Sunday, July 24, 2011

Gluten and the Brain: Dementia and Mental Illness

In the October 2006 issue of Archives of Neurology, the Mayo Clinic presented multiple case studies of cognitive decline and dementia within two years of having celiac disease. If caught soon enough before permanent damage is done, the dementia can completely reverse.

I had a man come into my office who had just dicovered, after several years of suffering, that he had celiac disease. He had chronic pain, high blood pressure, severe rashes, edema, depression, and could not concentrate, focus, or remember enough to do his work as an engineer any longer. He was in the process of applying for disability because he couldn't think well enough to do his work.

This man discovered he had a gluten sensitivity, or celiac, not from any doctor testing him. He had been to multiple doctors and none had considered the possiblity of celiac disease or gluten sensitivity. He discovered it through his own experimentation of striving to become gluten free, and how that began to improve his symptoms. His family practice doctor was not supportive of his efforts, and he came to me to assist him in his journey towards health. He was extremely sensitive, even to the point where xantham gum in a product would set off severe edema. But now he is completely gluten free, he is back at work, lost weight, normalized blood pressure, no depression, rashes are gone, and his pain is gone except in an area of injury, which is much improved. But most of all, his brain is functioning again. He says that the loss of brain function was so subtle that he didn't realize how bad it was until it returned again.

Studies have shown increased levels of celiac disease in those with schizophrenia, and increased levels of IgG antibodies (which is gluten sensitivity without celiac disease) in those with bipolar disease, than compared to a population without mental illness. Gluten free diets have been shown to improve symptoms of these disorders in people with gluten sensitivities. Gluten sensitivities can also increase levels of depression.

Another Mayo Clinic study in the July 2009 issue of Gastroenterology shows that Celiac disease is four times more common today than it was in the 1950s. And this doesn't count the people who are gluten sensitive without celiac disease. It is a growing epidemic. It also showed that those with undiagnosed celiac disease were four times more likely to die than those that were gluten free during the 45 years of the study. This is a much more serious problem than even most physicians realize.

There are blood tests that show gluten sensitivity and possible signs of celiac disease, but the gold standard has always been an intestinal biopsy that shows destruction of the intestinal villi. However, another study out of Mayo Clinic has shown that those with the blood markers but no villi destruction still show metabolic changes of gluten sensitivity and should go on a gluten free diet to reduce their risk of further damage.

Celiac disease used to be considered a children's disease. It is now shown that the elderly are much more likely to have problems caused by gluten sensitivities than children. Celiac disease can start at any age. But any child or adult with "brain problems" should be tested for anti-gliadin IgG and IgA antibodies, and for endomysial antibodies. Or better yet, make the supreme effort to go gluten free for a month, then spend one day eating a lot of gluten, and see what happens. It may save your brain, your sanity and your life.

Until we meet again,

Dr. Judi

Saturday, July 16, 2011

ADHD and Gluten Sensitivities

What could be better for you than a delicious slice of freshly ground, freshly baked whole wheat bread? "Wheat was made for man," right?

That may have been truer 150 years ago than it is now. When I was in medical school the disease I learned about called "celiac sprue" was considered fairly rare, about 1 in 2500 people, mostly found in children. However, now the estimate is 1 in 133 people. The reason it is estimated is that the experts believe that 97% of those with celiac disease are undiagnosed. They have had bowel problems their entire lives, but no one has tested for celiac disease. As they grow older they are at increased risk for chronic fatigue, neurological disorders, arthritis, heart disease, skin rashes, nutritional deficiencies, anemia, acid reflux, nausea, emotional illness, and more. Those doctors and hospitals that are testing are finding much larger numbers of celiac than suspected.

However, most doctors are not testing for wheat allergy that is not celiac disease. Celiac disease is when the villi in the intestinal tract are destroyed by antibodies made to gluten, which causes gastrointestinal symptoms and can cause major health problems. There are many people with allergies to gluten that don't have celiac disease. When my patients come in with chronic problems they tell me they have been tested for celiac and are negative. With the right testing, I am able to show them that indeed they are gluten sensitive, but no, they don't have celiac disease.

In the testing in my office (of course these are people with chronic diseases, so it can't be extrapolated to the general population), 3 out of 5 people show antibodies to gluten in their blood, including me.

