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November 12, 2019

Autoimmunity & the Gut Part 2: The Gut-Brain Axis Series, The Microbiome-Autoimmune Connection

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

Last week in Autoimmunity & the Gut Part 1, we introduced what is autoimmunity (AI) and discussed some gut issues that can contribute to autoimmunity; such as leaky gut and dysbiosis. This week we look at specific microbiome issues in common AI diseases and we will give you ways to manage and address an autoimmune condition.

As we saw last week in Part 1, certain pathological bacterial strains are found in dysbiosis and with certain AI conditions.

FURTHERMORE, THERE IS EVIDENCE OF MICROBIOME DISRUPTIONS IN COMMON AI DISEASES:

  • RHEUMATOID ARTHRITIS (RA): As we saw last week, patients with new-onset RA have higher levels of a pathological bacterial strain called Prevotella copri (Bo Li, 2018). A study comparing RA patients and healthy controls confirmed a disturbed microbiome i.e. dysbiosis, which was partially resolved after RA treatment (Bo Li, 2018). Other studies have distinguished patients with RA from healthy controls as having dysbiosis (Thomas S, 2017). Current treatments for rheumatoid arthritis target symptoms. However, by focusing on the role played by gut bacteria, new treatment options looking at reducing the spread of P. copri in the gut could delay or prevent the onset of this disease (Scher JU, 2013).
  • TYPE 1 DIABETES (T1D): Multiple studies have shown dysbiosis in individuals with preclinical T1D (Bo Li, 2018). Issues include a sharp decrease in microbiome diversity, low community stability, an abundance of the Bacteroides strain of bacteria, fewer Bifidobacterium species and a lack of butyrate-producing and lactate-producing species (Bo Li, 2018).
  • MULTIPLE SCLEROSIS (MS): Studies suggest a distinct alteration in the MS gut microbiome compared with healthy controls (Bo Li, 2018). A study of 60 MS cases has reported an increased abundance of Methanobrevibacter (Archaea) and Akkermansia and a reduction in Butyricimonas (Bo Li, 2018). These MS-associated bacteria in the gut predispose the body towards a pro-inflammatory profile (Bo Li, 2018).

In short, pathogenic bacteria can be highly problematic to overall gut health. In certain people with a genetic disposition, they can contribute to the development of autoimmunity. This is why is extremely advisable to be mindful of your gut health and consistently work on supporting a healthy gut.

WHAT CAN YOU DO TO ADDRESS AUTOIMMUNITY?

Once the AI disease process is activated, it does not have to be forever. It can be managed or even reversed by stopping the interaction between genes and the environment.

It is critical to reduce inflammation and calm the overactive immune response. Two steps are necessary:

IMPROVE GUT HEALTH AND HEAL LEAKY GUT

  • Address gut health with Functional Medicine. An experienced FM practitioner can order a stool test for you. A stool test can indicate the balance of bacteria in your gut microbiome and identify the good bacteria, the neutral bacteria and the bad. This tells if you have dysbiosis or not. Then you can work on reducing the bad bacteria and supporting the growth of good bacteria in your gut. Finding a good FM practitioner is crucial in achieving this.
  • SIBO or small intestinal bacteria overgrowth, alongside dysbiosis, is often a factor in leaky gut and in AI. With your FM practitioner, you can test for SIBO and address it if you have it.
  • Once you have treated any gut infections or overgrowths, it is critical to address leaky gut. There are therapeutic strategies aimed at re-establishing the intestinal barrier function and restoring leaky gut. These will downregulate or decrease the actions of zonulin and offer a way to manage AI diseases (Fasano, 2012).
  • Probiotics: Several trials show that the microbial changes caused by probiotics may improve gastrointestinal symptoms and inflammation in rheumatoid arthritis, ulcerative colitis, and multiple sclerosis (Liu Y, 2018). Probiotics are likely to be used in autoimmune diseases as a component of the treatment (Liu Y, 2018). However, one size will not fit all. The choice of optimal probiotic strains will differ for each AI disease (Liu Y, 2018). Work with an experienced FM practitioner to identify which probiotic strains will help improve your particular AI condition.
  • Prebiotics: Prebiotics are certain foods that feed the good bacteria of the gut. They are an important part of supporting overall gut health. Please see our dietary recommendations here for info on prebiotic foods.

TRY TO IDENTIFY YOUR ENVIRONMENTAL TRIGGER(S)

  • If you can identify the environmental trigger of your AI disease, you can eliminate or minimize your exposure to that trigger. A trigger is a specific antigen, or protein, that the immune system recognizes as a threat (real or not), that sets off the cascade of over-activation.
  • In the case of celiac disease, the trigger is gluten for example. However, in the vast majority of autoimmune diseases the trigger remains unknown.
  • It can be challenging to identify your trigger. The key autoimmune drivers usually fall into these six areas:
    • Diet
    • Leaky Gut & Dysbiosis
    • Infections
    • Toxins
    • Stress
    • Hormonal Imbalances

Your plan to manage and reduce AI symptoms should also include the following:

  • IMPROVE DIET: A few successful dietary approaches are being used to address AI. The two most common are the AutoImmune Paleo (AIP) diet and the Dr. Terry Wahls diet. The AIP diet was developed by Dr. Sarah Ballantyne. It does eliminate many foods and mainly focuses on meats and vegetables. Dr. Terry Wahls developed her Wahls diet which she used to greatly improve her MS. It focuses on high amounts of vegetables and other anti-inflammatory foods. Both diets support and improve gut health, reduce inflammation and remove problematic foods from the diet. Try one or both of these diets. You can work with your FM practitioner for more detail on the best diet for you.
  • RESOLVE INFECTIONS: Infections, bacterial or other, can be a trigger for AI. It is important to test for and address any infections. This could be bacterial like some of the overgrowths mentioned above that contribute to AI, viral like Epstein-Barr Virus, mycotoxin-related like Lyme disease or mold illness or other. Use an FM approach to resolve any infection you may have.
  • DECREASE EXPOSURES TO TOXINS: Pollution, chemicals, environmental toxins of all sorts are everywhere. We cannot escape exposure completely, but we can work to minimize our exposure to toxins. Eat a clean organic diet. Use clean, green household cleaning and other products. Switch to natural, non-chemical personal care products and use the EWG’s Skin Deep website (https://www.ewg.org/skindeep/search.php?query=fragrance&h=Search) to rate your products. Minimize EMFs from your phone and WIFI. Get an air filter for your home and a good water purification system. Avoid spending time in heavily-polluted areas or areas where chemicals are heavily used. Don’t smoke or drink excessive amounts of alcohol. Don’t use plastic containers for food or water storage. Switch to glass or stainless steel. Cook in clean safe cookware.
  • REDUCE / MANAGE STRESS: Stress can contribute to the development of leaky gut so reduce it wherever you can. Take on less commitments. Manage your stress through meditation, yoga, tai chi and time spent in nature.
  • ADDRESS HORMONAL IMBALANCES: Hormonal imbalances can also be an issue with AI. Address these with the help of your FM practitioner.

If you or someone you know is suffering from an autoimmune disease, get in touch with our clinic today. Book a free 15-min discovery call to see how we can help you with your symptoms. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

—-    Please follow our next article in the Autoimmune-Microbiome series    —-

We will provide more evidence of the effects that the microbiome has on autoimmunity.

 

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November 5, 2019

Autoimmunity & the Gut Part 1, The Gut-Brain Axis Series, The Microbiome-Autoimmune Connection

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

INTRODUCTION

Gut health is closely involved in autoimmunity (AI). In fact, there are three elements necessary for an autoimmune disease to develop. These are a genetic predisposition, a leaky gut and an environmental trigger (Fasano, 2012). This is commonly referred to as the triad of AI. Through intestinal permeability, or leaky gut, the gut becomes a critical factor in AI.

AI diseases are typically chronic and can require lifelong treatment. Conventional medicine says there is no cure for most AI diseases. But Functional Medicine has developed different approaches that can help to manage or improve an AI disease, and in some cases, to reverse an AI disease.

There are more than 100 different autoimmune diseases. Forty other additional diseases are thought to have an autoimmune component (The American Autoimmune Related Diseases Association, 2019). We cannot list them all here but common ones include multiple sclerosis, lupus, celiac disease, Crohn’s, Hashimoto’s, rheumatoid arthritis, fibromyalgia, type 1 diabetes, ulcerative colitis, vitiligo, Meniere’s disease and others.

AI diseases are becoming more and more common in our modern society.

• The National Institute of Health (NIH) estimates up to 23.5 million Americans suffer from autoimmune disease and that the prevalence is rising (The American Autoimmune Related Diseases Association, 2019). The NIH numbers only include 24 diseases for which good epidemiology studies were available (The American Autoimmune Related Diseases Association, 2019).
• The American Autoimmune Related Diseases Association (AARDA) says that 50 million Americans suffer from autoimmune disease when all AI diseases are included (The American Autoimmune Related Diseases Association, 2019).
• Autoimmune diseases are more common in women, and they often run in families.

AUTOIMMUNITY & THE GUT

Autoimmunity (AI) occurs when the body’s immune system attacks itself. The immune system protects the body by responding to invading microorganisms, such as viruses or bacteria, by producing antibodies or other types of immune cells. Normally, an immune response cannot be triggered against the cells of one’s own body. In some cases, however, immune cells make a mistake and attack the cells that they are meant to protect. Essentially, the person’s immune system attacks its own tissue. This can lead to a variety of autoimmune diseases.

Factors such as genetics, the environment, infections, and the gut microbiota all play a role in autoimmune disorders. The microbiome, meaning the specific bacteria in the gut, has a very important and long-term effect on the immune system, starting at birth. It also plays a significant role in autoimmune disease (Campbell, 2014).

It is not fully understood how the microbiome interacts with the immune system in either the development or the absence of an autoimmune condition (Thomas S, 2017). Microbial dysbiosis in early life can negatively affect how the immune system develops and provide the basis for allergic disorders or other health problems in later life (Thomas S, 2017). Dysbiosis may trigger intestinal permeability (or leaky gut) and consequently may trigger autoimmune diseases, given the right circumstances (Thomas S, 2017).

When leaky gut occurs, there are essentially small holes in the gut lining. Through these holes, various large protein molecules of undigested food can get into the bloodstream and travel all around the body. As this undigested food continues to pass through the holes of the gut lining, food intolerances will occur and the immune system will be triggered over and over into attacking these particles. Eventually, the immune system becomes excessively activated and goes into overdrive. Certain body tissue can look like undigested food molecules. This is called molecular mimicry.

The immune system can start to confuse a food or other foreign molecule with a particular body tissue, and start to attack its own tissue. This self-attack is what happens in an autoimmune disease. For example, Hashimoto’s is when the immune system attacks the thyroid. In MS, the attack is on the myelin sheath surrounding nerves.

WHAT CAUSES LEAKY GUT?

Several factors can lead to leaky gut:

DYSBIOSIS: Increased intestinal permeability is influenced by the make-up of the gut microbiota (Fasano, 2012). An unbalanced gut flora or dysbiosis, when more bad bacteria exist vs. good bacteria, can contribute to leaky gut. Dysbiosis has been associated with autoimmune diseases, particularly, rheumatoid arthritis (RA), type 1 diabetes (T1D), multiple sclerosis (MS) and autoimmune liver disease (AILD) (Li, 2018).

ZONULIN: Zonulin is a protein that regulates intestinal permeability by modulating the tight junctions of the gut lining (Fasano, 2012). Zonulin has been found to be higher in autoimmune conditions associated with a dysfunction of the tight junctions, including celiac disease (CD) and T1D (Fasano, 2012). Both animal studies and human trials have established that zonulin is involved in the development of autoimmune diseases (Fasano, 2012).

Zonulin is triggered or increased by small intestinal exposure to bacteria, as in the case of SIBO or small intestinal bacterial overgrowth, and gluten (Fasano, 2012). These have been identified as the two more powerful triggers (Fasano, 2012) for higher zonulin, which will lead to leaky gut. In the small intestine, when exposed to excessive bacteria, zonulin is secreted in genetically susceptible individuals (Fasano, 2012). This affects the intestinal barrier function by releasing zonulin and can cause leaky gut (Fasano, 2012).

POOR DIET: Diet dramatically affects gut health and the specific strains of gut bacteria. The US diet has changed dramatically since the 1950’s. We have new strains of grains, especially in wheat, rice, soy, and corn. The food supply contains GMO’s, chemicals, pesticides, fungicides, insecticides, antibiotics, heavy metals, such as arsenic, chemical ingredients such as artificial preservatives, colorings, and flavorings and plasticizers such as bisphenol A. Animal products contain the hormones and antibiotics given to the animals. In addition, antibiotics, antacids, proton pump inhibitors, histamine 2 blockers, and other drugs are widely used.

In line with these dietary changes, there has been a significant increase in autoimmune diseases, linking the quality of diet and autoimmune problems (Campbell, 2014).

