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2010-12-01 Eric Hassid MD 21st Century Neurology: The Role of Nutrition and Functional Medicine

An Interview with Eric Hassid, MD

KIRK HAMILTON: Hi, my name is Kirk Hamilton, your host of Staying Healthy Today, and our message is simple: To provide you credible usable health information from our interviews and educational resources to help you Stay and Be Well in the busy modern world. Please take a few moments before or after listening to this interview to browse through the Prescription2000.com website, the home of Staying Healthy Today Radio, for our free educational services.

Today's show topic is "21st Century Neurology: The Role of Nutrition and Functional Medicine." Our guest today is Dr. Eric Hassid, a functional neurologist and founder and medical director of the Institute for Restorative Health in Davis, California.

Welcome Dr. Hassid. Thank you so much for coming on the show today.

DR. ERIC HASSID: Thanks for having me Kirk. I appreciate it.

KIRK HAMILTON: So there's a term called functional neurology and you call yourself a functional neurologist. How do you become a functional neurologist from your traditional training in neurology?

DR. ERIC HASSID: Well that's a really good question because most of us as you know are trained as what we call allopathic or traditional neurologists so we really don't get any of this at all in medical school or residency. So it's almost like it's our own personal journey. For me being trained as a neurologist and a rehab neurologist, I always had a bent towards integrative care sort of you know restoring function. And as I was -- I was doing general neurology for about five years or so, in regular practice. I kind of felt that it was limiting in terms of what I was providing the typical approach. I didn't really feel like I was getting the results I wanted. And then actually, it's interesting a lot of the patients would come to me asking about this supplement or this type of integrative approach and alternative approach and I didn't know anything about it. So I basically started getting involved in the Institute for Functional Medicine which is up in Gig Harbor and there they're the premiere organization that does functional medicine. And heard about their very intense week-long course so I went ahead and did that for about a week and it was very, very intense. It was good. And that was sort of the beginning of my journey, and then I started getting much more involved in functional medicine in general, doing a lot more course training. And then eventually I got formally board-certified in anti-aging and regenerative medicine through the American Academy of Anti-Aging Medicine. So it was sort of my personal journey. There's probably maybe about a handful I guess of neurologists in the country who kind of do this idea of functional neurology. So it's sort of a growing profession, I think.

KIRK HAMILTON: Well let's look at this then. What are some of your tools or your assessment techniques that would be different than a traditional neurologist?

DR. ERIC HASSID: Well I think that the key thing is obviously because we do both sides. We obviously will have them come in and we will go ahead and do the typical diagnostics just to make sure we can understand what's going on. Does the patient have Parkinson's, MS? We will do that typical criteria. Once we get there, though, we have to figure out the difference between traditional neurology and functional neurology is, in traditional, well we have a diagnosis and here's your basic medication treatments that kind of fit that diagnosis. Whereas in functional neurology you try to figure out what the journey was in which the patient got there. Just because you have a particular symptom or syndrome doesn't necessarily mean that journey to get there is the same. So we will use a lot of the basic principles of functional medicine, which is basically looking at people's - looking at people's sort of where the thing began, where the process began, and then taking a really more detailed history about things like issues of detoxification, issues of gut health and of gut-brain health, looking at hormonal balancing, looking at environment, looking at a variety of different nutrient issues, and trying to figure out what are some of the factors that make things worse for them. And so we'll do the typical, I think what you'd call the functional medicine history that we're taught in functional medicine, and then of course we'll do our own specific type of lab tests and other types of imaging that we would normally do.

KIRK HAMILTON: So let's just stop there for a second because if you probably went to a regular neurologist and you said I'm gonna look at the gut to figure out if it affects Alzheimer's, Parkinson's or memory, they might look at you, you know, a little cross-eyed.

DR. ERIC HASSID: Pretty much.

KIRK HAMILTON: Yeah. So what do you look for in the gut? What do you look for in the gut that would affect the brain?

