Cognition
CASE STUDY: Cognition
SUBMITTED BY: Phil Rasmussen | M.Pharm., M.P.S., Dip. Herb. Med.; M.N.I.M.H.(UK), F.N.Z.A.M.H.
PATIENT: Female, 29 years old
INITIAL PRESENTATION:
The patient had been run down for the past 3 months since having a couple of bad drug experiences, with MDMA (Ecstasy), but also lots of alcohol over the New Year period. Had been awake all night, vomiting and feeling wired, and had been bedridden for a few days afterwards, with feelings of anxiety and unwellness.
She had taken an extra week off work to recover, but despite this, since starting work again she was still very fatigued and run down. While the anxiety and low mood she had initially experienced and grappled with for a couple of months had now abated, she was still suffering from a ‘foggy brain’ and finding it difficult to cope. Her job was a demanding one and involved lots of people interaction and high-level decision-making, and she was forgetting some important things, and not being as sharp as she normally was, when it came to interacting with colleagues and clients. This was very distressing, given the importance of her job to her sense of self and career aspirations, and the competitive nature of her workplace environment.
Her sleep had been disrupted for some time after she first became unwell, and while it had improved since, had lately reverted to being quite unsettled some nights. She was finding it difficult to get to sleep. She was concerned about her ongoing brain fog and was seeking herbal support for this, as well as to get back to better health and have more energy to exercise. She had tried a course of melatonin, but this hadn’t helped.
Physically she seemed reasonably healthy, although she had an active social life and a tendency to drink quite a lot at the weekends, and feel pretty bad the next day. She had recently had a full medical check-up including full blood and thyroid function tests with her GP, and nothing abnormal was found. Her diet was good.
Also taking a vitamin D supplement, vitamin C, and zinc drops.
HERBAL TREATMENT (200mL):
Main Mix (300mL)
Withania (Withania somnifera) 1:1 37 mL
Lemon Balm (Melissa officinalis) 1:2 30 mL
Ginkgo (Ginkgo biloba) 3:2 20 mLRosemary (Rosmarinus officinalis) 1:2 10 mL
Liquorice (Glycyrrhiza glabra) 1:1 3 mL
Dosage
8 mL twice daily, with water or juice. Shake well before dispensing.
Sleep Mix: (102ml)
Kava (Piper methysticum) 1:2 STD 70 mL
Hops (Humulus lupulus) 1:2 20 mL
Liquorice (Glycyrrhiza glabra) 1:1 12 mL
Dosage:
5-15 mL with water or juice at night. Shake well before dispensing.
ADDITIONAL TREATMENT RECOMMENDATIONS
She was advised to reduce her intake of alcohol and perhaps not commit to as many social events at the weekends until she felt better. We discussed the benefits of better sleep hygiene practices and advised her to not watch TV late into the evening, but to take a book to bed instead. Also to get back into more moderate exercise at the weekends, and consider returning to the gym, but only once or twice a week initially.
She had seen a clinical psychologist a couple of times a couple of months ago, and we discussed how returning for more sessions could be helpful, in terms of her ongoing concern and level of anxiety about her career and personal relationships.
FOLLOW-UP:
3-weeks later: She was feeling somewhat better, and her sleep had improved. She had been taking 5 mL and then 10 mL of the sleep mix at night, and had recently run out, and noticed it wasn’t so good again. Had a good session with the clinical psychologist, and had scheduled these on a fortnightly basis. She had noticed a moderate improvement in her cognitive functions at work, and her short-term memory had been better, though she still felt tired at the end of the day, and hadn’t had the energy for much exercise or the gym.
HERBAL TREATMENT
Main Mix (630 mL)
Withania (Withania somnifera) 1:1 40 mL
Lemon Balm (Melissa officinalis) 1:2 30 mL
Ginkgo (Ginkgo biloba) 3:2 25 mLLiquorice (Glycyrrhiza glabra) 1:1 5 mL
Dosage
A higher dose of 10 mL twice daily, with water or juice. Shake well before dispensing.
The Sleep Mix was also repeated, but a larger size (200 mL) was supplied.
FOLLOW-UP
Further 4 weeks later: Sleep usually good, taking the herbal sleep mixture most but not all nights. Managing to function much better at work, and felt as cognitively capable as she ever had been, during what had in fact been a particularly demanding period for her company. However, increasingly recognising just how demanding her job is, discussing this and her career also with the psychologist, and starting to reflect on the impact it was having on her health and work-life balance.
