The more we learn about methylation and MTHFR we realize how important B12 is. I am going to discuss the different types of B12 as it relates to methylation, absorption and genetics and which type might benefit you.

There are four types of Vitamin B12, Cyanocobalamin, Methylcobalamin, Adenosylcobalamin and Hydroxocobalamin

The first, Cyanocobalamin is not very good and we recommend never using it. It is synthetic or a man made form of B12. It takes the body more steps to convert it to a useable form of Hydroxyl B12.  Cyanocobalamin is commonly found in energy drinks.

Methylcobalamin is an active form of B12, which helps with the metabolism. It is basically cobalt attached to a methyl group. It is beneficial in methylation because it activates an enzyme called methionine synthase. This helps the myelin sheath of nerves as well as it helps to make red blood cells. Methionine synthase also plays a very important role in converting Homocysteine into methionine. This helps reduce the amount of Homocysteine in the body, which can at high levels cause cardiovascular as well and neurological damage.

Methionine is also utilized through the MAT enzyme to convert it to SAMe. It is the body’s major methyl donor, which is very significant for the breakdown of neurotransmitters (COMT) and breaking down histamines (HNMT).

The best dietary sources of B12 are animal products such as Meat, Poultry, Fish and Eggs. It is very common for people to be deficient in B12. Primarily because of the complex process that is required to absorb it, methylate it and assimilate it. For B12 to work properly it much combine with methylfolate as part of the methylation process to make methionine synthase.   Individuals with the MTHFR gene are already functioning at a 20-50% reduction in converting folate to methyl folate.

Some other causes of B12 deficiency are: Vegan Diets, Antacids, Bariatric surgeries, Alcohol and Pernicious Anemia.

The lab tests MCV and MCH if elevated suggest a B12 or Folate deficiency.

Too much of methyl B12 can cause megaloblastic anemia. A condition where you have high amount of red blood cells, hemoglobin and hematocrit in your CBC blood lab tests.

Adensosylcobalamin is the mitochondrial form of B12. It is great for energy and can be utilized for a person that is experiencing fatigue throughout the day. It can also be successful for the individual that exercises and experiences more muscle aches and fatigue following exercise.

Methylmalonic Acid is the gold standard test, to see if the patient is deficient in Adensosylcobalamin.   A high methylmalonic acid suggests B12 adenosyl deficiency.

Hydroxocobalamin is most beneficial to lower Nitric Oxide levels. If there is an abundant amount of nitric oxide in the body this creates too much ROS, reactive oxygen species. It is not uncommon to see elevated nitric oxide levels with chronic fatigue and autoimmune issues. To complicate matters are the eNOS and SOD snps. Generally, supplementing with SOD and Hydroxycobalamin are beneficial to lower the ROS and the nitric oxide levels.

Dependent on various SNP’s (single nuclear polymorphisms) at the COMT and VDR certain combinations can prove effective as outlined by Dr. Amy Yasko. I have followed her formula with success in my Functional Medicine/Genetic Coaching.

COMT V158                          VDR Taq                   B12 Types well tolerated

—                                           ++ (TT)                   All three types of B12

—                                           +- (Tt)                      All 3 with less methyl B12

—                                           — (tt)                       Hydroxyl and Adenosyl B12

+-                                          ++                             All 3 types with less methyl B12

+-                                          +-                              Hydroxy and Adenosyl B12

+-                                          —                               Hydroxy and Adenosyl B12

++                                         ++                             Hydroxy and Adenosyl B12

++                                         +-                              Hydroxy and Adenosyl B12

++                                         —                               Hydroxy B12

I recommend Pure Encapsulations Adenosyl/Hydroxy B12 liquid.

It can be found on my website store in liquid or capsule form. https://www.purecapspro.com/drmichaelveselak/pe/products/product_details.asp?ProductsID=2312

Difficulty Losing Weight

Through the years I have coached several patients to help them lose weight. However, every so often a more difficult one comes along exhibiting signs of hormone, glucose and insulin imbalance.   Over time I have been fortunate to learn how to break through some of these barriers and begin to identify the real causes of why they are unable to lose weight despite cutting calories and exercising.

Initially, I thought that the individual was not 100% being upfront with me with regards to diet and exercise. We started to monitor them closely documenting all food intake and exercise. What we discovered was quite revealing.

The major cause of weight loss resistance was inflammation. Inflammation originating in the cell affecting the mitochondria, the receptor sites for all hormones and vitamins and the nucleus, which is where the replication of DNA takes place.

