Short Circuits in Your Nervous System

SHORT CIRCUITS IN YOUR NERVOUS SYSTEM

How 2 Weak Links Can Lead To Damage And Disease In Your Brain And Body

BY DR. TERRY WAHLS Best-selling Author, Physician, and Researcher

Nervous System

Mitochondria

The Root Causes Of Mitochondrial Dysfunction

Brain Cells

The Brain Structures

Connections In The Brain

Transmission Of Information Into Deeper Parts Of The Brain And Out To The Body

The Cranial Nerves

The Spinal Cord

The Peripheral Nerves

Autonomic Nervous System Sympathetic

Or Fight

Parasympathetic Nervous System

Enteric Nervous System

Causes Of Nervous System Dysfunction

Neurogenetic Diseases

Neuroinfection

Traumatic Brain And Spinal Cord Injuries

Neurotoxins

Neurodegeneration And Peripheral Nerve Neuropathies

Autoimmune Diseases Of Central And Peripheral Nervous System

Poor Nutrition And Nutrient Insufficiencies

Remyelination, Repair Of Neurons, And Improvement Of

The Nervous System

The nervous system is highly complex and coordinates sensory information and movement, guiding our experience of the world. Our emotions depend upon our nervous system. So does our ability to think, remember, and reason. Our ability to feel pain, temperature, and touch, to see, hear, taste, and smell, to move and know where we are in space—that all depends on our nervous system, which is wonderfully complex. If you have anxiety, depression, brain fog, or fatigue, your brain is affected. If you have chronic pain, your brain and/or peripheral nerves are likely affected.

In this guide, I will explain our nervous system, its key parts, how they work together to create our experience of the world, and how our nervous system can malfunction, leading to a wide variety of symptoms.

Our brain and nerves are vital to our existence. They are how we process emotions, how we think and make decisions. All movements begin first in the brain. All sensations end in brain, where cells interpret sensory information. Our brains govern our understanding of the world and our movement through it. Our nerves are essential for our brain cells to communicate with each other and our bodies. For our brains and our nerves to function properly, we need healthy robust M and Ms: mitochondria and myelin.

Mitochondria and myelin are vital, and for many they are the weak links in our brains and bodies, leading to the development of neurological and psychological symptoms. Eventually, the symptoms are severe enough that we see our primary care team. But that visit doesn’t yield much. The physical examination is normal and lab tests, if they are done at all, are also normal. We are told that we simply have demanding jobs or a demanding home life and to recheck in six months.

Symptoms become more troubling. Eventually we have a neurological or psychiatric diagnosis. Medications are prescribed, but don’t help--symptoms slowly worsen. Additional symptoms develop and more medications are added. Unfortunately, most physicians do not consider the health of your mitochondria or myelin and how that might contribute to underlying neurological or psychiatric symptoms.

In this e-book, I will review how our brains and nerves work, the most common ways they are damaged, what your medical team may be overlooking, and how an integrative and functional medicine approach differs from a conventional medicine approach.

For many, problems with low mood and irritability are partly related to their brain and how well it is working. Fatigue and poor energy are also often related to how well one’s brain is working.

For many, chronic pain, muscle weakness, or poor coordination is due to problems with the brain, cranial nerves, spinal cord, or peripheral nerves.

The most common driver for these problems is damage to the mitochondria and/or myelin. In order to have a healthy brain and healthy nerves, we need to have healthy mitochondria and healthy cells.

Let me begin by reviewing our mitochondria, the powerhouse of the various cells in the nervous system. All of our bodies, including our brains, are made up of many different kinds of cells, all of which have very specialized jobs assigned to that specific cell type. The nervous system is a highly complex system that utilizes nearly 25% of all the energy that we consume and 25% of the ATP that we generate each day.

Mitochondria

Mitochondria first appeared on earth billions of years ago when the oxygen level in the atmosphere rose in response to cyanobacteria becoming able to conduct photosynthesis. As the oxygen level rose, 98% of all life (which was confined to single cell organisms at the time) died out. Thanks to the random mutations that occurred in the DNA of those ancient single celled organisms, the chemical pathways to make adenosine triphosphate (ATP) more efficiently arose. ATP is what our cells use to drive the controlled chemical reactions that must happen in our cells for us to be alive. ATP is the currency of life!

These bacteria became more and more efficient at making ATP. They were engulfed by

larger bacteria. This new organism developed a mutually cooperative relationship that would eventually evolve into a multicellular organism. The organisms evolved to create a nervous system that was capable of perceiving the world through sensory nerves. That organism continued to evolve; cells became specialized to create a nervous system and muscles, allowing for movement. As the organism continued to evolve, the cells in the nervous system needed the most energy, even more than the muscles needed. Those nervous system cells were packed with mitochondria, thousands per cell, to provide the needed energy. The mitochondria became the powerhouse of our cells.

Today the cells with the most mitochondria--tens of thousands per cell--are brain cells, retina cells, and heart cells. If the mitochondria are not producing sufficient ATP for the brain and nerve cells, those cells begin to falter. They do not function as well as before, and symptoms begin to develop.

