DALLAS--A sharp eye and a few simple physical tests can reveal a wealth of information about early-stage neurodegeneration, opening up a window for lifestyle-based interventions, said Datis Kharrazian, DC, at the Institute for Functional Medicine’s annual international conference.
At their root, most neurodegenerative conditions reflect a loss of mitochondrial function within the neurons. The mitochondrial dysfunction begins long before the obvious symptoms of, say, Parkinson’s disease or loss of cognitive function, said Dr. Kharrazian, a chiropractor, functional medicine practitioner, and health educator based at the Optimal Wellness Center, in Encinitas, CA.
It is especially important to look for indicators of neurological change in patients who are seeking help for chronic fatigue, he told the IFM assembly. The fatigue is, in and of itself, a reflection of systemic mitochondrial dysfunction, and a large percentage of these patients will have neurological issues.
Sharpening Your Eye
Simply put, impaired neuronal ATP production means impaired brain function, which can manifest in a variety of subtle ways. The signs are there, often before you start any formal examination--if you know what to look for.
- Did the patient get lost on the way to the office? Did s/he have trouble finding the way or did someone else drive because the patient feared getting lost?
- Was s/he late…and apologetic for “always being late?”
- Did you notice anything “off” about the patient’s posture, facial muscle tone, or gait?
- Did s/he take an excessive amount of time completing the intake paperwork?
- Was the handwriting variable or inconsistent?
- Was s/he unable to provide a detailed history?
- Did s/he become fatigued during the history-taking process?
Any of these patterns suggests that, at the very least, the patient’s nervous system is not operating optimally. A cluster of seemingly minor signs is definitely suggestive of a problem. The physical exam can provide further clues.
Dr. Kharrazian urged colleagues not to turn a blind eye to small but important indicators such as:
Facial Signs: Pay close attention to the face. A lack of blinking or excessive blinking; facial twitches or other signs of ataxia; ptosis on one or both sides; excessive muscle tone on one or the other side of the face all indicate mitochondrial dysfunction and early neurodegeneration. Facial drooping reflects failure of mitochondrial oxidative phosphorylation in the tissues. In people with early neurodegeneration, one side tends to deteriorate faster, so there will be facial asymmetry.
Loss of Balance & Postural Tremors: Many people—including many clinicians—will dismiss bad balance as an inherent personal variance. While it is not necessarily a sign of neurological disease, poor balance does suggest that, “the spinal-cerebellar system is not integrating properly.” Be on the lookout for postural tremors.
Weak Gag Reflex: Assess the gag reflex—it is a window into the vitality of overall vagal activity. A weak gag reflex indicates low vagal tone, which correlates with low digestive enzyme production and poor digestive function. Many people with early-stage neurological problems also have longstanding GI problems.
Hypertonia: Don’t write off symptoms like "frozen shoulder" and other forms of intense muscle stiffness or spasticity around key joints.
Poor Peripheral Circulation: Check the warmth of the patient’s hands; cold hands and white nail beds in a reasonably warm room indicate restricted circulation, which often goes hand in hand with mitochondrial dysfunction. Likewise, toenail fungus indicates diminished circulation.
Pupil Dilation: Test the pupils. The greater someone’s neuronal energy reservoirs, the longer the pupils can stay contracted under a bright focused light. The duration of contracture can tell you something. If the iris can't constrict when the lights go on, there's very low energy reserve in the nervous system.
Other Important Clues
As you are working with a patient, pay close attention to any signs of fatigue. If someone is fatigued after filling out your paperwork, ask if reading tends to bring on fatigue quickly. If so, there’s likely some degree of mitochondrial dysfunction in one or more parts of the brain.
Always ask how someone feels after they eat a big meal. If someone typically feels tired, s/he is likely insulin-resistent. If s/he feel restored & refreshed s/he probably tends toward hypoglycemia.
“The normal response after eating should be no major change of energy,” Dr. Kharrazian said.
Dr. Kharrazian says he usually has patients walk barefoot up and down a short hallway in his office. While they do so, he closely watches the gait. Asking the patient to walk heel to toe can also be revealing of someone’s sense of balance. People in early stages of neurodegeneration may have trouble with this.
It can also be instructive to ask patients to “double-task” by saying aloud every other letter of the alphabet while they are doing these gait tests. If someone is completely “thrown” by neurocognitive multitasking, it is also suggestive of energy deficits in the brain and central nervous system.
Ask patients to extend their arms to the side and then slowly bring their index fingers to touch their noses. If someone shows termination tremors as the finger comes close to the nose, it’s a subtle sign of early cerebellar degeneration.
The good news is that mitochondrial dysfunction in the brain and nervous system is reversible through a comprehensive program aimed at restoring healthy gut function (nearly all of these patients will have significant GI issues); addressing gluten sensitivity and other food allergies; stabilizing glucose metabolism; and stimulating neuronal plasticity.
In most cases, it makes sense to run comprehensive food allergen tests, stool analysis, and hormone evaluations, as well as measurement of insulin, fasting glucose and hemoglobin A1c or fructosamine. This information, viewed through the functional medicine matrix, will help guide treatment.
This is definitely not a single-modality situation, Dr. Kharrazian said. Treatment need to be individualized, and should include dietary changes, appropriate supplementation, mind-body techniques, and simple exercises that stimulate neuromotor coordination and neural plasticity.
“You can’t solve everything with dietary supplements,” Dr. Kharrazian told the assembly. “Massage, yoga, acupuncture, aromatherapy, all these things can help.” He added that, “stimulation of weak functions, and activation of pools of neurons is a very important but underutilized aspect of functional medicine.”
During his talk, Dr. Kharrazian shared a number of simple exercises that, if practiced regularly, can do a world of good in restoring healthier mitochondrial function in the neurons. These include:
Gargling to Improve Vagal Tone: If vagal tone is weak, there will be reduced circulation in the GI tract, as well as diminished digestive enzyme production all of which sets up conditions for GI dysregulation, dysbiosis, and poor nutrient absorption.
He advises patients to gargle with 6 glasses of water periodically throughout the day. It may sound odd, but gargling stimulates the vagus and the nerves in the palate, improving vagal tone and strengthening blood flow to the gut. Over time it can be very helpful. “It’s a way to get active change and stimulation going, so there’s new branch growth.”
Trace the Alphabet: Dr. Kharrazian often has patients sit down and practice tracing the alphabet in the air with their feet. “It stimulates new neural activity and done regularly, it can produce marked changes. It stimulates the secretion of brain-derived growth factor and increases plasticity.”