This week Dr. Audrey Nath speaks with Dr. Reeta Achari, a neurologist in private practice and clinical associate professor in the department of physical medicine and rehabilitation at McGovern Medical School in Houston. Dr. Achari shares her passion for nutritional neurology and discusses how foundational vitamins, minerals, and whole foods affect the brain.
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- Tasting Health
- Guard Against Stroke with these Four Recipes
- Eating Ultra-Processed Foods May Increase Risk of Dementia
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Episode Transcript
Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.
Dr. Nath:
And I'm Dr. Audrey Nath.
Dr. Correa:
This is the Brain & Life podcast.
Dr. Nath:
This week, Daniel, we're talking about, I think, our combined favorite topic, which is food.
Dr. Correa:
Yes.
Dr. Nath:
Nutritional neurology. So first off, in order to get Daniel and I ready and in the nutrition spirit, he and I both made the same recipe to try today, which is when featured in Brain & Life Magazine in the article Guard Against Stroke With These 4 Recipes, the link will be in the show notes. Daniel, how did you like it?
Dr. Correa:
I really liked it because I had an opportunity to mix in lots of different veggies.
Dr. Nath:
We should say what this is, shouldn't we? It's black bean and corn along with cilantro and avocado and tomatoes. It was really good. I liked it.
Dr. Correa:
In a way, it was almost like a burrito salad without the rice.
Dr. Nath:
Yeah, pretty much.
Dr. Correa:
And I like that it highlights lots of veggies. You get lots of good protein and really, it fits everything that we talk about. People mention things like the Mediterranean diet, but so many people, when they think of those things, they limit it to thinking, "Oh, what do people eat in the Mediterranean?"
Dr. Nath:
Yeah. I don't even know what that means. Daniel, what do you even mean by that?
Dr. Correa:
It's a focus mainly on plant-based oils, some inclusion of fish, lots of veggies and whole grain foods, not processed foods. And that's come out of the science that keeps suggesting this term. But we don't have to limit it to just thinking, "Oh, what do people eat in Italy and Greece?" We can think of it as lots of places in the world that eat grains, beans, lots of veggies, rice, and include some fish, and then only occasionally having a lot of the other meats.
Dr. Nath:
It's aspirational. But I would say a recipe like this was easy enough that I could repeat it very easily in my weekly menu. So this week to talk about nutritional neurology, I caught up with neurologist and fellow Houstonian, Reeta Achari, and she talks about all sorts of really interesting nutritional deficiencies that she's diagnosed in her neurology patients. Daniel, she caught a case of scurvy in a patient.
Dr. Correa:
Wow. Scurvy like sailors crossing the ocean of starving for fruit. Okay.
Dr. Nath:
Yes. Scurvy, right? So people way back in the day when they were traveling on boats didn't bring citrus fruit with them. They started to develop this disease with bleeding gums and neuropathy, and then they figured out to bring some lemons and limes and have that on the trip to prevent scurvy because of the vitamin C deficiency. And she saw this in her clinic and she talks about that and several other really interesting nutritional deficiencies, which just points out that nutrition is so important for every single one of us in and outside of the neurology clinic.
Dr. Correa:
It'll be really interesting to hear some of her perspectives of just how to make sure in our regular diets and nowadays we're getting all the things we need.
Dr. Nath:
That's right. Today I am joined by a neurologist and friend Reeta Achari. She is passionate about what I think is the most fun topic possible, nutritional neurology. It all started after she saw a patient after patient who had a neurological condition that could be traced back to a nutritional deficiency or even toxic doses of undisclosed ingredients in other products. She is also a talented cook and shares nutritious, tasty recipes in her website Tasting Health, and she practices neurology at her integrated neurology clinic here in Houston, Texas. Welcome to the podcast, Reeta Achari.
Dr. Achari:
Oh, Audrey, thank you so much for having me here. I'm just delighted and honored to be here.
Dr. Nath:
I love that you do what you do. As neurologists, I feel like in general, most of us don't spend a lot of time thinking about nutrition and supplements and vitamins and how that can affect our patients. And I want to hear in your own words, how did this all start for you? How did you start noticing these things and really paying attention?