Neurological symptoms such as fatigue, visual disturbance, cognitive changes, sensory disturbance, poor coordination, and/or sensory disruptions begin. Mental health problems like irritability, anxiety, depression, anger, rage, hallucination and/or delusions may develop. These problems may be constant or intermittent. A high level of oxidative stress, which signals that mitochondria dysfunction is occurring, is a common feature for many underlying neurological and/or psychiatric symptoms and disease states.

The Root Causes Of Mitochondrial Dysfunction

Common causes of mitochondrial dysfunction include toxin exposures, prolonged antibiotic use, chronic infections, and poor nutrition. Often patients have multiple environmental factors that contribute to developing mitochondrial strain, which leads to high levels of oxidative stress. Conventional physicians focus on using Food and Drug Administration (FDA)–approved medications to treat various neurological and/or psychiatric symptoms. They are generally not trained to evaluate and address the environmental factors that contribute to high levels of oxidative stress that stems from mitochondrial dysfunction.

To address the environmental factors that contribute to mitochondrial strain, it’s important to investigate the level of oxidative stress, which can reveal how much mitochondrial strain is present. After understanding those factors, integrative / functional medicine practitioners may investigate whether there is an underlying infection, toxin exposure, history of early or prolonged antibiotic use, and whether key mitochondrial nutrient levels are severely low. Many viruses are capable of hijacking the mitochondrial machinery, causing it to manufacture virus particles instead of ATP. Many integrative and functional medicine–trained physicians recommend patients use a combination of herbs and essential oils to rebalance the microbiome and control chronic viral or bacterial infections rather than prescribing chronic antiviral or antibiotic medication. They also investigate the history of antibiotic use and health of the microbiome. If there is evidence that the patient has a diseasepromoting microbiome, they will work with the patient to help them shift their microbiome to a healthier state.

The integrative / functional medicine–trained health care team may also investigate toxin exposure history and guide the patient on strategies to reduce toxin exposure and improve the body’s ability to eliminate toxins.

Many integrative physicians assess nutritional status and the patient’s usual dietary intake, working with patients as needed to improve their food choices. They also often encourage their patients to take supplemental omega-3 fatty acids and a B vitamin complex to support their mitochondrial function. Depending upon the nutritional assessment, additional supplements may be recommended to resolve specific key mitochondrial nutrient insufficiencies.

Brain Cells

The neuron is the brain cell that interprets sensory information, organizes and initiates thoughts and emotions, and organizes and initiates movements.

It has a cell body that contains the nucleus, projections called dendrites that emerge from the cell body, and an axon which is a long wire-like projection that ends in axonal projections. The axonal projections make the neurotransmitters at the synapse that activate the dendrites of the next neuron in the chain. The myelin sheath is the fatty insulation around the axon.

The brain and nerves are electrical organs. These cells create an action potential, a tiny electrical current that is transmitted down the length of the nerve. Myelin allows for a more efficient transmission of the action potential down the axon to the next nerve cell. The nodes of ranvier are tiny gaps in the myelin that help conduct the action potential (transmission of the electrical impulse down the nerve). The electrical pulses in the brain and nerves are transmitted more effectively when the nerve has an intact myelin sheath and healthy nodes of ranvier.

The neurons connect to other parts of the brain to help regulate mood. They interpret what is happening in the world so we can respond more rapidly. A healthy brain has lots of connections between neurons to make for more stable moods, better memory, better problem solving, and more efficient movement patterns.

Many autoimmune disease states attack the myelin sheath and the neuron (e.g. multiple sclerosis, Guillain-Barre, Rheumatoid Arthritis, Sjogren’s, Mononeuritis Multiplex). Some autoimmune diseases result in damage to neurotransmitter receptors, leading to psychoses and hallucinations (anti-N-methylD-aspartate receptor antibody or Anti-NMDA-Ab). Treatment for autoimmune diseases that affect the nervous system will be discussed later in the document.

The Brain Structures

PARIETAL LOBE

Touch perception

Movement control

Manipulation of objects

OCCIPITAL LOBE

Visual reception

Local orientation

Shape perception

CEREBELLUM

Coordination

Balance

Reflex motor acts

FRONTAL LOBE

Voluntary movement

Planning

Intellect

Problem solving

Abstract reasoning

TEMPORAL LOBE

Long term memory

Speech comprehension

Object perception

Face recognition

Hearing

BRAIN STEM

Conduction

Tract for pain, temperature and pressure sensations

Our nervous system is divided into the central nervous system and the peripheral nervous system. The central nervous system includes the brain and the nerves that come directly out of the brain, which are called the cranial nerves. First, I will present an overview of the brain, then the cranial nerves, spinal cord, and peripheral nerves. Then, I’ll discuss the autonomic nervous system, sympathetic nervous system, parasympathetic nervous system, and enteric nervous system. Then I’ll discuss the various mechanisms by which the nervous system can be damaged. The brain consists of the cerebrum, which is divided into four lobes (frontal, parietal, temporal, and occipital), the cerebellum, and the brainstem. The cerebrum is where the higher functions of the brain reside. The frontal lobe is essential for planning and executing learned behavior. It also controls impulses, preventing us from doing things that we think will have harmful consequences. This part of the brain, the pre-frontal cortex, is fully developed in our early 20s. It is why adolescents, whose pre-frontal cortex is not fully developed, often make poor decisions. They cannot see the consequences of their actions as clearly as they will when they are older.

