Beyond Medica on: Holis c Treatment for Children and Youth with Mental Health Challenges
{Food and Func onal } Medicine
Natalie Sadler, MD Children’s Mental Health Summit September 28-‐29, 2012 Background for Change
Holis c View: Body, Mind, Spirit of pa ent Undergrad: Math major, Nutri on minor Func onal Medicine perspec ve Natural curiosity as to why things happen Events that led me to think differently and look for underlying causes: • 1983 Dean of Medical School • 1987 Residency -‐ lead poisoning causing psychosis – Thyroid, B6, Folic acid UNC Dwight Evans MD • 2001 Pt asked that I watch TV show 20/20 on SAMe • 2001 New pt requested an alterna ve, nutri onal approach to her treatment. Abram Hoffer MD spoke at UNC e Integra ve Medicin Conference Sept 2001. Holis c Evalua on
• Psychiatric evalua on including religion, spirituality, abuse, vitamins, diet, food allergies/sensi vi es. • Symptom check lists for thyroid, adrenals, yeast/Candida, sugar metabolism, neurotransmi ers, vitamin deficiencies, autonomic nervous system/sympathe c/parasympathe c. • Sensory Profile Ques onnaire for sensi vity to light, sound, touch, taste and smell (sensory integra on). • Func onal Acuity Contrast Test (FACT) eye test for essen al fa y acids in the re na. DHA needed to see shades of gray. • Func onal Medicine Tes ng for biomedical factors to determine nutrient imbalances and metabolic dysfunc on Holis c Treatment
• Bringing the nutrient imbalances back into balance. • Address diet changes, sleep and exercise to sustain good health. • Iden fying the underlying psychological issues ing and work to resolve them using conven onal psychotherapy and alterna ve therapies. • Learning good coping skills to handle life and stress: Mindfulness, Heartmath, yoga • Address any sensory integra on and/or autonomic nervous system dysfunc on. A Holis c Approach to Mental Health Challenges in Children and Youth What a child eats makes a difference in their mental health. Epigene cs, gene expression, is a new way to look at mental health issues. Func onal medicine lab may tes ng be helpful in determining metabolic malfunc on and nutrient imbalances that underlie mental health issues. A Holis c Approach to Mental Health Challenges in Children and Youth
What a child eats makes a difference in their mental health. What a Child Eats…
Liu,et al, “ Malnutri on at Age 3 Years and Externalizing r Behavio Problems at Ages 8, 11, and 17 Years” Am J Psychiatry 161:2005-‐2013, November 2004 The more indicators of malnutri on there at age 3 were, the greater the an social : behavior •41% increase in aggression at age 8. •51% increase in violent and an social ge behaviors at a 17. What a Child Eats…
Bouchard PhD, Maryse, et al, A en on-‐Deficit/Hyperac vity Disorder and Urinary Metabolites of Organophosphate Pes cides Pediatrics 2010; 125:6 e1270-‐e1277 Children with organophosphates in their urine higher than the median were twice as likely to have ADHD.
Increased Risk of ADHD Associated With Early s, Exposure to Pes cide PCBs JAMA. 2010;304(1):27-‐28. Children exposed to organophosphates from fruits and vegetables had higher risk of developing ADHD. A good reason for organic fruits and vegetables! What a Child Eats…
Anita S. Wells, Altera ons et al, in mood a er changing to a low-‐fat diet. Bri sh Journal of Nutri on (1998), 79, 23-‐30 23 Need for good fats in diet: •Lowering dietary fat content from 41 to 25 % of energy may have adverse effects on mood in 10 men, 10 women age 20-‐ 37yrs. A er 1 month anger/hos lity significantly increased, tension/anxiety stayed unchanged. Those on the higher fat diet showed decrease in anger/hos lity and tension/anxiety. What a Child Eats…
Jacka PhD,Felice, et al, Associa on of Western and Tradi onal Diets ession with Depr and Anxiety in Women, Am J Psychiatry 2010;167:305-‐311 •Study of habitual diet pa erns of 1046 women in Australia ages 20 -‐93 as rela ng to mental . illness •Tradi onal Diet: vegetables, fruit, beef, lamb, fish, whole grains •Western Diet: processed or fried foods, processed meats, refined flour products, sugary products, flavored milk drinks and beer •Modern Diet: fruits, salads, fish, tofu, beans, yogurt, red wine What a Child Eats…
