Beyond Medicaon: Holisc Treatment for Children and Youth with Mental Health Challenges

{Food and Funconal } Medicine

Natalie Sadler, MD Children’s Mental Health Summit September 28-­‐29, 2012 Background for Change

Holisc View: Body, Mind, Spirit of paent Undergrad: Math major, Nutrion minor Funconal Medicine perspecve 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 alternave, nutrional approach to her treatment. Abram Hoffer MD spoke at UNC e Integrave Medicin Conference Sept 2001. Holisc Evaluaon

• Psychiatric evaluaon including religion, spirituality, abuse, , diet, food allergies/sensivies. • Symptom check lists for thyroid, adrenals, yeast/Candida, sugar metabolism, neurotransmiers, deficiencies, autonomic nervous system/sympathec/parasympathec. • Sensory Profile Quesonnaire for sensivity to light, sound, touch, taste and smell (sensory integraon). • Funconal Acuity Contrast Test (FACT) eye test for essenal fay acids in the rena. DHA needed to see shades of gray. • Funconal Medicine Tesng for biomedical factors to determine nutrient imbalances and metabolic dysfuncon Holisc Treatment

• Bringing the nutrient imbalances back into balance. • Address diet changes, sleep and exercise to sustain good health. • Idenfying the underlying psychological issues ing and work to resolve them using convenonal psychotherapy and alternave therapies. • Learning good coping skills to handle life and stress: Mindfulness, Heartmath, yoga • Address any sensory integraon and/or autonomic nervous system dysfuncon. A Holisc Approach to Mental Health Challenges in Children and Youth What a child eats makes a difference in their mental health. Epigenecs, gene expression, is a new way to look at mental health issues. Funconal medicine lab may tesng be helpful in determining metabolic malfuncon and nutrient imbalances that underlie mental health issues. A Holisc 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, “ Malnutrion at Age 3 Years and Externalizing r Behavio Problems at Ages 8, 11, and 17 Years” Am J 161:2005-­‐2013, November 2004 The more indicators of malnutrion there at age 3 were, the greater the ansocial : behavior •41% increase in aggression at age 8. •51% increase in violent and ansocial ge behaviors at a 17. What a Child Eats…

Bouchard PhD, Maryse, et al, Aenon-­‐Deficit/Hyperacvity Disorder and Urinary Metabolites of Organophosphate Pescides 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 Pescide 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, Alteraons et al, in mood aer changing to a low-­‐fat diet. Brish Journal of Nutrion (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. Aer 1 month anger/hoslity significantly increased, tension/anxiety stayed unchanged. Those on the higher fat diet showed decrease in anger/hoslity and tension/anxiety. What a Child Eats…

Jacka PhD,Felice, et al, Associaon of Western and Tradional Diets ession with Depr and Anxiety in Women, Am J Psychiatry 2010;167:305-­‐311 •Study of habitual diet paerns of 1046 women in Australia ages 20 -­‐93 as relang to mental . illness •Tradional 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, Associaon of Western and Tradional Diets ession with Depr and Anxiety in Women, Am J Psychiatry 2010;167:305-­‐311 Results: •Tradional Diet: less chance of having depression, dysthymia and anxiety, lower overall psychological symptoms •Western Diet: high correlaon with overall psychological symptoms •Modern Diet: slight correlaon with anxiety and depression Associaon between habitual diet quality and high-­‐ prevalance mental disorders What a Child Eats…

Jacka PhD,Felice, Associaon 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, Perspecve Study in Diet Quality and in Mental Health Adolescents, PLoS ONE, Sept 22, 2011 •Three quarters of lifeme psychiatric disorders emerge in adolescence or early adulthood, and that a recent naonal 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 parcipants in a project known as It’s Your Move, aimed to increase the capacity of schools to promote healthy eang and physical acvity. Assessed in 2005 and 2007. What a Child Eats…