So what does this mean for ADHD? Most children with developmental disorders (ADHD, Asperger's, autism and others) have gastrointestinal problems. More than half of those with celiac disease have neurological disorders. I cannot find studies on gluten allergies that are not related to celiac, however, my own experience with patients is that gluten often increases brain fog, difficulty focusing, stomach aches, acid reflux, depression, increased sugar cravings and difficulty sleeping, among other things.

There are no major long term studies that show the effect of gluten on ADHD, as there is no financial incentive to do one. However, there are smaller studies that have shown benefit in both autism and ADHD on a gluten free diet. One study showed that children with celiac disease have twice the amount of ADHD (20.7%) as their control group without celiac disease (10.5%).

Why are there so many more people with gluten sensitivities? Evidence is pointing to newer, genetically altered strains of wheat. There is even a difference of wheat in America with wheat in Europe. American wheat has a lot more gluten that most of the European wheat. Our bodies are not adjusting to the rapid changes in genetically modified grains, and our cells don't recognize the new wheat as good for us. Our immune system treats the food as enemies, making antibodies which affect our health.

I recommend if you have a child with ADHD, autism or another developmental disorder that he/she be tested for gluten allergy. If you ask your doctor to test, he'll most likely just test for celiac disease. Ask your doctor to test for both the IgG anti-gliadin antibody, and the IgA anti-gliadin antibody. The IgA antibody is related to celiac disease, so if that shows up there should be further testing. However, most doctors are not aware of the ability to test for the IgG antibody, which is what most of my patients show up with.

If you can't find a doctor that will do the test, do the following elimination trial: have your child (or even better, you and your entire family) go 30 days completely gluten free. That means no wheat, oats, rye or barley. Be careful with processed foods--most of them have wheat derivatives. If you must use processed foods, they should have the label "gluten-free." With celiac disease, even a small amount can increase antibodies, so no cheating allowed!

After one month, everyone gets to eat their favorite gluten foods all day. Then watch over the next 24 hours what symptoms arise. Watch for increased congestion, increased ADHD symptoms, increased gastrointestinal symptoms, increased joint or muscle pain, increased moodiness, increased weight, etc. It can affect all of these things. If there are no changes in symptoms, your child is probably free to eat gluten. If there are, then you will know if the symptoms are worth the increased work of the diet.

This may seem overwhelmingly hard, and with children who are picky eaters, it can be. But if your child (or you) is gluten sensitive, I believe you and they will come to see that the effort is truly worth it. I know that I feel much better on a gluten-free diet, which I have been following for two years since I discovered that I was sensitive. Besides helping the ADHD symptoms, it increases long-term health and reduces risk of serious illness, both physical and emotional.

Until we meet again,

Dr. Judi

Friday, July 1, 2011

ADHD and Angry Outbursts

One of the most difficult things to deal with in any child, and especially in an ADHD child, are the angry, uncontrollable outbursts. Not all children have them, but the ones that do can become very scary, and often violent.

These children are usually normally very pleasant, and can be fun to be around. However, it seems like in one minute they can turn from Dr. Jekyll to Mr. Hyde. The explosion seems to come out of nowhere. Often it is related to things they can't do, or making them do things they don't want to do. They may run to their room and slam the door, but it is harder when they yell, scream, break things, hit their siblings, and even hit their parents.

This is one of the most common causes parents put children on medication. The anger and violence can become scary and sometimes siblings are at risk. If the parents can find no other recourse, this may be the best thing to do for the moment.

When it comes to medication in this problem, often a combination of a stimulant and an anti-seizure drug, like Neurontin, may help the best. The Neurontin calms the excessive firing of the brain neurons with a sudden outburst, and often the children are calmer. If the child is bordering on bipolar psychosis, an anti-psychotic drug may be necessary.

But there are other possibilites that may work. Using supplements similar to the ADD Focus Boost AM and ADD Calm Time PM will often assist the child in calming. Sometimes, though not always, Neurontin or another anti-seizure medication may continue to be needed, but rarely are two medications needed when using the supplements. Also cut out as much as possible sugar and chemicals in food, especially artificial sweeteners and food colorings. Check for food allergies and low blood sugar, which can increase the anxiety and irritability in a child.

