if you do the functional imaging scans of these individuals , like SPECT scans or PET scans , you will see that there ' s a low attenuation in their frontal lobes . The frontal lobe is not coordinating well . As a result , there ' s a lot of noise in the system . When I say noise , it doesn ' t mean that they ' re hearing something . It is that they tend to have sub-particle structures override , and as a result , they become more impulsive . So it ' s like a more primitive brain is there . That ' s why impulsive behaviours are quite common in these individuals .
So the primary aim of the treatment , whether or not stimulants are used , is to block the uptake of dopamine and norepinephrine . So , when dopamine and norepinephrine uptake is blocked , as a result of that the neurotransmitter , which has been like a still pool , percolates through the front part of the brain . And as a result of that you see a substantial reduction in impulsive and inattentive behaviour . You can see that there is an improvement .
But when we use an integrated approach , about which we can talk in detail later , there is something I want to make very clear , that any medication you use , whether psychotropics , or an SSRI , or an SNRI , or tricyclic antidepressants , or multi-stabilisers , including stimulants , they do not make a neurotransmitter . They only trap the neurotransmitter . So they have no control on the production line . And this is where the integrated approach can help . Once we start addressing the other aspects of the individual ’ s wellbeing , then the chances are the need for the medication will be less , which means fewer side effects , which means better quality of life .
Adrian : Okay . So the medications that you ' re referring to either stop the breakdown of the neurotransmitter , or they affect the receptor sensitivity to the neurotransmitter , but they don ' t actually help make more of the neurotransmitter ?
Sanjeev : That ' s correct .
Adrian : Okay . And that ' s where the integrative approach , which we ' ll talk a bit more about , comes into play - where we can look at how we can actually increase neurotransmitter production .
Sanjeev : That ' s correct .
Adrian : You mentioned that there ' s some dysregulation in the frontal cortex , maybe there ' s some dopamine or noradrenaline issues or norepinephrine issues going on . Are there environmental factors or lifestyle factors that might be the cause of those or that contribute to those changes in the brain ?
Sanjeev : Yes . Very important point . And I think this is where the traditional approach misses the boat . We may talk in general terms about diet and wellbeing , but to be an actual integrated practitioner is very important . To give an example , look at the production line of manufacturing of dopamine . First , dopamine is a neurotransmitter ; neurotransmitters are synthesised from amino acids ; amino acid are found in protein foods . So , people could have suboptimal levels of proteins in the diet . They could lack certain cofactors - cofactors are basically B group of vitamins that are needed for the synthesis of neurotransmitters . It could be a low pH in the system . Then we need to create an environment that facilitates the production of that neurotransmitter .
But then environmental factors come into play . The brain is very vulnerable to oxidative stress because it has a very small number of mitochondria at its disposal , compared to the other organs . For example , a heart , and a liver , and a kidney may have thousands of mitochondria to each cell , the brain has hardly 300 to 500 which means that if there is an insult to the brain , there is a smaller workforce to combat it . Mitochondria undergo a series of chain reactions before we produce ATP , which is our powerhouse or energy . So , certain environmental factors , for example , heavy metal exposure , or PCBs , or environmental chemicals , or infections , could impede the production line of these individual neurotransmitters .
So what we commonly see in terms of brain health is that those patients who have not been responding , or those who have been struggling , could have either low levels of proteins , which means they ' re not able to detoxify these toxins , and that ' s what is needed , or they are quite acidic in their pH , which means that there ' s no environment that will facilitate clearance through the lymphatic channels . And the third thing is that the essential cofactors which are required for the production of neurotransmitters are fighting another battle to deal with that toxin . For just example , one molecule of mercury will keep 1000 molecules of zinc busy . One molecule of cadmium will keep 100 molecules of zinc busy . So , zinc is also required to produce neurotransmitters like dopamine , serotonin and gamma aminobutyric acid ( GABA ). But if it is engaged elsewhere then what happens is that bioavailability of zinc for producing these substances is not there . As a result we see blockages in an individuals ' performance . And you ' ll see not only mental health challenges , but there could also be a wide variety of physical health problems , with autoimmune issues and GI disturbances commonly seen . So , to answer your question in a nutshell , yes , environmental factors do play a very big role in changes in the brain .
Adrian : So , to recap what you ' re saying , could it be that through our diets , we ' re not consuming enough proteins , or essential nutrients that are important as co-factors ? Or there could be environmental exposures that then mean our body needs to work towards detoxifying or dealing with that exposure . And then say , for example , zinc is used to deal with that exposure , then it can ' t be used to help make dopamine or noradrenaline .
Sanjeev : Yes .
In the Winter issue of JATMS Adrian ' s and Sanjeev ' s discussion will extend to integrated
34 | vol29 | no1 | JATMS