Jacka PhD, Felicia, A et all, Perspecve 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, Perspecve Study in Diet Quality and in Mental Health Adolescents, PLoS ONE, Sept 22, 2011 •The invesgators found higher that healthy diet scores at baseline predicted higher (beer) 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 oxidave affects stress. It gene expression, and it has a potent impact on the neurotrophic factors, including brain-­‐derived neurotrophic factor, which we know are parcularly 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 maer in the introducon of bioferlizers and biocontrol agents to soil.” In: Chen Y, Avnimelech Y, eds. The Role of Organic Maer in Modern Weatherhand Farm Agriculture. Boston: Marnus Nijhoff Publishers, photo by Elizabeth Gibbs 1986:169-­‐180.; Henis Y. “Soil microorganisms, soil organic maer lity. and soil fer ” In: Chen Y, Avnimelech The Y, eds. Role of Organic Maer in Modern Agriculture. Boston: Marnus Nijhoff Publishers, 1986:29-­‐54. • The presence of these microorganisms at least parally explains the trend showing a higher mineral content in organic crops. What a Child Eats… What a Child Eats… What a Child Eats…

Recommendaons: 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…

Recommendaons: Eggs from free-­‐range chickens

Standing guard at Fickle Creek Farm photo by Roland McReynolds What a Child Eats…

Convenonal 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…

Recommendaons: Grass-fed, pasture-raised beef, lamb, pork, chickens, turkeys

Baldwin Family Farm photo by Elier Amy What a Child Eats…

Recommendaons: Good oils: Organic extra virgin olive oil, coconut oil, organic buer, 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…

Recommendaons: Eat food as it comes from the farm Nutrive 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 funconing ental pervasive developm delays referred by occupaonal therapist. • Diet was processed to OK. • Mom agreed to change his diet to Weston A Price/Sally Fallon Nourishing Tradions, “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 Holisc Approach to Mental Health Challenges in Children and Youth

Epigenecs, gene expression, is a new way to look at mental health issues. Epigenics: gene expression

Walsh, WJ PhD, Nutrient Power: Heal Your Brain Chemistry and Heal Your Skyhorse Brain, Publishing: New York (2012) p. 3-­‐5. Epigenecs is the study of heritable changes in gene expression that do not alter the genec code. Example in Mental Health: •Neurotransmier acvity at synapse of nerve cells is predominately reuptake facilitated by transporter proteins. Number of transporters has a more dominate effect than the amount of neurotransmiers. Neers Atlas of Human Neuroscience Epigenics: gene expression

Transporters are produced genec by expression, the process by which informaon in a gene is used to produce a protein. The rate of producon is enhanced by certain nutrients and inhibited by others. Methylaon ( CH3 ) switches off the genes that produce neurotransmier transporters. Net result: Undermethylated persons have reduced serotonin acvity and a tendency for depression. Overmethylated persons have excessive dopamine acvity and a Neers Atlas of Human Neuroscience tendency for anxiety and paranoid . Epigenics: gene expression

Nutrion 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 opmal brain levels of natural brain chemicals can differ widely from person to person. Williams (wearing glasses) and Pauling 1974 Epigenics: gene expression

Walsh, WJ PhD, Nutrient Power: Heal Your Brain Chemistry and Heal Your Brain, Skyhorse Publishing: New York (2012) p. 3-­‐5. •Genec and environmental influences can produce nutrient imbalances in the brain resulng in an overload or deficiency of a nutrient that is needed to make neurotransmiers or needed in their acvity. Mental illness symptoms result. •Treatment is diagnosing the nutrient imbalances through blood, urine, and ssues and then normalizing nutrient levels in the brain. A Holisc Approach to Mental Health Challenges in Children and Youth

Funconal medicine lab may tesng be helpful in determining metabolic malfuncon and nutrient imbalances that underlie mental health issues. Funconal Medicine Lab Tests for Biochemical Factors Urine: Blood: • Pyrroles* • Copper, • Organic Acids • Histamine, • Neurotransmiers • Zinc • Gluten/Casein Pepdes • IgG Food Sensivity Saliva: > age 5 yrs • Corsol • Oxytocin Stool: • Vitamin D • Comprehensive Stool Analysis

*2008 Mauve factor not kryptopyrroles, but the hydroxlactam of hemopyrrole, rrolin-­‐2-­‐one hydroxyhemopy (HPL) Funconal 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, Nutrion 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 paents undergoing experimental LSD model psychosis. •1961 -­‐ Drs. Hoffer and Mahon found Pyrroles in urine of 27/39 schizophrenic paents, 1/3 of other psychiatric paents •1965 -­‐ ’ O Reilly and Hughs found Pyrroles in 11% normal subjects, 24% disturbed children, 42% psychiatric paents, 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 oxidave 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 % • 20 -­‐84 % •Criminal behavior: • Depression, non – Adults sudden deviance 71% schizophrenic 12-­‐46 % – Youths, violent offenders 33% • Ausm 46-­‐48 % Joan Mahews Larson PhD: Pyrroles are elevated in 75% of paents seeking treatment substance for abuse at the Health Recovery Center, Minneapolis. Irrespecve of behavioral diagnosis, stress increases associated symptoms and excreon 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 excreon can rapidly rise in 30 min and peak in 1 hour reverng to baseline in 24 hours. •Irrespecve of behavioral diagnosis, stress increases associated symptoms and excreon Pyrroles of . Biochemical Factors

