The Stress Connection: Meeting Hormonal, Nutritional, and Metabolic Needs

Many chronic illnesses are affected by stress (see Stress, Immune Response, and Illness). There have been many links between psychiatric symptoms, stress, mitochondrial function, and the endocrine system. A common thread connecting them all is nutrition.

The United States' government organization, NIMH, is currently running studies using nutritional substances to augment treatment of some neurobiological brain disorders such as autism, bipolar and schizophrenia.

Here is their description of why they are testing one supplement--Coenzyme Q10 (CoQ10, also known as ubiquinone):

Mitochondria are small organelles inside the cell that are responsible for energy production. Recent studies in animals and humans suggest that abnormalities of mitochondria may be involved in bipolar depression. The study will also examine whether the food supplement Coenzyme Q10 (CoQ10) improves mitochondrial function and symptoms such as depressed mood, low energy, anxiety or slowness in thinking and movements in bipolar patients. CoQ10 has been used to increase cell energy production and as an antioxidant. It has had some benefit in patients with Parkinson's disease and migraine and in prolonging survival in patients with cancer and heart failure.

Mitochondrial dysfunction (see Mitochondrial Dysfunction & Psychiatric Symptoms) causes symptoms of aging, and even is involved in encephalopathies (dysfunction of the brain). Some cases of hereditary mitochondrial disorder is involved in hereditary schizophrenia. Oxidative stress can affect mitochondrial function, and mitochondrial function can affect oxidative stress. As is the case in most body systems, there is a highly interactive feedback loop.

CoQ10 is not the only nutritional treatment for mitochondrial function, nor the only one being tested. Other nutritional supplements such as Carnitine are being tested.

I cannot help but wonder if this piecemeal testing of nutritional supplements will fail because nutrition works synergistically with each other, and the body's specific requirements need to be addressed in a comprehensive manner.

In addition to the mitochondria, the endocrine system is often affected in these neurobiological brain disorders that seem so sensitive to the affects of stress. However, it seems that not only do many patients diagnosed with mental illness not get their endocrine system thoroughly evaluated prior to diagnosis, they are not monitored after diagnosis.

It is common to find that minimal testing of thyroid function may be performed, such as measuring TSH (thyroid stimulating hormone), but that's all. This is in spite of the fact that TSH is not what the cells of the body actually use, and it tells nothing about the amount of actual thyroid hormone available for the cells to use. The Free T3 and Free T4 levels represent the active hormones circulating in the blood. TSH is useless in diagnosing hypothyroidism resulting from pituitary or hypothalamic dysfunction.

Here's what is really scary--Measuring just TSH also doesn't detect low T3 resulting from low cortisol. T3 is the form of thyroid hormone the cells can actually use.

Low cortisol can be a result of adrenal insufficiency. Adrenal insufficiency can result from prolonged, chronic stress. Stress can result from physical illness, stressful symptoms from the illness or the "wiring" the child was born with, as well as social stresses, emotional stresses,etc.

To make things worse, as we have already discussed, many of our children succumb to the effect of very little stress (see Stress and Our Children. How Much is Too Much?).

But the picture is even more complicated. Other hormones, such as progesterone, can affect adrenal function, which can affect cortisol levels which can affect thyroid levels. All of this can affect the functioning of the brain, sleep, AND can affect how much stress a person can tolerate. Studies have shown that even low levels of testosterone and DHEA can adversely affect negative symptoms (such as lack of motivation), anxiety and depression. There are other important hormones and associated chemicals in the body, affecting the brain, that scientists and doctors, still know little about. One such chemical, affected by the pituitary-endocrine interactions is endothelin [See article endnote].

I was grateful when my own daughter's doctor took some continuing medical education seminars to learn how to better help her. I was surprised when he came back and got her on supplements to help her adrenals. He also got aggressive about fixing her hormone levels which endocrinologists had simply ignored for years, even though they were low.

I started asking around. How many other parents were told to put their children on the nutritional supplements for specific problems relating to their condition, such as pantothenic acid (vitamin B5), large doses of vitamin C, Vitamin E, omega-3 fatty acids, CoQ10, etc? It was hodgepodge. Some were told about omega-3 fatty acids. Some were on much more than my own daughter. Some had been told nothing at all. I noticed in my informal meetings with other parents that the children whose medication regimens had been aggressively augmented with nutritional therapies were in general more healthy, stable, and involved in life.