Both mixtures were repeated for the next three months, until the patient decided to travel overseas for an extended period of time.
CASE STUDY: Cognition and brain health
SUBMITTED BY: Sharlene Bennett, Naturopath and Medical Herbalist (BHSc, AdvDip Nat, AdvDip Med Herb)
PATIENT: Male, 32 years old
INITIAL PRESENTATION:
The client presents with low energy levels and feelings of fatigue associated with adrenal exhaustion. Also experiencing chronic emotional stress and poor concentration levels and memory. Due to existing sleep issues and shift work, there is a history of long hours of work and lack of sleep. Finds it hard to switch off. His daily diet typically consists of no breakfast, takeaways for lunch and dinner.
NUTRITION & LIFESTYLE RECOMMENDATIONS:
An inclusion of breakfast with whole foods protein such as poached eggs on wholegrain or sourdough toast, with a fruit smoothie or a side of fruit, like organic berries or bananas. Vit C powder 1000mg and NAC 100mg scoop.
and dinner to include a lean meat protein or nuts and seeds, such as almonds or raw cashews, walnuts with feta salad, and organic virgin olive oil or pumpkin seed oil and avocado. Take a Coenzyme Q10 and B vitamin supplement. Dinner to consist of a protein and steamed or roasted vegetables with a dessert of Greek yoghurt with organic berries or additional nuts, such as pistachios or walnuts.
Also, a mineral powder with magnesium to help alkalise the body and help the stress response and balance excessive cortisol release. This should be taken at night to help with sleep, alongside the below herbal formula.
HERBAL TREATMENT (200mL):
Adrenal Balance Herbs Blend
Rehmania Uncured Root (Rehmania glutinosa) 1:2 30 mL
Ginkgo (Gingko biloba) 3:2 30 mL
Withania Standardised Root & Leaf (Withania somnifera) 3:2 25 mL
Ginger (Zingiber officinale) 1:2 5 mL
Liquorice (Glycyrrhiza glabra) 1:1 10 mL
Daily Dosage
7.5mL twice daily. Take before breakfast and in the evening after dinner.
Sleep Well Tonic (200mL)
Skullcap (Scutellaria lateriflora) 1:2 30 mL
Californian poppy (Eschscholtzia californica) 1:2 30 mL
Valerian (Valeriana officinalis) 1:2 20 mL
Jamaican dogwood (Piscidia piscipula) 1:2 20 mL
Daily Dosage
7.5mL once daily. Take one hour before bed, and repeat if needed.
.
FOLLOW-UP:
4 weeks:
Experiencing more energy in the mornings. Starting to feel better and sleeping up to six hours instead of four hours. Eating differently, including focusing on whole foods and lean or fresh sources of protein and foods. Eating three meals daily now. Finding it challenging to include breakfast, but persisting.
8 weeks:
He is noting more energy again on waking and sleep has improved, at least eight hours daily per night.
He takes the adrenal support herbs twice daily and does not feel tired in the afternoon. Using the sleep herbs once per night now instead of twice. Beginning to enjoy three meals daily, and likes breakfast time more so. Feeling more balanced and coping better emotionally at work and home, alongside improved energy levels. Advised to continue on with the same dosage until next month’s appointment and will reassess dosage and situation once more.
CASE STUDY: Cognition
SUBMITTED BY: Katie Donnelly, Adv Dip HSc Naturopathy
PATIENT: Male, 28 years old
INITIAL PRESENTATION:
Male experiencing symptoms of brain fog and lethargy. He has noticed waning energy levels over the past two months and is feeling consistently tired. At work, he is struggling to focus and recall simple information and has found he is making mistakes more regularly. He is lacking drive.
Recent bouts of anxiety have been experienced with no known cause and are unrelated to specific events. He finds work stressful and is unhappy in his role. He has a happy home life with his long-term partner and one child, aged 8.
The client has had some digestive disturbances recently, including increased belching, bloating, and flatulence. Regular bowel movements are experienced and are well-formed. Dietary changes include increased sugar to counteract feelings of tiredness, and coffee intake increased from two coffees to three throughout the day.
Sleep has been consistent and undisturbed. He does go to bed late, between 11.30 pm to 2 am, and wakes around 8 am by alarm. This is due to the change to working from home, with later waking an option now. He has noticed worsened symptoms in relation to later bedtimes.