Jacka PhD,Felice, et al, Associa on of Western and Tradi onal Diets ession with Depr and Anxiety in Women, Am J Psychiatry 2010;167:305-‐311 Results: •Tradi onal Diet: less chance of having depression, dysthymia and anxiety, lower overall psychological symptoms •Western Diet: high correla on with overall psychological symptoms •Modern Diet: slight correla on with anxiety and depression Associa on between habitual diet quality and high-‐ prevalance mental disorders What a Child Eats…
Jacka PhD,Felice, Associa on between diet quality and depressed n mood i Adolescents: Results from the Australian Healthy Neighborhood Study ,Australian and New Zealand Journal of Psychiatry, 2010, 44: 435-‐442 •Study examined 7114 adolescents age 10-‐14 for diet quality and depression – Followed Dietary Guidelines for Children and Adolescents in Australia and recognized as important components of a healthy diet. •Conclusion: Low intake of nutrient-‐dense foods and/or high intake of high energy, nutrient-‐poor foods increase the likelihood of depression in adolescents. The poorer the diet quality, the higher the risk for depression What a Child Eats…
Jacka PhD, Felicia, A et all, Perspec ve Study in Diet Quality and in Mental Health Adolescents, PLoS ONE, Sept 22, 2011 •Three quarters of life me psychiatric disorders emerge in adolescence or early adulthood, and that a recent na onal survey showed more than 22% of adolescents aged 13 to 18 years had already experienced a clinically significant mental health problem. •2054 Australian adolescents aged 11 to 18 years at baseline who were par cipants in a project known as It’s Your Move, aimed to increase the capacity of schools to promote healthy ea ng and physical ac vity. Assessed in 2005 and 2007. What a Child Eats…
Jacka PhD, Felicia, A et all, Perspec ve Study in Diet Quality and in Mental Health Adolescents, PLoS ONE, Sept 22, 2011 •A healthy diet was defined as one that included fruit and vegetables as core food groups and included both 2 or more servings of fruit per day and 4 or getables, more servings of ve as well as general avoidance of processed including foods chips, fried foods, chocolate, sweets, and ice cream. •An unhealthy diet was high in snack ds. and processed foo What a Child Eats…
Jacka PhD, Felicia, A et all, Perspec ve Study in Diet Quality and in Mental Health Adolescents, PLoS ONE, Sept 22, 2011 •The inves gators found higher that healthy diet scores at baseline predicted higher (be er) Pediatric Quality of Life Inventory scores at follow-‐up, whereas higher unhealthy baseline scores predicted poorer mental health. •Adolescents who improved the quality of their diets also experienced improved mental . health In contrast, those whose dietary quality deteriorated experience a worsening of their mental health status. What a Child Eats…
“We know that diet quality has a real impact on your immune system and oxida ve affects stress. It gene expression, and it has a potent impact on the neurotrophic factors, including brain-‐derived neurotrophic factor, which we know are par cularly relevant in psychiatric illness. We think it is plausible that through dietary change we can modulate these biologic factors and, over me, modulate the risk for depression and anxiety.” Felica Jacka, PhD Medscape Medical News Oct 14, 2011 What a Child Eats…
Growing crops in healthy soils results in food products that offer healthy nutrients. • Soil that has been managed organically has more microorganisms. Hader Y. “ The role of organic ma er in the introduc on of biofer lizers and biocontrol agents to soil.” In: Chen Y, Avnimelech Y, eds. The Role of Organic Ma er in Modern Weatherhand Farm Agriculture. Boston: Mar nus Nijhoff Publishers, photo by Elizabeth Gibbs 1986:169-‐180.; Henis Y. “Soil microorganisms, soil organic ma er lity. and soil fer ” In: Chen Y, Avnimelech The Y, eds. Role of Organic Ma er in Modern Agriculture. Boston: Mar nus Nijhoff Publishers, 1986:29-‐54. • The presence of these microorganisms at least par ally explains the trend showing a higher mineral content in organic crops. What a Child Eats… What a Child Eats… What a Child Eats…
Recommenda ons: Organic, Biodynamic, Permaculture, Chemical-‐free, Seasonal fruits and vegetables