Pfieffer, CC, PhD, Nutrion 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 correcng pyrroles. Pellagra paents also had abnormally high Cu. (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 dispercepon 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: Undermethylaon, depression, anxiety, psychosis, reduced serotonin and dopamine, oposional-­‐defiant disorder •Responds to SAMe, Vitamins A, C, Tryptophan E and B6, /5HTP Low Histamine: Overmethylaon, depression, anxiety and 20% panic disorder, psychosis: paranoia, elevated serotonin and dopamine, chemical and food sensivies, no seasonal allergies, ADHD and underachiever, •Responds to Folic or Folinic acid with Vitamin ; B12 •niacinamide, choline, DMAE and manganese that reduce dopamine synapc acvity; •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 alternave 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 medicaon. • Urine pyrroles: 16.78 high • Histamine: 74 Funconal high • Zinc: 142 higher than Cu • Copper: 129 Funconal high • Vitamin D: 21.1 Funconal 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. Funconal Medicine Lab Tests for Biochemical Factors

Urine: • Neurotransmiers • serotonin, dopamine, norepinephrine , epinephrine, GABA, glutamate, glycine • Anxiety, panic, depression, insomnia Saliva: • Corsol, the stress hormone • Adrenal funcon relates fague, to anxiety, PTSD, insomnia, weight gain Urine Organic Acids: • confirms yeast/candida , unwanted bacteria, nutrient use, metabolic malfuncons or genec problems Urine Casomorphin/Gliadorphin : • Indicates need for a GFDF diet IgG Food Sensivity: • confirms foods that come through leaky gut and cause IgG anbodies 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. Neurotransmiers-­‐Nutrient Relaonship 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 oxidave stress GABA Pyridoxyl 5-­‐Phosphate, Zn Asparc acid Clinical Case 3

7 yo boy with Vocal Tics and ADHD. On Focalin for ADHD. Mom did not want him on neurolepcs. • Pyrroles: 5.73 • Cu: 100 funconal normal • Histamine: 43 funconal normal • Zn: 131 higher than Cu • Corsol normal at 7am, high at 12:30 pm, m 5:50 pm and 10:30 p • Urine Neurotransmiers all high to very high, except Serotonin e in normal rang • Comprehensive Stool: many good bacteria in gut • IgG Food sensivies: all dairy (whey, casein, cheese, yogurt, milk), 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 sll working on his aenon. Biochemical Factors

Endocrine Society (2012, June 25). Treang 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 funcons •Can facilitate learning and memory specifically for social interacons Andari, et al., Natl Proc Acad Sci, 2010 March2:107(9):4389-­‐94 Promong Social Behavior Oxytocin with in high funconing Ausm Spectrum Disorder Gustrella, et al, Biol 2009 Psychiatry Intranasal Oxytocin Improves Emoon Recognion for youth with Aussc Spectrum Disorder Clinical Case 4

• 24 yo male diagnosed Asperger with ’s Syndrome since age 12 yrs. On Lithium, Neuronn, Vyvance , Risperdal , Lunesta and Trazedone meds for containing his anger outbursts, ADD, and insomnia. He has struggled learning relaonal skills since he was 12. Now in community college and working part-­‐me. • 25-­‐Hydroxy Vitamin D: 18 low • Copper: 91 funconal normal • Urine Pyrroles: 3.19 normal • Zinc: 104 funconal normal • Histamine: 62 funconal normal • Oxytocin: 2.25 low • Started him on Magnesium Lactate at bedme to decrease sleep meds, Vitamin D3 and sunshine. oxytocin On he is very happy to be able to pay aenon, focus, improved me management, improved handling stress, improved relaonal 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 medicaons as oxytocin he adjusts to the . Conclusion

You are what you think and what you eat.

Whied-­‐Bowers Organic Biodynamic Fruit Farm photo by Cheryl Ree