The specific elements of our diet that contribute to leaky gut are:

• Refined and processed sugars
• Refined carbohydrates
• Genetically modified foods
• Vegetable oils
• Alcohol: Data indicate that alcohol is associated with dysbiotic changes in the gut microbiota, meaning that balance of good vs. bad bacteria tips into dysbiosis (Engen PA, 2015). Alcohol may also be associated with increased gastrointestinal tract inflammation and intestinal permeability resulting in systemic inflammation and tissue damage (Engen PA, 2015).
• Gluten: Gluten triggers the release of zonulin. Zonulin is a key factor in regulating tight junctions of the gut lining. Zonulin’s increase in genetically susceptible individuals may lead to immune-mediated diseases, i.e. autoimmunity (Fasano, Intestinal permeability and its regulation by zonulin: diagnostic and therapeutic implications., 2012).
• Dairy
• Packaged, processed, and junk foods: Glucose, salt, emulsifiers, organic solvents, gluten and nanoparticles are increasingly used by the food industry, allegedly to improve the quality of food. All of these additives are known to increase intestinal permeability by breaking down the tight junctions of the gut lining (Lerner A, 2015).
• Any food to which a person has a sensitivity or allergy

STRESS: Stress is a factor and can disturb the make-up of the microbiome and increase permeability (Camilleri, 2019).

MEDICATIONS: Certain medications can increase intestinal permeability. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil), aspirin, Celebrex and others increase permeability (Camilleri, 2019). Other drugs, such as antibiotics and oral contraceptives disrupt the intestinal barrier (Bischoff SC, 2014).

Once a leaky gut is established in a genetically susceptible person, an AI disease may potentially develop.

CERTAIN, OFTEN PATHOLOGICAL, BACTERIAL STRAINS ARE FOUND IN DYSBIOSIS AND WITH CERTAIN AI CONDITIONS.

Dysbiosis should be identified, monitored and treated because it can contribute to autoimmunity. Most infectious agents, such as viruses, bacteria and parasites, can induce autoimmunity via different mechanisms (Kivity S, 2009). Bacterial infections in particular are associated with many autoimmune diseases involving chronic inflammation (Sherbet, 2009).

In many cases, it is not a single infection but rather the ‘burden of infections’ from childhood that is responsible for the development of autoimmunity. The development of an autoimmune disease after infection tends to occur in genetically susceptible individuals, often with intestinal permeability or gut dysbiosis (Kivity S, 2009).

ENTEROCOCCUS GALLINARUM: One study has linked autoimmune reactions to a bacterium in the gut called Enterococcus gallinarum (Manfredo Vieira S, 2018). The autoimmune response can be triggered when the bacterium spontaneously migrates from the gut to other organs in the body, such as the spleen, liver, and lymph nodes (Manfredo Vieira S, 2018). The results were confirmed when researchers compared cultured liver cells of healthy people versus those of people with an autoimmune disease and found traces of Enterococcus gallinarum in the autoimmune group (Manfredo Vieira S, 2018).

BACTEROIDES FRAGILIS: Another study has identified the bacteria Bacteroides fragilis to be involved in AI (Stewart L, 2018). A protein produced by this common gut bacteria may trigger the onset of autoimmune disease through the concept of molecular mimicry. Researchers found that patients with autoimmune disorders display higher-than-normal levels of a “mimic protein” produced by Bacteroides fragilis (Stewart L, 2018). This specific microbe in the gut produces protein molecules that mimic a human protein, which can cause the immune system to attack its own cells by mistake through molecular mimicry and this can contribute to autoimmunity (Stewart L, 2018).

KLEBSIELLA PNEUMONIAE: It has been known for some time that the pathogenic bacteria, Klebsiella pneumoniae, is linked to certain AI diseases (Rashid T, 2013). Studies have found that Klebsiella is the most likely triggering factor involved in the initiation and development of two autoimmune diseases; ankylosing spondylitis (AS) and Crohn’s disease (CD) (Rashid T, 2013). It appears that Klebsiella microbes can grow and thrive in the bowel of genetically susceptible people.

MYCOBACTERIUM AVIUM SUBSPECIES PARATUBERCULOSIS or MAP: MAP is a bacterium that is the known infectious cause of Johne’s disease, a chronic inflammatory bowel disease (IBD) in cattle (Dow, 2012). MAP is also involved in Crohn’s disease, which is very similar to Johne’s. MAP acts as a trigger of autoimmune disease and is associated with autoimmune diabetes, autoimmune thyroiditis and multiple sclerosis (Dow, 2012).

PREVOTELLA COPRI: In a study of 114 people, a bacterium named Prevotella copri was present in the gut of 75% of people with rheumatoid arthritis (RA) compared to only 21% of healthy control subjects (National Institutes of Health (NIH), 2013). In addition, an abundance of Prevotella copri has been identified in patients newly diagnosed with rheumatoid arthritis (Alpizar-Rodriguez D, 2019). The presence of P. copri corresponds to a reduced amount of other beneficial microbes (Scher JU, 2013). This indicates the role of intestinal dysbiosis in the development of RA (Alpizar-Rodriguez D, 2019).

PROTEUS: A strong link exists between Proteus mirabilis microbes and RA (Ebringer A, 2006). It is thought that sub-clinical Proteus urinary tract infections are the main triggering factor (Ebringer A, 2006). In addition, molecular mimicry between these bacteria and the specific tissue under immune attack in RA leads to the continuation of the disease process (Ebringer A, 2006).

In short, pathogenic bacteria can be highly problematic to overall gut health. In certain people with a genetic disposition, they can contribute to the development of autoimmunity. This is why is extremely advisable to be mindful of your gut health and consistently work on supporting a healthy gut.

Please follow us again next week when we will continue with Autoimmunity & the Gut Part 2. We will discuss specific microbiome issues in common AI diseases and we will give you ways to manage and address an autoimmune condition.

If you would like immediate assistance with an autoimmune condition, then get in touch with our clinic today. Book a free 15-min discovery call to see how we can help you with your symptoms. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

 

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October 29, 2019

Depression & the Gut: Are they linked & what is the link? Part 2: Depression The Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

Last week in Part 1 of Depression and the Gut, we defined depression and outlined the potential causes of depression; genetics, a chemical imbalance in the brain, hormones, stress or trauma, blood sugar dysregulation, poor diet, medications, inflammation and gut health.

This week we provide specific ways to address depression through functional medicine.

In functional medicine, we look for the root causes and will always look at gut health and the underlying reasons for any potential inflammation.

WHAT YOU CAN DO TO ADDRESS DEPRESSION:

  • Balance Blood Sugar
  • Understand the Cause of your Inflammation and Reduce it
  • Improve Gut Health

These three key objectives can be achieved through:

DIET:

  • Adopting an organic, whole foods-based, anti-inflammatory diet is the best diet to balance blood sugar, decrease inflammation and promote gut health. Our food choices, alongside factors like stress, toxins, sleep and other lifestyle factors, determine the make-up of our gut bacteria and overall gut health. Diet is important for good gut health and for conditions like depression.
  • As a first step, we want to avoid the foods that are most damaging to gut health (Mu C, 2016):
    • Sugar & excess refined carbohydrates
    • GMOs
    • Highly processed foods
    • Lack of fiber
    • Excess caffeine
    • Excess alcohol
    • Vegetable oils high in omega 6 fatty acids
  • We recommend following the diet that we outlined in our article on anxiety, which is rich in omega 3 foods, fermented foods, prebiotics, polyphenols and tryptophan. See here for the full details
  • Prebiotics are foods that promote the growth of beneficial, health-supporting bacteria in the gut. They have been reported to improve inflammation and to alleviate psychological distress (Kim YK, 2018).  These foods contain non-digestible fibers that promote the growth of beneficial gut microbiota such as Lactobacillus and Bifidobacterium, benefiting the microbiome-gut-brain axis (Kim YK, 2018). Prebiotic foods include lentils, apple cider vinegar, dandelion greens, raw garlic, raw or very lightly cooked onion, leeks, raw asparagus, green bananas, green plantains, potatoes that have been cooked then cooled 24 hours (served cold or at room temperature, as is common in potato salad), apples and others.
  • Additionally, certain foods can be helpful when dealing with depression. One study looked at and identified twelve nutrients most effective for the prevention and treatment of depression (LaChance LR, 2018):
  • Folate
  • Iron
  • Omega-3 fatty acids (EPA and DHA)
  • Magnesium
  • Potassium
  • Selenium
  • Thiamine
  • Vitamin A
  • Vitamin B6
  • Vitamin B12
  • Vitamin C
  • Zinc
  • The study also came up with a list of anti-depressant foods. The highest scoring foods are: (LaChance LR, 2018)
  • Oysters, mussels, various types of seafood and organ meats
  • Leafy greens, lettuces, peppers and cruciferous vegetables
  • The categories of food that are most to least effective in reducing depression are: (LaChance LR, 2018)
  • Vegetables
  • Organ meats
  • Fruits
  • Seafood
  • Legumes
  • Meats
  • With grains, nuts, seeds and dairy being the least effective in fighting depression

SUPPLEMENTS:

  • Probiotics: Probiotics support the good gut bacteria, promoting better gut health. They also can significantly decrease depression (Huang R, 2016). Probiotics had an effect on both healthy people and on patients with major depressive disorder (Huang R, 2016).
  • Omega 3 fatty acids: Omega 3 fats are anti-inflammatory. They can inhibit many aspects of the body’s inflammation process (Calder, 2017). As we know, reducing inflammation is a critical piece in addressing depression. In addition, omega 3 fats can positively affect gut health. A few studies looking at omega 3 fats and the gut showed changes in the gut microbiome after omega 3 supplementation  (Costantini L, 2017). In particular, an increase in Bacteroidetes and butyrate-producing bacteria was found (Costantini L, 2017). The short chain fatty acid butyrate is known to reduce inflammation (Valles-Colomer M, 2019). Further, the relationship between gut bacteria, omega 3 fatty acids, and immunity helps to maintain the gut lining integrity, to avoid leaky gut. (Costantini L, 2017). Increasing evidence from various trials have identified that a deficiency in omega 3 fatty acids may contribute to development of mood disorders, and that supplementation with omega 3 may provide a new treatment option (Deacon G, 2017).
  • St John’s Wort: St John’s Wort is a popular herb used as a remedy for depression. It is widely used in many European countries. A large study found that for patients with mild to moderate depression, St John’s Wort is as effective as SSRIs (Ng QX, 2017). When compared specifically to the SSRI antidepressant drug, Paxil, in the treatment of moderate to severe major depression, St John’s Wort was found to be at least as effective as Paroxil, with fewer side effects (Szegedi A, 2005). A second study found that in the treatment of mild to moderate depression, St John’s Wort is equally effective as synthetic antidepressants (Schulz, 2002). Finally, it was found that St John’s Wort was equivalent to the SSRI Zoloft for the treatment of moderate depression (Gastpar M, 2005). It is not advisable to take St John’s Wort at the same time as other medications like antidepressants, anticoagulants and other drugs. It is best to work with an experienced functional medicine practitioner to help with the dosing and interactions of taking St John’s Wort for depression.
  • Vitamin D: One study found that a one-off dose of 100,000 IU of vitamin D improved depression better than light therapy, in patients with seasonal affective disorder (Gloth FM, 1999). The increased vitamin D levels were significantly associated with the improvement in depression symptoms (Gloth FM, 1999).
  • Magnesium: Magnesium is effective for mild to moderate depression in adults. In one clinical trial, positive effects were observed within two weeks of subjects taking magnesium chloride (Tarleton EK, 2017). Patients in the study had significant improvement in both depression and anxiety disorders (Tarleton EK, 2017). Magnesium works quickly and is well tolerated without the risk for toxicity (Tarleton EK, 2017).

