What is naturopathic medicine Outline for today s presentation (what we ll cover): Top behavioral issues in kids:

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1 Good kid Bad diet Alternative approaches to the treatment of pediatric behavioral issues Abby Laing, N.D. Avante Medical Center (ph) ~ (fax) What is naturopathic medicine: A distinct primary health care profession, emphasizing prevention, treatment, and optimal health through the use of therapeutic methods and substances that encourage individuals inherent self-healing process. The practice of naturopathic medicine includes modern and traditional, scientific, and empirical methods. The tenets of naturopathic medicine: o First do no harm o Doctor as teacher o Prevention is the best medicine o Identify and treat the cause o Treat the whole person o The healing power of nature Outline for today s presentation (what we ll cover): o Top behavioral issues in kids... what we're seeing in practice o Common conventional treatment approaches o What's really causing these issues? o Alternative/nutritional treatment approaches Top behavioral issues in kids: o Attention Deficit Disorder (ADD), with or without hyperactivity (ADHD) o Autism or Autism Spectrum disorders (ASD) o Depression o Anxiety o Sleep disturbance o Sensory processing disorder o Oppositional defiant disorder 1. ADHD (ADD is an antiquated term): o Definition: Core symptoms: inattention, hyperactivity, and impulsivity. The symptoms affect cognitive, academic, behavioral, emotional, and social functioning. o Prevalence: 8-11% in school age children... the most common disorder of childhood 2. Autism spectrum Disorder aka "Pervasive developmental disorders" (The World Health Organization International Classification of Diseases, 10th revision [ICD-10] terminology).

2 o Definition: Characterized by abnormalities in social communication/interaction and restricted, repetitive patterns of behavior, interests, or activities. o Prevalence: 4x more common in males that females. Increasing prevalence: 11/1000 in 2007 to 20/ (ASD, parent reported). 3-20% in siblings 3. Depression: o Definition: A major depressive episode is a period lasting at least two weeks, with five or more of the following symptoms: depressed mood, anhedonia, insomnia or hypersomnia, change in appetite or weight, psychomotor retardation or agitation, low energy, poor concentration, thoughts of worthlessness or guilt, and recurrent thoughts about death or suicide. In addition, the symptoms must cause clinically significant distress or impairment in functioning, and the syndrome is not due to the physiologic effects of a substance o Prevalence (lifetime) 3 to 5 years 0.6 %, 6 to 11 years 2.3 %, 12 to 17 years 7.1 % o ~ 40% of teens with major depression are not treated 4. Anxiety: Worries and fear are a normal (and adaptive) part of childhood development... it becomes diagnosable when they are: o Definition: persistent and excessive, causing notable distress or impairment in day-to-day life o Prevalence: Prevalence ranges from 10-30% in school aged children 5. Sleep disorders: o Definition/causes: Difficulty falling asleep Not staying asleep Sleep apnea Movement disorder Excessive daytime sleepiness Nocturnal seizures Behavioral sleep disorders o Prevalence: 20-30% of kids 6. There is a lot of similarity and overlap! Most common conventional treatment approaches 1. ADHD: Behavioral/psychological interventions and/or Psychopharmacological intervention o Medication management: Stimulants: methylphenadate Norepinepherine reuptake inhibitors: Atomoxetine Alpha 2-adrenergic agonists o First line therapy: stimulants...the studies proving superiority were funded, at least in part, by stimulant manufacturers

3 2. Autism: varied and individualized treatment approach o Regular follow up with a team of specialists: Developmental pediatrician Child neurologist Child psychiatrist Psychologist or neuropsychologist Geneticist or genetics counselor Speech language pathologist Occupational therapist Audiologist Social worker o Psychopharamcological intervention targeted symptoms: Hyperactivity, inattention, and impulsivity Aggression, outbursts, and self-injury Anxiety Obsessive compulsive behaviors, rigidity, and repetitive behaviors Depressive symptoms Sleep dysfunction 3. Depresion and Anxiety: Behavioral/psychological interventions and/or Psychopharmacological intervention o Medication management: First line: fluoxitine (Prozac) better for teens Second line: sertraline, citalopram, excitalopram Third line: bupropion, atypicals What could be really causing these behavioral problems? o Types of food: sucrose, simple carbs, soda... o Over feeding and under nourishing o Heavy metals o Eustachian tube dysfunction or otitis media o Could there be a gut connection? o Food additives o Food allergies/sensitivities 1. Food additives o Examples: Anti-caking agents: calcium silicate Anti-oxidants: BHT, BHA Bleaching agents: benzoyl peroxide Colorings: azo dye derivatives Preservatives: benzoates, nitrates, sulfites Thickeners: carrageenan, gums Flavorings, emulsifiers, mineral salts, etc...