Probably the greatest change I have seen in my 30 plus years in practice, is the level of toxicity in each patient. When I first started practice the adjustment was powerful and it could in of and by itself eliminate the stressors emotional, physical and chemical resulting in the vertebral subluxation. However, in recent times are bodies are over burdened with this toxic load from cosmetics, hair dyes, water supply, pesticides in food and just overall pollution. This bombardment has led to not only to a part of the population that is resistant to losing weight but also a dramatic increase in Autoimmune Conditions, Autism, Alzheimer’s and Thyroid Conditions.

All of the patients that I coach with regards to weight loss have tried other forms of dieting without much long -term success. Primarily, it is because we need to teach the body to become a fat burning machine and increase energy.

There are several ways we can achieve this and I will tell you the approach is slightly different for everyone. We utilize techniques to modify your diet to eliminate food triggers as well as modifying and varying your approach to food and eating.

It is necessary to eat whole foods, organic preferably. Also we need to incorporate strategies to allow our body to adapt to different situations. In recent years we have incorporated techniques such as modified fasting, intermittent fasting and on occasion block fasting.

There are numerous research articles on the benefits of fasting and varying the schedule of eating so our bodies are not so predictable. These benefits include: Reduction of Insulin Resistance and glucose sensitivity; Enhanced Immune System; Increase Human Growth Hormone which has anti aging properties; Improving Digestive Health and Improving Cellular Inflammation.

Remember I said the cellular inflammation is at the core of most modern day illness.

Intermittent Fasting or varying the schedules of when to eat as stated above has profound health benefits. When I began to implement this strategy the results with my coaching clients were clearly identifiable. We were able to take the body and shift its focus from burning sugar to burning fat.

Losing weight suddenly became easier as our cell walls became less toxic and in turn less resistant. Energy levels increased, sleep patterns improved, fat burning accelerated.

Our body will also prefer sugar burning to fat burning because it is easier and too much glucose will be toxic to the cell. During our normal day it is imperative that we drastically reduce our carbohydrate intake to make sure the shift stays in fat burning mode rather than sugar burning mode.

Read the labels and glance at the sugar and carbohydrate content. With huge glucose spikes we create more cellular inflammation ultimately increasing the resistance of the cell to hormones and vitamins causing an inability to not only feel good but too lose weight.

An increased amount of inflammation in the body will cause more oxidative stress, placing more burden on the body. Of course there is never one quick fix or one size fits all plan to help everyone. There are some people that their genetics leads them to more oxidative stress and the body’s ability to remove these harmful free radicals.

This is why I like to analyze the DNA through 23andme, so we can see exactly the hand we are dealing with to personalize our approach for each individual. Again, when employing this comprehensive strategy conditions such as the inability to lose weight, neurodegenerative diseases, autoimmune issues, ADHD, and anxiety has become much easier to support.

Ketosis is the ideal state we would like to achieve with our intermittent, modified or block fasting. This promotes healing and fat burning. Ketosis does not have to be a permanent state. We have individuals that go in and out of ketosis with good results.

On occasion there are a few individuals that their toxic burden is so great they will not shift into ketosis and do not experience the same results with regards to health and weight loss. With these individuals we will “carbo load” them, still maintaining good carbs, no grains and sugars.

While the food intake and maintaining a state of fat burning is very important, it is also important to begin the process of removing the toxins. We utilize certain supplements to help detoxification and support the body in recovery. This might entail supporting the liver, gall bladder, adrenals, thyroid and or kidney.

Most of us have been convinced that detoxification occurs with a 3 day or 5 day cleanse or a juice fast. Detoxification, phase 1 and phase 2 occurs on a minute, by minute basis.   It needs to be addressed and supported through good methods of dieting which we have discussed along with proper supplementation and support to help control the cellular toxicity and inflammation.

The final component is exercise. It is important to change your routine and do not get stuck performing the same exercises every single day. There has been a lot of research in regards to High Level Intensity Training. This type of exercise makes our body more efficient for burning fat, losing weight and increasing the overall metabolism.

If you are interested in our coaching program, call the office at 805 482-0723.

We are the only facility in Ventura County that addresses the patient from a Structural, Metabolic, Neurologic and Genetic Viewpoint.

FIND THE CAUSE!!!

TIPS TO HELP YOU IMPROVE YOUR SLEEP

We are all well aware of how important sleep is in our life. We have heard the saying that we can live without food but we cannot live without sleep. Sleep is the time when our body begins its regenerating process. It allows us to refuel or recharge our energy storage as well it assist in tissue regeneration.

When an individual does not get enough sleep it affects many systems in the body. First it increases inflammation, affects blood sugar leading to insulin resistance or diabetes type 2.

Ideally for maximum health benefits we should try and get 7-8 hours of sleep per night.