It is also helpful to look at:

  • CHRONIC INFECTION such as Lyme, Epstein-Barr Virus, mold, or other bacterial or viral infection: A hidden chronic infection can often be an underlying cause of inflammation. As we know, inflammation is involved with depression given that depressed people exhibit all of the classic features of an inflammatory response (Miller AH, 2016). An inflammatory response is also the body’s reaction to an infection. Thus it follows that an infection, which creates inflammation, can be a contributing factor to depression. Furthermore, there is a hypothesis called the “infection-defense hypothesis” of depression, which suggests that the immune system helps regulate mood to increase the body’s defense against infection (Midori T, 2011). Moods, which can drive different physical and behavioral responses, play an adaptive role by helping to fight existing infections, as well as helping both individuals and their family to avoid new ones (Anders S, 2013). This “infection-defense hypothesis” proposes that immune vulnerability to infection elicits a depressed mood, which in turn stimulates behaviors that help protect vulnerable individuals against infectious diseases (Midori T, 2011).
  • DENTAL HEALTH: Poor dental health can be a source of inflammation and affect overall health. Tooth infection, oral bacteria, tooth decay and exposure to mercury through amalgam fillings can all contribute to inflammation and poor health. There is less research on dental disease as it relates to depression, yet it should not be overlooked (Kisely S, 2016).
  • EXERCISE: Many studies have demonstrated that exercise reduces symptoms of depression. One study specifically found that aerobic exercise, three times per week, at a moderate intensity, for a minimum of nine weeks was the most effective in the treatment of depression (Stanton R, 2014). Another older study done in 2005 found that exercising 5 times per week led to the disappearance of symptoms of depression in 42% of the study subjects (Dunn AL, 2005).
  • COGNITIVE THERAPY (CT): Research has found that cognitive therapy is as effective as antidepressant medications at treating depression (DeRubeis RJ, 2008). Furthermore, its effects are longer lasting as therapy reduces the risk of relapse even after it is discontinued (DeRubeis RJ, 2008). Patients treated with CT learn to apply the CT strategies whenever they are in a situation in which they could potentially fall back into the habit of thinking negatively (DeRubeis RJ, 2008). They learn and begin to put into practice new skills, which result in a change in the patient’s general beliefs about themselves and their reactions become less negative (DeRubeis RJ, 2008).
  • SLEEP: Sleep is critical for good mental health. One study found that insomnia increases the risk of subsequent depression amongst people with insomnia (American Academy of Sleep Medicine, 2008). Seventeen to 50% of subjects with insomnia lasting two weeks or longer developed a major depressive episode (American Academy of Sleep Medicine, 2008). It has also been found that there is a link between poor sleep and suicidal behavior (American Academy of Sleep Medicine, 2008). In a study of depressed patients, 8% had sleep disturbances (American Academy of Sleep Medicine, 2008). Sleep loss is a risk factor in the development of insulin resistance, impaired glucose tolerance and type 2 diabetes mellitus (Saner NJ, 2018). We saw earlier that blood sugar imbalances and insulin resistance can contribute to depression.
  • STRESS: We know that chronic stress and stressful life events can contribute to depression (Shadrina M, 2018). Therefore, it is important to reduce stress wherever possible, perhaps by taking on fewer obligations. Stress management is also key and activities like meditation, yoga, tai chi, listening to music and spending time outdoors can all be very calming and help to reduce the stress response of the body.

If you or someone you know is suffering from depression, get in touch with our clinic today. Book a free 15-min discovery call to see how we can help you with your symptoms. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

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October 24, 2019

Depression & the Gut: Are they linked & what is the link? Part 1: Depression, in the Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

We’ve written about the gut-brain axis and anxiety, ADHD and autism. In this week’s article on the gut-brain axis, we address depression and the gut. The gut and the brain are linked by the “gut-brain axis”, which regulates brain function and behavior (Chunlong Mu, 2016). For a full explanation of the gut-brain axis, please see our first article on anxiety and the gut.

The gut-brain axis plays a critical role in many neurological disorders. It affects neuropsychiatric disorders like anxiety, depression, schizophrenia and dementia (Kim YK, 2018), as well as neurodevelopmental disorders in children including autism, ADHD, learning disabilities, intellectual developmental disorder, motor disorders, and specific learning disorders (EPA, 2015).

In this article, we will explore the link between depression and the gut-brain axis. Major depressive disorder, usually just called ‘depression’, refers to a psychological state characterized by a low mood and an aversion to activity. Depression is a widespread chronic medical illness that can affect thoughts, behaviors, feelings, mood, physical health and overall sense of well-being. Typical traits of depression are low mood, lack of energy, sadness, insomnia, and an inability to enjoy life.

Key facts about Depression:

 CAUSES OF DEPRESSION:

A person’s susceptibility to depression and other mental health issues depends on genetic and epigenetic (i.e. social and environmental) factors. These factors are connected, as epigenetics can activate a genetic predisposition.

Like many of the complex conditions we have written about (anxiety, ADHD, autism, fibromyalgia, hypertension), there is not one single cause of depression. Instead many possible causes of depression exist. Conventional wisdom says that depression is genetic and caused by a chemical imbalance in the brain. This may be true but there are other, possibly surprising, causes of depression; for example, blood sugar imbalance, inflammation and poor gut health. Other factors may be stress, trauma, medications and illness.

  • GENETIC VULNERABILITY: Family and twin studies show strong evidence that genetic factors contribute to the risk of depression (Shadrina M, 2018). One study using twin research data shows that the heritability rate for depression is 37% (Shadrina M, 2018). Data from family studies show a 2 to 3-fold increase in the risk of depression in children of parents with depression (Shadrina M, 2018). Heritability is especially relevant in the more severe forms of depression (Shadrina M, 2018).The severity of a person’s depression depends on whether it is inherited from the mother or father’s side (Shadrina M, 2018).
  • A CHEMICAL OR NEUROTRANSMITTER IMBALANCE in the brain: Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining a stable mood may play a significant role in depression and its treatment (Mayo Clinic, 2019).
  • HORMONES: Changes in the body’s balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions (Mayo Clinic, 2019)
  • STRESSFUL LIFE EVENTS & TRAUMA: Chronic stress and stressful life events are strong predictors of the onset of depression (Shadrina M, 2018). Prolonged activation of the stress response system of the body can cause a higher risk of obesity, heart disease, depression and other disorders (Shadrina M, 2018). Many studies have looked at the link between Adverse Childhood Experiences (ACEs) and mental and physical health in later life as an adult. ACEs are defined as childhood abuse, neglect, psychological stress, being spanked as a child, sexual abuse, violence against mother, living with household members who were substance abusers and general household dysfunction (Felitti VJ, 1998). People who reported experiences of childhood adversity, compared to those who had experienced none, had increased health risks for alcoholism, drug abuse, depression, and suicide attempt; an increase in smoking, poor self-rated health, increase in physical inactivity, risky sexual behavior and sexually transmitted disease (Felitti VJ, 1998). Being spanked as a child was significantly associated with self-reported mental health issues (Merrick MT, 2017). Generally speaking, the more ACEs a person has experienced, the greater impact it has on health in adult life, with a higher incidence of mental health issues such as depression (Felitti VJ, 1998).
  • BLOOD SUGAR IMBALANCES: Blood sugar, or glucose, imbalances can cause mood issues. We have seen this clinically in our practice. Over time, a glucose imbalance will also lead to insulin resistance. Multiple studies have found that blood sugar disturbances and insulin resistance are closely associated with depression (Peng YF, 2017), (Lee JH, 2017) and (Timonen M, 2005).
  • POOR DIET: An unhealthy diet has recently emerged as a significant risk factor for depression (Dash S, 2015). Nutrition can play a key role in the severity and duration of depression as well as in the risk of becoming depressed in the first place (Sathyanarayana TS, 2008). Depressed people tend to have a poor appetite, skip meals, and eat excessive amounts of sweet foods. These dietary habits have been observed both during a depressive episode and before the depressive episode, indicating that poor nutrition is a risk factor (Sathyanarayana TS, 2008). Nutrient deficiencies can contribute to depression and are often seen in depressed people. The most common nutritional deficiencies seen in patients with mental disorders are: omega 3 fatty acids, B vitamins, minerals, and the amino acids that are precursors to neurotransmitters (Sathyanarayana TS, 2008). In addition to creating nutrient deficiencies and causing blood sugar highs and lows, an unhealthy diet causes systemic inflammation and is negative for gut health. As you read on, you will see that inflammation and gut health are key factors in the incidence of depression.
  • MEDICATION & MEDICAL PROBLEMS: Certain medications can have side effects that include mood disorders like depression (Harvard Health Publishing, 2019). Also, having serious medical problems, a life-threatening diagnosis or disease can affect one’s mood and be a potential epigenetic trigger that may bring on depression (Harvard Health Publishing, 2019).

Newer research has looked at inflammation and gut health as leading causes of depression:

INFLAMMATION:

There is ample data supporting the role of inflammation in depression (Miller AH, 2016). Patients with major depressive disorder exhibit all of the classic features of an inflammatory response, including increased amounts of inflammation-related cells of the immune system (Miller AH, 2016).

One study found that hs-CRP (high sensitivity C-reactive protein) is a reliable indicator of depression. Hs-CRP is a marker found in blood testing that indicates the level of systemic inflammation in the body. This study linked higher levels of hs-CRP in participants with depression (Pasco JA, 2010). Thus systemic inflammation is a risk factor for depression.

Further evidence was found in a study looking at post-mortem brain samples from suicide victims that had depression (Miller AH, 2016). Researchers saw an increase of various inflammatory proteins and other molecules in the brain samples (Miller AH, 2016).

In addition, giving inflammatory cytokines (inflammation-related molecules of the immune system) to non-depressed people causes symptoms of depression (Miller AH, 2016). In contrast, blocking these cytokines has been shown to reduce depressive symptoms in patients with medical illnesses, including major depressive disorder (Miller AH, 2016).

These inflammatory cytokines affect neurotransmitters and neurocircuits of the brain, leading to behaviors that are classified as depressive (Miller AH, 2016). Thus, the faulty brain chemistry observed in depression is, at least in part, a consequence of increased inflammation in the brain.

GUT HEALTH:

As we outlined in our first article of the Gut-Brain Axis series on anxiety, gut health is fundamental to brain health. The vagus nerve, the HPA axis, neurotransmitter status, short chain fatty acids and the immune system all impact the brain and can, if out of balance, cause mood-related issues. For a review of these factors, please see our anxiety article here.

One study looked at the specific bacteria strains found in the guts of depressed people and healthy, non-depressed people (Jiang H, 2015). There were material differences in the bacteria composition of the two groups. In the depressed patients, there was either a majority of some potentially harmful bacterial groups or a reduction in beneficial bacterial groups, when compared to non-depressed people (Jiang H, 2015).

Another study out this year, 2019, has found that people with lower levels of a specific gut bacteria called Bacteriodes enterotype 2 reported a lower quality of life and a tendency toward depression (Valles-Colomer M, 2019). People in the survey who reported a higher quality of life had higher levels of two other types of gut bacteria, Faecalibacterium and Coprococcus (Valles-Colomer M, 2019). These two bacteria strains produce the short chain fatty acid butyrate, which is known to reduce inflammation (Valles-Colomer M, 2019).

The gut is critical to depression as certain bacteria can reduce inflammation and, as a result, depression, given that depression is an inflammatory disorder.

Any GI infections or overgrowths will be an issue because they cause inflammation of the gut. This could be issues like dysbiosis, SIBO, candida, parasites, leaky gut, food sensitivities, histamine intolerance or others. We know that these issues cause gut inflammation, so therefore will potentially contribute to depression.

Improving gut health through probiotics can play a major role in the communication between the gut and the brain (Huang R, 2016). Multiple studies have looked at probiotics’ effect on mood and depression and probiotics were associated with a significant reduction in depression (Huang R, 2016).

TREATMENT:

Many treatment strategies for depression exist, including pharmaceuticals such as selective serotonin reuptake inhibitors (SSRIs) and lithium; medical technologies such as electroconvulsive therapy, deep brain stimulation, and bright light therapy, exercise, and music therapy.

However, approximately 33% of all patients with depression fail to respond to conventional antidepressant therapies (Miller AH, 2016). Medication may be significant in only the most severely depressed individuals (Huang R, 2016). There is other data suggesting that antidepressants are not as effective as the marketing of these drugs suggests (Ioannidis, 2008). Short-term benefits are small and the long-term balance of benefits and harms is not well documented (Ioannidis, 2008).

Side effects of antidepressants exist and can be serious. It has recently come to light that suicidal ideation and completion is a side effect of antidepressant drugs. One study found that as prescriptions of antidepressant drug have increased over time, so has the suicide rate (Larsson, 2017). In fact, 52% of the study subjects who committed suicide were prescribed antidepressants within a year of committing suicide (Larsson, 2017). Antidepressants were detected in 41% of the study subjects who committed suicide, indicating that they were under the influence of antidepressants at the time of death (Larsson, 2017).

Clearly, there is room for improvement in the treatment of depression. Please tune in next week to Part 2 of Depression and the Gut, where we will provide specific ways to address depression through functional medicine.

 

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October 15, 2019

Autism & the Gut: Are they linked & what is the link? Part 3 The Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

Three weeks ago, we wrote a blog on Autism & the Gut Part 1 and covered some facts about ASD as well as some of the contributing factors as they relate to genes and the environment. Recently, in Autism & the Gut Part 2, we discussed all of the contributing factors including gut health and its important impact on ASD. This week, in Autism & the Gut Part 3, we will outline specific action steps that you can take with diet, supplements and lifestyle habits, to address ASD.

Autism Spectrum Disorder: What Can You Do?

Gut health

In the case of ASD, it is important to improve gut health. This can be done by addressing the issues discussed last week in Part 2. These are dysbiosis, leaky gut, food sensitivities, yeast overgrowth, imbalanced SCFA’s and NT balance. Also look for other GI issues that may exist (such as parasites, SIBO or other infections / overgrowths of the gut).