The basal ganglia is deep in the frontal lobe and controls movements, executive decision making, and behaviors. It is also involved in recognizing rewards and reinforcements and plays a role in addiction. Damage to the basal ganglia leads to a variety of tremors and movement disorders, including the development of uncontrolled movements, speech, words, and vocal grunts and grimaces, also known as tics.

The parietal lobe processes sensory information related to touch, taste, and temperature. It is also responsible for initiating movement. It allows us to coordinate our movements in response to visual and other sensory inputs.

The temporal lobe is responsible for processing auditory information, encoding memory, and language processing. The hippocampus is deep within the temporal lobe and is key to memory and learning. Damage to the hippocampus is a factor in many psychiatric and neurological disorders. The amygdala is part of the temporal lobe, sits adjacent to the hippocampus, and is involved in the processing of emotions as well as memories associated with fear, anxiety, anger, and pleasure. The hypothalamus, also deep within the temporal lobe, is responsible for maintaining homeostasis (a steady state for the various biochemical reactions that keep us alive). The hypothalamus is responsible for governing our response to stress, behaviors, and interest in sexual activity, and serves as the interface between the nervous system and the endocrine system. Damage to the hypothalamus has been associated with behavior problems, mental health problems, fatigue, weight problems, hypersexual behavior, and hyper/ hypothermia.

The occipital lobe is where visual information processing occurs. Notably more than 50% of the brain is dedicated to visual processing. That probably explains why it is much easier for us to learn a new concept when it is presented in diagrams and images as opposed to text. It is estimated that 80 to 85% of our learning, cognition, and perception activities are processed and mediated through vision. Visual information is processed 60,000 times faster than text-based information.

The cerebellum sits behind the cerebrum and is involved in the coordination and control of movement. It is involved in motor learning, that is muscle memory. The cerebellum is also involved in speaking, using the hands, walking, running, and coordinated movements involving both hands and legs.

The brain stem is at the base of the brain. It coordinates information from the cerebrum and cerebellum and controls the heart, lungs, pain perception, and consciousness.

Connections In The Brain

In the first two years of life, more than a million new connections are formed in the brain each minute. In early childhood, connections are reduced through a process of pruning, which removes synapses that are not being used. This pruning allows for the creation of superhighways in our brains that allow for more efficient conduction of information. Synapses or connections that are not used as much become smaller, less effective, and may be abandoned entirely. This is why we forget the foreign language that we studied in high school

or college if we do not continue to speak it regularly. We forget math concepts that we are not using. We forget names, addresses, and facts that we do not use regularly. However, songs and movement patterns such as dances and athletic maneuvers, also known as muscle memory, stay with us longer, though our performance will not be quite as sharp.

Transmission Of Information Into Deeper Parts Of The Brain And Out To The Body

Brain signals are passed from one neuron to the next, moving through deeper layers of the brain till they finally reach the spinal cord and travel out to (or up from) the body. When myelin is damaged in neurodegenerative and autoimmune conditions, transmission of signals is slowed. In addition, axons can become damaged and cut, leading to permanent loss of function.

https://www.cedars-sinai.org/programs/imagingcenter/exams/neuroradiology/mri-dti.html

Damage to the neurons, axons, and/or myelin can lead to intermittent or constant sensory disturbance (numbness, tingling, or pain), behavior change (hypersexual or aggressive behavior), mood (irritability, low mood, high mood, or mania), brain fog (problems with memory, calculations, word-finding difficulties, problem solving), muscle function problems (coordination, fine motor skills, balance, strength, endurance), and brain stem dysfunction (blood pressure, balance, ear ringing, vomiting, nausea).

Damage to the nervous system may be caused by neuroinfections, neurotoxins, and autoimmune diseases. Pharmaceutical companies are working to develop drugs to increase the ability of the body to repair damaged myelin. Several drugs are effective in animal models of peripheral nerve damage, multiple sclerosis, and dementia, but very few drugs have been able to restore lost function or improve remyelination. Scientists are devising experiments to test drugs and treatments to improve remyelination and restore better functioning, but no drugs have been approved for remyelination at this time.

Multiple environmental factors, such as poor diet, lack of exercise, stress, and loneliness, increase the nervous system’s vulnerability to damage. Integrative and functional medicine–trained physicians work with their patients to investigate the many environmental factors that have been identified as potentially damaging the nervous system and address the root causes of that damage. The first goal is to stop the decline. The next goal is to help the patient improve their function, ideally getting them back to their level of function when they were healthy.

Many integrative and functional medicine physicians also investigate the nutritional status of their patients and design a specific dietary approach that works for the patient and their family. They may also design a supplement program to ensure the patient has optimal levels of key nutrients needed to build and repair myelin. In addition, many integrative and functional medicine–trained physicians investigate toxin exposures and devise a plan to reduce exposure and improve clearance of stored toxins. Likewise, patients will be evaluated for potential chronic infections as previously noted.