4 o Feingold hypothesis: the theory that food additives induce hyperactivity. (Benjamin Feingold, M.D.) o In the late 90s it was estimated that the average American consumed eight to ten pounds of food additives per year 2. Excitotoxins: o Excititory neurotoxins (excitotoxins): can penetrate the brain and cause destruction of neurons by hyperactivation of NMDA receptors o Examples: Glutamate (MSG)- in processed Chinese food Aspatic acid (aspartame)- an artificial sweetener Cysteic acid L-Cysteine "Flavor enhancers - processed foods o The names of excitotoxins (what the food label reads ): Hydrolyzed vegetable protein Textured protein Hydrolyzed plan protein Soy protein extract Caseinate Yeast extract "Natural flavoring" 3. Food allergies/sensitivities o Allergy: IgE mediated immune response to a generally harmless substance o Intolerance: non-allergic hypersensitivity, typically IgG, IgA or IgM mediated o Sensitivity: includes both allergy and intolerance o Allergy types: Type I hypersensitivity: IgE and histamine, < 1 hr asthma, urticaria, angioedema, eczema, rhinitis Type III: IgG immune complexes, delayed > 48 hrs Non-immune-mediated (intolerance, not allergy) o Allergy Addiction Syndrome: "Addiction" to food allergies/intolerances due to short-term relief after ingestion of chronic aggravating food allergies... o Most common food allergies: Dairy (casein/whey) Gluten Eggs Soy Peanuts Tree nuts Shellfish Fish Sesame seeds

5 Gluten and casein are the most common in autism o The histamine connection Histamine release: Allergies cause histamine release. Some foods release histamine even without an allergy. Pro-inflammatory substances weaken the blood brain barrier via H2 receptors Increased permeability in the brain H3 receptors control neurotransmitter release including norepinepherine and serotonin Histamine effect/toxicity: Hyperactivity Compulsive behavior Depression Abnormal fears Intense mood swings Aggression Reduced concentration o A shout out to gluten: remember, just because it s gluten free does not mean that its healthy. Complex issue Celiac Allergy, intolerance, sensitivity Gluten, gliadin, wheat... Inflammatory food Yeasts and types of gluten matter 4. The many mechanisms of reaction o Antigen-antibody reaction: IgE, IgG, IgA, IgM o Hypoglycemic reaction: typically from sugar & simple carbs... ~80% of these people may have a food sensitivity o Chemical reaction: petrochemicals, dyes, preservatives, additives o Enzyme deficiency: gluten (celiac), lactose (lactose intolerance) o Histamine release o Excitotoxins o Peptides derived from gluten and casein may have opiodactivity -> agg autism o Leaky gut: 43% of autistic children o Chronic enterocolitis: 90% of autistic children o Nutrient deficiencies o Other mechanisms...? 5. Some case studies: o "The gluten made her do it" Anchorage Press Dec o "Is Sensory Processing Disorder the new black?" Huffington Post, March 2012 o A.F.... from autistic to normal

6 So, what do we do about it? o First... identify the cause o Elimination of aggravating substance(s) if applicable o Gut healing and repair o Rotation diet... o Eat whole foods! o Multiple vitamin, good protein intake 1. Find the cause: o Get a good diagnosis first o Good history is key o Specialist referrals if needed o Food intolerance testing (serum) o Food allergy testing (scratch) o Elimination Diet (free!) o Neurotransmitter testing (urine) 2. Eliminate the aggravating factor... SUGAR, food additives, excitotoxins, histamine, and other factors o But what if it s a food? Test, elimination diet, trial first Remove the food for > 2-4 weeks Keep a diet and behavior diary Challenge the food: 3 day trial per food 3. Heal the gut o Probiotics o Glutamine o Enzymes o Fish oil 4. Rotation diet: Eat foods once every 4 days 5. Whole foods diet o Nutritionally dense o Fruits and veggies o Unprocessed (at least minimally) o Limited added excitotoxins, dyes, preservatives o Allergy free o Don't eat food that comes through a window o If your grandmother wouldn't recognize it, don't eat it o Short and readable ingredient lists 6. Multiple vitamin, good protein intake 7. Supplements, in brief: o ADHD: Melatonin for sleep: 1 mg (>6yo) inc 1 mg q 2wk up to 3 mg

7 Vitamin B6 (pyridoxine): 30 mg/kg max of 1 g/day. Lower doses when used with Mg Magnesium: 6-15 mg/kg B6 and Mg work better together than alone. Mechanism is thought to be by modulating dopamine metabolism. Vitamin C for sensory motor activity: 114 mg/kg Multiple vitamin-mineral o Autism Test for iron deficiency, supplement if deficient Magnesium (6 mg/kg/d) and B6 (0.6mg/kg/d) Zinc: 15mg 1-2x/d, taper with improvement p 3 mo. Always balance with copper Fish oil: 1-3 g/d Amino acids References: Alan Gaby, MD. "Nutritional Medicine" Liza Bonin, PhD. "Unipolar depression in children and adolescents: Epidemiology, clinical features, assessment, and diagnosis" Kevin R Krull, PhD. "Attention deficit hyperactivity disorder in children and adolescents: Clinical" Kevin R Krull, PhD. "Pharmacology of drugs used to treat attention deficit hyperactivity disorder in children and adolescents" Marilyn Augustyn, MD. "Autism spectrum disorder: Terminology, epidemiology, and pathogenesis" Laura Weissman, MD and Carolyn Bridgemohan, MD. "Autism spectrum disorder in children and adolescents: Pharmacologic interventions" PubMed. Atomoxetine (Strattera) revisited. Med Lett Drugs Ther. 2004;46(1189):65. Heidi Brod and Kelly Dorfman, MS, LND. "Is sensory Processing Disorder the New Black". Mary Lochner. "The gluten made her do it: How going gluten free saved my daughter's mental health" Michael Murray, ND, and Joseph Pizzorno, ND. "Encyclopedia of Natural Medicine". Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri "Excitotoxins in Food". Neurotoxicology Fall;15(3): UpToDate Thanks!

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