“Jack” came to our clinic seeking solutions for his fatigue and sleep disturbance. He told me that he would wake up at 3:00am and not get back to sleep for an hour or two. If his workday was easier, he would still wake up at 5:00am, or about an hour before his alarm would go off. He was getting just 4 to 5 hours of sleep most nights.
His job required international business travel, as far afield as the US. These periods away further disturbed his sleep pattern owing to the jet lag on both sides of the trans-Pacific journeys.
Jack had a massive “sleep debt”. No wonder he was tired and irritable most of the time. He was suffering the most common symptoms of sleep deprivation:
- waking without feeling refreshed
- restless leg syndrome, twitching of the legs at night
- anger outbursts and similar signs of irritability
- very poor short term memory - to the point of affecting normal flow of conversation
- poor concentration at work, sleepiness at the computer at work
- extreme tiredness and near napping in his drive home at 8:00pm
- continual fatigue, partially remedied by his coffee and cola addiction
- disrupted sugar balance making him irritable when hungry and craving sugar as alcohol at night
Jack had also lost his interest in work and the usual pleasures he had before—even in sex. Jack’s wife naturally wanted him to spend more time with family and not be distracted with emails and phone calls. His irritability caused even more stress at home in the evenings and weekends. His wife managed to get him to a counseling session, but Jack “didn’t have the time” to do more. Eventually Jack turned to alcohol at night to provide an escape from his stress and unhappiness.
Jack’s tale is not uncommon in Hong Kong. Very often, the partner gets fed up over time, and a divorce could be the likely outcome.
Owing to the exhaustion Jack came in to see me instead of reaching for psychiatric prescriptions of antidepressants.
In diagnostic terms, Jack was in the late stage of stress called Adrenal Fatigue, characterised by exhaustion and depression. I explained the following chart to Jack and warned him the next stage is likely a more serious disease as the immunity or heart go beyond their capacity. Heart attacks and cancer are the end stage of chronic stress all too often.
Before we go into how I approached Jack's issues, let me outline another type of sleep disorder, that of inability to fall asleep.
“Jill” has always been an anxious person. Jill recalled in school and college she would have trouble with falling asleep during times of exams. One time she had a “panic attack”—hyper-ventilating with heart palpitations and an immobilising fear—right before an exam. She also mentioned some obsessive behaviours, such as rechecking her emails over and over before sending, or washing hands 15 times a day, and a habit of checking her front door was locked as many as seven times in one night.
Even though she seemed to be on high alert and not relaxing at any point in the initial consultation, she told me her childhood was free of abuse and had no history of post-traumatic stress.
I asked Jill if one of her parents had similar anxiety issues and she said that her mum was also very anxious. This is an important clue because anxiety and obsessive behaviours could be caused by a common DNA genomic variation. Jill could have inherited the genes from her one of her parents. So we looked for this by taking an early morning cheek scraping and sending the sample off to a specialist DNA testing lab.
From the report we discovered that Jill had a problem with her production of calming brain neurotransmitters (affecting her anxiety) owing to a common genetic variation. The metabolism affected was methylation. This poor methylation issue is found in some 35% of people, and such afflicted individuals have a long history of some types of mental disorders such as anxiety, depression, ADHD or insomnia.
In short, Jill’s problem involves a genetic inability to produce the active forms of B vitamins, which in turn hindered the production of some important calming neurotransmitters in the brain. Jill indeed had two key variations in her DNA (blocking MTHFR and COMT functions) that caused her lifelong tendency to have anxiety. The COMT gene variation is associated with obsessive behaviours in women.
While we cannot alter the DNA, it is possible to bypass the blockages by supplementation of some key nutrients. Some special forms of folate—NOT folic acid—can help the production of the active form of vitamin B12 (methyl-cobalamine) and SAMe (S-Adenyl-Methionine) in the brain, both of which are needed for normal nerve and mood balance. Those with poor methylation also need activated forms of vitamin B2 (riboflavin 5 phosphate), and active B6 (pyridoxal 5 phosphate) along with magnesium and zinc. These nutrients allow better production of other relaxing neurotransmitters such as serotonin, melatonin, as well as GABA, which inhibits hyper arousal, a condition Jill suffered from, especially at night. In Jill’s case, she also needed the mineral lithium.
The concept behind using the active forms of B complex and the extra mineral supplements is that these bypass and/or up-regulate the DNA bottlenecks, normalising the brain's capacity to function optimally.
I explained to Jill this method of overcoming her DNA bottlenecks would be needed lifelong. While the mineral levels could later be reduced, the active B complex would always be needed, along with plenty of green veggies, legumes, nuts and seeds for these nutrients from her diet.