The Cranial Nerves

There are 12 nerves that come directly from the brain, called cranial nerves. In general, these nerves manage the sensations from the five senses and the muscles in the face and mouth. Here is a description of each nerve:

CRANIAL NERVES

OLFACTORY(I)SENSORY:NOSE

TRIGEMINAL(V)SENSORY:FACE , TEETH

TRIGEMINAL(V)MOTOR: MASTICATION

FACIAL(VII) MOTOR: MUSCLES OF FACE

GLOSSOPHARYNGEAL(IX)SENSORY GLOSSOPHARYNGEAL(IX)MOTOR

TROCHLEAR (IV) MOTOR: SUPERIOROBLIQUEMUSCLE ABDUCENT(VI) MOTOR: EXTERNALRECTUSMUSCLE OCULOMOTOR(II)SENSORY OCULORMOTOR( III)MOTOR

INTERMEDIATEMOTOR:GLANDS INTERMEDIATESENSORY:TONGUE&SOFTPALATE

VESTIBULOCOCHLEAR(VIII)SENSORY:INNEREAR

VAGUS (X) MOTOR

VAGUS (X) SENSORY

HYPOGLOSSAL(XII)MOTOR:TONGUE

1. The olfactory nerve is responsible for smell. Smells are deeply connected to memory. Often a particular smell triggers a specific memory. Do you have a specific smell that reminds you of important events in your life? Loss of smell (that is not part of a recent infection due to COVID) can be an early indication of neurodegeneration and a developing dementia. Zinc is an important nutrient for the sense of smell. Zinc insufficiency may lead to decreased sense of smell.

2. The optic nerve transmits information from the special light receptors (cones and rods) in the retina. Rods are sensitive to black and white, are more plentiful than cones, and can help us see in low light situations, such as at night. Cones are present in small numbers and are responsible our ability to see colors. The two optic nerves meet inside the skull to form the optic chiasm, where half of the nerve fibers from each eye form two separate tracts back to the visual cortex in the back of the brain (the occipital lobe). The occipital lobe interprets the information from the optic nerve and is responsible for vision. Optic neuritis is an autoimmune attack (immune cells attacking other cells in the body that are not diseased) that can cause pain in the eyes and/or decreased vision. Difference in color perception between the two eyes may be an early sign of optic neuritis. 20% of patients with multiple sclerosis present to their physicians with eye pain and decreased vision. Optic neuritis is diagnosed, and the patient is referred for an MRI of the brain. If additional lesions are observed in the brain or spinal cord, multiple sclerosis is diagnosed. If lesions are detected in the spinal cord, further investigations will be made to check for Aquaporin antibodies, which are elevated in Neuromyelitis Optica Spectrum Disorder (NMOSD).

3. The oculomotor nerve governs the pupil’s response to light and movement of the eyeballs. The oculomotor nerve goes to 4 of the 6 muscles that move the eyeballs.

4. The trochlear nerve controls the super oblique muscles of the eye that are responsible for downward, inward, and outward eye movements. If this nerve is damaged, people have difficulty with double vision.

5. The trigeminal nerve has both motor and sensory nerve functions. Trigeminal neuralgia leads to episodes of severe, shooting, electrical pain that may be spontaneous or triggered by chewing, speaking, or touching the face and is often accompanied by facial spasms. Autoimmune diseases that affect the central nervous system may cause the development of trigeminal neuralgia. Trigeminal neuralgia pain is one of the most severe pain experiences by patients, more intense than renal colic (kidney stones), active labor, or bone fractures. Pain due to trigeminal neuralgia may be intermittent or constant. Many patients with a neuroimmune condition affecting the central nervous system also develop trigeminal neuralgia as part of their disease process. The natural history for trigeminal neuralgia

due to an autoimmune problem is to gradually worsen and eventually become constant. Once the pain becomes constant, eating and/or speaking often trigger severe jolts of pain, leading trigeminal patients to stop swallowing or speaking. Antiseizure medications such as gabapentin is often very helpful for controlling trigeminal neuralgia pain.

6. The abducens nerve controls the muscle that is responsible for the lateral movement of the eye that allows you to look to the side without moving your head.

7. The facial nerve has both sensory and motor function. It is responsible for providing a sense of taste for most of your tongue. It is also responsible for sending information to the tear glands in the eyes and salivary glands in the mouth. The motor function governs movement in your jaw and facial expression. Bell’s palsy is a sudden weakness of the muscles of facial expression, causing smiles to become lopsided. It may occur following a viral infection and will often resolve on its own within six months.

8. The vestibulocochlear nerve has sensory functions that govern both balance and hearing. Damage to the vestibulocochlear nerve causes problems with hearing, balance, and/or ongoing ear ringing or tinnitus. Tinnitus or Meniere’s disease is thought to be an autoimmune disease process.

9. The glossopharyngeal nerve is involved in sensory and motor function as well as taste on the back of the tongue and swallowing. Problems with the glossopharyngeal nerve lead to problems protecting the airway and initiating swallowing, making people more likely to cough when trying to drink water, to aspirate food into their lungs, and develop pneumonia.

