. However, while anecdotal evidence for SAMe's use in ADHD is moderately strong in some cases, very few reported clinical studies have been done on SAMe for ADHD. One very small study on SAMe and ADHD (only 8 people!) showed relatively positive results, however.

Returning to the diagram here (see below), we see that one of the end products (that's what the curvy arrow means) of this interaction between the PNMT enzyme and the SAMe nutrient is another compound called homocysteine.

We have alluded to this potentially harmful pro-inflammatory compound in some of our previous posts on tyrosine supplementation, and also examined homocysteine in more detail in post further back dealing with ADHD, alcoholism and nutrient deficiencies. As a natural byproduct of this norepinephrine to epinephrine conversion process, we must make sure that we are able to keep levels of homocysteine in check. We will see how we can potentially counter this with B vitamins and other nutrients in our next blog post on ADHD and tyrosine supplementation.

However, the three main points we should take away from this post on tyrosine supplements and ADHD are as follows:

• The conversion process of tyrosine to epinephrine does not occur in all cells, even in the brain and central nervous system. Many regions (even those associated with ADHD) "stop" with dopamine in the overall metabolic process of tyrosine.
  

• For the brain regions that do accommodate the norepinephrine to epinephrine conversion process, an adequately functioning enzyme called Phenylethanolamine N-Methyltransferase (or PNMT) is required.
  

• In order for the PNMT enzyme to do its job in converting norepinephrine to epinephrine (adrenaline), adequate supplies of the nutrient S-Adenosyl-methionine (SAMe) are required. This process, however, can leave us with a potentially hazardous byproduct called homocysteine, which must be kept in check to reduce the risk of "inflammatory" diseases such as cancer or cardiovascular disorders. Nutritional intervention strategies must be put in place to help prevent unwanted accumulation of this homocysteine. This is part of the "cleanup process" of the tyrosine supplementation strategy for ADHD, and will be discussed at length in the next blog posting.
  

read more...