More Than Pain: What is the Real Cause of Autoimmune Brain Fog, Fatigue, and Lack of Well-Being?
Autoimmune patients with chronic inflammation and pain often lack a sense of well-being. They commonly explain this feeling like a cloud or fog that stops them from thinking clearly and/or feeling well. Oftentimes, the rheumatologist explains that pain or depression will cause these feelings. While this is very true for some, many patients separate this feeling from their pain and insist that they are not depressed. Many patients know that it is more than this. There is an overwhelming feeling of fatigue, memory loss, irritability, and just not feeling right.
More and more research is pointing to a potential culprit: Quinolinic Acid. We have all heard of Serotonin, the “Happy Hormone.” Serotonin is well- known to make us feel good, and anti-depressant drugs like Prozac are meant to increase serotonin levels in the brain. Serotonin is naturally made in the body from tryptophan through a series of enzymatic reactions. However, in chronically inflamed patients, something goes very wrong in this pathway. Cytokines (inflammatory chemicals) like Interferon gamma and TNF alpha, which are elevated in autoimmune patients, stop tryptophan from being optimally converted to serotonin. This alone leaves patients feeling unhappy.
It gets worse. Interferon gamma and TNF alpha actually cause tryptophan to be shunted into another toxic compound in the brain called Quinolinic acid. Quinolinic acid is a known excitotoxin that stimulates the glutamate receptors in the brain. This can potentially cause feelings of depression, irritability, memory loss, and fatigue. The enzyme that turns tryptophan into Quinolinic acid is called IDO (indoleamine 2,3-dioxygenase). If you are chronically ill with an inflammatory disease (including fibromyalgia) and are experiencing these feelings, there are steps you can take.
1) Get an organic acid test to measure your Quinolinic Acid levels
2) Get a cytokine test to measure your Interferon gamma and TNF alpha levels. These cytokines are dominant in Th1-driven autoimmune diseases, like RA, Sjogren's, juvenile arthritis, psoriatic arthritis, multiple sclerosis, and others
3) A recent 2012 study looked at a number of natural flavonoids and measured their ability to inhibit the IDO enzyme, leading to reduced Quinolinic acid levels. The highest potency inhibitors of IDO were apigenin, chrysin, and baicalenin. Luckily, all of these flavonoids are found in a plant called Scutellaria baicalensis. In addition to inhibiting IDO, Scutellaria is also a potent immunomodulatory.
4) Address the underlying cause. By taking these flavonoids, you might get temporary relief, but you are only masking the symptoms. The real cure will come from reducing Interferon gamma and TNF alpha to stop Quinolinic acid from being produced in the first place.
Digging even deeper, we want to find out why your Interferon gamma and TNF alpha levels are so high: Is it genetic? Is it a food reaction? Is it a chronic viral or bacterial infection? By addressing all of these issues, we can help lower Quinolinic acid levels and potentially restore a feeling of well-being to patients with chronic inflammation.
Resources:
http://ac.els-cdn.com/S0006291X1201933X/1-s2.0-S0006291X1201933X-main.pdf?_tid=d86bbb28-9fbc-11e3-a8f0-00000aacb360&acdnat=1393512098_be5fdf037b09af53f616920bebc7a8cf#lb0035
http://www.ncbi.nlm.nih.gov/pubmed/23063682
http://www.ncbi.nlm.nih.gov/pubmed/24089628
