Now that you have been exposed to the concept of Carbohydrate Reversible Brain syndrome or CARB syndrome, the next critical strep is to decide whether or not you have the disease. When the Harvard Psychiatrists Hudson and Pope first introduced this concept, they called it Affective Spectrum Disorder (ASD) and they considered it to be the most common disease in modern Western societies. Because they never determined the triggers or pathology of the condition, their concept never made it out of academic medicine. Over decades of clinical practice, I also noticed that many common brain disorders seemed to be somehow connected. Many published studies have also documented these connections. We now understand that the primary trigger of this disease is long term consumption of highly processed food so I decided to change the name of the disorder to CARB syndrome, better reflecting the underlying pathology. Consuming this type of food leads to glucose spikes that have an adverse effect on brain function, eventually leading to the brain dysfunction symptoms that define CARB syndrome.
Become Your Own Physician
Because your physicians are likely unaware of this disease, if you develop this condition you will need to make your own tentative diagnosis of CARB syndrome and arrange for your own treatment. Making a tentative self-diagnosis of a disease isn’t so radical. People do it all the time with, flu, colds, gastroenteritis and similar common illness. They often then arrange for their own treatment using OTC remedies or home treatments. Because we are dealing with a new disease concept, in my experience it is relatively easy for you to understand this new concept if you or someone close to you actually has the disease.
The diagnosis of CARB syndrome is mainly based on identifying some or many of the 22 symptoms of the disease. Strong and persistent cravings for sweet and starchy food are the lead symptoms of this disease. People with normal brain function simply never have such cravings. Go through the rest of the list and see how many apply to you. If these symptoms are quickly pilling up, you likely have your diagnosis of CARB syndrome in the bag. An example might be helpful. My recent blog post speculated that Anthony Bourdain, the famous traveling foodie who recently committed suicide, might have had CARB syndrome. The tip off was his cravings. He admitted that often at night he would put on a hoodie so he wouldn’t be recognized and then he would sneak out of his hotel and go to a local Popeye’s to binge on mac and cheese and other highly processed fare. He would often do this days in a row. He then impulsively killed himself when nobody around him suspected that he might be depressed. I’m fairly sure that he had the mood swings and poor impulse control typical of CARB syndrome and that’s all it takes to push someone to make a stupid decision like killing yourself.
Follow The Metabolic Trail
Another important element of CARB syndrome is its close association with common metabolic issues. Almost all folks with CARB syndrome also tend to somehow struggle with their weight. Because obesity is defined as excessive body fat, it’s much more accurate to measure body composition rather than use weight or BMI, measurements that tell you nothing about what is inside your body. People with CARB syndrome will often have other abnormal metabolic markers besides excessive body fat. They may have elevated fasting glucose or insulin levels, an elevated hgb A1c or high inflammatory markers like an elevated ESR, an elevated highly sensitive CRP, an elevated homocysteine or a high AA/EPA ratio. These tests are beyond the scope of this discussion, but you can request them from your PCP and if many of them are elevated, it points to a diagnosis of CARB syndrome. There are special scales and other equipment that can measure body composition and if you have access to such equipment I recommend you measure the relative amount of fat in your body. Even if you are thin like Anthony Bourdain was at the end of his life, you might still be carrying too much fat for your size. Bourdain admitted that he recently lost 30 pounds and yoyo dieting is another tip off for CARB syndrome. It’s also important to remember that there is no correlation between the brain dysfunction symptoms of CARB syndrome and the metabolic issues. Some thin people have horrible symptoms whereas some large people have only minor symptoms.
The Key to Successful Treatment—Yourself!
Let’s assume that you have now made a tentative self-diagnosis of CARB syndrome. The label won’t do you much good unless you know how to treat the disease. When it comes to treatment of CARB syndrome, there are six pillars of treatment that you need to be concerned about:
- Eliminate high glycemic carbohydrates mainly from grains, excessive fructose mainly from added sugars and omega 6 fatty acids mainly from vegetable oils from your diet and eat a reasonable amount of real food loaded with healthy fats, moderate amounts of healthy protein, carbohydrates mainly from fruits and vegetables and omega 3 fatty acids.
