Neurochemistry & Nutrition Board Review
Neurochemistry Board Review Topics
- The 4 Neurochemical Priorities (never get lost!)
- Blood Tests and Codes for this Module
- CBC
- Phosphorus
- Comp Metabolic Panel
- Magnesium
- Hemoglobin A1c
- LDH
- GGT
- How to Work Up a Real Patient
- Every Case Study details the patient’s presentation, work up, treatment plan and follow up.
- Case Study – 17 year old female with headaches, fatigue, neck/back pain
- What Does a Brain Do?
- Global view of Brain function and purpose
- A primer on the evolutionary development of brain structure and function
- Structural Components of the CNS – Brain macrostructure
- Concepts of Neuron Structure & Function
- How Neurons Work – Thresholds and Potentials
- Neurotransmission, Transmitters and Receptors
- Dopamine
- GABA
- Serotonin
- Acetylcholine
- NMDA Receptors, Glutamate and Long-Term Potentiation
- Transneuronal Degeneration and Diaschisis
- The DARK Side of NMDA Receptors (creepy!)
- Excitotoxicity – what promotes it and what inhibits it
- Synaptic Integration
- Ions: sodium, potassium, calcium
- Glial Cells
- Macroglia
- Focus on Astrocytes
- Clinical Point on Aquaporins
- Oligodendrocytes and Schwann Cells
- Microglia
- Normal role and pathophysiological role
- Macroglia
- Blood-Brain Barrier
- Neurovascular unit aka Gliovascular Unit
- What crosses and what doesn’t
- Membranes and Lipids
- Amyotrophic Lateral Sclerosis
- When is ALS not ALS?
- A reasonable evidence-based approach to ALS
- Energy Metabolism in the Brain -glycolysis and oxidative phosphorylation
- Stroke
- What happens to energy production during and after stroke?
- Stroke-induced inflammation
- The Stroke-Migraine Continuum
- Epilepsy
- Pathophysiology
- Nutritional and Metabolic Factors to consider in Epilepsy
- The Ketogenic Diet for Seizures
- How to work up, manage and treat a patient with Seizures.
- Understanding Blood Chemistry – For each test:
- What physiology is actually being tested?
- What makes it high?
- What makes it low?
- What are the lab reference ranges?
- What is the functional/optimal ranges?
- Comp. Metabolic 14 PLUS
- Glucose
- Calcium
- Protein
- Albumin
- Globulin
- Sodium
- Potassium
- Chloride
- Carbon Dioxide
- Anion Gap
- BUN
- Creatinine
- eGFR
- Phosphorus
- Alkaline Phosphatase
- ALT
- AST
- GGT
- Bilirubin
- Comp. Metabolic 14 PLUS
- Hemoglobin A1c
- Lactate Dehydrogenase
- Special Section on Magnesium
- Normal roles in physiology
- Testing
- What makes it high?
- What makes it low?
- Magnesium in Migraine
- Magnesium in Stroke
- Magnesium in Chronic Pain
- Pattern Analysis of Blood Test Results
- Magnesium and Depression
- Excitotoxicity and Glutamate
- How to handle a patient with seizures
- Key points about ALS
- Blood Tests and Codes
- CBC / Differential with Platelet Count
- Iron
- IBC
- Serum Ferritin
- Serum Methylmalonic Acid
- Homocysteine
- Serum Vitamin B12
- Serum Folic Acid
- Hereditary Hemochromatosis, DNA Analysis
- cardiac CRP (or High sensitivity CRP)
- H. Pylori Urea Breath Test
- Helicobacter pylori Antibodies, IgA, IgG, IgM
- Helicobacter pylori Stool Antigen
- Intrinsic Factor Antibodies
- Gastric Parietal Cell Antibodies
- Big Picture of the Neurochemical Priorities
- #2 – Cellular Energy: RBCs, Nutrients, MItochondria
- #3 – Cellular Energy: HPA Axis and Glucose Handling
- Lab Reference Ranges vs. Functional/Optimal Ranges
- What’s the difference?
- Energy Production in the Body
- Citric Acid Cycle and Nutrient Co-factors
- Physiology of Red Blood Cells
- Understanding Blood Chemistry
- RBC
- Hemoglobin
- Hematocrit
- MCV
- MCH
- MCHC
- RDW
- Platelet count
- Reticulocyte count
- CBC Red Blood Cell markers interpretation
- Anemia Classifications
- Iron Physiology
- Iron Testing
- TIBC
- UIBC
- Serum
- Transferrin Saturation
- Ferritin
- Iron deficiencies
- Physical signs and symptoms
- Iron deficiency and the brain
- Causes of iron deficiency
- Work up for Iron deficiency and Iron deficiency anemia
- Treatment of Iron Deficiency and Iron deficiency anemia
- Hemochromatosis
- Iron Supplementation
- How much, what kind and when to take it
- B12 Physiology
- Absorption
- B12 Testing
- the problem with the serum B12
- Methyl Malonic Acid
- Metabolic B12 Deficiency
- Causes of B12 Deficiency
- What causes High levels of B12?