Jill asked me if I could help her get off Xanax, one of the classes of drugs that up regulate GABA. This medication has a calming effect, but does not address the ultimate cause, which is Jill’s genetic variations. I told her that in most cases this was possible.
I prescribed her the active B-complex in the morning, and a product called Mg Optima™ Relax at night. The therapy would allow Jill’s brain to make her own neurotransmitters GABA, melatonin and serotonin at the correct rate. In addition, 5mg of lithium was given morning and night, which is higher than the usual dietary levels but well below the toxic levels used medically for bipolar disorder (300mg).
Magnesium promotes nerve and muscle relaxation, and a positive effect on mood, however studies have found that 60-70% of people in Hong Kong consume below the WHO recommended levels of magnesium in their diet. Vital Nutrients Magnesium Glycinate is a well-absorbed, well-tolerated magnesium capsule we generally recommend.
Jill’s response was nearly immediate. The effect of the key nutrients was natural relaxation into easier deeper sleep. The active form of the B-complex and lithium allowed other areas of Jill’s brain biochemistry to balance as well. She found her sugar cravings disappeared and her premenstrual issues diminished. More interesting was that Jill reported that some of her obsessive habits were less active; she washed her hands less often and found that checking the door locks at night was just not occurring any more after 2 months on the supplements.
We were soon able to slowly reduce Jill’s dose of Xanax over the next 2 months as the active B complex started to saturate her brain and allow further corrections in her innate nerve function. At times of high stress when she had deadlines to meet she still had trouble falling asleep, but she would bounce back quickly once the deadline passed, and that normal days at work or home were never causing her poor sleep any longer. She was happier and far less worried about the future, and she said she worried much less about her children's passing issues.
Going back to Jack, he understood that his executive lifestyle had eventually worn down his nerves and he understood the issue of chronic stress depleting the stress related glands, the adrenal glands. I explained that herbs could help these to restore, but it would take time.
However, since Jack had been hitting the bottle and his liver had become irritable, I recommended a 10-day detox program as a start. The result was a 4 kg weight-loss—which he appreciated—and a much calmer, less irritable Jack, who was ready to take on lifestyle changes more positively. He developed a more patient attitude, probably helped by the detox and reduced alcohol intake since.
We discussed better “sleep hygiene”—meaning more relaxed evenings, more time with his family, and after the children were in bed an evening walk with his wife to help the flow of the emotional energy between them through regular communication. Jack also became more open to counseling and I recommended one of our IMI psychotherapists.
To tackle Jack’s sleep disturbance, I supported his adrenal glands with a daytime uplifting combination of the herb Ashwagandha and Siberian Ginseng called Sereni-Pro. Over a two month period this restored the positive adrenal hormone (DHEA), and reduced the over production of the negative stress hormone (Cortisol) associated with stress. Additional B-complex and vitamin C in the daytime further assisted the balancing of the adrenal stress hormones.
At night I gave a down-regulating formula called Sleep Manager, along with a magnesium supplement. He began to sleep better, credit to the evening walks (instead of emails and arguments), and the two nighttime supplements helped him to stay asleep as his neurotransmitters and stress hormones were being better balanced. His daytime energy improved after a month of better sleep.
At counseling he learned the value of listening more carefully, understanding what his wife was really saying before responding. Jack developed more empathy for his wife, and she had more trust and faith in him again. Jack happily reported that their sex life improved. The couple had passed the threat of divorce through better communication. Jack had looked at his lifestyle, and as a result he managed his evenings better—he had begun to come home by 7:00pm to spend some time with his children before the evening walk with his wife. Overall Jack was managing his stressful lifestyle and supporting his previously exhausted system with the necessary effective supplements for up regulating his nerve and adrenal functions.
After a month he got back into some exercise in the morning. At first he could only manage a walk for 30 minutes, but it soon picked unto a run, and he felt happier about his lifestyle overall following this. He did still have setbacks with the jet lag, but had discovered that getting up at 6:00am still and having his early morning run really shortened the time it took to get to normal sleep patterns again.
While we used active forms of B-complex in Jill for calming her neurotransmitters, we used a more regular B-complex for Jack to support the adrenals back from exhaustion. This is the interesting thing about nutrients: they have so many roles in the metabolism that they can seemingly be used for opposite reasons—calming for Jill and energy for Jack. In fact, two studies showed that people undergoing high stress jobs maintain better energy levels if they take B-complex.
The magnesium and zinc are practically always needed wherever the B vitamins do work in the brain. These minerals are co-factors in normal B vitamin metabolism, making them synergistic. All neurotransmitters need these nutrients to be present for their production.