He has been taking a magnesium supplement for muscle spasms and has followed a strict vegan diet for the past 18 months.
HERBAL TREATMENT (200mL):
Herbal Blend (200mL)
Reishi (Ganoderma lucidum) 1:2 60 mL
Withania (Withania somnifera) 1:2 60 mL
Ginkgo (Ginkgo biloba) 3:2 60 mL
American ginseng (Panax quinquefolium) 1:2 20 mL
Ginger (Zingiber officinale) 1:2 10 mL
Total 210 mL
Daily Dosage
7.5mL in the morning and 7.5mL in the afternoon.
ADDITIONAL TREATMENT RECOMMENDATIONS
Change is difficult for the client, so initial recommendations have been kept to a minimum to ensure it is achievable. Primary focus is to improve sleep patterns and introduce the daily herbal formula.
Recommended improved sleep hygiene:
- Set a regular bedtime of 10 pm. This allows downtime in the evening after work but still enables sufficient sleep. Doing this daily will help to nurture new sleep patterns.
- Avoid blue screen light within an hour of bedtime. Choose a physical book to read, or try and have some meditation time or listen to gentle music.
- When the weather is cooler, have a warm bath in the evening with Epsom salts to aid with sleep.
- Exercise in the afternoon to get the body moving and encourage sleep in the evening.
- Reduce intake of sugars and caffeine after midday and avoid completely within 2 hours of bedtime.
Dietary suggestions:
- Reduce coffee intake from 3 daily down to 2. This will help with anxiety and circadian rhythms, and prevent mineral loss. Slow change is important.
- Try to incorporate fruits as a snack, including berries, pineapple, oranges, and apples to provide some sugars balanced with fibre and nutrients and reduce the need to grab for sugary options as often.
- Consider blood testing for iron and B12 levels. May require supplementation.
FOLLOW-UP – After 2 weeks
The client has been taking the herbal formula fairly regularly but has missed the occasional day. He has said that it might be helping, with improved clarity with work and focus, but he still feels tired. Has reduced coffee and sugar and says he is feeling a bit better and bloating has reduced.
Sleep suggestions have not been followed as the client had a deadline that was highly stressful. Advised that we will revisit sleep goals and introduce a formula for the evening, to aid in routine.
Night Herbal Blend
Passionflower (Passiflora incarnata) 1:2 40 mL
Hops (Humulus lupulus) 1:2 40 mL
Valerian (Valeriana offincalis) 1:2 40 mL
Green Oats (Avena sativa) 1:2 40 mL
Lemon balm (Melissa officinalis) 1:2 40 mL
Total 200 mL
Daily Dosage
7.5mL in the evening, 2 hours before bed. 7.5mL again just before sleep.
Stress-management suggestions:
- Take regular breaks during the work day. Get outside, move around, stretch, and try to get some direct sunlight.
- Poor sleep will worsen the stress response, so focus on sleep is really important.
- Breathing exercises can help to regulate the stress response.
- Try to cut back on coffee from 2 cups to 1.
- Continue with daytime herbal formula also for stress and cognitive support.
FOLLOW-UP - After 4 weeks
The client has been taking the night formula and has made notable progress with sleep patterns. He is feeling more positive and changes are noticeable in his eyes – reduced bags and redness- and more colour in his face.
He had a big deadline to get through last week and says he feels ‘free’ from that burden now. Work/life balance has been discussed and the importance of taking time for himself each day. Eating regular, nutrient-dense foods and getting sufficient sleep is crucial to managing this.
He has had good success with both herbal formulas, helping him to get into a routine. Does not enjoy the flavour but has been diluting it with water. He feels as though he can take on further changes now and feels more optimistic about his ability to maintain the routine.
Additional Dietary Support:
- Aim to have a diet of whole foods. Convenience vegan options are full of additives, just like any highly processed foods are.
- Taking a day to meal prep will allow thoughtful choices and quality meals on hand.
- Include quality protein sources to maintain energy levels. This may include lentils, nuts, tempeh, quinoa, buckwheat, brown rice. When paired with a hearty sauce and plenty of vegetables - like leafy greens and quality starches like kumara, pumpkin, potato, beetroot and sweetcorn - this will make a substantial meal that will help with maintaining energy levels and focus.
- Include bitters in the diet – rocket, asparagus, vinegarettes, etc – to help stimulate bile flow for digestion.
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