- Signs, Symptoms and Effects of Low B12
- B12 Lab testing interpretation
- B12 Supplementation
- What kinds, how much and when
- Folate Physiology
- Testing for Folate status
- Serum Folate
- Effects of low folate
- Causes of low folate
- Folate supplementation
- how much, what kind of and when to take it
- Homocysteine and Remethylation
- Causes of high homocysteine
- MTHFR
- Homocysteine and Depression, Bipolar, Schizophrenia, Parkinson’s, Alzheimer’s Disease
- Testing for homocysteine
- Treatment of high homocysteine
- Interpreting patterns of RBC markers, Iron, B12, MMA, Folate and Homocysteine
- Effects of Iron Deficiency Anemia
- RBC Patterns on blood chemistry
- Anemias—there’s lots of them
- Treating underlying causes of an anemia
- Glucose Regulation
- Hormones 101
- HPA Axis and Adrenal Function
- Adrenal Glands – Anatomy and Physiology
- Pregnenolone
- DHEA
- Cortisol
- Glucose Regulation – Insulin, HPA and the Liver
- Assessing Adrenal Function (the real way)
- Dynamic Tests
- Serum DHEA-s
- Cortisol testing
- Salivary
- Urinary
- Adrenal Insufficiency
- Addison’ Disease
- TBI and HPA/Adrenal Function
- Adrenal Fatigue – does it exist?
- Overtraining Syndrome – it’s not just for athletes
- Cushing’s Disease
- HPA/Adrenal Treatment
- Lifestyle
- Supplementation
- Adaptogens and how to use them
- And more…
- Exercise
- Stress Reduction
- Peripheral Glucose Regulation
- C-peptide and insulin
- Insulin Resistance
- Causes of insulin resistance
- Effects of insulin resistance in the brain
- Hypoinsulinemia
- Type 2 Diabetes
- pathophysiology
- Hypoglycemia
- Reactive Hypoglycemia
- Hypoglucocytosis
- Glucose Regulation and Autoimmunity
- Cross Reaaction
- Type 1 Diabetes
- Latent Autoimmune Diabetes of the Adult
- Antibody testing
- Lab Diagnosis of hyperglycemia
- Lab Diagnosis of hypoglycemia
- Glucose Regulation Treatment
- Therapeutic Targets – what are you shooting for?
- Diet for hyperglycemia modulation
- Therapeutic Fasting – how to do ti
- Supplementation for Glucose Regulation
- What to use, how much and when to take it
- Gastrointestinal Physiology
- Digestion
- Absorption
- Elimination
- How to use GI symptoms to triangulate the location of the problem
- Intestinal Barrier- Anatomy and Function
- Tight Junctions, Zonulin, Occludin
- Gut Permeability
- Hyper-leaky gut
- SIBO
- Inflammatory Bowel Disease
- Support strategies for integrity of the gut barrier
- Liver physiology
- Normal Biotransformation
- Xenobiotics
- Toxicants
- How to improve liver function
- Blood tests for assessing liver function
- Gluten
- What is it?
- What does it do?
- Celiac Disease
- Pathogenesis
- Clinical Features and Manifestations
- Diagnosis
- Non-Celiac Gluten/Wheat Sensitivity
- Testing for Celiac and NCGWS
- Deep dive into wheat proteome and related markers
- Gluten-related disorders
- FODMAPS
- Low FODMAPS Diet
- The Anti-Inflammatory Repair Diet
- What’s allowed, what’s not allowed and why
- Testing for Food Sensitivities
- What does it really mean?
- What are you really testing?