- When necessary, use low dose medications to control key symptoms and improve compliance.
- Take supplements to enhance brain neurotransmitter levels and to maintain healthy brain function.
- Exercise your body and mind.
- Get plenty of restful sleep.
- Maintain as many healthy relationships as possible
Know Your Disease Inside and Out
If I had been managing Bourdain or someone like him, I would have first attacked his strong cravings for sweet and starchy food and his other symptoms with a combination of drugs and supplements. I would have considered using low dose Adderall XR, Wellbutrin XL or XR, or Ritalin plus a low dose of Celexa or Lexapro. The symptoms of CARB syndrome come from low levels of the key neurotransmitters dopamine, norepinephrine and serotonin. We know that these combinations of drugs will enhance all three key neurotransmitters, at least for a period of time, reducing the hallmark symptoms of the disease. You can’t obtain these drugs without a proper diagnosis from a licensed health care provider, so I recommend that you read extensively about depression, bipolar disorder II, ADHD, PTSD and similar conditions. If you have significant CARB syndrome as Bourdain likely had, you will have symptoms that qualify you for one or more of these traditional diagnostic categories. Any physician can legitimately prescribe these drugs for you without any knowledge of the CARB syndrome concept because they will be using the traditional labels that fall under the CARB syndrome umbrella.
Don’t pretend you have symptoms that you don’t really have, as that could be dangerous. From what I read about Bourdain, he likely could have qualified for any of the above diagnoses. Tell your physician that you tend to be sensitive to medications, so you want to start with very low doses of medications. That’s because once you throw in neurotransmitter precursors, you won’t need higher doses of drugs because precursors supercharge the effects of the medications. Keep going back to your PCP with appropriate symptoms until he or she stumbles on one of the combinations listed above. When it comes to dose, let your symptoms be your guide. All of these drugs are quite safe, especially when used in the low doses that I am recommending.
Jump Start Your Brain
If someone has advanced CARB syndrome, the medications are more or less to “jump start” their brain so they can comply with the lifestyle changes they need to make. If someone is moody, irritable, forgetful and sleep deprived with poor impulse control, it’s unlikely they will remember the dozen things they will need to do to regain their health. Once their brain function kicks in from the combination of medications and precursor supplements, compliance is much, much easier. Then I slowly taper them off the medications and leave them on the supplements long term. My friend Julia Ross is one of the world’s experts on how to use precursors and amino acids to improve brain function and I highly recommend reading one of her excellent books, especially her most recent book The Craving Cure.
The Magic Combination
I would then add a fixed precursor supplement that contains the amino acids L-tyrosine and 5-hydroxtryptophan (5 htp) in a ratio of 10 to 1 with some L-glutamine thrown in for good measure. L-tyrosine is the precursor of dopamine, epinephrine and norepinephrine and 5-htp is the precursor for serotonin, so with this combination you have all the key neurotransmitters covered. This type of product is hard to find, so I sell it on my web site as CARB-22. I recommend starting with two capsules twice a day on an empty stomach and if needed it can be increased to four capsules twice daily. Your level of cravings and other CARB syndrome symptoms should be your guide when determining the dose. The only side effect is occasional nausea that usually passes over time. Once Bourdain’s (or your) cravings were under control, I would advise abstaining from alcohol and highly processed food of any type and of course this would be much easier to do when cravings are controlled. Bourdain really needed to say, “Bye, bye hoodie, mac and cheese and Popeye’s buffet!”