We strongly recommend working with a qualified functional medicine clinic to properly assess gut issues through lab testing. A good functional medicine practitioner can guide you through the process of finding the most significant gut issues and working on those, in addition to identifying toxins and other root causes we’ve discussed in this article. If you would like to book a free 15-minute discovery call with our clinic, please click here. We work with people all over the world.

Tools that can be used to modify the gut microbiome are diet, supplements, probiotics, prebiotics, fecal microbiota transplant (FMT), microbiota transfer therapy (MTT) and antibiotics (Kang DW, 2019).

Diet

  • Diet influences the composition of the gut bacteria and overall health of one’s gut. We talked about a general gut healing diet and what to avoid for gut health in our recent article on anxiety. The approach discussed is always recommended for good gut health.
  • A gluten-free and/or casein- or dairy-free (GF/CF) diet has been found to improve ASD behaviors, physiological symptoms, and social behaviors (Li Q, 2017). Gluten and casein increase zonulin, which is a protein that increases gut permeability. Removing gluten and casein from the diet will improve leaky gut. Two trials have demonstrated the benefits that excluding gluten and casein have for symptoms of ASD (Whiteley P, 2010).
  • Avoid glyphosate. By only buying and eating organic food, glyphosate can be avoided. In addition to being used on the obvious GM crops, it is now also used as a desiccant to facilitate harvest in many other non-GM crops, like wheat, legumes and others. It is commonly found in alcohol, namely beer and wine, as it is sprayed on the crops used to make the alcohol. By going strictly organic-only, glyphosate exposure can be eliminated.
  • The GAPS Diet (The Gut and Psychology Diet) may be helpful in some cases of ASD. It removes foods that are damaging to gut bacteria and are difficult to digest, replacing them with nutrient-dense foods that heal the gut lining thereby addressing leaky gut. It is a fairly strict elimination diet that requires removing grains, pasteurized dairy, starchy vegetables and refined carbs. It is particularly helpful for neurological issues such as autism (Campbell-McBride, 2019).
  • There is some evidence that the ketogenic diet (a high-fat low-carbohydrate diet) leads to decreases in the total gut microbial counts, increased sociability, reduced repetitive behaviors, and improved social communication in an ASD animal model (Li Q, 2017). Animal research does fail in human trials about 92% of time, so it remains to be seen whether this will be effective for humans.
  • Prebiotics encourage the growth of beneficial bacteria. We encourage adding them to the diet of someone with ASD. We list prebiotic foods to add here.
  • It is helpful to work with an experienced FM practitioner to see which dietary approach will work best as research shows this can be case-dependent. To book a complimentary 15-minute phone consultation to see whether functional medicine is a good fit for your child, please click here.
  • It can be challenging to change the diet of children with ASD. Children with ASD typically tolerate only a narrow range of foods and have more feeding problems than children without ASD. They tend to refuse more foods and eat a limited food repertoire than typically developing children. Many parents complain that their children with ASD are very selective, ‘picky’ eaters. Children with ASD will reject foods for different reasons, including issues with the food presentation, texture, the use of certain utensils, and the mix of different types of food on the same plate. It can require patience to get a child with ASD to adapt their diet. Dr. Campbell-Mcbride explores this topic and recommends how to handle this situation in her book The GAPS Diet, Gut and Psychology Syndrome.

Supplements

  • In the case of ASD, children typically eat fewer fruits, vegetables, and proteins than non-affected children (Li Q, 2017).
  • They have a significantly lower daily intake of potassium, copper, folate, and calcium (Li Q, 2017). Research has looked at folate, vitamin D, omega 3, iron and zinc deficiencies with some links to ASD (Modabbernia A, 2017) and another study finds that zinc, copper, iron, and vitamin B9 are specific micronutrients related to ASD (Nuttall, 2017).
  • Vitamin D deficiency seems to be quite common in children with ASD (Modabbernia A, 2017).
  • We would recommend supplements in the case of ASD:
  • A good multi-vitamin & mineral supplement can help cover the bases with vitamin and mineral deficiencies. Specific testing for micronutrients can help to target treatment much better so consider working with a FM practitioner for this type of testing. Unfortunately, most multi-vitamins contain some nutrients that are problematic so we recommend using professional brands. We recommend Mitocore by Ortho Molecular in our clinic and you can buy it from our online store here.
  • Increased intake of omega 3 reduces hyperactivity, increases good bacteria in the gut and reduces risk of brain disorders (Amminger GP, 2007). You can use Olde World Icelandic Cod Liver Oil from our online store here.
  • In addition, test for vitamin D and iron status and supplement these if necessary. Too much of either is a problem so we recommend working with a practitioner to find the right dosage.
  • Lactobacillus probiotics help treat dysbiosis by controlling Clostridia overgrowth and aid the digestion of casein and gluten (Pelto L, 1998). Probiotics help to prevent intestinal inflammation, regulate intestinal tight junctions and barrier function, thereby improving leaky gut (Li Q, 2017). Probiotic treatments have a proven ability to normalize the microbiota and improve gut symptoms (Li Q, 2017). You can use Ortho Biotic probiotic from our online store here.
  • L-glutamine has been shown to improve barrier function and reduce intestinal permeability (Foitzik T, 1997). Protocol for Life Balance is a good brand that you can get from our online store here.
  • Digestive enzymes can aid the breakdown of food proteins and can improve digestive function. We often use Digestzymes by Designs for Health in our clinic, found here.
  • Vitamin B6 and magnesium supplements improve social and language skills (Mousain-Bosc M, 2006). P-5-P is the active form of B6 and we like the product by the company Designs for Health. Magnesium Chelate contains the preferred glycinate form of magnesium and we like the product by Designs for Health. Both of these can be found in our online store here.
  • Manganese (Mn) is an important nutrient, required for multiple functions in the body. A recent study revealed that glyphosate, the active ingredient in the herbicide Roundup, has been shown to severely deplete Mn levels (Samsel A, 2015). Low Mn affects the gut brain axis and is associated with gut dysbiosis as well as neuropathologies such as autism, Alzheimer’s disease, depression, anxiety syndrome and Parkinson’s disease (Samsel A, 2015).

Fecal Microbiota Transplantation (FMT)

FMT is the transplant of healthy human feces to a patient with severe gut dysbiosis, in order to regulate the intestinal microbiota of the patient. When the normal gut microbiota are destroyed, for example by excessive antibiotic treatment or other negative substances like GMO foods, it can be challenging to recover a normal healthy bacterial flora. FMT can be extremely helpful in these situations (Kim YK, 2018). Unfortunately this is not FDA approved for ASD in the US at this time.

Microbiota Transfer Therapy (MTT)

MTT is a modified FMT protocol. It involves 14 days of antibiotic treatment followed by bowel cleansing and a high initial dose of standardized human gut microbiota for 7–8 weeks. An open-label clinical trial showed that MTT improved both GI symptoms (i.e., constipation, diarrhea, indigestion and abdominal pain) and ASD-related symptoms and normalized the microbiota of ASD patients (Kang DW A. J., 2017)

Heavy metals

Heavy metals, combined with an inadequate nutritional status and an impaired detoxification function, can increase the severity of ASD symptoms (Blaurock-Busch E, 2012). Eliminating exposure to heavy metals will help prevent neurodevelopmental disorders in children. In children with ASD, it is best to test for heavy metals. If there is an issue with metals exposure, then seek treatment by supporting the detoxification process of the body and/ or chelating heavy metals from the body if necessary. Seek out a skilled functional medicine practitioner for both of these approaches.

Support detoxification

ASD children have a reduced ability to detoxify toxins from the body (Blaurock-Busch E, 2012). It is therefore advisable to find a skilled FM practitioner to help support the detoxification process. This will help the body to eliminate toxins, metals, and the other chemical types we have discussed, which contribute to the overall ASD picture.

Avoid toxins

In addition to enhancing the detox function, it is important to minimize toxin exposures wherever possible. Avoid pollution, endocrine disruptors, plastics, pesticides, GMO’s, glyphosate, mold or mycotoxins. You can do this by eating a clean, organic diet, and avoiding toxins or chemicals as much as possible. This would include cleaning up the family’s personal care and household cleaning products, avoiding pollution wherever possible, minimizing plastics use especially in food preparation and storage, not smoking cigarettes and keeping alcohol consumption to a minimum.

Avoid stress

Stress is not named as a cause of ASD but a stressful situation can trigger a person with ASD. For this reason, it is advisable to reduce stress where possible and manage stress. Stress can be managed with meditation and other mindfulness practices. Practice mediation, yoga or tai chi and spend time outdoors in nature.

 

If you or someone you know is suffering from ASD, get in touch with our clinic today. Book a free 15-min discovery call to see how we can help you with your symptoms. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

 

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September 30, 2019

Autism & the Gut: Are they linked & what is the link? Part 2: Autism, in The Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

Last week’s blog on Autism & the Gut Part 1 covered some facts about ASD as well as some of the contributing factors as they relate to genes and the environment. This week, in Autism & the Gut Part 2, we continue discussing the environmental factors that contribute to ASD, as well as cover gut health and its impact on ASD. Then in Autism & the Gut Part 3, we will outline specific action steps that you can take with diet, supplements and lifestyle habits, to address ASD.

In addition to what we covered last week, such as pre-natal factors, maternal nutrient deficiencies and environmental chemicals, these are Environmental Factors that can contribute to ASD:

  • Endocrine disruptors: These are chemicals that disrupt the endocrine (hormone) system of the body. Exposure to these chemicals pre-natally and in very early life can affect brain development.
    • It is thought that the effect of excessive testosterone on specific brain regions might be a key mechanism to push the brain to an extreme male pattern of more systematizing and less empathizing, which is in line with ASD characteristics (Modabbernia A, 2017). Therefore, factors that alter hormonal balance (and particularly fetal testosterone) might contribute to risk of ASD.  For example, flame retardants are both associated with an increased level of free testosterone and an increased risk of ASD (Modabbernia A, 2017).
    • Recent studies have shown that chemicals associated with lower testosterone levels are also associated with lower risk of autistic behaviors (Modabbernia A, 2017).
    • Another link between endocrine disruptors and ASD is alteration in thyroid function. Several studies have shown evidence of prenatal maternal thyroid dysfunction and ASD in the offspring (Modabbernia A, 2017). Many endocrine-disrupting chemicals that disrupt thyroid hormone function have also been hypothesized to increase the risk of ASD (Modabbernia A, 2017).
    • Studies of phthalate (an endocrine disruptor) exposure showed a significant association between phthalate exposure and risk of ASD (Modabbernia A, 2017).
  • Metals: Heavy metals, such as lead, cadmium, mercury, etc. are established neuro-toxins with documented impacts on cognitive and developmental outcomes (Lyall K, 2017).
    • Studies found an association between heavy metal concentration (mostly mercury and lead) and severity of ASD (Modabbernia A, 2017).
    • Twelve studies described improvement in symptoms of ASD following chelation therapy (a technique used to remove heavy metals from the body) (Modabbernia A, 2017).
    • In a genetically sensitive individual, toxic metals cause significant oxidative stress. This leads to impaired methylation/processing of folate and alters the capacity for synchronizing neural networks as a result of an impaired dopamine function (Modabbernia A, 2017). This affects epigenetic mechanisms, leading to abnormal gene expression. Both mechanisms, impaired synchronization of neural networks and epigenetic alterations related to methylation, are closely linked to ASD (Modabbernia A, 2017).
  • Glyphosate: Glyphosate is the active ingredient in Roundup Ready, the most widely used herbicide in the world (Samsel A, 2015). Glyphosate is liberally used on core food crops, because it is perceived to be non-toxic to humans. The adoption of genetically engineered “Roundup-Ready” corn, soy, canola, cotton, alfalfa, and sugar beets has made it relatively easy to control weeds without killing the crop plant, but this means that glyphosate is present as a residue in foods.
    • As weeds among GM Roundup-Ready crops are developing ever-increasing resistance to Roundup, use of the herbicide is increasing. In fact, its usage has increased steadily since 1987, in step with the rise in ASD rates (Samsel A, 2015).
    • In one study, the authors wrote: “Despite its relatively benign reputation, Roundup was among the most toxic herbicides and insecticides tested.” (Samsel A, 2015)
    • One paper states that this may explain the recent increase in incidence of multiple neurological diseases (Samsel A, 2015).
    • Glyphosate indirectly affects Lactobacillus, leading to increased anxiety via the gut–brain access (Samsel A, 2015). Both low Lactobacillus levels in the gut and anxiety syndrome are known features of ASD, and Lactobacillus probiotic treatments have been shown to alleviate anxiety and ASD (Samsel A, 2015).
    • Glyphosate indirectly results in mitochondrial damage, a hallmark of many neurological diseases and a factor in ASD (Samsel A, 2015).
    • This is a controversial topic, but glyphosate is frequently named as an environmental factor driving the rise in ASD that we see today.
  • Inflammation & immune system function: ASD is associated with an altered immune status, increased oxidative stress, and inflammation in the brain.
    • Concentrations of pro-inflammatory immune system molecules are increased in patients with ASD compared to those in healthy people (Modabbernia A, 2017).
    • A maternal autoimmune disease can increase the risk of ASD through the effect of maternal inflammatory mediators and autoantibodies on fetal neurodevelopment (Modabbernia A, 2017).
    • Substances such as lead, mercury, pollutants, or perinatal complications can cause inflammation and oxidative damage in the brain, which can impair neural growth and development (Modabbernia A, 2017).
  • Neurotransmitter changes and interference with signaling pathways in the brain: Neurotransmitters (NTs) are chemicals in the brain responsible for signaling. We wrote in some detail about NTs in our article on anxiety.
    • Abnormalities in the NTs glutamate, serotonin and GABA have been linked to ASD (Modabbernia A, 2017).
    • Some of the issues discussed already, like lead, environmental pollutants and flame retardants, disrupt the activities of NTs; NMDA, glutamate and GABA respectively (Modabbernia A, 2017).
    • Some environmental risk factors interact with intracellular signaling pathways and can impair neurodevelopment. For example, exposure to PCB and PBDE (chemicals used in plastics, construction, flame retardants, etc.) seems to alter a signaling pathway, leading to abnormalities in dendritic growth and neuronal connectivity, a key feature of ASD (Modabbernia A, 2017).