Castle Maine Farm at the Carrboro Farmer’s Market photo by Debbie Roos What a Child Eats…
Recommenda ons: Eggs from free-‐range chickens
Standing guard at Fickle Creek Farm photo by Roland McReynolds What a Child Eats…
Conven onal vs. Grass-‐fed Beef Data from: J Animal Sci (1993) 71(8):2079-‐88. What a Child Eats…
Good fats in local, grass-‐fed dairy Dhiman, T. R., Anand G. R. , et al. (1999). "Conjugated linoleic acid content of milk from cows fed different J diets." Dairy Sci 82(10): 2146-‐56. What a Child Eats…
Recommenda ons: Grass-fed, pasture-raised beef, lamb, pork, chickens, turkeys
Baldwin Family Farm photo by Elier Amy What a Child Eats…
Recommenda ons: Good oils: Organic extra virgin olive oil, coconut oil, organic bu er, ghee, lard Nuts and Seeds (soaked and roasted) Fresh herbs and spices for seasoning Raw honey as a sweetener Bee photo by Debbie Roos Lactofermented vegetables Soak and sprout whole grains What a Child Eats…
Recommenda ons: Eat food as it comes from the farm Nutri ve dense Local: where you know your farmer, farmer’s market, CSA (Community Supported Agriculture) Perrywinkle Farm photo by Debbie Roos Clinical Case 1
• 5 year old boy with high func oning ental pervasive developm delays referred by occupa onal therapist. • Diet was processed to OK. • Mom agreed to change his diet to Weston A Price/Sally Fallon Nourishing Tradi ons, “Organic food as it comes from the farm diet”, lactofermented vegetables. He kept working with OT. • One year later he had no symptoms of delay according to OT. A Holis c Approach to Mental Health Challenges in Children and Youth
Epigene cs, gene expression, is a new way to look at mental health issues. Epigeni cs: gene expression
Walsh, WJ PhD, Nutrient Power: Heal Your Brain Chemistry and Heal Your Skyhorse Brain, Publishing: New York (2012) p. 3-‐5. Epigene cs is the study of heritable changes in gene expression that do not alter the gene c code. Example in Mental Health: •Neurotransmi er ac vity at synapse of nerve cells is predominately reuptake facilitated by transporter proteins. Number of transporters has a more dominate effect than the amount of neurotransmi ers. Ne ers Atlas of Human Neuroscience Epigeni cs: gene expression
Transporters are produced gene c by expression, the process by which informa on in a gene is used to produce a protein. The rate of produc on is enhanced by certain nutrients and inhibited by others. Methyla on ( CH3 ) switches off the genes that produce neurotransmi er transporters. Net result: Undermethylated persons have reduced serotonin ac vity and a tendency for depression. Overmethylated persons have excessive dopamine ac vity and a Ne ers Atlas of Human Neuroscience tendency for anxiety and paranoid schizophrenia. Epigeni cs: gene expression
Nutri on Against Disease and Biochemical Individuality by Roger Williams PhD Biochemical Individuality Roger Williams, PhD biochemist at the University of Texas (1939-‐1986) discovered that actual op mal brain levels of natural brain chemicals can differ widely from person to person. Williams (wearing glasses) and Pauling 1974 Epigeni cs: gene expression
Walsh, WJ PhD, Nutrient Power: Heal Your Brain Chemistry and Heal Your Brain, Skyhorse Publishing: New York (2012) p. 3-‐5. •Gene c and environmental influences can produce nutrient imbalances in the brain resul ng in an overload or deficiency of a nutrient that is needed to make neurotransmi ers or needed in their ac vity. Mental illness symptoms result. •Treatment is diagnosing the nutrient imbalances through blood, urine, and ssues and then normalizing nutrient levels in the brain. A Holis c Approach to Mental Health Challenges in Children and Youth
Func onal medicine lab may tes ng be helpful in determining metabolic malfunc on and nutrient imbalances that underlie mental health issues. Func onal Medicine Lab Tests for Biochemical Factors Urine: Blood: • Pyrroles* • Copper, • Organic Acids • Histamine, • Neurotransmi ers • Zinc • Gluten/Casein Pep des • IgG Food Sensi vity Saliva: > age 5 yrs • Cor sol • Oxytocin Stool: • Vitamin D • Comprehensive Stool Analysis