10. The vagus nerve has both sensory and motor function. It conveys sensory information from the throat, ear, heart, and intestines and stimulates the muscles in the throat, heart, and intestines. It is responsible for reflex actions such as coughing, sneezing, vomiting, and swallowing. The vagus nerve is also involved in digestion, heart rate, blood pressure, and breathing. Vagus nerve activity may be involved in obesity and mood disorders. Devices that stimulate the vagus nerve are being investigated as a treatment for multiple sclerosis, rheumatoid arthritis, gastroparesis, posterior autoimmune uveitis, cluster headaches, and Alzheimer’s disease. Strategies to stimulate the vagus nerve include diaphragmic breathing, cold water immersion, gargling, yoga, and biofeedback.

11. The accessory nerve controls the muscles in your neck that allow to you flex and extend your neck and to turn your head.

12. The hypoglossal nerve is responsible for the movement of the tongue and is important for moving food to the back of the throat to initiate swallowing.

The Spinal Cord

The spinal cord sends motor commands from the brain to the muscles in the arms, legs, and torso to allow for movement. In addition, the spinal cord sends sensory information from the body to the brain. Transverse myelitis is an autoimmune disease that affects the spinal cord. The more severe the attack of transverse myelitis and the larger the segment of the spinal cord that is affected, the more likely the person is to develop severe ongoing, constant burning pain. Band-like, squeezing pain in the torso, also known as the “MS hug,” is due to spinal cord lesions or myelitis. Antiseizure medications such as gabapentin are often helpful in reducing the severity of pain caused by transverse myelitis. Treatment of autoimmune issues will be discussed in the autoimmune section. Traumatic injury to the spinal cord will be discussed in the trauma section.

The Peripheral Nerves

The peripheral nervous system are the nerves that connect to the sensory organs in the skin in our arms, legs, and torso and the motor nerves that connect to the muscles in our arms, legs, and torso. The nerves that go to the face, sensory organs in the head, and the mouth come directly from the brain and are classified as cranial nerves. Several cancer chemotherapy drugs are toxic to nerve cells, leading to painful neuropathies that persist after the cancer has been treated.

Autonomic Nervous System

Peripheral Nervous System

Brain

CNS Central Nervous System

The autonomic nervous system is a control system that regulates many bodily functions including pupillary response, blood pressure, heart rate, breathing rate, digestion, defecation, urination, and sexual arousal. It also controls coughing, sneezing, swallowing, and vomiting. The control of the autonomic system includes the hypothalamus, cranial nerves 3, 7, 9, and 10, (oculomotor, facial, hypoglossal, and vagus) and spinal nerves. The function of the autonomic nervous system is largely unconscious.

The sympathetic and parasympathetic nervous system are complementary systems that control the smooth muscles involved in blood pressure control and peristalsis (moving food and digestive juices through our digestive tract). It is the balance of the sympathetic and parasympathetic nervous systems that allows for the maintenance of a healthy blood pressure when we get up from lying in bed. If the sympathetic nervous system did not cause the small muscles around our blood vessels to constrict as we move from a reclining position to a standing position, our blood pressure would drop precipitously and we would faint. Likewise, the sympathetic and parasympathetic nervous system shift from moment to moment, regulating our blood pressure, heart rate, and respiratory rate to maintain homeostasis.

Sympathetic Nervous System

The sympathetic nervous system is activated when an individual is threatened. This stimulates the adrenals, which release epinephrine and norepinephrine. It also decreases activity in the digestive system, opens the airways, raises blood pressure, increases heart rate, dilates pupils, inhibits saliva production, inhibits tear production, increases sweat production, causes the liver to dump glucose into the bloodstream, and decreases the production of urine.

Freeze, Flee, Or Fight

The sympathetic nervous system may induce a freeze response or prepare the person to flee or fight. The freeze response is akin to the mouse that goes limp in the cat’s mouth after it is caught, playing dead. If the cat drops the mouse, the newly freed mouse flees as fast as it can, sometimes able to safely escape the cat. The cellular resources are redirected so that any nonessential cellular resources are taken offline, and all online cellular resources prepare to either flee or fight when the opportunity presents itself. A severely traumatic event can induce a freeze response, which makes some people feel guilty and troubled, believing they ought to have fought or fled. They do not understand the freeze response is a normal process that may occur with activation of the sympathetic system.

Parasympathetic Nervous System

The parasympathetic nervous system governs the release of digestive enzymes and saliva as well as the peristalsis or movement of food through the stomach, small intestine, and large intestine. It also slows the heart rate and constricts airways and pupils. And it governs the release of mucous in the eyes, mouth, gut, and vagina. Damage to the parasympathetic nervous system can prevent normal peristalsis in the gut, leading to gastroparesis. The stomach does not empty properly, making it difficult to eat and digest food. Damage to the parasympathetic system can lead to problems producing saliva, tears, and/or vaginal moisture, leading to dry eyes, dry mouth, and vaginal dryness and burning in the eyes, mouth, vagina, and rectum. Lubricating drops and gels are prescribed to keep the tissues moist. Inadequate saliva production increases the formation of cavities in the mouth, often leading to severe dental problems.