Dr. Achari:
Even though in contemporary neurology, what we do today, we don't think about nutrition as much. Neurologists have been integrated with nutrition for as long as neurology has been around. So the first vitamin, the first B vitamin, which is why it's called B1, Thiamin, was discovered as a consequence or the reason for Beriberi, and of course Beriberi's presentation is a neurologic one. So from weakness to numbness and tingling to difficulty thinking,
Dr. Nath:
You're referring to Beriberi, the condition. It's spelled B-E-R-I-B-E-R-I in case anyone wants to look it up. And it's a multi-system condition, but it does affect nerves and cause neuropathy as a result of decreased levels of vitamin B1.
Dr. Achari:
Correct. And describing that condition led to the discovery of vitamin B1, thiamin. So we as neurologists have been completely in the game of nutrition from early on. Even if you look at our textbooks, I was looking at a textbook by Victor and Adams.
Dr. Nath:
The big one.
Dr. Achari:
Which is what my residency used, and now chapter 40 is the Neurologic Consequences of Nutritional Disorders. And that chapter has grown and grown and grown and grown, and you would think it would be other way around, but it really isn't. So we know that some of the ancient diseases can have neurologic manifestation. So whether it's Beriberi, an old disease, not so old anymore, actually it's coming back, a vitamin B1 or thiamin deficiency. We know that folic acid deficiency used to cause difficulty in the formation of spinal cords in infants. So the March of Dimes, we gave a lot to folic acid. And guess what? Now we don't have as many people with spina bifida throughout the world.
Dr. Nath:
That's right, and it's in food here in the US. It's fortified in cereals and things to try to make sure we get it.
Dr. Achari:
Yes, we have fortified foods and that is supposed to help us. And then even vitamin B12. We know B12 deficiency for a neurologist can be one of the treatable causes of memory disorders. So it's really important to look for that. And then we know it can cause problems with a spinal cord, a fancy spinal cord disorder, subacute combined degeneration, which can cause numbness and tingling in our feet, in our hands, and some difficulty with balance. These are things that our nutrition is intimately tied to neurologic disorders. So for me, I mean you talked about that I had gotten to this in sort of an interesting way. May I tell you about the first patient that sort of got me involved in thinking this way?
Dr. Nath:
Yes. How did this all start?
Dr. Achari:
As I've said, we've always looked for B12 and folic acid in most neurologic evaluations, whether it's for nerve or for nerve disorders or for memory disorders. We've always included that. We started including a little bit of vitamin D in our evaluations, but that's sort of where it stopped. And then I had a patient, I guess it was about 15 years ago, a wonderful man who was a prominent attorney in town who had spent a year of his life going to multiple medical centers and academic institutions because he was experiencing difficulty thinking. He just could not concentrate. He could not keep up with what was going on in trial when he was trying to read things. He couldn't understand what was going on, and he had numbness and tingling. And the numbness and tingling was strange, would come and go. It would bother him. He felt he was weak from time to time and no one could find anything wrong with him.
So he had MRIs from the top of his brain to the bottom of his spine. He had spinal fluid done. So lumbar puncture, he had muscle biopsies and nerve biopsies and seen by rheumatological people and finally ended up with a psychiatrist. Because I like interesting cases, somehow he ended up in my office and he came with three banker's boxes of records and he had seen everybody. And I was a relatively young neurologist still at that time. And he said, "Well, this is what's going on." And I thought, okay, I'm looking at these boxes of records. And I said, "Well, I've got to come up with something smart." But at least I can buy some time and tell him I'm going to call you tomorrow after I look at all this.
And I stayed up all night looking at those records and all the things that needed to be done that I knew about at that moment had been done. So I thought, well, I have to sound a little smart, so maybe I can ask him if he has some weird exposure to something. So I called him up the next morning and I said, "Had you done anything different before these symptoms started? Did you all of a sudden start cave diving? Did you start welding in a warehouse where there may have been toxic chemicals in the ground?" I asked him all these questions and he said, "No, no, no, no, I didn't do any of those things." I said, "Okay, well, let me keep thinking." I hung up the phone.