*2008 Mauve factor not kryptopyrroles, but the hydroxlactam of hemopyrrole, rrolin-‐2-‐one hydroxyhemopy (HPL) Func onal Medicine Lab Tests for Biochemical Factors Urine: • Pyrroles* Blood: • Copper, • Histamine, • Zinc Psychosis/schophrenia, anxiety, depression, bipolar disorder, ADD/ADHD
*2008 Mauve factor not kryptopyrroles, but the hydroxlactam of hemopyrrole, rrolin-‐2-‐one hydroxyhemopy (HPL) Biochemical Factors Biochemical Factors
Pfieffer, CC, PhD, Nutri on MD and Mental , Illness Healing Arts Press, Rochester, VT (1987) p. 22-‐25. High Pyrroles / mavue factor , (HPL) •1958 -‐ Canadian, Dr. Payza noted a new substance in urine of several pa ents undergoing experimental LSD model psychosis. •1961 -‐ Drs. Hoffer and Mahon found Pyrroles in urine of 27/39 schizophrenic pa ents, 1/3 of other psychiatric pa ents •1965 -‐ ’ O Reilly and Hughs found Pyrroles in 11% normal subjects, 24% disturbed children, 42% psychiatric pa ents, and 52% of schizophrenics. McGinnis, A et al, “Discerning the Mauve Factor, ”, Part 1 Altern Ther Health Med, 2008: 14:(2): 40-‐ 50, Part 2, 14(3): 50-‐55. •2008 Pyrroles, HPL, is a subclass monopyrroles of that are biotoxic , “ nerve poisons”. •2008 High Pyrroles in urine correlated with B6 and Zinc deficiency, with oxida ve stress, and gut permeability. Biochemical Factors
McGinnis, A et al, “Discerning the Mauve Factor, ”, Part 1 Altern Ther Health Med, 2008: 14:(2): 40-‐ 50, Part 2, 14(3): 50-‐55 Neurobehavioral Disorders Associated with high Pyrroles: •Schizophrenia, acute 59-‐80% • Manic depression 47-‐50 % •Schizophrenia, chronic 40-‐50 % • Alcoholism 20 -‐84 % •Criminal behavior: • Depression, non – Adults sudden deviance 71% schizophrenic 12-‐46 % – Youths, violent offenders 33% • Au sm 46-‐48 % Joan Ma hews Larson PhD: Pyrroles are elevated in 75% of pa ents seeking treatment substance for abuse at the Health Recovery Center, Minneapolis. Irrespec ve of behavioral diagnosis, stress increases associated symptoms and excre on Pyrroles of . Biochemical Factors
McGinnis, A et al, “Discerning the Mauve Factor, ”, Part 1 Altern Ther Health Med, 2008: 14:(2): 40-‐50, Part 2, 14(3): 50-‐55 •High Pyrroles (HPL) in urine correlated with increased stress. 1992 US Navy used a brief cold water immersion test showed HPL excre on can rapidly rise in 30 min and peak in 1 hour rever ng to baseline in 24 hours. •Irrespec ve of behavioral diagnosis, stress increases associated symptoms and excre on Pyrroles of . Biochemical Factors
Pfieffer, CC, PhD, Nutri on MD and Mental , Illness Healing Arts Press, Rochester, VT (1987) p. 22-‐25. Copper high and Zinc low: •anxiety, depression, psychosis, schizohrenia •Responds to Zinc, Niacinamide with Vitamin C and removing Copper source and/or correc ng pyrroles. Pellagra pa ents also had abnormally high Cu. Niacin (B3) was found to reduce the Cu levels. Vitamin C reduces high Cu levels, and Vitamin C deficiency increases blood level Cu. Birth control pills, estrogen, late pregnancy raise Cu levels which may aggravate dispercep on and depression. Increased Cu from Cu water pipes, Cu pots and pans, even copper IUD’s or a vitamin C and B 3 deficiency. Biochemical Factors
Walsh, WJ PhD, Nutrient Power: Heal Your Brain Chemistry and Heal Your Brain, Skyhorse Publishing: New York (2012) p. 75-‐79. High Histamine: Undermethyla on, depression, anxiety, psychosis, reduced serotonin and dopamine, oposi onal-‐defiant disorder •Responds to SAMe, Vitamins A, C, Tryptophan E and B6, /5HTP Low Histamine: Overmethyla on, depression, anxiety and 20% panic disorder, psychosis: paranoia, elevated serotonin and dopamine, chemical and food sensi vi es, no seasonal allergies, ADHD and underachiever, •Responds to Folic or Folinic acid with Vitamin ; B12 •niacinamide, choline, DMAE and manganese that reduce dopamine synap c ac vity; •Zinc, PLP B6 and B6 which increase GABA;Vitamin C and E Clinical Case 2