Enteric Nervous System

The enteric nervous system is the intrinsic nervous system of the gut. There are more nerves and nervous tissue in the enteric nervous system than are present in the spinal cord. The enteric nervous system manages the digestive secretions and motor functions of the gut. It produces more than 30 different neurotransmitters, including dopamine, serotonin, epinephrine, norepinephrine, and acetylcholine. Gut microbes make serotonin and kynurenine, which influence mood and the immune system. More than 90% of the body’s serotonin and 50% of the body’s dopamine reside in the enteric nervous system (gut). The mix of microbes in the gut influences the production of neurotransmitters in the gut, which impacts enteric nervous system activity. The microbial action on foods consumed also influences the patient’s immune system, moods, and cognition.

Causes Of Nervous System Dysfunction

The nervous system can be damaged by genetic disease, infections, trauma, toxic exposures, and autoimmune disease. Patients may have more than one disease state or factor contributing to the development of neurological and/or psychological symptoms. Often patients have multiple environmental factors contributing the development of neurological and/or psychiatric symptoms and disease states.

Neurogenetic Diseases

People with a genetic disorder that affects the brain typically are unable to make enough of one or more key proteins that are important to the development or function of the brain and/ or peripheral nervous system. Examples of these types of disorders are phenylketonuria (PKU), Wilson’s disease, Tay-Sach’s disease, and leukodystrophies. PKU used to be a leading cause for developmental disability and mental retardation. By screening all infants born in the United States and placing children with PKU on a special diet, children born with PKU can now grow up with normal intellectual ability and function normally in society. Although a patient may have an underlying neurogenetic disease, investigating and addressing the other environmental factors that influence the health of the nervous system may reduce symptoms and improve function.

Neuroinfection

The nervous system can be damaged by infections, leading to encephalitis (infections of the brain) or meningitis (meninges are the tough lining over the brain). Examples of infecting organisms include the viruses Herpes simplex and West Nile, the bacteria Borrelia burgdorferi (Lyme disease), Neisseria meningitidis, and Listeria monocytogenes, which can cause serious brain infections. The fungi Aspergillus, Blastomyces, and Cryptococcus can also cause infections, as can the parasites toxoplasmosis (single cell parasite acquired through exposure to cat feces that is a threat to pregnant women), strongyloides (roundworm usually without symptoms but may cause pneumonia and neurologic changes in severe infestations), and Naegleria fowleri (amoeba living in freshwater that enters through the nose and severely damages the brain). Evaluating the patient for the possibility of an infecting organism as the cause of new onset neurological and/or psychiatric symptoms is key to diagnosing nervous system infections. Once an infecting organism is identified, it is possible to select the appropriate antibiotic, antiviral, or antiparasitic medications to treat the infection. Once the infection has been resolved, extensive rehabilitation is often required to improve the function of the patient.

The microbes that live in the gut aid in digestion, metabolizing the foods we eat. A healthpromoting mix of microbes helps calm the immune system and reduce the severity of autoimmune-related symptoms. An unhealthy mix of microbes increases the reactivity of the immune system and worsens autoimmune symptoms. There is a separate section devoted to autoimmunity. The mix of microbes also influences which neurotransmitters are made by the gut microbes and can influence our mood and thinking.

Traumatic Brain And Spinal Cord Injuries

The nervous system can be damaged by traumatic injury to the brain or spinal cord. A sudden severe blow to the head may lead to acute damage to the brain, leading to death or coma. A less severe blow may lead to persisting problems with headaches, light and sound sensitivity, problems with memory and thinking, and problems with mood and social interactions. History of concussion (or multiple concussions) leading to a loss of consciousness followed by a period of disorientation increases the risk of developing neurodegenerative disease in the future (Alzheimer’s, Parkinson’s, amyotrophic lateral sclerosis (ALS), and multiple sclerosis). Multidisciplinary care with physical therapy, occupational therapy, speech therapy, psychiatry, physical medicine and rehabilitation, and primary care is often needed to improve function following a severe traumatic brain injury or spinal cord injury.

A sudden severe blow to the neck, torso, or back may cause damage to the spinal cord, which may lead to loss of function of the leg (paralysis) or of both arms and legs (tetraplegia or quadriplegia). The spinal cord may have been completely damaged or sustained only a partial or incomplete injury. Intensive multidisciplinary care that includes physical therapy and occupational therapy and is managed by physical medicine and rehabilitation physicians in rehabilitation centers is often part of the initial care for patients with traumatic spinal cord injuries. Adding electrical stimulation of muscles during the rehabilitation process can improve functional outcomes and quality of life for patients with spinal cord injury.

Trauma often damages the brain or spinal cord by stretching and damaging the axons (the long wiring between the brain cells). Acute injury can cause increased and excessive levels of inflammation, which can lead to additional damage. Poor nutrition increases the vulnerability of the brain and spinal cord to the effects of trauma. Poor nutrition also decreases successful rehabilitation after traumatic injury to the brain or spinal cord. Patient nutrition is assessed and supported to improve outcomes. Additional omega-3 fatty acid and nutritional supplementation has improved outcomes following traumatic brain injury and spinal cord injury.