DR. ERIC HASSID: That's a really good question because a lot of people think that in order to have sort of gut-brain issues, you have to have gut problems. In other words, I have to have a lot of irritable bowel or I have to have a lot constipation or diarrhea, and of course that would be helpful diagnostically, but what we often try to do is we also try to figure out are their particular types of foods in their diet that I'm sure Kirk you do on a regular basis, to figure out is there something that could be a big trigger. And obviously the biggest triggers that we all know about are the gluten based products and even dairy based products. So like typical integrative practitioners, we'll look at that. We may even do a specific food sensitivity or IgG food sensitivity testing to see if there's something specific that they're not aware of that could be giving them trouble. And then based on that, we then do elimination. If they do have a lot of specific gut symptoms like in traditional integrative medicine we will go ahead and do the classical, what we call four Rs which is to remove, replace, reinoculate and repair programs to get them healthier again. The biggest connection that we do know with the gut and brain that is well known even in traditional medicine is the idea of celiac disease which is of course the aggressive problems with gluten. And in those cases, you could actually get neurological syndromes that even mimic MS. They can present with peripheral neuropathy. They can have a lot of other neurological symptoms that significantly improve with - on the basis of just removing gluten and healing the gut. So in some ways there's a little bit of an acceptance, but only in a very, very small way in traditional neurology. We just take it to a much higher level.
KIRK HAMILTON: So let's talk about the brain is thought to be fat mostly or a lot of it.

DR. ERIC HASSID: Right.

KIRK HAMILTON: And so do you just shotgun the omega-3 fats which everybody talks about or do you assess for fats?

DR. ERIC HASSID: Yeah, that's a good question. I mean to be honest initially, probably way back you know I was probably saying well you know we talk about fish oil which of course is very important because it has a high component of DHA which is very prevalent in brain and heart. But I think what a nice way to do it, is now we've been starting to look at red cell fatty acid analysis which is basically looking at the components of different cells and seeing where people lie. And there's still a little, a lot of controversy as to what really are the best places to get those tests are. But we will do that and see whether or not what type of composition their membranes are made up of and then try to adjust accordingly. It's very common you will see people who actually have problems with the top of the chain of omega-6, linoleic acid, for example. We always talk about we're an omega-6 predominant society, but we are on the basis of the lower chain arachidonic acid, but not so much on the upper chain. So we will look at all that, try to make sure we provide balance. We will, however, tend to emphasize the EPA and DHA specifically for brain issues but we will always make sure that there's a significant amount of balance when we provide, because if you take a patient and you push him over to one side you can actually cause more problems so balance is going to be critical.

KIRK HAMILTON: In the literature, you get down to some small little organelles in all cells called mitochondria and energy production. And there have been more popular nutrients such as coenzyme Q-10 which has been used in very high dose in Parkinson disease. So can you talk about producing energy in the cell, particularly the neuron as being important for Alzheimer's, Parkinson's or memory even, and how that fits in?

DR. ERIC HASSID: That's a great question Kirk because you know it's funny because now the mitochondria are getting a lot of buzz with regards to chronic illness. The thought is that the mitochondria as you were saying, they produce the majority of our energy called ATP, and they do so under oxygenation. Well as we get older as we get chronic illness the mitochondria get injured at the end of the day. And they get injured because of a lot of production of free radicals and free radicals are these sort of little electrons that have - or atoms that have lone in electrons that kind of want to bind to things. The problem with all that is that the mitochondria themselves in the process of producing energy and transporting electrons produce six times more free radicals than the other parts of the cells. So they themselves are at the highest risk of injury from themselves ironically. So with chronic illness we - like for Parkinson's, even potentially multiple sclerosis, Alzheimer's, migraine, they all have implications for abnormality in mitochondria called mitochondriopathy. And so what we do as you were saying is we try to optimize mitochondrial function by providing with higher levels of nutrients that are important in mitochondrial function like for example coenzyme Q10 as you mentioned, lipoic acid, glutathione, n-acetylcysteine, carnitine and a variety of others in a synergistic blend to see if we can optimize the mitochondrial function and now we're seeing that in some specific situations that if you do that, you can begin to see changes in mitochondrial function and even clinical states. So it is an anti-aging approach that has been talked about a lot recently.

KIRK HAMILTON: What's interesting is I just as I left the office I grabbed the current issue of JAMA and you will see in there an article about mitochondrial defects seen in autistic children as one of the lead articles.

DR. ERIC HASSID: Right.

KIRK HAMILTON: Which you know is another support in that area.

DR. ERIC HASSID: Sure.

KIRK HAMILTON: Let's talk about, I know you use a lot of methylation products and I sometimes get confused in trying to explain it. Go over the role of methylation in the brain and if you could keep it "quasi-simple."