He called me back five minutes later and he said, "Dr. Achari, I did one thing different." And I said, "What was that?" And he said, "I started a gluten-free diet." And I said, "When did you do this?" He said, "I started this about six months before my symptoms started." And I thought, "Well, that's very interesting." So I checked a vitamin B1 level, and sure enough, his B1 was extremely low. And when I started talking to him, I think what would happen, because his symptoms would come and go, he would say he would have cheat days. So on the weekends he would eat a little bit of whole grain bread and he probably would get a little bit better and then get worse again.
Dr. Nath:
That's so interesting.
Dr. Achari:
Yeah. What I tell all my patients is how you feed yourself today determines how you feel and function tomorrow. We don't always think about what we did two days ago affecting us today. Anyway, this gentleman, I gave him B1 injections, set him up taking B1 pills, taught him how to make bread, and got him a good source of flour, really well milled good flour from Utah.
Dr. Nath:
That means you knew how to make bread.
Dr. Achari:
I knew how to make bread. So I taught him a very simple method to make bread and within about eight weeks, he was restored to normal. He went back to work. He baked bread for probably about a year. I got a loaf of bread a month from him, which was absolutely wonderful. And he forgot about me, which is what we want from all of our patients, that they are well and forget that they need you. That was my first thing. I started now including vitamin B1 in my evaluation.
And then the second case, which really was a shocker to me, was a young lady who had epilepsy and she would stop taking her medications and have seizures. She's 22 years old at that time, and she was convinced that the seizure medicine she was taking was giving her abdominal pain and joint pain and a rash. And I said, "Well, okay, so my fellowship training is in epilepsy." So someone said, "Well, go see her and see if you can sort this out." And she was taking the same generic from the same manufacturer, nothing had changed and her levels were okay. I'm looking at her and she said, "I'm telling you I have joint pain, abdominal pain, and this funny rash." And I'm looking at her, and all of a sudden, I said, "Well, do your gums bleed?" She said, "Yes." And I said, "This is very strange." Anyway, I ordered more levels and things and something in the back of my mind said, order a vitamin C level because-
Dr. Nath:
Oh, the bleeding gums.
Dr. Achari:
She had symptoms of scurvy. And I said, "I don't even know how to order a vitamin C level." I had to call the lab, said, "How do I do this?" They'd never done it. So we figured out how to get the validated level. A couple of days go by, the level comes back and it's zero. And I thought, "I've done this incorrectly. I've ordered the wrong thing." I call the lab. So the lab technologist told me, "Dr. Achari, it's a valid level. We checked all of our own levels because we couldn't believe this either." I brought her in the next day and explained to her that the cause of her symptoms were not her anti-seizure medicine, but the fact that she had no vitamin C in her system. So I was curious, why would someone have no vitamin C in their system? Well, she had graduated from college, was living with a couple of roommates.
She was working in a bar at night, so she didn't eat during the day and she would eat canned vegetable soup, which has zero vitamin C. Even though there's pictures of peas and carrots, there's no vitamin C in canned soup.
Dr. Nath:
Yeah, there are pictures of carrots on there.
Dr. Achari:
That's right. That's right. We all think it's vegetable soup, so we should get some vitamin C.
Dr. Nath:
Yeah, like I'm good. Yeah.
Dr. Achari:
I had to do a field trip and I turned around all the cans of soup to see if vitamin C is in there. There's no vitamin C in there. So that's what she was eating. She'd only been doing this for about six weeks. But as we know from the studies on scurvy in sailors, it does not take very long for a vitamin C deficiency and the symptoms of scurvy to start. And that's what was going on with her. So I never thought in my lifetime that I would see in Houston, Texas vitamin C deficiency presenting as scurvy, the disease of sailors and pirates. But it does present here. And since then, I've got probably least 600 cases.
Dr. Nath:
What?
Dr. Achari:
Yes.
Dr. Nath:
My goodness.
Dr. Achari:
I had 600 cases, and this is because our recommendations are that you eat six to eight servings cup fulls of fresh fruits and vegetables a day. I don't know about you, but I certainly don't get that. And I try to eat well.