Neurotoxins

Neurotoxicity occurs when a biological, chemical, or physical agent harms the nervous system to cause temporary or permanent damage to the central nervous system or peripheral nervous system. Agents that can cause neurotoxicity include chemicals such as heavy metals (e.g. lead, mercury, arsenic), cancer chemotherapies (e.g. platinum-based agents, taxanes, vinca alkaloids, and thalidomide analogues), radiation therapies, bites from certain venomous animals (e.g. rattlesnakes, jellyfish, black widows), and insecticides (e.g. organophosphates, carbamates,

pyrethroids). Other examples of common neurotoxins include carbon monoxide (an odorless gas), beta-amyloid (manufactured in the brain in increasing amounts as we age), and mold toxins (e.g. aflatoxin, which is produced by a mold growing on peanuts).

The mechanisms by which toxins damage include increasing mitochondrial dysfunction, oxidative stress, and neuroinflammation. These can lead to abrupt or gradual onset of movement disorders and/or the development of mood and behavioral disorders. It can also lead to intense burning pains in the extremities due to damage of the peripheral nerves.

Damaged mitochondria that become less able to generate adenosine triphosphate (ATP) can cause brain cells to falter. The myelin (fatty insulation around the wiring between nerves) is damaged. The axons (the wiring between nerves calls) are damaged. If the axons die, the function of that specific nerve cell is permanently lost. The more axons that are lost in a specific region, the larger the level of disability the patient will experience. Poor nutrition increases vulnerability to toxins and decreases success with rehabilitation after neurotoxin exposures. Integrative and functional medicine–trained physicians will often investigate toxin exposures, dietary history, nutrient levels, and markers of mitochondrial function. They will then work with the patient to create a diet, supplement, and medication program to address the identified problem areas.

Neurodegeneration And Peripheral

Nerve Neuropathies

Diseases such as Parkinson’s disease, Alzheimer’s disease, and other types of dementias have loss of brain tissue as a hallmark. The ventricles enlarge and brain tissue shrinks as the brain cells lose their synaptic connections with other brain cells. New memories cannot be formed. Thinking becomes more and more impaired. Patients become confused. They may hallucinate, become irritable, and are more prone to angry outbursts.

A combination of genetic factors and environmental factors contribute to the development of a neurodegenerative disease. Toxin exposures such as organophosphates and polychlorinated biphenyls (PCBs) increase the risk of Parkinson’s. Heavy metals such as lead, mercury, and arsenic increase the risk of neurodegeneration and peripheral nerve neuropathies. History of concussion increases the risk of dementias and neurodegeneration. Autoimmune disease states also have neurodegeneration happening at the same time as autoimmune processes.

There are medications for Parkinson’s disease and Alzheimer’s that slow the rate of decline; however, medications have limited effect on improving cognitive function. Integrative and functional medicine medical teams evaluate and treat the environmental factors that contribute to cognitive decline and have reported success with stabilizing and improving patient cognition in cases of early dementia. This approach is less effective in patients with late dementia.

Autoimmune Diseases Of Central And Peripheral Nervous System

When immune cells begin to attack healthy cells, that is called an autoimmune disease process. There are over 80 disease states that are confirmed to be due to an autoimmune disease.

In addition, there many more diseases where excessive and inappropriate levels of inflammation cause problems in the nervous system. Some of these autoimmune diseases are attacking the nervous system directly, such as multiple sclerosis, optic neuritis, transverse myelitis, Sjogren’s, systemic lupus erythematosus, rheumatoid arthritis, Guillain-Barre syndrome, myasthenia gravis, mononeuritis multiplex, chronic inflammatory demyelinating polyneuropathy, Hashimoto’s encephalitis, and vasculitis.

The mechanisms of injury for autoimmune disease are related to excessive levels of inflammation in the brain, spinal cord, and/or adjacent to the peripheral nerves. Often damage occurs in multiple locations in the central nervous system and the body. In addition, brain and

nerve cells may be directly attacked by immune cells, which may damage axons, myelin, and neurotransmitter receptors.

The specific causes for developing autoimmune diseases are unknown. The current theories are that a person must have one or more genes associated with the development of autoimmunity, have had a prior infection associated with increased risk of developing autoimmunity, and then be exposed to some additional unknown environmental factors that lead to the development of autoimmunity. There is considerable debate about what these environmental factors are. Factors that appear to increase the risk of developing an autoimmune diagnosis include tobacco use, low vitamin D levels, inactivity, obesity, and poor diet. An unhealthy mix of microbes in the gut may also increase the risk of autoimmunity, although there is not agreement regarding which microbes are health-promoting and which microbes are disease-promoting.

Poor nutrition increases the risk of developing autoimmunity and a more severe disease course. Treatment for autoimmune disorders is focused on drugs that block some aspect of the immune system. Integrative and functional medicine–trained practitioners evaluate and then treat the environmental factors that contribute to the development of autoimmunity. These factors include toxin exposure, exercise, stress, and the nutritional needs of the brain and nerve cells.

Poor Nutrition And Nutrient Insufficiencies

Diets high in added sugars and processed foods are more likely to be missing key nutrients needed by neurons and mitochondria. Integrative and functional medicine–trained physicians investigate diet, assess nutrient levels, and guide patients on how to improve diet quality and utilize specific supplements to address any identified nutrient insufficiencies.