Targeted Supplements—Safe, Cheap, Readily Available and Effective
Even though CARB-22 contains some L-glutamine, I often recommend taking it as a separate supplement to help extinguish those pesky cravings for sweet and starchy food. You can safely take 500-1,000 mg of L-glutamine up to 3 or 4 times per day as needed. I would have also put Bourdain on a high-quality omega 3 supplement (I like Barry Sears Omega Rx) and increased the dose until his AA/EPA ratio was between 1 and 3. (My last reading was 1.9). I would have also measured his homocysteine level and if it was above 7, I would have put him on a combination of adenosylcobalamin (a more effective B12), pyridoxal 5’ phosphate (a more active form of vitamin B6), L-methylfolate (the active form of folic acid) and trimethylglycine or TMG. I would have then titrated up the TMG until his homocysteine was below 7. Because many folks with CARB syndrome suffer from excess anxiety, I often recommend they take the supplement L-theanine 100-200 mg 2-3 times daily as needed. It comes from green tea and it is very safe and effective in my experience.
Next I would have thrown in a good all-purpose brain boosting supplement like Cognitex from Life Extension or Brain Restore from NutriDyn. To be complete, I would have measured his testosterone level and treated him if indicated. I would have also considered throwing in some nicotinamide ribosome chloride for good measure. This supplement appears to have anti-aging properties, especially when it comes to the brain.
Next I would have added the drug metformin if there was any sign of glucose intolerance (elevated hgb A1c or elevated fasting insulin or glucose) along with vitamin C 1,000 mg daily. The combination of metformin and vitamin C has been shown to improve glucose tolerance and reduce glucose spikes that occur after eating carbohydrates or protein (but not fat). We believe that it is glucose spikes that cause most of the damage to neurons leading to the disease CARB syndrome. Next I would have recommended that he take one Cinsulin capsule before any meal containing carbohydrates. It’s a concentrated form of cinnamon that has a metformin like effect and it is very cheap and safe. I buy mine at Costco. For good measure I would have also added the supplement berberine to the Cinsulin to really knock down the glucose and insulin levels.
The point I am trying to make is that in my opinion, Bourdain had a treatable disease (CARB syndrome) that ended up killing him and this terrible outcome could have easily been prevented. I have treated thousands of patients with the above approach and to the best of my knowledge none of them has committed suicide. They moved on and most of them are living or did live wonderful and highly productive lives.
When I get some free time, I should really teach physicians how to manage patients who fit the CARB syndrome pattern with the above measures, because I know they work very, very well. Unfortunately, that might take 3 lifetimes because training physicians to do something new is like training cats to fly—good luck with that!
The last three points are good advice for anyone:
- Exercise you mind and body.
- Get plenty of restful sleep.
- Maintain as many healthy relationships as possible.
In an article I read about Bourdain, he apparently exercised (jujutsu) but I don’t know much about his sleep patterns or his relationships. His work schedule likely limited his sleep to some extent and although he had many friends and social contacts, he was also described as a loner. He apparently sought help from a physician concerning his depression, but he didn’t take their advice. I can’t blame him if it was someone who didn’t understand the disease he was dealing with—CARB syndrome. I would hope his terrible story will serve as a wakeup call for the public, the scientific community and the medical profession—we simply can’t afford to miss a killer disease that is decimating our population. Even one unnecessary death is one death too many. Therefore I dedicate this blog post to the memory of Anthony Bourdain, a truly remarkable person with almost endless talents.
Why Should Anyone Listen to a Simple Country Doctor from Northern Minnesota
I understand why many folks might be skeptical about the CARB syndrome concept and my approach to treating it. After all, there are no controlled studies to support the concept. It’s somewhat sad to say that much of what we do in medicine lacks these types of definitive trials. They tend to be very difficult to perform and they are very expensive. That leave us with empirical observations to serve as our guide. Despite its many faults and limitations, empirical observations are the backbone of modern medicine. I have spent over 40 years successfully managing many thousands of patients who fit the CARB syndrome disease model with the treatments outlined above. As a physician who truly cares about his patients, this is a record that I am extremely proud of, yet my ego is flexible. If you can show me a theoretical model that gives me better results than the CARB syndrome concept, I will adopt it in a heartbeat. To date that hasn’t occurred.