Dr. Nath:
That's hard.
Dr. Achari:
On the days when we have donuts in the office, which does happen, I take an extra vitamin C, so you have to know this. But she was the reason that now I included vitamin C, vitamin D and vertigo. And then the other thing I started testing was there is a literature a long time that when we give vitamin B2 riboflavin to patients with migraine that, for many people, their migraine improves.
Dr. Nath:
Absolutely. There's literature on this. Yes.
Dr. Achari:
There's a lot of good literature on this and it's helpful because for a lot of people, you may not have to take strong pharmaceuticals. You may be able to take magnesium and some riboflavin, then your headache gets better. I looked at those studies and no one had actually done vitamin B2 levels on anybody, so I started doing vitamin B2 levels. You can check riboflavin level on my migraine patients. What's interesting is that I would say about 60% of them do have low vitamin B2 levels, and those are the ones that respond really well to riboflavin therapy.
Dr. Nath:
You should publish this. I know you have a lot going on, but in your free time. That's incredible.
Dr. Achari:
So these are simple things that we can do as neurologists. We do have to think about them. And the nice thing is that you can check these levels quantitatively. Nutritional research is difficult. Very often it's hard to control people's diets and keep everything the same. But I like as a scientist, as a neurologist, trying to understand each individual's levels and then giving them back only the ones that they need. Some people don't need everything. They don't need a multivitamin. They just need the ones that they're low in. But that's how I got involved in doing what I'm doing, which is looking at nutritional levels and how they relate to neurologic dysfunction.
Dr. Nath:
I'm totally with you on trying to personalize things for people and give back what they need. Along those lines, there are sometimes people who will take large multivitamins that have a lot of things in them, or even multiple different supplements that some of them may be doubling up on the same nutrient and can have toxic levels of certain vitamins such as vitamin B6, or pyridoxine, which can cause neuropathy symptoms as well, which I'm sure you have seen.
Dr. Achari:
Yes. In fact, I just saw a patient yesterday. She is a patient who I had seen in the past for trigeminal neuralgia. She actually had surgery, she was fine. That was five years ago, and she came back in with severe neuralgic pain in her feet, and then her greater occipital nerve on the left side, the same side as her scar, she thought, "Oh my god, is something happening again?"
Dr. Nath:
Oh, wow.
Dr. Achari:
She having heard me talk about this before... Actually, her husband's a doctor. So she had her vitamin B6 level done and it was 90, so the upper range of normal is 22.
Dr. Nath:
Wow. That's a lot.
Dr. Achari:
[inaudible 00:18:14]. And she got the level back the day she came to see me and she said, "Oh wow, I've poisoned myself." And that is exactly right.
Dr. Nath:
It happens. Yeah. For sure.
Dr. Achari:
It happens. We don't think about it, but we do as neurologists very often with painful nerves, we get fancy. We do EMGs and we call things autonomic this or autoimmune something, and those things are possible. But sometimes if we just go for the low hanging fruit that's reversible, which is nutritional deficiency or hypervitaminosis or micronutrient toxicity can also cause these problems. So we should look for them. They're easy to look for and people feel so much better. But yes, you're absolutely right. Getting a personalized regimen is important. We all have different diets. Some of us are vegetarian, some of us have a low cholesterol diet, so we're trying not to eat eggs and meat and full fat dairy. People require low carbohydrates with diabetes.
Dr. Nath:
Yeah. For different reasons. Exactly. Yeah.
Dr. Achari:
For different reasons. So each individual not only needs a diet that is personalized for them, their nutritional needs are different and need to be checked. And in this country now, people say things like, "Well, I'm eating very healthy and I'm eating clean." I never understand what that means exactly. So I am in the habit of asking exactly what they had for breakfast.
Dr. Nath:
Yeah, because that can mean so many different things, eating clean to different people. Absolutely.
Dr. Achari:
It can. And I find that there are people who are eating smoothies, but they're putting frozen berries into their smoothie, and the reason that they're not getting any vitamin C from those frozen berries... I'm coming back to vitamin C. Vitamin C declines rapidly as you pick the leaf or the fruit or the vegetable off the plant. The vitamin C starts to degrade. If you chill it, it degrades even more quickly. If you freeze it, it's gone.