Remyelination, Repair of Neurons, And Improvement Of Neurotransmitter Levels

The brain is capable of repair. Intensive rehabilitation can lead to improved function of the hands and legs. Animal studies have demonstrated a variety of interventions that lead to improved remyelination and repair of damaged brain tissue in mice and rats. Human remyelination and brain repair studies are ongoing. At present there are no drugs that have Food and Drug Administration approval that improve remyelination or repair damaged brain tissue. Integrative and functional medicine practitioners evaluate underlying environmental factors and work with the patient and their families to address the specific issues the evaluation uncovered.

Wahls Clinical Research And Clinical Practice

In our clinical practice and clinical trials, we have been successful with helping patients with relapsing remitting multiple sclerosis, secondary progressive multiple sclerosis, and primary progressive multiple sclerosis reduce anxiety and depression symptoms and improve walking, hand function, verbal reasoning, and spatial reasoning. We have also treated patients with neuroimmune symptoms due to other autoimmune disease states and have success with those patients reporting reduced anxiety and depression and improved energy, walking, and hand function.

Schedule a discovery call to learn more about the various program that we have to help people with neurological, psychological, and autoimmune conditions improve their quality of life, reduce the severity of their symptoms and improve their functioning. Sign up below.

We have active clinical trials which are listed below. If you have clinically isolated syndrome, optic neuritis, or multiple sclerosis, complete the survey so that you can join the patient registry and potentially participate in our current and future clinical trials.

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References:

1. Bisht B, Darling WG, Grossmann RE, et al. A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue. J Altern Complement Med. 2014;20(5):347-355.

2. Bisht B, Darling WG, Shivapour ET, et al. Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2015;5:19-35.

3. Bisht B, Darling WG, White EC, et al. Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study. Degener Neurol Neuromuscul Dis. 2017;7:79-93.

4. Chenard CA, Rubenstein LM, Snetselaar LG, Wahls TL. Nutrient Composition Comparison between the Low Saturated Fat Swank Diet for Multiple Sclerosis and Healthy U.S.-Style Eating Pattern. Nutrients. 2019;11(3).

5. Chenard CA, Rubenstein LM, Snetselaar LG, Wahls TL. Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern. Nutrients. 2019;11(3).

6. Dean C, Parks S, Titcomb TJ, et al. Facilitators of and Barriers to Adherence to Dietary Interventions Perceived by Women With Multiple Sclerosis and Their Support Persons. Int J MS Care. 2022;24(5):235-241.

7. Elliott-Wherry AN, Lee JE, Pearlman AM, Wahls TL. The Wahls Behavior Change Model for Complex Chronic Diseases: A Clinician’s Guide. Degener Neurol Neuromuscul Dis. 2022;12:111-125.

8. Fellows Maxwell K, Wahls T, Browne RW, et al. Lipid profile is associated with decreased fatigue in individuals with progressive multiple sclerosis following a diet-based intervention: Results from a pilot study. PLoS One. 2019;14(6):e0218075.

9. Irish AK, Erickson CM, Wahls TL, Snetselaar LG, Darling WG. Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2017;7:1-18.

10. Lee JE, Bisht B, Hall MJ, et al. A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis. J Am Coll Nutr. 2017;36(3):150-168.

11. Lee JE, Titcomb TJ, Bisht B, Rubenstein LM, Louison R, Wahls TL. A Modified MCT-Based Ketogenic Diet Increases Plasma betaHydroxybutyrate but Has Less Effect on Fatigue and Quality of Life in People with Multiple Sclerosis Compared to a Modified Paleolithic Diet: A Waitlist-Controlled, Randomized Pilot Study. J Am Coll Nutr. 2021;40(1):13-25.

12. Reese D, Shivapour ET, Wahls TL, Dudley-Javoroski SD, Shields R. Neuromuscular electrical stimulation and dietary interventions to reduce oxidative stress in a secondary progressive multiple sclerosis patient leads to marked gains in function: a case report. Cases J. 2009;2:7601.

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14. Titcomb TJ, Bisht B, Moore DD, 3rd, et al. Eating Pattern and Nutritional Risks among People with Multiple Sclerosis Following a Modified Paleolithic Diet. Nutrients. 2020;12(6).

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18. Wahls T, Scott MO, Alshare Z, et al. Dietary approaches to treat MS-related fatigue: comparing the modified Paleolithic (Wahls Elimination) and low saturated fat (Swank) diets on perceived fatigue in persons with relapsing-remitting multiple sclerosis: study protocol for a randomized controlled trial. Trials. 2018;19(1):309.

19. Wahls T, Titcomb T, Bisht B, Ramanathan M. Patient Empowerment and the Exclusion of Dietary Intervention Studies. Comment on “Diet and Multiple Sclerosis: Scoping Review of Web-Based Recommendations”. Interact J Med Res. 2021;10(1):e17063.

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23. Wahls TL, Chenard CA, Snetselaar LG. Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic. Nutrients. 2019;11(2).

24. Wahls TL, Reese D, Kaplan D, Darling WG. Rehabilitation with neuromuscular electrical stimulation leads to functional gains in ambulation in patients with secondary progressive and primary progressive multiple sclerosis: a case series report. J Altern Complement Med. 2010;16(12):1343-1349.

25. Wahls TL, Titcomb TJ, Bisht B, et al. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin. 2021;7(3):20552173211035399.