then you ' re mentioning obviously , that there are potentially some nutrient deficiencies . And there ' s also research into food intolerances and ADHD , isn ' t there ?
Sanjeev : And that is something that must be checked as well .
Adrian : Okay . And what do you think is going on there ? Is it that food intolerances are causing some type of inflammatory exposure and the body is then dealing with that immune response , and therefore can ’ t produce neurotransmitters ? Is that one mechanism that you think is going on there ?
Sanjeev : Yes . So for example , first of all , if there are any adulterants or pesticides added to the production line of that food , that is one factor . Which means that if there ' s a heavy pesticide load on that food , then chances are that you are consuming that . Now , in the case of food intolerances what mainly happens is that if your detoxifying enzymes are also overwhelmed and they are not working to their maximum capacity - so , detoxifying enzymes are mainly protein .
Adrian : Okay .
Sanjeev : So , if you do not have robust mechanisms for clearance , then the chances are that these individuals will become intolerant or sensitive to certain foods . So , you can get a broad range of food sensitivity panel testing . I personally do not do those things because their cost is prohibitive but integrated GP colleagues who work with me definitely do help in looking into those aspects . And then people tend to avoid those foods temporarily . That doesn ' t mean some of them are inherently poor food items , but that certain individuals don ’ t tolerate them . For example amines . They ' re not “ bad food ”. But if you start improving their phase II metabolism , glucuronidation , methylation , glaciation and sulfonation , pathways also improve . And then you see where the challenge is , then you can specifically target intervention and gradually patients can start tolerating some of these foods , to which they have previously been intolerant . But some individuals may have gluten intolerance or coeliac disease , and these are the ones who have to be very careful . - particularly when it comes to ASD .
Adrian : So you say that you do your interviews and checklists and things like that . You don ' t do the food intolerance testing . But if you are suspecting ADHD , are there particular assessments that you are looking at that you may do from an integrated point of view ?
Sanjeev : Okay . Good question . So , I usually do a broad range of metabolic screening in any individual . ( Some patients are covered for this by Medicare , which makes it cost-neutral for them ). So , certainly , looking into a patient ’ s liver function will tell us not only how their liver is performing , but also about the status of their proteins . Then their pH balance can be tested through the anion gap .
Now , iron studies will give us a lead on the status of their iron load . Thyroid functioning will tell us that about their T3 andT4 balances . Vitamin D is very important , a big immune modulator . It ' s a hormone , it ' s not a vitamin . It ' s a psychosteroid . So , it has a broad range of roles . And then you can check for certain parameters like B12 , folate , and zinc .
So from some of these tests you get some kind of an idea of where this individual stands . So , my approach is always to be on the conservative side , because if you spend a lot of money on investigations , then treatment may not be possible . Sometimes people get overwhelmed . But the main thing is that once that these testings are done the whole session is dedicated to educating them . So , I give them evidence about how the neurotransmitters are manufactured . As I mentioned earlier , I share the relevant slide with them , then I tell them that how neurons work and what kind of diets would be helpful . So , for example , low carbohydrate , a sort of keto principles diet would be helpful , including healthy fats like medium chain triglycerides . And then we can look for some supplementations along with that .
Now , some individuals , those who are not responding , or sometimes have poor associated gut health , are the ones where you have to look for more advanced panels . like their methylation profiling , and genetic studies . Because if they have certain SNPs like MTHFR , MAO , COMT , GAD or RGST , these are the individuals who will have vulnerability in detoxification , and who may experience a side effect . And once you have created the environment in which these genes operate , then chances are that even the spare tyre will perform optimally : maybe not at the speed you want , but at least at a decent one where you are not reacting to those foods . So , from these perspectives , the individual is supported with their diet first , then with some supplements and nutrients , plus then adding a medication . I have seen good responses to this approach .
Adrian : Okay . So , it ' s dietary changes , medications , and then some supplements . So the supplements ... obviously , you are giving vitamin D when vitamin D is low . Is that based on the blood analysis ?
Sanjeev : Yes . That ' s correct . The range of nutrients is important . In certain nutrients that range is very broad . Vitamin D is a classic example of this . In Australian labs we measure [ vitamin contentrations ] in nanomoles per litre , and the range for vitamin D is 50 to 150 nanomoles per litre . These numbers aren ’ t absolutes : 49 nanomoles per litre isn ’ t a precise cut-off . So , our target , particularly in brain health , is to be around the 70th to 80th percentile of the top of the range . So , if you ' re targeting a vitamin D level of somewhere around 125 nanomoles per litre ( which is equal to 50 nanograms when there ' s a conversion factor ) that ' s where you will see optimal performance of the brain neurotransmitter . And usually , at that level it creates an environment
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