Gut health – As we have seen in our previous articles on the Gut Brain Axis (Anxiety, ADHD 1, ADHD 2, ASD 1), the gut microbiome is an important environmental factor that influences symptoms of various conditions, including ASD. Research has increasingly observed that children with ASD have distinctive gut microbiomes compared to neurotypical children (Kang DW, 2019). Thus through the microbiome-gut-brain axis, gut health influences ASD.

Gastrointestinal (GI) symptoms, such as abdominal pain, gas, diarrhea, constipation and flatulence, are common in people with ASD (Li Q H. Y., 2017). Constipation is found to be the most prevalent symptom (85%) in children with ASD (Li Q H. Y., 2017).

Other common symptoms are gut inflammation, intestinal permeability, low levels of digestive enzymes/ poor digestion, reflux esophagitis, impaired detoxification and dysbiosis (Horvath K, 1999). The prevalence of GI symptoms ranges from 23 to 70% in children with ASD (Li Q H. Y., 2017).

It has been found that improvements in GI and ASD symptoms are significantly correlated (Kang DW, 2019). In other words, attaining relief of GI symptoms may improve behavioral severity in children with ASD (Kang DW, 2019).

Dysbiosis, or an imbalance in gut flora with more bad bacteria than good in the gut, has been found in cases of ASD. Diversity, or the variety of gut bacteria found in people with ASD, is about 25% lower than in healthy people (Kang DW A. J., 2017). Their guts are missing hundreds of different species of bacteria, often ones that are important to fermentation and producing short chain fatty acids that influence health (Kang DW A. J., 2017).

For example, the guts of children with ASD exhibit lower levels of Bifidobacterium and Firmicutes and higher levels of Clostridium, Bacteroidetes, Desulfovibrio, Caloramator and Sarcina (Li Q H. Y., 2017). Children with autism who present GI symptoms have lower abundances of the species Prevotella, Coprococcus, and unclassified Veillonellaceae than that found in GI symptom-free neurotypical children (Li Q H. Y., 2017).

Clinical trials using fecal microbiota transplants (FMT) have shown promise with ASD. One trial using high-dose FMT for 1-2 days and then 7-8 weeks of highly purified oral solution dosing found significant GI and behavioral improvements (Kang DW A. J., 2019). A 2-year follow-up found that these positive changes continued to improve over time (Kang DW A. J., 2019). However, FMT is not FDA approved for ASD at this time, so it may be some time before this therapy is available in the US.

Re-establishing a healthy gut microbiome benefits the gut-brain axis that has become dysfunctional in ASD (Kang DW A. J., 2017). Also, simply removing the pain and distraction of a dysbiotic gut can help children concentrate better and benefit from speech, behavioral and other therapies they may be undergoing (Kang DW A. J., 2017).

In addition to dysbiosis, leaky gut is involved in ASD. A higher percentage of abnormal intestinal permeability, or commonly called leaky gut, was observed in 36.7% of patients with ASD compared with 4.8% of control children (Li Q H. Y., 2017).

In fact, the integrity of both the gut barrier and the BBB were impaired in ASD individuals (Li Q H. Y., 2017). Increased intestinal permeability results in the entry of the toxins and bacterial products into the bloodstream.

These circulating inflammatory molecules are then able to cross the blood-brain barrier, creating inflammation and immune responses in the brain (Li Q H. Y., 2017). For example, lipopolysaccharide (LPS), components of the cell wall of gram-negative bacteria, is increased in the serum of ASD compared with healthy individuals and is associated with impaired social behavior (Li Q H. Y., 2017).

Food sensitivities are often a problem, which ties back to a dysfunctional gut. Over 40% of children with ASD have food sensitivity issues, most commonly to wheat and milk products (Horvath K P. J., 2002).

The breakdown of gluten by pancreatic and intestinal enzymes produces ‘exorphins’ or undigested proteins.  When leaky gut is present, these undigested proteins can then enter into circulation and the central nervous system where they have a morphine-like effect (Reichelt K, 2003).

An increase in proteins, including opiates, has been linked to disruption in social awareness and behavior (Reichelt K, 2003). This sequence of events can occur with casein, from dairy products, as well (Reichelt K, 2003). Finally, gluten and casein increase zonulin, which is a protein that increases gut permeability i.e. leaky gut.

There is also a relationship between gut fungi or yeast and ASD. Yeast in the gut, particularly candida albicans, can result in less carbohydrates and minerals absorption and a higher release of toxins (Li Q H. Y., 2017).

A lower yeast rate of 19.6% was identified in non-autistic healthy volunteers (Li Q H. Y., 2017). It was found that in children with ASD, candida was two times more abundant than in normal individuals and that 81.4% of the yeast strains were candida, especially candida albicans (Li Q H. Y., 2017).

Candida can release ammonia and toxins that can induce autistic behaviors (Li Q H. Y., 2017). The changes in the bacterial microbiota in ASD individuals result in the growth of candida, which worsens the dysbiosis and can induce abnormal behaviors (Li Q H. Y., 2017).

SCFAs also play a critical role in patients with ASD. We talked about SCFAs here. SCFAs are products of the gut bacterial fermentation of carbohydrates and provide benefits to the human body.

Different SCFAs can be imbalanced in the gut of ASD patients. For example, proprionic acid, PPA, is a short-chain fatty acid that is mainly produced by Clostridia, Bacteroidetes, and Desulfovibrio bacteria, which are more frequently found with ASD, and can cross the BBB and induce ASD-like behaviors (Li Q H. Y., 2017). Higher PPA can lead to impaired social behavior, likely by altering some neurotransmitters, such as dopamine and serotonin (Li Q H. Y., 2017).

Finally, the impact of glyphosate on the gut is complex and multi-faceted. We cannot go into the tremendous amount of detail here but Stephanie Seneff has done so in this paper (Samsel A, 2015). There are multiple ways in which glyphosate can contribute to and worsen ASD. We advise avoidance and will explain how you can do that later in this article series on ASD.

Treatments used to date for ASD include behavioral therapy, speech and social therapy, diet / nutrition and medical treatments. However no medical treatment has been approved to treat core symptoms of ASD, such as social communication difficulties and repetitive behaviors (Kang DW, 2019). Considering the link between the gut and brain, the first approach should be to address gut health.

— To Be Continued —

Due to the complexity of ASD, we can’t cover everything that we want to say in one blog post. So please tune in again next week for ASD: Part 3, when we will outline specific action steps related to diet, supplements and lifestyle that you can take to address ASD.

If you want to address ASD sooner, then please get in touch with us today, by booking a free 15 minute discovery call here. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

—————-

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September 24, 2019

Autism & the Gut: Are they linked & what is the link? Part 1: Autism, in The Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

In this week’s article on the gut-brain axis, we address autism and the gut. The gut and the brain are linked, with the gut-brain axis regulating brain function and behavior (Chunlong Mu, 2016). For a full explanation of the gut brain axis, please see our first article on anxiety and the gut.

The gut-brain axis plays a critical role in many neurological disorders. It affects neuropsychiatric disorders like anxiety, depression, schizophrenia and dementia (Kim YK, 2018), as well as neurodevelopmental disorders in children including autism, ADHD, learning disabilities, intellectual developmental disorder, motor disorders, and specific learning disorders (EPA, 2015).

In this article, we will explore the link between autism and the gut brain axis. Autism, or autism spectrum disorder (ASD), is a brain developmental disorder (Li Q, 2017).

ASD is defined by significant social, communication and behavioral challenges, often with a pattern of stereotyped repetitive behaviors, speech and nonverbal communication behaviors and challenges with communication and social interaction (Li Q, 2017).

As autism is classified as a spectrum disorder, it affects sufferers differently (Autism Speaks, 2019). Cognitive abilities of people with ASD range from extremely gifted to severely challenged. Some with ASD need significant support in daily life, while others need less and some can live entirely independently.

ASD is often accompanied by sensory sensitivities, gastrointestinal (GI) disorders, immune deficits, anxiety, depression, sleep disturbances, seizures and attention issues (Lyall K, 2017).

A diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder (Centers for Disease Control and Prevention, 2018).

Important facts about ASD:

  • The prevalence is increasing (Autism Speaks, 2019). According to the CDC (Centers for Disease Control and Prevention, 2019):
  • In 2004, 1 in 166 children had ASD.
    • In 2006, 1 in 150 children had ASD.
    • In 2016, 1 in 68 children had ASD.
    • In 2018, 1 in 59 children had ASD, according to Autism Speaks, who used data from the CDC (Autism Speaks, 2018).
    • However, according to Pediatrics journal, using data from the 2016 National Survey of Children’s Health (NSCH), in 2018, 1 in 40 children had ASD (Kogan MD, 2018).
  • Some of this increase is due to better and earlier diagnosis, but there is debate about whether this explains all of the increase in ASD rates. This will become clear when we discuss causes. Our genes have not and cannot change so quickly, but our environment has. Thus some environmental changes or triggers are thought to be partially driving the increases seen.
  • Boys are four times more likely to be diagnosed with autism than girls (Centers for Disease Control and Prevention, 2019). Of the 1 in 59 children diagnosed with ASD in 2018: 1 in 37 are boys and 1 in 151 are girls.
  • However, the gender gap in autism has decreased (Autism Speaks, 2018). While boys were 4 times more likely to be diagnosed than girls in 2014, the difference was narrower than in 2012, when boys were 4.5 times more frequently diagnosed than girls (Autism Speaks, 2018). This is likely due to improved identification of autism in girls, who often do not manifest the stereotypical symptoms of autism seen in boys.
  • 31% of children with ASD have an intellectual disability (with an IQ <70), 25% are in the borderline range (IQ 71–85), and 44% have IQ scores in the average to above average range (IQ >85) (Autism Speaks, 2019).
  • ASD is one of the most serious neurodevelopmental conditions in the U.S. It has significant caregiver, family, and financial burdens. The annual total costs associated with ASD in the U.S. have been estimated to be approx. $250 billion (Lyall K, 2017). Lifetime individual ASD-associated costs are in the $1.5 to $2.5 million range (estimates in 2012 U.S. dollars) (Lyall K, 2017).

Most children are still being diagnosed after age 4, though autism can be reliably diagnosed as early as age 2 (Autism Speaks, 2019). Diagnosing ASD can be difficult. There is no medical test, such as a blood test, to diagnose it (Centers for Disease Control and Prevention, 2018).

Doctors look at the child’s behavior and development to make a diagnosis. It can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered to be very reliable (Centers for Disease Control and Prevention, 2018).

What are the CAUSES or Contributing Factors?

The causes of ASD are not completely understood. Studies on twins suggest that both genes and environment play roles in the development of ASD (Modabbernia A, 2017). The developing brain is vulnerable to environmental factors, which explains the causative association between environmental factors and ASD (Modabbernia A, 2017).

Some studies show ASD is primarily driven by genetic influences, and others report a nearly equal contribution from heritable genetic and non-heritable environmental factors (Lyall K, 2017). One study found that up to 40-50% of autism spectrum disorder (ASD) liability might be determined by environmental factors (Modabbernia A, 2017). Because environmental and epigenetic influences are not as well studied as genetic ones, there may be a much greater impact of environment than has appeared in studies so far.

Metabolism, gut, immune and mitochondrial dysfunction are frequent in ASD (Lyall K, 2017). Among children with ASD, gastrointestinal symptoms have also been associated with more frequent challenging behaviors (Lyall K, 2017).

