I’ve been thinking about that age-old quote from playwright George Bernard Shaw: “Youth is wasted on the Young.” Surely one of life’s most bittersweet paradoxes is that the most glorious years may have been our earliest–and yet, when our youth is all we know, we have no ability to comprehend just how special these years truly are. Only later in life, when youth is no longer ours to enjoy, do we fully appreciate how much those earlier years shaped us, made us who we are, and set the tone for the rest of our lives in sometimes startling ways. These last two weeks, we’ve been talking about a disease far from the years of youth: Alzheimer’s. Yet, while decades may separate our splendid years of childhood and young adulthood from our golden years of late-middle-age, and the inevitable aging process that occurs thereafter, it turns out these two eras of our life are not as discontinuous as they may seem. We know now that the processes responsible for Alzheimer’s begin years—even decades—before diagnosis occurs. Whether we like it or not, the state of our minds as youths, and the biological processes occurring behind those states, play a role in determining our brain’s health later in our lives. And the earlier we detect and address underlying vulnerabilities in our cognitive functioning, the more likely we are to protect and defend those critical functions throughout our lifespan, well into old age. Today, I want to tell you Shen’s story, and how we tweaked his genetic expression to help protect his brain for years to come. Youth may be wasted on the young, but chronological age is just a number. With the help of genetic testing, and actionable epigenetic modifications based upon what is learned, we can improve the likelihood that our minds will remain agile well into those twilight years!
Shen’s* Story: How Anxiety, ADHD, and Depression can Lead to a Vulnerable Brain
Shen* was an 18-year-old college freshman who was struggling mightily to survive a rigorous engineering program. Adding to his pressure were all the “tough acts to follow” in his family – a neurosurgeon, a successful entrepreneur, two prominent attorneys, and a departmental chair of physics. Poor Shen! He presented with symptoms of generalized anxiety, anxiety attacks, and ADHD, and as a result of these problems was feeling more and more depressed. Shen was receiving cognitive behavioral therapy (CBT) for these symptoms. Both Shen and his therapist reported that he was making progress, particularly in building routines in school that better enabled him to complete his assignments and stay on task. He just felt so miserable so much of the time.
In our first session, this highly likeable young man lamented how he would never live up to his family’s expectations. He said to me, “Dr. Kehr, my family operates according to ‘the Asian way of life,’ do you know what I mean?” Before I could answer, he went on with his pressured, anxious speech. “They just expect so much of me, I am already a failure because I am struggling so much in school. And I’m not sure that I want to become a professional like they insist I be. I might be happier in hospitality, or human resources – something where I can focus on making people happy. And if I become a loser in their eyes, I just know I will shame them!” He looked so sad and forlorn, and my heart went out to him.
“Shen, your therapist believes you suffer from ADHD and depression, along with a number of symptoms of anxiety. She referred you to me because she knows I utilize genetic testing, which yields a far more precise result than just prescribing medications based upon what works well for “most people” with your symptoms. And so I would like you to get a test called Mindful DNA by a company called Genomind**. It will help me learn about your genetic makeup and how it may relate to your cognitive problems and excessive anxiety. Would you agree to have your cheek swabbed?” Shen was reluctant, fearing possible privacy issues involved in genetic testing, citing China’s plan to create a “countrywide personal health information platform” that links data from local and provincial records into a national database that Beijing will mine. I reassured him with details of Genomind’s and our privacy policies.
How COMT, BDNF, and ANK3 Gene Variation can Increase Stress… and your Chances of Alzheimer’s
When I presented the results, Shen was dreading them, fearing that I would find some huge defects in how his brain worked. He was just so frightened of failure! The results revealed actionable variations: COMT Val/Val, BDNF Val/Met and ANK3 C/T. Let’s look at how each of these genes may impair cognitive functioning not only in the present but well into the futures:
COMT: If you will recall from our blog on this gene, COMT determines if you are a “worrier” or a “warrior” when it comes to managing stress in your life. While Shen may have suffered from generalized anxiety, his Val/Val variant actually suggested his anxieties were not necessarily triggered from bigger stress events—Val/Val individuals can manage those stressors with relative ease compared to individuals with different variants (especially Met/Met). However, while stress triggers may not have been an issue, the Val/Val variant on Shen’s COMT gene meant that in day-to-day life, he was equipped with less effective executive functioning skills. In other words, Shen’s anxiety was likely exacerbated by his “lower executive functioning” genetic variant.
BDNF: Shen’s BDNF variant predisposed him to low levels of Brain Derived Neurotrophic Factor, an important protein that helps your brain mitigate and manage epigenetic stressors like learned helplessness, defeat stress, inflammation, and—importantly for Shen—cognitive and emotional problems. BDNF is our brain’s fertilizer gene, and just like the nickname would suggest, the more we have of this protein, the more our brain is capable of adapting, regenerating, and thriving. BDNF restores neural connectivity, promotes healthy cognitive functioning, produces neurotransmitters, and improves memory. In the long term, a shortage of BDNF in our brains can further impair our abilities to ward off toxic stress.
ANK3: ANK3 is a gene that helps regulate your mood stability—or lack thereof. Those with a “resilient” ANK3 gene are able to “come down” quicker from emotional highs or lows we inevitably experience—their ANK3 variant biologically equips them to do so. Shen, however, possessed a “risk” ANK3 variant, which meant he, or rather his brain circuitry, was less able to come down easily from those more intense emotional experiences.
Armed with this information, I began him on a regimen of a prescription medication, Wellbutrin (bupropion) to address the COMT variant by boosting the amount of dopamine and norepinephrine in his brain’s synapses; and l-theanine to increase his BDNF levels and also increase brain dopamine; and omega 3 which both blocks excess sodium channel activity and increases BDNF. As is not uncommon, one epigenetic modifier can often help regulate two or more different genes!
Two months later Shen felt like a new man. For the first time in a year he felt hopeful that he would not end up “a loser” and disgrace his family. His therapist reported he was much more effectively executing the recommendations that she had provided him, and he was even getting up the courage to tell his parents that he might want to transfer to a university with a hotel management program!
And as for preserving and protecting Shen’s longer term prospects for healthy brain functioning, scientific research has documented that chronic stress and depression can increase one’s predisposition to developing Alzheimer’s Disease. All the more reason to address and correct these conditions while he is still young! And the joy I experience in seeing Shen become healthier and happier has an unintended side effect – it makes me feel younger too!
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*Although lessons learned from the treatment of actual patients are included in the patient stories on this website and blogsite, the historical events and facts represented have been changed to protect the identities of any real patients and to protect their confidentiality. For example, the names, ages, careers, the number and sex of their children, as well as the careers of the patients’ parents have been deliberately altered, as well as other alterations that have been made. Consequently, all characters appearing on these sites are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
**(Dr. Kehr holds no ownership interest in Genomind and receives no consulting fees)