There are a few things that can affect this. Hormones such as cortisol, which is produced with an increase in stress. This stress could be physical, chemical, or emotional. Cortisol has an inverse relationship with melatonin, the hormone that helps us sleep. We should have a lot of cortisol in the morning and very little melatonin and as the day progresses there should be less cortisol and more melatonin.

Light, especially blue light will affect this. Even lights in your room or a full moon will inhibit the production of melatonin.

If you are having difficulty sleeping here are some tips.

1. Turn off all electronics a few hours before bedtime. This includes the computer, cell phone and ipad.
2. Make sure the room you sleep in is dark, eliminating all light
3. Turn off router as the electromagnetic frequency can affect the brain and sleep.
4. Do not have the router or your cell phone in your bedroom when you sleep, or switch to airplane mode.
5. Make sure your bed and pillow are good. Try and avoid beds and pillows that have potentially allergenic chemicals such as polyurethane foam or mattress covers that are fire retardant.
6. Try sleeping with a pillow between your legs to make the back more comfortable.
7. Sleep on your side or back. Try and avoid the stomach as this can put more pressure on the spine and irritate degenerative disc or sciatic type issues.
8. Buy an air filter unit to ensure better air quality of the room.
9. Proper ventilation is important so keep a window open during the day and night.

Recently, I have been doing a lot of research and studying on the brain. During my research I was exposed to the use of Low Level Light Therapy for cognitive enhancement. Since in our practice we are supporting patients with early signs of dementia, concussions and traumatic brain injury, I was extremely pleased and overwhelmed by the amount of studies conducted on LLLT discussing its impact on the cells and the mitochondria.

In our office we have and utilized 3 different types of LLLT , dependent upon the area we are treating.

Laser therapy is effective because it exposes injured tissue to a coherent light at specific wavelengths that has been proven through research to be effective in pain relief as well as cognition in the brain. The best part is it stimulates the bodies ability to heal itself through photo biomodulation without any side effects. There have been more that 3000 published studies displaying the effectiveness of low level laser therapy.

I have been using Cold Laser in my office for approximately 10 years now. I have without a doubt found it the most effective therapy modality for the treatment of sports injuries such as tennis elbow, plantar fasciitis, knee pain and shoulder pain.

The term “cold” laser is used instead of Low Level Light Therapy, because the photons from the laser do not generate heat. Therefore it can not damage tissue or cause sensation of heat.

There are two other great benefits besides the fact that it is extremely effective. First as we just mentioned it is non- toxic, it does not interact with medications and create side effects. Second it is non-invasive.

How Does Laser Therapy Work For Cognitive Therapy 

There have been studies that conclude its impact on increasing BDNF, Brain Derived Neurotropic Factor. BDNF has been proven to reconnect neurons. So with neuroplasticity our main objective is to reconnect neurons that are degenerating and improve communication.

It has also been proven to increase Nerve Growth Factor and Stem Cells.

Our body has built in mechanisms that deal with free radicals and the formation of protein misfolding which occurs in some neurodegenerative diseases. This degeneration can occur for many reasons but some of the most common are inflammation, lack of oxygen, decrease in circulation, increase in blood sugar (insulin resistance or diabetes), and too much ROS (Reactive Oxygen Species)

Studies on LLLT have shown to

1. Decrease inflammation
2. Increase Anti-oxidant, which are protection against free radicals or ROS.
3. Improve Vascular Endothelial Growth , VEGF.   When the brain is hypoxic or has too little oxygen it compensates by releasing more VEGF
4. Increases ATP, this is cell energy
5. Increases Mitochondria
6. Increases Blood Flow and Circulation
7. Has been shown to reduce amyloid plaques in vitro, the plaque responsible for Alzheimer’s

Low Level Therapy Combined With Proper Exercise and Support

When LLLT is coupled with proper exercise of the joint or brain based therapies to improve function and neuroplasticity the results are even better. In our clinic we perform a comprehensive neurological examination assessing potential functional limitations of different lobes of the brain. Our rehabilitation then can be very specific to target those areas and improve the neuroplasticity.

Functional Neurology allows our brain to integrate more efficiently and effectively.

We also will recommend supplements to help improve the cognitive function and reduce inflammation . Supplements such as Tumeric, Resveratrol, Omega 3’s, PQQ, and phosphatidylcholine.

Conditions That Benefit from LLLT

Tennis Elbow

Plantar Fascitis

Tendonitis

Strains

Sprains

Improving Bonde Density

Neuropathy

Brain Fog

Dementia

Parkinsons

Alzheimer’s

Edema

Today we are going to discuss the Thyroid Gland and the 6 Patterns of Hypothyroidism

In our office we see a lot of patient with Thyroid Dysfunction. We always ask the 3 basic questions.   When did you first notice you had symptoms? How long did it take to get Diagnosed? How often do you change your Dose?