DR. ERIC HASSID: I'll try if I can figure it out. Well methylation is a process where the --biochemically the body is trying to take like these CH3 which is methyl groups and transfer them from one location to the other on different biochemical reactions. And one of the biggest things, that with the brain is the neurotransmitters which are basically our communicating signalers. And the neurotransmitter production requires the ability to take these methyl groups from point A to point B and put them on. Like a puzzle. Well we know that methylation is critical and with -- a lot of problems with methylation can occur for a variety of reasons. You can have problems because you have either certain types of B vitamin deficiencies, specifically you know B12, B6, folic acid, betaine and B2 maybe. They all are going to impact the ability for our bodies to methylate. So what happens is when you have a deficiency there, the body will not be able to make those into neurotransmitters and so consequently they will have some issues like depression, they can have some other issues going on, cognitive issues that are playing a role. And one of the areas that's really taking big strides now is the idea of this - a particular enzyme that is an enzyme that activates folic acid into an active folic acid. Which is really important because if you just give folic acid, the body has to do something with it to make it activated folic acid. If you have an enzyme deficiency there, it's called MTHFR - it doesn't matter. Then you might find that people can have refractory depression, refractory high levels of this chemical called homocysteine which causes problems, cognitive issues, and so we will always want to make sure that methylation is important. And we also know methylation is important for just a variety of other things. For just our genetics and DNA, for just myelin and all these great things that go on behind the scenes methylation is so important for.

KIRK HAMILTON: We're talking now with Dr. Eric Hassid, a functional neurologist and founder and medical director of the Institute for Restorative Health in Davis, California. And I want to go into some specific things like let's say dementia. And it's funny because I just got back some lab - a patient of mine, and this is fairly typical, bringing a mother home to live with them, 92 years of age, she's in a wheelchair and she can't live at home anymore by herself so they brought her over from New Mexico and brought her in like a week or two ago and said the diagnosis dementia, and she's on Aricept and she's on a few other antianxiety things. And so I just did my basic screen which is different than probably a regular neurologist, and it turns out her methylmalonic acid and homocysteine are like skyrocketed. I've never seen a homocysteine of 34 before, and methylmalonic acid was way up there, and then she's low in vitamin D, she's low in magnesium.

DR. ERIC HASSID: Exactly.

KIRK HAMILTON: And so you know for me, from my perspective we give her a few intravenous infusions and a few B vitamin shots and we give her some oral supplements and I've seen people, now I can't say all the time, but I've seen elderly people like that literally "wake up."

DR. ERIC HASSID: Uh-huh.

KIRK HAMILTON: And so in that context how do you approach, because one of her main complaints, she was labeled as dementia and you know they gave her Aricept and some antianxiety medicine. So how do you approach a memory loss patient or a dementia patient, and then when you answer that, is that a similar - is there a similar base approach to Alzheimer's and Parkinson's and then you get into specifics of each later, so to speak.

DR. ERIC HASSID: Yeah, yeah, yeah. So that's a good question because you know there's a lot of overlap, too. I mean I think if someone comes in with memory loss really I take a pretty extensive history because always history is 90% of what we do Kirk, as you know. But I think when someone comes in with memory, you have to first determine is the problem memory or attention. So first I'd have to figure is someone able to focus extremely well, but yet they're not able to remember anything you told them. And that's very typical of someone who has what we call early dementia, whether it be Alzheimer's or multiple strokes, versus someone who has like maybe us, we're just very stressed out, we're busy, we're not able to attend well.

KIRK HAMILTON: Don't tell me that!