- Schematic view of the Immune System
- Barriers
- Acute Phase Response
- Innate Immune System
- Adaptive Immune System: T cells, B cells and more
- Cytokines
- Immunoglobulins, Antibodies and Isotypes
- How the Immune System Works
- Challenges for the Immune System: Discrimination, Flexibility, Managing Infection, Memory
- Antibody Generation, T Cell Receptors
- Autoimmunity
- Lab testing: WBC and Differential, C-Reactive Protein/hs CRP, Vitamin D
- Microbiome/Microbiota
- Microbiota-Gut-Brain Concepts
- Microbiota-Gut-Brain-Immune Axis
- Short chain fatty acids and their clinical applications
- Dendritic Cells
- Induction of Treg cells
- Effects of Antibiotics
- Ectopic Colonization
- Intestinal Permeability Revisited: Tight Junctions
- Gut Barrier and Blood-Brain Barrier
- Feeding Microbiota and Protecting the Barrier
- Autoimmunity…the Deep Dive
- Pre-requisites
- Clinical Presentations
- Food Antigens and the Immune System
- Oral Tolerance
- Cross-reactivity
- Food Sensitivity Testing: the good news and bad news, and the really bad news
- Testing for clinically significant autoimmunity
- Clinical Immune System Challenge: the rules and how to interpret
- Predictive Antibody testing
- Survey of common antibody tests and what they mean clinically
- Type 1 Diabetes
- Celiac Disease
- Regulating the Immune System with Diet, Exercise and Supplementation
- The Anti-inflammatory Diet
- Anti-inflammatory/Immune Regulatory Supplementation
- Sleep
- Normal physiology including stages and Melatonin
- Abnormal sleep patterns
- Sleep hygiene
- Sleep Scenarios
- Acute Pain Relief
- Pain—in general and in specific clinical conditions
- The NLRP3 Inflammasome
- Autoimmunity and Pain
- Complex Regional Pain Syndrome
- Fibromyalgia – short and sweet
- Peripheral Neuropathy
- Vestibulo-Cochear System and Disorders
- Labyrinthine physiology including the Blood-Labyrinth Barrier
- Inner Ear Immune System
- Vertigo
- How does the immune system affect the Vestibulocochlear System
- Vertigo in Autoimmune Disorders
- BPPV: causes and treatments
- Vitamin D and BPPV
- Thyroid, BPPV and recurring BPPV
- Recurrent BPPV Treatment
- Meniere’s Disease
- Meniere’s and Autoimmunity
- Gluten and Meniere’s
- Meniere’s Disease Treatment
- Tinnitus: Definition, sources and clinical applications
- Vestibular Migraine
- Otolithic Vertigo
- Mesencephalic Dizziness
- The Gut and Psychiatry
- Major Depression Disorder:
- inflammation homocysteine, oxidative stress, Vitamin D, Thyroid autoimmunity, SAMe, Folate, B12, Tryptophan, probiotics, HPA, micronutrients, NAC
- Bipolar Disorder:
- Inflammation, thyroid autoimmunity, homocysteine, oxidative stress
- Obsessive Compulsive Disorder
- Autoimmunity
- Schizophrenia
- homocysteine, EBV, Autoimmunity, gluten-free diet, copper, lithium,
- Autophagy – how to induce it
- Mitophagy – how to induce it
- Neuroinflammation for homeostasis
- Neuroinflammation in CNS diseases: Parkinson’s, Alzheimer’s, Huntington’s, MS, Depression, Sleep Disorders
- Necrosis vs. apoptosis – cell death and survival
- Neurodegeneration: the role of the immune system, glucose, metals, mitochondria, microbiome, astrocytes, microglia, oral health, tryptophan/kynurenine, sex hormones, gluten, vitamins, NRF2
- A short course on TBI
- Definitions
- Clinical presentation
- Pathophysiology
- Downstream effects
- Diagnostic workup for a TBI a patient
- How to help a patient with TBI with diet, exercise, supplementation
- The clinical expressions of neuroinflammation and neurodegeneration
- Sleep and Cognitive decline
- Parkinson’s Disease: brain first type , body first type
- Risk factors for Parkinson’s: Diet, Diabetes, Influenza, Statins, Air pollution
- Parkinson’s Pathophysiology: alpha-synuclein, Autophagy, Tau, glutathione, Gut microbiome, immune system and inflammation, Kynurenine pathway, autoimmunity, mitochondria
- Medical Management of Parkinson’s
- Diet: fasting and more
- Exercise
- Supplementation
- Dementia: SCD, MCI, Alzheimer’s
- Dementia pathophysiology
- Dementia evaluation and diagnosis
- How to use the MOCA and SAGE
- Alzheimer’s Disease
- Pathological features of Alzheimer’s
- Pathophysiology of Alzheimer’s
- Genetics
- APOE & Lipids
- BDNF
- Mitochondria and ROS
- Autophagy and mTOR
- Amyloid Cascade Hypothesis
- Tau
- Infections
- Diabetes and Insulin Resistance
- Sleep
- Immune System, Inflammation and Neuroinflammation
- Autoimmunity
- Porphyromonas Gingivitis
- The gut and microbiome
- Alzheimer’s Risk Factors
- Depression
- Thyroid function
- Vitamin D
- Autoimmune Diseases
- Coffee and Tea Consumption
- Autonomic function
- Physical activity
- BMI
- Vaccinations
- Alzheimer’s and COVID-19
- Medical management of Alzheimer’s
- Frontotemporal Dementia cliff notes
- ALS review
- Strategies for Neurodegeneration
- Diet, fasting and ketones
- Exercise
- Specific Supplementation – so much to talk about here
- Diet interventions for Neuroinflammation and Neurodegeneration
- Neuroprotective Strategies