Most of our patients have tried everything to get their energy back and to feel good again.

Thyroid Problems are often not diagnosed for 2 reasons. First doctors do not run enough markers. Secondly the lab ranges are too wide. We utilize functional ranges 1.8- 3.0 for the TSH.

The current medical model, which is a 50 -year old model falls short in fully identifying the cause of the thyroid condition. It is based upon a limited number of lab markers focusing on TSH and T4. How can you manage the thyroid without all the information?

As you will see in the next few minutes there are several other lab markers that need to be addressed to determine the actual cause of the thyroid problem. Our complete thyroid panel includes TSH, T4, Free Thyroxin index Free T4 l Free T3l; T3 uptake; Reverse T3; TPO and TBG antibodie; TSH, antibodies and TBG levels.

When necessary we will also run other labs to determine the cause. Proper testing is crucial.   A complete metabolic panel including all the thyroid tests described above along with liver function, anemia, blood glucose levels. Hormone tests, Salivary cortisol levels; Cyrex testing for gut permeability issues, stool testing looking for infections, yeast or parasites. We also at times will run an organic acids test.

Other testing we may recommend is genetic testing and the MTHFR gene, Hair analysis to evaluate copper and mercury toxicity and deficiency of essential nutrients.

To understand how to support the thyroid it is extremely important to know how the thyroid works. Then when we discuss the 6 patterns of hypothyroidism it will become clear where the problem arises.

THE SYMPTOMS OF THYROID DYSFUNCTION:

• Fatigue
• Depression
• Weight Gain
• Hair Loss
• Constipation
• Morning Headaches
• Muscle Cramps at Rest
• Dry or Brittle Hair
• Chronic Digestive Issues
• Loss of Outside Portion of Eyebrows

The thyroid supports bone metabolism, immune system, brain and nervous system, endocrine system, GI function, liver and gall bladder, growth and sex hormones, fat burning, healthy cholesterol levels and proper stomach acid.

EVERY CELL IN YOUR BODY HAS A THYROID RECEPTOR!

Overview of the thyroid gland and how it is converted.

It all begins in the Brain, The hypothalamus releases a hormone TRH (Thyrotrophic Releasing Hormone – to the Pituitary Gland. The Pituitary gland the signals the release of TSH thyroid stimulating hormone) this is what is tested on lab work.

The pituitary gland also regulates the release of other hormones- ACTH to the adrenal glands; You can see the Adrenal glands are responsible for the release of Cortisol, Progesterone, aldosterone, DHEA, epinephrine and norepinephrine.   Pituitary gland also releases Lutenizing hormone and follicle stimulating hormone to the ovaries and testes which helps control the menstrual cycle and testosterone

To make Thyroid Hormone the Thyroid gland needs iodine and Tyrosine. T4 is 4 molecules of iodine and one of Tyrosine and T3 is 3 molecules of iodine and one tyrosine. The thyroid produces 93% T4 and 7 % T3

To transport the molecules they hop on a taxi cab which is called TBG or thyroid binding globulin. This taxi cab transports it to the liver where T4 is converted to T3 the useable form of T3.

60% of T4 is converted to T3 in the liver.   Selenium is also extremely important in the conversion of T4-T3

20% in the gut and 20% in other tissues As you can see it is essential to have not only a healthy liver, gut, pituitary , adrenals, but we also need iron, iodine, selenium, zinc, magnesium and tyrosine to make it all happen.

Once again they bind to a protein TBG to carry it to the cells. Free T3 is the active form of thyroid hormone. EVERY CELL IN THE BODY HAS A RECEPTOR SITE. The cell is dependent on methyl groups, viamin A and iron for absorption.

The 6 major Thyroid patterns: 

1 The first pattern is PRIMARY HYPOTHYROIDISM

(High TSH)

If the pituitary gland senses the thyroid isn’t doing its job, it will pump out extra TSH, giving the thyroid a kick in the pants.

Primary hypothyroidism is a true dysfunction of the thyroid gland and is the only pattern of hypothyroidism that can be effectively managed with thyroid replacement hormone – unless its autoimmune Hashimoto’s. Then is an immune issue and needs to be supported as such. 　If tissue destruction is severe, replacement hormones prevent complications due to deficient thyroid hormones. 　However, if the health care practitioner detects primary hypothyroidism before the damage is too far gone and approaches it nutritionally, the condition can be reversed in the majority of the people delaying the need for medication, if its required at all. If the TSH does not come down to normal after the nutritional protocol the hypothyroidism may be so advanced that thyroid medication is the only recourses.