But most families are told nothing about this. They are just told their child has a "mental illness" and the child is aggressively treated with powerful psychotropic medication and therapy. And many then languish. No effort is made to address their hormonal, nutritional and metabolic needs.

The next complication is that intestinal malabsorption issues are prevalent in these neurobiological brain disorders, with a higher incidence of Celiac/gluten and other food intolerance. So the very children needing extra nutrition may be absorbing the least.

I started wondering. If hormonal problems, adrenal function, mitochondrial dysfunction, and intestinal malabsorption issues are so prevalent in our children, teens, and young adults with these illnesses, WHY aren't they being routinely tested and treated aggressively for these problems?

I think that it all revolves around the term "mental illness." It revolves around the ridiculous placement of brain dysfunction into the "mental" category (as if it were a psychological problem) rather than the "medical" category (See Sets of Symptoms--Not the Cause–Get Diagnostic Labels).

I meet many parents whose children have displayed mood and psychotic symptoms and were labeled with "mental illness" without being tested for other illnesses that can have psychiatric symptoms (see What are some genetic causes of psychosis? and What other MEDICAL Causes get called “Schizophrenia”? ). They also don't get tested for known problems that can contribute to the symptoms seen and/or are highly associated with NBDs (see Genetic Links to “Developmental”, “Mental”, “Auto-Immune” and other Medical Disorders

Comprehensive treatment of our children is needed. But I fear that will not happen on a grand scale until our children's problems get new MEDICAL diagnostic labels. It will be complicated since it seems that the problems are on a cellular level and lie in the realm of neurology, immunology, endocrinology, and gastroenterology. They may still need the fields of psychiatry and psychology. More than other children, they need help learning to co-exist with a very complicated neuro-endocrine-metabolic-immune disorder that renders them exquisitely vulnerable to stress, and whose symptoms themselves are stressful. We need, at the minimum, for our children to be treated by physicians versed in neuropyschoendocrinology (aka psychoneuroendocrinology) with a strong integrative medicine background.

In the meantime, while we wait for that to happen, we just have to take control of their medical care. We have to fight for the testing and treatment our children need and deserve.


Important links to related articles and websites:

• Life Extension Foundation
• About.com: Thyroid Disease
• Identifying hypothyroidism’s psychiatric presentations (November 2006 edition of Current Psychiatry Online)
• Identifying hyperthyroidism’s psychiatric presentations (December 2006 edition of Current Psychiatry Online)
• EnteroLab
• TrueHope (EM Power)
• Journal Of OrthoMolecular Medicine: Therapeutic Nutrition Based Upon Biochemical Individuality
• Hypothyroidism and the Role of Armour Thyroid, Seaweed, Exercise, and More
  Cutting-Edge Interview with Joseph Mercola, D.O. by Mary Shomon, March 8, 2008
• Pfeiffer Treatment Center
• Hyperactivity Linked To Thyroid Hormones ScienceDaily (Mar. 12, 1997)
• The Child and Adolescent Bipolar Foundation (CABF)
• The National Alliance on Mental Illness (NAMI)>
• What is Pyroluria? See also Nutritional Healing: Pyroluria, which has reference articles and a list of labs that perform tests.
• Metabolic biomarkers of increased oxidative stress and impaired
  methylation capacity in children with autism American Journal of Clinical Nutrition, Vol. 80, No. 6, 1611-1617, December 2004

End Notes

Endothelin: The level of endothelin is regulated by the pituitary-growth hormone feedback loop. As the pituitary produces more growth hormone, it signals less production of endothelin. Elevated levels have been studied. Little is known about low levels. Elevated levels of endothelin have been implicated in cardiovascular risk. Pharmaceutical companies have researched ways to lower endothelin levels as a method of reducing cardiovascular risk. However, that hasn't gotten far because the side-effects from lowering the endothelin are rather horrific. One endocrinologist, in a display of brilliant insight, recognized that some of my daughter's symptoms were identical to the the outcome seen in trials attempting to lower endothelin. He measured her endothelin level and found it absurdly low. Thinking outside-the-box, he recognized the involvement of my daughter's hypothalamic-pituitary-adrenal axis in the low level of this obscure, but important, peptide. That was just one piece of the complex personal puzzle of one mentally healthy child's symptoms, diagnosed as a "mental illness".