DR. ERIC HASSID: I know. Like us today! So I think if we can first differentiate clinically if this is a primary what we call amnestic, which means memory, the short-term memory disorder, that will be the first thing. If I see that's the case, then I look at a lot of things. I look at, like you were saying Kirk. We look at a lot of metabolic stuff. But I think we first want to make sure is, as a neurologist, I want to make sure that there's no obvious other medical explanations that are critical. Like is there any history of strokes? Is there any history of multiple concussions and head traumas? Are there any mass lesions in the brain or abnormal cerebrospinal fluid collections in the brain or bleeds? I mean those are obvious and we have to figure out as traditional neurology what we should do. And then if assuming that's all negative for argument sake and there's no other medications that are playing a role, then we get into what I consider to be the functional neurology. We start saying, well let's see. Here we've got someone who's got dementia. The most common cause of dementia in the United States unfortunately barring everything else is going to be Alzheimer's, and then probably strokes. So what we do is, we do Kirk is exactly what you do. We actually look at a lot of hormonal factors because we know the hormones can significantly impact the brain, of which vitamin D is a big buzz word now. We look at methylation as you said Kirk because methylation is very important in so many different things. We look at a lot of different other - you know we talked about medications, we look at sleep for example, we look at cortisol levels and stress, we look at environmental toxicity, heavy metal exposures, and then we kind of, just do it sort of methodically and we see what's going on. And then at that point we can get more of an overall plan for the patient based on what we see and what we find.

KIRK HAMILTON: When you evaluate this memory loss patient, what -- you use sometimes intravenous therapies.

DR. ERIC HASSID: Right.

KIRK HAMILTON: Not just for memory loss, but for Parkinson's and Alzheimer's and you use a lot, I know, because some of our patients are referred there, of phosphatidal choline and glutathione. Can you explain number one why you have to give it IV versus orally, and then what you're trying to achieve and what you see.

DR. ERIC HASSID: Good question. I mean many people think that -- well first of all there's the two issues you mentioned. There's glutathione and there's the phosphatidal choline. We'll call it PC for short. Glutathione is a - is one of the body's strongest intrinsic antioxidants that is produced mostly by the liver. And with chronic illness, with chronic, for example neurodegenerative processes like Parkinson's and Alzheimer's and MS, you see a diminution of antioxidant capacity in the system to include glutathione, and if you have less of that around, it's almost like you're - you know like the president without the bodyguard. You become really, really vulnerable to injury. And the thought is that if you could somehow improve that glutathione levels, you can actually improve the ability for the cells to become more functional to be repaired and so forth. There's been a lot of controversy whether or not glutathione can be taken orally and being absorbed because it's a 3-amino acid protein and it gets digested. There are some - there's now some literature looking at liposomal glutathione and different transport systems that seem to work better, but in general up until recently, IV has been the best way to assure that glutathione gets into the system. Here's the kicker. There's a thought, though, that glutathione in a normal, in a relatively unbreached brain doesn't really get into the brain very very well. It has to be broken down and remanufactured by the supportive cells. That's a little bit controversial. You know Dr. Perlmutter who is a big functional neurologist in Florida seems to claim that it can get into the brain. A lot of people think you need to get the precursors on board to get the best effect. But what we do is we go ahead and give IV glutathione and in some cases - I won't say it's all cases - we find that for example in Parkinson's you can get some improvement in motor function with it. The problem with glutathione IV it's very, very short-lived and it's very short-acting, so there is some controversy as to the true practical application of glutathione in that regard. But we do do it. What we are finding though is when we given phosphatidyl choline, which is the other one we were talking about, PC, that's important for cell membrane health. It's a very strong constituent of cell membrane. And with chronic illness, you're actually getting breakdown of cell membrane and the change in the way the cell membrane works and the harmonics. So if you can incorporate very healthy phospholipid into the membrane, especially in the patient with chronic illness, you can begin to see a livening up of that cell, a livening up of that mitochondria. And then you begin to see patients with a whole list of different conditions get better, whether it be MS, whether it be fatigue, fibromyalgia, Parkinson's. I see a lot of benefit actually, Kirk, more in my energy, my fatigue patients and my fibromyalgia patients and even MS. But I also am seeing some -- over time I am seeing some benefits of stroke recovery and brain injury recovery and even Parkinson's. And when you give glutathione with PC, it seems like it may even work better because it gets a little bit better.

KIRK HAMILTON: Yeah, you've opened my eyes to that. I'm using PC more because actually I see how you use it in practice.

Now let's talk about detoxification because it's a term that gets thrown around and my pet peeve is 90% of the people that say it have no idea what they're talking about, what it is. That's number one. How can detoxification help the brain? And two is, what role do heavy metals play, if any, and if you assess them and find them elevated, how to you get rid of them?