The lab range is .5-4.5, functional range is 1.8-3.0. anything above lab range of the TSH is considered Primary Hypothyroidism.

The second pattern is HYPOTHYROIDISM SECONDARY TO PITUITARY HYPO FUNCTION

(Low T3, High Cortisol)

This is a very common pattern of functional hypothyroidism. 　Here TSH will be low (below 1.8) although not as low as with primary hypothyroidism but you will still have symptoms. Chronic stressors are at the root of this pattern because they fatigue the pituitary gland at the base of the brain. Then the pituitary fails to signal the thyroid to release enough TSH to stimulate activity. 　In other words, the thyroid gland may be perfectly fine but nobody is telling it to go to work because the pituitary is asleep on the job. Pituitary hypofunction is usually the result of one of four things.

An active stress response (poor diet, inadequate sleep, too much caffeine, high carbs　　　chronic inflammation, viral or bacterial infections are just a few factors which wear the body out

Postpartum depression. 　It’s not uncommon for women to dip into a low thyroid state after pregnancy, because pregnancy amplifies the demands on all hormonal systems in the body, keeping the pituitary busy 24/7. 

The third pattern is THYROID T4 UNDER-CONVERSION

(Low T3, High Cortisol)

This is a common pattern associated with chronic stress and excess production of the adrenal hormone cortisol. Here the body makes plenty of T4 but too much cortisol prevents the body from being able to convert enough T4 to T3, the form of the thyroid hormone the body can use. An elevated cortisol level suppresses the conversion of T4 to the useable form of T3.

Another common cause is deterioration of the body’s cell membranes in response to chronic infection or inflammation. Cell membranes are in charge of multiple functions, including the conversion of T4 to T3. Chronic inflammation causes lipid peroxidation, in which harmful free radicals damage the cell walls. And damaged cell walls hamper thyroid conversion. 　Finding the cause of the inflammation are keys to the support.

The 4^th pattern is  THYROID OVER-CONVERSION

(High Free T3, Decreased TBG)

This pattern is found with insulin resistance and polycystic ovary syndrome (PCOS), since excess testosterone production accompanies these conditions. Reversing insulin resistance reverses hypothyroid symptoms. 　This pattern also arises in those who already have developed Diabetes (DM) and are taking insulin. Gaining control over blood sugar, any insulin needs with diet, supplementation and exercise are critical.

The 5^th pattern is  THYROID BINDING GLOBULIN ELEVATION

(Low T3 Uptake and low or normal Free Thyroxine Index (FTI))

This pattern is often found with oral contraceptives or estrogen replacement therapy.

Thyroid hormones hitch a ride through the bloodstream on thyroid binding globulins (TBG). Since thyroid hormones in the blood bind to excess TBG’s, not enough free hormone is available to enter the cells. 　Clearing the body of excess estrogen addresses hypothyroidsim.

6 THYROID RESISTANCE

(Thyroid panel WNL, Elevated cortisol)

This is another stress related pattern in which the pituitary and thyroid glands function normally and make the right amount of hormones but the hormones are not getting into the cells to take affect. Symptoms of hypothyroidism show up. Elevated 　levels of cortisol, in response to stress, cause the cells to become resistant to thyroid hormones.

Functional Medicine Approach

Based upon our functional medicine lab findings we will offer support to the thyroid, adrenals, liver, gut, blood sugar, anemia or autoimmune regulation.

We must address nutrient deficiencies, food sensitivities, adrenal dysfunction, gut dysbiosis and liver detoxification issues.

I completely understand how you feel if you are frustrated and have no energy. A lot of our patients with thyroid issues felt the same way.

if you have any questions email me at dr.veselak@gmail.com,

Visit our website at drmichaelveselak.com

One of the most common questions I hear when I consult with patients is do I think they are over or undermethylated?

It is believed that genetic mutations can lead to abnormalities of the methylation process, which can influence energy production, neurotransmitter production, detoxification and our immune system. Most commonly we look at the MTHFR gene and its interaction with other genes. In essence undermethylation could lead to lower levels of serotonin, making them more susceptible to depression. Overmethylation can cause symptoms such as ADHD and Anxiety.

Rather than self diagnose it is important to analyze all the genes from the 23andme test and look at the big picture. Supplements can be recommended that can assist with the methylation process. At times we will prescribe labs such as histamine, zinc and copper to get a clearer picture of methylation.   It can also be beneficial to look at the SAM/SAH ratio through Doctors Data for further analysis.

For further information please check out our website mthfrandmore.com