Dr. Nath:
I didn't know that. I love my frozen berries. Good to know.
Dr. Achari:
Well, it's good. So my thing is always add something fresh, right? I love frozen dumplings, and on a night when I'm working really late, there'll be some frozen dumplings but we always add something fresh to that. So some sliced cucumber, radish, or something, but you can do quite a bit to try to help.
Dr. Nath:
In talking about how there can be deficiencies as well as toxicities from food, can you tell us a little bit about ingredients that can come up in other things in our daily lives that we might not even be aware of?
Dr. Achari:
Anything that we are consuming that does not look like food has been synthesized and powders of all kinds. So pre-workout powders, post-workout powders, energy drinks, can have substances in them while "natural" may be harmful to us. And then I'm going to speak just about THC and CBD and gummies, which seem to be everywhere these days. So people use them and they're considered natural. We give them to our pets, we give them to our children, and sometimes we give them to our aging parents to help them sleep or if they have pain. But that plant, the cannabis plant is a detoxifier for the soil. So that plant actually preferentially takes up heavy metals from the soil. So arsenic, molybdenum, and then selenium, which is necessary in the human body. Over a hundred reactions in the body requires selenium. If you have too little, any deficiency is not good for you, but selenium toxicity can also cause for neurologists a painful peripheral neuropathy. So painful nerves. It can cause muscle weakness. It can cause swelling in the brain.
And most recently, and I have never seen this, but I'm starting to see this, I now have three cases, but one person whose selenium was almost a hundred times the upper range of normal, and she is suffering from severe, painful neuropathy. Again, a case where she's been to many places, has suffered from this for five years, and I just happened to look for it because it's part of my nutritional panel that I do for people, and I had never seen this in anyone. I had to look up myself what selenium toxicity was. And lo and behold, it can cause neurologic problems, the exact ones that she had. So we looked at all of her supplements. There was no selenium in anything, but she vapes a particular THC. We are now going to get that checked so we can confirm that that's really where it's coming from.
So this is fun for me because it's detective work. Neurologists are the detectives. We're the Sherlock Homes of Medicine and I love that. So there are lots of things in powders and shakes and drinks that we don't really know all about. I'm a big proponent of eating whole foods that you sort of prepare yourself as much as you can.
Dr. Nath:
So basically, I need to cook more, and then you just need to tell me what to cook. Can I find all that on your website? Tasting-health.com?
Dr. Achari:
You can find some recipes on tasting-health.com. I'm hoping to post more, but I love the fact that I'm giving out recipes for people instead of writing prescriptions. It's been the joy of my life. Again, moving towards prevention. We have lots of neurologic illnesses that we're not getting to cures for. Some we are, which is delightful, but I use the river metaphor, which is we pull people out of the water when they're drowning, when they're really sick and resuscitate them and give them lots of medications. I really would love it if we as physicians, and even as neurologists went upstream, kept them from diving in and if you're me, invite them to a beautiful fresh picnic under a cool tree. That would be my hope.
Dr. Nath:
That they make their right bread for them and they send you a loaf every month until they feel better. That's the ideal.
Dr. Achari:
It's the ideal, and I think that there's just a lot that can be done very simply. We know these are the things that we're supposed to do, but then putting them to practice, we need some help from our doctors, and I hope in the future to teach our colleagues how to do some of these things simply so they can take them to their patients.
Dr. Nath:
Thank you so much for talking to us about this, and kind of like you said, some of these diagnoses were things that you had to really pull out of the back of your mind to put them in the front of our minds for both neurologists and our patients. Thank you so much for joining us.
Dr. Achari:
Thank you so much, Audrey, for having me and for allowing me this opportunity to share this information with your lovely audience.
Dr. Correa:
Thank you again for joining us on the Brain & Life podcast. Follow and subscribe to this podcast so that you don't miss our weekly episodes. You can also sign up to receive the Brain & Life Magazine for free at brainandlife.org.
Dr. Nath:
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Dr. Nath:
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