It is clear that there are three areas to look at to explain ASD:

  • Genes
  • Environment
  • Gut health

Genes – It is possible to have a genetic disposition to the condition. The fact that genes partly contribute to ASD is strongly supported by twin and family studies (Lyall K, 2017). Several genes have been identified in ASD; post-synaptic scaffolding genes, i.e. SHANK3, contactin genes, i.e. CNTN4, neurexin family genes, i.e. CNTNAP2, and chromatin remodeling genes, i.e. CHD2 (Lyall K, 2017). The specific genes involved are part of common genetic pathways involved in ASD (Lyall K, 2017). The cumulative effect of multiple common gene issues, i.e. the polygenic risk, is now becoming recognized as an important risk factor for ASD and other psychiatric disorders (Lyall K, 2017).

Epigenetics is the study of gene-environment interaction. Unfortunately there is little information on gene-environment interaction in ASD causality, as only a few studies have been published to date (Lyall K, 2017).

Some epigenetic changes have been found in the brains of people with ASD, including hypo- and hyper-methylation, i.e. related to the MTHFR gene, and spreading of histone 3 lysine 4 trimethylation marks (Lyall K, 2017). We talked in detail about MTHFR here.

Research has found an increased risk of ASD associated with common mutations affecting the folate/methylation cycle i.e. the MTHFR mutation (El-Baz F, 2017). A significant association between severity and occurrence of autism has been found with two common MTHFR gene mutations, called C677T and A1298C (El-Baz F, 2017). Further studies are needed to explore other gene mutations that may be associated with autism, to establish the genetic basis of autism. (El-Baz F, 2017)

Other genetic variants for ASD implicate chromatin remodeling, another aspect of epigenetic regulation (Lyall K, 2017). Other reports suggest interactions between gene risk and prenatal exposure to air pollutants, genes in the one carbon metabolism pathway and maternal use of prenatal vitamins, and genetic variations and maternal prenatal infection (Lyall K, 2017).

Environment – This can be an outright cause or a trigger of ASD. Systematic reviews of the available research suggest more than 20 individual, familial, pre-, peri- and neo-natal factors with some evidence for ASD risk (Lyall K, 2017).

The maternal environment is especially important for the risk of developing autism spectrum disorders. In particular infections present in a mother during pregnancy, micronutrient deficiencies, obesity, and toxic exposures are likely to interact with genetic risk factors to disrupt fetal brain development (Nuttall, 2017).

One study suggests that approximately 75-80% of the observed increase in ASD since 1988 is due to an actual increase in the disorder rather than to changing diagnostic criteria (Nevison, 2014). It attributes the increase to environmental factors driving this increase (Nevison, 2014).

For example, polybrominated diphenyl ethers (used in flame retardants, building materials, electronics, furnishings, motor vehicles, airplanes, plastics, polyurethane foams, and textiles), aluminum adjuvants (used in vaccines), and the herbicide glyphosate have increasing trends that correlate positively to the rise in autism (Nevison, 2014).

Environmental factors driving ASD risk include:

  • Parental age: Every 10-year increase in maternal and paternal age increases the risk of ASD in the offspring by 18 and 21% respectively (Modabbernia A, 2017).
  • Inter-pregnancy interval: Increases in risk of ASD with a short (<12 months) period between pregnancies have been consistently reported. Reasons for this are not clear but relate to maternal nutrient deprivation, inflammation, and stress (Lyall K, 2017). Adequate recovery time between pregnancies is recommended.
  •  Pregnancy-related complications: Abnormal or breech presentation, cord complications, fetal distress, multiple births, low birth weight <1500 g, small for gestational age, congenital malformations, birth injury or trauma, hyperbilirubinemia, earlier birth (first vs. third born) and feeding difficulties at birth can all play a role (Modabbernia A, 2017).
  • Immune factors: Maternal hospitalization with infection (bacterial or viral) during pregnancy has been associated with increased risk of ASD (Lyall K, 2017). Familial history of autoimmune disease has also been associated with increased risk of ASD (Lyall K, 2017).
  • Medication use during pregnancy: Antidepressants, anti-asthmatics, and anti-epileptics (especially maternal valproate use for epilepsy and bipolar disorder) are associated with ASD in the children (Modabbernia A, 2017). Some association with SSRI anti-depressants exist but are not fully established in the research (Modabbernia A, 2017). However, these drugs can cross the placenta and blood brain barrier (BBB), as well as be transferred to the child through breast milk (Lyall K, 2017).
  • Nutrient deficiencies: Research has looked at folate, vitamin D, omega 3, iron and zinc deficiencies with some links to ASD (Modabbernia A, 2017). One paper finds that zinc, copper, iron, and vitamin B9 are specific micronutrients related to ASD (Nuttall, 2017). Specific toxins can induce a maternal inflammatory response which leads to fetal micronutrient deficiencies in these nutrients (Nuttall, 2017). The fetal deficiencies disrupt development of the early brain (Nuttall, 2017). Maternal micronutrient supplementation is advised as it is associated with reduced risk of ASD (Nuttall, 2017). Higher maternal intake of certain nutrients and supplements has been associated with reduction in ASD risk, with the strongest evidence for taking folate supplements before conception (Lyall K, Schmidt RJ, 2014). In later life, vitamin D deficiency seems to be quite common in children with ASD (Modabbernia A, 2017).
  • Environmental chemicals: We are exposed to a vast, almost countless, number of environmental and industrial chemicals in today’s world. Certain environmental chemicals exposures during the pre-natal period interfere with and disrupt normal brain development in the fetus. These chemicals can cross the placenta and the blood brain barrier, accumulating in developing brains (Lyall K, 2017). Others disrupt hormone pathways or act on inflammatory pathways that may have negative effects on brain development (Lyall K, 2017). Prenatal exposure to air pollution has emerged as a risk factor for ASD. These are hazardous air pollutants, such as chlorinated solvents, methylene chloride and diesel particulate matter and others (Lyall K, 2017). Chemicals in flame retardants can result in mitochondrial toxicity and lead to issues with energy balance in the brain (Modabbernia A, 2017). In general, chemicals can contribute to the mitochondrial dysfunction that is well documented in people with ASD (Modabbernia A, 2017).

— To Be Continued —

Due to the complexity of ASD, we can’t cover all of the factors contributing to ASD in one blog post. So please tune in again next week for ASD: Part 2 where we will continue with the environmental factors that contribute to ASD. We will also discuss gut health and how it contributes to ASD. Finally, in ASD: Part 3, we will outline what diet, supplements and lifestyle action steps you can take to address ASD.

If you want to address ASD sooner, then please get in touch with us today, by booking a free 15 minute discovery call here. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

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September 10, 2019

ADHD & the Gut: Are they linked & what is the link? Part 2: ADHD, in The Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

In this next article on the gut-brain axis, we address ADHD Part 2. Last week, we looked at ADHD and its link to the gut in ADHD Part 1. This week, we explore a list of factors contributing to ADHD and specifically what you can do in the case of ADHD.  

In Functional Medicine, we like to dig deep and look for the root cause(s). As there is no single cause of ADHD, in FM the approach we take is to look at all the factors found in research to be influencing ADHD.

We cannot change genetics but we can affect how genes express. We cannot change any prenatal events as mentioned last week such as maternal stress, poor diet, smoking or alcohol use during pregnancy and/or a low birth weight.

We can, however, change and improve a number of health factors, which will improve the condition of ADHD.

Nutrient status & Diet: ADHD is associated with unhealthy diets and nutrients deficiencies (Chou WJ, 2018). Children with ADHD had significantly lower serum (blood) levels of vitamin B12, folate, vitamin B6, ferritin and monounsaturated fatty acids (Wang LJ, 2019).

They also had higher levels of serum saturated fatty acids and a higher omega 6 to omega 3 fatty acid ratio, which is inflammatory (Wang LJ, 2019).

Children with ADHD had a higher intake of nutrient-poor foods such as high sugar and high fat foods, and less vegetables, fruit and protein-rich foods (Wang LJ, 2019). Children with ADHD ate a higher intake of refined grains and a lower portion of dairy, calcium and vitamin B2 (Chou WJ, 2018).

It is clear from research that there is an association between unhealthy dietary patterns and ADHD. An unhealthy diet leads to the poor nutritional status of people with ADHD. In addition, food dyes and additives in the diet (Banerjee TD, 2007), common allergens such as eggs and micronutrient and mineral deficiencies (Wang LJ, 2019) have been implicated in ADHD. Improving diet and nutrition is expected to improve ADHD symptoms (Wang LJ, 2019).

Children with ADHD have been shown to have lower vitamin D levels when compared to children with healthy controls. Children with ADHD had an average blood level of 19.11 ng/ml whereas the control group average was 28.78 ng/ml (Sharif MR, 2015).

Of course, it is understandable that it can be difficult in some cases to help a child to eat a healthier diet with the peer and societal influences that push a standard American diet. However, with some diligent work and patience, a healthy diet can be achieved. Supplementation of some of the common nutrient deficiencies with a high quality professional grade B complex and cod liver oil may help.

Gut microbiome health: As we have discussed, the health of the microbiome is critical with ADHD. Dysbiosis and gut inflammation are factors that can lead to ADHD.

It is important to find a FM practitioner who will test for a variety of GI issues, such as dysbiosis, SIBO, overgrowths, infections, parasites, fungus, low SCFA’s or SCFA’s imbalance or any other type of infection or issues affecting gut health. After getting a clear picture of gut health, treating any issues found is critical.

Antibiotics use: Antibiotics disrupt the gut microbiome. They kill all bacteria in the gut, including the good ones. Antibiotics are commonly prescribed for infants and children. This negatively affects the gut microbiota and health and development outcomes.

One study found that children who had received antibiotics in the first 6 months of life had significantly lower overall cognitive and verbal comprehension abilities, increased risk of problems with cognition, impulsivity, hyperactivity, ADHD, anxiety and emotional problems (Slykerman RF, 2019). The study concluded that early exposure to antibiotics may be associated with detrimental neurodevelopmental outcomes (Slykerman RF, 2019). Limit antibiotics use wherever possible.

Acetaminophen: Tylenol contains an active ingredient called acetaminophen. Because it is available over the counter, many parents use Tylenol to treat pain and fever. It is typically used for mild to moderate pain relief and often used to relieve fever in children. However, research has identified that short-term maternal use of acetaminophen during pregnancy was negatively associated with ADHD in offspring and that long-term use during pregnancy was substantially associated with ADHD (Ystrom E, 2017).

Toxin exposure:  It is widely accepted that exposure to various toxins, such as the afore-mentioned food dyes, additives and artificial colors, lead contamination and exposure to other heavy metals, cigarette and alcohol exposure, and other potential toxins or chemicals, are environmental factors that contribute to ADHD (Banerjee TD, 2007).

It is important to minimize these exposures wherever possible, by eating a clean, organic diet, and avoiding toxins or chemicals as much as possible. This would include cleaning up the family’s personal care and household cleaning products, avoiding pollution wherever possible, not smoking cigarettes and keeping alcohol consumption to a minimum.

Another source of toxins that often goes undiscovered and can cause serious issues are mycotoxins, or toxins from mold. It is estimated that 1 in 2 American homes is water damaged (Spengler, 1994) and mold is not always visible. Our clinic specializes in helping people identify if they have been exposed to mold in the past or present and how to clear the toxins from the body.

Heavy metals: Exposures to heavy metals, particularly mercury, arsenic, lead, antimony and cadmium, can be contributors to ADHD. One study found that lead, cadmium and antimony were associated with susceptibility to ADHD and symptom severity in school-age children (Lee MJ, 2018).

Eliminating exposure to heavy metals will help prevent neurodevelopmental disorders in children. In children with ADHD, it is best to test for heavy metals.

If there is an issue with metals exposure, then seek treatment by supporting the detoxification process of the body and/ or chelating heavy metals from the body if necessary. Seek out a skilled functional medicine practitioner for both of these approaches.

MTHFR gene mutation: MTHFR is the name of both a gene and an enzyme in the human body called methylenetetrahydrofolate reductase. The gene tells the body how to make the enzyme. This enzyme is important to process folate properly. It turns folate into its bioavailable form, methylfolate, through the process methylation. The methylfolate then converts amino acids for many body functions, including the production of serotonin and dopamine.

If the MTHFR gene is mutated, it cannot produce the enzyme correctly, which disrupts various processes further downstream. One of these processes is the production of serotonin and dopamine, which are key players in ADHD, autism, and mood disorders (ADDitude, 2019). The malformation of the MTHFR gene causes the body to change folate into methylfolate at a reduced capacity (as low as 10% for homozygous and 50% for heterozygous) (ADDitude, 2019).