There are also some behavioral techniques, which, if repeated consistantly and practiced by parent and child alike, will assist the child in learning to control his own emotions better over time.

1. Of course, Be the example.
If you lose your temper easily, that is what the child learns. If you get angry, rather than explode, take a minute to go to your room and calm down. When you are calm and the anger has left, then you may choose to talk to the child about their behavior from a more peaceful and loving way. You can even tell your child, "Mommy was mad for a minute, but rather than yell at you I went to my room to calm down. Now I am calm let's discuss what happened. If you get angry while we talk, you may want to go to your room for a minute to calm down as well."

2. Acknowledge their feelings and don't make them bad for having them.
The feelings come out of nowhere for the child. They truly come so quickly that they immediately react. They usually don't like their anger any more than you do. Teach the child that it is ok to be angry about something, but not ok to hurt things or other people because of that anger. For example, you may say "I understand why you are angry. You want to watch this TV show and I won't let you. Of course you are angry when you don't get what you want. That's normal. You believe the TV show won't hurt you, but there are things in this TV show that I have seen increase the times you become angry and hit others. I don't think either one of us what that. You may get angry but it doesn't work for anyone when you yell at and hit your brothers. Let's find something else to do that may be fun. I know you would rather watch the TV show, but since you can't, let's go outside and play ball for a moment." They may still rather pout than play ball, but often acknowledging that you recognize that his anger is normal often softens the blow and they calm down to a degree.

3. Assist them in finding a positive outlet when they are angry.
At times when they are not angry, discuss with them ways that they can get their anger out rather than yelling, hitting and destroying. There is a powerful release of adrenaline with sudden anger, and it is important for them to move in order to get it out. Make sure they know that anger is normal but it doesn't work to hurt others by yelling, hurting or destroying from the anger. Help them make a list of things to do when they are angry until they find one that really works for them. The list may include: punching on a punching bag, a punching clown or on a pillow; running around the outside of the house three times; jumping on the trampoline or on the bed; going in the closet and yelling all of the things they want to yell at you or someone else; slamming a garage door that is outside the house over and over. I knew one family that got cheap dishes at yard sales, and they had a spot next to the fence in the back yard where their kids could throw dishes (you may want to find something safer than glass, and use plastic dishes to throw). That way they can be "safely destructive."

4. Find the underlying cause of the anger.
The child who is always angry usually has underlying fears and/or anger about things other than what she is angry about. Most children are not very self-aware, and may not be able to express fears and deep-seated anger. They just feel, and when the feelings get strong it comes out as an angry explosion or as withdrawal. There are several causes: a traumatic event such as death, divorce or abuse, anger in the family such as a frequently angry parent or parents frequently arguing (the children not only learn angry responses from parents, they are sensitive and feel the anger and take it on as their own), or their sense of security is threatened. Take a hard look at the influences on your child's life. What builds her up? What tears her down? What needs aren't being met? What may the inner fears and anxieties be? The anger is a protective shell that keeps the real fears tucked away. Sometimes counseling is necessary.

5. Find the good child under the misbehavior.
Sometimes a child's behavior is so much more "bad" than "good" that it is hard to find something to praise the child for. But when a child is constantly told or shown how bad they are, it becomes a truth in their subconscious mind, and then they give into negative behaviors because they believe they really are "bad." It is devastating to a child to believe he is a "bad" kid. He feels that he has no choice, and no matter how hard he tries he will never be "good." Keep telling your child things such as, "You're not bad, you are just young and made a mistake. We all make mistakes but as we grow up we learn to make less and less. You are still learning. Daddy and Mommy are going to help you learn from those mistakes so that you can grow up into the nice person you really are." It is important for YOU to recognize the real child, the loving and caring child, deep within the misbehavior, and not consider him a bad child.

6. Praise more than you may believe the child deserves.
Most of the time these children don't learn from punishment, except how to lie and cover up their "bad" behaviors, or run away to avoid punishment. These children learn much more from praise and being inspired into good behavior. I believe by being "attention deficit," these children have a "deficit" of "attention." They need a lot of attention, more than other children, and when they don't get the attention their brains desire they will do anything to get it, even to get negative attention. This is most likely due to their lack of dopamine, and positive attention increases their dopamine levels.