DR. ERIC HASSID: That's a really good question. You know, seriously, detoxification in Parkinson's -- there's even a thought that there's a defect in the liver to detoxify. And you know with Parkinson's there's so much thought about what, much of what Parkinson's is, is an environmental exposure from like pesticides or certain types of metals like manganese and a variety of things. And you know we all get exposed every day. The question is why some people have a problem more than others. And it may very well be that we - it's because some individuals have a defect in the ability to effectively detoxify from the liver. So detoxification is important because it's our way of filtering and getting rid of stuff, and in Parkinson's there's definitely, even in the traditional literature, there's a thought that there's maybe some defect there. So what you were saying is it is very important. And on that same side note would be the heavy metals. Because heavy metals are known mitochondrial and neurotoxins. And the question is, well how do we know that a heavy metal that has been accumulating over the years is a problem for any one patient and the answer is you really don't know. The best way to figure it out is to go ahead and assess them. And the way we assess them in terms of burden is to do a challenge. Because you know most heavy metals are sitting around in more innocuous areas like skin, bone, and then eventually they kind of percolate into other organs like the brain. But they're not hiding in the urine or serum. So if we do a chelation challenge where we give an oral DMSA and IV EDTA, then we're able to draw out some of those metals from the system into the serum and urine and then measure that into 24-hour collection. And then we can see. If we see elevations that are pretty significant, we then go ahead and recommend that they remove them through these IV chelation challenges every week until we get to the point where they're actually much lower. Whether or not it plays a significant role to be honest, in any particular patient is difficult because you often don't always get a lot of major improvements, but I look at it as an investment. It's like saying -- well they're not - these metals aren't supposed to be there so why shouldn't we go ahead and just remove them while we're at it. If you get better great, but hopefully what we will do is prevent worsening at the minimum.

KIRK HAMILTON: Let's talk about hormones for a second because we kind of glossed over that. When you say hormones benefit the brain number one, are you talking about bioidentical hormones? Two is, are you talking about pregnenolone, DHEA, testosterone, estrogen and progesterone?

DR. ERIC HASSID: Correct. Exactly. Very well said. I mean pretty much you know the most prevalent neurosteroid of the brain is DHEA. And actually there's a thought that a lot of these steroids can even be produced to a certain extent in the brain. But as we know as we age, especially above the age of 35, which both you and I Kirk are way past that level, we've pretty much started to see significant declines in a variety of hormones and the ones that we think are most important are like you said DHEA, pregnenolone, growth hormone, testosterone in men and even women to a certain extent, estrogen in women and even to a certain extent in men, progesterone and of course vitamin D. The hormones that actually tend to increase with age unfortunately are cortisol and insulin. And so what we try to do is we try to look at those hormones and try to see if we can optimize them to a level that makes sense for them. Now a lot of people you know - people ask a lot, well do I always have to be replaced with hormones and the answer is it's very personal. Some people really will do well with bioidentical hormone replacement therapy, others are doing really well without it. So it's very personal. It depends on what your brain status is. But when we do do it we go ahead and measure all of them in the serum to the best that we can and we try to shoot for about a 30 to 35-year-old range. And in that - in some situations you see a significant improvement in their overall cognition and well-being when you replace them appropriately

KIRK HAMILTON: Winding this down, I want to come together with some diet recommendations and one of the things is how important is it to regulate blood sugar, not have high insulin levels as a proinflammatory hormone for the brain, or is it that important?

DR. ERIC HASSID: It is. Actually it's funny because even in the most recent traditional literature, they're looking at the links between obesity or metabolic syndrome and Alzheimer's or maybe even Parkinson's and then of course migraines. So actually now it seems to be that, thankfully the traditional literature's coming around and the idea is that insulin as you said - too much insulin can cause, not only can it lead to problems with excessive growth of cells and potential of cancer, but it does aggravate the potential for inflammation, for atherosclerosis, which is hardening of the arteries, and that in and of itself can be its own problem. Also with a lot obesity, you end up having a lot of inflammation mediators being produced by the fat cells themselves and inflammation is one of the biggest issues that we talk about in chronic neurological problems like even Parkinson's, Alzheimer's and of course multiple sclerosis. So it is very important and the way you regulate your central adiposity, which is the fat around your central area, coupled with insulin is really critical for good control.

KIRK HAMILTON: I want to talk about something simple, and that's exercise. How important is physical activity in brain function and especially the aging brain?