A person with the MTHFR mutation can have too much folate, and not enough methylfolate, which impairs various processes downstream. MTHFR is also critical in the process of detoxification. If it’s not working properly, heavy metal and mineral levels can become excessive or imbalanced, which can cause hyperactivity, mood disorders, and more (ADDitude, 2019). It is best to seek help from a functional medicine doctor if this is an issue or is suspected.

HPA axis: Stress can contribute to ADHD. It is not often named as a cause of ADHD but a stressful situation can trigger a person with ADHD. For this reason, it is advisable to reduce stress where possible and manage stress. Stress can be managed with meditation and other mindfulness practices. One study based on adults found that self-reported ADHD symptoms, emotional dysregulation and clinician ratings of ADHD symptoms improved for those who practiced mindfulness meditation relative to those who did not (Mitchell JT, 2017).

Yoga is another modality to increase mindfulness and help to manage ADHD symptoms. A small study done with children in 2013 found that a regular yoga practice, alongside treatment for ADHD, led to ‘a significant improvement in the ADHD symptoms’ (Hariprasad VR, 2013). In the months following the study, the children practiced yoga irregularly and symptoms worsened again (Hariprasad VR, 2013).

Tai Chi has also been found to reduce symptoms. One small study involving Tai Chi twice per week resulted in the study participants experiencing less anxiety, better behavior, less daydreaming, more appropriate emotional responses and less hyperactivity after 5 weeks of Tai Chi (Hernandez-Reif M, 2000).

Similarly, it has been found that spending time outdoors and playing in green open spaces reduces overall symptom severity in children with ADHD (Taylor AF, 2011). Children with ADHD who play regularly in green play settings have milder symptoms than children who do not (Taylor AF, 2011).

Generally, meditation and gentle movement practices that are mindful can be helpful for regulating the stress response. Creating a good habit from a young age of daily meditation is an invaluable life skill. Even 3-5 minutes per day can make a difference. And children can and do learn to meditate. Even if it is only for a short time, it is still helpful.

Exercise: We know that exercise improves mood and behavior in children and adults and lowers chronic disease risks. One study looking specifically at behavioral health disorders in children found that aerobic exercise improved symptoms (Bowling A, 2017). The children taking aerobic exercise experienced 32% to 51% lower incidence of poor self-regulation and disciplinary time out of class when participating in the exercise. These effects were noticeably more pronounced on days that children participated in the aerobic exercise, but carryover effects on non-exercise days were also observed. Aerobic exercise shows promise for improving self-regulation and classroom functioning among children with complex behavioral health disorders (Bowling A, 2017).

Screen time on phones, computers, video games and TV: Research has definitively linked excessive and addictive use of digital media with physical, psychological, social and neurological adverse effects. Overall screen time and violent and fast-paced content can activate dopamine and the reward pathways, leading to ADHD-related behavior and sleep problems (Lissak, 2018). A case study involving 9-year-old boy with ADHD found that screen time induced ADHD-related behavior (Lissak, 2018). Research agrees that reducing screen time is an effective tool to decrease ADHD-related behavior (Lissak, 2018). A secondary effect of reducing screen time is increased sleep time, which improves overall health.

Practical things that you can do to address ADHD:

Diet:

  • Adopt a clean, organic whole foods diet. Limit sugar, refined carbohydrates and processed foods. Eat vegetables, fruits, high quality organic proteins and healthy fats such as omega-3 fatty acids found in certain types of oily fish, flaxseed and other foods. Fermented foods help gut health as they contain live probiotics. Prebiotic foods will aid gut health and specifically, the balance of SCFAs. For more specific information on a diet that supports gut-brain axis health, please refer to our article on anxiety and the gut-brain axis.
  • Remove food dyes and additives. Certain food colorings, dyes, additives and preservatives may increase hyperactive behavior in some children (The Mayo Clinic, 2017). Avoid foods with these colorings and preservatives:
    • sodium benzoate – found in carbonated beverages, salad dressings, and fruit juice products
    • FD&C Yellow No. 6 – found in breadcrumbs, cereal, candy, icing, and soft drinks
    • FD&C Yellow No. 10 – found in juices, sorbets, and smoked haddock
    • FD&C Yellow No. 5 – found in pickles, cereal, granola bars, and yogurt
    • FD&C Red No. 40 – found in soft drinks, children’s medications, gelatin desserts, and ice cream
  • Remove commonly allergenic foods such as gluten/wheat, eggs, chocolate, dairy, tree nuts, peanuts and any other food you think you may be allergic to.

Supplements: can be helpful, as specific nutrient deficiencies have been identified with ADHD.

  • B12, Folate, B6: B vitamins have been found to be lower in people with ADHD (Wang LJ, 2019). Certain genetic mutations, such as MTHFR which we mentioned previously, can impair the body’s use of B vitamins. In this case, it would be helpful to work with a FM practitioner to determine your MTHFR status and address it accordingly with supplements and other measures.
  • Ferritin / iron: Children with ADHD are typically low in ferritin, which is the storage form of iron (Wang LJ, 2019). Test iron and ferritin levels first to determine if supplementation is necessary. (NOTE: Too much iron is a problem so please do not supplement iron without the guidance of a functional medicine or other qualified healthcare professional.)
  • Omega 3: It has been found that in ADHD, omega 3 fat levels are low (Wang LJ, 2019). This is an important nutrient for the brain, which can help to reduce neuroinflammation. Either eat fatty fish such as wild salmon, sardines, herring and anchovies or supplement with fish oil to get adequate levels of the omega 3 fats, EPA and DHA.
  • Vitamin D: Optimize vitamin D levels from sun exposure (avoid burning though) and/or supplemental vitamin D. First measure levels and determine if they are below 35 ng/ml. If so, supplementation and/or a healthy amount of sun exposure without sunscreen that does not produce sunburn will increase levels of vitamin D. When supplementing with Vitamin D, we recommend also supplementing with Vitamin K2. You can purchase products that have both in one capsule. Test vitamin D levels periodically to see if the dose is too high or too low. The sun may offer additional benefits beyond supplemental vitamin D so it is helpful to have a healthy level of sun exposure without burning.
  • Probiotics: There is some research suggesting that probiotics may be helpful with ADHD (Pelsser LM, 2009). Getting to the root cause of gut issues is, of course, preferable and that can be done by working with a skilled functional medicine doctor.
  • It is best to work with an experienced FM practitioner to determine what nutrient deficiencies you may have and how best to address them.

Mindfulness: Increase mindfulness with yoga, tai chi and meditation.

Exercise: Be sure to get plenty of exercise, including time to play outside in nature.

Address gut health: See a Functional Medicine practitioner to help you with gut health. Issues like dysbiosis and gut inflammation are important to address with ADHD. It is advisable to test for a variety of GI issues; dysbiosis, SIBO, overgrowths, infections, parasites, fungus, low SCFA’s or SCFA’s imbalance or any other type of infection or issues affecting gut health. After getting a clear picture of gut health, treating any issues found is critical.

 

If you or someone you know is suffering from ADHD, get in touch with our clinic today. Book a free 15-min discovery call to see how we can help you with your symptoms. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

 

References:

Aarts E, E. T. (2017). Gut microbiome in ADHD and its relation to neural reward anticipation. PLOS One.

ADDitude. (2019, March 18). MTHFR: Another Piece of the ADHD-Genetics Puzzle. Retrieved August 14, 2019, from ADDitude: https://www.additudemag.com/mthfr-adhd-genetics-puzzle/

All About ADHD. (n.d.). Causes of ADHD. Retrieved July 30, 2019, from All About ADHD: https://www.adhd-information.com/adhd-causes.html

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM–5). American Psychiatric Association.

Banerjee TD, M. F. (2007). Environmental risk factors for attention‐deficit hyperactivity disorder. Acta Paediatrica.

Bowling A, S. J. (2017). Cybercycling Effects on Classroom Behavior in Children With Behavioral Health Disorders: An RCT. Pediatrics.

Cenit MC, N. I.-F. (2017). Gut microbiota and attention deficit hyperactivity disorder: new perspectives for a challenging condition. European Child & Adolescent Psychiatry, 1081–1092.

Centers for Disease Control and Prevention. (2018, September 21). Attention-Deficit / Hyperactivity Disorder (ADHD). Retrieved July 28, 2019, from www.cdc.gov: https://www.cdc.gov/ncbddd/adhd/data.html

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (2019). General Prevalence of ADHD. Children and Adults with Attention-Deficit/Hyperactivity Disorde.

Chou WJ, L. M. (2018). Dietary and nutrient status of children with attention-deficit/ hyperactivity disorder: a case-control study. Asia Pacific Journal of Clinical Nutrition, 1325 – 1331.

Chunlong Mu, Y. Y. (2016). Gut Microbiota: The Brain Peacekeeper. Frontiers in Microbiology.

EPA, U. S. (2015, October). America’s Children and the Environment. Neurodevelopmental Disorders | Health.

Hariprasad VR, A. R. (2013). Feasibility and efficacy of yoga as an add-on intervention in attention deficit-hyperactivity disorder: An exploratory study. Indian Journal of Psychiatry.

Hernandez-Reif M, F. T. (2000). Attention Deficit Hyperactivity Disorder: Benefits from Tai Chi. Journal of Bodywork and Movement Therapies.

Kim YK, S. C. (2018). The Microbiota-Gut-Brain Axis in Neuropsychiatric Disorders: Patho-physiological Mechanisms and Novel Treatments. Current Neuropharmacology.

Lee MJ, C. M. (2018). Heavy Metals’ Effect on Susceptibility to Attention-Deficit/Hyperactivity Disorder: Implication of Lead, Cadmium, and Antimony. International Journal of Environmental Research and Public Health.

Lissak. (2018). Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study. Environmental Research.

Ming X, C. N. (2018). A Gut Feeling: A Hypothesis of the Role of the Microbiome in Attention-Deficit/Hyperactivity Disorders. Sage Journals.

Mitchell JT, M. E. (2017). A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation. Journal of Attention Disorders.

National Institute of Mental Health. (2019). www.nimh.nih.gov. Retrieved July 28, 2019, from NIH Nationa lInstitute of Mental Health: https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

NHS. (2018, May 30). Treatment ADHD. Retrieved August 14, 2019, from NHS: https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/treatment/#

Pelsser LM, B. J. (2009). ADHD as a (non) allergic hypersensitivity disorder: a hypothesis. Pediatric Allergy and Immunology.

Reneman D, B. C. (2019). White Matter by Diffusion MRI Following Methylphenidate Treatment: A Randomized Control Trial in Males with Attention-Deficit/Hyperactivity Disorder. Radiology.

Sharif MR, M. M. (2015). The Relationship between Serum Vitamin D Level and Attention Deficit Hyperactivity Disorder. Iranian Journal of Child Neurology.

Slykerman RF, C. C. (2019). Exposure to antibiotics in the first 24 months of life and neurocognitive outcomes at 11 years of age. Psychopharmacology.

Taylor AF, K. F. (2011). Could Exposure to Everyday Green Spaces Help Treat ADHD? Evidence from Children’s Play Settings. Applied Psychology.

Thapar A, C. M. (2013). What have we learnt about the causes of ADHD? Journal of Child Psychology and Psychiatry.

The Mayo Clinic. (2017, September 28). ADHD diet: Do food additives cause hyperactivity? Retrieved August 14, 2019, from The Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/adhd/expert-answers/adhd/faq-20058203

Wang LJ, Y. Y. (2019). Dietary Profiles, Nutritional Biochemistry Status, and Attention-Deficit/Hyperactivity Disorder: Path Analysis for a Case-Control Study. Journal of Clinical Medicine.

Ystrom E, G. K. (2017). Prenatal Exposure to Acetaminophen and Risk of ADHD. Pediatrics.

 

 

 

 

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August 21, 2019

ADHD & the Gut: Are they linked & what is the link? Part 1: ADHD, in The Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

In this next article on the gut-brain axis, we address ADHD and the gut this week. Recent research has established a strong link between the gut and the brain. The gut-brain axis regulates brain function and behavior (Chunlong Mu, 2016).

The gut-brain axis plays a critical role in many neurological disorders. It affects neuropsychiatric disorders like anxiety, depression, schizophrenia, dementia and autism (Kim YK, 2018). It also affects neurodevelopmental disorders in children including ADHD, autism, learning disabilities, intellectual developmental disorder, motor disorders, and specific learning disorders (EPA, 2015).

In this article, we will explore the link between ADHD and the gut brain axis.

ADHD (attention-deficit/hyperactivity disorder) is a brain disorder marked by a pattern of inattention and/or hyperactivity-impulsivity that interferes with normal functioning or development (National Institute of Mental Health, 2019).

You may have heard the name ADD, or attention deficit disorder. This is an out-of-date term. It was previously used to describe people who have problems paying attention but aren’t hyperactive. Instead of using the term ADD, such a person is now said to have the type of ADHD called predominantly inattentive.

The term ADHD became official in May 2013, when the American Psychiatric Association established the diagnostic criteria for different mental health conditions in the ‘Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association, 2013).