Find anything you can to praise them (but don't forget to praise your other, non-ADHD children as well!). If they got up on time but left their clothes all over the floor, praise them for getting up on time. Praise them for paying positive attention to their younger siblings. Praise them for sitting still for 5 minutes, even though in 6 minutes they were up running around. These children learn much better from praise and rewards than from punishment.

7. Use "and" instead of "but."
These kids generally don't like to work. That is one of the big issues they get angry about. It seems to be a personal affront that you are forcing them to do something they don't want to do. Force doesn't work for these kids, but then how do we get them to learn to do their chores, homework, and help out? This is hard, but it is important to find ways to inspire them to do what is best for them to do. One of the ways is to use the word "and" instead of "but." Using the word "but," to a child, means they are in trouble and they don't want to hear it.

When your child got up on time but left their clothes all over the floor, you may say "I'm so pleased that you got up on time! Way to go, Susie! And I'll bet you can pick up your clothes quickly, too! I'll set the timer, and see if you can get them all picked up before the timer rings." That works much better for the child than "It's good you got up on time but you forgot to pick up your clothes. You'd better get that done before breakfast!"

Or, if your child completed a chore but was grouchy about it and got angry at his sister, you might say, "You did it! Great job, Billy! And now let's talk about how we can deal with your sister in a different way. Any ideas?"

Or if your child completed the chore but did a very poor job, you can say "Wonderful, sweetheart, you finished it! The sink is nice and clean. And now let's just make the toilet a little cleaner by scrubbing right here." You may choose to work together with your child until you know they know how to do it well, praising every step. The next time they will be more likely to the job better on their own, and be sure to praise the parts that were done well.

8. Find something to laugh about.
Even though the child just threw a destructive tantrum and broke a window, laughter diffuses the situation and keeps the child from feeling "bad." "Well, now you have air conditioning in your room!" There are still consequenses to their behavior, but give the consequences in love and laughter rather than anger and yelling, and they will learn better from them. When the parents are angry giving a consequence, the child becomes defensive and feels justified. When the parents are loving and laughing when giving a consequence, the child is not thinking how mean the parents are, but more about what they did.

9. Role play.
When you talk to your child at a time she isn't angry and she seems to feel sorry for her behavior, she may be ready to learn new ways to respond to things that normally would make her angry. Role play certain situations that she often gets angry about until she can come up with a way to diffuse the anger. One way is with laughter. When she is not allowed to do something she wants to do and she begins to get angry, she can think of doing that thing on a pogo stick, and see herself bouncing around doing what she wanted to do but on a pogo stick. It is silly. Another way is to use made up name calling to the person she is angry at, using non-negative words. "Brownie face!" "Oh, yeah? Snickerdoodle noodle!" etc. This usually ends up in laughter. Then practice doing it several times until it is easier for her to come up with the diffusing behavior than following through with the angry behavior.

10. Pick your battles.
Angry ADHD children seem to have an innate knowledge of how to push your personal buttons and get you riled up. They will sometimes do every behavior they can to get you angry. Take time to yourself and with your spouse to decide which behaviors to ignore and which are really important. You may choose to spend energy dealing with the shoplifting so many of these kids do but not spend a lot of attention on their habit of constantly leaving their plate on the table, or not having their shirt tucked in and their hair combed. That can come later. Family life doesn't work well when you are battling every little thing with your child. You may choose to pick 5 things that are most important and focus on them until they are learned. Then you can go on to other things.

11. Let go of your own guilt.
Yes, you are going to lose it sometimes. We all do. We are simply human, after all, and kids know how to push our buttons. Let go of guilt and just consider how you might chose to do it differently next time. The most important thing is to love your child (remember, fear and worry are the opposite of love). When your child really knows you love him in spite of his weaknesses and your weaknesses, he can work through your mistakes as you can work through his. Remember to express your love sincerely and frequently. You can apologize when you know you made a mistake, but don't apologize for disciplining their angry behavior. "Charity [love] covereth a multitude of sins." 1 Peter 4:8.

Please comment and let us know anything you may be doing that has worked, or what your struggles are that aren't working. We can all come together to serve each other.

You can get ADD Focus Boost AM, ADD Calm Time PM and SuperMulti Plus (children should take 1/2 to 1 capsule) at

Until we meet again,
Dr. Judi