• 16 yo adolescent male with a c/o of angry eks, outbursts x 3 we even with meds. hospitalized before for manic behavior hosis, with psyc smoked cannibis. Now Risperdal on , gained 40 lbs in 6 months on meds, wanted alterna ve treatment. • Feeling suicidal, not handling stress well, poor eye ed contact. Mom had start him on B complex and niacin. • Started him Tryptophan on , Protefood , Magnesium Lactate for sleep, calming, mood and EMPower + for mood. Tapered medica on. • Urine pyrroles: 16.78 high • Histamine: 74 Func onal high • Zinc: 142 higher than Cu • Copper: 129 Func onal high • Vitamin D: 21.1 Func onal Low • Added: B6, Zn, and Vitamin D, Treated gut for permeability and Candida. Gluten/Casein Free diet, candida diet • He stabilized, tapered meds and was able to return to high school without further problems. Func onal Medicine Lab Tests for Biochemical Factors
Urine: • Neurotransmi ers • serotonin, dopamine, norepinephrine , epinephrine, GABA, glutamate, glycine • Anxiety, panic, depression, insomnia Saliva: • Cor sol, the stress hormone • Adrenal func on relates fa gue, to anxiety, PTSD, insomnia, weight gain Urine Organic Acids: • confirms yeast/candida , unwanted bacteria, nutrient use, metabolic malfunc ons or gene c problems Urine Casomorphin/Gliadorphin : • Indicates need for a GFDF diet IgG Food Sensi vity: • confirms foods that come through leaky gut and cause IgG an bodies to form. Indicates leaky gut and foods to avoid. Biochemical Factors
Walsh, WJ PhD, Nutrient Power: Heal Your Brain Chemistry and Heal Your Brain, Skyhorse Publishing: New York (2012) p. 75-‐79. Neurotransmi ers-‐Nutrient Rela onship Increase Decrease Serotonin Methionine, SAMe, 5-‐HTP, Folic acid, DMAE, choline, tryptophan, inositol, Ca, Vit B5, niacinamide, CoA Mg, Vitamin B2, B6, D Dopamine Tyrosine, phenlalanine, Folic acid, Vit B5, C, Vitamin B1,B6, SAMe, choline, DMAE, Mn, methionine niacinamide, GABA, CoA Norepinephrine Tyrosine, phenylalanine, GABA, folic acid, DMAE, Cu, vitamins B6 and C niacinamide, Mg, Co A , Zn, Vit B5, choline NMDA Glutamine, gluthaione, Low Glycine level, low Glycine, D-‐Cycloserine, glutathione level , high sarcosine, D-‐Serine, Se oxida ve stress GABA Pyridoxyl 5-‐Phosphate, Zn Aspar c acid Clinical Case 3
7 yo boy with Vocal Tics and ADHD. On Focalin for ADHD. Mom did not want him on neurolep cs. • Pyrroles: 5.73 • Cu: 100 func onal normal • Histamine: 43 func onal normal • Zn: 131 higher than Cu • Cor sol normal at 7am, high at 12:30 pm, m 5:50 pm and 10:30 p • Urine Neurotransmi ers all high to very high, except Serotonin e in normal rang • Comprehensive Stool: many good bacteria in gut • IgG Food sensi vi es: all dairy (whey, casein, cheese, yogurt, milk), wheat and wheat gluten, oats, Gliadin , Peanut, Egg white and yoke, grapefruit, banana • Urine Casomorphine (milk) high • Off offending foods, his vocal cs greatly decreased. We are s ll working on his a en on. Biochemical Factors
Endocrine Society (2012, June 25). Trea ng vitamin D deficiency may improve depression. Science Daily Vitamin D • low levels associated with depression and anxiety Oxytocin •Hormone in brain that increases trust and reduces fear • Affect generosity by increasing empathy • Affects certain learning and memory func ons •Can facilitate learning and memory specifically for social interac ons Andari, et al., Natl Proc Acad Sci, 2010 March2:107(9):4389-‐94 Promo ng Social Behavior Oxytocin with in high func oning Au sm Spectrum Disorder Gustrella, et al, Biol 2009 Psychiatry Intranasal Oxytocin Improves Emo on Recogni on for youth with Aus s c Spectrum Disorder Clinical Case 4
• 24 yo male diagnosed Asperger with ’s Syndrome since age 12 yrs. On Lithium, Neuron n, Vyvance , Risperdal , Lunesta and Trazedone meds for containing his anger outbursts, ADD, and insomnia. He has struggled learning rela onal skills since he was 12. Now in community college and working part-‐ me. • 25-‐Hydroxy Vitamin D: 18 low • Copper: 91 func onal normal • Urine Pyrroles: 3.19 normal • Zinc: 104 func onal normal • Histamine: 62 func onal normal • Oxytocin: 2.25 low • Started him on Magnesium Lactate at bed me to decrease sleep meds, Vitamin D3 and sunshine. oxytocin On he is very happy to be able to pay a en on, focus, improved me management, improved handling stress, improved rela onal ability to read body language, facial expression, flirt with girls, more confidence, feels he will be able ow to finish college. N we are having to decrease his medica ons as oxytocin he adjusts to the . Conclusion
You are what you think and what you eat.
Whi ed-‐Bowers Organic Biodynamic Fruit Farm photo by Cheryl Re e