Some facts about ADHD:

  • ADHD is one of the most widespread neurodevelopmental conditions (Ming X, 2018).
  • The Center for Disease Control and Prevention (CDC) reports that 11% of all children (1 million) in the U.S. aged 4-17 have been diagnosed with ADHD in 2016. This represents a 43% increase since 2003. (Centers for Disease Control and Prevention, 2018).
  • In 2015, the CDC said the total number of Americans, adults and children, with ADHD continues to rise from 7.8% in 2003 to 9.5% in 2007 and to 11% in 2011 (Centers for Disease Control and Prevention, 2018).
  • ADHD rates are growing. Figures from 2003 to 2015/ 2016 show increases of 43% in children and 41% in all Americans with ADHD (Centers for Disease Control and Prevention, 2018).
  • The causes of the disorder remain unclear (Ming X, 2018). We do have some ideas on causes and they will be discussed later in this article so please do read on for information on causes of ADHD.
  • Boys have a higher incidence of ADHD than girls. In 2015-2016, Children and Adults with ADHD (CHADD) reported that 14% of children with ADHD were boys vs. 6.3% who were girls (Children and Adults with Attention-Deficit/Hyperactivity Disorder, 2019).
  • Co-occurring conditions are quite common in children (2-17 years of age). 63.8% of children with ADHD had at least one co-occurring condition: (Children and Adults with Attention-Deficit/Hyperactivity Disorder, 2019)
    • 51.5% had behavioral problems
    • 32.7% had anxiety problems
    • 16.8% had depression
    • 13.7% had autism spectrum disorder
    • 1.2% had Tourette syndrome
    • 1% (of adolescents) had a substance abuse disorder

Common symptoms of ADHD are:

  • difficulty focusing and concentrating on tasks
  • being easily distracted
  • forgetting to complete tasks
  • interrupting people while they’re talking
  • having difficulty sitting still

The National Institute of Mental Health further characterizes ADHD into three types; Inattention, Hyperactivity and Impulsivity: (National Institute of Mental Health, 2019)

  • Inattention: being easily sidetracked from the task at hand, lacking persistence, difficulty sustaining focus/concentration
  • Hyperactivity: appearing to move constantly, including when it is not appropriate, excessively fidgeting, tapping or talking, extreme restlessness or wearing others out with constant activity
  • Impulsivity: acting in a rash manner without first thinking about one’s actions, a desire for immediate reward or inability to delay gratification, being socially intrusive and excessively interrupting others

It is clear that the incidence of ADHD is growing. Part of this increase can be potentially attributed to better diagnoses. But in Functional Medicine (FM) we always want to dig deeper to get to the root causes and to understand why ADHD is on the rise. So what is going on?

In ADHD, there is an underlying metabolic and functional disorder in the brain. There are abnormalities in the neurotransmitter (NT) system in the brain, triggered by an imbalance of the neurotransmitters dopamine and noradrenaline (All About ADHD). These two NTs play an important role in the transmission of stimuli in nerve cells. When these neurotransmitters are out of balance, faulty information processing will result in the affected areas of the brain (All About ADHD).

With ADHD, the parts of the brain that are responsible for control and coordinating information processing are particularly affected (All About ADHD). This negatively impacts a person’s ability to concentrate, as well as their perception and impulse control (All About ADHD).

Causes of ADHD:

No single risk factor explains ADHD. Both inherited and non-inherited factors contribute and their effects are interdependent. (Thapar A, 2013)

In conventional medicine, it is widely accepted that ADHD is an inherited condition, although the precise cause or causes remain unclear. Studies have shown that children with a parent diagnosed with ADHD have a greater than 50% chance of having ADHD (Ming X, 2018).

However, only a small number of genes have been reported to have any effect in predicting ADHD and that effect is relatively small (Ming X, 2018).

The more likely explanation is that ADHD is due to a combination of genetic and environmental epigenetic factors. These environmental risk factors and potential gene-environment interactions increase the risk for the disorder (Banerjee TD, 2007). Environmental factors can be ‘inherited’. Growing up in and living in the same household means people – whether children or parents – are sharing their environment and are likely to be experiencing the same environmental factors.

Environmental factors influencing and potentially increasing the risk of developing ADHD are: (Banerjee TD, 2007) and (Ming X, 2018):

  • food dyes and additives in the diet
  • lead contamination and exposure to other heavy metals
  • micronutrient and mineral deficiencies
  • cigarette and alcohol exposure
  • maternal smoking during pregnancy
  • low birth weight
  • perinatal stress
  • neurotransmitter disruption

It is estimated that between 10% and 40% of the difference in heredity may be due to environmental factors (Ming X, 2018). Yet these known environmental factors do not account for all of the difference in heritability (Ming X, 2018).

More recent research into causes has highlighted the role of the gut, and specifically the microbiome-gut-brain axis, in ADHD (Ming X, 2018) and (Cenit MC, 2017). Please see our recent article on anxiety and the gut-brain axis for a full explanation of the microbiome-gut-brain axis.

In ADHD, it has been found that:

  • Dysbiosis, or an altered gut microbiome, and specifically increased Bifidobacterium species of gut bacteria, exist in patients and may contribute to the clinical expression of ADHD (Ming X, 2018).
  • Dysbiosis is associated with gastrointestinal symptoms, such as constipation, diarrhea, abdominal pain, and flatulence. A number of studies have noted an increase in these gastrointestinal symptoms in neurodevelopmental disorders and specifically in ADHD (Ming X, 2018).
  • Dysbiosis can lead to gut inflammation, due to a large amount of pro-inflammatory microbes. This can cause increased intestinal permeability and inflammation, allowing microbes into circulation through a leaky gut, which may lead to low-grade systemic inflammation and immune dysregulation (Ming X, 2018).
  • This low-grade systemic inflammation may gradually damage the blood–brain barrier and possibly cause the neuroinflammation seen in ADHD (Ming X, 2018).
  • Diet influences ADHD symptoms by affecting the gut microbiome through its impact on brain functioning and behavior. One proposed mechanism for these effects of gut microbiota is through their ability to synthesize neurotransmitters (NTs) and their precursors (Aarts E, 2017). Precursors of the NTs involved in ADHD (dopamine, noradrenaline and serotonin) are produced by the gut microbiota. Their precursors are amino acids (phenylalanine, tyrosine and tryptophan) which may pass through the gut lining, enter into circulation, and cross the blood-brain barrier (Aarts E, 2017). Once in the brain, they could potentially influence NT production. As a result, differences in gut bacteria may impair brain function and behavior relevant to ADHD (Aarts E, 2017). In fact, a higher amount of the gut bacteria Bifidobacterium in babies has been associated with increased risk of developing ADHD in childhood (Aarts E, 2017).

In conventional medicine, treatment used for ADHD is medication, behavioral treatment and/or a combination of medication and behavioral treatment. The most commonly prescribed medication for ADHD is Ritalin. Ritalin is not a cure for ADHD but it can improve concentration, reduce impulsivity and promote calmness (NHS, 2018). It does have side effects such as an increase in blood pressure and heart rate, difficulty sleeping, loss of appetite, headaches and stomach aches (NHS, 2018).

One recent study has just come out with findings that Ritalin changes the brain structure in children with ADHD (Reneman D, 2019). These effects were not found in adults with ADHD in the same study. The scans of the children’s brains showed changes in their brain structure in a short period of 4 months on Ritalin (Reneman D, 2019). These differences were in the left hemisphere of the brain and involved the process of coating nerve fibers, such as nerve fiber density, size and myelination (Reneman D, 2019). Patients can be on Ritalin and other medications for years, despite there being little knowledge about its long-term effect on the brain.

In Functional Medicine, we like to dig deeper and look for the root cause(s). As there is no single cause of ADHD, in FM the approach we take is to look at all the factors found in research to be influencing ADHD.

We cannot change genetics but we can affect how genes express. We cannot change any prenatal events as mentioned above such as maternal stress, poor diet, smoking or alcohol use during pregnancy and/or a low birth weight.

We can, however, change and improve a number of health factors, which will improve the condition of ADHD. Please stay tuned for a list of these factors and specifically what you can do in the case of ADHD in next week’s article ‘ADHD & the Gut: Are they linked & what is the link? Part 2’ of ‘The Gut-Brain Axis Series’.

 

References:

Aarts E, E. T. (2017). Gut microbiome in ADHD and its relation to neural reward anticipation. PLOS One.

ADDitude. (2019, March 18). MTHFR: Another Piece of the ADHD-Genetics Puzzle. Retrieved August 14, 2019, from ADDitude: https://www.additudemag.com/mthfr-adhd-genetics-puzzle/

All About ADHD. (n.d.). Causes of ADHD. Retrieved July 30, 2019, from All About ADHD: https://www.adhd-information.com/adhd-causes.html

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM–5). American Psychiatric Association.

Banerjee TD, M. F. (2007). Environmental risk factors for attention‐deficit hyperactivity disorder. Acta Paediatrica.

Bowling A, S. J. (2017). Cybercycling Effects on Classroom Behavior in Children With Behavioral Health Disorders: An RCT. Pediatrics.

Cenit MC, N. I.-F. (2017). Gut microbiota and attention deficit hyperactivity disorder: new perspectives for a challenging condition. European Child & Adolescent Psychiatry, 1081–1092.

Centers for Disease Control and Prevention. (2018, September 21). Attention-Deficit / Hyperactivity Disorder (ADHD). Retrieved July 28, 2019, from www.cdc.gov: https://www.cdc.gov/ncbddd/adhd/data.html

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (2019). General Prevalence of ADHD. Children and Adults with Attention-Deficit/Hyperactivity Disorder.

Chou WJ, L. M. (2018). Dietary and nutrient status of children with attention-deficit/ hyperactivity disorder: a case-control study. Asia Pacific Journal of Clinical Nutrition, 1325 – 1331.

Chunlong Mu, Y. Y. (2016). Gut Microbiota: The Brain Peacekeeper. Frontiers in Microbiology.

EPA, U. S. (2015, October). America’s Children and the Environment. Neurodevelopmental Disorders | Health.

Hariprasad VR, A. R. (2013). Feasibility and efficacy of yoga as an add-on intervention in attention deficit-hyperactivity disorder: An exploratory study. Indian Journal of Psychiatry.

Hernandez-Reif M, F. T. (2000). Attention Deficit Hyperactivity Disorder: Benefits from Tai Chi. Journal of Bodywork and Movement Therapies.

Kim YK, S. C. (2018). The Microbiota-Gut-Brain Axis in Neuropsychiatric Disorders: Patho-physiological Mechanisms and Novel Treatments. Current Neuropharmacology.

Lee MJ, C. M. (2018). Heavy Metals’ Effect on Susceptibility to Attention-Deficit/Hyperactivity Disorder: Implication of Lead, Cadmium, and Antimony. International Journal of Environmental Research and Public Health.

Lissak. (2018). Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study. Environmental Research.

Ming X, C. N. (2018). A Gut Feeling: A Hypothesis of the Role of the Microbiome in Attention-Deficit/Hyperactivity Disorders. Sage Journals.

Mitchell JT, M. E. (2017). A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation. Journal of Attention Disorders.

National Institute of Mental Health. (2019). www.nimh.nih.gov. Retrieved July 28, 2019, from NIH National Institute of Mental Health: https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

NHS. (2018, May 30). Treatment ADHD. Retrieved August 14, 2019, from NHS: https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/treatment/#

Pelsser LM, B. J. (2009). ADHD as a (non) allergic hypersensitivity disorder: a hypothesis. Pediatric Allergy and Immunology.

Reneman D, B. C. (2019). White Matter by Diffusion MRI Following Methylphenidate Treatment: A Randomized Control Trial in Males with Attention-Deficit/Hyperactivity Disorder. Radiology.

Sharif MR, M. M. (2015). The Relationship between Serum Vitamin D Level and Attention Deficit Hyperactivity Disorder. Iranian Journal of Child Neurology.

Slykerman RF, C. C. (2019). Exposure to antibiotics in the first 24 months of life and neurocognitive outcomes at 11 years of age. Psychopharmacology.

Taylor AF, K. F. (2011). Could Exposure to Everyday Green Spaces Help Treat ADHD? Evidence from Children’s Play Settings. Applied Psychology.

Thapar A, C. M. (2013). What have we learnt about the causes of ADHD? Journal of Child Psychology and Psychiatry.

The Mayo Clinic. (2017, September 28). ADHD diet: Do food additives cause hyperactivity? Retrieved August 14, 2019, from The Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/adhd/expert-answers/adhd/faq-20058203

Wang LJ, Y. Y. (2019). Dietary Profiles, Nutritional Biochemistry Status, and Attention-Deficit/Hyperactivity Disorder: Path Analysis for a Case-Control Study. Journal of Clinical Medicine.

Ystrom E, G. K. (2017). Prenatal Exposure to Acetaminophen and Risk of ADHD. Pediatrics.

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