DR. ERIC HASSID: You know it's funny. It's really important. You would never think that it would be. I mean years ago we talk about what does physical exercise have to do with our brain because you think cognitive exercise is more important. But for some reason physical exercise seems to have an impact on preventing worsening of cognitive functioning in patients with Alzheimer's disease. And we think that it may have to do with growth factors, with circulatory changes, hormonal changes, metabolic changes that occur as a result of that. So even though I'm not sure we have elucidated that exact mechanism, I think it's really - it seems to show it's pretty consistent that exercise is gonna really be critical as part of an overall treatment plan, not only for the healthy adult, but for someone with chronic neurological problems like MS or even dementia.

KIRK HAMILTON: If you had to pick, and I'm gonna put you on the spot here, five preventive things that you were gonna shotgun out there to tell congress, or tell the U.S. public to do to help preserve brain function as we get older, because we're gonna have this huge elderly population and we're gonna have to deal with it some way or another - what would you say? The top five.

DR. ERIC HASSID: I think it'll probably be the five that you would think. I think that definitely exercise is going to be really critical, because I think that you know especially with regards to lean body mass, obesity and for sugar control. That's number one. Number two is going to be nutrition. What we call an antiinflammatory diet where we tend to minimize excessive inflammatory foods like carbs, maybe dairy in certain instances, saturated fats and preservatives. That's really gonna be very critical. The other one is - and it's the silent killer that I call it - is stress. I mean really finding ways to optimize stress, because stress is a really bad issue when it comes to weight, when it comes to brain health, and if we can get that under control it's critical, and the other one would be sleep and because you know most of us actually don't spend eight hours of quality sleep a night, and with poor sleep we actually can see significant negative health declines. And then probably an appropriate, you know being aware of your environment. Being aware of your just overall emotional state, aware of your environment, toxins in your environment, what you're consuming, what you're taking that could be toxic. So I think if we look at those five major pillars, which I think functional medicine tends to do, I think we would make huge strides in improving overall health and overall cost of our healthcare system in the United States.

KIRK HAMILTON: I wanted to ask a question that's related, but it isn't. Let's say you were a consultant for a professional football team, or the National Football League, and you see guys getting head shots for years.

DR. ERIC HASSID: Right.

KIRK HAMILTON: Okay, the trauma. And number one, obviously, you don't try and run into a brick wall and expect nothing to happen, but if you're doing that for a living, how would you encourage them to protect their brains?

DR. ERIC HASSID: Well that's a tough one. I mean obviously we do know that the more concussions you have the more that they build on each other. So first of all, understanding what the impact of multiple concussions really can be on these brains and also knowing when to say enough is enough. And that's the hard part when you're a professional football player. Also, just of course awareness. I mean looking at the helmet, which I'm not an expert in, but looking at the helmets, looking at the design, maybe changing some of the rules of football, which they're trying to do now with helmet shots can help. And it's also just protecting the brain even nutritionally. You know just maybe these athletes, you know they're doing a lot of work on exercise, but what is their nutrition? What is their fatty acid intake? Are they on an anti-inflammatory diet? Are they eating healthy protein? Are they sleeping appropriately? Are they stressed out a little bit? I mean all those things to protect the brain function especially when you're taking a big shot which produces so much free radicals. Are you having the appropriate protection? So I think a lot of it's gonna be education, but a lot of it's just gonna be general health and wellness education to match the type of exercise intensity that they're doing.

KIRK HAMILTON: Dr. Hassid, how do people get ahold of you and your clinic and your work?

DR. ERIC HASSID: Well we - we're in Davis. We have of course a website which is www.4IRH.com and of course we have our phone number which is (530) 758-4474. And people either come on their own accord or they come through referrals from their physicians, so we're open to any of those. And you know we are an integrative clinic. We provide a lot of different services and approaches very similar to yours Kirk. And so we kind of focus on a holistically oriented approach and a functional medicine approach to get people to restore their function, not just kind of deal with the symptoms.

KIRK HAMILTON: Dr. Hassid, that was really good. It's not really fair to try and do all of neurology in a half hour, but you know because you could do Alzheimer's one half hour, etc., but thank you so much for taking time out of your busy day to do the interview.

DR. ERIC HASSID: My pleasure Kirk.
KIRK HAMILTON: And I want to thank you the audience, for this edition of Staying Health Today Radio. And until next time, Stay and Be Well.

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