On Memory

FYI, the blog below started out being what I had intended to be a short reply to a journalist for the Wall St. Journal asking for medical and nutritional experts to submit their credentials and take on memory.  A patient of mine gave me the heads up and I scrambled to put something together on short notice and tight deadline.  I ended up really enjoying the research I did and ended up writing way too much on the subject.  In the end, it was a day late and a page too long for the WSJ, but hopefully, you’ll enjoy the result….

As a nutritionist and practitioner of Chinese Medicine, I know treating memory problems has to be understood and treated with a systems approach rather than trying to find one cause and one magic bullet.

Both modern Functional Medicine (FM) and ancient Chinese Medicine (CM) view cognitive ability as the result of a complex interplay of various organs, somatic constituents (humos), diet, environmental factors, and lifestyle.  There is no one universal cause, etiology, or treatment in both systems of medicine.

In Western medicine, impaired memory could be caused by traumatic brain injury, seizures, cerebrovascular accident, chronic alcohol abuse leading to Korsakoff’s syndrome, illicit drug use, PTSD, dissociative identity disorder, and chronic vitamin B deficiency.  All of these have nutritional implications, but the last one is of particular interest to someone like me because it could
be caused not only by insufficient B vitamin intake, but by problems with digestion and absorption of these important brain nutrients.  For example, adequate B12 levels are contingent upon enough stomach acid (HCl).

The Framingham study in 1994 (Lindenbaum et al) showed that 40% of the elderly subjects were B12 deficient, compared to 17.9% of the younger controlled subjects.  Insufficient HCl would also potentially lead to amino acid insufficiencies.  Amino acids are critical in the formation of both neurotransmitters and hormones which can have dramatic impacts on memory. Adequate intake and absorption of B vitamins and amino acids (protein) are all heavily influenced by dietary habits—not just what you eat, but how you eat it and what you combine it with as well as adequate intestinal
permeability.

In addition to the basic brain nutrients, there is a plethora memory helping phytonutrients in foods such as blueberries (anthocyaninsand pterostilbene), grapes (resveratrol),
grape seeds, rosemary, ginkgo biloba, periwinkle (Vinpocetine), ashwagandha, and many others.  Also available to help cognitive and memory function are over the counter supplements such as L-alpha
glycerylphosphorylcholine, phosphatidylserine, tyrosine, taurine, pregnenolone.  These can help by modulating inflammation, increasing circulation, mitigating cortisol and the stress response, increasing neuronal communication, and preventing free radical oxidative damage.

The Chinese Medical view on memory is also complex.  There are 3 main viscera involved in memory: the Kidneys, the Heart, and the Spleen. Note these organs (capitalized) are the Chinese medicine version of the viscera distinct from the biomedical version of them.  For example, Western medicine directly associates kidney function with glomerular filtration rate or blood urea nitrogen (BUN).  CM directly associates the Kidneys with, among many other things, the emotion of fear, season of winter, and long term memory.  The Spleen is central in the roles of digestion, absorption, mental focus, and what biomedicine dubs metabolism.  Anxiety, cognition, communication and circulation fall within the purview of the Heart in CM.   There are at least 5 distinct patterns of disharmony or diagnoses in CM for impaired memory.  The differential diagnosis is based on a complex array of signs and symptoms involving the whole body, emotional factors, environment, lifestyle, and diet.  Each treatment involves varying degrees of treatment with acupuncture, herbal formulas, as well as diet & lifestyle modifications.

Despite thousands of years of empirical evidence and literate chronicles of success using the techniques of CM to treat memory problems, there are several factors making it difficult to conduct large scale clinical studies.  Besides the lack of big money funders like Big-Pharma, the very nature of CM makes it difficult to isolate one problem—impaired memory, and one variable, say, like a polyphenol in fruit.  The one problem, impaired memory, could be any one or two of the 5 patterns.  The treatments usually consist of several acupuncture points, herbal formulas consisting of more than 5 different herbs, and several diet and lifestyle modifications.  Isolating one herb or one acupuncture point for the purposes of a rigorously controlled clinical study would completely misrepresent an actual CM treatment and ignore the synergistic properties of these herbs and treatments together.

Some common herbs, foods, and formulas used in Chinese Medicine to treat/prevent impaired memory include:

Gou Qi Zi aka Goji berry, wolfberry, lycium fruit

Shi Chang Pu, acorus gram.

Hu Tao Ren, walnuts

Ling Zhi, Reishi mushroom, Ganoderma

Bai Zi Ren, Arbor Vitae, Biota Seed, Semen Pladycladi

Gui Pi Tang—“Restore the Spleen Decoction” for Spleen related memory deficiency

Bu Nao Pian—“Augment the Brain Tablet” for Kidney related memory deficiency

Tian Wang Bu Xin Dan—for Kidney and Heart related memory deficiency

Whether using Eastern or Western medicine, the key to success in treating memory issues is a good differential diagnosis taking into account the whole body and its various systems. Modern Functional medicine uses sophisticated lab tests to measure nutritional status, intestinal permeability, neurotransmitter levels, stress response, oxidation levels, and hormone balance.  Chinese Medicine uses very low-tech diagnostics to measure the equally complex balance between the Kidneys, Spleen, Heart, environment, lifestyle, and diet. In both cases, the expert practitioner treats the person rather than the disease and the root of the problem, rather than the symptom.

Oscar Sierra, L.Ac.